An unvaccinated worker set off an outbreak at a U.S. nursing home where most residents were immunize

[demmiblue]

Source: NYT

An unvaccinated health care worker set off a Covid-19 outbreak at a nursing home in Kentucky where the vast majority of residents had been vaccinated, leading to dozens of infections, including 22 cases among residents and employees who were already fully vaccinated, a new study reported Wednesday.

Most of those who were infected with the coronavirus despite being vaccinated did not develop symptoms or require hospitalization, but one vaccinated individual, who was a resident of the nursing home, died, according to the study released by the Centers for Disease Control and Prevention.

Altogether, 26 facility residents were infected, including 18 who had been vaccinated, and 20 health care personnel were infected, including four who had been vaccinated. Two unvaccinated residents also died.

The report underscores the importance of vaccinating both nursing home residents and health care workers who go in and out of the sites, the authors said. While 90 percent of the 83 residents at the Kentucky nursing home had been vaccinated, only half of the 116 employees had been vaccinated when the outbreak was identified in March of this year.

Read more: https://www.nytimes.com/2021/04/21/health/vaccine-nursing-homes-infections.html

[LisaL]

1. I hope health care facilities make vaccines mandatory.

For this very reason.

[underpants]

6. Beside mandatory, only half doesn't sound like much emphasis from management

They should have way more than that vaccinated.

[OneCrazyDiamond]

17. There are religious exemptions to vaccines for employees

K.6. If an employer requires vaccinations when they are available, how should it respond to an employee who indicates that he or she is unable to receive a COVID-19 vaccination because of a sincerely held religious practice or belief? (12/16/20)

Once an employer is on notice that an employee’s sincerely held religious belief, practice, or observance prevents the employee from receiving the vaccination, the employer must provide a reasonable accommodation for the religious belief, practice, or observance unless it would pose an undue hardship under Title VII of the Civil Rights Act. Courts have defined “undue hardship” under Title VII as having more than a de minimis cost or burden on the employer. EEOC guidance explains that because the definition of religion is broad and protects beliefs, practices, and observances with which the employer may be unfamiliar, the employer should ordinarily assume that an employee’s request for religious accommodation is based on a sincerely held religious belief. If, however, an employee requests a religious accommodation, and an employer has an objective basis for questioning either the religious nature or the sincerity of a particular belief, practice, or observance, the employer would be justified in requesting additional supporting information

[Politicub]

34. But it's not just a matter of saying, "religious, go away."

If, however, an employee requests a religious accommodation, and an employer has an objective basis for questioning either the religious nature or the sincerity of a particular belief, practice, or observance, the employer would be justified in requesting additional supporting information

[wnylib]

36. In that case, require the exempted employee

to wear full PPE to protect residents and other employees since it is a matter of life and death.

[Beartracks]

37. Does believing dumbshit conspiracy theories count as religion?

=============

[The Mouth]

76. What is the difference between them?

The only thing I can think of is that religions often have nice buildings.

Two different names for the same thing, invisible sky faries and invisible groups of people.....

[louis-t]

38. What you say to that person is:

"You are now on leave. You can come back when you are vaccinated or when the virus is gone. You cannot be allowed to endanger someone else's life because of your religious beliefs." I think the employee would have a hard time in court. You're allowed to infect me with a deadly disease because of your religious beliefs? I don't think so.

[Talitha]

70. THIS

[Wild blueberry]

80. Yes!

Thank you!

[GB_RN]

24. As An RN, I Can Tell You

That a hospital will fire your ass for not getting the FLU vaccine for that year. You can be damned sure that hospitals require their staff to get the COVID vaccine. So, my question is this: When the earliest epicenters were nursing homes and the elderly, is any nursing home allowing anyone to come to work UNVACCINATED?!?!? As much as the staff member is to blame here, the facility carries a share of the blame as well.

[Native]

28. I'm told by RN's here in Florida that they are not required to get the covid vaccine

because it's under emergency use authorization hasn't been cleared yet, unlike the flu vaccine.

[LonePirate]

2. A lawsuit or two from families will suddenly make these facilities mandate vaccines for staff.

[PortTack]

16. This! Don't like it..go somewhere else and work

[Lovie777]

3. Many in red states refuse the vaccine . . .

hopefully this incident will change some minds at least in Kentucky.

