Why do we need to vaccinate our most fragile people? The odd vote shows the dilemma

Of the panel of 14 CDC vaccination advisors, a lone doctor said no.

“I think she’s a weird woman,” Dr. Helen “Keipp” Talbot told Vanderbilt University staff. “I’m still struggling with this. It wasn’t an easy vote.”

Talbot was worried about whether the vaccine would work even in such weak, vulnerable patients. He was even more concerned about what it might look like if vaccination failed in this group, or how it would affect public perceptions if residents died soon after vaccination.

On the other hand, these people are most affected by the epidemic. They account for 40% of all deaths to date.

Homes for the elderly in the Midwest have been hit particularly hard, with more than 400% of cases per week since mid-September, according to a report released Tuesday by the American Health Association and the National Center for Assisted Living. On the week of November 15, 49% of new nursing home cases were in the Midwest.

Between mid-September and November 15, there was a 177% increase in new weekly nursing home cases nationwide. As the number of cases increased, the number of coronavirus deaths in nursing homes increased.

“Our worst fears have come true when Covid is proliferating among the entire population and they are helpless in completely preventing entry due to the asymptomatic and pre-symptomatic spread of long-term care facilities,” said Mark Parkinson, president and CEO of the organization.

Easier logistics

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

It is much easier to send a team to a facility and vaccinate everyone who works and lives at the same time than to vaccinate the two groups at different times. Because vaccination requires two doses, vaccinators should return approximately 21 days later.

“It’s at least two trips, compared to four trips,” said Dr. Kelly Moore, of the Immunization Action Coalition in Support of Frontal Workers Administering Covid-19 Vaccines.

“In practical terms, how quickly we vaccinate people who need it simply simplifies logistics, because people who are in long-term care can’t actually go to the vaccination site. They have to be vaccinated. And so it’s much easier if everyone we can vaccinate whoever needs it on one trip, instead of having to travel several times at different times to the same facility. “

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

They are the group of Covid-19 patients with the highest mortality rates, and many of the hospital nurses are people from long-term care facilities who infect Covid-19 and are hospitalized. When they get sick, it is a big burden for hospitals.

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

But there is also cause for concern. Covid-19 vaccines have not been tested in fragile elderly people, many of whom are residents of long-term care facilities.

“Because these populations have not been studied in humans, we don’t know how effective the vaccine will be for them. We know that most vaccines don’t work nearly as well in a fragile elderly person as someone who is fit and energetic, even if they are the same age, Moore said.

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

This uncertainty led Talbot to vote no.

“I spent my career studying vaccinations in older adults. We traditionally tried a vaccine in a healthy young population and then hoped it would work poorly in our older adults as well,” the committee said before the vote. “And so we enter this realm of ‘we hope it works and we hope it’s safe,’ and it preoccupies me on many levels.”

When the shots fall into the hands of residents, Moore says Americans need to understand that there may be deaths that don’t necessarily have to do with vaccination.

“We wouldn’t be at all surprised to see the vaccine accidentally and then have someone go away shortly after vaccination, not because it has something to do with vaccination, but only because this is where people end their lives. he lives, “Moore said.

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“One of the things we want to make sure people understand is that they shouldn’t be unnecessarily intimidated if there are reports that someone or several people die within a day or two after being vaccinated and who have been for a long time. They live. That’s something we can expect, as usual, because people often die in nursing homes. ”

On Tuesday, the National Health Association and the National Center for Assisted Living welcomed the residents ’rankings with a 13-1 vote on the CDC Advisory Committee.

“More than 100,000 residents in long-term care have died from the virus in the United States, and our nursing homes are experiencing the worst outbreaks of new cases since last spring, with more than 2,000 residents reporting the virus each week,” Parkinson said. “We are extremely hopeful that this vaccine will save the lives of literally thousands of residents.”

Governors in some states have begun to signal that they will follow the CDC’s priorities in distributing the vaccine to both health care workers and long-term residents.

In Georgia, more than 95% of nursing homes in the state have enrolled in the CDC through a partnership with CVS and Walgreens to introduce and distribute vaccines.

Nursing homes are still dangerously awaiting the results of the Covid-19 test

Chris Cox, senior vice president of CVS Health, says CVS is preparing to give Covid-19 vaccines to about 2 million residents in long-term care facilities across the country. According to Rick Gates, vice president of pharmacy and health at Walgreens, Walgreens is preparing to launch approx. Use the vaccine in one million long-term care facilities.

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

Dr. Troy Brennan, CVS’s chief physician, told CNN’s Kate Bolduan on Thursday that they plan to be ready to depart by Dec. 15.

“We’re working with each state now, and it’s a challenge because every state will be different,” Brennan said. “Some states say we only need to vaccinate people in a specialized nursing home. Some states want to vaccinate not only people in a specialized nursing home, but also health care workers working in those facilities, so details like this vary from state to state. set.”

Ending isolation

The debate over whether to vaccinate long-term care facilities and the planning to carry out vaccinations, as residents themselves were largely isolated from family and friends in facilities closed to visitors.

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

But when this will happen is unknown.

“Currently, the most pressing issue is to ensure that all long-term care staff and inmates are given priority over vaccinations. Long-term care facilities cannot get a normal feeling until the vaccine is given, and we know that everyone should he wants this to happen, “said Cristina Crawford, a spokeswoman for the American Health Association, in an email to CNN. “We hope we can discuss what the next steps will look like if vaccines are delivered and given to employees and residents nationwide.”

Moore said not to expect a change in policy outside the gate.

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

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