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Shot in the Arm

As COVID-19 vaccines begin to roll off production lines, many questions remain — about how quickly they’ll reach the general public, about long-term efficacy and safety, about how many Americans will actually want one.

But on one issue, there is no doubt, Dr. Andrew Artenstein said.

“This is a spectacular achievement just to get where we’ve gotten so far, and I think we should appreciate that,” the chief physician executive and chief academic officer at Baystate Health told BusinessWest. “It’s been a whirlwind, and I mean that in a good way.”

Everyone in healthcare understands the upside — the dramatic promise — of a vaccine as the COVID-19 pandemic enters its 10th month.

“A vaccine is a major component of getting on the other side of this,” Artenstein added. “It’s not the only component, but it’s an important and necessary piece of shortening the duration of this pandemic and possibly preventing future waves.”

With Pfizer gaining emergency-use authorization from the U.S. Department of Health and Human Services to begin distributing its vaccine — and Moderna expected to do the same — the Baker-Polito administration announced allocation and distribution plans for the first round of vaccine shipments to Massachusetts, expected to begin around Dec. 15. The state’s first shipment of 59,475 doses of the Pfizer vaccine was ordered from the federal government and will be delivered directly to 21 hospitals across eight counties, as well as to the Department of Public Health immunization lab.

Doses will then be redistributed for access to 74 hospitals across all 14 counties for frontline medical workers. Another 40,000 doses of the Pfizer vaccine will be allocated to the Federal Pharmacy Program to begin vaccinating staff and residents of skilled-nursing facilities and assisted-living residences in Massachusetts.

In all, Massachusetts is expecting 300,000 doses of vaccines from both Pfizer and Moderna to be delivered by the end of December. Both vaccines require two doses administered three to four weeks apart. While all delivery dates and quantities are subject to change due to ongoing federal approval and allocation, state leaders expect to receive and distribute more than 2 million doses to priority population groups by the end of March.

Dr. Andrew Artenstein

Dr. Andrew Artenstein says the public should not let down their guard when it comes to masking and social distancing while they wait for the vaccine.

“It does make perfect sense,” Artenstein said of the prioritization plans, which reflect judgments on the federal level and ensure delivery to groups like healthcare workers, first responders, the elderly, and people with co-morbidities before the rest of the public. In the case of seniors, for example, “it’s not that they’re more likely to get the virus, necessarily, but they’re more likely to die if they get infected. They do worse.”

Meanwhile, he added, healthcare workers have a greater risk of coronavirus exposure than most other people.

“We’ve been inundated — inundated — with calls from other groups that they want the vaccine,” he said, placing heavy emphasis on that word. “But the truth is, it isn’t available for the general population now, and it may be several months before it is.”

Artenstein, an infectious-disease expert who founded and directed the Center for Biodefense and Emerging Pathogens at Brown University for more than a decade before arriving at Baystate, has been one of the public faces locally of the fight against COVID-19, and he was careful to temper optimism about a vaccine with a reality check on the timeline — and what people need to do in the meantime.

“A vaccine may eventually be the answer, but it’s only going to be part of the solution for the next six to 12 months, assuming we continue to get vaccines that are safe and effective. It’s going to take a while — even if all goes well — before we get enough immunity in the population to really put an end to this thing.

“In the meantime,” he went on, “we would benefit greatly by continuing to push the classic ways to interrupt transmission: masks, distancing, avoiding gatherings. All those things will continue to help us because, even after we start vaccinating parts of the population, it will take the better part of the year to roll it out to everyone, and we need to continue to interrupt transmission.”

Jessica Collins, executive director of the Public Health Institute of Western Massachusetts, agreed, even though it can be a challenge getting through to people suffering from ‘pandemic fatigue,’ who feel isolated and weary of all the changes in their lives over the past year.

“I’m sorry people are tired,” she said. “But the basic messaging isn’t hard — wear a mask, wash your hands, and don’t be inside spaces with a mask off with people you don’t know. I do think the holidays have created a tremendous sense of urgency to remind people again, especially with students leaving schools and coming back to their homes.”

Hopefully, health leaders say, vaccines will put a definitive end to the crisis. But that day is still far off, Collins added. “People need to wait it out.”

