Dr. Rhonda Collins - A Glimpse At How a Senior Living Community Rolled Out the COVID-19 Vaccine

I discuss the COVID-19 vaccine with Dr. Rhonda Collins, M.D., Chief Medical Officer for Revera, an owner, operator, and investor in the senior living sector with an aim to improve the aging experience by celebrating the ageless spirit of older adults. She joins me today for the second time on Boomer Living to discuss the new coronavirus vaccines that have been in the news so much recently.

Topics of discussion:

• Why is it so important that our older adults get vaccinated quickly? [02:17]
• What is different about this vaccine? How does the vaccine work? [03:13]
• Myths and Facts about the vaccine [11:05]
• Should the vaccine be mandatory for Senior Living Staff? [13:00]
• Share with me the journey at your community and the rollout of the vaccine. When did it start? How has the the rollout been for you? [15:28]
• How has the pandemic affected you over the last year? [20:44]

Dr. Rhonda Collins
Chief Medical Officer

Dr. Rhonda Collins brings passion and expertise in memory care, dementia, falls prevention and clinical quality improvement to the role of Chief Medical Officer – a first for the seniors living sector in Canada.

Dr. Collins is a family physician with a certificate of added competence in Care of the Elderly from the College of Family Physicians of Canada. She has been lead physician for the Outpatient Primary Care Memory Clinic at Shaver Hotel Dieu Health and Rehabilitation Centre in St. Catharines, and Medical Director and attending physician for several long term care homes in the Niagara Region. She regularly consults on neuropsychiatric behaviours of dementia for the Niagara Seniors Mental Health Outreach program. She is Associate Clinical Professor with the Department of Family Medicine at McMaster University School of Medicine where she developed and leads a Care of the Elderly rotation for family medicine residents.

You can reach Dr. Rhonda Collins M.D. via LinkedIn at https://www.linkedin.com/in/rhonda-collins-96ba4067/

Transcript

Hanh: 1:48

Today my guest is Dr. Rhonda Collins. She is a chief medical officer at Rivera. It's an owner operator and investor in the senior living sector with an aim to improve the aging experience by celebrating the age of the spirit of older adults. So Dr. Rhonda Collins joins me today for the second time on Boomer Living to discuss the new Corona virus vaccines that have been in the news lately. So Dr. Rhonda Collins, welcome back.

Rhonda: 2:15

Thank you for having me, Hanh.

Hanh: 2:17

I wanted to go through just a series of questions that I have regarding the vaccine, the rollout, the distinction, So I guess, first of all, why is it so important that our older adults get vaccinated quickly?

Rhonda: 2:30

Great question. It's because we know that the virus, the COVID-19 virus has preferentially targeted older adults, especially those with underlying health conditions. So we know that we've seen this, severe outcomes in younger adults as well, but it's much less frequent in older adults, severe consequences, and even fatal outcomes are much more common, especially if there are underlying health conditions like heart disease, lung disease like asthma, or chronic bronchitis emphysema, diabetes, even obesity. So any underlying health conditions in an association with an older adult is, a, worrisome for severe outcomes.

Hanh: 3:13

This vaccine is so different from other vaccines that we created in the past. So can you explain how the vaccine is different and how does it work?

Rhonda: 3:22

Sure. I'm, and I'm speaking in Canadian terms right now. I think there may be more available in the US but in Canada there are about seven vaccines that are either available or coming close to being available, getting emergency authorization and emergency use authorization. The two that we have currently, there are two that are very common in the US as well, and I'll focus on them because they are different than the other vaccines, are the Moderna vaccine and the Pfizer vaccine. And the reason these are different is because most vaccines use a live or an inactivated or weakened virus, so that it, when you inject it, your immune system recognizes that virus so that when it sees it again, it will be able to respond with an immune response to protect the body. The Pfizer and the modern vaccines are unique because they contain a technology called messenger RNA or mRNA. And it's different because they're using genetic material. So it's not a virus. It's genetic material from the virus and it's synthetic genetic material. So if you think of a virus in the core of the virus are RNA and DNA, the genetic material, and that's wrapped around proteins. If you think about the the COVID virus, the Corona virus, the Novel Coronavirus, it, everybody's seen it. It's a ball and it's got those little spikes sticking off it that look like crowns, and which is Spanish, Corona is Spanish for crowns. So that's describing those, those are proteins though, those spikes. And so what this vaccine does is reproduce using genetic technology, have the RNA, DNA, make the messenger RNA produce this protein, these spike proteins, and so that when your body then is introduced to the real virus, it will be able to respond. So it's, I get really excited talking about it because it's a newer technology in terms of vaccines, but it's not really new it's been around, iIt's been studied for decades for about 30 years, actually. And it's been used for about the past decade in cancer research specifically. So it is, It's exciting and it's shown great promise, so far millions of people have now been vaccinated with very low rates of significant outcomes, a lot of minor side effects that we expect with any vaccine and are typical of our body trying to mountain immune response.

