Missouri Long-Term Care Information Update

Vaccination Events

Missourians in Phase 1A and Phase 1b Tiers 1 & 2 can access vaccinations through a variety of settings including their employer, health care providers, and mass vaccination events. Missouri’s latest press release with vaccine information can be found here. Below you can find information about a number of vaccine events that will be occurring during the month of February. Visit the websites for facilities listed below , watch your local news, talk with your medical provider, and/or visit the website of your local public health agency to get registered for these events. In addition, you can visit https://covidvaccine.mo.gov/events/ to register for some events as they become available. This site should be updated later in the week with new events, and regularly updated. PLEASE NOTE, events will fill quickly and some may already be filled due to sign ups through local channels such as local public health agencies and health care providers. Continue to watch for vaccine information from your local news, officials, and healthcare providers. Events will continue to be scheduled each week throughout the state.

For the month of February Missouri will be directing just over half of Missouri’s distribution of vaccine to selected hospitals across Missouri. These facilities will be able to vaccinate individuals in the activated Phases. Specific hospitals that will be hosting vaccine clinics are listed below.

In addition to these efforts, there will be Missouri National Guard supported events throughout Missouri. These events will continue on a rotating basis through the regions with additional locations added for subsequent weeks. Continue to watch for vaccine information from your local news, officials, and healthcare providers and check https://covidvaccine.mo.gov/events/. Events will continue to be scheduled each week throughout the state.

 

DHSS Led Events

Week of Feb 1-Feb 6

Region

Location

A

Henry County—Clinton
Friday, February 5, 2021
8am-5 pm (or until supply is out)
Clinton First Baptist Church
1531 N Vannsant Rd
Clinton, MO 64735

B

Marion/Ralls County—Hannibal
Friday, February 5, 2021
9am-6pm (or until supply is out)
Hannibal Inn & Conference Center
4141 Market Street
Hannibal, MO 63401

C

St. Francois—Farmington
Thursday, February 4, 2021
8:30 am-7pm (or until supply is out)
Community Civic Center
2 Black Knight Drive
Farmington, MO 63640

D

Greene—Springfield
Friday, February 5, 2021
8:30 am-5:30 pm (or until supply is out)
Ozark Empire Fair Grounds
3001 N. Grant Ave
Springfield, MO 65802

E

Pemiscot—Caruthersville
Friday, February 5, 2021
9am-4pm (or until supply is gone)
Centry Casino
777 E Third St.
Caruthersville, MO 63830

F

Cole—Jefferson City
Friday, February 5, 2021
8am-4pm (or until supply is gone)
The Linc
1299 Lafayette St
Jefferson City, MO 65101

G

Douglas—Ava
Saturday, February 6, 2021
8am-5pm (or until supply is gone)
MOCH Wellness Center
603 NW 10th Ave
Ava, MO 65608

H

Livingston/Harrison—Chillicothe/Bethany

Site 1
Thursday, February 4, 2021
8:30 am-5:00 pm (or until supply is gone)
Methodist Church
1414 walnut Street
Chillicothe, MO 64601

Site 2
Saturday, February 6, 2021
8:30am-5:00 pm (or until supply is gone)
South Harrison High School
3400 Bulldog Ave
Bethany, MO 64424

I

Phelps—Rolla
Thursday & Friday February 4-5, 2021
8am-5pm (or until supply is gone
Phelps Health Respiratory Screening Station
1000 W 10th St
Rolla, MO 65401

Statewide Project to Test Wastewater for COVID Virus – Recruitment of 20 Long-Term Care Communities

Since May 2020, the Missouri Department of Health and Senior Services (DHSS), Department of Natural Resources (DNR) and researchers at the University of Missouri – Columbia have been collaborating on a statewide project to test wastewater for genetic markers of SARS-CoV-2, the virus that causes COVID-19. The project recently received new funding through a grant from National Institutes of Health (NIH) to expand wastewater testing to additional congregate living facilities. Public health experts have identified wastewater testing as a useful tool for early detection of outbreaks, even as vaccination efforts progress and clinical testing improves. Please see the letter regarding information about this project and information on recruiting 20 congregate living communities to participate in an expansion of this testing. Ideally, communities would have 50 or more residents who contribute to the sewer system.

Please contact the Department of Health and Senior Services Environmental Public Health Tracking Team at EPHTN@health.mo.gov or 866-628-9891 or 573-751-6102 to express interest in the project or to ask any additional questions. Communities who are interested will receive a follow-up contact from the Missouri Department of Natural Resources to determine if their sewer system will work for this type of testing.

