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For West Virginians with homebound relatives, the COVID-19 vaccination process might seem like a nightmare.

West Virginia had administered both doses of the COVID-19 vaccine to slightly more than 1% of the population — 22,612 people — last Friday with nursing home residents, frontline healthcare and government workers and teachers and service personnel being prioritized for vaccinations.

That total includes West Virginians of the general population 80 and older. After Gov. Jim Justice announced Dec. 30 that the state would open vaccination clinics to that group, a line of seniors formed, stretching from the front door to the street outside the Kanawha-Charleston Health Department. People came using walkers, canes and wheelchairs.

Then Justice announced last Wednesday the state would open vaccine eligibility to people 70 and older. More than three-fourths of the 1,733 people in West Virginia claimed by the virus as of Friday were 70 or older.

West Virginia continues to lead the nation in vaccination distribution, but demand again has skyrocketed due to the number of newly eligible residents.

Health officials face a quandary over how to get homebound people vaccinated. The Pfizer-BioNTech vaccine must be stored at temperatures near minus 100 with each vial containing five to six doses. The Moderna vaccine can be stored near zero at 10 doses a vial. Those requirements make transporting vaccines problematic.

“The immediate concern with vaccinating homebound individuals is maintaining the integrity of the vaccine between visits,” said John Law, chief of staff for the Kanawha health department. “The hardest people to vaccinate will be those who don’t want a vaccine or who are not mobile enough to get to a vaccination site.”

Those concerns are exacerbated when patients’ homes are spread far apart, said Dr. Jessica McColley, lead clinician at Riverside Health Center in Belle, West Virginia.

McColley led a clinic Friday at Riverside High School, vaccinating more than 300 people. The Riverside clinic is part of the Cabin Creek Health System, which operates more than 15 health centers, pharmacies and school resource centers in both urban and rural Kanawha County.

Getting to a clinic is a challenge for some patients, McColley said.

“A lot of people in West Virginia have transportation insecurity. They can’t even get 10 miles down the road to a health center that’s close to them,” McColley said.

It is not just a rural issue. Community leaders on Charleston’s West Side, an urban area with the 27th lowest life expectancy of any neighborhood in the United States, said the most effective way to get this population vaccinated would be to use community centers, schools and churches for vaccine sites.

But the supply isn’t sufficient to set up clinics nearer to homebound people in such communities as Cabin Creek, Clendenin, Sissonville, Tornado or the West Side, McColley said.

“So we have to come up with a plan — how to effectively transport in larger quantities this vaccine,” she said. “That puts us all back to the problem of not having enough vaccines.”

On Friday, the Riverside clinic was initially told it would receive 500 vaccines, McColley said. Then the number dropped to 300.

“If you give us 1,000 more doses, we will have 1,000 people on this list,” she said. “My team is ready.”

Until providers can buy vaccines on their own, West Virginians are on the state and federal government’s time, said V.J. Davis, president of the West Virginia Association of Local Health Departments.

“At this point in time, the process that we follow is basically, we’ll find out each week if we’re going to get an allotment of vaccines that’s going to come directly to our health department, which we have had in the past few weeks,” Davis said.

The hope is that providers will be able to order set amounts and hold clinics on regular schedules, similar to how nearly all other vaccines are distributed, Davis said.

“The problem with that right now is there’s just not enough of it available to allow individual entities to order, so that’s why it’s all running through the state at this point,” he said. “It does make it frustrating because there’s a lot of entities out there that have the ability to administer the vaccine, but if it’s not available then it’s not there to administer.”

Partnerships

Setting up a clinic can be a struggle for smaller health departments, Davis said. Those agencies frequently rely on community partnerships.

Davis, who serves as administrator for the Preston County Health Department, said his department has a staff capable of operating small clinics. The agency works with local hospitals, federally qualified health centers, local pharmacies, community health clinics and the school system. In Preston and elsewhere, those partnerships were in place long before the pandemic.

“When we get ready to set clinics up,” Davis said, “we will draw on those partnerships.”

Finding clinic sites in Kanawha County, home to one of the state’s largest county health centers, would require structures with “easy entrance, easy exit and suitable space to administer large numbers of vaccines and to observe people following their vaccinations,” Law said.

McColley said even if her clinic had unlimited doses, there would be limitations.

“(Vaccinations) still would need to be scheduled because of the way that they have these vials dosed. They’re not single-use vials ... and they have to be used within six hours of opening the vial, so that limits us on how the events can be done,” she said. “But if we had unlimited doses and were able to create these partnerships to cover our community, it could be a daily, or definitely weekly event, with dedicated vaccination times.”

Davis described the vaccination process as being “like flying a plane and building it at the same time.”

For those still waiting to schedule a vaccination, Davis advised: “Patience really is the only thing we can do right now, because there’s really nothing we can do to get more vaccines right now.”

Reach Joe Severino at joe.severino@wvgazettemail.com, 304-348-4814 or follow @jj_severino on Twitter.

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