Hanh: 5:52

The two big players right now are Moderna and Pfizer and there's others I guess working their way through the approval process. Do you think one is preferable at all? Are they functionally the same?

Rhonda: 6:04

They're functional. the same. and they both do the same thing. I think right now, my, my take on Moderna and Pfizer is whatever gets here fastest that we can get into arms quickest is the one that I'm happiest with.

Hanh: 6:18

What's your thoughts on the New vaccine in clinical trials? Let's say the Johnson one, it's not as effective as preventing COVID, but does it prevent hospitalization? And is it only one dose as opposed to two dosages?

Rhonda: 6:33

And that's one of the big things about, um, some of the other vaccines, including the Janssen vaccine is one dose would certainly help the situation. There's, there are a few things with the Moderna and Pfizer vaccines that some of the others like the AstraZeneca Oxford that they're using in the UK, Covax is another, and then the Janssen, which is very close to approval in Canada, and I think you've got approval in the US for it, emergency use authorization, I should say, rather than approval. And so, one dose, it would be significant because the two dose strategy is a little challenging to operationalize. It's been a, it's been a challenge over the past couple of months, ensuring that we get the first dose and then the second dose in a timely fashion. And if you're following Canadian news at all, we've had a delay on some of the vaccines coming. And so a lot of people got their first dose and we've preferentially selected long-term care residents, senior living residents and then healthcare workers in long-term care. And then we gradually spread out to different parts of the population like healthcare workers outside of senior living. And so a challenge is faced when we have enough for the first vaccine, but we don't know if we're going to get enough of the vaccine, for, in time for the second one, which has led some of our provinces to have different rules and regulations. So we have much like the States, we have provincial health authorities and some are moving to a longer duration. So if, with Pfizer, for instance, the recommendation is day zero and then day 21 for the second dose, with Moderna its day zero and day 28. And so because of the delay of the vaccines, some are being spread out to 30, 35, even up to 42 days based on the research that's been done thus far. We know that after one dose with Pfizer and Moderna the effectiveness is approximately 52%, after the second dose that goes up to 94% and 95% for Moderna and Pfizer respectively. Those are really big numbers. Those are huge numbers. So when you ask about Janssen, it's more around the 85% mark, so that 85 out of a hundred people will have good immune response to the vaccine, still better than nothing. It's still I, I think again, the more people we can vaccinate, the greater, the likelihood we get the immune response up to where it needs to be and try to achieve some herd immunity so we can go back to a slightly normal way of life.

Hanh: 9:08

Ain't that the truth? So I know there are many people out there who are nervous that the vaccine was developed so quickly. So how can we convince these skeptics that, you know, that the vaccine is safe?

Rhonda: 9:20

I understand people's hesitancy and we're trying to overcome that, especially in healthcare workers, especially in people over the age of 65, by certainly explaining the vaccine because there's concern about the technology that it's new, which we know that it's not, but it's newer compared to the older vaccines. I would have said the same thing at the beginning of this pandemic I said, you know don't rely on a vaccine as being the, be all end all because it takes a long time for a vaccine to get through the approval process, to be produced to go through clinical trials to get through the approval process, to go through. I would not have anticipated in February of last year that we would have already been vaccinating people as of December. I think that's phenomenal. And the reason is because in China, when they first discovered the virus, and this is this is new and this is novel and this is incredible. The scientists shared literally on a website, shared the genetic sequencing, the genome for the virus across the world. They shared it broadly. And so instantly all of the scientists, researchers, physicians health authorities, governments, vaccine manufacturers, we're all able to start working on this process in collaboration and really moving at rapid pace. They also had a significant amount of funding, but just to have that genetic sequencing and be able to start working on a virus, a vaccine rather, that strategy is brilliant. And so that's why it came to market so quickly. If everything could work this quickly, it would be incredible. But this is just the incredible hard work of an awful lot of scientists and researchers.

