“We’ve told them not to,” Public Health Commissioner Dr. Kathleen Toomey told lawmakers during an appropriations hearing at the Georgia Capitol on Tuesday, “and asked them, please, if you are doing that to release those doses so we can use them for first doses.”

Not all health districts administering first doses have been automatically setting up follow-up appointments, which should be set three weeks later for the Pfizer vaccine and four weeks for the Moderna. Some departments have only been writing the dates on the backs of vaccination cards when patients should return for their booster, leaving it up to them to set the appointments.

Credit: Curtis Compton / Curtis.Compton@ajc.com

Credit: Curtis Compton / Curtis.Compton@ajc.com

That’s created fear and confusion within a population desperate to put the pandemic behind them, as a super-spreader variant strain is gaining a foothold and the death toll continues to break records.

The U.S. on Tuesday surpassed 400,000 deaths attributed to COVID-19, and it was also the worst-ever day for coronavirus deaths reported in Georgia. The Georgia Department of Public Health reported 170 confirmed new COVID-19 deaths and another 52 deemed “probable” coronavirus deaths.

To date, Georgia has reported 11,265 confirmed coronavirus deaths and another 1,317 deemed probable.

“Everybody is freaking out on Nextdoor,” said Karen Schaefer, 77, who received her first dose last week from the Fulton County Health Board site at Mercedes-Benz Stadium, but didn’t receive a second-dose appointment at the time.

“I’m assuming (the second dose) will happen one way or another ... It would be nice to have that appointment nailed down.”

Across the state, health department phones lines remain jammed and websites remain as difficult to navigate as when Georgians made their first appointment. But now a clock is ticking. The state opened up its vaccine program to most people ages 65 and older on Jan. 11, which means those first in line will need their boosters in early February.

Lisa Karesh, a retired schoolteacher who lives in Buckhead, managed to snag an appointment at Wolf Creek Amphitheater a week early, so she is due for her Pfizer booster on Tuesday. The Fulton County Board of Health has been telling frustrated seniors on Facebook to expect an email about a week before their second shot with a sign-up link. Karesh, 67, is among those yet to receive the email.

“We want to see our grandchildren,” she said. “We want to get back to life. We’ve done everything we’re supposed to do. And we’re terrified we can’t get this appointment.”

Alpharetta resident Ron Kurtz, 78, got his first shot on Jan. 12 but hasn’t been able to get through by phone or website to schedule the follow-up, he said.

Friends suggested he just show up at the office where he got the first shot in two weeks. “That seems a little risky,” he said. “I’ve got to try something.”

To address such concerns, on Tuesday the Fulton board started piloting a process where those who receive their first shot can schedule the follow-up before they leave the vaccination site, spokeswoman Sheena Haynes said.

“We understand everyone’s frustration and are trying to improve our process,” Haynes said.

Credit: Curtis Compton / Curtis.Compton@ajc.com

Credit: Curtis Compton / Curtis.Compton@ajc.com

Uncertain supply

Several seniors told The Atlanta Journal-Constitution that with health departments and grocery store pharmacies with vaccines all fully booked, they don’t see how providers will have enough vials left for their second shots next month.

In DeKalb, the health department has had to improvise to make sure it can administer the second doses to the roughly 8,000 people the agency has vaccinated with a first dose.

After federal officials last week admitted it had no doses in reserve, the uncertainty around the vaccine supply led the county to hold back some doses to have enough vaccine to give the second shots, said Dr. S. Elizabeth Ford, the county’s public health director.

“Everyone is trying their best, but we’re all operating in a dark cloud,” Ford said. “The lack of knowledge means we have no idea what’s coming and how it’s going to be distributed.”

The department is now scheduling appointments for the second dose at the time patients receive the first shot, she said. But there still can be barriers.

Cheryl Etheridge was among hundreds on Friday who got shots at DeKalb’s drive-thru vaccination site in Doraville. Afterward, a nurse tried to schedule the follow-up appointment, but the website was down and Ethridge was unable to secure the appointment before she left. The nurse sent her a link, but Etheridge has been trying in vain ever since to schedule the second shot.

“I don’t understand, unless they rushed into this, why when I filled out a registration form for the first appointment, why did it not automatically book me for 28 days out?” said Etheridge, 77.

Ted M. Ross, director of the University of Georgia’s Center for Vaccines and Immunology, said the vaccine should be effective as long as people get the second shot within a week or so of the target date. The announcement that there isn’t a stockpile of vaccine for the second dose has led to a bit of a panic, he said.

“People are very angry,” he said. “Maybe we wouldn’t have rolled out the vaccine the way we did if we had known there wasn’t a stockpile. But what that’s doing is putting a lot of faith in the manufacturers to make the vaccine as fast as they can to make sure we don’t run out.”

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

The one-dose hazard

Some experts say partial protection can be had with just one dose. Emory University global health professor Dr. Carlos del Rio said studies show the first shot offers 60% to 80% protection against COVID-19, though getting the second dose is preferable.

But clinical trials of the vaccines last year did not study a one-shot regimen in depth, and the U.S. Food and Drug Administration and other experts say they don’t know how long protection from a single dose would last. The FDA has strongly recommended that its authorization terms, with the 21- or 28-day boosters, be followed.

Georgia has administered about 22,300 second doses of the vaccine, according to Centers for Disease Control and Prevention data. That’s a tiny fraction of the 485,000 doses that the state vaccine dashboard shows Georgia providers have administered so far.

As of Tuesday, Georgia’s rate of second vaccinations — 210 per 100,000 residents — was the second-lowest rate of any state, the CDC data shows. Only Ohio had a lower rate, with 116 per 100,000 residents.

At the appropriations hearing Tuesday, Commissioner Toomey blamed the problems in part on not getting enough doses. “The hang-up now is the allocation is so slow,” Dr. Toomey said. “We’ve been getting 80,000 doses a week and that’s not much for a state with 11 million people.”

She also said that 800 doses of the Moderna vaccine arrived in Georgia yesterday already thawed out. Once thawed, the vaccines must be used in a few hours.

Toomey acknowledged “tremendous frustration” in making appointments, saying the performance of its 18 call centers hasn’t been “optimal.” She said her department thought the same web-based system used to make appointments for COVID tests would work for vaccine appointments, but demand proved too overwhelming.

Staff Writer Alan Judd contributed to this story.