Infections Increasing In L.A. Skilled Nursing Facilities Again As Delta Variant Breaks Through Vaccines

In the earliest days of the Covid-19 pandemic, nursing homes were ravaged by the virus as it spread among staff and closely grouped elderly people with compromised immune systems. Those communities were prioritized once vaccines came along, and infections dropped markedly there. No more.

With the high level of Covid spread occurring across Los Angeles, the county is now experiencing increases in cases among staff and residents at skilled nursing facilities once again, though not nearly to 2020 levels. This is in part due to the highly transmissible Delta variant and breakthrough infections among the fully vaccinated.

While Covid cases among fully-vaccinated Californians are still very rare, they are increasing. By late July, the county had a little over 5 million of its 10 million residents fully vaccinated. Of those 5-plus million who were inoculated, only 6,530 breakthrough infections had occurred as of July 20, 2021. That’s 0.13% overall. And only 30 of those 5 million people died. But as the prevalence of the Delta variant has grown, so have breakthrough cases.

In March 2021, when Delta was just a fraction of variants identified in L.A., breakthrough infections accounted for just 2% of that month’s total. By June, when Delta accounted for 50% of all variants, breakthrough infections among the fully vaccinated had risen to 20% of all identified cases in L.A. County. See chart below. In late July, county officials reported that the Delta variant had overwhelmed all others, accounting for more than 90% of all positive tests analyzed for variants. The parallel growth in breakthrough infections has not been reported, but it is likely significant, as well.

Even in breakthrough cases, however, vaccination still seems to prevent more serious disease and hospitalization, according to county data.

Currently, 86% of residents and 85% of staff at skilled nursing facilities are fully vaccinated. For the week ending July 18, there were 33 positive tests for Covid-19 related to nursing facilities: six new cases among residents and 27 new cases among staff. For the previous weeks, an average of 22 new cases were reported among staff and residents at skilled nursing facilities.

While the number of nursing home infections are a long way from the hundreds being reported weekly in April of 2020, the rise does recall a time when L.A. nursing homes were under siege. Still, there are some differences.

In early April 2020, Los Angeles County health officials reported that 11 local nursing facilities had outbreaks of 3 or more cases and nine more facilities with at least one suspected coronavirus infection. Of the county’s 54 Covid-related deaths during that period, at least six were nursing-home residents.

“Residents at skilled nursing facilities are often medically fragile and throughout this pandemic have been at great risk for serious illness and death from Covid-19,” said County Health Director Barbara Ferrer said on Tuesday. “Thankfully, because of their high Covid-19 vaccination rates and infection control measures at facilities, we are not seeing dramatic increases in Covid-19 cases among staff and residents at skilled nursing facilities, nor have we seen significant increases in deaths.”

There were just 20 new deaths reported on Tuesday. Five of the people who passed away were over the age of 80, six people who passed were between the ages of 65 and 79, six people who passed were between the ages of 50 and 64 and three people who passed were between the ages of 30 and 49.

California’s new state health officer order requires confirmation of vaccination for all workers in longterm healthcare facilities and/or the use of respirators and testing.

Possibly more vulnerable than L.A.’s mostly-vaccinated seniors are its younger, less-vaccinated population. Of the areas of the county where rates are highest Ferrer said last week, “Transmission in these neighborhoods is mostly being spread among young adults.”

While the 7-day average case rate for L.A. County residents was 4.29 per 100,000 on July 15, it was about five times higher — at 24.95 per 100,000 — for those ages 18-29.

There were 2,293 new cases of Covid reported in Los Angeles on Tuesday. That’s a nice drop from the more than 3,000 reported late last Thursday. But the drop may be due to lower testing over the weekend. The region’s test positivity rate — considered a better gauge of infection spread — was still high at 6.6%.

There were 1,138 people with Covid reported hospitalized on Tuesday and 22% of those people were in the ICU. This is an increase of 313 daily hospitalizations since last Tuesday.