DeWine Unveils Vaccine Program

Gov. Mike DeWine announced today that Ohio will receive confirmed shipments of 299,475 doses of vaccine beginning around December 15, with another 359,000 doses tentatively scheduled to arrive days later.

The Ohio plan is consistent with CDC priorities with Phase 1A focused on critical groups. This priority group includes:

• Health care providers and personnel routinely involved with the care of COVID-19 patients
• Residents and staff at nursing facilities
• Residents and staff at assisted living facilities
• Residents and staff at state veterans homes
• Patients and staff at psychiatric hospitals
• People with intellectual disabilities and those who live with mental illness who live in group homes and their staff
• EMS responders

Of the initial shipment of the Pfizer vaccine, 9,750 doses will go to Ohio’s prepositioned hospital sites and 88,725 to Walgreens and CVS for nursing home and long-term care facility and staff.

A shipment of 201,000 of the Moderna vaccine is anticipated on December 22. These will go to 98 hospitals and 108 health departments. A Pfizer shipment of 123,000 doses, for nursing home residents and staff, is expected the same day. A few days later, tentative shipments of 148,000 doses from Pfizer and 89,000 from Moderna are expected.

ODH Outlines Logistics for Vaccine Distribution

The Ohio Department of Health’s Vaccine Preparedness Office has been preparing for months, distributing adult influenza vaccine with the same process that will be used to distribute the COVID-19 vaccine as a test exercise, and running daily drills with prototype packaging to break down and repackage the vaccine in smaller units.

The Pfizer vaccine will be shipped to Ohio using the following process:

• The Pfizer vaccine will be shipped directly to Ohio’s 10 prepositioned hospital sites. As vaccine supply increases, additional providers will receive direct shipments if ordering 975 doses or more of the vaccine.
• Providers requiring fewer than 975 doses, such as smaller local health departments and physician offices, will not receive a direct shipment from Pfizer. In these cases, Pfizer will ship the vaccine to the ODH Receipt, Store, and Stage (RSS) warehouse, where the vaccine will be redistributed in increments of 100. The warehouse is equipped with ultracold freezers that can each hold up to 720,000 doses to be stored in the RSS at any one time.
  • When vaccinations are ready to be shipped from the RSS warehouse, the must be removed from ultracold storage and repackaged with dry ice in under two minutes. To ensure the vaccine can be repackaged safely, quickly, and effectively, ODH staff and members of the Ohio National Guard are running daily practice drills that include the following steps:
    • Each box is transported to a table where the vials are counted.
    • The box is closed and handed off to another team member who will place the vaccine box in a larger cold shipping container lined with bubble wrap.
    • Once the correct number of doses are placed in the larger cold shipping container, dry ice is added to the package, along with a sheet of cardboard. The lid is replaced and the package proceeds to the next step.
    • The package is sealed, a shipping label is applied, and the package is moved out for delivery.
    • All packages will be delivered to the providers within six hours. The vaccine will remain stable if sealed in the original shipping container from the RSS warehouse with dry ice for up to 5 days.
• Vaccine National Drug Control (NDC) and lot number information will all be tracked electronically, and parcels will be tracked as they are delivered. Each delivery vehicle will contain a GPS enabled device.

It is anticipated the Moderna vaccine will be shipped directly to providers administering the vaccine and will not be processed by ODH at the RSS warehouse.

Eight Counties at COVID High Alert, CDC Issues New Quarantine Guidance

At briefings this week, Gov. Mike DeWine, Ohio Department of Health Chief Medical Officer Bruce Vanderhoff, MD, and other physicians and health care workers repeatedly cautioned Ohioans to take precautions and stay home whenever possible. This week, Ohio’s COVID-19 hospitalizations hit an all-time high at 5,060 patients. That compares to just under 1,700 patients a month ago on November 1. 

There are now a total of eight counties at Level 4/Purple on the Ohio Public Health Advisory System: Lake, Lorain, Medina, Montgomery, Portage, Richland, Stark, Summit. Three counties are on the watch list, at risk of moving to Level 4/Purple: Cuyahoga, Fairfield, Madison.

Ohio was added to the state’s own travel advisory warning list this week. The advisory, issued every Wednesday, cautions residents about traveling to states with a COVID-19 positivity rate at 15% or above. Ohio is at 15%.

The CDC issued new guidance on Wednesday and now recommends two additional options for how long quarantine should last. Based on local availability of testing, for people without symptoms quarantine can end on day 10 without testing or on day 7 after receiving a negative test result. However, the CDC continues to endorse quarantine for 14 days and recognizes that any quarantine shorter than 14 days balances reduced burden against a small possibility of spreading the virus. Local public health authorities make the final decisions about how long quarantine should last in the communities. Vanderhoff said ODH is evaluating this latest recommendation. Today, ODH endorsed the shorter quarantine options.

