Maryland Gov. Larry Hogan on Wednesday authorized the state’s nursing homes and other congregate care facilities to consider residents 65 and older immunocompromised, making them immediately eligible to receive a third dose of the coronavirus vaccine.

The Biden administration has pushed for adults who received the Pfizer-
BioNTech or Moderna vaccines to get a booster shot eight months after receiving their second dose, starting Sept. 20. But the plan requires approval from the Food and Drug Administration, and then the Centers for Disease Control and Prevention. And it may initially be limited to recipients of the Pfizer vaccine.

Individuals who are immunocompromised, such as Hogan, who is a cancer survivor, are already eligible to receive a third shot — a process that began weeks ago.

But there has been confusion over the difference in boosters and third shots. Hogan (R) said his authorization is intended to make it easier for vulnerable older adults to boost waning immunity against the coronavirus and the highly contagious delta variant as cases rise in nursing homes.

And it follows a recent pilot program conducted by the Maryland Department of Health that tested 500 nursing home residents for antibodies and found that more than 60 percent had waning immunity and 1 in 3 showed a higher level of vulnerability, he said.

“These facilities will not have to wait to begin offering boosters,” Hogan told reporters Wednesday. “Boosters can now be administered, effective immediately.”

An FDA advisory committee is expected to discuss Pfizer-BioNTech boosters on Sept. 17, and must approve them before a CDC advisory committee will weigh in.

Hogan said Maryland has administered 28,000 third shots so far, a number he expects to grow now that he’s made it clear that congregate care residents are eligible.

Nationwide, 1.51 million people have received an “additional dose” since Aug. 13, according to the CDC.

Public health experts have said additional doses for people who are immunocompromised should be called “third doses” because it takes three doses for them to mount a full immune response.

Third doses for everyone else should be called “booster shots,” experts say, because they boost immunity that has waned over time in people who initially mounted the full immune response after two doses of the vaccine.

Hogan has used the terms interchangeably, and blamed the Biden administration for sowing confusion about who should get a third dose and when.

“For several weeks now, states have had to operate without clear guidance from the federal government regarding these booster shots,” Hogan said in a statement. “The limited guidance we have received has been confusing and contradictory, and it is still unclear when and how more people will become eligible.”

Nursing homes in Maryland increasingly have seen outbreaks of the coronavirus, which has led to the return of shutdowns of the facilities.

In July, fewer than 10 nursing homes in Maryland had an outbreak — defined by the federal government as at least one covid-19 case, according to the Health Facilities Association of Maryland. By early August, the number was 33. Last week, it had reached 92.

The order on boosters is the latest move by Maryland officials to protect older nursing home residents. Last month, Hogan ordered employees at all of Maryland’s 227 private nursing homes to have at least one dose of the vaccine.

Hogan also announced that the state Health Department has issued guidance to pharmacies that allow anyone who considers themselves to be immunocompromised to receive a third shot of the vaccine. Under the order, residents would not need a prescription or doctor’s order.

In Maryland, the number of people who are in intensive care continues to climb with 211 patients hospitalized in intensive care units, the highest number the state has seen since mid-May.

In recent days, Maryland has seen a drop in its number of reported cases but an uptick in deaths.

On Wednesday, the state reported 701 new coronavirus cases, a drop from 1,027 reported on Monday and 795 on Tuesday. The state reported 21 confirmed deaths due to covid-19 on Wednesday. Earlier this week, there were 11 deaths on Monday and seven on Tuesday.

Community transmission is highest in the state’s rural areas with the seven-day average case rate per 100,000 residents in Wicomico County on the Eastern Shore at 46.19, which is more than double the state’s average of 18.56.

Even Montgomery County, which ranks among the most vaccinated counties in the state with 74 percent of residents fully vaccinated, is teetering between substantial and high transmission rates from week to week.

Surging infection rates prompted County Executive Marc Elrich (D) to favor vaccine passports — a plan the county council, which also sits as the board of health, would have to approve.

“We have to expect to see a surge this winter . . . and we need to do something, because no one wants to go back to capacity limits and restrictions on businesses,” he told reporters Wednesday. “We want to make sure that the residents who’ve been vaccinated can go out and enjoy the things we told them they’d be able to enjoy when they got vaccinated.”

The District has high transmission as does the vast majority of Virginia, where public health officials have added 170 testing events this month, with a goal of vaccinating about 100 people per clinic.

Testing demand fell off dramatically once the vaccine was available, but has increased with the spread of the delta variant, said Laurie Forlano, deputy commissioner for population health at the Virginia Department of Health.

The state uses positivity rate as well as infection metrics to assess the changing pandemic landscape. While the state aims for a positivity rate of less than 10 percent, she said, it’s difficult to know how much testing is enough.

“That is the million-dollar question,” she said.

Karina Elwood contributed to this report.