[Evolve Dammit]

4. 22 cases among those who were fully vaccinated sounds pretty scary, and a death. nt

[stopdiggin]

7. also sounds -- a tad suspicious

clearly well out of the range of expected (or what testing has revealed). (in both the elderly, and the staff) I'm going to give this a wide berth -- and make a suggestion for some misinterpretation.

Edit: Article also references another study done in Chicago facility -- with far different numbers showing up. These numbers in KY (for the Pfizer vaccine) -- just don't make a lot of sense. Possibly taking in positives from people that had (perhaps asymptomatic) virus before the shot?

[LisaL]

10. Virus had several mutations in it.

Vaccine efficacy could be lower against the mutants.

[LymphocyteLover]

15. yes, looks like a nasty variant-- what a nightmare

[Greg K]

25. Or with older recipients.

Though prior to vaccination, this scenario would have likely led to many more deaths.

[Evolve Dammit]

35. That's what I am worried about. I find it very alarming that fully vaccinated contracted C-19.

[Earth-shine]

39. The vaccines don't stop you from becoming infected.

They help you to fight it off quickly and not get very sick.

You can still get the virus and transmit it.

That "95% efficacy" figure says of the people who get infected only 5% will get sick.

[LisaL]

42. No, that's not true at all.

Vaccines also prevent infection.
But they are not 100 % effective, especially against the variants.

[Earth-shine]

44. Not according to the scientists on CNN.

It may be a matter of definition - what does "infected" actually mean?

If you breathe in the particles, you become infected. That is to say, the virus penetrates some cells in the lungs.

If you are vaccinated, you can immediately fight it off before the virus substantially replicates. But, you can still transmit the virus to other people until your body kills it off completely.

If you are not vaxxed, your body has to figure out what to do before the immune system can fight it.

That's why the CDC says we still have to wear masks.

[LisaL]

47. I don't know what scientist are on CNN.

But vaccines prevent infections as well as symptoms.

[Earth-shine]

54. Just wear a mask, okay?

In the case of COVID, the vaccines reduce the time that one can be contagious.

But, the virus can still get *in* your cells -- hence the term *in* fection.

I'm done explaining it to you.

Do not write back. I will not read it.

[LisaL]

73. Well, maybe somebody else will read it. You are not going to get the last word here.

You are wrong, insisting you are right, when you are not.
Covid vaccines prevent infections. CDC recently did a study showing this. So, again, you are unware of new information, you insist on being right when you are wrong.

"A new CDC study provides strong evidence that mRNA COVID-19 vaccines are highly effective in preventing SARS-CoV-2 infections in real-world conditions among health care personnel, first responders, and other essential workers. These groups are more likely than the general population to be exposed to the virus because of their occupations."

https://www.cdc.gov/media/releases/2021/p0329-COVID-19-Vaccines.html#:~:text=A%20new%20CDC%20study%20provides,responders%2C%20and%20other%20essential%20workers.

[ShazzieB]

81. Thanks SO much for this!

I didn't think the numbers in this story made sense, but I didn't have anything to back up my gut feeling. Now I do!

[PSPS]

55. No, you're describing a palliative. The definition of a vaccine is preventing infection.

That's the big question as to what these shots are affording us. If a "fully vaccinated" person can spread the virus, it isn't a vaccine. It's a palliative. I'm not discounting the value of a palliative. It will increase survival rates. But Covid won't be licked with palliatives because it will continue to spread (and mutate.)

[Earth-shine]

63. You want to split hairs on definitions?

https://theconversation.com/coronavirus-few-vaccines-prevent-infection-heres-why-thats-not-a-problem-152204

[stopdiggin]

56. NO. You are just flat wrong about this. -(nt)-

[Earth-shine]

62. No, you are.

https://theconversation.com/coronavirus-few-vaccines-prevent-infection-heres-why-thats-not-a-problem-152204

[stopdiggin]

67. the article you link refutes your claim

Pfizer and Moderna both prevent infection -- with an efficiency at or above 95%, as proven in clinical trials -- and the small minority that might still contract, suffer less serious outcomes.

