The roughly 3 million Americans who reside in nursing homes, assisted living facilities and other group-care communities are an almost invisible population.
This week, however, they were singled out for high-priority access to a most precious resource: some of the first doses of COVID-19 vaccine available in the United States.
It's a distinction they'll share with the nation's 21 million healthcare workers, thanks to a vote by the Advisory Committee on Immunization Practices, an expert panel that advises the federal Centers for Disease Control and Prevention.
In some eight months of debate among the 14 members of ACIP, as the advisory group is known, the idea of prioritizing healthcare workers was never in doubt. The ability of these doctors, nurses, pharmacists, paramedics, hospital staffers, medical technicians and home health aides to show up for work is essential to our weathering the pandemic.
They are widely hailed as heroes, running toward danger while those who can protect themselves do so by staying home. Their jobs caring for the sick have led to outsized rates of infection and severe illness in their ranks — though they make up about 6% of the country's population, they account for 12% of U.S. COVID-19 cases.
It's a profile starkly different than that of patients who live in long-term care facilities. Retired from active life, they are on the receiving end of medical care. Indeed, they are so medically fragile that some fear the vaccine itself could hasten their demise.
If vaccines for diseases like the flu are any guide, the new COVID-19 shots may not be particularly effective in nursing home residents. The aging immune system is notoriously difficult to rouse with vaccines.
Neither of the first two COVID-19 vaccines likely to win emergency use authorization from the Food and Drug Administration — one from the pharmaceutical giant Pfizer and the other from a start-up named Moderna — has been studied in the kinds of very elderly, very frail patients who populate long-term care facilities. (In clinical trials largely involving thousands of younger, healthier adults, they've been shown to be more than 90% effective.)
Yet if states opt to follow ACIP's advice, this group will get the scarce vaccine before teachers, before workers deemed essential to the economy, and before younger seniors and those with underlying conditions.