AZ races to vaccinate health workers as infections rise

By Krista Allen
Special to the Times

KINŁÁNÍ-DOOK’O’OOSŁÍÍD AND TÓNANEESDIZÍ

The first coronavirus vaccination in Tónaneesdizí took place last Wednesday.

Tosh Seweingyawma, a registered nurse at Tuba City Regional Health Care Corp., received Pfizer’s and BioNTech’s COVID-19 vaccine.

Dr. Jeff Daniel, chief of the emergency room at TCRHCC, was also one of the first health care workers – who has witnessed the virus’s deadly toll – to receive the shot, the first known clinically authorized inoculation outside of a vaccine trial.

TCRHCC received 475 doses of the vaccine. The shipment, led by police escort, arrived at TCRHCC around 2:45 p.m. on Dec. 15. Hospital leadership and pharmacy staff accepted the shipment, after which it was placed in a special storage container and then inventoried.

Lynette Bonar, CEO for TCRHCC, who was on site when the vaccine shipment arrived, called it a momentous landmark in the Navajo Nation’s battle against the virus.

Bonar said the hospital received 95 vials, each containing five doses, totaling 475. An additional 800 doses are expected this week, signaling a turning point against the pandemic that has greatly scarred Diné Bikéyah, killing 748 people, according to the Navajo Department of Health’s Dec. 21 COVID-19 report.

The vaccine arrives at a time of urgency in the Navajo Nation, now confronting a worsening second surge.

A panel advising the Centers for Disease Control and Prevention voted Sunday to recommend that people age 75 and older, along with emergency responders, teachers, and grocery store employees, be next in line to receive the COVID-19 vaccine in the U.S.

“Two doses are required to be effective,” said Dr. Sophina M. Calderon, a family physician and the deputy chief of staff at TCRHCC, where she’s a member of the Epidemiological Response Team.

“So you’ll get the one dose first and then 21 to 28 days later,” she said. “Depending on which one you get — Pfizer BioNTech or Moderna — you have to get that second dose in order to get the full protectiveness out of this vaccine.”

Calderon said anyone getting the COVID-19 vaccine needs to sign a consent form to receive the shot, to make sure you are fully aware of all that go into the shot, such as data collection and side effects.

“If someone develops some odd side effect that we didn’t anticipate happening, the CDC would be able to have access to that information,” Calderon explained. “And we just want to make sure we keep track of all the data as much as possible.”

Dr. Diana Hu, a pediatrician at Tuba City Regional Health Care Corporation, where she’s part of the Epidemiological Response Team, said approximately half of the people who get the COVID-19 vaccine get a local reaction like pain at the injection site as well as redness and some fatigue after the first dose.

“But it grows up to about 75 percent of people with the second dose,” Hu said. “It starts within the first 24 hours and lasts an average of two days.”

Flagstaff Medical Center

The Arizona Department of Health Services recorded 461,345 COVID-19 cases as of Dec. 21. Patients are filling up hospital beds in numbers not seen since spring.

“We continue to care for COVID patients across the state. We continue to care for our communities during this pandemic,” said Flo Spyrow, president and CEO for Northern Arizona Healthcare. “We are feeling dramatically the impact that’s had on our health care heroes, and the stress and the burnout that they’re feeling as this pandemic continues to affect both their professional and personal lives.”

Spyrow said Flagstaff Medical Center and Verde Valley Medical Center in Cottonwood, Arizona, received the Moderna vaccine on Monday. Both NAH facilities began vaccinating their health care workers on Tuesday morning.

“We’ve applied to be a point of distribution center for the state of Arizona, partnering with Yavapai and Coconino counties,” said Dr. John Mougin, chief quality officer for NAH.

Mougin said the Moderna vaccine, or the mRNA-1273 vaccine, will be administered to NAH health care workers to keep the health workforce intact.

Both Pfizer BioNTech’s and Moderna’s vaccines rely on injecting snippets of messenger RNA into human cells to trigger an immune response. Moderna’s vaccine also requires two doses, four weeks apart.

“It can be kept in a freezer for up to six months,” Mougin said, “which is nice so you won’t waste two doses and you can keep it as long as you keep it frozen in a regular freezer and use it for up to six months’ time (as opposed to the Pfizer vaccine, which must be kept at -70 degrees Celsius).

