Santa Clara County has offered overdose of vaccine in the past month to a top county official and dozens of other non-health workers, raising new questions about providers’ discretion to vaccinate low-priority people amid a launch chaotic at the state level.
While Santa Clara County is not the only provider to have faced this problem, its choices raise eyebrows in part because the county has simultaneously taken a tough stand against other providers who deviate from normal protocols by recently discontinuing the vaccine at Good Samaritan Hospital. because he improperly vaccinated teachers in Los Gatos.
As of January 11, the county has relied on a written plan that explains what to do with the excess vaccine, which must be used immediately after it begins to thaw. It requires first offering the vaccine to those in Phase 1A, the highest priority, followed by those aged 75 and over, and then transporting the vaccines to the Valley Specialty Center at VMC or Saint Louise Regional Hospital.
As counties across the country struggle to ethically manage additional daily doses in the context of a general shortage, the protocol seems to leave room for what happens next. At least twice, the quick-thaw vaccines have landed in the arms of county employees who are considered part of Phase 1B, including County Attorney James Williams and others who do not regularly come face to face with coronavirus patients. Some of these employees, including Williams, are also much younger than those who are now a priority for vaccination.
The largest group was vaccinated on Dec. 30, nearly two weeks before the county established written rules for additional doses, when county executive Jeff Smith authorized about 45 county employees working at the county’s emergency operations center for to receive vaccines that the county says were otherwise going to garbage.
The state guidelines give priority to health workers and those living in long-term care facilities in Phase 1A, followed by those over 65, educators, food and agriculture workers, and emergency responders in phase 1B, which includes EOC employees.
“By definition, these are not previously known slots. These are not appointments – what was unique was that one day it was a much bigger number, ”said Williams, who is about 30 years old. “We usually talk about onesies, twoosies or maybe a dozen.”
Around 4 p.m., on Dec. 30, Smith said he received a call that Valley Medical Center employee medical center had a batch of unused doses of Pfizer and had no higher-priority health workers nearby. who needed him. With about 90 minutes left to deliver the doses, Smith allowed those physically present at the San Jose emergency room – including Williams, workers, analysts and other support staff – to receive the first doses that afternoon. Williams said he was one of the “very, very last people in line.”
At that time, approximately 6,000 county health workers and support staff were vaccinated at the county level.
“There was no group of people available at the hospital, so the staff at the emergency operations center seemed reasonable to me,” Smith said. “My thought process was, ‘Well, if there are no doctors, nurses and technologists available, then we should move to the emergency services.’ ”
The state’s vaccination guidelines since December provide some discretion to providers in moving to the priority list when vaccines are about to expire or when people do not show up for meetings. Health departments can “temporarily adjust prioritization” only after “intensive and appropriate efforts to reach priority groups at that time,” according to the California Department of Public Health, which did not respond to a request for comment Friday.
However, the exact way in which these scenarios are taking place in reality has caused both confusion and heated debate. Last week, the county sanctioned Good Samaritan Hospital for offering teachers what the hospital said were excess vaccines – also in the Phase 1B group. The county claimed that the hospital’s actions included a “problematic” series of events in which teachers were offered vaccines at future dates, not just excess vaccine.
Phase 1B county workers received vaccines only on the day they became available and with the exception of other options, Smith and Williams said.
In another court, on January 12, Deputy Director of Emergency Management David Flamm alerted emergency operations staff, public health personnel and other 1B workers about a registration link to register for appointments in the same day “approved by the county leadership”, according to an e-mail obtained by this news organization.
Flamm said Friday was the only time he had been asked to send such an e-mail, and the vaccines appeared to be available in several places. “NOT BEFORE !!!!!” The e-mail told recipients, adding: “If you can’t get vaccinated today, we anticipate that there will be additional days in the next few weeks when this opportunity arises.”
“With all the vaccination operations going on, it seems to me that there is always a bit of a delta between those administered and cancellations, or any number of other issues, so I anticipated that it could happen again,” Flamm said.
In all, there were “at least a couple” of cases of 1B workers receiving vaccines in addition to the Dec. 30 group, but with a much smaller number, Smith said.
“We were in a situation where we have a lack of vaccines, a challenge with interpreting state rules, a lot of people who would like to have the vaccine – and we tried, and still tried, to focus initially on health care. professionals and emergency interventions, ”said Smith. “It’s a situation of use or loss.”