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Originally published in Castine Patriot, January 14, 2021 and Island Ad-Vantages, January 14, 2021 and The Weekly Packet, January 14, 2021
COVID vaccination: ‘We’re not where we want to be just yet’

COVID-19 Local Updates Fall/Winter 2020
Click here to see the full COVID-19 Local Updates Fall/Winter 2020.

by Leslie Landrigan

Don’t expect to get vaccinated in the next week or two unless you’re a health care worker or you live or work in a long-term care facility, according to Dr. Michael Murnik, Blue Hill Family Medicine physician, on a January 12 Zoom call sponsored by the Healthy Island Project.

The COVID-19 vaccine has been slow to reach people outside those two categories, especially in rural Maine, Murnik said. Meanwhile, the number of new COVID-19 cases has recently reached upper triple digits, with 715 new cases and 11 deaths reported by Maine CDC on January 12.

Many people are calling local health care providers hoping to get on a list so they’ll be notified when it’s their turn to get their shot. But there is no list.

“We are hungrily eying being able to open the doors and get out to the general public,” Murnik said. But right now, he said, “we don’t have the supply, we don’t have the system.”

What’s happened already

As of Monday, January 11, 55,775 people in Maine had received one dose of the COVID-19 vaccine. But the vaccine requires two doses to be effective, and 5,981 people had received both doses, according to Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention.

Those who’ve been vaccinated are the people in the so-called “1a” group, which includes about 130,000 health care workers and residents and staff of long-term care facilities.

Locally, that first shot has gone into the arms of most of the local hospital workers and EMTs. More than 90 percent of the staff and residents of the Island Nursing Home and Parker Ridge have gotten the first dose, according to their directors.

During the week of January 11, Northern Light Health is reaching out to health care workers not affiliated with a hospital, such as chiropractors, dentists, in-home care workers and physical therapists, Murnik said.

However, the state has only shipped a trickle of vaccine, 50 to 100 vials at a time, into the peninsula and onto the island, he said.

Overall, the state had received a total 81,850 doses of vaccine from the federal government, Shah said in a virtual news conference on January 11.

Though the supply is small, there is demand for it. Locally, fewer than 10 percent of the people offered the vaccine are declining it, Murnik said.

Why the holdup?

President-elect Joe Biden’s plan to release available vaccine all at once will help, Murnik said, but it’s “nothing that will solve a problem this week or next, which is what we need.”

Hours after Murnik spoke, the Trump administration announced it would release more vaccine than previously planned. The administration was holding back the second dose, but no longer. Now, federal health officials are urging states to start vaccinating everyone over 65 and people with pre-existing conditions. U.S. Health Secretary Alex Azar said in two weeks each state will receive vaccines based on its population in the over 65 age group, according to news reports.

In Maine, Shah has said the “1a” group will probably be vaccinated by the end of January. The state then plans to move on to the “1b” group. But on January 12, Maine’s state government hadn’t yet decided on the “1b,” either on the age cut-off or on who counts as a frontline essential worker, Murnik said.

Not only does Maine lack rules for who gets the vaccine next, the state lacks a system to register people for it, he said.

Murnik explained that the federal government wants insurance companies to pay for the administration of the vaccine, even though it’s footing the bill for the vaccine itself.

People filling out insurance paperwork can create bottlenecks at vaccination sites, and Shah has said he doesn’t want to see Mainers sleeping in their cars overnight to get a vaccine. “We can do it in a more orderly fashion,” he said.

So the state is developing an online preregistration system to let people submit their insurance information before lining up to get vaccinated, according to Shah.

However, a computer security system has to be completed before the preregistration system can go live, and that’s holding things up, Murnik said.

Logistics challenge

Originally, Murnik said, Northern Light Health thought people could get vaccinated at local clinics: Island Family Medicine in Stonington, the Castine Community Health Center and Blue Hill Family Medicine. But the logistics challenges are too much for the local clinics, Murnik said.

Rya Trundy, practice manager at Island Family Medicine, said the clinic is fielding between 20 and 50 phone calls a day from people asking to get on the vaccine waiting list.

“People want to be on a list; we’re not doing that,” Trundy said on the HIP call. “There will be no list.”

Another problem: Maine orders specific amounts of vaccine each week, but the federal government has been sending less than ordered. Since the state doesn’t know how much vaccine to expect, clinics can’t schedule vaccinations, Trundy said.

Veterans

However, Maine veterans receiving Veterans Administration care can expect to be notified when more vaccine is available and it’s their turn to get vaccinated. The VA says on its hotline that its goal is to give a free vaccination to every Maine veteran in its care who wants one. “Your VA health care team will contact you if you are eligible,” the recorded message states. For information call 623-8411.

What’s likely

Murnik said Northern Light Health is contemplating how to turn drive-through COVID-19 testing centers into vaccination centers, since they’ve worked. But still there are problems with the drive-through approach, he said. People who receive the vaccine have to be observed by a health care worker to make sure they don’t have an allergic reaction to it. Those who do react should get a shot of epinephrine, according to the CDC.

“We have to observe people for 15 minutes, so you have to pull over and wait for 15 minutes,” Murnik said. “If you have a serious anaphylactic allergy, you have to wait 30 minutes.” He said the question then becomes, where do those cars park?

What may happen, said Murnik, is that vaccination clinics will be set up in large spaces, like high school gyms or the Island Community Center in Stonington. He said Northern Light Health is trying to get a pass on the gathering limit of 50 people. Alternatively, they could figure out a way to move people through a site in a socially distanced way, he said.

“I keep arguing we’re making it way too complicated,” Murnik said. “I want to do it quick and simple.”

A tall order

Though the COVID-19 vaccine is only going to a limited group of people, there’s still a need for volunteer help, Murnik said. “It doesn’t have to be all RNs and medical folks,” he said. People can help with registration, traffic control and even cleaning, he said.

Meanwhile, the virus continues to surge. The state reported a record number of 782 COVID-19 cases on Friday, January 8, 34 more than the previous record of 748 on December 23.