 

Making a List, Checking It Twice

In announcing the Commonwealth’s vaccine-distribution plans, Gov. Charlie Baker noted that Massachusetts goes further than national recommendations by prioritizing all workers in the healthcare environment, not only providers, but also food-service, maintenance, and other facility workers. Similarly, home health workers, including personal-care attendants, are prioritized on the list, recognizing their important role providing services to vulnerable individuals and the fact that they often reside in communities highly affected by COVID-19.

Jessica Collins

Jessica Collins

“Messaging is critical, and the messengers are critical. Hopefully, we’ll have good results, and more people will be willing to take it.”

Phase one of vaccine distribution — which, as noted, includes healthcare-facility workers; police, fire, and ambulance workers; congregate-care settings, including not only senior-living facilities, but shelters and jails; and home-based healthcare workers — is expected to last into February. Phase two, expected to run from February to April, will prioritize individuals with co-morbidities that put them at higher risk for COVID-19 complications; all adults over age 65; as well as workers in the fields of early education, K-12 education, transit, grocery, utility, food and agriculture, sanitation, public works, and public health.

Phase three, expected to follow in April or May, will see the vaccine more widely available to the general public.

Baker’s announcement noted that vaccines go through extensive testing, more than any pharmaceuticals, including extensive testing in clinical trials. The U.S. Food and Drug Administration, which approves the vaccine, and the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices, which will make its recommendation for use, must ensure any vaccine is both safe and effective for the public before approval and distribution.

All this is necessary for emergency-use authorization of the Pfizer and Moderna vaccines, Artenstein said, but the testing process is far from over, and long-term effects won’t be known until, well, the long term.

The emergency-use ruling “is not licensure, but allows the immediate use of the vaccine pending more information that leads to licensure down the road — because we’re in a pandemic,” he noted, adding that he’s optimistic about further testing, as trials so far have shown about 95% effectiveness across all age groups, with no serious adverse effects.

“The data I’ve seen is pretty impressive for efficacy and safety of the vaccine. And there were around 40,000 people in the trial, so that’s a good sample,” he said — enough to start delivering some immunity to high-risk populations now.

The question, especially as distribution widens in the spring, is how many Americans will actually take the vaccine. Collins said the Public Health Institute has conducted preliminary outreach and found some skepticism and mistrust of the government when it comes to vaccine advice, especially in communities of color.

“In order to counteract that, we have been trying to find and lift up messengers in the community who are trusted people, whether faith-based leaders or other trusted messengers, to counteract skepticism and fear about getting vaccines, whether the flu vaccine or the COVID-19 vaccine,” Collins told BusinessWest, adding that the institute held a virtual town-hall event two days before Thanksgiving and asked 10 such messengers to share their wisdom on prevention measures.

Artenstein breaks down vaccine attitudes into three distinct groups of people — two of which are those champing at the bit for a vaccine, and a small but robust community of anti-vaxxers who express skepticism at vaccines in general.

“Then there’s a whole middle group who could be convinced to get the vaccine, but they’re concerned about safety and effectiveness,” he explained. “It’s a risk-benefit calculation, and based on what I know about vaccines, the risk seems low, and the risk of COVID seems pretty high, especially right now, with such high rates in the community.

Hampden County, in fact, currently ranks third among Massachusetts counties for transmission rate, with more than 50 positive cases per 100,000 residents.

Typically, around 70% of people in a community — or a nation — need to be exposed, either through natural infection or a vaccine, to reach the desired herd immunity, he added. “In the U.S., that’s a big number. But the risk-benefit calculation is obvious. You’d like, over time, to have enough people willing to get the vaccine to help the general population.”

 

Anticipation and Reality

While surveys currently suggest about 60% of Americans are willing to take a COVID-19 vaccine, that number could rise higher if early results from the priority groups demonstrate both effectiveness and safety.

“The U.K. is going first, and then U.S. healthcare workers have to go — which is obviously the right thing to do — then people over 65,” Collins noted. “It’s not like the general public is being made guinea pigs. We will actually be able to see a lot of people getting the vaccine, and the companies will see the reactions.

“So, messaging is critical, and the messengers are critical,” she added. “Hopefully, we’ll have good results, and more people will be willing to take it.”

Artenstein agreed, adding that, for the group of Americans ready to line up right now, the wait may be longer than they realize, but that’s OK.

“We’re a little over our skis on this,” he said. “There’s a lot of excitement and anticipation, but it’s going to come out as more of a slow roll; there’s a manufacturing process, an approval process, and a safety process. There won’t be 300 million doses available tomorrow, and that’s hard for some folks.

