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John Hellerstedt

Vaccine roundup

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.

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?

Abbott speaks about the vaccination effort

It’s going great! We swear!

More than 877,000 Texans have received a COVID-19 vaccine since they first began arriving in Texas nearly four weeks ago, and that number is expected to increase by at least 50,000 more per day, Gov. Greg Abbott said Monday.

“Never before in the history of this state has Texas vaccinated so many people so quickly, “ Abbott said during remarks at the Esports Stadium Arlington & Expo Center, a newly-designated “vaccination hub” that local health officials said can vaccinate thousands per day. “It’s stunning to see what we’ve accomplished.”

The Arlington center, home to the city’s mass vaccination effort since December, is among 28 sites designed by the state as hubs.

“Our goal is, by the end of the week, we have no vaccines left,” said Tarrant County Judge B. Glen Whitley. The county’s health district was allotted 9,000 doses in the most recent shipment this week.

The hubs are meant to streamline vaccinations at a time when the state is seeing an unprecedented surge in COVID-19 cases, deaths, and hospitalizations. Texas continues to prioritize vaccinating health care workers, people who are 65 and older, and those with medical conditions that increase their risk of hospitalization or death if they contract the virus.

The large sites will receive most of the state’s next shipment of 158,825 COVID-19 vaccine doses this week. Just over 38,000 doses will go to 206 additional providers across the state, including several in rural counties that until recently had not received an allotment.

Officials promise bigger allotments in the weeks and months to come, but a patchwork local system of vaccine distribution, among other issues, has created a tumultuous rollout to the long-awaited vaccine.

On Monday, Abbott said Texas expects to see an additional 310,000 first doses per week for the rest of January and up to 500,000 second doses earmarked for those who have already received the injection in Texas. Continued increases are expected, Abbott said, depending on the federal government allotments.

[…]

The data on the number of doses administered has a reporting lag of at least two days, Abbott said, but added that Texans will start to see a significant uptick in those numbers as this week’s vaccinations are reported.

“You are going to see those numbers increase, as it turns out, somewhere between 50,000 and 75,000 per day,” Abbott said.

Texas Health Commissioner John Hellerstedt said the rate and scale of the state’s rollout has been “a really amazing operation” and said the creation of the hubs would ratchet up the rate of administration.

“Through the kind of vaccination operation we see here, we’re very confident it’s going to accelerate here even more,” Hellerstedt said. “It is really the way forward.”

That’s a lot of number being thrown at us. For sure, 50K per day is a big improvement over the “100K per week” we were at earlier in the year. That was a six-years-to-full-vaccinations pace, whereas 50K per day will get everyone vaccinated in 20 months. At the promised high end of 75K per day, we’re at about 13 months. Still not great – we sure would like to finish this task before 2022, wouldn’t we? – but at least in a timeframe we can envision. Note though that we are not at that pace yet – the 310K first doses per week rate is less than 50K per day, and puts us back at an almost-two-years duration. Again, I do expect things will get better, assuming of course that Abbott and the rest of our state leaders don’t reject federal assistance in the name of stupid partisan politics, but every week it takes us to get up to speed is that much longer to get to where we want to be. The hub approach is a sensible model, but it’s going to take a lot of effort and resources to make it work.

Coronavirus 2.0

Happy New Year.

The first known case of a new and possibly more contagious coronavirus strain has been reported in Texas, in an adult male resident of Harris County who had no history of travel, according to the state health services department and County Judge Lina Hidalgo.

The variant known as B.1.1.7 was first identified in the United Kingdom, where it has spread quickly, and cases have been found in several U.S. states, including California and Colorado. It does not cause a more severe disease, and vaccines “are expected to be effective against it,” the health services department said, citing the existing scientific evidence.

“The fact that this person had no travel history suggests this variant is already circulating in Texas,” said Dr. John Hellerstedt, commissioner of the state’s health services department. “Genetic variations are the norm among viruses, and it’s not surprising that it arrived here given how rapidly it spreads.”

While this variant doesn’t appear to be any nastier, as far as we know, and should still be covered by the vaccines, it is apparently capable of spreading faster. Really makes you want to stay away from people, doesn’t it?

On the plus side, maybe.

State officials will start distributing most of Texas’ vaccine doses next week to a handful of large pharmacies and hospitals, creating “vaccination hubs” where more people can get a shot quickly, the Department of State Health Services announced Thursday.

“As the vaccination effort continues to expand to people who are at a greater risk of hospitalization and death, in addition to frontline health care workers, these vaccination hubs will provide people in those priority populations with identifiable sites where vaccination is occurring and a simpler way to sign up for an appointment with each provider,” the department said.

Those hubs could vaccinate more than 100,000 people next week, officials said.

DSHS issued a survey earlier this month to vaccine providers gauging their ability to operate community vaccination sites. The state will release the final list of large-scale providers later this week, after the federal government decides how many doses Texas will receive next week.

