Shots For Homebound New Yorkers Have Lagged. A Vaccine Pause Didn’t Help.
Efforts to vaccinate homebound seniors in New York have lagged, and the national pause on the Johnson & Johnson vaccine set them back further.,
Antonia Laraki is homebound, with a leg badly swollen from lymphedema and a son with autism at home who relies on her. After applying for a citywide program in mid-March that vaccinates homebound people, she waited weeks just to hear when the city might be able to send someone to her apartment.
Finally, on Tuesday, she got the news: A team of vaccinators would be able to make it to her apartment the next day, with the Moderna shot. The city had been using Johnson & Johnson for the program, but after a national pause in administering that vaccine because of a rare blood clot disorder, some of its partners were able to pivot.
Still, the pause caused the cancellation of more than 1,000 appointments for homebound people, adding yet another hurdle to a program that has moved slowly.
“I’m happy,” said Mrs. Laraki, 75, on Friday, from her apartment in a Manhattan housing project. “I feel relieved.”
While more than 2 million people are now fully vaccinated in New York City, the city’s effort to vaccinate homebound seniors has lagged. Though there are an estimated 23,000 homebound seniors and other homebound adults who need shots, city teams had made 4,292 vaccination visits as of Friday.
The city did not begin its main homebound vaccine effort until March 1, in large part out of a desire to wait for the Johnson & Johnson vaccine, which planners knew would be logistically easier to use because it requires just one dose.
A committee of outside health experts on Friday recommended lifting the pause, and federal officials are expected to do so shortly. But the fear the pause generated has the potential to be a major setback to the program, which had finally ramped up and was reaching about 1,200 people per week.
- On April 23, a Centers for Disease Control and Prevention panel of advisers voted to recommend lifting a pause on the Johnson & Johnson Covid vaccine and adding a label about an exceedingly uncommon but potentially dangerous blood clotting disorder.
- Federal health officials are expected to formally recommend that states lift the pause.
- Administration of the vaccine ground to a halt recently after reports emerged of a rare blood clotting disorder in six women who had received the vaccine.
- The overall risk of developing the disorder is extremely low. Women between 30 and 39 appear to be at greatest risk, with 11.8 cases per million doses given. There have been seven cases per million doses among women between 18 and 49.
- Nearly eight million doses of the vaccine have now been administered. Among men and women who are 50 or over, there has been less than one case per million doses.
- Johnson & Johnson had also decided to delay the rollout of its vaccine in Europe amid similar concerns, but it later decided to resume its campaign after the European Union’s drug regulator said a warning label should be added. South Africa, devastated by a more contagious virus variant that emerged there, also suspended use of the vaccine but later moved forward with it.
“We are in a time frame here that is frightening,” said Gale Brewer, the Manhattan borough president, who has been leading a weekly task force meeting focused on the vaccine rollout. “We are all trying to beat the variants, and with the home health aides going in and out, there is risk.”
The city is hopeful it will be able to soon restart the program fully and convince people the vaccine is safe.
“As the primary provider of homebound vaccinations in the city, we remain undeterred in restarting the program to reach as many people as possible,” said Avery Cohen, a spokeswoman for City Hall.
The hurdles facing homebound seniors reflect the broader issues that have shadowed the nation’s vaccine drive in general. While nearly half of all New York City adults have already gotten at least one vaccine dose, roughly equal to the national average, the vaccine rollout has been most accessible to internet-savvy people who are mobile, and have time and energy to dedicate to getting vaccinated.
People who are frail, hesitant and not able to use the internet in English have been harder to reach. While 80 percent of people over age 65 have gotten at least one dose nationwide, according to the Centers for Disease Control and Prevention, in New York City, that number drops to 61 percent. And people 85 and older have the lowest rates of vaccination among the city’s seniors, with only 49 percent of New Yorkers in that age group having received at least one dose, according to city data.
The city said its vaccination rate for older residents overall was roughly on par with that of other cities, such as Los Angeles, where 70 percent of those over 65 had gotten a single dose. It pointed to the many other efforts it was using to reach seniors, from dozens of pop-up vaccine clinics in senior buildings to free transportation to vaccine sites.
