POST 105. January 8, 2021. CORONAVIRUS. Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.

“As New Jersey expands its COVID-19 vaccination efforts to larger groups of people, qualified volunteers are needed to help give shots into arms, officials said.

State Commissioner of Health Judy Persichelli called for volunteers across the state to help distribute shots through the Medical Reserve Corps, saying recently retired healthcare workers are desired.

“Individuals that can serve as vaccinators; physicians, nurses, pharmacists, paramedics, anyone who is certified to inoculate, to sign up with their County Medical Reserve Corps, because we do need vaccinators particularly when we bring up all the mega0sites,” Persichilli said. “I encourage particularly recently retired individuals to sign up.”

Gov. Phil Murphy echoed that call out during a Wednesday press briefing.

“If you have these skills we need you. So, we asked for health care help out of the bullpen in the spring, we’re asking for it again, please visit that website,” Murphy said.

Volunteers must have had previous experience and training with intramuscular injections, Persichilli said on Wednesday. There is no state training program at this time, she said.

The Medical Reserve Corps is a local-level branch of the Federal Citizen Corps, a federally-run volunteer program that works to harness civilian expertise during times of need. Members of the Medical Reserve Corps are used during public health emergencies, including pandemics, and can help provide emergency medical services, vaccine distribution, and assist with logistics, a description on the Middlesex County government website says…

In addition to vaccinators, local units are also looking for volunteers with experience in security, language translation/interpretation, education and outreach, warehouse operations, clerical, and counseling, Kearney said.

Volunteers are needed because they fill a role other emergency response organizations, like the National Guard, might not be qualified to fill, Murphy said at Monday’s press briefing.” (A)

“Drs. Peggy Pennoyer and Don Endrizzi came out of retirement this month to help Maine Medical Center launch an effort to vaccinate thousands of front-line health care workers against COVID-19….

At Maine Med alone, more than 300 retired nurses, doctors, students in medical fields, hospital employees between shifts and others have stepped up to help paid staff and fill a critical need at the start of a statewide vaccination effort that’s expected to last through most of 2021.

About 70 employees of the Central Maine Healthcare system based in Lewiston have volunteered to help vaccinate their co-workers on their own time, and Brewer-based Northern Light Health has enlisted students in advanced health care fields with the potential to bring in volunteers in the future.

The crucial role that volunteers played in staffing the first two weeks of Maine’s vaccine rollout suggests a shortage of qualified vaccinators and a need for volunteers, both clinical and clerical, that will grow as the inoculation effort expands into the community amid a surging pandemic….

But while state officials say they have been planning the vaccination program for months, and they’re hoping for more federal money to carry out the program, Maine’s COVID-19 interim draft vaccination plan doesn’t address how it will staff an effort that anticipates vaccinating more than 1 million people over the next six to nine months.

The plan identifies 468 potential partners in the rollout, including hospitals, pharmacies, municipal health departments, and businesses, but it doesn’t say exactly who will operate vaccination clinics and administer doses while those partners also maintain normal operations.

And while the volunteer response so far has been greatly appreciated, there is growing concern that the COVID-19 vaccination effort is too complicated and critical to be dependent on volunteer staffing, with strict federal record-keeping requirements, pandemic-related public health protocols and demand that are far greater than the flu shot…

Recognizing the growing need, the University of New England is organizing and training a large contingent of students and faculty to help staff vaccination clinics in both clerical and clinical positions, said Jennifer Gunderman, a professor of public health and epidemiology who heads the university’s workforce development team.

The effort will include more than 200 students in the university’s medical, pharmacy, physician assistant and nursing programs, and the staff members required to oversee them in the field. It’s being coordinated with MaineHealth, the Maine CDC and Guardian pharmacies in congregate facilities, and it will help students who have yet to fulfill required clinical practice hours, in part because of the pandemic.” (B)

“A group representing Missouri’s nurses says the state could be facing a coronavirus vaccine crunch with too few workers to administer the vaccine.