“With the surge of COVID, that becomes more and more of a struggle,” he said. ‘We see some people getting ill, including some of our employees. We’ll have health care workers as our priority.”

Mougin said there will be a tiered system on who gets the vaccination, adding that nursing home residents and nursing home workers will also be first priority.

“We will look forward and look at the full analyses as it’s released … about Moderna,” Mougin said.

In addition to not needing specialized freezers, the Moderna vaccine also comes in smaller allotments.

“That way, we can order vaccine weekly if needed; order more vaccine depending on the desire of our population within NAH and the populations in northern Arizona that want to receive the vaccination,” Mougin explained.

While vaccines bring hope of the pandemic’s end, scientists cite several reasons for staying masked and cautious for post-vaccine life.

“What this means is despite receiving the vaccination, we don’t know whether people who’ve received the vaccination can still spread the disease or not,” Mougin said. “For that reason, masking and physical distancing; avoiding large crowds will remain in effect to protect those who have not been vaccinated yet.”

Just as the Pfizer BioNTech’s and Moderna’s COVID-19 vaccines begin to offer hope for a path out of the pandemic, a highly contagious new variant of the coronavirus is circulating in England.

“So, as we close out 2020, we look back and have really, very, very much to be thankful for. We actually learned much in how to care for our COVID patients and (we) are having much better outcome,” Spyrow added.

Banner Health

Emily Beck had just finished up a difficult night shift inside the COVID ICU at Banner University Phoenix. The next day, Beck, a nurse, got the COVID-19 vaccine at the Arizona State Fairgrounds.

Beck received the very first vaccination, said Dr. Marjorie Bessel, the chief clinical officer for Banner Health, the largest health care system in the state of Arizona.

Bessel last Friday administered the COVID-19 vaccine to several Banner health care workers, calling the occasion “one of the most exciting days” of her professional career.

“Emily, like so many others working on the frontlines, understands how important this vaccine is in our fight against COVID-19,” Bessel said. “It is the beginning of the end to this pandemic, the glimmer of hope that she and her colleagues have longed for all year.”

Bessel said it’s important for everyone to know that the COVID-19 vaccine will not offer an overnight solution. And people must continue to mask and social distance.

“If we all do this exquisitely and get vaccinated when it is our turn, we can anticipate returning to a more normal way of living in the second half of next year,” she said. “I realize that it seems like a long way away. I know it isn’t what any of you want to hear but it is the reality before us.”

Bessel said Arizona is continuing to experience exponential growth of the virus with total cases, positivity rate and hospitalizations rising. The state’s reproduction rate, she says, is at 1.15, which is one of the worst in the country.

“This means that the virus is spreading at a faster rate than desired,” Bessel said. “We want this number to be below 1.0. This week, we also reached the highest number of hospitalized COVID-19 patients since the start of the pandemic, exceeding our prior surge this summer.”

This means that 49% of all hospitalized patients are now COVID-19 positive. And nearly half of the patients currently being cared for in Arizona hospitals are there because of the virus.

“Patients who are hospitalized with COVID-19 are very ill, some of the sickest we have ever seen,” Bessel said. “They require a significant amount of care and attention. Many of them are hospitalized for a prolonged period and if in the ICU will then spend an average of two weeks on a ventilator.”

For those fortunate enough to leave the hospital, COVID-19 survivors have a slow road to full recovery. That can take months, said Banner experts.

Banner’s ICU bed occupancy increased by 50 last month and increased by 50 more the first 15 days of this month.

“We started November with ICU occupancy closer to 75 percent of our peak winter occupancy,” Bessel explained. “Now that occupancy is at 150 percent of our peak for a typical winter. COVID-19 patients now occupy 55 percent of our ICU beds.”

That number was only 25% on Nov. 1 and ventilator use by COVID patients has increased by 500% since Nov. 1.

“The positivity rate for patients in our emergency rooms alone is close to 60 percent,” Bessel added. “And sadly, there are many COVID-19 patients who lose their battles with the virus. COVID-19 deaths in Arizona are on the rise. These deaths have caused us to exceed our morgue capacity at some of our hospitals which have resulted in the use of refrigerated trucks to expand our morgue capacity.”

One of the refrigerated trucks is in use at Banner University Medical Center Phoenix and another is at a Banner storage facility on standby.

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