COVID Update #233
HFAM Update, National Nursing Home COVID Action Network,
MDH LTC Webinar Recap, Third Vaccine Clinic Policy Reminder
HFAM Update

Please see below in this update for a reminder on the message we sent yesterday evening regarding guidance on third vaccine clinic policy. Per AHCA/NCAL: “The CDC will not be posting these on their website; however, state associations (such as HFAM) can use them in discussions with state public health agencies.” Obviously, we all still have federal supply concerns. This CDC guidance mirrors the path forward we have been advocating for here in Maryland on the association side, and continued partnership with state leadership will be essential. It is also critical that Maryland hospitals administer the first COVID-19 vaccine dose before discharging a patient to a SNF or ALF.
 
Over the last several weeks, we have been working with the Maryland Department of Health (MDH) on a COVID-19 vaccination plan moving forward once the federal CVS/Walgreens clinics are over. We have long advocated that our sector's institutional pharmacies should be allocated COVID-19 vaccines and hold periodic clinics in our centers. It seems the CDC is moving in that direction. Yesterday we had three separate calls with state leaders on vaccination. Together, we will continue to push forward. And again, we all still have federal supply concerns.
 
Thanks
 
It is vital that we still make the time to thank people. In fact, it is likely more important than ever. Today I want to begin by thanking Jon Weinstein at the Maryland Department of Health and his COVID-19 Testing Task Force. Since September 2020, Weinstein and the Testing Task Force have distributed 1.3 million point-of-care (POC) tests to Maryland skilled nursing and rehabilitation centers, assisted living campuses, group homes, and other congregate settings. That amounts to:

  • 11,000 POC tests shipped every day since September 2020.
  • 600,000 hand-packed boxes full of test kits.
  • Distribution of more than 832,000 BinaxNOW tests and more than 459,000 BD tests.
 
These 1.3 million POC tests have been critical in the fight against COVID-19 and have substantially augmented commercial lab testing. The term “healthcare heroes” sometimes gets thrown around a bit too much, but in this case the term is spot on. Thank you, Jon Weinstein and the COVID-19 Testing Task Force – you have saved lives!
 
Appreciation

As always, the HFAM team and I thank you and your teams for all you are doing in the fight against COVID-19. Positive cases in the community, as well as in skilled nursing and assisted living centers, are currently trending down. The downward trend in cases is partly due to the correlation between the community positivity rate and the positivity rate in healthcare centers; however, a large part of the downward trend is due to continued infectious disease control protocols. Vaccination rates, especially among residents and patients, is also a factor in the downward trend of positive cases in our sector.

 
Vigilance
 
The current decline of COVID-19 positivity rates is not permission to let our guard down. At home, at work, and in the community, we all must remain vigilant in our fight against this virus.
 
Clinical experts are very concerned about the current spread and incubation of the COVID-19 variants from Great Britain and South Africa. To the extent that Maryland and the nation can increase vaccine supply and vaccinate more people, the risk of increased cases, hospitalizations, and deaths can be mitigated. In the meantime, clinicians and others have learned much in the fight against COVID-19 and we are reminded of what is in our control.
 
As Always

  • People first, quality counts.
  • Be prepared to deploy people and PPE around your organization.
  • Our sector MUST double our efforts on infectious disease protocol, staffing, PPE, observation, and testing.
  • Train, train, and train teams again on infectious disease protocol.
  • Recognize that COVID-19 fatigue is an issue across the county, not just in our sector.
  • Overcommunicate with residents, patients, families, staff, and government partners.
  • Sound alarms early.
  • Know that WE WILL get through this and that you are saving lives!
  • Work with your hospital partners, and coordinate with local and state regulatory partners.
  • Take and document your action; keep a timeline.
  • CLICK HERE for the Dr. Katz Video, and please see the Donning and Doffing Checklist we have been sharing.
 
Visitation, Testing, and Observation
 
First of all, we must continue to advocate and act clinically driven in our recommendations. That said, Maryland testing frequency and cohorting orders were developed based on earlier CDC guidelines. These guidelines were rightfully linked to community positivity rates (at a time when those rates were much higher) and did not take vaccination in to account. In November 2020, Maryland orders linked testing directly to the community positivity rate. Now may be the time to reduce employee testing to once per week.

