‘We just need the vaccine.’
FARMINGTON – In early January, Franklin Memorial Hospital administrators learned that their vaccination program, roughly two-thirds of the way through delivering the Moderna COVID-19 vaccine to several hundred employees, would also be providing the vaccine to members of the general public.
Barbara Sergio, FMH’s chief operating officer, recalled the morning that enrollment opened. In five minutes, there were more than 80 people waiting in the queue on the phone. The hospital’s entire phone system crashed due to the traffic, despite bringing in extra lines. MaineHealth, the hospital’s parent company, opened up its own call center, drawing 82,000 initial calls and letting FMH focus on getting the vaccine into people’s arms. In approximately one week, the hospital expanded its effort into a public vaccination center, utilizing shifts of 18 employees borrowed from other departments, as well as firefighters and other volunteers organized by Franklin County Emergency Management.
Now, the hospital is distributing 120 new doses per day to qualifying individuals: health care workers and Maine residents 70 years or older. That’s not counting the additional 120 weekly doses that will be distributed in the near future to people completing the second half of their two-shot regimen. Last week, Sergio estimated that out of the 70-and-older residents that are expected to get a shot at FMH, the hospital had provided more than a third of them their first shot. Meanwhile, the vaccination program is expected to open up to those 65 and older sometime in early March.
The bottleneck, as is the case throughout much of the country, is the number of vaccine doses. Sergio said that she was confident that the FMH clinic could administer 1,800-plus shots per week, assuming the vaccine supply was large and stable enough.
“It’s the supply [of the vaccine],” Sergio said, seated in an office just off the large, sunlit convention hall that houses FMH’s clinic. “We will find the bodies and the space. We just need the vaccine.”
The challenge, of course, is so does everyone else.
Sign-ups
The only way to get a vaccine at FMH’s clinic is by calling the MaineHealth vaccination number: 877-780-7545. This will connect the caller to an automated answering service which will record a name, zip code and phone number, placing the individual in a big list of people that want the vaccine. That list is used to schedule appointments; Sergio noted that appointments are only scheduled when the hospital has the vaccine, meaning they’re scheduled roughly a week or so in advance. FMH administrators learn on Thursday how many shots to expect during the next week.
One common question, Sergio said, was whether people could assist a neighbor or relative by calling the number on their behalf. They can, but should take care to leave a phone number that will allow MaineHealth personnel at the call center to later contact the individual to confirm an appointment date.
There’s no geographical requirements for MaineHealth’s clinics, Sergio said, and a local resident qualifying for the vaccine could get the shot at a location other than FMH. Nor is MaineHealth the only organization taking part in Maine’s distribution effort: a number of health care centers and organizations are running their own clinics and Walmart pharmacies, including the Farmington location, are participating in a federal program that’s also seeking to distribute doses. Large vaccination centers have also opened in Scarborough Downs and the Cross Insurance Center in Bangor, but the state is also sending vaccine to smaller clinics and facilities throughout rural Maine. A complete list of vaccination sites is maintained by the Office of the Governor, located here.
The list of people interested in receiving a vaccination is used on a first-come, first-serve basis for MaineHealth in scheduling appointments. There is a lag time between MaineHealth receiving the request for a vaccine and calling to schedule an appointment. One common issue has been people putting in a request and then not hearing back promptly enough, so MaineHealth began sending out confirmation emails and calls last week.
In any case, Sergio said, the only way to get a shot at FMH is calling the hotline. This has led to some frustrating misunderstandings. For example, people who have seen media reports about expiring or “extra” doses have, in some cases, tried to camp out at the clinic hoping to pick up a dose at the end of the afternoon shift. That won’t work, Sergio said: Moderna vaccine containers hold a fixed number doses and appointments are scheduled accordingly. In some cases, a container may hold an extra dose, but those doses are subject to the same state requirements and would still go to people signed up through the MaineHealth line. Recently, Sergio said, FMH staff realized they were going to finish the day with an additional eight doses. She simply began calling people already booked on the appointment list and moved enough of them up to distribute the shots. Sergio said that so far she’s had to throw zero doses away.
Some of the frustration relates to confusion between the federal Center for Disease Control’s tiered system and the state’s own criteria, which remains focused on the 70-plus-and-older cohort. The cutoffs are strict and there is no wiggle room for the clinic staff. An example that Sergio said happened frequently was a 71-year-old resident coming into the clinic and requesting a shot for his or her 69-year-old spouse.
