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Providers still waiting for more doses…
Residents of Frio and La Salle counties who believe they are next in line to receive the first of two vaccines for the coronavirus face an undetermined waiting period before the state of Texas distributes more batches of the COVID-19 shots to rural areas.
In a brief statement on the vaccination process through Frio Regional Hospital this week, CEO John Hughson said there has been no word from the state when the next delivery of the shots will arrive.
The hospital has registered hundreds of local residents for the next phase of the vaccination plan, after prioritizing frontline healthcare workers and emergency responders, but has now suspended the registration because of uncertainty over the next delivery.
State authorities indicated last week that they will next deliver COVID-19 shots to “mass vaccination areas,” targeting large urban population hubs in order to reach more of the general public, a move that Hughson describes as potentially creating a disparity between population groups that have received their shots.
“It’s unfortunate that we simply don’t know when we will receive the next allocation,” Hughson said on Tuesday this week. “We were notified in December that we would receive two hundred doses, and that’s all we knew. Then, we were told the delivery would be made at 4 p.m. that day, and it arrived six hours early.
“We know that we should receive another two hundred doses, but that’s all we know,” the hospital CEO said. “We don’t have better information.”
Hughson acknowledged Tuesday that there is great demand in Frio and La Salle counties for vaccines to be made available to the general population but added that there are still recipients in Phase 1a and 1b waiting for their shots – those listed as being in most urgent need of vaccination, namely healthcare and service personnel who work daily in close contact with coronavirus patients.
“For the general population, it’s even harder to nail down a time when we can reach them,” Hughson said this week. “We get calls from the community all the time, but we don’t know when we will get the shots.”
Frio Regional Hospital is reporting that its vaccine registry includes as many as 1,200 area residents waiting for their first shot, predominantly the elderly and those with underlying health issues that make them vulnerable to serious illness or death from the coronavirus.
“We have suspended collecting further names,” Hughson said. “The state now says it will prioritize distribution to mass vaccination areas, and it makes logistical sense for them to target urban areas, but the result is a disparity with the rural markets.
“It doesn’t seem as though there is very good alignment in the organization of the distribution,” he added. “But we are just one small voice down here.”
The Texas Department of Health & Human Services has instructed hospitals and clinics that have been issued batches of the COVID-19 vaccine to distribute them as swiftly as possible and not allow spares to remain on the shelf.
Deliveries of the Moderna-brand of the vaccine were dispatched in late December to hospitals and clinics in South Texas, with as many as 500 coming to facilities in Frio County. Deliveries were made to Frio Regional Hospital in Pearsall, the FRH Urgent & Primary Care Clinic in Dilley, and the family medicine practice of Dr. Oscar Garza.
Hospitals at Hondo, Carrizo Springs and Kenedy did not receive any vaccines among the first shipments in December. Rural healthcare facilities that were issued hundreds of doses in late December received instruction to make them available to priority recipients in neighboring communities as well as their own.
Within 12 hours of the vaccine arrival, scores of shots had been administered in Pearsall and Dilley to frontline healthcare workers, paramedics, emergency responders, firefighters and law enforcement officers. Those included service personnel in both Frio and La Salle counties, as no vaccines were delivered to any sites in Cotulla.
At Frio Regional Hospital, Hughson said after the delivery that staff were pressed to find three hundred vaccine recipients and that when the line of healthcare and emergency personnel had diminished, vaccines were given to civilians who could be reached by phone. Those included senior citizens, persons with underlying health issues, and some members of the hospital board.
Hughson expressed disappointment after the initial distribution that some of the frontline staff who had been listed as priority vaccine recipients had given up their place in line or had failed to meet their appointed time to receive a shot. Vaccine distribution continued unabated, however, in accordance with instruction from the Texas Department of State Health Services that all available doses be administered.
Residents of nursing homes as well as senior citizens are next in line to receive their coronavirus vaccines, and doses are being shipped this month to facilities across Texas, including the Pearsall Nursing & Rehabilitation Center adjacent to Frio Regional Hospital. Staff at those facilities are likewise on the priority list to receive doses of the vaccine.
