How one Florida hospital system is vaccinating the ‘extremely vulnerable’

BayCare will limit its state-allocated 1,000 doses to patients with conditions that suppress the immune system.
These syringes were loaded in January with the Moderna COVID-19 vaccine in Pittsburgh, the same vaccine Florida is sending to 27 hospitals for distribution to extremely vulnerable patients.
These syringes were loaded in January with the Moderna COVID-19 vaccine in Pittsburgh, the same vaccine Florida is sending to 27 hospitals for distribution to extremely vulnerable patients. [ GENE J. PUSKAR | AP ]
Published Feb. 4, 2021

While Florida has set aside some vaccines for those younger than 65 who are considered extremely vulnerable to the coronavirus due to medical conditions, supplies are limited.

The state recently sent about 28,000 doses of the Moderna vaccine to 27 hospitals, telling them to use them on those patients. But the directive came with no specific instructions, leaving individual hospitals to decide on their own who to give them to.

The allocation “just barely scratches the surface” of Florida’s extremely vulnerable population, as it is defined by the U.S. Centers for Disease Control and Prevention, said BayCare Health System CEO Tommy Inzina. The list of conditions, which covers cancer patients to pregnant woman to smokers, likely includes about half the population, he said.

Tommy Inzina [Courtesy of BayCare Health System]
Tommy Inzina [Courtesy of BayCare Health System]

BayCare, which received just 1,000 doses, was the first health system in the region to release a detailed plan for them on Thursday. The company will start distributing them Friday, Inzina said, first focusing on those who have two or more conditions, then open it up to others as vaccine supplies grow.

“We all wish that there was more vaccine currently available and that everyone who wanted a vaccine could just call for an appointment,” he added. “But until there is more availability, BayCare is using its clinical judgement to identify outpatients who are among our region’s most vulnerable individuals.”

Related: Questions about coronavirus vaccines? Check our running list of answers.

A team of top doctors across various disciplines determined together how BayCare would distribute doses, the company said. They started with the CDC list and narrowed it to conditions that greatly suppress the immune system, making a patient more vulnerable to serious illness or death from COVID-19.

The narrowed list includes cancer with chemotherapy treatment; sickle cell disease; COPD or other respiratory conditions requiring chronic oxygen, chronic tracheostomy or chronic ventilatory support; heart failure with injection fraction less than 40 percent; complex adult congenital heart disease; obesity with body mass index greater than or equal to 40; HIV/AIDS; solid organ transplant; end-stage renal disease on dialysis; autoimmune disease on immunosuppressive therapy; and cerebral palsy.

The hospital system is using its patient database to identify those who will get shots first, and a team of about 20 volunteers is making calls to set up appointments, Inzina said. Patients should wait to be contacted rather than call their doctor.

Inzina said he expects to see a variety of approaches to vaccinating the vulnerable because “different people will have different views.” BayCare released its list to promote transparency about how the limited doses are being used, he said.

Related: Concerned about coronavirus vaccine side effects? Here's what to expect.

Until now, medically vulnerable Floridians younger than 65 haven’t had any sort of special access to vaccines, despite Gov. Ron DeSantis naming them as a priority group in a Dec. 23 executive order. The order said hospitals could use their vaccine supplies to inoculate those they deemed extremely vulnerable, but gave no guidance.

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A new state registration site debuted last week wrongly gave some with pre-existing conditions the impression they could use it to sign up for shots, while it appears instead that the only access point for these residents is hospitals.

“It’s a good role for hospitals to play,” Inzina said. “How would Publix or a health department verify these complex health conditions? Hospitals know the people and we can reach out to them.”

BayCare has been fielding calls for weeks since DeSantis’ order, Inzina said, adding that the announcement caused patients to look for shots before supply and logistics were in place.

Now that BayCare has a plan, it can handle more doses for at-risk patients, Inzina said, and he’s shared that with the state. He’s hopeful that there will be more allocations, but there’s no clear sign of if and when they’ll come.

“It seems to me (DeSantis) would put himself in a tight spot if he only did this once,” Inzina said. “I’m optimistic that they will continue ... but every time we ask, we’re told this is happening on a week-to-week basis.”

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