Too few for too long, COVID vaccines expected to surge. Is Michigan ready?
With a surge in coronavirus vaccine doses anticipated this month, Michigan public health departments are moving quickly to boost vaccination capacity by adding more vaccination sites, more hours, more nurses and more volunteers.
The state has said repeatedly that it can vaccinate 80,000 or more people a day. But if the 4 million new doses manufacturers have said could come by April materialize, that would mean vaccinating more than 100,000 or more a day.
For Oakland County residents, that could mean a trip to Pine Knob for a large-scale, drive-through clinic, said Kate Guzman, a registered nurse and administrator of medical services for Oakland County. Late Monday, Oakland County learned it would get 6,700 doses this week of the new Johnson & Johnson vaccine — authorized Saturday by the U.S. Food and Drug Administration.
Her department vaccinated 5,300 on Saturday at events in Novi and Southfield and has gotten as many as 50,000 doses a week from the state. Still, Guzman said her department is able to do more.
“We have been waiting for this moment — to have a real impact on our community,” Guzman said.
Lynn Sutfin, spokesperson for the Michigan Department of Health and Human Services, told Bridge Michigan Monday that, because of the limited supply of COVID vaccines to date, the state has not distributed vaccines as robustly as it is capable of doing. She said the state has sent vaccines to just 190 of the roughly 2,500 health departments, pharmacies, doctors offices and others that have enrolled as potential vaccine providers.
Gov. Gretchen Whitmer is expected to address the state’s plan to increase vaccine distribution on Tuesday afternoon.
Across the state, demand for vaccines has greatly outstripped supply — Oakland County has 500,000 people alone waiting for shots.
With the approval Saturday of the Johnson & Johnson vaccine and a pledge from Moderna and Pfizer-BioNTech officials to ramp up production, Michigan soon will have a different problem — putting those shots in arms.
The state said it’s set to get its largest shipments to date from Pfizer and Moderna this week, more than 400,000 doses. It learned Monday it will get an additional 82,700 doses of the one-dose Johnson & Johnson vaccine.
The state has repeatedly said it can vaccinate 80,000 people a day and it hit nearly 79,000 last Thursday. If 4 million doses arrive by April 1, less the nearly 500,000 received this week, that would average out to as many as 800,000 doses a week through then end of the month, which would mean over 100,000 doses a day.
The highest weekly doses the state has given out so far was 335,000 last week.
Despite the expected surge in doses, public health officials across the state, from Grand Rapids and Battle Creek to Detroit and Tawas City along the Lake Huron shore to Delta and Menominee counties in the Upper Peninsula, told Bridge Michigan Monday they are confident that they can schedule and administer the vaccines in far greater quantities. Some are relocating clinics to larger venues; others are eyeing the possibility of shifting to drive-through operations.
The Kent County Health Department can “easily administer significantly more vaccine than what we currently receive,” said Dr. Nirali Bora, the department’s medical director.
“We will ramp up our operation to whatever level is necessary based on supply,” said John Roach, spokesperson for Detroit Mayor Mike Duggan.
In Detroit, there have been reports of a pending mass vaccination site run by the Federal Emergency Management Agency, possibly at Ford Field, home of the Detroit Lions.
New strategies necessary
Still, administering hundreds of thousands of additional doses over the next month won’t be easy.
With more vaccines on the way “you start to thinking about increasing your number of community events, targeting larger community events, doing pop- up (clinics) in neighborhoods,” said Phillip Bergquist, operations officer of the Michigan Primary Care Association, which represents the state’s network of clinics, called Federally Qualified Health Centers, that primarily serve the poor and uninsured.
“You get a whole new set of strategies,” he said.
Beyond drive-through clinics and doctors offices, counties are considering pop-up neighborhood clinics and assistance from the local churches, as well as from local pharmacies.
In Washtenaw County, volunteers and temporary staff have been on standby awaiting more supplies, said Susan Ringler-Cerniglia, the health department spokesperson.
With the promise of more vaccines, the health department will open up a second site to supplement its current work at its clinic at Eastern Michigan University, she said. “Mobile teams” that can travel to seniors centers and churches are likewise at-the-ready, she said.
The county health department is working with the local hospitals and health systems, too, since most health workers have had the opportunity to be vaccinated, she said.
In Delta and Menominee counties in the Upper Peninsula, at least a half-dozen doctors and clinics have registered as vaccine providers. Once more supply arrives, “we’ll be able to pass it to them. They’re ready,” said Mike Snyder, health officer for the two-county health department.
Ringler-Cerniglia, Bergquist, Snyder and others told Bridge they’re undaunted by the mind-boggling logistics in front of them.
