The state of Michigan has identified 48 hospitals and 12 local health departments that will receive the first shipment of coronavirus vaccines for distribution to frontline health care workers, possibly as early as Dec. 15.
All major health systems will receive the Pfizer and Moderna vaccines once the FDA gives emergency use authorization and the CDC authorizes which frontline health care workers and nursing home residents will be inoculated in the first wave.
Health systems include the University of Michigan, Beaumont Health, Henry Ford Health System, Spectrum Health, Mid-Michigan, Trinity Health Michigan, and Ascension Michigan. They will most likely first vaccinate health care workers in COVID-19 medical units, emergency departments, intensive care units, and operating rooms.
It is also believed CVS Health and Walgreens will receive shipments from vaccine manufacturers or through McKesson Corp., which holds a delivery contract from the federal government, to administer to nursing home residents and health care workers, most likely in early January.
Bob Swanson, director of immunization with the Michigan Department of Health and Human Services, said the state’s goal is for all hospitals and local health departments to receive the first round of vaccine shipments so frontline health care workers and nursing home residents can be protected.
“We are planning to get vaccines to every hospital in the state. We are waiting for a couple hospitals to enroll before we can ship to them,” Swanson said. “Not everybody will get the Pfizer vaccine (because they lack ultra-cold deep freezers). Some will get the Moderna vaccine a week behind.”
Swanson said the state was told last week that it would get 90,000 doses of the Pfizer vaccine, a number lower than the initial allocation of 300,000. Those 90,000 doses will cover only 45,000 health care workers because each person requires two doses. Michigan hospitals employ nearly 250,000.
“We’re supposed to get a new number today (Wednesday),” he said. “It’s significantly less than what our original plans were. But I do know that CDC will continue to allocate more doses as the weeks go. As they become available through the FDA we will have more vaccine available.”
Swanson said the federal government asked each state to designate five hospitals that would be the first to receive vaccination shipments, expected about Dec. 12, to preposition for quick administration once approvals are finalized. Those five hospitals are University of Michigan Hospitals, Mid Michigan Health, Beaumont Hospital Troy, Spectrum Butterworth, and Ascension Macomb.
The five hospitals will not begin vaccination until after the CDC’s Advisory Committee on Immunization Practices makes its recommendation for the vaccine, said Swanson, adding that after the CDC gives final approval the remainder of the state’s vaccine allocation will be released about two days later.
After designated frontline workers are vaccinated, Swanson said essential workers and those over age 65 or those with chronic medical conditions will receive the two-dose shots in the next two phases.
Dr. Joneigh Khaldun, the state’s chief medical executive, said the general public will most likely receive the vaccine in early spring.
“Because there will be such a limited amount (of vaccine) in the beginning, our first priority will be to keep our health care systems operating and to protect those who are the most vulnerable,” Khaldun said at a Tuesday news conference with Gov. Gretchen Whitmer.
To prepare to store the Pfizer vaccine at -70 degrees Celsius, 48 hospitals and 12 local health departments purchased super-cold freezers in preparation for mass vaccinations, Khaldun said. Detroit-based Henry Ford Health System said this week it began installing the specialized freezers to be ready as soon as one or both of the proposed vaccines from Pfizer and Moderna are approved for use.
While the freezers are available commercially, many of the units are on back order as states, local health departments, health care providers, and businesses including Ford Motor Co. scramble to get them.
Swanson said another 100 hospitals will receive the Moderna vaccine after it has been approved and released.
“We’re working with all of these sites to make sure they have what they need to start administering the vaccine the moment it becomes available,” Khaldun said.
After front-line health care workers are vaccinated, the state will prioritize workers and residents in nursing homes and other congregate residential facilities to be vaccinated “hopefully” in January, Khaldun said.
“All of this is dependent on how quickly vaccine becomes available from the manufacturer,” Khaldun said.
Swanson said 12 local health departments across the state, including Detroit’s, will also receive an initial shipment of the Pfizer vaccine. He said emergency service personnel and unspecified others will be vaccinated at the health departments.
