COVID-19 Vaccine Distribution

A cooler containing the Pfizer COVID-19 vaccine sits on a table at Prestige Post-Acute and Rehab Center earlier this month in Centralia.

More than three weeks after the first vials of coronavirus vaccine arrived in Washington, the state has struggled to quickly vaccinate the most vulnerable people: long-term care residents and health care workers.

Some assisted-living facilities still don't have vaccine appointments. Hospitals have scrambled to transfer vaccine to other hospitals that are short on doses. Many health care workers can't find a site to get vaccinated. And the state Department of Health (DOH) can't answer basic questions, like how many long-term care residents have been vaccinated or how much vaccine has been wasted.

The health department on Friday reported that 466,775 doses had been distributed throughout Washington state, and 151,856 of them had been administered. That appears to be slightly faster than the national average, according to Centers for Disease Control and Prevention (CDC) data. Officials have said some of the gap between delivery and administration can be explained by a lag in reporting.

Amid the delays, the state has extended the timeline for vaccinating essential workers into April, and the general population after that.

Interviews with health care workers, long-term care providers, state officials and others reveal some of the reasons for the slow pace. CVS and Walgreens have fumbled scheduling vaccine clinics, after waiting weeks for state approval. The federal government's unpredictable supply has muddled hospitals' plans. And it simply takes longer to vaccinate nursing home residents than many had hoped.

This isn't the state's first logistical stumble during the pandemic. Its coronavirus call center was overwhelmed in February, and technical problems caused dropped calls for weeks. Contact tracing fell short of targets, despite thousands of newly trained staff. Tens of millions of N95 masks sat in a warehouse while health care workers reused their limited supply. Testing and data snafus also persisted for months.

The state Department of Health is responsible for routing doses into the hands of health care providers who can administer the shots, and state officials can't explain the bottleneck.

The lack of information has left Washingtonians frustrated, especially as the numbers show more doses are ready, but aren't making it into people's arms.

Long-term care facilities are still waiting

In early December, Liz Lightfoot received an email from Sunrise of Mercer Island, where her 91-year-old mother lives, that the assisted living facility expected to receive its first round of vaccines that month.

On Dec. 23, she received another update that the vaccines were "coming fairly soon." Six days later, administrators announced a CVS vaccine clinic would begin on Jan. 9, 2021.

On Tuesday, another delay. The clinic dates had been moved "due to vaccine allocation" to Feb. 2 for the first round, and Feb. 23 for the second.

"What if she made it all this time and then because of bureaucratic snafus and poor planning and management she got COVID now?" said Lightfoot, who praised Sunrise's transparency in providing updates. "I don't know if I would be able to stand it."

A spokesperson for Sunrise deferred all questions about the delays to CVS. A CVS spokesperson did not answer questions about the delays.

Deb Murphy, the CEO and president of LeadingAge Washington, which represents nonprofit nursing homes, said CVS has been "extremely challenging" to work with. CVS canceled clinics, claiming insufficient vaccine supplies or without a reason, according to Murphy.

"The rollout isn't going quickly enough," she said.

Long-term care facilities have been hit hardest by the COVID-19 pandemic, accounting for more than half the state's deaths. A record number of the facilities currently have at least one active case of COVID-19.

As part of a Trump administration program, CVS and Walgreens have a contract to vaccinate the bulk of the state's 4,164 long-term care facilities, with smaller numbers being handled by smaller pharmacies.

The two big national chains didn't begin vaccinating Washington nursing homes until a full two weeks after the first doses arrived in the state.

That delay was driven by the DOH, which waited to accumulate half of the needed shots for nursing homes, according to Michele Roberts, the acting assistant secretary in charge of the vaccine rollout. For another type of long-term care, assisted living, the state waited until Jan. 4 before giving CVS and Walgreens the go-ahead. The state prioritized nursing homes because their residents are typically more vulnerable.

"It has been a slower start than ideally we all want to see," said Roberts. "We are working regularly with the federal government, with CVS and Walgreens, to really look at the pace and figure out what we can do to increase it."

