As the first frontline workers begin receiving their COVID-19 vaccines, many are left wondering when they may be next in line. Details about the next stages of vaccine rollout are emerging on pace with supply, but much is still unknown about where, when and how more San Mateo County residents will get their shots.

With 22,200 doses received so far, 16,500 distributed and more on the way, the county is on track to get enough vaccines to its 38,000 frontline health care workers and 12,000 residents of long-term care facilities soon. But the next phase of distribution, set to start mid-January, will be entirely new territory. 

Next up for the vaccine, according to San Mateo County Health Chief Louise Rogers, are high-priority essential workers and residents age 75 or older, followed by people 65 to 74 years old. That edict follows the state’s soon-to-be-released guidance. The third phase is set to be complete by late spring and is likely to include adults 50 to 64 and anyone with underlying medical conditions as well as the remaining essential workers. Prioritization of workers will take into account “societal impact of the job, equity, impact on the economy and occupational exposure/risk,” Rogers wrote in an internal update to county health staff and partners. In California, 68 percent of all workers fall into the essential worker category.

It’s not yet clear how, logistically, any of those groups will get access to the vaccine and if they’ll have to prove their status or qualification in any way. 

The first phase of vaccination of the so-called “1a group,” including health care personnel, emergency first responders and long-term care facility residents, has been largely successful, Rogers wrote. She said around 33 percent of eligible county residents vaccinated with their first dose. Health care providers have taken the lead on vaccinating their own staff and will handle their members, too. CVS, Walgreens and now Safeway, are going into dialysis centers and long-term facilities this and next week, with 15 of the county’s 17 skilled nursing facilities and 60 other congregate facilities already scheduled for vaccination.

“The roll out of the first vaccines has gone smoothly,” Rogers wrote on Dec. 24.

But the phase 1 rollout may not prove a good model for subsequent phases, which could require much more complex logistics and more coordination with health care providers and across county lines. Rogers said at Tuesday’s county Board of Supervisors meeting that the vast majority of residents, around 80 percent, will get their vaccinations from their health care provider. The remaining 20 percent of residents will fall to the county. Plus, Rogers said that with a new administration coming to the White House, supply may increase dramatically and distribution plans will evolve.

“We have a very strong impression that the game plan will likely change, especially as the new federal administration grapples with the bandwidth, pipeline and pace of the rollout,” Rogers said.

The county’s vaccination distribution plan, sent to the state on Dec. 4, indicates that drive-through or walk-up clinics might be utilized, similar to successful socially distanced flu clinics this year. Details, however, have been scant.

There is one indication of how future vaccination events might roll out. This week, the county opened the San Mateo County Event Center as a mass vaccination site for eligible 1a residents only. The drive-through site requires advanced online registration and for patients to confirm their eligibility under penalty of perjury. Anand Chabra, section chief of COVID-19 Mass Vaccination at the county, said the weeklong event could get up to 11,000 Moderna shots into arms. But the site is targeted: It’s only set to operate this week and in four weeks when patients come back for their booster shot. 

And last week, in partnership with local fire departments and American Medical Response, which runs local ambulances, the county helped run vaccination clinics to get shots to around 1,200 local first responders. 

Cal Fire Public Information Officer Cecile Juliette said Cal Fire’s designated infection control officer worked with the county Health Department to create a vaccination schedule of eligible firefighters based on their shift schedules. She said firefighters were required to bring identification to the clinic.

“We had an overwhelming majority of our firefighters choose to get the vaccine,” Juliette wrote in an email to the Review. “That includes all first responders who might have patient contact in the course of their duties."

For local doctor Dan McMillan, the lack of clarity about upcoming vaccine distribution isn’t a surprise.

“Basically, we have almost no guidance,” said McMillan, who sees patients at Purisima Family Medicine in Half Moon Bay. “It's not that surprising given our chaotic federal response. Why would we expect this to be different, or smooth?”

McMillan has gotten phone calls from patients asking when they might be eligible for the COVID-19 vaccine. While he doesn’t have answers, he can give advice.

Because people will still be advised to take precautions like mask wearing and social distancing even after having been vaccinated, McMillan said he is telling his patients not to be too concerned about their place on the list. While he hopes to get the vaccine himself when it’s his turn, he says there is an upside to waiting. 

“My message is this: If they’re not the first people to get the vaccine, don’t panic,” McMillan said. “People who are last to get it, consider yourself lucky. You will have a few more months to see what happens.”

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