Today’s show doubles as an episode of the Charlottesville Quarantine Report. With the COVID pandemic still raging, today’s Patreon-fueled shout-out from an anonymous contributor is once again to state clearly:
"We keep each other safe. Wear a mask, wash your hands, and keep your distance."
At a briefing on January 22, 2021, the executive director of the Blue Ridge Health District had a clear message for people in the greater Charlottesville area.
“There is a vaccination shortage and I just need everyone to understand that,” said Dr. Denise Bonds.
Bonds appeared at one of three press briefings held Friday to explain the current situation. In this edition of the newsletter, we’ll also hear from Dr. Costi Sifri from the University of Virginia Health System and Dr. Danny Avula, Richmond’s health director who is also serving as the state’s vaccine coordinator.
“Right now in Virginia we’re getting about 105,000 new doses per week and clearly there is much more demand than that,” Avula said. “Why is that and how do we address it?”
The post holiday surge appears to be receding slightly, with several indicators trending downward over the past several days. Today’s count of 3,792 new cases reported by the Virginia Department of Health is the second lowest-one day count of the year, and the seven-day average for new cases has been trending downwards and is now at 4,735.
Virginia has now surpassed five million PCR tests administered and the seven-day average for positive test results is now at 12.7 percent. That number has been declining since January 10 when it hit a high of 16.8 percent.
There have now been a total of 10,132 cases in the Blue Ridge Health District with a 7-day average of 82 new cases a day. The holiday surge has been felt more dramatically in surrounding counties. Nearly two-thirds of the 573 cases in Nelson County have been reported since January 1 and more than half of Louisa’s cases have been in 2021. In comparison, the city of Charlottesville has only had twenty-percent of its 2,639 cases reported this year.
Throughout the pandemic, a lot of planning has been based on an epidemiological model created by the University of Virginia’s Biocomplexity Institute. Their model depicts several scenarios which could unfold under various conditions. The latest one considers new forms of COVID that are believed to be circulating across the world. The “new variants” scenario assumes a 40 percent increase in transmission rate and a potentially dramatic increase in new cases.
“In this scenario, new weekly cases peak at almost 75,000,” reads the report. “However, peaks are sustained, with 65,000 or more cases expected for 10 weeks, from late February to late April. By comparison, Virginia had about 50,000 new cases during the entire month of November.”
For comparison, there’s been 33,142 cases this week, compared to 40,449 the week before.
Take a look at the report if you want to look further, but do know the last two sentences under “model-results” remind everyone this scenario is not inevitable.
“Do your part to stop the spread,” reads the ‘model results section.’ ”Continue to practice good prevention and get vaccinated when eligible.”
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However, there is an issue with supply. It has been two weeks since the Blue Ridge Health District announced the opening of Phase1B, and some in the community have expressed frustration with the roll-out. Cynthia Neff is an Albemarle resident who spoke to the Board of Supervisors on January 20.
“As this vaccine roll-out has began having one problem after another, I’ve started to talking to a lot of people to try to better understand,” Neff said. “Certainly we can do this better, quicker, faster, more effectively. And I’m not sure that I’m seeing that in spite of a lot of people working really hard.”
To clear up some of the confusion, the Blue Ridge Health District held a press briefing on Friday. Here’s Dr. Denise Bonds, the agency’s director.
“We recently opened up vaccination to Phase 1B,” Bonds said. “This was a request by the federal government and an encouragement by our state government to really begin to offer vaccines to those who were at highest risk at having of having an adverse outcome if they were impacted, and that would be people over the age of 75, and to a large degree those over the age of 65 or younger with comorbidities.”
Based on an email sent out on January 7, the Health District had originally anticipated opening up that phase in early spring, but they complied with the request and announced on January 15 they would proceed on January 18 at the mass vaccination site built at the former K-Mart building on U.S. 29 and Hydraulic Road. An arrangement was worked out with the University of Virginia to supply people who could administer doses.
However, Dr. Bonds said she learned of a major problem on January 20.
