'This is game time': Hospitals across the country are gearing up to give the first COVID-19 shots to millions of healthcare workers
healthcaresystems — Intermountain Healthcare in Utah, Northwell Health in New York, McLaren Health Care in Michigan, and Yale New Haven Health in Connecticut — shared their plans for vaccinating staff.
- Pfizer and Moderna have filed for emergency authorized use of their promising COVID-19
vaccineswith the US Food and Drug Administration.
- The US Centers for Disease Control and Prevention recommended healthcare workers get vaccinated first.
- After the FDA greenlights the vaccines, states will allocate initial shipments to health systems. Many do not know how many doses they will receive yet.
- All four systems plan to give the limited doses to workers closest to
COVID-19patients. Their efforts will inform how they later vaccinate the general public.
It's nearly go-time.
With COVID-19 vaccines on the verge of getting the greenlight from US regulators, health systems and hospitals across the country are gearing up to give the shots to their own workers, who will be some of the first people to receive them.
Federal officials say vaccines could start shipping to hospitals and other healthcare providers in as little as two weeks, if they're authorized.
While many hospitals don't yet know the number of doses they will get, they've been laying the groundwork to be able to quickly and efficiently vaccinate their caregivers and other staff against the disease, which has so far killed more than 276,000 Americans.
The initial supply of vaccines will likely be limited, and hospitals are grappling with which workers to put at the front of the line.
Officials expect to vaccinate about 20 million people by the end of December. That effort will begin with an initial distribution of 6.4 million doses of Pfizer's vaccine across the country, followed by weekly shipments as more vaccines become available. There are roughly 21 million healthcare workers in the US.
Some hospitals are devising plans to stagger when they give certain departments the shots, so they aren't left with a shortage of doctors or nurses should workers be sidelined by vaccine side effects, which could include fatigue and headaches. Others are letting workers decide for themselves whether they want the first vaccines or prefer to wait for later shipments.
Major health systems Intermountain Healthcare in Utah, Northwell Health in New York, and Yale New Haven Health in Connecticut are prioritizing staff who work with COVID-19 patients and those most at risk of potential exposure, whether it be intensive care unit nurses or housekeeping workers. They plan to vaccinate their own workers.
McLaren Health Care, a $5.1 billion system based in Michigan, based on revenue, plans to spread the initial doses equally to ultra-cold freezers in the northern, central, southeastern, and Detroit-area part of the state. It's working with Walgreens to give staff the shots.
Hospitals say giving the shots to their healthcare workers will inform future efforts to vaccinate their communities when more vaccines are available.
"This is game time. This is not a test," said Dr. Tom Balcezak, chief clinical officer at Yale New Haven Health. "We will refine our effort and it may look different as we learn more."
Healthcare workers will be among those who get the first vaccines by mid-December
Two vaccine candidates from pharmaceutical company Pfizer and biotech firm Moderna are close to getting the green light from the US Food and Drug Administration.
An FDA advisory committee will meet December 10 to review Pfizer's request for emergency-use authorization of its vaccine and December 17 to discuss Moderna's request. Both vaccines require two doses. Federal health officials have said they want to begin distributing vaccines within 24 hours of authorization.
Read more: Pharmacies, doctor's offices and hospitals are gearing up to give coronavirus vaccines to millions of Americans. Here's how they're preparing and how much they stand to profit along the way.
A US Centers for Disease Control and Prevention committee called for healthcare workers and residents of long-term care facilities to get the shots first. While states aren't held to those recommendations, most are expected to follow them.
States have already submitted their plans for distributing COVID-19 vaccines and have chosen the hospitals that will receive the first batches.
It's the hospitals, however, who are charged with figuring out the details of how to give the shots within their own workforces. It's a task health systems are willing to take on.
"Neither the federal government nor even the state department of health really understand the exact operational issues in every single hospital, and every hospital is different," said Dr. Mark Jarrett, New York-based Northwell Health's chief quality officer.
"Leaving that to the hospitals with some guidance from the state health department about things to think about when making those decisions makes more sense than somebody trying to figure out how to micromanage."
Health systems across the US are busy figuring out which workers they should prioritize for a vaccine
With only a few million doses available in December, health systems won't likely be able to vaccinate their entire workforces, which can employ tens of thousands of people. In the first few weeks, hospitals will have to prioritize who gets the first of the first shots.
Northwell, for instance, drew up a list of frontline employees that should be first in line to get shots based on whether or not they interact with COVID patients and how many of those employees they have. The system, which collected $12.5 billion in revenue in 2019, is also considering workers' ages, since people older than 65 are at higher risk of getting sick.
Staff taking care of patients in the emergency department or critical care areas are some who could get priority. If many of those workers get COVID-19, Northwell could be left with staff shortages, Jarrett said.
"It's both an issue that they have the most potential exposure, but also an issue that there aren't a lot of them," he said.
Healthcare workers, particularly Black, Asian, and other minorities, are three times more likely than the public to test positive for COVID-19, according to researchers at Massachusetts General Hospital and King's College London.
The potential for staff shortages is also the reason the health system is planning to stagger when it will give the shots to employees within the same department.
If employees get side effects, such as low-grade fevers or aches, Northwell could be left without enough workers. So the health system will give a third of the staff of a single ICU a shot on one day; a couple of days later, another third will get the shot, for example.
Intermountain, a 23-hospital system based in Salt Lake City, worked with the University of Utah Health and the state health department to pinpoint the types of healthcare workers who have the most contact with COVID-19 patients and are at risk for exposure. The system is also taking into account employees' risk of becoming infected outside of work.
