Greg Arling, PhD, School of Nursing, Purdue University, USA
More than a year has passed since the first major COVID-19 outbreaks in US long-term care (LTC) facilities. By the end of January 2021, residents and workers in long term care had accounted for over 1.2 million cases, and 153,000 deaths, or nearly 40% of all COVID-19 deaths in the US. No wonder the Center for Disease Control and Prevention (CDC) gave top priority to LTC facilities in its roll-out of COVID-19 vaccines. Most states, which can set their own priorities, have followed the CDC guidelines.
This brief report presents information on the CDC–Pharmacy Partnership, which is the main vehicle for vaccinating LTC residents and workers. The report includes discussion of the current number of people vaccinated and doses administered, acceptance of the vaccines, and the need for continued vigilance, even after the initial phase of the vaccine rollout.
The Partnership has targeted the rollout of vaccines to “long-term care facilities”, defined broadly to include nursing facilities, assisted living facilities, memory centers, and other congregate settings for older or disabled people. Most vaccinations in long-term care facilities are being administered under contract by major drug store chains (Walgreens, CVS, and others). Facilities sign up to participate in the program. Vaccines are administered en masse through “clinics” held on-site in long-term care facilities. According to data provided by CVS and Walgreens pharmacies on January 28, 2021, 13,353 nursing facilities and 59,422 assisted living facilities have been targeted for vaccinations through the Partnership. Each facility is scheduled for two clinics. On January 28, nearly all of the first clinics had been completed for nursing facilities, while first clinics for assisted living and other care homes were in various stages of completion. Many additional first and second clinics were being scheduled over the next 7 days. The pharmacies report on total doses administered (see below) but they do not report on the number or proportion of facility residents and staff who are vaccinated or who decline vaccinations.
According to figures from the CDC, on January 31, 2021, 31,123,299 doses (25,201,143 people with one or more doses and 5,657,142 with a second dose) had been administered to the overall population. Of this total, 3,683,718 doses, either 1st or 2nd doses, had been administered in long-term care facilities as of January 31, 2021. This is a huge increase over the number of doses administered on January 15 (1,384,963) and January 25 (2,714,487); it represents an increase of nearly 133,000 doses per day from January 15 to 25, and 162,000 doses per day from January 25 to 31. The total number of residents or workers in care homes with one or more vaccinations was 3,102,811. Of this figure, 1,460,303 were residents, 966,314 were workers, and for 646,194 their status was unknown. The total number of residents or workers with a second dose was 567,575. With the ongoing rollout of the vaccines, the numbers are increasing rapidly.
Coverage of Residents and Workers
The number of nursing facility residents is estimated to be 1,937,345, while the number of health and other workers associated with long-term care facilities is probably roughly the same. A national survey indicated that 945,700 full-time equivalent nurses and other health care workers were employed in nursing facilities and 298,800 were employed in residential care facilities. The addition of other care workers, such as administrators, housekeeping, dietary, and maintenance personal would push the totals up considerably. Given these care home population estimates, a high percentage of residents appear to have received a first dose, i.e., at least 1.4 million residents with one or more doses out of 1.9 million residents. The percentage of care workers receiving one or more doses was lower (at least 1 million) yet still substntial.
Acceptance of the Vaccines
The CDC offers guidance to long-term care residents and staff on the risks, benefits, and decision to be vaccinated for COVID-19. Individuals can refuse vaccination for any reason. Written consent is not required by Federal law but states may have their own requirements. Pharmacy chains or facilities may establish their own requirements regarding verbal, email, or formal written consent from residents or persons making medical decisions for them.
Media outlets have reported anecdotally on some facilities having high rates of vaccine refusal, particularly among care home workers. However, these reports must be viewed with caution. No comprehensive data have been released on refusal rates. The proportion of residents with one or more doses is quite high (at least 1.4 million out of a population of 1.9 million residents) and the numbers of doses being administered is rapidly growing. Multiple additional clinics may have to be scheduled in the CDC-Pharmacy Partnership in order to follow up on refusals or other reasons people have missed vaccinations.
We also have to keep in mind that the US nursing facility population is dynamic with large numbers of people entering nursing homes from hospitals for post-acute care and then returning to their homes within a few weeks. These transitions will require ongoing vaccination protocols for patient being discharged from hospitals to nursing homes. Also, it points to the importance of stepped-up vaccinations for older people in the general population who are not only at risk of COVID-19 but also of entering a nursing facility.