Family members of nursing home residents can certainly be forgiven for imagining an instant return to normal after Pfizer’s COVID-19 vaccine received emergency approval from the federal government late Friday.
The Centers for Disease Control and Prevention (CDC) has placed this population at the front of the line for the shots, and families have been locked out of their loved ones’ rooms and lives for months, worried around the clock about the very real potential for outbreaks — and the serious negative effects of social isolation.
With deliveries already en route on Sunday, the first doses could be ready for health care workers to receive as soon as Monday, the AP reported over the weekend.
Leaders at major non-profit nursing home operator ProMedica SeniorCare — formerly HCR ManorCare — say the early data on the vaccine’s effectiveness is promising, but they also warned that the inoculations will still only represent a single weapon in the arsenal that operators across the country have developed since March.
“Our day-to-day operations won’t change,” ProMedica Senior Care chief medical officer Dr. Mark Gloth told SNN. “The vaccine doesn’t fix the problem. It is just one more tool.”
In this second installment of a two-part interview with Gloth and ProMedica Senior Care president David Parker — conducted earlier this month — the leaders discussed how the chain will handle residents and staffers who are skeptical of the vaccine, along with the company’s plan for an effective rollout.
How is ProMedica preparing for the vaccine rollout?
Gloth: Obviously, we’re very encouraged and optimistic. I was on a call with another news outlet the other day, and they said: “Are you concerned that it’s only 95% effective?”
Am I concerned? I’m ecstatic! 95% effectiveness when the flu vaccine last year was, what, only 45% overall effectiveness? And you’ve never seen a vaccine have 95% effectiveness.
I’m unbelievably encouraged, and frankly, anticipating an additional tool in our tool belt of attacking this vicious virus — and particularly now that we have been really able to identify how many individuals who have this virus are completely asymptomatic. What we thought was 30% or 40% is now turning out to be like 60% of our patient population is completely asymptomatic.
People were concerned about how quickly this spread — my term was it’s fire through dry grass when it enters into a skilled nursing facility. That was really because we didn’t have the access to the testing to be able to identify those individuals who were asymptomatic. You’re symptomatic — we can address that. You’re asymptomatic, that’s the invisible enemy to the Nth degree.
The first really monumental concern that we had was access to PPE. And the second thing that we looked at very clearly was access to effective testing. Right now, we certainly have staffing challenges that are associated with the increased incidence and prevalence that we’re seeing of the virus in the community.
Then obviously, the next big one is being able to allocate the vaccine effectively. We’ve already started. We just put together our FAQs; we’ve started communicating.
I actually sent out the communication to all of our medical directors and physicians that are affiliated with us, as well as our employed nurse practitioner groups, specifically going over the frequently asked questions associated with the vaccine — everything from how a vaccine is introduced, how it gets Emergency Use Authorization, all the way down to: If I’m allergic to eggs, can I still take the vaccine?
Those types of questions are very real. Comparing it to the same type of education that we do with the influenza vaccine: The timing, frankly, couldn’t be better to get this vaccine out — unless it had been earlier — but with us doing education as it’s associated with the influenza vaccine, which is a mandatory vaccine for us.
As we introduce the opportunity for our health care workers — and then soon after, we anticipate for our patient population — to receive the vaccine, education is paramount. We’ve started with what we’ll call a portal or university education for all of our clinical folks, as well as all of our employees and vendors. Second, we will initiate a combination of video town halls, which means prerecorded town halls [with] frequently asked questions — something that was very effective to us early on in the pandemic in just providing education about COVID-19.
We will follow that up with smaller kind of town hall or Zoom town hall meetings, as appropriate. We can do small huddles, if we’re in appropriate PPE and socially distanced, at the facilities. Frankly, those types of educational opportunities can’t be underestimated, and we still need to move forward with those. Education is going to be absolutely key, communication of that information, and there’s no such thing as over-communication when it comes to this.
But we’re also going to have to do some one-on-ones. While we’re not going to mandate this vaccine, we are going to make sure that anybody who does not feel comfortable receiving the vaccine gets one-on-one education, and that they complete a declination form, just like we have done in past years, prior to the influenza vaccine being mandatory. They say: “Look, I don’t want to receive it. Here are the reasons why I don’t want to receive it.”
We want to be respectful that it is a new vaccine. As encouraged and optimistic as I am, an Emergency Use Authorization is just that — [an emergency]. While we are confident, based on the information that we have in hand, that this is a very strong and robust system that is putting this into place.
This has been warp speed as far as the development. But that all slows down as soon as it goes to the FDA. The T’s have to be crossed, the I’s have to be dotted. I am very comfortable and confident, based on the information that we have received from the CDC and the FDA, that has been made available to us, that the warp-speed process ended. As soon as the application was submitted for the Emergency Use Authorization, this is going to get all of the checks and balances required.
Once we get that Emergency Use Authorization, our job is going to make sure that we have access, and we have started already a partnership with CVS Health. We just got some communication from them specifically today [December 3]; they’re going to be setting up clinics in our skilled nursing facilities across the country. We have already begun the process of putting the numbers together as to how many vaccines we’ll need at each of those locations.