Heidi Lucas, director of the Missouri Nurses Association, told ABC 17 News she’s concerned that once the vaccine is available to the public there will be a shortage of nurses and staff who are qualified to administer it.

“Once the vaccine is in the state we are going to have a massive need for people who know how to give injections to be giving those,” Lucas said. “The vaccine rollout is going to be a huge undertaking and I don’t think people realize exactly how big of an undertaking that’s going to be. We haven’t seen anything in this country like this probably since the smallpox rollout.”

Lucas said there is already a nursing shortage nationally and statewide that could translate into not having enough people to provide injections…

Lucas said students currently in nursing programs will be trained on injections and will be on the front lines of administering the vaccine. She said the need will be so great that retired nurses will be asked to administer vaccinations. Lucas said she has already seen programs in Kansas City to get volunteers certified to provide injections.

States across the country are getting creative to fill the need for people to administer the vaccine.

Organizations representing dentists and optometrists in California and Oregon are talking with public officials about providing coronavirus vaccinations. Nursing students at Montana State University have already been given the green light to administer flu shots this fall because of the national nursing shortage…

Eric Maze, spokesman for MU Health care said in a statement, “We are confident that we will have enough staff to administer the COVID-19 vaccine when it becomes available. We work closely within our organization to identify and properly train those who will be administering the vaccine, including nursing students who are trained to perform vaccinations as part of their learning and educational requirements. In the past, MU Health Care has also utilized retired nursing staff to assist with vaccination clinics, and we anticipate this practice will be part of the COVID-19 vaccination effort as well.” (C)

“The need for a Covid-19 vaccine is as urgent in Arizona as anywhere else. Numbers show that the coronavirus is spreading faster here than in almost any other state, and Arizona is home to a large number of older people who tend to be at higher risk of dying if they contract the virus.

But that doesn’t mean vaccine doses are flying off the shelves. Instead, 4 out of 5 doses that arrived in Arizona by early this week hadn’t been used, waiting for someone qualified to give the shots.

The halting rollout has sparked anger and disappointment nationwide, even as officials said there was still plenty of time to pick up the pace of vaccinations before they start for the general public.

At least in Arizona, one reason for the slow pace was frustratingly simple: Years of belt-tightening and neglect of state and local health budgets mean there aren’t enough trained people to administer vaccinations, current and former government officials said.

“In our state, it’s a skeleton crew by design,” said Will Humble, executive director of the Arizona Public Health Association and former director of the state’s Department of Health Services. He said a desire for low taxes and smaller government was coming back to bite residents of the state, which has a long history of conservative politics.

Maricopa County, the fourth most populous county in the U.S., with 4.5 million people, has gotten about 133,000 vaccine doses for its 125,000 front-line health care workers. But through this week, only about 44,000 people had gotten their initial vaccinations.

The snags are affecting a relatively small number of people eligible to be vaccinated now, so the impact may not be long-lasting. But they raise questions about the larger rollout that is still to come, and they risk damaging public confidence in the country’s capacity to deliver shots quickly, especially after testing was delayed throughout the pandemic.

The job of vaccinating the public has fallen to the same county health departments and hospitals that have been working under the strain of the pandemic for 10 months. And there are only so many workers to go around.

“It’s easy to say you should have 123,000 people through in one week, but we’re also talking about the fact that these are people who are trying to service these hospitals, and these individuals administering the vaccines also have to medically be able to provide a vaccine,” said Marcy Flanagan, executive director of the Maricopa County Public Health Department…

Delays and snags have been reported in other states, and Trump administration officials this week acknowledged their disappointment in the rollout. They said Christmas and other holidays have caused delays, as have snowstorms and problems storing the vaccine doses at the required temperatures.

“There really has to be a lot more effort, in the sense of resources for the locals,” Dr. Anthony Fauci, the government’s top infectious disease expert, said Thursday on “TODAY.” “We have to support the local groups, the states and the cities to help them to get this task done.”

