The speedy development of COVID-19, Moderna and other drugmakers is raising hopes of stopping the pandemic, which has killed more than in the U.S. so far this year. But as the coronavirus continues to spread, some experts worry that the plan to inoculate some of the most vulnerable Americans — those living in nursing homes and other eldercare facilities — is inadequate.
"The way the government has approached the vaccination distribution for nursing homes has been keeping me up at night," said Michael Wasserman, a geriatric care specialist and president of the California Association of Long Term Care Medicine.
Back in March, Wassermanthat nursing homes risked becoming COVID-19 "killing fields." Eight months later, he remains deeply concerned, with the now engulfing much of the U.S. and official new case counts approaching 200,000 a day. "The government has rolled out a plan without engaging with people who have knowledge of how to care for this population," he told CBS MoneyWatch. "I am exceedingly skeptical that implementation will go smoothly."
At least 67,500 people in nursing homes have died of COVID-19 since the government began collecting data in May, according to the government's Centers for Medicare and Medicaid Services. Around 2 million Americans live in a nursing home, which is less than 1% of the population. Yet the COVID Tracking project estimates that such facilities have accounted for about 40% of total deaths during the pandemic. Infections in nursing homes are in the latest wave of infections.
Experts have— especially when it comes to distributing vaccines to nursing homes, assisted living centers and other long-term care facilities:
- Unlike the general population, many nursing home residents can't travel to a hospital or outpatient clinic. Therefore, vaccination teams will have to travel to the more than 15,000 nursing homes in the U.S. at least twice — both the Pfizer and Moderna vaccines require two shots separated by several weeks — but likely multiple times beyond that. Tens of thousands of additional assisted living facilities may also have residents who cannot travel.
- The federal government is coordinating the vaccination effort for nursing home residents, but not for the people who work in nursing homes. That piece of the effort is being left to individual states. In California, for instance, the plan is to vaccinate workers at the nursing homes. But in Ohio, nursing home employees will have to travel to one of 10 hospitals around the state, forcing some to travel hours to get the vaccine.
- Possible side effects of the vaccine, which include headaches, muscle pain and in some cases extreme fever, could be difficult for nursing homes to manage, especially if workers are vaccinated at the same time and have similar symptoms.
- The specialty pharmacies that normally serve long-term care facilities have mostly been cut out of the government's vaccination distribution plans in favor of national pharmacy chains CVS and Walgreens. Some experts say that not leveraging existing pharmaceutical systems to administer the vaccine will complicate distribution.
"Nursing home residents being one of the initial tranches will be part of the country's learning curve on how we appropriately distribute the COVID-19 vaccination," said Soumi Saha, a pharmacist and director of advocacy at Premier, which is a purchasing agent that works with 28,000 nursings homes and assisted-living facilities across the country. "And these facilities have already been hit pretty hard by the coronavirus pandemic, so the circle of trust has already broken down in that regard."
Wasserman is particularly concerned that nursing home workers seem to be an afterthought in the federal government's inoculation plan — especially given the evidence that employees account for many of the infections in nursing homes.
"The workers of nursing homes tend to be lower wage workers and often immigrants," he said. "You have a population that is prone to vaccination hesitancy. We need to help them understand the need for the vaccination, and we need to make it easy for them."
"I hear confusion"
In October, the Trump Administration announced a partnership with CVS and Walgreens that put the national pharmacy chains in charge of distributing coronavirus vaccines in nursing homes. Nursing homes were allowed to opt out of the program, and instead get the vaccine from one of the hundreds of specialty pharmacy companies that specialize in servicing long-term care facilities.
But Peter Van Runkle, head of the Ohio Health Care Association, which represents the nursing care industry in that state, said the government discouraged nursing homes from opting out of the federal planning initiative.
Premier's Saha expressed concern that nursing homes that teamed with their existing specialty pharmacies, and not CVS or Walgreens, would be passed over in the first round of vaccination, noting that speciality pharmacies have patient records as well as a knowledge of how those facilities operate. Although leaning on CVS and Walgreens streamlines the process for the government, it may lead to lower vaccination rates and worse medical outcomes, she said.
"It is going to be critical, once there are various vaccines on the market, to know the patient records to select the best one for each patient," she said. "In order to get the highest vaccination rates, you have to lever the long-term care pharmacy network that already services every single nursing home across the country."
"I hear confusion from nursing home operators," Kevin Fearon, who is the president of the American Society of Consultant Pharmacists. "They say of course we want to use you, but there is confusion and we tell them you should do what you feel is right."
Earlier this week, officials with Operation Warp Speed, the Trump administration program to vaccinate Americans, announced during a press briefing that 99% of all nursing homes had opted into the government's distribution plan.
CVS and Walgreens: We're ready to go
A spokesperson for CVS dismissed the concern that it would prioritize vaccine distribution to its existing nursing home customers as "completely unfounded."
"We'll administer vaccines at any long-term care facility that chooses CVS Health as its preferred vaccination provider," CVS spokesperson T.J. Crawford told CBS MoneyWatch. Crawford also said the drugstore giant —the largest pharmacy chain in the country, with nearly 10,000 stores — would draw on its experience administering tens of millions of flu vaccines in nursing homes and elsewhere across the country each year.
Walgreens, the No. 2 drugstore chain with 9,300 stores, said in a statement it is working with long-term care facilities to help them determine the best approach to administering COVID-19 vaccines. "We have the infrastructure required to manage the complexities of administering a COVID-19 vaccine, along with vast pharmacy expertise in the administration of immunizations," Walgreens spokesperson Kelli Teno told CBS MoneyWatch. "We're confident we can support long-term care facilities that request our support."
CVS and Walgreens have divisions that specialize in providing medicines to nursing homes. Combined, however, the two service only roughly a quarter of nursing homes across the U.S. That means thousands of facilities will have to rely on the chains for a vaccine despite having little prior relationship with them.
"The skilled nursing providers are nervous about the government's plan," Van Runkle said. "They would be more comfortable using the pharmacies they already have a relationship with."