Gov. Janet Mills speaks a news conference at the State House, Thursday, March 12, 2020, in Augusta, Maine. Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, is at right. Credit: Robert F. Bukaty / AP

AUGUSTA, Maine — Maine’s health care system will have to quickly adapt and overcome logistical hurdles in the coming weeks as it fast-tracks a massive population of older and vulnerable residents on the coronavirus vaccination schedule.

Gov. Janet Mills announced Wednesday that Mainers over age 70 would be moved into the next phase for vaccinations following changes to federal guidelines prioritizing vaccines for older people. About 193,000 Mainers — 14 percent of the population — are over 70, though some have already been vaccinated in the first phase, which targets long-term care facilities.

That next phase will start as early as next week, presenting a challenge as Maine expects an increase of doses, even though allocations have been lower than expected. Health care providers must ensure doses match appointments and find ways to handle huge demand.

The next phase will be a “heavy lift” for providers who are now vaccinating staff and other health care providers, Steven Michaud, the president of Maine Hospital Association, said. Providers will ramp up by vaccinating their patient rosters, but that will be the easy part. It will be more difficult to vaccinate people who they do not have a relationship with, he said.

“It’s not as simple as just going through a line,” Michaud said. “People don’t realize the amount of people they have to go through when they’re getting vaccinated for the first time.”

Even though a large new population will be eligible, Maine Center for Disease Control and Prevention Director Nirav Shah said on Wednesday that it was not clear how many more vaccines will come to the state after the federal government promised to release typically reserved second doses. Those are expected to be available roughly two weeks, and Shah maintained the state would be able to administer any increase.

Since vaccines became available in December, Maine has ordered enough doses to cover just shy of 100,000 people. More than 53,000 Mainers had received first doses of the vaccine as of Wednesday, while only about 8,500 had received second doses.

Scheduling that population requires careful timing, Shah said on Wednesday. Vials containing vaccines must be thawed and mixed before use. If vaccines do not match appointments, some could be in danger of being wasted, leading to a scramble to find someone to get the shot.

“Everything has to be thought out in advance, so that people don’t show up and congregate and still have to wait hours to be vaccinated,” he said.

The wait time between now and the release of the additional doses kicks up urgency to find community sites to vaccinate the wider public, Shah said. Identification of those has been tricky. The state maintains a list of places where vaccines can be given, but some are too close to the road or do not have enough parking or accessibility.

Shah said the two sites where Maine can alternative hospitals in Portland and Bangor could serve as vaccination sites because of their size and locations. But he was wary of committing to that as increasing hospitalizations could eventually require their use to treat patients.

There would be logistical challenges associated with scaling up, such as setting up enough appointments to ensure no vaccines were wasted and resolving MaineCare reimbursements, said Joe Bruno, the CEO of Augusta-based Community Pharmacies and the former president of the Maine Board of Pharmacy.

But Bruno, whose nine locations have been helping administer vaccines in nursing facilities, said his pharmacies planned to set up clinics where pharmacists could administer vaccines uninterrupted, and he had no doubt there would be sufficient demand.

“If you were to just send more vaccines to us, we could do a lot more,” he said.

Unlike influenza vaccines, which are given over several weeks, the demand for coronavirus vaccines among the next phase is expected to be massive and upfront, said Michaud of the hospital association. Smaller, rural hospitals will have an easier time, Michaud said, because they often serve as the health care hubs of their communities and have smaller populations. The “sheer population” in places like Portland and Bangor create more logistical issues, he said.

That was evidenced by Fort Kent’s Northern Maine Medical Center, which started allowing patients to schedule vaccination appointments by phone on Wednesday. Meanwhile, MaineHealth, the state’s largest health system in Portland, is working on establishing a call center, an online portal people can use to determine when they may be eligible and where to get an appointment and a scheduling system. Those could be online in the coming days, said spokesperson John Porter.

Bangor-based Northern Light Health, which serves parts of northern, eastern and central Maine, is also preparing a registration and scheduling system for patients. But such systems need to be carefully constructed, said Andrew Soucier, spokesperson for Eastern Maine Medical Center, so as not to schedule more people than vaccines available.

“As this will be on a scale never seen before we want to ensure we get it right from the start,” he said.

BDN writer David Marino Jr. contributed to this report.

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