Details of outbreak, which included a significant percentage of breakthrough cases among vaccinated residents and staff, were previously not reported
Details of a COVID-19 outbreak at an assisted care facility in Vancouver earlier this year have surfaced in recent days after it was previously left unreported by Clark County Public Health (CCPH) officials.
In August, there was a significant COVID-19 outbreak among both staff and residents at the The Hampton and Ashley Inn Memory Care Community. Fourteen of the 78 residents died, CCPH officials revealed this week. Six of the 14 individuals were vaccinated.
According to information contained in e-mails and other documents from CCPH officials, shared with or obtained by Clark County Today (CCT), 90 percent of residents and 87 percent of the staff at the facility were vaccinated. The initial report indicated 58 of the 67 cases cited in the outbreak were “breakthrough” cases involving residents and staff members who were already vaccinated.
That was later revised to be 53 confirmed cases and five probable cases. There were 34 residents who tested positive, for a 62 percent rate of breakthrough cases. Among staff, there were 10 of 24 cases that were vaccine breakthroughs, for a 42 percent rate.
At the Dec. 8 Clark County Board of Health (BOH) meeting, Dr. Alan Melnick, Public Health officer, said the initial data cited was incomplete and wrong. He shared with county councilors, who serve as the members of the Board of Health (BOH), that there were 53 confirmed and five probable cases and 14 deaths.
On Aug. 31, a KPTV (Fox 12 Oregon) news editor in Portland sent an email request to CCPH. The news station had received a viewer report that there were 30 COVID cases among the residents and another 17 among the staff.
CCPH Senior Communications Specialist Marissa Armstrong received data from Dana Nguyen, program manager of COVID-19 Response. Armstrong told Dr. Melnick and the staff, she would report the following to KPTV.
“I’m going to respond with the basic information we typically provide about outbreaks:
Confirm we are working with the facility in response to a COVID-19 outbreak.
67 total cases
- 32 cases in residents
- 35 cases in staff
First case was identified Aug. 17.
If they have follow up questions about vaccine breakthrough, I’ll provide the additional context we gave the Columbian when they inquired about vaccine breakthrough in LTCF outbreaks (% vaccinated and unvaccinated, % infected, etc.).
Note that CCPH does not tell the media about the significant number of vaccine breakthrough cases, and would only do so “if” there were follow up questions.
Melnick and his staff apparently chose not to inform the public or the Board of Health about one of the largest outbreaks in a single Clark County facility this year. There was animated discussion during the BOH meeting, as Chair Eileen Quiring O’Brien said “we didn’t know . . . why?”
“Dr. Melnick in the Clark County Public Health did not inform you,” said area resident Rob Anderson during the public comment portion of the meeting. “They absolutely didn’t inform the public out of the 67 infections reported originally. Which would be, by the way, one of the largest outbreaks in the county.”
Anderson said state law requires Melnick to report outbreaks and inform the public of “causes and nature” of the health concerns. In Wednesday’s BOH meeting, Melnick said they don’t announce breakout cases unless there’s a risk to public health.
Nguyen emailed Melnick and Armstrong indicating 87 percent of those either “confirmed” or “probable” cases were individuals who had previously been vaccinated. The data indicated two of the three who died were fully vaccinated.
The withholding of the numbers of vaccine breakthrough cases followed an Aug. 20 email in which Melnick complained to his staff.
“The news is getting ahead of us and it’s giving the public the perception that vaccines are ineffective.” He encouraged staff to “present data in a simple way that compares rates in vaccinated vs. unvaccinated persons.”
The outbreak began Aug. 17 with the first positive COVID-19 test at the facility. The first case involved a resident of the facility. CCPH indicated that it was not able to be determined how that resident was exposed to the virus.
The outbreak reportedly took place during a two-week period ending Aug. 30. This resulted in two known hospitalizations and three deaths according to the initial communications between CCPH officials. At this week’s BOH meeting, Melnick shared that there were ultimately 14 deaths. At the time, the facility had 78 residents and 80 staff members, according to the report. It indicates 90 percent of residents were vaccinated and 87 percent of employees were vaccinated.
This was occurring during the beginning of the Delta variant surge in COVID-19 cases in Clark County. CCPH data indicates a low number of cases reported around the 4th of July. Daily cases climbed from less than 20 per day in late June and early July, to between 100 and 200 per day in August.
It also occurred as “breakthrough cases” were happening and some people were beginning to question the efficacy of the approved vaccinations against the Delta variant.
Current CCPH data shows a “low” case rate per 100,000 residents of 50.1 in early July, and a “high” of 549.3 in late August or early September, the exact time frame of this outbreak and the inquiry by KPTV.
After the media response was given, Melnick asked the following later that evening in a follow up email.
“How can both staff and residents each have 29 BT (breakthrough cases)? Are there 58 BT cases? Can you separate out the BT cases for staff and residents? Does the BT include probable as well as confirmed cases? It’s difficult to draw conclusions regarding attack rates for vaccinated and unvaccinated based on the chart below.”
The next afternoon, Sept 1, Nguyen reported the following to Dr. Melnick and the staff. The importance of the “Assisted Living Facility Covid outbreak?” email is shown as “high.”
“We have a serious problem with this facility providing the requested information. Please note that the verbal report from the facility is that they have 35 total staff that are COVID positive and 29 that are VBT. Below you will note what our team has been able to validate in WDRS and WAIIS.”
The vaccine breakthrough (VBT) cases were highlighted in red in the initial email chart. The next day, the numbers changed and the VBT cases were shown in black.
