Light at the end of the tunnel: Local public health officials are preparing for vaccines

STEAMBOAT SPRINGS — With COVID-19 cases spiking in Routt County and across the state and country, the next weeks and months are headed down a troubling path.

“This is the second big wave,” said Lauren Bryan, an infection preventionist at UCHealth Yampa Valley Medical Center in Steamboat Springs. “And it’s going to get worse. … If we don’t slow the speed of this train, it’s going to go off the tracks. It’s really concerning right now.”

The holidays, with gatherings and travel, only add to that concern, she said.

But there is light at the end of the tunnel in the form of a vaccine, with a new vaccine by Moderna announced Monday and a Pfizer vaccine announced Nov. 9.

Routt County’s public health officials and the local hospital are busy getting ready for the first delivery of those vaccines.

“We expect CDPHE (Colorado Department of Public Health and Environment) to start providing us with a vaccine sometime in December,” said Routt County Public Health Medical Officer Dr. Brian Harrington.

“Public health will lead the charge in distribution, and we are going to be a partner in safely storing the vaccines,” said Eli Nykamp, director of operations at the hospital and YVMC’s incident commander for the COVID-19 pandemic.

Partnering with the state, the hospital will be a regional storage hub for Northwest Colorado, Nykamp said, as it already has been for personal protective equipment supplies.

The first phase of vaccines will be distributed to three groups, according to the state health department’s plan — the first reserved for frontline health care workers, first responders and workers in assisted living centers.

Next are police officers, firefighters, public health workers and corrections staff. In Routt County, that will likely also include Steamboat Ski Patrol.

The third level of vaccine recipients will be the highest risk residents in nursing home and assisted living facilities.

Harrington said Public Health Director Roberta Smith and her colleagues at the health department are already working on the list of the first vaccine recipients.

For the second phase, the state health department outlines a plan to give vaccines to homeless people living in shelters, adult group home residents, workers, such as ski industry and agricultural employees who share living spaces, students living in dormitories, essential workers, such as grocery store workers, teachers and child care workers and employees of businesses where workers are in close proximity to each other, such as the meat-packing industry.

Part of the second phase also will include people 65 and older and those who have certain health risks.

After that, the vaccine will be made available to all adults ages 18 to 64. The precise timeline is not yet known, but the hope is to have the vaccine available to the general public in the spring. Harrington said to his best knowledge at this time, the vaccine will be free.

“Initially, the vaccine won’t change our ability to get together and socialize and the need for masking,” Bryan said. “The initial rollout is very limited and targeted to make sure those who care for others are still able to care for others.”

“Change will not occur overnight,” echoed Harrington. “We will probably get just a few hundred doses at first. The supply will be based on county population.”

And there remain a lot of unknowns.

“Vaccinated individuals will still need to take precautions to prevent passing the virus from contact, for example,” Harrington said. “We will need to understand if such individuals need to still wear masks to prevent spread of the virus. Perhaps the vaccination will prevent serious illness but not prevent still being able to carry the virus. We also could get into a difficult position of people not wearing masks, but the public not knowing who has had the vaccine yet and is thus safe to do so.”

But Harrington also said that a “home-run” vaccine is a realistic expectation at this point.

Pfizer announced a 90% effective vaccine. Moderna said its vaccine is 94.5% effective.

Other vaccines are likely not far behind.

UCHealth is participating in trials of the Moderna and Oxford/AstraZeneca vaccine, which also is in a late-stage clinical trial.

Harrington said there are at least four main types of vaccine being developed, with at least two companies working in each vaccine area.

“It is a sort of horse race,” he said.

Because the Pfizer vaccine requires freezer storage around negative 75 degrees, Nykamp said the hospital is expecting a special freezer to be delivered any day, courtesy of the state health department.

The freezer will be capable of going to negative 90 degrees.

The freezer should be capable of storing tens of thousands of units the Pfizer vaccines, Nykamp said.

When the hospital was looking at purchasing its own freezer, Nykamp said an under-the-counter, smaller freezer could hold 30,000 units.

