COVID-19 vaccine supply issues plague California
Vaccine supply issues continue to plague California as the state tries to ramp up COVID-19 vaccination efforts. So far 3.2 million doses have been shipped to California and 1.5 million doses administered, the state’s top health official said. (Jan. 19)
Eisenhower Health in Rancho Mirage vaccinated nearly 1,800 people against COVID-19 this week. But unlike Riverside County’s vaccination clinic at the Indio Fairgrounds — which the public could go online and book appointments for — there has been no open call to register.
Instead, Eisenhower decided who would get the doses. Representatives said appointments were scheduled for select first responders, community physicians and their staffs, and volunteers “who will in turn help with the vaccination effort.”
The nonprofit hospital also acknowledged inviting financial donors to be among the first vaccinated — a move that comes amid increasing frustration among residents who have been unable to book appointments for vaccines anywhere in the county.
Eisenhower’s vaccinations were part of a “pilot program” that started over the weekend and ended Friday, officials said, to test the organization’s ability to administer the doses on a large scale.
Eisenhower Health spokesperson Lee Rice said all of the donors were over age 65, making them eligible for vaccination based on newly updated federal, state and county guidelines that had providers scrambling to expand access last week.
“In hopes of receiving sufficient doses soon to begin daily clinics for its patients, Eisenhower Health quickly scheduled mass vaccine clinics for this past weekend as part of its pilot program,” Rice said in an email.
The effort, she said, was aimed at testing the speed and efficiency of registration and scheduling as well as ensuring proper storage of the vaccine for when the hospital expands to inoculating large numbers of patients at “multiple locations.”
Eisenhower has started scheduling its “most vulnerable” patients ages 65 and older, Rice said, with more than 11,000 additional invitations planned to go out on Monday for appointments starting early next month.
“There’s always the risk in these specific (priority) groups that we’re going to see inequality,” said Andrea N. Polonijo, a medical sociologist at UC Riverside School of Medicine. UC Riverside’s Department of Social Medicine, Population and Public Health.
While donors and others included in Eisenhower’s pilot program might not be line-jumping since they were eligible to receive the vaccine, Polonijo said their status as donors or even volunteers may have helped them get to the front of the line.
“Organizations really need to be aware of the potential for these inequalities in access to pop up and think about what they can do to make sure they’re involved in equitable distribution,” Polonijo said.
Lower-income individuals and racial or ethnic minority groups are not going to have equal access, she said. To combat this, Polonijo suggested organizations refer to the U.S. Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) to help identify vulnerable, harder-hit communities where they can do outreach.
Why were Eisenhower donors included?
Rice said donors were included because they were easy to reach at the last minute. When asked how many were part of the pilot program, Rice said she didn’t know.
Due to the long hours involved in contacting people for the clinics, Rice said she was not able to provide a breakdown of how many donors, volunteers, or health care and emergency service workers had been vaccinated in the effort.
To determine this, she said, hospital staff would need to go through lists manually — a task they don’t have time for right now. “They’re being scheduled by phone from multiple lists with many schedulers making these calls,” Rice said earlier this week.
This past weekend’s two-day, indoor vaccine clinic was scheduled in less than 24 hours, she said. It had a goal of administering 900 vaccinations in those two days, and exceeded it with 904 people inoculated.
For the test clinic, the hospital reached out to physicians in order to include some of their highest risk patients, Rice said, and also contacted Eisenhower volunteers and donors. This was to “ensure a robust response rate that allowed the team to determine the limits of the program,” she said.
“Donors and volunteers are among Eisenhower’s most responsive groups,” Rice said, “exhibiting patience with new processes and feedback when it’s needed quickly.”
They’re also familiar with how the hospital works, she said. “Both groups were a logical choice for a program that had to be executed quickly with few no-shows in order to test the system with a full schedule of patients,” Rice added.
Judy LeBlang, 74, of La Quinta is a patient at one of Eisenhower Health’s 365 clinics. “That’s great,” she said when she learned the hospital had started the pilot program. “I’m glad they’re doing seniors that they considered high-risk, and it’s fine they’re doing volunteers and EMS.”
LeBlang said she understood including donors, too. “They give huge money to the hospital,” she said.
LeBlang said she was told her primary care doctor didn’t have any doses, and she’d be contacted when vaccines were available. Of the program, she said: “To me that’s still not open to their patients — they’re calling the ones that high-risk,” she said. “They don’t have enough yet to call anybody else.”
Nearly 1,800 doses were administered in the pilot program by the time it concluded Friday, Rice said. That total is about 8% of the 21,500 doses that Eisenhower had received, according to Riverside County.
Are other hospitals doing ‘pilot programs’?
For now, Eisenhower Health appears to be the only hospital in the Coachella Valley planning a vaccination effort at this scale.
Together, Desert Regional Medical Center in Palm Springs and JFK Memorial Hospital in Indio have received 4,525 vaccine doses, according to spokesperson Todd Burke.
In addition to hospital staff, the facilities also have vaccinated contract workers, individuals working in Emergency Medical Services, and Desert Regional volunteers age 65 and older.
“It was the same process as for regular staff,” Burke said in an email Wednesday. “We contacted them and made an appointment.”
Though the hospitals are not planning mass clinics at this time, Burke said that starting Wednesday, the Comprehensive Cancer Center at Desert Regional is offering vaccines to current patients age 65 and older as they come in for their treatments.