Misunderstandings are also caused by a consistent misconception that the restricting element is time, or clinic space, or staff. Members of the public will come in during a lull and look around at a mostly-empty clinic and ask to be squeezed in, Sergio said, but the true limiting factor is the amount of vaccine distributed to FMH each week. Other people have tried to volunteer at the clinic, incorrectly believing it will automatically earn them a shot. In some cases, Sergio said, clinic staff have had to call security.
“You try to be sympathetic, empathic,” Sergio said, “but we’re given a set of rules.”
The Clinic
People who do call the hotline and are called back to be assigned an appointment arrive at FMH’s main entrance. Waiting for them are volunteers organized by Franklin County Emergency Management Agency, rotating through in the same four-hour shifts that health care workers are filling in the clinic. The volunteers, a combination of first responders, ham radio operators and other citizens that have worked with EMA in the past, help direct incoming and outgoing vaccine recipients and provide assistance to the wheelchair-bound.
Collaboration between the hospital and local first responder agencies started early in the pandemic last year, EMA Director Tim Hardy said, and the local agencies have been participating with the hospital’s incident command staff meeting twice a week.
“It’s been very useful, definitely,” Hardy said. “I know it’s provided valuable situational awareness to us and vice-versa. It’s been a good partnership.”
Hardy himself checks in with the hospital, usually daily. He said that, for some local residents, signing up for the shot, going to the hospital, the vaccine itself – was part of an uncertain, unfamiliar process. Having the clinic run smoothly, with volunteers ready to push wheelchairs or move cars, could help alleviate some of that stress, Hardy said.
“If you’ve been there, people are excited,” Hardy said, referring to FMH’s clinic. “I think it runs very well.”
Upon arriving and asked a battery of now-familiar, ‘do-you-have-COVID?’ questions, participants in the vaccine clinic are directed into a room with FMH personnel who ask basic medical history and allergy questions. The screening process doesn’t incorporate more complex medical conditions – questions relating to the vaccine’s potential impact on a specific condition should be directed to the individual’s primary care provider or specialist, as appropriate. The state has also been directing Mainers to the 2-1-1 informational and referral service to get general questions about the vaccination effort answered. At the clinic, staff members review a photo identification as well as insurance information. No one is charged for doses, but insurance companies are billed for the administration of the vaccine. Funds have been set aside for people without insurance.
After checking in, people wait for their shot in the Bass Room, a convention hall located inside the hospital. The process is fast and there are few lines. After the vaccine is administered, residents settle into chairs in a waiting area in the same room. On each chair hangs a digital egg timer counting down a 15- to 30-minute waiting period to ensure that if someone has an adverse reaction to the shot, they can be treated immediately at the hospital. As of last week, clinic staff have reported no cases of reactions to the Moderna vaccine severe enough to warrant medical attention.
While waiting, people are met by still more clinic staff with clipboards, ready to schedule the second dose. Moderna’s vaccine, like the similar Pfizer product, requires two injections approximately a month apart. A critical part of the state’s rollout is ensuring second doses will be available for people to complete their vaccination processes; so far, so good on that front, according to Sergio. Second doses must be administered at the same location as the first dose: people that get their initial shot at FMH will be scheduled for a second shot at the same clinic.
The Impact
Whether Maine’s vaccination program is beginning to pay dividends in a seven-day positivity rate that has tumbled from more than 600 new cases statewide in mid-January down to 150 is unclear, according to public health experts. At Thursday’s briefing, Maine CDC Director Dr. Nirav Shah said that 265,991 doses had been distributed in the state so far, including roughly 186,000 initial doses and 80,000 second doses. That vaccination rate – roughly 14 percent of the state’s population receiving at least an initial dose – was less than the 30 to 40 percent benchmark at which point Shah said that many epidemiologists suggested that the state’s positivity rate could start seeing an appreciative decline. Herd immunity – meaning enough of Maine’s 1.3 million people have been immunized that disease spread is unlikely – has been generally associated with approximately 80 percent of the population being immunized.
