We report on how an elder care system already in crisis imploded under the weight of the coronavirus pandemic.
A top government panel in the United States has recommended healthcare workers and nursing home residents get the country’s first coronavirus vaccine shots, as nationwide deaths linked to COVID-19 hit the highest number for a single day in six months.
The Advisory Committee on Immunization Practices voted 13-1 on Tuesday to recommend those groups are given priority in the first days of any vaccination programme when available doses are expected to be limited. The two groups amount to about 24 million people out of a US population of about 330 million.
“I believe that my vote reflects maximum benefits, minimum harm, promoting justice and mitigating the health inequalities that exist, with regard to distribution of this vaccine,” said Jose Romero, the committee’s chair.
The US Food and Drug Administration (FDA) is yet to approve any vaccines, but a panel of outside advisers are set to meet on December 10 to consider authorising the emergency use of two vaccines – one made by Pfizer and the other by Moderna.
Current estimates project that no more than 20 million doses of each vaccine will be available by the end of 2020, with each product requiring two doses. As a result, the shots will be rationed in the early stages.
An adviser to President Donald Trump said the government plans to begin vaccinating Americans against COVID-19 as early as mid-December.
The timeline described by Moncef Slaoui, who is overseeing the vaccine portion of Trump’s Operation Warp Speed programme, appeared to assume that the FDA’s authorisation of the first vaccine would come within days of the December 10 meeting.
“Within 24 hours, maybe at most 36 to 48 hours, from the approval, the vaccine can be in people’s arms,” he said at an event conducted by The Washington Post newspaper.
‘The right way’
But the head of the FDA’s Center for Biologics Evaluation and Research, Dr Peter Marks, told patient advocacy groups last week that it might take “a few days to a few weeks”.
FDA Commissioner Stephen Hahn has also said the process could take longer.
“Everyone is working really hard to look at these applications and get this done,” Hahn told the ABC TV network in an interview on Instagram Live on Tuesday. “But we absolutely have to do this the right way.”
The outbreak in the US has killed nearly 270,000 people with more than 13.5 million confirmed cases. Cases, hospitalisations and deaths have rocketed in recent weeks.
A further 2,295 fatalities nationwide were linked to COVID-19 on Tuesday, even before California, the most populous US state, reported its latest numbers.
Officials in several states said numbers were higher in part due to a backlog from the Thanksgiving holiday.
The monthly death toll from COVID-19 is projected to nearly double in December to a pandemic-high of more than 70,000 and surpass 76,000 in January before ebbing in February, according to a widely cited model from the University of Washington’s Institute for Health Metrics and Evaluation.
The Advisory Committee on Immunization Practices was unanimous in voicing support for vaccinating healthcare workers – about 21 million people, according to
Centers for Disease Control and Prevention (CDC) officials.
That broad category includes medical staff who care for – or come into contact with – patients in hospitals, nursing homes, clinics and doctor’s offices. It also includes home healthcare workers and paramedics. Depending on how state officials apply the panel’s recommendations, it could also encompass cleaning staff, food service employees and medical records clerks.
The government estimates people working in health care account for 12 percent of US COVID-19 cases but only about 0.5 percent of deaths. Experts say it is imperative to keep healthcare workers on their feet so they can administer the shots and tend to the booming number of infected Americans.
Who is second in line?
Nursing home residents have been hit particularly hard by the pandemic. About three million people are living in the country’s nursing homes, long-term chronic care hospitals and other long-term care facilities. The CDC says patients and the staff who care for them account for 6 percent of the US’s coronavirus cases and a staggering 39 percent of the deaths.
Despite the heavy toll, some members on the Advisory Committee on Immunization Practices said they hesitated to include such patients in the first group for vaccination.
Dr Helen Keipp Talbot, an infectious diseases researcher at Vanderbilt University who was the lone committee member to vote against the proposal, cited flu research that found vaccinating the staff of such facilities has the greatest impact on preventing its spread there.
Dr Richard Zimmerman, a University of Pittsburgh flu vaccine researcher who watched the meeting online, echoed Talbot’s concerns.
“I think it was premature” to include nursing home residents as a priority group, Zimmerman told The Associated Press news agency. “Their vote seems to assume that these people will respond well to the vaccine … I don’t think we know that.”
The committee did not vote for what would happen after the initial phase, but experts have proposed to then give priority to essential workers in phase “1b,” followed by adults with multiple risk factors and adults more than 65 years old in phase “1c”.
Essential workers include teachers, workers from the slaughterhouses to the supermarkets who keep Americans fed and those who drive buses and trains, sell them their medicine, maintain order, or deliver mail and parcels. People in these jobs are often minority Hispanics or Black, and have been hit disproportionately by the pandemic.
There are worries that in practice, these ethical, epidemiological and economic considerations could be ignored in the initial rush on doses.
Even with a vaccine in sight, health officials are pleading with Americans to stick with coronavirus restrictions and state and local officials have returned to imposing restrictions on businesses and activities in response to the latest surge of infections.
Meanwhile, the CDC is moving to shorten the length of self-quarantine recommended after potential exposure to the coronavirus to 10 days, or seven days with a negative test, a federal spokesperson said on Tuesday.
The CDC currently recommends a 14-day quarantine in order to curb the transmission of the virus.
The pandemic-related restrictions have ravaged the US economy. A bipartisan group of US legislators on Tuesday unveiled a $908bn COVID-19 relief bill aimed at breaking a deadlock over emergency assistance for small businesses, industries and the unemployed.