As of Thursday, CVS data showed it had administered 4,320 vaccine doses in Washington. Walgreens would not release state-level data. Nationally, the pharmacies had administered just 17% of the doses they had received, according to the CDC.

One challenge, state officials and pharmacy representatives say, is that vaccine administrators have to visit every room in a nursing home, instead of having people line up for vaccines in a central location.

Administering vaccine to elderly patients typically takes at least twice as long as it does for young, healthy patients, said Jenny Arnold, chief executive officer of the Washington State Pharmacy Association.

"When you have a buttoned-up shirt on an elderly man, he's going to unbutton it himself, and it takes longer," Arnold said.

Timelines can stretch for patients with Alzheimer's, memory problems or flexibility issues.

As the delays mounted with CVS and Walgreens, some long-term care facilities dropped out of the federal program and found local pharmacies that could begin vaccinating sooner.

At Josephine Caring Community in Stanwood, CEO Terry Robertson was counting on CVS' scheduled vaccine clinics. A deadly outbreak at the facility had infected more than 100 residents, including 19 who died.

But when he learned CVS had scheduled the first shot for Jan. 9, he opted to switch to Consonus Pharmacy, a smaller chain. Instead, Josephine residents received the first vaccine Dec. 27.

"I thought two weeks could prevent someone from getting the virus and might even save a life," Robertson said.

CVS and Walgreens announced last week they are on track to vaccinate residents and staff at nearly all nursing homes nationally by Jan. 25. Assisted living facilities, adult family homes and other sites are the next priority. And after some initial confusion, the state announced last week that the pharmacies could vaccinate people in independent living, if their facility also has other long-term care residents.

Transparency lags some states

The state has a major hole in its vaccine data. It can't tell to whom its doses were given, whether to a long-term care resident or worker, or to other health care personnel.

"We have to find new ways to parse apart our data because it's all coming in as 'doses given,' " Roberts said during a news briefing last week.

Washington has been releasing high-level summary statistics about once a week.

Some other states already have robust online vaccine "dashboards," and are updating them daily. Michigan's, for instance, shows administration and distribution trends by county and demographics, and it has a downloadable spreadsheet that breaks out the number of doses administered by each site, each day.

This week the DOH plans to release its vaccine dashboard. Originally, the state planned to launch the dashboard in late December, but it was delayed due to a lack of "staffing resources," a department spokesperson said.

Washington is currently publishing "more data than some states are reporting, but much less than what others are," said Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.

"You want to know who's getting the vaccine, and where they are," Tolbert said. "Policy officials can then try and figure out what is going wrong, and what we can do to fix it."

One concern with any vaccine, especially one in short supply, is how much is being wasted. The Pfizer vaccine has strict temperature requirements, and could be unusable if not properly refrigerated. But the DOH does "not systematically capture this information," a department spokesperson said in an email.

The state's public health system, which has faced chronic underfunding, is rushing to organize a mass-vaccination machine. King County on Friday directed $7 million from its budget to pay for mobile clinics and two mass vaccination sites.

Workers outside hospital systems can't find the vaccine

On Dec. 23, Ted Hardman, a 65-year-old home health aide, received an email from his union, SEIU 775, confirming he qualified for vaccination, but saying supply remained limited and the state was still working out logistics.

Hardman took matters into his own hands. He used an early version of the health department's PhaseFinder web application to document his eligibility, and began calling hospitals.

Hardman called the EvergreenHealth and Swedish health systems. Neither was accepting appointments.

"Swedish said: 'It's not available,' click," Hardman said, indicating the phone hung up.

Hardman cares for a medically fragile patient, along with his wife and son who are both registered nurses. He worries for his family's safety and about passing the virus to the patient.

"It's potentially fatal for him," Hardman said.

Health workers and caregivers like Hardman, who are not affiliated with large medical systems, have struggled to find out where they can be vaccinated. The health department listed vaccine sites online and instructed workers to call those nearby, but many don't have enough doses to accommodate them.