Representatives with Riverside Community Hospital, which has received 5,700 doses, said Friday that plans were in the works but couldn’t yet provide details.
Dr. Paula Cannon, professor of molecular microbiology and immunology at the University of Southern California, said a trial program is not necessarily a bad idea. She emphasized that the number of people vaccinated on a daily basis depends on the availability of vaccines and the size of the vials shipped.
“Speed is going to be just as important as transparency and equal distribution according to the rules,” Cannon said. “As we’ve seen in recent days, fear of not perfectly obeying the rules can lead to unintended consequences including disposal of unused vaccines. So, I do have sympathy for hospital systems trying to navigate this.”
Vaccinating health care workers vs. patients
Holding mass vaccination clinics for patients is a different process than vaccinating the hospital’s own health care workers, Rice said.
The clinics held for Eisenhower’s physicians and staff have been conducted in smaller numbers due to “scheduling considerations to protect the workforce from additional stresses at one indoor location.” The doses didn’t need to travel far and could be prepared throughout the day, she said.
Since employees are on location on a near daily basis, she added, communicating with them is different than what is needed for mass vaccination clinics.
Drive-thru clinics are under consideration; however, Rice said that because most of the hospital’s patients are older, there are questions about mobility and safety.
“Keeping patients in their cars for hours at a time is not ideal for this population of patients, and Eisenhower must conduct significant testing and planning to determine if such a plan is safe and feasible,” she said. “Eisenhower must customize its vaccine clinics according to its patient population and is using a strategic approach in testing different options for mass vaccine clinics.”
Some who received doses through the test clinic included those with health and mobility issues, she said; among them was a 97-year-old World War II veteran and a lung transplant recipient — neither were donors.
As of Sunday, 4,387 first and second doses of the vaccine had been distributed to hospital staff, according to Rice. Eisenhower has nearly 5,000 employees, about 600 volunteers and about 4,000 donors, she said.
“For the mass vaccine clinics, there is significant technology planning taking place, some which is new and still being developed, little of which was needed to reach employees and physicians,” she said.
Already, Eisenhower is scheduling appointments for vulnerable seniors, which includes individuals who may have had challenges scheduling an appointment online “due to disabilities or lack of computer access.”
“The most vulnerable patients have been a significant part of the pilot group and they will comprise the majority of the vaccines being given through next week,” Rice said.
The goal is to work up to 1,100 vaccinations a day by Feb. 1, she added.
“Eisenhower Health will schedule patients under the assumption it will receive doses and will cancel and reschedule vaccine clinics should the doses not arrive,” Rice said.
Rice said that an efficient, well-planned rollout is paramount. Unlike vaccine clinics carried out by government entities like the military or public health, Rice said the hospital is also taking care of COVID-19 patients and the workforce is stretched as it is.
“Eisenhower Health does not have an unlimited number of health care workers available,” she said. “Every health care member providing vaccines is one less who can take care of patients elsewhere in the health system, including the COVID-19 testing site. Our vaccine clinics have to be conducted with these realities in mind.”
What to expect if Eisenhower calls you
Eisenhower patient Roe Polito said she’s exasperated and tired from spending every morning calling around trying to get a vaccine appointment or just have her name added to a waiting list.
“I called my doctor, I said ‘Can you get me a shot? I’m 90 and I live alone,” the Cathedral City resident told The Desert Sun.
Polito said she was told her doctor wasn’t able to vaccinate anyone since his office doesn’t have the necessary cold storage capacity. The office told her to call Eisenhower directly but that didn’t help, she said.
“That’s all he did was give me the phone number,” Polito said. “There’s a lot of questions I don’t get answers to.”
Eisenhower Health patients may receive either a phone call or outreach through the electronic system used by the hospital — called MyChart — if they’re registered for it.
Nearly 82,000 of Eisenhower’s senior patients are signed up with MyChart, nearly 64,000 are not.
Rice said “invitations for online scheduling” will start going out Monday through MyChart to more than 11,000 patients, starting with oldest patients first to ensure the “most vulnerable continue to be prioritized.”
They will then be able to self-schedule an appointment for clinics beginning Feb. 1.
Eisenhower expects it to take several months to vaccinate seniors, and will hold second doses back for patients.
“Eisenhower will vaccinate seven days a week with the caveat that we must have sufficient doses of the vaccine to do so,” she added.
According to Eisenhower’s current plan, after an appointment is made, individuals will show up at the designated location, where their identity will be verified and a COVID-19 screening will be done. They must also fill out a consent form if they haven’t already done so.
During their check-in for their first shot, they will be scheduled for their second appointment, Rice said.
Any additional necessary information about the patient will be collected and put into a data system along with when and where their first dose was administered and what brand vaccine they received. There are federal- and state-mandated reporting requirements that come along with being a coronavirus vaccine provider.
“Patient demographic information, including insurance information, will be verified,” Rice said. “This information must be provided if they wish to receive the vaccine at Eisenhower Health.”
Patients’ insurance will be billed for an administration fee, which Rice said is a requirement for health systems.
The patient will not be charged a co-pay and, if their insurance denies the charge, the patient will not be billed, she said.
After receiving a shot, patients will be monitored for any adverse reactions for 15 minutes and, if one should occur, receive appropriate medical attention.
Desert Sun reporters Maria Sestito, Mark Olalde and Brian Blueskye contributed to this report.