COVID-19 UPDATE #279

January 6, 2023

Rapid Response Team staffing resources are still available for assisted living facilities (ALF), enhanced services facilities (ESF), and skilled nursing facilities (SNF). There is no cost to facilities to utilize this resource. DSHS currently has funding through June 2023 to continue Rapid Response Team staffing assistance. ALF, ESF and SNF providers can request short term staffing support by completing a Rapid Response Request form (DSHS 02-716) and submitting to the Department at rapidresponse@dshs.wa.gov.

Rapid Response Team 2 Management will screen requests based on three priorities:

• Priority 1 is patient admissions from acute care hospitals to offload discharges and supporting providers participating in the ALTSA incentive program.
• Priority 2 is staffing homes with a certain percentage of COVID-19 cases.
• Priority 3 is for other urgent staffing needs to meet resident care and service delivery. Screening will be in order of prioritization.

More information can be found in the DSHS Dear Provider letter.

Critical staffing strategies and recommendations from CDC remain in effect. Please access the CDC website for more information. DSHS guidance for assisted living, enhanced services facilities, and skilled nursing facilities related to critical staffing management in LTC settings can be found here.

With increasing cases of respiratory disease, including COVID-19, this winter it is imperative to encourage residents, staff, and family members to receive the updated (bivalent) COVID-19 boosters.

A recent CDC report showed:

• Adults ages 65 years and older:  
• Continue to have the highest COVID-19-related mortality rates. 
• The COVID-19-related death rate among unvaccinated people who are 65 years and older has consistently been higher than the rate among vaccinated people.

• Adults ages 85 years and older:  
• Remain at particularly high risk of dying of COVID-19. 
• The proportion of COVID-19–related deaths accounted for by adults in this age group increasing during April–September 2022 from 28% to around 40% of COVID-19–related deaths. ​

CDC data on nursing homes showed:  

• COVID-19 case rates are higher in nursing home residents who have not received all recommended doses than those who are up to date. 
• COVID-19 vaccination rates, as of December 11:  
• 43% of nursing home residents in the United States are up to date with COVID-19 vaccination. 
• 10% of nursing home staff in the United States are up to date with COVID-19 vaccination. 

The updated (bivalent) COVID-19 boosters are the best protection against COVID-19 variants causing illness right now. The CDC is creating COVID-19 vaccine sub-provider agreements to allow LTC facilities that are not directly enrolled as providers in the CDC COVID-19 Vaccination Program to access COVID-19 vaccine doses through enrolled pharmacy providers for direct administration by the LTC facilities to their residents and staff. See the CDC agreement for more information. 

To support efforts to increase vaccine and booster uptake, you can share this sample letter with residents and their families, advocate for a strong and clear recommendation from the patient's health care provider and stay up to date on the latest COVID-19 data in your state or county. This quick reference tracker provides information on COVID-19 cases, deaths, hospitalizations, testing and vaccinations. Read more here.

Today at 1 PM PST, there's a webinar titled, Don't be AmBivalent about the Bivalent Boosters: Understanding the Emerging Science Behind the Updated Boosters. Click here to register.

The Washington State Department of Health (DOH) continues to support enhanced efforts to protect those in long term care (LTC) as the flu, COVID-19 and RSV outbreaks continue. Data continues to show vaccines reduce the rates and severity of illness for seniors and staff who may get ill.

Please offer COVID bivalent and influenza vaccines now to all residents and staff who are not up to date or already vaccinated. Immunity from initial COVID vaccination series is known to have decreased over time and does not sufficiently protect individuals from new viral strains. Please read more here for additional information on the Centers for Disease Control and Prevention (CDC) and DOH vaccine program supports and resources to help meet current immunization needs. You may also use this Vax In a Minute (VIAM), edition 2 flyer as a resource for LTC vaccine assistance. Also available is the LTC Bivalent Booster and Flu Tool Kit, the LTCF Bivalent Booster flyer and a sample letter for residents.

The CDC has provided additional guidance and clarification regarding the December 2022 NHSN Influenza Vaccination Data Reporting through NHSN. The CDC is aware that there is some confusion regarding LTC reporting of influenza vaccination data through NHSN. Read more here.

Reporting current COVID-19 vaccination status to NHSN is important. For NHSN reporting during the September 26, 2022 to December 25, 2022 period, individuals are considered up to date with their COVID-19 vaccines if they meet one of the following: 

1. Received an UPDATED (bivalent) booster dose
2. Received their last booster dose less than 2 months ago
3. Completed their primary series less than 2 months ago

NSHN has a presentation that includes the definition of up-to-date (see page 2), examples (see pages 3 and 4), and a decision tree (see page 10).  

In the case of a person who only received the first vaccine in the primary series, and it has been more than two months, it is recommended they complete the primary series before receiving the bivalent booster. You can determine which booster to get by answering a few questions under “Find Out When You Can Get Your Booster.”

In a Dear Provider letter dated December 29, 2022, nursing home administrators were informed that the CR-103E emergency rule filed to continue to extend waiver rules related to transfer and discharge of nursing home residents expires on March 22, 2023.

On November 22, 2022, the department filed emergency rules under WSR 22-23-155, effective November 26, 2022. These emergency rules continue the suspension of certain transfer and discharge requirements previously suspended under Governor Proclamation 21-15 and align with the federal 1135 blanket waiver.

These emergency rules amend WAC 388-97-0140 to allow nursing homes to immediately

transfer or discharge COVID-19 positive nursing home residents to facilities that are equipped to treat the disease when the nursing home is unable to treat COVID-19 positive patients. The emergency rules also amend WAC 388-97-0120 to waive the requirement for nursing homes to suspend certain transfers and discharges pending the outcome of a resident appeal hearing, improving resident safety by allowing faster grouping of COVID-19 positive residents in one facility, or by grouping asymptomatic residents together. These emergency rules help expedite infection control processes and maximizes the availability of nursing home beds.

This emergency rule aligns with Centers for Medicare and Medicaid Services COVID-19

blanket waiver. The department also filed a CR-101 WSR 22-08-060 on April 4, 2022, to begin rulemaking to identify the time period these requirements are suspended under emergency rules.