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'This is a Race'

As mass COVID-19 vaccination appointments go unfilled, officials look to meet residents where they are

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To those following it closely, last week's COVID-19 news hit like a barrage of punches to the gut.

Cases spiked to levels not seen since the post-holiday surge, with 34 reported April 19, followed by 10, 28, 38 and 20 in the ensuing days, making 130 for the week. That was up from 71 the week before, itself a more than doubling from the prior week, all as test-positivity rates doubled then redoubled. Sixty-eight cases were confirmed the following Monday, April 26, capping an eight-day period that saw 198 cases reported, along with eight hospitalizations and one COVID-related death, offering a stark reminder that any gains Humboldt County has made against the disease remain fragile, dependent on continued vigilance in following public health directives.

Against that backdrop of escalating case counts came the news that Humboldt County's vaccination efforts appeared to be hitting a wall, with Public Health sending out repeated calls for residents to sign up for a slew of open appointments at mass vaccination clinics in Arcata. Then came news that health officials had worked frantically to ship 1,000 doses of Pfizer vaccine to San Francisco before they expired, with local efforts to find arms to put them in having come up empty. Then, on April 23, the county announced it would be receiving an allocation of 4,140 COVID-19 vaccine doses this week — down from more than 7,400 the previous week and less than half the 11,000 doses the week before that. And perhaps more alarming was the announcement that Public Health had turned down an additional 1,000 doses of vaccine — declining a state allotment for the first time because officials feared local demand wouldn't meet the supply, even with tens of thousands of local residents having become newly eligible to receive the vaccine just a few weeks earlier.

All together, the picture looked alarming, with case counts doubling at an alarming rate and vaccination efforts — which health officials at all levels have deemed our best tool to beat this pandemic — seemingly having stalled, with 41 percent of the population having received at least one dose. But while there is indeed plenty of cause for alarm, some believe the slowing vaccination rates simply indicate that mass vaccination clinics have largely served their purpose and it is time for a strategy shift— and quickly — as the vaccination effort is effectively a race against the virus and its ability to mutate.

Stakes are High

In the closing minutes of an April 21 news conference with officials at the forefront of Humboldt County's COVID-19 response, the Journal asked each to offer their views on what they see at stake in the county's race to get shots into as many arms as possible as quickly as possible.

"I think people don't realize there is a real danger we can still go backward," said Board of Supervisors Chair Virginia Bass, who earlier in the meeting had said the board will discuss re-opening all county government offices next month and looks forward to the day it can return to in-person meetings. "We are not immune from going backward."

And going backward — whether that means the implementation of more COVID-19 restrictions or increased disease circulation prompting more schools, businesses and other organizations to close or modify operations — could have dire impacts on local children, families and local governments' tax bases, she said.

Economic Development Director Scott Adair agreed, saying many economists believe consumer confidence is the best measure of economic health, noting that consumer confidence plummeted at the onset of the pandemic.

"I think everyone has heard the phrase that the best remedy for the economy is a cure for the disease," he said, later noting the vaccines are that cure. "If consumers feel unsafe, then they're less likely to engage in economic activity, or at least less likely to engage in local physical economic activity and may over-participate in online economic activity, which isn't always local. ... The more vaccines we can get out into the community, the more safe consumers will feel, and the safer they feel, the more likely they are to spend money and to spend it locally."

Emergency Services Manager Ryan Derby, who earlier in the press conference talked about how the county's Emergency Operations Center hopes to wind down in June, putting pandemic response back entirely under the purview of Public Health in preparation for the coming fire season, said Humboldt County's transition to recovery hinges on the vaccination effort. "To be frank, everyone is sick of this — everyone is tired of dealing with the pandemic," he said. "And the best way to get through this, to get over the pandemic, is to get vaccinated."

Linsey Mendez, a member of the county's vaccine task force and a nurse family practitioner, said when she thinks about the stakes of this effort, she thinks of Humboldt County's children, many of whom have already lost an entire year of in-person learning, sports, dance recitals and playdates with friends.

