BCHHS Public Health Provider Update: COVID vaccine updates; transition into Phase 1b, group 1

January 11, 2021






COVID-19 Situation Update

  •          As you are likely well aware, we continue to experience a high volume of new COVID-19 cases, hospitalizations and deaths in Buncombe County and across the state. The percent of tests coming back positive for COVID-19 in Buncombe County is currently at 11.7% (with over 7,600 tests performed the week of 12/27/2020). For the state as a whole, 13.7% of tests are positive. Additional data can be found on the NCDHHS COVID-19 dashboard.
  •          Recently, NCDHHS instituted a new process whereby people who test positive for COVID-19 may receive a text message alerting them of their positive result along with guidance on what to do. This message will only be sent if a valid cell phone number is included with their lab information and their lab result automatically feeds into the state’s COVID-19 reporting system.

COVID-19 Vaccine Rollout Update

  •          Buncombe County Public Health has finished our 3rd week of COVID-19 vaccination of Phase 1a healthcare workers and LTCF residents & staff. This past week we finished our initial Moderna shipment and switched to administering our Pfizer-BioNTech inventory.
  •          We will begin adding in the Phase 1b, group 1 population (anyone 75 years or older, regardless of health status or living situation) on Monday, 1/11, while we continue to vaccinate the remaining Phase 1a population.
  •          To do this, we are scaling up our operations with more staff and a more accessible space at the AB Tech/Mission Conference Center (16 Fernihurst Dr., Asheville, 28801).
    •    Walk-ins will not be seen at our vaccination clinics. Vaccinations will occur by appointment only.
  •          As we expected, the 75 and older population is very eager to be vaccinated and late last week they flooded our phone lines to try to get COVID-19 vaccine appointments. We added an online scheduling option to take burden off the phones, and those appointments filled up quickly. Please refer your patients/friends/family in this age group to the COVID-19 Immunization button on the www.buncombeready.org website for up-to-date information on how they can get their vaccine appointment through us. This information also is being shared with our local media partners.
  •          It is important that everyone remembers that we continue to have a limited supply of vaccine that is shipped to us weekly based on state allocations from the federal government, typically with less than a week’s notice of how many doses we will get the following week. This limits our ability to open large numbers of appointments far out in advance. It also means that our available appointments are limited and fill up very quickly when there is large demand. As we are informed each week of the next week’s shipments, we will open additional appointments for the following week. We are asking for patience and understanding as the supply doesn’t come close to meeting the demand, especially as we move into Phase 1b, group 1.

Clinical Protocols at Buncombe County’s COVID-19 Vaccine Clinic

  •          At our vaccine clinic, we are using the CDC’s Pre-Vaccination Checklist for COVID-19 Vaccines to determine if individuals have contraindications or precautions to the vaccine, and what actions we should take based on their answers. I encourage all of you to become familiar with this document as you counsel patients on the vaccine, prepare for getting the vaccine yourself, or prepare your clinic for receiving vaccine supply in the future. This is a living document, being updated regularly by the CDC, so I encourage you to bookmark it, rather than print it.
    •    It is important that you know that we will not routinely administer the current COVID-19 vaccines to anyone who has received any other vaccine in the prior 14 days, based on the lack of data on the safety and efficacy of mRNA COVID-19 vaccines administered with other vaccines. We also counsel individuals vaccinated for COVID-19 to avoid getting other vaccines for the following 14 days.
      •   However, administration of these COVID-19 vaccines with other vaccines can occur within a shorter time period in situations where the benefits of vaccination are deemed to outweigh the potential unknown risks of vaccine co-administration (e.g., tetanus toxoid-containing vaccination as part of wound management, measles or hepatitis A vaccination during an outbreak) or to avoid barriers or delays to mRNA COVID-19 vaccination. If mRNA COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.
    •    Buncombe County’s COVID-19 Vaccine Clinic is NOT requiring notes from providers for administration of COVID-19 vaccine to anyone on blood thinners or anyone with a bleeding disorder. When they arrive for their vaccine appointment, we inform these individuals they may have increased bruising around the injection site, use a 25-gauge needle and encourage firm pressure on the site for 2 minutes post-vaccination. If they report a history of bleeding issues with intramuscular injections or if we knew their last INR was >5.0, we would defer administering the vaccine and refer them to their prescribing provider. Here is guidance that Mission’s Anticoagulation Clinic is following in regards to this situation that you may wish to follow for your patients on blood thinners.
    •    Per CDC guidance, we will NOT vaccinate persons who have received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment until it is 90 days or more after their treatment.
    •    Anyone else who had COVID-19, but did not receive these treatments, can receive the COVID-19 vaccine as soon as they are released from isolation. They may choose to delay vaccination until closer to the end of the 3 months post-infection, but this is not necessary if they want to be vaccinated sooner.
    •    For additional CDC guidance on these and many other clinical considerations for COVID-19 vaccination, go here.

