When the two mass COVID-19 vaccine sites in Shelby County went dark Monday, Jan. 4, hordes of people planning to get in line threw up their arms.

To those unimpressed with the rollout so far, it was another sign of poor planning.

Your coronavirus vaccine questions answered

The Health Department did not have enough vaccine to simultaneously run the drive-thru sites at Lindenwood Church and at its offices on Sycamore View Road and begin mass inoculations in long-term care facilities. It closed the drive-thru sites to administer shots at the others.

Director Alisa Haushalter says the early days of the rollout are going to be bumpy and people will have to make their plans based on an announcement of where and to whom immunizations will be given that day.

“I’ve asked the team to send out every day, as part of our regular update, the vaccine update — what groups are being vaccinated that day, or what we’re doing that particular day or week,” she said Monday.

The situation, she said, will improve as soon as the county Health Department begins receiving larger and more consistent vaccine shipments from the state and can make longer-term plans.

Until then, the announcements will post on The Daily Memphian site shortly after 10 a.m. Updates will also be available on the Health Department website.

This comes after a tumultuous first week. The Health Department vaccinated more than 9,500 people in the county in the seven days ending Sunday, Jan. 3. At the highest pitch, it was giving 190 shots an hour. It saved 2,500 of the doses to begin vaccinating this week in nursing homes and other long-term care facilities.

Drive-thru vaccine sites closed for now

Here’s what it looks like behind the scenes

To understand how fluid the situation is, the Health Department started last week with 3,000 doses planned for first responders. Some 9,000 more arrived because other counties in the state forfeited their early shipments.

“I received an email late one afternoon that said I had one hour to agree to accept additional vaccines. We agreed to accept that additional vaccine,” she said.

“Two or three days later, but in that same week, we received a similar email that another community could not accept vaccine and would we be willing to accept that additional vaccine?”

In a county with a population of 925,000 people, getting more vaccine is a boon. But it makes managing a day-to-day affair.

“We just have to continue to say to the public: ‘Please tune in daily and tune into trusted resources.’ Social media is not always accurate. And unfortunately, even someone’s private (health care) provider may steer them in the wrong direction,” Haushalter said.

“We just have to continue to say to the public: ‘Please tune in daily and tune into trusted resources.’ Social media is not always accurate. And unfortunately, even someone’s private (health care) provider may steer them in the wrong direction.”

Alisa Haushalter
Shelby County Health Department

The Health Department is asking for 7,000 doses a week, based on the pace of the busiest hours last week.

“But we don’t know yet if that’s something that’s feasible or not,” she said.

People want answers

Michael Clark, 73, is watching the rollout with some anxiety. He has several underlying conditions, and like thousands of people in the county, wants to know the system is fair and is being managed by competent people.

“The problem for me is communications. We need more transparency, more information and/or a more efficient way to convey what’s happening to the public,” he said in an email Monday afternoon.

“Looking deeper, the federal government needs to take a bigger helping hand as well as sending money to help states and cities cope with a logistical challenge.”

Last week, hundreds of people converged on the sites designated for first responders because they were alerted by friends, and in some cases, physicians, that the vaccinations were open.

While the Health Department initially tried to accommodate those in line, it later turned hundreds away because it didn’t have enough vaccine.

“I did have to reinforce that that was not a communication from us, and it did cause a great deal of confusion,” Haushalter said.

Dr. Stephen Threlkeld, infectious disease physician who practices at Baptist Memorial Hospital-Memphis, says people are appropriately “a little frustrated.”

“I mean, it’s a huge endeavor to undertake to vaccinate everybody in the United States, 330-plus-million people. I think Anthony Fauci had said you expect some hiccups in the first situation. We saw some last week,” Threlkeld said. 

“But I think this week and next week, we need to get it right.”

Threlkeld describes the vaccine as the “end game” in the most serious public health tragedy the world has faced in more than a century.

“We have to get it out. And we have to get it out fast. As long as there are people who are out there with outstretched arms and rolled up sleeves, we’ve got to go faster,” he said, noting that the start has been less than spectacular here, a city with the “some of the best logistics minds in the world. ...

“So, if it’s working smarter, we need to do that. We need more people making phone calls to fix the problems that we have seen over the last week or two and to get that vaccine out,” Threlkeld said.

“If it’s working harder, if you have something to offer, you don’t need to be going home at 5 (p.m.). You need to be continuing to work on this because of the magnitude of the problem. I don’t care if you’re a politician or a person working on logistics or anybody in the public health system, we need this done and we need it done very quickly.”

But he also said every citizen has a role to play, “to give the vaccine less to accomplish.”

Last week, the state released detailed plans of when specific workers and age groups will receive their vaccinations, including that people 75 and older would be eligible, starting in January. 

“Every community is different”

While Shelby County did serve older people, and many younger, who showed up in line last Tuesday, Dec. 29, the rollout here could be slower.

“Every community is different,” Haushalter said. “So, when they say January, it’s sort of estimate that in January it will begin to open up. ...

“We have to go by both the supply we have and the phase that we are in. That’s what is going to be difficult. In Shelby County, we have the largest population (in Tennessee) to serve.”

The Health Department is also governed by equity standards, which means access to the vaccine must be the same regardless of where people live and their resources, including transportation or internet access.

To do that requires a flexible plan, Haushalter said.

Over time, the Health Department intends to offer the vaccine in a variety of venues, including physician offices and drug stores. Geographically, it likely will make sense to offer a clinic in a church for a week or two and then move on to another neighborhood.

Its plan for the first two weeks was to offer the vaccine to first responders at two drive-thru sites located near the bulk of the population. This week, it is sending teams into nursing homes not affiliated with pharmacies to take care of people who cannot easily travel.

But because the vaccine must be used within six hours of being in the syringe, the Health Department has identified groups that can quickly come in and use what is left so doses are not wasted.

For that reason, it invited workers from funeral homes last week, knowing they would be a smaller group, Haushalter said.

It also has arrangements with the Memphis Medical Society and independent physician groups that have agreed to quickly find physicians or other health care providers who will be inoculated with unused doses.

“It’s not limited to physicians and nurses. There’s also occupational therapy, physical therapy, and a variety of other health care-related providers,” she said. 

In some cases, it will use Eventbrite or other registration apps to invite certain groups for shots.

Confusion not limited to Shelby County

Dr. William Schaffner, infectious disease expert at Vanderbilt University Medical Center, was on a conference call Monday with other infectious disease experts in Middle Tennessee and couldn’t believe none of them knew what was going on with the rollout.

“There was universal confusion,” Schaffner said. “We don’t know what phase we are in. We know there are clinics here (in Nashville) that are delivering the vaccine, but we don’t know who is eligible. None of us have seen any communications that tells us.”

He finds it hard to fathom that the Shelby County Health Department intends to communicate changes in plans on what could be a daily basis, fearing it will lead to “chaos.”

“Key to all of this COVID response is, as my mother used to say, communication, communication, communication. It really has to be crystal clear.”