An Imperial County Public Health Department staffer (right) draws a single dose of the Pfizer-BioNTech vaccine on Dec. 18 to administer to a Public Health worker who would go on to inoculate others. Boxes of the Moderna vaccine are handled by a Public Health worker when they were delivered on Dec. 22. | COURTESY PHOTOS

County Officials Drill Down on Vaccine Logistics; New COVID Variant Details Explained

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(UPDATED Jan. 14: Information was added regarding the Governor’s announcement Wednesday that persons age 65 and older are to be administered the COVID vaccine as soon as possible. Other statistical updates were made to story.)

Imperial County Public Health Director Jeanette Angulo | COURTESY PHOTO

State officials are stepping up efforts to vaccinate more people through new initiatives, including a call to open up vaccinations to all residents age 65 and older, it was announced Wednesday, Jan. 13.

With supplies of vaccine already scarce throughout the state, the move to immediately allow those in that age range access to the vaccine equates to some 6 million people moving ahead of many emergency workers, teachers, childcare providers, and food and agriculture workers, based on the state’s current prioritized tier system.

“There is no higher priority than efficiently and equitably distributing these vaccines as quickly as possible to those who face the gravest consequences,” Gov. Gavin Newsom said in a statement issued Jan. 13. “To those not yet eligible for vaccines, your turn is coming. We are doing everything we can to bring more vaccine into the state.”

In Imperial County, the announcement means some 26,000 residents would qualify to be moved to the top of the list. That number came from a brief statement put out by the Imperial County Public Health Department on Wednesday evening.

“We are currently working diligently with the state to secure enough vaccine supplies to provide to the more than 26,000 residents age 65 and older in our community. Vaccine supply is currently limited in Imperial County, but we are diligently working on securing additional doses from the state of California,” according to the county Public Health statement.

“We will announce dates and locations where those eligible can receive the vaccine as soon as the necessary supplies are secured,” the statement continued.

Nearly 2.5 million vaccine doses have been shipped to California, Newsom said Monday, Jan. 11. An estimated 784,000 shots have been administered as of this past weekend.

Last week, Newsom set a goal last of delivering 1 million doses by Friday, Jan. 15, beyond the roughly 480,000 that had been administered by last week.

Newsom’s move in this direction follows a similar recommendation by the U.S. Centers for Disease Control and Prevention on Tuesday, Jan. 12.

“With our hospitals crowded and ICUs full, we need to focus on vaccinating Californians who are at highest risk of becoming hospitalized to alleviate stress on our health care facilities,” said Dr. Tomás Aragón, director of the California Department of Public Health and the state’s Public Health Officer. “Prioritizing individuals age 65 and older will reduce hospitalizations and save lives.”

The goal in Imperial County was to vaccinate most, if not all, of Phase 1A Tier 1 workers by Wednesday, Jan. 13, Imperial County Public Health Director Janette Angulo said Tuesday. Second doses of Pfizer’s vaccine were set to start this week as well.

There were 2,580 first doses allocated to Tier 1 individuals, Angulo stated Tuesday, Jan. 12, during her weekly report to the Imperial County Board of Supervisors.

Some 96 percent of those doses had been administered as of Thursday, Jan. 14, according to the Public Health Department.

Phase 1A Tier 1 is made up of acute care (Pioneers and ECRMC), psychiatric, and correctional facility hospital staff; paramedics, emergency medical technicians, and other emergency first-responders who provide direct medical care; dialysis center staff; staff of residential and inpatient substance abuse disorder treatment and mental health facilities (such as Jackson House in El Centro); and skilled-nursing facilities, assisted living facilities, and similar settings for older or medically vulnerable people.

The focus is still high- and highest-risk people in Tiers 1 and 2, Angulo said Tuesday. Vaccinations for Tier 2 started on Tuesday. There’s still not enough vaccine to start Tier 3 yet, Angulo said.

