Health care workers prioritized in first phase
North Valley Hospital in Tonasket and Family Health Centers, headquartered in Omak, have been approved by the Washington Department of Health to receive the first shipments of COVID-19 vaccine in Okanogan County.
A vaccine produced by Pfizer and BioNTech, which is being evaluated this week for emergency use by the federal Food and Drug Administration (FDA), could be shipped as early as mid-December, according to the state Department of Health (DOH). The first vaccinations are expected to prioritize health care providers on the front lines of patient care and first responders, according to plans developed by DOH.
“It’s exciting,” said John McReynolds, CEO of North Valley Hospital. “For a lot of us, this is hopefully marking the beginning of the end. It’s a good milestone.”
“It feels like there’s a little bit of a light at the end of the tunnel,” said James Wallace, chief health officer for Family Health Centers and a family practice doctor. Getting the vaccine to health care workers is critical, he said.
“They’ve been on the front line, running a marathon at a sprint pace for 10 months and they need some relief,” Wallace said.
“For me personally, when I’m taking care of patients, questioning whether I’m bringing home this illness to my family after a day at work, it will be a huge relief. I’ll be able to work with less fear of becoming infected,” Wallace said.
“That’s been a huge source of stress [to health care providers] over the last 10 months. This is going to be a huge relief to us and our families.”
The Pfizer-BioNTech vaccine is the first to be considered for emergency use authorization by the FDA. If it is approved, which could happen this week, it would be reviewed by a Scientific Safety Review Workgroup, a group of scientists convened by Washington, California, Oregon and Nevada to evaluate COVID-19 vaccine safety efficacy prior to use in those states.
The review by the Western states workgroup should take about one or two days, “and would be done while the vaccine is being processed and shipped, so it should not cause any delay in making the vaccine available to people in Washington,” said Danielle Koenig of DOH.
The first shipments of the Pfizer-BioNTech vaccine will come in units of 975 doses. To get approval from the state to receive and distribute the vaccine, hospitals, clinics and other health care providers were invited earlier this fall to submit applications demonstrating their ability to store and administer the vaccine.
The Pfizer-BioNTech vaccine requires shipping in special thermal containers packed in dry ice, and storage at ultra-cold temperatures of about minus 70 degrees Celsius (minus 94 degrees Fahrenheit). Applicants who receive the vaccine must have ultra-cold freezers or the ability to administer the 975 doses of vaccine within 20 days — the amount of time the vaccine remains viable in the thermal shipping containers packed in dry ice.
North Valley Hospital purchased an ultra-cold freezer a few months ago, “when we heard Pfizer was one of the leading candidates,” McReynolds said. “We’re glad we did it because they are hard to come by” due to increased demand for them by hospitals around the country.
Family Health Centers does not have an ultra-cold freezer to store the vaccine. But with medical and dental clinics in six communities in Okanogan County and in Bridgeport, and through partnerships with other hospitals, EMS services, assisted living facilities and health care providers, Family Health Centers will be able get the 975 doses out within the required time constraints, Wallace said.
“As soon as we receive that shipment and open the box, the clock is ticking and we are in mass distribution focus to get it out,” Wallace said. The process will likely be “like we normally do with vaccines that we receive at one site and get out to six medical clinics for distribution.”
Because the process of vaccine approval and distribution is moving so quickly, planning is a work in progress, health officials said. North Valley Hospital and Family Health Centers only learned of their approval as vaccine sites within the past five days. “I was frankly surprised to get this email [from DOH] so quickly,” McReynolds said.
“We will know a whole lot more by end of the week,” Lauri Jones, community health director at Okanogan County Public Health, said Monday (Dec. 7). “I think it will be a community effort for sure.”
Health care providers in Okanogan County have been in discussion to prepare for the day that a vaccine becomes available, Wallace said. “Regardless of who receives the vaccine, we’re planning on pooling our resources and getting as many of our health care workers across the county vaccinated in that first shipment,” he said.
“We’ve got our organization’s list of front-line health care workers and are asking our community partners — schools, EMS, first responders — to make their own lists,” Wallace said. “The instructions from the Department of Health are, we have to administer the vaccine within five days of opening [the shipping containers]. That’s what we’ve been planning for with community partners. We know there are 975 people across Okanogan County” that qualify for the vaccine based on state guidelines, he said.
Wallace estimated there are 170-180 front-line health workers in Family Health Centers facilities. Front-line workers will probably include not only doctors and nurses, but also employees that have face-to-face contact with patients, he said. North Valley Hospital has a total of 200 employees, but only a portion of those are front-line workers, McReynolds said.
