Published on January 8, 2021
Somer Overshon: Today, we have Ed Clayton, who is the president and chief executive officer of Phelps Health. A whole lot of stuff has been happening at Phelps Health. We have a lot to talk about today, Ed. Before we do, can you talk a little bit about where you came from, how you ended up being the CEO at Phelps Health and why you choose to stay here?
Ed Clayton: Sure. I have been in Rolla almost 20 years now, and I came here because of an opportunity to join the organization when it was going through a transition to a new electronic health record, ironically. When I came into the community, I thought it was somewhere I would spend a few years and get experience and transition to bigger and better things, and as I became more familiar with the organization and the community, it was just something that was comfortable. I've been able to have opportunities present themselves to me while I've been here, and about five years ago, I was blessed with the opportunity to become the CEO of Phelps Health, and it's a great organization. It does great things for the community, and I am just excited about what is going on there and what things look like in the future.
SO: Well, I think we are all tired of hearing how this year has been unlike any other, but it truly has. So let's talk a little bit about what all has happened this year. Usually, you always give some sort of year-end recap where you talk about a large variety of things, but today we are going to focus on one topic, and that is COVID-19. What is going on recently, and what is happening? How is Phelps Health working to help slow the spread of the disease?
EC: Yes. So, let me talk about what we have experienced locally with COVID-19. With all the attention placed on New York, Washington and Florida earlier in 2020, we were very fortunate here. We in essence missed the first wave. It gave us the opportunity to prepare for what the future might hold. So, as the summer turned into fall, we started noticing an uptick in the numbers of COVID-19 positive patients. We admitted our first patient, I believe, in late July or early August. We saw the numbers of patients with [a] positive diagnosis ramp-up, to the point that by the time we got to mid-November, I would say we were a... I hate to use the word crisis, but we were certainly stressed as an organization taking care of the community’s needs associated with COVID-19. Our respiratory screening area was overflowing with patients every day, and some patients had spent four to five hours waiting to be tested. That is not a pleasant experience, sitting in a car waiting for that long. Our ICU was full; our ED was stressed, and our surrounding communities that oftentimes we refer patients to, that need services that maybe we don't provide here, they were unable to accept patients at that time. We were feeling a great deal of stress.
EC: What has happened over the last, I will say, a month and a half now, is things have stabilized a little bit here on the local level. We went from having an inpatient census of COVID-19 patients of around the mid-40s, at points in November to early December, whereas today we have a COVID-19 inpatient census in the high teens to low 20s. The volume of patients going through our screening area has slowed down some. The positivity rate is still where it was at, which is concerning. It reached a high for us right around 30%. It is still a very high number, in the upper-20s at this point. So, we are still seeing a number of positives. The key is we need to keep doing the things we are doing to get the rate to start to fall. So, that is what our focus is.
SO: Yes, and you were talking about how the respiratory screening station was stressed. Some of the numbers coming from there have been staggering. I think the record was a little over 200 patients in one day. That is unbelievable. That is not a record you want to set.
SO: It definitely has been stressful, and one of the things that I think has happened recently is the vaccine, which is really what we want to talk about today, because there has been some movement with that at Phelps Health. Can you discuss a little bit about what has been happening and what that process looks like?
EC: Sure, so to start with, the vaccines were made available to us by the federal government sometime in mid-December, and each state has their own program and way the vaccines are being distributed to its citizens. Those plans are based from guidance from CDC and others. The state of Missouri has its plan, and the plan has four phases. The phases are 1A, 1B, and two and three. So, we are in phase 1A right now. The way that 1A is defined is for long-term care residents, long-term care employees and patient-facing employees of health providers. We were fortunate enough to receive a shipment back at the last week of December. There [are] a lot of communities that have not received it yet. So, we were very fortunate that we did receive that shipment and were able to begin vaccinating our employees right away. Again, our employees by definition are in that 1A category. We spent the last couple of weeks trying to push out as much of that vaccine to our employees as possible. We have been excited about that. We are looking forward to those additional phases opening up and being able to vaccinate more of the community. It becomes yet another tool in our toolbox to thwart the spread of the virus.
SO: I know that the vaccine that we received was the Pfizer vaccine, and there has been talk about Pfizer and Moderna. Will we be getting the Moderna vaccine or is it just probably going to be the Pfizer vaccine?
