Updated 8:30 a.m. Jan. 27
Starting Monday, patients with chronic conditions began hearing from their doctors that it’s their turn to come in for the COVID-19 vaccine.
The city’s major health systems are pivoting from Phase 1A, during which they vaccinated their patient-facing staff, to Phase 1B, where they shift to their highest-priority patients.
Those priority lists, as determined by the likelihood for serious illness or death from COVID-19 are:
- People over 75
- People with active cancer
- Recent or upcoming transplant patients
- People with chronic kidney disease
- People with diabetes
Penn Medicine has already begun vaccinating high-priority patients, according to its website. Einstein is piloting its program, set to roll out in full later this week. Temple Health started scheduling patients Monday.
According to an email about pre-registering for the vaccine sent out to patients, Jefferson Health will begin contacting those who are in the five eligible categories, as well as pregnant individuals; those with obesity, chronic obstructive pulmonary disease (COPD), Down syndrome, heart conditions (including heart failure, coronary artery disease, and cardiomyopathy), sickle cell disease, and who smoke; and those who are immunocompromised due to immune deficiencies, HIV, use of corticosteroids or use of other immune-weakening medication.
A Jefferson Health spokesperson did not immediately respond to a request for more details or a timeline.
How it will work
Tony Reed, the Temple health system’s chief medical officer, said eligible patients who have a mytemplehealth patient portal setup will be able to schedule an appointment the fastest, because that’s where the notification will come in. Those who don’t will receive an email or phone call.
At Einstein, primary care physicians will be sent a QR code that links to a referral form they can fill out to recommend patients. Einstein will then send those patients invitations to sign up for appointments through its patient portal.
Penn notes on its website that it won’t make appointments for people who call.
Temple’s Reed said he never wants to discourage patients from calling their doctors, but the best thing is to wait until your provider contacts you to avoid overwhelming the phone lines.
From there, patients will be instructed to schedule a time to be vaccinated at either Temple University Hospital in the auditorium, or at Jeanes Hospital in the parking lot, where a tent will be erected.
Injections will be given by Temple’s nurses, pharmacists, some doctors, and students on their clinical rotations with supervision. The system may also tap some dentists and podiatrists, who are authorized by the state to provide vaccines.
Reed said Temple Health receives roughly 1,000 doses a week from the city, and has some stores in reserve since the interest among its staff had started to wane in later weeks of Phase 1A. He estimated being able to inoculate 1,500 people per week at first, slowing down to a steady pace of 1,000.
Einstein gets between 1,500 and 2,000 doses a week, according to its chief medical officer Rohit Gulati.
From Phase 1A to 1B
As the city shifted from Phase 1A to 1B, the big health systems were instructed by Health Commissioner Thomas Farley to begin inoculating their patients with chronic conditions instead of their staffs.
Einstein and Temple have both offered vaccines to all staff members who deal with patients who want one, including facilities, dining, housekeeping, and environmental staff. At Einstein, 35% of staff across all medical campuses have declined the vaccine or expressed uncertainty. Both health systems have teams reaching out to patients who may still be deciding or have declined to talk about options.
Temple has administered roughly 12,000 doses so far, with about 3,000 people fully immunized.
Einstein in Philadelphia has given 5,365 doses, with more than 2,000 fully inoculated. Penn Medicine says it has administered more than 25,000 doses across all its campuses, including outside of Philadelphia.
The next phase will be a much heavier lift. Reed estimated that there are between 30,000 and 40,000 active Temple patients among the five categories, and noted his is among the smaller networks in the city. Gulati at Einstein agreed.
“It will be way more than the number of vaccines we get,” said Gulati. “By a lot.”
Priorities within priorities
At Einstein, the primary care providers will be entrusted to decide which of their patients most vulnerable to COVID-19 or at risk of serious illness to refer first. Gulati said the health system is working on a prioritization scheme that will put those who are over 65 and also have chronic conditions first. (The health system uses the state’s age cap, not the city’s, because it has campuses in Montgomery County.)
Reed said at Temple they are starting with those over 75 because it’s an easy list to pull and that group is at the greatest risk of dying. His team is still figuring out how to order patients within the other categories, but it will likely be by age.
“We let the data guide us,” Reed said. “You do your best to get to the sickest first, and you understand that you know somewhere along the way you’re going to miss something.”
When discussions about moving into Phase 1B began, Reed said, Health Commissioner Farley determined the hospitals were too overwhelmed with peaking COVID patients to be very involved in vaccinating the general public. That’s starting to change.
Penn, Temple and Einstein all applied for the city’s RFP to provide community vaccinations last Friday, and expect to hear back about it from the city in the coming weeks. Penn hopes to partner with a Federally Qualified Health Center to offer vaccines to the community outside of Penn patients. Temple, if selected, hopes to deliver vaccines directly to neighborhoods using a mobile van. Einstein will set up vaccinations in the Olney Transportation Hub, where it has been conducting testing until now. It hopes to be up and running by March 1.
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