arm getting injection

As the coronavirus (Covid-19) vaccine rolls out nationwide, questions about who will get it and when have been occupying a lot of space. Doctors and other health care providers are first in line — with others likely to wait until spring or summer, depending on supplies.

Perhaps not unexpectedly, the rollout has been very organized in some places, and disorganized other places. The New York Times has contributed by making an interactive tool allowing people to input basic information to determine where they will probably be in line.

State health departments are central to the planning. Hospitals so far are the primary recipients of vaccine shipments. They have come up with priority schedules based on their criteria and on the Centers for Disease Control recommendations, with some anomalies.

A New York area doctor wrote: “I am sure you have been reading…it’s been a little messy. A young marketing staffer at Mt. Sinai (not someone caring for patients) was one of the first to get (before nurses/doctors/etc). Trainees in some places are being put at the bottom in terms of priority, even though they do as much as anyone else (especially ER residents). Every institution is different. Ours is slowly getting people their vaccines. It’s caused a lot of angst. Many people upset that they aren’t being prioritized.  I truly don’t know if there are enough in the first go round for all essential workers?”

Some big hospitals are very organized.

“Northwell Health has received its first round of the BioNTech/Pfizer mRNA COVID-19 vaccine, which is under Emergency Use Authorization,” Maria Hale, PsyD, Associate Executive Director, Northern Westchester Hospital, wrote in an email. “We have begun administering the vaccine to those who are occupationally at highest risk of exposure to COVID-19 in the care setting, according to guidelines and criteria from the New York State Department of Health. At Northern Westchester Hospital, physicians and staff started receiving the vaccine on Tuesday, December 15th.  We anticipate being able to extend a vaccine invitation to every team member by the end of February, but this could change based on vaccine supply.

“Vaccine availability is a fluid situation. Front line staff members who are at the highest risk for exposure qualify to receive the first set of vaccinations. The vaccine is authorized now for Emergency Use Authorization only and will be distributed based on the Department of Health criteria. As additional manufacturers secure approval, the availability and timeline will continue to evolve. The good news is, the FDA has upped the number of doses that can be drawn from a single vial from five to six which will allow more of our team members to be vaccinated.”

State by state plans, affected by politics

A specialist at a New York City hospital, who spoke on condition of anonymity, said the state rollouts are very different, partly because they are based on logistical capabilities, including the need for extremely cold freezers for the Pfizer vaccine. “Large academic medical institutions will have the freezers,” she said. “A large private practice with hundreds of people will not have the deep-freeze for the Pfizer vaccine.”

Each state will also have different rules “dependent on the politics of each state,” she said.

A friend in Connecticut said today on Facebook that her mom, in a long-term care center in the state, had gotten her first shot of the vaccine.

A member of the hospital support staff in Birmingham, Ala., wrote in mid-December: “My hospital is the only one in the area receiving the first batch of vaccine, expected next week, and we’ve been given very specific percentages of that vaccine that are for our facility vs others. 15% to first responders. 15% to nursing homes. 20% to vaccinate medical people at other facilities in the area. Some of these people will be going to a drive-through vaccine clinic we’re starting. I’m unclear on how nursing homes are being handled.”

Later, this person added: “Initially, only 8 hospitals in Alabama were scheduled to receive vaccine next week. Then last night I heard it was 15.”

A nurse at a pediatric intensive care unit at a big New York City hospital wrote on Dec. 15:

“We have no plan yet… we are not in the first round and rumor has it we are not in the second round.  Pediatrics has not suffered as much as ADULT. ED department should get first doses by tomorrow. (Not Pediatric ED). Communication here is pitiful.  Everyone asking yet no answers.

“Crossing my fingers that I will get an offer of vaccine soon!  I’ll take it!!

Who’s first in line?

The question of who gets the vaccine first is puzzling. Emergency room doctors, of course. Yet we heard of a woman doing leukemia research at Dana Farber in Boston who was scheduled to get vaccinated Saturday, Dec. 19.

A microbiology supervisor at a lab in Maryland wrote: “Management has informed us that lab personnel testing the COVID-19 samples are Tier 3, not a priority, so, there’s that!”

The specialist at a New York City hospital said she has noticed a number of anomalies. “A friend from medical school is a urologist,” she said. “He is not a front-line worker, and is not near the front of the queue, but he got vaccinated two days ago.”

She added that the supply of the vaccine is a key point. “If the vaccine comes quickly, none of this will matter that much if a front-line worker stands in line behind that researcher,” she said. But if it doesn’t come quickly, it will matter a lot.”

At Westchester Medical Center in Westchester county, north of New York City, the picture is less clear. A pediatrician in a multi-specialty practice that is a contractor with the hospital wrote that she would get her vaccine at the hospital. “Priority 1 top tier are the ER physicians.  Next in line are ICU and hospitalists, which includes me. “ She followed up on Dec. 15: “WMC got the vaccines today but the CEO has not reported how many doses have arrived.  Vaccines were given to a few starting at 1:45pm (head of MICU, resp therapist, ER doc, etc.).  They sent out a mass text to the nurses around 12noon asking if anyone can stay overtime to give vaccines tonight.  I have seen more organized efforts in friends’ hospitals with a clear cut appointment scheduling system and prioritization, so I can’t come up with more.”

