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California Focus Opinion

California Focus: Nursing home residents need high vaccine priority

Teachers’ unions, police and firefighters argued in early December they ought to get the expected new coronavirus vaccines before anyone else but health workers.

They got a tough response at the federal Centers for Disease Control, now operating as it is supposed to for the first time since Donald Trump became president. Freed after the fall election of censorship by political operatives Trump stationed in its executive offices, the CDC let its vaccine advisory committee of top epidemiologists and ethics experts write the priority guidelines most states will follow in distributing still-scarce vaccines.

They very properly placed nursing home residents alongside medical personnel as the first recipients. But that’s not how California now says it will operate.

Yes, health workers will be the first Californians to get the vaccine. But not nursing home residents. This is a huge failing in the state’s plan for prioritizing inoculations against the plague that has killed almost 300,000 Americans — about one-third of them living in long-term care.

Yes, just about everyone agrees front-line medical responders need first crack at the two new vaccines entering national use.

Beyond that, things are murkier. People with underlying pre-existing medical conditions like suppressed immune systems and heart disease ought to go next, some academic ethicists said. Nope, said others, the vaccine should go first to the elderly, about 65% of the COVID-19 patient load.

Teachers, cops and firefighters should make up the second group, said their unions, teachers arguing that schools can only reopen widely after they get their shots.

This has some validity but ignores the one group that fits into both the medical condition class and the elderly category: nursing home residents.

The proportion of disease victims and the degree of isolation among denizens of nursing homes has been staggering. Most have been deprived of virtually all direct contact with family and friends for the 9-month (so far) duration of anti-virus lockdown measures.

For some, this causes extreme disorientation and distress as they suffer diseases and death in isolation, notwithstanding a few ground-floor window sightings and the occasional outdoor visit.

The coronavirus has also taken more lives in nursing homes than anywhere else — about 40% of California deaths from the virus.

With each viral surge, the scene in nursing homes grows more grim. Especially in larger facilities catering mostly to Medi-Cal patients, who often turn their life savings over to government to qualify for financial aid.

During October and November, new COVID-19 cases in nursing homes surged fourfold in more than 20 states. Unlike most others, residents of the homes can’t do much about it.

They cannot avoid close contact with nursing home staffers, from nurses and other aides to administrators. Those staffers come and go daily, subject to the same contagions as the general public. That’s why even California’s plan gives them the same priority as other health workers.

Staffers serve meals to residents, help them bathe, assist them to sitting areas and to bathrooms. When they are infected, residents are, too. When caseloads outside the homes rise, they skyrocket on the inside.

What’s more, most residents are elderly. Few would live in skilled nursing facilities if they did not have some pre-existing condition also making them extra-susceptible to COVID-19.

Residents of the 14,000 facilities belonging to the American Health Care Association and the National Center for Assisted Living may be followed statistically more closely than people in other homes. It’s from them that we learn how caseloads among long-term care residents rise faster and lead to many more deaths per capita than on the outside.

This all explains why the CDC committee had nursing home folks share top priority for the new vaccinations. They may be only subsets of the elderly and people with medical conditions, but they are the main reason statistics for those two classes are so cruel.

If the lives of people in the homes have value — and California’s newly set priorities suggest some think they don’t — they must get the new shots before anyone other than front-line medical workers.

But in California, it appears they won’t, and that is both inhumane and unfair.

Email Thomas Elias at [email protected].

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