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One doctor gives Idaho vaccine rollout a B or B-, another says D-. Here’s why

One doctor gives Idaho vaccine rollout a B or B-, another says D-. Here’s why

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Dr. David Pate

Dr. David Pate, former CEO of St. Luke’s Health System. 

BOISE — Idaho is a year into the COVID-19 pandemic. Public health officials are awaiting test results to determine if more infectious variants of the coronavirus have begun to circulate in Idaho. Meanwhile, thousands of Idahoans are getting vaccinated against the virus each day. But many more are anxiously waiting for their turn.

The Idaho Statesman hosted a live Q&A on Feb. 4 with two people who have been closely involved in health care during the pandemic.

Stay tuned for details about our next live Q&A on March 2.

Dr. David Pate spent a decade leading St. Luke’s Health System, the state’s largest health care provider. He now helps advise Gov. Brad Little on Idaho’s pandemic response. He blogs at drpatesblog.com, and you can find him answering questions on Twitter at @drpatesblog.

Dr. Tommy Ahlquist is a former emergency physician, the CEO of BVA Development and the co-founder of Crush The Curve Idaho, which has arranged COVID-19 testing for businesses and the public since early in the pandemic. Crush The Curve also has launched a website — vaccinatethe208.com — that offers daily updates on vaccine availability around the state. You can find Ahlquist on Twitter at @TommyAhlquist.

Here are a few highlights from the conversation with Pate and Ahlquist.

Q: What grade would you give Idaho’s vaccine rollout?Dr. David Pate: You know, that’s a tough question. Obviously there’s opportunity for improvement. The problem is that so much of this is not exactly in the state’s hands. But I guess, if I was forced to come up with a grade, I give it a B or B-minus.

I think what is going right is the amazing efforts by health care providers in the state. All of these providers have taken on a Herculean task, and they’re doing it for everybody, not just their patients.

I would commend the Coronavirus Vaccine Advisory Committee. There’s nobody that agrees with every decision they’ve made, and they’ve had to make hundreds of decisions (about who gets the vaccine when), but somebody had to make those decisions.

What hasn’t gone as well, a lot of it is related to the federal government. Anybody in that position is going to know, and should have sounded the alarm, that states aren’t ready for this (vaccine rollout), states don’t have the resources for this, and more should have been done to help equip states to do this.

There was an opportunity for the Trump administration to buy 100 million more doses of Pfizer vaccine and they passed that up. I don’t understand it. Maybe there was a good reason, but I can’t think of one.

I think there’s been a lot of problems, and I think a lot of those problems come down to federal, state coordination. You’ve got to work together.

Dr. Tommy Ahlquist: There is no shortage of effort and desire and people that love Idaho and want to do the right thing. It’s hard to give yourself a bad grade, when you’re trying so hard, especially when so many things are out of your control.

Tommy Ahlquist
Dr. Tommy Ahlquist, co-founder of Crush the Curve Idaho. 

But I gotta be honest. We got caught flat-footed when the pandemic hit us last year, as a state, as private industry, as a country. And I think everyone kind of did their best with testing and (pandemic response), but we’ve known a vaccine has been coming for months, right? We didn’t know what (vaccine) when, but we knew it was coming. I’d give it a D-minus.

I think all of the things we’re experiencing right now — systems crashing and ‘what do we do next?’ — it’s not because people aren’t trying hard. It’s that we were not prepared.

I had the advantage to go visit all of the health districts around the state. They were underfunded (and thus) underprepared for a pandemic. I thought we learned a lesson with contact tracing, and with testing, when we pushed everything down to them and that failed miserably in Idaho. So to think that you could do the same thing on a vaccine distribution …

The federal response to coronavirus has been just pathetic. I don’t know how it could have been worse. And even though the promises of the vaccines that came out through the Trump administration … certainly they did some things very, very right with the vaccine production. But, boy, there’s just been no support, and it keeps getting pushed down, pushed down, pushed down. Now, unfortunately, who suffers are the people.

We can’t make any more excuses, it is what it is. Let’s come together. Let’s figure out solutions, and let’s go forward. And I think that’s what I’m seeing happening in the community, and I have a lot of hope that we’re gonna figure this out …

Q: Why can’t Idahoans with high-risk conditions get vaccines yet? Ahlquist: For me personally, looking at who was at risk and who was hospitalized, it’s hard for me to not say, “Hey, I wish high-risk people were getting it earlier.”

