SIOUX FALLS, S.D. — Two people who lived in a small, rural South Dakota nursing home are dead and more are sick with COVID-19, even though 100% of the facility's elderly residents were vaccinated against the virus, Forum News Service has learned.

The outbreak in the Good Samaritan Society-Deuel County senior care facility in Clear Lake, South Dakota, mirrors a rise in vaccine breakthroughs in nursing homes across the nation: Vaccinated seniors regularly deal with unvaccinated staff, visitors and community residents, face the rise of the more dangerous delta variant, and are less protected by vaccines that previously thought.

It's not yet clear what caused the Clear Lake outbreak. But such outbreaks underscore the importance of nursing home staff and surrounding communities getting more widely vaccinated against COVID-19, researchers say. It's simply not enough to get vulnerable older adults vaccinated if they're still surrounded by those who aren't.

That's a problem in South Dakota, which is struggling to meet vaccination targets, and specifically in Deuel County, where vaccination rates are significantly below both state and national averages, according to the Centers for Disease Control and Prevention.

The Clear Lake facility, with its 30 or so fully vaccinated residents, was something of an island in a county where only 36% of those age 12 and older have been vaccinated. But no elder care facility is truly an island. They're workplaces. And homes where family and friends come to visit.

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Still, the 40-bed facility had made it through the pandemic without losing a single resident to COVID-19, according to weekly reports submitted to federal health authorities.

Then, in the last two weeks, the virus finally broke through.

The outbreak

Seven residents among 30 were sick with COVID-19 and two ill with the virus had died as of Thursday, July 29, according to Rochelle Rindels, vice president for nursing and clinical services at Good Samaritan Society, which owns and operates the Clear Lake facility.

Upon discovering COVID-19 among residents, Good Samaritan quarantined each resident to a room. The Good Samaritan Society sent a regional nurse leader to head up the response, added staff members to isolate staff caring for residents who had tested positive for the virus, and redid fit testing for personal protection equipment, Rindels said.

The two residents who died had underlying, contributing medical conditions, and the vaccine should be credited with reducing illness severity in the other residents who tested positive, she said.

"Among the seven that we currently have in-house, they really have mild to no symptoms," Rindels said.

It's likely impossible to prove how COVID-19 got introduced to the Clear Lake residents. But it's clear they're surrounded by people not as well vaccinated against COVID-19.

Only 61% of staff are fully vaccinated, according to the CMS report for the week ending July 18. That's below the industry target of 75%. But it matches the state senior care facility staff average, is slightly better than the national average and far better than the surrounding community, according to federal data.

Deuel County has not flocked to get the vaccine. As of Friday, July 30, only about 30% of the county's 4,300 or so residents was vaccinated against COVID-19, according to the CDC. Only 12 people in the county are currently sick with the virus, per the state's COVID-19 data dashboard.

But in the last two weeks alone, five workers at the Clear Lake facility tested positive for COVID-19, Rindels said. "No staff were working while they were sick," she added.

There are safeguards in place. Per Good Samaritan Society policy, staff are tested twice a week for the virus, and immediately if they're showing symptoms. The facility also tightened up its visitation policy, encouraging window and virtual visits, and only allowing indoor visitations for compassionate circumstances.

The facility's staff will be fully vaccinated by Nov. 1. Good Samaritan Society, which is part of Sioux Falls, South Dakota-based Sanford Health, is one of the largest nonprofit senior care providers in the country, with more than 200 locations in 24 states.

On July 23, Sanford Health said it was requiring all employees to be vaccinated by Nov. 1, as a condition of employment. That includes Good Samaritan Society employees.

Vaccine effectiveness a concern

There's growing evidence that vaccinations, while powerful, aren't a silver bullet against COVID-19 for the elderly and those with compromised immune systems.

A study from the Oregon Health & Science University, recently published in the Journal of the American Medical Association, found that older people seem to have fewer antibodies to fight off COVID-19 after getting vaccinated, compared to other younger people. But the vaccines are still effective enough to prevent infection and severe illness in most people of all ages.

“Our older populations are potentially more susceptible to the variants even if they are vaccinated,” said the study's senior author, Fikadu Tafesse, assistant professor of molecular microbiology and immunology at Oregon Health & Science University. “The good news is that our vaccines are really strong.

The study's findings were mirrored cases studies described in a recently leaked CDC presentation discussing the need to change messaging on the state of the pandemic, amid the surging delta variant.

While the CDC estimates more than 80% of new cases among the nation's unvaccinated are the delta variant, it's hard to say how widespread the variant is in South Dakota..

Only 13 cases of the delta variant have been caught so far in state spot checks, with none in Deuel County, according to the state Department of Health. But state health officials have warned that additional positive cases of variants caught via limited testing indicates wider spread of that variant.

The South Dakota Public Health Laboratory is now running tests on positive specimens from the Clear Lake facility residents to see if they're the more transmissible and dangerous delta variant of COVID-19, said Rindels, of the Good Samaritan Society.

The state Department of Health, which oversees the public health lab, didn't immediately respond to questions for this story.