School, food-service workers again eligible for vaccine in Marin
Marin County last week reinstated COVID-19 vaccine eligibility to high-risk essential workers in education, child care, food service, agriculture and emergency services, while high-schoolers were to return to classrooms this week.
Meanwhile, the U.S. Food & Drug Administration issued emergency-use authorization for a single-dose COVID-19 vaccine; the three drug manufacturers are ramping up production; and the University of California at San Francisco scientists warn that an easily spread mutation that’s evading antibodies is being increasingly found in Marin and should be considered a “variant of concern” like those in Great Britain, South Africa and Brazil.
The Feb. 24 eligibility announcement re-expands Phase 1B, Tier 1 in the county’s localized model of the state’s vaccine-distribution framework, which had initially included high-risk essential workers before Marin temporarily suspended occupation-based eligibility to focus on an age-based model.
To date, more than 60 percent of Marin residents ages 65 and older have received at least one shot of the two-dose Pfizer and Moderna vaccines.
“We’ve made a lot of progress in vaccinating our health-care workers and older residents, and it’s time to move ahead to protect our essential workers,” Dr. Matt Willis, Marin’s public health officer, said in a press statement. “Vaccinating teachers, food-service workers and others who have been on the front lines will offer our community another crucial layer of protection as we roll out the vaccine.”
The county has the oldest average population in the state, with a quarter of all residents over age 65. At the same time, some 93 percent of Marin’s COVID-19 deaths have been among those 65 and older, three of four among those 75 and older.
After completing its initial offering in January to those in Phase 1A — a three-tier phase that included first responders, health-care providers and those in congregate senior-living facilities — Marin moved to the first tier of Phase 1B, which at the time included those 65 and older and high-risk essential workers. The transition included a Jan. 17 mass-vaccination event at Marin Center for more than 1,200 school workers, a fraction of school workers countywide.
However, on Jan. 21 the county announced that, outside of health care, it was suspending occupation-based eligibility and raising the age minimum to 75. Willis said at the time that if eligibility was immediately extended to all those in the first tier, roughly a third of the county’s residents would qualify, creating a demand that would far outstrip weekly supplies. Those supplies have been limited by manufacturing rates and, more recently, by supply-line and shipping interruptions amid winter storms enveloping the Midwest and South.
Willis noted the age-based move in Marin has maintained health equity among disadvantaged populations, with the proportion of deaths among older residents nearly equivalent to Marin’s population along racial and ethnic lines.
Marin on Feb. 15 reincorporated eligibility for those 65-74, though Kaiser Permanente, which reportedly serves one in four Californians, initially continued to vaccinate only those 75 and older, reflecting the age of its patients. Kaiser, as a major provider, gets its supply directly from the state rather than through the Marin Health Department; it has now expanded eligibility to those 65 and older.
In the interim, the two strategies and limited local appointment availability had a ripple effect in the Bay Area, as surrounding counties including Sonoma, Alameda and San Francisco continued with the broader eligibility and were working to vaccinate their own residents and workers 65 and older and in high-risk occupations. Counties get their allocations based on efforts to vaccinate their own residents and workers, but some county-run sites weren’t verifying the eligibility of those booking appointments. Many Marin residents ages 65-74 or in high-risk jobs, including in Tiburon, who couldn’t get access to the vaccine locally began booking appointments in neighboring counties, reducing already-limited supplies for eligible vulnerable populations elsewhere. Both of San Francisco’s mass-vaccination sites, at Moscone Center and City College, were forced to shut down mid-month due to limited supplies.
Last week, SF Gate reported that ineligible Marin residents have been sharing access codes intended for vulnerable Black and Latino populations — who represent more than three of every four cases in Alameda County — and using them to reserve appointments at the Oakland Coliseum’s mass-vaccination hub.
To date, 22.9 percent of Marin residents, more than 59,000, people, have received their first dose, with nearly 27,000 of those receiving their second dose.
About 25 percent of school workers have received vaccines as of last week, according to Superintendent of Schools Mary Jane Burke.
Kaiser and MarinHealth Medical Center are contacting eligible patients individually when vaccines and appointments are available and request residents do not use online or phone appointment-booking services in order to keep the lines clear.
Sutter Health is offering its patients appointments online and by phone.
More commercial pharmacies, including CVS, RiteAid and Walgreens, as well as those inside Safeway and Costco, are expected to offer vaccines within the next two weeks as doses become available.
The county also has mass-vaccination sites at Marin Center and the Larkspur ferry terminal.
To find more information and to book appointments, visit coronavirus.marinhhs.org/vaccine/status.
The county also has its own vaccine-interest form, at coronavirus.marinhhs.org/vaccine, which has been touted as a one-stop sign-up and notification system for all health-care providers and for the uninsured. However, the form does not request occupation information that could play a role in individual eligibility alongside age, health conditions and whether someone resides in a congregate-living facility.
The state also has an eligibility-notification and appointment-booking website, at myturn.ca.gov, which does include occupation-based eligibility selections.
The county has not yet announced when it will enter Phase 1B, Tier 2, which includes moderate-risk essential workers in transportation and logistics and critical manufacturing, as well as congregate settings including prisons, jails and homeless shelters. However, those criteria may change.
Phase 1C, for now, is to include those 50-64, those 16-49 with underlying health conditions and low-risk essential workers, including those in water and waste management, defense and energy, and government workers and media.
Phases 2 and 3, to reach the general population, are targeted to begin in spring and summer, respectively.
FDA approves single-dose vaccine
The FDA on Feb. 27 issued emergency authorization for the single-dose Johnson & Johnson vaccine against SARS-CoV-2, the virus that causes COVID-19.
