Rural hospitals begging for vaccine
With smaller staffs, they’re left off distribution lists
PEARSALL — The tiny vials of vaccine that arrived this week at Frio Regional Hospital gave nurse Monique Reyna and her colleagues the first glimmer of hope after months of tending to COVID-19 patients.
The rural hospital’s 45 nurses and half-dozen doctors have been stretched thin for months by the pandemic.
Frio Regional normally would send critically ill patients to larger facilities 55 miles away in San Antonio, but it often has been unable to because of the recent surge of COVID-19 admissions there.
Instead of working her normal three 12-hour shifts per week, Reyna sometimes has worked five.
“We had people out because of COVID-19,” Reyna said. “When you take one person out, and everyone that’s been exposed, you take half our staff.”
By the time Fedex delivered 300 doses of COVID-19 vaccines Wednesday — enough to vaccinate Frio Regional’s entire staff and start on first responders in nearby communities — half of the hospital’s 12 patients were sick with COVID-19.
The hospital operates 22 beds, and on the worst days, all of them are filled.
“This gives us a chance,” said Reyna, who volunteered to be one of the first people to take the vaccine
Frio Regional fared better than many of the state’s small hospitals. Less than two weeks into COVID-19 vaccine distribution in Texas, some rural hospital administrators already are experiencing delays and difficulties securing the shots for their staffs.
Only half of Texas’ rural hospitals have made the list for the early shipments, even though rural
communities have been among the hardest hit, according to the Texas Organization of Rural & Community Hospitals, which advocates on their behalf.
“This is very concerning to us as staff and physicians in many rural hospitals are drowning right now and don't have the ability to lose any more workers to COVID due to sickness or quarantine,” said Don Mcbeath, director of government relations for the hospital organization.
Almost 330,000 Americans have died of COVID-19, including about 26,000 in Texas.
Even before the virus tore through communities, the state already grappled with shortages of health providers, particularly in rural swaths of Texas. Rural Americans also are more likely to be older, live with disabilities and lack health insurance.
Health policy experts feared the pandemic could further widen the health care gap between rural and urban areas.
As the most ambitious immunization campaign in recent history kicked off this month, medical experts warned fair and equitable distribution of the vaccine is the key to defeating the virus.
Texas convened a 17-member panel to decide who would get vaccines and when. The group is tasked with considering “equitable distribution across urban and rural communities” and among vulnerable populations, such as older adults and people with underlying conditions.
But when the state released the list of where it would send the first 225,000 doses of COVID-19 vaccine early this month, not a single rural hospital made the list.
It was disappointing for hospital administrator Janice Simons, who runs Medina Regional Hospital, a 25-bed facility that serves a county of 50,000 people 40 miles west of San Antonio.
Still, she was hopeful her hospital would make it into the second week of distribution, when the state promised to send smaller amounts to more providers.
Then the second week's list arrived: 620,000 doses would go to
1,100 facilities, including pharmacies, medical practices and urgent cares. The H-E-B pharmacy “almost next door to us,” Simons said, received 100 doses.
But once again, Medina Regional Hospital was missed.
“We were frustrated because Medina Regional happens to be the only hospital in Medina County,” Simons said.
The state said it shipped the first doses to large health care providers because the minimum
order of the Pfizer-biontech vaccine is 975 doses — a number far higher than what most rural hospitals have on staff.
The Pfizer vaccine also must be shipped and stored at about -94 degrees Fahrenheit.
Nonetheless, rural hospitals were ready to meet those challenges, said Mcbeath of the rural hospital association. Some planned to team up and share one tray of 975 Pfizer doses. Others shelled out upward of $10,000
to buy ultra-cold freezers to store the shots.
In the worst-case scenario, rural hospital administrators figured they'd have to wait only until the state began shipping the Moderna vaccine — the second COVID-19 vaccine to receive emergency approval in the U.S. It ships in batches of100doses and can be stored in a regular freezer.
Moderna shipped 460,500 doses of the Moderna vaccine to Texas, but 79 of157 rural hospitals were left out, the hospital organization said. Meanwhile, vaccines were sent to dozens of pharmacies, private medical practices and urgent cares.
“We're hearing from hospitals that are saying, ‘I can't get it, but three retail pharmacists in my town did,'” Mcbeath said.
The online application to request vaccines from the state is lengthy and has been glitchy for some hospital administrators, Mcbeath said. And no one was warned it could take two or three weeks for the state to add a rural hospital to the list once it submitted its request.
“I understand they have to have a lot of data points to make their decision as to if a hospital gets it and howmany doses — I get all that,” Mcbeath said. “But I can tell you that the front-line physicians and nurses in these rural hospital ERS that are slammed, (where) people are dying every day … they don't really care about all that.”
Chris Van Deusen, a spokesman for the state health department, said the agency is working closely with health care providers that are having trouble enrolling in the vaccine distribution program, which has been open since early October.
In Medina County, Simons didn't find the state to be of much help. Even though an email from the state said her hospital was approved Dec. 14 to receive doses, Simons has no idea how many — or when — vaccines might arrive.
Unlike large hospital systems that need thousands of doses to protect their staffs, Medina Regional Hospital would need only about 250 to 275 vaccines to protect its entire workforce, Simons said.
The state is experiencing what could be the worst surge of the pandemic yet — and several members of Simons' staff have been out because they tested positive for COVID-19. But there's little she can do.
“We just wait patiently until the end of the week,” she said, “to see if we're on the next distribution list.”