Pioneer Network: Hot Topics – Culture Change in Action

January 21, 2021: Working Together to Find Our Way to Yes

How many times have you or your team had a great idea about how to do something in your community, and you want to say ‘yes’, but are stopped short because it might be too risky, or the biggest reason heard, that the regulations say you can’t do it.

Even as we say this, we know that person-centered practices and the regulations are not at odds. Sometimes it’s the interpretation, or more often, it’s not WHAT we do, but HOW we do it that creates the conflict.

Pioneer Network is proud to bring together a dynamic panel of individuals from the field of aging services – all of them risk-takers at heart – to share and discuss ideas on how we can work together to find a way to say yes to the person-centered practices we strive to bring to our communities.

Standing Order to Administer BinaxNOW Rapid Antigen Test By Licensed Long-Term Care Facilities

Dr. Randall Williams has signed a standing order for Long-Term Care Facility staff to receive Abbott BinaxNow testing at the facility they work in to ensure timely testing and isolation of positive employees who are caring for Missouri’s most vulnerable residents, the elderly and disabled. Long-term care facilities should continue to obtain orders for residents through resident personal physicians or facility medical director/physician.

Standing Order – BinaxNOW – LTCF – Symptomatic or Asymptomatic 1-12-21

COVID-19 Healthcare Quality and Worker Safety Information

Please find this week’s review of CDC’s COVID-19 resources and information. We continue to highlight COVID-19 vaccine information in addition to resources specific to healthcare quality and worker safety and health.

COVID-19 VACCINE RESOURCES
CDC COVID Data Tracker — Vaccinations are now being tracked on CDC’s COVID Data Tracker. Numbers reported on CDC’s website are validated through a submission process with each jurisdiction and may differ from numbers posted on other websites. Differences between reporting jurisdictions and CDC’s website may occur due to the timing of reporting and website updates.

How to Report COVID Vaccine-Related Adverse Events — As Americans start receiving their first COVID-19 vaccines, additional data on potential adverse events are needed in real time. Healthcare providers will play a critical role in reporting vaccine-related adverse events through the Vaccine Adverse Event Reporting System (VAERS). Providers can also encourage individual patients to self-report potential adverse events as they occur through v-safe, CDC’s new patient reporting platform. Read more in this new CDC Medscape Expert Commentary by Dr. Tom Shimabukuro, CDC’s COVID-19 Vaccine Safety Team Lead.

Updated Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States — This guidance has been updated to include the following:

  • Additional information on antibody therapies and COVID-19 vaccination
  • Information on COVID-19 vaccination and outbreak management
  • Additional information on vaccination of immunocompromised persons
  • Updates to contraindications and precautions to vaccination
  • Information on COVID-19 vaccination and tuberculin skin testing

To learn more, please visit: mRNA COVID-19 Vaccines.

Frequently Asked Questions about COVID-19 Vaccination in Long-Term Care Facilities (LTCF) — Making sure LTCF residents can receive COVID-19 vaccination as soon as vaccine is available will help save the lives of those who are most at risk of dying from COVID-19. CDC updates frequently asked questions for Healthcare Infection Prevention and Control and Healthcare Professionals regularly based on feedback from professionals on the ground.

ADDITIONAL RESOURCES
US COVID-19 Cases Caused by Variants — The cases identified are based on a sampling of SARS-CoV-2-positive specimens and do not represent the total number of B.1.1.7 lineage cases that may be circulating in the United States and may not match numbers reported by states, territories, tribes, and local officials.

SARS-CoV-2 Transmission from People Without COVID-19 Symptoms — Researchers used a model to assess the proportion of COVID-19 spread that likely occurs from infected people who do not have symptoms. They found that more than 50% of new COVID-19 infections were estimated to have come from people without symptoms. These findings underscore the importance of measures such as wearing masks, social distancing, and washing hands to slow the spread of COVID-19. Strategic testing of people who are not ill, such as those who have been exposed to COVID-19 or those with frequent contact with the public, can also reduce the spread of COVID-19 until safe and effective vaccines are widely available.

Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages — This quick reference summarizes CDC’s strategies to optimize personal protective equipment (PPE) supplies in healthcare settings and provides links to CDC’s full guidance documents on optimizing supplies which provide additional strategies and details.

Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages — This summary is intended to help healthcare facilities optimize supplies of disposable N95 filtering facepiece respirators when there is limited supply during the COVID-19 pandemic.

Updated People with Certain Medical Conditions — Revisions were made on December 23, 2020 to reflect recent data supporting increased risk of severe illness among persons with Down Syndrome from the virus that causes COVID-19. Revisions also include addition of sickle cell disease and chronic kidney disease to the conditions that might increase the risk of severe illness among children.

