Editor's note: KHN wrote about St. James Parish Hospital in April, when it was experiencing its first surge of covid-19 patients. Ten months later, we checked in to see how the hospital and its staff were faring.
The "heroes work here" sign in front of St. James Parish Hospital has been long gone, along with open intensive care unit beds in the state of Louisiana.
Staffers at the rural hospital spent hours each day in January calling larger hospitals in search of the elusive beds for covid-19 patients. They leveraged personal connections and begged nurses elsewhere to take patients they know are beyond their hospital's care level.
But as patients have waited to be transferred out of the hospital, which is about 45 minutes outside New Orleans, doctors such as Landon Roussel are forced to make unthinkable choices. As recently as Jan. 29, he had to decide between two patients: Which one should get the sole available BiPAP machine to push oxygen into their lungs?
That's like a "war situation, which is not a situation that I want to be in — in the United States," he said.
As the nation's attention shifts to the vaccine rollout, rural hospitals such as St. James Parish Hospital have struggled to handle their communities' sick following the holiday surge of covid patients.
"We knew it was coming. We saw it coming," Mary Ellen Pratt, St. James Parish Hospital's CEO, said by phone. "It really has to happen to their family for them to really go, 'OK, wow.'"
And even though the vaccines have arrived and caseloads continue to improve after the holiday surge, only about 30% of staffers have opted to get their shots. Disparities in the broader community persist: In the initial rollout, only 9% of those vaccinated were Black in a parish — the Louisiana equivalent of a county — that is nearly 49% Black.
Staff members are burned out from months of handling never-ending covid crises.
"They had been giving 150%, and they're just getting really tired," Pratt said. "It's just exhausting."
'Sometimes, Your Best Isn't Enough'
In mid-January, the closest intensive care bed the staff could find was some 600 miles away in Brownsville, Texas — so far that a plane would have been necessary to transport a patient. After three days, a closer bed was found at a Veterans Affairs hospital about 45 miles away.
Staffers have tried Mississippi and Alabama with mixed luck. One patient they tried to transfer four hours away couldn't go because the ambulance didn't have enough oxygen to make it that far. A hospital in Florida even called them looking for ICU beds at St. James Parish Hospital, which has never had any.
More than half of U.S. counties are like St. James Parish and have no intensive care beds, full or empty. Rural hospitals in those communities are designed for step-down care: They often serve as a stopping point to stabilize people before they can be sent to larger hospitals with more specialized staff and equipment.
Across the country, rural residents' mortality rate from covid has been consistently higher than that of urban residents since August, according to the Rural Policy Research Institute Center for Rural Health Policy Analysis. That has occurred even though covid incidence has been lower among rural populations than urban ones since the middle of December, said Fred Ullrich, who runs the health policy department at the University of Iowa's College of Public Health and co-authored the study.
But, he said, rural populations are typically older, sicker and poorer than urban populations. And the nation has lost at least 179 rural hospitals over the past 17 years.
"This crisis is just magnifying existing access issues in a rural context," said Alan Morgan, the head of the National Rural Health Association. "If you don't have a local hospital, that impacts the diagnosis, the initial treatment, the complex treatment. It has multiple impacts, all leading to what we're seeing: higher mortality."
And at the hospitals that remain, such as St. James Parish Hospital, the stress level is palpable, because the level of care needed for such sick patients is higher than what staffers normally handle, said Karley Babin, the hospital's acute nurse manager.
"It's just an uncomfortable spot," she said. "You know you're doing everything you can and that patient just needs more."
That's led to many sleepless nights for Pratt.
"Sometimes your best isn't enough if you don't have the right resources," she said.
'We Know All These People'
Radiology technologist Brooke Michel lives seven minutes from the hospital, where she works with her husband and five other relatives. Her grandfather, grandmother and aunt were hospitalized there in December with covid.
Her family brought folding chairs to sit outside her 83-year-old grandfather's hospital window each day, keeping vigil through the glass on Christmas Eve. He died Jan. 3 while family members stood outside, taking turns looking in and praying.
"It gave us a sense of closure," Michel said. "We were all together. We were with him. We would never have gotten that at a bigger hospital."
Seeing multiple family members hospitalized at the same time is tough on the staff, said Scott Dantonio, the hospital's pharmacy director. "We know all these people," he said.
Dozens of hospital staffers also have battled covid, and three have been hospitalized. A nurse's aide died last summer after contracting it. One staffer, who was particularly close to that aide, now has a hard time treating covid patients, said Rhonda Zeringue, chief nursing officer.
"It's a reminder: 'You took my person,'" she said.
'It's Just Exhausting'
St. James Parish Hospital has been running short-staffed, because they haven't been able to hire more nurses or pay traveling nurses — they're just too expensive. Amid the pandemic, traveling nurses can command more than double what the staff nurses make.
So Babin's kids ask often why she works all the time.
Community praise has died down, she said. People aren't thanking them in grocery stores anymore. One upside? Pratt is happy to have finally lost the "covid 19" — the weight she put on from the community bringing food to the hospital back in the spring.
Pratt and Zeringue have offered staff members counseling, massage sessions, coffee and doughnuts. But it's not enough.
Zeringue said the stress has gone through the staff in waves: First they were scared to death of being the front line in the spring. Now she sees burnout and sheer exhaustion.
The vaccines were supposed to offer hope. But when Pratt heard they would be distributed through CVS and Walgreens, she knew immediately the logistics of getting the ultra-cold Pfizer vaccine from its cooler into residents' arms would fall to them. She said the community has no chain pharmacies nearby and the local health department is overloaded.
"We get an email at, like, 4:30 on Friday which says, 'We're going to send you another 350 vaccines on Wednesday and you have to respond in the next 10 minutes,'" Pratt said. "There's not enough planning or time to do it."
Staff members, who are juggling monoclonal antibody infusions and elective surgeries to deal with the backlog from the spring on top of the surge, must also call members of the community to let them know they have the vaccine available. And then the problems begin.
"People don't answer the phone or they're not available," Dantonio said. "Or they can't come at that time or they scheduled somewhere else."
Most of the people coming in following the hospital's advertising online and on Facebook have been white. So Pratt called on the people she had relied on during the rollout of the Affordable Care Act: Black preachers and well-respected Black local leaders such as Democratic state Rep. Kendricks Brass. After word from the pulpit spread and Brass' team staffed a phone line, the vaccine distribution the next week jumped to 30% Black residents from the prior week's 9%.
Even some among the St. James Parish Hospital staff have been reluctant. Many have told Zeringue they're worried about their fertility. Others just don't want to be first. So the hospital's line of defense has many holes.
And the covid patients keep coming.
"This is a nightmare," said Kassie Roussel, the hospital's marketing director. "It's crazy because it's at the same time we marketed the beginning of the end."
President Joe Biden has an unexpected opening to cut deals with red states to expand Medicaid, raising the prospect that the new administration could extend health protections to millions of uninsured Americans and reach a goal that has eluded Democrats for a decade.
The opportunity emerges as the covid-19 pandemic saps state budgets and strains safety nets. That may help break the Medicaid deadlock in some of the 12 states that have rejected federal funding made available by the Affordable Care Act, health officials, patient advocates and political observers say.
