Last week, Nicole Chiabotti helped the 14-bed community hospital in Cook, Minn., Administer the second dose of the COVID-19 vaccine to all its patients 65 years and older who wanted it.
This week she is helping to organize a clinic for everyone else in the area – patient or not – who is eligible for the vaccine. They expect to receive an additional 300 doses.
“I have planned at least 200 people personally,” said Chiabotti, the hospital’s nursing director, “and I have many people who come from other cities in the Iron District such as Hibbing, Aurora, Gilbert.”
Cook Hospital in the small town of St. Louis County with 51
“Most of the community, our community 65 years and older, [has] have already been vaccinated between us and the clinic, ”Chiabatti said.
Across the country, people aged 65 and over – as well as health professionals, educators and childcare workers – are eligible to be vaccinated. But as the state’s vaccination efforts continue, they are markedly limited by a supply that lacks demand – a problem that has plagued health departments nationwide and frustrated patients eager to get their shots.
And in Minnesota, it depends on whether people 65 or older have been vaccinated against COVID-19, to a large extent, where they live.
In some rural Minnesota counties, elderly residents are more than twice as likely to have received at least a first dose of the COVID-19 vaccine than if they live in most parts of the Twin Cities metro area. But even in the rural areas of the state, there are significant differences from county to county.
Chiabotti said people from Duluth and even the twin towns, 3 1/2 hours away, are planning vaccine appointments at her hospital for their latest batch of the vaccine. Many, she says, have cabins in the area, which is how they learned that vaccines were available.
“They are so happy and so grateful,” she said. “And they all feel very lucky compared to what they see on TV.”
What they see, she said, are reports of people around Minnesota who have not been so lucky. They see people getting more and more frustrated while waiting – while watching family, friends and strangers on social media get vaccinated.
Many of the locations in Minnesota with the highest vaccination rates for people 65 and older are in rural areas, such as Cook, who receives multiple streams of the vaccine.
Mahnomen and Red Lake counties, for example, have vaccines from the state and federal governments for clinics, pharmacies, local health departments and Indian health care facilities. Both are among the top five counties across the country with the highest vaccination rates among residents aged 65 and older.
But other rural counties owe their success to at least partial success.
For several weeks early in its rollout to recipients age 65 and older, the Minnesota Department of Health split the vaccine supply among small and medium-sized health care providers through a lottery system. This meant that in a given week, some hospitals received hundreds of doses, while others did not receive any.
Liz Sorenson heads Ortonville Area Health Services in western Minnesota’s Big Stone County, where more than 62 percent of seniors as of Sunday had received their first shot – the fourth-highest percentage of 65-plus vaccinations in the state.
“And we’ve just been lucky enough to have gotten a share of this lottery system,” Sorenson said. “Many of our neighbors were not so lucky.”
It includes Watonwan County, southwest of Mankato, which has one of the lowest vaccination rates in the state.
Jeff Mengenhausen is the CEO of Madelia Community Hospital and Clinic in the county. They have received enough vaccine for health care providers and area teachers. But he said his hospital is still waiting for its first shipment of the vaccine for patients 65 and older.
“And all the rural hospitals, including us, we have plans, we have people, staff, we are ready to go,” he said, “but we just do not have the vaccine.”
Last week, the state switched back to a system in which eight regional health coalitions help distribute the vaccine among local providers.
Each week, the state health department receives a vaccine distribution from the federal government, which it in turn distributes among several units, including the eight regional coalitions.
From there, said Shawn Stoen, emergency coordinator for the state’s west-central region, the coalitions will meet to decide how to allocate their allocation to health facilities in the region that week.
“The vaccine is not under the ownership of the facilities [or] agencies – it is society’s vaccine, ”said Stoen.
They take into account several factors, including the size of each county’s 65-plus population and how many people in that population have been vaccinated.
Ann Jenson helps lead the Southwest Minnesota Coalition, which hosts regular meetings with all providers in the region. She said some hospitals in the region went three weeks without receiving any vaccine for their elderly residents. But she hopes the coalition model can help ensure a fairer distribution.
