IDAHO FALLS — With an outbreak stemmed, the dining room is finally looking more full.
Residents at Lincoln Court Retirement Community are still required to social distance. But they can finally see each other's faces as they eat in the same room where, two months ago, Walgreens held the facility's first COVID-19 vaccine clinic.
After a novel coronavirus outbreak last year infected 120 staff and residents and killed seven, Lincoln Court hasn't reported a new coronavirus case this year, state records show.
Facility director Matthew Johnson, like many, can't put his finger on just one cause for resolving infections. But he's happy to see his residents' smiling faces again.
"There's definitely happy tears being shed and a renewed positive energy in the building," Johnson said.
He said 100% of residents and 95% of his staff have been fully vaccinated against COVID-19.
As coronavirus infections fall in long-term care facilities across the country, facilities in Idaho are also seeing a reprieve.
Falling infections in high-risk facilities this year are cause for celebration. Many facilities are finally finding ways to let residents see family again and interact with each other safely.
"We are rounding the corner," Katy Palmer, who manages a University of Idaho program, ECHO, that worked with skilled nursing facilities to cultivate best practices for infection control.
But the recovery caps a deadly winter surge for the entire state that left health care systems close to a resource crisis. By Christmas, 300 of 415 long-term care facilities had reported outbreaks in Idaho, according to the Post Register's review of weekly public reports by the Idaho Department of Health and Welfare. Seven in 10 outbreaks were active at the time. About 7,500 residents had been infected with the virus; 539 had died.
By the end of January, the situation had turned around. Spread had slowed across the state and in long-term care facilities. But death counts continued to climb — totaling 762 in long-term care facilities by Feb. 26.
Outbreaks grew as well, but slowly. And as more residents accessed COVID-19 vaccines, starting Dec. 28 and still ongoing, more and more outbreaks were listed as resolved by the state health department, which says outbreaks are not active if no new cases were reported in staff or residents for 28 consecutive days.
"Infections aren't ravaging their facilities," Palmer said.
Tera Fellows, who works with long-term care facilities across eastern Idaho as an ombudsman, has seen the impact firsthand. She visits three to four facilities a week lately. Each has their own policies. Some let visitors into residents' rooms. Some facilities set time limits. But generally, Fellows is seeing "some sense of normalcy" with residents mingling and activities returning.
"They're just so happy to see that there's a light at the end of the tunnel," Fellows said. "The facilities are doing a really good job continuing to do the procedures they need to do, but encouraging residents and getting them excited."
The state doesn't know how many people live in long-term care facilities, making it difficult to say which portion of them have been vaccinated against COVID-19 or even contracted the coronavirus. Health director Dave Jeppesen said at a media briefing Tuesday that nearly half of all 291,000 Idahoans age 65 and up had received at least one dose of COVID-19 vaccines. By Wednesday night, 18,577 COVID-19 vaccine doses had gone to residents of long-term care facilities, state health spokeswoman Niki Forbing-Orr told the Post Register in an email. She said the state had 420 long-term care facilities.
The lack of resident-level data makes it difficult to discern why outbreaks, infections and deaths are slowing inside long-term care facilities. Starting around the new year, the significant improvements align with two developments that changed the nature of Idaho's COVID-19 battle: Coronavirus cases began declining after Christmas; and the first Idahoan was vaccinated against COVID-19 on Dec. 14.
In congregate living facilities such as nursing homes, the only way viruses get in are from people who don't live there. When many facilities were on strict lockdowns last year, staff were the main vector.
A presenter with U of I's ECHO program with skilled nursing facilities, Dr. Megan Dunay, medical director at the Idaho State Veteran's Home, said it's too soon to say whether facilities are fully protected once "80 out of 100 or 99 out of 100 residents" are vaccinated.
"We simply don't know enough about this virus. It's only been a year," Dunay said. "... We don't know what two years from now looks like. We don't know what six months from now looks like. What we do know is that our infection control and prevention practices are working. And we need to remain vigilant about that. We know that the threat to residents in these facilities is staff. And staff, it's not their fault, right? It's community transmission. The threat to staff is community transmission and positivity rates."
"Everything that happens outside the walls of these facilities has profound implications for the people inside these walls," Dunay said.
For now, Johnson said his facility in Idaho Falls is playing it safe but enjoying the lull. Families can schedule masked visits with screenings during the day in residents' rooms, while they used to have "window visits," Johnson said.
But he's ready if the virus creeps back in.
"If we do have even one resident test positive in the building for the foreseeable future, we have to go right back to how it was," Johnson said.
Editor's note: This article has been updated to clarify the number of COVID-19 vaccine doses residents of Idaho long-term care facilities had received as of Wednesday night.