A group of health workers rushed out of a Boston hospital one recent weekday morning, holding small red coolers filled with COVID-19 vaccines.
Their challenge: traffic, an impending snowstorm and beating the clock. They had to receive injections into the arms of their homebound patients before the vaccines expired in a few hours.
“That clock is in the back of my mind all the time,” said Dr. Won Lee, a home care specialist at Boston Medical Center.
Millions of US residents will need COVID-19 vaccines because they rarely, if ever, leave the home. Doctors and nurses specializing in home care are leading this push and are starting to get help from state and local governments around the country.
But they face several challenges. Researchers say many homebound people do not receive regular medical care, making it difficult to identify anyone who needs a vaccine.
Stocks are also limited and both the Pfizer and Moderna vaccines expire a few hours after the syringes withdraw the vaccine from the vials.
That makes it difficult for one doctor to see many patients if they also have to stay at someone’s home for at least 15 minutes after the injection in case an allergic reaction develops.
“They don’t live next to each other,” said Dr. David Moen of Prospero Health Partners, which provides care to patients in several states. “It’s a challenge to go to multiple locations.”
Doctors and nurses specializing in home care are pushing to vaccinate millions of US residents who rarely, if ever, leave home. (February 19).
Still, health care providers report progress. Lee thinks she can give five or six doses on an average day. That will be her main focus in the coming weeks.
One of her recent stops was in the second-floor apartment of a resident patient, 106-year-old Domingas Pina, who has not left home for a year.
Lee sat at her dinner table with Pina, wiped the patient’s shoulder, then quickly administered the injection while Pina looked away.
The patient then smiled under her surgical mask and raised her thumb. Pina, who speaks mainly Portuguese Creole, will receive her second dose of the vaccine next month, around her 107th birthday.
“She misses all of her grandchildren and her friends who came all the time,” said daughter Maria Lopes. “We don’t want to lose her.”
After giving Pina the injection, Lee asked how she was doing and what her blood pressure medication was. Then she took off Pina’s Darth Vader slippers to examine her feet.
It didn’t take long for the doctor to leave for her next patient.
Lee’s office arranges the appointments and explains the vaccine ahead of time. That helps the visit go smoothly, and Lee tries to see patients who live nearby to save time.
She also tells them that she cannot stay too long after the injections “because I have to make sure I get these vaccines with all the patients who need them today.”
Dr. Karen Abrashkin hopes to take a similar approach. She will use mapping software to schedule stops between clusters of patients living together near New York City.
But the director of Northwell Health’s House Calls program is still waiting for the vaccine.
“We get a lot of questions every day about when we will have vaccines to give at home,” she said. “The stock is just not there yet.”
One of her patients, 103-year-old Ida Sobel, has no plans to leave her apartment building until she has been vaccinated.
While she waits, Sobel, who is legally blind and lives with a doctor, receives food. She walks down the hall outside her front door to exercise and opens a window if she wants fresh air.
“I’m in a very busy area,” said the resident of Floral Park, New York. “People are not aware enough to avoid you and stay far away, so I avoid them.”
Dr. Christine Ritchie, a professor at Harvard Medical School, estimates that about 2 million US residents are house-bound. Another 5 million people have difficulty leaving home or need help. Many of them may also need vaccines.
This population generally includes older people with a lower than average income and serious medical problems such as dementia, advanced heart disease or arthritis.
Ritchie noted that homebound people attract less attention from public health officials than those who live in group settings, such as nursing homes, who receive vaccines from major drugstore chains.
Homebound people, Ritchie said, “are usually a little invisible to society.”
On Staten Island, James De Silva has become frustrated at not having good vaccination options for his 96-year-old mother, but people much younger than her can get an injection when they leave home. Mary Stella De Silva is largely bedridden and receives round-the-clock home care.
That care does not include the vaccine, and De Silva will have to arrange an ambulance or special transport to take her to an appointment, if he gets one.
“I think the homebound should be a little more priority than someone who is just 65 and may not have an underlying disease,” he said. “To be honest, it’s not getting the attention it deserves.”
That seems to be changing. Fire departments across the country have started delivering vaccines.
In Corpus Christi, Texas, on the Gulf Coast, the Fire Department has used a list of Meals on Wheels recipients since late January to deliver more than 2,000 doses of the Moderna vaccine. Chief Robert Rocha said they have also set up a hotline for anyone who needs another vaccination.
Last week, New York City Mayor Bill DeBlasio said his city would send medical personnel to the apartments of homebound people as soon as a one-time vaccine from Johnson & Johnson is available. Federal regulators can approve that vaccine in a few weeks.
Such deliveries cannot start soon enough for De Silva and his mother.
“Had she been in a nursing home or long-term care facility, she would have been vaccinated by now,” he said. “She’s really in the same situation, but she’s at home.”
Associated Press video journalist Rodrique Ngowi contributed to this report.
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