BUNKER HILL, WEST VIRGINIA – Since December, Ken Reed and his wife Tally, who own a small pharmacy chain 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 that their familiarity with people in counties like Jefferson, Berkeley, Morgan and Pendleton makes all the difference in earning their trust.
“These are your neighbors, your friends, the parents of your friends, and you just treat them as you would like to be treated,” said Ken Reed.
West Virginia, a small and predominantly rural state with a large elderly population, was marked from the start as a place that is likely to have problems with Covid-19 and any vaccine implementation.
But the state is now being hailed as a vaccine success story, with 85 percent of its doses delivered already used, according to data from the Center for Disease Control, placing it second in the country, behind North Dakota last week.
A key part of the strategy, health officials say, was the decision not to activate a federal partnership with the pharmacy chains CVS and Walgreens and instead rely on independent drugstores like those owned by the Reeds.
“We are a fragmented state that is resilient,” said Dr. Clay Marsh, secretary of the West Virginia coronavirus and vice president and executive dean of health services at the University of West Virginia.
“But we are totally confident in the creativity and innovation of all our people. Because we don’t want to depend on external resource requirements to be able to do what we need to do. “
West Virginia’s initial success is even more notable given that a study published by the Kaiser Family Foundation in April 2020 classified it as the state with the highest proportion of adults at risk of serious illness if infected with Covid.
In an Appalachian state known for secondary roads, mountains and an endangered coal industry, the population has long suffered from high rates of comorbidities, including smoking and chronic conditions that lead to their low overall health rating.
But the state’s unique characteristics helped Covid’s response in many ways.
The relatively small and homogeneous population has contributed to its success, said Dr. Gabor Kelen, director of the Johns Hopkins Department of Emergency Medicine. And the state really outperforms the country in some aspects of health care, including access to primary care doctors and the percentage of insured patients. Only 6% are uninsured, compared to 9% nationwide, according to US Census Bureau statistics.
“Access to primary care doctors for the population, at least, allows people to have confidence … in the public health system,” said Kelen.
A large part of this population lives more than 45 minutes by car from any point of sale in the drugstore chains that dominate most other states. Health officials say this leaves local independent pharmacists, like the Reeds, in a better position to provide medical and operational expertise.
Ken Reed said there was no paperwork to join the state’s vaccination effort when he received a call from a health officer.
“Because we’re the boss,” he said, laughing with his wife Tally. “There is no middle management. (…) She asked if we could do this and there was no chain of decision making. It has reached the top of the decision-making chain. “
West Virginia was, in fact, ahead of much of the nation in its Covid response since the start of the pandemic, due to careful planning and – again – its close-knit, small-town culture. A casual encounter at a football game gave the state an advantage in Covid’s 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 an executive at Labcorp, a national network of medical and blood test sites.
Dr. Marsh, the Covid state czar, met the executive, a graduate of West Virginia University, at a college football game in Morgantown. Marsh got in touch and the two men were soon drawing up a plan for statewide testing, which they launched on March 5. The public-private partnership tested all 28,000 West Virginia asylum residents in just two weeks.
The state also created a “team of teams” – leveraging the National Guard from the beginning to create and manage an operations command center that focused on inter-agency communications and working with the Department of Health and Human Resources, the governor and state health officials.
The National Guard has been involved in the state’s response since November, executing distribution from the state’s five centers. This includes logistical support for receiving and transporting vaccines – helping to repackage refrigerated vials and containers suitable for locations where stability can be maintained.
Through a partnership with another company, Everbridge, the consortium has already created a pre-registration system so that each person can have a place in the queue and be notified when and where they can be vaccinated. In the first four days after the system was launched, Marsh says more than 100,000 people signed up.
After initially trying the clinics on a first-come, first-served basis, he says it was trial and error that led his team to the registration platform. Without the ability to predict the precise doses you will receive each week, meeting the demand was a challenge – something that the pre-registration system now aims to address.
According to the CDC, by Saturday, West Virginia had distributed more second doses per capita than any other state, with more than 3% of the population fully vaccinated.
Or, as Ken Reed says, “We crush everything.”
The Reeds spend their nights and mornings combing through the paperwork on the kitchen table and entering data so that the state can track the doses administered. Ken says he also often dispels incorrect information about the vaccine – what he calls “trash – on social media.”
In line with the state’s progress, the Reeds finished administering their quota of second doses at long-term care centers last week and are ready to work in schools.
“Nothing compares to being able to help your neighbor,” said Tally.
As case rates began to decline across the country, and dropped about 35 percent in West Virginia last week, according to CDC data, Marsh points to the vaccine’s launch.
“We saw a very large decrease in the rate of transmission, hospitalizations, ICU admissions, use of a ventilator … I attribute this to the vaccine.
But it is too early to take a victory lap, said Marsh.
Supply remains the critical problem. Marsh’s team says it is currently positioned to vaccinate up to 23,600 people a week and has the capacity to increase to 100,000 – but not the necessary vaccine supply.
“We need more,” he said. Although the distribution is currently population-based, talks with the federal government have led to the promise of additional doses of the Moderna vaccine. “We are very optimistic. But now the supply chain does not seem to be able to fulfill the opportunity. “
West Virginia’s most remote rural communities also remain a challenge. About 40 percent of residents do not have access to broadband internet, partly due to the topography that makes connectivity a challenge.
To address this, Marsh’s team is creating mobile vaccination vans and engaging with local health departments and religious organizations with a special focus on vulnerable groups and black communities.
“When it comes to an opportunity to come together, to help each other, to strengthen each other, that’s what West Virginia does best,” said Marsh. “And we are seeing that now.”
For a West Virginia native like Marsh, success in the face of so much adversity also meant polishing the image of his state.
“At the moment, we are changing the narrative externally,” he said. “And we are not doing this to do this. But this is a very, very good side effect. “