Nursing home residents and staff could start getting COVID-19 shots as soon as Christmas week, good news for a population that was ravaged by the pandemic last spring. But already administrators are wrestling with daunting logistical challenges as they try to protect their people.
Their biggest fear: A compressed vaccination schedule, mandated by federal guidelines, could mean many staff and residents get their shots on the same days, leading to lots of people suffering vaccine side effects. That could mean nurses and aides calling in sick with side effects such as fatigue and low-grade fever just when old and frail residents with the same side effects need attention, say medical directors at the state’s skilled nursing facilities and other long-term care sites.
“That would be a dire situation,” warned Dr. Asif Merchant, a geriatrician at Newton-Wellesley Hospital who serves as medical director for four suburban Boston nursing homes.
Merchant, who sits on the state’s vaccine advisory committee, said he and colleagues have raised the issue with Massachusetts health officials. But the vaccine schedule was set by the pharmacy companies that will deliver and administer the vaccines at senior sites based on guidelines from the US Centers for Disease Control and Prevention.
Memories of the first COVID-19 surge remain fresh for the 50,000 residents and more than 65,000 employees of the state’s nursing homes, rest homes, and assisted living facilities. Many of them grappled with staff shortages even before the pandemic, and the shortages have intensified this year, making it crucial for them to have enough caregivers in the coming weeks.
Families of senior care residents believe state officials were slow to recognize the vulnerability of the elderly as outbreaks of the fast-spreading virus overwhelmed dozens of nursing homes last spring. To date, residents of long-term care facilities have accounted for 6,920, or about 62.5 percent, of the 11,076 probable or confirmed coronavirus deaths in Massachusetts, a higher share than in almost any other state.
Operators at senior care sites have been waiting for the state’s vaccine distribution plan for weeks as Food and Drug Administration officials get ready to approve the first COVID-19 vaccine for emergency use as early as Thursday. Governor Charlie Baker last week promised details on Monday, but on Monday said they would now be coming on Wednesday.
Most long-term care facilities already have enrolled in a federal pharmacy partnership program that, in Massachusetts, is using CVS and Walgreens as suppliers for both the Pfizer vaccine and a second vaccine, from Cambridge-based Moderna, that is expected to be approved next week.
The pharmacies have told senior facilities that, under federal guidelines, they will be making three visits to each site, bringing the vaccines and setting up clinics to administer injections. Each resident and staffer will need to receive two doses, four weeks apart for the Pfizer vaccine and three weeks apart for the Moderna vaccine.
Medical personnel say more visits should have been scheduled so they could stagger inoculations, making sure there are enough healthy staffers on the job to help residents struggling with side effects.
“It’s another example of people making decisions who know nothing about our operations,” said Dr. Larissa Lucas of the North Shore Physicians Group, who serves as medical director for nursing homes in Peabody, Lynn, and Marblehead. “What we’re worried about is that there’s going to be a bulk of people sick at the same time when we need them.”
Some patients in Pfizer and Moderna’s clinical trials have suffered mostly mild and moderate side effects, including headaches, muscle aches, and soreness as well as fever and tiredness in some cases, the companies report. While most side effects resolved in a day or two, and could be treated by rest and Tylenol, long-term care clinicians say their residents are especially vulnerable.
They say they will work to educate staffers and residents about the vaccine, telling them that any side effects they may feel do not mean they have the coronavirus.
The medical directors are anticipating the arrival of the long-awaited vaccine with excitement, seeing it as the beginning of the end of the nightmare they’ve been battling for the past nine months. “It was on top of my Christmas list,” Lucas said. “Hopefully, Santa will deliver.”
But the out-sick calls are only one of the logistical hurdles they’re confronting from the compressed vaccination schedule. Long-term care staffers typically work throughout the day and night in eight-hour shifts, so it will be necessary to bring everyone in — and keep them spaced safely apart — during the limited hours of the vaccination clinics.
If staffers are off during the clinics, if some staffers and residents decline to get the first shot, or if some residents are newly admitted for rehab services after the first shots have been given, the schedule leaves little room to adapt.
“There could be 100, 200, or more staffers who would need to be vaccinated in one day” at some Massachusetts long-term care sites, said Dr. Mark Yurkofsky, medical director at Spaulding Nursing and Therapy Center in Brighton. “It will be a logistical challenge, and we would like to have more flexibility.”
A representative from the US Department of Health and Human Services, which has been handling queries about the vaccine rollout, didn’t respond to questions about why federal regulators recommend only three visits per facility.
CVS, which will administer vaccines at more than 1,800 long-term care sites in Massachusetts “plans to follow the [federal] guidance based on data that three clinics per site is sufficient for staggering purposes,” a spokesman for the pharmacy said in an e-mail. “If a facility requests more, we will assess that on a case-by-case basis.”
A Walgreen spokeswoman wrote in an email that “at least three clinics will be scheduled with each long-term care site,” leaving open the possibility the pharmacy could add visits to some sites.
The timing of vaccinations is emerging as a pressing issue beyond the world of long-term care. Community health clinics, too, are hoping they’ll get multiple chances to give their front-line employees injections over the coming weeks.
“You have a workforce of 100 people and you were to give them all the vaccine at the same time, people would start calling in sick and that could create an inability to respond to the health care needs of the community as well as the surge we’re dealing with,” said Michael Curry, president of the Massachusetts League of Community Health Centers, who also sits on the state’s vaccine advisory group.