Nursing Homes, Ravaged by Covid-19, Start Vaccinating the Most Vulnerable

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By Frances RoblesNeil MacFarquhar and Miriam Jordan, NY Times, December 17 2020

Shannon Taylor, who survived the coronavirus, was vaccinated on Tuesday at Sundale Rehabilitation and Long-Term Care in Morgantown, W.Va.Credit…West Virginia National Guard

Vaccines have now been administered at long-term care facilities in several states, but administrators warn that they will not bring a quick end to the long siege of the virus.

Patricia John was still in her nightgown this week in the West Virginia nursing home where she lives when a nurse hurried her out of her room to join a line that had formed in the hallway.

After nine months of watching television alone in her room — visits from her family, lunches at Olive Garden, all postponed — an end was in sight: Mrs. John, 93, became one of the first nursing home residents in the United States to be vaccinated against the coronavirus.

At Sundale Rehabilitation and Long-Term Care in Morgantown, W.Va., where she lives, five residents have died and visitations have been on hold. But on Tuesday, the mood was downright giddy. While there was still yellow crime scene tape enforcing social distancing in the lounge, a woman named Sue was playing Christmas carols on the piano, and the pharmacist was singing along. News of the first vaccinations brought a ripple of applause and fist bumps.

“It was easier than what I have seen on television,” Mrs. John said of the injection. “It was such a quick shot that no one should be afraid.”

Patricia John, who lives at Sundale, was among the first nursing home residents in the United States to be vaccinated against the coronavirus.Credit…Mike Hicks

As the pandemic has spread into every corner of the country, homes for the aging have suffered the brunt of the lethal consequences. At least a third of the more than 305,000 deaths have been reported among residents and employees of nursing homes and other long-term care facilities for older adults, and more than 787,000 staff members and residents have become infected.

But an early round of vaccinations is getting underway this week in a handful of states, ahead of the wide-scale federal program through CVS and Walgreens that is scheduled to roll out at nursing homes on Monday.

West Virginia began inoculating residents and staff members at long-term care facilities on Tuesday, nearly a week ahead of the pack. Ohio was also getting an early start, with Connecticut and Delaware expected to begin by the end of the week.

In Florida, which has one of the country’s largest populations of aging people, Gov. Ron DeSantis said on Wednesday that vaccinations were being administered at 118 facilities this week.

“I think you’re going to see CVS and Walgreens start getting in these facilities on Monday,” Mr. DeSantis said. “We were not happy with allowing that wait. We really believe time is of the essence.”WIFI ON BUSESRemote learning is extra hard for millions of students who lack reliable internet at home. Wi-Fi buses are the solution in this Michigan community.

West Virginia officials said that 48 of the state’s 214 skilled nursing facilities should have completed their initial round of vaccinations by Friday. “Using smaller, independent, rural pharmacies allowed us to expedite the distribution,” said Marty Wright, chief executive of the West Virginia Health Care Association.

Sundale, known as West Virginia’s coronavirus “ground zero,” began inoculating residents nearly a week before most nursing homes around the United States.Credit…Ron Rittenhouse/The Dominion-Post, via Associated Press

Ohio was scheduled to deliver its first inoculations to nursing home residents on Friday. Five to 10 institutions will begin giving the shots, Gov. Mike DeWine announced, saying the Centers for Disease Control and Prevention had selected Ohio to start early.

Florida will distribute about 21,450 doses of the vaccines to nursing homes this week to get a jump start on those vaccinations, which are expected to begin Wednesday or Thursday.

“The governor has a goal to get all long-term residents vaccinated by the end of the year,” said Kristen Knapp, a spokeswoman for the Florida Health Care Association, a trade organization representing nursing homes. “We are all trying to meet that goal.”

The first vaccinations are starting just as conditions in long-term care facilities have deteriorated anew, with nearly 20,000 cases and an estimated 5,000 deaths per week, according to the American Health Care Association and National Center for Assisted Living.

“The numbers, of course, are staggering,” said Mark Parkinson, the organization’s president. Nursing home residents in their 80s are now more than 600 times more likely to die from a coronavirus infection than someone in their 20s, he said at a news conference last week.

In interviews this week, nursing home administrators said they were unsure whether the number of residents who agree to be inoculated would mirror the number in the general population, or whether firsthand experience of the tragic losses would make both residents and staff members more inclined to take the vaccine.

In any case, they said, it will not be a magic wand that will automatically lift the lockdowns and isolation that have been imposed for months.

First, it is unclear whether the 95 percent effectiveness rate that researchers reported for the vaccine during clinical trials will hold true for older people, who are generally more vulnerable to disease.

And it will also take some time for relatives to get vaccinated, delaying the time when many homes can fully open their doors to visitors.

“We need to be just as careful as we were before vaccination until the risk of someone spreading the virus to them is diminished,” said Dr. Richard Feifer, the chief medical officer for Genesis HealthCare, one of the largest providers of long-term care with more than 325 facilities in 24 states. Genesis was planning to administer its first vaccines on Thursday in Dover, Del., and Friday in West Hartford, Conn.

Residents of long-term care facilities, like the one relatives visited in Kirkland, Wash., have been hit particularly hard by the pandemic. Credit…Grant Hindsley for The New York Times

The sometimes complicated issue of obtaining consent, including from some patients with dementia who are unable to make the decision on their own, has delayed the rollout at facilities in most states.

