Crescent City Pharmacy Manager Dr. Lishunda Franklin vaccinates Laverne Rose, 74, on Tuesday, Jan. 5. (Philip Kiefer/The Lens)

Days into Louisiana’s distribution of COVID-19 vaccines to portions of the general public, hospital systems and local pharmacies have begun administering thousands of doses to eligible populations. But the scale of available vaccines is dwarfed by demand from eligible Louisianans, leading to overrun phone lines and ad-hoc wait lists.

Wednesday comments from Gov. John Bel Edwards, and Dr. Joseph Kanter, the interim assistant secretary at the state Office of Public Health, as well as an email provided to The Lens, shed light on planning at the state and city level to roll out mass vaccination sites for the general public.

An email obtained by The Lens indicates that the city of New Orleans has begun to look for volunteers to staff possible sites. And Edwards acknowledged that the National Guard could be used in the future to deliver vaccines to the general public, in the same way that it has provided testing. He’s brought that idea up before, but this week also suggested that private partners, like hospital systems, might be enlisted for mass vaccination efforts.

The comments were given at a press conference in a tense state Capitol building this afternoon,  as pro-Trump protesters gathered on the steps outside and news filtered in from Washington that armed insurrectionists had stormed the U.S. Capitol.

In addition, state officials’ optimism about the ongoing vaccine  was tempered by the fact that Louisiana currently has more people hospitalized with COVID than at any other point in the pandemic.

Vaccination levels might be important for individuals, said Kanter, but the state is “nowhere near” the number of vaccinations necessary for major public health impacts.

“When we talk about distractions, the vaccine work is essential, but right now, in order to stop having to report 40 to 60 lives lost a day, we need mitigation measures.”

Right now, Kanter said, the thing standing between Louisiana and mass vaccination is “more vaccine.”

The state’s nine public health offices have been conducting drills to practice mass vaccination plans, he said, and can expect to begin executing those plans “once we have enough vaccine made available to us to make those types of events practical.”

Email calls for volunteers for city vaccination program

In an email to the Tulane School of Public Health, Associate Dean for Global Health Richard Oberhelman solicited volunteers from Tulane public health students and faculty to assist the city of New Orleans Health Department with a vaccination program. The email says that volunteers are needed to staff sites in New Orleans where “specifically targeted members of the general public can get vaccinated,” called “open pods,” and “sites that are limited to a specific population, like a nursing home,” called “closed pods.”

So far, all decisions about vaccinations have been overseen by the state, and have largely been administered through healthcare institutions and pharmacies, but Dr. Jennifer Avegno, the director of the New Orleans Health Department, has said that the city will likely roll out mass vaccination sites for the general public. Those sites are likely to be modelled off of the city’s community COVID testing sites, as well as the drive-through flu vaccination drives the city has been conducting this fall.

But it’s still not clear where funding for additional staff for administering vaccinations might come from in New Orleans, which is already wrestling with a budgeting crisis. Avegno has said that the city will be looking for hundreds of new volunteers to assist with vaccinations.

Avegno was not available for an interview Wednesday, and a city spokesperson has not responded to subsequent requests. 

The call for volunteers solicited two types of participants: those with medical experience who could join the New Orleans Medical Reserve Corps and potentially administer vaccines, and those without who can help with “patient registration, triage, supply restocking, post-vaccination observation, traffic control, and other operational and logistical support.”

‘It’s going to get better’

Meanwhile, other states have begun to set up mass vaccination clinics. A city in New Jersey that was allocated 600 doses outfitted a high school gym to deliver doses to healthcare workers, with plans to use it for the general public soon.

But Kanter argued that for the moment, busy phones were better than what had happened in Florida this week, when seniors camped out overnight or crowded into vaccination sites.

“At the end of the day, our goal was for the vaccine that is available to be used as quickly as possible,” he said after the press conference. “And more importantly, do so in a way that does not create unsafe conditions. Seeing what happened in Florida completely terrified us. In our minds, as frustrating as it might be to have phones ringing off the hook, it doesn’t create a health risk.”

In spite of LDH’s instructions to not go to pharmacies so as to minimize COVID transmission risk, however, many seniors did in fact show up in person this week after being frustrated by busy lines.

