An employee works in the coronavirus unit at the Durgin Pines nursing home in Kittery in a 2020 photo. The nursing home saw two outbreaks that begun in 2020 that infected 88 people, 13 of whom died, but has not seen any new outbreaks begin since the COVID-19 vaccine became available to residents and staff. Credit: Courtesy of Jabbar Fazeli

Coronavirus outbreaks in Maine long-term care facilities have grown significantly less deadly since the widespread rollout of the COVID-19 vaccine, an analysis of Maine Center for Disease Control and Prevention data shows.

While COVID-19 outbreaks in the facilities that have been hard hit throughout the pandemic have continued since vaccinations became widely available, the post-vaccination outbreaks have been smaller, and fewer infected nursing home residents have succumbed to the virus.

The portion of nursing home residents with COVID-19 who have died in outbreaks declined by more than 50 percent between 2020 and 2021, the analysis of the data shows. In outbreaks that began last year, 9.6 percent of residents infected with the coronavirus died. That figure has dropped to 4.3 percent for outbreaks that began this year.

Nursing home residents were among the first groups prioritized for the COVID-19 vaccine, and shots at their facilities began late last year.

While vaccines are not perfect in preventing all coronavirus cases, they are highly effective in preventing severe infection and death, even among a population that’s most susceptible to complications from COVID-19, the data show.

Maine Health Care Association President Angela Westhoff said she was not especially surprised by the numbers. More than 95 percent of Maine long-term care residents are vaccinated, she said, and staff vaccinations have risen sharply since Gov. Janet Mills’ health care worker vaccine mandate took effect this fall.

“The data demonstrates that vaccines are working and are effective,” said Westhoff, whose group represents nursing homes. “A vaccine doesn’t necessarily mean an individual won’t get COVID, but the person would be much less likely to get severely ill, hospitalized or pass away.”

They also show the power of vaccines in protecting society’s most vulnerable members living in high-risk settings, said Dr. Noah Nesin, chief medical officer of Penobscot Community Health Care. People in long-term care facilities are some of the most likely to contract a breakthrough infection. They are older, often have weakened immune systems and live in congregate settings in which the virus can spread rapidly.

“That’s a pretty dramatic effect from immunizations,” Nesin said. “With the addition of a booster, it should have even more impact.”

Nesin cautioned that medical experts still have very little definitive information about the strength of the omicron variant, including how much protection the vaccines provide against it. Yet, it is clear that — regardless of how omicron compares with the delta variant, the currently dominant COVID-19 strain — getting the booster will help staff and residents stay safe in long-term care facilities, he said.

“Suppose the vaccines are half as effective against omicron that they are against delta,” Nesin said. “That’s still a lot better than not being immunized.”

Amid an expected uptick in cases due to holiday gatherings and dropping temperatures, Nesin said the best way to keep others safe, including those in long-term care facilities, is to return to pre-vaccine behaviors including wearing masks indoors, social distancing and frequent hand-washing.

Dr. Jabbar Fazeli, medical director of the Durgin Pines nursing home in Kittery and a spokesperson for the Maine Medical Directors Association, said personal protective equipment use had also worked to stem the spread of outbreaks in long-term care facilities.

When outbreaks emerge in locations where staff are using personal protective equipment, they tend to not progress to severe disease, hospitalization or death, Fazeli said. In his experience, residents who got vaccinated after previously contracting the coronavirus appeared to have the most robust antibody protections — a view that health experts are increasingly taking for the general population.

Westhoff noted that cases had recently begun to rise at long-term care facilities, as they are in the rest of the state. Maine recorded the highest rate in the nation of nursing home deaths for a recent month-long period.

She attributes the spike to many long-term care residents being vaccinated so early in the pandemic. Maine’s vaccination rate for nursing home residents is ninth in the nation, and it’s second for staff vaccinations, according to the federal Centers for Medicare and Medicaid Services.

Long-term care facility residents are receiving booster shots, but Westhoff wasn’t sure how many residents had received them so far.

Studies have shown that the COVID-19 vaccine weakens over time, which is why health officials like infectious disease expert Dr. Anthony Fauci are asking that all Americans get the COVID-19 booster, especially amid news about the omicron variant.

Maine CDC Director Dr. Nirav Shah said that it is far too early to tell how the new variant could affect the future of long-term care facilities but said the numbers clearly showed the power of vaccines and vaccine boosters.

“Vaccines are our way to protect,” he said.

In the 85 long-term care facility outbreaks that began in 2020, there were 335 deaths total arising from 3,479 cases among residents and staff, meaning 9.6 percent of infections resulted in death.

But in the 138 outbreaks that began on Jan. 1, 2021, or afterward, state data show that there were 109 deaths arising from 2,548 cases, meaning 4.3 percent of cases resulted in death.

The numbers show an even steeper decline when looking at how deadly individual outbreaks became in 2020 versus 2021. An average of 3.8 people died in each outbreak in 2020, compared with an average of 0.8 in 2021, a 79 percent decrease. The size of outbreaks shrank from an average of 40.9 cases per outbreak in 2020 to 18.5 this year.

The data do not include information from five 2021 outbreaks for which the Maine CDC did not provide the number of cases. The data do include outbreaks — 16 in 2020 and 18 in 2021 — where only staff members were infected.

While the data show the power of vaccines, the numbers should not allow people to forget the enormous human toll brought by the pandemic, Westhoff said.

“Every death represents someone’s loved one,” Westhoff said. “It is incredibly difficult and tragic, and our thoughts are with those who have lost loved ones throughout the pandemic.”