When it comes to administering Covid-19 vaccine to frontline healthcare workers and long-term-care facility residents, a small county on the Canadian border in eastern Washington may have an advantage.
Earlier this year, the Ferry County Health system, with headquarters in Republic, Washington, constructed two outbuildings for Covid-19 testing and vaccinations. Then they purchased specialized freezers that can reach temperatures as low as minus 94 degrees Fahrenheit – the storage temperature for one of the vaccines on track for federal approval.
“We were one of the rare ones who got that freezer,” said Aaron Edwards, CEO of Ferry County Health. “We were watching the media about who looked like they were going to come through with the vaccine and made an educated guess that it would be Pfizer, so we went ahead and ordered one. … Being this remote, we thought we had to have one.”
Ferry County is about 120 miles northwest of Spokane and contains large swaths of Colville National Forest and the Colville Indian Reservation. It has a population of about 7,600.
Along winding roads that snake up and down mountains, getting vaccines couriered to the hospital didn’t seem practical, Edwards said. And the area’s one airlanding strip is closed for the season. Ensuring that the facility can store the vaccines is key to keeping the community safe, he said.
But that decision puts Ferry County Health in a much better position than most rural hospitals. In November, Claire Hannan, executive director of nonprofit organization the Association of Immunization Managers, told Reuters that about a third of the states had purchased the ultra-cold freezers needed to store the virus. Companies that produce the freezers are now saying there could be months’ long backlogs to get freezers to those who want them.
Storing the vaccine is one of a few challenges rural hospitals face when it comes to getting and distributing the vaccines.
Earlier this week, the Advisory Committee on Immunization Practices, a group that advises the Centers for Disease Control and Prevention (CDC) voted 13 to 1 to make healthcare workers and residents in long-term care facilities the first group of Americans to receive the vaccination for Covid-19.
In a presentation on the subject, Dr. Sarah Oliver said there were an estimated 21 million healthcare workers and 3 million residents in long-term care facilities across the country. She also said the U.S. government has contracted with Pfizer and Moderna to receive about 40 million doses of the vaccines – enough for between 15 and 20 million people because the vaccine requires two shots between three and four weeks apart – by the end of the year. Starting in January 2021, the CDC anticipates the vaccines will come in at a rate of about 5 to 10 million doses per week.
The U.S. Department of Transportation announced this week that it is working with Operation Warp Speed, the Trump administration’s commission on the virus, to ensure that all “necessary regulatory measures have been taken for the safe, rapid transportation of the coronavirus disease 2019 (Covid-19) vaccine by land and air.”
Reports indicate that the vaccine will be distributed to states based on their populations, and rural health advocates wonder if that will harm some rural hospitals.
“If the vaccine is distributed by population, less populated — and more rural — states will get fewer doses of the vaccine initially,” said Carrie Henning-Smith, an associate professor in Health Policy and Management at the University of Minnesota School of Public Health and the deputy director of the University of Minnesota Rural Health Research Center.
“Once the vaccines are divided by states, however, many of the specific distribution plans will vary by state, and rural facilities may face a disadvantage relative to larger facilities in more populous cities within their states,” she said.
If the distribution plan is based solely on population size, rural areas with higher-than-average infection rates may not get enough vaccine to meet their needs, she said.
Edwards said he’s been assured that his hospital will receive the vaccines, mostly because he has the freezers. To administer the vaccine, according to policy in Washington state, a healthcare facility must have the ultra-cold storage facilities that have been validated, Edward said.
Ferry County Health’s small size could work to the community’s advantage. The smallest unit of delivery for the vaccine is about 900 doses, he said, enough for 450 people. FCRH has 134 people on staff. It also has nine patients in long-term-care and 15 in assisted living in an attached facility.
The state may have him use those extra doses on front-line workers like EMS personnel, firefighters and law enforcement, he said. Or the state may have him re-package what he doesn’t use and send it to another healthcare facility.
Hospitals and state health department officials in Washington are conducting weekly calls about the vaccination plan, but there are still questions, such as how the state will deliver the vaccines.
“They have not communicated the way they’re going to get them to us,” Edward said. “We think it’s going through UPS, but we’re not sure. If I’ve got to drive down there in my little gray Tundra to get it, then I guess that’s what I’m going to do.”
During its hearing this week, members of the federal immunization advisory committee also suggested that hospitals and healthcare facilities not vaccinate an entire unit at once. Because some people who get the vaccine have experienced symptoms of the disease, having staff members out due to sickness would put increased pressure on those remaining.
It could be worse in rural hospitals, Henning-Smith said.
“This could present a complicated issue for small rural facilities already facing workforce shortages,” she said. “If there are limited providers within a facility, any additional staffing shortages caused by potential side effects could compromise access to care for patients and put added strain on providers.”
That doesn’t mean healthcare workers shouldn’t get vaccinated, she said. “But in smaller facilities without a deep bench of staff, creativity and collaboration will be needed to address any staffing shortages that arise during this period.”
Edwards said differing work schedules and the natural timing of vaccination schedules should be enough to prevent staff shortages.
But getting that vaccine is crucial, he said. He said he is especially concerned about patients in the hospital’s long-term care facility.
“I do know it’s a matter of time before the weasel gets into the henhouse,” he said. “I’m very concerned about our long-term care patients and I want to make sure we protect them. I can’t expect my staff to keep batting a thousand. It’s going to get in. It’s just a matter of time.”