As limited supplies of COVID-19 vaccines make their way into Maine, hospitals and other health care providers are facing confusion about who can be inoculated now and when the eligibility pool will expand under the state’s changing vaccination plan.

Officials at MaineHealth, which operates one of the state’s largest hospital networks, said they are seeking further guidance from the Maine Center for Disease Control and Prevention about whether they should be vaccinating health care workers who are not part of the MaineHealth system. Company officials also are seeking information on the Maine CDC’s plan for distributing vaccines for medical providers outside of hospital settings.

MaineHealth spokesman John Porter said Tuesday that while the current focus is on vaccinating the system’s frontline staff, such as emergency room and COVID ward workers, the company anticipates having to make decisions in the near future about non-employees such as private practitioners, therapists and physicians with admitting privileges.

“We are working with the CDC cooperatively,” Porter said. “We want to make sure we do it right and do it efficiently and effectively.”

Private practitioners who work with patients at risk of serious complication from COVID-19 also are seeking guidance – and assurances – from both the Maine CDC and the hospital networks administering this first-wave of vaccinations.

Dr. John Paul Winters, a hematologist/oncologist with New England Cancer Specialists in Scarborough, said many of the staff members at the cancer treatment clinic are likely lower risk because of their age and relative health. But Winters said “what keeps you up at night is that you might become an asymptomatic carrier and transfer the virus to one of your patients who is battling cancer.”

Doctors and nurses often spend an hour or more in small rooms with patients, and “infusion room” staff have close personal contact with patients when they administer treatments to fight cancer and other diseases.

“From the standpoint of being in a private oncology practice, we may not be on the frontlines where we are taking care of COVID patients in an (emergency department) or ICU,” Winters said, “however, we are not able to practice much telemedicine. We are hands-on and our patients are very sick.”

Dr. Nirav Shah, director of the Maine CDC, said on Monday that he was aware of at least one health care system that was administering vaccines to non-employees who work in that company’s locations. But he acknowledged that they do not yet have explicit guidelines on vaccinating non-employee health care providers.

Maine’s state-specific vaccination plan is changing in response to ever-evolving federal guidance based on vaccine availability and the latest science on the pandemic. An interim draft plan posted on the Maine CDC’s website in October is now partly obsolete because state health officials have since adopted multiphase vaccination plans proposed by the U.S. Centers for Disease Control and Prevention.

For instance, the Maine CDC added residents of long-term care facilities to the first phase of its vaccination plan in response to federal guidance. In the latest adjustment, Shah indicated Monday that Maine will follow a federal advisory committee’s recommendation to include individuals age 75 or older as well as front-line “essential” workers in the next phase of vaccinations.

That means tens of thousands of teachers, police officers, correctional officers, grocery store workers and postal employees could be eligible for vaccination as early as late January or early February, if vaccine supplies and federal distributions keep pace.

Maine CDC spokesman Robert Long said Tuesday that the agency is largely following the federal recommendations for the current vaccine administration during what is known as Phase 1A. Phase 1B would involve Mainers age 75 or older and non-health care essential workers, while Phase 1C would include those ages 65 to 74, younger individuals with high-risk medical conditions and other essential workers.

Under those scenarios, the rest of the general public in Maine might not be eligible for vaccines until late spring or early summer.

Long said the Maine CDC was waiting for the Advisory Committee on Immunization Practices to finalize the recommendations endorsed on Sunday, including the proposal to move individuals age 75 and older into a higher priority category.

“Until more clarity comes from them, we will continue to focus resources on getting available doses of the vaccines to groups in Phase 1A,” Long said. “We also want to be sure manufacturers can deliver full vaccine orders consistently to Maine before making further adjustments to the state’s vaccination plan.”

The fast-evolving situation and changes to the multiphase vaccination plan have led to confusion among health practitioners as well as the general public. Many Mainers, particularly those over age 60 or with health conditions that put them at greater risk of death from COVID-19, have reached out to doctors, police stations, fire departments and media outlets asking when and how they can get vaccinated.

Maine Health’s request for clarification appears to stem from confusion over who would be responsible for vaccinating private practice workers and other employees outside of the larger hospital networks.

During a briefing on Monday afternoon, Shah said the Maine CDC has “asked hospitals to do what they think is the right call given the risk that employees or health care providers face” from COVID-19.

While Shah said the Maine CDC needs to provide hospitals with more uniform guidelines, he added that the agency is “in mass-vaccination mode right now” focused on getting everyone in Maine vaccinated as quickly as possible. Shah suggested the agency will not issue granular-level guidance specifying, say, how many hours or patients a provider must log in order to qualify for a vaccine.

“If they are a health care provider who is encountering patients in that facility, it behooves all of us to keep the health care system healthy and have those people vaccinated,” Shah said.

Victoria Foley, director of marketing and communications at New England Cancer Specialists, noted that administrators at Portsmouth Regional Hospital in New Hampshire have already reached out to her group’s local office to let them know that they will be contacted when vaccines are available. Foley said she is optimistic, based on ongoing discussions, that MaineHealth will be able to include the Maine offices in their vaccination plan for health care workers.

“We are very pleased to hear there is some discussion about how private practices and private practice physicians will be incorporated” into the vaccination schedule, Foley said.

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