Week XLIII: The race is on: Will vaccines outrun infections?

Albany County Health Commissioner Elizabeth Whalen

The Enterprise — Michael Koff
“I believe as we continue to ramp up, we will be able to meet the demands of supply as it comes in,” said Albany County Health Commissioner Elizabeth Whalen of COVID-19 vaccinations.

ALBANY COUNTY — Getting the COVID-19 vaccine into residents’ arms — as the county’s infection rate continues to top 10 percent and records for hospitalization were broken three times — was the focus of Albany County’s 43rd week of coping with the pandemic.

“Our phones are ringing off the hook at the health department,” said the county’s health commissioner, Elizabeth Whalen, on Wednesday. “We are getting thousands of calls from individuals, asking about vaccinations, who want to  present their individual cases to get the vaccine.”

The Capital Region, like the rest of the state, is adhering to a strict prioritization schedule and is currently still in the first tier: 1a.

“This is our Olympics and my staff is really energized. We are prepared to meet the challenge,” said Whalen.

Governor Andrew Cuomo frequently refers to a footrace, pitting vaccine implementation against the infection rate and hospital capacity.

On Tuesday, Cuomo said the highly transmissible strain from the United Kingdom, which was confirmed in a Saratoga County case on Monday, could be a “game changer” in the race.

“This U.K. strain changes the whole footrace because the U.K. strain, the rate of transmission goes way up, the rate of infection goes way up, and it’s no longer the race that we were running,” Cuomo said at Tuesday’s press conference. “Apparently, the U.K. strain can actually overtake the original COVID strain in a matter of weeks, that’s how quickly it can transmit.”

On Wednesday, Cuomo wrote a letter to United States Department of Homeland Security Acting Secretary Chad Wolf, asking him to require that airline travelers to the United States receive a negative COVID-19 test result before being allowed into the country.

About 120 countries require that passengers present a negative test result prior to boarding international flights, Cuomo wrote, adding that between 70,000 and 80,000 international passengers arrive at John F. Kennedy International Airport in New York City each week. The federal government now requires travelers from the UK to receive a negative test result, but the UK variant of COVID-19 has spread to more than 30 other countries.

“While we do not yet know if there is any impact on the ability of these variants to outsmart the vaccines we so urgently developed, we can only hope that we stop it before it surges our caseload beyond the capacity of the U.S. health care system,” Cuomo wrote to Wolf.

At his press conference on Wednesday, Cuomo said that, with aggressive contact tracing, “it appears now that there is evidence that the U.K. strain case in Saratoga Springs was actually connected to U.K. travel.”

He concluded, “So, if we had tested people from the U.K. before they got here, we wouldn’t have had the U.K. travel spread.”

 

Capital Region works “very well” together

On Tuesday, the New York State Association of Counties held a widely covered press conference, urging that counties be made an integral part of the vaccine distribution process.

“To be successful in this vital task, county leaders are now looking for information and data so that they can answer questions and help coordinate the distribution of the vaccine in their communities,” said Stephen Acquario, NYSAC’s executive director, in a statement.

“We see the people critical to the function of county government who are getting sick and need the vaccine now; police, firefighters, emergency management, 9-1-1 dispatchers,” said Orange County Executive Steven Neuhaus. “We’re ready and able; we just need the green light to do what we need to do to start making a difference.” 

“Our hospital network was not set up for what is going on here; that’s why the county health department should have been used. They’re making the best of a bad situation, but the fact of the matter is we’re wasting resources by duplicating efforts,” said Chemung County Executive Chris Moss. 

Whalen has repeatedly said the eight counties in the Capital Region have been working well with the designated hub, Albany Medical Center, and developed a model that other counties can follow.

On Wednesday, responding to local coverage of the NYSAC press conference, Whalen said, “While that disconnect may be happening in other parts of the state, I think Albany Med and our county health department and the other participating county health departments are launching a fantastic effort.”

Whalen said there are daily phone calls among the partners. “If one person has an issue and they share how they solved that issue, it helps all the other partners. We work together very well.”