“It’s going to get better. We’re getting more vaccine every week,” said Kanter. “This is the very first week. People need to hang in there and be patient. And again, in the grand scheme of things, this is gonna be a really effective way to move vaccine quickly and safely without the super spreader events that we saw in Florida.”

The state is expecting to receive about 28,000 doses of Pfizer and 27,500 of Moderna next week, Kanter said. That’s the same shipment size as this week, he said. With those vaccines on hand, the state will have received about 293,000 doses.

18,700 of the Moderna doses will be diverted to the federal partnership with Walgreens and CVS which is providing vaccinations in long-term care facilities. The state has estimated that there are roughly 80,000 people living and working in those facilities, and Kanter said that 93,000 doses have now been allocated to the group.

Where the rollout stands currently

As of Wednesday, the state had allocated 10,700 Moderna vaccines to 107 pharmacies across the state specifically for distribution to the Phase 1B Tier 1 priority group. That group includes anyone 70 and older, home healthcare patients and staff, dialysis patients, medical school residents, and many other healthcare professionals who weren’t included in Phase 1A.

The state estimates that about 640,000 people are eligible under Phase 1B Tier 1. 

To sign up for a vaccination, people were asked to call local pharmacies directly to schedule an appointment. Each pharmacy had 100 doses to distribute. Almost immediately, pharmacy phone lines jammed with calls and the state pharmacy lookup portal crashed. (It was quickly fixed.)

The pharmacies were issued two pages of guidance, which described their obligations as vaccinators, including “scheduling arrangements to ensure individuals receive appropriate appointments for their second dose,” entry of vaccination records into the state database within 24 hours, and preparations “to answer a higher than normal volume of incoming calls, counsel callers, and schedule appointments.”

Despite the chaos, at Crescent City Pharmacy, one of six pharmacies in New Orleans to receive doses, the first day of vaccinations on Tuesday went smoothly, but slowly.

The pharmacy planned to do about 15 total vaccinations on Tuesday afternoon, but only got through 12. Three people didn’t show up for their scheduled vaccinations, said Lishunda Franklin, the pharmacy manager, because they’d double-scheduled and were able to get doses at other pharmacies.

She said that she’s planning to start asking people to drive up to get vaccinated in their cars, and hoping to go through all 100 doses by Friday. But she’s got a waitlist of more than 500 names, and no word on when she’ll get more doses. However, she’s heard from an LDH hotline that other pharmacies in the area may get their own allocations soon.

Meanwhile, some hospitals in the area say that they’ve received allocations specifically for Phase 1B priority groups. On Monday, New Orleans East Hospital, which is run by LCMC Health hospital system, announced that it would begin vaccinating members of the community regardless of whether they were patients at the hospital, and published a number where people could make an appointment.

Aziza Landrum, the hospital’s marketing and community relations manager, said those slots filled up immediately. She did not have information on how many doses would be available, but said that it was her understanding that the hospital had received an allocation of Pfizer doses specifically to use on the Phase 1B priority group, on top of doses for healthcare workers.

But Kevin Litten, a spokesperson for LDH, said over email that hospitals hadn’t received vaccines specifically for 1B populations. “Outside of pharmacies,” he wrote, “the only allocations we’ve made specifically for Phase 1B has been to dialysis centers.”

Instead, LDH announced this week that any hospital could begin distributing vaccines to “any eligible groups” once they had more vaccines allocated than they needed for their staff.

At Wednesday’s press conference, Kanter explained that hospital systems had started to see a slowdown in healthcare workers signing up for vaccinations.

“Our trigger to move to the next phase … is when you start to see appointments go from 100 percent capacity down to 80 percent capacity, that’s an indicator that it’s time to move on to the next step.”

He also said that the state’s contractor for vaccine distribution, Morris & Dickson, had been holding onto vaccines for small clinics and healthcare institutions that didn’t want to receive all their allocations at once. “They could ask the department to hold onto some of their supply, to make sure that they had enough storage room,” and to practice giving a small number of vaccines without risking an entire shipment, he said.

“We’ve changed that policy as of this week,” he said, and so the 9,000 Moderna doses that the state will receive outside of the long-term care program will be “combined with between 10,000 and 15,000 doses that were at Morris & Dickson and will all be pushed out and divided largely between pharmacies on clinics.”