Hanh: 11:05

What are some of the other common vaccine myths or misconceptions?

Rhonda: 11:09

Um, well, the safety, the safe, safety and efficacy of, because of the fact that it's come to market so quickly. And, but remember, even though it doesn't have full FDA approval, it has emergency use authorization, which means that it has to have undergone the same clinical trials that any other medicine or vaccine has to. So they require a specific number of volunteers to be in the trials. They certainly look at different types of people to be in the trial. So there is a concern brought forward that will"What about for people over the age of 65? Is it safe for those people?" because they weren't included in the trials. They actually were, there was, about 40%, just over 40% of people in the clinical trials for both Moderna and Pfizer were between the ages of 56 and 84, I believe. So, and if you think about the clinical phase three clinical trials, there were over 40,000 people involved. And even beyond that, so going beyond the fact that there were 40,000 people, some people might say that's, that's not very many, but look at how many millions of vaccines have been distributed, administered now. So the other piece of that is with, from a safety perspective, we have adverse events reporting. So through governments, through the CDC and the FDA there are adverse events, reporting systems for all medications, but also vaccines. So anytime there's an adverse event associated with a vaccine, that's going to be reported. The, there's a very stringent process even to allow for emergency youth authorization it's not a simple process. So it has to undergo a lot of scrutiny before they will allow this to be approved.

Hanh: 13:00

Do you think it should be mandatory for senior living staff to get the vaccine when it's available to them?

Rhonda: 13:06

That's the million dollar question. Vaccines in general, mandating vaccines is a very challenging thing to do because it is a treatment. And If we think about health law, mandating a treatment is a tough thing to do. And there are a lot of reasons why people can't have vaccines. I think about medical reasons that people can't have vaccine, specifically. There are also cultural and religious reasons that people choose not to be vaccinated. The argument for vaccinating, requiring vaccination of all staff is so that they can protect the people for whom they care. The one thing we still don't know about these vaccines at this point, what we know is they're incredibly effective at preventing symptomatic illness. So for our residents, our, and are everybody over the age of 65, who is at higher risk, to get the vaccine is incredibly important because we reduce the risk of severe side effects and fatal outcomes. Where it gets a little tricky is when we say "We don't know at this point, if they're going to reduce transmission." So the idea of me getting the vaccine is to protect myself and to protect those around me. We need a lot more data to say that my getting the vaccine is actually protecting others because asymptomatic spread has been the number one concern with COVID since the beginning. And the reason why there was such rapid spread, especially in congregate care settings, like nursing homes and skilled nursing facilities, is because people were not wearing masks because they were unaware of the fact that they could spread the virus asymptomatically without symptoms or before they started showing symptoms. So I think some more work needs to be done. I am familiar with organizations who are mandating the COVID vaccine for healthcare workers in senior living residences. I, in my organization, I'm not there yet. I would much rather see that... Our staff being vaccinated is protecting our residents. Right now I am much more concerned about our residents getting vaccinated first. I'm doing everything I can to overcome vaccine hesitancy for my employees because certainly the more staff, the more healthcare workers, the more of the general population that gets vaccinated, the greater, the likelihood we're going to achieve herd immunity.

Hanh: 15:28

So now share with me the journey at your community and the rollout of the vaccine. When did it start? How has the the rollout been for you?