Staff, volunteers, funding, space, transportation, scheduling, outreach and of course, supplies — “the art and the science is in making it all come together,” Bergquist said.
He and others say there are ways to make it work.
Amazon-style in planning
If the world can develop vaccines just one year after discovering a brand new virus — “a world’s record in the history of medicine,” it can certainly distribute them, said Dr. Howard Markel, a former pediatrician and director of the University of Michigan's Center for the History of Medicine.
“There are a number of logical problems, but we have wonderful logistics companies here in America, not least of which is called Amazon,” said Markel, who has studied pandemics and whose books include When Germs Travel: Six Major Epidemics That Have Invaded America and the Fears They Have Unleashed.
“If (Amazon) can find me a spatula that — I don’t know — was massaged by the sun in Tuscany and get it to me in 24 hours or less, they could surely help,” he said.
Residents shouldn’t be surprised, he said, when health departments find help with logistics or staffing clinics — the National Guard, which has assisted with COVID testing, or American Red Cross volunteers, for example.
In the northeast lower peninsula, Chris Zimmel came out of retirement to help clinics hosted by the District Health Department No. 2, which covers four counties — Alcona, Iosco, Oscoda and Ogemaw.
The volunteers help older residents seeking vaccines cross parking lots on icy days, push wheelchairs and position walkers, answer questions, point residents from one station to the next, screen them for allergies and medications, sit with them afterward to make sure they have no adverse reactions, then help them return to their vehicles, said Zimmel, 71, a registered nurse.
Before each clinic, maps and paperwork handed to volunteers show each person’s assignment and location. Arrows guide the traffic flow.
All this involves layers of logistics: finding locations that are big enough, accessible and available and working with law enforcement and paramedics. There is equipment to move into place and vaccines to track and store.
“We did 900 (vaccinations) in less than eight hours one day,” Zimmel said, of the staff and volunteers working together. The health department “has been eminently prepared for this.”
But, she said, “it wouldn’t be possible without the volunteers.”
Get shots to primary care physicians’ offices
The state distributed its first vaccines to hospitals and health departments — a logical step since health care workers and first responders were the first to receive them. (Two pharmacy chains, part of national contracts, also received vaccines specifically for nursing homes residents and staff.)
But primary care physicians — family doctors, as some know them — are a trusted source, and their offices and staff are familiar, said Dr. Mustafa 'Mark' Hamed, president of the Michigan Academy of Family Physicians.
Already, primary care physicians give just over half of non-COVID vaccines — about 54 percent, according to the Robert Graham Center, a national advocacy group for primary care physicians.
As the state tries to reach its target of vaccinating 70 percent or more of residents 16 and older against COVID, “literally every percentage counts. You get the most bang for your buck in the (primary care) office with that established, trusted relationship,” Hamed said.
Unlike the Pfizer and Moderna vaccines which must be stored frozen, the new Johnson & Johnson vaccine can be stored in clinic refrigerators, Hamed noted. That will allow smaller doctors offices to store and distribute them.
More weekend clinics
Some Federally Qualified Health Centers and other clinics have already shown they can operate on weekends, offering COVID testing and flu shots. That means the process is largely in place to convert them to mass COVID vaccination sites, so that Michigan’s vaccination efforts don’t falter on Saturdays and Sundays, said Bergquist of the Michigan Primary Care Association.
Michigan is averaging 35,000 vaccines on weekdays, but that number plummets by nearly two-thirds, to just 13,000 vaccinations on Saturdays and Sundays.
State funds and federal funds will help clinics hire staff focused only on vaccines that can operate weekend clinics or pay overtime for existing staff who can help with vaccine efforts, he said.
“Right now, most health centers don't have a large enough allocation to do weekday vaccines. We're doing three or four days right now, and that uses up all of the doses they have,” he said.
Eric Pessell, health officer of the Calhoun County Health Department, said his department could not staff weekends on its own. The solution may be a regional weekend vaccination program if supplies continue to climb, he said.
More doses, same challenges
However vaccines are ramped up, it’s crucial to do so with an eye toward making sure the vaccine reaches the most vulnerable and that distribution is equitable, said Josh Michaud, associate director of global health policy at the Henry F. Kaiser Family Foundation, a health advocacy organization. Michaud has studied the hurdles states face in mass vaccination programs.
Preliminary data shows that white residents in Michigan are getting vaccinated at twice the rate of Black residents of the state. State and local officials have said they are trying to ensure minority populations and the most vulnerable get a fair shot at getting vaccines and Gov. Whitmer created a task force aimed at reducing racial healthcare disparities during the pandemic.
“I am confident that they can do it,” he said. “The question is can you do it with an eye toward equity and rapidity.”
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