Off the Kuff

Just a few news stories (and a Twitter thread) of interest from recent days.

How do you get a COVID-19 vaccine? In Texas’ rollout, it’s a game of luck and chance

Still, the contrast shows just how sharp and seemingly random the divide has emerged between those who are able to get the vaccine easily and those who cannot. In the fourth week of Texas’ vaccine rollout, a dermatology practice in Bellaire got 300 doses while Hope Clinic, which serves Houston’s poor and immigrant communities, got 100, according to the state’s most current list.

County registration hotlines have crashed under the volume of applicants while some doctors reported fielding calls from friends asking how to move to the front of the line.

In the month since the vaccines got federal approval, getting them into arms of the most vulnerable has been anything but smooth. Distribution has lagged. Demand has far outstripped supply. Critics call it yet another chapter in the failed government response to a virus that arrived nearly a year ago.

“There does seem to be no discernible distinction between those who are getting the vaccine and those who aren’t,” said Elena Marks, CEO of Houston’s Episcopal Health Foundation, an organization that works to improve health care access for poor.

Such unevenness is happening not just among the public but also within the medical community. At some small and midsize private practices, access to the vaccine remains elusive for front-line health care workers who regularly treat COVID patients, doctors say. Yet employees of large medical practices and big-name facilities are vaccinating staff that is not in direct contact with patients and in some cases working from home.

Clogged phone lines and ethical dilemmas: Texas health providers scramble to roll out vaccine with little state guidance

Texas has largely left the vaccine rollout process in the hands of local providers like Tarrytown Pharmacy, one of more than 1,000 providers approved to vaccinate Texans. And outside of dictating the first two groups allowed to receive it, providers say the state has given little instruction or information on when allotments will arrive, how immunization operations should be organized and what principles ought to be followed in prioritizing within groups 1A and 1B.

As they spearhead vaccination in a state of 29 million people, hospitals, pharmacies and community health centers alike across Texas built new scheduling systems from scratch, struggled to sync their patient information systems with the state’s and answered to an increasingly anxious public wondering when their turn for the shot will come — all while helping fight the COVID-19 pandemic during its highest peak in Texas.

“Every space I have is booked. I have phones going off the hook saying, ‘Where’s mine?’” said Dr. James McCarthy, chief physician executive for the Memorial Hermann Health System in Houston. “The demand is insatiable right now. Everybody wants it today, and we just don’t have enough vaccines. It will take months.”

The state’s initial allocation of 1.2 million doses had been shipped by Jan. 3, according to state health officials, and another January shipment was expected to bring the state’s total allotment to 1.7 million. That’s still hundreds of thousands of doses short of the roughly 1.9 million necessary to provide just a first dose of vaccine to those Texas health care workers and residents of long-term care facilities eligible in group 1A.

But before many of those first in line had received a dose, the state allowed providers to start administering the vaccine to the second group — about 8 million people older than 65 or at least 16 with certain medical conditions. A Department of State Health Services official said there is some overlap between groups 1A and 1B (doctors and other health care workers over age 65, for example).

The sudden announcement to open vaccinations to the second group — just a week after the first distribution of vaccines for the first group — caught many providers off guard.

“It was in response to all of the chatter and angst to ‘Oh my God, they haven’t given all their vaccines out,’ and it’s been five days,” said McCarthy of Memorial Hermann. “I thought we would get all the health care workers done, and then we would move on. I didn’t think we’d be doing them simultaneously.”

Greg Abbott’s Politics Create a Vaccine Stampede

But Texas decided to do things differently than the CDC. While the state’s designated first tier matched that of the feds, its second tier included all Texans age 65 and older, as well as those with preexisting health conditions that make them vulnerable to severe cases of COVID-19. This approach put lower priority on police and younger essential workers, like grocery clerks or restaurant servers, many of whom were bitter about the state’s decision. Then, just before the new year, Governor Greg Abbott and his state health department changed the game further. On December 29, state health commissioner John Hellerstedt ordered providers to start vaccinating those in the second tier immediately, even though many in the first tier remained unvaccinated. Abbott backed him up in a tweet: “The state urges vaccine providers to quickly provide all shots.”

In an instant, I effectively had been moved to the front of the vaccination line. The problem was finding where that line began. Abbott had started a stampede.

There were too many eligible people chasing too little vaccine. The Texas Department of State Health Services reported that it had received 1.3 million doses. But Abbott had authorized another 8 million people to receive the vaccine even though providers weren’t anywhere near finished inoculating the 1.9 million Texans in what was supposed to be the first-tier priority group. Abbott’s declaration got too many in the state (even those under 65 and without any severe health conditions) thinking vaccines were more widely available. With few providers actually offering shots to the general public, the Hunger Games of vaccination had begun.

Advocates worry vaccines will be out of reach for Black and Hispanic neighborhoods devastated by COVID-19

COVID-19 has been disproportionately deadly for communities of color in Texas. And advocates for those communities are worried that they will have more trouble accessing vaccinations than the white population because of where vaccination sites are located.

“We already saw huge disparities in death rates and people getting [coronavirus] infections, and there wasn’t availability of resources like health care for brown and Black communities suffering tremendously,” said Kazique Prince, interim executive director for the Central Texas Collective for Racial Equity, a nonprofit association based in Austin. “I’m very nervous and anxious that this [vaccination effort] is not going to work out for us.”

According to the Texas Department of State Health Services data, more than half of the fatalities in Texas due to COVID-19 have been Hispanic individuals and almost 10% have been Black people. Yet the state’s designated vaccination sites — mostly hospitals, clinics, nursing homes and pharmacies — are concentrated in more affluent areas where those facilities tend to be located.

.
So talking to a Doc yesterday, he’s frustrated with @TexasDSHS vaccine guidance. He says the original plan, to vaccinate frontline workers after medical workers, would have gone faster. 1/

— Miya Shay (@miyashay) 07:52 PM – 10 January 2021

And, just as a reminder:

Health officials in Austin are considering opening a makeshift hospital as its intensive care units fill up. Patients in North Texas are being treated in lobbies or in hallways. And hospitals around Laredo, Abilene and College Station have three or fewer intensive care unit beds open, according to state data.

A week into the new year, hospitalizations in Texas have well-surpassed a deadly summer wave that overwhelmed health care workers in the Rio Grande Valley. Health experts have long warned of a dark winter — with a public tired of following safety precautions, a raging pandemic and cold weather drawing people indoors where the virus can more easily spread. Add to that holiday gatherings and increased levels of travel, which health officials say are already being reflected in the growing numbers of hospitalized coronavirus patients.

New year, same story. We deserve so much better. We’ll get better soon from the federal government. When will we get it from our state government?