Any breakthrough will require a delicate political balancing act. New Medicaid compromises could leave some states with safety-net programs that, while covering more people, don't insure as many as Democrats would like. Any expansion deals would also need to allow Republican state officials to tell their constituents they didn't simply accept the 2010 health law, often called Obamacare.
"Getting all the remaining states to embrace the Medicaid expansion is not going to happen overnight," said Matt Salo, executive director of the nonpartisan National Association of Medicaid Directors. "But there are significant opportunities for the Biden administration to meet many of them halfway."
Key to these potential compromises will likely be federal signoff on conservative versions of Medicaid expansion, such as limits on who qualifies for the program or more federal funding, which congressional Democrats have proposed in the latest covid relief bill.
But any deals would bring the country closer to fulfilling the promise of the 2010 law, a pillar of Biden's agenda, and begin to reverse Trump administration efforts to weaken public programs, which swelled the ranks of the uninsured.
"A new administration with a focus on coverage can make a difference in how these states proceed," said Cindy Mann, who oversaw Medicaid in the Obama administration and now consults extensively with states at the law firm Manatt, Phelps & Phillips.
Medicaid, the half-century-old health insurance program for the poor and people with disabilities, and the related Children's Health Insurance Program cover more than 70 million Americans, including nearly half the nation's children.
Enrollment surged following enactment of the health law, which provides hundreds of billions of dollars to states to expand eligibility to low-income, working-age adults.
However, enlarging the government safety net has long been anathema to most Republicans, many of whom fear that federal programs will inevitably impose higher costs on states.
And although the GOP's decadelong campaign to "repeal and replace" it has largely collapsed, hostility to the health law remains high among Republican voters.
That makes it perilous for politicians to embrace any part of it, said Republican pollster Bill McInturff, a partner at Public Opinion Strategies. "A lot of Republican state legislators are sitting in core red districts, looking over their shoulders at a primary challenge," he said.
Many conservatives have called instead for federal Medicaid block grants that cap how much federal money goes to states in exchange for giving states more leeway to decide whom they cover and what benefits their programs offer.
Many Democrats and patient advocates fear block grants will restrict access to care. But just before leaving office, the Trump administration gave Tennessee permission to experiment with such an approach.
"It's a frustrating place to be," said Tom Banning, the longtime head of the Texas Academy of Family Physicians, which has labored to persuade the state's Republican leaders to drop their opposition to expanding Medicaid. "Despite covid and despite all the attention on health and disparities, we see almost no movement on this issue."
Some 1.5 million low-income Texans are shut out of Medicaid because the state has resisted expansion, according to estimates by KFF. (KHN is an editorially independent program of KFF.)
An additional 800,000 people are locked out in Florida, which has also blocked expansion.
Two million more are caught in the 10 remaining holdouts: Alabama, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Wisconsin and Wyoming.
Advocates of Medicaid expansion, which is broadly popular with voters, believe they may be able to break through in a handful of these states that allow ballot initiatives, including Mississippi and South Dakota.
Since 2018, voters in Idaho, Nebraska, Utah, Oklahoma and Missouri have backed initiatives to expand Medicaid eligibility, effectively circumventing Republican political leaders.
"The work that we've done around the country shows that no matter where people live — red state or blue state — there is overwhelming support for expanding access to healthcare," said Kelly Hall, policy director of the Fairness Project, a nonprofit advocacy group that has helped organize the Medicaid measures.
But most of the holdout states, including Texas, don't allow citizens to put initiatives on the ballot without legislative approval.
And although Florida has an initiative process, mounting a ballot campaign there is challenging, as political advertising is expensive. Unlike in many states, Florida's leading hospital association hasn't backed expansion.
Another route for expansion: compromises that could win over skeptical Republican state leaders and still get the green light from the Biden administration.
The Obama administration approved conservative Medicaid expansion in Arkansas, which funneled enrollees into the commercial insurance market, and in Indiana, which forced enrollees to pay more for their medical care.
Money is a major focus of current talks in several states, according to health officials, advocates and others involved in efforts across the country.
The health law at first fully funded Medicaid expansion with federal money, but after the first three years, states had to begin paying part of the tab. Now, states must come up with 10% of the cost of expansion.
Even that small share is a challenge for states, many of which are reeling from the economic downturn caused by the pandemic, said David Becker, a health economist at the University of Alabama-Birmingham who has assisted efforts to expand Medicaid in that state.
"The question is: Where do we get the money?" Becker said, noting that some Republicans may be open to expanding Medicaid if the federal government pays the full cost of the expansion, at least for a year or two.
Other efforts to find ways to offset state costs are underway in Kansas and North Carolina, which have Democratic governors whose expansion plans have been blocked by Republican state legislators. Kansas Gov. Laura Kelly this month proposed using money from the sale and taxation of medical marijuana.
Some Democrats in Congress are pushing to revise the health law to provide full federal funding to states that expand Medicaid now. Separately, in the stimulus bill unveiled last week, House Democrats proposed an additional boost in total Medicaid aid to states that expand.
Other Republicans have signaled interest in partly expanding Medicaid, opening the program to people making up to 100% of the federal poverty level, or about $12,900, rather than 138%, or $17,800, as the law stipulated.
The Obama administration rejected this approach, but the idea has gained traction in several states, including Georgia.
It's unclear what kind of compromises the new administration may consider, as Biden has yet to even nominate someone to oversee the Medicaid program.
Some Democrats say it's time to give up the search for middle ground with Republicans on Medicaid.
A better strategy, they say, is a new government insurance plan, or public option, for people in non-expansion states, a strategy Biden endorsed on the campaign trail.
"Democrats can no longer countenance millions of Americans living in poverty without insurance," said Chris Jennings, a Democratic healthcare strategist who worked in the White House under Presidents Bill Clinton and Barack Obama and served on Biden's transition team.
"This is why the Biden public option or other new ways to secure affordable, meaningful care should become the order of the day for people living in states like Florida and Texas."
For people who’ve been without health insurance during the pandemic, relief is in sight.
In January, President Joe Biden signed an executive order to open up the federal health insurance marketplace for three months as of Monday so uninsured people can buy a plan and those who want to change their marketplace coverage can do so.
Consumer advocates applauded the directive. Since 2016, the number of Americans without health insurance has been on the rise, reaching 30 million in 2019. The economic upheaval caused by the novel coronavirus has made a bad situation worse, throwing millions off their insurance plans.
The move is in stark contrast to the Trump administration’s approach. As covid-19 took hold last spring and the economy imploded, health experts pleaded with the Trump administration to open up the federal marketplace so people could buy insurance to protect themselves during the worst public health emergency in a century. The administration declined, noting that people who suddenly found themselves without coverage because they lost their jobs were able to sign up on the marketplace under ordinary rules. They also cited concerns that sick people who had resisted buying insurance before would buy coverage and drive up premiums.
The Biden administration is promising to spend $50 million on outreach and education to get the word out about the new special enrollment period. That’s critical, experts said. Although the number of people signing up for Affordable Care Act plans has generally remained robust, the number of new consumers enrolling in the federal marketplace has dropped every year since 2016, according to KFF, corresponding to funding cuts in marketing and outreach. (KHN is an editorially independent program of KFF.)
