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The Latest COVID-19 News, Delivered to You!
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Welcome to the National Health Care for the Homeless Council’s COVID-19 Flash Blast. This brief synopsis of key issues specific to the HCH community, policy developments, resources, and reading lists on the topic of COVID-19 will be delivered every two weeks. You are receiving this email because you subscribe to NHCHC communications. If you do not wish to receive this bi-weekly alert, you may unsubscribe below. (Note: These e-blasts will be archived here.)
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Not “Waste”: Unused Vaccines Are an Investment in Your Vaccinated Clients
Providing services -- to include vaccines -- to a person at the time when they are ready to receive them is essential for building trust and improving health outcomes. Without access to single-dose vials, however, HCH’ers are presented with a dilemma: open a new vial, vaccinate the person in front of you, and risk “wasting” the other doses in the vial (sometimes as many as 10); or schedule a vaccine appointment and risk the client not returning. Fortunately, the CDC’s response is clear: “Providers should not miss any opportunities to vaccinate every eligible person who presents at a vaccination site, even if it means puncturing a multidose vial to administer vaccine without having enough people available to receive each dose.”
After months of being directed to not waste a drop and spending hours locating enough people to ensure every dose gets used, health care providers are often still struggling with the reality of potentially wasting lifesaving vaccine (even though for-profit pharmacy chains have contributed to most of the wasted doses). Consider those doses that go unused as “investment doses” in the person who is getting vaccinated, and celebrate the success of making another step toward herd immunity.
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Modifying Shelter COVID-19 Protocols
The CDC also released updated guidance containing important considerations for homeless service providers who are considering decreasing facility-level measures to prevent the spread of COVID-19. Essential to this guidance is the direction to make small, incremental changes only when your community’s COVID-19 positivity rates indicate that it is safe to do so, both within the facility and the broader community. These changes should be made one at a time and assessed for impact before considering additional modifications. As an alternative to removing these safety measures, communities should focus their efforts on continuing alternate care sites and investing in permanent housing.
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CURRENT/EMERGING ISSUES & STRATEGIES FOR SUCCESS
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With new developments every day in the nation's effort to control the COVID-19 pandemic, there are a number of emerging issues for HCHs that we are following:
Current/Emerging Issues
- Decreasing vaccine acceptance in those who have not yet received it now that supply is no longer an issue.
- Offering health education is taking longer, requiring more contacts, and producing less vaccine excitement than previous efforts.
- Assuring staff that it is okay to “waste” vaccine when necessary is difficult for many to accept (see information above).
- Knowing clients’ vaccination status is more difficult as more communities offer incentives and clients are now less likely to get vaccinated by their primary providers.
- Discussing the “freedoms” of being vaccinated (e.g., not wearing a mask, not needing to distance, etc.) can be an incentive for some, while others may be taking those freedoms without getting the vaccine.
- Closing alternate care sites with no adequate plans for preventing a return to congregate shelters is a significant concern as efforts to make more permanent improvements continue.
- Continuing challenges with some community partners not allowing the Johnson & Johnson vaccine to be administered at their sites due to concern about how the vaccine was developed.
- Sweeping encampments prevents both health education efforts and vaccine events from taking place at those sites because the residents have dispersed.
- Expanding opportunities to use vaccine ambassadors is often limited by funding uncertainties.
- Determining vaccination rates among this population is challenging without the ability to conduct data-matching between homeless services (often HMIS) and state vaccine databases.
Strategies for Success
- Offering incentives persuades some people to receive the vaccine. Incentives may be gift cards, hygiene items, or hotel stays to recuperate from vaccine side effects.
- Schedule vaccine clinics on Fridays to allow those who work Monday-Friday time to recover from side effects.
- As an added incentive, discuss what vaccinated people can do without wearing a mask.
- Use alternate care sites as venues for administering vaccines and engaging clients in other services.
- For multi-site clinics, transport single syringes of vaccines from one site to another to minimize unused doses.
- Collaborate with local education institutions to develop and offer vaccine ambassador training programs.
- Purchase isolation hotels and transition to providing medical respite care or permanent housing as the need for isolation and quarantine decreases.
- Extend isolation and quarantine accommodations even if decompression alternate care sites are discontinued.
- For clients getting another service during a visit, administer the vaccine at the beginning of the clinical visit so that the observation time can occur over the course of the visit, negating the need for the patient to stay longer and a designated observation area.
- Commit to housing residents currently staying in protective housing/alternative care sites rather than returning them to congregate shelters.
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There will be many policy changes related to C19 in the next several months as the Biden-Harris administration moves forward with its agenda. Below are the most recent developments:
- The CDC published guidance on vaccine wastage, which prioritizes vaccinating any interested individual even if it means that other doses in the vial may need to be wasted. (See above text box for more information.)
- The FDA authorized longer storage time for thawed Pfizer-BioNTech COVID-19 vaccine. Undiluted Pfizer vaccine vials can now be stored up to one month at refrigerator temperatures.
- HHS designated $4.8 billion from the American Rescue Plan Act for COVID-19 testing for the approximately 29 million uninsured U.S. residents.
- HRSA announced a Notice of Funding Opportunity (NOFO) for health centers to create and expand their public health workforce, which includes hiring community health workers, patient navigators, and social support specialists.
- The U.S. Equal Employment Opportunity Commission (EEOC) announced that employers may require all in-person employees to be vaccinated, provide non-coercive incentives to employees to be vaccinated, and provide vaccine education to employees and their families as long as reasonable accommodations are provided.
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Federal guidance, local tools, and new research are being published every day. Below are the newest items we've selected that will be helpful to the HCH community.
- NHCHC: COVID-19 Vaccines: Moderna, Pfizer BioNTech, Janssen
- CDC MMWR: Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity -- United States, December 14, 2020–May 1, 2021
- CDC MMWR: Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties – United States, December 14, 2020 – April 10, 2021
- CDC MMWR: COVID-19 Vaccine Breakthrough Infections Reported to CDC – United States, January 1 – April 30, 2021
- CSH: Key Considerations for States and Local Jurisdictions Exploring Hotel/Motel Acquisitions as a Housing Strategy for People Exiting COVID-19 Shelters
- CDC Update: Preparation and Administration Summary: Pfizer-BioNTech and Moderna
- CDC Update: Standing Orders: Pfizer-BioNTech and Moderna
- CDC Update: COVID-19 Vaccine Quick Reference Guide
- CDC Update: Interim Clinical Considerations Document
- KFF & UnidosUS: The CONVERSATION/LA CONVERSACIÓN
- HRSA: Patient Fact Sheet: HRSA COVID-19 Uninsured Program Fact Sheet
- HRSA: Provider Fact Sheet: What Providers Need to Know About COVID-19 Vaccine Fees and Reimbursements
- Health Equity Tracker
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Have a resource or issue you want to add to a future COVID-19 Flash Blast? Let us know! Email Katie League.
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Katie League, LCSW-C
COVID-19 Project Manager
National Health Care for the Homeless Council
kleague@nhchc.org
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National Health Care for the Homeless Council
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National Institute for Medical Respite Care
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| Grounded in human rights and social justice, the National Health Care for the Homeless Council's mission is to build an equitable, high-quality health care system through training, research, and advocacy in the movement to end homelessness.
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