The Macomb County health department has purchased five of these freezers and placed them at different sites across the county, said Bill Ridella, the county’s health officer.
Macomb County is working on identifying a site where the county health department can give 2,000 vaccination shots during an eight-hour period daily, Ridella said.
Swanson said COVID-19 vaccine and supply kits will be delivered to hospitals separately. He said each kit will include 105 needles of various sizes, 105 syringes, 210 alcohol prep pads, four surgical masks, two face shields, and 100 COVID-19 vaccination record cards for vaccine recipients.
To track patients receiving the vaccine, each hospital will maintain records, but Swanson said providers will have 24 hours to notify the Michigan Care Improvement Registry, the state’s immunization database, to track the vaccinations.
Dr. Rosalie Tocco-Bradley, chief clinical officer for Trinity Health Michigan in Livonia, said six of the Catholic system’s eight hospitals have 60 ultra-cold deep freezers required to store the Pfizer vaccine. Only the two small hospitals in Livingston and Lakeshore in western Michigan won’t have the Pfizer vaccines to distribute.
Tocco-Bradley said details on how the system will administer the two-dose vaccines to designated health care workers within the systems are still being developed. It is expected that a central location for administration within the hospital will be chosen, she said.
Trinity formed a multidisciplinary vaccination workgroup to manage the administration plan for frontline health care workers and eventually the public, Tocco-Bradley said. The committees include receiving, storing, and handling the vaccine, logistics in how to administer it, documentation and tracking patients and education and communications about vaccine safety, she said.
“We are running a survey now about those who will receive the vaccine,” she said. “It’s not mandatory right now (according to the emergency use authorization requirements), but I suspect many will agree to take it.”
Tocco-Bradley said the side effects of the Pfizer and Moderna, as the companies have described, are minor and include sore arms, headaches, and general lethargy.
“We don’t want to vaccinate the entire ER in the same day” in case there are side effects where people feel sick, Tocco-Bradley said. “If there are reactions, some people might not want to come to work for a day (to recover). We will most likely phase it in across several areas.”
Heidi Pillen, Beaumont’s senior director for pharmacy services, said Beaumont has nine ultra-cold deep freezers located at each of its eight hospitals and corporate office in Southfield.
“We are prepared. We have freezers at all hospitals and the administration building,” Pillen said. “The final plan has not been completely flushed out yet. … When we give out the flu vaccine, employees sign up online. There most likely will be a central location (at each facility) where the vaccines will be administered.”
Like Trinity, Dr. Jeffrey Fischgrund, Beaumont’s chief of clinical services, said it has formed a vaccine steering committee composed of doctors, nurses, pharmacists, ethicists, and administrators to coordinate the administration effort.
“We have a Beaumont vaccine committee that will independently review vaccine safety for staff members,” said Fischgrund, adding that the committee will render a decision on safety within 24 hours after receiving the data and well before the vaccine doses are received by the system.
“Our mandate is to take care of those most at risk and those are the frontline workers with the highest exposure,” Fischgrund said. “We did an antibody study in the spring (and found) the frontline workers with the highest exposure are mostly nurses, respiratory therapists, and phlebotomists.”
Fischgrund also Beaumont plans to counsel and provide education to frontline workers who aren’t comfortable receiving the vaccine because federal rules prohibit mandatory vaccinations as a condition of employment.
“We have to respect their wishes,” he said. “I am completely confident that the COVID vaccine is safe and effective. If there are questions, we would counsel them. Our advice would be not to place yourself at risk.”
Tocco-Bradley said phase two of the coronavirus vaccination program will probably start in February and go out to larger population groups that potentially will include the general public, people in homeless shelters, group homes, prisons, and other healthier older adults.
“School teachers will probably be in phase two, although there is some confusion right now and they may be placed in phase one,” Tocco-Bradley said. “Phase three is going to be young adults and children. They’re going to be further out.”