Obviously, this is our staff and our direct employees, but also any of those individuals who are coming into our facilities that are providing clinical care and services to our patient population. Remember, as we look at this virus, this virus is introduced from the outside, right? It doesn’t spontaneously occur in a skilled nursing facility; it is introduced, and typically it is introduced by a health care worker. As many precautions as we put into place, it’s an invisible virus.
We have got to, one, protect our health care workers — because if we protect our health care workers, we significantly decrease the risk of an impact on our patient population. And then obviously, the next line of business is to take care of our patient population. We know that’s going to follow straight behind. But we’ll approach our patients and our residents the exact same way we do our employees — it’s not going to be mandated. But we are going to make sure that they have the opportunity, the access, the education to receive that vaccination.
Our day-to-day operations won’t change. The vaccine doesn’t fix the problem. It is just one more tool. It certainly will allow us to start exploring other things like enhanced visitations for our communities. But those are all things that I’m looking forward to starting to review the evidence on and have conversations about.
That’s where we really get to tackle the social determinants of health. The next big fallout concern associated with the pandemic is the ramifications associated with the social isolation for our seniors. And that is, first and foremost, the next thing that we’re going to have to address very aggressively. We’ve been addressing it all along. But the vaccine gives us an opportunity to be much more focused in expanding our ability to, if you will, enhance the human touch aspect that’s so critical in providing good quality of care.
What will your protocol be for a resident or worker who doesn’t want to take the vaccine? How will you accommodate the balance between individual rights and collective safety?
Gloth: We’re going to do the education. Based on the initial response that we’ve seen out in the community, particularly with the enhanced education, we think we’re going to see numbers that exceed the voluntary response to the influenza vaccine.
Those individuals will continue to be able to provide care and services. We’re going to look at our patient populations, specifically. Our higher-risk patient populations are going to be those individuals who we’re going to have to look at what our staffing approach is. Obviously, you would want to put your higher-risk patients with those individuals that present the least amount of risk to them.
So if I have an employee who has been vaccinated, as opposed to one that hasn’t been vaccinated, and I have a patient who is considered to be higher risk from an age and comorbidity standpoint, it would make sense that from a staffing standpoint, I would look at focusing that health care worker appropriately, so that we can do everything we can to protect our residents.
But it really goes back to our infection control pieces at the end of the day. It’s PPE, the social distancing, the strict attention to hand washing. Those are the marching orders of the day. None of that is going to change. But we’ll have to take on some additional considerations as we do that.
There is no easy protocol for playing musical chairs with how we staff. We always want to staff to meet the needs of the patients in an individualized way, the best way we possibly can. We’ll continue to do that, and certainly, I anticipate that whether someone has received the vaccine or not will impact how we staff. But it’s not going to limit our health care workers from being able to come in and provide care and services, and it’s not going to limit access to good care for our patient population.
Parker: It’s not going to be the silver bullet. We’re going to be able to get a certain portion of our frontline healthcare workers, and then our patients, vaccinated. But in all probability, we’re still going to be receiving guidance, and still going to have expectations by CMS, or even in the 27 states where we operate, that, you know, if a county is red, then we’re going have to test twice a week.
If that person has not been vaccinated, and they test negative, then they’re going to probably be in full PPE on whatever particular unit they may work. You’re still going to end up following some of the existing guidance that’s out there. But that guidance might be a little bit different if that individual has had the vaccination, and I think that is going to continue for an extended period of time.
Gloth: The vaccine is 95% effective in keeping me from getting sick from the virus. We don’t know if it actually keeps me from infecting someone else. It doesn’t put up a wall and says that you’re not exposed. If I’m exposed to the virus and the virus is introduced into my body, the vaccine impacts how my body responds to that virus. The question that hasn’t been answered in these early phases of the trials is whether the vaccine actually keeps me from transmitting the virus to someone else.
We have to be sensitive to that. We’re not taking down all of the precautions that we put in place. We’re not going to change that individual piece of it. We’re going to continue, as David said, with all of the specific components that we have in place to monitor and protect our patients and residents.
That is one of the things I think that gets a little bit confusing out there in the lay community in particular, but even in the medical community, is that the vaccine serves to decrease my likelihood and decrease my risk of morbidity and mortality associated with the virus. We don’t know, nor do we have enough cases at this point, to be able to say definitively that it’s protecting me from giving it someone else.
We think that’s the way it should work, right? We think my viral load is going to be lower. It’s not going to be able to replicate, and it’s going to be less likely that I’m going to transmit this to someone else. Remember, the sicker I am, the higher my viral load is typically, even with this virus.
Those are all things that we’re going to be taking into consideration as the months go by, and as we see more people vaccinated, and they continue to study the vaccines and the human response to those vaccines — because while we’re out of phase three, you’re talking 45,000 cases with the Pfizer study that were involved in those trials.
Now we’re going to be looking at millions of individuals who are going to be receiving the vaccine, as we anticipate over the next couple of months. These are all things that are to be determined. So, this — as David says very well — is just one additional resource that we have available to fight the invisible enemy, and we embrace that opportunity.
This interview has been condensed and edited.