Why is Sonoma County not vaccinating 65-year-olds?

Dale Beltz couldn’t believe it.

A number of his friends in their 60s had just received coronavirus vaccinations at a new Sutter Health clinic that opened this week at Luther Burbank Center for the Arts in Santa Rosa, despite county guidelines that resulted in the cancellation of thousands of appointments at other clinics for people younger than 75.

“How can this be!! My wife and I are 67. Everything I read says 75 and up currently,” the Coffey Park man wrote in an email to a Press Democrat reporter on Thursday. “I know this has been a mess but it just continues to get worse!!!”

The rollout of the vaccination campaign in Sonoma County has resulted in widespread confusion and anger, for a simple reason: On Jan. 13, Gov. Gavin Newsom declared that all Californians 65 and older were eligible to be vaccinated. But he gave counties the latitude to set their own criteria, and Sonoma County put the cutoff at 75.

Even after more than 55,000 doses of vaccine administered in Sonoma County, the rules remain perplexing to many county residents, especially the seniors who fall into the 65-74 age range. Many feel they’re walking a tightrope of eagerness and guilt. Web portals built in accordance with the state standards allow them to sign up for shots, even after they enter their birth dates, while county leaders constantly urge them to wait for their turn in line.

“The hiccups are there. It’s a very hard process, we understand that,” county health officer Dr. Sundari Mase said Thursday. “We apologize to everybody who’s been put out as a result of the process, but keep in mind that we have the community’s best interest at heart.”

Sonoma County officials have been consistent in their explanation: Newsom told everyone over 65 they’re eligible, but the county does not have nearly enough doses of vaccine to serve that large population. So Sonoma County is rationing what arrives here by focusing on a smaller demographic, one that has disproportionately suffered COVID-19-related hospitalizations and deaths.

“We are getting a trickle every week, and that forces us to prioritize in a way that makes sense,” said Dr. Urmila Shende, the county’s vaccine chief. “So over the next few weeks, two months, as our supply starts to increase, then we will be able to expand our tiers. But at this point, we simply do not have the supply.”

This week, Sonoma County received a total of 7,425 doses from the state, a number that is independent of vials going to local hospital groups Kaiser Permanente, Sutter Health and St. Joseph Health.

“Which is up from last week,” Shende said. “But it’s still not nearly enough to vaccinate everybody at the same time.”

So the county is focusing on its most vulnerable population, and staff and government leaders say there is ample evidence to define that as 75 and older. According to the county, those 75 and older make up 7.5% of the local population but account for 24.2% of COVID-19 hospitalizations and about 65% of deaths.

Conscious of the risk posed to its oldest residents, the state of California originally prioritized people older than 75 above other seniors. In its initial vaccination scheduling system, people 75 and older were put in Phase 1B, Tier 1, while people between the ages of 65 and 74 were placed in Phase 1B, Tier 2.

That changed Jan. 13, when Newsom elevated all of those seniors to Tier 1. He was responding to widespread criticism that the state’s complicated ranking system was one reason the vaccine rollout was so inefficient in the nation’s most populous state. The merging of the two age levels was seen as a way to simplify.

Newsom’s announcement set up a disconnect with Sonoma County, though. Over 20% of the county’s population is 65 or older, almost double the number statewide. While counties with younger populations believe they have enough vaccine to move forward on immunizing everyone older than 65, Sonoma County has concluded supplies are not adequate for that at the moment.

Hospital clinics, like the one opened by Sutter this week at LBC, can set their own eligibility standards because their parent organizations procure vaccine directly from the state. But the county, which controls less than half of the doses administered locally, can set qualifications for its doses, too.

It is a life and death decision. Public health data shows that people older than 75 account for 65% of the COVID-19 deaths in Sonoma County, compared to 53% statewide.

That was enough to convince Mase to hew to the more limited age criterion for Phase 1B, Tier 1, and county leaders have aligned with her.

“I don’t want the Board of Supervisors or any political group to be deciding who goes next in line,” county supervisor Chris Coursey said this week at a public board meeting. “We’re making that decision with our staff of experts, epidemiologists, people who understand that the way to save lives is to take care of the most vulnerable first. We’re going to prioritize what the experts believe is the best way to get us through this life-and-death situation, not who makes the most noise politically.”

Sonoma County is by no means alone. Napa, Mendocino, Marin, Solano, Humboldt and Santa Clara counties, among others, all are immunizing those 75 and older first, and Contra Costa was doing the same before recently shifting to 65-plus.

Sonoma County plans to make that transition, too.

Starting Monday, residents 70 and older will be able to receive the vaccine at designated county-supported clinics and 11 Safeway pharmacies, county health officials announced Friday. But the state-operated OptumServe site in Rohnert Park for now will continue to serve only 75 and older residents.

