Why Nursing Home Patients First Get COVID-19 Vaccine

Approximately 3 million Americans living in nursing homes, livelihoods and other group care communities are almost invisible.

But this week, they were chosen for their high-priority access to the most valuable resources: some of the first doses of the COVID-19 vaccine available in the United States.

This is a difference shared with 21 million healthcare professionals in the United States. Vaccination Implementation Advisory Board, A panel of experts advising the US Centers for Disease Control and Prevention.

In the approximately eight-month discussion among the 14 members of ACIP, the idea of ​​prioritizing healthcare professionals, as the advisory group is known, was undeniable. The ability of these doctors, nurses, pharmacists, emergency care workers, hospital staff, medical technicians, and home care assistants to attend work is essential to surviving the pandemic.

They are widely welcomed as heroes and are running towards danger, but those who can protect themselves do so by staying at home.Their job of caring for the sick is Very high rates of infection and severe illness In their rank — they make up about 6% of the country’s population, but they make up 12% of US COVID-19 cases.

This is a completely different profile from the profile of patients living in nursing homes. Retired from an active life, they are receiving medical care. Indeed, they are medically very fragile, and some fear that the vaccine itself can accelerate their death.

The new COVID-19 shots may not be particularly effective for nursing home residents if vaccines for illnesses such as influenza are the guide. The aged immune system is notorious for being difficult to stimulate with vaccines.

Neither of the first two COVID-19 vaccines is likely to obtain an emergency license from the Food and Drug Administration — One from pharmaceutical giant Pfizer And The other is from a start-up company named Moderna — It has been studied in very old and very frail patients living in long-term care facilities. (Clinical trials, primarily in thousands of young and healthy adults, have shown a 90% or greater benefit.)

However, if the state chooses to follow ACIP’s advice, this group will vaccinate teachers, workers considered economically essential, and younger elderly and people with underlying illnesses with rare vaccines. ..

why?

Simply put, they pay privileges in their lives.

More than 100,000 caregivers have died from COVID-19 in the United States. Patients at these institutions account for less than 1% of the US population, but account for 7% of US coronavirus cases and 40% of COVID. -19 people died.

The death toll may increase in the coming weeks. By mid-November, more than 16,000 coronavirus infections had been reported in nursing homes and life support centers. report By American Healthcare Assn. And National Support Life Center.. Nursing homes have experienced the worst new cases since this spring, saying that more than 2,000 residents are infected with the virus each week. Mark Parkinson, The person who leads the combined group.

“The mortality rate is very different from that of the average person,” he said. Dr. Helen “Keipp” Talbot Of Vanderbilt University studying the effectiveness of vaccines in the elderly. “It’s not a little different. It’s completely different. It’s driven these inhabitants before anyone else,” she said.

To Tuesday 13-1 ACIP Voting, Talbot was the only person who opposed the prioritization of caregivers. She said she opposed sending the message that the oldest and most vulnerable should not be considered later in the development and testing of vaccines they may need.

“I had to make a little stand,” Talbot said.

“I don’t hate grandma. I love grandma!” She added. “But we need to think, plan and protect this population.”

In effect, it is a definition of a vulnerable population, and people living in long-term care facilities need basic support and skilled medical care just to live.To protect it, they are often quarantined in group settings Avoid crowds — One of the few protections against coronavirus infection — almost impossible.

They may appear to be separated from the world, but they are far from protected. Their facility has an army of low-wage workers who are most likely to get seriously ill with COVID-19. Blacks and Latin Americans — Illness makes a disproportionate sacrifice — — Occupy 40% Of their rank.

In 2018, half of the nursing assistants who helped with bathing, eating and nursing earned. Less than $ 13.38 per hour.. Paid sick leave is rare, and many return home to crowded, multi-generational living conditions where coronavirus infections are widespread.

The socio-economic situation of these workers also means that they are likely to suffer from many of the underlying conditions. Increased risk of serious COVID-19Includes, asthma, obesity and diabetes.

The impact is clear for medically vulnerable residents of nursing homes.

“Nursing facilities cannot be completely prevented [the coronavirus] From entering for asymptomatic and presymptomatic spreads, “Parkinson said. “Our worst fears have come true,” as the virus spreads among the general public.

According to Talbot, the inhabitants are suffering the most, even though they are clearly not responsible.

“If you’re in the facility and can’t leave, you won’t bring the virus into the facility,” she said. “Only the people who work there bring the virus into churches, homes, restaurants, grocery stores, etc.”

Therefore, vaccination of long-term care facility staff is an important goal. It not only protects the major segments of healthcare professionals, but also indirectly protects the people they care for.

Does it make sense to vaccinate residents at the same time, even if there are few data on safety and efficacy?

Some members of the ACIP committee said they believed so.

“You are vaccinated through the staff, so there are people who can benefit from it,” he said. Dr. Paul Hunter, A family medicine expert at the University of Wisconsin. Nursing homes and home caregivers may not have another convenient opportunity to get vaccinated.

Vaccination of both at the same time is “efficient,” he said.

However, doing so entails an obligation to explain to residents, their families, and their doctors that the vaccine poses considerable uncertainty to the elderly and frail people who were not included in clinical trials.

The vaccine may not work. On the other hand, it can provoke a strong immune response and make the patient feel poor for days.

“”We don’t know all that information, and in the ideal situation we wouldn’t make a recommendation without it. ” Dr. Robert Atmer, Infectious Disease Specialist and ACIP Member of Baylor College of Medicine. “But we are not in the ideal situation. We are in the midst of a raging epidemic, and many of us have been impressed by the suffering we have seen in long-term care facilities over the past eight months. “

Atmar isn’t too worried that the vaccine itself turns out to be unsafe, but mild reactions from some nursing home residents can encourage dangerous and unnecessary medical work-ups, hospitalizations, and treatments. He said he had sex.

The CDC has assured ACIP members to draft a fact sheet to guide residents and their caregivers in making decisions. But that may not be enough, Talbot said, because there are so many unknowns.

Does my family feel responsible if my loved one dies after vaccination? Do they blame the vaccine and refuse to give it themselves?

Moreover, as some experts fear, unavoidable reports of post-vaccination deaths, many of which are due to unrelated causes, will undermine public confidence in the safety of vaccines. Is it?

With little science to answer the last question, experts said they had no choice but to put this hit population at the forefront and hope that the COVID-19 vaccine would help at least a little.

“It won’t necessarily be the home run we want,” Talbot said. “But it will probably be a good solid base hit.”