While hospital doctors, nurses and other critical staff are being vaccinated against the coronavirus, some private practice doctors — many who test and treat virus patients — are wondering when they’ll be next.
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Earlier this month, vaccines were distributed to various hospitals around the county in an effort to immunize critical care doctors, nurses, technicians and other frontline medical workers.
At a news conference last Wednesday, OC health officer Dr. Clayton Chau said the county got 25,000 first doses of the two-part Pfizer vaccine, with the 25,000 second doses arriving next week or so.
There’s also an additional 17,000 first doses arriving sometime this week, Chau said.
And with the Food and Drug Administration recently clearing the two-part Moderna vaccine, OC expects roughly 32,000 first doses of that sometime this week, he said.
That’s a total of around 74,000 first doses of the two-part vaccine.
There’s roughly 200,000 health care workers in OC, Chau said.
“As you can imagine it’s not enough. So we have to go down the line on tiering,” he said.
One primary care doctor, anonymously speaking to Voice of OC out of fear of retaliation by the hospital organization they’re a part of, said they have been testing, diagnosing and treating at least a dozen virus patients a day since late last month.
Primary care physicians generally have different roles from hospital doctors and are usually someone’s first point of contact for an undiagnosed health concern.
The doctor said they’re uncertain if they will get the vaccine any time soon and fear they might get the virus because the office doesn’t have negative pressure rooms — which help contain virus particles — and other high-end medical equipment that many hospitals have.
But the doctors may soon have access to the vaccine.
Orange County Medical Association President, Dr. Jason Cord, said primary care and urgent care doctors will be able to get inoculations from the incoming Moderna vaccine. Cord also sits on the OC vaccine task force, which has been working to roll out distribution plans.
Because the Pfizer vaccine has to be stored at extremely low temperatures, and has sensitive expiration times, Cord said those shipments went to the big hospitals who can manage to store and easily distribute them to frontline health care workers.
The storage and distribution for the Moderna vaccine is easier, Cord said, which will allow a broader distribution to private doctors and urgent care physicians.
“So that’s really a good thing. So that’s going to mean our next step is we can go to small to medium practices,” Cord said in a Tuesday phone interview. “It’ll be a lot easier, logistically, to have sites that we can service those kinds of providers.”
For months, public health officials have been urging people to check in with their primary care physicians or urgent care doctors if they feel coronavirus symptoms, instead of going to an emergency room, in an effort to save hospital space and free up staff for the wave of virus patients.
Dr. Michelle Hure, a private physician who practices dermatology and pathology, said she and her colleagues in the private medicine field aren’t sure when they’ll be able to get vaccinated.
“As a private practice physician, in my own office without hospital association, I have absolutely no recourse or way of gaining access to the vaccine. OCMA (Orange County Medical Association) has not really reached out to those of us who are not affiliated with hospitals to put together any sort of plan of action,” Hure said in a Tuesday phone interview.
Hure said she wants to volunteer at the mobile field hospitals to help treat coronavirus patients, but worries about not being able to get vaccinated.
“Private practice physicians in OC never expected to be first in line for the vaccine, but we anticipated to be included in the master plan ahead of non-clinical hospital staff,” Hure said.
Cord said the medical association, along with the county Health Care Agency, are putting together a vaccine application process for physicians like Hure.
“The biggest problem right now is we do not have a great platform to manage people, who are not affiliated with a hospital system, in an easy fashion. That’s something we’re working on right now,” Cord said.
Cord said the program has already been created and will be rolled out once the Health Care Agency is able to find a clinic to house it.
“That’s going to be where we can cross the bridge to solo doctors and other practitioners,” Cord said. “It manages scheduling you, finding a location close to you and assures you get the same vaccine the second time.”
Moderna and Pfizer vaccines can’t be mixed, people have to use the same ones from the respective companies.
Meanwhile, Orange County hospitals continue to be filled up with coronavirus patients.
As of Tuesday, 1,806 people were hospitalized, including 390 in intensive care units.
