Who’s Next? Colorado’s COVID-19 Vaccine Plan Creates Confusion For Most, Competition For Some

January 5, 2021
COVID-VACCINE-HOSPITAL-WORKERS-NORTH-SUBURBASN-THORNTON-201217COVID-VACCINE-HOSPITAL-WORKERS-NORTH-SUBURBASN-THORNTON-201217Hart Van Denburg/CPR News
Health care providers were administered doses of COVID-19 vaccine at North Suburban Medical Center in Thornton, Dec. 17, 2020.

After months of meetings with an advisory panel, the administration of Gov. Jared Polis developed a strategy for the distribution of the COVID-19 vaccine and a gradual rollout to ensure that health care workers and Coloradans living and working in eldercare facilities were the first to be protected.

Then, the vaccine arrived. The plans were upended.

First, the Centers for Disease Control and Prevention issued its own guidelines for who should get next dibs on the vaccine. Just as frontline health care workers were getting vaccinated, Colorado essentially followed the CDC, moving hundreds of thousands of people from certain age or occupational categories up the priority list.

Then, faulty estimates led some counties to get more of the vaccine than needed for the original group of health care workers. Those counties began vaccinating the next in line well before their neighboring counties could do the same. 

Eventually, there will be enough vaccine for everyone. But for now, the result is a system that is distributing some vaccine doses to Coloradans based on who they know, where they live or how fast they can log in — not necessarily who they are.

For example, Summit County began offering vaccines to people 70 and older last week — if they were paying attention and saw where it was being distributed.

Eagle County took reservations online and by phone this week for vaccine clinics that will occur later this week, filling every spot in just five minutes.

Garfield County? Yes. Douglas, Arapahoe or Adams County? Not yet. Denver? Maybe soon.

Educators, Coloradans over 70 and others got moved up in the vaccine line. Then came more questions.

The same goes for groups prioritized, then shifted, then re-prioritized for vaccines by the state. On Tuesday afternoon, the state health department announced that educators should expect to wait until at least the end of February for access to vaccine, after everyone 70 and older has been inoculated.

It was less than a week after Polis announced teachers were being moved up the priority list. Turns out they weren’t being moved up very far.

“The current supply of the Pfizer and Moderna vaccine received by the state of Colorado from mid-January to late February will be allocated to completing vaccinations for moderate risk health care workers, first responders and adults 70 and over,” according to the state release.

While it appears, for now, that people 70 and older are at the top of the list for those next to get the vaccine, confusion still reigns even for that group.

After Polis’ announcement that seniors 70 and up would be eligible for vaccines and word got out that some were already receiving them, people flooded the phone lines at public health departments across the state and even showed up in person looking for shots that weren’t ready.

In Pueblo, so many seniors jumped into vaccine lines intended for health care workers that the local health department had to put out a press release encouraging patience.

“It’s great to see so many Puebloans trust the science and want to get the vaccination quickly but I’m encouraging everyone to have a little bit of patience as we roll out the vaccinations to Puebloans over 70 and to the larger public,” Pueblo Mayor Nick Gradisar said. “We are working hard to get the vaccination into as many arms, as possible, as fast as we can.”

The scenes are different from place to place, but the anxiety is shared statewide.

Seventy-two-year-old retired RTD bus driver Stephne Keller, of Lakewood, said she regularly calls King Soopers, Walgreens, the state and the county, trying to figure out when she can get vaccinated. She hopes they don't recognize her as a repeat caller, she's just desperate for information.

“Everyone I talk to, you can just tell they're strained from not having any answers,” Keller said. “Everyone has a different answer because nobody knows” when vaccines will be available.

She lives in a community of older people where many of her neighbors are just as uncertain about where to turn.

“My neighbors are in their 90s... I worry about them. I live in a neighborhood where we're all older, and everyone is just kind of hunkered down,” Keller said.

She was finally able to reach her doctor and he said he was able to get a couple of his patients over 80 vaccinated, but that he thought you had to be over 75.

She had to educate her doctor on the priority order.

“I don't want to die!” Keller said, explaining why she is concerned. “A million years ago I was a nursing student so I've been sterile, but I'm tired of being careful.”

The responsibility for who does the vaccinating is not always clear.

The system was set up for hospitals to inoculate their frontline staff and for local pharmacies, under a federal program, to handle nursing home workers and residents. That would take care of group 1A.

But as group 1B of firefighters, police officers and EMS workers got to the front of the line, vaccination procedures began to vary from place to place. Then, when Polis moved senior citizens, teachers and other essential workers into that same group, adding hundreds of thousands of additional people without providing any immediate guidance for how, when or in what order those inoculations would occur, confusion took hold.

“Originally local health departments were going to be responsible for (vaccinating residents 70 and older). That would overwhelm most health departments, particularly in large metropolitan areas. So we are working with some of the other providers to see if they can take that over,” said Dr. Mark Johnson, chief medical officer of Jefferson County Health Department and president-elect of the Colorado Medical Society.

The hodgepodge of approaches has generated anxiety among seniors, teachers and others who were declared eligible, but have quickly learned that eligibility and access are very different things.

One reason some areas have been able to move forward more quickly than others is that, due to inaccurate employment information on health care workers, some counties got more of the vaccine than they need for the earliest groups, according to Dr. Anuj Mehta of Denver Health who chairs the group that advises the governor on vaccine allocation. 