Fauci said the federal government should provide more resources to states and localities, rather than take over the effort entirely. Congress only recently approved $8.8 billion for vaccine distribution. Cara Christ, director of the state Department of Health Services, said it would be a “monumental task” to vaccinate the entire state population over the coming months. “It’s going to seem like it’s moving very slowly,” she said. “Everyone is figuring this out as we go.”…

Gov. Doug Ducey, a Republican, issued an executive order Wednesday empowering the Health Services Department to “take possession of any vaccine allocation and reallocate it to provide statewide coverage” for faster distribution and administration.” (D)

“As New Jersey prepares to establish its first vaccine “megasites” this week, state officials are looking for retired medical professionals to help administer COVID-19 immunizations to fellow health care workers at risk for infection.

Gov. Phil Murphy said Monday that 100,000 New Jerseyans have been vaccinated so far through the state’s program, which began Dec. 15 at select hospitals and two weeks later at nursing homes under a federal partnership with pharmacy giants CVS and Walgreens.

As of last week, the state had received some 400,000 doses from vaccine manufacturers Pfizer and Moderna, officials said, 120,000 of which are slated for nursing homes and other long-term care facilities. Eventually the state hopes to immunize 4.7 million people, a process that could last well into the fall.

Murphy and state health commissioner Judy Persichilli defended the pace of the rollout, but suggested the process has been complicated by changes in the federal shipping schedule and a limited pool of clinicians available to actually administer the inoculations.

“You’re basically shipping these (vaccines) out and asking the very people at the front lines fighting the pandemic to be the same people to not just get the vaccine, but to administer” the shots, Murphy said Monday during a media briefing.  As a result of the limited staff, few vaccines have been administered over the weekends in New Jersey, he noted.

Persichilli said some 200 sites — hospitals, urgent-care centers, drug stores — and dozens of nursing homes are now immunizing the priority, or 1a group of residents, which includes all paid and unpaid health care workers at risk for COVID-19 exposure and residents and staff at long-term care facilities.

On Friday the state will open the first two of six planned vaccine megasites, Persichilli said, in Gloucester and Morris counties. Those operations will initially serve members of the 1a group and will aim to vaccinate 1,000 people a week, she said Monday.

Murphy said members of the National Guard or other military branches may be deployed to help set up the immunization operations — as they did with field hospitals in the spring — but only someone with the proper license and training can provide the shot in the arm. And that means more work for clinical staff already strained by rising COVID-19 hospitalizations and growing community spread.

To beef up the immunization workforce, Persichilli said the state Department of Health has put out an alert via a vaccine-related newsletter seeking to recruit retired physicians, nurses, pharmacists, paramedics and others whose training and license enables them to immunize patients. Those who want to help are urged to sign up to volunteer through their county branch of the New Jersey Medical Reserve Corps, a 5,000-member group that can serve as a backstop during a public health crisis.

We do need vaccinators, particularly when we bring up all the megasites. So I encourage particularly recently retired individuals to sign up,” Persichilli said.” (E)

“While inoculation is currently focused on frontline healthcare workers, the vaccination drive is expected to expand to tens of millions of essential industry workers beginning in January or February.

From New York to Tennessee, states are hoping medical and nursing students will free up medical staff focused on tending to the record numbers of new COVID-19 patients.

“Being able to staff vaccination clinics with volunteers from our reserve workforce means that staff at the vaccination sites can continue to perform their normal duties, which is crucial as our hospitalization rate has increased,” said a spokeswoman for Indiana University’s School of Medicine.

As the first vaccines arrived, Indiana health officials called on the state university because of its far-reaching campuses. More than 630 of Indiana University’s medical and nursing students have signed up as volunteers and receive 90 minutes of online and hands-on training.