“There’s going to be a lot of interest, questions, and anxiety, and rightly so,” he added. “We’re living in a very different time, and people want to move very fast. But we have to make sure we do things in the safest possible way.”

 

Joseph Bednar can be reached at [email protected]

 

Construction Special Coverage

Safety First

By Mark Morris

Carl Mercieri says the pandemic protocols have been challenging, but they’ve kept his company’s job sites totally free of COVID-19.

Call it a time of constant adjustments.

Since COVID-19 hit, area contractors have continued to work after adopting a number of state-mandated safety protocols to prevent the spread of coronavirus. Construction managers have adjusted to the extra requirements to get the job done, but it has come with a learning curve.

After working with safety consultants, Kevin Perrier, president of Five Star Group, said his company established a COVID-19 compliance plan and implemented it across all its job sites.

“It’s been helpful because it covers everything — daily sign-in sheets, temperature checks, self-reporting procedures, sanitation of the job site, and social distancing.”

Even with a solid plan, Perrier admits the additional protocols make it more challenging to bring projects to completion on time.

“We try to maintain social distancing as much as possible, and that delays our production. The reason for the slowdown is that we can’t cram as many workers onto the sites as we have in the past.”

Tim Pelletier, president of Raymond R. Houle Construction, said it’s a common occurrence on a job site for a large number of people to work in close proximity to each other.

“There’s a point where you have lots of moving parts, where different trades are working together in order to meet a completion schedule,” he said. “Because of coronavirus mandates, we can no longer have large numbers of people in one spot.”

In the beginning, adopting the safety mandates proved cumbersome as Pelletier would allow only one trade at a time to work on a site. After a few adjustments, more crews were able to be on site and still follow the guidelines.

“It’s a challenge to stay on schedule, but at least we’re now able to bring more than one trade in at a time and assign them work in different areas, so they’re not on top of each other,” he noted.

Wearing a mask all day has also been met with grudging acceptance; Pelletier said crews typically look forward to the moment they can remove them. “In the 90-degree weather, wearing a mask is definitely a health concern, as well as a comfort concern, but they are required, so we wear them.”

In the early days of the pandemic, shortages of personal protective equipment (PPE) also affected construction projects, as each site needed certain quantities for workers, as well as extra devices such as thermometers and wash stations.

At the beginning of the pandemic, Marois Construction was overpaying for — and overbuying — things like thermometers because they didn’t know how many they would need, said Carl Mercieri, vice president and project manager. On one occasion, he recalled, the project owner stepped in and provided enough hand-washing stations for the entire construction site.

“That worked out well,” he said. “Everyone did what they had to do, and we got through it together.”

 

Pandemic Problems

Implementing safety protocols didn’t always go smoothly early in the pandemic. Mercieri noted a school building project where as many as 30 workers stood in line each morning for a temperature screening and sign-in before they could start their workday.

“Our biggest concern was the loss of labor caused by all the downtime in the beginning,” he said. “It’s hard to put a number on it, and you can never really recoup that cost.”

Building material costs also increased with the onset of the pandemic. Perrier’s construction portfolio includes retail buildings, which require substantial quantities of lumber. So far this year, lumber wholesalers are reporting price increases of 300%, and, to make matters worse, they won’t hold those inflated prices for more than 48 hours.

Kevin Perrier

Kevin Perrier

“We try to maintain social distancing as much as possible, and that delays our production. The reason for the slowdown is that we can’t cram as many workers onto the sites as we have in the past.”

“The volatility of lumber prices makes it difficult to bid on a large, wood-framed project that we wouldn’t be framing until next summer,” he said. “It’s a big problem because you really have no idea where the pricing is going to be.”

Availability of building materials has also been an issue this year. Perrier said light fixtures and flooring materials are two items he’s had trouble procuring for the last several months, while Pelletier said doors and hardware have been in short supply. Rahkonen said finding certain parts for heavy equipment, such as excavators, has been difficult as well.

“We had a couple projects that needed vinyl fencing, and we just couldn’t get it because it just wasn’t out there,” Mercieri said. “We’ve since finished those jobs, but we were delayed by four to six weeks in getting the fencing.”

Much of the supply deficits are caused by overseas factories that experienced shutdowns early in the pandemic. These manufacturing delays from months ago are still being felt now as contractors need these supplies. “We just can’t meet the same deadlines because we can’t get our hands on the materials,” Pelletier said.

