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Early vaccinations might depend on your medical provider

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While every Californian over the age of 65 is encouraged to get a coronavirus vaccination as soon as possible, actually finding one may depend on where you get your health care.

Because of the patchwork nature of the vaccine rollout, not all seniors will have equal access to shots, at least not immediately. The first doses of vaccine are likely going to patients who get their care directly from one of the big three in Sonoma County: Kaiser Permanente, St. Joseph Health and Sutter Health. Even for them, experiences may vary in ways that seem random.

People under the care of independent physicians and health clinics — and people with no insurance at all — are likely to wait longer for a chance to get inoculated.

“When we’re setting up our system in such a way that we’re allowing our (private) health systems to vaccinate, which is the reality, that’s our system of care in Sonoma County,” said Jason Cunningham, CEO of West County Health Centers. “That’s not something we’re doing just because of the pandemic. That’s what we have inherently. Which creates a problem with disparities.”

The speed with which the Federal Drug Administration approved the Pfizer-BioNTech and Moderna vaccines was unprecedented in American history. That approval was a major breakthrough in the fight to limit a virus that has killed more than 400,000 people in the nation, and at least 247 in Sonoma County. But the accelerated process didn’t allow for seamless planning and implementation.

The result is a system in which vaccine doses arrive in Sonoma County via multiple streams. Some come to the county Department of Health Services for dispersal to clinics and small hospitals, others directly to major medical providers such as Kaiser Permanente, others to the Safeway Pharmacy chain, yet others to CVS and Walgreens, which are servicing long-term elder care facilities.

Up to this point, the vast majority of those doses have been reserved for front-line medical workers. Now the county is preparing to move into vaccinations for seniors living independently, a much more complex tier. And the timetable for administering those first doses to elders may well depend on their health care plans.

First in line will probably be those who pay for benefits through the mega-providers — Kaiser, Sutter and St. Joseph, which owns Santa Rosa Memorial and Petaluma Valley hospitals.

California Gov. Gavin Newsom announced Jan. 15 that the state was opening Phase 1B, Tier 1 to everyone over the age of 65, and encouraged counties to vaccinate seniors “immediately.” But with doses in scarce supply, hospitals have had to mete them out them carefully.

“Each week, we receive a fraction of the vaccine required to meet our demand,” Kaiser said in a Jan. 18 e-newsletter to members. “Kaiser Permanente cares for more than 1.5 million members age 65 and older, and last week we received a vaccine supply of just 20,000 first doses.”

Locally, Sutter and Kaiser both are now scheduling appointments for patients 75 and older, though they don’t have enough doses even for that narrower demographic. Sutter is asking members to sign up online or by phone; Kaiser is sending eligibility notification via email or the Postal Service.

Chad Krilich, chief medical officer for St. Joseph Health in Sonoma County, said its hospitals will begin immunizing seniors 65 and up next week.

“I think it’s the right next step in the process,” Krilich said. “It’s very encouraging to be able to share that with the public, to be able to demonstrate that we’re moving in the right direction. But what I’m not going to say to your readers is, ‘Look at us, we’ve arrived.’ Because there’s still a considerable amount of work that needs to be done.”

As Krilich noted, the total population in Sonoma County is close to 500,000, and the number of residents 65 and older is on the order of 100,000. As of Wednesday, a total of 26,237 doses had been administered in the county (excluding the federal CVS/Walgreens program), the equivalent of giving a full two-dose course to a little more than 13,000 people.

Even among patients of the larger providers, experiences have varied. Some Kaiser subscribers have reported spending hours on hold while trying to schedule a vaccination appointment, only to give up in frustration. Others have had more success.

Elizabeth Apana of Santa Rosa said she waited 3 hours, 46 minutes to reach a Kaiser representative. Her reward was a vaccination appointment, scheduled for two days later. The rub: It was in San Francisco, where she used to receive her medical care. To complicate matters further, Apana’s car was in the shop. Still, she leapt at the chance. She wound up taking a Golden Gate Transit bus to receive her first dose of Moderna, a trip that took two hours each way.

“I told my friend, if worse came to worst, I would have stood on the side of the freeway with a sign that said, ‘I need a ride to San Francisco for a vaccination,’” Apana said. “I was willing to pay gas.”

Apana has substantial underlying conditions that put her at risk, but she is only 72. A Kaiser Permanente representative did not reply for clarification on how Apana was able to get vaccinated, and how she reserved a spot by phone.

Hers was an extreme effort to receive a shot. But at least Apana got the opportunity. Patients outside the large networks haven’t been as fortunate.

Healdsburg Hospital recently came under the management of NorCal HealthConnect, a secular affiliate of Providence St. Joseph. It does not have access to the super-cold freezers necessary for storing the Pfizer vaccine, the first to hit the market in December, and is not yet vaccinating seniors. A hospital representative said the facility hopes to start with patients 75 and older the first week in February.

A Sonoma Valley Hospital spokeswoman confirmed her facility, an affiliate of UCSF Health, also remains focused on immunizing staff and has not begun to process eligible seniors.

And then there are the many Sonoma County residents who receive their primary care through community clinics and private practice. Those would include the patients of Santa Rosa Community Health, a group that runs eight clinics spread around the city. The network of clinics treats about 900 people aged 75 and older, and roughly another 2,300 in the 65-74 range, CEO Naomi Fuchs said. It hopes to begin vaccinating the older subset beginning the week of Jan. 30.

There is no guarantee, though. Santa Rosa Community Health requested 975 doses through CalVax, a website coordinated by the state with county oversight, but must wait to find out if its request is honored.

Northern California Medical Associates, which operates medical offices in eight cities in Sonoma and Mendocino counties, has no idea when it will receive the doses it wants, a spokesman said.

Like a lot of health care professionals, Fuchs sees the vaccination drive as a path out of the sickness, economic ruin, educational stagnation, isolation and anxiety of the past 10-plus months. But she knows it will be effective only if it can reach the most vulnerable people in the community.

“The county is saying you should contact your primary care provider, but not everyone has a primary care provider,” Fuchs said. “I think there needs to be a more centralized, coordinated approach to vaccination. I’m hoping there will be more resources available with the new administration, that will help states and counties to take that sort of centralized approach, to help reduce inequities.”

County officials insist even those with no health insurance will eventually be able to get vaccinated at the drive-thru sites currently dedicated to immunizing health care workers.

“In the meantime,” Fuchs said, “we’ll do the best we can.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.

Track coronavirus cases in Sonoma County, across California, the United States and around the world here.

For more stories about the coronavirus, go here.

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