What Long-Term Care Facility Administrators Should Know

Staff and residents of nursing homes and assisted living facilities are among the first groups to receive COVID-19 vaccines in the United States. As an administrator, your and your staff’s participation in vaccine safety monitoring is essential to ensuring the safety of COVID-19 vaccines. No safety concerns have been detected to date, but ongoing monitoring will continue. The CDC has expanded safety surveillance through new systems and additional information sources, as well as by scaling up existing safety monitoring systems.

What is V-Safe?

V-safe is a new smartphone-based tool that helps CDC monitor the safety of COVID-19 vaccines through the use of text messaging and web surveys. These health check-ins inform CDC how the participant is feeling after receiving a COVID-19 vaccine. Depending on the answers, someone from CDC may call to check on the participant and get more information. V-safe will also remind the participant to get a second dose of the vaccine if they need one. V-safe enrollment and check-ins are quick and easy and can be done on a smartphone. V-safe cannot schedule vaccination appointments. If a participant needs to schedule, reschedule, or cancel a COVID-19 vaccination appointment, they should contact either the location that set up their appointment or local vaccination provider.

• All long-term care staff members who are vaccinated against COVID-19 are encouraged to enroll in V-safe.
• Long-term care residents can also enroll in V-safe. Healthcare providers and caregivers may assist residents with enrolling. However, providers or caregivers should not complete check-ins for residents.
• At this time, only people with smartphones will be able to participate in V-safe monitoring. Long-term care residents may be less likely to have access to a smartphone and, therefore, may not be able to report side effects or adverse events through V-safe. Long-term care staff should monitor recently vaccinated residents for any potential adverse events and report those events to VAERS.

What is VAERS?

VAERS is a national vaccine safety monitoring system that helps CDC and the FDA monitor health problems after vaccination. VAERS is not designed to determine if a vaccine a health problem but is especially useful for detecting unusual or unexpected patterns of adverse event reporting that might indicate a possible safety problem with a vaccine. Residents, caregivers, healthcare providers, and nursing home staff can report medical events or health problems following vaccinations to VAERS, even if they aren’t sure the vaccine was the cause.

• Anyone can report health problems that happen after vaccination to VAERS.
• In general, report any medical event or health problem after COVID-19 vaccination that is concerning to you, your staff, or your residents.
• It is especially important to report any problem that results in hospitalization, significant disability, or death.
• VAERS does NOT provide treatment or medical advice. If a vaccine recipient needs medical advice, please contact a healthcare provider.

Healthcare providers are encouraged to report to VAERS any adverse event they think is medically important or clinically significant, even if they think the event might not be related to the vaccine. However, healthcare providers are required to report to VAERS the following adverse events, in accordance with the emergency use authorization (EUA) for COVID-19 vaccines:

• Vaccine administration errors, whether or not associated with an adverse event
• Serious adverse events (as defined by federal law), regardless of causality, including:
  • Death
  • A life-threatening event
  • Inpatient hospitalization or prolongation of existing hospitalization
  • Persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions
  • Congenital anomaly/birth defect
  • An important medical event that based on appropriate medical judgement may jeopardize the individual and may require medical or surgical intervention to prevent one of the outcomes listed above
  • Cases of Multisystem Inflammatory Syndrome (MIS-C or MIS-A)
  • Cases of COVID-19 that result in hospitalization or death

To learn more, visit https://www.cdc.gov/vaccines/covid-19/downloads/ltcf-help-monitor-covid-19-vaccine-safety-508.pdf

COVID-19 spreads easily between people. CDC tracks how much COVID-19 is spreading as well as likely people are to be exposed to it with a measurement known as the “level of community transmission”. You can use the COVID-19 County Check Tool for a snapshot of your county’s level of community transmission over the past 7 days. The tool also displays guidance on masking based on how the virus is spreading in your county.

How CDC Measures the County Level of Community Transmission

CDC looks at two numbers – total new cases and percent positivity – to determine the level of community transmission.

