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COVID-19 Vaccine in Boulder, CO:
What You Need to Know at This Stage

By Sharon Udasin, The Boulder Reporting Lab

December 11, 2020 (Updated JAN. 21, 9:30 pm MST)

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About 18,500 Boulder County residents have received a single COVID-19 vaccine dose (as of Jan. 21, at 8:00 am). Some 3,100 people have received two doses, as vaccine supplies remain scarce.

"Vaccine is not being wasted in the county, and all the doses coming to the county are going into people's arms," Boulder County Public Health said.

Currently, people age 70 and older and moderate-risk healthcare providers are the focus of vaccination.

(The county has said it is wrapping up vaccinations for the most at-risk healthcare workers, as well as residents and staff of long-term care facilities. First responders have been vaccinated, it said.)

There are nearly 30,000 Boulder County residents in the 70+ age group, and about 3,000 moderate-risk healthcare providers still waiting to be vaccinated.

"We expect it will take about seven weeks to provide the vaccine to everyone [in these groups] who would like it," Chris Campbell, Boulder County Public Health emergency manager, said in a Jan. 21 press release.

Teachers and other frontline essential workers will be next, and likely won't be eligible before March 1.

The county is encouraging eligible residents to sign up for an appointment through their healthcare providers (while noting appointments are likely full). Instructions and links for doing so are here.

If you're not yet eligible, you can sign up here to be notified when you will be.

Many questions remain. How many doses are arriving in Boulder County? Will there be vaccine mandates? What about the general public, and our kids? Can a vaccinated individual still spread the virus?

The Boulder Reporting Lab has compiled an explainer to help you sort through the information.

We will update this story as we learn more.

Critically, Boulder residents should plan on donning masks and postponing gatherings well into the foreseeable future. 

"It's a middle step," said Dr. Thomas Campbell. Campbell is a virologist and infectious-disease specialist at the University of Colorado School of Medicine and UCHealth. He is leading the Moderna Phase 3 clinical trial at UCHealth on the CU Anschutz campus.

"The end game will be when COVID-19 stops overwhelming our hospitals and stops killing people. The vaccine is not going to be the end of SARS-CoV-2," he said.

How many doses has Boulder received? How many are coming?

Colorado is getting about 60,000 vaccine doses per week from the federal government. The first one-third of those are automatically allocated to long-term care facility residents and staff.

About 3,000 doses a week currently end up in Boulder County (pop. ~330,000). 

"While each vaccine provider ([Boulder County] Public Health, hospitals, clinics) orders the doses they need each week from the state, how much and when they receive them changes from week to week," Boulder County Public Health said on Jan. 19.

Five Boulder County hospitals received the initial allocation of the Pfizer-BioNTech vaccine, according to Boulder County Public Health.

They were: Boulder Community Health, Good Samaritan Medical Center in Lafayette, UCHealth Longs Peak Hospital in Longmont, Longmont United Hospital and Avista Hospital in Louisville.

“These locations were chosen for their unique abilities to store, monitor, and handle vaccines in ultra-cold temperatures,” the Colorado Department of Public Health & Environment (CDPHE) said. 

Eleven local hospitals received the Moderna vaccine, with Boulder Community Health slated to receive the most initial Moderna doses.

Will healthcare workers (or anyone) be mandated to take the vaccine?

No. 

Colorado "will not be issuing a vaccine mandate," the Colorado State Joint Information Center told The Boulder Reporting Lab. 

In Campbell’s opinion, a mandate would not be sensible at this point. 

The Pfizer and Moderna vaccines were designed to protect individual health — to prevent a person from getting ill, once exposed. They’ve been about 95 percent effective at that. The hope is that the vaccines would also protect societal health by preventing the spread of the virus. But these clinical trials weren’t designed to evaluate transmission.

That’s "going to be evaluated by good epidemiology studies," Campbell said. (Not knowing whether vaccinated individuals are spreaders is also why mask-wearing and other restrictions must continue.) 

Dr. Nancy Stolpman, director of pharmacy at UCHealth, agreed that a mandate is premature. 

"There are so many unknowns right now — how long does the vaccine last, do we have to be vaccinated again, does it give us the herd immunity people are looking for?" she told The Boulder Reporting Lab. "I think it will be a while before a mandate will come out."

How is BVSD planning? 

The Boulder Valley School District will not be requiring teachers to get vaccinated. 

"Our practice has been to follow the best advice of our partners in public health," Randy Barber, BVSD chief communications officer, said. "We will encourage participation, but do not expect to mandate the vaccine."

"Knowing that it will be an important development in returning our schools to more normal operations, we are advocating that educators be among the first to receive a vaccine," he said.

Boulder County said that "teachers and other frontline workers in transportation, grocery stores, etc. will be next after we provide the vaccine to the nearly 30,000 residents who are 70 years of age and older."