Whalen said her health department has had plans in place for years to deal with vaccination. “But all of us are learning real-time lessons, too,” she said.

Whalen said, although her staff is dealing with record numbers of case investigations because of the recent surge in cases, that this “critical juncture” has “reinvigorated my very fatigued staff.”

She went on, “Everybody has found new energy, new focus, and a new purpose and that is to get the vaccine out.”

She also said, “The narrative that there is not coordination going on, I can only speak for Albany County, but I would unequivocally say that the best job that can be done is being done.”

Whalen also said, of the 1a population currently getting vaccines, about 75 to 80 percent of people who are eligible are taking the vaccine.

Similarly, at his press conference on Wednesday, Cuomo said a survey of hospital staff across the state has shown about 85 percent of staff want the vaccine. The survey doesn’t include doctors, whom, Cuomo said, “are an even higher percentage.”

“Among the 18,000-plus people we have not seen serious side effects, allergic reactions, et cetera,” she said.

 

Tiers

These are the first three tiers for vaccination:

— 1a is for health-care workers; first responders in medical roles such as emergency medical services providers, medical examiners and coroners, funeral workers, and ambulatory care providers; and for residents and employees of long-term care facilities including congregate settings overseen by the state’s Office of People with Developmental Disabilities, Office of Mental Health, and Office of Addiction Service and Support;

— 1b is for frontline essential workers such as fire fighters, police officers, corrections officers, food and agricultural workers, postal workers, manufacturing workers, grocery-store workers, public-transit workers, and those who work in education like teachers, support staff, and day-care workers; and people aged 75 and older; and

— 1c is for people aged 65 to 74 years; people aged 16 to 64 years with underlying medical conditions that increase the risk of complications from COVID-19; and other essential workers, such as those who work in transportation and logistics, food service, housing construction and finance, information technology, communications, energy, law, media, public safety, and public health.

New York State has about 2.1 million health-care workers and nursing home people, Cuomo said at his Wednesday press conference.

“Just to give you an idea of the numbers,” he said, “there are about 870,000 teachers, 200,000 first responders, 100,000 public-safety workers, 100,000 public-transit workers, 1.3 million” people aged 75 or older.

“Obviously,” he went on, “it would take us weeks to work through this population if not months. In 1b there are about 5 million essential workers and that 1.3 million 75-plus, so that’s over 6 million people in 1b. You’re getting 300,000 dosages per week, it takes a long time. Flip side is that the federal government will be increasing production.”

 

Three tranches

According to a website maintained by the Centers for Disease Control and Prevention, tracking federal vaccine distribution and administration on a state-by-state basis, as of Wednesday evening, New York State had received close to 935,000 doses of vaccine and administered close to 312,000.

Cuomo said on Wednesday that the daily rate of vaccination in New York over the past three weeks was about 10,000 hospital staff per day.

“Since Monday, they’ve been doing 30,000 per day,” he said. “So, the vaccination rate has tripled since Monday. So, I’m glad they heard me, but you have to keep it up, because we need that hospital staff vaccinated.”

Cuomo noted, in his Tuesday press conference, two elements to understanding vaccinations: supply and distribution.

“We have been getting about 300,000 per week. That’s roughly 1.2 million per month of vaccines. The state needs 20 million people vaccinated. You have to do that twice. That’s 40 million,” said Cuomo. “Obviously, it’s a very long timeline at this supply rate. The supply rate has to increase and the supply rate is the limiting factor now.”

He said the federal government may approve vaccines from companies other than the two available now — from Moderna and Pfizer-BioNTech.

Distribution in New York State, Cuomo said will be in three tranches: nursing homes, hospitals, and special efforts.

The federal government used pharmacy chains to administer vaccines in nursing homes and Cuomo said, “The state is now going to step in and expedite the program.”

The state has about 611 nursing homes, Cuomo said on Monday, and about 288 have completed first doses for residents. He said 234 more doses would be given this week, which will reach 85 percent of the state’s nursing-home residents by the end of this week.