• Total New Cases refers to a county’s rate of new COVID-19 infections, reported over the past 7 days, per every 100,000 residents. To calculate this number, CDC divides the total number of new infections by the total population in that county. CDC multiplies this number by 100,000.
• Percent Positivity refers to the percentage of positive COVID-19 tests in a county over the past 7 days. This number is based on reports from states on a specific type of test known as a Nucleic Acid Amplification Test (NAAT). To calculate this number, CDC divides the number of positive tests by the total number of NAATs performed in that county. CDC multiplies this number by 100 to calculate the percentage of all tests that were positive. Learn more at Calculating SARS-CoV-2 Laboratory Test Percent Positivity.

A higher number of total new cases and a higher percent positivity correspond with a higher level of community transmission, as shown below. If the values for each of these two metric differ (for example, if one indicated moderate and the other low), then the higher of the two should be used to make decisions about mask use in a county.

County Level of Community Transmission and Masking

People and local decision-makers should consider the county level of community transmission when making decisions about masking. Although COVID-19 vaccines authorized in the United States are highly effective at limiting the spread of COVID-19 and preventing severe illness, vaccination in some parts of the country remains low. Layered prevention strategies – like masking along with getting vaccinated – can help further reduce the spread of COVID-19. CDC’s updated guidance, issued in July 2021, advises using county community transmission levels over the last 7 days to help determine who should mask and under what circumstances. See below for a quick reference on when to mask:

County Level of Community Transmission	Guidance
High or Substantial Transmission	Everyone should wear a mask in public, indoor settings
Moderate or Low Transmission	Unvaccinated people should wear a mask in public, indoor settings

Mask requirements vary from place to place. Make sure you follow local laws, rules, regulation, or guidance. To learn more, visit https://www.cdc.gov/coronavirus/2019-ncov/more/aboutcovidcountycheck/index.html

What We Know

Two 2-dose mRNA COVID-19 vaccines (from Pfizer-BioNTech and Moderna) and a 1-dose viral vector vaccine (from Janssen [Johnson & Johnson]) are currently used in the United states.

• Pfizer-BioNTech
• Moderna
• Johnson &Johnson’s Janssen

What is New

Among US adults without immunocompromising conditions, vaccine effectiveness against COVID-19 hospitalization during March 11-August 15, 2021, was higher for the Moderna vaccine (93%) than the Pfizer-BioNTech vaccine (88%) and the Janssen vaccine (71%).

Implications for Public Health Practice

Although these real-world data suggest some variation in levels of protection by vaccine, all FDA-approved or authorized COVID-19 vaccines provide substantial protection against COVID-19 hospitalization.

Two-dose regiments of the Moderna and Pfizer-BioNTech mRNA vaccines provided a high level of protection against COVID-19 hospitalizations in a real-world evaluation at 21 hospitals during March-August 2021. VE against COVID-19 hospitalization for Moderna and Pfizer-BioNTech vaccines was 93% and 88%, respectively, whereas the single-dose Janssen vaccine had someone lower VE at 71%. Persons vaccinated with Janssen also had lower postvaccination anti-SARS-CoV-2 antibody levels than did recipients of mRNA vaccines. Although an immunologic correlate or protection has not been established for COVID-19 vaccines, antibody titers after infection and vaccination have been associated with protection (8). These real-world data suggests that the 2-dose Moderna and Pfizer-BioNTech mRNA vaccine regimens provide more protection than does the 1-dose Janssen viral vector vaccine regimen. Although the Janssen vaccine had lower observed VE, 1 dose of Janssen vaccine still reduced risk for COVID-19-associated hospitalization by 71%.

The findings in this report are subject to at least six limitations. First, this analysis did not consider children, immunocompromised adults, or VE against COVID-19 that did not result in hospitalization. Second, the Cis for the Janssen VE estimates were wide because of the relatively small number of patients who received this vaccine. Third, follow-up time was limited to approximately 29 weeks since receipt of full vaccination, and further surveillance of VE over time is warranted. Fourth, although VE estimates were adjusted for relevant potential confounders, residual confounding is possible. Fifth, product-specific VE by variant, including against Delta variants (B.1.617.2 and AY sublineages), was not evaluated. Finally, antibody levels were measured at only a single time point 2-6 weeks after vaccination and changes in antibody response over time as well as cell-mediated immune responses were not assessed.