Morbidity and Mortality Weekly Report (MMWR) — Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020 — This report summarizes the clinical and epidemiologic characteristics of people in the U.S. with anaphylaxis and non-anaphylaxis allergic reactions following administration of a first dose of Pfizer-BioNTech COVID-19 vaccine during December 14-23, 2020. Monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination. Post-event follow-up indicates that the patients experiencing anaphylaxis fully recovered following treatment. You can learn more here: Morbidity and Mortality Weekly Report

Morbidity and Mortality Weekly Report (MMWR) — Rates of COVID-19 Among Residents and Staff Members in Nursing Homes — United States, May 25–November 22, 2020 — A federal mandate issued by the Centers for Medicare & Medicaid Services (CMS), required nursing homes to commence enrollment and routine reporting of COVID-19 cases among residents and staff members by May 25, 2020. This report uses the NHSN nursing home COVID-19 data reported during May 25–November 22, 2020, to describe COVID-19 rates among nursing home residents and staff members and compares these with rates in surrounding communities by corresponding U.S. Department of Health and Human Services (HHS) region. You can learn more here: Morbidity and Mortality Weekly Report

Morbidity and Mortality Weekly Report (MMWR) — Assessment of Day-7 Postexposure Testing of Asymptomatic Contacts of COVID-19 Patients to Evaluate Early Release from Quarantine — Vermont, May–November 2020 — On May 8, 2020, the Vermont Department of Health (VDH) issued a Health Update recommending shortening the duration of quarantine for persons exposed to SARS-CoV-2, the virus that causes COVID-19. Exposed persons who were in quarantine could be tested by polymerase chain reaction (PCR) on or after quarantine day 7. Those who had remained asymptomatic throughout quarantine and who received a negative SARS-CoV-2 PCR test result on or after day 7 could end quarantine. You can learn more here: Morbidity and Mortality Weekly Report

UPCOMING CALLS/WEBINARS
COVID-19 Partner Update Call: CDC COVID-19 Case Investigation and Contact Tracing Guidance and Tools – Thursday, January 21, 2021, 2:00 p.m. – 3:00 p.m. (Eastern Time) — Dr. Cliff McDonald, Acting Chief Medical Officer, and Dr. Melanie Taylor, Deputy, COVID-19 Contact Tracing Innovations Support will present. Ms. Michelle Putnam, Deputy, Policy Unit Partnerships & Risk Management Team will moderate. Dr. McDonald will share updates on CDC’s COVID-19 response, including the latest scientific information and what everyone should know about protecting themselves and others. In addition, Dr. Taylor will provide an overview on contact tracing guidance and tools. All questions will be collected in advance of the webinar. Click here to register

The call will be recorded and posted with previous Partner Update webinars here.

Clinician Outreach and Communication Activity (COCA) – Treating Long-COVID: Clinician Experience with Post-Acute COVID-19 Care — The Clinician Outreach and Communication Activity (COCA) will hold a call Thursday, January 28, 2021, from 2:00–3:00 p.m. (Eastern Time). During this COCA Call, presenters will share their firsthand experiences with treating long COVID, focusing on the pulmonary, neurologic, and psychological aspects. They will also describe their experiences with establishing clinics that provide care for patients with these long-term effects. For more information, please visit: COCA Calls/Webinars

IN CASE YOU MISSED IT — Clinician Outreach and Communication Activity (COCA) – COVID-19 Vaccines: Update on Allergic Reactions, Contraindications, and Precautions — The Clinician Outreach and Communication Activity (COCA) hosted a call Wednesday, December 30, 2020. During this COCA Call, presenters gave an overview of recommendations for use of COVID-19 vaccines in certain populations. Clinicians learned more about the recent reports of anaphylaxis following vaccination, as well as CDC’s updated clinical considerations around contraindications and precautions to vaccination. For the recording of this call, please visit: COCA Calls/Webinars

Abbott BinaxNOW Testing Supplies

The federal government is sending Abbott BinaxNOW rapid antigen test kits to states for distribution. There is limited availability of these tests to Missouri Long Term Care Facilities (RCF, ALF, ICF, and SNF) and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) with a CLIA certificate.

Department of Health and Senior Services (DHSS) and the State Emergency Management Agency (SEMA) will distribute available tests to LTCFs for use. Because there are a limited number of tests available, these tests are best suited for use with patients or staff who are symptomatic and who may have had a credible exposure to COVID-19.

Demand will be high and so we ask homes to only request what they will need for a 45 day timeframe- that is not covered by other testing capacities. Our understanding is that federal shipments will begin again next week in counties with high positivity rates. This effort is to supplement existing testing capacity- not to replace it.

