Even as the first doses of vaccine arrive in nursing homes and assisted living communities, the COVID-19 death toll among residents and staff of these facilities continues climbing to staggering heights, with the final month of 2020 proving to be the deadliest of the pandemic for long-term care.
There were more than 5,600 deaths linked to long-term care in the last week of December.
Long-term care facilities — places that care for the most vulnerable, high-risk populations — now account for close to 40% of all U.S. deaths due to the virus.
"It is an American tragedy," said Elaine Ryan, vice president for state advocacy and strategy at AARP. "The states need to redouble their efforts to make sure that vaccines are being administered as quickly as possible."
Only about 14% of the first shots distributed to long-term care facilities have gone into someone's arms via the federal pharmacy partnership, according to data from the Centers for Disease Control and Prevention.
Meanwhile, the COVID Tracking Project shows more than 50,000 new cases are being reported in long-term care each week.
In at least a dozen states, about 50% or more of all COVID-19 deaths are among residents and staff of these facilities.
"Unfortunately, even though we've been at this for so many months, not that much has changed," said Tamara Konetzka, a professor who studies long-term care at the University of Chicago.
Konetkza said the research is clear: Even the best-run nursing homes are not impervious to outbreaks when there is a reservoir of disease in the surrounding cities and towns.
"All along it's just been delusional that we could have these areas with high community spread and let the virus rage among young people and somehow protect long-term care residents," she said. "It just doesn't work; we're too interconnected."
With vaccines arriving, some ask, "Is the nightmare over?"
Since the virus first swept through a nursing home outside Seattle, the pandemic has left an outsize imprint on those living in long-term care, a broad category that includes nursing homes, assisted living and other congregate settings.
The vaccine is a godsend for places such as Josephine Caring Community in Stanwood, Wash., where an outbreak in late fall eventually led to more than 170 infections among staff and residents, and more than a dozen deaths.
"It was just awful. We were doing everything we could," said Terry Robertson, CEO of Josephine. "But it's hard, we just had so many residents testing positive."
Robertson said by mid-December they finally had brought the outbreak under control and were eager to get their first doses of the vaccine — until learning that CVS did not intend to start administering the shots until the second week of January.
"I just thought, 'That doesn't work,' " said Robertson, who then decided to switch to another pharmacy, called Consonus, which works specifically with long-term care and was able to get residents at Josephine their first shot just a few days after Christmas.
"Just pinch me, am I dreaming or is the nightmare over?" Robertson said. "Like, wow, this thing could really be over in a month."
However, many facilities are not getting the shots so quickly.
The first phase of vaccination includes residents and staff of long-term care facilities, but the speed at which they are receiving the doses varies significantly from state to state. Because of their vulnerable population, nursing homes are generally being prioritized ahead of assisted living facilities.
"Every week that the vaccine is delayed in long-term care facilities will mean at least an additional 4,000 to 6,000 deaths," said Mark Parkinson, who heads the American Health Care Association and the National Center for Assisted Living.
"There's just no excuse for any governor or any state to not make this an incredible priority."
West Virginia Gov. Jim Justice had said his state planned to get every facility its first dose by the end of December. Connecticut also set an aggressive timeline of reaching all nursing homes by Jan. 8.
Parkinson said he believes the country is on track right now to have every facility receive its second dose by the beginning of March, and that generally residents seem receptive to getting the shot.
"What we've seen in these vaccine clinics is a very high uptake, about 90% or so are taking the vaccine," he said.
But for the operators of some nursing homes the rollout is not coming nearly fast enough.
In Pennsylvania, about 250 long-term care residents are dying each week from COVID-19, and the state did not begin vaccinating any residents until the last days of December, according to Zach Shamberg with the Pennsylvania Health Care Association, which represents long-term care providers in the state.
"Since Day 1 of the pandemic, we have fought for one thing, and that's prioritization, whether it was testing, whether it was personal protective equipment, whether it was staffing assistance," Shamberg said.
"It's no different now than it was 10 or 11 months ago," he continued. "And unfortunately, we as a state — and in some cases we as a nation — have not learned our lessons."
Shamberg said some of his members aren't scheduled to get their first doses until the end of January or even early February.
Vaccine not yet "a magic bullet"
The hard reality is that months will go by with the virus rampant in many places until vaccinations can have a sustained effect and significantly curb outbreaks in these facilities.
Not only do the second doses need to be administered to residents three weeks later, but there is also constant churn among staff and residents in long-term care, which means that vaccine clinics will need to be ongoing, said the University of Chicago's Konetzka.
"The vaccine isn't a magic bullet. It's a great thing. It will dramatically reduce the number of deaths that we see, but will it eliminate the problem?" Konetzka asked. "No, not yet."
Throughout the pandemic, the national picture of which long-term care facilities have ongoing outbreaks and the extent of deaths has been spotty, said the AARP's Ryan.
"There is a lack of accountability," she said. "The responsibility for the protection of these individuals [has] been delegated from the federal government to the states, and the state governments have delegated their responsibility to nursing home facilities."
Ryan said there should be more transparency about exactly which places are getting the vaccine, how many staff and residents are getting vaccinated and how smooth the process is playing out around issues involving consent, which can be given by a family member.
"Anecdotally, the reports we're getting is that it is not a well-structured process," she said.