Miller Report for the Week of January 18th 2021
Many people in our community are expressing frustration that we have not yet been able to give them the vaccine. The simple answer is that, we can’t vaccinate unless we have the vaccine to give them. To examine the problem, let’s consider a few facts. There are two vaccines approved for use in the US under the emergency use authorization (EUA) by the FDA. The Pfizer vaccine was approved on December 11th, just 5 weeks ago. The Moderna vaccine got its EUA approval one week later on December 18th.
The US has purchased approximately 14% of the worlds supply of vaccine totaling 31.2 million doses, and essentially all of these have been distributed to the 50 states to administer. As of this writing, 12.3 million of those doses, or roughly a third, have been administered according to the University of Oxford School of Public Health website. This comprises about 4% of the US population having received at least the first of the two recommended doses thus far.
The Washington Post reported last week that all of the US doses obtained thus far by the federal government have been released and there are none in reserve. This means that further vaccination plans will have to depend on producing new vaccine doses. According to the same article, President-elect Biden is calling for an additional 100 million Americans to be fully vaccinated in the first 100 days of his presidency. Pfizer and Moderna have agreed to produce and sell to the US the 200 million needed doses to fulfill this call.
California received the largest allocation of any state, 3.55 million doses, and these were all delivered to the state early on. According to the New York times “Vaccine Rollout” website, which is updated daily, California has administered 30% of its allocation as of January 19th. Other states that got large numbers of doses include Texas with 2.1 million (55% administered), Florida 2.0 million (41% administered) and New York 1.9 million (40% administered).
There are several challenges that have conspired to delay roll out in California. Aside from the logistical challenge of keeping the vaccines at the correct storage temperature, which is turning out not to be the big hurdle we expected, the State has developed a complex algorithm for determining who should be vaccinated and in what order. This algorithm has at least 3 phases, divided into sub-phases and sub-phases being divided into separate tiers. This strategy is designed to make sure that the vaccine is given out fairly and ethically and considers factors such as risk of exposure, risk of mortally and the essential nature of particular jobs in society. We are in the second stage of that algorithm, which includes persons age 75 and older.
Another complexity is the State’s mandates to track every single dose to ensure that the vaccine is being given according to the algorithm. Then, there’s the decision to distribute the vaccine through multiple different venues. Nursing homes, for example get them through commercial pharmacies like CVS, while the general public is to get it through public health departments. Again, well intentioned in that the strategy was hoped to avoid bottle necks, instead it has created confusion adding to slow downs.
In response to political pressure, Governor Gavin Newsom announced last week that the age limit for this stage was being lowered to 65 to accelerate administration. The problem with that decision is that we don’t have enough to vaccinate those over 75 as it is. Lowering the age is only diverting doses from those at the very highest risk of mortality and further stoking frustrations. According to the 2010 US census, there are about 4,400 people on the Mendocino Coast over age 65.
Mendocino County has done well in handling the vaccines it receives. All vaccine doses that are received in the County, either through the health department, Adventist Health or elsewhere, are being administered to people right away, usually within two days of arrival. So, there are no delays once we get the vaccine, the problem is that distribution from the State has been very limited and sporadic. Part of the challenge has been that we don’t know exactly how many doses we will get with any particular shipment until it arrives, making scheduling of appointments to give the vaccine difficult.
A little over 8,000 people in Mendocino County have received at least the first dose. This represents about 10% of those who are 16 years of age an older (no COVID vaccine has been approved to be given to children at this time). Ten percent compares favorably to the 4% nationally and 4% across the state of California in general. About 5,870 of these were distributed through the health department with additional doses coming from Adventist Health, Indian Health Service and CVS pharmacy (for use in nursing homes). All of our front-line health care workers who desired vaccination have been vaccinated, most of these receiving both the first dose and the booster. Additionally, most of first responders and almost all nursing home residents have also been vaccinated.
Last week, we received only 120 doses at AH Medical Offices (formerly North Coast Family Health) directed for patients over 75. We are not expecting to get any additional doses this week. Mendocino Coast Clinic (MCC) in Ft. Bragg gave 300 shots last week that were earmarked for school employees and expects to get another 300 this week for people above 75. Redwood Coast Medical Service (RCMS) in Gualala vaccinated 700 people in the last week following the tier system and expects to vaccinate another 100 this week. Appointments have already been fully scheduled for this week at both MCC and RCMS, so please don’t call looking for a vaccine. The best way to get on the list is to register with www.VaccinateMendo.com or call 707-472-2663.
Beckkie Emery, manager of the county’s Department Operations Center, noted, “We appreciate all of our community partners (including) hospital, clinics, cities and county. Absolutely a group effort.” We will continue to do our best as local health care providers and county health department officials to make the vaccine available as quickly and as fairly as possible. This pandemic continues to be a call for us to work together as a community.
— William Miller, MD – Chief of Staff at Adventist Health – Mendocino Coast Hospital