The plan is to vaccinate the remaining 15 percent over the next two weeks while simultaneously vaccinating the nursing-home workers. “We’ll be sending in additional personnel into nursing homes to do the vaccines. Some nursing homes can actually do the injections themselves,” Cuomo said.

Hospitals — the state has 24 public hospitals and 170 private hospitals — have been administering vaccines to health-care workers. “So far, 900,000 vaccines have been distributed for 2.1 million health care workers. Obviously, we don't have enough vaccine distributed for all health-care workers,” he said.

“The hospitals have been receiving vaccines over the past three weeks, roughly 46 percent of the total allocation,” Cuomo said on Monday.

He said he wants to hold hospitals accountable and named a handful of the highest and lowest performing hospitals. New York Presbyterian was at the top, having administered 99 percent of its allocation and Samaritan Hospital was at the bottom, having administered 15 percent.

Albany Medical Center, the hub for the Capital Region, was not in either group.

Any provider must use the vaccine inventory currently in hand by the end of week or face a fine up to $100,000. “Going forward, they have to use the allocation within seven days; otherwise they can be removed from future distribution,” Cuomo said.

After health-care workers, which are in the 1a category, essential works and New Yorkers over the age of 75 will be vaccinated in the 1b category, which is roughly 2.5 million people, Cuomo said on Tuesday.

With 1b, the focus will shift from hospitals to a “retail network,” Cuomo said, stressing that the shots are free.

“Right now, we’ve employed 3,700 provider sites statewide, and we’re continuing to grow that,” Cuomo said on Tuesday. These sites include medical practices, pharmacies, long-term care facilities, federally qualified health centers, and urgent-care centers.

Later on Tuesday, Cuomo’s office released numbers of sites that have enrolled to administer the vaccine; medical practices were by far the largest number, at 1,285, followed by pharmacy chains, at 802.

In the Capital Region, 343 sites have enrolled and 37 of the sites have already been activated.

Of the 7,300 sites, 636 already have vaccine statewide, Cuomo said.

“I’m asking police departments, fire departments, transit workers, who are going to be essential workers, if they can operationalize their own vaccination system ….,” Cuomo said. “I’d like them to start thinking about that now because I’d like to reduce the burden on the hospitals and the private system whenever possible.”

The third “special efforts” tranche will involve pop-up sites at churches and community centers as well as large-scale sites at the Javits Center in New York City and at state university campuses.

“Again, we need the supply to do that, but we are already setting those up. We did it with the COVID testing,” said Cuomo. “We’ll do it again here and then I made a point to say that this state is going to make a statement as to social equity and we’re going to make sure that the social injustice and the health-care disparities that we’ve seen are not replicated.”

 

“Am I Eligible”

On Monday, the state launched a new “Am I Eligible” app to help New Yorkers determine their eligibility for vaccination, connect them with administration centers, and schedule appointments.

To access the app, as well as find the latest information concerning the vaccine and its administration, visit: https://covid19vaccine.health.ny.gov/.

Whalen said on Wednesday that residents who click through the online program and are eligible to receive a vaccination will be linked to the health department.

“There is not a live link at this juncture,” she said.

“Right now, for our POD planning,” Whalen said of points of dispensing, “we are reaching out to populations and we are getting populations signing up … As these links become public, as we get into 1b, that is when … the public will have access to the links.”

There is no database or list currently being put together, she said.

“Our goal is to get vaccines into arms as quickly as possible. This goal is shared by the medical center and all the partners of the regional hub,” Whalen said.

In addition to the county’s Medical Reserve Corps many other medical professionals have volunteered to help administer the vaccine, Whalen said. This week, members of the corps will be tapped, she said, and other volunteers will be contacted later.

“As the size and scale of our efforts go up, we will need more,” said Whalen.

Whalen also explained the vaccine’s role: Even after getting injected with a second dose of vaccine, the recipient should still wear a mask, wash hands, and stay socially distant, she said.

“What it does is prevent you from getting sick,” said Whalen. “It doesn’t prevent you from transmitting infection.”

