On Dec. 18, Mount Nittany Health doctors administered the first COVID-19 vaccinations in Centre County. Starting with the State College-based health systems own direct care providers and staff, the effort soon expanded to other health care workers in the community.
Nearly four months later, as Pennsylvania’s eligibility guidelines have expanded, 48,651 people in Centre County have received at least one COVID-19 vaccine dose and Mount Nittany has been the county’s largest single provider. It has administered more than 30,900 doses to community members and has another 5,000 future doses are scheduled. With Pennsylvania expanding eligibility to all adults by April 19 and production ramping up, many more are in the future.
Mount Nittany has adapted along the way to develop an efficient process for scheduling and administering the vaccines to thousands of people during clinics throughout each week at the medical center.
“I’d actually say the day of the clinics is actually the easiest part of the entire process,” Tiffany Cabibbo, Mount Nittany’s executive vice president of patient care services and chief nursing officer who oversees the clinics, said during an interview last week.
“The day of, it’s such a fun day usually. It’s nonstop action but it runs very, very smooth. It’s kind of funny to me because people on first-dose clinics tend to come very early before their appointment — which is no big deal; we just take them. But by second-dose clinics everybody’s learned ‘I don’t need to get there early. I’m in and out in less than 30 minutes, with the 15 minute wait.’ They come closer and it paces in at a nice kind of schedule. It runs really smooth on those days.”
Initial uncertainty in how much vaccine would be available on a week-to-week basis was the biggest challenge. Learning from the Pennsylvania Department of Health on Mondays what the shipment would be that week, Mount Nittany at first offered a first-come, first-served sign-up online (while also reaching out to some of its own high vulnerability patients). That meant thousands of people flooded the website, with 10 times more trying to schedule than there were appointments available.
In February, Mount Nittany switched to a waiting list system, which has also been used by providers like Centre Volunteers in Medicine. Eligible residents can sign up any time and receive a notification when it’s their time for schedule an appointment.
“We had to go through a couple variations to get to what’s been working well,” Cabibbo said. “Now it’s at a point that it’s a pretty well-oiled machine in how they’re booked.”
Increased consistency with allocations has helped. Now primarily receiving the Pfizer vaccine, Mount Nittany regularly receives a tray a week for about 1,200 first doses. It also provides about the same number of second doses each week.
“We’ve been able to predict that the last few weeks, and so we’re able to book people more in advance, kind of continue out the scheduling process moving forward. So that’s been nice,” Cabibbo said.
The clinics involve the work of hospital staff and volunteers to make everything run smoothly.
When individuals with appointments arrive, signage directs them to a dedicated parking area at the rear of the hospital, where security officers are on hand to greet people as they arrive. Wheelchairs are available for those who need them.
Upon entering the medical center, a team of about four greeters are on hand to ask patients if they have their consent forms completed and direct them to the appropriate line for registering or filling out the brief paperwork.
“In the last couple of weeks, that’s been some of the positions we’ve been able to bring back our classic volunteers, not necessarily to vaccinate but to help in that,” Cabibbo said. “So you’ll see our typical blue coat of our volunteers that have come back to help there.”
Six Mount Nittany employees are usually working at any given time to register individuals.
Two or three pharmacists draw up the vaccine on site. A team of 10 vaccinators is split between two areas: four in the hospital’s board room and six in the auditorium. Cabibbo said they are typically a mix of staff and volunteers, including some retired Mount Nittany nurses and current doctors, physician assistants and nurse practitioners volunteering their time.
Other volunteers and staff, meanwhile, have a utility role of getting needed items or handling the regularly scheduled disinfections of the areas being used.
“It’s a pretty big operation,” Cabibbo said.
Demand for appointments has remained high and, anecdotally, Cabibbo said she has seen community members who were previously on the fence about getting the vaccine now deciding they want it.
“They’re maybe still a little bit nervous about it. They ask some questions,” she said. “But they did change their mind in that process. I do think we’re probably seeing that continue.
“I think some people who are on the fence — because if you’re adamantly against or adamantly for you’ve probably made your decision — but some of the people that are in the middle probably say ‘I know so-and-so is going to get it,’ and maybe are watching how others responded before they make their decision. It gives them more comfort or maybe people have done more research and gotten past what they were worrying about.”
Countless experts and organizations like the Centers for Disease Control agree the COVID-19 vaccines are safe and effective. Instances of severe allergic reaction, including anaphylaxis, are rare, occurring in no more than five people per million vaccinated in the United States, according to the CDC.
And Mount Nittany has, to date, seen no severe adverse reactions.
