The vaccins are coming!

In the context where the first vaccines become available, this raises questions for our organizations about the measures to be taken or advice to be given. In the United States, Little Brothers – Friends of the Elderly opens the debate with this article published in their second edition of Network News & More, December 2020.

“According to the experts, the end of the pandemic is in sight and will come through widespread vaccination. Dozens of companies have been scrambling to produce vaccines, and as of early December, three had released data from trials showing their vaccines worked. In the United States, the next steps are for a panel of the Federal Drug Administration, or FDA, to review the data and decide whether to issue an EUA or Emergency Use Authorization. Once that happens, the first vaccines will be sent out and offered to people according to their priority groups. Prioritization at a national level is being decided by a CDC Advisory Committee on Immunization Practices. States have similar groups, and local public health departments are already at work on the logistics of distribution.

For now, health care workers (not just clinicians but anyone at risk and not just hospitals but also community workers) and long-term care (skilled nursing, nursing homes, assisted living) residents and staff are in the first group, essential workers (people needed to keep society and the economy going) are in the second group, and older adults and people with preexisting conditions are in the third group. But this may vary by locality and is subject to change. Some people are eager to be vaccinated and others are hesitant for a wide variety of reasons from politics to past and present racial injustice.

The situation is complex. We need the vaccine to end the pandemic, stop the isolation and deaths of Americans – realities for all ages but particularly for older people, and get the tens of millions of newly unemployed, homeless and hungry people back to decent lives. The vaccines appear to work well, protecting more than 90% effective. Yet there are many different types of vaccines, that work on the immune system in different ways. And there is much we don’t know: how long will the protection last? Do the vaccines prevent transmission to others in addition to preventing disease in the vaccinated person? What are the differences in the effectiveness of the vaccines? Will they work better, as well, or less well in different age groups?

It’s worth considering how these developments will impact Little Brothers – Friends of the Elderly: elders, staff and volunteers. Although our elders are very high risk, they are not in the first priority group unless they live in a board and care or other congregate setting, and many don’t. Still, they are very high risk since 80% of covid deaths have been in elders with the risk for serious illness, hospitalization and death rising dramatically with age, starting at age 50 and especially for those over 70 or 80 years old with other medical conditions. That means in the immediate future, our focus must remain on combatting loneliness despite their ongoing isolation. At the same time, it would be good to help them think through whether, when and how to get vaccinated. The trials did include people over age 65 and the companies say they too responded though we don’t know if their responses were different than younger adults. Our elders have the most to gain but they may also need help if they get common side effects such as aches and fevers. They may need help getting to their doctor’s office or another location for vaccination, and they will need phone calls and possibly visits (using all possible precautions) in the days after vaccination.

Depending on the state, staff may or may not count as essential workers. Staff may also qualify for a certain group based on their own age or risk factors and depending on local priorities. The same is true for volunteers. Chapters may want to consider how they will proceed with services in a situation where some staff and volunteers are vaccinated and others are not. Critically, the vaccine protects the person who received it but it is not known whether it protects the vaccinated person from giving the virus to others. That means a vaccinated staff person or volunteer must continue to do the same masking and distancing as everyone else until local public health officials say otherwise.

This will be an interesting time for our organization. It will be important for the chapters to stay up to date on local and national guidance, to be creative in supporting our elders through the coming months, and to work together to share information, knowledge and experiences.”

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