Peconic Landing – R&R – Reachout and Rebuild

Frustrations Boil at Pace of Vaccinations at Long-Term Care Facilities

David Posnett — Sun, 17 Jan 2021 20:24:55 +0000

Our local ‘Retirement’ facility

The Trump administration raised hopes of a speedy process for nursing homes and assisted living facilities. Patience is wearing thin.

By Rebecca Robbins

In mid-December, a top Trump administration official floated an enticing possibility: All nursing home residents in the United States could be vaccinated against the coronavirus by Christmas. “It’s really a remarkable, remarkable prospect,” Alex M. Azar II, the secretary of health and human services, declared.

It turned out to be a fantasy.

A month later, vaccinations of some of the country’s most vulnerable citizens are going more slowly than many state officials, industry executives and families expected. Their hopes had been buoyed when government officials said long-term care facilities would be at the front of the line for vaccines.

CVS and Walgreens, which are largely responsible for vaccinating residents and workers in long-term care facilities, are on track to make at least initial vaccination visits to nearly all nursing homes they are working with by Jan. 25. The two pharmacy chains have already given out more than 1.7 million vaccine doses at long-term care facilities.

But the progress is uneven across the country and not nearly as comprehensive for different types of long-term care. For example, thousands of assisted living facilities — for older people who need less care than those in nursing homes — do not yet even have an appointment for their first visit from the pharmacy teams, in large part because states have given such facilities lower priority in their vaccine-distribution plans.

“I’ve had facilities call me, and I’ve had people cry, I’ve had people curse, because this was the first sign of hope that they’ve had in many, many months,” said Betsy Johnson, who leads a group that represents Kentucky’s nursing homes and assisted living facilities.

“It’s just human nature to think, ‘OK, but I was supposed to be first — and I don’t even know when my clinic is going to happen,’” Ms. Johnson said.

In Pennsylvania, teams from CVS or Walgreens are not scheduled to visit some nursing homes until February, and the vast majority of the state’s assisted living facilities have not yet been scheduled for a first visit, said Zach Shamberg, president of the Pennsylvania Health Care Association.

“There’s a great deal of frustration, there’s a great deal of apprehension, as to when or if this vaccine will come,” Mr. Shamberg said.

The pace of the vaccination program has taken on greater urgency as the rapidly spreading virus continues to decimate nursing homes and similar facilities. The virus’s surge since November has killed about 30,000 long-term care staff and residents, raising the total of virus-related deaths in these facilities to at least 136,000, according to a New York Times tracker. Since the pandemic began, long-term care facilities have accounted for just 5 percent of coronavirus cases but 36 percent of virus-related deaths.

Even as the vaccination campaign accelerates, the suffering is unlikely to wane. The coming months could be “the deadliest of the pandemic” for people living and working in long-term care, according to an analysis released on Thursday by the Kaiser Family Foundation.

The Trump administration announced in October that it had teamed up with CVS and Walgreens to lead a federal effort to vaccinate residents and workers at long-term care facilities, among the first eligible groups.

On Friday, CVS said it had given out just over one million doses in more than 12,000 initial visits to long-term care facilities. Nearly 8,000 visits are scheduled for the coming week. Walgreens said it had given out nearly 750,000 doses in nearly 9,000 visits to facilities, mostly nursing homes. The number of visits that Walgreens has scheduled with assisted living facilities “continues to accelerate,” a company spokeswoman, Rebekah Pajak, said.

The vaccinations by CVS and Walgreens were always expected to take several months because of the need to visit tens of thousands of facilities three times. The first two visits are for most residents and staff to get the two doses of the vaccine, with the third visit as a backup for people who missed the first clinic.

The idea that all nursing home residents could get their first doses by Christmas was not a realistic prospect even when Mr. Azar, the health secretary, floated it 12 days before the holiday. By that point, some states had told the Centers for Disease Control and Prevention that they would not activate the federal program to vaccinate their nursing homes until Dec. 28. The logistics would have been challenging even if states had put a priority on getting their first doses to nursing homes.

Michael Pratt, a spokesman for the Health and Human Services Department, said Mr. Azar had been speaking only aspirationally about what states were capable of doing, since they had enough vaccine doses to cover all nursing home residents by Christmas. But that would have required that states place less of a priority on vaccinating high-risk groups like heath care workers.

T.J. Crawford, a spokesman for CVS, said the chain was making first visits to all facilities within four weeks of each state’s activating its vaccination program for nursing homes or assisted living facilities.

“This isn’t a drive-through or stadium vaccination effort,” Mr. Crawford said. “We’re visiting more than 40,000 facilities with an average of less than 100 residents, in some cases going room to room.” He said CVS was “on track and delivering on goals established and communicated early in the process.”

But a growing number of governors and state health officials have voiced frustration with CVS’s and Walgreens’ speed.

In Mississippi, some long-term facilities won’t get their first visit until Feb. 11, the state health officer, Dr. Thomas Dobbs, said this month. “We’re clearly disappointed with the progress in the long-term care program,” he said.

Some states and cities are exploring ways to hasten the inoculations.

Seattle is using its Fire Department to vaccinate nearly 1,000 residents and staff at adult family homes, a type of long-term care, by the end of January. Florida hired an emergency services company, CDR Maguire, to give out doses at 1,900 assisted living facilities that had not been scheduled for visits by CVS and Walgreens teams before Jan. 24.

In Michigan, officials have asked the federal government to let them work with other pharmacies, such as the supermarket chains Meijer and Kroger, to speed up the vaccination effort in long-term care facilities, said Bobby Leddy, a spokesman for Gov. Gretchen Whitmer.