Fourth-year medical student Nicholas Clough began administering COVID-19 vaccines to frontline healthcare workers last Wednesday. He has lost several family members during the pandemic.

“It finally felt like it was a real, tangible strike back against COVID,” said Clough, 26.

The University of Wisconsin is offering a $500 tuition credit to students with medical credentials working at understaffed hospitals during the winter break, including administering vaccines.

The university is also talking to government officials to turn universities into vaccine distribution hubs, a spokesman said.

In California, fire department paramedics have been trained to administer the vaccine, initially to fellow employees.

“They have already received online training and will have another one-hour live training session,” said Peter Sanders, a spokesman for the Los Angeles Fire Department, which expected its first shipment of the Moderna COVID-19 vaccine on Wednesday.

Michigan has set up a volunteer registry (here www.mivolunteerregistry.org), allowing officials and hospitals to recruit help for upcoming vaccine clinics.

“We encourage all medical and nursing students to register now so they will be ready when their assistance is needed!” a health department spokeswoman said.

Other states are not actively recruiting nursing students. A spokeswoman for Georgia’s health department said the state might do so later, as the vaccine becomes more widely available to the public.

Depending on state licensing laws, medical and nursing students are allowed to administer vaccines, often under supervision of a fully-licensed professional.

Facing a shortage of vaccinators, the Association of Immunization Managers, a nonprofit representing state and local health officials, recommends relaxing regulation or adjusting licensing requirements.

At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.

New York Governor Andrew Cuomo on Dec. 13 allowed medical, nursing, pharmacy, dentistry, podiatric and midwifery students to administer flu and COVID-19 shots under supervision.” (F)

“County officials who have for years been planning for a mass vaccination said they are seeing that training and preparation — much of it funded by millions of dollars in federal grants — pushed aside as the administration of Gov. Andrew M. Cuomo has retained control of the state’s coronavirus vaccination program, including having hospitals rather than local health departments administer the doses…

Gareth Rhodes, a member of Cuomo’s coronavirus task force, said the county health departments and their pre-designated “points of distribution” for vaccinations are still integral to the governor’s plan, which is being done on a regional rather than county-by-county basis. As part of that process, the state is gathering details from counties about their vaccination plans and capabilities.

“The state then refines and approves and we implement the regional plan, of which every single health department plays a large role,” Rhodes said. “It’s not like we’re sitting on 50 million vaccine doses. … We’re getting a very small number every week, and criteria for who is eligible is obviously very narrow at this point.”

Rhodes, who is helping lead the administration’s vaccination strategy, said the planning is complicated because every person needs to receive two doses of the same vaccine — roughly three weeks apart — and the vaccine being distributed by Pfizer must be kept in deep-freeze storage containers until it’s thawed for use.

Rhodes took issue with the idea that the county plans were being ignored. “We’ve been working very closely with them, have had a number of calls with them,” he said. “I think our goals are all the same; we want to get this thing done as quickly as possible and in the most efficient way as possible.”

Still, the tensions between some county officials and the state were palpable this week.

“Public health departments should be distributing the #COVID-19 vaccine, not hospitals. It has always been their role,” Oneida County Executive Anthony Picente Jr. said in a tweet directed to the Times Union. “#OneidaCounty has the plan, the training and the experience and stands ready to execute.”

Rhodes said the points-of-distribution sites — such as churches, fire departments and senior centers — will still be used, but he stopped short of saying that counties would be called on to administer vaccinations or to use their own computer systems to track who has received their shots.

“The state already has an IT (information technology) vendor. … It would not make any sense to have 62 different scheduling systems and 62 different reporting systems,” he said. “There has to be a real statewide coordination here, which is what we’re doing. … It’s just a completely different level of coordination and logistics than a lot of people were expecting … and that is why were are doing the planning the way we are, which is on a regional level.”..

During a press conference on Wednesday, Albany County Executive Dan McCoy acknowledged the Cuomo administration “threw us for a loop when it went to Albany Med and it took it out of of the control of the (county) health department, but it’s a good thing and it’s a different approach.”

