COVID-19 UPDATE #136
February 11, 2021
CHANGES TO CDC QUARANTINE GUIDANCE FOR VACCINATED STAFF
This week the CDC revised their guidance on quarantining after exposure for staff members who have completed vaccination. The new guidance indicates that vaccinated persons with an exposure are not required to quarantine if they meet all of the following criteria: 
  • Are fully vaccinated (i.e., more than two weeks following receipt of the second dose in a two-dose series, or more than two weeks following receipt of one dose of a single-dose vaccine) 
  • Are within three months following receipt of the last dose in the series 
  • Have remained asymptomatic since the current COVID-19 exposure 

This guidance applies to healthcare workers only and does not apply to residents of long term care facilities due to the increased risks for severe disease and death and the unknown effectiveness of the vaccine in this population. The CDC recommends that residents continue to quarantine following exposure to someone with suspected or confirmed COVID-19, and only suggest lifting this requirement to mitigate critical issues (such as limited bed capacity). 
The CDC recommends that vaccinated individuals continue to follow all other guidance to prevent the spread of COVID-19, such as mask wearing, social distancing, and hand-washing because the risk of transmission from vaccinated individuals to others is still uncertain. Read more.
ACCESSING THE COVID-19 VACCINE IN LTC POST-PHARMACY PARTNERSHIP
After the completion of the CDC’s Pharmacy Partnership for Long Term Care (LTC) Program, long term care facilities must secure ongoing access to COVID-19 vaccines for new or not previously vaccinated residents and staff.   
 
The CDC recently posted new guidance on how LTC facilities should ensure ongoing access to the COVID-19 vaccine. This guidance provides three options for LTC facilities (skilled nursing facilities, nursing homes, assisted living facilities, and other congregate living setting) to continue to receive the vaccine:  
  • Work with an LTC pharmacy enrolled through the Federal Retail Pharmacy Program. Facilities may coordinate directly with participating LTC pharmacies to get access to vaccines and plan vaccination clinics. A list of pharmacy partners participating in the federal program is available here.  ​
  • Work with an LTC pharmacy enrolled as a COVID-19 vaccine provider with your state or territory. Facilities can contact their current LTC pharmacy to verify if they are enrolled as a vaccine provider in their state/territory.  
  • Enroll as a vaccine provider and order, distribute, and administer the vaccine yourself. This is the most burdensome option as it requires the facility to be responsible for vaccine ordering, storage, handling, and administration, plus reporting supply and vaccine information to the state. COVID-19 vaccine provider requirements differ by state. Contact your state immunization office for more information. 

Facilities should immediately reach out to their LTC pharmacy to understand whether the pharmacy can supply and administer COVID-19 vaccine to their residents and staff.  If they cannot, facilities should seek alternative pharmacy partners by visiting the Federal Retail Pharmacy Program or contacting Washington Department of Health (DOH). ​

Please note that facility staff cannot administer the vaccine on behalf of the pharmacy unless the facility itself is enrolled as a vaccine provider with Washington DOH. However, LTC pharmacies participating in the Federal Retail Pharmacy Program are allowed to subcontract staff for vaccine administration, which could include facility staff.

WHCA has reached out to the Washington State DoH Immunization Registry office to obtain additional information regarding the processes for a LTC facility to enroll as a COVID-19 vaccination provider. As more information is obtained regarding this process, WHCA will share it with our members.
POTENTIAL NEXT STEPS FOLLOWING VACCINE CLINICS
As the COVID-19 vaccine rolls out in long term care facilities, many questions have arisen about when we will see changes to restrictions on visitation, dining, and other activities, as well as guidance on testing, PPE, and other infection control measures. CMS and CDC have indicated they will not issue changes to this guidance until we know more about the real-world impact of the vaccine. 

Through clinical trials, these vaccines have been proven to be extremely effective at preventing illness caused by COVID-19, but we do not yet know whether individuals who are vaccinated can still contract COVID-19 (without symptoms) and spread it to others. So if a vaccinated visitor enters the facility, it’s possible they could spread COVID-19 to others. This is why CMS and the CDC are hesitant to modify guidance at this time.