“There are a lot of uninsured people who even before covid were eligible for either hefty marketplace subsidies or for Medicaid and not aware of it,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. A marketing blitz can reach a broad swath of people and hopefully draw them in, regardless of whether they’re uninsured because of covid or not, she said.
Here are answers to questions about the new enrollment option.
Q: When can consumers sign up, and in which states?
Most of the states and the District of Columbia that operate their own marketplaces are establishing special enrollment periods similar to the new federal one, though they may have somewhat different time frames or eligibility rules. In Massachusetts, for example, the sign-up window remains open until May 23, while in Connecticut, it closes March 15. Meanwhile, Colorado has reopened enrollment in its marketplace for residents who lack insurance, but anyone already enrolled in one of the state’s marketplace plans won’t be allowed to switch to a different plan based on this special enrollment period.
At this point, only Idaho has not announced plans to open their marketplaces, said Corlette. It may still do so, however.
Q: Can people who lost their jobs and health insurance many months ago sign up during the new enrollment period?
Yes. The enrollment window is open to anyone who is uninsured and would normally be eligible to buy coverage on the exchange (people who are serving prison or jail terms and those who are in the country without legal permission aren’t allowed to enroll).
People with incomes up to 400% of the federal poverty level (about $51,500 for one person or $106,000 for a family of four) are eligible for premium tax credits that may substantially reduce their costs.
Typically, people can buy a marketplace plan only during the annual open enrollment period in the fall or if a major life event gives them another opportunity to sign up, called a special enrollment period. Losing job-based health coverage is one event that creates a special sign-up opportunity; so is getting married or having a baby. But usually people must sign up with the marketplace within 60 days of the event.
With the new special enrollment period, how long someone has been uninsured isn’t relevant, nor do people have to provide documentation that they’ve lost job-based coverage.
“The message is quite simple: Come and apply,” said Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities.
Q: What about people who are already enrolled in a marketplace plan? Can they switch their coverage during this new enrollment period?
Yes, as long as their coverage is through the federal marketplace. If, for example, someone is enrolled in a gold plan now but wants to switch to a cheaper bronze plan with a higher deductible, that’s allowed. As mentioned above, however, some state-operated marketplaces may not make that option available.
Q: Many people have lost significant income during the pandemic. How do they decide whether a marketplace plan with premium subsidies is a better buy for them than Medicaid?
They don’t have to decide. During the application process, the marketplace asks people for income information. If their annual income is below the Medicaid threshold (for many adults in most states, 138% of the federal poverty level, or about $18,000 for an individual), they will be directed to that program for coverage. If people are eligible for Medicaid, they can’t get subsidized coverage on the exchange.
People can sign up for Medicaid anytime; there’s no need to wait for an annual or special enrollment period.
Those already enrolled in a marketplace plan whose income changes should go back into the marketplace and update their income information as soon as possible. They may be eligible for larger premium subsidies for their marketplace plan or, if their income has dropped significantly, for Medicaid. (Likewise, if their income has increased and they don’t adjust their marketplace income estimates, they could be on the hook for overpayments of their subsidies when they file their taxes.)
Q: What about people who signed up under the federal COBRA law to continue their employer coverage after losing their job? Can they drop it and sign up for a marketplace plan?
Yes people in federal marketplace states can take that step, health experts say. Under COBRA, people can be required to pay the full amount of the premium plus a 2% administrative fee. Marketplace coverage is almost certainly cheaper.
Normally, if people have COBRA coverage and they drop it midyear, they can’t sign up for a marketplace plan until the annual fall open enrollment period. But this special enrollment period will give people that option.
Tens of thousands of middle-aged sons and daughters caring for older relatives with serious ailments but too young to qualify for a vaccine themselves are terrified of becoming ill and wondering when they can get protected against the coronavirus.
This article was published on Tuesday, February 16, 2021 in Kaiser Health News.
Robin Davidson entered the lobby of Houston Methodist Hospital, where her 89-year-old father, Joe, was being treated for a flare-up of congestive heart failure.
Before her stretched a line of people waiting to get covid-19 vaccines. "It was agonizing to know that I couldn't get in that line," said Davidson, 50, who is devoted to her father and usually cares for him full time. "If I get sick, what would happen to him?"
Tens of thousands of middle-aged sons and daughters caring for older relatives with serious ailments but too young to qualify for a vaccine themselves are similarly terrified of becoming ill and wondering when they can get protected against the coronavirus.
Like aides and other workers in nursing homes, these family caregivers routinely administer medications, monitor blood pressure, cook, clean and help relatives wash, get dressed and use the toilet, among many other responsibilities. But they do so in apartments and houses, not in long-term care institutions — and they're not paid.
"In all but name, they're essential healthcare workers, taking care of patients who are very sick, many of whom are completely reliant upon them, some of whom are dying," said Katherine Ornstein, a caregiving expert and associate professor of geriatrics and palliative medicine at Mount Sinai's medical school in New York City. "Yet, we don't recognize or support them as such, and that's a tragedy."
The distinction is critically important because healthcare workers have been prioritized to get covid vaccines, along with vulnerable older adults in nursing homes and assisted living facilities. But family members caring for equally vulnerable seniors living in the community are grouped with the general population in most states and may not get vaccines for months.
The exception: Older caregivers can qualify for vaccines by virtue of their age as states approve vaccines for adults ages 65, 70 or 75 and above. A few states have moved family caregivers into phase 1a of their vaccine rollouts, the top priority tier. Notably, South Carolina has done so for families caring for medically fragile children, and Illinois has given that designation to families caring for relatives of all ages with significant disabilities.
Arizona is also trying to accommodate caregivers who accompany older residents to vaccination sites, Dr. Cara Christ, director of the state's Department of Health Services, said Monday during a Zoom briefing for President Joe Biden. Comprehensive data about which states are granting priority status to family caregivers is not available.
Meanwhile, the Department of Veterans Affairs recently announced plans to offer vaccines to people participating in its Program of Comprehensive Assistance for Family Caregivers. That initiative gives financial stipends to family members caring for veterans with serious injuries; 21,612 veterans are enrolled, including 2,310 age 65 or older, according to the VA. Family members can be vaccinated when the veterans they look after become eligible, a spokesperson said.
"The current pandemic has amplified the importance of our caregivers whom we recognize as valuable members of Veterans' healthcare teams," Dr. Richard Stone, VA acting undersecretary for health, said in the announcement.
An estimated 53 million Americans are caregivers, according to a 2020 report. Nearly one-third spend 21 hours or more each week helping older adults and people with disabilities with personal care, household tasks and nursing-style care (giving injections, tending wounds, administering oxygen and more). An estimated 40% are providing high-intensity care, a measure of complicated, time-consuming caregiving demands.
This is the group that should be getting vaccines, not caregivers who live at a distance or who don't provide direct, hands-on care, said Carol Levine, a senior fellow and former director of the Families and Healthcare Project at the United Hospital Fund in New York City.
Rosanne Corcoran, 53, is among them. Her 92-year-old mother, Rose, who has advanced dementia, lives with Corcoran and her family in Collegeville, Pennsylvania, on the second floor of their house. She hasn't come down the stairs in three years.