This has been know -- for a good period of time now. And this is not the familiar flu vaccine scenario.

[Earth-shine]

69. You are outright lying about the article.

Such dishonesty!

"Vaccines are a marvel of medicine. Few interventions can claim to have saved as many lives. But it may surprise you to know that not all vaccines provide the same level of protection. Some vaccines stop you getting symptomatic disease, but others stop you getting infected too. The latter is known as “sterilising immunity”. With sterilising immunity, the virus can’t even gain a toehold in the body because the immune system stops the virus entering cells and replicating.

There is a subtle yet important difference between preventing disease and preventing infection. A vaccine that “just” prevents disease might not stop you from transmitting the disease to others – even if you feel fine. But a vaccine that provides sterilising immunity stops the virus in its tracks. "

You are now on my ignore list. I never want to read a thing from you again.

[LisaL]

74. We are discussing covid vaccines here. Not all vaccines.

Covid vaccines are effective at preventing infections.

[Chakaconcarne]

83. The study you cited supports what you're saying.

This (Covid vaccine preventing infections) was as unknown a couple months ago... All we knew and were hearing was that it reduces the severity of sx's. There's even some promising signs Moderna and Covid might prevent transmission.

It's still early and more studies are needed to be definitive, IMO. There were some limitations to the study.

https://s3.ca-central-1.amazonaws.com/assets.jmir.org/assets/preprints/preprint-28925-submitted.pdf

All the right things are falling into place with regard to the scientific battle.

[muriel_volestrangler]

71. Remember, that includes asymptomatic cases

The summary from the CDC paper may express it better:

In a COVID-19 outbreak at a Kentucky SNF involving a newly introduced variant to the region, unvaccinated residents and health care personnel (HCP) had 3.0 and 4.1 times the risk of infection as did vaccinated residents and HCP. Vaccine was 86.5% protective against symptomatic illness among residents and 87.1% protective among HCP.
...

https://www.cdc.gov/mmwr/volumes/70/wr/mm7017e2.htm?s_cid=mm7017e2_w

So the number of people who showed symptoms, whether residents or workers, was cut significantly more by the vaccine than those who had positive Covid tests (the vaccine effectiveness figure for positive tests, which corresponds to the 3.0 and 4.1, were 66.2% and 75.9% for residents and workers respectively). Deeper in the paper, it shows the hospitalization was cut further still - 94.4% vaccine effectiveness among residents; no workers were hospitalized, whether vaccinated or not.

Asymptomatic cases can still potentially pass on the infection (I'm not sure, but I think the current thinking is they're less likely to. For one thing, they're not coughing so much), so those figures are still important to working out subsequent spread, but the symptomatic cases are what we notice in our daily lives.

[Bayard]

5. Unacceptable

No vaccination, no job. And why were 8 residents unvaccinated?

[stopdiggin]

8. because it's not manditory

in any jurisdiction. (either resident, or staff)

[totodeinhere]

51. I agree with no vaccination, no job.

However, there are rare cases where a physician might advise against getting vaccinated for medical reasons. I'm not sure if that was the case with those eight people or not.

[riversedge]

9. Effectivenes--66 percent for residents and 75.9 percent for employees,

https://www.nytimes.com/2021/04/21/health/vaccine-nursing-homes-infections.html

..........“To protect skilled nursing facility residents, it is imperative that health care providers, as well as skilled nursing facility residents, be vaccinated,” the authors of the Kentucky study wrote.

The outbreak involved a variant of the virus that has multiple mutations in the spike protein, of the kind that make the vaccines less effective. Vaccinated residents and health care workers at the Kentucky facility were less likely to be infected than those who had not been vaccinated, and they were far less likely to develop symptoms. The study estimated that the vaccine, identified as Pfizer-BioNTech, showed effectiveness of 66 percent for residents and 75.9 percent for employees, and were 86 percent to 87 percent effective at protecting against symptomatic disease.

