A vial of the Moderna COVID-19 vaccine
A vial of the Moderna COVID-19 vaccine. Photo by Darrow Montgomery

Ivy Young has been eligible for the COVID-19 vaccine since Jan. 11 but has not gotten vaccinated. She wants to. But like some D.C. residents, she is homebound and cannot leave her house to visit one of D.C.’s vaccine sites. 

“I don’t leave my house because of my breathing condition,” says Young, 73. “If I were to go out, it would be a whole production.” She requires oxygen 24 hours a day and a wheelchair to leave her home.

Young lives in the home she grew up in, a row house in Northeast D.C. After returning from a hospital stay in 2018, she became limited to her home. Because she cannot leave, family and friends would visit her. A cleaner would also come by once a week to help her around the house. Young was about to hire a home health aide when the coronavirus pandemic hit. 

People whom Young depends on for support can no longer visit because they could spread the deadly virus to her. Right now, only her niece visits to help with groceries and laundry, and most human connection still occurs virtually.

Young thought she’d get access to the vaccine once the ones manufactured by Moderna and Johnson & Johnson were approved for emergency use. Only the Pfizer vaccine needs to be kept extremely cold. The storage and handling of the Moderna and J&J vaccines seem less complicated, so Young thought it was a matter of time before she got one of those shots. DC Health started to receive shipments of the Moderna vaccine in late December, and J&J in early March. Weeks flew by and Young received no call to schedule an appointment. Then she started to notice neighboring states vaccinate homebound individuals, leading her to wonder what was going on in D.C. 

“How would you not know that there are people who can’t get out who need the vaccine? Why wouldn’t you think about that? Why wouldn’t that be among the first people you would think about, especially when you got a vaccine that wasn’t as problematic to deliver?” Young asks.  

Young learned from the office of her councilmember, Ward 7’s Vince Gray, that DC Health is working to vaccinate homebound residents. She regularly calls his office for updates. “They’ve been working on something for a while,” Young says. Gray’s office advised her to pre-register on the government portal, vaccinate.dc.gov, even though she could not accept an in-person appointment if DC Health were to offer one. Just thinking about trying to leave the house to get vaccinated gets Young exhausted. “When you have certain disabilities, everything makes you tired,” she says. 

The Council has repeatedly asked Mayor Muriel Bowser’s administration when vaccinators will visit medically homebound residents. Ever since DC Health opened up eligibility to residents 65 and older, on Jan. 11, councilmembers have asked for an update during weekly conference calls with the executive. And every time, a member of Bowser’s team will say they are working to launch a homebound initiative very soon. 

Some homebound residents who live in public or affordable housing buildings have gotten vaccinated thanks to a partnership between DC Health, the D.C. Housing Authority, and local health care providers. For example, a mobile clinic set up at Triangle View, a 100-unit senior building on B Street SE, meant residents with mobility limitations were able to access the Pfizer vaccine. Meanwhile, homebound residents who live in smaller apartments or single-family houses are still waiting for the vaccine to come to them.  

During a press conference on Monday, DC Health Director Dr. LaQuandra Nesbitt said her agency will begin registering residents who are 100 percent homebound or have significant mobility limitations by the end of the week. People will have to indicate that they need a vaccinator to visit their place of residency while registering on vaccinate.dc.gov. The portal, which launched March 10, hadn’t been asking whether users were homebound. Nesbitt also said her agency has already begun identifying homebound residents through government programs they may use, like Medicaid or meal delivery. 

Nesbitt did not indicate when exactly they’d start vaccinating those who register, and then said on Tuesday that the initiative to vaccinate homebound residents will be delayed. DC Health is delaying the initiative because local vaccinators are pausing the use of the J&J vaccine. Federal authorities called for a nationwide pause on Tuesday, after six women developed rare but serious blood clots within two weeks of receiving the J&J vaccine.

The pause, which gives experts time to study the six cases out of nearly 7 million people who received the vaccine, was expected to last a matter of days. A CDC advisory panel of experts declined to vote on whether to resume the use of the vaccine on Wednesday, likely extending the pause for another week. DC Health is trying to pivot from the J&J vaccine to the Moderna one for other initiatives, including vaccinating residents experiencing homelessness and those staying in DC Jail, said Nesbitt. She did not specify why the agency couldn’t do that for homebound residents too.

