A Waiting Game

Liz Healy (left), vaccination coordinator for Avera Sacred Heart Hospital (ASHH), provides education about administering vaccine shots to Vickie Helland, RN, prior to a mass vaccination, or clinic, held Friday at ASHH’s Pavilion. 

High-priority vaccinations against COVID-19 have begun in Yankton, but organizers are still waiting for more details from the South Dakota Department of Health (DOH) about how the rollout will proceed and how many doses will be released.

“Our goal is to inoculate as many people as possible,” Liz Healy, infection prevention coordinator and vaccine coordinator for Avera Sacred Heart Hospital (ASHH) in Yankton, told the Press & Dakotan. “We are going to do everything in our power to make sure that people know about these vaccine clinics, how to get signed up, where they are and what times they are.

“We will have information everywhere so that you literally cannot turn a corner without getting information about how to get a vaccine.”

South Dakota is currently only distributing vaccines to the three major health-care groups in the state — Monument, Sanford and Avera — but that will soon expand to other health-care providers, Dr. Byron Nielsen, a nephrologist at the Yankton Medical Clinic and president of its board of directors, told the Press & Dakotan.

“The Yankton Medical Clinic is all ready to start giving vaccinations,” he said. “We have trained people, and we have a process set in place. We are currently waiting for the state Department of Health to give us an allotment of vaccine and let us know that we’re OK to do the vaccinations.

“As soon as we know more, the public will know more.”

Individuals who choose to be vaccinated will have to sign up in advance and can expect the process to take about 30 minutes. They will receive one intra-muscular injection at the first clinic and a second 21-28 days later, depending on which vaccine they get. They will also be asked to wait for 15 minutes after receiving the shot, in case of an adverse reaction.

According to the DOH, the state is currently in the 1c vaccination phase and expects the next phase, 1d, to begin in early February.

The Priority 1 vaccination group has been divided into five tiers, including:

• Priority 1a — Health-care personnel working in emergency departments; intensive care units and dedicated COVID-19 acute care units or frontline staff providing care to COVID-19 patients in general wards in the absence of a dedicated unit; and long-term care staff in nursing homes and assisted living facilities;

• 1b — Long-term care residents in nursing homes and assisted-living facilities.

• 1c — Other health-care workers, including laboratory and clinic staff, public health workers, emergency medical services (EMS), law enforcement and correctional officers.

• 1d — Persons with two or more underlying medical conditions; teachers and other school/college staff; persons aged 65 years and older; residents in congregate settings; residents in licensed independent-living facilities; residents of licensed group homes and funeral-service workers.

• 1e — Fire service personnel followed by other critical infrastructure workers, including water and wastewater; energy; finance; food service; food and agriculture; legal; manufacturing; shelter and housing; transportation and logistics; information technology and communications.

Phase 2, the last phase, is expected to start in May and includes the rest of the state’s population age 16 and older for the Pfizer vaccine and 18 and older for the Moderna vaccine.

“Avera is conducting vaccination clinics for different population groups, according to the priority given by the state of South Dakota,” Healy said. “We are still in our Priority 1a and 1c.”

Priority 1d vaccinations, which are estimated to comprise 265,000 individuals, are expected to begin in April, Healy said.

In its official statement on the vaccination process, Avera said, “Because the (vaccine) supply is limited, priority groups have been set by the state. For many, it may be weeks or months, depending on age and risk factors. As the vaccine supply increases, additional groups will be able to get vaccinated, including those who have higher-risk health conditions.”

Underlying conditions listed by the DOH that would qualify individuals for Priority 1c vaccination include; cancer; chronic kidney disease; chronic obstructive pulmonary disease (COPD); heart failure; coronary artery disease; cardiomyopathies; immunocompromised state from organ transplant; obesity or severe obesity; sickle-cell disease or type 2 diabetes mellitus.

“This is where it is such a gray area, because it really depends on the individual,” Healy said. “I wish that we had this perfect algorithm where we could take what a person tells us and have that give us the exact category that they’re in. But we don’t have that.”

The challenge will be prioritizing underlying conditions of age and health according to COVID risk factors, she said.

“A 29-year-old with high blood pressure, who’s not taking any medication, shouldn’t get the vaccine before a 75-year-old who is overweight, has high blood pressure and takes a medication for it,” Healy said. “The thing we don’t know and that we hope for is that by the time we do get to that priority 1d, the vaccine will be more available and we’ll have a larger quantity.”

How much vaccine each state gets at any given time is in the hands of the federal government, which, according to reports, is holding back doses in order to have enough for the required booster shots 30 days from initial vaccination

“With more vaccine availability — especially with more vaccines that aren’t quite as fragile as the two RNA vaccines, Moderna and Pfizer, that we currently have — we will be able to increase our ability to inoculate the population,” she said. “Many of those other vaccines, because they don’t need the ultra-cold freezers and that sort of thing, will be able to be sent to rural areas to inoculate many more people than what we’re able to do right now.”

But the vaccine is not for everyone, including those who have had serious adverse reactions to anything for any reason in the past, Healy noted.

“Those people seem to be more prone to have an allergic reaction,” she said. “If it’s somebody who carries around, like, an Epi Pen, they may need to talk to their provider to see if the benefits of the vaccine outweigh the risk.”

Also, individuals allergic to any of the vaccines’ ingredients, which are listed in the Emergency Authorization (EA) available online, should not receive it, she said.

Former COVID patients who have received monoclonal antibodies or convalescent plasma should wait 90 days from the date of administration to have their vaccine. It is recommended that individuals who have had COVID be vaccinated as long as they are 10 days recovered from infection and not having symptoms.

Those who are sick or exhibiting COVID symptoms on the day of their clinic should postpone their vaccination.

So far, there have been no adverse reactions to the vaccine in Yankton and people have been happy and excited to get it, she said.

“The energy of these vaccine clinics is palpable,” Healy said. “I have had ICU nurses that, when they received their first vaccine, were literally crying. They were just so grateful, because it has been a very, very dark few months.”

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