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Who's getting vaccinated when?

There are three phases in the state's vaccination program. 

We’re currently in Phase 1A and 1B.

Phase 1A covers the highest-risk healthcare workers and individuals, and includes residents and staff members of long-term care facilities. In Boulder County, this phase is nearly finished.

Under Phase 1B are moderate-risk healthcare workers, such as home health, hospice and dental workers. Signup for this phase is complete, according to Boulder County Public Health. But there are still 3,000 people in this group who are awaiting their vaccines.

This phase also includes emergency first responders. Their vaccinations are complete, according to the county.

People age 70 and older are eligible to get vaccinated under Phase 1B, and their vaccinations have begun.

Phase 1B, as of Dec. 30, also includes frontline essential workers, including teachers, grocery store employees, postal service workers and people who work in high-density environments like farms or meat-packing plants. Also in this group are essential government officials and essential frontline journalists. (See chart below for detailed list.)

Boulder County has made clear that, per the state's orders, teachers and other frontline essential workers will be vaccinated only after all people age 70 and older have been given the opportunity to be vaccinated.

Phase 2 would begin in the spring, and would include "higher-risk individuals and other essential workers." Also in this cohort would be: individuals age 60-69 and people age 16-59 with certain diseases or who are immunocompromised.

Healthcare workers not included in Phase 1 and adults who received a placebo during a COVID-19 vaccine trial would also be part of Phase 2.

Source: Graphic courtesy of CDPHE

What about the general public?

Only in Phase 3, expected in summer 2021, would members of the general public — anyone age 16-59 without high-risk conditions — be eligible for vaccination. 

What about children under 16?

The Pfizer vaccine was authorized for anyone 16 and older. Moderna's was for anyone 18 and older. There remain unknowns about young children and the vaccines (see below), which is typical at this stage of vaccination trials. 

It’s likely to be a long while before there is enough data to begin vaccinating children.   

How will vaccines be distributed in later phases?

Boulder County Public Health has said that in Phases 2 and 3, vaccines will be made available through a federal contract with 12 national pharmacy chains as well as regular health care provider offices.

How much will it cost residents to be vaccinated?

Nothing.

"As a condition of receiving free COVID-19 vaccines from the federal government, vaccine providers will not be allowed to charge individuals for the vaccine or administration of the vaccine," the CDPHE guidelines say. 

"Providers will also not be allowed to turn away an individual because of their inability to pay or medical coverage status."

This is not unprecedented. The State of Colorado allows individuals without private insurance, Medicare, Medicaid or Child Health Plan Plus (CHP+) to receive other recommended vaccines for free at select healthcare providers. 

How far apart are the doses adminstered?

Both the Pfizer and Moderna vaccines require two doses. Pfizer’s booster must be administered three weeks after the first shot, and Moderna’s has to be given four weeks later. While Pfizer’s vaccine needs a deep freeze of -70 degrees Celsius, Moderna’s requires a milder freeze of -20 degrees Celsius. 

On Jan. 18, the state directed hospitals to use their reserved second doses as first doses. Boulder County Public Health said it will not be adhering to this order because it does not have a vaccine reserve.

Still, it said: "We want to assure all Boulder County residents that second doses will be provided to those who receive a first dose."

Are there any concerns about the deep-freeze requirement? 

Administering vaccines at local hospitals that lack ultra-low freezers will be "challenging, although doable," Stolpman, the UCHealth director of pharmacy, said.

The Pfizer vaccine, she explained, arrives in storage containers that can extend the drug’s shelf-life by 20 days, without an ultra-low freezer. Upon  arrival, pharmacists have to replace the dry ice, extending the vaccine’s life by five days. They can do this up to three times, before placing the drug in the refrigerator, where it can survive an additional five days.

"You can get 20 days just using the ultra-low containers to get you going," Stolpman said. "That's going to be really really helpful when we have to start vaccinating the mass population."

Many hospitals already had ultra-low freezers, she explained. At two rural UCHealth hospitals, the state provided the freezers. (Click, and scroll down, to see where these freezers are in Boulder County.) 

Dr. Amie Meditz, an infectious diseases specialist for the Beacon Center for Infectious Diseases, operated by Boulder Community Health, said she was able to secure four portable ultra-cold freezers that will be capable of transporting the Pfizer vaccine to communities that can’t easily access vaccine hubs, once enough doses arrive.

How will the county ensure the vaccine is distributed equitably?

Chana Goussetis, Boulder County Public Health spokesperson, said the state’s distribution model inherently accounts for equity, as many of the individuals in priority categories are members of populations who have been disproportionately affected by the virus.

"For example, many workers in high-risk settings, such as long-term care facilities, often are new immigrants or non-English speaking residents, and many essential workers who directly interact with the public are part of our Latinx/Hispanic communities," she said. 