McCoy also noted that Albany Medical Center had “never done this” and that the county — and other counties across the state — had for years been practicing and planning for mass vaccinations under a program involving the state and the federal government…

As the Times Union reported last month, five years after the 2001 terror attacks, the New York City Department of Health and Mental Hygiene sought a uniform procedure to deal with a mass-casualty event, including a bioterror attack. All citywide hospitals were directed to participate in a drill in which a small team of health professionals, including a pharmacist and two nurses, took part in a mass vaccination exercise.

According to a report in the Journal of the American Pharmacists Association, one five-person team was able to immunize 942 health care workers in a four-hour period. The drill indicated that in a 48-hour operation, the team would be able to immunize 12,000 health care workers.

“By allowing pharmacists to expand their scope of practice, New York state will inevitably see a drastic improvement in its adult immunization rates for influenza and pneumococcal vaccinations through greater public awareness and expanded vaccine access,” the report noted.

The integral role pharmacists play in vaccination has been driven by a proliferation of pharmacies in the past 20 years, including 2,869 licensed pharmacies in New York City’s five boroughs.

It remains unclear how many of the state’s pharmacies will be authorized to distribute the COVID-19 vaccines. The state Department of Health (DOH) earlier this month Thursday said it had received nearly 1,200 “provider enrollment applications,” which are necessary to become authorized by the U.S. Department of Health and Human Services for vaccine distribution. But the state agency declined to say how many of those applications — which have been submitted by county health departments, hospitals and long-term care facilities — also included pharmacies or county health departments.

Several weeks ago, the state Association of Counties set up an online meeting with DOH officials and county leaders to discuss New York’s vaccine distribution plans, which include mobilizing the points-of-distribution sites.

Loretta Santilli, director of DOH’s Office of Public Health, briefed county leaders on the state’s plan and noted that “it will be a state-driven, directed implementation response, but it will be all hands on deck. … Gov. Cuomo’s charge is to put the best vaccination program in the nation out there.”  (G)

“New York hospitals may face $100,000 in fines if they do not use up their share of COVID-19 vaccines by the end of the week, Gov. Andrew Cuomo said in a Jan. 4 media briefing.

Mr. Cuomo said the state health department issued regulations to speed the vaccine allocation process.

Specifically, vaccine providers now will have seven days to use all vaccine doses allocated to them. Those that fail to comply may face fines or be disqualified from administrating future vaccine doses. The regulations take effect immediately, Mr. Cuomo said.” (H)

“As governments around the world rush to vaccinate their citizens against the surging coronavirus, scientists are locked in a heated debate over a surprising question: Is it wisest to hold back the second doses everyone will need, or to give as many people as possible an inoculation now — and push back the second doses until later?

Since even the first shot appears to provide some protection against Covid-19, some experts believe that the shortest route to containing the virus is to disseminate the initial injections as widely as possible now.

Officials in Britain have already elected to delay second doses of vaccines made by the pharmaceutical companies AstraZeneca and Pfizer as a way of more widely distributing the partial protection afforded by a single shot.

Health officials in the United States have been adamantly opposed to the idea. “I would not be in favor of that,” Dr. Anthony S. Fauci, the nation’s top infectious disease expert, told CNN on Friday. “We’re going to keep doing what we’re doing.”

But on Sunday, Moncef Slaoui, scientific adviser of Operation Warp Speed, the federal effort to accelerate vaccine development and distribution, offered up an intriguing alternative: giving some Americans two half-doses of the Moderna vaccine, a way to possibly milk more immunity from the nation’s limited vaccine supply…

That would be a remarkable departure from the original plan. Since the vaccine rollout began last month in the United States, second shots of the vaccines have been held back to guarantee that they will be available on schedule for people who have already gotten their first injections.