From the delays caused by socially distanced workers to not having materials when they’re needed, Pelletier said it’s difficult to take on fast-track jobs that need to hit a deadline. Mercieri echoed that point when discussing his company’s many jobs at hospitals.

“If you are renovating an operating room, for example, the hospital will need it back on line by a certain date, no matter what.”

Mercieri also mentioned a recent instance where he was offered a project that involved complicated construction and needed to be built on a tight schedule.

“When COVID hit, we were up front with the owners and advised them that, with the tight schedule and all the uncertainties of COVID causing delays, they might want to consider some alternate plans,” he told BusinessWest. “They rejected our suggestion and wanted to move forward at 100%, but ultimately they scrapped the project.”

Another concern early on was lost time due to COVID-19 infections. However, Mercieri said none of his workers have tested positive. The closest call was an exposed plumber who was not on site, but had worked with the plumber on Mercieri’s job site. Contact tracing revealed these two had not worked together in the previous six weeks. Perrier said a few of his employees and subcontractors on projects in Eastern Mass. weren’t so lucky and contracted coronavirus.

“We shut down the site for two or three weeks while contact tracing was completed,” he said, adding that the employees recovered, and everyone who had been affected tested negative. “Sites were sanitized, and then back to work.”

Tim Pelletier

Tim Pelletier

“It’s a challenge to stay on schedule, but at least we’re now able to bring more than one trade in at a time and assign them work in different areas, so they’re not on top of each other.”

John Rahkonen, owner of Northern Constructions Service, said four of his employees came down with minor cases of COVID-19, with one showing no symptoms at all. He was quick to point out that no one contracted the virus from the job site.

“Even though most of our crews work outside, we encourage people to stay in their own bubbles,” Rahkonen said. “If you stay within your bubble, you’ll be in pretty good shape.”

 

Widespread Impact

The economic impact of COVID-19 on a national level is often reflected at the local level, especially for construction companies. In the travel sector, Standard and Poor’s recently projected a 70% decline in airline-passenger traffic for 2020. The core business of Perrier’s company involves aviation construction, ranging from airline and rental-car facilities to restaurants and retail stores located at Logan International, Bradley International, and other airports.

“We had a considerable amount of work that, within a period of two weeks, was flat-out cancelled for the airlines,” he said. “A great deal of the other work was either temporarily postponed or put on an indefinite hold.” One large airline client told Perrier that its facility’s goal was to reach a “zero spend by November first.”

Two to three months into the pandemic, Mercieri began getting word of projects being canceled. His company had already bought materials to start construction for one of those projects.

“When they first shut us down, they told us it was temporary,” he said. “Then, six weeks later, they wrote us a letter to say they had canceled the project.”

Two natural-gas compression stations that Rahkonen’s company had planned to build in Pennsylvania this year have been put off until next year. While those still look viable for 2021, they represent $20 million less in projects for Northern Construction this year.

Perrier predicts the long-term impact of aviation construction will be felt by many for years to come. That’s why his company has diversified into other industries besides aviation.

Houle Construction

Houle Construction continues to take on work in the medical field, including this recent project at a local hospital.

“We are doing a decent amount of work in the cannabis industry. It’s booming right now, so that’s helped us out,” he said. One project nearing completion is Dreamer, a cannabis dispensary in Southampton scheduled to open in 2021.

The holiday season tends to be a time when activity begins to slow down in construction and many jobs approach their completion. It’s also a time for active bidding on projects for next year. Mercieri struck a positive tone and suggested a possible rebound in construction activity for 2021.

“Back in March, a lot of projects were delayed, and now they are getting put back on the table and going out for bid,” he said, adding that some of the projects getting approved involve bringing public buildings into compliance with COVID-19 mandates.

When Pelletier surveys the landscape, he senses both uncertainty and hopefulness.

“Clients have had projects on the docket to get done but were skittish for the last seven months, and with a rise in case count, there is still some uncertainty,” he said. “On the plus side, interest rates are extremely low, so borrowing the money for a project is less expensive now.”

Pelletier and the other managers we spoke with have all taken a one-day-at-a-time approach because they understand that coronavirus levels, and the government regulations aimed at lowering them, will most likely change again — and they will simply make the necessary adjustments.

“Because we’re wearing masks all day, everyone has a sore on their nose and a generally irritated demeanor,” Pelletier said. “But we’re navigating through it.”