Mary Beth Haskins, LCMC’s director of public relations, wrote in an email that “each hospital [in the system] is operating a little differently” with regards to 1B vaccinations. She wrote that University Medical Center was giving some vaccines to clinic patients, and that Touro had started making vaccines available to its patients by appointment.

So far, she said, LCMC has vaccinated “over 5,800 employees, contractors, faculty, and residents,” and said that she could not yet provide other numbers.

Ochsner Health, the largest hospital system in the state, has also begun scheduling vaccines for its patients. At a Wednesday morning press conference, Robert Hart, Ochsner’s chief medical officer, said that the system had vaccinated just under 17,000 total people so far. That number included several thousand patients, he said, but didn’t have a specific breakdown.

He said that the hospital system has between 32,000 and 33,000 employees.

Warner Thomas, Ochsner’s CEO and president, also acknowledged that there had been a “miscommunication” with Ochsner pharmacies on Monday. Some Ochsner pharmacies are included in the 107 distributing to the general public, but had told callers that they could only vaccinate Ochsner patients.

Thomas said the system had “a very organized approach to people being registered and booked” for vaccinations, and that they’d “identified about 205,000 patients who are over 70.”

“We sent out electronic messages to many of them over the weekend,” he said. “But we’re doing it in waves because we didn’t want to get flooded with 205,000 appointments when we only have 10,000 vaccines,” although he didn’t specify how those waves were being determined.

And Thomas also expressed skepticism about the kind of mass vaccination plans that have been described by Edwards. 

“We’re looking to ramp up our capacity to be part of this solution for the state to the best of our ability,” Edwards said. “I do think, frankly, that healthcare systems and our providers doing this is probably better. I think you’re going to have better uptake from patients if they’re getting it done from a health system versus the National Guard.”

‘A multitude of options

Edwards stressed that not all mass vaccination events would operate through the National Guard, especially given the challenges in storing the Pfizer vaccine.

“If we’re going to continue to get the Pfizer vaccine, then we’re going to have to use it,” he said. “And those ultracold storage requirements will drive us to our hospital partners. We’re right now working through all the planning necessary to do these events, but we don’t have the vaccine on hand.”

For the next few weeks, though, the vaccines will come out much as they have been so far, in small batches at a wide number of facilities. Kanter said that a list of pharmacies where vaccines could be obtained next week would be available by Monday at the latest.

“It’s going to be a multitude of options,” he said. “Pharmacies are going to continue to be an access point, as will hospitals.”

He said that there wasn’t a plan currently in the works to have a centralized system for signing up at those different facilities, and that those who wanted vaccines would need to continue contacting pharmacies directly. That system has posed problems to people over the age of 70 who don’t have a lot of fluency with the digital communications that LDH has relied on, and many have showed up in person to pharmacies after encountering blocked phones.

Susan Hassig, a professor of epidemiology at Tulane University who has advised the state’s vaccine plan, said that the lack of a centralized signup tool wasn’t especially surprising, given the resources that would go into making such a tool, and the lack of federal support.

“You have to remember that the recent piddly-ass support bill only got passed after Christmas,” she said. “And we know the city has no money, the state has no money. So anything that’s outside of utilizing their normal personnel is something they can’t pay for. That’s why a federal structure that doesn’t just focus on the vaccine product, but also that last mile of getting the vaccine in the arm is so important.”

“Does the state of Louisiana have the expertise to build [a sign up tool] independently? Maybe the federal government should have,” she said. “Especially with medical information and personal identifying information which is needed for these systems, these are nontrivial kinds of platforms to build. So it’s not like filling in some kind of little bogus survey on Facebook.”

An interim strategy, she suggested, would be distributing information through churches, or even partnering with them for vaccinations.

But next week may pose even more communications challenges. “There will be more sites, and I have instructed [health secretary Courtney Phillips] to make sure that we are in all 64 parishes,” said Edwards. “Not necessarily pharmacies, but with a provider.”

Thirteen parishes didn’t have any pharmacies with vaccines allocated this week.

But getting vaccines to those parishes might mean that pharmacies that received vaccines this week won’t get them next. 

“If we can accomplish that and resupply every pharmacist who received it this week,” said Edwards, “then that’s what’s likely to happen.”