ST. LOUIS 鈥� Vaccinations and other COVID-19 preventive measures have been an unmitigated success story in Missouri nursing homes, pushing case rates near zero and depressing weekly deaths, statewide, for months.

But now, infections are spiking again, according to federal data released this week. And case rates among Missouri nursing home workers 鈥� with the lowest vaccination rates in the nation 鈥� are even worse.

At the same time, some facilities are grappling with employee shortages yet unseen during the pandemic.

鈥淚t鈥檚 really a challenge for facilities to get and retain workers, and that goes directly to patient care,鈥� said Marjorie Moore, executive director of VOYCE, a south St. Louis County nonprofit that advocates on behalf of nursing home residents. 鈥淚f there鈥檚 not enough people to work in the facility, quite honestly, there鈥檚 not enough people to take care of all of the residents. That鈥檚 really scary.鈥�

Nursing homes statewide reported 895 cases among residents for the week ending Sunday, down from a peak of 1,339 last fall, according to new data from the U.S. Centers for Disease Control and Prevention. At the same time, cases among nursing home staff ballooned to 1,261, up from a peak of 981 last fall.

And while many nursing homes residents are vaccinated 鈥� 87%, in Missouri 鈥� just two-thirds of nursing home staff are immunized, lower than any state in the nation.

Still, vaccinated residents are faring relatively well, overall, against COVID-19 during this wave, even when breakthrough cases occur, said Dr. Charles Crecelius, medical director for two area nursing homes and an elder care specialist for BJC Medical Group.

鈥淭hey鈥檙e not getting infected as much,鈥� Crecelius said. 鈥淭hey鈥檙e not going to the hospital nearly as much. ... They鈥檙e definitely not as sick.鈥�

Nursing homes have contended with staffing shortages throughout the pandemic, but the latest surge has sent yet-unseen numbers of health care workers home due to illness or exposure.

In some cases, the absences have forced some homes to curtail activities and space out bathing schedules.

Moore, the patient advocate, said VOYCE has been fielding more complaints from residents about issues such as unanswered call lights.

Some nursing home workers have left the industry during the pandemic, in some cases due to burnout or low pay. As the U.S. population ages, the industry鈥檚 workforce issues will continue, Moore predicted.

鈥淭his is a problem that is going to be with us for a really long time,鈥� Moore said.

Some nursing homes are bringing on short-term workers through contracts with staffing agencies 鈥� which have helped bridge workforce gaps in the region鈥檚 health institutions throughout the pandemic. But they are often more expensive than other employees, at times are in short supply and aren鈥檛 as familiar with the residents.

鈥淭he homes are really in a bind,鈥� Crecelius said. 鈥淭here鈥檚 just not the labor force there, at times.鈥�

In the past, if a nursing home had an outbreak, some facilities would opt to form a dedicated unit to isolate those residents. And often, they would even take on additional COVID-19 patients from hospitals 鈥� normally those who were no longer contagious, but still needed care and rehabilitation, Crecelius said. During this surge, facilities are so overwhelmed, they often can鈥檛 do that.

On Thursday, the number of COVID-19 patients in area hospitals declined slightly but was still the second-highest on record, at 1,356.

Admissions broke records again, with the seven-day average reaching 215 newly admitted COVID-19 patients. The data, provided by the St. Louis Metropolitan Pandemic Task Force, includes patients in area BJC HealthCare, Mercy, SSM Health and St. Luke鈥檚 Hospital facilities, and the numbers lag two days.

The hospitals reported 24 COVID-19 deaths, the highest daily number since Jan. 7, 2021.

鈥淲e likely wouldn鈥檛 have had this fourth surge, had everybody gotten vaccinated,鈥� Crecelius said. 鈥淪o I鈥檓 still encouraging vaccination, for the future. So that the next time we think we鈥檙e over this, we really will be.鈥