Coronavirus (Covid-19) and the vaccine: Amidst chaotic rollout, healthcare workers struggle to actually receive vaccine

Filed Under: Costs

- photo by Hakan Nural on Unsplash

Healthcare workers have long been slated to be first in line to receive the Covid vaccine, as many of them are on the dangerous front lines, dealing directly with potential Covid patients. According to figures from the Centers for Disease Control and Prevention, “nearly 344,000 health care workers have come down with Covid-19 infections since the start of the pandemic and 1,177 have died.”

However, as vaccine distribution has begun over the past month, many healthcare workers have found themselves disappointed at a distribution process that seems chaotic and fraught with errors.

Furthermore, healthcare workers not affiliated with large hospital systems that have the resources necessary to store and distribute the vaccine are left in the uncomfortable position of having to petition nearby hospitals to try and get a spot.

“The majority of the vaccines are reserved for hospital employees,” Dr. Nina Watson, a board certified diagnostic radiologist with subspecialty training in breast imaging, and founder and owner of Watson Medical Consulting Group, told ClearHealthCosts in a video interview. “So it takes a little bit of maneuvering in order to find a hospital that is also willing to give it to me as an independent contractor.

“Fortunately, for my first dose, a small community hospital that I work at in Indiana offered me that dose, which is great. Now I’m in a position where at the 21 day mark, I will be in Atlanta, where I’m based out of and now I’m, you know, searching now to be able to get the second dose of the vaccine.”

Another non-staff health care worker, a Chicago area physician assistant student who is doing in-person care in her hospital’s emergency department, said she got her vaccine only because a previous employer mistakenly had her listed as an employee. Otherwise, as a student, she would still be doing in-person care without the vaccine.

Who is supposed to be prioritized?

Long before the vaccine was first being distributed, experts warned that the U.S. would initially have a limited supply, and that choices would have to be made on whom to prioritize for vaccine distribution. NIH Director Francis Collins, MD, PhD, and CDC Director Robert Redfield, MD tasked the National Academies of Sciences, Engineering and Medicine with recommending how the vaccine should be distributed.

On Sept. 1, the National Academies of Sciences, Engineering and Medicine released a preliminary framework to help policymakers plan. The report drew on lessons learned from previous mass vaccine distribution campaigns, including those for H1N1 influenza (“Swine flu”) in 2009 and Ebola in 2013-2016, and took into account further lessons learned during the Covid-19 pandemic on scarce medical resource allocation.

The committee identified those prioritized to receive the vaccine as, “individuals who have a greater probability of being in settings where COVID-19 is circulating and exposure to a sufficient dose of the virus,” “individuals who have a greater probability of severe disease or death if they acquire infection,” “individuals with societal function and upon whom other people’s lives and livelihood depend directly and would be imperiled if they fell ill,” and “individuals who have a higher probability of transmitting the disease to others.”

The report lays out four phases of distribution. The first phase, according to Becker’s Hospital Review, is known as the “Jumpstart Phase,” and “prioritizes giving the vaccine to healthcare workers in high-risk settings and first responders.”

However, as the first rounds of the vaccine have rolled out, many healthcare workers have found themselves unable to easily access the vaccine, for a variety of different reasons.

Algorithm failure at Stanford

Earlier in December, “a botched algorithm, crashing scheduling platforms and other logistical mishaps” prevented many frontline healthcare workers from receiving the vaccine as planned, The Guardian reported.

“Vaccine rollout was an absolute mess,” Ronald Witteles, program director at Stanford Health Care’s internal medicine residency program tweeted on Dec. 18. “Faculty members who are attending on COVID-only units were not included in Wave A, while others with little exposure were. There are more absurd examples than you can imagine.”

More than 100 Stanford Medical Center doctors gathered in protest on Dec. 18, the San Francisco Chronicle reported, accusing the university of “prioritizing the wrong health care workers to receive coronavirus vaccines ahead of residents and fellows who work directly with COVID-19 patients.”

