COVID-19 infections and deaths among nursing home residents and staff took a terrible toll last month according to the latest health data. In the week ending January 23, there were 42,584 resident cases, according to Centers for Disease Control and Prevention (CDC) data. This number surpassed the record set during last winter’s surge, when vaccines were just becoming available.

The number of resident deaths increased each week in the last month, with 1,298 people dying from the virus in the week ending January 23. However, this figure is down from the 4,100 deaths reported in the same week from last year, according to the CDC.

Nevertheless, the latest figures show how hard the highly contagious Omicron variant has hit the at-risk group of nursing home residents and staff with another preventable wave of infections and deaths.

During the week that ended January 9, there were more than 32,000 cases of COVID-19 among nursing home residents, with 645 deaths, a sevenfold increase from just a month earlier and a 47 percent rise in deaths. Among staff, there were 57,000 cases in the same week, a 10-fold increase from a month earlier.

These figures come on the heels of a report by the Kaiser Family Foundation, which found that more than 200,000 residents and staff in long-term care facilities have died since the pandemic began in early 2020, accounting for at least 23 percent of all COVID-19 deaths in the US.

Dr. Eric Feigl-Ding, epidemiologist and senior fellow at the Federation of American Scientists, told the Associated Press as cases were surging in mid-January, “We need to build a Fort Knox around protecting nursing homes, but we’re not doing that right now, and that’s why cases are surging,” adding, “We’re going to have exponential numbers of hospitalizations and deaths.”

Vaccinations have saved lives and prevented even deadlier outbreaks in long term care homes, with recent tolls being eclipsed by the horrific records set in December 2020, when 6,200 deaths were being recorded in a week.

According to the CDC, 87 percent of nursing home residents have been fully vaccinated, with 63 percent having received a booster shot. The number of fully vaccinated staff is 83 percent with 29 percent having their boosters. The US Supreme Court recently upheld a Biden Administration mandate requiring most health care workers to get a vaccine.

Breakthrough infections still occur, despite vaccines and safeguards such as social distancing and increased testing. The Webster at Rye nursing home in New Hampshire was hit by an outbreak in late November despite it’s staff and residents being 100 percent vaccinated, although many were not boosted and were awaiting their shots. Six residents died as a result while dozens more were infected, including 20 staff.

Nursing home residents are also having to deal with longer wait times for COVID-19 test results. Slower response times for lab-based PCR tests and a shortage of rapid antigen tests have severely limited the ability to quickly identify outbreaks and quarantine individuals.

An analysis from the Kaiser Family Foundation of data from the Centers for Medicare & Medicaid Services found that 25 percent of nursing homes that sent tests to a lab waited on average three or more days for the results in January. A month before, the figure was only 12 percent.

The long waits for test results render them practically useless according to health officials, forcing many nursing homes to rely on rapid antigen tests. These however, have been compounded by shortages further straining efforts to contain Omicron in nursing homes. Experts point out that any delays in testing mean that outbreaks can emerge undetected, and breakthrough infections among the elderly have appeared to cause more severe symptoms.

The Biden Administration is sending 1 billion rapid COVID tests to households and another 2.5 million tests every week, but health experts say this is not nearly enough. A survey from LeadingAge in January, which lobbies for nonprofit nursing homes and other care for the elderly, found that 76 percent of nursing homes had adequate testing supplies, but that restocking supplies was getting more difficult. The American Health Care Association estimates that nursing homes need 5 million tests per week.

The rise in COVID-19 cases among nursing home residents and staff has also caused a shortage in admissions, creating a backlog of patients stuck in hospitals. Normally, hospitals would discharge patients into residential care, but the surge in Omicron means that these facilities have seen many staff get sick and unable to transfer new patients.

Staff shortages at nursing homes have included 234,000 caregivers leaving their profession during the pandemic, a 15 percent reduction. At one point during the pandemic, health care work was listed as the most dangerous occupation in America, according to death rates. These working conditions and shortages led Wisconsin to train 200 National Guard members to work as nursing aides.

Nursing homes have been struggling with understaffing for decades even before the pandemic. Many workers feared correctly that they could bring the coronavirus home to their families, while others struggled to care for children because of school and day care closures. Many became sick or died, or simply moved on to less hazardous and better paying jobs.

Admissions to nursing homes are still not at pre-pandemic levels with some patients delaying procedures, like hip replacements, because it would mean staying at a nursing home or some step-down facility. Many were also rightly concerned about the high rates of death and sickness in nursing homes as well as the isolation and loneliness.

Residents are also complaining of substandard care at their facilities, like not being changed or receiving meals on time. Laurie Facciarossa Brewer, the Long-Term Care Ombudsman in New Jersey told NPR that her office received complaints that facilities have one nurse taking care of more than 50 residents, when the normal ratio should be one certified nursing assistant for eight residents on the day shift. New Jersey has also deployed National Guard units to help nursing homes with worker shortages.

Many nursing homes have been forced to shut down or close wings of their facilities and reduce the number of new patients they accept, further exacerbating pressures on hospitals and primary caregivers.

The average length of stay in a hospital for patients being discharged to a nursing facility is up 21 percent in the last month compared to 2019, according to Careport, a company which connects patients in hospitals to long-term care facilities. The average hospital stay for patients being transferred to home care agencies, which are also dealing with worker shortages, was also up 14 percent during the same amount of time.