Nearly everyone in Virginia who lives or works in long-term care and who wants the COVID-19 vaccine has been vaccinated by CVS or Walgreens under the federal pharmacy plan.
The homes have been on lockdown throughout the pandemic to curtail the spread of the virus, and it is not yet known when family will be permitted to once again visit their relatives inside.
But as of Monday, every dose of COVID-19 vaccine intended for long-term care had been given, and the state has made arrangements to continue to vaccinate new residents and staff, and those who have changed their mind and now want the vaccine.
“If you could see me, I would be smiling,” Keith Hare, president and CEO of Virginia Health Care Association-Virginia Center for Assisted Living, said by phone last week. “The coordination between the nursing homes and assisted living providers and CVS and Walgreens and the state has just been wonderful. To think they started Dec. 28, and at two months they are almost finished.”
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Though the federal contract called for doses to go to nursing homes and assisted living facilities, the pharmacies and the state extended the program to independent living facilities as well.
“When they realized through conversations with providers there are independent living also on these campuses, even though it was not within their contract to do that, if the vaccine was made available they also vaccinated those individuals, too,” Hare said.
Dr. Laurie Forlano, deputy health commissioner of population health and lead on the state’s long-term care task force, said vaccinating residents of nursing homes and assisted living facilities continues to be a top priority because they are the ones most likely to be hospitalized and die from the coronavirus.
To understand how heavily the burden of the disease has fallen onto long-term care, consider that as of Monday, 577,174 Virginians had tested positive for the coronavirus. Only 5% of them lived or worked in long-term care settings. But of those 30,043 people infected in long-term care, 3,618 died. They account for 41% of the 8,783 lives lost to COVID in the state.
Viewed another way, the disease killed 1% of Virginians known to have COVID who didn’t live in long-term care, and 12% of those with COVID who did.
“I will say there obviously has been an aggressive push among residents and staff in long-term care, and we are seeing improvements there,” Forlano said. “We started those vaccinations Dec. 28, so we have about two months under our belt. I think it’s possible we are starting to see the beginning of an impact.”
Last week, 13 outbreaks in long-term care were reported to the Virginia Department of Health, compared with 38 the week of Jan. 17-23. Case counts throughout Virginia had surged to their highest peak in January; midway through that month, 951 nursing home residents tested positive for the virus in one week. By the last week of that month, the figure had dipped to 364.
Outbreaks also ebb and flow with the transmission of the disease in the community, which is also on a downward trend.
“So I think it’s a combination. I am cautiously optimistic because we are seeing variants pop up and emerge,” Forlano said. But the trends are going in the right direction.
She said they are surveying nursing homes and assisted living facilities to get a better count to calculate the percentage of residents and staff who have been vaccinated.
As of Monday, 224,055 doses had gone to long-term care, after 223,470 were received. The counts can vary as more doses are in vials than initially thought, and the state has supplemented the federal contract with more doses. CVS and Walgreens were obligated to visit each home three times, but Virginia is working with them to make sure if someone asks for their first dose on the pharmacy’s third visit, pharmacists will return to give a second dose.
The Virginia Department of Health, which licenses nursing homes, figured there are about 30,000 residents and 30,000 staff members in those facilities statewide. The Department of Social Services licenses assisted living facilities, and a census of residents and workers is needed to better calculate the percentage who have been vaccinated, Forlano said.
“The goal is 75% of residents and staff to be vaccinated because that’s where the herd immunity is,” Hare said. “We believe we know from the resident side, we are pretty darn close. The hesitation is falling away. The national average was running low, but we believe Virginia is ahead of that.”
The Centers for Disease Control and Prevention reported about a month into the vaccination campaign that uptake nationwide at nursing homes with at least one vaccination clinic was 77.8% for residents and 37.5% for staff. Hare said at that point, half of Virginia’s nursing home staff had been vaccinated.
He said providers have told him that rates have gone up as staff members who were initially reluctant hear from coworkers that it was similar to getting a flu shot.
Patricia Williams of Virginia Beach, whose sister is in a nursing home, has advocated statewide for more transparent information throughout the pandemic and for letting others know the toll the disease has had on long-term care residents.
She said she is relieved her sister is vaccinated and looks forward to the day that homes can reopen to family visits.
“That’s the million-dollar question” Forlano said. “The guidance has not changed. I’m hopeful that visitation guidance might relax a little bit, but we are waiting on the CDC.”
Virginia has followed the CDC’s guidance on long-term care. Most of the state still has substantial transmission of the disease, which requires the homes to do frequent testing.
“With public health, we want to walk the tight rope. We don’t want to open the door so widely that we then end up having to slam it all shut again. We want to be measured about our relaxing community measures, facility measures, and all these other measures we have in place that are the reason transmission is going down,” she said.
Hare said the good news is that vaccinations can protect the most vulnerable.
“It has brought so much hope to these facilities, and I don’t say that lightly. We are going to get through it, and hopefully sooner rather than later, CMS [Medicare] and CDC will see the uptake in the vaccine. They’ll see that it is working; more vaccine will get to the general public and counts will go down. At that point these residents will be able to see their family members in a more regular way.”