Dose #2 Scheduling Info for those Vaccinated in Phase 1a

  •          This coming week we will be opening dedicated 2nd dose appointment slots for the week of 1/18 and beyond for those who received the Moderna vaccine in our first round of vaccination. An email with this link will go to the primary and backup points of contact for the clinics/agencies/individuals who were vaccinated in Phase 1a. The federal government has guaranteed that we will have sufficient doses to match the initial doses we administered and we will manage our staffing to ensure those needing their 2nd dose get it in a timely manner. The 2nd dose of the currently available COVID-19 vaccines can be given 4 days prior to when the dose is “due” up to any time after the 21 (Pfizer) or 28 (Moderna) day timeframe.
  •          The lack of a functional scheduling platform in the NC COVID Vaccine Management System (CVMS) at launch led us to utilize a temporary scheduling system. We had hoped to be able to switch over to CVMS or a different scheduling platform sooner, but that has not been possible yet. Once we do switch scheduling platforms in the coming weeks, the goal is for individuals to be able to schedule their 2nd dose appointment at the time they receive their initial dose. We will send email notifications when the switch to a different scheduling platform is made.

Preparing for Phase 1b, Groups 2 and 3

  •          To review NCDHHS’ revised vaccine rollout phases, please click here.
  •          As we enter Phase 1b, Group 1 tomorrow, we are ramping up preparations for the coming transition into Phase 1b, Groups 2 & 3. We do not yet have a date for when these transitions into Groups 2 & 3 will occur.
  •          Phase 1b, groups 2 and 3 is when healthcare workers with in-person patient contact who were not vaccinated as part of Phase 1a and frontline essential workers can get vaccinated. Of note, the state still is working on the final definition of a frontline essential worker.
  •          For those healthcare workers/clinics/agencies that were not included in Phase 1a, please review the attached clarification from NCDHHS on which healthcare workers are eligible for vaccine in Phase 1b, Groups 2 & 3.
    •    These healthcare workers must be those directly caring for or working directly in areas where in-person patient care occurs. Healthcare workers who do not meet this criteria will fall into subsequent phases based on age, underlying health conditions, or end up in Phase 4.
    •    Group 2 is for these workers who are over the age of 50, while Group 3 is for the remainder of these workers.
  •          At this time, we are asking that all healthcare workers/clinics/agencies, complete and submit the attached spreadsheets for those staff who meet criteria for Phase 1b, Groups 2 & 3.
    •    Many clinics/agencies submitted spreadsheets previously despite not meeting Phase 1a criteria. If you were not included in Phase 1a, we are asking you to resubmit your information for these next phases, following the instructions below. Please read and follow these instructions carefully. (If you still have Phase 1a staff – those providing in-person care to people known to have COVID-19 – who need vaccination, submit your information promptly, noting Phase 1a in the email subject line and on your spreadsheet.)

1.       Complete the attached spreadsheets titled “Recipient Bulk Upload File 1B-Group 2” and “Recipient Bulk Upload File 1B-Group 3” for your clinic/agency, listing all staff who meet Phase/Group criteria AND are interested in (or at least are considering) getting the vaccine. This will enable us to get them pre-registered in the state’s COVID Vaccine Management System (CVMS).

