CHARLES TOWN – Lolita Kirk remembers several flash points during her 30-year career in public health. The mobilization of the health community during the H1N1 influenza pandemic in 2009, she said — that was a hectic, stressful time.
But Kirk, the executive director for the Putnam County Health Department in Winfield, said nothing compares to the coronavirus — it’s a 100-year natural disaster for today’s public health officials.
“This has been the hardest response to date for me because it’s been such a long response,” she explained.
Nearly a year ago this month, the first coronavirus infection occurred in Jefferson County. Since then our county’s response to the pandemic reaching West Virginia has played out similarly in the state’s 54 other counties.
Local health departments across West Virginia have been facing similar challenges: Unprecedented and unfamiliar challenges. Limited information. Continually shifting circumstances, processes and priorities. Cumbersome technology. Short-handed staff. Uncertain funding.
“Every place has its own problems, but every place is having problems to a greater or lesser extent,” offered Dr. Terrence Reidy, the chief health officer with Jefferson County’s Health Department.
Meanwhile, West Virginia is set to receive its first shipment this week of the Johnson & Johnson vaccine that the federal government recently approved. The state should receive 15,500 doses, state officials said.
In addition to the Johnson & Johnson vaccine, the state will also be receiving more than 70,000 doses of the Pfizer and Moderna vaccines this week.
“We’re ready for these doses,” Gov. Jim Justice said. “We’re going to knock them out just as fast as they get here.”
This week, Jefferson’s health department will be administering nearly 1,800 doses of vaccine, six times the amount it has delivered before in a similar timeframe. Meanwhile, 27 other counties in West Virginia have received exponentially larger shipments of coronavirus vaccinations to administer. Coping with the vaccination challenge has created common challenges for all of those communities. Every health department is scrambling.
Putnam County in western West Virginia, where Kirk serves as executive director of the health department, and Harrison County in the state’s central region, where Chad Bundy serves as the community’s health department administrator, are among them.
Putnam is distributing about 1,440 vaccination doses this week, three times what the county handled before. Harrison is giving out 2,200 shots, also exponentially more than it has ever managed in a week.
Putnam has a population of 57,000, close to Jefferson County’s. The Putnam County Health Department operates with a staffing of four full-time employees and six part-time nurses and office support staffers.
Harrison’s population is about 67,000, and its health department has 13 full-time staff members with a couple of part-time office assistants.
Jefferson County’s population sits at 57,146 and its health department currently has 10 of its 14 full-time positions filled, along with two permanent part-time positions and eight temporary part-time positions.
In both counties, marshaling the community talents, resources and able bodies has been a key part of the formula for their stressed and harried successes so far, according to Kirk and Bundy.
“The only way you can get a job like this accomplished is community support,” Kirk said. “It’s the only way.”
Employees from every county agency in Putnam, from the prosecutor’s office to the county commission office, are turning out to help at vaccination clinics. Volunteers from skilled retirees to Boy Scout troops have pitched in.
It’s a similar story in Harrison, where hospital staff and emergency medical responders are among those administering shots. Bundy said about two dozen agencies are providing staff to work vaccination clinics.
Both Putnam and Harrison counties need about 50 volunteers to efficiently conduct a vaccination clinic that will process hundreds of people in a single day. That reflects Jefferson’s experience so far, too.
Kirk and Bundy said the biggest, most important task is preparing for a clinic beforehand.
In Harrison, on-site organization and preparations to arrange equipment and materials begin the day before a clinic, Bundy said. Sometimes that preparation takes a full day to set up.
Managing the flow of traffic to and from a clinic, and keeping people away who don’t have appointments with a clinic, has been important to keeping mass vaccination events operating efficiently, Bundy said. Harrison has been using an armory building with security fencing and gateways that allow officials to screen people entering the clinic, an advantage that keeps those without appointments out of the way and the clinic queues flowing, he said.
For Kirk, fielding the rush of incoming phone calls every time a new vaccination development occurs can be overwhelming. “I can have every phone in this building with a body sitting at it all day every day and still miss phone calls,” she said.
To alleviate the scheduling challenge, Harrison officials arranged to have the county’s 911 communications center provide technical help in directing the spike in calls to and from the health department. The system was designed with multiple incoming and outgoing phone lines, receiving first calls to the health department.
That allowed dispatchers to direct calls to people prepared to manage those calls and take or provide whatever information necessary. Working this way, Harrison’s health department can schedule appointments for about 35 people every 15 minutes or about 140 people an hour, Bundy said.
“Once we figured that out — it took us three or four or five big clinics to figure that out — that changed everything,” he said.
Harrison County began using a live spreadsheet in Google Docs software that allows several people in different locations to share and work on the same vaccination waiting list to schedule appointments. Using the software, people can see the same information and changes made by others in the same document, but only one person at a time can add or change the information in a particular place in the document, Bundy explained. In that way, everyone is working with the latest information in real-time, preventing wasted effort on redundant calls and appointments.
Every county and local health department in West Virginia is ironing out processes and solutions to fit their particular resources and circumstances, Kirk and Bundy acknowledged.
However, Kirk has offered her own advice to her tired and frazzled staff. “I tell my staff here worrying about this vaccination thing: This isn’t a sprint, it’s a marathon,” she said. “We have to try to pace ourselves.”