(Update, Dec. 22: “Mass General Brigham is racing to fix faulty software that crashed its vaccine enrollment website, leaving thousands of frustrated employees unable to sign up,” The Boston Globe reported. “At Boston Medical Center, some staffers treating coronavirus patients complain they weren’t invited to get vaccines in the first batch at all.

“And tensions are running high at Boston Children’s Hospital, where some employees are irked their president was near the front of the line for a shot.”

At Stanford, residents take a back seat

 

At Stanford Medical Center in California, medical residents complained last week that the Stanford plan for allocation gave just seven doses for the entire resident cohort, ProPublica reported. The residents are often patient-facing, and they said that Stanford staff members who are Facetiming from home or working in the elective surgery ward — where all patients will be Covid-tested before surgery — were getting vaccinated, while the residents, at demonstrably higher risk, were not.

Sen. Joni Ernst, an Iowa Republican, was trashed on Twitter for tweeting about getting vaccinated on Sunday. Ernst said a few months ago that doctors were coding deaths as Covid deaths to make more money.

Northrop Grumman, a big military contractor, apparently has gotten its employees a high vaccine priority, higher than people over 65, according to a tweet from Ken Klippenstein, a reporter for The Nation.

He tweeted: “Northrop Grumman employee sent me this rather stark reminder that defense contractors are a higher vaccine priority than people ages 65+ and “adults with high risk medical conditions.”

From Iowa to Maryland to Massachusetts to New York

A specialist in Iowa said: “I presume health care workers will be at or near the front of the line, but don’t know exactly when. We have the necessary freezers at the hospital and at my clinic.”

An emergency room doctor in the University of Maryland system wrote: “As an ER doc, I concur with all of the positive sentiments regarding the vaccine. I will be one of the first in line to receive the vaccine. Not only is the vaccine safe, but we owe it to our patients to keep them safe since we pose a significant risk to them if we are infected.  … We expect to get the vaccine next week. “There are a lot of moving parts but those of us in the ED and covid units are prioritized first. It is not mandatory at our shop yet but we expect most people to get it when offered.”

A New York area internist who is a member of a multi-specialty group wrote, “I have not been told when I will get the vaccine. I’m guessing I may be in the 2nd wave of recipients of vaccines for health providers–but it’s only a guess. I’m not on the “front lines”–ICU, ER–but I have been seeing COVID patients in the office. I’m also 67–not sure how that will figure into this.

A Boston primary care doctor wrote: “We got an online app from the state last week to fill out re this but no definite date re receiving them. I doubt it will be early though given i’m just a little guy. i’m sure the big hospital systems, CVS Minute Clinics etc will get them before we do. Just like the rapid tests and everything else covid related.”

A Lawrence, Kan., primary care doctor wrote: “Our county health department just announced phase 1A which includes healthcare workers who have direct contact with COVID patients. I registered our clinic (myself, NP, and 2 RNs) and we’ve been told mid/late December, but not an exact date.”

‘Public health called to ask’

A family practitioner/OB in Grinnell, Iowa, said, “Public health called to ask how many folks need vaccinated at our clinic!”

A family doctor in Grinnell, Iowa, wrote:  “Poweshiek county health dept. just e-mailed me that healthcare workers in Grinnell, whether the hospital or private offices will not get Pfizer because of the logistics of keeping it cold. Long term care will get it directly from pharmacies. We healthcare workers (and staff) will get the Moderna vaccine, as soon as it get approved. As soon as the week of the 21st. They’ll come to our office and immunize everyone who wishes. Pfizer should be rolling in soon. We are very relieved to be getting this so soon!”

A Midwestern anesthesiologist wrote: “I assume most here would jump at the chance at a vaccine.  I should have an opportunity to get the vaccine sometime before Christmas and welcome the opportunity.   I am very surprised at the number of people who do not want any part of the vaccine.  Falls on all sides of the spectrum- anti Vaxers, distrust of science and government, some with no real discernible reason.  It seems to be getting harder help people help themselves.”

An emergency room doctor in Houston wrote: “I’m expecting to get the first dose of the Pfizer vaccine in 1 month. My program says they’d provide it to us then, but they also told us that if we can find a way to get a vaccine quicker at one of the area hospitals we should go for that. People have been putting random sentences in emails like ‘we’re working on getting the vaccine’ so it seems like a lot of systems are being set up behind the scene. It doesn’t seem particularly organized and there may be some overlap/supply shortage in the future, but welcome to America. I think I should be fully vaccinated by the spring.”

It’s not for everyone

Despite the excitement around the vaccine, there are people refusing to get it. The anti-vaccine movement continues to have a hold on a substantial number of Americans and others worldwide.

Beyond that, not everyone should get it.

“It is imperative to Northwell’s mission that we provide the most up-to-date information on the safety and efficacy of a COVID-19 vaccine. Because there is currently no cure for COVID-19, prevention is our best strategy,” Hale wrote. “The vaccine will not be recommended for everyone and you should be evaluated for any exclusion criteria prior to being vaccinated. If you have questions about the COVID-19 vaccine in relation to children, the elderly, people who are immunocompromised, women who are breastfeeding/pregnant/considering becoming pregnant, and those with a significant history of allergic reactions, please consult your doctor.

“The development of COVID-19 vaccines is an important step in helping minimize the effects of this potentially deadly virus. Our team members who have received the vaccine have been excited to be part of this historic public health initiative.”

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...