By Jeffrey Schweers, Tallahassee Democrat
Joe and Rita Leone live in an all-ages condominium community in Estero. He’s 84, she’s 79.
He has persistent, chronic AFib, or atrial fibrillation, an abnormal heart condition that he manages with regular doses of the blood thinner Coumadin.
“If I got COVID I wouldn’t survive, given my heart condition,” he said during a phone interview Wednesday. “I would really fear contracting the disease and going into the hospital.”
Wearing masks and social distancing have so far kept him and his wife from getting COVID-19 in the 10 months since the pandemic began in March.
But it would be nice to know when they will get the vaccine.
“I got an email from someone where you put in your age and condition to see where you are in line for a vaccine, and I found there are 48,000 people ahead of me in Lee County,” Leone said.
Leone and his wife are among the 4-million-plus Floridians over 65 who aren’t residents of the state’s 4,500 nursing homes and assisted living facilities. Those 145,000 people and 222,000 staff are first in line along with front-line hospital workers to get the first batch of the vaccine in Florida.
“My wife and I were kidding each other that we should sign up for a nursing home,” Leone said.
The state received 179,400 doses of the Pfizer vaccine last week and another 127,000 doses this week along with 367,000 doses of the Moderna vaccine, both of which require two shots spaced three to four weeks apart to achieve maximum protection against the COVID virus.
Just over 93,000 people were vaccinated as of Christmas Eve, the vast majority of whom were under 65. The number 65 and over is expected to skyrocket as more vaccines are distributed to nursing homes throughout the state.
Meanwhile, Florida has experienced a surge in COVID-19 cases, hospitalizations and deaths since the governor reopened the state for business and prohibited counties and cities from enforcing local ordinances to control the virus’s spread.
The state has reported close to 1.25 million infected and 21,000 dead since the pandemic began with nearly 8,000 of those deaths among nursing home residents and staff. Floridians 65 and over account for 83 percent of all deaths to date, Department of Health records show.
Nationally, close to 18 million Americans have been infected and 326,000 have died from COVID-19. CDC officials predict as many as 420,000 Americans will have died of COVID-19 by mid-January.
Federal officials expect 20 million doses to be distributed nationwide by the end of this month. Enough for 10 million Americans.
They also hope to have 100 million Americans vaccinated by mid-March.
While folks are waiting on the vaccine, mitigation measures are still the most effective means of containing the spread of the virus, public health officials have said repeatedly.
Along with the Moderna emergency use authorization by the FDA, the Centers for Disease Control and Prevention put out an advisory that the second round of shipments, what they’re calling Phase 1b, be administered to essential workers like teachers, firefighters and grocery clerks as well as nursing home residents and healthcare workers.
But DeSantis has pushed back hard, repeatedly saying those new shipments would be committed to those “tip-of-the-spear” frontline healthcare workers who work directly with COVID-19 infected patients, and nursing home residents and staff.
He codified that priority in an executive order issued Wednesday, ensuring that all Floridians 65 and over, long-term care residents and staff, health care personnel with direct patient contact, and hospital patients deemed to be extremely at risk to COVID-19 are first to get the vaccine. It doesn’t mention people in assisted living facilities or short-term care for people with developmental disabilities.
“We are not going to put young healthy workers ahead of our elderly,” DeSantis said.
That priority is set to last for the next six to eight weeks, DeSantis said, because it is going to take at least that long for Florida to get enough vaccine shipments for all its seniors.
“We are not going to have over the next six weeks, 4.4 million doses,” DeSantis said. “We will probably have a couple million doses. It will be reserved for you.”
The news conference Tuesday at The Villages — where health care providers were inoculated and then administered doses to several residents of the seniors-only community — was a preview of how people over 65 in the general population might receive vaccines, DeSantis said.
The Villages is more than a residential development for seniors. It’s an unincorporated community that has its own census designation and spans three counties with an estimated 123,000 residents, where Republicans outnumber Democrats two to one.
Also, UF Health Central Florida has a huge presence in The Villages, so there is a robust medical infrastructure in place to put shots in arms.
“We will have some community vaccination sites available for older individuals as well as working in conjunction with our hospital systems to be able to deliver as many vaccines as possible to those who want the vaccine, particularly in the elderly demographic,” DeSantis said.
Eight county health departments, including Leon, have been allocated thousands of doses of vaccine each to distribute to seniors under a pilot program. State officials have not responded to requests for the names of the other seven counties.
Once it is offered to all the elderly who want it, and particularly if the Johnson and Johnson single-shot vaccine gets approved, DeSantis said, the vaccine will be offered more broadly, to essential workers in law enforcement, firefighting and education.
The state will also work with hospitals for efficient delivery, DeSantis said. “Once they get through their health care workers, we will have their system to reach out to the community.”
DeSantis did not provide a specific timeline, other than indicate that enough vaccine could arrive in Florida to cover most of the state’s 65-plus population.
If 75% percent of the state’s 3.12 million seniors over 70 want it, DeSantis said, “we will probably have enough vaccine over the next six weeks for that but not 4 million by February 1.”
When asked if full-time residents over 65 would have priority over snow birds, DeSantis had no immediate answer.
“Well… we have not necessarily done that, I mean, we’ll see,” DeSantis said.
Nor did he contemplate a system where people under 65 with serious underlying medical issues or comorbidities would be given a higher priority than seniors.
“The problem is how do you administer that? Do you want the hospitals to slice and dice everyone’s comorbidity? If you look at the numbers, someone who’s 40 with a comorbidity, and someone who’s 80 with those same, the person who’s 80 has a much higher risk,” DeSantis said. “We are going to focus on age, not necessarily health status and the reason for that is efficiency.”
THE LAST MILE
The last mile of distribution was always going to be the most challenging and complex, said Dr. Scott Gottlieb, former FDA Commissioner for President Trump and member of the Pfizer board of directors.
“It will get harder after this month,” Gottlieb said on Face The Nation two weeks ago. “Going into hospitals and nursing homes, they have big institutions they can work with – big pharmacies and hospitals. Once they go into the communities, that’s where the challenge is. I’m not sure the country is prepared to do that right now.”
Florida’s draft plan, issued in October and not updated since, calls for county and state mass vaccination sites at some point, though it is not specified when that could happen. It also calls for the DOH working with pharmacies and hospitals to get vaccines distributed to the general public.
Local health departments need to have some sort of notification system so people like him know when they’re eligible for shots, said Joe Leone of Estero.
“That would be the easiest thing,” he said.
One thing that bothers Margaret Oathout, 86, of Hobe Sound, is that when the governor talks about getting vaccines to seniors is that it is almost exclusively in terms of nursing homes, “as if all seniors live in nursing homes.”
She lives independently in her own one-story townhouse in a 55-plus community where she does her own cooking and most of her own cleaning.
Except for autoimmune disease that affects her thyroid gland, she is in good health for her age. But she still wants to know how to register to get the vaccine and what sort of time-frame there is for people like her who live on their own.