On front lines but in back of the line

As some health staff get vaccine, others are left to wait

So far, the effort is concentrated in hospitals. Workers treating COVID-19 patients in intensive care units and in emergency departments have been beaming symbols of the virus’ demise.

But there are roughly 21 million health care workDr. Biron Baker runs a ers in the United States family medicine clinic in and vaccinating everybody Bismarck, North Dakota. in the first wave would be Every day patients walk impossible. That has left through the door, and any entire categories of worknumber of them could be ers wondering about their sick with the coronavirus. place in line.

Baker treats them anyway, There are broad gray doing the best he can with areas, said Arthur Caplan, his small staff to keep from a bioethics professor at getting sick. NYU Grossman School of

But as the nation’s daily Medicine: primary care death counts from the doctors in areas with high coronavirus shatter previinfection rates, workers ous records and the vaccine who handle bodies, firerolls out for front-line fighters who respond to health workers across the 911 calls, dentists, patholocountry this week, Baker gists who handle coronaviand his staff are so far not rus samples in labs, hospice among those scheduled to workers. receive it — and they do not “Right now, they are know when their turn will asking, ‘Where am I in all come. of this?’ That’s turned into

“We haven’t heard a quite a behind-the-scenes word from our state,” he tussle.” said, adding that he had The Centers for Disease tried several times to call Control and Prevention has state officials for an answer laid out categories but they but with no luck. are broad, so each state —

The vaccine is perhaps and each hospital system — the lone bright spot for the has come up with its own country as the coronaviplan and priorities. The rus continues its rampage result has been a sometimes around the U.S. and new confusing constellation of data show a jobless crisis rules and groupings that far worse than in other has left health care workrecessions. ers like Baker — as well as

Still, in the scramble professional societies of to vaccinate millions of groups such as patholohealth workers, difficult gists, dentists and medical choices about who comes examiners — wondering first — and who must wait where they stand.

— have started to surface. One of the most critical categories has been firefighters and other emergency services workers.

F i r e f i g h t e r s , who respond to 911 calls and enter people’s homes, are often a first point of contact with the health care system. They provide about 85% of emergency medical response in the country, said Harold Schaitberger, general president of the International Association of Fire Fighters

But despite their frontline role, he said, it is unclear when they will be vaccinated.

“We should be absolutely up front,” Schaitberger said. Firefighters had to fight to get access to adequate personal protective equipment, he said, and now they are having to do it all over again with the vaccine.

And as the virus surges in many places, that job has only gotten more dangerous. Last week, six of the 33 firefighters serving Newport, Kentucky, a city across the river from Cincinnati, were out of commission because they had either contracted COVID-19 or had close contact with someone who did.

Hospitals are ground zero for the vaccine effort, but even there, not everyone can be covered with the first allotment.

Dr. Melanie Swift, a doctor at the Mayo Clinic, is helping that hospital system manage the effort to begin vaccinations of its large staff, mostly in the

Midwest.

The system made a spreadsheet of risk categorizations for each of its 72,000 staff members, and the workers with the most frequent, intensive and least controlled contact with COVID-19 patients — including emergency department workers and long-term care workers — will be vaccinated first. The first doses of the vaccine, set to arrive this week, will probably cover most of those workers, Swift said, roughly 6,500 people in their flagship Rochester, Minnesota, location.

What other workers have asked when they will get it?

“Oh, only everyone,” she said. “Most people have prefaced their question with, ‘Of course I don’t think I should be ahead of the COVID ICU staff who have been drinking from a fire hose since March.’ But our pediatric patients don’t stay reliably masked; perhaps we are at increased risk,” she said, listing an example of one common question.

She said she had been telling people that everyone would eventually get vaccinated.

The question of when is a moving target. Dr. William Borden, chief quality and population health officer at G.W. Medical Faculty Associates in Washington, said that the doses it had received would not cover all of the workers in the top priority departments but that he hoped to receive more soon.