At Lyon’s Corner Drug, a historic pharmacy and old-fashioned soda fountain on the main strip in Steamboat Springs, more than 100 older residents lined up on a bitter cold morning when the temperature dipped to single digits.
The pharmacists’ children, two of them dressed as Disney princesses, delivered ice cream and caramels to the folks waiting for their coronavirus vaccines. Nearby businesses passed out free coffee and donuts.
The vaccine clinic last Sunday — thrown together in two days after a box of 100 doses arrived at the pharmacy via FedEx — was the kind of small-town event that epitomizes the rollout of the coronavirus vaccine in rural Colorado. Through word of mouth, social media and even sticky notes on the public health director’s desk reminding her to call an 80-year-old man who doesn’t use a computer, rural counties are trying to vaccinate residents in priority order and make sure no one falls through the cracks.
“You could tell they haven’t been out in a while,” said pharmacist Matt Johnson, who stretched the 10 vials of 100 doses to vaccinate 116 people in three hours, following guidelines from state government. “They were seeing friends in line that they hadn’t seen in 10 months.”
Across Colorado, much of the vaccination work — about half — is being done by hospitals and large health systems, and they are building increasingly monumental programs to get the job done. UCHealth says it can vaccinate 35,000 people per week now. Centura Health expects to be able to vaccinate 22,000 per week by the end of February. Kaiser Permanente is aiming to eventually provide 50,000 vaccinations per week.
These major players have comprehensive records-keeping systems and online sign-up portals that help them identify patients, schedule appointments and send out reminders for follow-ups. But the other half of Colorado’s vaccine providers — the community clinics, public health departments and retail pharmacies that are doing much of the work to reach under-served populations — are finding the logistics more challenging.
Public health officials in several counties told The Colorado Sun that while they’re doing their best to make sure doses are getting into arms as quickly as they arrive, they lack the technology to adequately keep track of scheduling, who is due for a second dose of the two-shot vaccination, and how to notify an entire category of people who are next for immunizations under the state’s rollout plan.
At Lyon’s Drug, only those age 75 or older were eligible. Johnson was asking people to show their Medicare card and give their date of birth. He posted a sign behind the counter for his clerks with the required birthdate, much like the kind stores use when checking IDs for alcohol sales.
Johnson entered his customers’ vaccinations into his own system, intending to email and call them in a few weeks when he’s secured their second dose of vaccine.
At Routt County Public Health, executive director Roberta Smith borrowed an online form from Pitkin County that residents can fill out in order to get notified when it’s their turn. The form asks for age, place of employment and whether the person has a high-risk medical condition, such as diabetes or lung disease, and if they work with the public.
Smith dumps the data into a spreadsheet, then sorts it by age and profession. Her crude system is not sustainable, she said.
More than 1,000 Routt County residents have filled out the form — for about 60 doses the local health department will have available at its next clinic.
“It’s like Lady Gaga tickets,” Smith said. “It’s challenging and it just leads to disappointment, too. When we get more vaccine into our communities, it’s going to be less stressful. I wish I could jump in a van and deliver vaccines to everyone’s houses, but we are just not there yet.”
Smith and other county public health leaders are hoping the state health department will come up with better technology to help them schedule and prioritize.
When people are vaccinated, the data is entered into the Colorado Immunization Information System, which is a statewide database that keeps track of lifelong immunizations, making it easier for residents and their doctors to keep track of vaccinations. Coloradans can opt out, and the information in the system is kept confidential.
But the system has no scheduling feature, so it’s no help to local health departments and pharmacists who are trying to round up people eligible for the vaccine.
The Colorado Department of Public Health and Environment recently obtained a commercial, “off-the-shelf” system for online appointment scheduling, patient consent and vaccine tracking, a department spokesperson said Tuesday. The system is available to all local public health agencies and the state has scheduled a training for later this week.
When Routt County was ready to vaccinate dentists, Smith’s office contacted a local dentist who was rumored to have a Listserv with all of the county’s dentists. The department still got emails: “Oh hey, you forgot us,” Smith said, so local officials invited dentists who were left out of the first clinic to another one.
In Boulder County, officials are reaching out to the local Area Agency on Aging to try to find residents who are 70 and older and notify them when it’s time to get vaccinated.
Boulder County has a similar online form on its website for people who want notification of when it’s their turn. About 60,000 have already filled it out.
The county is still working to vaccinate health care workers and first responders and has not yet moved on to older residents, health department spokeswoman Chana Goussetis said.
“Scheduling and technology has been difficult and less than ideal for us at public health,” she said in an email. “We are hopeful, though, that the statewide software will be available soon.”
Mass vaccination clinics are coming — but won’t be the answer
Colorado is receiving about 70,000 doses of vaccine a week that the federal government has designated as first doses, and the state has deployed those doses to at least 235 locations in all corners of Colorado. There have been pop-up clinics and small-scale outreach efforts, especially targeted at reaching communities of color and the under-served.
