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Health care workers receive their COVID-19 vaccine in the tailgate lot of PETCO Park. / Photo by Matt Thomas for the San Diego Padres

If you’re twiddling your thumbs awaiting that call from your doctor to come and get a vaccine, prepare to twiddle a while longer.

Thanks to extreme under-planning by President Donald Trump’s administration (is he still president?) the people in charge of getting you a vaccine don’t feel informed about when, from where or how that will happen. The Wall Street Journal revealed Friday that leaders of Trump’s COVID-19 vaccine plan, dubbed Operation Warp Speed, waited more than two months to approve a plan to distribute and administer the vaccines, which gave states even less time to implement their own vaccination campaigns.

California’s vaccination rate is lagging behind other states, a reality blamed in part on its confusing and complicated tiered system prioritizing which patients get inoculated.

Cool, guys. (Incoming President Joe Biden announced Friday the fed would play a larger role soon.)

In contrast, the United Kingdom’s National Health Service that covers all of its people chose 50 hospitals that would first get the vaccine, how much of it and who could get it. In the United States, it’s something of a free-for-all, in the worst way.

The Trump administration is doling out the vaccine to states based on population and letting state governments decide how to divvy up the doses.

“We haven’t received a dime of state or federal funding to plan or prepare or execute vaccine distribution,” San Diego County Supervisor Nathan Fletcher said Wednesday. “We’re holding onto our receipts,” hoping to get reimbursed eventually for the more than $100 million the county plans to spend on a ramped-up vaccine distribution plan.

(The latest stimulus bill passed by Congress Dec. 22 includes $16 billion in vaccine development and supply support.)

Bearing that chaos in mind, Voice of San Diego attempted to answer some big outstanding questions on vaccine distribution.

How will I know when I’m eligible for a vaccine?

That depends on where you get your health care. Bottom line, they will let you know, and that’s because there isn’t enough medicine to go around yet.

“We need people to be exceedingly patient … because vaccines have simply not arrived in significant quantities to administer,” Fletcher said last week. “We expect more vaccines to arrive soon but we don’t know when, how many or which ones.”

Officials are asking everyone to stop calling their health care provider about available vaccines. (Scripps Health issued a plea directly to patients via email, bolding words “please do not call your physician’s office” and emphasizing they do not know when vaccines will be available.)

That’s a change from the county’s Jan. 6’s advice, when Fletcher announced public health officials don’t know how much vaccine has landed in the region. (Which is still true.)

Remember, there are a series of phases for the vaccine rollout determined by the California Department of Public Health, based on federal Centers for Disease Control standards. Phase 1A patients are health care workers and long-term care residents. Phase 1B includes people 65 and older and others at risk of exposure, like teachers and child care workers.

San Diego County doesn’t have enough vaccines move onto Phase 1B. Neither does Scripps Health, Sharp, Kaiser Permanente, Alvarado Hospital Medical Center or Paradise Valley Hospital, according to the San Diego Union-Tribune.

The one exception so far seems to be University of California-San Diego, which gets its physical shipments of the vaccine straight from the manufacturer, UCSD spokesman Scott Lafee confirmed Friday. The University of California health system gets vaccine supply based on county-by-county determinations from the California Department of Public Health, and then an academic health center’s populations, said Heather Harper, a spokeswoman for the UC System.

As of Thursday, if you’re 65 or older and a patient of University of California-San Diego’s hospital system, you could be contacted to receive a vaccine.

In contrast, it’s a mix for Scripps Health. Spokesman Stephen Carpowich said Friday the hospital receives its vaccines at the direction of the county, which approves every allocation to that hospital. It can’t order directly from manufacturers but they may get direct shipments, from Pfizer for instance because the hospital has the deep-freezing refrigerators necessary to hold them.

Still, UCSD said it will only vaccinate the groups that the state permits, and won’t move beyond that until it’s told – and if it has enough medicine.

How is eligibility determined?

On Friday, the county announced that San Diegans age 65 or older are the next priority for COVID-19 vaccination, hopefully later this month. But again, because there’s not enough medicine only a few health care providers can actually vaccinate their patients. That’s again why patients should wait to hear from their provider to let them know medicine is available.

Since UCSD has enough, it said decisions about who gets vaccinated first within that 65-plus risk pool is determined by the patient’s medical record.

“For example, a patient with diabetes or cancer (both risk factors for more severe COVID-19 infections) will be invited to vaccinate before healthier persons within their age cohort,” wrote Marlene Millen, an internal medicine specialist and chief medical information officer for ambulatory care at UCSD Health, in an email. She’s also part of the leadership team overseeing UCSD’s vaccine distribution program.

The county is supposed to serve as a backstop for patients without insurance or a medical provider.