The company was to begin shipping millions of doses this week, with 100 million provided to the U.S. by the end of June.
Unlike the Pfizer and Moderna vaccines, which use messenger RNA, the Johnson & Johnson vaccine uses an inactivated adenovirus — the one that causes the common cold — that contains a piece of DNA that tells the body to make the coronavirus spike protein. That triggers an immune response and creates antibodies to provide future protection against infection. Like the other two vaccines, Johnson & Johnson’s single-dose shot does not contain any live virus and cannot infect the recipient.
While the new vaccine was found to be 85-percent effective in preventing severe and critical illness and 66-percent effective in preventing symptomatic illness versus the 94- to 95-percent effectiveness of the Pfizer and Moderna vaccines, experts say those direct comparisons are misleading. Trials for Johnson & Johnson’s vaccine included some of the newer, more-contagious variants, while the Pfizer and Moderna vaccines did not — making them all effectively equivalent in warding off the disease and its variants under current conditions.
The Johnson & Johnson vaccine was also 100-percent effective in preventing hospitalization and death from COVID-19.
It can also be stored at normal refrigeration temperatures for up to three months and is less prone to the side effects of the Pfizer and Moderna vaccines, which are typically seen after the second dose that the Johnson & Johnson shot doesn’t require.
More doses on the way
Of the two-dose vaccines, Pfizer is reportedly increasing its deliveries to 13 million per week by mid-March, up from 5 million in February, and Moderna will double to 10 million per week by April. Both need a second dose, three and four weeks apart, respectively.
Johnson & Johnson is expected to deliver 20 million doses this month.
If the manufacturers meet expectations, which would provide more than 150 million doses in the U.S. in March and April, experts suggest bottlenecks in distribution and vaccine hesitancy by residents may be the only obstacles to reaching 70-percent inoculation nationwide by the end of April.
That figure is considered a crucial initial goal to reach herd immunity, in which enough members of the population are protected against the virus to slow or even stop community transmission, which in turn protects those who have never been infected or vaccinated.
Variant has increasing prevalence in Marin
In a new study, UCSF researchers said the California coronavirus variant B.1.427/B.1.429 was found in six of 38, or 15.8 percent, of Marin samples collected mid-December to early January, up from just a single case in 156 samples from November to mid-December.
Statewide, it was found in more than 50 percent of samples collected in late January.
USCF virologist Dr. Charles Chiu, who discovered the variant, warned the strain could account for some 90 percent of all cases by the end of this month, though it remains unclear how much of a public threat it poses.
Chiu’s team found the strain was 40 percent more effective at invading cells and produced twice the viral load, while antibodies produced by those who recovered from other variants were four times less effective at blocking the California strain. Antibodies produced by the Pfizer and Moderna vaccines were two times less effective at blocking the variant.
As a result, those infected were 4.8 times more likely to require intensive-care-unit hospitalization and 11 times more likely to die.
The preprint study has not yet been peer reviewed, and other experts commenting on the study in major science and news publications warned against “overinterpreting” it.
Chan and other researchers acknowledge the effect on immunity appears to be smaller than the South Africa and U.K. strains and that the spread of the variant may be minimized by reducing ongoing transmission through rapid vaccination of the population.
Chan warned, however, that over time the variant has the potential to impact the ability to vaccinate.
Though not officially recommended in Marin, health experts nationwide have been increasingly encouraging double masking — ideally by pairing an N95 or equivalent respirator with a surgical mask — as way to protect against the spread of variants.
Marin officially moves to red tier; Redwood High reopens
California on Feb. 23 confirmed Marin’s assignment to the red tier, indicating substantial transmission of the coronavirus, effective the following day. The county was one of just two in the Bay Area, including San Mateo, to be allowed into the red tier, which in part allowed for secondary-school students to return to classrooms.
Local health officials had been expecting re-assignment going into last week.
The move from the most-restrictive purple tier, indicating widespread transmission under the state’s four-tier blueprint for reopening the economy, allowed indoor retail and malls to expand to 50-percent capacity; indoor dining, worship, movie theaters, museums and zoos to reopen at 25-percent capacity; indoor gyms and fitness centers to reopen at 10-percent capacity; and wineries, family-entertainment centers and cardrooms to reopen outdoors only.
It also allowed for high schools to open five days later. The Tamalpais Union High School District — which includes Redwood, the main public high school for Tiburon Peninsula students — was to have its first day of in-person learning in nearly a year on March 2, after The Ark’s press deadline.
The district is using a hybrid model, with three cohorts of students rotating between in-class instruction and distance learning. It plans to return to full-time in-class instruction in August to start the 2021-2022 school year.
Even though Marin’s seven-day adjusted new-case rate was 7.4 per 100,000 on the evaluation date, greater than the 7-per-100,000 rate allowed to qualify for the red tier, Marin was allowed to advance because its seven-day test-positivity rates were low enough to qualify for the orange tier indicating moderate transmission. Those test-positivity rates were 2.2 percent for the county as a whole and 3.4 percent rate among its most vulnerable populations.
Free public transit for vaccinations
Starting Feb. 24, Marin Transit and Golden Gate Transit began offering trips to and from any vaccination site.
Riders must provide printed or digital confirmations of same-day appointments when boarding.
The effort, which also includes Golden Gate Ferry and Sonoma-Marin Area Rail Transit, intends to reduce cost and transportation barriers for those seeking the vaccine.
Kevin Hessel is The Ark’s executive editor. Reach him at 415-435-2652, on Twitter at @thearknewspaper and on Facebook at fb.me/thearknewspaper.