28 Days Later 

As local case numbers continued to soar, Humboldt County Public Health, with much hope and fanfare, distributed the first local doses of the new Pfizer-BioNTech COVID-19 vaccine last week in what officials predict will begin a steady, if slow, march out of this pandemic.

But many questions about the vaccine and how it will be distributed locally remain.

"This has never been done before," said Humboldt County Health Officer Ian Hoffman. "This is medical history. We are literally building the ship as we sail it."

In a Dec. 22 press release, the county's Joint Information Center reported that 1,100 local healthcare workers were expected to have been vaccinated by day's end and that the California Department of Public Health had indicated the county may receive approximately 1,600 new vaccine doses per week for the next few weeks, though that could change "at the federal level." Here's a brief rundown of what we know — and don't — about the vaccine and how it will be distributed in Humboldt County.

What the Vaccine Does

Pfizer's first-of-its-kind vaccine is what's called an mRNA vaccine, meaning it teaches cells in the human body to make a protein that triggers an immune response and builds up antibodies that will protect it if exposed to the real virus. The vaccine does not contain a live virus and poses no risk of infecting people with COVID-19.

As hundreds of thousands of doses were administered throughout the world last week, there were several reports of people developing anaphylaxis, or a severe allergic reaction, after receiving it. While these instances were incredibly rare — just six reported in the United States — they were enough for the U.S. Food and Drug Administration to recommend that anyone who has previously had a severe allergic reaction to a vaccine or who has a known allergy to one of the vaccine's ingredients avoid the shot.

The vaccine requires two doses administered 21 days apart, and a person should become immune to the COVID-19 virus 28 days after getting the first dose. In clinical trials, the virus proved 95 percent effective, meaning 95 percent of those who received it developed immunity to the coronavirus. It is currently approved for use in people 16 and older.

But because the vaccine was developed on such a rushed schedule, studies have yet to determine how long that immunity lasts. Similarly, because the trials were rushed and hyper-focused on finding a way to keep people from falling ill, it's currently unclear whether getting the vaccine will prevent someone from becoming a carrier and transmitting the virus, though that's the case with most other vaccines that protect from viral illness.

Because of that uncertainty — and the slow, tiered roll out of distribution — health officials are urging everyone who does get vaccinated to continue all the public health measures used to slow the virus' spread, including physical distancing, masking and frequent hand washing, until more data becomes available and a majority of the population has been vaccinated.

As to when that might be, it's hard to say. The vaccine — as well its Moderna counterpart that was also recently approved for emergency distribution — is in incredible global demand with limited supplies. Asked whether vaccinations would be widely available to the general population in Humboldt County by spring or summer, Hoffman said he simply does not know.

"I can't give any definitive or realistic timeframes," he said.

How will it be Distributed

First in line to get vaccinated in California are the state's frontline healthcare workers and nursing home residents, the former being at heightened risk of contracting the virus and essential to the state's response and the later being at greatest risk of infection and critical outcomes. But exactly how that line forms in Humboldt County — and who's next — is much less clear.

For nursing home residents, they will be receiving the vaccine from CVS or Walgreens through a federal contract, and Humboldt County Public Health has no control over that process. Hoffman said the first shipment of these vaccines is slated to arrive the week of Dec. 28, though it's unclear how facilities — including Granada Rehabilitation and Wellness, which is currently the site of an outbreak that has sickened almost 100 people, leading to the deaths of seven residents — and their residents will be prioritized.

When it comes to healthcare workers, Public Health Family Nurse Practitioner Lindsey Mendez said the initial push is vaccinating those most at risk — meaning intensive care and emergency room staff, emergency medical service providers and those caring for COVID-19 patients. Hoffman said Public Health is allocating the doses to local healthcare institutions based "months of research on who their employees are and what category" of risk they fall into.

"From there, Public Health has instructed them to follow the guidance," Hoffman said, indicating there is no granular oversight of which employees are vaccinated or when.

But exactly how the shots are distributed to hospital staff has been the source of virulent controversy elsewhere. Stanford Medical Center, for example, was the site of numerous protests last week after it was reveled that only seven of 1,300 resident physicians — many of whom directly treat COVID-19 patients — were among the first 5,000 vaccinated there, while administrators and doctors working remotely from home made the list. Others have been critical that members of Congress — including North Coast Rep. Jared Huffman — were prioritized for the vaccine ahead of some frontline healthcare workers.

Locally, when reporter Kym Kemp posted a story noting that Southern Humboldt Health District CEO Matt Rees was among the initial 25 staff members vaccinated at Jerold Phelps Community Hospital in Garberville, commenters on her website were quick to accuse him of jumping the line. Responding to an email inquiry from the Journal, Rees said "there were a lot of employees nervous about the vaccine" so he and Yousri Gadallah, a physician who serves as the clinic's medical director, volunteered to receive it first.

"Dr. Gadallah and I chose to lead the way in hopes of encouraging more staff to get the vaccine," he wrote, adding that he suffered no side effects. "When some of the employees saw a line of people waiting for the vaccine, it made them more comfortable about getting it."

While Hoffman said the vaccine campaign "is about equity, transparency and safety," he also said "we have to trust the hospitals" to prioritize the employees most at risk, adding that there are "a lot of factors" in who gets vaccinated when. Those seem poised to get more complicated as more vaccine doses become available and the county moves through the state's prioritization tiers, which will move from healthcare workers to frontline essential workers and those over the age of 75 in the next phase.

Last week, a state panel offered preliminary recommendations — including everyone from childcare workers, teachers, police officers and firefighters to restaurant and grocery store employees and agricultural workers — but counties will ultimately decide how to prioritize distribution.

In a contrast to those accused of cutting the line, some locally have already announced they'll pass on the vaccine with the hopes of getting more quickly to those perceived at higher risk. The Humboldt County Deputy Sheriff's Organization recently decided most of its members would forgo the vaccine to prioritize those it considers more at risk, though employees who want the vaccine as soon as possible because they care for an older family member or have underlying health conditions will retain their place in line. (So far, 10 employees have opted to remain on the priority list while 270 have agreed to pass, according to Sheriff William Honsal.)

Honsal said the organization's decision was based on data and employees' realization that others in the community are more at risk of suffering critical outcomes should they catch the virus.

"Our job as law enforcement officers is to protect our community," Honsal said. "Most of us are healthy — we take care of ourselves. If we can allow the vaccine to go to someone else, to save their lives, I think we're doing our jobs."

For his part, Hoffman said Public Health recognizes there are plenty of challenges that remain as the vaccination program continues to role out. But asked if he is concerned about Humboldt County residents — a portion of whom, data indicates, have traditionally proven leery of vaccinations — opting not to get the vaccine, Hoffman said he's not.

"I've never seen this level of enthusiasm, this level of uptake of a vaccine," he said.

Journal staff writer Iridian Casarez contributed to this report.

Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.