Atrium canceling 97 COVID vaccinations, faces scrutiny over who’s in line next

Some at Atrium Health who were scheduled to get their first dose of a COVID-19 vaccine next month will be delayed, following a controversy this week over non-medical employees being included in the first phase of vaccine distribution.

Officials at Atrium told the Observer on Thursday as many as 97 employees will have vaccination appointments canceled. Based on North Carolina health officials’ vaccine guidance published in October, those first in line should be “healthcare workers and medical first responders who are at high risk of exposure based on work duties or who are vital to the initial COVID-19 vaccine distribution.”

“I can assure you that the only people who have received vaccines by Atrium Health were categorized by (Phase) 1a...” Dr. Scott Rissmiller, Atrium’s executive vice president and chief physician executive, told the Observer. “The key is to get those most at risk and those who are on the frontlines risking their lives for the community. We get the vaccine to them so they can care for those who need it as others are waiting.”

The issue arose after several Charlotte television stations reported on Atrium social media manager, Katie McKiever, tweeting she’d scheduled her first vaccine appointment for early January. The celebratory message quickly erupted into controversy as people tried to determine who should — and should not — receive the initial doses of an extremely limited supply from Pfizer and Moderna.

Atrium previously submitted a list of tens of thousands of hospital employees who needed vaccinations to the North Carolina Department of Health and Human Services.

The department then screened and categorized those Atrium employees, including who fit into Phase 1a, Rissmiller says.

In public statements, though, state officials said they do not individually approve vaccine recipients.

A spokeswoman for DHHS sent a statement Thursday to the Observer saying it’s the responsibility of hospitals and providers to verify individual recipients are in the priority group.

“As part of the vaccine provider agreement, all vaccine providers agreed to follow the state’s vaccine guidance. Balancing maximum impact of the vaccine with priority needs of North Carolinians requires providers to follow the state guidance as doses are distributed across the state each week,” the statement says.

Atrium officials also say they’ve revised the system’s internal plan for vaccine distribution to exclude non-frontline healthcare workers from the first phase. Atrium told the Observer Thursday that this occurred on Wednesday night — when state health officials, incorporating feedback from the hospital, revised criteria for the first phase of vaccine distribution.

However, DHHS has not released publicly, as of Thursday, new guidance on the first prioritized population. On the agency’s website and in the agency’s 148-page vaccination plan, workers included in the first phase includes “those caring for COVID-19 patients, cleaning areas where COVID-19 patients were admitted (and) performing procedures at high risk of aerosolization.” The first priority group, according to DHHS, also includes home health nurses, dentists, pharmacists, paramedics, workers who tend to the bodies of those who have died from COVID-19, those who administer coronavirus vaccines and long-term care facility workers.

The next subset, Phase 1b, is expected to include healthcare employees who are not on the frontlines of COVID-19 patient care or vaccinations.

In these early days, transparency surrounding the vaccine process is still murky, with the public and media not able to observe the nuanced decision-making at play and who ultimately is inoculated daily, beyond demographics like race, age, ethnicity and gender.

The state’s COVID-19 dashboard now has a tab logging vaccinations in all counties, though the raw numbers offer scant insight into the people behind the data. To complicate matters, the weekly allocation and anticipated shipment date is unclear to hospitals and the county health department — making it tricky to forecast vaccine counts even in the short-term.

More than 4,000 Atrium employees have received their first dose as of Thursday afternoon, said Atrium spokesman Chris Berger. And more than 10,500 scheduled their first appointment, though that volume could change again, he said.

Rissmiller said Atrium has begun deploying its surge capacity plans, which include pulling employees from their normal positions. Someone who holds a more administrative-focused role, for example, may transition to a patient-facing job to avoid a staff shortage among doctors and nurses. That also complicates questions about vaccine eligibility and priority classifications.

Atrium is in near constant communication with DHHS. As recently as Wednesday, Atrium CEO Gene Woods spoke with DHHS Secretary Dr. Mandy Cohen, Rissmiller said.

“I think it’s important to remember this is a massive and extremely complex undertaking,” Rissmiller said. “I feel really good about where we are two weeks into this ... Nobody is trying to do anything here that does not follow strictly the intent and the process, and we’re committed to the community.”

Phased vaccine distribution

North Carolina’s phased vaccine framework was too broad for Atrium to fairly divvy up doses, Rissmiller said, so the hospital created its own four classes within Phase 1. Vaccinations for Atrium’s top two classifications, mostly encompassing frontline clinicians, are already underway.

But the third classification, including physicians and other employees not directly treating COVID-19 patients, is what partially triggered the social media firestorm about essential workers and vaccine eligibility.

The fourth tier is intended for the rest of Atrium’s workforce, including those in corporate services and working remotely (Rissmiller falls into that category).

No one assigned to these tiers has been vaccinated yet, Rissmiller said.

Vaccines cannot come soon enough for medical workers on the frontlines, as a staggering second wave of infections has led to record-breaking hospitalizations in the Charlotte area and across North Carolina.

Groups included in Phase 1b include frontline workers with two or more chronic conditions at high risk of exposure, healthcare workers not included in Phase 1a with chronic conditions, migrant workers in congregate housing with multiple chronic condition or are 65 and older, those who are incarcerated or in homeless shelters with multiple chronic conditions, and other adults with multiple chronic conditions.

Cohen, the DHHS secretary, said the pace of vaccinations is dependent on how quickly doses are manufactured and administered, and if additional vaccines, beyond Pfizer and Moderna, receive emergency use authorizations. At a recent new conference, she predicted vaccines won’t be widely available until “well into the spring.”

Phase 2 includes migrant workers, people who are incarcerated, residents of homeless shelters, and frontline workers who do not have two or more chronic conditions. It also includes individuals over 65 and teachers, school staff, and any adults with one chronic health condition.

School-aged children and young adults will be vaccinated in Phase 3, which also includes essential workers at increased risk of exposure with no chronic health conditions.

The remaining population, adults with no underlying health conditions, will be vaccinated in Phase 4.

Devna Bose contributed to this report.