Videos of the protest posted on the San Francisco Chronicle’s twitter account show protesters chanting, “healthcare heroes, support is zero,” amidst voicing their failing trust in the administration and demanding transparency in the vaccine distribution process.

Apparently, only seven residents and fellows were included in the first round of 3,900 vaccinations at Stanford Medical Center, which began on December 18th. Protesters told the San Francisco Chronicle that those slated to receive the first round included “orthopedic surgeons, nurses treating outpatients and a dermatologist,” as well as some physicians who have been working from home since the start of the pandemic with no in-person patient responsibilities.

In a letter to top Stanford officials, protesters accused the university of having “no articulated plan to vaccinate the remaining 1,300+ residents and fellows, including those on the front line directly treating COVID-19 patients.”

The university relied on an algorithm to select those eligible for the first round of vaccines, which President and CEO of Stanford Health, David Entwhistle, said followed federal guidelines prioritizing healthcare workers and older employees, according to the San Francisco Chronicle. Protestors accused the university of ignoring an apparent error in the algorithm that allowed employees not working directly with patients to be vaccinated first.

Stanford officials apologized profusely to employees and said that they are working on a revised distribution plan.

Online scheduling platform failures in Massachusetts

On the other side of the country, healthcare workers at Boston’s Mass General Brigham healthcare systems were also upset when the hospital’s online vaccine scheduling platform crashed.

According to the Boston Globe, Mass General Brigham informed its nearly 80,000 employees that they were experiencing “technical difficulties” with scheduling at 11 P.M. on Dec. 16, the night before employees were supposed to start receiving vaccinations.

According to The Guardian, employees gathered in a long, in-person line to receive the vaccine after not being able to schedule their appointments online. Other employees, including those in the hospital’s emergency departments, were not able to leave their positions to wait in the line, The Guardian reported.

Once the scheduling platform came back online, appointment availability was apparently snatched up within minutes. “Employee was pitted against employee in a dystopian race,” one physician, who requested to remain anonymous, told The Guardian. “What should have been a moment of triumph for medicine and the healthcare system writ large was instead clouded by the dysfunction that hospitals are known for only too well.”

Apparently, even once the system was back online, many physicians still were unable to schedule their vaccines, with several posting images on social media showing error messages they received instead of confirmed appointments.

Once scheduling resumed, it was only accessible in waves, with employees at specific hospitals in the Mass General Brigham system only able to schedule their appointments at certain times. Cooley Dickinson Hospital in Northampton was first in line for scheduling, as the hospital lacks the ultra cold storage capacity necessary to store the vaccine, which must be kept at -94 degrees fahrenheit.

According to the Boston Globe, the scheduling system asks employees to self-identify whether or not they will be in direct contact with the coronavirus (either through direct dealing with infected patients, or use of rooms and equipment contaminated by infected patients), relying on the honor system to identify those eligible for the first round of vaccines.

This system failure frustrated doctors, many of whom shared painful memories of PPE shortages earlier in the pandemic. “For the nurses and respiratory therapists working tonight, to be denied that access, to have that feeling of waiting for an online system to reboot and then fail, it brought people back to those early feelings of not knowing whether they would have enough PPE, the feeling of not being protected by an institution,” a physician who also requested anonymity wrote in an email to the Boston Globe.

Healthcare workers not affiliated with large hospital systems left to fend for themselves

As vaccine distribution continues in hospitals across the country, healthcare workers at private practices, contracted and traveling healthcare workers and the like — even those working directly with Covid patients — have been largely overlooked.

“In San Diego, vaccine has been given to IT workers, billing administration, tele-workers, PR staff, engineering department, etc. that are affiliated with a hospital conglomerate but do not have and never will have responsibilities that involve direct patient care contact with COVID+ or otherwise ill patients,” Dr. Jessica Hollingsworth, an independently contracted anesthesiologist from California, said in a letter that she shared with NBC News. The letter was also sent to the California Department of Public Health, to which Hollingsworth says she received an unhelpful automated response.