The Moderna vaccine that is being administered in South Texas does not require subzero refrigeration and may be kept in standard refrigerators, as opposed to the Pfizer-brand vaccine. Most rural hospitals and health clinics are not equipped with adequate refrigeration units to maintain the Pfizer vaccine.
The Moderna vaccine is shipped in smaller batches, coming in boxes of 100 each, while the Pfizer vaccine is shipped in groups of 975, according to the state health agency.
This week, Texas will direct most of the COVID-19 vaccine received from the federal government to providers who can vaccinate a total of more than 100,000 people, TDHHS reported, and additional vaccines will be distributed to smaller providers in other parts of the state.
“As the vaccination effort continues to expand to people who are at a greater risk of hospitalization and death, in addition to frontline healthcare workers, these vaccination hubs will provide people in those priority populations with identifiable sites where vaccination is occurring and a simpler way to sign-up for an appointment with each provider,” the health and human services agency noted in a prepared statement last Thursday. “Providers that receive the larger amounts of vaccine will vaccinate healthcare workers, people who are 65 and older, and those who have a medical condition that increases their risk of severe disease or death.”
The providing facilities also agree to provide a registration phone number and website and focus on areas and populations hardest hit by COVID-19 “while vaccinating people from surrounding areas,” according to the state.
Hughson said he is concerned that the most vulnerable patients – the elderly, economically disadvantaged and physically challenged – will face transportation problems and other obstacles in reaching urban areas to receive their vaccines at the earliest opportunity.
“A case in point is a seventy-year-old woman who called us and wanted to register her name for a vaccine,” Hughson said. “Now, if she thinks she is in line to get her shot here and there is an opportunity to go to a large urban area, to a mass vaccination site, she may have to wait a long time if the state re-routes the distribution.
“Our message to the people who need the shots and who can go and get them elsewhere is to take that opportunity whenever possible and not to risk delay,” Hughson said on behalf of the hospital. “We don’t want people to miss that opportunity. Don’t wait on us.”
The Texas Department of State Health Services is reporting that it surveyed vaccine providers about their capacity to operate large, community vaccination sites the week of Jan. 11 and will publish a list of vaccine hub providers once vaccine allocation is finalized.
The health and human services agency also reported that large and small sites around Texas will receive a total of about 200,000 doses of vaccine this week.
Priority rankings for those who should receive the vaccine first effectively end this week, as the current shipment of doses is the last to be specially reserved for urgent-need recipients, according to the TDHHS.
“That will be the last week the state is required to reserve doses to vaccinate residents and staff of long-term care facilities under the federal pharmacy-LTC partnership, freeing up more vaccine for use in other settings in the future,” the agency reported.
All those administering vaccines to the priority recipients and to the general population, however, are constrained by the amount of doses they receive in each shipment.
At Frio Hospital, Hughson said no vaccines are being withheld as second doses.
“These vaccines are given in two doses, about three weeks apart,” the hospital CEO said. “The initial belief among some was that we would have to keep half of the vaccines back, to give as second doses, but that is absolutely not the case.
“If we received boxes of vaccines to give as the first dose, we were instructed to give them all,” Hughson said. “The understanding was that we would receive a corresponding number of vaccines for the second round when the time comes. None of these first doses were to stay on the shelf.”
Healthcare workers and vaccine providers have reiterated that anyone receiving the vaccine must be given the same vaccine in the second round, as it is not possible to mix brands of vaccine. In effect, those who receive a Moderna vaccine in the first round must return to their provider for the second and matching dose.
The health and human services agency has echoed the Texas Department of State Health Services in its updates on the distribution efforts, priorities, and the availability of first and second doses.
“Vaccine remains limited based on the capacity of the manufacturers to produce it, so it will take time for Texas to receive enough vaccine for the people in the priority populations who want to be vaccinated,” the THHS reported. “The supply is expected to increase in the coming months, and additional vaccines are in clinical trials and may be authorized by the Food and Drug Administration.
“Providers should use all doses allocated to administer the first dose of vaccine to people,” the agency reported. “There is no need to reserve shots for a second dose because they will get a matching number of doses for that at the appropriate time.”