“Some places will have a little bit more so they can vaccinate a few extra people within that phased approach,” Mehta said. “Some places will have a little bit less than they'll have to wait until the next week's allocation.” 

Mehta said larger metropolitan areas are likely to be slower in vaccinating top priority groups because there are more of them to vaccinate and a shortage of workers to administer the vaccines. 

Small counties moved through Group 1A faster than metro counties, and have moved on to vaccinating lower tiers. And as eligible residents of one part of the state see that vaccines are available elsewhere but not to them, they get frustrated and concerned that they have been passed over.

“Because you start hearing about school teachers getting it, and they're in a group that is lower than you are, and you're not getting it,” Johnson said. “And you don't have a clear way of knowing where you're supposed to go to get it.

“That's kind of the mess that we're in right now.”

Vaccine rollout has been different county to county, hospital to hospital.

Through Jan. 5, 120,510 Coloradans had received their first shot — about 2.6 percent of the state's adult population, or 2 percent of the total population. That's good enough to place the state in the upper 25 percent of states for vaccine distribution. The CDC reports Colorado has received just more than 262,000 doses of vaccine so far.

But the way counties have communicated with citizens about the availability of the vaccine has been uneven. In Eagle County, those 70 and older were informed on an ad-hoc basis. Some found out through local media and press events, others were told by their doctor that the vaccine was available. 

In Summit County, it helped to be social media savvy enough to learn from Instagram when and where to sign up or to be watching local web sites. If you didn’t move fast, you were out of luck. 

Hospital systems have been urged to vaccinate those in lower tier priority groups if they end up with extra doses, to avoid wasting vaccines. UCHealth in Denver had physicians or staff calling some of their patients to let them know which clinic to approach for a shot.

Word spread by social media and through neighborhood groups and some Denver residents 70 and older with the best connections have now gotten their first dose of the two-dose regime.

Not all the vaccine has gone to big hospitals and the state’s wealthiest counties.

Places like Denver’s Tepeyac Community Health Center, serving a low-income, largely Latino population, said they’ve already vaccinated clinical staff and are working with the Colorado Department of Public Health and Environment to figure out logistical details in order to begin vaccinating their older patients next week.

Inmates who are 70 or older in the state Department of Corrections will begin receiving vaccine Wednesday, being made eligible at the same time as their cohort in the non-incarcerated population, as Polis had promised.

With thousands of doses received but not injected in the state weeks after the first shipments arrived and a new coronavirus variant, B.1.1.7 now present in the state, Scott Bookman, head of the COVID-19 response for CDPHE, sent a letter to hospitals and other providers on Jan. 5 threatening to take vaccine away from them if it wasn't quickly injected into Coloradans or they didn't get approval to wait.

“You must begin vaccinating within 72 hours of vaccine receipt,” Bookman wrote. “To request more time and avoid transferring doses, you must complete the vaccine delay request form and receive approval from CDPHE or the vaccines will be moved to another enrolled provider...

“We appreciate our partners are already working hard and stretched thin, but with the new arrival of the B.1.1.7 we are in an urgent race against the virus to vaccinate as many Coloradans as fast as possible to end this crisis.”

Still, the amount of vaccine that has reached Colorado’s diverse racial and ethnic groups is a mystery. After initially promising transparency, the state hasn’t provided demographic information on who has received the vaccine so the public has no way of knowing whether Colorado’s diverse population is getting equal access to protection from COVID-19.

The state has recently announced it will update the data it provides about vaccine distribution which will include how many vaccines have been administered by vaccine type as well as daily and weekly numbers and cumulative numbers.

Primary care doctors, dentists and other groups remain in the dark.

One major gap in planning, critics said, is the process for vaccinating primary care doctors, especially those in small practices and rural areas outside of large hospital systems. Some doctors said they haven’t been told where to go for their vaccines, yet will need to receive them before they can begin vaccinating their own patients. 

Dr. Mary Catherine Husney, a private practice physician in Denver said she was able to get a vaccine through Kaiser Permanente, which has offered to vaccinate doctors outside of the system. But she said she’s still not sure what to tell patients — especially older ones and those with pre-existing conditions. 

“They're asking tons of questions,” Husney said. “Not just about the vaccine itself, but also about how they're going to get it and where they're going to get it.” 

She said she is anxious to get more guidance from the state so she can begin planning. 

Dentists, too, said they’ve been left out of the planning. 

Dr. Karen Foster, a pediatric dentist in Aurora, and board member of the Metro Denver Dental Society, said some dentists with hospital admitting privileges have gotten the vaccine, but many dentists are left wondering where they fit into the distribution.  

“I've seen colleagues posting on Facebook saying that they are struggling [to get the vaccine] not only for themselves but also for their team members in their offices,” she said.

Foster said the Metro Denver Dental Society is lobbying state health officials and the governor’s office to get dentists, who are inherently at risk of COVID-19 exposure because they have their hands in people’s mouths throughout the day, vaccinated.

Foster sympathizes with the difficulty of vaccinating an entire state. And she understands that there will be chaos. 

“It is a little frustrating, but it's not a surprise,” Foster said.

CPR News Director Rachel Estabrook contributed to this report.

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