We expect another 200K total doses next week as part of this preparation. That’s good, but as we’ve discussed before, the numbers remain daunting. Texas has almost 30 million people in it. At 100K shots a week, you’re looking at six years to get everyone vaccinated. The optimistic interpretation of this story is that 100K per week is a starting point, and we’ll accelerate from there. Great, I sure hope so, but if we want to get enough of the state done to get close to herd immunity this year, we need to get to 500K per week, and every week we operate at less than that makes the target number have to be a little higher. (A better and more organized federal response will surely help.) I know, it’s a hard problem, everyone’s doing the best they can (well, not really, but let’s be generous for these purposes), and so on, but this is the math. As someone once said, the stars may lie but the numbers never do.

How’s the vaccine rollout going?

Not very quickly.

Top Texas officials again urged health care providers to administer more coronavirus vaccines Tuesday, the same day the state reported that the proportion of Texans whose coronavirus tests come back positive has hit levels not seen since a summer wave of cases that overwhelmed some hospitals.

The state reported Tuesday that 163,700 Texans had been vaccinated with at least one dose of the vaccine. About 1.2 million doses have been allocated to providers across the state through the first three weeks since their arrival, according to the Department of State Health Services.

“A significant portion of vaccines distributed across Texas might be sitting on hospital shelves as opposed to being given to vulnerable Texans,” Gov. Greg Abbott said in a tweet Tuesday evening.

That tweet came after health officials asked providers that received doses of the COVID-19 vaccine to “immediately vaccinate” all eligible Texans, including people 65 and older and those who are at least 16 with a qualifying medical condition. That renewed push echoed a statement Dr. John Hellerstedt, commissioner of the Texas DSHS, sent to providers last week directing them to “administer their entire allotment with all deliberate speed.”

“Dr. Hellerstedt put out that statement today to make it clear to all providers that people over the age of 65 and people with medical conditions that put them at greater risk of severe disease of death from COVID-19 are eligible to receive vaccine now,” said spokesperson Douglas Loveday. “Vaccine supply remains limited but more vaccine will be delivered to providers each week. It will take time to vaccinate everyone in those priority groups.”

To be fair, lots of states are stuck in low gear right now, but even accounting for that, Texas is in the back of the pack. There are distribution problems, and there is confusion over who can get a vaccine and where and how they can get it.

A single state website and hotline, with accurate and updated information about vaccine locations and supplies sure would be nice. What we have here evokes the old proverb that a person with one watch knows what time it is, and a person with two watches is never sure. Maybe when Greg Abbott and Ken Paxton are finished harassing the city of Austin, they can spend a few minutes thinking about that. In the meantime, hospitals are pushing back against the claim that they are the bottleneck.

The state’s largest hospital association is pushing back against a suggestion from Gov. Greg Abbott and the state’s top health official that a large number of coronavirus vaccines could be going unused in Texas hospitals.

The back and forth comes as the state vaccine dashboard shows that just 205,463 Texans had received the first dose of the coronavirus vaccine as of midweek, although 678,925 doses have been shipped around the state.

Abbott and Dr. John Hellerstedt, the commissioner of the Texas Department of State Health Services, sounded the alarm Tuesday, urging health care providers to begin vaccinating people 65 and over and those with underlying health conditions, including pregnant women, if they have concluded the first phase of vaccinations.

But most hospitals in the state are still vaccinating the first group of eligible Texans — hospital staffers working directly with coronavirus patients; long-term care residents and staff; emergency workers; and home health care workers — or have not yet received any shipments of the vaccine, according to Carrie Williams, spokeswoman for the Texas Hospital Association, which represents more than 85% of the state’s acute-care hospitals and health care systems.

“Vaccine is not sitting on hospital shelves,” Williams said, suggesting the state’s immunization reporting system has caused delays in reporting data. “With regard to data, we have no certainty it is accurate at this point in time. The number of doses administered is higher than what’s indicated.”

While the number of vaccines shipped across Texas is accurate, there have been “varying reports of the actual number of vaccines administered,” a spokesman for the Texas Division of Emergency Management said Wednesday.

The agency launched a website Wednesday showing up-to-date numbers of vaccine doses and therapeutics available at health care providers.

Abbott spokeswoman Renae Eze touted the website as a source of “real-time reporting system to show vaccine usage data from health care providers across Texas.”

The site, however, does not show how many COVID-19 vaccine doses have been administered.

[…]

For their part, hospital directors say the call from state leaders to move onto the next tier of vaccinations has caused chaos across the state as hospitals try to manage a vaccine rollout and a growing number of COVID-19 patients, Williams said.

“Hospitals are being flooded with calls from the general public seeking vaccine, which creates further operational challenges,” she said. “And, there are still hospitals that have not received any vaccine for their frontlines.”

