There have been a whirlwind of COVID-19 developments in the past few weeks.
We know there are two available vaccines, from Pfizer and Moderna. And we know approximately where we are in line for the vaccine. We even know that the federal government is covering the cost of the vaccine, and largely leaving administration fees to payors.
What we still don’t know is exactly how the vaccines will be distributed. The Pfizer vaccine must be kept at –94 degrees Fahrenheit during transport, and the Moderna vaccine at –4 degrees Fahrenheit. Immunization managers across the U.S. are in the process of creating detailed plans to transport and deliver these much-anticipated vaccines.
The kind of extreme refrigeration required for the Pfizer vaccine is not unheard of. The Ebola vaccine also required ultra-cold chain storage and was effectively distributed even in hot and humid countries. Of course, the need for such low temperatures during transportation is still expensive and complicated – emphasizing the need for a comprehensive and efficient strategy.
Who is getting the COVID-19 vaccine first?
Right now, public health experts are suggesting the first people to get the vaccine should include:
- Healthcare workers
- Essential workers
- First responders
- Teachers, and
- Elderly adults, particularly those in long-term care facilities
According to Definitive Healthcare data, there are more than 2 million healthcare providers in the U.S. This includes more than 989,000 physicians. However, this number does not account for administrative and custodial staff at healthcare facilities who are considered essential.
Hospital intensive care units are also reaching capacity across the country, with even more nearing ICU and ventilator capacity. These facilities are primarily in major cities like Detroit, Dallas, Houston, and Las Vegas according to a New York Times map. According to Definitive Healthcare’s COVID-19 Capacity Predictor, average nationwide ICU bed capacity was exceeded in mid-November.
By combining data on ICU capacity and provider density, vaccine distributors can create an accurate picture of where the first doses should be administered.
COVID-19 vaccine will go to physicians first - but where?
Fig 1. Map represents 10,000 of the 989,000 physicians tracked by Definitive Healthcare’s Physician database. Represented physicians have reported clinical activity levels of "moderate" to "very high". Clinical activity level is gathered using data from the CMS Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF), Standard Analytical File (SAF), and medical claims data. Physician employment data is updated weekly through proprietary methods. Accessed December 18, 2020.
As seen in the map above, physicians are clustered in metro regions like New York City, Boston, Chicago, and Washington, D.C. Provider density is often directly related to population density in a given area, making nurses and physicians in these areas ideal targets for the first round of vaccinations.
Another key factor to consider is whether the target facilities have the technology and the staff to properly store and administer the vaccine. The extreme cold needed to preserve the Pfizer vaccine may be impossible to maintain for providers in rural areas. This could limit which regions and populations receive the Pfizer vaccine versus the Moderna vaccine, which does not have to be kept as such frigid temperatures.
Finding elderly patient populations for COVID-19 vaccinations
After healthcare and essential workers, public health experts recommend vaccinating the most vulnerable populations. This includes elderly Americans, particularly those in long-term care facilities. Some of the most common long-term care (LTC) facilities are nursing homes, also known as skilled nursing facilities (SNFs).
Where are the highest volumes of elderly patients?
According to Definitive Healthcare data, there are nearly 17,000 active SNFs in the U.S. As you can see in the map below, larger SNFs are concentrated in metro areas like New York City, Boston, and Chicago. SNFs are an area of focus for vaccinations because they serve large populations of vulnerable patients living in close proximity.
Fig 2. Map displays the 10,000 SNFs with over 75 beds, as these larger facilities are more likely to spread viruses like COVID-19. SNF data is from Definitive Healthcare’s Long-Term Care database. Facility bed counts are found through a combination of proprietary methods and data from the Medicare Provider of Service File. Proprietary information is updated daily. Data accessed December 18, 2020.
The primary financial impact to SNFs during the COVID-19 pandemic is additional staffing costs. Patients require more intensive medical care to prevent infection as well as during treatment for COVID-19. These increased patient demands require new staff as well as overtime and hero pay for existing staff.
Skilled nursing facilities provide residents with a variety of essential medical services. These services range from daily medication management and physical therapy to speech pathology. However, more than two-thirds of SNFs report they are likely to close in 2021, according to a survey from the American Health Care Association (AHCA).
Focusing on providing healthcare providers and elderly patients with the COVID-19 vaccine first could help alleviate the financial burden by preventing new COVID-19 cases.
Unpopular opinion: focus on the super-spreaders
In a November article, Wired contributor Christopher Cox made the bold claim that the elderly should not be prioritized for vaccines. Instead, Cox wrote, vaccines should first be given to “super spreaders.” These are people who have large social circles and have likely not adhered to social distancing measures throughout the pandemic.
Super spreaders are the individuals who continue to attend social gatherings and participate in other high-risk activities. This could include people who don’t wear masks or don’t wear masks properly while in public. To many, these people are inconsiderate – but they’re also most likely to be the ones spreading COVID-19 to the most people.
By this logic, eliminating super spreaders could mean ending the pandemic faster. The people who are traveling between social groups can no longer bring the virus with them. Many elderly Americans are quarantining in their homes or in long-term care facilities, with little exposure to the general public. Cox’s argument is that vaccinating these individuals will have little impact on stopping the wider spread of the virus.
It is a complex ethical issue, and one that can be guided by data. If the goal is to protect the most vulnerable populations, vaccinating the elderly and others with compromised immunity makes sense. However, if the goal is to limit the spread of the COVID-19 virus quickly, it could make more sense to focus on the individual "super spreaders."
There are limited vaccine dosages over the next 12 months. Public health experts will have to decide which groups should receive them first to make the greatest impact on the COVID-19 pandemic.
Are you looking for more information on how the COVID-19 pandemic is impacting healthcare providers? Visit our recent article, Pandemic Stress Forces Physician Groups to Close, to understand how private practices are responding to the pandemic.
Would you prefer to see the most recent data on when U.S. hospitals will reach ICU capacity? Check out our COVID-19 Capacity Predictor. This free tool allows users to segment hospital capacity data by state and county.