Dr. Watson said that she has reached out to her local health department to try to secure her second dose of the vaccine, which requires two doses taken 21 days apart in order to be effective. “Right now, I’m due for my second dose in 11 days, and I still haven’t been able to secure it,” said Watson.

There are two main vaccines currently out — the vaccine by Pfizer/BioNTech requires two doses 21 days apart, while Moderna’s vaccine requires two doses 28 days apart. This adds another layer of difficulty for private or contracted healthcare workers attempting to receive the vaccine, as they must ensure their second dose is received in the required timeframe, and is from the same company as the initial dose.

For those healthcare workers struggling to obtain the vaccine, Watson said, much information is being spread via word of mouth on social media. Watson said she found out through social media that in her area, physicians who are not associated with hospitals must fill out a form and email the local health department for scheduling, but that this process only ensures the first dose of vaccine.

“If you do work as an independent contractor with some hospitals, they’ll send you an email to let you know if you qualify,” Watson said. “But then there’s a matter of if you’re not scheduled to work during that time frame, you know, do you fly across the country, just to get a dose? Will you be paying all of the out of pocket expenses and also time? Depending on when you’re scheduled, you know, maybe you’re at a hospital that will not consider you for a dose of the vaccine. All of those things sort of factor in.”

Ultimately, Watson said she believes there needs to be much more assistance for physicians in receiving the vaccine. “I think there is assistance and support for those who are associated with hospitals,” Watson said. “But for those outside the hospital, you feel kind of like you’re somewhat left on your own to try to get vaccinated. That assistance could come through medical societies, it could come through the state Health Department….you know, we are all licensed within the state. It seems like there should be some type of mechanism where every physician who is licensed is sent information on possible ways and options [on how to receive] the vaccine if they so wish.”

Healthcare students struggle to receive vaccine

S., a Physician Assistant (PA) student from the Chicago area, who requested anonymity for fear of hospital retribution, said she was only able to receive a vaccine because a hospital she had previously worked at mistakenly still had her listed as an employee.

“I’m a former employee of where my current clinical rotation is,” S. told ClearHealthCosts in a phone interview. “So I ended up getting a notification in my inbox of where I get my care, which is essentially the same system where I used to work, and I had a ticket to make an appointment for a vaccine. I don’t really understand exactly how it happened, but through some system I was able to make an appointment, even though I had been told by my preceptor that I wouldn’t be able to get the vaccine as a student. So somehow, I was still kind of categorized as an employee, and I ended up being able to get my first dose.”

S. is currently working in the emergency department of that hospital for her clinical rotation. Employees in that department were guaranteed the vaccine as they are on the front lines in dealing with Covid patients, but for students, who are not technically employees, the guarantees were a bit murkier.

As students, S. and her classmates were not necessarily guaranteed vaccines through their school, or through the places in which they were working on rotation. S.’s school told their students to register as healthcare workers in all of the places where they might be able to get the vaccine — through county health departments, schools, and hospitals they had worked or rotated at — to try to secure a dose.

“We go in as healthcare providers, but because we’re not employed, it’s just kind of like, this weird situation,” S. said. “I think if you’re an employee of a larger hospital system, they likely have plans in place to give you the vaccine, because they have the manpower for that. But I think it’s people who don’t work for a larger hospital system, or students of a university like me, who are having trouble signing up. You know, like, if you work for a small private clinic, obviously you don’t have these negative Celsius freezers to store a vaccine. So you’re going to have to send your employees out to get the vaccine. You know what I mean? It’s not really centralized. It doesn’t feel very organized at all.”

S. said that pretty much her entire class has struggled to secure vaccine doses for themselves, despite all of them working directly with patients. “I’m frustrated, because I mean, we all want to get the vaccine, you know, we recognize the benefits,” S. said. “We may not be, like, categorized as frontline workers, but we are frontline workers. I’m in the emergency department seeing patients with Covid symptoms. It could turn out that that patient has Covid later on, you know, and so I want to be protected, we should all be protected.”

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