Ms. Cohen noted that a total of 6,584 vaccinations had been completed through the program as of Friday, in part because on each visit, vaccinators may also give shots to others in the home who qualify. While the Johnson & Johnson pause had brought the program to a complete halt, within days, some of its providers had been able to start administering Moderna vaccines instead.
The city’s main homebound vaccine effort, run by the Fire Department, is still hoping to return to using the Johnson & Johnson vaccine if it is again approved by federal regulators, officials said.
Each weekday morning before the pause, 30 teams of homebound vaccinators, each with a nurse, a data entry person and a driver, have been gathering at a South Brooklyn base before spreading out around the city to reach the homebound, said Rich DePrima, the fire department battalion chief coordinating the program.
George Rodriguez, 83, lives alone and is also homebound. He has not gotten vaccinated yet, but he will only agree to an injection if his beloved caseworker from the local community center is there to make him feel safe, he said. And ever since the national pause, he fears getting the Johnson & Johnson shot.
“I only have him, he is my second half,” he said of his caseworker, Albert Bencosme. “I don’t have nobody else. Just him and God.”
A travel nurse provider called Aya Healthcare has been supplying the nurses for the Fire Department’s effort. The city has also begun contracting with other companies, including the Visiting Nurse Service of New York and Zeel, a tech-focused wellness company, in order to speed up vaccinations to thousands of people already on waiting lists. The Northwell Health and Mount Sinai hospital systems each have also made around 550 visits to people already receiving at-home care through their systems, they said.
But the city’s vaccination program also been hindered by red tape, Ms. Brewer and several community-based organizations working with older New Yorkers said.
People wishing to register for a homebound vaccine through the city must fill out an interest form. Then someone from the city is supposed to reach out to each senior to verify they are “fully homebound,” meaning that they cannot leave their home, even with assistance. Then, the representative can schedule a vaccination.
This multi-step process has proved difficult to navigate, and does not line up with the reality of many homebound New Yorkers, said Maria Muniz, program director at Casabe Houses for the Elderly, a subsidized senior building in East Harlem. There are about 30 homebound people in her building, she said, and she filled out a form for each of them. She then gave her office phone number for each, because her residents, many of whom do not speak English well and have health impairments, do not always answer their phones.
Vaccinators sometimes call in the evenings when her office is closed, or on the weekends, she said. They have not been leaving messages, or they want to speak to each resident individually.
“Their response is really bad, I’m not getting anywhere,” Ms. Muniz said.
She has started talking with a local community clinic to see if she can get them to visit her residents directly. One of her homebound residents, she said, is 99; two others are in their mid-90s.
Gregory J. Morris, the executive director of the Stanley M. Isaacs Neighborhood Center on East 93rd Street, said he has been frustrated that the city has not asked him for more help coordinating and communicating with the 1,000 homebound seniors his organization delivers meals to in East Harlem and the Upper East Side, including Mrs. Laraki and Mr. Rodriguez.
The senior center said Friday that many of their homebound clients were feeling isolated and confused.
“We could shape the delivery process, be active in saying to people what’s happening when. We can help them feel comfortable and safe when it happens,” Mr. Morris said. “And right now, I can’t say what my role is except that I’ve been asked to send names into a void.”
Kathryn Haslanger, the chief executive of JASA, another organization that provides services for homebound seniors, said that of the 250 people the organization had referred for home vaccination, 60 had gotten vaccinated so far.
Ms. Cohen said that the city’s initial list of homebound seniors had been compiled largely through case managers at the Department of Aging and Medicaid referrals, and that the city was now “laser-focused” on rescheduling those whose shots were canceled.
Instead of waiting, at least one nonprofit organization, the Bronx Rising Initiative, has decided to organize shots on its own. It has raised $500,000 from private donors to bring vaccinations to homebound residents in the Bronx, and is going door to door in housing projects and working with tenant organizations to find people, said Tomas Ramos, the organization’s founder.
Working with a local clinic, VIP Community Services, the group had just started vaccinating with the Johnson & Johnson on April 12. It has since pivoted to the Moderna shot. Unlike the city, it is not requiring documentation or checking a senior’s mobility level before scheduling at-home visits.
“There are a lot of gaps when it comes to government,” Mr. Ramos said. “Because we are in the community, we solve the problem.”