Questions and Answers about COVID vaccine process in Cape Girardeau and Southeast Missouri

Applause has been breaking out around the area as the first COVID-19 vaccine doses are received, opened, prepared and injected. In a modern miracle, the vaccines were developed with historic speed while not cutting any safety corners, say health experts, in part by implementing research trials and production steps in parallel rather than sequentially. Credit goes to researchers, pharmaceutical companies and everyone involved in the Trump Administration’s “Operation Warp Speed” for the accomplishment.

In Missouri, five hospitals were identified as initial “pre-position points” for the Pfizer-BioNtech vaccine, which was the first approved by the Food and Drug Administration under Emergency Use Authorization in the United States. A second vaccine, this one produced by Moderna, is expected to be approved this week. Both drugs indicate roughly 95% efficacy in trials. Other vaccines are in testing.

In Southeast Missouri, SoutheastHEALTH was selected as the pre-position point for the Pfizer vaccine. On Tuesday afternoon, I spoke with Shauna Hoffman, vice president of marketing and business development at SoutheastHEALTH, about what people should know. At times, Hoffman struggled to hold back her emotions as she talked about front line health care workers who were to receive the vaccine first – according to CDC and Missouri Department of Health and Senior Services guidelines -- and how amazing that staff has been in taking care of COVID-19 patients.

“About three weeks ago we had an average daily census of around 45, which was kind of scary,” Hoffman said. “We could manage it, but it takes a lot of resources and puts a strain on personnel. One of those days, because of other hospitals south of us [facing resource challenges], we received seven patients in a 20-minute window that needed to be ventilated. You can’t even begin to imagine the workup that the physician team has to do on one patient, let alone seven, all within 20 minutes. It’s incredibly intense.”

That intensity is being mirrored at other health care facilities throughout the region.

Thankfully, according to Hoffman, the number of hospitalized patients has returned to a more manageable level, even as cases rise in much of the country.

When asked if infections from Thanksgiving gatherings did not hit this region as hard as they did elsewhere, she said, “We get really nervous about making a statement that [we’re through the worst]. It seems that if we say something, then, oh my gosh, you know, mayhem will come back.”

SoutheastHEALTH is being careful to follow the guidelines from the CDC and state, which charges it with targeting health care workers first, then essential workers and high-risk populations, Hoffman said. After that, as vaccine availability increases, access to others will begin. It was clear in talking to Hoffman that some decisions will be made week-to-week according to the quantity of vaccine delivered to the area. Also affecting the timeline will be the approval of other drugs besides Pfizer’s, as well as the number of health care workers and first responders who sign-up.

Because of uncertainties, a key to the distribution of the vaccine will be constant collaboration among health organizations, and Hoffman underlined the steps SoutheastHEALTH is taking to reach out to medical providers throughout a 10-county area of the state.

Meanwhile, she encouraged the public to follow information from their county public health department, check the SoutheastHEALTH website SEhealth.org/COVID or call the hospital COVID-19 hotline at (573)519-4983, which is open 7 a.m. to 7 p.m. daily. Residents of long-term care facilities and their families should contact their facility’s management.

Here are excerpts from my conversation with Hoffman.

__Q: Hospital systems in Kansas City, St. Louis, Springfield and Jefferson City were identified as pre-positioning sites for the Pfizer vaccine, along with SoutheastHEALTH. How did that process work?__

A: “We submitted an application in the spring to be an authorized site to receive the first shipments of the vaccine based on FDA Emergency approval, and we received notice from the governor’s office about eight weeks ago that we were selected. One of the reasons why we were chosen is because of our coverage as a system for the area, including the rural area. We’re quite honored.”

__Q: The CDC has identified health care workers — especially those on the front line — for the first phase of the vaccine. How are you managing that?__

A: “We are reaching out to the hospitals and medical providers throughout the area. [As vaccine becomes available] it will be our team that will work with a facility, go on site, oversee with the team to administer those vaccines that make sense.

“To assist the process and make the vaccine available to those health care workers as quickly as we can, we’re conducting a survey [with the medical providers], and then working with an online schedule module, because we want to be very vigilant. If someone signs up, they absolutely have to show up, because we’re not wasting a single dose. We will also have a standby list or be ready to move someone from a later schedule immediately into an earlier time spot if necessary.

“Once the vaccine is thawed [before thawing, the Pfizer vaccine must be kept in a specialty freezer – or in dry ice -- colder than minus 94 degrees Fahrenheit], it is good for six hours if untapped. Once it’s tapped, it must be used in two hours.”

__Q: Is the vaccine mandatory for health workers?__

A: “No, this isn’t something they have to do. It’s not mandatory. It’s based on their willingness or need. But so many health care workers, especially those on the front lines, are directly faced with COVID every day. Those bedside COVID nurses and that care team are really the first level of prioritization we’re working to, and then first responders and our local emergency management teams.”

__Q: How important is collaboration?__

A: “It is vital, and we’re working in full collaboration, for example, with the Cape Girardeau County Health Center. The public health center has requested a quantity of vaccine, which will be from Moderna once it’s approved, and we’re making sure to have clear information and coordination.

“We’ve also reached out to area hospitals and independent physicians groups.

“What we have not accomplished yet, but will shortly, is a full outreach to other public health centers, to understand what they’ve requested from Moderna, and whether they may need our assistance with Pfizer.”

__Q: Of course, how quickly the vaccine can be rolled out depends on a number of factors, including how many health care workers want it and what quantity is made available?__

A: “Yes. Pfizer is holding us very tight to what is allowable on a weekly distribution standpoint. We will know what’s available, and from our survey who the next segment is to vaccinate, until we eventually get to the general population.”

__Q: Are you taking any special precautions around the security of the vaccine?__

A: “Yes, there is a lot of sensitivity around this from the standpoint of a national security issue. We’ve ramped up our own security and also worked with the local police to make them aware to have added support if necessary. It’s crazy, but this is what we’re dealing with. Then, when the vaccine is on site, there are literally only two individuals that have codes and keys to access our quantity. So, it’s been well-orchestrated, and we’re doing everything we possibly can to deliver the vaccine safely and efficiently.”

__Q: Residents of long-term care facilities and other vulnerable populations have also been identified for first-phase vaccinations. But most of those will be handled via Walgreens and CVS or other pharmacies, working with public health centers. Is that correct?__

A: “Yes. The federal plan through the states is for long-term care facilities to be managed initially via the pharmacies [which already have relationships with facilities] but our feeling is that at some point in the future, we may be able to assist there, too. What I don’t know now and can’t answer is what is their availability, what is their timing. Long-term care facilities should be reaching out to Walgreens, CVS or their public health departments.”

__Q: What if you’re in a high-risk population – including advanced age – but are not in a long-term care facility. What should you do if you’re interested in taking the vaccine?__

A: “The public health center will always be a great resource, and our hotline will have all the information on when we’ll be able to open to the public, to high-risk populations, etc. And our web page, and Facebook, will have up-to-date information about vaccinations and scheduling. As this progresses, we’ll know how many doses we will have each week and what we can commit to for the maximum allowed distribution for the next week.”

__Q: The Pfizer vaccine entails two doses roughly 21 days apart to achieve maximum effectiveness. Are there any concerns about giving a person the first dose and then not having the booster available later?__

A: “No. Pfizer has guaranteed that the second shot will be available.”

n

Thank you Shauna for the information. And congratulations and thanks on helping the community fight the pandemic with a powerful new tool – a vaccine.

Jon K. Rust is publisher of the Southeast Missourian.