Waiting is Hard

 WAITING IS HARD

To all you video game addicts, you cocktail party haters, you isolationists, you antisocial

homebodies and hermits: 2020 was your year! Need an excuse to say home and avoid the

crowds? Covid was the perfect cover. Need a reason to avoid travel? Blame Covid! However,

now that the vaccine is here we all need to prepare to socialize again..at some point. The

vaccine roll out is upon us, and proceeding steadily.

As a pediatrician I am very familiar with the ups and downs of giving vaccinations and the

national plan for the COVID vaccine roll out raised some concerns for me. The plan, as I

understand it, is that federally purchased vaccines get allocated to each state on a weekly

basis, and from there get distributed to various hospitals (listed first), clinics and pharmacies in

each county.

While hospitals are wonderful organizations, their focus is to run emergency rooms and care for

in-patients. Historically they have not vaccinated large numbers of the general public, so they

have no existing infrastructure for this type of project. Tasking them with a massive vaccine roll

out when they are already overwhelmed with unprecedented numbers of ill patients doesn’t

seem like a very good idea.

Clinics and pharmacies are the other locations people go for vaccines, but again, these

businesses are already occupied with their primary functions and the number of vaccines that

need to be given out is massive. It’s not easy to take on the task of giving hundreds of extra

vaccines each day when you are already busy and understaffed. This morning (Jan 15) the

New York Times had an uplifting story about a team of Walgreens employees who went to a

nursing home and vaccinated the residents. The pharmacy team volunteered their time, which

is admirable, but relying on volunteers to implement this massive vaccine effort is not a good

strategy. Skilled medical providers and pharmacists are already busy. How many days in a

row are such pharmacy crews expected to volunteer? Who watches the store while they are

gone? How must it feel to volunteer to help with the vaccine effort when the volunteers

themselves may be much further down the line to receive a vaccine? Shouldn’t vaccine

volunteers have the right to receive a vaccine in exchange for their help?

While much appreciated, I am also concerned about the fact that the vaccine is “free”. The

gears of our health care system turn because people and organizations get paid for what they

do. With no administrative funding provided, the vaccine program relies on private entities to

hire staff and provide space for an endeavour that may or may not prove profitable for their

businesses. What if they lose money doing this? If unprofitable, I imagine their enthusiasm for

this project will evaporate pretty quickly. Besides, why should private insurance plans get off the

hook from helping to pay for the vaccine? Isn’t that their purpose? Additionally, if we all agree

that it is good that the federal government provides free COVID vaccines for all Americans, why

shouldn’t the government provide all essential medical care for everyone? How can you

rationalize one line item, and ignore the rest? But that is a topic for a different day.

Locally, according to the last public health news conference (January 14th), Humboldt County

had received 12,500 vaccine doses of which 7,300 (or 60%) had been administered. According

to Dr. Hoffman, most of the remaining vaccine was slated for appointments that had been

scheduled. (On January 18th, National Public Radio reported that in all of California only 25%

of received vaccines have been given, so Humboldt County is doing really well compared to the

rest of the state. A huge shout out to all the folks at public health and those involved in

coordinating this effort!) This means that Humboldt county residents have received, on average,

about 1,800 shots each week over the past month. The population of Humboldt County is about

135,000 and 19% are under 18, leaving approximately about 110,000 adults eligible for the

vaccine. To vaccinate 80% of the eligible adult population with the two dose series would

require 176,000 doses to be administered. Subtract the vaccines given and that leaves 163,500

doses yet to be given. At a rate of 1800 vaccines per week, it will take 90 weeks or well over a

year and a half to finish. In order to get 80% of remaining eligible adults 2 vaccinations in a 6

month time span, you would have to give about 7,000 vaccines each week, which is

approximately 4 times more than we are currently doing. Hopefully supply and manpower will

increase to accommodate that level of intensity, but it is not clear that that will happen. The

CDC website

(https://data.cdc.gov/Vaccinations/COVID-19-Vaccine-Distribution-Allocations-by-Juris/b7pe-5n

ws/data) that lists vaccine allocations to each state reports numbers that are steady but not

increasing. Patience will serve us well over the coming months.

As I was finishing this editorial, the Trump administration suddenly changed its recommendation

from the ACIP endorsed tiered approach to one allowing everyone over the age of 65 access to

the vaccine. Supposedly there was going to be a release of stockpiled vaccine from federal

reserves to support this recommendation, but when the state of Oregon tried to order some they

were told there is no stockpile. My 86 year old mother lives alone in a small Oregon town, and

she is upset because although the vaccine has been approved for her age category, she cannot

get it. She has called her doctor’s office and local pharmacies but no one has anything to offer.

She doesn’t use a cell phone and has a hard time navigating the internet, so if she cannot make

contact by phone she could be left out. For her, each day that goes by without a vaccine is one

more day of risk and isolation, and if I could have given her my vaccine I would have.

Continuing to wait is really hard.