Since the earlier Maryland orders, CDC cohorting requirements have been reduced to seven and ten days depending on the setting. Therefore, now may be the time to reduce the cohorting requirement from fourteen to ten days. Finally, we must take a long hard look at revising visitation rules based on vaccination rates, individual vaccination status, community positivity rates, and PPE usage.
 
Onward together!

Be well,
Joe DeMattos
President and CEO
Join the Maryland AHRQ ECHO National Nursing Home COVID-19 Action Network

Sign up with the Green House Project

As we have previously shared, the Agency for Healthcare Research and Quality (AHRQ) has partnered with the University of New Mexico’s ECHO Institute and the Institute for Healthcare Improvement (IHI) to establish a National Nursing Home COVID Action Network (NHCAN). The network will provide free training and mentorship to nursing homes across the country to increase the implementation of evidence-based infection prevention and safety practices to protect residents and staff. 

We’re excited to announce that the Green House Project will be joining the second round of this important collaborative to support local nursing home staff working to combat COVID-19. We highly encourage you to take a look at and participate in the Green House Project HUB. While participation in this initiative is considered optional by CMS, it should be viewed as mandatory by our sector because we firmly believe that this is beneficial work. Over 7,500 nursing homes have already participated in the first round of the series.
 
The program features a 16-week curriculum focused on the latest research-based approaches to safety and quality improvement to support your fight against COVID-19. You will be joined by a range of subject matter experts and a local community of nursing homes facing similar challenges. In addition, nursing homes with 2-4 participants attending 13 of the 16 sessions will receive $6,000 in compensation through the Provider Relief Fund.

Take a look and sign up ASAP. The Maryland Cohort
starts this Wednesday, February 10, 2021.
Want to sign up? Click here to enroll today!
(Enroll now even if you can't join the first session)

Need more information? Click here for a FAQ!

Questions? Email ECHO@thegreenhouseproject.org or call 410-246-3806.
MDH Webinar Recap

Last week, the Maryland Department of Health held a webinar call to update the long-term care sector on COVID-19 developments and best practices. The call was recorded, in case you were unable to join or would like to review the topics discussed, which included:

  • Maryland Epi Updates
  • CDC Updates
  • Maryland Updates
  • Variants of Concern
  • Q&A

You can also view the webinar's PowerPoint presentation here and the chat box here.


If you have any questions, please email mdh.ipcovid@maryland.gov.
Reminder: Update on Third Clinic Vaccine Policy

CDC’s Long-Term Care (LTC) Pharmacy Partnership Program provides three COVID-19 vaccination clinics for LTC facilities enrolled in the program. As many LTC facilities are closing in on their third clinic, questions have arisen whether residents and staff will be able to receive a first dose of the vaccine at the third and final clinic. AHCA/NCAL has been actively working with CDC, CVS, and Walgreens on this issue. 

CDC policy is to optimize vaccine access for residents and staff, which means delivering the first dose of either vaccine at the third clinic. However, the pharmacies will defer to state/jurisdictional guidance. So, if your state health department decides not to allow first doses at the third clinic in all cases, for example, the pharmacy will follow that guidance.  

If residents and staff receive the first dose of the vaccine at the third clinic, it’s important to determine how they will access the second dose. For assistance in securing the second dose on behalf of staff or residents, providers should: 

  • Contact their state public health department for more information on vaccine availability. 

  • Call on of the retail pharmacies involved in the CDC’s Federal Retail Pharmacy Program. Retail pharmacies participating in the program vary by state and territory, visit the CDC website to find out which pharmacies are participating in your state. 

If you are in a state that is delivering the Pfizer-BioNTech vaccine through the Pharmacy Partnership, it will be more challenging to access a second dose due to the unique cold chain storage requirements. If all potential options for administering the second dose have been exhausted, clinical leadership may consider the following:  

  • Counseling residents to finish the vaccine series using the Moderna vaccine. The Advisory Committee on Immunization Practices recommends: 

  • ​“In exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series.” ​ 

Delay timing of the second dose administration up to 6 weeks (42) days. CDC guidance dictates that in situations where it is not feasible to adhere to the recommended interval (21 days for Pfizer and 28 days for Moderna, the second dose can be administered to 6 weeks (42 days) after the first.
Did you miss HFAM's previous alerts?

Visit our website to view all previous HFAM alerts, as well as guidance
from our federal and state partners.
Thank you.

We cannot thank you enough for the dedication and diligence in doing all that you can for the residents in your communities. HFAM continues to monitor the COVID-19 pandemic with our state and national partners and will do all we can to support you during this time.