The story doesn’t indicate what the URL of this new website is. The TDEM website is here, but all I found on a cursory search was information about testing, not about vaccines. This WFAA story about the bumpy vaccine rollout says that this DSHS page is the state’s main vaccine information center, but it’s mostly about eligibility. The story also reports, as Miya Shay did in her tweet, that DSHS and TDEM have two different maps showing providers who have received vaccine doses, and advise people to reach out to providers with their questions. That is not going to help with the flood of questions hospitals are already getting. Meanwhile, State Rep. Donna Howard tried to answer some questions on Twitter:

You can read the thread, but it largely comes down to lags in reporting, the timing of distribution, and confusion over who is eligible. For a guy who’s emphatically rejected calls for further COVID restrictions because the vaccines will save us all, you’d think Greg Abbott would want to put more effort into getting the vaccine distribution part of it right. Just a thought, but maybe this should be a campaign issue next year. What has been your experience trying to chase down a vaccine, for yourself or for a family member?

UPDATE: Later last night, the Trib published this longer story that covers all of the topics I’ve touched on here and more. At some point, Greg Abbott really needs to feel some heat for this.

So this is reopening

There’s not much to this, is there?

Gov. Greg Abbott on Friday announced initial steps to reopen the Texas economy during the coronavirus pandemic, including those that in the next week will loosen surgery restrictions at medical facilities, allow all retail stores to provide product pickups and reopen state parks.

Abbott also named a “statewide strike force” devoted to getting the economy going again. Austin banker James Huffines will chair the task force, while veteran lobbyist Mike Toomey will lead its staff. The group will oversee what Abbott described as a phased reopening, starting Friday with additional announcements set for April 27 and sometime in May.

At the same time, Abbott announced all Texas schools will stay closed through the rest of the academic year. He had previously shuttered them until May 4.

Abbott made the announcements during a news conference at the Texas Capitol that he began on a note of optimism.

“Because of the efforts by everyone to slow the spread, we’re now beginning to see glimmers that the worst of COVID-19 may soon be behind us,” Abbott said, noting the number of infections is “beginning to level off” and the death toll, while tragic, has “not come close to the early, dire predictions.”

“We have demonstrated that we can corral the coronavirus,” Abbott added.

[…]

Abbott said the task force will include fellow state leaders such as Patrick and Texas House Speaker Dennis Bonnen, as well as top medical experts including state health commissioner John Hellerstedt and Mark McClellan, former commissioner of the U.S. Food and Drug Administration. The medical advisers will focus on developing a strategy to “comprehensively test and trace COVID-19 that will enable Texas to gradually and safely” begin returning to normal, Abbott said.

The task force will be rounded out by an advisory group of business leaders, Abbott said, naming prominent entrepreneurs including Kendra Scott and Michael Dell.

The first phase came in a series of executive orders issued Friday. One order allows for product pickup at retail stores — what Abbott described as “retail-to-go” — that will begin April 24. Outlets will be allowed to bring orders straight to customers’ cars in a manner similar to how many restaurants are currently offering curbside pickup.

Another order, which goes into effect 11:59 p.m. Tuesday, will allow a limited amount of nonessential surgeries at hospitals, as long as those surgeries don’t deplete the hospitals’ supplies of personal protective equipment and allow the facilities to keep at least 25% of their capacity available for the treatment of patients with COVID-19, the illness caused by the new coronavirus.

A third order will allow state parks to open Monday. Visitors to parks will be required to wear masks and keep a safe distance from people outside their households.

Additional openings will be announced April 27 “after further input from medical staff,” Abbott said.

See here for the background, and here for the very manly-man-named Strike Force. Just so we’re clear, “beginning to level off” means we’re still not yet at the peak, which is to say the curve of new cases and deaths is still increasing. Go read that previous post about the curve maybe starting to flatten in Houston. “Near the peak” is not where you want to be.

There’s also no actual plan for expanded testing, which is a bare minimum for easing the restrictions. We are not testing more people in Texas. We don’t even really have the funding to test more people. Who are your medical advisors, and what is their advice for getting true comprehensive testing off the ground?

Hey, remember when Greg Abbott decided that it was better to let Mayors and County Judges lead the way on stay-at-home restrictions? Well, local leaders are nowhere to be found on the Strike Force.

What happens if the Strike Force and Dan Patrick’s Secret Megadonor Team disagree? Do they fight it out?

What if Greg Abbott reopened the economy and no one came, because they’re more worried about ramping down social distancing too quickly than they are about being able to go out in public like they used to? I can tell you that the latest word from the large multinational corporation that I work for is that they expect us all to still be working from home into May. I won’t be surprised if a lot of similar businesses are thinking along the same lines.

You get the idea. We all want to return to normal. We all want businesses to open again. But we all also want to not get sick and maybe die. I don’t think we’re ready for the returning to normal and opening things up part yet. The Chron, the Texas Signal, the Press, the Observer, and the Current have more.

UPDATE: What RG Ratcliffe says:

The problem is not so much that Abbott has named an advisory committee but that he has again found a way to deflect responsibility before taking action. Just as he let mayors and county judges do the hard work of shutting the state down to stop the spread of COVID-19, he is now hoping the strike force will help him balance competing demands for fighting the virus and getting Texans back to work. Abbott put his toe into the water on Friday, but put off big decisions until April 27, saying he wanted to be guided by data, doctors, and the advice of his strike force.

Such a weak leader.