February 12, 2021
This week, I received far too many emails and voicemails from elderly constituents and their loved ones across the country concerned that Montgomery County and Maryland do not have clear timelines or processes for vaccinating vulnerable seniors. So this week I focused my attention on piecing together the patchwork of vaccination eligibility and access for seniors. I also gathered some new important information for people with developmental disabilities, pre-existing conditions, and all of us who are concerned with an equitable vaccine distribution.
As of Monday, Montgomery County’s pre-registration list had more than 17,000 people over age 85 waiting for a vaccine. Of these, more than 5,000 are over 90 years old (this data may include duplicate registrations).
We know that according to the CDC people over age 85 are 630 times as likely to die from COVID as people in their 20's. People between 75 and 84 are 220 times as likely to die. That's why getting seniors access to the vaccine immediately is imperative. Vaccinating our seniors will save lives. In addition to reducing Maryland's COVID death rate, it will also decrease the burden on our hospitals, and significantly improve the quality of life for many families who long to spend time with each other but have been painfully distant due to the risks of COVID.
Great News on Nursing Homes & Assisted Living
Walgreens and CVS have finished all of the first shots and most of the second shots at every skilled nursing facility in the County. These pharmacies are more than halfway through the Assisted Living communities and expect to be finished with first shots at every Assisted Living community by mid-to-late February. The vaccines for this work were delivered from the state's weekly federal allocation.
Mixed News on Independent Living & Senior Housing Communities
Medstar Hospital has a multi-week agreement to vaccinate residents of Leisure World that began this week. Appointments are being assigned by lottery beginning with residents 75 and over. Medstar is receiving vaccines directly from the state. At the current rate, it will take at least four weeks to vaccinate the entire community. Adventist Hospital has nearly completed vaccinations at Riderwood. Leisure World and Riderwood are the two largest officially designated Senior Housing Communities in Montgomery County.
The Montgomery County Area Agency on Aging has worked in partnership with the state Department of Aging to develop a list of 61 Independent Living Communities in Montgomery County. These Communities are required to be prioritized by the County Health Department and each Hospital or Health System participating in the vaccine program. In addition, some of these facilities have been approved to participate in the Federal Long Term Care partnership, where CVS and Walgreens provide the vaccines directly, again, through the state's weekly federal allocation.
Within the list of 63 Montgomery County Independent Living Facilities, 14 have had their first doses administered. Another 8 have clinics scheduled for the near future. So we are 22 down, 33 left to go. We need to identify vaccinator partners for these remaining communities! The good news is that since the largest sites were prioritized first, the majority of seniors in Senior Housing have been taken care of. However, about 4,937 of our seniors living in these 33 Senior Housing communities are still waiting for a hospital, pharmacy, or health department to partner with them.
I don't live in Senior Housing.
What about me?
This is one of the major gaps in our system that needs to be addressed immediately. Montgomery County has a significant number of residents ages 75 and over living in their own single-family homes, apartments outside of officially designated "senior housing" communities, or living with their extended family members. These residents are not covered by the Federal Long Term Care Partnership or in the State Independent Living plan. That means these residents need to find a way to get their own vaccine from one of the multiple vaccinators in the County or across the state.
Right now, we don't know how many of the 5,000+ people over 90 years old, or 17,000+ over 85 years old on the County waitlist are not in official "Senior Housing" but it's reasonable to assume a significant number are not, and will not receive a vaccine unless they proactively seek an appointment. I have been hearing from them, and their extremely concerned loved ones, quite regularly.
This week, I asked Deputy Secretary for Public Health Jinlene Chan to revise the state health directives to require vaccinators to prioritize residents over 85. Talbot County did this with great success. If we do this, Montgomery County's entire waitlist of elderly residents could be vaccinated within two weeks just through the vaccines administered by our local hospitals and Health Department. I also called on Montgomery County Health Officer Travis Gayles to prioritize Montgomery County's 4500 weekly doses towards this group. If we don't prioritize this group, they will be struggling to compete with a large pool of younger, healthier residents who are much less likely to die from COVID. Without special prioritization, it could be 2 months before the vaccinators work their way through the waitlist of residents over 85 years old. This is unacceptable and I hope state and county officials heed my call to prioritize this population.
