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Monday, February 22, 2021

COVID vaccination program to expand to include more pharmacies

Addo-Ayensu
Virginia health officials hope the COVID-19 vaccination process will speed up when the federal retail pharmacy partnership expands.

So far, CVS is getting 52,000 doses a week statewide, said Dr. Danny Avula, Virginia’s vaccine coordinator, at a COVID vaccine town hall hosted by state Sen. Dave Marsden, whose district covers the Annandale area; Del. Karrie Delaney (Loudoun County); and Del. Dan Helmer (Prince William County).

According to Avula, the number of doses in that program will be doubled, hopefully starting late this week. CVS will get about half the doses, and other pharmacies, most likely Giant, Safeway, and Walgreens, are getting the rest. Final details haven’t been worked out yet, including how this program is being integrated with state and local health departments.

It’s nearly impossible to get an appointment from CVS as the website continually shows pharmacies, including the one in Annandale, are always fully booked. But Dr. Gloria Addo-Ayensu, director of the Fairfax County Health Department, said that program is helping reduce the county’s waitlist.

Federally Qualified Health Centers (FQHCs) – clinics and networks of clinics that serve the uninsured – will also be given doses starting at the end of next week, Avula said.

State vs. county registry  

There were several questions at the town hall about why Fairfax County chose not to participate in the Virginia Department of Health’s (VDH) new system for registering for vaccination appointments. Addo-Ayensu said Fairfax County might eventually join the state system, but is waiting to make sure the kinks are worked out and to see how it performs.

Related story: Fairfax County addresses confusion on vaccine registration

She discourages Fairfax County residents from registering with the state, but if people do, the state will refer them to the county system.

Some people who registered with the county received an email saying they are automatically on the state list. They don’t have to do anything, Avula said. The data is being merged; if they registered with Fairfax County, they are still on the county waitlist.

Demand outstrips supply

According to Avula, about 1.57 million doses have been administered in Virginia since the vaccine became available in late December. More than 95 percent of first doses are already in the database and in people’s arms.

Virginia’s vaccination program got off to a rocky start, ranking near the bottom of states on the percentage of doses administered but has since improved. As of Feb. 22, the state is in 16th place.

Avula
The big winter storms that hit much of the country last week messed up vaccine deliveries, however, so the 160,000 doses Virginia was expecting last week were delayed, Avula said. The VDH hopes to catch up this week.

Avula predicts it won’t be until the middle or end of April until everyone in group 1b who wants a vaccination can get one. That group includes people age 65 and older, people with medical conditions that put them at risk of serious illness if they get COVID, essential workers, and residents and staff of correctional facilities and homeless shelters.

By the end of May through June, everyone else could get vaccinated, assuming increased production of the Pfizer and Moderna vaccines and approval of the vaccine from Johnson & Johnson.

Two of the COVID variants, the B.1.1.7 variant from the United Kingdom and B.1.351 from South Africa have been found in Virginia, Avula said. Both variants are more contagious. The Pfizer and Moderna vaccines are effective against the UK variant, and Moderna is studying the possibility of developing a booster for the South Africa variant. 

The state’s dual priority is to get the vaccine out fast and get it to the most vulnerable, Avula said, and to “do it fast and do it equitably.” 

VDH is planning mass vaccination events, but “we don’t have enough vaccine to feed those channels,” he said.

Avula acknowledged the VDH hasn’t been able to get private healthcare providers involved quickly enough but hopes to bring them in when the supply increases. “They are a key part of his rollout,” as people have a trusted relationship with their doctors.

Thousands in the queue

The Fairfax County Health Department’s waiting list for vacations has shrunk but there are still  96,900 people in the queue, and the department is still schedule appointments for people who registered on Jan. 18, the first day people 65+ were allowed to sign up.

“The process so far has not been as smooth as we’d like. We’re still working through some kinks,” Addo-Ayensu said.

Half of the doses received by the Fairfax County Health District are allocated to the 65+ population; the rest goes to frontline essential workers and people with health conditions.

One person who submitted a question at the town hall said he and his wife registered at the same time and wanted to know why she was notified about an appointment and he wasn’t.

That could happen for a variety of reasons, Addo-Ayensu said. When Health Department staff worked on cleaning up the data, they found a lot of errors, such as people who put in the wrong email or accidentally typed an extra space.

Related story: Fairfax County issues new vaccine dashboard

Also, the registration for the 65+ population opened at 9 a.m. on Jan. 18, but a lot of people signed up between midnight and 9 a.m. At that point, there wasn’t an option for 65+ plus, so people chose 75+ and put in their correct date of birth. The system had a hard time reconciling that, she said.

Also, volume was so high on Jan. 18, that the system crashed and some data wasn’t fully captured. “As the data gets scrubbed, they are being placed back in the queue,” Addo-Ayensu said. But as a result, it’s possible that someone who registered later than you is getting notified earlier. [Also, it’s a good idea to check your spam folder.]