"I wouldn't be able to take her somewhere to get the vaccine. She doesn't have any stamina," said Corcoran, who arranges for doctors to make house calls when her mother needs attention. When she called their medical practice recently, an administrator said they didn't have access to the vaccines.
Corcoran said she "does everything for her mother," including bathing her, dressing her, feeding her, giving her medications, monitoring her medical needs and responding to her emotional needs. Before the pandemic, a companion came for five hours a day, offering some relief. But last March, Corcoran let the companion go and took on all her mother's care herself.
Corcoran wishes she could get a vaccination sooner, rather than later. "If I got sick, God forbid, my mother would wind up in a nursing home," she said. "The thought of my mother having to leave here, where she knows she's safe and loved, and go to a place like that makes me sick to my stomach."
Although covid cases are dropping in nursing homes and assisted living facilities as residents and staff members receive vaccines, 36% of deaths during the pandemic have occurred in these settings.
Maggie Ornstein, 42, a caregiving expert who teaches at Sarah Lawrence College, has provided intensive care to her mother, Janet, since Janet experienced a devastating brain aneurism at age 49. For the past 20 years, her mother has lived with Ornstein and her family in Queens, New York.
In a recent opinion piece, Ornstein urged New York officials to recognize family caregivers' contributions and reclassify them as essential workers. "We're used to being abandoned by a system that should be helping us and our loved ones," she told me in a phone conversation. "But the utter neglect of us during this pandemic — it's shocking."
Ornstein estimated that if even a quarter of New York's 2.5 million family caregivers became ill with covid and unable to carry on, the state's nursing homes would be overwhelmed by applications from desperate families. "We don't have the infrastructure for this, and yet we're pretending this problem just doesn't exist," she said.
In Tomball, Texas, Robin Davidson's father was independent before the pandemic, but he began declining as he stopped going out and became more sedentary. For almost a year, Davidson has driven every day to his 11-acre ranch, 5 miles from where she lives, and spent hours tending to him and the property's upkeep.
"Every day, when I would come in, I would wonder, was I careful enough [to avoid the virus]? Could I have picked something up at the store or getting gas? Am I going to be the reason that he dies? My constant proximity to him and my care for him is terrifying," she said.
Since her father's hospitalization, Davidson's goal is to stabilize him so he can enroll in a clinical trial for congestive heart failure. Medications for that condition no longer work for him, and fluid retention has become a major issue. He's now home on the ranch after spending more than a week in the hospital and he's gotten two doses of vaccine — "an indescribable relief," Davidson said.
Out of the blue, she got a text from the Harris County health department earlier this month, after putting herself on a vaccine waitlist. Vaccines were available, it read, and she quickly signed up and got a shot. Davidson ended up being eligible because she has two chronic medical conditions that raise her risk of covid; Harris County doesn't officially recognize family caregivers in its vaccine allocation plan, a spokesperson said.
Many health officials find their mission complicated by a pervasive mistrust of government and law enforcement among unauthorized immigrants, a population estimated at 11 million across the U.S.
This article was published on Tuesday, February 16, 2021 in Kaiser Health News.
In eastern Tennessee, doctors have seen firsthand how a hard-line immigration policy can affect the health and well-being of a community.
In 2018, federal agents raided a meatpacking plant in Morristown, a manufacturing hub in the Tennessee Valley, and detained nearly 100 workers they suspected of being in the country illegally. In the weeks that followed, scores of immigrant families who had found work in the meat-processing plants dotting broader Hamblen County scrambled to find sanctuary in churches — and scrupulously avoided seeking medical care.
The reason? Immigration agents were staking out clinics.
"We did not want people to come in for care because there were ICE officers in our parking lot," said Parinda Khatri, chief clinical officer at Cherokee Health Systems, a nonprofit provider in Hamblen County.
As Tennessee, like other states, embarks on the daunting task of inoculating millions of residents against covid-19, many health officials find their mission complicated by a pervasive mistrust of government and law enforcement among unauthorized immigrants, a population estimated at 11 million across the U.S.
The challenges are particularly acute in the South, where large populations of immigrants living there illegally help maintain the region's thriving agricultural and food-processing industries even as many state and local Republican leaders, emboldened by the Trump administration's four years of anti-immigrant vitriol, denounce unauthorized residents as criminals and call for more limited paths to citizenship.
The confluence of those aggressive attitudes and a highly contagious virus has prompted concerns in some states that lackluster vaccination of people in the country without legal permission will short-circuit efforts to achieve herd immunity for the broader community.
"We will never get on top of this pandemic if the undocumented are left out," said Dr. Sharon Davis, chief medical officer at Los Barrios Unidos Community Clinic in Dallas, which serves 28,000 patients, the majority of them in the country without authorization.
She acknowledged the challenge that poses in a state such as Texas, where the state Republican Party platform calls for the immediate expulsion of all "illegal aliens." Echoing clinic directors in many Southern states, Davis said rolling out vaccination plans in immigrant communities is a "don't ask, don't tell" policy.
"We live in Texas, so you don't bring it up. You don't mention it," she said. "We talk about the uninsured, and we talk about the Latinx population with the highest morbidity and mortality — that's who we're trying to serve."
In the Dallas-Fort Worth area, home to one of the nation's largest populations of unauthorized immigrants, the covid death rate for middle-aged Latino men is eight times higher than for their non-Latino white counterparts.
Epidemiologists say the disparity is not surprising, given vast numbers of Central and South American workers in the country illegally are doing jobs deemed essential in the pandemic, including farm labor, meat-processing and food service, and most have no health insurance.
Compounding the risks, many of these workers labor in conditions ripe for viral spread, standing shoulder to shoulder along conveyor belts in vegetable-packing houses, washing dishes in restaurant kitchens, stocking grocery shelves and cleaning hotel rooms. At day's end, many return to bunkhouses or cramped homes housing multiple generations of family.
"It's going through the whole house, and if the whole house doesn't work, they don't eat," Davis said. "We've had patients begging us not to test them, because then they can't go to work."
Davis was among the medical directors who said the mass vaccination sites many states are using in the rollout — giant tents staffed by uniformed National Guard troops and iPad-toting medical personnel — have spooked immigrant families.
"They are asking, 'What documentation do we have to show at the mass vaccination sites?'" said Davis. "Fear of deportation is just huge, and very real."
And not unfounded, advocates noted, coming off four years in which former President Donald Trump sharply curtailed both legal and illegal immigration through mass detention and deportation, travel bans and severely restricting asylum. President Joe Biden has pledged to undo many of Trump's policies, but immigrant advocates say support for more drastic measures runs strong among some immigration agents and local law enforcement officers, who could make life difficult for immigrants they suspect are in the country illegally.
Beyond fear of harassment or arrest, Davis said, public health officials are dealing with misinformation, including widespread rumors about government surveillance efforts secreted in the vaccine. "They are hearing horrible stories on social media," she said. "They believed there was a microchip in the vaccine and they would be tracked."
