Vaccine appointment scheduling paused due to lack of supply

Munson Healthcare and District Health Department #10 have had to stop scheduling first doses as state faces COVID-19 vaccine shortages
The COVID-19 vaccination effort in northern Michigan continues to be hampered by a shortage of vaccines, according to area health officials.
Representatives from Munson Healthcare and District Health Department #10 said last week that the Michigan Department of Health and Human Services (MDHHS) recently changed its allocation methods, and the amount of vaccine available for health facilities continues to be “uncertain.”
“The Michigan Department of Health and Human Services recently adjusted how they are distributing the vaccine to health departments and hospitals. Previously, each location would put in a request for the amount of vaccine they anticipated needing and the state would determine how much each location would receive. Now, the state is no longer requiring vaccine requests and will determine the amount each location will receive using population-based and Social Vulnerability Index metrics,” according to District Health Department #10. “DHD#10 will continue to schedule vaccine clinics based on vaccine supply made available to us from MDHHS.”
District Health Department #10, as of Wednesday, February 3, was not offering vaccine appointments, but it did have an online registration process to be on the waiting list.
“We continue to improve our processes and ask for patience while vaccine supply is uncertain,” according to District Health Department #10.
Munson Healthcare officials – during a weekly online press conference on Tuesday, February 2 – said they are “not scheduling any first dose clinics” right now.
“MDHHS is changing the way they allocate the vaccine across the state to really focus both on population-based and need-based allocation process,” said Dr. James Whelan, Munson Clinically Integrated Network Medical Director. “Munson Healthcare’s current vaccine supply is already allocated to those currently scheduled for an appointment, so at this point we are not scheduling any additional first dose clinics.”
“Obviously this is not the news everybody wanted at this point. None of us are excited about it but it’s not really surprising. We’ve been getting hints for the last couple of weeks that for the next couple of weeks supply numbers will go down. MDHHS has changed how they’re allocating that, so that algorithm – as it’s evolving – it has become a little less predictable, so that’s been an impact,” Dr. Whelan said.
“We are very optimistic in the next two weeks that we’ll see an increase over our previous week’s allocation in our supply,” Dr. Whelan said. “The reduced supply is not unique to northern Michigan. It’s a statewide challenge, not a northern Michigan problem.”
Health officials have said that two doses of the currently available COVID-19 vaccines are required in order to achieve maximum effectiveness against the virus. Scheduled second doses of the vaccine are still available for those who received their first doses through Munson Healthcare, officials said.
“If you received your first dose from Munson Healthcare you will be able to receive your second dose at your scheduled time,” Dr. Whelan said.
Munson Healthcare officials said people who received first doses through a different source are not eligible to receive their second dose from Munson.
“If you’ve had your first dose you should go to the same location to get your second dose,” said Dianne Michalek, Munson Healthcare Chief Marketing and Communications Officer. “Munson Healthcare can not give you a second dose if you received your first dose somewhere else.”
Munson Healthcare officials said vaccine side effects are more common among those getting their second doses. 
Dr. Nick Torney, Munson Healthcare Infectious Disease Pharmacist, said “expected side effects” include a “sore arm, low grade fever, (and) headache,” and other side effects such as general tiredness, nausea, and chills “also can happen.”
“What we’ve seen is that these are a little more common after the second dose,” Dr. Torney said.
Munson Healthcare officials said the common side effects are “a good thing” because it means that the body is “building an immune response.”
“The risk of these side effects and even some of the very rare side effects that have been reported in the clinical trials, the risk of those is in magnitudes lower than the risk of COVID-19 and the risk of propagating the pandemic in not getting vaccinated,” Dr. Torney said.
Health officials said side effects typically last for a day or two but can linger for as long as a week.
“The most common duration is one day, two days, and they could be seen up to seven days, so that’s uncommon but definitely up to seven days has been noted,” Dr. Torney said.
Dr. Torney and Dr. Whelan advised against using over-the-counter pain medications as a preemptive strike against possible vaccine side effects.
“Loading up on Tylenol or Motrin before the vaccine to try to prevent any vaccine-related adverse events is really not recommended,” Dr. Torney said. “It kind of takes a day or so for those adverse reactions that are typical – like sore arm and that sort of thing – so you, by giving a dose before getting the vaccine, you’re really not preventing any of that, and so we would really just recommend waiting until those occur and using safe doses of those over-the-counter medications, of course talking to your primary care physician first to make sure that those are safe based on your specific clinical scenario.”
“It’s a complete waste of medication. It’s not going to prevent a single symptom. It’s not going to reduce the likelihood that in 24 hours your arm hurts or that you have low grade fever,” Dr. Whelan said. “We never want people to take medications that have no potential benefit, so there would be no reason to take any medications beforehand.”
Dr. Torney said people who experience “abnormal” side effects after getting the vaccine – such as new or worsening cough, shortness of breath, or sore throat – should consult with their physician.
“The vaccine should not be causing these things and that’s something that you want to watch out for and contact your primary care provider,” Dr. Torney said.
Dr. Whelan said people should continue to wear face coverings after being vaccinated because it is still possible to get and spread COVID-19.
“We know that if you got the Pfizer vaccine in both doses you have a 95 percent chance you’re not going to get super sick if you get the virus. You have exactly the same chance of getting exposed to the virus and breathing it in and having it multiply in the body but now you have a protective device inside your immune system that keeps you from getting sick,” Dr. Whelan said. “You could carry it and spread it to a close contact. It’s still responsible of us to wear our masks and protect others – which is what the masks have always done – even if you’ve been vaccinated.” 
Dr. Whelan said overall COVID-19 numbers in Munson Healthcare’s region continue to improve. Munson Healthcare hospitals, in total, had 23 COVID-19 inpatients as of Tuesday, February 2.
“At Thanksgiving time to the first week of December we were in the eighties and now we’re down to 23, which is really positive trending. We hope to see that continue,” Dr. Whelan said.
He acknowledged that gatherings to watch the Super Bowl on Sunday, February 7, and the reopening of dine-in service at restaurants on Monday, February 1, could lead to increases in cases of COVID-19.
“Of course we will stay cautious. We’re nowhere near zero. There are 127 new positives in the last 24 hours,” Dr. Whelan said. “We do know that there will be a slight bump and we’re just going to carefully monitor how big that bump is and be ready to adapt on the fly if it becomes larger than we hope.”
Munson Healthcare officials reported that they are changing the visitation policy for their hospitals to allow COVID-19 patients to have one visitor per day for up to one hour. The visitors must wear personal protective equipment provided by the hospitals, officials said.
“This is something that we see as a really positive thing that we can do for those patients as we know that having family members there and having visitors there is really part of the healing process,” Michalek said. “We look forward to welcoming some visitors for those COVID-19 patients.” 

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