Tier 2 includes staff of “intermediate care facilities for persons who need noncontinuous nursing supervision and supportive care”; home health care and in-home supportive services staff (often family caregivers); community health workers including promotoras/es (Latino community members who receive specialized training to provide basic health education in the community who are not professional healthcare workers); public health department field staff who work directly with the community, including those who immunize others or who are involved in COVID testing; staff of primary care clinics, including federally qualified health centers (Clinicas De Salud Del Pueblo), rural health centers, correctional facility clinics, and urgent-care centers (such as Vo Medical Center or All Valley Urgent Care); and staff of outpatient substance abuse disorder treatment and mental health facilities, and crisis stabilization units.

Angulo reported there are about 4,100 people identified in Tier 2, and the county has enough vaccine to reach around 40 percent of them. An additional 500 doses will be arriving this week, she said.

IMAGE COURTESY IMPERIAL COUNTY PUBLIC HEALTH DEPARTMENT

Angulo added that Public Health will be conducting drive-through vaccination clinics Mondays through Saturdays, by appointment, and is also coordinating with 35 agencies inoculate those in Tier 2.

Tier 3 will include healthcare workers in settings such as specialty clinics, laboratories, dental and oral health clinics, and pharmacy staff not working in higher-tier settings. It also includes mortuary employees.

About 400 people have been identified by the county as high- and highest-risk in Tier 3.

Dr. Munday said late last week that those included in Phases1B and 1C are still being determined. The general population likely won’t be vaccinated until the second through fourth phases, the hierarchy of which will depend on occupations, co-morbidities, and numerous other factors.

It wasn’t immediately clear on Wednesday how Newsom’s announcement would affect the state’s current tier system. Newsom said that starting next week, a new system to let people know if they are eligible to receive a vaccine will be in place.

Adding the aging “does not mean we’re abandoning our commitment” to those already in line for vaccines, said California Surgeon General Dr. Nadine Burke Harris in a separate statement Jan. 13. She is co-chair of a state vaccine advisory panel that questioned whether adding all residents 65 and older would negatively impact the vaccination plan already in play. “We are working together to solve multiple challenges at the same time.”

As for the new system Newsom announced, if residents are not yet eligible, the system will allow them to register for a text or email notification when they are.

A “second phase” of that system will help counties and cities that have begun mass inoculation centers at sports stadiums and fairgrounds by allowing eligible members of the public to schedule their appointments at mass vaccination events, which was another major initiative the Governor announced this week.

Three locations, including Petco Park in San Diego and Dodgers Stadium in Los Angeles, have been selected for large-scale vaccination sites, and are slated to open as early as this week, Newsom said during his weekly update on Jan. 11. More large-scale vaccination sites are planned as well. The Los Angeles Times reported Tuesday that Disneyland theme park will be used as a site.

Health Officer Asks Public to Be Vigilant

The only way to control hospitalizations and hospital-capacity issues related to coronavirus is to stop transmission, Imperial County Public Health Officer Dr. Stephen Munday reiterated this week.

Imperial County Public Health Officer Dr. Stephen Munday | COURTESY IMAGE

“All of us wish they (the vaccines) were out nine months ago, and we wish we had enough for everyone. We have to deal with reality, not what we want,” Munday told the Imperial County Board of Supervisors on Tuesday, Jan. 12, during the Public Health Department’s weekly COVID-19 update. “Our hope is that we will continue to see additional doses of the vaccine roll out. We’ll continue to vaccinate populations that are most at risk. 

“The bottom line is, the only way we can control who gets admitted to the hospital or (intensive-care unit) is by limiting transmission, and that’s either by the public health measures or the vaccine,” he continued, referring to ongoing ICU capacity problems that have plagued the state since early December, particularly the 11-county Southern California Region, of which Imperial is part.

Additionally, Public Health officials also thoroughly laid out the counties vaccination plan and updated the board on variants of the SARS-CoV-2 virus that causes COVID-19.

Meanwhile, as of Thursday morning, Jan. 14, ICU capacity for Southern California was at zero percent for what has been more than two consecutive weeks, although that percentage is cumulative. It’s true that ICU beds come open and quickly fill several times a day throughout the region. While ICU stats for Imperial County were not immediately available for Jan. 14, data from Monday, Jan. 11, show there were 24 total ICU beds open between Pioneers Memorial Hospital in Brawley and El Centro Regional Medical Center. Some 68 of the total occupied ICU beds were filled with COVID-positive patients.

