"Mentally, it's going to make me feel a whole lot better, because I know I won't have to worry about catching COVID, and I won't have to worry about giving it to other people," Apana said. "I feel it will be a new chance at life."
Apana wanted to know when she'll be eligible to receive her first dose of vaccine, and how she might be alerted to that bit of good news. So she started calling around. She phoned Sonoma County's COVID hotline, was directed to Emergency Services and spoke to a health administrator there. She called county Supervisor Susan Gorin and left a message. She called her doctor. "All the places that it's been listed," Apana said.
After all of that, she felt no closer to the clarity she was seeking.
Apana is no outlier. People across Sonoma County, and especially seniors and those who care for them, are trying to sort out the details of their promised inoculations.
When can you get vaccinated? And how will you know when it's your turn? Two simple questions with rather convoluted answers.
By now, most people have heard about the state's detailed system of prioritizing immunity based on vulnerability. It's an outline of phases and tiers that starts with front-line medical staff and those who live and work in nursing homes, and ends with the general population — the "herd." It's cumbersome.
"The way the state named this makes my stomach turn," said Sonoma County Supervisors Chairwoman Lynda Hopkins. "I mean, Phase 1A, Tier 2? Why not just make it phase 1, 2, 3, 4...? People don't know phase vs. tier."
At least the order of eligibility is pretty clear. Much less obvious is the "when" of it all. Sonoma County is still in the midst of vaccinating Phase 1A, Tier 1, a group that includes health care workers with the highest risk of exposure. It also recently dipped a toe into Phase 1, Tier 2, giving doses to some federally qualified health centers. For the most part, though, a tier won't open up until the one before it is thoroughly served.
For that reason, the county has been reluctant to offer specific calendar targets. Dr. Sundari Mase, the Sonoma County health officer, said recently she expects to begin Phase 1B by the end of this month. Dr. Gary Green, an infectious disease specialist at Sutter Santa Rosa Regional Hospital, believes his facility might start into 1B as soon as mid-January.
That's a hopeful sign for elders 75 and older, who are included in the first tier of that phase along with people working in education, child care, emergency services, food and agriculture. Seniors in the 65 to 74 range join some other groups in the tier after that, but it's difficult to get a sense of when exactly their turn in the order will arrive.
Many residents are also having a hard time figuring out the mechanism of how they will be alerted. A few California counties are creating online registries to notify people about vaccinations. In Mariposa County, in the Sierra foothills, those eligible for shots can state whether they will need transportation to the vaccination site.
Mase said Friday that "we definitely plan to prioritize those folks as their tiers come up," and several working in Sonoma County government have talked about the county's new vaccine-related webpage as a hub for information. As of now, though, there is no plan for a central waiting list.
Hopkins said she has talked to Santa Rosa Mayor Chris Rogers about the possibility of using the county's existing alert system, not necessarily to send a notification when someone's tier is eligible, but to direct residents to a landing page for more information.
Jason Cunningham, CEO of West County Health Centers, thinks it's imperative for the public to be able to turn to the county for information and messaging on the vaccine.
"That will likely be part of the solution," Cunningham said. "It has to be. There needs to be leadership. This will be our most important public health intervention in our lifetime. We can't screw this up. Otherwise, businesses won't open, schools won't open up, we'll fall behind in our health measures."
Cunningham is part of a committee made up of representatives in government, health care and education that is aiming to streamline logistics and communications among all local medical providers involved in the vaccination effort, with a particular focus on making sure vulnerable populations such as farmworkers are served.
Mase and her deputy health officer, Dr. Kismet Baldwin, are attempting to ramp up vaccination delivery through outreach and the addition of sites.
First to be up and running might be 11 Safeway Pharmacy sites throughout the county, including four in Santa Rosa. Baldwin said she learned Friday the state had approved the partnership between the county and the grocery store chain. She hopes Safeway pharmacists will begin administering the vaccine within a week. Those shots would go to Phase 1A customers first, of course. But these walk-in sites could be a boon to seniors when they become eligible.
Mase and Baldwin have also talked about providing vaccines through the nonprofit Sonoma County Medical Association, local paramedics and EMTs, and the county's Department of Emergency Management. Mase said her office is in discussions to use the fairgrounds in Santa Rosa for vaccinations, and is exploring the conversion or expansion of pop-up testing sites to administer vaccines. Dentists may also be employed in the inoculation campaign.
For the most part, though, residents of any age will need to communicate with their primary care physicians about when they might be eligible.
"They know you best," Baldwin said. "And if you feel more comfortable getting vaccinated in their office, perfect. But there are going to be multiple other ways to get to receive the vaccine."
The six hospitals in Sonoma County are still working on plans to communicate this information to the people who rely on them for care.
"We will do direct outreach to patients who we can identify being within specific tiers when it is their turn to be vaccinated," said Chad Krilich, chief medical officer of St. Joseph Health in Sonoma — the group owns Santa Rosa Memorial and Petaluma Valley hospitals — in a statement. "In addition, we will work with primary care physician partners, who typically have the closest relationship with the patient, to enable that communication."
Kaiser Permanente offered a similar statement. "We anticipate that expansion of vaccination to prioritized groups of patients in the general public will occur as vaccine supply increases and federal and state guidelines are issued, and we are making the appropriate preparations. We anticipate using our normal methods to provide information about vaccine eligibility and appointments for vaccination," the HMO said.
Hopkins wants to do her own forms of outreach, talking to community leaders in various segments of Phase 1B, like educators and agriculture organizers and business owners, to make sure they're aware of the timing.
Many people are putting energy into this, and their efforts to raise awareness can only help. The challenge will be getting everyone to understand their options by the time their tier is eligible, lest vulnerable members of the community fall through the cracks of vaccination.
"That's the race against time," Cunningham said. "The health care system, we can vaccinate our own. But when you talk about Phase B and Phase C, you're talking about going out into the community with it. And we have to be ready by the end of January."
You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.
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