Vaccine lands for Marin’s frontline

12/16/2020

A health care worker at a nursing home in Marin is set to be vaccinated for Covid-19 today, an important milestone in the fight against the coronavirus that has infected at least 107 people in West Marin and upended nearly every aspect of life. Although the first vaccine is a beacon of hope, it will be months before shots are widely available, particularly on the coast, where cases are surging.

Pfizer’s initial shipment of 1,950 doses is destined for hospital staff and health care workers at Marin’s 13 skilled nursing homes, where deadly outbreaks have been triggered by employees travelling between facilities. Next week, Marin is expecting to receive a repeat shipment, plus another 3,000 doses from Moderna, the second vaccine producer awaiting emergency authorization. These doses will go toward remaining hospital staff and first responders, including active volunteer firefighters. Then, the rest of the county’s health care workforce, such as clinical doctors and social workers, will be due.

“Things are moving quickly,” said Dr. Matt Willis, Marin’s public health officer. “We are encouraged. If the supplies continue and grow, it could be as early as late January when this becomes real for some community members and March for the community as a whole.”

Vaccinating health care workers is the first of three phases developed consensually by local, state and federal health departments. The second phase consists of essential workers and high-risk residents, and the final phase is for anyone who wants one. California is distributing the vaccine on a per capita basis, with adjustments based on an area’s number of hospitals. In West Marin, the county will set up point-of-dispensing sites in underserved areas, and the Coastal Health Alliance will vaccinate patients. Paramedics are now authorized to administer doses, too.

Marin is following state guidance for the order of inoculation but could diverge slightly based on local conditions. For example, teachers may get priority because there is a relatively high number of them back in the classroom, Dr. Willis said. Plans for phases two and three are still being worked out.

The Centers for Disease Control and Prevention is undertaking a separate program to vaccinate non-medical staff and residents at care homes for the elderly through a partnership with CVS Pharmacy and Walgreens. Two facilities in West Marin signed up: Stockstill House in Point Reyes Station, where eight people live, and Sam’s House in Tomales, which houses five. 

“It’s still unclear when we’re going to get enough [doses] for everyone, so we’re just waiting,” said Pam Osborn, the associate director of West Marin Senior Services, which runs Stockstill House. 

The chain pharmacies aren’t expected to send vaccination teams until after Christmas. If they take too long, the county will use its vaccine.

“We are very anxious to provide people with protection,” said Lael Duncan, Marin’s lead physician for infection prevention and outbreak mitigation at elderly care sites. “It’s going to save hundreds, if not thousands, of lives in our region over the next couple of months."

Elderly residents and workers are excited to feel safe, but everyone realizes that they have quite a way to go before that’s true. Prevention strategies won’t change anytime soon, Dr. Duncan said.

Meanwhile, the coronavirus continues to spread more than ever in West Marin. Although the region was relatively spared from the surge in the summer, cases have risen by 65 percent since the start of November. Point Reyes Station has seen nine new cases in that time, and several other towns now have more than 10 cumulative cases: Inverness, Nicasio, Woodacre, Bolinas and Stinson Beach. Studies show that the true number of cases is six times higher than detected, Dr. Willis said.

There are 12 active cases in West Marin, and potential exposures have forced many establishments to temporarily close their doors; the Inverness Park Market is the latest to do so, closing this week through Wednesday for employee testing. 

In the county’s intensive care units, 28 of 29 staffable beds were filled on Tuesday, and 11 of those patients had Covid-19. If the I.C.U.s were to reach capacity, it will lead to higher mortality, both from Covid-19 and other ailments, Dr. Willis said. Hospitals will decline elective surgeries, reduce worker-to-patient ratios and increase overtime shifts if needed. 

West Marin has a sizeable anti-vaccination population: Between 10 and 24 percent of kindergartners failed to receive their required immunizations before entering school over the past five years. To calm fears, Marin is launching an educational effort that starts with frontline workers, because they are the ones who have personal, trusted conversations with patients. Last week, an infectious disease specialist hosted a call with over 300 health care workers to dive into Pfizer’s trial data. At the end of the call, 84 percent of participants said they would definitely take the vaccine. 

The vaccine will not be mandatory, but the public health goal is to get as many people as possible immunized.

“The potential for the vaccine in reuniting us, bringing kids back to school, putting businesses back online, letting us hug our grandparents—my hope is that vision is enough for people to get vaccinated not just for their own health, but the health of others,” Dr. Willis said.

The Pfizer vaccine is manufactured at production sites in Wisconsin, Michigan and Missouri. From there, UPS and FedEx ship doses by road and air to hospitals, health departments, clinics and pharmacies across the United States. The vaccine must stay below minus-76 degrees Fahrenheit while it travels, so vials are shipped with dry ice and a thermal sensor in a suitcase-sized container. 

Vials can be stored in ultra-cold freezers for up to six months, in the shipping containers for 30 days, or in a refrigerator for five days. Before injection, the vaccine is thawed and diluted.

The shot is injected into the muscle, sending genetic instructions to cells to create proteins that mimic the virus, triggering an immune response. The vaccine requires two injections, separated by three weeks. Recipients will receive a record card that says when they were vaccinated.

The vaccine comes with side effects: In clinical trials, 63 percent of vaccine recipients had fatigue, 55 percent had a headache, 38 percent had muscle pain, 32 percent had chills, 24 percent had joint pain, and 14 percent had a fever. The vast majority of these symptoms were moderate.

Over 43,000 participants over the age of 16 were given either a placebo or a vaccine in trials; 170 people were later confirmed positive, but only eight of them from the vaccine group, showing the vaccine is more than 90 percent effective. How long the vaccine’s effectiveness lasts is unknown.

The Moderna vaccine uses a similar cellular technology and is about as effective as Pfizer’s, but it is stored in more conventional freezers and ships in smaller packages. The federal government is expected to grant emergency-use authorization in the coming days. Because the vaccine is stored in refrigeration facilities found at any medical provider, it is better for serving rural areas like West Marin, where there are no ultra-cold freezers for storage.