Hospital systems still have option to vaccinate community under TDH parameters
NASHVILLE, Tenn. (WJHL) – Tennessee’s health departments and partners have plenty of infrastructure ready to deliver many more COVID vaccinations to an anxious public, Health Commissioner Dr. Lisa Piercey said in a conference call Friday. The problem is continued supply constraints from the federal government, which have averaged about 80,000 doses per week.
“There are some really big levers we have that we can pull quickly, as in like a day or two, and those are those big mass vaccination sites that can be staffed,” Piercey said.
“Within a day or two I could deliver a 5X multiple and within a week or two I could deliver a 10X multiple. It’s just the product that I don’t have.”
On a day the Tennessee Department of Health (TDH) rolled out several changes to the state’s COVID-19 vaccination plan, Piercey said data show the state appears to have avoided a major Christmas surge in new cases.
“You would typically expect to see the beginning of a surge anywhere between one to three weeks after a superspreader event and we haven’t seen that yet,” Piercey said.
“In fact we’ve seen some at least stabilization if not a decrease in our case counts and a dramatic decrease in hospitalizations, both of which are really good signs.”
Piercey said the arrival of a the new, more contagious variant could lead to a surge later if Tennesseans fail to follow good prevention guidelines but said “for not we’re in a good spot and I do think we have dodged the holiday surge.”
But when it comes to a further vaccination ramp up, Piercey repeatedly stressed the limitations until the state’s weekly supply increases.
That was supposed to happen next week but when the national portal opened Tuesday night, it became clear that change would wait at least a week.
“We’ll be watching for this coming Tuesday night to see if we will get an increased allocation for the first week of February,” Piercey said.
She said the federal government and manufacturers have signaled that manufacturing will ramp up in February.
“We’re just waiting for that to pan out on the state level.”
Piercey said the state has done a good job getting out what it’s received using a two-pronged strategy that concurrently works through critical infrastructure phases and a risk-based approach.
In other words, the “1a1” medical providers all the way through later groups like essential workers are worked through while at the same time the state starts and continues a primarily age-based rollout.
That latter prong started over the past week or two as counties have opened up vaccinations to people over 75.
Piercey also said a partnership with CVS and Walgreen’s has progressed such that more than 90 percent of first doses had been administered in nursing homes and skilled nursing facilities across the state.
The long-term care effort is now transitioning to a focus on assisted living facilities, whose residents are at somewhat less risk from severe COVID symptoms than those in nursing homes.
What it means for 75 and over population, others
Piercey provided numerous details about intra-county supply protocols, the timeline for 75 and over populations to get the vaccines (as well as those down to 65) and the role hospital systems have played and will going forward in the effort.
She said the effort to vaccinate older Tennesseans had more than 100,000 out of about 450,000 75 and over residents on a state waiting list earlier this week.
Piercey touted the fact that about half of the 438,000 doses administered have gone to people 60 and over.
“When you look at those percentages and you compare that to who has the highest risk of hospitalization and death it really is a testament to our effort for a risk-based approach in making sure it gets to those most vulnerable first.”
How quickly those 75 and over yet unserved will get the vaccine remains completely at the mercy of the federal rollout and manufacturing speed, she said.
As to the claim Tennessee could administer five times the volume of doses it has been within a few days and 10 times as many within a few weeks, Piercey said there’s a plan.
“We’ve got locations all over the state – Dollywood, Opryland, Nissan Stadium. You just name it. We can do it there and we even have the people to do it, whether it’s through strike teams, health departments, community volunteers, a lot of EMS folks have raised their hand saying we’re willing to do it and then we’ve got the national guard already on orders.
“So we’ve got the sites and we’ve got the staff. You know what I’m gonna say next – we’re just waiting on product and then we can open up those sites.”
The relative trickle of product has caused the state to push its timeline for opening community vaccination to the 65 and up population back to March. Initially it was expected to begin sometime in February.
“If the floodgates open and all of these vaccines start coming in in the first or second week of February, that timeline will be accelerated.”
But Piercey stressed what she called a “clear stepoff” in morbidity from age 75 to age 70, and another from 70 to 65. Below that age, she said, the risk levels for those who contract COVID vary much less.
“Instead of just throwing everybody into a 65-plus category our next big effort (will be) to move down to 70. We do think we will able to do that in the next couple three weeks.”
Ballad’s bow out — what are the options for hospital systems?
Piercey also addressed a change in expectations for hospital systems that want to offer community vaccinations.
We want you to vaccinate everybody – not just your patients. We want you to be a community site regardless of if they’ve ever been there before, regardless if they even have a payor source.Tennessee Health Commissioner Dr. Lisa Piercey on parameters for hospital systems to continue vaccinating community members.
She said the plan all along had been for hospitals to get larger portions of available vaccine first to immunize their own front line staffs. In December, hospital systems got about 60 percent of vaccines and health departments the rest.
This month, health departments have received about 75 percent of the supply.
Providers like Ballad asked about vaccinating community members “because of reduced uptake” among staff. After broadening vaccine offers to other providers, physicians groups and the like, some — like Ballad — broadened their offerings to the 75 and over population.
Equity is key
Piercey said she met with more than a dozen hospital CEOs and the Tennessee Hospital Association about a week ago to explain new parameters if those providers wanted to keep doing community vaccinations.
Some, like Ballad, had started those rollouts with a targeted approach that only reached patients within their systems — primarily with outpatient providers affiliated with Ballad in the case of Northeast Tennessee.
Piercey said systems that want to keep receiving vaccine for community distribution have to change that model.
“Our focus is equity and making sure that we get it out to everybody that wants it, even in the underserved and minority communities,” she said.
The word to hospital systems was this, she said:
“We want you to set up a site in the community that’s easily accessible particularly by those who rely upon public transportation. We want you to vaccinate everybody – not just your patients. We want you to be a community site regardless of if they’ve ever been there before, regardless if they even have a payor source.”
Ballad announced Thursday they were ceasing community vaccinations, and Piercey noted a number of systems opted for the same — but not all.
That leaves Ballad currently able to vaccinate its own patients if it has enough vaccine left, Piercey said.
“There’s nothing wrong with doing that, but the guidance that we gave them is if you want to continue doing this on a large scale and you want to continue to be a vaccination site we want you to have equal access or we want your community to have equal access to this site.
“And so some have said, ‘yeah, sure we want to do that,’ and the others have said they will finish what they’ve got and then not get anymore.”
Plan updates add some groups to ‘Phase 1c’ group
The TDH changes to the state’s COVID-19 Vaccination Plan added certain people to Phase 1c.
According to a release from TDH, “Tennessee has added people living in households with medically fragile children to Phase 1c of the state’s COVID-19 Vaccination Plan.”
Parents, caregivers and other members of households with the susceptible children will be eligible to receive the vaccines when their regions enter Phase 1c.
TDH says the decision to include household members of medically fragile children was made in light of the fact that “at this time no COVID-19 vaccine has been approved for use in children under age 16.”
Tennesseans 16 and older with medical conditions that put them at high risk of death or severe illness from COVID-19 have also been added to Phase 1c.
TDH also announced that correctional officers and jailers have been placed in Phase 1a1 of the vaccination plan.
You can read the full TDH release below: