It has been less than a month since COVID-19 vaccinations began in South Dakota and calls are pouring in to Avera Health.

Avera has been flooded with questions from people inquiring how and when they are eligible to be inoculated. But for a large portion of the population, there are currently more questions than answers.

As of Tuesday, 27,260 South Dakotans have received the first of two doses of the COVID-19 vaccine. Front-line health care workers, long-term facility care workers and residents were the first to be inoculated, while other health care workers, emergency medical services, law enforcement and correctional officers are currently eligible.

But as health care providers prepare to move into the fourth bucket of people — which includes a broader range of the general public — questions remain as to who qualifies, how they will be notified and where mass vaccinations will take place.

Nationally, the federal government has left state officials to determine rollout plans. Meanwhile many states have left those plans to counties and health care providers, creating a gap in many areas of the country.

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Some states have online sign-up portals, while others have hotlines for people to call with questions, but aside from website pages that show which priority group is currently eligible, the South Dakota Department of Health currently does not have a specific outlet to answer direct questions from the public.

“We have the same questions when it gets into those harder groups — ‘Do you really qualify?’” said Eric Larson, Avera Queen of Peace director of pharmacy and vaccination coordinator. “At this point, we don’t have those answers, other than we know they’re questions that need to get answered in the upcoming weeks.”

The state Department of Health has instructed which groups of the population to vaccinate first, but left many of the logistics to Avera, Sanford and Monument Health. The initial priority groups of Phase 1 have been obvious, but with Group 1D approaching, health care providers are still attempting to determine eligibility.

Source: South Dakota Department of Health
Source: South Dakota Department of Health

Some of the groups are obvious, such as teachers and school staff, those over the age of 65 and funeral service workers. But others are more ambiguous. People with two or more underlying medical conditions are eligible, but what conditions or how it is proved is still to be determined. Group 1E also offers more uncertainty, with critical infrastructure workers becoming eligible, but a lack direction in who exactly fits the profile.

Source: South Dakota Department of Health
Source: South Dakota Department of Health

“We think there might be a website sign-up process, possibly, but nothing has been finalized yet,” Larson said. “I want to try to avoid the first-come, first-serve methodology as much as possible and put more people in smaller buckets so we have a more controlled turnout. … At this time, there’s no magical list or something you should be doing as a patient to get in line for the vaccine.”

Although Avera Queen of Peace Hospital in Mitchell is close to completing Group 1C, vaccinations with Group 1D will not immediately commence. The DOH has expressed a desire for each health care provider to start each phase simultaneously and there are some pockets of the state that are behind.

Through the first three phases, inoculations have occurred at AQOP, but with a greater percentage of the population becoming eligible, larger spaces will be needed. A total of 79,774 people were eligible in Groups 1A-1C, but 265,561 people will be eligible in the next priority group and 227,448 in 1E.

On Wednesday, AQOP will meet with Davison County officials to discuss potential places. One such destination to be discussed is the Corn Palace, which hosts the county’s annual flu POD (point of distribution) as a simulation for potential mass vaccinations.

“We know that we’re going to need more coordination with this,” Larson said. “It just can’t be our health system trying to pull this off. We’re going to need a lot more resources across our community and bigger clinic sites to open this up for the much larger groups.”

Avera offered reassurance that the public will be notified when there is a concrete plan, but it may not happen within the next two weeks.

“You don’t need to call us. When the time comes, you will know,” said Hilary Rockwell, AQOP emergency physician. “I’m hoping it won’t be too long until we’re in that 1D bucket, but I can’t make any promises right now.”

Future vaccines hinge upon distribution

Early stages of the vaccine rollout have largely gone smooth in South Dakota.

The state is top in the country with 3,230.74 vaccinations per 100,000 people. AQOP has administered 886 vaccinations thus far, with 824 going to residents of Davison County, while also helping Aurora and McCook counties. Initially, Avera estimated February was the target date to finish the first three priority groups.

Rockwell noted those who receive the vaccine are kept for 25-30 minutes to monitor any potential allergic reactions and there have been none to report thus far. The lone symptoms reported have been sore arms, fatigue and headaches, which are common in a flu vaccine.

“Most said it wasn’t as bad as their flu shot,” Rockwell said. “They got a headache or a little body-ache, but that’s not unexpected. That’s a sign that your immune system is working and forming antibodies.”

Upon receiving the first dose, people also sign up to receive the second dose before departure. Distributors have been setting aside second doses, but first doses for many also remains uncertain.

Rockwell estimated 70-80% of the population would need to be inoculated for society to return to normalcy. According to the DOH, roughly 34% of the people eligible in the first three groups have been vaccinated.

Avera did not offer a timetable on when vaccinations could hit the 70-80% mark. The Centers for Disease Control and Prevention reports 44,300 vaccines distributed thus far, but production has not caught up to distribution yet. There is limited availability for groups 1A-1D through the late winter and limited for 1E in the spring, before the DOH estimates general availability for all in the summer.

“So much depends on how much vaccine we get each week,” Rockwell said. “We would have the capacity to ramp up a POD and do a lot of doses at a time, but all of it is going to be determined by how much vaccine we get. We just don’t have a good idea of that yet.”