Even some immigrants living in the U.S. legally have reservations about receiving a government-provided vaccine. The Trump administration pushed to derail citizenship for any immigrant who used taxpayer-funded public services, including healthcare. In December, the Department of Justice withdrew the rule, but confusion abounds, and clinic directors say patients will prioritize their green cards above almost all else.
Sluggish vaccination rates among immigrant populations are already apparent. In Mississippi, for example, the Department of Health reported last week that fewer than 2,800 Latinos have been vaccinated — about 1% of all vaccinations administered so far.
Tennessee offers a prime example of the tensions underlying the vaccine rollout.
The Republican governor, Bill Lee, made headlines in May when he allowed the state Department of Health to share the names and addresses of those who tested positive for the virus with police. The city of Nashville's health department separately provided local police with the addresses of people who tested positive or were quarantining.
Both efforts came under criticism and eventually ended, but Lee defended the effort, saying the information was "appropriate to protect the lives of law enforcement" and permitted by federal health privacy laws. The city later sought to reassure its "diverse immigrant communities" that the information would not be shared with federal immigration authorities.
Alabama, like Tennessee, has a history of tough rules regarding immigration, including a sweeping 2011 law that bars unauthorized immigrants from receiving nearly all public benefits, including most nonemergency medical care.
Velvet Luna, a 26-year-old registered nurse, has built her life in Ozark, Alabama, a small city in the Wiregrass, a region known for its poultry-processing facilities and large populations of Hispanic and Vietnamese immigrants. Luna enrolled in Deferred Action for Childhood Arrivals, or DACA, an Obama-era program that granted temporary status to unauthorized immigrants brought across the border as children. According to the National Immigration Law Center, nearly 500,000 DACA-eligible immigrants are essential workers.
Luna, who speaks with a soft Southern accent, once freely shared her immigration status, she said, but in recent years men who flirted with her "would find out my status and they would immediately change their attitude toward me. They would say ugly, ugly, hurtful things. 'You are the reason our country is declining. You need to get out of here.'"
As a nurse at an area hospital who volunteered in the covid unit, she has received both doses of vaccine, but she understands the risks undocumented families weigh; neither of her parents, who live close by, are authorized to be in the U.S. "It's OK to be scared, and it's a courageous move to go get the vaccine and protect your family," she said.
Even hard-line immigration opponents acknowledge the pandemic has tied together the fates of everyone living in the U.S., regardless of how they arrived.
"The main thing is to get shots into as many people's arms as possible," said Mark Krikorian, executive director of the Center for Immigration Studies, a conservative think tank that strenuously advocates for restricting immigration. "Your immigration may catch up with you someday, but that's not today."
The Biden administration has said U.S. Immigration and Customs Enforcement will not conduct enforcement operations at or near vaccine distribution sites. "ICE does not and will not carry out enforcement operations at or near healthcare facilities, such as hospitals, doctors' offices, accredited health clinics, and emergent or urgent care facilities, except in the most extraordinary of circumstances," according to a Feb. 1 statement issued by the Department of Homeland Security.
State health commissioners also have tried to calm rattled nerves. "We are not denying vaccine to anyone who shows up at our sites and is in a phase," said Dr. Lisa Piercey, commissioner of the Tennessee Department of Health. "This is a federal resource, and if you're in this country, then you get a vaccine."
Advocates, however, said hurdles remain in convincing wary emigres that the personnel information collected as part of the vaccination process will not be used against them. The Centers for Disease Control and Prevention expects providers administering covid vaccines to upload patient information to state registries, including TennISS in Tennessee or ImmTrac2 in Texas. The tracking systems allow providers to ensure patients return for their second dose, and to identify any adverse reactions.
The use of such information for health initiatives, not immigration crackdowns, is a nuance that providers struggle to explain.
"Patients, particularly those of immigrant origin, are highly sensitive to sharing family details," Brian Haile, executive director of Neighborhood Health, a community clinic in Nashville, wrote to Tennessee health officials in December. "If we ask them to provide this information to providers they do not know, they will be even more reticent to have their families get vaccinated."
In Hamblen County, Khatri said she's trying to persuade those laboring on tomato and tobacco farms and in meat-processing plants — hot zones of coronavirus outbreaks — to trust her clinic not only to administer the vaccine but also to handle sensitive data.
"They want to go to a trusted group," said Khatri, whose clinics have received approval to distribute the vaccine but have not yet received any doses.
Helena Lobo, who coordinates Hispanic outreach at Cherokee Health, echoed that, saying, for some immigrants, the choice may come down to choosing their health or choosing to remain hidden.
"If they have to risk their immigration status to have the covid vaccine, they will not have it. I don't blame them," said Lobo. "They go by risk: 'What is my biggest risk? Being deported or to have covid?'"
As the state vaccination plan moves past long-term care facilities and on to the next group, deploying mobile units will help prevent eligible people in small facilities from being left behind.
This article was published on Tuesday, February 16, 2021 in Kaiser Health News.
ANTIOCH, Calif. — A mobile "strike team" is bringing vaccines to some of Northern California's most vulnerable residents along with a message: This is how you avoid dying from covid-19.
So far, that message has been met with both nervous acceptance and outbursts of joy from a population that has been ravaged by the disease. One 68-year-old pastor, who lives in a racially diverse, low-income senior housing complex, rolled down his sleeve after his shot and said he wants to live to see 70 — just to spite the government.
The team of county nurses and nonprofit workers is targeting Contra Costa County residents who are eligible for covid vaccines but have been left out: residents of small assisted-living facilities that haven't yet been visited by CVS or Walgreens, and occasionally people who live in low-income senior housing. The retail pharmacy giants have a federal government contract to administer vaccines in most long-term care facilities.
Launched a few weeks ago, the strike team moves through each vaccination clinic with practiced choreography. At a small group home in Antioch recently, a nurse filled syringes while another person readied vaccine cards and laid them on a table. An administrative assistant — hired specifically for these clinics — checked everyone's paperwork and screened them for symptoms and allergies before their shots, logging them into the state's database afterward. After the shots, a strike team member told each person when their 15 minutes of observation was up.
In a little over an hour, 14 people had a shot in their arm, a card in their hand and their data in the system. Nurses wiped down the chairs and tables and packed up supplies.
As the state vaccination plan moves past long-term care facilities and on to the next group, deploying mobile units will help prevent eligible people in small facilities from being left behind, said Dr. Mike Wasserman, past president of the California Association of Long Term Care Medicine.
"The assisted living side has been our greatest tragedy," Wasserman said. "It's February. We're vaccinating others already and we haven't finished vaccinating those who need it most."
California is in the midst of transferring primary control of vaccine distribution from local public health departments to Blue Shield of California. The agreement between the state and the insurance company includes incentives for vaccinating underserved and minority populations, and like Contra Costa, Los Angeles, Kern and other counties are creating mobile clinics to reach vulnerable residents.
But as efficiently as these clinics can run, it's still slow going to vaccinate a few people at a time in a state that has lost more than 44,500 people to covid.
Small long-term care facilities, usually with no more than six beds, are the strike team's main target. These "six-beds" are a major source of residential care for older Californians, as well as others who need care and supervision but don't want to live in nursing homes. Of almost 310,000 long-term care beds in California, about one-third are in nursing homes, according to Nicole Howell, executive director for Ombudsman Services of Contra Costa, Solano and Alameda counties. Two-thirds are in some form of assisted living, mostly six-beds.
