If mass vaccination is the road that will ultimately lead Humboldt County and the nation out of the COVID-19 pandemic, it's proving a bit bumpy, with a series of blind turns that seemingly just keep coming.
There were glimmers of hope in a Jan. 14 press conference — one of just a handful held since the county was put under a shelter-in-place order last March — when Health Officer Ian Hoffman announced Humboldt had offered a vaccine to all local healthcare workers and would be moving in the coming days to vaccinate residents aged 75 and older. Further, Hoffman said he expected vaccine shipments from the state to potentially double in the coming weeks.
But the remarks of Hoffman and Public Health Director Michele Stephens also made clear a long road likely lies ahead and the county faces both internal and external challenges in vaccinating the 70 to 85 percent of the local population that health experts say is necessary to bring the virus' spread under control and adequately protect vulnerable populations.
Underscoring the challenges are the raw numbers. At the press conference, held a month to the day after Humboldt County administered its first vaccination dose to much fanfare, Hoffman said approximately 7,300 doses had been administered to local healthcare workers, widely considered the easiest demographic to vaccinate because they are easy to identify and most can receive it in their workplaces. Meanwhile, the next phase will include 10,000 local residents ages 75 and older, who will have to coordinate vaccination with their primary care physicians or, if they don't have one, Public Health. The task gets logistically more daunting from there, moving into the age 65 to 74 demographic, which includes 16,000 residents, or groupings by employment sector.
Pressed as to why Humboldt County was not opening vaccinations to everyone over the age of 64, or to teachers, Hoffman said it simply comes down to supply.
"There currently is not enough vaccine," Hoffman said, adding that's not for a lack of effort. "This is happening in every single county, in every single jurisdiction across the country. ... We took what we were offered. We've accepted everything we've been offered. We've never declined vaccine, and we are allocating it out with our healthcare partners to give in the order that was laid out in the phases and tiers. When we have enough vaccine to move on in the phases and tiers, we will absolutely do that."
The extent to which much of this is out of local hands would come further into focus in the days following the press conference.
Both of the vaccines approved to date — one by Pfizer and one by Moderna — require two doses administered several weeks apart to achieve full immunity. Early last week, the federal government directed states not to hold second doses in reserve but to administer all they had, raising hopes a windfall of doses that had been in storage would be released. But several days later, the Washington Post and other news outlets reported that the federal government had already effectively emptied its reserve of second doses and no such windfall was coming. As the Journal went to press Jan. 19, it was unclear if Hoffman's estimates at the press conference that Humboldt would soon go from receiving 1,000 to 2,000 doses a week to potentially 3,000 to 4,000 were based on the state's expectation that federal allocations would increase.
But that news would pale in comparison to the state announcing Jan. 17 that a cluster of people in San Diego had suffered adverse allergic reactions after receiving shots from a single batch of Moderna vaccine, prompting the state to ask counties not to administer doses from that batch until investigations could be completed. Humboldt County then announced that roughly 90 percent of its approximately 3,900 doses on hand were from that batch, leaving appointments for more than 3,000 residents at vaccine clinics planned for the following week uncertain.
While news of Pfizer and Moderna's vaccines — both of which clinical trials showed to be highly effective and safe — was met with great hope and fanfare locally, a perceived slow rollout has led to frustration in some quarters, particularly among those who are statistically more vulnerable to suffering critical outcomes from the disease and are hungry for some sense of safety.
But there's no escaping the fact that vaccine distribution on the scale required to inoculate at least 70 percent of Humboldt County's population over the age of 16 — roughly 110,000 people — is a heavy lift for a rural healthcare system already stretched from 10 months of pandemic response. And to date, it's being done with very little federal or state support.
Early on, Hoffman said, the state offered some trainings on how to do mass vaccination clinics and work with local healthcare partners but the resources that would really speed the effort — namely funding and workforce reinforcements — have so far not materialized from the state or federal governments. The hope, however, is that will change as efforts ramp up and the vaccine becomes more widely available.
"We will get state resources to help administer as this gets bigger and bigger," Stephens said.
Hoffman then jumped in to underscore the challenge ahead.
"Just to put into scope what needs to happen, though, at some point to hit the goal of getting everyone who wants to get vaccinated vaccinated by late summer, we'd really need to be giving out 8,000 doses a week — first and second doses — so you can see the scale of that is extraordinarily large," he said. "And to do that, we will need to leverage every single aspect of our healthcare system to make it happen, including all of our partners, Public Health and state, as well as national, resources."
The first phase of vaccine administration focused on healthcare workers, which was both essential to keeping frontline caregivers healthy amid increased COVID-19 exposure but also logistically the low hanging fruit. The vast majority of these people worked in settings where someone was qualified to give the vaccine, so Public Health could coordinate deliveries and essentially let organizations handle vaccinating their own, while also setting up a small clinic of for healthcare providers who, for whatever reason, couldn't get the vaccine at their place of work.
