Juneau nursing home outbreak could be a model for what COVID-19 looks like after vaccine

Wildflower Court, a longterm 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. (Photo courtesy Wildflower Court)
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.
(Photo courtesy Wildflower Court)

Over the last two weeks, at least a dozen people, including both staff and patients, 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 deadly virus, staff say nearly everyone who has been infected has been 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 (Photo courtesy Wildflower Court)

Staff and outside experts attribute the health of these people in the face of their COVID-19 infections primarily 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 shots in the two-shot series.  

And while medical experts say they have a lot of questions about the circumstances that led to the outbreak at the nursing home, and how patients and staff who have been vaccinated are responding to the virus — none are surprised by the outbreak. 

“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 “That we will still have outbreaks in facilities, but the higher percentage of the population is vaccinated and the higher percentage of residents and staff that are vaccinated, the smaller and less severe these outbreaks will be moving forward.”

Medoff advises staff for the 700 nursing homes, assisted living and psychiatric facilities in the state. And, he said this particular outbreak at Wildflower Court is interesting because it is a 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 it’s not surprising because when the vaccines were being developed, researchers tested them to make sure people who were exposed to COVID-19 didn’t get sick. And the vaccines are really good at that. 

During trials, the Pfizer vaccine — which is 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 that people who are vaccinated could be carriers for the virus even if they don’t become sick from it.

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

But both Medoff and the Wildflower Court administrators say there are some other things that could have happened to explain why vaccinated and partially vaccinated people tested positive for COVID-19. 

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

The Pfizer vaccine is 95% effective. But that still leaves 5% of people who just won’t respond as strongly to the vaccine.

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)

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

Or, some of the people at Wildflower Court who caught the virus may have gotten it shortly before or shortly after receiving the vaccine — so their bodies didn’t have the time to learn to fight the virus off. 

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

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

Those vaccines were developed before new strains of the virus popped up in South Africa and Brazil. There’s some evidence that 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 of COVID-19 has been detected in Alaska yet. But, they could be here. The state only does genomic sequencing — the process needed to detect which strain of COVID-19 a person has — on a small fraction of its positive COVID-19 tests. 

In an interview right after the Wildflower Court outbreak was discovered, the state’s chief medical officer, Dr. Anne Zink, said they will prioritize getting genomic testing on the Wildflower Court population, but results from that analysis haven’t been released yet.

Medoff said the state is part of a national collaborative effort to find out how effective vaccines are at fighting these 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. And, in a letter to residents on Friday, Merli wrote that they did find one newly COVID-19 positive resident in an area of the nursing home outside of its current COVID unit. That patient has also gotten both doses of a COVID vaccine and doesn’t currently 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 say Wildflower Court will continue to test twice a week until they detect no more positive cases. 

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

Rashah McChesney

Daily News Editor, KTOO

I help the newsroom establish daily news priorities and do hands-on editing to ensure a steady stream of breaking and enterprise news for a local and regional audience.

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