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Even as rates of new COVID-19 cases in long-term care facilities have dropped dramatically, life on the inside looks unchanged for now. Here, Judy Ryan is one of the first Berkshire County nursing home residents to get vaccinated.

More than two months after long-term care vaccinations began, life in Berkshire County nursing homes looks more or less the same.

As the push to inoculate long-term care residents and staff charged into high gear in January and drew to a close in February, reaching tens of thousands of people statewide, the number of deaths and infections in long-term care facilities tumbled. But, state regulators and local facilities have toed the line, sticking to proven pandemic-era restrictions while cautiously anticipating better months ahead.

“We’re excited folks are vaccinated; we’re looking forward to warmer weather so people can get together outside and we can get to a semblance of normal life,” said Lisa Gaudet, vice president and spokesperson for Berkshire Healthcare Systems, which operates facilities in the Berkshires and statewide. “But, we’re being exceedingly cautious until we get clarity.”

The seven-day rolling average of new daily cases in long-term care settings statewide dropped from more than 150 at the peak of the previous surge to just 18 by late February. In the final months of 2020, long-term care cases made up nearly 3 percent of the state’s total new cases each day; that rate dropped to just 1.3 percent by the last week of February.

Deaths also fell once the vaccines had time to take effect, though the vaccination push coincided with a spike in deaths from the fall surge.

Fatalities swelled statewide from late November to January for nursing home residents and the general population. But, by mid-February, the rate of death in long-term care settings had fallen back to 16 deaths each day, close to November averages. The daily averages for the general population still were twice the rates in November.

That is, even as cases and deaths dropped dramatically across the state, they fell slightly faster in long-term care settings through most of February.

And at Berkshire Healthcare Systems, where more than 80 percent of residents and two-thirds of staff have been vaccinated, the inoculations seem to be stopping the virus in its tracks.

“Rates of infection have dropped,” Gaudet said. “There have been no large outbreaks like we were seeing before. We’re seeing one-offs, generally a staff member testing positive because they had a direct contact in the community.”

But, even as case counts decline statewide and the vaccine kicks in, the Department of Public Health has yet to loosen its guidelines on life inside the facilities, according to Gaudet.

“The department hasn’t changed anything about guidance related to visitation, dining, activities,” she said. “There’s a groundswell of curiosity and questions from the industry. We’ve done the vaccinations; now what? But, that guidance hasn’t come yet.”

At Berkshire Healthcare facilities, the state restrictions mean residents still are kept to strict distancing mandates during meals, and visits with loved ones remain limited to 45 minutes, when they are possible at all. Residents who leave for an overnight stay still are required to go through an extensive quarantine when they return, according to Gaudet, regardless of their vaccination status.

Gaudet said she thinks the state’s guardrails still are in place in no small part because of the uncertainty surrounding the vaccine and the new variants circulating through the country. Though the vaccines have brought relief, Gaudet says the state worries about rolling back restrictions when there still are unknowns.

“The industry each week has a call with DPH,” she said. “And many individuals from the industry are asking for greater clarity on the impact of the vaccine, and the ability for people to leave the building and go home for a visit.”

Currently, overnight visits mean the patient risks losing their spot: If there is no “quarantine bed” available at their facility, the resident cannot be readmitted.

On top of that, nursing homes also must consider the long-term concern of continued vaccinations.

“We feel very positive about the fact that so many people were vaccinated,” Gaudet said. “Now, we’re in process of establishing, how do we continue to vaccinate new residents? New staff that come through?”

Most residents and staff were offered vaccines on-site through large-scale clinics, which no longer are an effective option for the trickle of new residents and staff. For now, Gaudet said, the state’s rapid response teams have been working with Berkshire Healthcare to vaccinate new arrivals who want the shot. She expects the commonwealth to formalize a program in the next couple of weeks.

Francesca Paris can be reached at fparis@berkshireeagle.com and 510-207-2535.