Third and fourth-year medical students at Virginia Commonwealth University came back from winter break expecting to resume clinical rounds, a key part of their curriculum that allows students to take a hands-on role in patient care.
Instead, at a Jan. 1 meeting, faculty from the medical school’s Office of Student Affairs — along with Dr. Arthur Kellermann, the CEO of VCU Health System — made a surprising announcement.
Medical students were being pulled from their clinical responsibilities for the next two to three months. Faculty cited an ongoing outbreak of COVID-19 at VCU Medical Center, which has seen more than 89 cases since the beginning of December, according to data from the Virginia Department of Health. But they also informed students that they wouldn’t be included in the health system’s first phase of vaccine distribution.
“This meeting was very out of the blue for us,” said one third-year student in attendance. (She’s part of a group of concerned medical students that’s since sent an anonymous letter to Kellerman but asked not to be individually identified out of fear there could be consequences from senior faculty and staff at VCU. The health system, like many others, has policies against speaking to the media without going through a liaison, and the Mercury granted anonymity in this article to some students and employees who had concerns about retribution at work.)
“Up until Jan. 1, we had all been asked to return to Richmond after the holidays to continue our clinical training,” the student said. “No one had mentioned that we wouldn’t have access to vaccines.”
The letter says that “unlike the CDC, who declared medical students essential personnel, it appears that VCUHS disagrees, valuing employees who can telework and have no patient contact, over clinical students who are promised and expect patient interaction for their training.”
It was a much different approach than the one taken by other state medical schools, including Virginia Tech Carilion, which began offering vaccines to students in late December.
And to many VCU students involved in clinical care, it didn’t make a lot of sense. The day before, the university sent out a mass email — not only to employees of the health system, but in other departments — informing them that COVID-19 vaccines were available to all VCU “team members.” Those included frontline “Tier 1” employees to the lowest grouping, Tier 9, which includes staff who have been working from home since the start of the pandemic.
“I was at the very lowest tier,” said one IT employee who received his first dose of vaccine from the health system on Monday. “Of course, I don’t do face-to-face patient care. I don’t do any patient care. And I’m not over 65, I don’t have whatever conditions. But when they opened it up to everybody, I was like, ‘Okay.’ I don’t think there’s anything wrong with me signing up for one of these slots.”
But the chain of distribution at VCU — one of 18 hospital sites selected to directly receive a portion of Virginia’s allotted vaccines — has led to questions and frustration on the part of unaffiliated providers and residents in the surrounding community, who wonder how work-from-home employees with no medical risk factors can receive a vaccine sooner than community nurse practitioners or elderly Virginians with a much higher risk for severe disease.
And VCU isn’t the only large health system to open vaccinations to lower-priority employees. INOVA, in Northern Virginia, notified employees on Dec. 28 that vaccination was available to “ALL team members” regardless of clinical status. The system wouldn’t open vaccines to unaffiliated community providers until the next week, but clinical executives said in an email that INOVA had immunized more than 10,000 staff and had “capacity to meet higher demand.”
The frustration for those outside large hospital systems has been compounded by the slow rollout of vaccines across the state. As of Tuesday, the state health department reported on its vaccine distribution dashboard that Virginia had received 481,550 doses — a little more than the roughly 480,000 initially expected by the end of December. But so far, it’s only administered 104,083 — just over 20 percent of the state’s total allocation.
VDH officials have attributed the discrepancy, at least partially, to a lag in reporting the vaccinations. Multiple state leaders have also pointed out that Virginia set aside a portion of its allotment for staff and residents at long-term care facilities, who are currently being immunized through a national partnership with major pharmacy chains.
Alena Yarmosky, spokeswoman for Gov. Ralph Northam, described the allocation to long-term care facilities as “a large percentage” of the state’s total doses in a statement to the Richmond Times-Dispatch and other outlets. But on Tuesday evening, VDH spokeswoman Erin Beard said the vaccines reserved for long-term care facilities are not included in the count on the dashboard.
“That is a number reported to the CDC,” she wrote in an email. “We are working to streamline the reporting process for doses administered at LTCFs and put that figure on our dashboard, but we don’t currently have that number either.” Available data still suggests that Virginia has yet to distribute a significant portion of its vaccines, and Beard said the department did not have an estimate on how many doses the state dashboard might be missing.
The Mercury has been asking the department for additional information on vaccine allocation since in mid-December, when it requested the names of the 18 hospital sites selected to directly receive some of the state’s early doses. Beard declined to name them “primarily for security reasons,” but a reader later filed a Freedom of Information Act request with the department and forwarded the response, which revealed that most sites were affiliated with some of the state’s largest health systems, such as VCU, Inova, Sentara, and Ballad in Southwest Virginia.
According to the agency, some sites agreed to distribute a portion of their doses to other hospitals in the area. On multiple occasions, both VDH and the Virginia Hospital and Healthcare Association have said the sites were selected to maximize geographic distribution and ensure the vaccine was distributed to other health systems in the region (Julian Walker, VHHA’s vice president of communications, said in December that it was “part of the deal.”)
But in VDH’s FOIA response, public relations assistant Tristen Graves wrote that “it is not guaranteed the vaccine has been redistributed.” Augusta Health, for example — a 255-bed health system in the Shenandoah Valley — informed the agency it would redistribute part of its allotment to Bath Community Hospital. But only 43 doses of vaccines have been administered so far in Bath County, according to VDH data, and it’s unclear how many have been received and given out by the local hospital. Bath spokeswoman Amy Phillips did not respond to a call and an email for comment.