Rachel Muñoz, a dental hygienist from Seattle, said she had to drive to a Tacoma pharmacy and wait in a line among 40-50 health workers in rainy, 40-degree weather. After an hour outside, she received a dose of vaccine in a corner of the store where pencils, glue and sticky notes were sold.

"Lovely pharmacy," Muñoz said, but the "overwhelming response" made it feel like "disorganized chaos."

Hardman's union, SEIU 775, represents some 45,000 home care workers who provide care to seniors and people with disabilities. Adam Glickman, the union's secretary-treasurer, estimated Friday that fewer than 1% have been vaccinated, based on discussions with members.

Glickman said it took time for the state to identify vaccine providers who had the capacity, supply and the will to schedule and vaccinate workers who were not their own.

"The state has been hesitant to put out a lot of information on where to get vaccines when there weren't vaccines to have gotten," Glickman said.

Glickman said the state, the union and these workers' primary insurer are beginning to promote and communicate about vaccine sites.

"It's starting to tick up."

Hardman hopes to get vaccinated this week at International Community Health Services (ICHS), a Seattle-based network of clinics.

"We have been inundated with requests from providers," said Rachel Koh, the chief operation officer of ICHS. Her organization signed up eight of its facilities to administer the vaccine.

Koh said ICHS fielded 80 calls in a span of less than 24 hours. The organization was still working through its own employees and plans to begin vaccinating outside providers this week.

Unpredictable federal supply

Some health organizations have had to scrape to find more vaccines as their employees wait, while others have received too many and scrambled to transfer doses to needy hospitals.

By Dec. 23, Pacific County had received more doses of vaccine than the number of people eligible for the first phase of vaccination, according to Brenda Sharkey, chief nursing officer at Ocean Beach Hospital and Medical Clinics.

So the clinics transferred 500 doses to the CHI Franciscan health system, whose chief of pharmacy, Eric Wymore, has been at the center of several trades and transfers. Some have kept vaccination clinics from being rescheduled.

Meanwhile, the Skagit Regional Health system received a tray of Pfizer vaccine with 975 doses on Dec. 17, and began vaccinating the next day. By Christmas Eve all of the doses at Skagit Valley Hospital were used. Because additional doses could be extracted from each vial, the hospital managed to vaccinate some 1,200 people.

Since then, the health system of 3,200 total staffers has not received another shipment through the state's ordering process, except for a tray last week to complete the two-dose regimen for those initially vaccinated.

Each week, hospital leaders fill out a survey asking for more supply. Then, they wait to receive a notification if supply will be made available. About 150 employees are scheduled to staff the vaccination clinic.

"We've gone a couple weeks ... with no additional doses," said Brian Ivie, president and chief executive officer of the system. That's frustrated staffers who have agreed to work weekends to administer vaccine, and for employees who are left waiting for their vaccination date.

"The requests are far greater than what the state is receiving from the feds," said Cassie Sauer, the chief executive officer of the Washington State Hospital Association. "For those who need more it's really challenging"

The Skagit system has vaccinated 41% of its staffers and been forced to seek doses from other health systems.

The Snohomish Health District was able to provide 300 doses for the system's Cascade Valley Hospital. Swedish was scheduled to send 500 doses for a vaccination clinic beginning this week at Skagit Valley Hospital.

Ivie said the hospital is hearing from patients who are eager to receive vaccine. He said having a predictable, steady supply will be critical to managing appointments for the public.

"If we don't have that transparency when this process moves to vaccinating the general public, it's going to be quite a guessing game," Ivie said.

Reasons for hope

Federal supply could open up soon.

President-elect Joe Biden announced on Friday his administration would release nearly all vaccine doses, instead of reserving some "booster shots" for a second round.

Arnold, from the Washington State Pharmacy Association, expects the state will soon launch a software tool for vaccine providers called PrepMod. It will streamline screening, scheduling appointments and reporting immunization data.

"We're just going to have a restrained supply for quite some time," Arnold said. "We're all going to need a lot of patience for a lot longer."

Seattle Times reporter Asia Fields contributed to this report.

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(4) comments

Logger Jim

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HeavyHemi

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jbundy48

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americandad

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