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If there is an appointment with the destination, it is marked on Dr. Taison Bell’s calendar.
At noon Tuesday, Bell, an intensive care physician, is scheduled to be one of the first healthcare workers in the University of Virginia Health System to roll up his sleeves for a vaccine to protect himself from the coronavirus.
“This will take a long time to come,” said Bell, 37, who signed up via email from the hospital last week. “The story of this crisis is that each week feels like a year. This is really the first time that there is genuine hope that we can turn this around.”
For now, that hope is limited to a select few. Bell provides direct care to some of the sickest COVID-19 patients at UVA Health hospital in Charlottesville, Virginia. But he is among the 12,000 workers “treating patients” at his hospital who could be eligible for about 3,000 first doses of vaccine, said Dr. Costi Sifri, the hospital’s director of epidemiology.
“We’re trying to find the highest-risk categories, the ones that actually spend a significant amount of time caring for patients,” Sifri said. “It doesn’t take everyone into account.”
Even as the Federal Food and Drug Administration (FDA) was engaged in intense deliberations ahead of Friday’s authorization of the Pfizer and BioNTech COVID vaccine, and days before the initial 6.4 million doses were released, hospitals across the country have been grappling with how to distribute the first meager shots.
An advisory committee to the Centers for Disease Control and Prevention recommended that long-term care facilities and front-line healthcare workers be top priority, but it was always hoped that early allocation would not meet the need and required screening even among critical hospital workers.
Hospitals are generally advised to target the highest-risk members of their workforce, but institutions must decide exactly who it will be, Colin Milligan, a spokesman for the American Hospital Association, said in an email.
“It is clear that hospitals will not receive enough in the first few weeks to vaccinate all of their staff, so decisions had to be made,” wrote Milligan.
At Intermountain Healthcare in Salt Lake City, the first injections will be for staff members “with the highest risk of contact with COVID-positive patients or their waste,” said Dr. Kristin Dascomb, medical director of infection prevention and health. employees. Within that group, managers will determine which caregivers are first in line.
At UW Medicine in Seattle, which includes Harborview Medical Center, an early plan called for high-risk staff to be randomly selected to receive the first doses, said Dr. Shireesha Dhanireddy, medical director of the infectious disease clinic. But the University of Washington hospital system hopes to receive enough doses to vaccinate everyone at that high-risk level in two weeks, so randomization is not necessary, for now.
“We allow people to schedule themselves,” Dhanireddy said, and we encourage staff to get vaccinated near the end of their workweeks in case they have reactions to the new vaccine.
Trial results have shown that injections often produce side effects that, while not debilitating, could cause symptoms such as fever, muscle aches, or fatigue that could keep someone home for a day or two.
“We want to make sure that not everyone gets the vaccine the same day so that if there are any side effects we don’t end up being short-staffed,” said Sifri of UVA Health, noting that the guidelines require no more than 25 % of any unit to be vaccinated at one time.
At UVA Health, once the initial 3,000 doses are distributed, the hospital plans to rely on what Sifri described as “a very strict code of honor” to allow staff members to decide where to line up. They have been asked to consider professional factors, such as the type of work they do, as well as personal risks, such as age or underlying conditions such as diabetes.
“We are going to ask team members, using the honor code, to determine what their COVID risk is and determine if they need to have an early registration time for the vaccine or a later time for the vaccine registration,” said. .
That plan was chosen after members of the health care staff flatly rejected other options. For example, few favored a proposal to assign doses through a lottery, such as the chaotic birthday-based system depicted in the 2011 pandemic horror film “Contagion.” “That was the biggest loser,” he said.
Hospital officials also emphasized that they are trying to devise distribution plans that ensure vaccines are equitably allocated among healthcare workers, including social, racial, and ethnic groups that have been disproportionately harmed by infections by COVID-19. That requires thinking beyond the front-line doctors and nurses.
At UVA Health, for example, one of the first groups invited to get vaccinated will be 17 workers whose job it is to clean rooms in the special pathogens unit where severe cases of COVID are treated.
“We recognize that everyone is at risk of contracting COVID, everyone deserves a vaccine,” Sifri said.
In many cases, it will be clear who should go first. For example, even though Dhanireddy is an infectious disease doctor consulting on COVID cases, she is happy to wait to be vaccinated. “I wouldn’t put myself in the first group at all,” he said. “I think we have to protect our staff who are really there with them most of the day, and that’s not me.”
But hospitals must remain vigilant in relying on workers to prioritize their own access, Dhanireddy warned. “Sometimes self-selection works more for self-defense,” he said. “It’s great that some people say they would give in to others, but sometimes that’s not the case.”
For some healthcare workers, not being the first in line for vaccination is okay. Because the vaccine has initially been licensed for emergency use only, hospitals will not require employees to be vaccinated as part of this first round. Between 70% and 75% of UVA Health and Intermountain Health healthcare staff would accept a COVID vaccine, internal surveys showed. The rest are unsure or unwilling.
“There are some who will accept immediately and others will want to watch and wait,” Dascomb said.
Still, hospital officials say they are confident that those who want the vaccine won’t have to wait long. Doses sufficient for approximately 21 million health care personnel should be available by early January, according to CDC officials.
Bell, the intensive care physician, said he is grateful to be among the first to receive the vaccine, especially after his parents, who live in Boston, contracted COVID-19. He posted about his upcoming appointment on Twitter and said that he and other healthcare workers who are among the first in line should be public about the process.
“We will serve as an example that this is a safe and effective vaccine,” he said. “We’re letting it enter our bodies. You should let it enter yours as well.”
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