BUNKER HILL, WEST VIRGINIA – Since December, Ken Reed and his wife Tally, the owners of a small chain of pharmacies in eastern West Virginia, wake up at dawn to travel to rural counties to vaccinate as many long-term care residents as possible .
The Reeds say their familiarity with people in counties like Jefferson, Berkeley, Morgan and Pendleton makes all the difference in gaining their trust.
“These are your neighbors, your friends, your friend’s parents, and you just treat them the way you want to be treated yourself,” said Ken Reed.
A small and mostly rural state with a large older population, West Virginia was early labeled as a place likely to struggle with Covid-19 and vaccine rollout.
But the state is now being hailed as a vaccine success story, with 85 percent of the doses delivered already used, according to data from Centers for Disease Control, putting it in second place in the country behind North Dakota since last week.
A key part of the strategy, health officials say, was the decision not to activate a federal partnership with the CVS and Walgreens pharmacy chains and instead rely on independent drugstores like the Reeds’s.
“We are a filthy state that is resilient,” said Dr. Clay Marsh, West Virginia coronavirus tsar and vice president and executive dean of health services at West Virginia University.
“But we absolutely rely on the creativity and innovation of all our people. Because we don’t want to depend on the requirements of outside sources to be able to do what we need to do. “
West Virginia’s early success is all the more striking, as a study published by the Kaiser Family Foundation in April 2020 named the country as the state with the highest proportion of adults at risk for serious illness when infected with Covid.
In an Appalachian state known for its country roads, mountains and a dying coal industry, the population has long suffered from high comorbidities, including smoking and chronic conditions, which determine the country’s overall health score.
But the unique features of the state contributed in many ways to the response to Covid.
The relatively small and homogeneous population has contributed to its success, said Dr. Gabor Kelen, director of the emergency medicine department at Johns Hopkins. And the state is even outperforming the nation in some aspects of healthcare, including access to primary care physicians and the percentage of insured patients. According to US Census Bureau statistics, only 6 percent are uninsured compared to 9 percent nationally.
“Access to general practitioners for the population at least allows people to have confidence … in the public health system,” said Kelen.
Much of that population lives more than 45 minutes’ drive from a retail outlet of the pharmacy chains that dominate most other states. Health officials say local independent pharmacists, such as The Reeds, are best placed to provide operational and medical expertise.
Ken Reed said there was no red tape involved in participating in the state’s vaccination effort when he received a call from a health official.
“Because we’re in charge,” he said, laughing as he and his wife Tally. “There is no middle management. … She asked if we could do it, and there was no chain of decision making. She reached the top of the decision-making chain. “
West Virginia was actually ahead of much of the nation in its Covid response from the start of the pandemic, thanks to careful planning and – again – its tight-knit, small-town culture. A chance meeting at a football game gave the state a head start in Covid tests last spring, they said.
Two months before the White House required testing of all nursing home residents in mid-May, West Virginia was already negotiating with a director of Labcorp, a national chain of blood and medical testing sites.
Dr. Marsh, the czar of the state of Covid, had met the director, a graduate of West Virginia University, at a college football game in Morgantown. Marsh contacted, and the two men soon came up with a state-wide testing plan, which they implemented on March 5. Their public-private partnership tested all 28,000 residents of the West Virginia nursing home in just two weeks.
The state also created a “ team of teams ” – deploying the National Guard early on to devise and run an operational command center focused on inter-agency communications and working with the Department of Health and Human Resources, the office of the governor and state health officials.
The National Guard has been involved in the state’s response since November, carrying out distribution from the state’s five nodes. That includes logistical support for the receipt and transportation of vaccines – allowing vials and suitable refrigerated containers to be repackaged to locations where stability can be maintained.
Through a partnership with another company, Everbridge, the consortium has now set up a pre-registration system so that each person can get a place in the queue and be informed when and where they can be vaccinated. In the first four days of the system’s launch, Marsh says more than 100,000 people signed up.
After initially experimenting unsuccessfully with first-come, first-served, he says it took his team to the registry platform through trial and error. Without the ability to predict the precise assigned dose it will receive each week, meeting demand has been a challenge – something the pre-registration system now needs to address.
According to the CDC, as of Saturday, West Virginia had given out more second doses per capita than any other state, with more than 3 percent of the population fully vaccinated.
Or, as Ken Reed puts it, “We crushed it.”
The Reeds spend their nights and early mornings with the paperwork on their kitchen table, entering data so the state can track the doses administered. Ken says he’s also been committed to clearing up misinformation about the vaccine – what he calls ‘junk’ on social media.
In line with the progress of the state, they already delivered their share of second doses in long-term care centers last week and will start working in schools.
“There’s nothing like being able to help your neighbor,” Tally said.
As the number of cases across the country has started to decline, dropping about 35 percent in West Virginia since last week, Marsh points to the introduction of the vaccine, according to data from the CDC.
“We have seen a significant decrease in transmission rate, hospital admissions, hospital admissions in the ICU, use of respiratory equipment… I attribute that to the vaccine.
But it’s too early to make a victory lap, Marsh said.
Delivery remains the critical point. Marsh’s team says it is currently positioned to vaccinate as many as 23,600 people per week and has the ability to scale up to 100,000 – but not the necessary supply of vaccines.
“We need more,” he said. While the allocation is currently based on population, talks with the federal government have led to the promise of additional doses of the Moderna vaccine. “We are very optimistic. But right now, the supply chain doesn’t seem to be able to take advantage of the opportunity. “
West Virginia’s most remote rural communities also remain a challenge. About 40 percent of residents do not have broadband internet access, in part due to the topography that makes connectivity a challenge.
To address that, Marsh’s team is creating mobile vaccination vehicles and working with local health departments and faith-based organizations with a special focus on vulnerable groups and communities of color.
“When it comes to an opportunity to get together, help each other, cancel each other out, that’s what West Virginia does best,” said Marsh. “And we see that now.”
For a West Virginia native like Marsh, success in the face of so much adversity also meant polishing his state’s image.
“Right now we are changing the story externally,” he said. And we don’t do it to do that. But that’s a really great side effect. “