APPLICATIONS FOR TEST KITS MUST BE RECEIVED BY JANUARY 22, 2021 at this link: https://arcg.is/1XvLeP.

COVID-19 Vaccine, TB testing, and Co-administration with other Vaccines

We have received a couple emails regarding this, so passing along CDC guidelines on receiving COVID vaccine after/before flu vaccines, TB testing, etc.:

https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html

Interpretation of tuberculosis test results in vaccinated persons

Inactive vaccines do not interfere with tuberculosis (TB) test results. There is no immunologic reason to believe either a Tuberculin Skin Test (TST) (administered by intradermal placement of 0.1 cc of purified protein derivative) or blood draw for interferon gamma release assay (IGRA) would affect the safety or effectiveness of mRNA COVID-19 vaccines. We have no data to inform the impact of the COVID-19 mRNA vaccines on either TB test for infection (i.e., TST or IGRA).

For healthcare personnel or patients who require baseline TB testing (at onboarding or entry into facilities) at the same time they are to receive an mRNA COVID-19 vaccine:

  • Perform TB symptom screening on all healthcare personnel or patients.
  • If utilizing the IGRA, draw blood for interferon gamma release assay prior to COVID-19 vaccination.
  • If utilizing the TST, place prior to COVID-19 vaccination.
  • If vaccination has been given and testing needs to be performed, defer TST or IGRA until 4 weeks after COVID-19 vaccine 2-dose completion.
    • All potential recipients of COVID-19 vaccination should weigh the risks and benefits of delaying TST/IGRA with their providers.

If a facility has a concern regarding delaying the TST or IGRA, because of vaccination- then they can rely on the state waivers currently in place to delay the TB test, if necessary.

Another question we have received has been regarding CDC guidance related to co-administration with other vaccines.

Coadministration with other vaccines

Given the lack of data on the safety and efficacy of mRNA COVID-19 vaccines administered simultaneously with other vaccines, the vaccine series should routinely be administered alone, with a minimum interval of 14 days before or after administration with any other vaccine. However, mRNA COVID-19 and other vaccines may be administered within a shorter period in situations where the benefits of vaccination are deemed to outweigh the potential unknown risks of vaccine coadministration (e.g., tetanus toxoid-containing vaccination as part of wound management, measles or hepatitis A vaccination during an outbreak) or to avoid barriers or delays to mRNA COVID-19 vaccination (e.g., in long-term care facility residents or healthcare personnel who received influenza or other vaccinations prior to/upon admission or onboarding). If mRNA COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.

COVID Vaccinations and Infection Control

SLCR has received many questions regarding COVID-19 vaccinations and the impact those vaccinations will have on infection control guidelines. At this time, there are still many questions unanswered regarding vaccination that make infection control changes uncertain right now. Current CDC can be found here: https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care/index.html.

Vaccination is one important tool (not the only) in our tool belt to address COVID-19 infections. Vaccinating healthcare personnel and residents is essential to helping prevent individuals (who may not be able to recover) from getting COVID-19. For long-term care facilities, vaccinations are vital to protecting healthcare capacity. Staff who are sick cannot work and provide the necessary case and services to residents to ensure their health and safety.

The toolkit includes some helpful information for staff and residents/loved ones regarding the vaccine as well.

LTCF Staff pdf
LTCF Residents & Loved Ones pdf

CMS Memo: QSO 20-31-ALL: Revised COVID-19 Survey Activities, CARES Act Funding, Enhanced Enforcement for Infection Control deficiencies, and Quality Improvement Activities in Nursing Homes

CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care. In addition, CMS has provided Frequently Asked Questions related to health, emergency preparedness and life-safety code surveys.

See the memo for details.

COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers 

COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC, and front line staff and providers
Wednesday, 6, 2021, at 3:00 pm (Central Time)

Join The Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) for a fireside chat on vaccine safety. This is the second discussion in a special series, a part of the CMS National Nursing Home Stakeholder Call Series, aimed at addressing staff questions and concerns about the new COVID-19 vaccines. Each session will be moderated by CMS with speakers from CDC and representatives of front line staff and providers.

