Melinda Hicks has seen her 75-year-old mother just once in the last eight months, a brief visit in late October to the Alzheimer’s unit at a Texas City nursing home, before a recent spike in COVID-19 cases again restricted in-person visits to residents.
When Hicks heard that Texas would be receiving millions of doses of a recently authorized COVID-19 vaccine that prioritizes nursing home residents, she was hopeful that she might be able to hold her mom’s hand again, maybe even before the holidays.
“I’m not an anti-vaccine person,” Hicks said, noting that as her mother’s medical power of attorney, she would have to sign off on her getting a dose. “I get my flu shot every year. I make sure (my mom) gets hers. I wouldn’t have a problem with her taking the vaccine.”
While COVID-19 cases continue to rise across Texas, there is renewed optimism that this latest surge might end up being the virus’ last gasp. For nursing homes and long-term care facilities, where the virus has been particularly harmful to staff and elderly residents, the announcement on vaccine distribution could not be more timely. As of Thursday, there were nearly 5,500 COVID-19 deaths from Texas nursing homes, making up roughly one-quarter of virus deaths statewide. Of Texas’ more than 1,200 nursing homes and long-term care facilities, 98 percent have reported virus cases.
“Before COVID there were about 90,000 nursing home residents, and obviously there are fewer now, so at least half of them have been infected,” said Amanda Fredriksen, state director of outreach and advocacy for AARP Texas.
A dose of hope
Two vaccines developed by pharmaceutical companies Pfizer and Moderna are in the midst of a federal approval process with the Food and Drug Administration after clinical trials demonstrated their effectiveness in preventing viral infection.
If approved, Texas is poised to become one of the first states to receive doses of the vaccines, with nursing home residents and staff at the front of the line.
Gov. Greg Abbott announced Wednesday that the Centers for Disease Control and Prevention has made an initial allotment of more than 1.4 million doses of the vaccines to Texas; they should begin arriving the week of Dec. 14. The first tier of this initial phase of vaccinations would also include hospital-based workers, emergency medical services providers and home health aides who manage “vulnerable and high-risk” patients.
“The State of Texas is already prepared for the arrival of a COVID-19 vaccine, and will swiftly distribute these vaccines to Texans who voluntarily choose to be immunized,” Abbott said in a statement.
Texas is one of four states — the others are New Mexico, Rhode Island and Tennessee — to jump the line in getting the first doses of the Pfizer vaccine. The rollout is part of a pilot delivery program designed to test the company’s distribution system, which requires ultracold storage at minus-94 degrees Fahrenheit.
The Pfizer vaccine requires two doses, the second to be administered three weeks to a month after the first. The state estimates there are 1.6 million health care workers in Texas who would be among the initial recipients. The second doses will be shipped in January.
The Texas Department of State Health Services is tasked with administrating vaccine distribution to the first tier of recipients and, eventually, to the general public. The agency has prepared for months for a vaccine to eventually be authorized by the FDA. The state partnered with Walgreens and CVS pharmacies to store and distribute vaccines and reduce the burden on long-term care facilities and local health departments to administer shots.
Three visits over two months will likely be needed to administer both doses of the vaccine and to vaccinate new nursing home residents and staff. Vaccination data must be reported to local, state and federal authorities, including the Texas Immunization Registry, within 72 hours of administering each dose.
Working out details
Since the Pfizer and Moderna vaccines would be approved under emergency-use authorization from the FDA, the state by law cannot mandate that anyone receive the vaccine. Elderly residents who are mentally incapacitated will need approval from a legal guardian, medical power of attorney or conservator.
But nursing home advocates are still awaiting guidance from the state health department as to which facilities will be prioritized for receiving the initial batch of doses and how they will go about administering shots.
While some pharmacies already partner with long-term care facilities to administer flu vaccines, it’s unclear if pharmacies will come to nursing homes to deliver the COVID-19 vaccines or if staff will need to schedule visits for residents at pharmacies ahead of time. Advocates note that time is of the essence given that the date for vaccine shipments is rapidly approaching.
“A lot of members are making plans and backup plans, and then we’re waiting to see exactly what comes down from the state regulatory agency and the Department of State Health Services,” said Carmen Tilton, vice president of public policy for the Texas Assisted Living Association. “We’re talking about a Dec. 14 date for shipments to arrive, and that’s 11 days from (now).”
Tilton also worries about vaccine distribution for nursing homes and long-term care facilities in rural areas that don’t have easy access to major pharmacy chains.
“I know that in our conversations with the state, rural communities and smaller providers in particular tend to get a little bit lost,” she said.
Patricia Ducayet, the state’s long-term care ombudsman, said that while she has been impressed by Texas’ preparation for vaccine distribution, she worries vaccine skepticism among the general public may prevent the state from meeting the necessary “herd immunity” threshold to eventually resume some semblance of a normal post-pandemic life.
“What might keep me up at night is if people are skeptical of taking a vaccine, and then we don’t get the vaccine into our most vulnerable people, and then we don’t have the protection we all want from an effective vaccine,” Ducayet said.