Rhonda: 15:37

So it's been very interesting. So we have Revera owns 175 long-term care homes and retirement residences across Canada. And it's, the way it started in December was because, of the, I had alluded to earlier some of the challenges with Moderna and Pfizer, especially Pfizer is an extremely delicate vaccine that has a really low temperature requirement, minus 80 degrees, certainly not all seeing it. No senior living facilities have the availability to store vaccines at those temperatures. So when the vaccine came into my province, Ontario, there were only two hospitals within the entire province who could store the vaccine. And so it was a matter of doing some pilot programs and looking at the logistics of how do we get a vaccine with these, very specific cold chain requirements this minus 80 degree temperature from the hospitals to the homes? Moderna could be stored at the home. So what basically happened in a lot of jurisdictions here is that Pfizer was given to workers - long-term care staff. They had to go to the hospital to receive it because that was the only place the Pfizer could be stored. Within the homes Moderna was being given to the residents because that could be brought to the homes. As we've learned over the past couple of months, we've had more stability with Pfizer as in, we can take it from the hospital to a home, allow it 30 minutes to thaw and then administer it within a couple of hours. So it, the rollout has been very different across multiple jurisdictions, in some places it's hospitals coming in and doing the vaccinations of all residents and staff, in some jurisdictions, it, staff are still going to hospitals and public health is bringing the vaccine into the home for the residents. Um, it's been a mixed bag of tricks.

Hanh: 17:34

Are you at the time of the second vaccine right now? Or did you pass that?

Rhonda: 17:39

We've passed it. A lot of people have received their second dose, some have not. I spoke earlier about different health authorities having different plans and some of the ideas were when we were looking at a potential shortage."Would it be better to give one dose and save the remainder for the second dose to a specific number of people or would it be better to vaccinate as many people as possible with what was available at the time while waiting for further shipment to come in?" So some jurisdictions actually, instead of saying, "We have, I'll give a hundred, we have a hundred doses. Let's give 50 and save 50 for the second dose." They would say "We have a hundred doses, right? Let's give a hundred doses. And if the second shipment is delayed, we've got some time." That idea that it's better to vaccinate a larger number of people with a lower efficacy than to try and hold onto it and vaccinate a smaller number of people for higher efficacy, it's that epidemiology challenge thats trying to strike a balance there.

Hanh: 18:40

What tips, lessons learned, since now that you've gone past the second dose that you could share to the listeners, what lessons learned?

Rhonda: 18:49

I would say that the side effects are pretty mild, generally speaking, after the first dose. We have seen more significant side effects after the second dose, and by that, more muscle aches and pains, headache fever, chills. And that is probably the body's mounting a response to the protein. And so that's, that's a good thing. I know people get concerned about side effects but we haven't seen a great deal of significant side effects. Mostly it's been those flu like symptoms and they're more prominent after the second dose. One of the things that we've identified is that, and, and gives people cause for concern, and it isn't a cause for concern when it's explained, is that people are testing positive aAfter they've had their vaccine. And there's several reasons for that, number one is that, okay the vaccine, as I mentioned is none of them are 100% effective. So if I say a vaccine is 95% effective, that means 95 out of a hundred people who receive it will become immune, five people won't. It's a good number. It's a huge number but we have to remember that it's not a hundred percent effective. So there are some people who won't have a response to the vaccine. So that's one thing. The second is the incubation period. So there is a possibility that somebody has been infected with the virus. They're not positive yet on testing because it's too early in the incubation period. Now they received their vaccine and they subsequently test positive. I've had the question well "Is that, is that because they're having a reaction to the vaccine? Is the vaccine that made them positive?""Can you get the virus from the vaccine because it's not a virus that's being injected?" No, you can't. And so that's the reason is it's somewhere in that incubation period that they may be exposed to the virus before they've received the vaccine, but before they've tested positive, so not to be too concerned about that.

Hanh: 20:44

That's great. Gosh, so now having gone through the last 11 months of the pandemic and serving older adults, has it changed you in any way?

Rhonda: 20:53

Has it changed me? That's a great question. It's made me aware definitely of some of the vulnerabilities within our sector. I spoke, to, way back in the beginning, where in wave one, we had some wildfire outbreaks at homes. We did definitely deep dives into what happened in those homes that had the really big outbreaks and what could be done differently and how we could change going forward. And so it's caused me to think a lot more about what we do. The biggest thing I can say that I'm concerned with, you and I spoke about this, is the isolation that we've inflicted upon people. It's necessary and when we talk about the senior living sector it's easy for you and I to say, "We aren't going to go shopping and we aren't going to go visit our family and we're going to wear our masks and we're going to do all the things we need to do to flatten the curve and end this pandemic." It's very different when we talk about our senior living communities and where we've prevented essential caregivers from coming in, like families, where we've isolated our residents and made them wear masks and made them eat in their rooms and taken away activities. We've done this with good intent. We're trying to protect them from the virus because we know that the outcomes can be severe. But what we've done is exposed them to other Negative outcomes. And we know that the negative outcomes of isolation in older adults can be worsening function, worsening cognition, or worsening social engagement, where they can experience more depression, more anxiety. If they have dementia, more confusion. If they don't have dementia, more cognitive decline. I worry about our residents who have been sitting and not engaged in physical activity. What that's going to mean when we start engaging them again, where their muscles have weakened, because they haven't been doing the things they used to do. So has it changed me? I've always been very passionate about care of the elderly, I'm even more so now. I think we need to do everything we can to end this pandemic and get back to a state of normal, not only for us, but more for our residents in senior living communities and even those who live independently in the community they're suffering as a result of this as well.

