A doctor receives a vaccine shot at Dominican Hospital in late 2020

Dr. Laura Likar, a Dominican Hospital employee, receives a COVID-19 vaccine Dec. 16, 2020. (Pool photo by Shmuel Thaler — Santa Cruz Sentinel)

SANTA CRUZ >> As Thursday’s deadline approaches to require COVID-19 vaccinations among healthcare and nursing home staff, Santa Cruz County has at least 9 in 10 healthcare workers vaccinated, according to preliminary county data. 

Before the mandate, vaccination rates at skilled nursing and senior residential care facilities were stuck at about 7 in 10, said Dr. David Ghilarducci, Santa Cruz County’s deputy health officer. The mandate is important in part because 103 of the 213 COVID deaths in Santa Cruz County have been among skilled nursing and senior residential care residents, according to county data as of Sunday, Sept. 26.

“We were seeing (COVID) transmission mostly from employees that would come to work who didn’t even know they were ill,” Ghilarducci said. “They transmitted the virus to medically vulnerable people, and that was where most of our deaths have been.”

The California Department of Public Health set a deadline of Thursday, Sept. 30 for healthcare workers — including skilled nursing facility staff — to either prove they’ve been vaccinated for COVID-19, qualify for an exemption, or potentially lose their jobs. The deadline applies to hospitals, skilled nursing facilities and most other healthcare settings. Employees there do not have the option of weekly COVID testing to get out of it. 

Separately, senior residential care facilities operate under an earlier order where workers can opt out of COVID vaccines and instead be tested weekly — even after Sept. 30.

Ghilarducci, the county deputy health officer, said the mandates have had a significant impact at nursing homes and residential care facilities.

“Doctors were talking with the staff and doing what they could but there was just a lot of resistance,” Ghilarducci said. Now, the seven skilled nursing facilities in the county have an average staff vaccination rate of at least 90%, county officials said. The 40 residential care facilities average 93%, although data is missing from four facilities, county officials said.

Healthcare worker vaccinations

Before the Delta variant, many experts thought a safe threshold for herd immunity might happen with around 70% or 80% of the population immune. Now it might be much higher. Still, Ghilarducci said he is “pleased” with the percentage of healthcare workers vaccinated in the 90s, especially in combination with the similarly high rates of vaccination among facility residents.

Ghilarducci said that as the Delta variant has spread, the county has not seen COVID-related hospitalizations among the highly vaccinated residents of skilled nursing facilities. “It’s a powerful, powerful testament to how these vaccines work,” he said. “But what we have seen is the younger subgroup coming into the hospitals. We’ve seen people in their thirties that have died,” Ghilarducci said. “Many of these young patients were people without underlying medical conditions, and they were universally unvaccinated,” said.

“It really is two pandemics at this point,” Ghilarducci said. “We can educate and we can cajole and we can ask as much as possible, but the only way we’re going to get to [higher] numbers community-wide is more mandates going forward.”

Vulnerable patients

The healthcare and elderly care sectors are some of the first parts of the workforce subject to mandates because of the risk that unvaccinated workers pose to vulnerable patients. Early in the pandemic transmission from staff to patients, particularly in elderly care and skilled nursing facilities, was a significant source of spread.

From December 2020 through March 2021, most COVID deaths in Santa Cruz County were among long-term care patients. Since then, COVID deaths at long-term care facilities have leveled off largely due to increased vaccination rates, health officials said. (Kara Meyberg Guzman—Santa Cruz Local)

For residents and family members of people in nursing and retirement homes, widespread vaccination and full mandates can’t come soon enough. Currently there are no active cases among staff and residents of skilled nursing and residential care facilities, but there have been some recent cases.

After a COVID outbreak at Brookdale Assisted Living Scotts Valley in early September, a relative of one of the residents expressed dismay.

“They took a sort of a relaxed attitude after the outbreak and didn’t provide a lot of information,” said the family member. Brookdale wouldn’t immediately share what percentage of the staff was vaccinated or the vaccination status of the infected staff and residents, the person said. Santa Cruz Local is not naming the family member because the person fears that Brookdale staff could withhold information.

On Sept. 23, Brookdale’s director shared with families that 81% of the staff was vaccinated. Brookdale, as a senior residential care facility, is not subject to the Sept. 30 deadline. It instead allows testing for workers to replace vaccines.

Last week, Brookdale representatives told Santa Cruz Local that it will impose its own deadline of Nov. 15 for staff to be vaccinated. It is voluntarily following the stricter mandate, which means unvaccinated employees could lose their jobs.

Andrew Young, a Brookdale representative, said last week there were no COVID cases among residents or staff. “We’re working to meet all those state requirements,” Young said.

All staff and residents of Brookdale have recovered and have tested negative for COVID-19 as of Thursday Sept. 23. A vaccine “strike team” from the county plans to visit the campus this week to answer questions and offer vaccines, county health staff said.

Hospital workers

Dominican Hospital has a staff vaccination rate of approximately 96%, according to county data. Watsonville Community Hospital has a staff vaccination rate of about 95%, according to county data. The hospitals are subject to a strict mandate which does not allow an option for weekly testing to replace vaccination.

Representatives from Dominican Hospital and Watsonville Community Hospital said that the state mandates have not made a significant difference in acceptance. However, “Employees who have not begun the vaccination process and do not have an approved exemption will be placed on administrative leave as of Oct. 1,” said Kevin Kimbrough, a spokesman for Dominican Hospital’s owner Dignity Health. “Every member of our team is valuable and integral to the care we provide in our communities,” Kimbrough added.

Matko Vranjes, an assistant administrator at Watsonville Community Hospital, said a significant number of the unvaccinated staff members are on voluntary leave or otherwise absent for various reasons. They may be vaccinated but the hospital doesn’t have a record of it yet. Some staffers have submitted exemption requests. Vranjes said the hospital is “hopeful that the impacts are not going to be too significant.”

Many more Santa Cruz residents will soon face vaccine deadlines. Federal mandates for federal workers and businesses with more than 100 employees start later this fall.

Ghilarducci, the county’s deputy health officer, said he believes this will be good news for public health.

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