Fireworks Bill Amended, Legislators Have a Busy Lame Duck Session

The Ohio Senate Transportation, Commerce and Workforce Committee amended HB 253, the fireworks bill, this week. The measure, which was scheduled for a possible vote, was deferred until next week as the Committee Chair noted the intention is to take a vote before this session adjourns. The amendment changes the legislation to an opt-in system with local governments deciding whether to legalize the discharge of fireworks in their jurisdictions and limits that legalization to July 3, 4 and 5. Previously, the bill would have allowed for year-round usage.

Prior to the Committee meeting, the OOA joined with a coalition of other organizations to send a letter to Senate President Larry Obhof strongly discouraging him from passing the bill during the final weeks of lame duck and outlining health and safety concerns. It reads in part:

Enactment of this legislation would be ill-advised and dangerous under normal circumstances, and Ohio is in a very abnormal situation right now. With all of the challenges our state is facing, we are perplexed to see HB 253 moving after just two committee hearings in the Senate and with no dialogue among stakeholders.

In addition, OOA members whose state senators serve on the Transportation Committee received an action alert this week. Emails to those senators urged a “no” vote on HB 253; pointed out that studies show the frequency and severity of fireworks injuries increase when discharge is legalized in a state; and noted that one-third of all fireworks injuries are to children.

With the amendments to the bill, the Fireworks Safety Coalition will likely take a neutral position on the legislation.

It was active week during the lame duck legislative session. There was movement on several other bills of interest to the profession:

• HB 412 There was an amendment to the Rare Disease Advisory Council bill which will need concurrence from the House. Because the amendment was added with an emergency clause this will be on a fast track.
• HB 418 which deals with changing of prescription drug plans during a plan year for non-medical reasons was voted out of the Health Committee.
• SB 97, referred to as the price transparency bill, requires hospitals to provide patients with an estimate in advance for scheduled services. The bill was approved by the Health Committee, 14-1, after several unsuccessful attempts to add amendments.
• SB 252 which prohibits “fail first” coverage of drugs to treat stage four advanced metastatic cancer is scheduled for a House floor vote next week.

DeWine Vetoes SB 311

The legislative and executive branches continue to tangle over the levers of power that balance public health and the economy. As expected, Gov. Mike DeWine vetoed SB 311 yesterday, stating in his veto message that “it is not in the best interest of protecting the health and safety of all Ohioans.”

The bill would limit the executive branch powers, specifically curtail Ohio Department of Health (ODH) authority to order quarantine and isolation; block ODH from issuing statewide quarantine orders for people who aren’t ill or haven’t been directly exposed to an infectious disease; and give the state legislature authority to rescind state public health orders. In his veto message, DeWine cited objections from health care professionals and business leaders who said SB 311 was detrimental to pandemic response and public health.

Senate President Larry Obhof initially signaled an override in the Senate but negotiations are ongoing regarding compromise language.

Educational Opportunities for Ohio Physicians

The Ohio Psychiatric Physicians Association (OPPA) is offering a series of on-demand webinars to prepare for upcoming changes in the coding, documentation and payment of evaluation and management services that go into effect January 1 for psychiatry and addiction medicine. OOA members who register for the full series by December 10 receive a discount. Use the code OOA2020.

The American College of Emergency Physicians is sponsoring Zoom-based MAT (DEA-X) Waiver training. The free course consists of a live, four-hour virtual webinar taught by clinical experts and a four-hour online self-study portion. Upon completion, physicians are eligible to apply to the Drug Enforcement Agency for a waiver to prescribe buprenorphine, one of three medications approved by the FDA for the treatment of opioid use disorder.

Prevent Blindness Ohio (PBO) offers several services to help primary care practices save the sight of their patients, including free vision screening trainings for children. Upon successful completion, attendees receive free vision screening equipment valued at $930. There has never been a more important time to reach children with preventive services since many are not in their usual school routine. PBO offers other vision-related services for primary care offices.

License Renewal Update

HB 404 was signed by Gov. Mike DeWine on November 23. The provisions related to the extension of the COVID-19 emergency are effective immediately:

• Medical Board licensees who have licenses set to expire during the period of emergency (March 9, 2020 – April 1, 2021) now have until July 1, 2021, to renew their license.
• Medical Board hearings and meetings can continue to be conducted electronically. The board must provide at least 24 hours advance notice of a meeting to the public, media who have requested advance notice and any parties required to be notified.

Whether you renew now or at a later date, your next license renewal date will not change.

For questions, contact the State Medical Board of Ohio at License@med.ohio.gov.