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The rollout of the US coronavirus vaccine is starting slowly as states grapple with logistical challenges.
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Public health experts fear the next round of vaccinations, for the elderly and essential workers, will be even more chaotic.
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Several state health departments told Business Insider they are still working out who gets vaccinated next and how that process will play out.
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It is not known if people will need an appointment. But distributing vaccines on a first-come, first-served basis could lead to long queues and health risks.
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The news appeared in a press release last weekend: Elderly residents of Lee County, Florida could be vaccinated against the coronavirus on a first come, first served basis.
In the hours and days that followed, hundreds of people aged 65 and over lined up outside the vaccination sites. Some endured temperatures as low as 47 degrees Fahrenheit while camping overnight. Most sites reach capacity before 7 a.m. each day – two hours before they open.
It was a glimpse of what a larger vaccine rollout might look like without proper preparation and communication.
Currently, in most states, vaccines are first distributed to health workers and residents of long-term care facilities. These are among the easiest groups to vaccinate: Healthcare workers get vaccinated at their workplace, so it’s not difficult to check their eligibility or tell them where to go. Meanwhile, CVS and Walgreens are traveling to individual facilities to vaccinate nursing home residents.
But the next round of vaccinations will likely be more difficult to manage.
“It’s going to get a lot uglier,” Dr. Ashish Jha, dean of the School of Public Health at Brown University, told Business Insider.
The Centers for Disease Control and Prevention has recommended that states prioritize essential frontline workers and people aged 75 and older in their next phase of immunization. This category is much larger than the previous one, with around 49 million people. The original groups numbered only 24 million people. In addition, the status of “essential worker” can be difficult to define and can vary by state.
Many state health departments, including those in Colorado, Connecticut, Indiana, Maryland, New Jersey, Pennsylvania, Vermont and Virginia, told Business Insider they were still working out the logistics of who will get vaccinated next, how individuals will be prioritized, and which sites will help with vaccination. Some departments have said they hope to finalize the settings in the coming days or weeks.
This timeline is too slow, Jha said.
“It’s not like we’re months away from vaccinating 80-year-olds,” he said. “We hope that we are a few weeks away from vaccinating those 80 years old. I don’t understand how we’re going to do this, and no one else is.
Vaccination of essential workers poses new challenges
For the most part, state health departments say vaccines will be available at a combination of federally qualified local hospitals, health departments, pharmacies, doctor’s offices, and health centers. The federal government has partnered with large drugstore chains like CVS, Walgreens, and Walmart.
Vermont said it is forming its own partnerships with pharmacies and already has relationships with local hospitals, but did not elaborate further. Illinois said it will work with pharmacies and also deploy mobile vaccination teams to vulnerable communities. Texas said decisions and procedures would be left to each of its 50 local health departments.
It’s still unclear whether people will need to make appointments to get vaccinated in these or other states, or if we’ll see more long lines. The Colorado Department of Health said Business Insider appointments may be available “in certain circumstances.”
“I don’t see a uniformly concise and clear communication on how to get vaccinated as it is being rolled out in a more public forum outside, for example, hospital staff,” Marissa Levine, professor of public health at the University of South Florida, told Business Insider. “People need to know how to get vaccinated, when to get vaccinated, who should get vaccinated, and then how those decisions are made.
Standing in line with people, she added, “seems like a very dangerous way to do this.” Coronavirus-related hospitalizations have reached peak levels – more than 120,000 a day – in the United States, and the country reported its highest number of daily deaths on Wednesday: more than 3,700. Encourage vulnerable groups to rally in lines could fuel transportation.
It is also unclear what type of identification states will require to verify that people are in priority immunization groups. Lee County health officials, for example, have asked health care workers to provide a copy of their ID badge or an up-to-date pay stub.
“If you are a nurse practitioner or pharmacist at CVS, how do you verify that someone is a transit worker? Said Jha. “Do you need a letter from their human resources department? Can someone forge a letter?”
He added that states are “too busy” to deal with these issues on their own.
Vaccination sites remain in the dark
According to the CDC, states should have enough vaccines to start vaccinating essential workers and people over 75 in January, and then complete those vaccinations in February.
But even large healthcare systems don’t know how it’s going to turn out. In a statement to Business Insider, Kaiser Permanente, one of the largest healthcare systems in the country, said it was working with state officials but acknowledged that “we don’t yet know how each state will approach this. process”.
Three major primary care chains recently told Business Insider they don’t know when to expect vaccines for their own health workers, let alone patients. They also don’t know how many doses will arrive, or what to say to patients who call to ask when they can get the vaccine.
“We don’t get a lot of information from state health departments, pharmacies, or hospitals right now on when we’re going to be hired,” Dr Jason Lane, infectious disease physician at ChenMed, a company based in Miami. primary care chain, said.
Dr Emily Maxson, chief medical officer at Aledade, a network of independent physician offices, said the plan to roll out the vaccine so far is “completely a mystery to frontline providers”.
“ A complete mess of a national deployment ”
The United States has shipped about 12.4 million doses of the vaccine so far, but fewer than 2.8 million people had received injections as of Wednesday morning, according to the CDC. The data lag means the real figure could be higher: Bloomberg’s tracker suggests nearly 3.5 million Americans were vaccinated on Friday.
Either way, it’s a far cry from the Trump administration’s goal of vaccinating 20 million people by the end of 2020.
In a press call on Wednesday, Dr Nancy Messonnier, director of the CDC’s National Center for Vaccination and Respiratory Disease, attributed the slowness of vaccinations to the Christmas holidays and confusion over the number of doses available.
“We knew the vaccines would arrive in December,” Jha said. “It’s no surprise – and you would have thought that all the infrastructure, all the planning, all the data infrastructure, everything would have been in place months ago so that the day the vaccine was cleared , it could be shipped and it could have started to go into people’s arms. “
The disparate nature of the deployment, however, put the strain on the already overwhelmed health services.
Local officials were tasked with coordinating immunization schedules while dealing with a tsunami of sick patients. Many health services do not have the funds to hire enough staff to administer large doses. Others lack the expertise to transfer thousands of doses from local warehouses to individual guns – what experts call the “last mile” challenge.
“Vaccines on the shelves do nothing as thousands of Americans die,” Jha said. “This is a travesty. This is the most ridiculous example of our country’s incredible ability to innovate in vaccine production and yet our government’s failure to help get it to people.”
The recently passed coronavirus relief package gives states about $ 8 billion to help them tackle these vaccine delivery problems. President-elect Joe Biden has said he will need more congressional funds to meet his goal of vaccinating 100 million people in his first 100 days in office.
“The Trump team is putting a complete mess of a nationwide deployment,” Jha said. “The Biden team is going to have a lot of work to do.”
Shelby Livingston contributed reporting.
Read the original article on Business Insider
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