Implementation of COVID-19 Vaccination in Substance Use Disorder Residential Settings

To the Editor: In a previous commentary, we explained the corona virus disease (COVID19) infection control plan used in our residential substance use disorder (SUD) program. At Mount Sinai, an SUD residential facility located in Dahlonega, Georgia, the American Society of Addiction Medicine (ASAM) and the Center for Disease Control (CDC) guidelines were used as a foundation for building a strong infection control plan to help ensure a safe environment for our patients and staff. The COVID-19 infection mitigation plan helped the facility to contain the infection to a great extent as evidenced by the infection percentage rate. Themain goal of this plan was to reduce the risk of person-to-person exposure which may lead to a wide spread of the infection on campus. The plan was focused on multiple screening processes before and after arriving on campus for all newadmissions and employees. All positive cases were isolated in a timely manner to contain the infection and reduce its spread to others. All exposed individuals on campus were tested immediately and sometimes we tested all clients on campus because of having more than 1 positive case. We reported previously that the number of COVID-19 cases in the United States in August 2020 was over 5.5 million and the death rate was over 170,000. Since that report, COVID-19 cases continued to grow in the United States and internationally. As of February 2021, the number of COVID-19 cases in United States is over 28 million and the current death rate is over 508,000. Therefore, there was a need to review and update the infection control plan to use more resources to help in the mitigation of COVID-19 in this residential SUD setting. Since our initial report in August 2020, the facility has applied 2 major revisions to improve the outcome of the infection control plan. First, the facility decided to utilize the antigenbased testing instead of the COVID-19 antibody testing. Second, the facility applied and was granted to be a vaccine site for administering COVID-19 vaccine supplied by the State Department of Health and Human Services (DHHS). The US Food and Drug Administration (FDA) has granted emergency use authorization (EUA) for antigen-based tests. These tests are immunoassays that detect the presence of the COVID-19 virus in nasal swabs. They are considered point of care tests. One advantage of the antigen-based testing is its moderate sensitivity and high specificity rate. This makes it more reliable compared with the bloodbased antibody testing previously used. The COVID-19 polymerase chain reaction (PCR) test is still the most reliable with high sensitivity and high specificity rate but PCR tests should only be used as the confirmatory test to provide definitive answers for any suspected infection. The FDA has also granted EUA for 2 vaccines produced by Moderna and Pfizer-BioNTech. Both vaccines need 2 doses to provide full immunity. Per CDC website, evidence from clinical trials showed that Moderna vaccine is 94.1% effective and Pfizer-BioNTech vaccine is 95% effective at preventing COVID-19 illness in people who received the 2 doses. In this commentary the details of the revised infection mitigation plan in a SUD residential setting will be explained along with the outcome measure of this plan.