Gov. Ned Lamont said Tuesday the state has begun the process of suspending permanent state employees who have not complied with his COVID-19 vaccination-or-test mandate.

After dismissing 28 noncompliant probationary employees on Friday, Lamont said the administration’s attention was turning this week to permanent state employees who did not get vaccinated or begin weekly testing.

“The good news is many, many, many more are coming in, showing their vaccination or testing protocol,” he said. “And so it’s going to be not that many, at the end of the day, that are noncompliant. We’re giving them one more chance today.”

Workers still in their six-month probationary period who refused to get vaccinated or tested were fired. Permanent employees will be suspended without pay for 45 days then face the loss of their jobs. Some employees were told Tuesday of their suspension.

Lamont said health care workers who refuse vaccinations face suspension, even in settings that are short-staffed, such as the Whiting Forensic Hospital.

“I can tell you that we’re looking very carefully at getting some additional support in there very quickly,” Lamont said. “But it’s really important if you’re working there with those folks, you’ve got to be vaccinated. That’s the CDC guidance, and that’s our rule as well.”

The governor had no updated data on compliance or details on where the first suspensions will come. His staff said they expect an update Wednesday.

At the end of business on Thursday, all but 671 of the 32,000 employees subject to Lamont’s vaccination order had been vaccinated or tested, a compliance rate of 97.8%.

Lamont estimated the compliance rate now was about 99%, but that could fluctuate in coming weeks: Last week’s data showed that 19% of employees had opted for testing, meaning they will be required to show proof of current testing every week; 79% had shown proof of vaccination.

The administration agreed with state employees last week to use federal funds to cover the cost of weekly testing of state employees who decline vaccinations.

Proof of testing must come from a state-licensed clinical laboratory, pharmacy-based testing provider or other approved health care provider. Employees may use vacation, sick leave, comp time and personal leave to get tested. Home tests are not acceptable.

Vaccination rates fluctuating among nursing home residents

In January, Lamont announced that Connecticut was the first state in the nation to vaccinate all nursing home residents. By the end of that month, the state had even administered more doses than there were residents, in part because some facilities cater to residents discharged from hospitals who enter nursing homes for short periods to recover.

But while the overall rate of vaccination among residents remains extremely high, it’s that kind of turnover that has some facilities now reporting rates as low as 66%. Just under a third of nursing homes reported rates under 90%. “Some facilities might have more recently admitted residents who were not vaccinated upon admission,” Department of Public Health spokesperson Chris Boyle wrote.

“We can’t turn down patients because they aren’t vaccinated,” said Tim Brown, spokesperson for Athena Health Care Systems, which runs 26 nursing homes in the state. “As long as we have it documented that we offered them the vaccine, there is nothing else we can do.”

Nursing home residents have been disproportionately impacted by the coronavirus, from the early days of the pandemic through the delta variant wave these past few months. As Connecticut heads into the winter, COVID-19 is expected to make a resurgence, as do most respiratory viruses in the colder months.

But low resident vaccination coverage in some of the state’s nursing homes is not a problem that has immediate solutions.

In early September, Josh Geballe, the state’s chief operating officer, wrote that the governor’s office was not planning to institute a vaccine mandate for residents in long-term care facilities. The state has mandated that nursing home staff be vaccinated, citing a desire to ensure resident safety.

DPH also has retired “Operation Matchmaker,” a vaccination initiative that specifically targeted short-term residents in nursing homes, though nursing homes still have access to vaccines via pharmacies.

Poor data collection on short-stay residents poses another problem in understanding and mitigating the risks posed by those entering nursing homes for short-term rehabilitation. DPH does not have an up-to-date facility-level count of the short-stay residents trekking in and out of the state’s approximately 209 nursing homes.

The agency is reliant on a federal COVID case reporting system called the National Healthcare Safety Network, instituted by the Centers for Medicare and Medicaid Services. CMS does not break out resident coronavirus cases by whether individuals are short-stay or long-term residents, and therefore DPH cannot differentiate between them, Boyle wrote.

Sunil Parikh, an epidemiologist at the Yale School of Public Health, has been studying COVID spread in Connecticut nursing homes in conjunction with DPH.

“We are working with them to understand the factors that are leading to COVID spread in the time of the delta variant and good vaccination coverage,” he said.

Parikh is “definitely interested in this question” of how short-stay residents impact disease spread — but at the moment, “I don’t think we really have this data yet,” he said.

Understanding resident vaccination rates

Data on resident vaccination rates are published by the CMS weekly with a delay of about two weeks. The most recent data available go through Sept. 26. The federal data may contain some reporting errors; DPH conducts a quality check where “outliers and potentially inaccurate data are flagged.”

In addition to being old and error-prone, the public data “show stochasticity,” Boyle wrote in a statement to CT Mirror. That means a nursing home’s vaccination rate today will not necessarily have any bearing on its vaccination rate two weeks in the future, since rates would depend on the vaccination status of discharges and admissions, which may vary widely week to week.

For instance, as of Sept. 12, Arden House in Hamden posted a resident vaccination rate of 76%. Last week, the number rose to 85%, according to a statement provided by spokesperson Lori Mayer. The nursing home also has scheduled a COVID-19 vaccine clinic this week “for any additional residents who want to be vaccinated,” she wrote.

But patterns have emerged from the data. Brown said that Athena has seen lower resident vaccination rates recently in facilities where short-term rehabilitation is a large focus.

It’s not uncommon for a short-term rehab facility like Middlesex Health — which reported the lowest DPH-verified resident vaccination rate — to have four or five discharges or new patients in a day, he said. Northbridge Health Care Center in Bridgeport is in a similar situation and under 80% of residents there are vaccinated, according to the most recent data.

Despite the random variation that any individual nursing home might see over time, the range of resident vaccination rates posted by all nursing homes has remained relatively constant over the past few months.

In other words: Though individual nursing homes may move up or down in a ranking based on resident vaccination rates, the range of rates reported has remained fairly broad, between 60% and 100%. The median rate has hovered between 91% and 94%; half of nursing homes report rates under the median, and half over.

By contrast, the range has narrowed for staff vaccination rates since the state announced that it would mandate vaccinations for staff in the first week of August. The median rate of vaccination also has increased significantly, though latest figures still had it lower than residents at 90%. The most recent data available show rates just before Sept. 27, the state’s staff vaccination mandate deadline.

The state is not currently imposing a similar mandate for resident vaccinations. No other states in the country have announced such a mandate.

Arthur Caplan, professor of bioethics at NYU Langone School of Medicine, did not believe that there was precedent for a resident vaccination mandate for other illnesses such as the flu, either. “Residents who are elderly tended to be more highly vaccinated, so mandates focused on staff bringing in flu and also being sick and absent from work.”

Nevertheless, Michelle Mello, professor of law at Stanford University, said the state had the ability to impose a COVID mandate if it chose, provided that it allowed for religious, disability-related and medical exemptions.

But such a mandate could do more harm than good.

“Resident vaccination rates are already extremely high, we ensure there is regular testing to identify and mitigate outbreaks," Geballe said, "and many residents have no alternatives about where to live.”

Pazniokas, Pananjady and Altimari are reporters for The Connecticut Mirror (www.ctmirror.org). Copyright 2021 © The Connecticut Mirror.