“These are our most vulnerable residents and we need to give them a head start so they wouldn’t lose out on getting a vaccine appointment,” Lynda Hopkins, chair of the Sonoma County Board of Supervisors, said during a press briefing.

Officials also announced that the county’s newest vaccination clinic would open Tuesday at the Petaluma Campus of the Santa Rosa Junior College. Supervisor David Rabbitt said initial appointments will be by invitation only and the site is expected to vaccinate about 300 people a day.

“But this could expand up to 500 per day, depending on the supply of vaccine,” he said. “In the uncertainty about the vaccine supply, we are never sure how much we received from the state week to week.”

Officials said vaccinations for those 70 and older on Monday at the Safeway stores are by appointment only and 20 doses a day will be available at individual supermarket pharmacies.

With the change in age eligibility, officials said clinics administering the county’s vaccine supply are being encouraged continue making vaccines available to health care workers and first responders while prioritizing members of the general public aged 70 or older. Twenty percent of their appointments are to be reserved for people 75 and older.

The current strategy raises questions, though. It’s obvious seniors 75-plus are dying at a much faster rate than other subgroups during the pandemic. But they also make up an overwhelming share of residents at long-term elder care facilities, congregant settings that have proven to be breeding grounds for COVID-19 outbreaks. Some wonder if 75-year-olds are truly that much more vulnerable than 65-year-olds if both are living independently.

About one-third of COVID-19 deaths among the 75-plus group occurred in congregant care, said Kate Pack, the county’s lead epidemiologist. But the data is incomplete. For another third of the data set, there was no information in the case files on where the deceased had been living, Pack said.

Even if the figure were no more than one-third, though, it would mean 75+ seniors living at home were dying at a rate of 1 in every 712 people, while 65-74 seniors living at home were passing at a rate of 1 in every 1,477. In other words, twice the fatality rate.

But there remains significant risk in the county/state age disparity: the sort of chaos that erupted two weeks ago when OptumServe, a state contractor operating a vaccination clinic in Rohnert Park, opened an online portal that allowed people under the age of 75 to book appointments. Well-intentioned but ineligible residents flooded the appointment system, forcing OptumServe to cancel 9,000 appointments made by people who did not qualify for doses under county guidelines. Since then, West County Health Centers and Sonoma Valley Health Partners have had to hustle to avoid similar debacles at their clinics.

Given those complications and the angst they caused, is it really worth trying to adhere to the plan?

“It’s absolutely important to always do the right thing,” Mase said in response to that question. “And what we’re doing, from a county perspective, is to protect our most vulnerable population. We want to prevent hospitalizations and deaths.”

Now Sutter Health’s decision to lower its threshold to 65, even in Sonoma County, is adding to the uproar.

During the Board of Supervisors meeting, chair Lynda Hopkins had sounded an alarm about various health providers using various standards.

“We’re lucky so far, because they’ve been collaborating with us to stay at the same phase,” Hopkins had said. “But it’s entirely possible you could have Kaiser vaccinating one group and Sutter vaccinating another group, and everyone off at a different level. And that’s inequity, if your health care provider determines when it’s your turn for a vaccination.”

Two days later, Hopkins’ hypothetical became a reality as Sutter announced the opening of the Luther Burbank Center clinic to everyone 65 and older.

“We are rolling up our sleeves so more patients can roll up theirs,” Sutter Health said in a statement. “At this time, we are prioritizing our patients who are 65-plus years of age and community health care workers. These populations are at greatest risk, according to CDC guidance.”

Hopkins said she was broadsided by the announcement.

“And so was Department of Health Services,” she said. “I learned Sutter might be doing 65 and older because I’m a Sutter patient. I forwarded those emails to our vaccination chief, and she had just been on a call with Sutter, and she was not informed. I was on the phone with a Sutter representative, and I received the text message about it two minutes after I had hung up. And they didn’t tell me, either.”

It’s just the sort of fragmentation Hopkins lamented recently when she argued for the county to take greater control over the local distribution of vaccine doses. She believes 75-and-above is the proper standard right now, and she wants hospital partners to follow suit. Hopkins said she is working to set up regular meetings with executives of those health companies to ensure more balance.

“I don’t want to come with a hammer,” she said. “I want to come with arm outstretched — I guess not for a handshake right now, but maybe an elbow bump. No one’s a bad actor, right? We’re all just trying to vaccinate. But when you’re not communicating and coordinating, there are inadvertent negative outcomes.”

Staff Writer Martin Espinoza contributed to this story. You can reach Staff Writer Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.