In the Kentucky outbreak, the virus variant is not on the C.D.C.’s list of those considered variants of concern or interest. But, the study authors note, the variant does have several mutations of importance: D614G, which demonstrates evidence of increased transmissibility; E484K in the receptor-binding domain of the spike protein, which is also seen in B.1.351, the variant first recognized in South Africa, and P.1. of Brazil; and W152L, which might reduce effectiveness of neutralizing antibodies.

In Chicago, meanwhile,.....................

The authors of the Chicago study said their findings demonstrate that nursing homes should continue to follow recommended infection control practices, such as isolation and quarantine, use of personal protective equipment and doing routine testing, regardless of vaccination status..................

[LisaL]

11. Virus had mutations in it.

So efficacy could very well be lower for the mutants.

[riversedge]

19. agree. The article did not give us the nitty gritty details.

[speak easy]

23. E484K is the escape mutation

That is the mutation that makes vaccines less effective.

[intrepidity]

13. All kinds of questions

1) which vaccine?
2) did they sequence to see if a variant was involved?
3) when a vaccinated person is exposed to the virus, and their immune system defends them (no symptoms, but PCR positive), are they then considered infected? I believe the clinical trials were basing their efficacy metrics on illness/symptoms, so vaccinees becoming infected should not be surprising, right?

This is either very concerning, or not, depending on the answers, imho.

ETA: I see above that a variant was involved..

[womanofthehills]

82. Also, how would you know who gave it to who

The unvaccinated person could have caught it from someone at the facility who caught it from a visitor. I think the story was twisted - because the big story is why did so many vaccinated get-it?

[Midnight Writer]

14. I hope all these people who spread this are faced in the afterlife by the people they killed.

They should be haunted in their dreams in this life, but honestly I think they are so depraved they don't care.

[roamer65]

41. People need to realize REAL quick these covidiots are a menace to public health.

[Dreampuff]

18. I definitely agree with those of you who said

The shot should be mandatory at many places of business. I know it isn't mandatory here at the hospital or at the dental offices or probably any business. I find that very scary considering the fact that one of those places I go to have people who don't even believe this is real.

[Susan Calvin]

21. Oh dear, you mention dental offices.

I was to finally go to the dentist, having had both my shots, and now I think I'll put it off again. The vaccinated resident of the nursing home dying is really scary to me.

[mtngirl47]

20. And this is why I will keep wearing my mask

and require my customers to do the same.

[PoliticAverse]

22. "The report underscores" the limits of vaccination. n/t

[stopdiggin]

60. The report is an aberation -- and significantly misleading

everything else points to a very significant level of protection -- on all measures (infection, transmission, and degree of illness) -- provide by the vaccines.

Lets not get completely transfixed by one nursing facility in KY.
The following make for far better (and in my opinion, more accurate) reading --

https://www.democraticunderground.com/100215362612

[progressoid]

26. Being unvaccinated is irrelevant to the outbreak.

He/she could have been vaccinated AND infected to still spread the virus.

WEAR A MASK

WASH YOUR HANDS

[diverdownjt]

27. Talk to the residents and tell them....

that they will not accept these unvaccer's in their room's.

The customer is always right.

The employer will have zero room to wiggle.

[nuxvomica]

29. The vaccines need to be approved beyond emergency use

At that point, a lot of places can make the mandatory. I would think there should be enough clinical data by now to move them beyond emergency use but I don't know what's involved in that.

[bluestarone]

30. I would think the nursing homes and Hospitals would be better off

Letting the staff go, that refuse the vaccine. That would be better than facing numerous lawsuits from resident family members. It's reall stupid to want to work in a healthcare facility without the vaccine! (no consideration for others at all)

[CaptainTruth]

31. Why were there 16 unvaccinated health care workers???

"20 health care personnel were infected, including four who had been vaccinated"

[LisaL]

32. Nursing home workers were offered vaccines, but a large number of the declined.

I think only about 50% got vaccinated.

[totodeinhere]

50. Any nursing home worker refusing the vaccine without a legitimate documented medical reason

should be suspended and not allowed to return until they do get vaccinated.

[Jetheels]

33. Ooof, I have been feeling confident about not getting covid since I'm all vacced but this makes me

worried all over again.

[totodeinhere]

49. You are misinformed. The vaccines are designed to keep you from getting really sick or dying but

but not necessarily to keep you from getting it. However, some studies are showing that the vaccines might also reduce infection rates.

