Intimidating logistics to vaccinate people confined at home

Some people cannot make it to an immunization clinic. Instead, someone has to turn to them in what will be a painstaking process of getting vaccines to everyone who wants one.

By Rose Hoban

A few days ago, Jay Smith and his wife, Yolanda, loaded his wheelchair into the car and drove to the state Division of Motor Vehicles office near his Raleigh home to surrender his license.

“You can’t do it by mail, you have to get there,” Jay Smith said. “It’s like 3 months to get a date.

Smith, 57, was diagnosed with amyotrophic lateral sclerosis, more commonly known as ALS or Lou Gehrig’s disease, in December and he quickly lost his abilities. By the time his appointment arrived, he could barely switch from his car to a wheelchair to enter the building.

“I did, and it was the last thing I could do,” he said.

Smith and his wife believe getting him out to receive a COVID vaccine will be even more difficult, as it becomes increasingly difficult for him to get in and out of a wheelchair. They could drive through a clinic, but he couldn’t get an appointment. He also worries about leaving the house to drive and then stand in line, where it might be difficult for him, for example, to use a bathroom if he needed to.

“There are people who are worse than me,” Jay Smith said. “They have to take the electric wheelchair with them as they cannot be transferred to a traditional wheelchair without a problem, they may have to be inside a special medical transport.”

So he hopes someone will come into the house to give him a shot.

Jay Smith is one of the thousands of North Carolinians who are confined to their homes for one reason or another. It could be a disability, old age, or an intellectual or developmental disability, but these people are some of the hardest to reach with vaccines. And while we have all been told to stay home for our safety over the past year, people who are housebound often need the help of caregivers – both professionals and family members – who enter and leave the house, which increases their risk of infection.

Vaccinating these vulnerable people is vital, said Charlene Wong, policy manager for COVID-19 at the state Department of Health and Human Services. Search found that people with disabilities had one of the highest deaths from COVID this year.

Wong estimates that there are between 15,000 and 100,000 homebound people like Smith who cannot make it to a pharmacy, clinic or mass vaccination site.

Instead, someone will have to come to them.

Rural advantage

“A lot of the employees who work here actually know the people of the county,” said Kimberly Irvine, director of social services for Yadkin County.

Yadkin has less than 40,000 people, Irvine said, with about 7,700 people over 65. She said only 10 percent of those people needed someone to get them vaccinated.

The small numbers made things a little easier.

“There aren’t many people,” she said. “It’s a community where you have mothers, grandparents, generations who live here. “

This made it easier to verify everyone on a compiled list by talking to all types of caregivers.

Nonetheless, there were challenges. For one thing, the older older population, mostly over 75, lacked the computer skills to register online for a vaccine, so the folks at Irvine did what they did. they could to spread the word.

“Seniors’ centers, churches, through our websites, through mailings, through newspapers, through robocalls, all kinds of different ways, we let them know that we have the option to come and vaccinate.” , she said.

For weeks, Irvine has been sending teams to people’s homes. She estimates that only about 10 percent – or 750 – of the county’s over-65 population were housebound and in need of this extra help.

Sometimes they get a helping hand from a family member.

“We don’t normally have drive-through clinics, but for people who can get to one of our clinic sites… done,” she said. Instead, someone comes out to give the vaccine to Grandma sitting in a passenger seat.

Far

In eastern North Carolina, a team of East Carolina University staff and students traveled to remote churches, homes and senior centers for injections.

Paul Shackelford, a medical school doctor, led teams of volunteers to get to the last mile vaccinees.

Shackelford will pile a group of volunteers into a van and they will travel to a remote church to vaccinate half a dozen people. He compared it to missionary work.

On another occasion, in coordination with the Pitt County Health Department, Shackelford and his volunteers were able to bring people from several group homes together at a recreation center where they administered around 75 vaccines.

Want Dr. Shackelford’s team to come to your area in eastern North Carolina? You can reach it here.

“I had a team member to start with us and I came back and said, ‘You know, I just don’t think it’s very effective,’ Shackelford said.

But that’s what it will take to reach out to remote people who otherwise wouldn’t have access, including farm workers, he said.

“I guess this stuff is happening statewide,” Shackelford said. “Like in the west, the center and the north and the south and everyone is working hard.”

In an even more remote part of eastern North Carolina, Albemarle Regional Health ServicesDirector R. Battle Betts said they are using GPS mapping to plan the most efficient routes between people’s homes in an area spanning eight counties and more than 3,100 square miles.

His teams used the Moderna vaccine, which only requires freezing temperatures, not the very cold temperatures needed to preserve Pfizer / BioNtech vaccines. It takes an hour to thaw a 10-dose vial of Moderna, then the vaccine powder is mixed with saline and a six-hour clock starts.

Betts said nurses were traveling with a cooler and ice.

“Depending on how accurately you can get your mapping, you can literally thaw another vial as you go around,” he said. “Of course, then a six hour clock starts on that flask.”

Albemarle teams have successfully vaccinated between 1,000 and 1,500 people confined to their homes, Betts said.

Part of how they’ve been able to reach people who are housebound is by partnering with the Meals on Wheels program.

“We use our transit buses,” he said. “We can literally have a hot meal and someone’s shot.”

Having these regular visitors also helped overcome the logistics associated with a two-dose vaccine.

“Hopefully they are getting a meal on a regular basis and then we can just step in and get these people home for the second shot in 28 days,” Betts said.

More people, more logistics, more delays

In many parts of the state, however, vaccine vendors have waited for the rollout of the Johnson & Johnson single-injection vaccine to conduct a “one-time and complete” visit for homebound patients.

In Mecklenburg County, health ministry officials put a special request form on their county’s website for people needing a home visit.

In the first week after announcing the program on March 11, the health department’s medical director, Meg Sullivan, said she had received more than 300 requests.

“The team has looked at these requests and made plans to start administering vaccines probably from early to mid-April, depending on the supply of Johnson & Johnson vaccine we receive,” she said.

Wong, of the DHHS, said federal authorities are aware of the need to visit some of these remote places and hard-to-reach people. The department only recently added people with intellectual and developmental disabilities to the group 1 vaccine group, after pressure from advocates for people with disabilities.

“We made a few changes based on their feedback which was really valuable,” she said. “For example, recently by adding to group one people receiving long-term care for more than 30 days, including home and community services for people with I / DD, private nursing, services personal care, home care and palliative care. ”

She said the state had requested help from the federal program to partner with pharmacies and the federal vaccine allocation program for community health centers.

“What we are hearing from them is that they are really going to encourage the creation of more mobile units within these programs, which should hopefully also be in a good position to vaccinate those confined to the hospital. home, ”Wong said.

She said those efforts will accelerate as more Johnson & Johnson vaccines are marketed in the states.

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