Once vaccines are available for more of the general public, the county hopes to eventually have up to four vaccine “super stations” constructed, Fletcher said. Right now, there’s only one at Petco Park. The second one is slated to open early February in the South Bay and subsequent ones in East County and North County, Fletcher said.

The county has four smaller stations called “pods” delivering vaccines to health care workers right now too. Fletcher said the county will expand that to 12.

What’s with the second dose?

There are two available vaccines, one produced by Moderna and the other by Pfizer. They both require a patient to receive two doses to be fully effective. (A third vaccine by Johnson & Johnson would be a single-dose shot but isn’t available yet. It is in the final stages of its clinical trial.)

To use UCSD as an example, it said dose delivery is tracked via a patient’s medical. Patients are told when to come in for their vaccine (21 to 28 days apart) and subsequently invited to schedule a time for their second dose, Millen said.

The doses are about the same amount of medication. The Pfizer vaccine is shipped in five-dose vials, but Millen said some of those are overfilled and health systems have been able to extract a sixth dose per vial. Moderna’s vaccine comes in 10-dose vials.

It’s hard to track how many vials of vaccines are swimming around San Diego County. We have state numbers, though.

As of Jan. 18, Pfizer will have delivered 3.1 million doses of the vaccine to California, according to CDC data. But, assuming everyone gets a first and second dose, that really means there’s enough Pfizer vaccine for 1.5 million people.  (The population of California is about 39.5 million)

First and second doses are recorded as being shipped within the same week starting on Dec. 14. But California isn’t getting the same number of doses from week to week.

So, for instance, for the week of Dec. 14, California got 655,200 first and second doses (half and half). For the week of Jan. 18, the state will get 483,600 first and second doses.

The Pfizer vaccine is harder to manage because it needs to be stored at ridiculously cold temperatures – minus 70 degrees Celsius, which is how cold the surface of Mars is at nighttime. Moderna’s storage temperature is between 2 and 8 degrees Celsius (36 and 46 Fahrenheit).

California is slated to have received 3.2 million Moderna doses by Jan. 18 since distribution started Dec. 21, which is enough to vaccinate 1.6 million people twice.

Presumably, over 3 million Californians should be inoculated soon. That is if local agencies can assemble enough health care workers and secure locations to actually start pricking people.

On Wednesday, Fletcher said the county’s best estimate is that 241,825 doses have been shipped to the region as of Jan. 11. But 620,000-or-so people qualify for the first phase (Phase 1A) of inoculation.

Eventually patients will be able to sign up for a shot via a new county-run web portal, hopefully “in the coming weeks,” Fletcher said.

The goal is to complete 250,000 vaccinations by the end of January and, starting Feb. 1, administer about 24,000 doses a day every day, said Fletcher. The goal is to vaccinate 70 percent of San Diego’s population age 16 and over by the end of June. That will take over 3.7 million vaccines (first and second dose).

“All of that is dependent upon the arrival of vaccines, something that is completely and totally outside of our control,” he said.

What’s up with allergic reactions?

Six health care workers who got the Moderna shot on Wednesday at the Petco Park super station developed an allergic reaction, reported KPBS.

About .2 percent of the 1.9 million receiving the first dose of the Pfizer vaccine experienced some kind of negative effect. Twenty-one people experienced anaphylaxis (a life-threatening allergic response that can cause a person to stop breathing or go into shock), the majority of which already had some history of allergies or allergic reactions.

The CDC is still compiling a report on the bad effects of the Moderna vaccine, since it’s only been available since Dec. 21.

County health officials told KPBS they haven’t determined what’s behind the cluster of reactions at Petco Park, but the cases were referred to the Food and Drug Administration and CDC who are the primary investigating authority.

Top complaints (if they complained at all) from patients getting Pfizer’s vaccine are injection site reactions (84 percent), fatigue (63 percent), headaches (55 percent), muscle pain (38 percent), joint pain (24 percent) and fevers (14 percent), UCSD’s Mellin wrote. But all those symptoms aren’t unique to COVID-19 vaccines; in fact, they’re similar to complaints from people who get flu shots.

Both companies’ vaccines contain different amounts of medicine. Pfizer’s contains 30 micrograms of medicine per dose, and Moderna’s contains 100 micrograms – more than three times as much as Pfizer but with similar results, Mellin said.

Basically, before you get the shot, just tell the person giving it to you if you:

  •         have any allergies
  •         have a fever
  •         have a bleeding disorder or are on a blood thinner
  •         are immunocompromised or are on a medicine that affects your immune system
  •         are pregnant or plan to become pregnant
  •         are breastfeeding
  •         have received another COVID-19 vaccine


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