That’s an increase of nearly 100 in one day.
The positivity rate also sits at 15.5%, according to state public health data, which is updated daily.
The virus has now killed 1,779 county residents out of 130,414 confirmed cases.
The virus has already killed more than three as many people as the flu does on a yearly average.
For context, Orange County has averaged around 20,000 deaths a year since 2016, including 543 annual flu deaths, according to state health data.
According to those state death statistics, cancer kills over 4,600 people, heart disease kills over 2,800, more than 1,400 die from Alzheimer’s disease and strokes kill over 1,300 people.
The county is on track to surpass its average yearly deaths with over 19,000 people dead as of October, the latest available state health data.
There’s various guidelines from health agencies at the federal and state level, along with national medical organizations — which could be adding to the vaccine rollout confusion.
Cord said interpreting the various guidelines has been tricky.
“I think the guidelines get you to the general ballpark of where you need to be, but that interpretive stretch of does this one person qualify? It’s hard to do,” he said. “Our role is to help mitigate against those problems and help to try to make sure there’s equity, make sure there’s parity among the facilities and, and I think we’re doing that.”
The California Department of Public Health issued guidelines on vaccine distribution earlier this month, which put health care professionals at the top of the list on one plan, yet scatter physicians on the second plan, which is for limited stocks of vaccines.
Workers at hospitals, skilled nursing homes, assisted living facilities and paramedics are in the first tier.
Primary care physicians and urgent care doctors are in the second tier.
At a Monday news conference, Secretary of the state Health and Human Services Agency, Dr. Mark Ghaly, said the guidelines are based on risk factors like job settings.
“The fundamental platform that California’s vaccine distribution plan is based on is prioritization based on risk factors and making sure that it’s an equitable distribution across the state,” Ghaly said.
He said the first round of vaccinations are slated “to be provided to the priority group 1a. That includes our frontline health care workers and our residents of long term care facilities.”
Ghaly also said some health care workers will get the vaccines first, while others will have to wait.
“Certain health care professionals who are on the frontlines are in tier one and others are in tier three,” he said.
Yet Ghaly didn’t offer specifics on what types of medical workers are in each tier.
The Centers for Disease Control and Prevention issued vaccine distribution recommendations earlier this month, which call for health care workers and nursing home patients to be first in line for the vaccines.
“The Advisory Committee on Immunization Practices (ACIP) recommended, as interim guidance, that both 1) health care personnel and 2) residents of long-term care facilities be offered COVID-19 vaccine in the initial phase of the vaccination program,” reads the recommendations.
The CDC also defines who health care personnel are.
“Health care personnel are defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials,” reads the CDC recommendations.
Doctors, like primary care physicians, look to be a part of that group.
“Public health authorities and health care systems should work together to ensure COVID-19 vaccine access to health care personnel who are not affiliated with hospitals,” read the recommendations.
The OC Health Care Agency is using vaccine guidelines from the National Academies of Science, Engineering and Medicine, according to the agency’s website.
The CDC and the National Institutes of Health tasked the National Academies with producing the guidelines.
The group suggested a four-phased approach to vaccine distribution, with health care workers high up on the list.
“Included in Phase 1a would be “frontline” health workers—health professionals who are involved in direct patient care, as well as those working in transport, environmental services, or other health care facility services—who risk exposure to bodily fluids or aerosols,” reads the guidelines.
Over the weekend, Irvine Mayor Farrah Khan sparked confusion and anger among numerous OC doctors last Friday with a Facebook post, indicating doctors had to be part of the medical association to get a vaccine.
“As of right now we don’t have enough vaccines for private care professionals. One must be a part or affiliated with the OC Medical Assoc to receive the vaccine,” reads Khan’s post.
Cord said that’s simply not true.
“God no. That’s completely, completely incorrect,” Cord said. “There’s no affiliation required.”
Spencer Custodio is a Voice of OC staff reporter. You can reach him at firstname.lastname@example.org. Follow him on Twitter @SpencerCustodi
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