A nurse prepares to administer the Pfizer Inc./BioNTech COVID-19 vaccine to health care workers at Michigan Medicine on Tuesday, December 15, 2020. Dominick Sokotoff/Daily.  Buy this photo.

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Some health care workers at Michigan Medicine are dissatisfied with the health system’s vaccine prioritization plan, alleging that the algorithm used to determine who gets the vaccine first does not accurately prioritize those who are at higher risk of COVID-19 exposure in the hospital setting.

The concerns mainly stem from members of the House Officers Association, a union representing resident physicians at Michigan Medicine. Resident physicians are medical school graduates who are training in a specialized field of medicine, some of whom directly interact day-to-day with COVID-19 patients. 

HOA Executive Director Robin Tarter told The Michigan Daily she is concerned that the plan does not give first access to the groups that have the highest exposure risk for COVID.

 “The handler of the therapy dogs got a vaccine before my 75-year-old faculty attendees in anesthesiology, and the optics of that seem so wrong,” Tarter said.

Last week, frontline workers at Stanford Medical Center, including numerous resident physicians, protested the hospital’s vaccine rollout plan for not including them in the original vaccine list despite working in areas that have high risk of COVID-19 exposure.

In a Dec. 22 email to The Daily, Michigan Medicine spokesperson Mary Masson said the health system will be following the Centers for Disease Control and Prevention and Michigan Department of Health and Human Services guidelines for vaccine prioritization.

“There are many classes of individuals who fall into these higher risk categories that are involved in the care of COVID-19 positive patients — ranging from nurses to residents and fellows to faculty physicians to respiratory therapists and many others, including environmental services and food services workers,” Masson wrote. “Above all, Michigan Medicine is striving to get the vaccine out as safely and quickly as possible, prioritizing the highest-risk members of the University of Michigan community first.”

The prioritization plan developed by Michigan Medicine aims to vaccinate all members who fall into the Tier 1 subgroup of Phase 1A by January 11. This category includes staff working in patient care areas with patients suspected or known to have COVID-19, the intensive care unit and the emergency departments.

In an email sent to HOA, Michigan Medicine wrote that the classification of employees who fall into this category was based on a survey which asked for respondents to self-identify. The Michigan Medicine task force then used an algorithm to take responses to this survey and randomize invitations to get vaccinated across all departments. This randomization is meant to prevent potential short-term side effects of a second dose from keeping many employees in a single department home at the same time, the email said.

In the email, Michigan Medicine leadership wrote that they “decided to put trust in the respondents’ self-report, and move forward to expedite the vaccination process. That could mean that someone made it through that did not fit the criteria. We believe that is a rare occurrence.”

Employees with additional risk factors were given special consideration. The number of invitations being sent out to staff is also dependent on the quantity of vaccine available, the email said.

HOA had originally planned a protest for Dec. 22, but canceled it after Michigan Medicine provided more transparency on the vaccination process. While HOA did cancel the protest, the association still disagrees with Michigan Medicine’s decision making, HOA leaders Tarter and Steve Smith wrote in an email to members.

“We do not agree with the prioritization plan, but we do recognize that the university increased communication, expanded hours, and communicated the plan to vaccinate Phase 1, Tier 1A within three weeks,” Tarter and Smith wrote. “It is our view that all of these positive changes were a direct result of the dissatisfaction expressed by our members, and our continued discussions with leadership.”

Tarter said that though the union still disagrees with the effectiveness of the algorithm used to determine prioritization, they acknowledge their employer’s right to make such a decision.

“We just disagree with how they decided they were going to randomize the invitations that they sent out for direct and indirect employees to get the vaccine,” Tarter said. “What it boils down to is that the algorithm does not prioritize people who work in the ED or in ICU’s. There’s a big difference between a frontline worker and an essential worker, and we hoped that frontline workers (would be prioritized) first.”