"What will be most important is ensuring that populations who have been most impacted have accurate and timely information about where and how to get vaccinated should they choose to do so," she said.

The city and county are relying on "a cross-sector collaboration of Cultural Brokers beyond city and county government" to deliver that information to vulnerable communities, according to Guillermo Estrada-Rivera, the program coordinator for Boulder County’s Cultural Brokers Resilience Program. 

Cultural brokers act as bridges between groups of different cultural backgrounds, to advance racial equity and social justice.  

"Cultural Brokers have already been working on this capacity by sharing resources and updates from original sources," he said.

What is the City of Boulder’s plan to encourage vaccination more broadly?

In short, the same: information. 

"The city will use its communication platforms to help amplify need-to-know information from our valuable health partners," said Sarah Huntley, the director of communication and engagement for the City of Boulder. 

What should we know about severe side effects?

No vaccine is free from side effects, but severe reactions to the Pfizer and Moderna vaccines have been rare.

A small number of healthcare workers have had serious allergic reactions to their doses, severe enough to be considered anaphylaxis. 

“People have allergies to vaccines,” Meditz, who was the first person to be vaccinated in the City of Boulder, said. “We do not know whether this is some sort of specific signal with this vaccine. We don’t have a denominator now of everyone who has gotten the vaccine.” 

Vaccine administrators, she explained, have safety precautions in place to reverse the rare case of anaphylactic shock. After receiving a COVID-19 vaccine, recipients are required to wait for observation, in order to rule out an allergic reaction. 

The CDC has said that people who have had serious allergic reactions to other vaccines should talk with their doctors about risks before geting the vaccine. If the reaction was to any ingredient in the COVID-19 vaccine, they should not receive it.

The agency wrote:

If you have ever had a severe allergic reaction to any ingredient in a COVID-19 vaccine, CDC recommends that you should not get that specific vaccine. If you have had a severe allergic reaction to other vaccines or injectable therapies, you should ask your doctor if you should get a COVID-19 vaccine. Your doctor will help you decide if it is safe for you to get vaccinated.

CDC recommends that people with a history of severe allergic reactions not related to vaccines or injectable medications — such as allergies to food, pet, venom, environmental, or latex — may still get vaccinated. People with a history of allergies to oral medications or a family history of severe allergic reactions, or who might have an milder allergy to vaccines (no anaphylaxis)—may also still get vaccinated.

Following her own inoculation, Meditz said that her only symptom was a mildly sore arm the next day. “That’s my immune system responding to the proteins my cells are making — the spike protein,” she added. “Even if people get a little more symptomatic, that’s OK. It’s your immune system responding to these proteins.”

In an interview, she described the fast path to the vaccine as “one of the most breathtaking moments in science.”

“I was just starting my career when we first developed treatment for HIV,” she said. “It has that feel. You just feel that potency. This is something even more robust. This could reverse this pandemic."

What are some important unknowns about the vaccines at this point?  

1. How long protection will last. 

Both the Moderna and Pfizer Phase 3 clinical studies will last two years to determine the durability of the vaccine’s protection. (That’s standard for a Phase 3 trial.) Researchers are only four months into the COVID-19 trials. 

"We need to know what happens over the long-term and whether protection diminishes," Campbell said. "And of course, if it does, there might be a need for another booster dose at a later time."

2. The vaccines' effectiveness in children.

There are question marks about whether the current vaccines could be effective in individuals under the age of 18. Pfizer only recently began enrolling adolescents in its studies, and Campbell said he knows of no trials involving younger children. 

"The answer to that question lies in what are these vaccines intended to do?" he said. 

The initial intention of vaccine development, Campbell stressed, has been to prevent the occurrence of COVID-19 illness, rather than stop the transmission of SARS-CoV-2 virus.

In a school environment, this means that the goal of vaccination would be to protect the teachers from becoming sick if they were exposed to SARS-CoV-2, rather than eliminate the virus’s existence entirely.  

"If we protect the vulnerable part of the population that is at risk for getting very sick, then it’s possible that schools could open even without getting children vaccinated," Campbell said. 

"It’s really a question of how much the infection of children contributes to the current spread of COVID-19. We won’t know that until we see what the effect is of vaccinating adults. The important things to monitor will be hospitalizations and illness of COVID-19."

3. Pregnancy and breastfeeding.

None of the vaccines in development have been tested on pregnant women or women who are breastfeeding. The CDC has said pregnant and lactating women should have the opportunity to be vaccinated, if they choose, but they should discuss their situations with their healthcare providers. 

“We really have no data to speak to risks specific to the pregnant women or the fetus, but also no data that would warrant a contraindication to use in pregnancy at this time,” said Dr. Doran Fink, deputy director for vaccine development at the FDA, according to The New York Times. 



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