  •          Please be sure that all names and email addresses are spelled correctly.
  •          Please be sure to include everyone the first time. Even if staff are unsure if they want to get the vaccine, go ahead and add them to your spreadsheet. Signing up does not mean they have to get the vaccine, but it makes the process go more smoothly than having to add additional people after you’ve already submitted a spreadsheet.
  •          Each individual must have a unique email address (no shared email addresses).
    • If your staff does not have an email address, do not include them on the spreadsheet. They will enroll onsite when they come for their vaccine.
  • If your clinic/agency later identifies additional staff who weren’t included on the spreadsheets that were submitted to us or if there was an error in an email address on a submitted spreadsheet, please submit a new version of the appropriate spreadsheet, including only information about these specific staff, per the same process outlined here.
  • All columns must filled out for each individual.
    • For RISK (column D):
      • Enter “High” if the employee is responsible for one or more of the following:  caring for COVID-19 patients; cleaning in areas with COVID-19 patients; performing tasks with high risks of aerosolization (intubation, bronchoscopy, suctioning, invasive dental procedures, invasive specimen collection, CPR) on patients with known COVID-19; handling decedents with COVID-19, or administering COVID vaccine.
      • Enter “Low” if the employee does not meet any of the above criteria.
    • For TYPE (column E):
      • Enter “Employee” if the person works for your clinic/agency.
      • Enter “Individual” if the person is a resident of your facility.
  • Please submit the spreadsheet to us in the same format (.xlsx) as the original.
  • Individuals do not have to live in Buncombe County or even NC to receive vaccine from Buncombe County.
  1. Send an email with your completed spreadsheets (in .xlsx format) attached to COVIDvax@buncombecounty.org.
    • In the subject line, enter your clinic/agency name and “Phase 1b”
    • You will receive an automated response once we receive your email. There is no need for you to send another email asking for confirmation that we received your information.
    • We will review your spreadsheet and reach out to you if we have any questions or concerns.
    • We will hold on to these spreadsheets and upload them into CVMS when we approach transition into Groups 2 and 3, so that your staff are able to enroll in CVMS at that time.
  2. Wait patiently for additional information on next steps, including how & where staff will get their vaccine.
  •          Learning a new, clunky IT system that is being enhanced continuously in the midst of vaccine rollout has not been easy, and we are refining our processes along the way. We ask that you continue to grant us some grace in this endeavor. Know that we are giving feedback to the state frequently, so they hopefully can improve CVMS by the time those of you who will be providing vaccine have to use it.

Buncombe County Community Testing Update

  •          Due to the need to focus more of our resources on vaccination, this week we decreased our COVID-19 community testing to one site a week with expanded hours:  Sundays at AB Tech, Genevieve Circle, from 11a-5p. Pre-registration is encouraged, but not required.

Isolation and Quarantine Reminder

  •          As I mentioned in my 12/9 email, Buncombe County Public Health implemented changes to quarantine protocols for the general public (those not working or living in nursing homes, residential care facilities or correctional facilities). For details, please see the attached handouts in English and Spanish that we distribute at our county COVID-19 test sites. Feel free to use these with your patients.
  •          There is no need for anyone to get our approval to do a 7 or 10 day quarantine.
  •          It is important that you understand that, with the surge in cases that started after Thanksgiving, like most other health departments in NC, we aren’t able to investigate every case and, therefore, are not able to do contact tracing on every close contact who should be quarantining. To address increasing case counts, Buncombe County Public Health has implemented a case investigation prioritization tool based on guidance by NCDHHS. At this point, it’s all hands on deck, and we ask that you educate and counsel your patients using the quarantine guidance on the attachment as well as the guidance on the NCDHHS “Steps for People After COVID-19 Testing” handout (English, Spanish & Russian), which you should be giving to everyone you test for COVID-19.

Please know that Buncombe County Public Health, along with our partners in Emergency Services, is working hard to continue to get vaccine into the arms of those in need, based on state guidance. As I’ve mentioned before, the State Health Director, Dr. Betsey Tilson, has said this is the biggest, most complicated mass vaccination effort ever, at the fastest pace ever. We continue to ask for your patience, understanding and cooperation. Everyone in Buncombe County is important to us and we want everyone to get vaccinated when it is their turn based on the state’s prioritization framework. Our goal continues to be ensuring that vaccine administration is safe, efficient and equitable in all our populations.

For COVID-19 related information, continue to check the CDC and NCDHHS websites.

Contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7) or the NC Division of Public Health epidemiologist on-call line at 919-733-3419 (available 24/7) for additional consultation about COVID-19 or other public health concerns.