State data shows that about 25% of Montgomery County’s 75 and older residents have been vaccinated. A significant number of these residents have been getting their vaccines at state-run "mega-sites" and pharmacies outside of Montgomery County. More information on these options is available below.
A Special Note About Friendship Heights & NORCs
In Montgomery County, we have a number of Naturally Occurring Retirement Communities (NORCs). These are not official senior housing communities, but they have extraordinarily large numbers of seniors living in one area and sharing some common spaces. If you live in an apartment community that is mostly seniors but is not on the County priority list for “Senior Housing” your community may qualify to be added to the list being developed by the County Agency on Aging. Getting on this list doesn’t guarantee you a vaccine partner, but it does allow vaccinators to more easily partner with your community to do on-site clinics with state approval. According to the State Department of Aging, NORCs can qualify for this list if they meet certain age and population standards.
Friendship Heights is one example of an area that would make sense to be added to this list. With a population density greater than Manhattan, and more than 1600 seniors (including more than 400 over age 85) this community is second only to Leisure World in terms of seniors living together in one dense community. I have been advocating with the State and County to have Friendship Heights counted as “Senior Housing” for vaccine clinic partnerships.
People with Developmental Disabilities
This group is in 1B, with caregivers in 1C. Vaccines for 1B are available through the Montgomery County waitlist. However, caregivers will have earlier access through a state vaccination site or a private pharmacy. The state Department of Disabilities has begun to work on partnerships with The Arc to roll out vaccine clinics for this population. When I have more information on this opportunity, I will share it.
Under Age 65 With Pre-Existing Conditions
This is a complicated eligibility group. Each Hospital is receiving 100 doses a week from the state specifically earmarked for this population. They are reserved for people who are hospitalized or in outpatient treatment with the following conditions: Cancer, End-Stage Renal Disease, COPD, Organ Transplant Recipients, Sickle Cell Disease, Type 1 and 2 Diabetes. If you have one of these conditions but are not receiving active hospital-based treatment, you are in Phase 2.
Except...if you live in Montgomery County, the County Health Department may prioritize you in their unique version of group 1C. These conditions and more eligible conditions are included in Montgomery County Health Department's 1C. Pre-register with the County and await further instructions on necessary documentation. For this group, private pharmacies and hospitals will be more restrictive than the County Health Department.
Federal Supply For Maryland Increases!
On Thursday the Federal government expanded the Walgreens and CVS partnerships to include eligible residents outside of long-term care facilities. That means on top of Maryland’s 88,000-90,000 weekly doses, we got an additional 11,000 doses this week into CVS pharmacies and an additional 9,200 doses into Walgreens pharmacies. In total this week we got 110,200 doses from the Federal Government, up from 72,000 a week just a month ago.
Yesterday President Biden also announced the purchase of 100 million more first doses of the Pfizer and Moderna vaccines by May and another 100 million available by July. This deal will increase Maryland’s weekly allocation in the months to come.
Montgomery County Doses
As I explained last week, the federal doses are allocated by the state to jurisdictions on a per capita basis. I’m proud to have been joined by my House and Senate colleagues in asking the Governor to update this allocation formula to consider the percentage of a jurisdiction's population that is vaccine eligible in 1A, 1B, and 1C during the early phases of the rollout. We also asked for COVID death rate and COVID case rate to be considered in allocations. We eagerly await a response. (Here's a link to the letter).
***Today, the state of Maryland guaranteed the Montgomery County Health Department an allotment of 4500 first doses a week for the next four weeks. This will allow the County to plan clinics in advance and better prioritize appointments.***
Promoting Equity in Vaccine Access
While comparisons to West Virginia are easy to make, it’s important to remember that Maryland is an incredibly diverse state with unique population characteristics that makes our vaccine rollout different than many other states. Montgomery County also has unique characteristics within Maryland and has become increasingly diverse over the last few decades. Our immigrant communities and communities of color are younger, and our white population, on average, is older as compared to the rest of the state. Our elderly population is disproportionately white.