"We do not want to go backward," she said. "We do have a mental health crisis. We have a housing crisis. We have many things that are competing with the pandemic right now that are not sustainable for many households and many community members. Everyone is feeling that heat. I know right now it's really hard to see the forest for the trees ... but (the reason we're trying to) get vaccine out and empty our freezers is because we want to end this pandemic. We want children back in school next year. We want children playing sports. We don't want them to have to lose all their friends. We want families to be able to do vacations together and to see each other around the holidays. And that's how we're going to do it — by emptying our freezers of vaccine every single week."

Vaccination Rates Slow

The week of April 19, Public Health planned five consecutive days of mass vaccination clinics at the Arcata Community Center, with messaging daily on social media platforms and in press releases urging all residents age 16 and older to show up and get vaccinated. In all, there were 3,769 appointments available, according to the Joint Information Center. When the week was over, 2,551 of them — roughly 68 percent — went unfilled.

Through the first months of vaccine rollout in Humboldt County, the focus was almost entirely on supply, as far more local residents were eligible to receive their shots and clamoring to get them than supply allowed. People showed up uninvited at clinics hoping to get leftover doses and accusations of line jumping flew. The first signs the paradigm was shifting from a climate of "scarcity" to one of "abundance," as Health Officer Ian Hoffman put it, came April 8, when the county issued a press release noting it had "hundreds" of appointments open for upcoming clinics. The following day, it announced it was jumping ahead of the state and opening eligibility to all county residents 16 and older, making tens of thousands of people eligible overnight, with many people's expectation being that would keep clinics bulging for weeks to come.

That didn't turn out to be the case and perhaps that should not have come as a surprise.

"Mass vaccine clinics depend on people going out of their way to go someplace and get a thing," explained Candy Stockton, chief medical officer at the Humboldt Independent Practice Association. "For the 50 percent of people who have been desperately waiting for their turn to get a vaccine, who have been calling around asking if they can get on waiting lists or stand in lines in case there are extra doses, that's great. They'll do that. But if you're talking about individuals who are homebound or maybe a bit more skeptical and want to talk to someone they trust and ask a bunch of questions before they get vaccinated, those clinics aren't going to work for those people. ... I think everybody recognizes that to get maximum vaccine penetration, mass vaccine clinics aren't going to do it in this area."

Disparities Abound

Perhaps underscoring Stockton's point, a Journal analysis of county vaccination data by ZIP code found some profound disparities in vaccine uptake.

Some of the areas of the county where residents are being vaccinated the fastest, according to the analysis, included Trinidad, Bayside and Blue Lake — where median home prices are nearly double the county average and residents have received an average of about a dose of vaccine per person. In these affluent areas, residents on average face fewer roadblocks to getting to a vaccination clinic — they can get time off work, have access to transportation and are less likely to face language barriers — and are more likely to have access to a primary care physician who can answer questions they have about the vaccines.

Some of the county’s outlying areas, however, are clearly falling behind. While Trinidad, Bayside and Blue Lake have seen an average of nearly one vaccine dose administered per resident, outlying areas like Redcrest, Carlotta and Alderpoint have seen less than 0.3 doses administered per resident, well below the countywide average of 0.41.

There also appear to be some data holes in the county’s dashboard, which uses data from the CAIRS reporting system. For example, the dashboard lists Hoopa as having administered just 0.13 doses per resident, which would be by far the lowest vaccination rate in the county. And that would be despite the tribe’s having opened vaccination to eligibility to all residents age 16 and older weeks ahead of the county.

But Allie Hostler, an operations section chief for the Hoopa Valley Tribe’s Office of Emergency Services COVID-19 Incident Management Team, said those numbers are simply inaccurate. An April 24 vaccination summary document from the tribe indicates it had administered 2,608 doses, which would be an average of about 0.75 doses per resident.

Still, Hostler said vaccination efforts have not been as successful as officials had hoped. The tribe held a mass clinic March 27 and invited anyone 16 and older in the region — from Willow Creek to Happy Camp and Lord Ellis to Burnt Ranch — to attend, hoping to create a "preventative bubble" around the reservation. She said officials planned to administer 1,000 doses but only 310 people showed up.
While Hostler said the tribe, having deemed the vaccine an appropriate response to the pandemic, has held question and answer educational forums and a "vaccines save lives" ad campaign, there's a cultural distrust that's difficult to overcome.

