Those at greatest risk given vaccine priority
Hospitals focus on front-line workers by need, weighing their job duties and risk factors
As health care workers line up for the precious COVID-19 vaccine, what matters is not power or privilege, but need.
On the long list of eligible employees compiled by every hospital, this is who counts: The janitor who disinfects the emergency room. The aide who strains to lift and move a patient. The critical care nurse who monitors breathing machines. The physician who shuttles between intensive care beds. The transport staff who roll bodies to the morgue.
“They take priority … over anyone in the ‘C suite’ or the directors of departments,” said Sarah Sherwood of Regional Medical Center in San Jose, which serves hardhit Latinx and Asian communities.
This week’s vaccinations, the first in a staggeringly complex national campaign, offer a glimpse of true meritocracy. In a nation where status can rush the most fortunate to the front of the line —
whether for airport security screening or country club admission — the COVID-19 vaccines are offered first to the truly needy.
“These are the people who have instrumental jobs in making sure others are taken care of,” said Dr. Charles E. Binkley, a surgeon and health care expert who directs the bioethics program at Santa Clara University’s Markkula Center. “They play a pivotal role.”
On the fifth-floor corridor of the Contra Costa Regional Medical Center in Martinez, lab technician Gilberto Garcia was one of the first on Tuesday to receive a vaccination and said his wife was concerned about the potential side effects. But Garcia trusted all along that science would find a solution.
“For me, whatever happens will happen,” Garcia said. “I will never regret getting this vaccine.”
At Zuckerberg San Francisco General Hospital, a radiology technician joined two nurses and two doctors to receive the city’s first five doses.
As more vaccines arrive, hospitals aim to protect their entire workforce, a stunning development that will spare those who have spent grueling months in the trenches of the country’s coronavirus nightmare.
“We are planning and preparing for the ability to vaccinate everyone — hopefully by the end of January,” depending on supplies, said Dr. Niraj Sehgal, chief medical officer for Stanford Health Care. With access to 4,000 doses, it is now crafting the most logical sequence of workers.
Even as the vaccinations are infusing hope for health care workers, the more immediate reality in California is of a pandemic raging out of control.
At least 250 deaths were reported statewide from COVID-19 on Tuesday, a new daily record. The number of new coronavirus cases also smashed records, with more than 41,000 reported statewide on Monday, according to data compiled by this news organization. Of the more than 15,000 people hospitalized with the virus, 3,193 were being treated in intensive care units — a number that has almost tripled over the past month.
ICUs have nearly reached their capacities in the San Joaquin Valley and Southern California, with perhaps thousands more patients expected to arrive over the coming weeks. Statewide, the units have just 5.7% of their total capacity available. The state is also scrambling to find nurses and doctors to care for the swelling numbers of patients.
In a grim counterpoint to the logistical work of distributing the vaccine, Gov. Gavin Newsom said California has also secured 5,000 body bags and 60 refrigerated trucks to handle the surge of deaths. And that toll is expected to keep rising, as people who contracted the virus in recent weeks succumb to it.
Speaking before the Santa Clara County Board of Supervisors on Tuesday, Heath Officer Dr. Sara Cody paused, briefly overcome with emotion, as she described how the county was in “very bad shape” amid the surge.
“Our pandemic locally is out of control, and our health care system is quite stretched,” Cody said. “We cannot normalize this. We need a statewide action to keep people from dying.”
Newsom said California plans by the end of this month to start vaccinating 2.1 million of the roughly 3 million people it considers first in line — health care workers at acute care hospitals, as well as residents and staff at long-term care facilities. Paramedics and others in emergency medical services are also among those considered a top priority for the vaccine.
Hospitals are using different strategies to rank vaccine recipients. Almost all facilities are prioritizing workers in four departments: intensive care, emergency care, COVID-19 care and respiratory therapy.
At Regional Medical Center, employees of these departments received an email with a link to sign up, with questions about risk factors, such as diabetes, obesity, autoimmune diseases or other conditions. Those at greatest risk moved to the front of the line. Once everyone in those departments is protected, the hospital’s other employees will also be ranked, based on vulnerability.
In the Department of Medicine at UC San Francisco, “we’re poring over spreadsheets of thousands of clinicians to figure out which ones should go 1st, 2nd, 3rd, etc.,” department chair Dr. Robert Wachter wrote on Twitter. After UCSF identifies workers at greatest risk in one job category in one unit, it arranges the timing of shots to balance work schedules and any missed shifts due to side effects.
In a process it calls “sequencing,” Stanford Health Care’s vaccine planning group focused on four principals: preserving the health of its central health care workforce, protecting the most vulnerable, ensuring equity and providing transparency throughout the process, said Sehgal. It considers job duties but also risk factors such as age. Leaders of each department provide input.
Contra Costa Regional Medical Center is prioritizing staff members who are most regularly exposed to COVID-19 patients. Radiologist Dr. Robert Liebig said he self-reported the number of patients he treats, then was cleared to receive the vaccine on Tuesday afternoon.
“This has been a very optimistic 48 hours,” Newsom said. “We are finally seeing the vaccine being utilized.”
But at the same time, he added, “We are going through perhaps the most intense and urgent moment of this pandemic. … We are not at the finish line yet.”