This chat will continue to address myths surrounding vaccine danger with the following panelist:

  • Dr. Lee Fleisher, CMS Chief Medical Officer and Director, Center for Clinical Standards and Quality (CMS)
  • Dr. Amanda Cohn, Chief Medical Officer (Acting), Office of Vaccine Policy, Preparedness, and Global Health, Office of the Director (CDC)
  • Cassandra Lowe, Certified Nursing Assistant (CNA)

Preparing for the call:

Target Audience: Nursing Home Frontline staff, Chief Nursing Officers

Register in advance for this webinar (After registering, you will receive a confirmation email containing information about joining the webinar): https://cms.zoomgov.com/webinar/register/WN_VQnfc77zTaOho3-yYrtGUAA

Monoclonal ECHO Mini-Series

This series will provide a deep dive on new and emerging COVID-19 outpatient therapeutics, including monoclonal antibodies. The goal of this mini-series is to equip clinicians with the appropriate knowledge, resources, and tools needed to initiate and scale administration of these therapies and reduce strain on the U.S. healthcare system.

Registration is at https://hsc.unm.edu/echo/institute-programs/covid-19-response/us-covid19/hhs-aspr/miniseries.html.

The upcoming event on January 6, 2021 will discuss the recent and very successful experience with MABs in the State of Michigan.

Free COVID-19 Testing Opportunities Available Throughout Missouri

Date

Times

City

County

Location

Jan. 4, 2021

12PM – 4PM

Tarkio

Atchison

Tarkio United Methodist Church

Jan. 4, 2021

9AM – 4PM

St. Louis

St. Louis City

CareSTL Health

Jan. 4, 2021

10AM – 4PM

Potosi

Washington

Great Mines Health Center

Jan. 4, 2021

9AM – 3PM

Kansas City

Jackson

Bruce R. Watkins Cultural Center

Jan. 5, 2021

10AM – 4PM

Farmington

St. Francois

Christian Life Church

Jan. 5, 2021

1PM – 6PM

Warsaw

Benton

Katy Trail Clinic Parking Lot

Jan. 5, 2021

12PM – 3PM

St. Louis

St. Louis City

Affinia Healthcare

Jan. 6, 2021

1PM – 6PM

Camdenton

Camden

Central Ozarks Medical Center

Jan. 6, 2021

9AM – 6PM

Kansas City

Clay

Worlds of Fun

Jan. 6, 2021

10AM – 5PM

Ste. Genevieve

Ste. Genevieve

Civic Center

Jan. 7, 2021

12PM – 3PM

St. Louis

St. Louis City

Affinia Healthcare

Jan. 7, 2021

1PM – 7PM

Warrensburg

Johnson

Johnson County Fairgrounds

Jan. 7, 2021

12PM – 4PM

Mound City

Holt

Northwest Health Services – Mound City Clinic

Jan. 7, 2021

9AM – 4PM

Kansas City

Jackson

Kansas City Zoo (Cheetah Parking Lot)

Jan. 8, 2021

12PM – 4PM

Maryville

Nodaway

National Guard Armory

Jan. 8, 2021

9AM – 4PM

St. Louis

St. Louis City

CareSTL Health

Jan. 8, 2021

10AM – 1PM

Osceola

St. Clair

Clearview Care Center

Jan. 8, 2021

9AM – 4PM

Kansas City

Jackson

Kansas City Zoo (Cheetah Parking Lot)

Jan. 9, 2021

9AM – 6PM

Cassville

Barry

ACCESS Family Care

Jan. 11, 2021

12PM – 4PM

Grant City

Worth

Worth County High School

Jan. 11, 2021

9AM – 4PM

St. Louis

St. Louis City

CareSTL Health

Jan. 11, 2021

9AM – 3PM

Kansas city

Jackson

Bruce R. Watkins Cultural Center

Jan. 12, 2021

12PM – 3PM

St. Louis

St. Louis City

Affinia Healthcare

Jan. 12, 2021

10AM – 5PM

Cape Girardeau

Cape Girardeau

Agricultural Barn

Jan. 13, 2021

9AM – 6PM

Kansas City

Clay

Worlds of Fun

Jan. 13, 2021

11AM – 2PM

Kimberling City

Stone

First Baptist Church Ministry Center

Jan. 14, 2021

12PM – 3PM

St. Louis

St. Louis City

Affinia Healthcare

Jan. 14, 2021

12PM – 4PM

Stanberry

Gentry

Stanberry City Hall

Jan. 14, 2021

9AM – 5PM

Hermitage

Hickory

Ozarks Community Health Center

Jan. 14, 2021

9AM – 4PM

Kansas City

Jackson

Kansas City Zoo (Cheetah Parking Lot)

Jan. 15, 2021

9AM – 4PM

Kansas City

Jackson

Kansas City Zoo (Cheetah Parking Lot)

Jan. 15, 2021

9AM – 4PM

St. Louis

St. Louis City

CareSTL Health

NHSN Notification Message

DHSS has received notification of an application error impacting NHSN COVID-19 data for the period of December 26-31, 2020. Steps for a work around are below.