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COVID Vaccine Availability and Rollout

California governor Gavin Newsom has asked the State to allocate $300 million to go for COVID vaccine distribution and education.  The first vaccine was FDA approved about a month ago and California has now received around 1.5 million doses of the Pfizer and Moderna vaccines combined.  Almost all of these are directed to go to front-line health care workers, first responders, nursing home residents, and other healthcare and infrastructure personnel. Criticism is mounting that only about 35% of those doses have been administered so far in the State. If we consider the huge logistical challenges to distributing something like this with its special storage requirements, need for careful tracking of doses and that it takes some training of personnel to give the injection, then maybe 35% in less than 3 weeks isn’t too bad for a state as large as California.  However, at the same time, California is in the bottom 10 of US states to efficiently get their vaccine allocations administered. 

We have been more fortunate here in Mendocino County.  The planning done by our County Health Department and the smooth coordination with Adventist Health led to most front-line health care workers getting vaccinated within the first two weeks.  We are now gearing up to provide the booster shots to those who received initial doses.  The Pfizer booster is to be given after 21 days (+/- 4 days) and the Moderna booster at 30 days (+/- 4 days).   The initial dose is thought to provide about 50% of recipients with immunity to the virus that causes COVID, with the booster bringing this up to an impressive 95%.  For comparison, in some years the flu shot only gives 30% immunity and in really good years that might get as high as 65%.

One of the logistical challenges of distribution that we found here on the Coast was that the State decided to send vaccines ear-marked for nursing homes through CVS pharmacy instead of through the county health departments.  The reason for this decision is not clear to me, however, it led to Sherwood Oaks not receiving any vaccine with no indication as to when it would be getting it.  Their medical director, Dr. John Cottle, reached out to me and with the help of Dr. Andy Coren, Mendocino County Health Officer, and Dr. Bessant Parker, our Adventist Health (AH) Chief Medical Officer, we were able to legitimately appropriate doses from the County’s allocation to be given to Sherwood Oaks staff.  As of this writing, the hospital assisted in giving 58 Sherwood Oaks staff their shot.  The residents should be receiving their vaccinations soon, which is expected to occur through CVS pharmacy.  I am proud to see that the collaboration between our two facilities, with the support of the Health Department, continues to be strong after what we forged back with the COVID outbreak at our nursing home.

In other vaccine related news, at the beginning of this week the storage freezer being used to hold 830 doses of the Moderna vaccine at our sister facility, Adventist Health Ukiah Valley, failed.  This started at about 9 PM on Sunday, January 3rd, and by about 2:00 AM Monday morning warmed enough that the vaccines started to thaw.  According to the manufacturer, the vaccines must be administered within 12 hours of thawing and cannot be refrozen.  Along with the mechanical failure of the refrigerator, the alarm that was supposed to alert staff that the temperature was out of range, also failed to go off.  Fortunately, the back-up procedure was to manually check the temperature twice a day and thus at about 11:00 AM the temperature problem was discovered.  Immediately, the AHUV leadership notified the Mendocino County Health Department.  Together, a rapid and coordinated response was made recognizing that the doses would be lost if not administered within the next few hours.  

“The County Health Department really lead the process of helping us salvage the situation.  It was another great example of how we are able to work well together here in Mendocino County,” said Cici Winiger, communication spokesperson for AH in Ukiah.

Several Ukiah nursing homes received doses, the sheriff’s office helped get staff at the local jail vaccinated, healthcare workers at various other clinics and locations were vaccinated and finally about 300 people in the local community were also vaccinated.  It should be stressed that these were all vaccines designated for the first shot and thus, all of those people are guaranteed to receive the booster since the booster doses will still be available in four weeks.

While this event was unfortunate, it was an example of how quick thinking on the part of public health leaders, the sheriff’s office and AH leadership came together to at least ensure that none of the doses were lost and that all were given in the short time span allotted.  AH leadership is also doing an internal investigation into how this failure of both the refrigerator and its alarm monitor occurred. 

By William Miller, MD – Chief of Staff at Adventist Health – Mendocino Coast Hospital

Miller Report for the Week of January 4th 2021

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