Prior to the J&J vaccine issue, it was not entirely clear to homebound residents and their advocates why it’s taken so long for an initiative focused on the homebound population to launch. In calls with the Council, executive officials have been vague about the practical challenges. Dr. Erin Athey, a nurse practitioner at United Medical Center who runs the mobile clinic program at the hospital, told City Paper that the hospital declined DC Health’s request to vaccinate homebound seniors. It wasn’t logistically possible to visit multiple properties across the city in a day with such a large van and little staff. DC Health did not immediately respond to an email request for further comment. 

Tim McNeill, the manager for House Calls of the District of Columbia, a geriatric practice that serves homebound residents primarily in Wards 7 and 8, says patients or their family members call and ask about the COVID-19 vaccine daily. McNeill says his practice asked DC Health for doses so their health care providers can administer the vaccine in patients’ homes. McNeill says House Calls of the District of Columbia also tried to partner with MedStar Health so the hospital’s providers could administer the vaccine to their patient population instead. Neither materialized. (MedStar Health, which is able to use its own supply for special initiatives pending DC Health’s approval, did not respond to request for comment.) Now, McNeill says he is sending a list of patients that are in need of the vaccine to DC Health because many couldn’t register on their own.  

“We hear all this stuff about vaccine hesitancy. Every day, we’re getting people pleading for the vaccine. They’re not hesitant. They just don’t have access,” says McNeill. “The comments we’ve gotten from our patients is that they will be able to see their grandchildren and see their loved ones once they’re vaccinated.”

The last year has been a “nightmare” for patients of House Calls of the District of Columbia, says McNeill. Patients are socially isolated for fear of contracting COVID-19. Some cannot fully isolate or even quarantine if they were to be exposed because they require assistance bathing or eating. One of McNeill’s patients was exposed because of their home health aide. McNeill says the geriatric practice has seen a “significant number” of deaths related to COVID-19 within the last six months.

“They can’t just stop letting strangers come into their home,” McNeill says. “We have quadriplegics, paraplegics—self isolation is not a possibility for many of our patients.” 

It astonishes McNeill that many D.C. residents who are homebound cannot access the vaccine four months into the rollout, though he doesn’t blame DC Health. McNeill acknowledges that it would be difficult to maintain the required temperatures of the Pfizer and Moderna vaccines if vaccinators were going door-to-door. He also points out that the federal government shortchanged D.C. in the first stimulus bill. But it’s hard to not be angry when a few hundred people who are at risk of serious illness and death from COVID-19 want to be vaccinated but are not.

House Calls of the District of Columbia has about 600 patients and most of those that live within city limits have not been vaccinated. (One-fourth of its patient population lives in Prince George’s County.) The few vaccinated patients that live in D.C. have family members who’ve spent money to make it happen. Most patients have been eligible for three months due to their age alone. Patients who live in Prince George’s County are starting to get vaccinated.

Prince George’s County started sending vans into the community to vaccinate seniors, residents who are medically homebound, and other hard-to-reach individuals in February, says a spokesperson for the county health department. As of this week, 200 homebound seniors have been vaccinated through this initiative. Homebound individuals are getting vaccinated regardless of housing type, and individuals sign up by calling 311 or getting referred. The spokesperson says vaccinators use three vans the county first purchased through federal funds to conduct COVID-19 testing. 

Prince George’s County’s vaccination rate is higher than D.C.’s. About 27 percent of county residents have received at least their first dose, and another 2 percent received the single-dose shot, according to the Maryland Health Department. About 26 percent of D.C. residents are at least partially vaccinated, according to DC Health.  

D.C.’s vaccination rate among seniors is lower than the national average. As of April 9, roughly 70 percent of seniors are vaccinated. DC Health has worked to vaccinate seniors, like by registering some through door knocking. On Wednesday, the Bowser administration announced walk-up sites for seniors that require no appointments.