"There's been a long history of mistrust between tribes and government-led healthcare initiatives," Hostler said, adding that the tribe won't be holding more mass vaccination clinics but will instead look to interface with families through school settings, the K'ima:w Medical Center and other opportunities to educate residents about the safety and efficacy of the vaccine and answer their questions.

New Approaches

While the county's approach to vaccinating Humboldt's general population has largely centered on mass clinics, that's likely changing. At last week's press conference, Mendez said the county will be deploying its mobile medical unit to do smaller-scale vaccination clinics in outlying areas, while also partnering with fire departments, schools and other organizations in an effort to meet people where they and with familiar faces.

Stephanie Dittmer, immediate past-president of the Humboldt-Del Norte Medical Society who practices family medicine while working in local hospitals and a local nursing home, said this is absolutely the right approach to overcome some of the vaccine hesitancy she's seen locally. She said she'd like to see vaccinations offered where people feel comfortable — whether that's the farmers market or El Buen Gusto Market in Fortuna.

"We're going to have to use our individual relationships now, which means we're really going to have to partner with our physicians and our community organizations," she said. "People in that vaccine hesitancy group are more likely to get the vaccine if the person who presented them information about it is trusted and respected and someone seen as aligning with their interests."

Stockton said the Humboldt IPA is currently working with the state medical association in an effort to remove some barriers that would allow smaller provider offices to administer the vaccine, making it easier for local physicians to get their patients vaccinated. Noting that Humboldt's problems "aren't local problems," Stockton said the regulations that qualify a provider to administer COVID vaccines are overly burdensome for offices in rural areas. For example, she said one was that providers maintain a 24-hour business line staffed by a live person who can be contacted with questions, noting that not even the county's largest providers have that. (Some providers were grandfathered into the system after being approved by county Public Health, she said, which is why Open Door, Mad River Community Hospital and St. Joseph are approved to administer vaccines.)

She said the IPA ran the numbers on what it would take to meet state requirements and found it would demand a minimum of 200 hours in additional staff time, which is just not feasible for most offices.

But Stockton said the bottom line, she believes, is that most of the 40 percent of people that national polls show as being "vaccine hesitant" aren't necessarily opposed to the vaccine, they just have lots of questions and want to get answers from someone they know and trust and who knows their medical history.

Personally, Stockton said she asks all her patients about the vaccine and, if they're hesitant or even opposed, if she can share information with them.

"I say, 'I'm not here to make you do something you don't want to do, but I want to make sure you're making decisions based on good information and I'm worried for you,'" Stockton said, adding that she talks patients through concerns about everything from the complications of signing up online and potential side effects to whether the vaccines use stem cells. (Pfizer and Moderna do not.)

And perhaps most importantly, Stockton said she shares her personal views.

"I talk freely with my patients about how my entire family is vaccinated," Stockton said. "I say, 'Not only is this something we're recommending, but it's something I believe in so strongly that I couldn't wait for my son to get a chance to get vaccinated.' Those kinds of conversations with people make the difference for people who are hesitant."

Dittmer agreed, saying it's the power of these conversations between people that keep her from feeling "doom and gloom" about reports that vaccination clinic appointments are going unfilled. The bottom line, she said, is that the trials and the data show these vaccines are "insanely effective and really safe," noting that a person is 5,000 times more likely to die of COVID-19 than a vaccine complication and the vaccines have shown to prevent serious illness or death due to COVID-19 in 95 to 97 percent of cases.

"That's the most effective vaccine in history," she said.

But Dittmer said there's a lot of urgency to this conversation, noting that every infection provides a chance for the virus to mutate and potentially create variants that the vaccines aren't as effective against, making it imperative to get as many people vaccinated as quickly as possible.

"We're racing against this super bug that no one has ever seen before, no one has ever dealt with before, and historically humans haven't done very well with that," she said. "This is a race."

Editor's note: This story was updated to include additional vaccination data provided by the Hoopa Valley Tribe received after initial publication.

Thadeus Greenson (he/him) is the
Journal's news editor. Reach him at 442-1400, extension 321, or thad@northcoastjournal.com. Follow him on Twitter @thadeusgreenson.

The Community Voices Coalition is a project funded by Humboldt Area Foundation and Wild Rivers Community Foundation to support local journalism. This story was produced by the North Coast Journal newsroom with full editorial independence and control.

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