Nearly 1.2 million nursing home residents are eligible for a COVID booster, but only about half of them have gotten one.
People in nursing homes were among the first to be eligible for COVID-19 booster shots.
But even as the Delta variant is driving a winter surge and Omicron is spreading, about half of this vulnerable population still haven't gotten one.
"There is a collective sigh from my patient population," Dr. Panagis Galiatsatos of Johns Hopkins School of Medicine said.
The number of people in nursing homes getting boosters has increased since the FDA authorized the extra shots for them in late September, but the latest CDC counts show nationwide only 54% of eligible nursing home residents have gotten a booster.
North Dakota is the only state with more than 75% of nursing home residents fully vaccinated with a booster.
Seventeen states have more than 60% of eligible nursing home residents boosted.
Dr. Panagis Galiatsatos treats COVID patients in the intensive care unit at Johns Hopkins in Baltimore. He says age and health problems can lead to weaker immune systems in nursing home residents, and they're more at risk to end up in the hospital if they get the virus.
"A patient, especially coming from a nursing home, coming from a nursing home with COVID, especially severe case, I mean, that's that's not a failure of physiology alone, that's a failure of a system," Dr. Galiatsatos said.
A few factors could explain the low booster count.
This time last year, the initial U.S. vaccine rollout included a federal program where pharmacies brought shots directly to long-term care facilities and high-risk residents.
Now those places are on their own.
Dr. Karl Steinberg is the president of AMDA - the Society for Post-Acute and Long-Term Care Medicine.
"A lot of facilities are having to scrounge a little bit to figure out how to get the boosters in their residents," Dr. Steinberg said.
It's the nursing home staff vaccine numbers that worry him, with 23.5% of them having received a booster dose.
The Centers for Medicare and Medicaid issued a nationwide federal mandate for nursing home staff earlier this year. It requires nursing home staff have one dose of Johnsnon and Johnson or two doses of Moderna or Pfizer by Jan. 4. It does not include boosters.
"I just wonder why on Earth they wouldn't give that simple gift of having a vaccine to save the lives potentially of these people that they care so much about," Dr. Steinberg said.
Dr. Steinberg says nursing homes also face challenges of community infection coming in with visitors.
CMS guidance for nursing homes changed in early November. Now homes can't require visitors to get a COVID test or show proof of vaccination.
Since Nov. 21, more than 4,000 new COVID cases have been counted in nursing homes each week.
Experts say lowering that number depends on raising the booster numbers.