“There is a vaccination shortage and I just need everybody to understand that,” Bonds said. “There are five million Virginians that are currently eligible to receive a COVID-19 vaccine. Virginia gets each week 105,000 doses for the whole state. As you can see, there is considerable demand and not much supply.”
For the Blue Ridge Health District, that means a weekly distribution of 2,950 first doses for the next four weeks. Dr. Bonds said she learned on Wednesday that would be the new supply from the Virginia Department of Health as they contend with a shortage.
“Prior to that we ordered what we needed for the next week but the state quickly realized they were getting twice to three times as many as orders as we actually got vaccines, so they switched to a per capita distribution system,” Dr. Bonds said.
For the next four weeks at least, the Blue Ridge Health District will need to figure out how to prioritize the limited amount of doses. Ryan McKay is the director of policy for the health district.
“The 2,950 dose fall significantly short of what we know we can dispense in any given week,” McKay said. “What that means is that we have to plan a little bit more accordingly in terms of how we distribute vaccines to localities but also how we apply that distribution to the guidelines that are provided by VDH and how we use an equitable lens to make sure that we’re reaching all of the hardest hit individuals in the district.”
As of Friday afternoon, the Blue Ridge Health District had administered 1,500 first doses, and were scheduling appointments for 4,200 people using resources shared by the UVA Health System. Dr. Bonds repeated again that there are limited doses.
“Please be patient,” Dr. Bonds said. “We are trying to make sure that we offer to anyone over the age of 75 a vaccine, but it’s going to take us some time to get through the entire list.”
Dr. Bonds said anyone who currently has an existing appointment with the Blue Ridge Health District for a first shot will get their initial dose.
“Individuals who need a second dose will also get a vaccine,” Bonds said. “That 2,950 represents first doses only. Second doses are distributed in a second separate distribution system and we will contact individuals on a week by week basis to make sure those people who need a second dose are given an appointment so they don’t have to compete in the general IT system.”
As new supply comes in, the health district will be able to make more appointments. Dr. Bonds recommended people who qualify under Phase 1B to fill out the survey but continued to urge patience.
“I want to set very clear expectations,” Dr. Bonds said. “At our current rate of receiving vaccines it will take months to vaccinate all of the individuals that qualify under Phase1B.”
Dr. Bonds said capacity would be expanded by the authorization of new vaccines. They’re also switching to a new computer system to make the scheduling process more efficient, as there have been reported difficulties. In the meantime, Dr. Bonds repeated the most effective tools to stop or slow the spread of COVID.
“We need everyone to continue those great mitigation strategies that we have all become so good at,” Dr. Bonds said. “Please continue to wear your mask. Please continue to maintain physical distancing. Wash your hands frequently and properly. And please limit your social gatherings, particularly with other households. We know this has been a huge source of infection, particularly recently.”
UVA Health System’s role
Since Monday, the University of Virginia Health System has been helping to bolster capacity in the Blue Ridge Health District’s efforts. They’ll begin their second week tomorrow.
“We have plenty of capacity in terms of our ability to provide shots,” said Dr. Costi Sifri, the health system’s director of hospital epidemiology. “We’re willing to do whatever Blue Ridge Health District wants us to do to meet the needs of our community.”
The University of Virginia Health System has been vaccinating its personnel. As of Friday, the University of Virginia had received 25,075 first doses of vaccine.
“Of those, we have provided a total of 17,321 total doses and we have scheduled 22,693 first doses, or have provided those vaccines,” Dr. Sifri said.
However, those numbers may be much lower over the next few week as supply chains struggle to keep up with demand. Dr. Sifri said the work has been done to set up the system for when more doses are available.
“I think this is becoming a clear realization around the country that vaccine supplies are going to be limited,” Dr. Sifri said. “I think that we understood that from the launch of this vaccine program. Some of the initial efforts for the first couple of weeks as we got vaccines were to figure out that last mile. How to figure out how to get a vaccine into a person’s arm and make it a vaccination. That work is now done within our health system and I think that’s true around the rest of our health district, around the state and the country. Now that we have capacity to distribute vaccine and get it into people’s arms, we’re starting to see that the supply is limited.”