“Some people have anxiety, those types of things, but no anaphylaxis in any of our clinics thus far,” Cabibbo said. “We’ve had a really good experience.”
As availability and eligibility expand, Mount Nittany is prepared to scale up its clinics based on the allocations provided by the state.
“As we have done since we began our vaccination clinics last December, we will closely follow the DOH timeline and administer as many vaccines as are made available to us, during each approved eligibility phase,” Cabibbo said.
Mount Nittany and CVIM have been the main recipients of Department of Health vaccine allocations in Centre County and operate the largest regular clinics. (Most retail pharmacies receive federal allocations, although Boalsburg Apothecary and Moshannon Valley Pharmacy have received allocations from DOH.)
The longstanding relationship between the two organizations means they have had regular discussions about COVID-19 and the vaccine distribution process. In February, Mount Nittany stepped in to help when CVIM saw its expected shipment of doses delayed just before a scheduled vaccine clinic, temporarily diverting its weekly shipment so the clinic could go on as scheduled.
“They’ve been the main provider that we have ongoing conversations with and part of that is because we have an ongoing relationship,” Cabibbo said. “Since the beginning we’ve always been part of their board… I think we just naturally work well together and so we have just helped in any way we can…”
Based on calls with the Department of Health, Cabibbo said she expects “it probably won’t be just the two of us in the show anymore at some point,” as the state expands its provider network when vaccine supplies become more abundant.
“Their goal is to basically be, wherever you are you can practically fall over four different places to get the vaccine,” she said. “My understanding is it’s very likely the distribution and the site opportunities are going to expand as the quantity expands.”
But that doesn’t mean the role of organizations like Mount Nittany and CVIM will diminish.
“They have been clear that when the floodgates open, if you will, [they plan] to kind of further support what’s already been in place,” she said.
One significant new addition to the vaccine availability in Centre County will be a regional vaccination clinic at the Bryce Jordan Center run by the Department of Health and Pennsylvania Emergency Management Agency.
The clinic, which will administer the one-dose Johnson & Johnson vaccine by appointment, will open Friday and starting next week will be open Thursdays through Mondays. It initially will vaccinate 600 people per day with the capacity for more as operations expand, according to PEMA.
Cabibbo said in an interview last week that DOH has discussed working on large-scale clinics in the spring but she was not aware of specific plans.
However the state moves forward, Mount Nittany stands ready to vaccinate as many people as possible.
“We can scale up,” Cabibbo said. “We’ve done 4,000 a week if we need to. We do know how to turn those on. We’re just not sure of what it means from the supply, or if there’s a big retail pharmacy strategy from the state. Those are things we’re kind of waiting to see and then see how we can continue to complement that.”
While vaccines become more widely available, Centre County health, education and government leaders have urged continued vigilance amid a recent rise in COVID-19 cases and hospitalizations, which have been at their highest levels locally and statewide in more than two months.
After COVID admissions at Mount Nittany trended down throughout February, they began to climb again in March, when the hospital had 124 COVID positive inpatients and an average daily census of 18. Last week, the COVID census was as high as 30, though it was at 19 as of Tuesday morning. The uptick prompted Mount Nittany to suspend most visitations to patients at the medical center as of Saturday.
Over the past month, the county also has added nearly 1,800 new COVID-19 cases. For the week of March 26-April 1, Centre County’s PCR testing positivity rate was 10.3%, up from 9.2% the previous seven days, according to the updated DOH early warning monitoring dashboard.
“We’re definitely seeing community spread,” Cabibbo said. “Ninety-two percent of those 30 [inpatients] are just general community members. They’re not coming from nursing homes. It’s just the general population. Right now our average [COVID patient] age is 62 so that tells you we have a young mix.”
Cabibbo said the presence of the B117 variant, confirmed locally in analysis of wastewater by Penn State epidemiologists last month, may be contributing to the spread. However, lengths of stays and severity of illness among inpatients at Mount Nittany has not substantially changed. Throughout the pandemic, the hospital has averaged between one and two COVID patients in intensive care.
“Most of the time you start to see mutations after something’s been around for awhile,” she said. “It’s just a testament that it’s not going to go away and there’s still lots to do.”
And for community members, that includes continuing to practice measures such as wearing masks, frequent hand washing, social distancing and avoiding large gatherings.
“I can appreciate that people want to move on but it really is too early… We’re not out of the woods,” Cabibbo said. “Are we in a better position than we were a year ago with having the vaccine? Yes. We have some other tools but they’re not instantaneous. We really have to keep that diligence.
“It’s still the basics 101: social distancing, washing your hands and wearing your mask. That’s pretty much it and we can’t stop that yet.”