Every day, patients at Evergreen Family Clinic in Williston pepper Dr. Paul Reiss with questions about when they’ll be able to get the Covid-19 vaccine.
When and where will they get it? Can they get it at Evergreen?
Reiss’s answers, he admitted sheepishly, feel woefully inadequate. He wants to offer the vaccine to his 10,000 patients, but couldn’t say whether that will happen, or when he will find out.
“We really don’t know much of anything,” Reiss said. “It’s hard to be optimistic or even critical, because we don’t seem to be in the loop. It’s really just a waiting game.”
Doctors and hospital officials say they’re ready and willing to offer vaccines to their patients as the state prepares to roll out the next phase of vaccinations to Vermonters age 75 and over, starting this week.
But they say they remain in the dark about even the most basic components of that process — who’s eligible to administer the vaccine, for instance, and how the state decides. And, for those who will help vaccinate people, how much vaccine they’ll receive and how they should prepare.
Dr. Stephen Leffler, president of University of Vermont Medical Center, said he’s trying to prepare for every possible outcome. His goal? “We want to vaccinate people safely and quickly” — regardless of how many doses show up on the hospital’s doorstep.
The state has administered about 50,000 doses of Covid vaccine since the effort began in mid-December. Hospital CEOs say all eligible health care workers will be vaccinated by the end of the month; the state has also started vaccinations in a majority of elder care facilities.
Starting this coming week, Vermonters 75 and older can sign up to receive their first dose of the vaccine. The state has launched a registration portal and a call center to help residents enroll. Initially, the Department of Health will offer 54 inoculation clinics in 39 towns.
By Feb. 1, Vermont hopes to enlist hospitals and other groups to provide vaccinations on a state or countywide basis. The state issued a request for proposals in early January, and had received 20 applications by last week’s deadline.
Among them: Copley Hospital in Morrisville has teamed up with other local health organizations to vaccinate Lamoille County residents out of the National Guard armory in Hyde Park, said chief medical officer Don Dupuis. The UVM Medical Center has also applied, Leffler said. Neither had heard whether their proposal was accepted.
The lack of clarity has made it difficult to plan, and to predict, so doctors and administrators are trying to prepare for every possible outcome.
“We’re building out a model for what it would look like if we get 8,000 doses a week — what if we get 80,000 one week,” Leffler said. “I’m not saying that will happen, but if it did, we have to build a plan to deal with that. We’re doing our best to do that because we know the path out of this pandemic is getting people vaccinated.”
If the hospital is selected, Leffler said, it will stand up a vaccination site, such as the Champlain Valley Expo, and perhaps have a team to visit elderly Vermonters who can’t drive themselves.
Medical center officials are still deciding how and if they’ll use their 11 affiliated primary care offices; they have to figure out how to deliver doses, and what to do if the practices have unused vaccines at the end of the day. It’s “logistically difficult,” Leffler said.
The Agency of Human Services has said its yearlong contract with the vaccine providers will start on Feb. 1, but whether hospitals and other organizations could launch the clinics isn’t clear.
Hospital officials say they don’t blame the Vermont Department of Health; vaccine doses from the federal government have been notoriously inconsistent. The changing of presidential administrations has led to evolving policies and unpredictable communication.
Even so, “all of us are asking us for, just give me one steady amount a week,” said Dr. Joe Perras, CEO of Mount Ascutney Hospital and Health Center.
In-house vaccine delivery?
Primary care doctors won’t have the option to offer the vaccine to their own patients — at least for the time being, Agency of Human Services Secretary Mike Smith said Friday. He cited “storage requirements and the logistical requirements” as challenges that would preclude vaccinations at smaller shops.
Some primary care doctors say they’d like to give the vaccine to their own patients; they argue that Vermonters are more likely to opt in to vaccination from a doctor they know and trust, rather than from someone they don’t know. They can easily identify the patients with comorbidities that put them at high risk, and can reach out directly to those people and encourage them to get the vaccine, Reiss said.
Lisa Paquette, nurse case manager at White River Family Practice, said she’s fielding questions from patients on both sides of the Vermont-New Hampshire border. It’s tricky, she said.
New Hampshire residents have already started registering for the next stage of vaccination, for people over age 65 or who have two preexisting health conditions. The practice is faxing medical records to the state to verify the underlying conditions for patients.
Meanwhile, Vermont is planning its rollout for residents age 75 and over.
There are other logistics to navigate too. New Hampshire residents who see a primary care doctor in Vermont can get a vaccine in either state. But Vermonters cannot cross the border; New Hampshire has reserved its doses for its own residents.
“We’re trying to keep patients updated and alleviate their anxiety,” Paquette said. But she has no information about where Vermonters can get the vaccine and when, or whether the practice staff can administer it themselves. “We haven’t been given any information at all.”
Messy categories
The process hasn’t been clear cut, as Vermont’s definition of “health care worker” has shifted and evolved.
After the first groups were established, the state started adding workers — optometrists, home angels who visit and help elderly Vermonters at home, ski patrol, and police and firefighters, said Perras, of Mount Ascutney.
When too few workers have shown up to use the vaccine doses, someone will walk through the hospital and try to persuade previously skeptical workers to get the vaccine to avoid wasting doses, he said.
The state sends each hospital a list of workers who are registered with the state; the hospital is responsible for following up with each individual or organization. In some cases, the person has moved or the phone number is out of date. In other cases, the health care worker is only seeing patients remotely and wouldn’t qualify for the first phase of vaccination.
UVM Medical Center staff members check the list with trade associations and professional societies, and call employers, Leffler said. “It’s a huge job; it’s taken a huge amount of time,” he said.
At times, it’s messy. Some mental health workers who see patients remotely told VTDigger they were contacted by the hospital to receive the vaccine. The Howard Center, which provides mental health, substance abuse and disability services, offered all of its patient-facing workers a vaccine, and some people objected because that included teachers at the Baird School, a K-8 school for students with emotional and behavioral challenges.
Teachers in public schools aren’t scheduled to get the vaccine.
That comes with the turf of the country’s largest inoculation effort ever, Leffler said.
“We’ve done our very best to try to make sure that we contacted everybody who the state has told us is included in those groups,” he said. Vaccinating 11,000 people in a month’s time has required flexibility, he said — the next steps will require more of the same.
“I’m proud of how many people we’ve done and I can’t wait to get started on our community,” Leffler said.
