POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”

“Overall, we find states are increasingly diverging from CDC guidance and from each other, suggesting that access to COVID-19 vaccines in these first months of the U.S. vaccine campaign may depend a great deal on where one lives. In addition, timelines vary significantly across states, regardless of priority group, resulting in a vaccine roll-out labyrinth across the country.

CDC ACIP Recommendations for COVID-19 Vaccine Prioritization for Phase 1

Phase 1a:  health care workers and long-term care facility residents

Phase 1b:  persons aged ≥75 years and frontline essential workers (non–health care workers). ACIP classifies the following workers as frontline non–health care essential workers: first responders (including firefighters and police officers), corrections officers, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those who work in the education sector (teachers and support staff members), and child care workers.

Phase 1c: persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions, and any essential workers not included in Phase 1a or 1b. Essential worker sectors recommended for vaccination in Phase 1c include those in transportation and logistics, water and wastewater, food service, shelter and housing (e.g., construction), finance (e.g., bank tellers), information technology and communications, energy, legal, media, public safety (e.g., engineers), and public health workers.” (A)

“The Centers for Disease Control and Prevention recommended that the Covid-19 vaccine should go to healthcare workers first—guidance most states seem to be following—but many states have indicated they will deviate from the CDC’s suggestion on who gets it next: people 75 and older and essential workers.

States following CDC guidelines: Alabama, Maine, South Carolina

States offering vaccines to essential workers and a wider group of older residents (65+) in the second phase: Delaware, Washington D.C., Georgia, Mississippi, Missouri, Pennsylvania, Utah, Colorado

States prioritizing older residents over essential workers: Texas, Florida, Hawaii, Oklahoma (adults with pre-existing conditions included)

States prioritizing essential workers over older residents: Alaska, Arizona, Arkansas, Idaho, Kentucky, Michigan, Nebraska, New Jersey, New York, Virginia, West Virginia, New Hampshire, Vermont, Massachusetts, and Nevada.

States prioritizing older residents and people with preexisting conditions over essential workers: Hawaii (first responders were included in the first phase), Indiana, Kansas, Tennessee, Texas

States prioritizing people with preexisting conditions over older residents and essential workers: North Carolina    (B)

“All states have released updated prioritization criteria for Phase 1, primarily in response to ACIP deliberations and guidance. Some had planned emergency meetings in anticipation of the FDA’s announcement and ACIP’s follow-on recommendation. Importantly, most indicate that these criteria could change depending on supply, vaccine characteristics, and other factors.

Most states are following ACIP’s Phase 1a recommendation.

45 states are following ACIP’s interim Phase 1a recommendation to prioritize HCWs and LTC residents. Some states will start vaccinating both of these groups together, while others will start with one of these groups first as they await more supply to start vaccinating the other. Still, even with these state criteria, decisions about how to allocate limited initial vaccines to HCWs and LTC residents will mostly be left to facilities.

7 states depart from ACIP’s Phase 1a recommendation in some way. For example, the District of Columbia and Utah include HCWs in Phase 1a but LTC residents in Phase 1b.  In addition to HCWs and LTC residents, Nevada, New Hampshire, and Wyoming also include law enforcement in Phase 1a (per ACIP’s proposed framework, they are in 1b). Massachusetts also includes people incarcerated in prisons and those living in homeless shelters in Phase 1a (neither is explicitly mentioned in ACIP’s Phase 1 framework).

More than 20 states also provide further sub-prioritization rankings or criteria within HCW and/or LTC resident groupings. For example, Alabama segments HCWs into “very-high”, “high”, and “medium” risk. Idaho provides specific rankings within each group. Texas groups Phase 1a into “first” and “second” tier.

The majority of states are still developing criteria for subsequent Phase 1 prioritization, but there are already some differences from ACIP’s preliminary framework.

30 states indicate that they are still developing more specific criteria for these next phases.

Of the 21 with criteria, 8 follow ACIP for Phase 1b and 5 follow ACIP for 1c.

The main differences lie in where states place people ages 65 and older and those with high risk medical conditions, relative to essential workers. For example, Alabama, Delaware, Florida, Maryland, North Carolina, and Tennessee each prioritize those 65+ and/or those with high risk medical conditions over non-health essential workers; North Carolina and Tennessee prioritize those with high risk medical conditions over those ages 65 and older.