EC: Well, one of the things I have learned is that you never know with this process. The state of Missouri and the federal government had a little bit of miscommunication on what the expectations were of vaccines that were allocated to Missouri. One of the things that happened because of that was that Missouri decided it was going to focus the allocation of the Moderna vaccine to long-term care facilities and residents. That is the focus of the Moderna vaccine really through late January, or early February. For us, Pfizer is the primary option, and there were good things about that and some not so good things. The Moderna vaccine comes in lots of 100. An approved vaccinator by the state can order from Moderna and receive a lot of 100 doses. Pfizer requires ordering a shipment of 975 doses. So, for smaller vaccinators or smaller entities, it is easier for them to be able to administer the 100 doses as opposed to the 975. The other thing is the Pfizer vaccine requires much cooler refrigeration than the Moderna vaccine.
EC: In order to be able to accept the Pfizer vaccine, you have to, number one, be able to administer doses in that amount. The second is that you have to be able to appropriately store the vaccines. Those requirements limit the distribution of the Pfizer vaccine, more-so than the Moderna vaccine. That is why for us, the Pfizer vaccine is an optimal choice. We have the size, scope and ability to store it, both in the short term and the long term. We may get Moderna at some point. You just do not know. If Moderna is what becomes available, we will take it at the right time, but right now, we are primarily focused on Pfizer.
SO: You were talking about storage. Did you have to buy any extra equipment to store the vaccine, because it does have to be refrigerated or kept at such a cold temperature?
EC: There is a process with the Pfizer vaccine that it can be stored on dry ice for a period of time. That is actually the process we are using right now. We follow the guidelines for maintaining it at the appropriate temperature so it does not spoil. Looking long-term, because we believe there is going be such a community demand for the vaccine, we have ordered the larger refrigeration freezers so we will be able to store greater amounts of the vaccine. We expect those freezers to come in February.
SO: What is the cost of getting the vaccine? Can you talk a little bit about cost? I know some people may be concerned they will not be able to afford it.
EC: The actual cost of the vaccine does not cost anything. As a vaccinator, we receive it from federal government without cost, and we do not pass any cost along. There is a charge associated with the actual administration of the vaccine, and it is going to be dependent on your health plan. I suspect, and I have not heard to the contrary, that most health plans are going to provide the vaccine as part of the coverage to their recipients. Doing so is in their best interest, to give it to the folks that have insurance to get the vaccine, and health plans are going to want to encourage that. Really, cost is dependent on your health plan. For the most part, I believe that the health plans are going to provide the vaccines most likely free of charge.
SO: So even though we are starting to see this vaccine come out, why should we continue to do all the other things that we have been doing all year, which is wearing masks, staying distanced from people, and practicing hand hygiene? Why are these things still important even though you may have been vaccinated?
EC: I will mention a few things. The first one is, in our organization, we have followed the guidance of CDC and other regulatory entities in terms of public safety, and they continue to tell us that is what we should do. There is one reason. The second reason is, at the end of the day, I think the jury is still out on how long these vaccines are going to be good or effective. We will find out over time, whether it is 90 days, 60 days, six months, a year or permanently, or maybe we will have annual shots. The data is still not clear.
EC: In order to continue to keep the spread in check, it is important that we continue to do take these preventive measures. The hand hygiene is important. It was important pre-COVID. The social distancing and mask wearing are still important, because at the end of the day we do not know how long the vaccines will be effective. I get the same questions for individuals who have been positive and have built up antibodies and recovered from COVID-19, why should they do those things? It is the same reason. We do not really know whether they have permanent immunity or whether it is for three months or whether it is six months. Right now, the general guidance is three months with the thought that maybe it is longer, but we do not know those things for sure yet. Unfortunately, in terms of a disease like this, we are still early in the game.
SO: With each vaccination given, there is information that needs to be collected and recorded. And, with Pfizer, since it is a two-dose vaccine, you have to return for your second shot. Can you talk a little bit about what that reporting structure is and why that is occurring?
