Nevada's COVID-19 immunization plan framework distribution to begin with frontline workers

Health care workers, first responders and lab employees will be among the first in Nevada to receive the COVID-19 vaccine when it becomes available, according to a draft of the state’s vaccination plan released Monday.

As expected, the initial round of COVID-19 vaccinations will be focused on the populations most at risk of contracting the virus, including health care providers who work in close proximity with COVID-19 patients, people at increased risk for severe illness from COVID-19, including the elderly and people with underlying medical conditions, and other essential workers. Because Nevada expects to receive very few doses of the vaccine at the beginning, the vaccination plan ranks categories of Nevadans by priority to receive the vaccine.

The first two, of four, tiers include “critical infrastructure workforce,” with about 155,000 people in the first tier, including hospital staff, lab workers, pharmacists, and law enforcement officers, and about 370,000 people in the second tier, including education and childcare staff, higher education faculty, public transportation workers and retail workers.

The third tier includes long-term care facility residents, Department of Corrections inmates, the homeless population, people with underlying health conditions and the elderly — grouped together as “people at increased risk for severe illness or of acquiring/transmitting COVID-19,” or about 2.3 million people — while the fourth and final tier includes all healthy adults aged 18 to 64, about 620,000 people.

Sisolak, in a press conference announcing the draft plan, said that while there is no approved vaccine yet, Nevada will be ready to distribute and administer doses when they become available.

“We are fortunate to have an existing framework that is managed by a team of experts who work on these efforts on a day to day basis with other programs such as vaccines for children, and the flu shot program, which we're dealing with right now,” Sisolak said.

Candice McDaniel, health bureau chief in the Bureau of Child, Family, and Community Wellness, characterized the plan as a “living document” that will be added to and adjusted as more information is made available.

“The plan is like a frame of a house, and it sets the structure, but now we need to furnish it and attend to the details,” McDaniel said. “Our goal is to be as prepared as possible when the vaccine becomes available in our state.”

Nevada’s draft immunization plan was submitted to the federal Centers for Disease Control and Prevention on Oct. 16 as required of all states and is awaiting approval.

In addition to being distributed by priority group, vaccines will be targeted to the counties at elevated risk for the spread of COVID-19 using the three criteria laid out by the COVID-19 Mitigation and Management Task Force. A county is considered to be at risk if it meets two of the three criteria:

— The average number of tests per day per 100,000, calculated over a 14-day period. If this number is fewer than 100, a county could be considered at risk.

— The case rate per 100,000, calculated by taking the number of cases diagnosed and reported over a 30-day period. If this number is greater than 200, a county could be considered at risk.

— The case rate per 100,000 and the test positivity rate, calculated over a 14-day period with a seven-day lag. If the case rate is greater than 50 and the test positivity rate is greater than 8.0 percent, a county could be considered at risk.
Under the plan, each county priority population will be allocated 80 percent of its share before moving onto the next county. For instance, if Washoe County has the most serious outbreak of COVID-19, it would be allocated 80 percent of the vaccines needed for its health care workforce — the first priority group in the first tier — before moving onto the county with the second worst outbreak, which would receive an 80 percent allocation based on the size of its health care workforce, and so on.

The overall COVID-19 vaccine response plan will be divided into three phases: The first will focus on reaching priority populations; the second will focus on ensuring that those priority populations have all been vaccinated and expand to the general population; and the third will focus on “equitable vaccination access” across the state’s population and focus on how to boost vaccination rates in communities with low participation.

State and local health officials may deploy COVID-19 vaccine strike teams to target specific populations, including residents of long-term care facilities and skilled nursing facilities, homeless individuals and the incarcerated population. They may also employ contracted nursing services and mobile vaccinating units to ensure all homebound Nevadans are reached, while ensuring those who are able to leave their homes on their own know it is safe to do so to obtain the vaccine.

“Efforts are being made to reach Nevadans who have intentionally chosen to stay home through the pandemic with the message it is safe to go into their community to get an influenza vaccine now and the COVID-19 vaccine when it is available,” the plan states. “This population is large in number and characteristically different than the traditional elderly or disabled homebound populations.”

During the second phase, when the vaccine is widely available, vaccination efforts are likely to happen at doctors’ offices, mass vaccination events, pharmacies and public health sites. In the third and final phase, the COVID-19 vaccine will be widely available and integrated into routine vaccination programs.

Because most COVID-19 vaccines are expected to require two doses to be effective, anywhere between 21 and 28 days apart, the state is planning a “second dose reminder” program to ensure that Nevadans receive the full course of the vaccination. The immunization program is exploring the use of robocalls, emails and text message-based systems to ensure that Nevadans receive their second dose.

Chief Medical Officer Ihsan Azzam, or his designee, will be responsible for overseeing the state’s immunization efforts, with the Nevada State Immunization Program ordering, storing, distributing, tracking, administering operations and providing guidance.

Public Health Preparedness staff will be responsible for all point-of-dispensing activities in the state’s rural and frontier counties with Carson City Health and Human Services managing efforts in the Quad Counties — Carson City, Storey, Lyon and Douglas counties — Washoe County Health District overseeing operations in Washoe and the Southern Nevada Health District managing Clark.

The State Immunization Program is also individually working with tribal communities across the state to prepare for vaccine distribution. Some tribes have requested their own allocations of vaccines to administer within their communities, while others have not yet engaged with the state on the vaccination process.

Anticipated COVID-19 vaccine sites will include health care provider offices, public health clinics, chain and independent pharmacies, worksites and occupational health clinics, hospitals and temporary or mobile vaccination clinics. The state is also preparing for storage of COVID-19 vaccinations, including identifying three ultra-cold freezers in Reno, Elko and Las Vegas and securing facilities from which to purchase dry ice to keep the vaccine cold.

Data management of the vaccine program will occur through the state’s existing vaccine portal, called WebIZ. All vaccination data will be required to be recorded in the WebIZ portal at the time of vaccination or, if data will be entered off site, within 24 hours.

The state also plans to establish a vaccination data dashboard, similar to the state’s existing dashboard for COVID-19 case numbers, deaths, hospitalizations and testing numbers.

Read the full vaccination plan here.

— This story was used with permission of The Nevada Independent. Go here for updates to this and other stories.