Distribution of Covid-19 vaccine confuses doctors in private practice and patients

“The reason this is important is that patients trust their doctors when it comes to the vaccine,” said Carroll, who complained on social media that his county has yet to published plans for how primary care physicians will be involved.

Collectively, the county’s doctors could vaccinate thousands of patients a day, he said, and could attract some who would otherwise be hesitant if they had to go to a large hospital, fair or other central site.

His concern comes as nationwide vaccine rollout begins slower than expected, far behind the original goal of giving 20 million doses before the new year.

But Dr Jen Brull, a family doctor in Plainville, Kansas, said her rural area had made good progress in the first phase of vaccinations, attributing a close working relationship long before the pandemic.

This fall, before the doses were available, the local hospital, health department and doctors’ offices coordinated a sign-up list for medical workers who wanted the vaccine. So when their county of 5,000 people received their first 70 doses, they were ready to go. 80 more doses arrived a week later.

“We will be able to immunize almost anyone associated with health care who wanted it in the county,” Brull said recently.

Gaps in deployment

But this is not the case everywhere.

Dr Jason Goldman, a family doctor in Coral Gables, Fla., Said he was able to get the shot at a local hospital that received most of the vaccines in his county and oversaw the distribution.

In the weeks that followed, however, he said several of his frontline workers “still did not have access to the vaccine.”

Plus, “a huge number” of patients are calling his office because Florida has relaxed distribution guidelines to include anyone over the age of 65, Goldman said, asking when they can get the shot. He asked officials to distribute the vaccines as part of his practice, but heard nothing back.

Patients “are frustrated that they don’t have clear answers and that they don’t have clear answers to provide them,” he said. “We have no choice but to direct them to the health service and some of the hospital systems.”

Another troubling point for Goldman, who served as the liaison between the American Academy of Family Physicians and the expert group writing the CDC’s distribution guidelines, is the enormous variation in how these recommendations are implemented across the states.

The CDC recommends several phases, with frontline healthcare workers, residents, and nursing home staff in the initial group. Then in the second part of this phase come people over 75 and frontline non-health care workers, which could include first responders, teachers and other designated essential workers.

States have the flexibility to design their own deployment schedule and priority groups. Florida, for example, offers doses to anyone 65 and over. In some counties, older people were told vaccines were available on a first-come, first-served basis, resulting in long queues.

“To say now, 65 and over, when you haven’t even adequately immunized all healthcare workers, is canceling the phasing,” Goldman said. “There has to be a national standard. We have these guidelines. We have to offer some oversight.”

The American Hospital Association echoed this concern on Thursday in a letter to Secretary of Health and Human Services Alex Azar. Hospitals – as well as health services and large drugstore chains – perform the bulk of vaccinations.

Calling for further coordination from federal officials, the letter described what it would take to meet the goal of vaccinating 75% of Americans by the end of May: 1.8 million vaccinations per day. Noting that there are 64 different deployment plans from states, cities and other jurisdictions, the letter asked whether HHS had “assessed whether these plans, taken as a whole, are capable of achieving this level of immunization?”

Make it work

The lack of support or a straightforward national strategy means that each county is essentially on its own, with success or failure being affected by the resources available and the experience of local officials. Most state and local health services are underfunded and under intense pressure due to the growing pandemic.

Yet the success of immunization efforts depends on planning, preparation, and clear communication.

In Lorain County, Ohio, a population of 310,000, local authorities began practicing in October, said Mark Adams, assistant health commissioner. They’ve set up mass flu vaccination clinics to study what would be needed for a Covid-19 vaccination effort. How many employees? What would traffic be like? Could patients be 6 feet apart?

“It gave us a sense of what’s good, what’s bad and what needs to change,” said Adams, who previously had experience coordinating mass vaccination efforts at the county level.

So when the county received its first shipment of 500 doses on December 21, Adams had his plan ready. He called the fire chiefs to invite all emergency medical technicians and staff affiliated to an ad hoc vaccination center set up in a large entertainment venue run by his health service. Upon arrival, people were greeted at the gate and directed to spaced “lanes” where they would receive their shots, then to a surveillance area where they could wait 15 minutes to ensure there was no reaction. .

Right after Christmas another 400 doses arrived – and the makeshift clinic reopened. This time the doses went to doctors, dentists and other practitioners in the community, 600 of whom had already signed up. (Hospital staff, nursing home staff and residents are vaccinated in their own facilities.)

As they move into the next phase – beneficiaries include residents over 80, people with developmental disabilities, and school staff – the challenges will grow, he said. The county is planning a multi-pronged approach to let people know when it’s their turn, including use of a website, local media, churches, other organizations, and word of mouth.

Adams shares the concerns of medical providers across the country that he is only getting two days’ notice of the number of doses he is going to receive, and at the current rate of 400 or 500 doses per week, it will take a certain time before most people in the county. have a chance to be vaccinated, including the approximately 33,000 people aged 65 and over.

With 10 nurses, her clinic can inject about 1,200 people per day. But many other healthcare professionals have volunteered to administer the injections if he receives more doses.

“If I had to run three clinics, five days a week, I could do 15,000 vaccinations a week,” Adams said. “With all the volunteers, I could do almost six clinics, or 30,000 per week.”

Yet for those in the latter public group, those aged 18 and over with no underlying medical conditions, “it could be summer,” Adams said.