Some get COVID shots. One who didn't died. The uneven effort to vaccinate NJ's homebound

On a weekday morning in late April, a paramedic from St. Joseph’s Health arrived at Robin Chowdhury’s Paterson home to give him his first dose of Pfizer's COVID vaccine. His father helped the 31-year-old, who has Duchenne muscular dystrophy, sit up in bed for the shot.  

Eleven days earlier and a few miles to the east, Judy Rostkowski died at her home in Hasbrouck Heights after testing positive for COVID-19 just the day before. Her daughter had spent months searching in vain for someone to administer a vaccine to her 93-year-old homebound mother.

"Had I been able to get this vaccine to my mom in February or March she might still be with us today," said Jana Thorson, Rostkowski's daughter.

Four months after New Jersey's vaccination campaign began, the ability to get doses to thousands of homebound seniors and people with disabilities has been an uneven enterprise, marked by successes and tragic failures.

Gov. Phil Murphy's administration's slow rollout of a plan to vaccinate the homebound and its heavy reliance on local health departments, hospital networks and visiting nurse services to carry it out has been criticized by senior advocates, including the New Jersey chapter of AARP. 

“The current localized and decentralized system for homebound residents is difficult to navigate and leaves too many behind,” three AARP executives wrote to Murphy on April 14.

Part of the slow rollout was initially due to a limited supply of the one-shot Johnson & Johnson COVID vaccine, which is seen as critical for the homebound because it requires only one visit and can be stored and transported more easily than Pfizer and Moderna vaccines. An 11-day pause by federal health officials to review reports that the Johnson & Johnson vaccines may have caused serious blood clots in a very small number of women compounded the problem.

But other states have been able to establish large-scale plans to vaccinate the homebound even with the J&J problems, according to AARP.

For instance, Massachusetts has a dedicated webpage and call center for the homebound and their caregivers to make appointments. In Rhode Island, each town has a designated homebound provider whom residents can call. Connecticut has a statewide web portal for the homebound that connects them with someone in their town to administer a shot.

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New Jersey officials first spoke in February about the state's plans for the estimated 11,000 homebound residents, before the J&J vaccine was approved and when vaccine supplies were far below demand. But by late March, only a few pilot projects were underway, such as one by Essex County health officials and another by Valley Health of Ridgewood.

In response to the AARP's criticism, Health Commission Judy Persichilli said last week that local health departments have the responsibility to vaccinate the homebound, as they do with seasonal flu.

“It’s a combination of oversight by the Department of Health, but operationalized on the local level,” she said.

A statewide call center also has been collecting contact information from incoming calls concerning homebound individuals, and that information is then provided to local health departments, said Nancy Kearney, a state Health Department spokeswoman.

But that doesn't go far enough, say family physicians who argue that they could easily vaccinate their homebound patients if only they had doses. Only a few larger practices have received vaccines from the state Health Department, despite doctors lobbying state officials for months.

“If I had doses readily available, I would literally drive the doses to their homes and vaccinate my patients and their families,” said Dr. Michael Cascarina, president of the New Jersey Academy of Family Physicians, who runs a practice in Ocean County. “The reality is that I am hesitant to reach out to my homebound patients because there is currently nothing I can do, nothing I can offer."

Neither Robin Chowdhury nor Judy Rostkowski were physically able to get to a vaccine provider. But one got the vaccine at home and was given a chance to live. And one did not.

"There was no plan"

Having been widowed in 2003, Judy Rostkowski still lived a very active life — she was involved at her Hasbrouck Heights parish and the town's senior club, and she had frequent interaction with her family, which in recent years grew to include great-grandchildren.

But two years ago dementia slowly started to change her life. And last May, she was stricken with an infection that weakened her significantly. 

Aides came into her Hasbrouck Heights home around the clock, and a physical therapist and family members visited. All wore masks and practiced as much infection control as possible, said her daughter, Jana Thorson.  

But Rostkowski's condition worsened and by the fall she was mostly confined to bed. The family needed a hydraulic lift just to move her to a chair.

A few weeks after senior citizens and those with underlying conditions became eligible to receive a COVID-19 vaccine in mid-January, Thorson began calling around to see how she could get one for her mother. And so began months of frustration. 

Thorson spent weeks calling the local board of health, area hospitals, her elected representatives, the state’s vaccination call center, local pharmacies and her mom’s home health agencies — to no avail. She even went to the Meadowlands mega-site in person to see if she could get help.

“Everyone repeatedly said, ‘We are working on it,’” Thorson said.

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Rostkowski was still able to speak. She recognized her children and was able to carry on a conversation, albeit brief. But in April she became more lethargic and began to have trouble swallowing. Her doctor sent a nurse practitioner to the house to perform a COVID-19 test on April 16.

The next day Rostkowski died. Two days later the test results came back positive for COVID-19, Thorson said.

"If the vaccine could have been given when I started this quest in February, she would have been OK," Thorson said. 

No one person was at fault in her mother's death, Thorson believes. It was, instead, a breakdown of the health system — a system that was capable of sending a nurse to test for COVID, but incapable of sending a vaccinator to prevent it.

"There was no plan,” she said. “This was the forgotten population of Bergen County — the most vulnerable and the least able to get the vaccine.”

Last week, Thorson received a call from a woman at the local health department who had tried to get a vaccine for her mom. She finally had one and wanted to schedule an appointment. But it was too late.

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'Enormous relief and happiness'

Eleven days after Rostkowski's death, a rig from the St. Joseph’s Health Mobile Integrated Health team pulled up outside Robin Chowdhury's Paterson home to provide his first dose of COVID vaccine. 

His father, Sajjad Chowdhury, had requested help for his son from Paterson's mayor a week earlier, when he saw the mayor at the city's mass vaccination site while getting his own COVID vaccine.  

For more than a year, his parents have kept Robin safe from the pandemic. Duchenne muscular dystrophy is a progressive genetic disease that causes severe muscle weakness, and Robin has a tracheostomy — a hole in his throat to let air in. He  would be at extremely high risk of complications if he became infected with the virus.

Although Robin has a power wheelchair, his father must lift him into it and help him maintain his balance, making it difficult to leave the house. “It’s hard to take him someplace to get vaccinated,” Sajjad Chowdhury said.

Bob Bertollo, the paramedic who manages the mobile team, arrived with a Ziploc bag containing a pre-drawn syringe of the vaccine, Pfizer’s vaccine information sheet, and a federal Centers for Disease Control vaccination card, which he handed to Sajjad. He bantered with Robin, a 2008 graduate of Paterson’s Kennedy High School, while he cleaned a spot on Robin’s upper arm with an alcohol pad.   

“Just a little pinch,” Robin said as the needle went in. He hopes that his sister and her family, who live in Sweden, can come to visit after he gets his second dose on May 21.  

Bertollo checked Robin’s blood pressure and oxygen level with a pulse oximeter. He observed the pristine condition of Robin’s room and its medical equipment, as 15 minutes — the time required to check for an adverse reaction — ticked by.  

Then he went out to his rig and removed his face shield, N95 mask, surgical mask, and gloves. He sprayed his face, hands, clothing and shoe soles with a diluted mixture of peroxide, as he does after every patient visit.   

He set his GPS, and headed off to vaccinate other homebound people in Clifton, Hackensack, Paterson, Pompton Lakes and Totowa. There would be 12 patient visits that day, the number of doses in two vials of Pfizer vaccine. Once the seal on a vial of vaccine is broken, all the doses must be used within six hours.

It’s a slow process to drive to each location, don and doff personal protective equipment, greet the patient and caregiver, hand over the vaccine information sheet and vaccination card, inject the vaccine, and wait 15 minutes to watch for an adverse reaction. Depending on the distances involved, it takes close to an hour per visit.

But that’s what’s necessary to reach this hidden, vulnerable population, experts say. St. Joseph's has vaccinated about 50 homebound residents of North Jersey since April 1.

At Clover Hill Senior Living, an upscale boarding home in North Haledon, three women — aged 84, 86 and 94 — were scheduled for vaccines. Maryanne McGuire, the facility’s executive director, arranged the visit by the St. Joseph’s Health team after a relative of one of the residents learned about it from the town’s health department.  

One of the women is dependent upon a wheelchair and very hard of hearing, another has memory and cognitive impairments that would make standing in line at a vaccine center disorienting. The third lacks a nearby family member to transport her to a vaccine site. In the comfort of their rooms, each received the first dose of Pfizer and was assessed, with minimal disruption to their routines. 

Bertollo hands out teddy bears to his oldest patients to ease their anxiety. He tells them to take three deep breaths. When they turn to ask what’s next, he says he’s finished, having snuck in the shot on the second breath. The small pediatric-gauge needle is so fine that most people don’t notice it going in.  

Bertollo was surprised at first when families asked to pose with him and their newly vaccinated loved one for a photograph, but now he’s used to it. “I think they’ve felt enormous anxiety” trying to protect their fragile family members from infection, he said, “and now they feel enormous relief and happiness.”

How to get help

To find out more about the program at St. Joseph's Health and learn how to schedule an appointment, call 973-507-9788. The paramedics currently are using the Pfizer vaccine, which requires two doses three weeks apart.

Scott Fallon covers the environment for NorthJersey.com. Lindy Washburn covers health care. To get unlimited access to the latest news about COVID-19,  please subscribe or activate your digital account today.

Email: fallon@northjersey.com; washburn@northjersey.com 

Twitter: @newsfallon