Providers cope with uncertainty, lack of guidance
Approximately 3,800 doses of COVID-19 vaccine have arrived in Okanogan County as of early this week, and local health officials are working to get the vaccine into the arms of eligible people, despite logistical hurdles, uncertainty and rapidly changing information.
Dealing with challenges faced by health care organizations in launching the vaccination effort is like “building the plane as we’re flying it,” said Scott Graham, CEO of Three Rivers Hospital in Brewster.
“Administering vaccines isn’t new,” said Jennifer Best, a spokesperson for Three Rivers Hospital, “but doing it in this way, on such a wide scale, as quickly as possible, is brand new to all of us.”
North Valley Hospital in Tonasket was the first state-approved vaccine site in Okanogan County to receive vaccine three weeks ago. The hospital began administering the required second dose of the Pfizer-BioNTech vaccine this week to about 570 people who have received the first round of vaccine, said John McReynolds, chief executive officer.
Vaccinations are currently available to front-line health care workers and residents and staff of extended care facilities, under state guidelines. State health officials recently expanded eligibility in the first phase of vaccinations, called 1A, to other workers in health care settings after those at the highest risk of COVID-19 infection are vaccinated.
Since the first shipment on Dec. 15, North Valley Hospital has received about 3,200 doses of the Pfizer-BioNTech vaccine, which must be stored at ultra-cold temperatures of minus 94 degrees Fahrenheit. North Valley is currently the only facility in the county with a freezer capable of storing that vaccine.
Three Rivers Hospital has received 400 doses of a vaccine made by Moderna, which is stored at temperatures similar to most vaccines. The hospital gave its first vaccinations to hospital employees on Christmas Eve, the day after receiving its first shipment, and had provided about 115 vaccinations to hospital employees, first responders and other health care workers as of Monday (Jan. 4), Best said.
Family Health Centers, headquartered in Omak, received 200 doses of Moderna vaccine, and has vaccinated about 80 staff members in partnership with North Valley Hospital, said James Wallace, chief health officer of Family Health Centers.
Of the approximately 3,800 doses of vaccine distributed to the three state-approved vaccine recipients in Okanogan County, about 700-800 doses had been used as of early this week, based on numbers provided by the facilities.
“We still schedule of lot of folks each day, but it seems like the numbers are leveling off or decreasing,” McReynolds said Tuesday (Jan. 5). “Over the next few days, we will have large numbers that mirror our initial launch” as people return for their second dose of vaccine, he said.
“There are certainly a lot of people that have not signed up but there is the capacity for them to get vaccinated quickly,” he said.
Health care organizations in Okanogan County — including hospitals, EMS, medical clinics and Okanogan Public Health — have collaborated to notify eligible people in Phase 1A about the availability of vaccinations.
“This degree of collaboration, given the logistical hurdles, uncertainty and rapidly changing new information is impressive, and honestly inspiring,” said Wallace, who was recently appointed health officer for Okanogan Public Health.
Wallace said the decline in demand at North Valley Hospital is attributable to several things. “A number of 1A workers have reported that they’d rather wait and save the supply for higher-risk patients or community members,” he said.
“There is vaccine hesitancy among some Phase 1A health workers, especially the expanded definition of all people in the health care industry. Some (are) wanting to see the impact of the second dose before getting their first,” Wallace said.
North Valley Hospital has also faced restrictions on how far the Pfizer-BioNTech vaccine can be transported from Tonasket to other facilities, because of requirements that it be maintained at such cold temperatures.
The Moderna vaccine sent to Family Health Centers went to its Bridgeport medical clinic in Douglas County, but Family Health Centers has received approval to use it in Okanogan County as well, where Family Health Centers operates six other clinics, including one in Twisp. Family Health Centers “is preparing to distribute vaccine broadly with additional shipments,” Wallace said.
The vaccine manufacturers “require continuous data tracking, like all vaccine suppliers do, so we’ve invested in mobile temperature trackers and data loggers so we can ship across the county to where demand/need is greatest,” Wallace said.
Once removed from freezers and prepared for injection, both vaccines must be used within a few hours, or be thrown out.
“Each vial of Moderna holds 10 doses so we try to schedule 10 per hour,” said Jennifer Best at Three Rivers Hospital. “The Moderna vaccine is good for six hours once you poke it. Thankfully, last week the state announced that we can administer the vaccine to more hospital employees than just the front line workers, so that is helping us cover more ground.”
The Pfizer-BioNTech vaccine at North Valley Hospital requires thawing and dilution with saline solution before injection.
“The Department of Health has encouraged us to make reasonable efforts to ensure we do not waste any doses,” McReynolds said. “Once a vial is diluted it has a shelf life of a few hours and contains five to seven doses. Toward the end of the day or at the end of a vaccination event there are doses that will be wasted if not given. To avoid this we have vaccinated a small number of people outside of the 1A classification if we can’t find 1A eligible volunteers.”
In a recent correspondence with hospitals in the state, the Washington State Hospital Association (WSHA) expressed concern that more vaccines have not yet been used.
“In Washington State, only a fraction of the vaccine received has been actually administered,” the organization said. “WSHA is growing more concerned about this — the vaccine is our ticket out of the pandemic. We understand that the federal distribution system is poorly designed, communication is challenging, supply is uncertain … and yet, hospitals are the best-equipped placed to continue rolling through high-risk groups quickly and stand to gain enormously when these Washingtonians are vaccinated.”
A challenge for Three Rivers Hospital has been “managing the increased number of phone calls” related to vaccinations, said Best. “We’re trying to get a vaccine webpage up ASAP so people can refer to that.” The hospital has set up an electronic registration form for Phase 1A, and that will be available to the public when more people become eligible, she said.
Vaccine providers in Okanogan County early this week said they were hoping that the state would soon provide guidance and open vaccinations to people in Phase 1B. States make their own determinations about how to administer vaccines, but federal guidelines say 1B should include people 75 and older and frontline essential workers — like grocery store employees, teachers and police officers.
“New information is coming daily … but we’re in a good place on a county level and ready and hopeful that we’ll be able to move to phase 1B very soon,” Wallace said.
“We are eagerly awaiting direction to move to Phase 1B, which should enable us to get through our doses much more quickly,” said McReynolds. “All the health care organizations in Okanogan County are working together for vaccine planning and hope to aggressively roll out the vaccine in accordance with the timing and eligibility from the [state] Department of Health,” McReynolds said.
The Department of Health recently announced plans to create an online questionnaire for the general public to help people determine their eligibility for vaccination. The new program, called “PhaseFinder,” would allow people to complete an eligibility form to present at vaccination sites.
Vaccine providers in the county said they will also be working to let the public know when new vaccination phases open up. “As we move towards larger groups of eligible patients we will market the availability and do everything we can to communicate what steps need to be taken to receive a vaccine,” McReynolds said.