“It’s our hope,” she said. “One hundred percent yes. I mean, we’ve been able to fill those gaps like the three hospitals that got none. [vaccine] – they were our first to receive our first award. ”
She is happy that the state went back to the coalition model. In the old system, the hospital in Dawson, where she lives, received no vaccine for three weeks, while the hospital in the next town in Madison received hundreds of doses.
“There was simply no capital in this system,” she said.
Available vaccine supply has played an important role in determining which counties have received the most shots in arms. But that is not the only factor. Carrie Henning-Smith, director of the University of Minnesota’s Rural Health Research Center, said small town networks – among providers, public health and individual patients – make a difference.
“People are more likely to be connected to their local clinic, their local healthcare system,” she said. “There’s less confusion about ‘which system I go with’ because you initially have fewer systems to choose from.”
Plus, she said, the word moves fast in small towns when the vaccine is available.
Sorenson of Ortonville said people are also less likely to fall through the cracks in rural areas.
Especially an elderly patient is holding on to her mind. She knew he wanted to be vaccinated, she said – but she could not get hold of him. So she got in touch with his home supplier.
“I knew the home nurse might have a good number to reach out to their daughter or their son to see if they wanted to be vaccinated,” she said. “And those are the connections we have.”
Cook County, at the northeastern tip of Minnesota, has the state’s highest vaccination rate: As of Saturday, nearly 90 percent of people 65 and older have received at least one dose.
“Sometimes you think of being in a very rural remote place. And in some ways, with a pandemic, it’s a weakness, ”said Grace Grinanger, the county’s public health counselor. “If we have to transfer someone to a level of care for the ICU, they have to walk two to three hours to Duluth. So it feels like a real vulnerability. ”
“But when it comes to being able to work together and reach out to our community, I feel we have an advantage. And we have a strength in the collaborative relationships that we have built up over many years. ”
These conditions can also help convince people to get the vaccine that can be careful with it. This is especially important in rural areas, where research has shown that residents are more likely to say they do not trust the vaccine.
In Cook County, the Public Health Department set up a campaign designed to make residents feel proud to be vaccinated – to encourage people to get the shot not just for themselves but for the health of the community.
“So we have buttons, we have a big banner up where we thank people for coming [to get vaccinated], ”Said Grinager. “It’s a little weird to say that mass vaccination is fun, but it’s really fun. People just look really happy, as if they have been waiting for this to come. ”
And when rural hospitals and public health agencies show that they can get the vaccine to patients within the three-day period set by the state as a guideline, they are likely to receive more doses in the future. Both the state health department and the regional coalitions say it is an important factor in the distribution of the vaccine.
Liz Auch of Countryside Public Health, which serves five counties in western Minnesota, said she believes it has helped her agency continue to have a robust supply of the vaccine.
“This sounds like I’m bragging, but we’ll get them within three days, do you know what I mean? We have always got our vaccine out within the three-day window, we have met all the guidelines that the state gets. And I have to assume that it has helped us continue to get the first doses. ”
If some rural communities get a seemingly disproportionate distribution of the vaccine, it is as it should be, argues U’s Henning-Smith.
“Villagers are, on average, older than urban dwellers,” she said. “And as we prioritize older adults and health workers, we should see higher vaccination rates in rural areas.”
She says there should also be higher rates for people of color who, like people in rural areas, are statistically more likely to have more underlying health conditions that make them vulnerable to the worst of COVID-19.
“I wish we didn’t see the type of variation that I see,” she said. “But it does not appear that there is a uniform history across the country or even within Minnesota from one rural location to another.”
Basically, she said: There are just not enough vaccine doses to go around right now, in small towns or in big cities.
Correction (February 23, 2021): Liz Sorenson’s name was misspelled in an earlier version of this story.
Data in these graphs are based on the Minnesota Department of Health’s cumulative totals released at. 11 a day. You can find more detailed statistics about COVID-19 at Health Department website.
Coronavirus is transmitted through respiratory droplets, coughs and sneezes, similar to the way influenza can spread.
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