Just after 8 a.m. on Tuesday morning, emergency medical technician Shakera Brown pulled up to a brown house with green trim in the Gentilly neighborhood of New Orleans.
This time last year, most of the houses she visited were for people with symptoms of COVID-19 who had called 911 because they couldn’t breathe. She went into houses fully gowned with a respirator. She got COVID anyway.
But she has a different job today. In a hospital bed tucked into a backroom as television reruns played in the background, Deidra Howard, 59, watched intently as Brown sunk a needle into her arm.
“Thank you, thank you,” Howard repeated quietly as her older sister, Deborah Lemon, 65, looked on.
Howard, who has cerebral palsy and mental impairment after a car accident 16 years ago left her bedbound, is one of 20 people in New Orleans who would receive a second dose of the Moderna shot at home on Tuesday.
New Orleans EMTs have vaccinated 121 people so far with another 125 on the waitlist. But the program is making a small dent in getting vaccinations to one of the state’s most medically fragile populations.
There are over two million people in the U.S. who are confined to their homes. While it’s not clear how many people have medical conditions that keep them from leaving their homes in each state, researcher and epidemiologist Katherine Ornstein of Icahn School of Medicine at Mount Sinai in New York City estimated it would be around 5% to 6% of people over 65 in the state, plus younger people who are bedridden like Howard.
That means about 37,000 people over 65 in Louisiana are likely homebound — a population that is “by definition invisible in many ways,” said Ornstein.
Although many have been eligible for months, homebound people have so far had little hope of receiving a vaccine. Until recently, the process has required long waits on the telephone or scouring websites for open appointments. There are programs in some cities, such as New Orleans, Baton Rouge and Monroe, but most vaccinations happen at clinics, pharmacies, hospitals and mass vaccination events, which the homebound cannot get to.
While residents in New Orleans can get on the at-home vaccine list by dialing 311, there is no similar service available in nearby Jefferson Parish right now, for example.
“It would take an ambulance ride to get them anywhere,” said Jonathan Fourcade, spokesperson for New Orleans Emergency Medical Services. “It’s just a whole lot easier to come to them.”
Though people who are bedridden cannot leave their residences, they’re still at high risk because of the people they live with and the close proximity they share with caregivers, who feed, bathe and dress patients. In Howard’s home on Tuesday, there were five other people sharing the 1,261 square-foot space, including her niece, who serves as her caregiver, and her niece’s two children.
The vulnerability of medically fragile people was demonstrated by the earliest COVID-19 deaths. Nursing homes were quickly ravaged by the disease, accounting for nearly a third of COVID-19 deaths in the U.S. and over 4 in 10 deaths in Louisiana by the end of 2020, even though they made up just 5% of cases in the state.
The state’s early vaccination plan accounted for nursing home residents, but not homebound residents.
That changes next week, when the state will launch a hotline to address the lack of universal at-home vaccinations for people who cannot leave their homes.
Some workers who were contract tracing are now being shifted to vaccine scheduling, according to Kevin Litten, a spokesperson for the Louisiana Department of Health. Seven teams across the state will work with regional medical directors to implement at-home vaccinations.
As New Orleans has done, the state is advising regions to use the medical evacuation list for hurricanes and is working with the Office for Citizens with Developmental Disabilities and Office for Aging and Adult Services, along with Medicaid to begin outreach to homebound people.
Lemon found out about the homebound vaccination program through a friend, who told her to call 311. Someone came out to her house the next day to give her sister the first shot.
“Everybody else in the family and all of us have been vaccinated,” said Lemon, who got the Moderna vaccine in February. “I want to make sure she’s safe, too.”
After Howard’s shot, Brown, the EMT, has nine more doors to knock on, where she’ll spend around 30 minutes with each patient.
“Every patient I go to, they all say the same thing,” said Brown. “They just thank us so much.”
Story by: Emily Woodruff at Nola.com