These homes are typically in residential areas, with little to distinguish them from other houses on a suburban block. They're small businesses, often owned by families, that offer a "social" model of care, not a medical one. There is no doctor or director of nursing on staff.
Long-term care residents were in line to be vaccinated right after front-line health workers, starting in nursing homes. Theoretically, residents of small facilities like six-beds should get their shots from the same federal program vaccinating most nursing homes, which is administered through CVS and Walgreens.
But it's difficult to coordinate with these homes because there are so many, Howell explained, and they often have fewer resources and minimal IT infrastructure. Because these aren't large corporate chains or 500-bed facilities with everyone's medical records on hand, it takes time and local knowledge to reach them all, she said.
Catherine Harris, 72, gets her first dose of covid vaccine in the community room of a low-income senior housing complex in Richmond, California. She got her shot from a mobile vaccine team that visits Contra Costa County's vulnerable residents. (Rachel Bluth/KHN)
CVS and Walgreens said they have administered first and second doses to nearly all nursing home residents in the state and have started on assisted living communities. They said they do not have breakdowns of which kinds of assisted living facilities they have visited, but CVS Health spokesperson Joe Goode noted that the pharmacy has completed the first round of doses at nearly 80% of participating assisted living facilities, with hundreds more clinics scheduled.
The state has largely left it up to facilities to call the pharmacies to schedule clinics, though many did not know it was their responsibility until late January, according to Mike Dark, a lawyer with California Advocates for Nursing Home Reform. He had been fielding calls for weeks from families who were told that, if they wanted to get their loved ones in six-bed homes vaccinated, they needed to figure it out themselves, he said.
"Smaller assisted living facilities, the ones least equipped to deal with this virus, still house people with significant impairment and needs," Dark said. "It's been a scandal, really, how poorly this process has been going."
The residents at Above All Care, a six-bed in Orange County, finally got their first shots on Feb. 4, according to owner Nicolas Oudinot. But that came after weeks of confusion and silence.
"From November to mid-January, I had no information," Oudinot said. "I went from nothing to getting a call every day. They tried to schedule the same facility two or three times."
In late December, when it became clear that many long-term care facilities wouldn't get clinics scheduled for months, Contra Costa County decided the federal program needed to be supplemented with local resources, said Dr. Chris Farnitano, the county health officer.
"This is where we're seeing the most dying happening," Farnitano said. "These are the most vulnerable people. We've got to protect them sooner."
The mobile vaccine strike team emerged from a collaboration among the county, local home health agencies, advocates for long-term care residents and nonprofit groups. It was created without additional public funding when Choice in Aging, a local nonprofit that provides community-based support to older residents, paid its own administrative workers to staff the clinics alongside county public health nurses.
The team of five or six people heads out several days a week, hauling rolling carts packed with syringes, bandages and a special vaccine cooler. The team might spend one day vaccinating 100 people in six-bed and other small facilities for older people or those with disabilities. The next, it might visit 50 seniors and their caregivers gathered from a few low-income apartments.
The vaccines are treated like a precious resource. Nothing goes to waste and there's a list of caregivers on standby if the team finds itself with extra shots. Nurses say they can almost always squeeze a sixth dose of what they call "liquid gold" out of the vials, intended to contain five.
When defrosted vials aren't in the cooler, they're carried gingerly, sandwiched between two egg cartons so they don't tip or break. Often, the team's biggest problem is running too far ahead of schedule.
Its efforts seem to be working: 810 people in 50 facilities had been vaccinated as of Tuesday.
Choice in Aging CEO Debbie Toth said she originally got into this line of work to give people a choice of where to spend their last years. But the pandemic has given her work new urgency: saving lives.
"These are people who would die" if they got covid, she said. "We have an opportunity to make sure they don't. That's our north star."
California Healthline correspondent Angela Hart contributed to this report.
Internal Revenue Service filings from thousands of nonprofit hospitals show they sent $2.7 billion in bills over a year to patients who probably qualified for free or discounted care.
This article was published on Monday, February 15, 2021 in Kaiser Health News.
Jared Walker, who runs a nonprofit that helps people pay medical bills, posted a TikTok video explaining the recipe to “crush” hospital bills via charity care policies.
“What that means is that if you make under a certain amount of money, the hospital legally has to forgive your medical bills,” Walker said in the video.
The video has been viewed more than 10 million times. Walker’s organization, Dollar For, had already helped wipe out millions in medical bills before he posted that video.
Internal Revenue Service filings from thousands of nonprofit hospitals show they sent $2.7 billion in bills over a year to patients who probably qualified for free or discounted care.
That number is more likely a floor than a ceiling, experts said.
The strategy Walker espouses won’t work for all bills, but it could help address some of those billions — and is a good place to start.
A tweet circulating on social media claims vaccine shortages wouldn't exist if Pfizer and Moderna shared "their vaccine design with dozens of other pharma companies who stand ready to produce their vaccines and end the pandemic."
This article was published on Monday, February 15, 2021 in Kaiser Health News. This story was produced in partnership with PolitiFact.
Vaccine makers Pfizer and Moderna earned praise for creating highly effective covid-19 vaccines in record time. But are they inadvertently hurting the public by not sharing their technology with other pharmaceutical companies to help speed up vaccine manufacturing and distribution?
That’s what one post circulating on social media claims.
“The vaccine shortage doesn’t need to exist,” reads an image of a tweet shared thousands of times on Facebook. “Pfizer and Moderna could share their design with dozens of other pharma companies who stand ready to produce their vaccines and end the pandemic.”
In short, the situation is not that simple. The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about PolitiFact’s partnership with Facebook.)
The tweet doesn’t mention that the two drugmakers are already partnering with other companies to produce the vaccine. It also makes it appear as if dozens of companies are regulated to make vaccines and have a ready supply of the raw materials, equipment and storage needed to efficiently and effectively produce them. Experts say that’s not the case.
When PolitiFact reached out to the tweet’s author, Dr. James Hamblin, a public health policy lecturer at Yale University and writer at The Atlantic, he acknowledged that using the words “stand ready” in the tweet inaccurately implied the process could begin immediately.
“It takes time and investment to begin making mRNA vaccines,” Hamblin told PolitiFact. “The companies would need the assurance that they not lose money by getting into that space, possibly in some way similar to the assurances given during the research phase of warp speed.”
Vaccine Technology Narrows the Field
Both Pfizer and Moderna’s vaccines rely on newer messenger RNA technology. (It has been studied for some time but hasn’t been used in a vaccine until now.) The mRNA is fragile and needs to be handled carefully, with specific temperatures and humidity levels to keep it from breaking down.
It’s highly unlikely, experts say, that “dozens” of manufacturing plants have the capability to get this type of production off the ground immediately. Even if Pfizer-BioNTech and Moderna made their vaccine designs open source today, pharmaceutical researchers estimate, it would still take several months for other companies to produce the shots, and by then mass distribution and inoculation will be well underway.
PolitiFact reached out to both companies for comment but did not hear back.