That could include anybody from nurses who work in the ICUs to environmental services staff who clean the hospital and handle COVID waste, Dr. Kristin Dascomb, medical director for infection prevention and employee health, said in an interview.
Environmental services workers are disproportionately impacted by the disease, both from the community and the hospital, putting them higher on the list to get vaccines, Dascomb said.
"We are discussing it both from an epidemiological point of view from the community, as well as an exposure risk assessment from internal to the hospital," she said.
Grand Blanc, Michigan-based McLaren has a different approach.
Bart Buxton, president and CEO of McLaren Health Management Group, said the health system used a survey to initially determine which employees and affiliate doctors have interest in the first vaccine shipment.
The system had planned to get an initial allotment of 30,000 doses for 3,000 employees who indicated they would like the access to the delivery. But Buxton said Michigan told the system on Friday to "expect approximately one-sixth" of what they had planned for.
McLaren had hoped to give all employees, including clinical staff, cleaners, and administrative workers, equal access to the vaccine.
"Our survey was very focused on the entire McLaren network because regardless of where you work in the delivery model of healthcare, you're essential," Buxton said.
Due to the decreased allotment, however, Buxton said the health system would prioritize workers closest to COVID-19 patients.
Health systems are preparing to vaccinate staff with the help of pharmacies or on their own
When it comes to administering doses, health systems are busy figuring out the best approach.
McLaren bought five ultra-cold storage freezers that keep Pfizer vaccines in the weeks leading up to the vaccine distribution, Buxton said. Once the state gives the health system the initial vaccine allotment, McLaren will store equal amounts in each location, giving both rural and urban based locations the same amount.
Buxton said the health system plans to partner with pharmacy chain Walgreens for help administering vaccines. In the company-wide survey, McLaren employees said most live within five to 10 miles of a Walgreens store, and 11% of those who wanted initial vaccine doses prefer getting them at Walgreens.
"We made a fairly strategic decision to partner with Walgreens for community distribution, and also to help us cover those employees that may not be directly in the hospital," Buxton said.
McLaren will ship vaccines from the freezers to Walgreens in time to use before they thaw. Employees will use "electronic tokens" to identify themselves at Walgreens stores to get access to the vaccine.
Intermountain plans to vaccinate its own workers. Four Intermountain hospitals will be among five hospitals in Utah tapped by the state to receive some of the first vaccines, as they were best equipped to give the shots quickly and provide the ultra-cold storage necessary to store Pfizer's vaccine, which must be kept at a temperature of negative 94 degrees Fahrenheit.
Dascomb said Intermountain is expecting the four hospitals will each receive 1,000 doses to start, though they could end up getting more. A Utah Department of Health spokeswoman said the state expects to get 23,000 doses initially, with 9,750 going to the four Intermountain hospitals and a fifth University of Utah hospital.
Designated caregivers from other parts of the Intermountain system will be invited to come to those four facilities to receive the vaccines, Dascomb said.
The Moderna vaccine doesn't have to be stored at such cold temperatures, so once that vaccine is available, Intermountain can keep it at smaller facilities, like critical access hospitals, she said.
Rather than saving half of the first shipment to give workers their second dose of the Pfizer vaccine 21 days later, Dascomb said Intermountain will dole out shots to as many people as possible because it anticipates getting regular shipments.
Hospitals are also considering how to schedule healthcare workers to get COVID-19 shots so they don't wait in line and risk spreading the disease. People who get shots will also need to be monitored for adverse reactions for about 20 minutes, hospital leaders said.
Connecticut-based Yale New Haven, which is hoping for 26,000 vaccines, will use the temporary staff it hired to run flu clinics to give coronavirus shots, Balcezak said.
Workers will schedule appointments for both vaccine doses through the same app that they used to schedule a flu shot. Yale New Haven will give first priority to staff working in units caring for COVID-19 patients and those working in the emergency department.
The system will also stagger employees who work together by the alphabetical order of their last names, "so we don't inadvertently cause a problem from a staffing perspective," Balcezak said.
While it secured enough ultra-cold freezer space to store 170,000 doses, Balcezak said the plan is to get vaccines into arms as quickly as possible.
"I don't want to store any vaccine. If we're hanging onto 160,000 doses, I'm going to consider that a failure. I want to get it out there as fast as we can," he said.
Balcezak said Yale New Haven was part of Pfizer's phase three clinical trial, so it already has experience storing, handling and administering the vaccine.
Vaccine distribution plans are ever-evolving, for both staff, and the public
At least initially, hospitals aren't planning to require medical staff and other employees to get COVID-19 shots, as they don't have enough information on the safety or efficacy of the vaccines. Their stances could change as more data is released.
Health systems are still grappling with a number of other unknowns, such as how they'll find enough staffing to vaccinate large numbers of people and later convince wary members of the public to come in for a shot.
Several hospitals, including Henry Ford System in Michigan and RWJBarnabas Health in New Jersey, told Business Inside they weren't ready to share their vaccination plans.
"There's going to be logistical challenges around scheduling the second dose, about making sure there's continuity between the types of vaccine that are given between the first and the second dose, and making sure that we're doing accurate reporting to the state and ultimately to the feds," Balcezak said.
He said these are "solvable" challenges, however.
Hospitals' plans are evolving by the day. Some said their plans are likely to evolve over time as they learn how best to vaccinate their workers.
Later, what they've learned should translate to vaccination plans for the general public.
"We're going to learn from the caregivers - how they react to it and how best we can give them the second dose," Intermountain's Dascomb said. "We're going to learn what works and what doesn't work in terms of the administration piece of it. One of the things we're going to have to learn is where we're going to find enough people - and train people - to be able to administer vaccines in a very large way, in a very short amount of time."
"This is going to be a challenge for the whole state."
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