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As covid infections spread, nursing homes lag behind booster shot rollout


A Connecticut nursing home planned to roll out Covid booster shots for residents early this month.

But before the program could begin, the coronavirus swept through the home, the Geer Nursing and Rehabilitation Center in Northern Canaan, infecting 89 people, including 67 residents. Almost all of them were fully vaccinated.

Eight of the residents died of Covid, according to the house, which described all as having “serious underlying health conditions”.

The severity of the outbreak helped prompt Connecticut officials to recently announce that the state would set up booster clinics in all of its nursing homes to cover facilities that had yet to administer additional doses.

Several states are experiencing new spikes in Covid cases, especially in the Midwest and Northeast. And this month, new outbreaks have been reported in nursing homes in Vermont, Virginia and elsewhere, despite a nationwide vaccination rate of about 86 percent among residents of skilled nursing facilities.

Booster programs have gained urgency as nearly 4,000 new Covid cases are reported weekly in nursing homes, according to federal data, and experts say many of the case clusters are in homes that have yet to administer the extra doses.

“If we compare the rates of Covid-19 disease between those vaccinated with two doses and those who received a booster dose, the disease rate is significantly lower for those who received their booster, showing that our booster shots work, said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, at a White House briefing this month.

And in some places, outbreaks among residents can still occur as vaccination rates among nursing home workers lag behind the national average.

Contrary to last winter’s concerted federal push to vaccinate residents and nursing home staff, the booster’s rollout has been slow and patchy, health experts said. Public information is scarce: About 42 percent of Americans over the age of 65 have received a booster shot, according to federal reports, but no data is yet available on US sites to track nursing home booster programs.

The staggering number of Covid deaths in nursing homes in 2020, precipitous declines in cases after the successful vaccine campaign, and then steady rises in late summer and this fall should have made boosters a top priority for older Americans, some experts say.

“What was surprising is the lack of data and focus on nursing homes this time around,” says Dr. Ashish Jha, a physician and dean of the Brown University School of Public Health. The government should have approved additional doses as early as July, he noted, especially as nursing home residents were among the first to receive the vaccines 10 or more months ago.

“The data was clear at the time,” said Dr. yah. “We saw declining immunity, especially in the elderly.”

In August, the third doses of some vaccines were approved for people with weakened immune systems. But by the time booster shots were approved for the Pfizer-BioNTech vaccine in late September, followed by approvals for the Moderna and Johnson & Johnson vaccines the following month, many nursing home residents had already lost some of their original protection against infection. , experts say. And they were more vulnerable to serious illness because of their age and declining health.

“Six months for them was much earlier than six months for the general population,” said David Grabowski, a Harvard health policy professor who studies nursing homes. Residents of assisted living facilities are especially at risk because there seems to be no coherent strategy, he said. New outbreaks complicate matters by putting booster programs on hold until the cases clear up.

The effort to vaccinate residents last winter has been delegated to two major drugstore chains, CVS Health and Walgreens. When federal contracts expired earlier this year, nursing homes returned to the pharmacies commonly used to help vaccinate residents against the flu.

The Biden administration said it was successful in its efforts to ensure residents receive the extra doses. “We’re seeing really, really strong progress in states across the country,” said Sonya Bernstein, White House senior adviser on Covid. She called programs in West Virginia, Ohio and North Carolina robust.

Other areas have also managed to provide significant booster coverage. For example, Los Angeles County announced in mid-November that nearly all residents in skilled nursing facilities had received booster shots.

Ms. Bernstein said the federal government was also working with facilities that cannot find a pharmacy. “Every long-term care facility that needs assistance will be linked to one of our partners,” said Ms. Bernstein.

Half of the over-65s eligible for booster shots of the Pfizer vaccine at the end of September have received them, public health officials said in a recent announcement. That’s compared to the nearly three months it took to give half of the first doses to this group.

The Centers for Medicare and Medicaid Services, which reports vaccination rates across the country and for individual facilities on their website, said it plans to post data on boosters within the next two weeks and on its website so consumers can view individual nursing homes. compare “in the coming months.”

“CMS is working with nursing homes to increase Covid-19 booster uptake,” the agency said.

Pharmacies that help nursing homes say that they have not encountered any specific problems. “From our perspective, we haven’t heard anything about delays or concerns,” said Chad Worz, the chief executive of the American Society of Consultant Pharmacists. “The vaccine is readily available.”

CVS Health, whose Omnicare unit provides services to nursing homes, said it could not provide data on the number of booster shots it had delivered to nursing homes. “We have seen strong interest from our customers in long-term care and continue to meet that demand through various distribution channels,” said TJ Crawford, a spokesperson.

But other pandemic-related issues continue to plague nursing homes, some of which still had large numbers of unvaccinated workers, even though the average staff vaccination rate has now reached 74 percent. The federal mandate to immunize personnel is approaching, though numerous states are suing to block the rule.

Many facilities also suffer from serious and expensive staff shortages. Some say CMS’s decision earlier this month to require nursing homes to allow unfettered visits from residents is complicating their efforts. Some said they were caught off guard by the announcement that visits were now allowed at all times for all residents, which could introduce new community infections into the homes.

In Minnesota, a state where the number of cases is rapidly increasing, only a fifth of nursing home residents had received boosters by early November a report by The Star Tribune. State health officials declined to comment.

To cope with the increasing workload, Governor Tim Walz recently deployed 400 members of the Minnesota National Guard to the state’s nursing homes, struggling to find enough workers to care for residents.

For its part, the nursing home industry’s trade group, the American Health Care Association, said the booster’s rollout “went well.”

“With 15,000 nursing homes across the country, these on-site clinics need some time to plan and prepare,” the association said.

With approval for booster shots of all three vaccines granted in late October, the association said it would be “about another month before much of the residents and staff received a boost.”

Still, many view the current outbreaks as evidence of the need to act much more quickly. At ArchCare, which operates six nursing homes in the New York area, 93 percent of residents have received their boosters, said Scott LaRue, its director, after he began giving additional doses in mid-October.

“In my mind, it’s too late to make plans if you want to save lives,” said Mr. laRue. “You have to vaccinate residents and staff and you have to get boosters in it. It is a matter of life or death.”

Booster shots in nursing homes “couldn’t have come too soon,” said Brendan Williams, the chief executive of the New Hampshire Health Care Association, whose facilities are reporting an increasing caseload. “All that’s happening now is booster shot advertising,” he said.

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