But in Britain, doctors have been told to postpone appointments for second doses that had been scheduled for January, so that those doses can be given instead as first shots to other patients. Officials are now pushing the second doses of both the Pfizer-BioNTech and Oxford-AstraZeneca vaccines as far back as 12 weeks after the first one…

Shweta Bansal, a mathematical biologist at Georgetown University, and others also raised concerns about the social and psychological impacts of delaying second doses.

“The longer the duration between doses, the more likely people are to forget to come back,” she said. “Or people may not remember which vaccine that they got, and we don’t know what a mix and match might do.”…

Dr. Slaoui of Operation Warp Speed said in an emailed statement on Sunday that “the approach some countries are taking of delaying the booster shot could backfire and could decrease confidence in the vaccines.”

The vaccine makers themselves have taken divergent positions.

In a trial of the Oxford-AstraZeneca vaccine, volunteers in Britain were originally intended to receive two doses given four weeks apart. But some vaccinated participants ended up receiving their doses several months apart, and still acquired some protection against Covid-19.

An extended gap between doses “gives you a lot of flexibility for how you administer your vaccines, dependent on the supply that you have,” said Menelas Pangalos, executive vice president of biopharmaceuticals research and development at AstraZeneca.

Delayed dosing could help get countries “in very good shape for immunizing large swaths of their populations to protect them quickly.”

Steven Danehy, a spokesman for Pfizer, struck a far more conservative tone. “Although partial protection from the vaccine appears to begin as early as 12 days after the first dose, two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95 percent,” he said.

“There are no data to demonstrate that protection after the first dose is sustained after 21 days,” he added.”  (I)

Doctor, Did You Wash Your Hands?®  at  http://doctordidyouwashyourhands.com/

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(A)N.J. COVID vaccine: ‘We do need vaccinators.’ State calls for help with massive effort., By Katie Kausch, https://www.nj.com/coronavirus/2021/01/nj-covid-vaccine-state-needs-retired-medical-professionals-to-distribute-vaccine.html

(B) Volunteers answer staffing shortage for vaccination clinics, expose growing need, BY KELLEY BOUCHARD, https://www.pressherald.com/2020/12/27/volunteers-answer-staffing-shortage-for-vaccination-clinics-expose-growing-need/

(C) Missouri nursing group fears shortage of workers to give coronavirus vaccines, https://abc17news.com/news/coronavirus/2020/12/08/missouri-nursing-group-fears-shortage-of-workers-to-give-coronavirus-vaccines/

(D) Dr. Fauci hopes Covid vaccine distribution will be ‘gaining momentum’ after slow start, https://www.nbcnews.com/news/us-news/arizona-shortage-public-health-staffers-slowing-vaccine-rollout-n1252631

(E) NJ looks to retired medical professionals to speed pace of COVID-19 vaccinations, by LILO H. STAINTON, https://www.njspotlight.com/2021/01/covid-19-vaccinations-retired-medical-professionals-speed-vaccination-efforts/

(F) U.S. states enlist medical, nursing students to give out COVID-19 vaccine, By Tina Bellon and  Melissa Fares, https://www.reuters.com/article/us-health-coronavirus-vaccine-nurses-idUSKBN28Y124

(G) New York’s mass-vaccination plans are shelved as Cuomo takes different path, by Brendan J. Lyons, https://www.timesunion.com/news/article/New-York-s-mass-vaccination-plans-are-shelved-as-15824607.php

(H) New York threatens to fine hospitals $100K if vaccine rollout doesn’t speed up, by Alia Paavola,  https://www.beckershospitalreview.com/finance/new-york-threatens-to-fine-hospitals-100k-if-vaccine-rollout-doesn-t-speed-up.html

(I) As Rollout Falters, Scientists Debate New Vaccination Tactics, By Katherine J. Wu and Rebecca Robbins, https://www.nytimes.com/2021/01/03/health/coronavirus-vaccine-doses.html?referringSource=articleShare

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