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Bioscience-Medicine

Smaller, Rural Hospitals In Texas Don’t Have Equal Access To COVID-19 Vaccines

COVID-Vaccine-Delivery_4234.jpg
Courtesy of Hendrick Health
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Hendrick Health Pharmacist Greg Perry puts doses of the Pfizer vaccine into an ultracold freezer. Hendrick Medical Center in Abilene has the ability to store the doses, but many rural facilities throughout the state do not.

Hendrick Medical Center in Abilene is overwhelmed with COVID-19 patients. As Hendrick Health chief medical officer Rob Wiley explained, the intensive care unit has been over capacity for weeks.

“So right now, we are presently staying over probably 130% capacity every day,” he said. “And we've been that way for a very long period of time — for over a month.”

That means there are more patients requiring intensive care than the total number of staffed beds. Hendrick Medical Center and other hospitals have been forced to activate surge capacity.

“We're being asked to manage patients in the emergency room on floors that typically are not ICU beds, but we've converted to ICU beds,” he said. “Fortunately, we've had the nursing staff who have been able to take care of it because if you don't have the nursing staff, you can't take care of the patients, obviously,” Wiley said.

The nursing staff got a bit of relief last week, when the first shipment of the Pfizer vaccine arrived. As a pharmacist removed a layer of dry ice and pulled out the boxes containing about 1,000 doses, healthcare workers clapped and cheered. The boxes were quickly placed into an ultracold freezer — a necessity for this vaccine, which must be stored at extremely cold temperatures.

And that’s the downside of the Pfizer vaccine. Hendrick Medical Center in Abilene has the ability to store the doses, but many rural facilities throughout the state do not.

Those smaller “critical access” hospitals have been less than pleased to not receive any shipments in the first rounds of vaccine distribution, and Danny Updike is one of the people who hears those concerns. He’s the executive director of Trauma Service Areas J and K — the state-funded administrative networks that help coordinate trauma care from the Big Bend border region of rural west Texas to the Concho Valley near Central Texas.

COVID-Vaccine-Delivery_4145.jpg
Courtesy of Hendrick Health
About 1,000 doses of the Pfizer vaccine arrived to Hendrick Medical Center in Abilene covered by a layer of dry ice. The boxes were quickly placed into an ultracold freezer — a necessity for this vaccine, which must be stored at extremely cold temperatures.

“We've had a little concern from the rurals, like you said, about them not being on the list to get it,” he said. “Part of the problem for the Pfizer vaccine: they don't have the capability for the, what, minus 70 to minus 90 degree freezer temperature.”

The bigger hospitals in his area — in Midland and San Angelo — have received shipments. Those facilities have the bulk of COVID-19 patients, as many rural hospitals don’t have intensive care units, and generally transfer their critical patients to the larger care centers. But the smaller, “critical access” hospitals are dealing with COVID-19 patients, too.

“They've got a problem with some COVID cases with their nurses,” Updike said. “In those places, even one or two nurses that are out is maybe half of their staff on a normal day.”

Healthcare workers in rural regions have expressed frustration about the order of priorities.

“Yeah, I don't want to get too small into the weeds on that,” Updike said. “But I think everything is so rapidly changing — especially from day to day with the vaccine and the distribution and what's available — I think most of them do have an understanding as to why they're not in that first round of getting the vaccine. They might not be completely happy with it, but I also do think they understand.”

But, Updike said, there is good news: some rural facilities expect to receive shipments of the newly authorized Moderna vaccine later this week or next, and some of the larger hospitals have begun sharing doses of the Pfizer vaccine with smaller care centers.

Many rural hospitals are only days away from getting their first shipments of COVID-19 vaccines. But nationwide, the second round of Pfizer vaccine distribution has been unexpectedly reduced by up to 40% in some places. And for the general public, widespread vaccine availability is still months away.

Some medical professionals fear that people will take the gradual rollout of vaccines as a sign to return to normal, even as the present situation in Texas hospital remains dire.

In the United States, hospitals often operate near or at capacity. To some people, the current figures — more than 170 intensive care units in Texas at or near capacity — might not seem alarming. But about 17% of all hospital patients in the state have COVID-19, according to federal data.

“And what I think a lot of the general public doesn't always realize is that the other patients who are in those ICUs at baseline haven't gone anywhere. We still have car accidents, we still have cancer patients, we still have all the things that were filling our ICUs before,” said Sharmila Dissanaike.

She’s the chair of surgery at Texas Tech University Health Sciences Center and the chief of surgery at University Medical Center in Lubbock, where the intensive care unit is over capacity.

University Medical Center is the only Level One Trauma center in a huge region of Northwest Texas, and it’s been forced to reject transfer at higher than normal rates.

“That was probably one of the hardest things, when our hospital is completely over capacity, and I don't have an ICU bed,” she said. “And if someone is shot in a town just outside here, they can bleed to death if they don't get to me.

The overcapacity situation also takes a toll on quality of care. Healthcare personnel suffer from “compassion fatigue” and burnout when they have more patients to take care of than they can handle.

Dissanaike said many hospital workers find the situation especially frustrating because it’s preventable.

“Here's the thing: disease — we understand people dying from disease. That's what we do all day, every day. It's sad. It's tragic, but it's what that's what we signed up for. We understand that. I think what makes this particularly hard is when we're in this pandemic situation — this overflow situation, this overcapacity situation — because people are refusing to take some fairly simple, easy steps,” she said. “And I shouldn't say easy, I know, they're not easy, but they're a heck of a lot easier than watching someone die in a hospital.”

With widespread vaccine distribution on the horizon, Dissanaike said she hopes people will continue to exercise caution and help slow the current surge, which has already shattered several daily records in recent weeks.

Those records come as state data show more than 10,000 Texans hospitalized with COVID-19 just a few days ahead of Christmas.

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