[Jetheels]

53. I think that's a myth. The vaccines do in fact reduce infection rates.

[Earth-shine]

65. Greatly reduce infection rates, but not absolutely block infection.

The vaccine does not stop you from breathing in other people's droplets.

If you have been vaxxed, your immune system is ramped up.

As soon as the first lung cells get infected, antibodies start preventing further viral replication. But, there still can be some small amount of time where it can be transmitted to others.

Regardless, if enough of us get our shots, we will achieve the so-called herd immunity.

[stopdiggin]

58. No. A great DEAL better than just helping reduce.

The vaccines are remarkably effective in preventing (as well as lessening effects)

[stopdiggin]

59. You have a very 'considerable' level of protection.

I hate that this is getting people all worked up again. Here's another bit of new information -- much, much more reassuring.

2 'breakthrough infections' out of 417. That's pretty effective!

https://www.democraticunderground.com/100215362612

[roamer65]

40. Unvaccinated employees can be terminated once the vaccine is approved for general use.

Especially if the employee is an “at will” employee. Given what I see here, I would terminate their employment if they refuse to take the vaccine.

All the company has to do is set the policy and it’s done.

Only thing stopping them right now is the FDA status of the vaccines.

[LisaL]

43. Both Pfizer and Moderna have enough data to apply for full FDA approval.

They followed clinical trial participants for six months now. So they should soon be applying to FDA for full authorization.

[FakeNoose]

45. Most of us on DU are not in nursing homes

... therefore our takeaway from this should be two things:

Current vaccinations keep us safe to a point. We'll need to stay on top of booster vax when they are available.

Even though we are (many of us) vaccinated already, we can still transmit the virus to others without realizing we've been in contact. We might not feel sick but we still could unintentionally transmit.

We need to wear masks at all times, and practice social distancing as if our loved ones' lives depend on it. It's up to us because the Repukes aren't helping - at all.

[Grasswire2]

52. yes, and I don't think most of the public realizes this.

They believe they are home free, and run wild.

Even if you are immunized, you can catch it, and you can transmit it to someone who has not been immunized and could die.

[Liberty Belle]

46. Feds must mandate this. Caretakers weren't vaccinated at Mom's nursing home,

I found out, at least about half of them had refused to get vaccinated. This infuriated me as they said family couldn't visit due to COVID risk, even though I was vaccinated at the time.

We finally got her out of there and into a board and care that requires all staff to be vaccinated. Every senior care facility should mandate this.

[totodeinhere]

48. Remember that the vaccines are designed to prevent you from getting really sick or dying

should you get infected. They are not necessarily intended to stop you from getting infected, only from getting really sick. And with an approximate 90% efficacy rate for these vaccines that means that a few people might die even if vaccinated. And that is nothing new. People who are vaccinated for the common flu die all the time. No vaccine can be perfect. But having said that, that employee should not have been there if not vaccinated.

[PSPS]

57. Sorry, you're wrong. The definition of a vaccine is prevents infection.

What you're describing is a palliative which, while useful to lessen symptoms and increase survival rate, does nothing to stop the spread (and mutation) of the virus. If "fully vaccinated" people are spreading the virus, they aren't really vaccinated.

Examples of actual vaccines are smallpox and polio.

[totodeinhere]

85. Not according to this.

Data has shown that you can still get coronavirus even after you're fully vaccinated, which means if you do get an infection, you could still spread it.

https://www.nbcchicago.com/news/local/can-you-spread-covid-after-receiving-vaccine/2478894/

[stopdiggin]

61. Nope. Your information is not correct.

The vaccines are designed to prevent infection -- and they do a very, very good job of it. This is NOT analogous to the flu vaccine.

[totodeinhere]

86. No I am correct.

https://www.nbcchicago.com/news/local/can-you-spread-covid-after-receiving-vaccine/2478894/

[Earth-shine]

64. You are correct. The people arguing with you are wrong.

It seems to be a matter of definition.

