I remember Scott Gottlieb saying a few days ago that nursing homes would be the “canary in the coal mine” with respect to whether vaccinated Americans need booster shots or not. Nursing-home residents were the first people to be vaccinated this year and, being elderly, their immunity is weaker and should wane more quickly than it does in younger people. If they start dying again, the feds will probably scramble to authorize third shots for the entire senior citizen population.

There have been several reports lately of outbreaks erupting in nursing homes in different parts of the U.S. but there’s not necessarily any silver-bullet cause. Maybe the immunity of frail residents is waning, or maybe the Delta variant is so contagious that it’s destined to break through the vaccinated population’s immunity more often. (Or both.) But there’s a third factor: A shockingly high number of nursing-home staffers across the country are still unvaccinated. Which is mind-boggling given the severe risk they pose to their patients.

And the answer to the question of what to do about it isn’t as easy as it seems.

Nationally about 59% of nursing home staff have gotten their shots, about the same as the overall percentage of fully vaccinated adults — but significantly lower than the roughly 80% of residents who are vaccinated, according to Medicare. And some states have much lower vaccination rates of around 40%…

At one memory care facility in the Grand Junction area, 16 fully vaccinated residents were infected and four died, according to a CDC slide provided to The Associated Press. The residents who died were described as being in hospice care, with a median age of 93, indicating they were particularly frail…

The CDC investigated several nursing homes in Mesa County that were experiencing new outbreaks. At one location — described as “Facility A” — 42% of the staff were still not fully vaccinated, contrasting with only about 8% of residents who had failed to complete their shots.

One never can tell for sure how any specific outbreak began but nursing-home staff are obvious suspects each time since they’re moving back and forth between the facility and the surrounding community more often than anyone else. And unvaccinated staff are especially dangerous because the unvaccinated shed a much higher viral load than the vaccinated do, a problem compounded by Delta’s high transmissibility.

The good news is that the vaccines are holding up in most cases even among elderly residents, preventing the mass death we saw last year. At one Cape Cod nursing home, 24 residents and nine staffers tested positive for COVID; “most” were vaccinated and experiencing only mild symptoms or none at all, which is terrific. But even in a blue northeastern state with high vax rates like Massachusetts, just 73 percent of nursing-home staffers have been immunized. More than one in every four workers who are around elderly residents risk exposing them to a high dose of the coronavirus.

Not everyone fared well at an outbreak in an Indiana nursing home recently.

Half a dozen residents at a long-term care facility in Kokomo have died due to a recent COVID-19 outbreak, local health officials said, marking the first major outbreak in a nursing home for months…

A total of 19 staff and residents at the long-term care facility tested positive within the past few weeks, local health officials said. Of the 19, just a handful were vaccinated against COVID-19, Backer said, with one of the reported deaths being a vaccinated individual.

“It is concerning, obviously, because I think a lot of us just assume everyone at a nursing home has got their vaccine,” Backer said, adding that the rate of staff inoculation at the facility was only around 35%.

Six dead, one of them after being immunized, because two-thirds of the staff couldn’t be bothered to take a free precaution that would have protected them and made them markedly less infectious to their charges. Grotesque. And not uncommon in Indiana: Just 49 percent of nursing-home staff and 79 percent of residents statewide are vaccinated. That last number may mean bad things for us as Delta spreads, too. Britain’s death toll remains low amid a massive wave of Delta because around 95 percent of seniors there have been immunized. In America slightly less than 80 percent have. There are many more vulnerable senior citizens here than there. The Kokomo nursing-home outbreak feels like an omen.

So the need to vaccinate nursing-home staff is urgent, and could be done via employer mandates once the vaccines are fully approved by the FDA. But that’s where this gets tricky. Nursing-home work is difficult and doesn’t pay well in many cases. If you call unvaccinated staffers’ bluffs by telling them to get vaxxed or get lost, they might get lost. And suddenly you’d have a different urgent problem, how to care for a large group of elderly who depend heavily on assistance without enough trained workers to tend to all of them. Better to run the risk of residents getting an infection which they’ll probably survive while making sure their other needs are met, the thinking goes, than risk depleting your work staff to protect residents from COVID and suddenly have to deal with the logistics of keeping everyone fed, bathed, and medicated.

I’d call the bluff of unvaxxed staffers anyway. If they refuse, let ’em test their luck with the job market at a moment when beefed-up federal unemployment is winding down.

That’s one reason why the White House is resisting a push for mandates, though, fear of disruption to the nursing-home industry. The other is that our old friends in labor leadership continue to resist vaccine mandates for their members, even when that means risking exposing defenseless older people to the most contagious COVID strain known to science.

Tell it to SEIU bud

They've opposed mandates for public healthcare workers for a decade+

they couch it in diplomatic "we strongly encourage" language, but their lawyers go mafia-tactics on any pols suggesting they should be required to comply. pic.twitter.com/UNtcfNOQ88

— Children's Knife-Fighting Association (CKFA)⚔️🚸⚔️ (@Bugs_Meany) March 17, 2021

Teachers’ unions prioritize their members’ right not to get vaxxed over the best interests of children. Why wouldn’t nurses’ unions prioritize the same way vis-a-vis the best interests of grandma and grandpa?

The state with the lowest rate of vaccination among nursing-home staff is Louisiana, by the way. But right behind it is Ron DeSantis’s Florida, where it’s less than 42 percent(!). DeSantis has strenuously opposed vaccine mandates of any stripe but he may be tested on that within this niche once the vaccines gain full approval. Is he willing to make an exception to his no-mandate policy to protect the most vulnerable people in the population? We’ll see. It’s not like Florida has a lot of senior citizens, right?