Dr. Rajeev Venkayya, president of the Global Vaccine Business Unit at Takeda Pharmaceuticals and former director of vaccine delivery at the Bill & Melinda Gates Foundation’s Global Health Program, wrote a Twitter thread addressing the complexity and risk of vaccine manufacturing.
Among many other issues, Venyakka said, vaccines are complex biologics and it’s hard to predict whether changes to the manufacturing process will affect the vaccines’ effectiveness or safety.
“Many vaccines are made by growing viruses in cells, and when that doesn’t happen as expected, it can lead to losses in production and delayed timelines. This is an area where cell- and virus-free mRNA vaccine production has a major advantage,” Venkayya wrote.
“For these reasons, every aspect of vaccine manufacturing is tightly controlled: raw materials, equipment, production processes, training, operating procedures etc. All of it happens under GMP [good manufacturing practice] regulations, and facilities are regularly inspected.”
According to the Food and Drug Administration, manufacturers may share any information or data about their products they choose, as they are the owners of the information. But the company is responsible for ensuring that any contract manufacturer is in compliance with the FDA’s good manufacturing practice regulations.
These rules establish minimum requirements for the methods, facilities and controls used in making and packing pharmaceuticals. They aim to ensure that a product is safe for use and that it has the ingredients and strength it claims to have.
Existing Partnerships Are Already Speeding Production
John Grabenstein, associate director for scientific communications at the Immunization Action Coalition, a vaccine information organization that works in partnership with the Centers for Disease Control and Prevention, told PolitiFact the tweet wrongly presumes that the companies aren’t already outsourcing production. Grabenstein tracks partnerships between pharmaceutical companies and contract manufacturers.
He said Pfizer-BioNTech is working with biopharmaceutical companies Rentschler and Polymun, while Moderna has partnered with Rovi, Recipharm and Lonza. Some of the companies are located exclusively overseas, while others have plants in the U.S.
Typically, the contractors are doing one of the major portions of production, Grabenstein said, such as manufacturing the bulk product, formulation of the bulk into the final preparation, filling the drug product into vials, or finishing the final packaging, which could include labeling vials, inserting them and paperwork into boxes, and assembling boxes for a carton.
For example, Rovi, one of the companies working with Moderna, signed a contract in July to start filling and packaging 100 million doses of the vaccine in early 2021.
In fewer cases, a full-fledged manufacturer is commissioned to make a mirror image of the original product, from start to finish.
One example of this is the Serum Institute of India — the world’s largest vaccine manufacturer — which is already producing a parallel version of the Oxford-AstraZeneca vaccine that the institute will market with the trade name CoviShield. The institute launched the construction of new facilities in June to make that happen. The organization recently announced a similar partnership with Novavax.
“This is incredibly intricate and the number of facilities and trained personnel is really, really small,” Grabenstein said. “It’s not like you’re just giving a recipe to another restaurant. That ‘recipe’ is thousands and thousands of pages long, and then you have to validate and show that you meet all the really tight performance specifications and prove consistency of process before any of the regulators will let you distribute any of the vaccine.”
Hamblin, the author of the Twitter post, said it’s unlikely the companies would share their vaccine designs, given the current system of intellectual property and funding, though he noted exceptions, like Sanofi.
Sanofi, a French multinational pharmaceutical company, announced in January that it had entered into a partnership with BioNTech, the company that co-developed the vaccine with Pfizer. Sanofi said it will provide the company access to its “established infrastructure and expertise to produce over 125 million doses of COVID-19 vaccine in Europe.” Initial supplies will originate from Sanofi’s production facilities in Frankfurt, Germany, this summer.
Hamblin noted that if vaccine makers open the intellectual property in a permanent, unconditional way — rather than on a small scale for a finite period — it could help get more companies and governments into the production “in a more permanent, cost-effective way.”
“If we have to manufacture boosters in specific areas for new strains, for example, or for the next coronavirus, we could be on it right away,” Hamblin said. “Again, speaking hypothetically about that — not implying it will happen or would be quick or easy or anything else.”
Defense Production Act Allows Greater Collaboration But Takes Time
With President Joe Biden invoking the Defense Production Act, couldn’t that serve to help speed things up? Yes, but the law is not as sweeping as some think.
The Defense Production Act of 1950 gives presidential authority to promote national defense by expediting and expanding the supply of materials and services from the U.S. industrial base.
Dr. George Siber, a vaccine expert on the advisory board of CureVac, a German mRNA vaccine company, told KHN that invoking the act would allow the government to commandeer an appropriate plant to expand production, but that it would still take about a year to get going.
Companies would first have to undertake a thorough cleaning of their equipment and facilities to prevent cross-contamination and would need to set up, calibrate and test equipment, and train scientists and engineers to run it, Siber told KHN.
“Do you want glass? Aluminum? Filter resins? What is the thing that you need?” Grabenstein said. “For example, vaccine manufacturers say, ‘If only I had more glass vials, I could increase my weekly production.’ OK, the government gets you more glass vials. Then it reveals the next bottleneck.”
He added: “Is there production that could be stopped or delayed, and let those machines be used for this goal? Sure, but you still have to clean it, and quality-control that it’s really clean, and then the transfer and validation of process. It’s months or years of commitment. This is not turn-on-a-dime kind of stuff.”
According to the CDC, nearly 66 million doses of the Moderna and Pfizer-BioNTech vaccines had been distributed and roughly 45 million administered by the second week in February.
A post claims the covid-19 vaccine shortage doesn’t need to exist because Pfizer and Moderna can share their vaccine designs with “dozens” of other pharmaceutical companies that are ready to produce the vaccines and end the pandemic.
This premise oversimplifies the vaccine manufacturing process.
First, the post doesn’t mention that Pfizer-BioNTech and Moderna already have partnerships with various contract manufacturers to help speed up vaccine production. Second, industry experts say it’s highly unlikely “dozens” of pharmaceutical companies that aren’t already producing the vaccines stand ready to do so. Supplies, personnel training and facility compliance are just a few aspects that make the process complex and lengthy.
So, while such partnerships are clearly an asset to rapid vaccine production, they are not entirely practical in the grand sense that this tweet implies.
The statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.
Tweeters lit up KHN's timeline in recent days with valentine messages about topics ranging from covid-19 vaccines and mask-wearing to the price of healthcare.
This article was published on Friday, February 12, 2021 in Kaiser Health News.
Nothing warms our hearts like a few good Health Policy Valentines ― especially those that are sweet on KHN. Tweeters lit up our timeline in recent days with valentine messages about topics ranging from covid-19 vaccines and mask-wearing to the price of health care. Here are some of our favorites.
In honor of Valentine’s Day, the panelists on the latest episode of KHN’s “What the Health?” chose their favorite #healthpolicyvalentines from Twitter.
❤
Just like Medicaid I won't terminate your eligibility with me until the end of the PHE. #HealthPolicyValentines
Some savvy readers report no problem getting in line for the vaccine, but others say that balky application processes and lack of information have stymied their efforts.
This article was published on Friday, February 12, 2021 in Kaiser Health News.