Now that the vaccine is being made available to local residents over the age of 75, Public Health is leveraging the fact that most residents in that demographic have a primary care provider to help coordinate vaccinations. Hoffman said he's instructed local providers to contact their over-75 patients, preferably prioritized based on underlying conditions and other risk factors, to schedule vaccinations. Those who don't have a primary health provider are asked to contact Public Health to schedule a vaccine at one of its clinics, which can currently administer about 750 doses of vaccine a week.
But a looming challenge is that when the vaccine is made available to younger residents, an increasing percentage will not have a primary care provider or a medical home, meaning other providers will have to step in to inoculate patients who are not their own or Public Health will have to pick up the slack. Hoffman said Public Health is quickly ramping up capacity, hoping to accommodate as many as 1,750 weekly appointments as soon as this week.
And when vaccinations are opened up to people by employment sector — teachers, firefighters, police officers, grocery store employees and agricultural workers are slated to be vaccinated later in this phase — that will bring another host of logistical challenges. Hoffman said the county has sent surveys out to school districts and other large employers to gather information needed to prepare for this next phase, but there's still a lot of uncertainty about how members of the general public will be identified by tier priority and vaccinated.
The fact that all of this is happening during a highly contagious pandemic also obviously complicates factors, as the need for physical distancing makes simply lining up hundreds of people or filling an auditorium with folks waiting to be vaccinated impractical. Some other jurisdictions have turned to converting stadium parking lots into drive-through vaccination clinics, but Stephens said nothing like that is being planned locally at this point, noting providers are required to monitor patients for 15 minutes after they receive the vaccine to make sure they don't have severe adverse reactions.
"There's a clinical piece to this we have to be mindful of," Stephens said.
While the county waits anxiously for vaccine deliveries to ramp up, local healthcare providers are working to build out and coordinate the infrastructure needed to dramatically increase local capacity to put shots in arms.
St. Joseph Health spokesperson Christian Hill said St. Joseph Hospital has agreed to make its large conference rooms available to St. Joseph Medical Group for clinics to inoculate the group's primary care patients, while Redwood Memorial Hospital is planning to similarly host clinics in the near future. Mad River Community Hospital is also planning to accommodate for its clinics primary care patients. But these large-scale vaccine efforts need to be carried out in addition to the hospitals and clinics day-to-day operations, which poses significant staffing challenges in an area in which nurses and healthcare workers were in high demand before the pandemic. And arguably nobody faces a larger challenge than Open Door Community Health Centers, by far the largest provider of primary care in the county.
Open Door CEO Tory Starr said the organization is currently trying to assess how it can continue treating patients while also administering tens of thousands of vaccines in the coming months.
"It's definitely a lift," he said. "We need to think about the workforce, about expanding our workforce, by pulling in people who are retired healthcare professionals or in the nursing school at (College of the Redwoods)."
"It's a great opportunity for people to get really good at giving shots," he added with a chuckle.
But Starr said the organization is still working to calculate how many injections it can do in an hour, noting the 15-minute monitoring period and need to follow COVID-19 distancing protocols, as well as the workforce needed to do that, mindful of the fact there will inevitably be workforce disruptions, like quarantines due to COVID-19 exposure or illness. Ultimately, he said, he expects Open Door at some point will operate parking lot clinics in Eureka, Arcata and Fortuna.
"It's a heavy lift but we're up to the task," Starr said. "But it won't go as quickly as everyone would like."
While there is currently no plan in place to reimburse healthcare providers for this mass vaccination effort, Starr said he's confident that it will come together.
"The county has been great but the reimbursement is certainly a state or federal issue," Starr said, adding that while Open Door will do what the community needs now and worry about reimbursement later, that's an important component to keeping the system financially solvent.
Starr said he's hopeful more help is coming. "I have great belief that with the change of (presidential) administration, we'll have a much more unified and coordinated approach to doing all this, which will make a big difference."
There is understandably a lot of hope tied up in these new vaccines that health officials and scientists consider nothing short of a medical miracle based on their efficacy and the speed at which they were produced and approved. But it's becoming increasingly clear they are not a bullet train that will speedily pull Humboldt County out of this pandemic.
During the press conference, Hoffman stressed the vaccine is only a means of "individual protection" at this point.
"When an individual gets the vaccine, they are protecting themselves from COVID-19, severe disease, hospitalization and death," he said. "We do not have sufficient evidence yet to say that the vaccine will prevent the spread."
At this point, Hoffman said, nothing is going to change about the health measures in place to prevent spread of the virus, meaning masking, physical distancing and avoiding gatherings with people outside one's household will remain imperatives for the foreseeable future. The return to normalcy so many crave could still lie many months in the future.
"When we have enough evidence that this vaccine will reduce case the counts and we see that reflected in the epidemiological data, I think we'll start to roll back (restrictions) as we're comfortable," Hoffman said. "When that is is a really difficult thing. You know, I think if we're complete optimists, it could be sometime later this year. Some people have said into next year. Some people think we might be wearing masks for the next several winter seasons."
Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or firstname.lastname@example.org. Follow him on Twitter @thadeusgreenson.