The Health Department’s new vaccine dashboard provides a general sense of where people are in the queue. But it doesn’t tell you when people who registered on a certain date and time might expect to get an appointment. People can confirm whether they registered here and sign up for an appointment here

When the vaccination program expands, the pharmacies that already provide flu vaccinations will be brought into the program, Addo-Ayensu said. The county is also working with clinics and healthcare providers to build capacity for when the supply increases and is planning vaccination clinics targeted to the Hispanic population.

Health conditions

One of the biggest challenges – and one reason for why demand far exceeds the supply – is because so many people are in the queue who are age 16-64 and have health conditions that put them at greater risk if they get COVID, Avula said.

According to the CDC, some of those conditions include heart disease, chronic kidney disease, obesity, chronic obstructive pulmonary disease, and others. The CDC also lists diseases that might put someone at risk if they get COVID, such as asthma, cystic fibrosis, and type 1 diabetes.

Virginia lumps all those conditions together in 1b, even though a person with leukemia is at a higher risk than someone with asthma, Avula noted. “We don’t want vaccinators on the ground requiring proof of a condition or a doctor’s note.” Doing that would slow down the process of getting as many people vaccinated as fast as possible.

Nevertheless, Avula said, a team of professionals is considering whether there is a way to prioritize those risks.

The Fairfax County Health Department isn’t prioritizing certain health conditions either, Addo-Ayensu said, but “maybe sometime down the line there could be a way to look at priorities.”

There are priorities listed online for different categories of essential workers. So far, K-12 school staff are on top of that list in Fairfax County.

Avoiding waste

When asked why many vaccine doses are wasted, Avula said the Pfizer vials were previously rated for five doses, but some vaccinators are able to get six doses per vial if they have the right type of syringe. 

The federal government began shipping the right syringes, but some of those shipments were delayed due to bad weather. In some cases, vaccinators were still getting five doses per vial and listing the sixth as waste. In other cases, they are vaccinating volunteers at the end of the day, so the doses aren’t wasted.

Fairfax County reduces waste by cutting off new vials at a certain time. As the closing time nears at vaccination clinics, vaccinators aren’t allowed to open a new vial. They share what’s left in the vials already opened.

At the town hall, there were complaints about why Virginia wasn’t better prepared for vaccines. When the pandemic started over a year ago, public health officials were working 16 hours a day, trying to get enough masks, ventilators, and hospital beds, Marsden said. Mistakes were made, but they were focused on saving lives, rather than planning for vaccines, which at the time seemed much further down the road.

The rates of diagnoses, hospitalizations, and deaths are declining. But COVID is still here. “Don’t get careless,” Marsden said. “Keep your guard up.”

4 comments:

  1. "The Health Department’s new vaccine dashboard provides a general sense of where people are in the queue. But it doesn’t tell you when people who registered on a certain date and time might expect to get an appointment."
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    This makes the dashboard pretty much useless. In addition, the numbers displayed on the dashboard don't add up. The dashboard indicates 247,343 registered but the sum of the registrations by day is 77,386. We are more than 30 days past the first sign-up date for those 65+ and the County can't tell us where we are in the queue?Limited vaccine supply is understandable. Not knowing where we are in the line isn't.

    And here's a pro tip. Having been a professional survey researcher many years ago and having designed countless data collection forms, you may not want to be telling people that you're not capable of designing an online form that either calculates age from birth date or if you're collecting both, requires the registrant to reconcile a discrepancy between the two. The failure to do either one of these doesn't inspire confidence in the County's staff.

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  2. The only important information on the dashboard is that they are now calling people who registered on Jan 18. There are 42,000 people who did that, and what would actually be helpful is to tell us how far down the list they have gotten. It would be a simple thing to do and to display. It would actually be helpful to those of us who feel very frustrated that other parts of Virginia are doing much better than Fairfax County in vaccinating citizens. Most of the other numbers actually do not make sense. The number of Total doses hasn't changed in days. The number of vaccinations this week is in the 15 thousands, but the total number vaccinated has risen by 1,000. The numbers are all updated on different schedules, so the dashboard is more frustrating than helpful.

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  3. Why don't CVS and Walgreens tell us when they open up appointments? At least then, we would all have a chance to sign up. Now, everyone randomly checks, and it appears that there are NEVER appointments available.

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  4. Hidden in this article is the reason Fa. County is not telling us where they actually are on the list on Jan 18. When they said that they were taking reservations on Jan 18, they neglected to tell us a time that we could start (a very basic requirement of any signup that shows the lack of proper planning put into this). So people started signing up incorrectly at midnight. I signed on at 8:45, and the site said they were only taking 75 and over. So I waited until the afternoon to sign up. As a result, all the people signing up after 9 were ahead of me, and Fa. County is going back and allowing all the midnight to 9 signers to go ahead also. Is there any wonder that we feel frustrated by Fairfax County's response to this crisis?

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