Too little covid vaccine and too great a demand: That’s what KHN readers from around the country detail in their often exasperating quest to snag a shot, although they are often clearly eligible under their local guidelines and priority system. Public health officials say the supply is growing and will meet demand in several months, but, for now, readers’ experiences show how access is limited. Some savvy readers report no problem getting in line for the vaccine, but others say that balky application processes and lack of information have stymied their efforts. Their unedited reports are a good snapshot of the mixed situation around the country.
TALE OF THE DAY — Feb. 12 —
I’m 65 and eligible for the vaccine. But I belong to an independent medical group, and many of the big vaccinators here are big medical groups. When I call my doctor, he tells me that they are waiting for a clinic, that he has no vaccine. The touted “mass vaccination site” at Cal Expo is barely used. When I hear there’s vaccine available at various hospitals, pharmacies and clinics, when I log on there are no appointments available. It’s vaccine for the privileged and members of the big medical groups. Everyone else loses out.— 65-year-oldSacramento, California
— Feb. 12 —
I am trying to get my 86-year-old mother vaccinated in Manhattan, NYC. Aside from the shortage, I am very angry at the hospitals and other vaccination sites for their horrible, inconsiderate websites, which are making the anxiety worse. Very simple things could be done to make them kinder. At present, you end up going in circles. For example: NorthwellHealth’s facilities are near her apartment. After going to the NYC covid page, I select one of their hospitals and click to their site. When they do not have any vaccine, they have no information on their covid page about 1st vaccine appointments. None. There is a button for making appointments, which leads you to making regular appointments with doctors. There should be a big button on the page you land on from the NYS listing that says MAKE A VACCINATION APPOINTMENT, even if there are no appointments. Some of the other sites make you fill out the forms before telling you that there are no vaccines. And you can’t just do it once. You have to do it over and over again. My sister and I are trying to do this for her. The fact that you MUST go thru the internet is pushing the elderly, those who need the vaccine the most, to periphery. But, at least, they could make the websites friendly and helpful. We’re a country where we spend more money and time making sure people know how to drink coke than they do helping people understand healthcare. This is a systematic problem that should be improved. There are marketing people out there who know how to interact with the public, but the healthcare system chooses not to use them.— New York
Yesterday I experienced the good and the bad of the vaccine rollout. My 95-year-old mother endured a one hour, twenty minute ordeal mostly standing outside 380 W MacArthur Kaiser in Oakland, thankfully a wheelchair was offered and very much appreciated.We were there 15 minutes early for the 10:15 appt. and finished at 11:20. The whole operation seemed clunky and bureaucratic, think of standing in a long line at a rental car company.Now to my almost dreamlike experience gliding through the Moscone Center in SF, arriving about 25 minutes early for my 5:45 appt. I was immediately checked in and escorted to the vaccination booth, the nurse checked me out on her screen asked me the routine questions jabbed my arm gave me my 5:45 sticker and sent me to observation area. After my morning in Oakland I’d love to take my mom to Moscone for her second shot but as far as I can tell Kaiser doesn’t seem to allow that.— Oakland, California
I’m a stage 4 cancer survivor and may have long-term heart and lung effects from the treatments I went through. I’m 44 and live in Denver. It’s unclear which vaccine group I fall into. Some states, such as New York, prioritize any cancer survivor, but Colorado only considers people who have been in treatment for the past month. Also, they want you to have two high-risk conditions — how are those defined? Do I qualify? Do my doctors have any input on that?My oncologist and my primary care doctor have no word on when I might get vaccinated. My health system’s website says if you have an online account, you’re already in their system and they will inform you when you’re eligible. I do not know if that takes into account my medical history.I’ve been to four pharmacies so far in my area; only one has had vaccines, and they did have a list on paper to call if they wound up with extras. I also signed up online with a couple of health care systems (Centura, National Jewish) for notifications; only one asked about medical conditions upon sign-up.So, at this rate, I’m guessing: spring? Summer? Will I be treated as a healthy adult and be the last vaccinated?— 44-year-oldDenver
Checked the Sacramento County website on Feb. 3. Found a link to a vaccination clinic at our neighborhood Safeway. Made an appointment for Feb. 6, at which time I received my first dose. Within minutes of being vaccinated, I received an email confirming an appointment for the second dose in 28 days.— Sacramento, California
We heard the local center would allow people to sign up at 3 p.m. on a Sunday. My husband and I were refreshing our respective computers every five seconds waiting for the portal to open. We snagged appointments via EventBrite on the same day, same hour. When my husband and I went for our first shot, we stood in line for roughly 1½ hours outside, in the sun and heat, before we got inside the county health office, which administered the shot. Most of the other people in line were older and/or frail, with walkers and in wheelchairs. The county staff did their best to make them comfortable, which wasn’t much due to the logistics of the operation. The second shot was a breeze — in and out in about 25 minutes, including the mandatory 15-minute wait after the inoculation. I have a friend who is 80 years old, a three-time cancer survivor, and still can’t get an appointment and has tried numerous times.— Lakewood Ranch, Florida
I signed up with the Kalamazoo County Health Department in Michigan. It was just a couple of weeks, I think, before they sent the application to sign up for the appointment. I had a choice of two days and three time spans with first, second and third choice and was asked if I needed any assistance. I then was emailed an appointment. When I got there, a policeman was directing traffic and giving instructions to stay in the car until five minutes before my appointment. It seemed less. I went through several stops very fast. The parking lot had so many cars and I had to wait 30 minutes after my injection. And, still, in 45 minutes I was driving down the street and also had my second appointment made. They reminded me days before my appointment, the day before my appointment and the morning of my appointment. So fast, so efficient and so many people there that there was no time to do anything but get done what had to be done. AMAZING planning and amazing workers and volunteers.— 77-year-oldKalamazoo, Michigan
Maryland covid distribution is a true mess. There is no central registration site. The state has a site that lists many providers, most of which do not have the vaccine. One of the large statewide vaccine sites, Six Flags America, does not allow you to sign up for the vaccine. Almost all the sites listed on the state’s website indicated they do not have the vaccine.— 68-year-oldEllicott City, Maryland
It’s terrible here in the county for Tier 2. That includes all the educators and everyone over 70. The appointment software company they chose to use did nothing to change their program to account for thousands daily and hourly trying to get an appointment.I eventually was able to get my first shot. I still was not able to use the information that the Carson City Health and Human Services was putting in the news. I noodled around on the internet and discovered a notice that a drugstore (Walgreens) and a drugstore within a supermarket (Smith’s Food and Drug) were being sent the Moderna vaccine and were taking appointments starting the next day. I tried Walgreens but I don’t shop there and could not enter its system. I tried Smith’s, and it was so simple anyone could get on it. I made an appointment so easily for the next morning. Four days ago, I received an email from Kroger, the parent company of Smith’s, telling me the day and time for my second dose. Each city, county and state seem to have surprisingly different ways of putting out information, where and how the vaccine is delivered and administered. I do think it is still a logistics issue that was not anticipated by our former government officials.— 78-year-oldCarson City, Nevada
I signed up for a vaccine several weeks ago with the county health department. I’m 78, living in Albuquerque. My registration was acknowledged but nothing further. The county program appears to be in chaos.— 78-year-oldAlbuquerque, New Mexico