COVID-19 Vaccines' Effects On Long-Term Care Visitation
The COVID-19 pandemic has had a substantial impact on our lives. For older Americans and other high-risk groups, that means living in constant fear of contracting a potentially fatal disease. For younger adults, the challenge is in navigating the emotional and mental health effects caused by prolonged isolation due to the virus.
Nowhere have the effects of the pandemic been felt more acutely than in long-term care (LTC) facilities, where COVID-19 poses a significant health risk to the sites’ primarily elderly resident population. Unfortunately, the visitation restrictions that were put in place to protect the elderly have contributed to widespread feelings of isolation and depression among LTC facility residents.
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With distribution of the Pfizer-BioNTech and Moderna vaccines underway, leaders of LTC facilities grapple with determining when they can resume normal visitation protocols. In this blog, we explain why the road ahead is more complicated than facility leaders may realize—and how they can adapt.
What's the vaccine distribution strategy?
Each state and jurisdiction has the final say on how their supply of COVID-19 vaccines is distributed to the population. However, the Centers for Disease Control and Prevention (CDC) has recommended that high-risk groups and healthcare workers receive first priority for vaccines:
What are the challenges of resumed visitation?
1. Limited supply
As we have already seen, many states across the country currently do not have enough supply of the vaccine to cover all high-risk individuals and healthcare workers. As a result, states are deciding for themselves which members of the population must be prioritized over others. In New York, for example, the decision was made to vaccinate healthcare workers first, then move on to LTC facility residents when the next batch of vaccines is received.
2. No vaccine is 100% effective
Fortunately, with vaccine makers ramping up production, supply limitations are likely to be only a short-term challenge. But even when production and distribution catch up to demand and LTC facility residents are vaccinated, it’s important to remember that no vaccine is 100% effective—and the COVID-19 vaccines are no exception. Pfizer-BioNTech and Moderna have reported 95% and 94% efficacy, respectively. In other words, LTC facility residents may still be at risk even after they have been vaccinated.
3. “Vaccine euphoria”
Current estimates suggest that it will likely take six or more months for the vaccines to be rolled out to all population groups. In the meantime, there is a significant risk that we could fall prey to a phenomenon known as “vaccine euphoria.” With vaccine euphoria, the existence of a vaccine leads to fewer people following disease-prevention guidelines—and prolonging the length and severity of the pandemic as a result.
The vaccines are not a silver bullet, and COVID-19 will remain a threat for the near future. LTC facilities should be wary about relaxing visitation restrictions until after vaccines have been made widely available to all members of the public.
4. Public resistance to vaccines
Recent research noted that a vaccine with 80% efficacy would need to be distributed to 75–90% of the population to achieve herd immunity. Applying this formula to the higher-efficacy Pfizer-BioNTech and Moderna vaccines, we would need to vaccinate, at minimum, 70% of the population to achieve herd immunity.
Unfortunately, according to a recent Kaiser survey, that may be easier said than done: only 71% of respondents said they “probably or definitely would get a COVID-19 vaccine if it was determined to be safe by scientists and available for free to everyone who wanted it.” Incidents such as the recent nationwide coverage of a Boston doctor experiencing an allergic reaction to the Moderna vaccine could drive that number below the necessary threshold for herd immunity.
5. Vaccine storage
The Pfizer-BioNTech vaccine requires “ultracold” storage at -70°C; once it is thawed, the vaccine is viable for only five days. Unfortunately, many healthcare facilities lack the equipment necessary to meet these storage requirements.
The Moderna vaccine can be safely stored in temperatures as warm as -15°C—roughly the same as varicella, MMRV, or shingles vaccines. However, those vaccines can tolerate temperatures as low as -50°C; the Moderna vaccine, on the other hand, can only tolerate temperatures as low as -25°C. This means that the margin for storage error is twice as thin. The Moderna vaccine is slightly more durable, remaining stable at refrigerator temperature for up to 30 days, and at room temperature for up to 12 hours.
What's the long-term picture for visitation?
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued guidance restricting most LTC facility visitation, a necessary precaution to prevent outbreaks of COVID-19 at these sites. As the pandemic continued throughout the summer, however, it became clear that the periods of extended isolation were just as harmful to the residents’ health as COVID-19 itself was. As a result, in September, CMS updated its guidance to allow for increased visitation.
The vaccines are a light at the end of the tunnel, but COVID-19 still poses just as much of a threat to LTC facilities now as it did earlier in the year, and it is unlikely CMS will revise its most recent visitation guidance.
Until the pandemic is comfortably under control, LTC facilities should continue to prioritize the safety of facility residents and staff by adhering to existing CMS guidelines. symplr Visitor Management helps facility staff keep track of vaccinated versus unvaccinated visitors and make the visitor check-in process as efficient and safe as possible, ensuring that their residents can safely enjoy the benefits of interaction with friends and loved ones.