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The rapid development of COVID-19 vaccines by Pfizer, Moderna and other drugmakers are raising hopes of stopping the pandemic, which has killed more than 250,000 people in the United States so far this year. But as the coronavirus continues to spread, some experts fear that the inoculation plan for some of America’s most vulnerable – those living in nursing homes and other senior care facilities – is inadequate.
“The way the government has approached the distribution of vaccines to nursing homes has kept me awake at night,” said Michael Wasserman, geriatric care specialist and president of the California Association of Long Term Care Medicine.
Back in March, Wasserman told CBS News that nursing homes were at risk of becoming COVID-19 “killing fields”. Eight months later, he remains deeply concerned about the coronavirus now engulfing much of the United States and the number of new official cases approaching 200,000 per day. “The government has a plan in place without engaging with people who know how to care for this population,” he told CBS MoneyWatch. “I am extremely skeptical that the implementation will go smoothly.”
At least 67,500 people in nursing homes have died from COVID-19 since the government began collecting data in May, according to the government’s Centers for Medicare and Medicaid Services. About 2 million Americans live in nursing homes, which is less than 1% of the population. Yet the COVID Tracking project estimates that these facilities accounted for around 40% of total deaths during the pandemic. Infections in nursing homes shoot again in the latest wave of infections.
Experts have a range of concerns – in particular for the distribution of vaccines in nursing homes, assisted living centers and other long-term care establishments:
- Unlike the general population, many nursing home residents cannot visit a hospital or outpatient clinic. Therefore, vaccination teams will need to visit the more than 15,000 nursing homes in the United States at least twice – the Pfizer and Moderna vaccines require two injections several weeks apart – but likely several times beyond. Tens of thousands of additional assisted living facilities may also have residents who cannot travel.
- The federal government coordinates the vaccination effort for residents of nursing homes, but not for people who work in nursing homes. This part of the effort is left to individual states. In California, for example, the plan is to vaccinate nursing home workers. But in Ohio, nursing home workers will have to visit one of the state’s 10 hospitals, forcing some to travel hours to get vaccinated.
- Possible side effects of the vaccine, which include headache, muscle pain, and in some cases extreme fever, could be difficult for nursing homes to manage, especially if workers are vaccinated at the same time and present similar symptoms.
- Specialty pharmacies that normally serve long-term care facilities have mostly been excluded from government vaccine distribution plans in favor of national pharmacy chains CVS and Walgreens. Some experts say that failing to take advantage of existing pharmaceutical systems to deliver the vaccine will complicate distribution.
“Residents of nursing homes in the early stages will be part of the country’s learning curve on how we properly distribute the COVID-19 immunization,” said Soumi Saha, pharmacist and advocacy director at Premier, who is a buyer that works with 28,000 retirement homes and assisted living facilities across the country. “And these facilities have already been hit hard by the coronavirus pandemic, so the circle of trust has already been broken in this regard.”
Wasserman is particularly concerned that nursing home workers appear to be an afterthought in the federal government’s vaccination plan – especially given the evidence that employees are responsible for many infections in nursing homes.
“Nursing home workers tend to be low paid workers and often immigrants,” he said. “You have a population that is prone to vaccine hesitation. We need to help them understand the need for vaccination, and we need to make it easy for them.”
“I hear confusion”
In October, the Trump administration announced a partnership with CVS and Walgreens that tasked national drugstore chains to distribute coronavirus vaccines to nursing homes. Nursing homes have been allowed to opt out of the program and be vaccinated at one of the hundreds of specialty pharmacies that specialize in long-term care facilities.
But Peter Van Runkle, head of the Ohio Health Care Association, which represents the nursing industry in that state, said the government was discouraging nursing homes from pulling out of the federal planning initiative.
Prime Minister’s Saha expressed concern that nursing homes that partner with their existing specialty pharmacies, and not CVS or Walgreens, will be ignored during the first round of immunization, noting that specialty pharmacies have records of patients as well as knowledge of the operation of these facilities. While relying on CVS and Walgreens streamlines the process for the government, it can lead to lower vaccination rates and worse medical outcomes, she said.
“It will be essential, once there are various vaccines on the market, to know the patient records to select the best for each patient,” she said. “To get the highest immunization rates, you need to take advantage of the long-term care pharmacy network that already serves every nursing home across the country.
“I hear confusion among retirement home operators,” Kevin Fearon, president of the American Society of Consultant Pharmacists. “They say of course we want to use you, but there is confusion and we tell them that you should do what you think is right.”
Earlier this week, officials from Operation Warp Speed, the Trump administration’s program to immunize Americans, announced at a press briefing that 99% of all nursing homes had opted for the plan. government distribution.
CVS and Walgreens: we’re ready to go
A CVS spokesperson dismissed concerns about prioritizing the distribution of vaccines to its current nursing home clients as “completely unfounded”.
“We will administer vaccines at any long-term care facility that chooses CVS Health as their preferred immunization provider,” CVS spokesperson TJ Crawford told CBS MoneyWatch. Crawford also said the drugstore giant – the nation’s largest drugstore chain, with nearly 10,000 stores – would benefit from its experience administering tens of millions of flu shots in nursing homes and elsewhere. across the country every year.
Walgreens, the No.2 drugstore chain with 9,300 stores, said in a statement it is working with long-term care facilities to help them determine the best approach to administering COVID-19 vaccines. “We have the infrastructure to handle the complexities of administering a COVID-19 vaccine, as well as extensive pharmaceutical expertise in administering vaccinations,” Walgreens spokesperson Kelli Teno said, at CBS MoneyWatch. “We are confident that we can support long term care facilities that request our support.”
CVS and Walgreens have divisions specializing in the supply of drugs to nursing homes. Combined, however, the two services only serve about a quarter of retirement homes across the United States. This means that thousands of facilities will have to rely on the chains for a vaccine despite little previous relationship with them.
“Qualified nursing providers are worried about the government’s plan,” Van Runkle said. “They would be more comfortable using pharmacies with which they already have a relationship.”
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