SB’s Covid Mess

I know I am not alone in having friends or family battling COVID – making up a small part of our national tragedy. The more devastating piece for Santa Barbara is those who are fighting for their next breath at Cottage Hospital after being denied or deemed ineligible for vaccination by the County. In the last two weeks, I know of six new cases of COVID, four hospitalized, three of which were excluded from the County’s rigid tier system because they were not yet 75. Three of them have multiple co-morbidities and two contracted the virus while at Cottage Hospital for their outpatient treatments.

Until January 18, Kroger Pharmacy at Ralphs was filling in a crucial age gap, vaccinating those 65-plus, per state and CDC guidance – and saving lives. The pharmacy has been the go-to resource for immunologists, pulmonologists, et al for their highest risk patients.After all, state and federal law supersedes County rules except, as is too often the case, in Santa Barbara.

In mid-January, County Health officials ordered Ralphs pharmacy on Carrillo to stop providing vaccines to those 65 to 74, regardless of co-morbidities, the pleas of doctors, or any other health considerations. Those who had waited their turn in line for weeks for their appointments were turned away.

Not surprisingly, the County’s heavy-fisted edict led to chaos, tears and blow-ups according to doctors, pharmacy staff, and impacted residents. Dozens of expectant seniors were sent home without vaccinations – some visibly ailing, some physically impaired by chemo or radiation treatments. No matter: if they cannot prove they are 75, they’re sent away. “There have been a lot of tears here,” said one of the staff pharmacists, asking not to be identified, “on both sides of the counter; those who showed up and also us.” Changing the rules so many times, an employee added, “has made it real complicated for us and much harder.”

One pharmacy staffer told me it would involve “making hundreds of calls and we simply don’t have the personnel to do so,” though they are attempting to do so, losing valuable time away from vaccinations. One Ralphs/Kroger employee said softly, “We are very, very sorry but County Health told us they could take our license away.” “We are concerned that we can’t get our most at-risk patients vaccinated now,” said pulmonologist Jeffrey Kupperman M.D., former head of Cottage Hospital’s Pulmonary Department. Quite a few Santa Barbara residents are now hightailing it to L.A., San Diego, and Northern California, areas where they follow state guidance to provide for 65 and over.

It goes without saying that the COVID vaccination rollout is an epic federal disaster. Think of it as the Donald J. Trump farewell gift that keeps on giving – and taking. But SB has always had a talent for making a mess even messier. Exhibit A, of course, is cannabis. While the State offered muddled regulations, our Supervisors succeeded in crafting a Cannabis Ordinance many times worse – one that has prompted untold appeals and lawsuits, a U.S. Attorney investigation, a smackdown Grand Jury Report – along the way, becoming a national cautionary tale and the go-to for How-Not-To-Do.

Nor has the County’s COVID response to date disappointed expectations: Santa Barbara County scored a recent #1 spot for most cases per capita in the state – hence, the most in the U.S. Meanwhile, COVID has proven an irresistible backdrop for political showboating and has provided excellent cover for burying legislation that Supervisors would prefer not be known. Since COVID, a relentless stream of cannabis permits has been quietly pushed along, opponents sidelined or silenced and enforcement funds and personnel slashed.

But unlike their cannabis mismanagement, the botched COVID response could cost lives. Consider that in mid-December, vaccinations began at hospitals and medical offices for all doctors, nurses, clerical staff – employees. Cafeteria staff, custodians, cleaning personnel were reportedly all included.

That’s good all good news. There was just one ommission: patients. Hence, cardiology, cancer patients and others whose immune systems have been compromised or leveled, were not on the list. Somehow, the most vulnerable in the community didn’t make the cut.

I know some of them. I also know people who were just shy of 75, hence unable to get a vaccine, and then contracted COVID during their outpatient hospital visits.

I understand there are shortages. I am not a doctor. Then again, neither is Director of Public Health Van Do-Reynoso, who seems like a diligent, hard-working public servant, assisted by Health Officer Dr. Henning Ansorg. 

But the COVID crisis has led some to revisit the Supervisors’ puzzling decision not to install Charity Dean, M.D., a well-regarded epidemiologist, who was both SB’s Health Officer and Acting Director of Public Health. Dean was also an outspoken patient advocate who long championed vaccination. The top job went to Van Do-Reynoso in 2017, not Dr. Dean who was promptly hired by Governor Jerry Brown to be deputy Director of the California Department of Public Health.

SB’s COVID crisis would seem to demand a COVID A-Team of epidemiologists and statistical whizzes. A logistical genius, preferably an MD in daily contact with the county’s immunologists and oncologists should be on the team.

At the current rate with guidelines that rank age ahead of co-morbidities, a 16-year-old leukemia patient, a 25-year-old with cystic fibrosis, or a 40-year-old with melanoma will likely get vaccinated this summer. Age is an important factor but should not be a sole factor.

I was one of those who received a group email from a mortified immunologist that her patients’ vaccine appointments at Ralphs were suddenly being cancelled per County orders, despite some having an abundance of co-morbidities.

With Ralphs’ pharmacy being shut down word spread that Dignity Health in Santa Maria was filling the void. One friend, 64, phoned from Dignity saying she had just been “vaxed” by a nurse who told her, “so happy you are here.” We made our appointments online and raced north the next day. When I approached the nurse, I tentatively asked if there was “some age limit.” Without a beat, she smiled and said, “we don’t turn away anyone. We’re just glad you’re here.” I’m not much for public displays of emotion, but I felt my eyes well up. 

Driving home, I called Ralphs hoping to give my “cancelled” appointment to a needy family member. The staffer asked if I knew anyone who wanted a vaccine who was 75. “When?” I asked. “Now,” she said. It was 4 on a Sunday and they were open two more hours. But they had some extra vaccines, presumably from all those 65-plus they were forced to cancel. Other pharmacies, I’m told, faced the same dilemma after the County read them the Riot Act for the 65-plus crowd.

I called a 78-year-old Vet friend named Tony. An hour later he was vaccinated. He wept. The next day, same thing: spare vaccines were available in the afternoon. We sent over another needy friend.

Although it’s not in my neighborhood, I will forever shop at Ralphs. And I’m praying for the nurses and volunteers at Dignity Health who have refused to turn away people. Pray the County keeps their Big Foot out of it. [As of press time: responding to ostensible political pressure, Dignity has reportedly stopped providing vaccines to those in need, regardless of tier group.]

Today, I found out that one friend with COVID had gotten out of Cottage but then relapsed and is back in the COVID ward. That makes four people I know – all older than 65 – who are fighting for their lives in Cottage Hospital.

Had they been vaccinated – when hospital clerical and custodial staffers were – they would be home, safe… and breathing.