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A public hospital and public health system strain under vaccine demand

Angela Sides gives a shot to George Gibson at the vaccination clinic Pardee UNC Health operates at Blue Ridge Community College. Angela Sides gives a shot to George Gibson at the vaccination clinic Pardee UNC Health operates at Blue Ridge Community College.

In a windowless room on the ground floor of Pardee Hospital, 10 people are speaking into headsets as they type information into the Covid Vaccine Management System.

On the other end of the line are lucky winners of the Covid-19 lottery. They have gotten through, always after a long wait, and they’re getting appointments for their Covid vaccination.

“All these (call center schedulers) are fulltime Pardee employees that were doing other jobs — most of them leaders” in administration, planning, community relations and other areas, said Johnna Reed, a registered nurse who is Pardee’s chief administrative officer. “We just yesterday brought in two temps, from an agency.”
That may sound like a quick fix. But in the pandemic world, nothing is as easy — or as quick — as it appears.
“We had to get them through Epic security (the hospital’s computer network system), we had to get them through Epic training and we had to get them an ID number. So it’s a herculean process,” Reed adds. It’s not the first time during a two-hour tour of Pardee’s call center and the vaccine clinic it runs at Blue Ridge Community College that Reed uses the word herculean.
In Henderson County, as in many counties across the state, the system is struggling to meet the demand for shots. Last Wednesday, when the health department opened its freshly upgraded call center for appointments, the phone system inadvertently sent calls to voicemail instead of queuing them up to be answered.
The decision by the N.C. Department of Health and Human Services to lower the eligibility pool age from 75 to 65 overwhelmed call centers.

“I’m not sure that this is our future,” Steve Smith, director of the Henderson County Department of Public Health, told county commissioners last week when asked what could be done to improve the call center’s ability to handle the demand. “I really want to propose, at least we need to consider that perhaps there’s a different way of doing this. I had some really personal conversations with people that are very very frustrated. And what they don’t like is being thrown into the maul and competing for very limited appointments in this scramble, no matter how robust the call center. … And so an option for us to think about — and we’re ready to pivot very quickly, depending on your feedback — is opening up a wait list so that we could open up the call center five days a week. I could let you enroll on line or through a phone call and I think we let you get in a virtual line.”

‘Take a deep breath. Accept the challenge.’

Pardee first opened its call center with two operators on Dec. 14 then upgraded the capacity to eight stations on Jan. 12 when it began taking appointments from people over 65. That age group numbers more than 30,000 in Henderson County.

At the Pardee call center, a large electronic screen shows the current calls in the queue, how many are currently connected to a scheduler and the average wait time. Last Wednesday, the average wait was an hour and 21 minutes. The peak call volume in a day was 8,000, and most of those would not be answered. The system can accommodate 50 calls in the queue at a time, with a maximum wait time of two hours. On Thursday afternoon, 49 people were on hold.
Although UNC Health also offers an online signup option, the available slots fill up so fast “it never looks like it’s live,” Reed said.
To get the call center up and running fast, Pardee redeployed people from across its campus.
“These people are all 100 percent call center,” Reed said. The men and women in headsets are scheduling appointments through Feb. 5, even though “we only have enough doses to last us through end of day next Wednesday (Jan. 27). We don’t know, until the Tuesday of the week that we’re in, if we’re going to get any more doses. So we will know Tuesday morning if we’re going to get any doses Thursday. We didn’t get any this week. So now, next week, we’re going to be out by Wednesday, so we are crossing our fingers.”

The call centers at Pardee and at the health department, which schedules appointments for its clinic at East Henderson High School and for one Blue Ridge Health operates at North Henderson High School, are trying to meet this overwhelming demand, deal with uncertainty and comfort people in tears at a time when the workers themselves are stressed under months of pressure.
“The same people, whether it’s us or the health department, that have been caring for Covid patients in Henderson County — whether it’s testing, whether it’s treatment, whether it’s education and prevention — it’s been us and the health department,” Reed said. “Now we’re the same ones being tasked to give the vaccine, so the best thing that could happen is to have a more normalized distribution system (through) doctor’s offices, pharmacies. This is not sustainable. Yes, we want more vaccines to go to the community but we also want a broader more consistently dispersed distribution.”
Reed says this in a matter of fact way, not as a complaint. After all, the training sheet for Covid-19 features the header: “Take a deep breath. Accept the challenge.”
Aside from the regular calls that come in one-by-one, Pardee’s call center also get special requests.
“We just got a huge list of MAHEC residents in Buncombe that couldn’t get in, that are UNC residents,” Reed said, referring Mountain Area Health Education Center, a program of UNC’s medical school. “We just gave them a long list, calling them to get them in, because they were 1A (bedside medical providers). We need to get them in as quick as we can.”
Last Wednesday, a group of neighbors gathered in one place to watch President Biden’s inauguration, managed to get through.
“I bet we scheduled a hundred people” from one phone call. Turned out, they lived in South Asheville. “Then I asked the question,” said Reed. “They’ve got a big health department, they’ve got tons of vaccine. They said, ‘Yeah, but the Buncombe County Health Department sent us to you.’ You know what, it’s like Jay Kirby said. ‘We serve Western North Carolina.’ The lion’s share of our appointments have been Henderson County residents.”