EC: Yes. There is general information that has to be collected prior to vaccination. It is mainly your address and the general things you give when you register for any kind of service. Contact information, things like that. That information is reported to the state of Missouri through a system called ShowMeVax. The primary reason why they are tracking that is, as you mentioned, Pfizer requires a second dose, and so does Moderna. With both of these vaccines, it is important that the second dose takes place to ensure that you get the full effect of the vaccine. Recording the information is a tracking mechanism to make sure that if you have gotten the first dose of the vaccine, but you have not gotten the second dose, that information is tracked. The other reason for that information is to track the number of vaccines that have been distributed versus the amount that has been actually administered. This is another tracking mechanism used, just to make sure that the states have their process in place, and the federal government, who is allocating these vaccines, want to make sure vaccines are being administered appropriately and are not being hoarded or being held on to for some reason.
SO: Why can we trust this vaccine?
EC: I know there has been a lot of conversation about the speed with which the vaccine has gone through the process. But, the vaccine has gone through the same rigorous scientific studies as other vaccines. Our clinicians will tell you, and I am not going to say 100%, but the vast, majority of our clinicians were the first ones in line for the vaccine. They are comfortable with the science behind it, and the scientific, appropriate process taken to make sure the vaccine is safe. We are comfortable it is safe, and the public should feel comfortable as well.
SO: Yes. And, a large number of Phelps Health employees have received the vaccination, correct?
EC: A large amount, yes. We are, as of yesterday [1-7-21], we had vaccinated over 800 of our employees. We are anticipating by the end of the week, we will have vaccinated over 1,000 of our employees, which puts us over 50% of our employees being vaccinated. Our employees were very excited to get it. What we have found is that once the vaccine was made available, some employees that were on the fence, or were not sure about getting the vaccine, now they have seen their co-workers get it and know they are fine. So, we are seeing more of them go ahead and get the vaccine now.
SO: Again, what would you say to people that are maybe reluctant about being vaccinated? Would you just try to encourage them and reassure them that it is safe?
EC: Yes, and seek the advice of your primary care physician, as you should with all matters concerning your health. That would be my recommendation, too. The same goes if you are concerned about the vaccine’s safety, again, talk to your primary care provider. They have read the studies, they are informed, and they can speak to you about the benefits that it gives you.
SO: We have heard that COVID-19 is mutating now, too. Is that anything that you are concerned about at this point?
EC: Oh, I am worried about all kinds of things. My understanding of the mutation is that—and this has not been borne out completely in studies yet, but the thought is, the vaccine is likely to defend you against the variant as well. It is not unusual as a virus goes on through time to mutate, and it happens with the flu on [an] annual basis. So, the fact that there is mutation is not a surprise. We just have to continue to follow these changes and make sure we respond in a way to keep everyone safe.
SO: I know people are wondering when they might be able to get the vaccine and does Phelps Health have plans to vaccinate the public at some point?
EC: Yes, so let me talk about the phases that the state of Missouri has in their plan. Again, there's four phases, although they number them strangely--1A, 1B, phase two and phase three. We are in Phase 1A right now, which is the long-term care residents, long-term [care] facility workers and healthcare workers. These are the only folks right now that are designated by the state to receive the vaccine. As a registered vaccinator, we are required to follow the plan the state of Missouri puts forth, and these are the individuals designated as the most critical groups upfront to get the vaccine. These are the instructions that we follow.
EC: That plan as originally laid out was that phase 1A was supposed to last 90 days. After 90 days, you move into phase 1B. Phase 1B includes critical infrastructure workers in the community. This would be people like our teachers; it would be people like our first responders, police, fire, etc. It would be your city electric workers. These individuals would then become eligible as well as high-risk individuals. And there is a definition for what qualifies as high-risk, but it is the general things you think of with high risk, whether it is heart conditions, respiratory conditions, being overweight, age specific—these are the kinds of individuals that qualify for phase 1B. That is about 90 days out. That is 90 days out in the plan, which kicked off in mid-December. So this would be middle to late March. Then, as the plan rolls through the final phase three, the general availability to the public is supposed to happen in mid-June.
EC: I can tell you there is a ton of pressure happening from the federal government, and I think because they are getting pressure from people who want the vaccine and want to move that process along more quickly. I can see the plan morphing to shorten the time span between the beginning of 1A and 1B, and 1B and just this phase two and phase three. At its longest period, it is going to take six months to roll out to the public. I believe the way, just as my personal thought, and the information we are getting, there is going to be a push to roll the plan out much quicker. And our plan is to, as best we can, and for as long as we can, to vaccinate our community. We are going to do everything we can to do that.
SO: Because doing so follows Phelps Health’s mission.