With little information available on how hospitals are handing out the vaccine — and little data on where, exactly, the state’s more than 450,000 doses have been distributed — state health officials haven’t explained why administration of the vaccine appears to be so far behind. In Virginia, like many other states, hospitals were given a leading role due both to their frontline status and their capacity to store doses of the Pfizer vaccine, which requires ultra-cold temperatures of around -94 degrees Fahrenheit. That’s less of a concern for the Moderna vaccine, which can be stored at regular freezer temperatures and stays good for 30 days after it’s thawed.
So far, VDH hasn’t provided a full breakdown of how many of the state’s doses have come from Pfizer, how many are Moderna’s, and how many have gone to hospitals, long-term care facilities and local health departments. The Mercury first requested the information after an agency news conference last week.
But the consensus among most medical providers is that vaccination is more efficient at hospitals, where — despite challenges in staffing and an influx of new COVID-19 cases — many have been able to vaccinate hundreds of employees every day. As of late December, UVA Health had the capacity to handle 5,300 appointments a week. Laura Rossacher, a spokeswoman for VCU, said last week that the health system had administered more than 6,000 doses by the end of 2020.
On Tuesday, she added that the health system “hope[s] to get sufficient vaccines soon to include students who are on clinical training now, or able and willing to help in VCU Health System’s current and planned COVID response.” In total, she said the system has received a little more than 10,000 doses of Pfizer and Moderna vaccine and immunized more than 8,000 employees (“team members that are patient-facing represent about 85 percent of our total vaccinations to date,” Rossacher wrote in an email).
She said the health system is scheduled to administer the roughly 2,000 remaining doses over the next few days. What’s not clear is why VCU, along with some other large health systems, chose to vaccinate non-medical employees instead of moving onto independent community providers.
An early infographic from VHHA stated that hospitals would be involved both in immunizing “their teams and assisting on other caregiver vaccinations.” But both Rossacher and Walker justified non-clinical vaccinations with a line from the state’s first-phase prioritization guidelines, which states that other personnel can be vaccinated if their duties “require access to clinical settings at health system facilities” or they’re considered “critical” to ongoing operations.
“Suggesting that this is not part of what was planned is not reflective of the reality of the planning process,” Walker said in a phone call last week, referring to vaccinations outside the health care community. Beard said Tuesday that “Virginia has prioritized health care personnel and long-term care facility residents and staff to receive initial COVID-19 vaccine doses.” But the agency “acknowledge[s] that when the vaccine is provided to facilities across the commonwealth, VDH cannot maintain full control over how the doses are distributed.”
Since late December, local health departments have taken the lead in vaccinating independent health care workers.
But experiences seem to vary widely.
Dr. Joe Fields-Johnson, an independent osteopathic family physician in Richmond, said he was able to schedule an appointment on Tuesday by calling a hotline provided by his local health department and registering through the Vaccine Administration Management System, an optional online system developed by the U.S. Centers of Disease Control and Prevention. The Richmond-Henrico Health District is using VAMS to register medical employers, and recently launched its own online interest form to capture providers who haven’t yet been vaccinated.
But Heather Saxby, a family nurse practitioner in Chesterfield County, said her most recent effort to get vaccinated ended with an email from the health department informing her that it was up to her employer to register her in the system. In Fairfax County, on the other hand, community providers have to call a hotline and make an appointment individually — often spending hours on hold in the process.
“Physicians are very, very, very upset,” said Dr. Soheila Rostami, the president of the Medical Society of Northern Virginia. “I cannot describe it. They’re already short-staffed, and now they have to have their staff members take two, three hours of the day to sit by the phone trying to make an appointment to get vaccinated.”
MSNVA has been so concerned by the slow rollout that leaders recently sent a letter to Health Secretary Dr. Daniel Carey — which Rostami credited with prodding INOVA to announce that it would begin to immunize unaffiliated providers. Cassie Calabio, a home health care nurse in Fairfax County, said some of her friends have waited hours to receive the vaccine after registering for one of the health department’s local clinics.
Beard said VDH is still determining when to move into the next phases of its vaccine rollout based on whether “vaccine supply significantly increases” and “if vaccine demand is less than supply.” Last week, the department said it had no data on how many health care providers had refused the vaccine. Even without a clear timeline, Northam will announce priority groups for the next phases at a news briefing today.
But amid an ongoing COVID-19 transmission surge, and with few concrete plans, Rostami said there are serious reservations about how the state will handle vaccinating a larger pool of people. Like other providers, she said many doctors in Northern Virginia received no communication, either from VDH or their local hospital system, about when they’d be eligible for a vaccine.
Dr. Melissa Viray, the deputy director of the Richmond-Henrico Health Department, said last week that neither her department nor the VDH central office was pulling from any centralized list of providers across the state. As a result, much of the effort so far has been focused on registering health care workers for vaccinations or encouraging them to reach out to their local health officials.
“I don’t understand why they couldn’t just pull from who holds a medical license in Northern Virginia,” said Dr. Nancy Tanchel, an opthamologist in Fairfax County who waited four hours to schedule an appointment with the local health department.
“It’s been a very chaotic rollout,” she said. “And it’s not the federal government’s fault. They got vaccines into the hands of Virginia. It’s local management that’s the problem.”