High-risk workers first
Under a COVID-19 vaccination proposal developed by the DOH in October, this first phase, called 1a, will provide the vaccine to high-risk health workers and first responders. The next phase, 1b, would include older adults living in congregate housing like assisted living facilities, and people with underlying conditions that put them at significantly higher risk, according to the vaccination plan, which DOH said is still being finalized based on feedback from communities, medical providers and others.
An outbreak last month of COVID-19 at North Valley Extended Care in Tonasket has taken the lives of 15 residents. Not all of the deaths have been classified by Public Health as caused by COVID, but McReynolds said he anticipates they will be. Twenty-five employees at Extended Care and at North Valley Hospital, which operates the facility, have tested positive for COVID-19.
Wallace said Family Health Centers has been involved in vaccine planning with state health department officials. “We advocate hard for our patients and rural areas in general,” he said. “I always have a fear that rural areas are going to be the last ones [served] … or be lower on the pecking order. But I’ve been impressed with the DOH process so far. They went to great lengths to get input and feedback from stakeholders.”
The Pfizer-BioNTech vaccine requires two shots, delivered three weeks apart. Shipment of vaccine for the second dose is expected to follow later this month, state health officials said. The state will coordinate with the federal Centers for Disease Control “to ship vaccine directly to enrolled providers once the vaccine is available,” according to Koening at DOH.
Three Rivers Hospital in Brewster and Mid-Valley Hospital in Omak are also applying to the state to enroll as vaccine providers, but do not plan to participate during the first phase.
Three Rivers Hospital recently ordered an ultra-cold freezer but doesn’t expect delivery until sometime in January, said Jennifer Best, hospital spokesman. The hospital has completed its application to receive the vaccine but has not heard back from DOH, she said.
“We opted out of the first phase and will partner with other health providers,” said Afton May, director of quality at Mid-Valley Hospital. “We don’t have that kind of sub-zero freezer. There might be other vaccines that don’t require super cold storage. We will see how the first round [of vaccinations] rolls out and help where we can.”
A vaccine candidate produced by Moderna requires less-complicated shipping and handling, because it can be stored at minus 20 Celsius, which is similar to many other medications. Moderna is also seeking emergency use authorization from the FDA and could receive approval this month.
Documents published Tuesday (Dec. 8) by the FDA show that the Pfizer-BioNTech vaccine provides strong protection against COVID-19 within about 10 days of the first dose, according to news reports. Last month, Pfizer and BioNTech said that their two-dose vaccine had an effectiveness of 95% after two doses administered three weeks apart. The new analysis from FDA shows that the protection starts kicking in far earlier, and the vaccine worked well regardless of a person’s race, weight or age.
A Moderna study of 30,000 people found the vaccine to be 94.5% effective in preventing COVID-19 infections, and 100% effective at preventing severe disease from the coronavirus. The Moderna vaccine was developed in collaboration with government researchers from the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases.
News of potentially imminent vaccine shipments comes as hospitals throughout the country, including Central Washington Hospital in Wenatchee, are struggling with surging COVID-19 cases that threaten to overwhelm their capacity to care for patients with any kind of health problem. Health officials have warned that the numbers may grow even worse in the coming weeks because of travel and gatherings for Thanksgiving.
Washington’s proposed vaccination plan includes four phases. Included in phase 2 are teachers, essential workers who are at high risk of exposure, people of all ages with underlying conditions that put them at higher risk, people in homeless shelters or group homes for individuals with disabilities, people in prisons and detention centers, and all older adults not included in the first phase.
Phase 3 would include young adults, children and workers in industries important to the functioning of society who are not included in the previous phases. In phase 4 the vaccine would be available to everybody.
Washington state has been told by the federal government that it will receive 62,400 doses of the Pfizer-BioNTech vaccine for the initial allocation, according to Koenig at DOH. Another 200,000 doses of the Pfizer vaccine should arrive by the end of December, and regular weekly shipments should begin in January, Koenig said.
Although the promise of the first vaccines is encouraging, COVID-19 will remain a threat for many months, Wallace warned.
“You’ve got to look at this as the world needing to be vaccinated,” he said. “The true effectiveness of the vaccine on the public health level — we’re not going to see until 50% or more of the population is vaccinated. It’s good to know we are much closer this week than last week. But I wouldn’t trade the vaccine for masking and distancing yet.”