Our County Health Department is rightly concerned with making sure that their vaccine allocation is administered with racial equity principles in mind. As we move into Phase 2 and Phase 3 this will be even more important. As we all know, communities of color have been disproportionately impacted by this disease across the country and here in Montgomery County.
As a general rule, using national data, Black and Hispanic COVID patients experience death rates comparable to their white counterparts who are ten years older. So a 65-year-old Black man faces a similar risk of death to a 75-year-old white man. Right now, Montgomery County's death rates are 144 per 100,000 for the white population, 132 for the Hispanic population, 122 for the Black population, and 77 for the Asian population. However, these numbers hide the fact that our residents of color are younger than our white residents. I have asked the County to break our death rates by age band so we can identify any disparities in health outcomes here in Montgomery County. Montgomery County's Black population's death rate is much lower than the state average which is 144 per 100,000, and the national average which is 155 per 100,000. For the Hispanic numbers, the County death rate is higher than the state and the national average of 111 per 100,000 and 120 per 100,000 respectively.
We do know that case rates in Montgomery County are noticeably higher in areas with larger minority populations. This is one reason the County is prioritizing certain zip codes in their vaccine allocation.
What Happens In The Next Few Months
I have been working with State and County officials to get approximate timelines for vaccine availability by group to share with constituents. Here’s what we know. I’ll be as precise as I can. In Maryland, this week we saw an influx of 20,000 additional vaccines from the Federal Pharmacy Partnership Program, in addition to our 88-90,000 dose weekly state allotment. While this frees up availability a bit, it won’t allow us to move into Phase 2 anytime soon. Here in Montgomery County we are still struggling in Phase 1B and will be for the next few weeks (Two weeks ago the County suggested 4-5 weeks as a timeline, however, it doesn’t seem likely to me that we will meet that goal based on available data related to seniors and essential workers who are still not vaccinated. Hopefully, I am proven wrong!).
State mass vaccination sites and pharmacies are currently open to 1C residents. More mass vax sites will be opening up across the state in March.
Throughout March we need to continue to do the heavy lifting of making sure the most vulnerable populations are being vaccinated by all state vaccinators. This is likely when Montgomery County will begin the difficult work of figuring out how to prioritize and verify the people under age 65 who have signed up with pre-existing conditions.
By late spring (hopefully April), we should have availability to expand to doctors and urgent care clinics. This is based on Dr. Fauci’s estimate of when vaccines should become more readily available. Ideally, we want these operations up and running, with limited capacity, before eligibility expands, so processes and procedures have their kinks worked out. By late April and early May, we should see an increase in vaccine allocation headed our way from the Federal government, both from the new Pfizer and Moderna doses just secured by President Biden and doses from the (hopefully) soon to be approved Johnson & Johnson vaccine.
By July, according to President Biden, we should have vaccines readily available. The public health infrastructure will need to be working on reaching populations that lack access and/or remain vaccine-hesitant. Pfizer and potentially Moderna may be approved for school-aged children by late summer, and this would be another intensive push prior to return to school in the fall.
A Note On Requests for A Single Site for Appointment Sign Up
It’s a great idea. And I’m jealous of the four states that have done this. But, quite simply, it’s become clear that's just not going to happen in Maryland. The state is committed to having multiple options for delivery. While this is extremely frustrating for this phase, which should be designed around the specific needs of the elderly and essential workers, this less coordinated approach will be useful as vaccines become more available and we move into phase 2 and 3. At that point, we will not want the state micromanaging vaccine appointment access through a single portal, and physicians' offices, urgent cares, pharmacies, and hospitals wouldn’t want it either. Every week that passes makes it less likely that the state will move backward to redesign a system that would make the 1A, 1B, and 1C process work more smoothly. However, Virginia is innovating by combining the pre-registration lists from each local jurisdiction. This will allow that state to eliminate duplicates and more effectively target vaccine distribution for vulnerable residents. Montgomery County would benefit tremendously if Maryland followed Virginia's lead on this. (Did I just say that! What have we come to?)
Please remember, vaccinated or not, please remain vigilant -- mask up, practice social distancing and stay safe!