It took hours of diligent searching, a late-night tip and many hits on the “refresh” button, but Shawnee, Kansas, resident Kathy Cook managed to get five of her relatives, mostly in their 70s and 80s, appointments for the COVID-19 vaccine.
The one exception was her husband, Steve, who has been treated for three years for cancer at the University of Kansas Health System.
He’s done well with treatments and, as a patient at KU, would be on the list the medical facility uses to invite people to get a vaccination. The problem: He’s only 58 and Kansas doesn’t yet prioritize people with medical histories that make them vulnerable. In Kansas, people 65 and over take precedence.
Steve’s cancer makes him eligible on the Missouri side, though. But without connections as a patient in a Missouri hospital or through an employer there, he can’t get a shot in Missouri either.
Hospitals play a big role in distributing the limited supplies of the coronavirus vaccines. But as pressure builds to get people vaccinated before the virus’s more transmissible variants take hold, people throughout Kansas City are finding that the criteria for getting a shot are different from state to state, hospital to hospital. Being in the correct state tier doesn’t necessarily guarantee an appointment anytime soon.
In Kansas, for example, it often helps to have been a recent patient at the hospital doing the vaccinating. Johnson County hospitals have the option of prioritizing their own patients 65 and older while the county health department focuses on other at-risk groups.
Missouri, on the other hand, strictly forbids hospitals from giving preference to their recent patients. But the state has also directed its hospitals to limit vaccine to Missouri residents, patients or workers.
The result is often confusion for people seeking the quickest, closest shot.
Sasha Fritzel and her mother are both Missouri residents and both have medical conditions that put them in the current Missouri tier.
“I signed up with every hospital, county and city list we were eligible for and called every few days to follow up,” she said.
But they found some places limiting the vaccine to those 65 and older, which ruled both of them out. Eventually they got appointments at a Missouri clinic an hour and a half away, although “well worth it to get vaccinated,” Fritzel said.
Cook had similar experiences getting appointments for all her eligible relatives. Although they signed up for alerts at Johnson County hospitals, none heard back. They all ended up getting vaccinated through Walmart or grocery stores.
KANSAS
Because Wyandotte County does not vaccinate through hospitals, Kansas-side hospitals work with the Johnson County public health department for guidance on how to distribute vaccine.
The county decided early on that COVID-19 shots should be available at many different sites because it would be more efficient and faster, said Johnson County Public Health Director Dr. Sanmi Areola. So vaccination in the county is organized with a slightly different emphasis for each type of provider.
Hospitals, with their large patient lists, are vaccinating people in the 65-plus age group. The county concentrates on those 80 and over for its clinics and other providers serving nursing homes. For that reason, it’s considered okay for the Kansas hospitals to prioritize their own patient lists for Johnson County, Areola said.
Each Kansas hospital handles things a little differently. The University of Kansas Health System has an online form open to the public but is working through its own patient list of Johnson County residents in the 65-plus age group before calling on non-patients, said assistant chief nursing officer Kim Dixon.
So far the hospital has given out over 26,500 first and second doses, and has about 4,000 more to go before exhausting its list of eligible patients. A person is considered a recent patient if he or she has been treated at the hospital in the past three years, excluding lab work and radiology.
There is no prioritizing within the patient group. In fact KU randomizes its pool of names so that everyone has an equal chance at being called, Dixon said. The hospital will help out with clinics and other efforts as vaccine becomes more available, she said.
AdventHealth also invites people from its patient list. But it has also opened up vaccinations to the public at large through clinics as well as drawing names from the online form.
Because of the limited amount of vaccine, “we’ve only hit small portion of each of those groups,” said Morgan Shandler, communications manager at AdventHealth. “But we have tried to really equitably share and disburse what we’re receiving from the county.”
So far the hospital has vaccinated around 10,000 people, including employees, with first and second doses, she said.
AdventHealth considers it a priority to reach out to underserved communities, Shandler added.
“This virus doesn’t know if they’re a patient of ours or not. We want to make it easy for our patients to get the vaccine through us but we are not reserving it only for our patients,” she said.
Stan Holm, president of Olathe Health, said at a press conference last week that having 15,000 county residents over 65 on its patient list “all queued up and ready who had already started calling us” made for an efficient way to administer vaccinations.
He added that the hospital does treat underserved patients.
“There might be a perception that we have all these patients that are being seen in all our health systems that are not underserved. They are. We have patients that are underserved that we will take care of,” Holm said.
The hospital plans to work with the county on efforts to reach people who have a harder time accessing health care. Meanwhile, vaccinations are still available to those people through county clinics and as more doses become available at pharmacies and grocery stores, Areola, of the Johnson County health department, said.
“Equity has always been the primary lens through which we have looked,” he said, adding the county has worked hard to serve independent living facilities and is trying to come up with a solution for people who have no transportation.
MISSOURI
In Missouri, selected hospitals get 53 percent of the state’s weekly vaccination allocations. Truman Medical Centers is one of those hospitals. So far Truman has vaccinated in the neighborhood of 23,000 people, including first and second doses, said Charlie Shields, its president and CEO.
Truman uses three methods to fill its vaccination schedule – an online or call-in signup, its patient list and community clinics. But those names all go into one hat and no one gets any greater preference than is outlined in the tier group, Shields said. The order is first-come first-served.
Although patients are not preferred, Missouri residents are. Residents of other states can get the vaccine if they were patients at the hospital or if they work in Missouri, Shields said.
That wasn’t always the case. When the vaccines first became available, the state’s rules only said vaccines couldn’t cross the state line but out-of-staters could be vaccinated. Once the bigger tier opened up in February, Missouri officials decided to tighten things up.
Truman, a safety-net hospital, will continue to reach out to people having trouble with access, Shields said.
“We’ve probably done more than anybody else and that’s fine. But we also realize there’s more work to be done,” to make it available to underserved groups.
“Across every category there is still more demand than supply,” Shields said. “But we know that’s going to change.”
With fierce competition for vaccination slots, the best bet is to sign up anywhere and everywhere possible, say health officials, who are banking on bigger shipments in the next few weeks.
That worked for Cook and Fritzel, although they said it was nerve racking. Cook took time off work to run things down for her relatives.
“It is a hunt,” she said, and one that disfavors those without the time and computers and family to help.
