Staff and residents at senior care facilities may be only days behind

By Deanna Pan and Robert Weisman Globe Staff,Updated December 11, 2020, 7:03 p.m.

The Food and Drug Administration Friday night approved the first COVID-19 vaccine in the United States for emergency use, clearing the way for the first Massachusetts residents to receive inoculations as soon as Tuesday, as hospitals and senior care facilities say they can begin immunizing staff and residents within hours of receiving their shipments of the precious cargo.

Shipments of the two-dose regimen from drug makers Pfizer and BioNtech, packed in dry ice, should be en route to hospitals on Monday or Tuesday, officials said.

Within 24 hours of receiving their first shipment, officials at the state’s largest hospital system, Mass General Brigham, will be able to vaccinate a limited number of employees, said Dr. Paul Biddinger, the system’s medical director for emergency preparedness. He said the system, which includes Mass General and Brigham and Women’s hospitals, expects to ramp up vaccination capacity before the end of the week.

“We want to start with a minimum across the enterprise of 1,000 employees a day, but we want to actually be able to accelerate beyond that relatively quickly,” Biddinger said. “We’re hoping it’s only a matter of a couple of months to get us through the majority of our workforce.”

Mass. hospitals hope to administer COVID-19 vaccine to some workers as soon as next week

Dr. Saul Weingart, chief medical officer at Tufts Medical Center, said he anticipates the hospital will receive its first 975 doses on Monday, and begin offering the vaccine to employees in “patient-facing” areas shortly after that.

“So we would potentially have about 1,500 to 2,000 staff members who would be eligible to receive the vaccine, and our expectation is we would get it into them all in a six-week period,” he said.

Boston Medical Center, meanwhile, is preparing to roll out its staff vaccination program on Dec. 16, the day after the hospital expects to receive its shipment of two trays containing 975 vaccines each. BMC has already hired temporary nurses on contract to begin administering shots.

The hospital is still finalizing which employees will be offered vaccinations first, explained David Twitchell, BMC’s chief pharmacy officer, with staff who are at risk of exposure to COVID-19 receiving priority. Employees will be notified of the opportunity to schedule their vaccination appointments in randomized batches of 300.

“We’re trying to be transparent [about the process],” he said. “It’s not about one person being more important than the other; it’s about trying to have a rational way of rolling this out.”

Governor Charlie Baker this week announced a plan to offer the first vaccinations primarily to health care workers and seniors in long-term care facilities. He expects the state to receive 300,000 doses of the vaccine by the end of December, although this is contingent on the FDA giving approval to vaccines developed by Pfizer and Cambridge-based Moderna.

Mass. lays out COVID-19 vaccine timeline, but most will have to wait till spring

The FDA advisory committee is scheduled to debate whether to allow emergency use of Moderna’s vaccine next Thursday.

Both vaccines require people to get two shots a few weeks apart to be maximally effective; the shots also must be kept at extremely cold temperatures to prevent the vaccines from spoiling. As a result, the first shipment of Pfizer’s vaccine is being delivered only to Massachusetts hospitals equipped with ultra-cold freezers.

Senior care sites are hustling to set up their own vaccination spaces, ready consent forms and protective gear, and reassure skeptical health workers and seniors that the vaccines are safe and effective.

“This is an entirely new experience,” said Matt Salmon, chief executive of Salmon Health and Retirement, which hopes to vaccinate 700 residents and 1,500 staffers at a half dozen skilled nursing facilities across central Massachusetts over the coming weeks. “In the history of nursing homes, we’ve never had to do mass vaccinations in such a short period of time.”

Some senior care facility administrators have been told vaccinations at their sites will start on the week of Dec. 21 or the following week. But they are clamoring for more information from federal health authorities and from their contractors, CVS and Walgreen, which will administer the vaccination clinics, on how it’s all going to work.

“Operators are living in fear that they’ll just get a knock on their door,” and the vaccinations will begin without adequate preparation, said Tara Gregorio, president of the Massachusetts Senior Care Association.

While the pharmacy companies have promised to bring the equipment needed to handle the injections and have hosted webinars providing basic information, senior care operators say they’re still in the dark on key points, such as clinic hours and expectations of their staffs.

The companies, following federal guidelines, have committed to making only three visits to each nursing home, rest home, and assisted living center to administer the two-dose regimen — a schedule operators say is far too compressed to vaccinate hundreds of staffers working in three shifts. Some fear that side effects of the vaccine could cause temporary staff shortages if everyone is vaccinated at once.

“We have a lot of ground to cover between now and when the vaccinations start,” Salmon said. “If we don’t coordinate on this, it’s not going to be as effective as it could be.”

Assisted living administrators, meanwhile, are waiting to find out how many initial doses they will receive from the state. They’re also cautioning against letting down their guard at a time when virus infections are rising in senior facilities.

“We want to lean into best practices in infection control in assisted living now as we see the light at the end of the tunnel,” said Brian Doherty, president of the Massachusetts Assisted Living Association.

Some organizations employing home health care workers have registered to receive vaccine supplies from the state Department of Public Health. Front-line workers who help home-bound seniors are in the high-risk group set to be vaccinated first, but details of how and when they’ll get their shots remain to be worked out.

“As soon as we can do it, we’re ready to go,” said Dr. Joanna Duby, medical director at Element Care in Lynn, a nonprofit that sends more than 100 nurses, personal care assistants, physical and occupational therapists, and other workers into the homes of elderly low-income residents. “In terms of when we’re going to get the vaccine and how we’re going to get it, we’ll wait to hear.”

Staff at senior care facilities have gotten used to adjusting to fast-changing conditions since the COVID-19 pandemic began last spring, but Salmon of Salmon Health and Retirement, said preparing for vaccinations on short notice without adequate information may pose the biggest challenge yet.

“This is a whole new level of flying by the seat of our pants,” he said.

At Mass General Brigham, by contrast, administrators are well along planning a rapid mass vaccination. They’ve divided the work force into four waves, starting with staffers involved directly in COVID-19 evaluation, testing, and care. The hospital system also is launching a feature on one of its smartphone apps that will allow staff to schedule their vaccination appointments.

“We want to try and make it through each of the wave as quickly as we can,” Biddinger said.