Atrium Health, other systems struggle to decide who will get the vaccine first

Atrium Health has canceled dozens of staff vaccination appointments after a controversy erupted around who the North Carolina system was prioritizing to receive the COVID-19 vaccine.

The system was simply following the prioritization set by the state public health department, said Dr. Scott Rissmiller, Atrium’s executive vice president and chief physician executive. The trouble exemplifies the difficulties systems face in deciding which staff members will be vaccinated and in what order.

State guidelines stipulate that in the first phase of vaccations, only healthcare workers who are at a “high risk” for catching COVID are eligible. The North Carolina Department of Health and Human Services defines “high risk” as those caring for patients with COVID-19; working directly in areas where patients with COVID-19 are cared for; performing procedures at high risk of aerosolization on patients with COVID-19; handling decedents with COVID-19; and those administering the vaccine.

Dr. Rissmiller said that Katie McKiever, an enterprise social media manager, was among the 41,000 Atrium staff members to receive state certification to be immediately vaccinated, and grouped in the state’s Phase 1a category.

Within this cohort, Atrium created subsets of personnel to receive the vaccine, with emergency room personnel, front-line physicians and hospital staff working in the COVID-19 unit among those to receive the highest priority. The healthcare system relied, in part, on its human resource department lists to help create these subsets. The original guidelines caused McKiever to receive an appointment because she had worked in a vaccination area at Atrium, documenting the first vaccines.

“At this time of this surge in patients, we have people who are volunteering to work in areas that are a higher risk for COVID, and if you just look at their job description, you would not realize that,” Rissmiller said.

On Dec. 23, North Carolina state health officials sent providers a letter further clarifying how staff in their Phase 1a cohorts should be prioritized. Atrium then re-evaluated its list of people who would receive the vaccine first and removed the social media manager and 96 other “operational people who were involved in managing the front line offices but don’t come in direct contact with patients who might have COVID, or are at a lower risk of doing so,” Rissmiller said. McKiever has since been moved to Phase 1b prioritization, and the state has yet to offer guidance on when she will be vaccinated.

“Of the 33,000 that were sent out, over 99% of them were accurate, the others have been rescheduled to the next phase,” Rissmiller said.

Atrium has so far vaccinated 5,000 of its workers.

Stanford Health recently came under fire for its prioritization process. The Palo Alto, Calif.-based health system’s algorithm allegedly prioritized high-ranking doctors above medical residents working on the front-lines of COVID-19, with some residents telling ProPublica that only seven residents were scheduled to receive one of the initial 5,000 doses of the vaccine given to Stanford.

Dr. Yvonne Maldonado, senior associate dean at Stanford, said that the initial dataset powering the health system’s algorithm was built to consider individuals’ job title, assignment location and, with an eye toward equity, aimed to prioritize those who “already had a risk of severe complications” from COVID-19, individuals over the age of 65 and “groups coming from certain zip codes.”

ProPublica reported that this led the algorithm to exclude residents, who are often younger than senior healthcare personnel and not assigned a specific location in the health system. Maldonado said the rush to deliver initial doses of the vaccine led hospital leaders not to vet the dataset. She said Stanford has since gone back to individual unit leaders and asked them to review the vaccine prioritization list. Stanford has so far vaccinated “several thousands” of personnel, she said.

“Many of our colleagues around the country have had issues as well,” Maldonado said. “It’s very hard to set up a brand new system to allocate thousands of doses of a new product in a 24- to 48-hour period.”


Tags: covid-19, pandemic

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