At a news conference on Tuesday, Gov. Jared Polis spoke proudly about a weekend clinic at Zion Baptist Church in Denver — 150 congregants over the age of 70 were vaccinated. Dr. Richard Zane, UCHealth’s chief innovation officer, said his system is working with community groups and health clinics to stand up small-scale clinics in communities where access to transportation and the internet are limited.
UCHealth is also preparing to open the state’s first mass vaccination drive-thru clinic. Zane said it would be in Denver but didn’t provide other details.
“We hope to be able to do over 10,000 in one single day,” he said.
Polis, though, said the state’s strategy won’t depend upon mass vaccination clinics. He said people will likely prefer a more personalized approach and not want to have to wait in long lines to receive the vaccine.
“We think it is generally more convenient to have 10 sites that do 1,000 a day than one that does 10,000 a day in terms of people accessing the vaccine,” Polis said, “but you will see some of all of the above.”
For the smaller health care providers offering those medium-sized clinics, the burden is substantial. John Santistevan, the president and CEO of Salud Family Health Centers, said his clinics are operating 13 vaccination sites in 10 communities. So far, they’ve vaccinated nearly 4,500 people, with about 80% of those being over the age of 70. But the effort to do so has meant pulling some of their medical staff off patient care to focus on the vaccination campaign.
“The downside to that is not as many people are getting primary health care,” Santistevan said. “But we are vaccinating more individuals, which we totally believe that that’s the right thing to do and to save individuals’ lives.”
The work is straining in another way. Santistevan said Salud is joining with UCHealth to offer a vaccination clinic in Aurora on Thursday and Friday. They have the capacity for 500 people on each day, but walk-ins won’t be accepted. Everyone needs to have an appointment — and he would prefer those be set up online.
“Our phone systems are getting overwhelmed,” Santistevan said. “… So it would be great if you would use our website.”
Will counties verify whether people are eligible?
So far, local health officials said they have no rigorous plan to verify whether people are accurately representing their jobs, age or health issues when they sign up for vaccinations. They just don’t have time.
“We will not be able to verify if a person is truly a part of the priority group eligible at each particular stage of the vaccination rollout,” said Goussetis from Boulder County. “We hope that residents will put the health and safety of those at higher risk ahead of their own desire to be vaccinated before their priority group allotted time.”
At Routt County Public Health, which will have dispensed about 400 doses of the vaccine by the end of this week, officials are asking for age and profession and hoping people are honest. A person who tried to sign up and identified as a lawyer had his appointment canceled, health director Smith said.
“We were verifying, early on. It’s labor intensive,” she said. “We do trust that people are being honest.”
Most counties are finished or nearly finished vaccinating frontline health workers, who were in the highest priority category under the state’s flow chart, called Phase 1a. Phase 1b is split into two halves, with the top half first responders and all adults over 70 years old. The bottom half includes frontline essential workers such as teachers and grocery employees.
State health department Director Jill Hunsaker Ryan told The Sun last month that the state has no plan to ask for paperwork to verify eligibility.
“We’re trying not to make this too bureaucratic because it’s really important that we’re able to get vaccines in arms as quickly as possible and not waste any vaccine,” she said. “And so we’re leaving it up to the providers’ discretion for them to ask the questions and assess that. But at the state, we’re not requiring any sort of documentation that someone is in a certain phase.”
Larger counties are relying on health systems, pharmacies
The kind of coordination happening in small towns to make sure everyone gets invited to a vaccine clinic is harder for larger counties to pull off. Instead, big-city health departments are so far relying mostly on older adults, first responders and essential workers to seek out clinics or wait until they are contacted by their health system.
At Tri-County Health, which is the public health authority for Adams, Arapahoe and Douglas counties, people who are age 70 and older are most likely to receive notice about vaccination opportunities from the health system where they receive care — at least at the start of the rollout.
Those who haven’t been notified will have to “actively seek out vaccination opportunities,” Karen Miller, Tri-County’s vaccine coordinator, wrote in an email. They will have to find clinics at hospitals, pharmacies, safety-net clinics and local health departments, he said.
“Up to date information on vaccination opportunities will be posted on state and local health department webpages when it becomes available,” she added.
In Denver, public health officials were still fine-tuning details about how they will reach out to prioritized populations, such as essential workers. “We are developing messaging and hope to connect businesses and essential workforce with existing vaccine providers,” said Cali Zimmerman, Denver Public Health and Environment’s emergency management coordinator, via email.
Polis, in a news conference Tuesday, asked for patience.
“There will be a future date where this will be just like your flu shot,” he said. “Your local pharmacy, your doctor’s office, plenty of supply, no particular drama around getting it or scheduling appointments. I suspect it is fall of this year.”
“In the meantime, we are constrained by quantity. We are prioritizing those whose lives we’re most likely to save.”