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By Hannah Critchfield
Mark Shepherd got off the phone with the public health department and began reaching out to members of the Henderson County Rescue Squad.
It was early January. The volunteers, all emergency medical professionals, were needed at The Laurels of Hendersonville, an assisted living facility about 20 miles outside Asheville.
Shepherd, a physician assistant and head of the county rescue team, had been to The Laurels before.
“But this time,” Shepherd recalls telling his team, “We have a cure.”
Early on in the pandemic, counties across North Carolina formed “strike teams” to help fight outbreaks in long-term care facilities. Henderson County’s team, which includes many members of Shepherd’s rescue squad, continued to assist facilities throughout the year, including the Laurels. Now, these multidisciplinary teams are helping to quickly vaccinate the public and aid nursing homes that aren’t receiving federal assistance.
“There was an overwhelming sense of urgency to help with these clinics — to kind of see the operation and the disaster to its finish,” said Shepherd. “The team had been so involved all year, and has worked so hard. This was a natural next step.”
What are ‘strike teams?’
Traditionally used in natural disasters like wildfires, floods, and hurricanes, strike teams apply an emergency response model to public health crises like novel coronavirus outbreaks. The teams are composed of about 10 to 15 members from local emergency management agencies, health departments, and volunteer groups, and are designed to provide more staffing and resources at a disaster scene.
Western North Carolina, with its mountainous, river-rich areas and limited cell service that provide fertile ground for excursions-gone-wrong, is no stranger to this kind of emergency response.
To Henderson County officials, it seemed logical, if novel, to apply the model in long-term care homes facing outbreaks.
“It was huge for us in the initial part of the pandemic,” said Steve Smith, the health director of Henderson County. “In Henderson County, strike teams went directly into facilities to mitigate the spread of the disease.”
Similar teams proliferated across the state and country, coming to similar conclusions simultaneously.
‘This is the rescue’
While initially used to help rapidly test and isolate residents, set up decontamination tents and educate staff on proper PPE use, and coordinate communication to concerned family members, strike teams now arrive at long-term care facilities with a solution in tow.
“Any time we have an incident, there’s the actual rescue, and then the demobilization and resolution,” said Shepherd. “And this is kind of doing that rescue-resolution phase. This is the rescue — getting these vaccines.”
Strike teams in Henderson County have vaccinated facilities that did not enroll in the federal government program for long-term care homes run by CVS Health and Walgreens.
“I don’t know those facilities’ reasoning for staying out of that national contract, but I think there was a lot of confusion on the initial enrollment,” said Smith. “Strike teams were beneficial for those in particular because we were already familiar with them [from responding to previous outbreaks].”
Local vs. federal vaccinations in long-term care
One of the residents who benefitted was Dianne Norvell.
Norvell, who is 76, has lived at The Laurels of Hendersonville for the past four years.
With the help of strike team members, she received her first dose of the vaccine on Jan. 5, and her second on Feb. 2, according to her daughter Jennifer Wyatt.
“It was great, especially knowing that hopefully once everybody gets it, I can actually go in and visit,” said Wyatt. “Since March, I’ve only been able to see her through the window and talk to her on the phone. It’s been really hard on her — as much as the staff tries, it’s not the same as your family.”
Some long-term care residents, particularly those within assisted living facilities participating in the CVS-Walgreens program, have seen slower rollouts — sometimes at a high cost.
Barbara Fischer, 83, died of COVID-19 three days before she was scheduled to receive her first dose of the vaccine on Jan. 26.
Her assisted living facility, Brookdale Meadowmont, was partnering with CVS Health.
Pharmacy officials have cited staffing shortages and logistical challenges, both hurdles strike teams are designed to address, as partial reasons for the slow administration of their vaccines.
“Our public health department has a lot of different functions,” said Shepherd. “We allow them to one, be able to administer more vaccines, but then two, we also free them up to make sure that the important work of public health for a community like Henderson County is still happening. They’re driving the ship — we’re just backing them up.”
The Henderson County strike team has vaccinated three long-term care homes, both skilled nursing and assisted living facilities, so far.
Speeding up vaccinations?
The efficacy of strike teams, both in stopping spread in long-term care and in speeding up vaccinations, needs more research — and some is being done. Their use in the vaccine effort is so new, no papers have yet been published on the initiative.
Dr. Philip Sloane, a geriatrician and professor at the University of North Carolina School of Medicine, said deploying strike teams to help with vaccinations makes sense.
“Strike teams are essentially a way of rapidly getting expertise into a low-resource setting that really needs help,” said Sloane, who is studying the response model’s use in long-term care facilities. “Whenever you have something that has to be done rapidly that takes manpower, you have to get that manpower from somewhere – a good organizer will pull resources from where they can within the community.”
Mass vaccination clinics
The strike team in Henderson County is also helping with mass vaccination clinics for the general public.
At these events, where the county is currently vaccinating anyone 65 and older, members of the team help with registration, guiding older residents through the clinic, administering shots, and monitoring people after they receive the vaccine.
“They have been invaluable,” said Smith. “We now know how fast we can vaccinate people. That has allowed us to build larger plans for how to scale up big numbers quickly. Right now, every jurisdiction in the state is just waiting for vaccinations. We’re ready to go.”
Health departments across the state are adopting similar collaborative models alongside emergency management teams and volunteers, even if they aren’t calling them “strike teams,” according to Smith and Sheryl Zimmerman, professor and co-director of the Program on Aging, Disability, and Long-Term Care at the UNC School of Social Work.
“They’re calling themselves all sorts of things,” said Zimmerman. “It’s still just part of the community trying to respond to areas of need.”
The Henderson team will continue to assist with mass vaccination clinics throughout the rollout, but questions remain for their future in long-term care homes.
“These types of facilities have new admissions all the time,” said Smith. “Even we have not figured out a systematic way to get these one-or-two new people a day. How are we going to maintain those ongoing vaccinations, at places that aren’t part of that national pharmacy contract, amid this ongoing admission?”