An HOA member, who wishes to stay anonymous due to fear of repercussion from the Michigan Medicine administration, said she was disappointed with an initial lack of communication about the rollout and prioritization process. Though the vaccination program began Dec. 14, this member, who will be referred to as Jane, said she has not yet been sent an invitation to schedule her vaccine administration.

“Last week when the vaccine arrival was highly publicized on Michigan Medicine’s social media platforms, it brought a lot of hope,” Jane said. “But then after, for like a week, we didn’t hear anything so it seemed very nebulous to us as to who is getting prioritized. And just to see all of our friends across the country, from big hospital systems to small community hospitals, already have gotten vaccinated without a whole lot of drama, it just feels really unfair.” 

Without knowing when she’d receive a vaccine from Michigan Medicine, Jane decided to get her first dose of the Pfizer vaccine from the Washtenaw County Health Department on Dec. 22, which currently administers the vaccine to all critical health care workers on a first-come, first-serve basis. She will be going back in three weeks for her second dose.

Jane said she is aware that residents who are in their 20s and 30s would be at the end of the line for prioritization since they are relatively younger and less at-risk for severe illness from COVID-19. However, she said residents are often the first to see a COVID-19 patient, mark them as needing critical care and pronounce them dead if they die from COVID-19, and thus should have been offered some clarity on when they could get their vaccine.

“It was just morally distressing,” Jane said. “We have put the hospital system first — above the needs of our own families — and that risk that we just take every single day by going to work … it almost made that feel like we weren’t necessarily being recognized for that sacrifice.”

Like Jane, Mary, another resident physician who wishes to stay anonymous due to fear of repercussion from the administration, also decided to get the Pfizer vaccine at the Washtenaw County Health Department. Mary said she was upset that Michigan Medicine waited until the initial supply of vaccines had arrived on Dec. 14 before sending out that questionnaire to employees to determine prioritization, which slowed down the process.

“I’m not sure what they were thinking with that, especially in a pandemic,” Mary said.

Susan Ringler-Cerniglia, a spokesperson for the Washtenaw County Health Department, said that they are working in collaboration with Michigan Medicine to administer as many vaccines as possible. There is a separate survey for health care workers to fill out that supports workers who are “not being vaccinated through a larger organization and will need to be vaccinated through the Health department.” Both Jane and Mary said they filled out that survey.

Michigan Medicine plans to have all essential employees under Tier 1 of Group 1A vaccinated by Jan. 11, with vaccine administration continuing through the holidays. As of Wednesday morning, Michigan Medicine has received 11,950 COVID-19 vaccine doses and administered 6,003 doses. 3,205 appointments are scheduled through Sunday, and 5,120 appointments are available over the next 7 days.

Kinesiology junior Amaya Farrell works at an acute rehabilitation facility in Ann Arbor that is an outsourcing facility for Michigan Medicine. Farrell said she is concerned no one at the facility has had the opportunity to receive a vaccine yet. The workplace has had multiple outbreaks, and Farrell and other employees have caught COVID-19 from the facility, she said. 

“It’s interesting to see because hospitals have seemed to be prioritized before assisted living homes and subacute rehab facilities, which are still health care facilities with high risk, live-in patients,” Farrell said.

Doctors and hospital staff often are not in the room with the patient for more than a few minutes, but in a rehab facility, health care workers can be in close proximity to a patient for up to an hour at a time, Farrell said. 

Farrell acknowledged that Michigan Medicine is rolling out a mass vaccination campaign for the first time, as is every health care system, but she asked that the administration keeps in mind the sacrifices all frontline employees and health care workers have made.

“You can’t operate in a healthcare facility without all the moving parts,” Farrell said. “And if you aren’t protecting (all parts) adequately, you’re going to lose them, whether it be by death, or by choosing to quit their job due to unsafe health, like working conditions.”

Daily Staff Reporters Shannon Stocking and Varsha Vedapudi can be reached at sstockin@umich.edu and varshakv@umich.edu.

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