Not every institution was eager to be first in line, with some preferring to see what happens elsewhere, and there has been some hesitancy among both residents and staff members, said Peter Van Runkle, executive director of the Ohio Health Care Association, an organization of about 1,100 long-term care facilities.

Vaccinations are voluntary, so it was unlikely any nursing home would get 100 percent consent, he said, but officials were hoping that an education campaign aimed at calming fears would convince 70 to 80 percent of those offered to get vaccinated. At that level, officials believe, the virus cannot spread effectively. “It is the only way we are going to beat down the disease and get somewhat back to normal,” Mr. Van Runkle said.

Dr. Shaun Corbett, chief medical officer for the Miami Jewish Health nursing home in Florida, which was also selected to receive early vaccines this week, said residents were more willing to take the vaccine than the staff was.

“They understand clearly their own risks,” Dr. Corbett said. “There’s more resistance among the staff, I would say.”

Virginia Ann Rowland, 84, a retired nurse anesthesiologist who resides at an independent living facility in Boca Raton, Fla., said heated debates over whether to take the vaccine have been erupting in the dining room.

“A lot of people are saying that they will not take it,” she said. “Some say that they want to see how the people who get vaccinated do.”

Administrators there told residents on Monday that the first doses would go to people living in the skilled nursing portion, who are considered the most vulnerable, as well as the staff, with those like her in independent living coming last. She expects that her shot is still a few weeks away but said she will sign up at the first opportunity.

“I really believe in science,” she said.

The several hundred residents have been told they will have to continue to wear masks to protect other residents who opt not to take the vaccine, and there has been some grumbling about that. “I don’t know how many people are going to wear masks if, after all, those people had a chance to take the vaccine and did not,” she said.

Barbara Gutierrez of Coral Gables, Fla., said she signed a vaccine consent form for her 91-year-old mother, Magnolia, who lives in a home in a nearby suburb. Although Ms. Gutierrez is hesitant to take the vaccine herself because of her allergies, she said she had no qualms about whether her mother should.

“I haven’t hugged or kissed my mother since March,” Ms. Gutierrez said.

Officials are hoping that they can convince 70 to 80 percent of those offered the vaccine at nursing homes to take it. Scott McIntyre for The New York Times

Don Gerrero, 86, who has lived for the past four years in a nursing home in Wheeling, W.Va., said he had seen his daughter twice in eight months, though she has been allowed to drop off things like shampoo and his favorite snacks, beef jerky and Doritos.

The last time he set foot outside the property was last Christmas, when his daughter took him home for a holiday dinner. He misses his favorite Italian restaurant and the Wheeling symphony orchestra he used to attend monthly.

Despite having Parkinson’s disease, Mr. Gerrero, an accomplished organist who ran his family’s music stores for decades, has managed to play tunes on the piano in the activity room to entertain himself. He reads the paper and watches TV.

But as days have turned to months, the monotony and isolation have gotten to him. A couple weeks ago, he called his daughter and begged her to let him come home.

“I am tired of this, I want to do something else,” Mr. Gerrero recalled telling her. “Little simple things would be wonderful. Every day is exactly the same, and then it starts all over again.”

On Tuesday, however, his spirits were lifted, he said. The director of the nursing home showed up at his side, with a list of residents and clipboard in hand, and asked if he was prepared to get a coronavirus vaccine.

“I told her yes. I was willing to sign up without asking questions,” he said. “We are all anxious to get over all this and get back to being able to associate with our friends and family face-to-face. Not being able to shake hands and give hugs, that’s hard.”

Mary Prewett, 84, who lives in an assisted-living facility in Memphis, Tenn., had never received even a flu shot, refusing one yet again just recently. Her daughter, Cecelia Prewett, got a consent form for her mother on Tuesday and wondered whether she would be receptive to a coronavirus vaccine.

“We are going to have some serious conversations about the consequences of not getting the shot, like not being able to spend time with her three children and five grandchildren,” said the younger Ms. Prewett, a communications executive in Washington. “My mother is hard to talk into things. I don’t know what she is going to say.”

At the Sundale facility in West Virginia, the arrival of the vaccine this week undoubtedly was a watershed. Sundale was considered “ground zero” for the virus in West Virginia, said its director, Mike Hicks, after one of its residents, Shannon Taylor, fell ill with the state’s first locally acquired case of Covid-19. She was on a ventilator for several weeks but managed to recover.

As the vaccine injections began this week, Mr. Hicks said, it was only fitting that Ms. Taylor, 73, was inoculated first.

“I was No. 4,” he said.

Frances Robles is a Florida-based correspondent who also covers Puerto Rico and Central America. Her investigation of a Brooklyn homicide detective led to more than a dozen murder convictions being overturned and won a George Polk award. @FrancesRobles • Facebook

Neil MacFarquhar is a national correspondent. Previously, as Moscow bureau chief, he was on the team awarded the 2017 Pulitzer Prize in International Reporting. He spent more than 15 years reporting from around the Mideast, including five as Cairo bureau chief, and wrote two books about the region. @NeilMacFarquhar

Miriam Jordan is a national correspondent whose narratives pull back the curtain on the complexities and paradoxes of immigration policies and their impact on immigrants, communities and the economy. Before joining the Times, she covered immigration for more than a decade at the Wall Street Journal and was a correspondent in Brazil, Israel, Hong Kong and India. @mirjordan