I worry about disadvantaged populations. I worry a lot about poor people that have health conditions that don’t have good health care to begin with, and now they’re the ones that should be getting this vaccine early on. My vote would have been to put that group as a priority, but … there’s probably a lot of other competing interests that drove those decisions the way they went.

Pate: The problem is, we were getting about 20,000 doses a week. Now, we are getting up close to 25,000 doses a week, but that’s not very much. If I were on the Vaccine Advisory Committee, I would say, “OK, what is going to be our decision-making framework, because I think there’s several ways you can approach this.”

I can think of three objectives that would all have merit.

One is, let’s make sure that we reduce hospitalizations, reduce deaths, reduce the pressure on the health care system. If that was your objective, then the people you would vaccinate first would be those over 60, and those with multiple medical conditions that put them at high risk, even if they were younger.

Another way you can say is, well, let’s actually take an approach of decreasing transmission. What we want to do is decrease the spread of this disease. And if you’re going to do that, then you have priorities. Prioritize people that are 20 to 40, because they seem to be really driving the spread.

A third way you could say is, “Let’s preserve our infrastructure.” And if you do that, then you’re going to prioritize those people that you have to depend on: health care workers, grocery stores, pharmacies, transportation, police, fire, EMS, you know.

I think all three of those (priorities) have merit. I think what the committee did … I think they tried to do a combination of those priorities.

I’ve had a lot of elderly friends telling me, “I’m locked up in my house, and I’m watching people half my age get vaccinated.” And it’s because they didn’t understand (the priorities).

Q: Why is there no centralized way for Idahoans to get vaccine appointments? Ahlquist: The interesting thing about Crush The Curve is we’re working a lot with Massachusetts, we’re doing a lot in Tennessee, we’re doing a lot with Texas. We’re helping other states with the same problem.

What we found with testing is everyone had plenty of testing — until you needed testing. And as soon as you needed testing, there wasn’t any testing. So what we did at Crush The Curve was we spent a lot of our time and effort putting together software that basically connected a patient with a test. But it was agnostic, who ran that test.

So it basically matched up capacity with labs, with patients. We easily could have modified (it for vaccines), and we actually proposed to the state: Why don’t we just use this same HIPAA-compliant system that we already have, that’s agnostic to health care providers? Based on your zip code, it would send you to a provider that had a capacity for vaccines. It would auto-email you back, and tell you where you are in line, and where you’re going to get hooked up to a vaccine.

We proposed that a few weeks ago. I think it would have worked — we’re actually working with Massachusetts today, to try to implement that in the state of Massachusetts.

We’re launching today at Crush The Curve, if you go to vaccinatethe208.com … you can click on your region, and then a list of all the providers, and then we’re calling those providers every day to at least give the public updated locations where there’s vaccine.

We only have nine full time employees, by the way, and we have someone calling clinics every day all around the state.

I don’t know how many people call me every day saying, “Hey, how do I do this? How do I do this?” I have no idea. But all I can tell you is, you got to come in every morning and try to get an appointment. That’s just, I mean, listen: The ‘90s called and they want their technology back. Right, like, the next thing we’re gonna do is roll out a rotary phone.

We have people hurting. There are people that have been waiting for this for eight months. They’re just so anxious. They want the vaccine, they know they need the vaccine, they want to see their families, they have a comorbidity that they’re worried about.

There are people that are committed to this, that are spending 16 hours a day trying to help figure this out, down at the lower level. But we need help from the upper levels because, you know the saying: It all rolls downhill. And that is true. With COVID, we have proven once and for all, it rolls downhill, and it’s not very fun to be the guy at the bottom and they’re working their tails off.

Pate: I totally agree with Dr. Ahlquist. We have seen over and over and over again through this pandemic, all the limitations we have concerning technology. It’s not that there aren’t technology solutions. We just don’t have them. And it gets back to his previous point about, you know, we have to learn how to do this better.