West Virginia is the only state that has not activated the federal program involving CVS and Walgreens, though Walgreens is separately working with West Virginia to vaccinate 32 of its long-term care facilities. Relying mostly on local independent pharmacies, the state said on Dec. 30 that it had wrapped up the first round at its 214 long-term care facilities.

Some of the initially feared problems that could slow down the vaccine rollout in nursing homes have not emerged as serious obstacles, at least so far, according to facility operators and industry researchers.

Despite widespread worries that the vaccines’ side effects — which can include fevers, chills and fatigue — would cause staff to miss work and residents to need more care, that has not happened to any significant degree. And while there was early confusion about how nursing homes should get consent from residents or their families, that process has largely gone smoothly.

But other things are slowing the campaign. A significant number of long-term care workers have balked at receiving the vaccine. The virus’s spread is also delaying the process. People should not be vaccinated while they still have Covid-19 symptoms or are isolating, according to the C.D.C.

Outbreaks and cases of Covid-19 in some long-term care communities have led Walgreens to delay scheduling initial visits or to reschedule them, said Rick Gates, an executive leading the company’s long-term care vaccinations.

CVS has encountered the same issue, though it has not been widespread. The company has left the decision about whether to proceed with visits in such cases to local clinic team leaders and officials at the facilities, Mr. Crawford said.

Another factor is that some states did not quickly activate their programs to vaccinate people at assisted living facilities and similar communities. In some cases, they waited until weeks after they began vaccinations at nursing homes.

But many long-term care facilities include both nursing homes and assisted living. In those cases, pharmacy teams have been able to vaccinate only a subset of residents.

In Prairie du Chien, Wis., for example, a team from Walgreens on Thursday made its first visit to the local nursing home, Prairie Maison, to inject nearly all of its roughly 50 residents with the Moderna vaccine.

But Prairie Maison is part of a larger senior community, which includes about 50 assisted living residents. Because Wisconsin did not activate its vaccination program for assisted living until Friday, those residents weren’t offered the vaccine — even though they are in the same building as the nursing home residents.

“Vaccinating one group and not the other doesn’t make a lot of sense,” said Dr. Mark Grunwald, the chairman of Prairie Maison’s board.

From Kristin Stephens

Assistant Vice President, Media Relations and Public Affairs, GREATER NEW YORK HOSPITAL ASSOCIATION

See prior blog posts relevant to Peconic Landing:

Why is COVID-19 Testing Important?

David Posnett — Sun, 29 Mar 2020 04:24:17 +0000

Earlier today, March 28, 2020 and According to News 12

Suffolk County Executive Steve Bellone says 4,138 people in the county have tested positive for coronavirus.

Bellone also says 409 people are hospitalized due to coronavirus, with 139 in the ICU. “There are 2,644 hospital beds, with 570 available. There are also 309 ICU beds, with 78 available.” Clearly, we will soon run out of necessary beds and of course ventilators.

Bellone says there are 30 deaths in the county due to coronavirus.

7 deaths have occurred in the retirement home Peconic Landing

At Peconic Landing, the Greenport retirement home, there was another death today, the seventh. There are about 40 people known to have tested positive. Peconic Landing has perhaps 377 staff, and well over 300 residents (301 independent “members” and 86 nursing home patients). Peconic Landing is the hotbed of COVID-19 in Suffolk county. Think of it as a “Cruiseship”. And it is full of frail elderly clients. Find the updated information regarding Peconic Landing and COVID here.

The leadership of Peconic Landing claims there are no available tests for their home. I understand that there may be a rush on tests, but isn’t the situation at Peconic Landing a quasi emergency? Their residents are mostly over 80 years old. If they get sick with COVID-19 one would expect a mortality rate of 10-20% at least. For the rest of us, the mortality (risk of dying if we get the virus) is more like 1-2% .

Some say “well aren’t they going to die anyway?” How would you feel if your parent or grandparent were there?

Why is it important to test everyone at Peconic Landing?

There are currently 2 types of testing:

RT-PCR test – it detects viral RNA and therefore a component of the virus itself. This involves a nasal swab that is sent to a lab and the turnaround is about 1-2 days currently.
Antibody test: A new test for IgM and IgG antibodies (Ab), which are part of the immune system’s response to the virus. This test takes 15 minutes and involves a pinprick of a finger, like the glucose test performed by diabetics.

Both tests should be done because the combined information might be useful:

Here are the 4 possible outcomes and what they mean.

PCR+ Ab –

you have COVID-19, symptomatic or asymptomatic. You should take precautions (self-isolation) to avoid transmission of virus to your loved ones. You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR+ Ab+

you are likely recovering from COVID-10 (1-3 weeks out); you may have been symptomatic or not. Because you are still PCR+ you need to take precautions (isolation). Isolation should be for 10 days after symptom onset or for the duration of symptoms plus 3 days after resolution of symptoms. You absolutely may not have any contact with residents at a home, like Peconic Landing.

PCR- Ab-

you never had COVID-19. You are susceptible, and if you live or work in a high risk situation, such as Peconic Landing, you shouldn’t be there. But if that is impossible, you should take very stringent precautions.

PCR- Ab+

you are fully recovered from COVID-19. Generally, this group could be considered “immune” and possibly

- go back to work
- might be well suited for caretaker and health provider roles
- might donate plasma at a blood bank to be administered to critically ill COVID-19 patients in the ICU: this is called passive immunotherapy, used successfully for the Spanish Flu and for Ebola.

On the Diamond Princess Cruise ship, all elderly passengers and those with underlying medical conditions, and all crew were tested. Passengers who had negative [SARS-CoV-2] RT-PCR test results, no respiratory symptoms, and no close contact with a person with a confirmed case of COVID-19 completed a 14-day ship-based quarantine before disembarking. In other words, testing helped make informed decisions to save as many lives as possible.

We should do the same for our senior friends at Peconic Landing.