While the two vaccines being administered are 95 percent effective in preventing sickness, she said, until enough people are vaccinated to achieve herd immunity, protocols must be followed.

“It will take months to roll out to the entire public,” concluded Whalen. “It will be a long time till we are living lives without masks.”

 

Newest numbers

Albany County Executive Daniel McCoy started his Wednesday morning briefing by announcing nine more deaths, bringing the county’s COVID-19 toll to 239.

The victims were a woman in her sixties, a man and a woman in their seventies, three men and a woman in their eighties, and a woman and a man in their nineties. Four deaths had occurred at a private nursing home between Dec. 12 and Jan. 3, but were previously unreported to the county’s health department. Nursing homes must report deaths to the state’s health department but are not required to report them to the county.

As of Wednesday morning, Albany County has had 12,944  confirmed cases of COVID-19, with 272 new cases since Tuesday.

Of the new cases, 213 did not have a clear source of infection identified, 39 had close contact with someone infected with the disease, and 20 are health-care workers or residents of congregate settings.

The five-day average for new daily positives has decreased to 242.8 from 257.6. There are now 1,781 active cases in the county, down from 1,878 on Tuesday.

The number of county residents under mandatory quarantine decreased to 2,898 from 3,071. So far, 40,803 residents have completed quarantine. Of those, 11,163 had tested positive and recovered. That is an increase of 360 recoveries since yesterday.

There were 16 new hospitalizations overnight, and there are 154 county residents currently hospitalized from the virus — a net decrease of seven. There are now 18 patients in intensive-care units; yesterday there were 23. 

“Our hospitalization rate continues to go up,” said McCoy, noting the current rate of 8.65 percent is the highest it has been since Dec. 4.

“We really need people to stay home,” he said, urging support of local businesses and restaurants by using curbside pick-up.

“We’re trying to bring that number down,” McCoy said of hospitalizations, “so we don’t end up like California.”

He referenced hospital beds in parking garages and “makeshift tents.”

In Los Angeles County, ambulance operators have been told not to bring patients who have virtually no chance of survival to hospitals.

Of the state’s 10 regions, the Capital Region continues to have the worst rate for available ICU beds, according to numbers released by the governor’s office on Wednesday. Currently, 192 of the region’s 238 ICU beds are occupied, leaving 17 percent available.

Statewide, 28 percent of ICU beds are available.

The Capital Region also continues to have one of the worst rates for hospital-bed availability. Currently, the region has 472 hospitalized COVID-19 patients, which is 0.04 percent of the region’s population and leaves 24 percent of its hospital beds available.

Under a surge plan, 28 percent of the region’s hospital beds could be available in seven days.

Statewide, 0.04 percent of New Yorkers are hospitalized with COVID-19 and 29 percent of hospital beds are available, 34 percent under a surge plan.

The infection rate for the Capital Region, as a seven-day average, is 10.07 percent. Statewide, the positivity rate is 7.92 percent.

During Tuesday’s press conference, Cuomo scolded areas with high infection rates, singling out the Finger Lakes. He noted that the state’s most densely populated areas, Manhattan, has the lowest rate: 3.74 percent.

“Your behavior matters,” he said. “Depending on the behavior of your community is how fast the virus spreads, how many people get sick.”

More Regional News

  • On Sunday, Governor Andrew Cuomo announced that, for the second day in a row, New York State has another case of the highly transmissible strain of COVID-19 first identified in the United Kingdom. This latest case is in Westchester County, bringing the state’s total of B.1.1.7 cases to 18.

  • While the Senate Republican Conference’s Long Island delegation is blaming Governor Andrew Cuomo for  “utter chaos” in the state’s vaccine roll-out, Cuomo maintains the fault lies with the federal government naming 7 million New Yorkers eligible while distributing just 300,000 vaccine doses weekly.

  • “Many, many seniors are afraid to go out,” said Albany Mayor Kathy Sheehan. “They will not take public transportation. They will not get in a taxi.” So, once COVID-19 vaccine is available, Mohawk Ambulance, working with the city and county, will vaccinate residents 75 and older in their homes.

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