The region, and any other region in the state with ICU capacity below 15 percent, has been under a temporary stay-at-home order that comes with numerous restrictions and which cannot be lifted until projected capacity exceeds 15 percent for four weeks. Other regions under the threshold include San Joaquin Valley (zero percent), the Bay Area (4.7 percent), and Greater Sacramento (9.4 percent). Only Northern California is above the 15 percent threshold, with ICU capacity at 17.6 percent.

Locally, hospital census data for Pioneers showed 55 COVID patients of a total of 91 patients in-house on Jan. 14. For El Centro Regional, there were 93 COVID patients among 127 total admissions.

“Until the vaccine is readily available and accepted, we’re still going to need to be dependent on the public health measures. So, it’s very important that our message does not change. People still need to distance and mask and not to gather. And that’s really the most important message we can share right now,” Dr. Munday said.

Although Imperial County still has some of the highest COVID numbers in the state, there does seem to be a pattern of cases and hospitalizations trending downward slightly, which is mirroring the state in many ways.

Gov. Gavin Newsom, during his weekly COVID press conference on Monday, said the expected surges coming from the Christmas and New Year holidays (which typically follow a 14-day period, give or take a few days) had yet to appear in a significant way. Although the same seems to be occurring locally, it still might be too early to tell with certainty; Tuesday’s data on COVID-positive tests is from the weekend (Sunday, Jan. 10), when some testing sites are closed and fewer people tend to get tested.

On Jan. 14, there were 1,878 active COVID cases in Imperial County, 460 deaths (which are delayed for anywhere from three to six weeks pending investigation and death certificates), and a positivity rate of 34.7 percent and 68.8 new cases per day per 100,000 residents (unadjusted).

Update on New COVID Strain

There appears to be little to worry about regarding the new United Kingdom-based variant of the SARS-CoV-2 virus (which causes the COVID-19 illness) found in the various counties surrounding Imperial Valley, Munday told the county board, and it’s something he has said on multiple occasions.

The variant, B117, which has been located in at least eight U.S. states since first appearing in England, is most widespread in California and Florida, according to published reports. Multiple cases have been found in San Diego and San Bernardino counties.

Multiple new strains have been located outside the United States, aside from B117. In addition to a variant in South Africa, researchers reported yet another mutation found in Japan, it was reported Monday. That makes a total of four, including the variant that spread from Wuhan, China, to the United States early last year.

As for B117, Munday said that it has not been found in Imperial County so far, but last week he said there really wasn’t the capability to look for it either, other than to see whether any positive tests show any findings inconsistent with the present strain.

The most notable mutation in the B117 variant of the SARS-CoV-2 RNA virus that was first found in the United Kingdom is to the spike protein, the part of the virus that attaches onto human cell receptors and which makes it 50 percent more transmissible, according to the U.S. Centers for Disease Control and Prevention. | COURTESY IMAGE

In the end, Munday told the county board that this behavior is not unexpected from an RNA virus like SARS-CoV-2. RNA viruses, according to medical literature, have very high mutation rates and are difficult to make effective vaccines against.

“This virus has been mutating for the entire year it has been circling the globe as RNA viruses do,” Munday said. “This is why we change our flu vaccine every year, because the flu virus is also an RNA virus that changes. … What’s the question, of course, is what effects do the changes have either on the clinical illness that the virus causes, whether or not it increases or decreases how contagious it is, and also the diagnostics and therapeutics.”

While there have been early signs that B117 is easier to transmit (50 percent more transmissible, according to the U.S. Centers for Disease Control and Prevention), there is no evidence that it is more severe and no evidence that measures like social-distancing and wearing face coverings can’t help combat transmission, Munday said.

He has also said during previous press conferences that it is not known at this point how the vaccines in use respond to B117. However, according to a late December published report, a BioNTech official, which is half of the Pfizer-BioNTech vaccine partnership, said that the U.K. variant shared 99 percent of the proteins found on the prevailing SARS-CoV-2 strain. RNA viruses spread when viral proteins bind to host cell receptors.

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