In addition, some include other congregate settings (not indicated in ACIP’s framework). Alabama, Nebraska, Nevada, North Carolina and Oklahoma explicitly include those living in homeless shelters and prisons in Phases 1b or c. Delaware and Tennessee explicitly include people incarcerated in prisons in 1c.

Discussion

Our review finds that almost all states hew to ACIP regarding initial allocations of a COVID-19 vaccine (Phase 1a) and have looked specifically at ACIP for decision-making.  Beyond that, a good number of states are still developing criteria for Phases 1b-c.  Given that ACIP has yet to issue recommendations for these phases, states may be waiting for further guidance. However, based on ACIP’s preliminary framework, there are some differences between state priorities and where ACIP is likely to land, primarily related to the prioritization of seniors and/or those with high risk medical conditions relative to non-health essential workers. Moreover, these later prioritization decisions are likely to be more difficult given the large numbers of people in these groups and continued limits on vaccine supply.” (C)

“The rapid expansion of COVID-19 vaccinations to senior citizens across the U.S. has led to bottlenecks, system crashes and hard feelings in many states because of overwhelming demand for the shots.

Mississippi’s Health Department stopped taking new appointments the same day it began accepting them because of a “monumental surge” in requests. People had to wait hours to book vaccinations through a state website or a toll-free number Tuesday and Wednesday, and many were booted off the site because of technical problems and had to start over.

In California, counties begged for more coronavirus vaccine to reach millions of their senior citizens. Hospitals in South Carolina ran out of appointment slots within hours. Phone lines were jammed in Georgia.

“It’s chaos,” said New York City resident Joan Jeffri, 76, who had to deal with broken hospital web links and unanswered phone calls before her daughter helped her secure an appointment. “If they want to vaccinate 80% of the population, good luck, if this is the system. We’ll be here in five years.”

Up until the past few days, health care workers and nursing home patients had been given priority in most places around the U.S. But amid frustration over the slow rollout, states have thrown open the line to many of the nation’s 54 million senior citizens with the blessing of President Donald Trump’s administration, though the minimum age varies from place to place, at 65, 70 or higher.

On Thursday, New Jersey expanded vaccinations to people between 16 and 65 with certain medical conditions — including up to 2 million smokers, who are more prone to health complications…

Hard-hit Los Angeles County, the nation’s most populous county with 10 million residents, said it couldn’t immediately provide shots to the elderly because it had inoculated only about a quarter of its 800,000 health care workers….

In Mississippi, officials said new appointments will probably have to wait until a hoped-for shipment of vaccine in mid-February.

In South Carolina, Kershaw Health in Camden implored people not to call its hospitals or doctors to schedule vaccination appointments after receiving more than 1,000 requests in two days. State health authorities said their hot line got 5,000 calls on Wednesday….

Meanwhile, some states, like Minnesota, are waiting before throwing open the doors.

“As we learn more, we will work to make sure everyone who is eligible for a vaccine knows how, where, and when they can get their shots,” the state Health Department said in an email. “Everyone’s opportunity to get vaccinated will come; it will just take some time.”

Arizona, which had the nation’s highest COVID-19 diagnosis rate over the past week, will start signing up people 65 and older next week. It also plans to open a vaccination site at Phoenix Municipal Stadium in addition to the one dispensing thousands of shots daily at the home of the NFL’s Arizona Cardinals.

To step up the pace of vaccinations, South Carolina made a rule change allowing medical students, retired nurses and other certain professionals to administer the shots.” (D)

“NYC has launched a city vaccine finder tool to help the hundreds of thousands of New Yorkers who are now eligible to schedule an appointment for the shot. But a patchwork of scheduling systems between providers and different government websites for making appointments has caused confusion—raising immediate questions about how older, less tech-savvy New Yorkers will gain access.

Comptroller Scott Stringer, a mayoral candidate, called the sign-up process “bewildering” on Sunday evening.

“We should be #1 in vaccinations in the nation from day one—and we should be using every tool at our disposal to vaccinate as many New Yorkers as possible as quickly as possible. Instead we’ve set up a gauntlet that requires tech support,” Stringer wrote in a tweet.

