Noam Galai / Noam Galai for Getty Images
Dr Leora Horwitz is treating fewer and fewer COVID-19 patients at NYU Langone Medical Center in New York City. Still, she thinks there are too many.
And, in particular, COVID patients almost all have something in common.
“I have only had one patient who was vaccinated and he was treated for cancer with chemotherapy,” she says, referring to recent research on the limited effectiveness of vaccines for cancer patients.
But what if you take that patient out of the equation and look at the rest? “Not everyone has been vaccinated,” explains Horwitz, internist and hospital researcher.
While caring for those severely ill with COVID, Horwitz asks these patients, with sympathy and respect: why not get vaccinated?
A few of the patients told him they were concerned about the safety of the vaccines. But mainly, she says, the responses fall into two groups: one includes people who have planned to get the vaccine but have not yet done so. The second group highlights a worrying gap in the city’s public health response to the pandemic: patients wanting to be vaccinated but unable to do so because they are confined to their homes.
“For many older people, people with chronic illnesses, it was very difficult for them to go out and get vaccinated,” she says. And, as many of these patients receive home visits from health care providers, she wonders why the vaccine was not given to them.
“They are already connected to a health care organization that comes to their home regularly. It looks like this should be a strategy we should be using,” Horwitz said.
Hospitals report most COVID hospital patients had not been vaccinated
Doctors in Denver, Cleveland and other cities have noted the same trend: COVID departments are filled with unvaccinated people. According to the Centers for Disease Control and Prevention, 76% of Americans aged 65 and over have been fully immunized and about 87% have received at least one dose.
Cities and states have slowly implemented programs to reach some of the 4 million homebound Americans in the country, but the programs tend to have modest goals and only target a fraction of the people who have. probably need awareness.
To increase financial incentives to immunize people at home, Medicare recently announced that it would reimburse injections delivered this way at $ 75 per injection instead of $ 40 per injection.
New York City launched a program to reach homebound people in March by working with housing agencies, private health care providers, the city’s Department of Aging, and nursing teams from the ward. fire. By the second week of June, the program had reached 11,000 people, according to a spokesperson for the town hall.
Horwitz and others say the city’s program for reaching these people appears to be working, but not as quickly and efficiently as it can.
For example, the Visiting Nurse Service of New York, one of the region’s largest home care providers, has a contract with the city to vaccinate residents of Queens. Anyone confined to the home in Queens is eligible whether or not they are a VNS client. But if you’re in Brooklyn, Manhattan, Staten Island, or the Bronx and receiving home care from VNS, it won’t help you get the vaccine. You then need to go through the central bureaucracy and be assigned to one of the other contracted vendors to work in your area.
“The city and the providers we use are the primary entity for home immunizations in the city,” said Avery Cohen, spokesperson for the administration of New York Mayor Bill de Blasio. “It is a long and complex operation, and we are doing our best to reach as many people as possible.”
A spokesperson for the Visiting Nurse Service said that in the past 10 weeks, its nursing teams have administered 2,600 doses and vaccinated 1,700 residents of Queens. The contract runs until early July.
Homebound patients are by definition isolated and their needs vary.
About 75% of the city’s residents aged 65 and over are partially or fully vaccinated, according to the city’s Vaccine Dashboard. This is about 10 points lower than the national average. It’s hard to say how many of the remaining 25% are homebound, but advocates say it’s surely several times larger than the 23,000 people the city is targeting in its home vaccination effort.
This is because defining and counting “held home” can be problematic. Laird Gallagher, of the Center for an Urban Future, says there are 141,000 people aged 60 and over who live alone and report ambulatory difficulties in New York City. Susan Dooha of the Center for Independence of the Disabled, using a broader standard for disability, estimates that there are 422,000 city dwellers aged 65 and over who are either completely housebound or severely disabled, including 262,000 who are at least 75 years old.
Dooha says the city should cast a wider net in the definition of containment and then create a network of public and private providers to meet the immunization needs of this population. Some who are not vaccinated despite the desire to be vaccinated may meet certain needs on their own. But they may be cognitively impaired and not have the organizational means to find a hit, says Horwitz.
After raising the issue for much of the past six months, Dooha was happy the mayor had announced a program, but was immediately appalled at his limitations. “I kept asking, what are the criteria? ” “, she says. “Under the [Americans with Disabilities Act], if you need a home visit – you don’t have to be absolutely homebound with a disability – you deserve housing. “
Manhattan Borough President Gale Brewer, who sits on a panel overseeing the vaccine rollout in Manhattan, says she was unable to get a direct response from city officials on how which they define “home,” then decides who is targeted for home visits for vaccines.
“There was a lot of back and forth and confusion,” Brewer says. “It’s like, ‘Am I confined to the house if I go down to get my mail, but don’t go out?’ The real problem is transparency, and we don’t know what the rules are, and we don’t have any data. “
Dr Zenobia Brown, a doctor and executive at Northwell Health, New York state’s largest hospital network, foresees a difficult task getting the remaining New Yorkers vaccinated.
“What we are finding is that there is not a single barrier, not even a single set of barriers,” says Brown. “We’re at the point where it’s a hand-to-hand combat, to understand what the individual barriers are and then create solutions for them.”
For example, the parents of a 22-year-old autistic man wanted their son to be vaccinated, but due to very fixed routines they were only able to make him available at limited times. Another patient, in his 90s, did not want to disturb anyone to come to his sixth-floor elevator-free apartment.
Family photo courtesy of Jennifer Kotter
Robert Janz, 88, and his wife, Jennifer Kotter, 68, did not hesitate to ask for help. As soon as the city’s plans were announced to serve the housebound, Kotter tried to secure a date for her husband, an artist and a poet who is bedridden due to what she describes as a “series of minor medical failures”, including back injuries from a fall.
It took months before she could book her husband’s immunization – even though caregivers already come frequently to their no-elevator apartment on Manhattan’s fourth floor. One of them gave Kotter a phone number to call, which led to another phone number, then another, until she was finally successful. On June 1, a nurse and paramedic arrived together and administered the Johnson & Johnson single-shot vaccine to Janz.
Kotter came to expect such delays as a caregiver. “When you take care of a patient, you have to be patient,” she said.
This story comes from NPR’s reporting partnership with KHN (Kaiser Health News), a national newsroom that produces in-depth journalism on health issues.