As aggravated as people are at failing to get through or spending hours on hold, they’re often overwhelmed with gratitude when they reach a scheduler.
“We’ve had people crying on the phone, they’re so grateful. They’re relieved,” Reed said. “I’ve heard personal stories every day answering the phone — ‘I finally feel like now maybe I can babysit my grandkids again.’”

BRCC nursing students on front lines

Operating the clinic at BRCC, the nurses have not lost a shot yet. In the rare case of a cancellation or no-show, the team works quickly to recruit a new arm to receive the shot.
“So far, we have scrambled,” Reed said. “We call back over here and say, ‘You get somebody on the line that come today. We’ve got two doses.’”

The director of Pardee’s pharmacy, Adrienne Giddens, is a key leader in making sure every dose is accounted for, kept viable and injected into a patient’s arm. The Pfizer vials contain enough for five doses, each .03 milliliters.
“It’s a mad dash if we have extra doses,” Giddens said. “It takes a whole team of people.”
Like the rest of the countywide Covid-19 response dating back to last March, the quick standup of clinics is a cooperative effort of numerous public agencies. The school system permitted clinics to take over gym floors at East and North high schools. When Pardee and the public health leaders asked for permission to use BRCC’s largest space, the Blue Ridge Conference Center, President Laura Leatherwood immediately said yes. The agreement is mutually beneficial. Seventy-three students in BRCC’s nursing program work on the front lines giving shots.
“They’re learning the role of a nurse in a pandemic, anywhere from interviewing patients to learning how to process” the information, said Leigh Angel, dean of health sciences at the community college. “They’re learning about principles of community health within this pandemic — how can we keep people safe, how can we keep people well? We have seen patients tearful because they’re grateful to get this vaccine.” A student “would not get that in simulation. The gratitude these people are exhibiting when they come through is not something I can replicate in a lab setting.”

Bright Mensah came to the U.S. 13 years ago as an Eckerd Camp counselor before he trained to become a medical social worker. Now a second year nursing student at BRCC, Mensah, 43, is giving Covid shots.
“It’s been very wonderful,” he said. “I learn by doing so this is a perfect environment for me.” The patients “have been very grateful for the opportunity to get a vaccine.”
“It’s pretty delightful,” added Laylah Weaver, another second year student working in the clinic. “It’s very organized. People are excited to get their Covid vaccine. So when they come in, you get to chit chat a little. I try to make sure I’m going over their paperwork with them really thoroughly and then get them in and out. The needle itself, the gauge is pretty tiny and so most people say they hardly even feel it. … I think it’s good for everyone. They’re ready, they’ve been waiting for it. They say ‘I’ve been looking forward to a vaccine so much’ and they’re excited.”

Hard to plan when ‘every week is a surprise’

Mensah and Weaver are part of the process that by all accounts is working well.
Two weeks ago, Bruce Mills, 71, was so aggravated with his failure to get through to make an appointment that he called the situation a “travesty” and a “disservice to the public.”
After he sent an email to all five county commissioners, Commissioner Rebecca McCall responded. She told Mills she was sorry to hear of the trouble he had experienced.
“She said they had had many many problems in trying to get their system up and running and off the ground,” he said. “They actually saw that I got an appointment and I got my first vaccination last Friday.”
He got his shot at the health department’s clinic at East Henderson High School.
“I could not have been more impressed with how organized they were,” he said. “I handed them the paperwork, sat down and in less than two minutes they called me. I entered the gymnasium. They stuck a needle in my arm. I had to wait 15 minutes before exiting. I couldn’t be more impressed with how organized they were. They had lots of volunteers there and lots of people helping out. It was very very impressive.”
As happy as Mills was, thousands more are waiting.
The short notice of the supply line is a problem throughout the state, even the nation.
“I think one of our frustrations as vaccine providers is we do not get any reliable forecasts about what’s going to happen two weeks from now or a month from now,” Smith told commissioners last week. “It is literally waiting on a week to week basis about what we might be allocated.”
Ellis echoed that concern.
“It would be very useful if we knew in advance how many we were going to be getting next week,” he said. “Scheduling patients beyond what you’ve got in stock is dicey.”
This week county public health directors from across the state and another statewide association wrote letters to Gov. Roy Cooper and DHHS Secretary Mandy Cohen imploring them to improve the vaccine distribution system.
“When every week is a surprise, it’s hard to plan if you have all the resources and the people that are distributing the shots,” said Steven Lawler, president of the North Carolina Healthcare Association, which advocates for the state’s hospitals.
On Monday, Dr. Cohen responded. In a call with hospital leaders and county public health directors, she pledged that the state would guarantee a minimum baseline allocation each week for the next three weeks, WRAL-TV reported.
In Henderson County, as the first large wave of vaccinated retirees arrives for Covid booster shots, the workload — the number of patients and the need for space, check-in desks, nurses and volunteers — will double. The public demands that providers “give more shots, give more shots, give more shots,” Ellis said. “I understand that. But if we’re going to ‘give more shots, give more shots, give more shots,’ in 21 days we have to be ready to give twice as many as we’re giving.”