And for the other vaccines, Nykamp said the hospital has plenty of storage.

Preparation also means adding power and ensuring the special freezer can be monitored 24 hours a day, he said. Generators also back up that power supply.

The reason the Pfizer vaccine requires such specialized storage, Bryan said, is related to the lipid — like a fat — that is the delivery platform for the vaccine.

“We are making sure we have the tools we need to be able to store and deliver the vaccine,” Bryan said.

And, even with the deep-freeze Pfizer vaccine, Bryan said she doesn’t think the hospital will need to store it at those temperatures for very long, and they are talking about also being able to use dry ice.

“I think we will be able to deliver it relatively quickly to the small population that meets the criteria,” Bryan said.

The Pfizer vaccine can survive for five days in the refrigerator after it comes out of the freezer.

The Moderna vaccine can be stored in a regular freezer and kept in a refrigerator for 30 days after coming out of the freezer, according to the company.

Bryan noted she still is waiting to see the actual data on the vaccines, the trials, independent reviews and FDA approval before “doing the happy dance.”

In terms of the Pfizer vaccine, the 90% effectiveness rate is simply what is being touted by the CEO, she said. Bryan, as well as Nycamp and Harrington, were all interviewed for this article prior to the Moderna announcement.

“I’m not jumping up and down,” Bryan said. “I will reserve my excitement until I actually see the data to back it up.”

But the news thus far looks positive, Harrington said. And the process does not entail simply putting trust in the pharmaceutical companies, but includes extensive independent review.

The vaccine trials are not actually exposing people directly to the virus. Instead, they take large groups of people and give half the group a placebo and the other half the vaccine. Then they allow them to go about their daily lives, exposed naturally to the virus in their respective communities.

So there are still some unknowns — like whether or not the people who got the vaccine were actually exposed to the virus and how the trials tracked people who may have gotten the virus but never developed symptoms.

Another big unknown is how long the vaccine will render people immune.

“The studies are good, but they don’t have longevity on their side,” Bryan said. “Just because someone didn’t get it during the three to six months of the trial, doesn’t mean they couldn’t get it next year.”

The Pfizer and Moderna vaccines are administered in two doses, while the Astro Zeneca vaccine only uses one dose, Bryan said.

One good thing Bryan said she is reading relates to how the virus is mutating. All viruses mutate, but at this point, she said the “building blocks of what COVID-19 is” are not changing, keeping the vaccine effective.

Another unknown is how the vaccine will work with children.

“We are still a long time away from getting kids vaccinated,” Bryan said.

The ultimate goal of the vaccine is to facilitate the concept of herd immunity, Harrington said. And the goal of herd immunity is “to break the transmission links,” Bryan added.

“If we can get 60% to 80% of the population, for example, immune to this virus, that will provide an effective barrier to continued transmission,” Harrington said. “Highly infectious diseases like measles need herd immunity over 90%.”

Allowing the virus to run unchecked through the population is another way to achieve herd immunity but a much more deadly one.

“Vaccines provide a safe and quick way to achieve a high herd immunity,” Harrington said. “Relying on COVID-19 to work its way naturally through our population would take many years to achieve a high enough herd immunity and would leave a trail of perhaps millions of unnecessary deaths along the way.

“Many public health experts have labeled such a permissive approach to just let people get infected as immoral and akin to mass murder,” Harrington continued. “This virus is called ‘novel’ for a reason — our entire population has not seen it before and does not have immunity. But we will soon have a safer and quicker option with vaccines.”

While the current surge in cases is very concerning, Bryan noted it isn’t surprising, given how every respiratory disease behaves in the winter season.

“The cold dry air allows these viruses to stay airborne for longer,” she said.

In addition, more people are gathering indoors for longer periods of time, and many have let their guards down.

“We have both individual behavior and environmental factors conspiring against us,” Bryan said.

Bryan emphasized the efficacy of mask wearing, which research increasingly supports, and limiting close indoor gatherings.

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