Maine’s COVID Vaccine Rollout Ramping Up; With Little Detail

Published in Maine Medical Association’s Weekly Update 12/23/2020

Maine CDC announced Thursday (12/23) that approximately 8,000 essential health care workers and staff had been vaccinated. Unfortunately, they reported one strong allergic reaction experienced by a Maine Medical Center employee. The employee is understood to be doing well at home. We wish them good health and a happy holiday season.

The Maine Medical Association fully understands that as with other COVID-19 supplies, demand is high, and supply is low. MMA leadership also concurs with Maine CDC’s focus that initial distribution is meant for hospital Intensive Care Unit teams, front-line Emergency Department caregivers, and those providing care in dedicated COVID-19 inpatient units, along with other critical and essential inpatient services not available elsewhere. That includes certain nonmedical workers who must work within a hospital that are critical to protect as well.

However, we continue to press the state for more detailed information related to any plan to allocate vaccinations for physician practices and staff not employed by hospitals or unaffiliated practices. We urge the state to begin developing clear and informative guiding principles and/or tier lists that outline a foundation for the vaccine allocation process, as numerous other states have already done.

Information received thus far from the state outlines a focus on “hospitals, Emergency Medical Services personnel, and home health providers who help keep COVID-19 patients out of hospitals and nursing facilities.” They also have relayed they are “following the U.S. CDC recommendation to vaccinate residents of long-term care facilities, who have been hard hit by COVID-19.”

We feel it is important to note that the Advisory Committee on Immunization Practices (ACIP), which is the group that provides those recommendations to the US CDC, voted nearly unanimously on December 1 for the following to be included in phase 1a of the committee’s recommended priority plan:

• Hospitals,
• Long-term care facilities,
• Outpatient clinics
• Home health care,
• Pharmacies,
• Emergency medical services,
• Public health

There was no determination made between hospital-based or non-hospital-based outpatient clinics. In fact, several ACIP members stressed before the vote that small physician offices should not be left out when supplies are available, with one saying,

“Transmission dynamics suggest providers who care for patients earlier in their course of illness may be at higher risk.”

The ACIP also stressed,

“Health systems and public health should work together to ensure vaccine access to health care providers who are not affiliated with hospitals.”

During another ACIP meeting last weekend, a statement was made that, “even with limited supplies, most of the states have told the CDC that they think they can vaccinate all of their healthcare workers within 3 weeks — some in less time.” As we quickly come up on the final week of December, we have received no detailed information or general structure to provide our independent members on when they will have access.

Within the last day, the MMA has been informed the state expects less than half of what is needed to fully vaccinate the group in Phase 1a and it may not be until early February before doses are available to vaccinate all health care workers and residents of long-term care facilities. However, the MMA is still unaware of what fully constitutes Phase 1a for Maine CDC or if there is an order past critical hospital infrastructure, long-term care facilities, and first responders. It was disclosed at Maine CDC’s Wednesday (12/23) media briefing that there will be enough doses to vaccinate about 64,775 people in the first three weeks of distribution—or by the end of the year

Maine CDC’s Draft Vaccination Plan submitted to the federal government includes the following:

Total high risk hospital employees: 19,946

Health care workers in LTC facilities: 22,280

TOTAL: 42,226

As outlined earlier, US CDC ACIP recommendations listed outpatient clinics behind only hospitals (with a focus on critical staff) and long-term care facilities. Again, there was no determination made between hospital-based or non-hospital-based outpatient clinics. Independent physicians and their staffs feel like they are scrambling and almost competing against their peers due to a lack of engagement and information on distribution plans. They just do not know why they are not yet considered a priority despite the fact that community physicians and their staff have played a critical role from day one of the pandemic by screening and providing care to patients.

We are encouraged and happy for our physician colleagues and staff employed by hospitals and large systems are being vaccinated. Those not employed or affiliated continue to battle pandemic stressors, uncertainty and helplessness associated with a lack of PPE, paying bills, and waiting for any details on their place in line for a potentially life-saving vaccine. Many feel they are not valued as peer clinicians nor do they understand why there seem not to be any detailed measures of equity in place for physicians and staff regardless of employment status. Several MMA leaders and staff have heard, or received reputable, reports of limited doses already being provided outside the direct ED/ICU/COVID units(s) infrastructure, including many doses being given to complete departments of outpatient practice clinicians and staff employed by hospitals.

MMA staff will continue attempts to engage state leaders and local hospitals. In the meantime, MMA leadership recommends members who have not registered through the state’s vaccine provider portal or enrolled as a vaccine provider to visit the following sites to complete the process and be ready. Thank you for your work and be safe.

Maine CDC COVID-19 Vaccine Provider Portal:

https://www.maine.gov/dhhs/mecdc/infectious-disease/immunization/covid-19-providers/index.shtml

Maine CDC COVID-19 Vaccine Provider Enrollment:

https://www.maine.gov/dhhs/mecdc/infectious-disease/immunization/covid-19-providers/enrollment.shtml