Juneau nursing home could be model for COVID-19 outbreaks in a vaccinated world

An empty foyer
Wildflower Court, a long-term care facility, in Juneau, Alaska. The facility has had an outbreak of COVID-19 among residents and staff, but despite the vulnerable patient population, most cases have had no symptoms. (Wildflower Court)

Over the last two weeks, at least a dozen patients and staff at a Juneau nursing home have tested positive for COVID-19.

But while Wildflower Court caters exclusively to people who are among the most vulnerable to getting very sick or dying from the virus, staff say nearly everyone who’s been infected is symptom-free.

“Other than one resident that developed a little bit of shortness of breath … which is not unusual for that person outside of COVID,” said Wildflower Court Administrator Ruth Johnson.

Ruth Johnson (Photo courtesy Wildflower Court)
Ruth Johnson. (Wildflower Court)

Staff and outside experts attribute good health despite being COVID positive to the Pfizer and Moderna vaccines. Nearly 80% of the people who live and work in the facility have received at least one of the two recommended shots.  

While medical experts say they have lots of questions about how an outbreak occurred at the nursing home, and how patients and staff who have been vaccinated are responding to the virus, none are surprised by the outbreak itself.

“I hope it’s kind of the canary in the coal mine,” said Dr. Sar Medoff, an emergency room doctor who also works for the State of Alaska’s Division of Public Health. “We will still have outbreaks in facilities, but the higher percentage of the population is vaccinated, the higher percentage of residents and staff that are vaccinated, the smaller and less severe these outbreaks will be moving forward.”

Medoff advises staffs of 700 nursing homes, assisted living and psychiatric facilities around the state. He said the Wildflower Court outbreak is particularly interesting because of its mix of people.

“Some of the populations who tested positive for COVID have had both doses of the vaccine. Some of them have had one dose of the COVID-19 vaccine, and some of them had no doses,” he said. 

Medoff said the results aren’t surprising: When the vaccines were developed, scientists made sure they prevented people exposed to COVID-19 from getting sick. And the vaccines are really good at that. 

During trials, the Pfizer vaccine — the one most people at Wildflower Court have received — was 95% effective at preventing severe COVID-19 cases. 

But keeping people from getting sick and keeping people virus-free are not the same thing. 

“What the studies did not look at is whether or not someone who has been vaccinated is able to become infected with COVID and maybe is infected at such a low level that they don’t develop symptoms,” Medoff said. “However, they are still able to transmit the virus to others.”

What that means is vaccinated people could carry the virus even if it doesn’t make them sick.

That’s why, post-vaccine, health officials say people should still practice safe pandemic behavior: wearing masks, avoiding crowds, limiting the number of people in your bubble and washing your hands — all things Wildflower Court administrators said they continued doing as they vaccinated people. 

But both Medoff and Wildflower Court administrators said there are other reasons that could explain why vaccinated and partially-vaccinated people tested positive for COVID-19 at the nursing home. 

The first: There’s a possibility people who got sick didn’t have a strong immune response to the COVID-19 vaccine. 

The Pfizer vaccine is 95% effective. That still leaves 5% of people who just won’t respond as well to the vaccine, and might be less protected.

The Moderna and Pfizer vaccine bottles compared during Juneau’s COVID-19 vaccine clinic at Centennial Hall on Jan. 15, in Juneau. (Photo by Rashah McChesney/KTOO)

“It’s possible that … their immune response just wasn’t as strong,” Medoff said. 

The second: Some of the people at Wildflower Court who caught the virus may have done so shortly before or after receiving the vaccine. Their bodies wouldn’t have had time to learn how to fight the virus from the shot.

“They may have been within that window where they were infected before the body could build its immune response,” Medoff said. 

A third possibility is they were infected by a strain of COVID-19 the Pfizer and Moderna vaccines aren’t as effective at fighting.

The two were developed before new strains of the virus popped up in South Africa and Brazil. There’s some evidence the Pfizer vaccine may be less effective against those strains. 

“We just don’t have as much data yet on the South Africa and Brazil variants so far,” Medoff said. 

Neither of those strains have been detected in Alaska yet, but they could be here. The state only sequences the genes of the virus — detecting which strain of COVID-19 infects someone — in a small fraction of positive COVID-19 tests. 

In an interview right after the Wildflower Court outbreak was discovered, Alaska’s chief medical officer Dr. Anne Zink said they would prioritize gene sequencing for the Wildflower Court outbreak, but no results have been released.

Medoff said the state is part of a national collaboration to determine how effective the vaccines are at fighting new strains of COVID-19. 

“We want to make sure that if those strains are present in [Alaskans], we’re detecting them early again,” Medoff said. “It is one of the reasons that those specimens will jump to the head of the line for sequencing.”

Wildflower Court Director of Nursing Emily Merli said morale among residents is pretty good.

“I think the initial reaction is shock, especially for the vaccinated folks,” she said. “Then there’s just kind of like, sort of a sense of resignation that like — of course this is happening now.” 

After the initial shock wore off, most of the residents passed through the rest of the quarantine period uneventfully: Five of the seven positive residents came out of quarantine over the last week. 

In the last week of January, the home did two rounds of testing. In a letter to residents on Friday, Merli wrote they found one newly COVID-positive resident in an area of the nursing home outside the current COVID unit. The patient has already had both doses of a COVID vaccine and doesn’t have any symptoms. 

“We are anticipating a symptom-free duration, as this is what we have been seeing with all our other vaccinated positives,” Merli wrote. 

Administrators said Wildflower Court will continue to test twice a week until they detect no positive cases. 

And administrators are gearing up for another round of vaccinations for residents and staff Merli wrote, which will bring the homes’ vaccination rate up to 87% for residents and 81% for staff. 

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