COVID-19 Update | March 4, 2021

Staff Contact: Mat Reidhead or Jackie Gatz

Understanding the drivers of the likelihood of individuals failing to receive the required second booster dose of Pfizer and Moderna COVID-19 vaccines will be critical in optimizing allocations of the newly approved single-dose Johnson & Johnson vaccine. Through March 1, 56,720 individual Missourians have not received booster doses within the manufacturer-prescribed window of 21 days for Pfizer and 28 days for Moderna. This accounts for roughly 6.5% of all individuals who have received any dose in Missouri, and among those, only 1,817 are beyond the latest guidance from the Centers for Disease Control and Prevention that recommends booster doses be administered within 42 days of the first dose. Nationally, the rate of series incompletion is 12%. One of the factors contributing to the high second dose completion rate in Missouri is the COVID-19 Vaccine Navigator program — a one-stop shop for vaccine registration, event location and second dose reminders.

Due to high frequencies of ShowMeVax records missing race, it is difficult to evaluate completed booster rates along demographic lines. However, a near-monotonic relationship exists between poverty of the recipient’s ZIP code and the percent of total vaccine recipients that are overdue for the booster dose. This signals the potential for the single-dose J&J vaccine to be an effective strategy in fully protecting socially vulnerable populations. Additionally, while the distribution of vaccines to date has been driven by phase-eligible individuals and not the total population, a pattern is emerging that suggests an inverse relationship between poverty and the percent of total doses received to date across Missouri’s communities. The continued monitoring of this disparity will be critical as the state aims to increase vaccine acceptance in underserved communities.

Staff Contact: Kara Amann-Kale or Carissa Van Hunnik

To assist members experiencing COVID-19 vaccine booster dose shortages, MHA staff developed an EMResource query and static view that was activated earlier today to identify and quantify these discrepancies. Vaccinators with time-sensitive vaccine booster dose shortages are encouraged to update query statuses any time a need is identified and provide additional updates as the status of that request changes. Vaccinators with surplus vaccine are encouraged to reference this information to identify potential opportunities for vaccine redistribution. Training opportunities are being incorporated into standing regional and statewide meetings.

Staff Contact: Jackie Gatz or Keri Barclay

Yesterday, the State of Missouri approved waivers that permit Emergency Medical Technician Basics (EMT-B) and first responders to be added to the list of providers that may administer COVID-19 vaccinations. The waiver requires additional education and training for these providers before administering vaccine to patient populations. To support this new waiver, updated standing orders for the Pfizer, Moderna and Janssen COVID-19 vaccines are available.

Staff Contact: Jackie Gatz or Kara Amann-Kale

President Biden announced that teachers and child care staff now are being offered vaccine appointments at some pharmacy locations regardless of where they fall in their state’s system. These vaccines are available through the federal vaccine allocation to pharmacies. This initiative is part of a broader effort aimed at getting teachers and students back into the classroom. Individuals who are interested in getting vaccinated at their local pharmacy should check the pharmacy’s website, and visit Vaccine Finder to find eligibility criteria and if vaccine is available. All Missourians can visit the Vaccine Navigator to find the latest information and opportunities for vaccination.

Staff Contact: Mary Becker

In a Facebook Live video posted earlier today, MU Health Care’s Dr. Margaret Day explains how the mRNA vaccines work to combat the coronavirus and why it’s important to receive both doses of the vaccine. She said, “It’s very important to follow through with receiving your second dose of vaccine. The second dose is where this 90% to 95% efficacy comes from in the Phase 3 trials.” Dr. Day also said that while receiving one dose probably offers some protection, it only has been found to be 52% effective with one dose.

Staff Contact: Daniel Landon

Gov. Parson’s chief of staff, deputy chief of staff, and director of the Missouri Department of Health and Senior Services participated in a conference call with the MHA membership on the state’s response to the COVID-19 emergency. The governor was delayed in transit and unable to participate. It was the 28th such call with the MHA membership since the pandemic began. The calls provide an opportunity for an update on state activities and hospital issues, and for hospital executives to ask questions and make comments.

The state leaders indicated that a substantial increase in vaccine supply will arrive in April and May, building on the state’s burgeoning capacity. In the last seven days, 250,000 doses of vaccine have been administered. Missouri is ranked 16th among states in its efficiency of getting shots into arms. In response to member questions, officials noted that the state does not now have a specific plan for vaccinating teachers, is continuing its media campaign to promote disease control behaviors and will assess opportunities to use new federal funds to offset hospitals’ costs of vaccination events. Also, they will investigate whether the federal vaccination program is bound by state residency requirements and might be a referral target for out-of-state residents.

Staff Contact: Jackie Gatz or Kara Amann-Kale

The Centers for Disease Control and Prevention is hosting a Clinician Outreach and Communication Activity call, “The Roll of Telehealth in Expanding Access to Healthcare During the COVID-19 Pandemic: Considerations for Vaccine Uptake and Monitoring for Adverse Events,” at 1 p.m. CST Thursday, March 11. Presenters will provide a summary of a recent series of discussions with the telemedicine community and share their experiences using telehealth tools for triaging, navigating patients, managing infectious and chronic illnesses, and monitoring for COVID-19 vaccine adverse events.

Staff Contact: Sarah Willson or Dana Dahl

It has been challenging to remain apprised of state and national regulatory requirements, waivers and changes that have evolved throughout the COVID-19 pandemic response. Visitor screening and entry guidance is a topic that MHA continues to follow closely.

Federal regulatory guidance suggests that hospitals have a patient, staff and visitor screening process in place that follows federal guidance, such as from the Centers for Disease Control and Prevention. The most recent guidance from the Centers for Medicare & Medicaid Services can be found in QSO-21-08-NLTC. In addition, the most recent guidance from the CDC also is available. The information from these agencies would suggest that hospitals have a screening process that includes temperature assessment as one component; however, there seems to be an allowance for self-attestation. In this situation, the patient/staff/visitor has taken their temperature before arrival and follows the hospital’s direction if they had a fever of 100.0. MHA encourages consult before making changes to hospital policy and transparently communicating visitor policy with the community.

Staff Contact: Jackie Gatz or Keri Barclay

The Centers for Disease Control and Prevention released a clinical alert in response to the two recent Ebola outbreaks in the Democratic Republic of the Congo and Guinea. Passengers arriving in the U.S. from these locations will be directed to identified airports for screening. The CDC recommends that all hospitals screen and triage everyone entering their facility for COVID-19, and in addition, document patients’ travel histories and post-contact information for infection control personnel responsible for reporting Ebola Virus Disease in a visible location. Infection control, response and treatment guides remain available on the CDC website. Additional information also is available from the National Emerging Special Pathogens Training and Education Center.