Hot Topic #41 | Vaccine FAQ 4.0

COVID-19 updates from San Juan County around subjects on the minds of islanders

||| FROM BRENDAN COWAN for DEPARTMENT OF EMERGENCY MANAGEMENT |||

For obvious reasons vaccine roll-out is the very definition of a hot topic at the moment (and likely for many months to come). This Q&A will attempt to explain and highlight some current information. A few important things first:

• This is the fourth in a series of vaccine Hot Topics. It is the latest information, but it may also be useful to review previous editions by going to www.sjccovid.com and clicking on the Hot Topics section.
• Even the members of the Vaccine Team at San Juan County Health & Community Services don’t have all the information or answers. Many of the most critical pieces of info and direction come from the State or Federal government. Sometimes that information changes with no notice, sometimes your public health responders hear about it via the media the same time as the general public.
• For some time to come, demand will exceed supply. Just to be clear: demand for vaccine will drastically exceed supply until production matches the need. Patience and maintaining existing safety protocols will be vital.
• Local medical providers and pharmacies will play a critical role in vaccinating our community. This Q&A will focus on the San Juan County response but know that there are a number of local organizations working hard to get approval from DOH so they can receive supplies and begin administering doses.

QUESTION: Did the County lose any vaccine supply due to the power outage?

No. The freezers used to store the County’s vaccine supply have back-up power, and are equipped with data loggers that track the temperature within – allowing for an easy check on whether the vaccine has been maintained within the required temperature range.

It is unrelated to the outage, but the County has had to return 60 doses of vaccine to Moderna due to the vials not thawing properly before injection. The County has yet to be notified of the cause of the problem.

QUESTION: When will the County finish with Phase 1a and move to Phase 1b?

It is expected that nearly all Phase 1a eligible individuals in San Juan County will be vaccinated by the end of the day on January 15. This includes healthcare workers, first responders, and long-term care facility residents and staff.

There will still be opportunities for any remaining 1a islanders who have yet to be vaccinated to receive doses going forward.

At the time of writing, WA State DOH has not yet authorized the move to Phase 1b, but that decision is expected to be announced very shortly (if indeed it hasn’t happened already).

QUESTION: Please remind me again, who is in Phase 1b, and what about after that?

The full Phase 1b guidance from WA DOH is online here, and this simple graphic helps explain Phase 1b and the four tiers that break it into four distinct groups (based on priority). There is currently no information on phases beyond 1b.

Note that for reasons that are not totally clear, DOH has used several different terms for describing Phase 1b and its four tiers. Sometimes they say 1B1 with means Phase 1b, Tier 1. Some documents describe the four tiers as B1, B2, B3, B4. Either way, the Phase after 1a is called 1b. It is divided into four sections. There is no information yet on what is beyond Phase 1b.

Yes, you are correct, this is confusing. Regardless of exact terminology, Phase 1b – Tier 1 includes:

• Anyone over the age of 70
• Those over the age of 50 living in a multigenerational household. The term multigenerational household is a bit vague – but here are the specifics (courtesy of these more detailed DOH guidelines):
  • An eligible member of a multigeneration household is defined as someone who has high vulnerability (e.g., an individual over the age of 50 who cannot live independently and is being cared for by a relative or in-home caregiver) or who has high risk of exposure (e.g., an individual over the age of 50 who is  living with someone who works outside the home, or an individual over the age of 50 taking care of a grandchild) This category does not include older adults who are able to live independently and are taking care of their own children.

Again, the full details on Phase 1b – Tiers 2 through 4 are best reviewed here.

QUESTION: I’ve read that the vaccine is now being offered to those 65 and over, not 70. What’s the story there?

At this time, the system set by DOH that has been described above and prioritizes those 70 and over is still in place. That may change, and San Juan County will adjust with any changes to the state-wide requirements.

While nothing about this situation is clear-cut, it is worth bearing in mind that policy at the national level often flows downhill to create unsupported on-the-ground challenges at the local level. While it is easy for someone in Washington, D.C. to make the decision to expand categories, that doesn’t solve the problem of limited vaccine supply. The goal will always be to protect those most at risk and work outward from there.

QUESTION: These Phases and Tiers- they seem somewhat arbitrary and easy to cheat. What’s to keep someone from lying about their eligibility, and why is a 70-year-old more at risk than a 68 year old with cancer or a 12 year old with asthma?

In short, yes. Things are arbitrary and they aren’t perfectly enforceable. There’s simply no way to organize the vaccine line so that it is perfectly objective and concrete or so that there’s no way someone can jump the line.

Certainly there are some eligibility requirements that are easy to verify. Age. High Risk Conditions. Employment. Other things are much more difficult to determine. Vaccine providers need to be devoting time to getting shots in arms, not weeding out the dishonest. An effort will be made, but at the end of the day, people are going to be asked to do the right thing.
And the Phases or Tiers have lots of overlap, and not everyone will fit into one category of the other.

