Why vaccinate our most vulnerable? Strange vote shows dilemma

Nursing homes in the Midwest have been hit particularly hard, with a more than 400% increase in weekly cases since mid-September, according to a report released Tuesday by the American Health Care Association and the National Center for Assisted Living. During the week of Nov. 15, 49% of new nursing home cases were in the Midwest.

Between mid-September and the week of November 15, there was a 177% increase in new weekly cases in nursing homes across the country. Along with the increase in cases has been an increase in coronavirus deaths in nursing homes.

“Our worst fears have come true as Covid is rampant among the general population and long-term care facilities are powerless to completely prevent it from entering due to its asymptomatic and pre-symptomatic spread,” said Mark Parkinson, President and CEO of the organization.

Logistics made easy

From a practical point of view, the reason for vaccinating is simple.

It is much easier to send a team to a facility and vaccinate all of the people who work and live there at the same time than it is to vaccinate both groups at different times. Since the vaccine requires two doses, vaccinators must already return approximately 21 days later as is.

“That’s two trips to a minimum of four,” said Dr Kelly Moore, associate director of the Immunization Action Coalition, which supports frontline workers who will administer the Covid-19 vaccines.

“From a practical standpoint of how quickly we can get the people who need it vaccinated, it greatly simplifies the logistics, as people in long-term care cannot get to a vaccination site. You have to bring them the vaccine. And so it’s much easier if we can immunize everyone who needs it in one trip, instead of having to make multiple trips at different times to the same facility over and over. “

From a medical point of view, the reason for vaccinating residents of long-term care facilities is more complex.

This is the group of patients with Covid-19 with the highest death rate, and many hospitalizations are people from long-term care facilities who contract Covid-19 and are hospitalized. When they do get sick, it places a heavy burden on hospitals.

“These are all great reasons to vaccinate residents,” said Moore.

But there are also reasons for concern. Covid-19 vaccines have not been tested in frail elderly people, many of whom reside in long-term care facilities.

“Since they haven’t been studied in people in these populations, we don’t know how well the vaccine will work for them. We know that most vaccines don’t work as well in a frail elderly person as they do in someone else. one who is fit and vigorous even though they are the same age, ”said Moore.

“There is a question about the direct benefit of the vaccine, if it is given to people who live in these facilities, because we have not yet studied how it works in this group.”

It is this uncertainty that led Talbot to vote no.

“I have spent my career studying vaccines in the elderly. And we have traditionally tried a vaccine in a young, healthy population, and then hoped it would work in our frail elderly, ”she told the committee before her vote. “And so we get into this area of ​​’we hope it works, and we hope it is safe,’ and that concerns me on a number of levels.”

When vaccines start to enter residents’ arms, Moore said Americans need to understand that deaths can occur that won’t necessarily have anything to do with the vaccine.

“We would not be at all surprised to see, by coincidence, that vaccination happens and someone dies soon after receiving a vaccine, not because it has something to do with the vaccination but simply because that’s where people end their lives, ”said Moore.

“One of the things we want to make sure people understand is that they shouldn’t be unnecessarily alarmed if there are reports, once we have started vaccinating, of someone or more. people dying within a day or two of their vaccination who are residents of a long time This would be something we would expect, as usual, as people frequently die in nursing homes. “

On Tuesday, the American Health Care Association and the National Center for Assisted Living applauded the CDC advisory committee’s 13-1 vote to recommend prioritizing their residents.

“More than 100,000 long-term care residents have died from this virus in the United States and our nursing homes are now experiencing the worst outbreak of new cases since last spring, with more than 2,000 residents succumbing to this virus each. week, ”Parkinson said. “We hope this vaccine will literally be a lifeline for thousands of residents.”

Some state governors have started indicating that they will follow CDC priorities for vaccine distribution to healthcare workers and long-term residents.

In Georgia, more than 95% of state nursing homes have enrolled in the CDC through partnerships with CVS and Walgreens for vaccine deployment and distribution.

Across the country, CVS is preparing to administer Covid-19 vaccines to approximately 2 million residents of long-term care facilities, according to Chris Cox, senior vice president of CVS Health. Walgreens is preparing to administer the vaccine to approximately 1 million residents of long-term care facilities, according to Rick Gates, senior vice president of pharmacy and health care at Walgreens.

Drugstore chains plan to store the vaccine in around 1,900 “centers” across the country and then distribute it to more than 48,000 long-term care facilities across the country.

CVS chief medical officer Dr Troy Brennan told CNN’s Kate Bolduan on Thursday that his plan was to be ready by December 15.

“We are currently working with each of the states, and it will be difficult because each state will be different,” said Brennan. “Some states will just say to vaccinate people in the skilled nursing facility. Some states will want us to vaccinate not only people in the skilled nursing facility but also healthcare workers in those facilities, so these types of details vary from state to state. establish.”

Ending isolation

The debate on whether to vaccinate residents of long-term care facilities and on the planning of immunizations has arisen because the residents themselves have been largely isolated from family and friends in facilities closed to visitors.

In addition to saving lives, Parkinson said he hopes the vaccine “will speed up the reopening of our facilities to family members and loved ones.”

But when that will happen remains unknown.

“The most pressing issue at the moment is getting all long-term care staff and residents the top priority for a vaccine.” Long-term care facilities will not be able to have a sense of normalcy until a vaccine is given, and we know everyone is eager for that to happen, ”said Cristina Crawford, spokesperson for the ‘American Health Care Association, in an email to CNN. “We hope to be able to discuss what the next steps will look like once a vaccine is delivered and administered to staff and residents across the country.”

Moore said you shouldn’t expect policy change from the start.

“Right now we just don’t have the data to know how well vaccines will work in these people, so we’re going to have to be careful at the start because we know they are by far the most vulnerable to serious illness. and the death of Covid. We’re going to play very carefully until we know for sure that these vaccines will be really effective in protecting them, ”Moore said.

“As we learn more and see if the vaccine really works well in these groups, I certainly hope we can help these people reconnect with their families because they need each other.