Maine health officials are considering changing the state’s guidelines for administering COVID-19 vaccinations amid nationwide complaints that some hospitals are inoculating executives and others not directly involved in patient care.
Although the director of the Maine Center for Disease Control and Prevention, Dr. Nirav Shah, didn’t say what is prompting the change, he said it is aimed at ensuring that people at highest risk of infection are targeted for vaccination.
Shah was asked Monday how the state has been advising hospitals when it comes to the first phase of vaccinations, specifically for the broadly defined category of health care workers.
“There is a bit of a balance there,” he said. “On one hand, we want to provide guidance that is rooted in the epidemiology of COVID, such that those who are at the highest risk of contracting or dying from COVID-19 are the ones who are getting it. But there is also some degree of flexibility that we need to afford.”
Shah said he has heard stories of vaccines being wasted in other states because hospitals worried about being punished for giving doses to people who shouldn’t be at the front of the line. He also referenced a New York Times story published Sunday that detailed examples of “folks in hospitals that were generally low risk who received vaccines.”
“I think we’re going to be making some changes there to be a bit more prescriptive around where we want the vaccine to be going and into whose arms, to really underscore that our concept of operations is that those who are at the highest risk of contracting COVID, spreading COVID or dying from COVID should really be where the vaccines are used,” Shah said. “We’re thinking that through right now and I foresee us making some changes on that in the very near future.”
CDC spokesman Robert Long said in an email Tuesday that he didn’t have any more information about what those changes could mean.
Gov. Janet Mills announced Tuesday evening that she has been reviewing federal immunization guidelines and would be updating Maine’s vaccine distribution in the coming days, giving priority to protecting older residents and those with underlying health conditions. But the governor did not refer to hospitals, and it is not clear whether her pending update will affect hospital vaccination practices.
Until vaccine production and distribution ramps up, states like Maine will continue to receive a limited supply of the two approved vaccines, Pfizer and Moderna. That means the organizations entrusted with the doses will have to make decisions daily.
The first phase of vaccinations under the state’s plan, which covers health care workers (including paramedics and EMTs) and residents and staff of long-term care facilities, involves vaccinating 130,000 people. As of Tuesday, just shy of 40 percent of that total had received at least one dose of vaccine, according to the Maine CDC, although the number is likely higher because there has been a lag in data reported by the pharmacy chains CVS and Walgreens, which are conducting the vaccination clinics for long-term care facilities.
Of the more than 80,000 vaccine doses that have come to Maine so far, about two-thirds have been sent to hospitals.
Hospital administrators said they are willing to work with the state on any changes to guidelines, but also said they are proud of how the vaccination process has gone.
“We consider ourselves to be stewards of the vaccine,” said Dr. John Alexander, chief medical officer for Central Maine Healthcare in Lewiston. “There have been, of course, some challenges with scheduling and queuing employees, but we also have to remind people that there are a lot of different types of healthcare workers.”
He said the first group in the hospital was those immediately and directly involved in COVID patient care. From there, it has been offered to other hospital workers and those in ambulatory settings. Alexander offered the example of vaccinating IT staff who might have to come into hospitals regularly to address any problems.
“Our clinicians rely heavily on medical records being up and running so if that goes down, we would need to call them right away,” he said.
Another thing to consider, Alexander said, is that not every staff member at the hospital wants to be vaccinated right away. He said a survey of staff found that just 55 percent said they would take it immediately, 20 percent said they didn’t want it and 25 percent were on the fence.
Alexander received his first dose last week. He said his work is almost all administrative so he waited until front-line staff and clinicians were vaccinated.
Dr. James Jarvis, COVID-19 incident commander for Northern Light Health, the parent company of Eastern Maine Medical Center, Mercy Hospital and others, agreed that front-line health care workers is a broad category that doesn’t just mean doctors and nurses.
“Our housekeeping staff play just as critical a role as our doctors do right now,” he said.
Jarvis said he fielded a complaint recently from an employee who wanted to know why a young, healthy front desk clerk was vaccinated ahead of others. He explained that the front desk clerk is often the first point of contact for patients who might walk in, some of them unmasked.
“That person is at risk, too,” he said.
Jarvis said he’s heard rumors circulating that Northern Light administrators were among the first to get doses but said that’s not true. He said he received his own vaccine in the second wave after front-line Northern Light staff. He said his contact with patients is limited but he is the operations chief and in the hospital regularly. He also said he has a child who is a cancer survivor and he’s concerned about bringing COVID-19 home.
“That’s a story I share when people ask,” he said. “If there had been an infinite supply, I would have been there Day 1.”
John Porter, a spokesman for MaineHealth, the parent company of Maine Medical Center in Portland, said it has been following CDC guidelines from the beginning.
“At this point in time, vaccinations have been offered to MaineHealth care team members in both direct clinical and support roles,” MaineHealth said in a statement. “This has been done to minimize threats to critical infrastructure, incident command functions and the other support mechanisms required to maintain patient care in our communities, both for severe COVID-19 infections and other critical patient needs.”
MaineHealth also has offered vaccinations to physicians and other providers who are employed elsewhere but who serve on the medical staffs of its hospitals, as well as to those providers’ other clinicians and support staff. This week, MaineHealth has begun to offer vaccinations to other health care workers within the community.
Each state is responsible for administering its own share of vaccines under Operation Warp Speed, the federal government’s vaccine response. Although they are all following U.S. CDC guidelines generally, there are some differences from state to state, according to an analysis published Monday by the Kaiser Family Foundation, a San Francisco-based nonprofit health policy organization.
For instance, Phase 1A includes health care workers and long-term care residents and staff, but some states have added other groups in that phase. Utah includes K-12 and childcare personnel in the first priority group. Louisiana is vaccinating hospital staff in the first phase, but all other health care workers are in Phase 1B. Some states have seniors included in Phase 1A. Massachusetts and New Jersey have included incarcerated individuals in the first phase.
Jennifer Tolbert, director of state health reform for Kaiser, said states have been more likely to diverge in the phases after 1A, and states are taking slightly different approaches to health care workers.
“There is a feeling, and some have explicitly stated this, that we need to get vaccines in people’s arms even if they are not on the priority population,” she said. “Administering all doses is better than adhering to strict guidelines that might result in doses getting tossed at the end of the day.”
In Maine, Phase 1B will target those age 75 or older and essential front-line workers, such as police officers, teachers, grocery store workers, postal clerks, daycare workers and those involved in food/agricultural production. Vaccination of those groups, which comprise roughly 200,000 people, is expected to begin in February, although that schedule hinges on production and distribution. Shah also has said that Maine could reprioritize some within this category.
Shipments from the federal government have been slower than anticipated, although Maine has consistently ranked among the states with the highest vaccination rates in the early weeks of the rollout. Maine had administered four doses for every 100 residents as of Monday, which was the fifth-highest in the country behind South Dakota, North Dakota, West Virginia and Alaska, according to tracking by Bloomberg.
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