For the health and safety of our residents and staff, the American Health Care Association and National Center for Assisted Living (AHCA/NCAL) supports this position. However, AHCA/NCAL is asking the federal agencies for data and funding to prioritize this research. In a letter to Dr. Rochelle P. Walensky, Director of the CDC, AHCA/NCAL formally requested this support, explaining the burden that these restrictions place on residents and staff of long term care. Read more.
NHSN UPDATES - WHAT YOU NEED TO KNOW
Last week, NHSN emailed its users to notify them of updates made to the Long-Term Care Facility COVID-19 Module. Below is a brief summary of the updates that were made. 
  • COVID-19 Point of Care Test Reporting Tool – This is an optional reporting component if your facility is reporting to state/local authorities. If your facility is not reporting to state/local authorities, then you are required to report to the COVID-19 Point of Care Test Reporting Tool to meet the requirements of reporting.  
  • COVID-19 Resident Impact and Facility Capacity Pathway – This is a required pathway, as it always has been, but updates were made to this pathway. There is now a question in this pathway that asks about vaccination status for residents newly positive for COVID-19. 
  • COVID-19 Therapeutics Module – This is a new optional reporting module. However, the information gathered from this module helps inform decision making processes. 
  • ​COVID-19 Vaccination Data Modules – This is an optional reporting module. However, the information gathered from this module helps inform decision making processes.  

For more guidance on each of these, please refer to the NHSN LTCF COVID-19 Module website.
OUTPATIENT THERAPEUTICS MINI-SERIES AND MONOCLONAL ANTIBODIES RESOURCE AVAILABLE
Project ECHO has launched an Outpatient Therapeutics Mini-Series supported by HHS ASPR. This series provides a deep dive on new and emerging COVID-19 outpatient therapeutics, including monoclonal antibodies. The mini-series is designed to equip clinicians with the appropriate knowledge, resources, and tools needed to initiate and scale administration of the therapies. The Outpatient Therapeutics Mini-Series has launched a resource library packed with information including administration procedures, physician orders, care plan, checklist, and flowsheets, to name a few.  

The Journal of American Medical Association (JAMA) published a resource page to share with patients on what monoclonal antibodies are, including their use with COVID-19 for noncommercial distribution.
NEW COVID-19 VACCINE TOOLKIT AVAILABLE
COVID-19 vaccines are an important tool to help end this pandemic. Check out the Centers for Disease Control and Prevention’s (CDC) new COVID-19 Vaccination Communication Toolkit for Essential Workers to help build confidence in COVID-19 vaccines.

Use these resources to educate your employees about COVID-19 vaccines, raise awareness about the benefits of vaccination, and address common questions and concerns. It will take all of our tools to protect our essential workers against COVID-19.
LIVE WEBINAR ON INFECTION CONTROL PREPAREDNESS AND PREVENTION
The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) are hosting a free live webinar on February 24, at 11:00 AM PST. Click here for details and to register.

It has become clear that infection control preparedness and prevention needs to extend beyond COVID-19 in the long term care setting. Awareness of the current trends in CMS surveys is crucial. This webinar will explore how ongoing staff education and competency provide the foundation for these efforts and help you to to develop an action plan when surveys result in citations. 

Upon completion of the hour, you will gain a deeper understanding of infection control-related regulatory and survey implications, and you will know what steps to take in order to prepare for increased oversight of your entire infection prevention and control program. 
WHCA WINTER CONFERENCE TO FEATURE COVID-19 EDUCATIONAL PROGRAMMING
The WHCA Winter Conference will begin next week, and we look forward to sharing outstanding educational programming with our members. There are some sessions in particular that will focus on COVID-19 best practices, response, and risk management:
  • February 17 | 9 – 10:30 AM | Regulatory Trends in Assisted Living
  • February 17 | 9 – 10:30 AM | Regulatory Trends in Skilled Nursing
  • February 18 | 9 – 10:30 AM | Best Practices in COVID-19 Response in Skilled Nursing
  • February 18 | 3 – 4:30 PM | COVID-19 and Infection Control
  • February 19 | 9 – 10:30 AM | Best Practices in COVID-19 Response in Assisted Living
  • February 19 | 1 – 2:30 PM | Risk Management in a Pandemic: It’s the Same, But Different
  • February 19 | 1 – 2:30 PM | Road to Recovery: The COVID-19 Vaccine

For details on these sessions, please refer to the full conference brochure. If you are not registered yet, you can do so now by clicking here
ADDITIONAL RESOURCES
WHCA continues to post resources and information as it becomes available on our website. If you have questions or need additional information, please call the WHCA office at (800) 562-6170.