The city has created an aggregated information site for vaccine locations called the NYC vaccine finder. But the Health Department and NYC Health + Hospitals still have sign-up sites for their locations, and clinics or other smaller healthcare centers have their individual sign-up processes as well. Those seeking appointments must fill out a multi-step verification process to set up an account and face about 51 questions or fields to check off on the Health Department’s site, according to Stringer.

“Any barrier to getting shots in arms is only going to prolong the agony of this crisis,” Stringer wrote…

On Monday, the city launched a hotline—877-VAX-4NYC—to make appointments by phone, with 750 customer service reps answering the phones 8 a.m. to 9 p.m. De Blasio said 24/7 hours are coming soon.

New York State will launch its own hotline at 4 p.m. Monday at 1-833-NYS-4VAX.

The state also set up another website for New Yorkers to determine eligibility and schedule an appointment. Demand is expected to outweigh supplies, so Governor Andrew Cuomo’s office noted those eligible should be prepared to schedule an appointment as far as 14 weeks in the future…” (G)

“It’s enraging that after the scientific marvel of inventing Covid-19 vaccines, now there are bureaucratic and technical bottlenecks that have slowed the vaccine rollout. (Feel free to scream out loud with me.) But don’t be angry about botched government technology or direct your fury only at your local officials. Be mad about the broad systemic failure.

As we have seen with other frailties of government programs during the pandemic, botched technology is often a symptom of misguided policy choices, chronic underfunding of public health and the generally dysfunctional and decentralized coronavirus response in the United States.

When I read several tales last week about botched vaccine scheduling in some parts of Florida, I contacted the U.S. Digital Response, an organization I’ve written about before that pairs tech-savvy volunteers with state and local governments needing tech assistance.

Until I spoke with them, I didn’t grasp the complexity of what public health authorities are doing to get people vaccinated. The hard part is not just the scheduling hotlines or websites that you and I see; it’s everything that the public doesn’t see.

Officials at the organization outlined eight or more discrete requirements for local governments to manage their vaccination programs. The steps include keeping tabs on the incoming and outgoing inventory of shots, making sure people meet the eligibility requirements for vaccines, scheduling appointments (twice!) and reminding people of them, collecting patient information, keeping records to report to state and federal health authorities, and potentially billing health insurance programs.

Government officials must also keep the public informed about where and when to get vaccines, make sure health care information is secure and private, and ensure services are accessible for people who don’t have computers or speak languages other than English. Sounds super fun and easy, right?!..

The frustrating thing is that all the bungled vaccination efforts fit a pattern. When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….

When you start to pull your hair out because you can’t register for a vaccine on a local website, remember that it’s not (only) the fault of a bad tech company or misguided choices by government leaders today. It’s a systematic failure years in the making.” (H)

“While bureaucratic snafus, delivery problems and a lack of planning has bogged down the initial rollout of COVID-19 vaccines, more and more states are expanding the list of eligible recipients.

Still, while political figures and celebrities have already received the vaccine, distribution for the public will take more time. Each state has set priorities about who gets the vaccine first, based on recommendations from the federal government. Currently, the states are rolling the vaccine out in categories based on need. Health care workers and people living in nursing homes are highest priority, and they began receiving the vaccine in mid-December. People ages 75 years and older, along with essential workers like first responders, will be next, although several states have lowered that requirement to 65

Adults between 65 and 75 years old, and younger people (between 16 and 64) at high risk, along with other essential workers, will get the vaccine in the next phase. Assuming there is enough of the vaccine to go around after that, everyone else will be able to get one, likely sometime in the late spring or early summer.

Most vaccinations are now taking place at hospitals or public health clinics. But, the vaccine will likely be available to the public at most pharmacy chain stores like CVS, Walgreens, and others; along with in-store pharmacies at Costco, Kroger, Target, Publix, HEB, and other national and regional chains.

Experts suggest regularly checking state public health department websites for information. Some states offer vaccine safety information, details about who qualifies for vaccines now, where to get them, and ways to sign up for COVID-19 and vaccine alerts. Those websites are listed below.” (E)

“It isn’t easy, and it’s probably going to be that way for a while. Right now, there are more eligible people than doses of vaccine. You need diligence and luck.

