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A Maury Regional Health staff member receives among the first doses of the Pfizer COVID-19 vaccine.

Health care workers Williamson Medical Center started receiving a COVID-19 vaccine last week, and the Williamson County health department started delivering its first doses on Monday.

But those initial vaccines are only a drop in the bucket. 

The Centers for Disease Control and Prevention estimated that there are about 21 million people who work in hospitals, long-term care facilities and other medical settings. Those people — along with the 3 million Americans who live in long-term care facilities — will be first in line to get a coronavirus vaccine.

Williamson County is home to several large health care companies with facilities all across the U.S. and one of the largest senior living companies in the country. Over the next weeks and months these companies will face the enormous task of coordinating the vaccination of thousands of employees, and deciding which employees should get the vaccine first.

Health care workers

The Franklin-based hospital chain Community Health Systems operates 90 hospitals in 16 states. Across the U.S. health care workers and long-term care facilities will receive the first doses of the vaccine, but each state has a slightly different take on what that means. 

"Each state is doing its own thing,” Lynn Simon, the Chief Medical Officer at CHS, said. “General parameters are the same. Health care workers and long term care residents and staff. Other than that, it gets very complicated.”

Each CHS facility is working working directly with state health departments to coordinate vaccine deliveries. Some of those hospitals have ultra-cold freezers, which are needed to store the recently approved Pfizer-BioNTech COVID-19 vaccine. 

That storage capacity could affect when hospitals receive the first doses of a COVID-19 vaccine. Facilities without ultra-cold freezers could receive shipments packed in dry ice, but may have to wait for the Moderna COVID-19 vaccine, which can be stored at higher temperatures. The U.S. Food and Drug Administration Approved emergency use of the Moderna vaccine last week. 

"In some states, we're hearing that because of that issue, larger hospitals will receive the Pfizer vaccine and maybe smaller rural facilities may get the Moderna vaccine just because of those logistics," Simon said. "But it's really, quite frankly, up to the states and it's all over the board.”

The Home Page interviewed Simon on Dec. 10. The vaccine distribution plan for many hospitals likely changed between the interview and the publication of this story.

"In a 24 hour period I've heard one hospital say they were initially getting no doses, and then the next day they were told they were getting hundreds of doses. It changes minute by minute," she said.

That speed at which information about vaccine distribution is changing is a big part of what makes it difficult to coordinate.   

Hospitals also have to answer a critical question before the vaccine arrives. If most employees are eligible under state plans to receive a vaccine in the early stages of distribution, who should get the first shot? 

Tennessee’s vaccine distribution plan offers some guidance to help answer that question. The state health department recommends prioritizing older workers or people with certain medical conditions. Other states leave that question more open ended and its up to hospitals to make that decision. 

In states with more open ended recommendations Simon said CHS facilities are using criteria such as age and medical conditions to decide who should be vaccinated first. However, she said someone’s role at a hospital is also an important consideration. 

“I probably don't want to vaccinate every person in the emergency department first, because what if they have reactions?” she said. “That further impacts my ability to provide staff on the front lines.”

Another crucial factor is an employee’s willingness to take the vaccine. CHS is not going to require employees to receive a coronavirus vaccine, so employees will need to volunteer. 

Simon said she hopes that a large number of CHS workers will step forward, but she plans to achieve that goal through education and examples rather than strict policies. It’s the same approach the organization takes to encouraging workers to get a seasonal flu vaccine. 

"It's not about pushing people to do it. Our goal is to make sure people have enough information and they feel comfortable and confident about getting the vaccine for them,” she said.  

Long-term care facilities

The Brentwood-based senior living company Brookdale also has to distribute a coronavirus vaccine to an enormous number of people. The company has about 65,000 residents across 726 communities and 44 states. Brookdale calls itself the largest operator of senior living communities in the United States.

The U.S. government is working with large pharmacies to manage the entire vaccine distribution process at long term care facilities. The pharmacies will ensure that vaccines stay at cold temperatures, administer the vaccines on site and report progress back to the federal government. The Centers for Disease Control and Prevention expects the vaccination effort at long term care facilities to continue for about two months.   

Long term care facilities registered for the program in November and selected a pharmacy to work with. Brookdale will be working with CVS and Walgreens to distribute the vaccine to residents and staff.  

The company has signed all of its communities to participate in the vaccine distribution program. Brookdale provides a range of senior living options, including independent living, assisted living and skilled nursing. All Brookdale residents will have a chance to get the vaccine through this program.  

In an informational video about the company’s vaccination program, Brookdale executives said the effort to deliver COVID-19 vaccines will be similar to the way its facilities already distribute seasonal flu vaccines.   

While clinical trials have showed that both vaccines are safe and effective, Brookdale executives warned that staff and residents will need to continue many of the current precautions to prevent the spread of the virus. Residents and staff will continue to wear masks during the vaccination campaign.

Critical infrastructure

The Brentwood health care company Premise health operates medical clinics for large workplaces in several industries. 

Premise clinics are much smaller than hospitals. The smallest clinics have a few employees and the largest have a few dozen. But those clinics care for 11 million people, often in critical industries like food production or transportation. 

“Many of our sites have tens of thousands of members,” Premise president Jami Doucette said.

After health care workers and residents at long-term care facilities get a COVID-19 vaccine, workers in critical industries could be next in line. Tennessee’s vaccination plan put critical infrastructure workers in the second phase of vaccine distribution, along with school teachers, prison guards and prisoners. 

“I do think we're going to play a critical role in that 1b or critical infrastructure phase because many of our clients will fall into that bucket,” Doucette said. 

Doucette said Premise will likely vaccinate millions of people over the next year, but the details of how and when that will happen is still somewhat unclear. Each state has a slightly different definition of what constitutes a critical industry.

However, Doucette emphasized that the company already carries out successful flu vaccine campaigns every year, and in many ways the COVID-19 vaccination effort will be similar. 

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