To learn more, visit https://www.cdc.gov/mmwr/volumes/70/wr/mm7038e1.htm?s_cid=mm7038e1_x

You should get a COVID-19 vaccine, even if you have already had COVID-19. Research has not yet shown how long you are protected from getting COVID-19 again after you recover from COVID-19. COVID-19 vaccinations also help protect you even if you’ve already had the virus

Evidence is emerging that people get better protection by being fully vaccinated compared with having COVID-19. One study showed that unvaccinated people who already had COVID-19 are more than two times as likely than fully vaccinated people to get COVID-19 again. Learn more about why getting vaccinated is a safer way to build protection than getting infected. If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your healthcare professional if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.

Experts are still learning more about how long vaccines protect against COVID-19 in real-world conditions. CDC will keep the public informed as new evidence becomes available. To learn more, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/prepare-for-vaccination.html

South Shore Nursing & Rehabilitation is proud to recognize Bonnie Ritchie’s Success Story.

Bonnie came to South Shore in late July after a hospital stay. The beginning process was difficult for Bonnie, but now she has fully recovered! Bonnie said her favorite thing about being here is talking to the other residents. She is so fun to talk to and she will make you laugh within minutes of the conversation. Bonnie will be returning home this week and we are sad to see her go, but we wish her the very best and hope she does great at home. Bonnie, we are going to miss you!

South Shore Nursing & Rehabilitation is proud to recognize Michelle William’s Success Story.

Michelle Williams has been a resident here at South Shore a few times now. This last time, she came to us for therapy after a repair to a tendon in her right leg. Michelle always works hard, and this time was no different. In just two short months, Michelle was moving around with ease, and walking up and down steps. She was ready to go home! Our great therapy team did an amazing job helping get Michelle back on her feet and doing the things she loves. Everyone here loves Michelle; she definitely has made some life-long friends here at the Shore.

Michelle, we are so proud of you and all your persistence. We wish you the best of luck!

Find a COVID-19 Vaccine: Search vaccines.gov, text your ZIP code to 438829, or call 1-800-232-0233 to find locations near you in the U.S. 

There are several ways you can look for vaccination providers near you in the United States. 

• Visit Vaccines.gov to find vaccination providers near you. In some states, information may be limited while more U. S. vaccination providers and pharmacies are being added. Learn more about COVID-19 Vaccination Locations on Vaccines.gov. 
• Text your ZIP code to 438829 or call 1-800-232-0233 to find vaccine locations near you in the United States. 
• Check your local pharmacy’s website to see if vaccination appointments are available. Find out which pharmacies are participating in the Federal Retail Pharmacy Program. 

• Contact your state health department to find additional vaccination locations in the area. 
• Check your local news outlets. They may have information on how to get a vaccination appointment. 

The COVID-19 Viral Testing Tool is an interactive web tool designed to help both healthcare providers and individuals understand COVID-19 testing options. This tool helps healthcare providers quickly access the most relevant, actionable information to determine what type(s) of COVID-19 testing they should recommend to patients. The tool helps individuals determine what type of test they should seek. After test results are in, the tool can help interpret test results and guide next steps.  

The online, mobile-friendly tool asks a series of questions, and provides recommended actions and resources based on the user’s responses. 

To use the COVID-19 Viral Testing Tool click here: Testing | CDC 

Now that there are authorized and recommended COVID-19 vaccines in the United States, accurate vaccine information is critical and can help stop common myths and rumors. Read about some common myths here: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html  

How do I know which COVID-19 vaccine information are accurate?  

It can be difficult to know which sources of information you can trust. Before considering vaccine information on the Internet, check that the information comes from a credible source and is updated on a regular basis. Learn more about finding credible vaccine information.   

The COVID-19 Travel Planner is a centralized communication platform that travelers can search to find COVID-19 information for the state, local, territorial, and tribal communities they’re passing through and for their destinations. This information will help travelers make informed decisions, protect themselves, and reduce transmission before, during and after they travel. Learn how you can promote Travel Planner on your social media platforms and website. 

Check Travel Planner for state, local, tribal, and territorial government restrictions before traveling.