People are swapping tips in text chains and social media groups to try to gain an edge, and there is a dizzying array of websites and phone numbers to keep track of.

At every turn there are more questions about how best to book a slot, what happens when you arrive for an appointment, and what might happen if you just show up without one. The answers seem to change from moment to moment.

Here’s what we know about the process to get vaccinated in New York City.” https://www.nytimes.com/article/nyc-vaccine-shot.html?referringSource=articleShare (I)

“In its framework for the equitable allocation of the COVID-19 vaccine, the National Academies of Science, Engineering and Medicine offered a bit more detail, explicitly recommending that high-risk health care workers, first responders, people with two or more underlying medical conditions, and older adults in long-term care facilities or other overcrowded settings be prioritized. That rough framework for prioritization was subsequently adopted by the CDC’s vaccine advisory group.

However, the reality of vaccine distribution thus far — at a critical moment when COVID-19 cases are surging and vaccination resources are still scarce — has been marred by a patchwork of variable vaccination strategies on the local and state level, logistical inconsistency, and the exploitation of long-standing socioeconomic power structures….

Biden says his administration will work with states to quickly move to the next phase of vaccine distribution — allowing people age 65 and older as well as front-line workers like teachers, first responders and grocery store workers to get immunized. He’s pledged to also work with community-based organizations and trusted health care providers to make sure people in marginalized and medically-underserved communities quickly get access to the vaccine.

But there is still reason to be deeply concerned that over the next few months — as hospital systems, states, and nations begin to distribute vaccines to the wider public — the process could become even more flawed and inequitable…

Already, there are early signs that the privileged and wealthy are eager to access the vaccine before others — once again trying to buy and leverage their connections to achieve a spot at the front of the line.

The scarcity of vaccines combined with the fear and desperation surrounding the pandemic is exposing a true moral tragedy: People are willing to save themselves at the expense of others.

The prioritization of certain groups for early COVID-19 vaccination is not arbitrary. When drafting guidelines about vaccine distribution, the CDC aimed to both reduce illness and deaths by helping those most at risk, and to preserve those integral to the everyday functioning of society to be able to keep doing their essential work…(F)

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(A) The COVID-19 “Vaccination Line”: An Update on State Prioritization Plans, by Jennifer Kates, Jennifer Tolbert, and Josh Michaud, https://www.kff.org/coronavirus-covid-19/issue-brief/the-covid-19-vaccination-line-an-update-on-state-prioritization-plans/

(B)       Here Are The States Breaking From CDC Guidelines On Vaccine Priority, by Jack Brewster, https://www.forbes.com/sites/jackbrewster/2020/12/24/here-are-the-states-breaking-from-cdc-guidelines-on-vaccine-priority/?sh=3093a3493804

(C)       How are States Prioritizing Who Will Get the COVID-19 Vaccine First?, by Jennifer Kates, Josh Michaud, and Jennifer Tolbert, https://www.kff.org/policy-watch/how-are-states-prioritizing-who-will-get-the-covid-19-vaccine-first/?utm_campaign=KFF-2020-Coronavirus&utm_medium=email&_hsmi=102982102&_hsenc=p2ANqtz–mlrIQ1XVng-Pe8RRpOzkCKmbehwMpNp5z2lUYND9Ny9d3ac5ILjMumeP-LtEpagMT484l_JEsEIdPvQNzCV-WXr-ZQw&utm_content=102982102&utm_source=hs_email

(D)       US states where it’s easiest, and most difficult, to get a coronavirus shot, by Aria Bendix, https://www.businessinsider.com/states-easy-hard-coronavirus-vaccine-per-capita-2021-1

(E)        State-by-State Guide to COVID Vaccine Information, By Lane Holman, https://www.webmd.com/vaccines/covid-19-vaccine/news/20201224/state-by-state-guide-to-covid-vaccine-information

(F)        OPINION: Moral Tragedy Looms In Early Chaos Of U.S. COVID-19 Vaccine Distribution, by HAZAR KHIDIR and MELANIE MOLINA,

(G)        New Yorkers Eligible For COVID Vaccine Report Frustrations With City Registration Websites, by SYDNEY PEREIRA, https://gothamist.com/news/new-yorkers-eligible-vaccine-report-frustrations-city-registration-websites

(H)        The Problem With Vaccine Websites, By Shira Ovide, https://www.nytimes.com/2021/01/12/technology/the-problem-with-vaccine-websites.html?referringSource=articleShare

(I)          How to Get the Coronavirus Vaccine in New York City, by Ron Lieber, https://www.nytimes.com/article/nyc-vaccine-shot.html?referringSource=articleShare

New York -Phased Distribution of the Vaccine

Phase 1a & Phase 1b

We are currently in Phase 1a and initial groups from Phase 1b.