There will be a tendency to think “Why them and not me?” That’s a totally natural reaction, but just know that the system has been designed to save lives. Exact strategy is debatable, but in the end, there needs to be a system, even if it isn’t perfect.

QUESTION: How many people are in Phase 1b – Tier 1 in San Juan County?

Current estimate is that approximately 4,000 people in San Juan County are eligible for Phase 1b – Tier 1. This represents nearly 25% of the population of San Juan County.

QUESTION: 4,000 is a lot, what is the plan for getting all those people vaccinated?

Here is a very simple explanation of the plan in San Juan County:

1. WA DOH opens Phase 1b.
2. The County will release (in local media and at www.sjccovid.com) a link to an online registration
   tool.
3. Eligible individuals will sign up. To begin, the number of slots will be extremely limited. Supply will be restricted by the volume of vaccine delivered to San Juan County. The vast majority of those 4,000 people will not receive a slot at first.
4. The County Health & Community Services Team will be operating vaccine clinics 5 days a week, rotating between San Juan, Orcas, and Lopez Islands (with periodic service to other islands). The goal is to be able to provide approximately 1,000 doses per week. REMEMBER: This goal will be limited by supply for some time to come. Also remember that current vaccines require two doses.
5. As local healthcare providers and pharmacies roll out their own vaccine efforts, the options for receiving an immunization will increase.

QUESTION: What do we know about what supply will look like? How long until San Juan County starts receiving 1,000 doses a week?

Short answer: we don’t know. There are counties in WA that are still far from completing Phase 1a. Will that mean that DOH will prioritize those jurisdictions? Not sure. We’ve also seen that doses promised to states are not always delivered. There is also much uncertainty about if/when additional vaccines will become approved and available and what sort of supply will be produced.

In short, this is an important but unanswered question. Rest assured that vaccine providers in San Juan County will continue to press and advocate for doses being sent to the islands.

QUESTION: So, at 1,000 doses a week, and two doses for each of San Juan County’s roughly 15,000 residents over the age of 16*, that means it will be more than eight months until we’re all vaccinated?

If San Juan County Health & Community Services were to be the only provider of vaccine in the islands, that would be true. Fortunately, many island medical providers and pharmacies are planning on delivering vaccine. Some of those have already been approved by DOH and are awaiting delivery of supplies. Others are at various stages of the application process or awaiting final review. As those efforts ramp up, the rate at which islanders are vaccinated will hopefully increase considerably.

QUESTION: What about this idea of delaying second doses and just using all available vaccine to give first doses?

This is certainly something being considered at the state and national levels and something we’re keeping an eye on locally. The scientific wisdom of that decision is being debated. It certainly seems possible that a national plan based on that approach will be adopted. Again, as DOH requirements change, so will be approach in San Juan County.

QUESTION: I’m 27 years old and healthy, when will I receive my vaccine?

Hard to know for sure, but best answer might be not anytime soon.

For Tiers 2-4 in Phase 1b, there are eligibility groups that are not age-dependent, but someone who is not in a high risk category may not receive their vaccine until summer – though keep in mind that any time estimates at this early stage are nothing more than rough approximations.

QUESTION: What will the vaccine cost?

San Juan County Health & Community Services will not be charging for the immunizations they deliver. For those receiving their vaccine from other providers, the full cost of the COVID vaccine will be covered by Medicare, Medicaid and most private insurance, and the cost of the vaccine will be covered for people who are uninsured. There may be a copay or office visit fee, depending on your insurance plan or the doctor you see to get vaccinated.

QUESTION: So COVID isn’t going anywhere in the short-term, what should we keep in mind for now?

This whole situation is unbelievably challenging. Patience is running low and anxiety high. The uncertainty is exhausting and the disruption to so much that we value, need, and enjoy as a society continues to wear. The only real things we have control of during this unprecedented time are our own behaviors and approaches. Everyone requires and is capable of different responses, but some things to strive for perhaps:

• Steadiness. Continuing with our precautions and protocols. None of this is fun, but we know that masks and social distancing work. San Juan County has one of the lowest case rates in WA, and our state continues to do well compared to other regions of the United States. That isn’t just luck- it is due to
  sacrifice and attention. Let’s keep it up.
• Patience. Information is changing or unavailable, tensions are high, many are suffering through incredible financial, familial, and health challenges. Very few of us are at our very best these days. Empathy, patience, and thoughtfulness will see us through.
• Generosity. We’ve been in a burning building for almost a year. And we can finally see the exit to fresh air. A tendency to push our way out the door is entirely natural, but now is the time to recognize that some are truly at a greater risk than others. Stepping back to allow those with the greatest need to move to the front of the vaccine line is kindness exemplified.