However, Shah also noted that there were a number of Mainers beyond the reported 40,000-plus positive cases who had contracted COVID-19 and recovered without ever being tested. A combination of the initially-inoculated, plus Mainers with natural immunity relating to their recovery, could push the resistant population up to a point where it could theoretically result in a reduction in new cases, Shah said Thursday, adding that he had asked analysts to look at that hypothesis.
As an aside, the state does recommend that people who have recovered from COVID-19 eventually get the vaccine. This is because it isn’t yet clear how long the natural protection associated with COVID-19 will last.
In general, Shah said Thursday, it was likely that a combination of factors beyond vaccines and/or natural immunity, including widespread mask usage, social distancing adherence and a dearth of holiday-related gatherings, were responsible for the improved position.
Shah did say that immunization efforts targeting 70-and-older Mainers and health care workers in long-term care facilities could be resulting in fewer outbreaks in those settings.
“There’s probably a straighter line in the number of vaccinations and the number of outbreaks,” Shah said, referring to long-term care facilities. “It speaks to the power and promise of the vaccines.”
As prioritized by Gov. Janet Mills, the state’s vaccination strategy has been to target populations at the greatest risk of death or severe cases of the disease, Shah said. State officials have been looking at expanding the program to ages 65 and up in early March, although Shah said that vaccine supply would govern those decisions.
That supply is increasing; Shah announced Thursday that the state anticipated receiving 27,740 doses this week. That increase, 5,265 doses above last week’s allotment on paper, is due in part to an additional three trays of the Pfizer vaccine, up from the previous nine, as well as a reporting change from the federal government designed to capture the “extra” sixth dose that can be extracted from the Pfizer vials, previously listed as containing five doses. Shah said that 3,510 of the state’s additional doses were due to additional trays, while the other 1,755 doses were due to the reporting change. In total, the state is anticipating receiving more than 13,000 doses of Moderna vaccine and 14,000 doses of Pfizer this week.
FMH is currently administering the Moderna vaccine, but Sergio said that there wouldn’t be any issue administering the Pfizer vaccine, if the clinic gained access to a supply.
Maine Department of Health and Human Services Commissioner Jeanne Lambrew said Thursday that federal support for the pharmacy-based vaccination effort was also expected to double.
“Hopefully with the expanded supply we can get to the next group,” Lambrew said, noting that the 65-to-69-year-old group numbered approximately 92,000 people statewide.
Looking ahead
One of the question marks surrounding what the coming months will look like relates to variants, different versions of COVID-19 that, in some cases, show increased rates of transmission. One of these, B.1.1.7, has been detected in Maine in two instances, including one case involving a Franklin County resident with a history of international travel. Per the Maine CDC, there’s no known link between that case and a second B.1.1.7 case detected in York County. More contagious COVID-19 variants added urgency to the effort, Sergio said, but initial indications are that the vaccines being administered in Maine will still be effective.
Another issue is vaccine hesitancy, referring to people who are eligible to get the vaccine but choose not to. That hasn’t been a problem with the 70-plus cohort, Sergio said.
“This age group remembers the polio vaccine process,” she said. “It’s the younger group that is more skeptical.”
Some of the people that Sergio has spoken with about the vaccine have cited the shortened trial period (Sergio pointed out that while the schedule was compressed, the vaccine still went through the clinical trials and review processes) while others have expressed concerns that the shot causes infertility (no evidence of this) or contains tracking devices (untrue). A lot of the misinformation is being passed around on social media in the form of documents or videos, Sergio said, adding that “we’re trying to mythbust” to combat hesitancy.
Zero hesitancy was exhibited by Janice Bullen, wearing a surgical mask and her ‘Got My Vaccine’ sticker, and had her second dose already scheduled before she paused briefly on her way out of the clinic to describe her first shot.
“It was beautiful, never felt a thing,” Bullen said. “I thought it was the safest thing to do.”
Bullen said that she missed her family “terribly” – children, grandchildren and great-grandchildren – after an absence related to the public health crisis. “We’ve all been very careful,” she said. “Grocery shopping, that’s pretty much it.”
As vaccine supply improves, or additional vaccines become available, Sergio said that the clinic should be able to scale up the number of shots delivered. Not bad for a clinic pulled together in a week, she said.
“I do think we’re making a difference, I do,” Sergio said. “And I think six months from now, we’ll be in a different place.”
