When COVID-19 exploded last March, my community went to work attempting to keep COVID out of our facilities. We developed county-wide virtual learning collaboratives for Assisted Living (AL) communities and for SNFs, which met on a weekly basis. By the end of June, we had done well with no outbreaks and only 4 deaths in the county. Unfortunately, last summer’s surge in COVID prevalence shattered the myth that we had done enough to contain it. Like the rest of our state, we pivoted to follow guidance focused more on infection control and early recognition of outbreaks. By the end of October, we seemed to be back in the driver’s seat with much better facility COVID metrics. However, with the winter surge, we are stretched thin on staff, resources, and again wondering when the bad news will end. In my county, we have now have had 196 deaths, and 70% of them have occurred in senior congregate living facilities.
With these grim events in mind, I was surprised to hear in the national media and from several of my former facilities that a significant percentage of staff was reluctant to take the new mRNA vaccines. At CALTCM, our vaccine Delphi group developed a webinar in early December that addressed vaccine confidence, which I found helpful for preparing facilities and staff for rolling out their vaccination programs.
One of the Delphi participants, Dr. Leslie Eber, the President of the Colorado Medical Directors Association, subsequently reframed the problem in a wonderful podcast for AMDA ON-THE-GO on 12/16 titled, “Building Vaccine Confidence”. I’ve shared this podcast (including her slides) with our learning collaboratives and many have found it to be very timely and helpful. You can obtain this free resource at: https://paltc.podbean.com/
Although rare to date, in-facility anaphylactic reactions have become a potential issue with both of the currently available vaccines, and warrants efforts to prevent, recognize, and provide initial management pending paramedic arrival. I have created a brief slide deck on this subject (visit Vaccine wepage) and have just received fact sheets for both mRNA vaccines which detail the ingredients of both vaccines for review by staff and residents/DPOA prior to vaccine administration. Epinephrine is the mainstay of treatment of a presumed anaphylactoid reaction and should be readily available on the facility’s emergency (e-)kit.
Armed with these tools and other resources, I hope that 2021 will allow us to live with less fear, more freedom, and a better quality of life for all.