"I was, like, uh-uh. I don't trust the vaccine,” Ramos, 35, remembers thinking before it became available at Greenville Center, the Rhode Island nursing home where she's worked for five years. “I was having all those crazy thoughts that everybody else had."
But the certified nursing assistant (CNA) has since become an advocate for vaccination among her coworkers. Her labor union has asked her to speak with other CNAs who have not yet been vaccinated. She even testified in Congress about the lack of vaccine education for her and her colleagues.
Ramos takes her advocacy seriously. She understands what's at stake, because she has witnessed scores of residents — who she says felt like family to her — fall sick and has seen two dozen of them die last year.
Nationwide, COVID-19 has claimed the lives of more than 180,000 residents and staff of nursing homes and other long-term care facilities. There are roughly 550,000 CNAs working in nursing homes across the United States, providing over 90 percent of the direct patient care, according to the National Association of Health Care Assistants (NAHCA).
An informal survey of CNAs conducted late last year, before the vaccine rolled out, showed 72 percent were skeptical about getting vaccinated, says Lori Porter, CEO of the NAHCA. But more recent reports show a growing acceptance. A survey from the Kaiser Family Foundation and The Washington Post, for instance, showed that by early March, half of health care workers in nursing homes or assisted living facilities had received a COVID-19 vaccination.
But there's still a long way to go to vaccinate the rest, leaving long-term care facility residents vulnerable in the meantime. A March outbreak at a Kentucky nursing home killed three residents, including one who was vaccinated, and was traced to an unvaccinated employee. Now, a growing number of facilities have started requiring workers to get vaccinated; those who don't face termination.
'I want to protect them'
As a woman of color and an immigrant, Ramos can relate to her coworkers’ fears of being used for experimentation. The pace of the vaccine's development made her nervous, too. Politics bleeding into science and mixed messages from top officials stoked her doubts. And the misinformation that spread online, no matter how outlandish — “The vaccine will affect your DNA!” she laughingly recalls — didn't help.
What did help was her hunger to get informed. She paid attention to the news and tuned in to the Netflix docuseries Pandemic: How to Prevent an Outbreak. She blocked out the noise swirling on social media and, instead, listened to experts like Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. She realized the battle against COVID-19 began long before she heard about it and before it ravaged Greenville Center.
Seventy-six residents in the 125-bed facility contracted the virus, and 24 died in the span of about six weeks last spring, says Lori Pendleton, the nursing home's executive director. More than 30 employees also tested positive, including Ramos — who was asymptomatic — and one CNA died.
"It was traumatizing, something that we never lived through before,” says Ramos, who's worked in the field for more than a decade. “We're used to our residents passing away. But the way they died — so many of them, and so many were sick at the same time — you could not keep up with it. It was horrifying."
She would have liked to have held the hands of those who were dying for a little longer, but there was too much to do. The nursing home was short-staffed before COVID hit. The pandemic made matters worse, as employees tested positive and older staff members with preexisting conditions retired early to protect themselves, Ramos says. Her usual 32-hours-a-week schedule morphed into 16-hour days, up to seven days a week. Whenever she thought she couldn't take it anymore, she stepped outside to scream or cry. Then she'd think about the residents who never needed her more.
The experience left them all with a form of PTSD, Ramos believes. She doesn't think they'll ever get back to what she calls “normal normal.” But one key to moving forward, she now says, is the vaccination.
"I don't want to be the reason why our residents get infected or my family gets infected,” says Ramos, who's married and has a 15-year-old son from a previous relationship and a 14-year-old stepdaughter. “I want to protect them.”
Nursing home vaccination numbers creep up
By the time the vaccine arrived at Greenville Center in January, Ramos was ready. Many of her coworkers opted out, adding to their list of concerns a mounting fear of side effects. “I'll be the guinea pig for y'all,” she told them.
Ramos has been a union delegate for three years with the Service Employees International Union District 1199 New England. The union tapped her to speak with coworkers individually about the vaccine's safety while sharing her own experiences. She also testified in March before the Senate Finance Committee during a virtual hearing on the impacts of COVID-19 in nursing homes, during which she spoke about a lack of vaccine education for CNAs.
"We all have different backgrounds. We all speak different languages. We come from everywhere,” says Ramos, who moved to the U.S. more than 20 years ago from Cape Verde, a former Portuguese colony off the coast of West Africa. “So if there's more resources in the community and leaders that they trust, it would be easier for them to get vaccinated,” she told lawmakers.
Consistent, clear and accurate messaging is key, whether from religious leaders, political officials, employers or others, she says. So far, Ramos has helped convince 10 coworkers to get their shots and encouraged at least five family members to get inoculated. And she's become the vaccination point person for friends — and friends of friends — of her parents, having helped to register about 20 people for vaccine appointments.
It's local efforts like these that are helping boost the national vaccination rate.
"Vaccine confidence among CNAs has grown since our initial survey,” says the NAHCA's Porter, thanks to enhanced education efforts by her group, other organizations and the passage of time. “There's been a lot of folks that waited to see [what would happen with the vaccine], and no one grew a third arm.”
The vaccination numbers are creeping up at Greenville Center. At least 68 percent of staff members are now fully vaccinated, with more heading that way with one shot to go, says Greenville's executive director Pendleton.
"Not only are they helping themselves and their family members, but they are helping all of our residents stay safe,” she says. “This is very encouraging to all the family members who rely on us to care for their loved ones. For that, I am truly grateful.”
If Ramos has her way, those vaccination numbers will keep going up, one conversation at a time.
Jessica Ravitz is a contributing writer who covers nursing homes and human-interest stories. She previously wrote for CNN Digital and The Salt Lake Tribune, and her work has also appeared in Smithsonian magazine, The Washington Post and The Atlanta Journal-Constitution.