One of the reasons that so many states are struggling … is the fact that states have continuously tried to ratchet back their budgets. After we learned how to purify water, after we learned how to handle food safely, after we had the emergence of antibiotics, we just quit. All states consistently decreased their investments in public health, and so our public health infrastructure is not robust, is not supported. All you need is a pandemic like this to show you that we don’t have the resources that we need.

I hope we learn from this, because there’s some people saying, “Oh, well, who could have imagined we’d have this pandemic?” Well, every scientist, every doctor, every health care administrator. We’ve been planning … for 20 years for this. We didn’t know it was going to be January of last year. We didn’t know it was gonna be the coronavirus. But we knew it was coming. And yet, our governments — state and federal — were not making the necessary investments.

Other highlights from the COVID-19 vaccine conversationPate on the Idaho Legislature: (State legislators are) actually trying to figure out ways we can make this worse. So they’re trying to take away the emergency declaration, which is just about the craziest thing I’ve ever heard. “Let’s just not have any restrictions, let’s just everybody go out and get together in big groups.” At the same time that we know these variants are coming, it is just absolutely terrible, and I do hope voters will hold these legislators accountable.

Ahlquist on the Idaho Legislature: I could not wait for this legislative session to start, because I thought, finally, we have this beautiful chance in Idaho to have legislators who must be listening to their constituents, they must come to town and say, “Hey, what are we going to do to help solve this problem? We know that these seven local health districts are in shambles, that they weren’t prepared. What are we going to do to be part of the solution?”

And I’m telling you what. I can’t even watch, because it’s the most disappointing thing, and (COVID-19 is) not on anyone’s agenda. Instead, they’re dealing with all this baloney that has nothing to do with people. And we’re in a pandemic.

So, if a pandemic and people suffering in your own district is not enough to get a local legislator to literally pay attention for five minutes to something that matters, I don’t know what we’re gonna end up doing.

We’ve got problems. I would say, anyone listening out there, pay attention to local politics. We got to get some of these circus clowns out, because it’s hurting our people. And they dominate. So even if a good idea is there, the clowns are sucking up the oxygen, and that’s the state we live in. We need to pay attention now and let this pandemic be an example to us just how bad it is.

Pate on people declining the COVID-19 vaccine: I think people are in for a rude awakening come March or April, because when those variants get here? Last year, we didn’t have a whole lot of previews of coming attractions. We’ve had a preview of coming attractions on this one. You just have to watch the UK, Ireland, Denmark, and see what’s going on there. I can’t think of a reason why our experience is going to be different.

What’s going to happen is our cases are going to shoot way up. And I think that when people see, “Oh, this really isn’t under control, this really isn’t going away,” I do think more people will want to get vaccinated.

Part of this whole problem is our public health approach. Public health has to be based on trust. And it has to be based on science. You need leadership, and with leadership comes role modeling. I have to say, we have had abysmal leadership … at the federal level, and then in our Legislature — I mean, here we are a year into our pandemic, (some legislators don’t) wear masks in the Capitol. So, what message is that sending? I mean, they are undermining our public health efforts.

Ahlquist on people declining the COVID-19 vaccine: One of the most confusing things in my lifetime will be thinking back to how this pandemic rolled out, and how pro-business we (are). We want our kids at school, we want to stay open, we want our businesses to thrive. … So for me, and as a physician, it was so clear in my mind. Boy, if we’re all coming together on this and reducing transmission and following precautions and doing what we can do, we’re gonna stay open.

And then this freedom thing of “don’t tell us what to do” came in, and frankly, as a physician … it was pretty odd, because we’re pretty used to sitting down with a patient in a room on a stool and looking him in the eye and saying: “Hey, I care about you and your family. And this is what I would do for you to be healthy.” And your whole career, people are looking at you (saying), “Thank you, that’s what I’ll do.” (But now, they would say) “Oh, you’re wrong, because I read this, or Trump said that, or, you know, a legislator told me to just snort oregano and it’s gonna go away.”

We need to take the people that have vaccine hesitancy very seriously. They have been told lies. They’ve been told things that are just not true, and if you just say, “I’m right, you’re wrong,” you’re never going to come together. And what I found, even on my own in the last several weeks, if I can sit down with someone and say: “Listen. Here’s what I understand about the science. I want to stay open. I want to thrive as a family and as a community, but these are the things that we do,” and you really talk through it, you can get to a pretty good spot, but it takes a while.

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