Dr. Sifri said he did not know how much vaccine would be distributed to the UVA Health System. He said they have the capacity to deliver 1,000 doses a day but the limiting factor will be vaccine supply.
“Our hope is and our anticipation is that vaccine production efforts are ramped up in the next month and perhaps the prospect of having new vaccines come to approval within the next month or so, we’ll be able to ramp up further delivery to everybody,” Dr. Sifri said.
Dr. Sifri encouraged people in Phase1B to sign up through the Blue Ridge Health District through its online portal to register. He also said people should be prepared for changes as more information is known.
“Keep attentive to how the situation may change,” Dr. Sifri said. “Maybe there’s going to be other avenues to receive vaccine, perhaps through pharmacies, perhaps through your primary care physician. Those structures aren’t in place yet because of the limitations of the vaccine and because of some of the challenges of the current vaccine that we have available.”
Dr. Sifri stressed it is crucial that people who have been vaccinated continue to wear a mask, continue to follow social distancing protocols. The vaccines are all approved under an emergency declaration.
“We don’t have a lot of information yet as to whether being vaccinated reduces the ability to carry the virus,” Dr. Sifri said. “There is some information from the clinical trials that suggests it does reduce the amount of virus that people carry and that some people may no longer carry the vaccine in addition to being protected from the vaccine but I think it’s still to early to tell.”
The word from Virginia’s vaccine coordinator
Virginia has 35 health districts, and Dr. Danny Avula runs both the Richmond and Henrico County departments. Now he is also playing the role of vaccine coordinator for the entire Commonwealth. He began his press briefing Friday with a statement and a question.
“Right now in Virginia we’re getting about 105,000 new doses per week and clearly there is much more demand than that,” Avula said. “Why is that and how do we address it?”
Health districts across the Commonwealth have moved quickly to create vaccination sites and to train people to administer the dose. However, there isn’t enough vaccine yet to go around.
“Clearly to get to our goals of herd immunity and get up to 70 to 80 percent of the population vaccinated, we are going to need that kind of infrastructure,” Avula said. “But right now when we’re only getting about 105,000 new doses a week, that infrastructure will sit idly until our supply increases.”
On Sunday, January 24, the Virginia Department of Health reported that the seven-day average for vaccinations is now at 21,007 a day. The dashboard reported 474,979 doses administered, which is less than half of the 1,055,975 doses Virginia has received.
Dr. Avula said the reason for some of that gap is that CVS and Walgreens are slowly rolling out their distribution of the vaccine into long-term care facilities.
“There is a large number of doses, probably around 100,000 at this point, that have been distributed into Virginia but have not been administered yet,” Avula said. “The CVS and Walgreens are working those various nursing homes and assisted living facilities as quickly as they can. We have been on the phone with their state leadership multiple times this week and they are accelerating their pace.”
But back to the allocations for health districts across the Commonwealth which are much smaller than had been anticipated. Dr. Avula said Phase1B covers a very large portion of the population.
“The challenge of this is when you’re only getting a couple of thousand new doses a week to be distributing between hospitals, health systems, health departments, providers, and pharmacies, how do you do that in a way that comes even close to meeting demand?” Avuld asked. “The answer is, you don’t, you can’t. And understandably that has led to a great deal of confusion and frustration on the part of our public.”
We can expect to hear more questions in the weeks and months to come, and these health briefings are expected to continue.
Defense Production Act
Before we go today, one piece of federal information. One of President Joe Biden’s first actions in office was to sign an executive order that invokes the Defense Production Act which could help speed up vaccines.
“The Federal Government must act urgently and effectively to combat the coronavirus disease 2019 (COVID-19) pandemic. To that end, this order directs immediate actions to secure supplies necessary for responding to the pandemic, so that those supplies are available, and remain available, to the Federal Government and State, local, Tribal, and territorial authorities, as well as to America’s health care workers, health systems, and patients. These supplies are vital to the Nation’s ability to reopen its schools and economy as soon and safely as possible.”
January 24, 2021: Virginia and local health officials acknowledge vaccination shortage, urge patience