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COVID hospitalizations reach January levels, long-term care facilities worry about low vaccination rates
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COVID hospitalizations reach January levels, long-term care facilities worry about low vaccination rates

Over the last week, Montana added 1,636 new COVID-19 cases, 15 deaths and 42 hospitalizations.

As of Aug. 8, 161 cases of the Delta variant have been recorded in Montana, up from 112 the previous week. Gamma variant infections total 35 in the state with 18.5% of cases resulting in hospitalizations.

According to the state dashboard, 49% of the eligible population has been vaccinated.

The state positivity rate is 10%, the highest it’s been since February, according to COVID Act Now.

Over the last week, Montana has averaged 139.1 COVID patients a day in hospitals, the highest it’s been since January. Of those hospitalized at Billings Clinic, about 85% are unvaccinated. Over the last week, hospitalizations with unvaccinated patients has ranged from 85% to 90%, according to Communications Specialist Zach Benoit.

Out of the 226 ICU beds in the state, 107 are filled by non-COVID patients and 38 are filled by COVID patients, up from 29 the previous week.

Montana has averaged 2.6 deaths a day over the last week.

Breakthrough surveillance started in February 2021 and is defined by a positive COVID test in an individual 14 days after completing vaccination. As of August 3, DPHHS reported 842 breakthrough cases, this includes 72 hospitalizations and 17 deaths.

Long-term care worries

The surge in COVID-19 cases and the more transmissible Delta variant threaten to derail progress made in long-term care facilities, especially as staff vaccination rates are consistently lower than vaccination rates among residents.

In Montana, 59.3% of nursing home staff have been fully vaccinated against COVID-19 and 84.3% of residents have received the shot, according to the latest data on AARP’s nursing home COVID-19 dashboard.

On August 2, 12 long-term care facilities and nine assisted living facilities had ongoing COVID-19 cases, according to the most recent report from the Montana Department of Health and Human Services, DPHHS. The number of active cases in in long-term care facilities totaled 29 and assisted living facilities had 39 active cases. During the last week of July, COVID outbreaks sent 21 facilities into stringent restrictions, the most since March 2021.

“The next couple weeks will be interesting with the growing surge of COVID-19 infections in the state,” said St. John’s United President and CEO David Trost. “Over the last two years, we’ve followed the national trends fairly consistently. We are likely to see a resurgence (in care facilities).”

On Monday, St. John’s United moved two facilities out of the 14-day COVID restrictions in which visitation was limited and group activities ceased for residents. One St. John’s facility in Yellowstone County is still in a 14-day “outbreak” mode, said Trost.

Six care facilities in Yellowstone County are under restrictions due to positive cases in staff and residents, according to RiverStone Health communication coordinator Pat Zellar. 

An outbreak is defined by Centers for Medicare and Medicaid Services, CMS, as any one staff member or resident that contracts COVID-19, Trost said. When one positive test crops up, staff move into full personal protective equipment for all patient care including gowns, gloves and goggles. Visitation is limited to end-of-life visits, group activities stop for two weeks and residents cannot move between rooms.

Staff and residents are tested at the seven-day mark of the two week quarantine and at the 14-day mark. Screenings are increased to three times a day for residents and twice a day for staff. All tests must come back negative in order to move out of the restrictions.

At St. John’s United, 60% of full- and part-time staff are vaccinated and 95% of residents have received the shot.

When the facility is not restricted, unvaccinated staff are tested weekly, as determined by the county positivity rate of 6.74%.

Facilities receiving funding from the CMS are subject to its COVID-19 testing and reporting requirements. Counties with positivity rates between 5% and 10% are required to test unvaccinated staff and residents once weekly. Counties with a positivity rate greater than 10% test twice weekly.

At Immanuel Lutheran Communities in Kalispell, 56% of staff are fully vaccinated and 90% of residents are vaccinated. Flathead County’s positivity rate sits at 16.74%.

Since the start of the pandemic, the 300 bed facility has seen 43 cases in residents and three deaths, according to data from CMS.

After a brief reprieve, the Kalispell facility moved into restrictions twice in recent months as positive cases appeared in asymptomatic staff, said CEO Jason Cronk.

Due to Montana's vaccine discrimination law, Cronk cannot require his staff to get the COVID-19 vaccine or the flu shot.

“We’re doing less than best for our residents,” Cronk said, adding that residents are the ones who are isolated from family and friends when there is a positive case.

Those who are unvaccinated have a greater chance of being pulled from work, making staffing challenges more pronounced. The recent restrictions have hindered efforts to recover occupancy as the labor shortage has forced Cronk to limit admissions at the facility.

Activities such as group dining have been a challenge as only vaccinated residents and staff can participate, but with limited staff who got the jab, Cronk said providing the dining experience has been difficult.

“I think we took a step back in Montana,” Cronk said when talking about the law. “(Before) staff had a choice, they chose not to work here, and that was fine.”

Unvaccinated staff also increases the risk of breakthrough cases in the elderly. Those who are immunocompromised are more at risk of COVID-19 serious illness, said RiverStone Health Vice President of Communications Barbara Schneeman. This would include older individuals as a weakened immune response to the vaccine is typical.

Since the vaccine became available, Cronk said the facility has managed to keep the virus at bay with no new hospitalizations or deaths among staff or residents.

“For now, there’s a lot of joy, joy, joy,” Cronk said.

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