Hanh: 23:14

I agree with you wholeheartedly. Maybe I should reframe my question is how has it changed you? Because I think everybody that's breathing has been impacted by this, whether it's from the economy, health wise and relationship and all components of your life, you know? I'm just looking forward to the positive from this administering the vaccine and our economy to stay open, that, as we ease into this. Cause we all need the socialization. Obviously the older adults have more adverse, um, impact from that, but I'm looking at school, age kids um, it's not good at all age levels, right?

Rhonda: 23:55

No, I think we're going to see the consequences of this down the line. I think we're just, I think we're just seeing the tip of the iceberg right now.

Hanh: 24:03

Yeah, I agree. Now with regard to leadership that you and your team had to do to keep the operation in motion as we get through this pandemic, what leadership skills would you advise?

Rhonda: 24:19

Compassion and understanding, I know they don't sound like leadership skills, but they're critical, and collaboration. One of the things I've said many times throughout this pandemic is "That if anything good has come from it, there is a greater understanding within the different health sectors of what we face in long-term care." It is often an overlooked sector. There's a great deal of focus on acute care. Hospitals seem to get a lot of attention, and long-term care nursing home, skilled nursing facilities have a tendency to be left out of a lot of the discussions. And so what I've learned in the past year is that we've had some breaking down of silos between the public health units, between the acute care sector and the long-term care sector and various other stakeholders. And I am so hopeful that continues beyond the pandemic because it's been remarkable the way the different stakeholders have come together to work through solutions. So collaboration is one of the key leadership skills and listening. No, I think at, no time more than now has listening been so important, asking questions, not for the sake of asking, but for the sake of actually hearing the answer and being able to action it.

Hanh: 25:38

I echo that, communication collaboration, teamwork, cultivation of staff culture and of course technology, and the vaccine, so many things to be thankful for. Wow. Thank you so much for giving us that update. Do you have anything else that you would like to add?

Rhonda: 25:57

I think everybody stay strong, stay positive. Um, we're going to move through this eventually, I was hoping sooner rather than later, but we're in a, we're in a marathon. It's not a sprint, it's a marathon, and so people need to stay positive. I would also say on a personal note, pay attention to the people around you, and that's as, as a leader, as well as a human being the ability to ask people "How they're doing?", and listen to how they're doing is incredibly important right now. Um, I know that we all, it's a social, it's social etiquette when somebody asks you "How you're doing?" to say, "I'm fine." We all do that even when we're not fine. There's been some very good literature on what stage people are. It was derived from a PTSD scale, but there is a thriving surviving, a struggling, and in crisis set of pillars and recognizing that. Some of us are struggling and some of us are in crisis and we don't necessarily show that outwardly. So it's looking for signs that somebody is a little more irritable than they typically are. Somebody is less engaged in a conversation than they typically are. Somebody's performance at work isn't where it usually is. Those are triggers for a leader to say,"Is there anything I can help you with?" So I think we need to get into a habit of saying, "How are you" saying, "How can I help you?"

Hanh: 27:28

That's awesome. That's a very compassionate and I can see why you're great at what you do, so well, thank you.

Rhonda: 27:36

Great.

Hanh: 27:36

Thank you so much.

Rhonda: 27:38

Thanks Hanh. It was good to see you. Take care of yourself.

Hanh: 27:40

Good talk. Good talking to you.

Rhonda: 27:42

You as well.

Hanh: 27:43

Bye-bye.

Rhonda: 27:43

Bye.