Fireside Chat Highlights - Wednesday, January 27, 2021

Regulation | January 27, 2021 | by Jill Schumann

On January 27, 2021, LeadingAge’s Janine Finck-Boyle joined experts Dr. Lee Fleisher (CMS) , Jean Moody-Williams (CMS), Dr. Janell Routh (CDC), Dr. Ruth Link-Gelles (CDC), Arjun Srinivasan (CDC), and Evan Shulman (CMS) for a Fireside Chat.

On January 27, 2021, LeadingAge’s Janine Finck-Boyle joined experts Dr. Lee Fleisher (CMS) , Jean Moody-Williams (CMS), Dr. Janell Routh (CDC), Dr. Ruth Link-Gelles (CDC), Arjun Srinivasan (CDC), and Evan Shulman (CMS) for a Fireside Chat.

Q: There are many questions about how soon there will be changes to guidance on visitation, testing, masking, etc. now that vaccination is underway.

A: CMS and CDC are in daily conversation about this and understand how important these questions are. However, it is early. People need two doses of the vaccine, and then a 10-14 day period after the second dose before they are protected. Some people will not have received any doses for a while for a variety of reasons. And, we don’t know if the vaccine prevents someone from transmitting the disease – they may still potentially be a carrier of the virus. We just don’t know yet, so it is important to adhere to current CMS/CDC guidance regarding masking, infection control, testing, visitation, etc. We look forward to changing that guidance whenever it is possible, but not yet. However, as vaccinations increase that should reduce outbreaks and cases which will, in and of itself, make for less testing and other liberalizations.

Q: We are pleased that the pharmacy partnership includes clinics for HUD Section 202 affordable housing communities. However, these communities have few staff and those are not medical professionals. What advice do you have for HUD communities to help with clinics and with vaccine hesitancy?

A: Three things are important: communication, consistent outreach, and partnership building to identify barriers and build trust. Try to identify trusted community members and equip them to provide information about the vaccines. We need to meet people where they are. There are resources on the CDC website that can be used by HUD 202 service coordinators.

Q: Are there additional resources on the horizon to help with vaccine hesitancy?

A: Yes, CDC is developing specific toolkits for particular audiences. We are also observing that vaccine uptake increases at second and third clinics when people have had a chance to observe that peers are doing well.

Q: Now that there have been more vaccinations, what sorts of adverse reactions are you seeing?

A: Beyond the small number of cases of anaphylaxis we are not seeing adverse reactions other than those expected – sore arm, fever, headache, fatigue, and chills. We have data from the more than 2 million people who are reporting through the V-SAFE platform.

Q: Some people need more basic information about how the MRNA vaccine works.

A: MRNA harnesses a process that our cells use every day to make proteins. The vaccine teaches our cells to make a precise protein that lives on the surface of the virus. The vaccine breaks down and doesn’t remain, but the body has an immune response. The MRNA is broken down by our cells – it doesn’t enter the cell nucleus and does not enter or alter our DNA. MRNA technology has been around for ten years. These vaccines have been rigorously tested. Safety is first and foremost at the CDC.

Q: What will happen when the Pharmacy Partnership ends?

A: CDC is gearing up a retail pharmacy partnership program and it will be expanded to include 21 different partners including groups of small chains. There will also be a list of the long term care pharmacies to be included. Some states are working on state-level partnerships and strategies. We know that there will be ongoing need and we recognize that there is resident/client/ patient/ staff turnover.

Q: We are hearing in the media reports of vaccine doses being taken back from the Partnership.

A: It is difficult to anticipate the precise number of people in Pharmacy Partnership sites who will receive the vaccine on any given day as census varies and the number of staff choosing to be vaccinated varies. Pharmacies need to take extra vaccine doses back to use in their own pharmacies or to follow the instructions of the state.

Q: Can you speak to new vaccines in the pipeline?

A: There are two new vaccine candidates nearing completion. One is the AstraZeneca vaccine which is a two- dose adenovirus vaccine. The other is the Johnson and Johnson vaccine, a one-dose adenovirus vaccine. J and J’s trials are fully enrolled (45,000) and it seems likely that they will file for EUA in February.

Q: Do the Moderna or Pfizer vaccines use fetal cells?

A: They do not use fetal cells.

Q: Should people be double-masking?

A: We do not recommend double-masking. We where masks for two reasons. The first is source control – your mask protects me. The other is for our own protection. In health care masks such as the recommended N 95 has respiratory protection. If you start adding layers of PPE it makes it harder to deliver healthcare and the danger is with taking PPE off, not putting it on. Adding elements can increase chances of contaminating yourself.

Q: What level of protection to people have after the first dose of the vaccine?

A: We don’t have data to support that one dose offers effective protection, so our message is to get the second dose and at the recommended interval. We have seen some barriers to getting the second dose on such a rigid schedule so we have relaxed slightly and are now saying that people can get the second dose up to six weeks after the first dose. But, we stress that people should try to get the second dose within the prescribed window.

Q: Has the vaccine been studied enough in persons of color?

A: Persons of color were included in clinical trials for both vaccines. V-SAFE will provide additional data. We recognize that vaccine distribution and administration needs to be equitable. The CDC is also developing toolkits designed to promote confidence in communities of color.

Q: Thinking about home and community based services, we are wondering what sorts of chronic conditions for people under 65 would make them early vaccine-eligible?

A: There is CDC guidance regarding what conditions make people more at risk for severe COVID and those are generally the ones considered, however there is variation among jurisdictions.

NOTE: All Fireside chat recordings are housed on the CMS website here: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts