Carlos Reyes wears a mask at home and eats alone in his bedroom. During the night, he has nightmares of accidently infecting his family with COVID-19. During the day, he works as a certified nursing assistant at nursing homes in central Massachusetts, often caring for COVID-19 patients.
Reyes assumed that as a frontline healthcare worker he would be among the first to receive the vaccine. But when he asked his nursing homes about getting a shot, the answer was "no."
Reyes is not alone. Many medical personnel who care for COVID-19 patients have struggled to get vaccinated. Clinicians in private practice, those who work for staffing agencies and others who are not directly employed by hospitals or long-term care facilities say they have been overlooked in the vaccine rollout.
"It feels as though we have been forgotten," said Reyes, who works for a nurse staffing agency. He picks up shifts at four or five different nursing homes in Massachusetts and, he said, none of them agreed to vaccinate him.
Between 5% and 10% of staff in nursing homes are people like Reyes. His staffing agency, IntelyCare, surveyed their nurses and nursing assistants in Massachusetts and more than half report being told they cannot get the shot.
"It's a big oversight that was not factored into the rollout plan," said Chris Caulfield, the chief nursing officer at IntelyCare, which operates in 15 states and employs 15,000 nurses and certified nursing assistants. "We've seen our employees throughout the country having the same frustration."
From Georgia to California, Pennsylvania to Ohio, New York to Texas, private medical practices — including pediatrician offices and urgent care clinics — say they are in a similar situation. Their clinicians care for COVID-19 patients but are often in line for the vaccine after hospital employees. At times those in private practice have been in line after hospital administrators and even after those working from home.
"It's hard not to be bitter," said Emily Swilling, a pediatrician in a private practice in Peabody, Massachusetts. Despite seeing upwards of 20 patients a day who have COVID-19 or coronavirus-like symptoms, she has struggled to access the vaccine because she is not affiliated with a hospital.
"We're not going to give up, but it would be a whole lot easier if we didn't have to be afraid of the patients in the rooms when we go in to care for them," she said. After several weeks of trying to get vaccinated, Swilling said, she recently heard from her local hospital that it's her turn.
Each state has devised their own vaccine distribution plans and often crucial decisions about who gets the vaccine first – and who does not – are made by individual medical facilities or by local boards of health. This has led to a lot of variation and sometimes a lot of confusion.
The Massachusetts Department of Public Health did not respond to multiple interview requests. However, Paul Biddinger, who chairs Massachusetts' Vaccine Advisory Group, said the state is aware of the concerns and working hard to fix them. He points out that the vaccine rollout is still relatively new, and the undertaking is enormous.
"This is more complex by orders of magnitude than any normal vaccination campaign, whether it's the complexity of the product, or the scale of the effort, or the limited supply," Biddinger said.
The work falls to public health systems and hospitals that are already overstretched and often under resourced.
"There are still lots of other important priorities in addition to vaccinations, such as planning for and accommodating the surge [and] the state rolling out field hospitals. There's so much that's needed," he said.
In Massachusetts, vaccinations at nursing homes and long-term care facilities fall under a federal program, whereas the state is responsible for all other vaccination efforts. In many cases, states have delivered vaccines in bulk to hospitals and medical centers.
Andrew Karson, the chief medical officer at UMass Memorial Medical Center, said each medical facility designed their own system for how to prioritize their employees and those working within their buildings. At UMass Medical, the rollout started with employees who are continuously taking care of COVID-19 patients before, eventually, making its way to hospital administrators and those working remotely.
"The governor in the State of Massachusetts has said: 'Please make sure you vaccinate those people, too, because if the administrators get ill, we won't be able to care for our patients because they are supporting all these critical services,' " Karson said.
Hospital administrators and remote workers were vaccinated before many community clinicians, Karson said, because they can be called up on short notice. He points to UMass Medical's Human Resources department, which has been needed to help staff their field hospital.
And, he added, that while UMass Medical was waiting for the go-ahead from the state to vaccinate community-based caregivers, first responders and patients, it decided to move ahead with hospital employees who have less COVID-19 exposure.
"Since we had the vaccine in hand, we didn't want to slow down the process of getting as many people vaccinated as quickly possible, so we moved ahead to invite the less-patient facing employees (including the employees who work remotely) as we waited for the broader guidance," Karson wrote in an email.
Only after UMass Medical had enough vaccine for all 15,000 employees did the state say they could start planning to open up to others, including local doctors, nurses and staff in private practices. He said that this new phase of the rollout is expected to begin in the next week or so.
Across much of the country, physician and nurses in private practices say they are slowly gaining more access and information.
"It seems as though local authorities and state authorities are listening. But it certainly took us not only raising our hand, but waving it wildly," said Christina Johns, senior medical advisor of PM Pediatrics, a network of urgent care offices in 13 states including Massachusetts.
In the coming days and weeks, experts expect most of those in private practices to get the first dose of the vaccine.
However, for contract nurses it's a little less clear. Caulfield, of IntelyCare, said he has yet to see improvements in the Federal Pharmacy Partnership, which is overseeing vaccinations in long-term care facilities. He said there are some small moves to increase access to vaccines but that it's happening at the "very local level and not quick enough."
Regardless, it's too late for Carlos Reyes. After a week of trying to figure out how to get a shot, he contracted COVID-19.
"It's very scary. It feels unnecessary because, again, the vaccines are there," he said. "Everything could have been avoided. Everything. Absolutely everything."
He said, now, he hopes his story will be a wake-up call for the nursing homes where he works, and maybe for others, to treat temporary healthcare workers the same as permanent employees.