Two days later, Melnick held a press conference to inform the public about the pandemic and the present situation for COVID-19 in the county. “We’re not heading in a good direction with the pandemic right now,” he said in opening remarks.
Melnick said case rates and hospitalizations were at the highest rates of any time in the pandemic. “In the last week we averaged 225 new cases each day. Two months ago, we averaged 21 cases a day; so more than 10 times the case rate of two months ago,” he said.
“What is driving this are low vaccination rates,” Melnick told the press and the public, despite the fact that earlier that same week, he had information that a significant outbreak had occurred at the memory care facility, in which at least 87 percent of those involved were vaccinated individuals.
He spoke about the Delta variant causing 98 percent of COVID-19 cases in the county.
“I also want to point out that the vaccine is still really effective,” he said. “Ninety-three percent of the cases statewide in Washington through mid August, are in people who are not fully vaccinated.”
He also spoke about hospitalization. The unvaccinated had 10 times the rate of hospitalization as those who are vaccinated. “Hospitals are getting full, including ICUs, with people who are unvaccinated,” he said.
Melnick went on to talk about vaccination rates, emphasizing that 40 percent of eligible county residents were not vaccinated.
Yet, staff had reported to Melnick earlier in that same week “the verbal report from the facility is that they have 35 total staff that are COVID positive and 29 that are VBT.”
Dr. Lawrence Neville of PeaceHealth also participated in the Sept. 3 press conference. He shared the following regarding waning vaccine effectiveness.
“The great majority of our patients being hospitalized are unvaccinated. I also want to say though, in full transparency, we are seeing some in some vulnerable populations who are vaccinated, that the vaccination immunity appears to be waning a little bit. We are seeing for example, nursing home residents, people who are vaccinated very early in the pandemic, that they do seem to be suddenly more vulnerable to getting COVID despite the vaccination. And that is something that’s concerning us.”
Melnick clearly had evidence for his Sept. 3 press briefing indicating there was a significant problem, in at least this one outbreak, with protection offered by the vaccine. Yet he painted a picture that the spike in COVID-19 cases was a problem of the unvaccinated, in spite of the facts he had from the memory care facility.
Later in the press conference, Melnick spoke about the Delta variant as “a game-changer,” noting that 98 percent of current cases in the state were from the variant.
Clark County Today asked during the press conference “Is there a need for a Delta-specific vaccine, since that is the real problem we are experiencing?” CCT later asked “what is the chance that everyone will require a ‘booster?’ What is the possibility we will need annual ‘booster’ shots for COVID?”
Melnick expressed confidence in the current vaccines, and also indicated there was a national discussion underway about people getting booster shots. He used that as an opportunity to encourage the unvaccinated to get their shots, ahead of the potential demand for booster shots if they became approved.
Response from CCPH
Armstrong addressed a question from CCT about the significance of the high number of breakthrough cases in this outbreak.
“This facility (like most long-term care facilities) has a highly vaccinated population,’’ she wrote in an email response. “The facility reports vaccination rates of about 90% among residents and 87% among staff. As we know, the vaccines are not 100% effective (no vaccine is); there will be some cases among people who are fully vaccinated. When such a large percentage of the population is vaccinated, it is not unexpected to see more cases among vaccinated people. For example, if we had a population that was 100% vaccinated, then every case (100%) would be vaccine breakthrough.
“This outbreak demonstrates what local, state, and national data has consistently shown: rates of COVID-19 infection, hospitalization and death are highest among people who are not vaccinated,’’ Armstrong added. “The most recent Clark County data (posted on our website), shows the rate of death among people who are unvaccinated is nearly 6 times higher than the rate of death among those fully vaccinated. Larger data sets show even greater protection for those who are vaccinated. The latest DOH report shows the death rate for those unvaccinated is 11 times higher than for those fully vaccinated, and a recent CDC report indicates the death rate is more than 10 times higher for those unvaccinated.’’
Armstrong also explained why CCPH elected not to inform the public (or members of the BOH) of this outbreak even though CCPH has been forthcoming with information about other outbreaks, including those at Firestone Pacific Foods, Clark County Jail and Pacific Crest Building Supply.
“Clark County Public Health does not typically publicly announce or report COVID-19 outbreaks under investigation unless they pose a significant risk to the general public,’’ Armstrong said. “Public Health works closely with facilities when responding to outbreaks, and we rely on the facilities to cooperate with our investigation and be forthcoming with information so we can help them to mitigate the spread of the virus. Publicly announcing an outbreak at a business or other facility when our control efforts can prevent a risk to the public could lead to adverse business impacts and may make businesses less likely to report these outbreaks and partner with us in the response. That could actually increase the risk to the public because it can impact our ability to mitigate the outbreak and prevent it from spreading into the community.
“Unlike with public places, long-term care facilities most often can identify everyone who has been in the facility – residents, staff and visitors – and potentially exposed to a COVID-19 case,’’ Armstrong added. “When there is an outbreak at a long-term care facility, we support the facility in identifying and notifying all close contacts who need to quarantine. The facilities are required to notify affected residents and their families about possible COVID-19 exposures. Facilities also identify and notify staff and visitors in the facility who may have been exposed. These steps were taken during the investigation at the Hampton and Ashley Inn. Because the outbreak at the Hampton and Ashley Inn, along with our investigation and response, did not pose a significant risk to the general public it was not announced publicly.’’
Clark County Today Editor Ken Vance contributed to this report.