How many virons in one's system does it take to call it an infection?

https://theconversation.com/coronavirus-few-vaccines-prevent-infection-heres-why-thats-not-a-problem-152204

[totodeinhere]

87. Thank you. There is a lot of misinformation being put out at DU on this topic.

n/t

[Deminpenn]

66. In this case, the vaccine was 95.4%

effective. The same as shown in the clinical trials.

[Buckeye_Democrat]

68. Here's how Pfizer/Moderna/J&J defined infection...

... during their trials, with Pfizer & Moderna having stricter definitions while still showing higher efficacy rates. (On the other hand, there were also fewer variants during their trials.)

COVID-19 vaccines: What does 95% efficacy actually mean?
https://www.livescience.com/amp/covid-19-vaccine-efficacy-explained.html
-----
So, if efficacy means some percent fewer cases of COVID-19, what counts as a "case of COVID"? Both Pfizer and Moderna defined a case as having at least one symptom (however mild) and a positive COVID-19 test. Johnson & Johnson defined a "case" as having a positive COVID-19 test plus at least one moderate symptom (such as shortness of breath, abnormal blood oxygen levels or abnormal respiratory rate) or at least two milder symptoms (such as fever, cough, fatigue, headache, or nausea). Someone with a moderate case of COVID-19 by this definition could either be mildly affected or be incapacitated and feel pretty sick for a few weeks.

Barker cautions that it’s tricky to directly compare efficacy between the Johnson & Johnson, Pfizer, and Moderna vaccines, because the clinical trials happened in different geographic areas with different populations, and at slightly different time points in the pandemic when different variants of COVID-19 were circulating. “There were more people who had the B117 [U.K. variant] or other types of variants during the time of the Johnson & Johnson trial than during the Moderna trial,” she said.

And none of the three vaccine trials looked at all for asymptomatic COVID-19. "All these efficacy numbers are protection from having symptoms, not protection from being infected," Barker said. (Some early studies hint that the Pfizer and Moderna vaccines also reduce the number of viral particles in a person's body, called viral load, and the likelihood of testing positive at all, which would cut transmission. Still, because we don't yet know that for sure, people "can't throw away their mask" once they're vaccinated, Barker said.)

But all three trials also used a second, potentially more important, definition of "cases." What we care most about is protecting people from the worst outcomes of COVID-19: hospitalization and death. So Moderna, Pfizer and Johnson & Johnson also measured how their vaccines performed against severe disease (which meant severely affected heart or respiratory rate, the need for supplemental oxygen, ICU admission, respiratory failure or death).

All three vaccines were 100% effective at preventing severe disease six weeks after the first dose (for Moderna) or seven weeks after the first dose (for Pfizer and Johnson & Johnson, the latter of which requires only one dose). Zero vaccinated people in any of the trials were hospitalized or died of COVID-19 after the vaccines had fully taken effect.

"We are incredibly lucky with how effective these vaccines have been," Barker said.
-----

[inwiththenew]

72. This is why COVID is going to be here for a long time

It will still be in an issue in the 2024 Presidential election. You watch.

If one person can infect dozens of vaccinated people and we will struggle to get to 70% vaccination it means that we will be dealing with this for years. What is going to happen next is the virus is going to mutate to something we don't have a vaccine for thanks to the anti-vaxxers and we will be in the same position we were last year with a more contagious and likely more deadly variant.

[LisaL]

75. That person must have been a super spreader.

In other words, someone who manages to infect a lot of people. With covid, some are super spreaders and some are not.

[BobTheSubgenius]

77. Yes, the protocols must be tightened up for nursing homes, and other institutions.

But this leads to the much larger question - what does this mean for the world?

[BobTheSubgenius]

78. COVID-19 is a extremely injurious, even fatal threat.

Kentucky is a Stand-Your-Ground state. Just sayin'....

[BobTheSubgenius]

79. Meaning that the infected person should be required to leave. Clearly.

None of us want to see even a loon like that harmed - we just want to be protected from them. Right?

[TheFarseer]

84. I didn't see where it said

If the worker refused vaccination or if it was not made available yet. Although given it was March, it was probably an anti Vaxer. Scary if half the staff refused vaccination. They really should be made to get it or resign.

[henbuck]

88. Getting vaccinated should be mandatory without exception.