Eligible New Yorkers in Phase 1a and 1b are:

High-risk hospital workers (emergency room workers, ICU staff and Pulmonary Department staff)

Residents and staff at nursing homes and other congregate care facilities

Federally Qualified Health Center employees

EMS workers

Coroners, medical examiners and certain funeral workers

Staff and residents at OPWDD, OMH and OASAS facilities

Urgent Care providers

Individuals administering COVID-19 vaccines, including local health department staff

All Outpatient/Ambulatory front-line, high-risk health care workers of any age who provide direct in-person patient care

All staff who are in direct contact with patients (i.e., intake staff)

All front-line, high-risk public health workers who have direct contact with patients, including those conducting COVID-19 tests, handling COVID-19 specimens and COVID-19 vaccinations

This includes, but is not limited to,

Doctors who work in private medical practices and their staff

Doctors who work in hospital-affiliated medical practices and their staff

Doctors who work in public health clinics and their staff

Registered Nurses

Specialty medical practices of all types

Dentists and Orthodontists and their staff

Psychiatrists and Psychologists and their staff

Physical Therapists and their staff

Optometrists and their staff

Pharmacists and Pharmacy Aides

Home care workers

Hospice workers

Staff of nursing homes/skilled nursing facilities who did not receive COVID vaccination through the Pharmacy Partnership for Long-Term Care Program

Beginning January 11, 2021:

Individuals Age 65 and older

First Responder and Support Staff for First Responder Agencies

Fire Service

State Fire Service, including firefighters and investigators (professional and volunteer)

Local Fire Services, including firefighters and investigators (professional and volunteer)

Police and Investigators

State Police, including Troopers

State Park Police, DEC Police, Forest Rangers

SUNY Police

Sheriffs’ Offices

County Police Departments and Police Districts

City, Town, and Village Police Departments

Transit of other Public Authority Police Departments

State Field Investigators, including Department of Motor Vehicles, State Commission of Correction, Justice Center, Department of Financial Services, Inspector General, Department of Tax and Finance, Office of Children and Family Services, and State Liquor Authority

Public Safety Communications

Emergency Communication and Public Safety Answering Point Personnel, including dispatchers and technicians

Other Sworn and Civilian Personnel

Court Officers

Other Police or Peace Officers

Support or Civilian Staff for Any of the above services, agencies, or facilities

Corrections

State Department of Corrections and Community Supervision Personnel, including correction and parole officers

Local Correctional Facilities, including correction officers

Local Probation Departments, including probation officers

State Juvenile Detention and Rehabilitation Facilities

Local Juvenile Detention and Rehabilitation Facilities

In-person college instructors

P-12 Schools

P-12 school or school district faculty or staff (includes all teachers, substitute teachers, student teachers, school administrators, paraprofessional staff and support staff including bus drivers)

Contractors working in a P-12 school or school district (including contracted bus drivers)

Licensed, registered, approved or legally exempt group Childcare Providers

Exempt Childcare setting

Grocery store workers

Employees or Support Staff of Licensed or Registered Childcare Setting

Licensed, Registered, Approved or Legally Exempt Childcare Providers

Public Transit

Airline and airport employees

Passenger railroad employees

Subway and mass transit employees (i.e., MTA, LIRR, Metro North, NYC Transit, Upstate transit)

Ferry employees

Port Authority employees

Public bus employees

Individuals living in a homeless shelter where sleeping, bathing or eating accommodations must be shared with individuals and families who are not part of the same household

Individual working (paid or unpaid) in a homeless shelter where sleeping, bathing or eating accommodations must be shared by individuals and families who are not part of the same household, in a position where there is potential for interaction with shelter residents