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NH allows doctors flexibility to bump patients up in vaccine line

The state’s vaccine distribution plan allots residents to one of six phases: teachers are in phase 2a, adults 75 and older are in phase 1b, those moderately medically vulnerable to the virus are in phase 3a, and so on.

While age and profession can be sorted into categories, medical vulnerabilities are not so easily classified. In an attempt to operationalize “medical vulnerability,” the state lists 12 medical conditions on its website, including obesity, pregnancy and cancer. If you have one of the listed conditions, you’re in phase 3a. Two conditions? Phase 1b.

Medicine, the state says, is much more complicated than that.

To account for the seemingly infinite combination of conditions that could make someone vulnerable to COVID-19, the state is giving doctors latitude to move people between phases.

“Every patient has a different medical history,” Gov. Chris Sununu said at Tuesday’s press conference. “You could have folks not just with asthma but severe asthma. You could have stage II cancer, stage IV cancer. You can have a lot of different factors in there.”

What this exception process might look like in practice is still fuzzy.

Asked about how the state would ensure doctors are consistent in their exceptions, Sununu said the state hasn’t come up with a way to standardize the program, nor do they necessarily plan to. He said decision-making will be left to the “best and the brightest,” which he expects to lead to some inconsistency.

“There is a lot of gray area, frankly,” he said. “Physicians can make determinations based on what they see with their patient’s history.”

Michael McLeod, the Associate Chief Clinical Officer at Concord Hospital, said few details have been provided to hospitals about the logistics of this program. How vaccines will be allocated to those given an exception, whether the state will oversee the process, or how many exceptions doctors are allowed to grant, is still unknown.

He said the hospital will likely try to implement a system of checks and balances to standardize the process to the best of their ability, but overseeing decisions that involve weighing a variety of complex medical conditions will be extremely difficult.

“The textbooks are really helpful to provide you with general guidance but part of the reason they call it the art of medicine is because nobody ever has one condition,” he said.

As the next stage of vaccinations nears, the hospital will have to iron out the details, hopefully with more guidance from the N.H Department of Health, McLeod said. Whatever the process for exceptions ends up being, McLeod said he doubts patients will have to call their doctors to plead their case. He said the hospital will likely use their database of medical records to determine who meets the state’s definition of phase 1b. From there, physicians will be able to advocate for patients who don’t necessarily fit the exact requirements of phase 1b.

Stephanie Patrick, executive director of the Disability Rights Center of New Hampshire, said this flexibility is essential to ensure vaccines are going to the most vulnerable Granite Staters, even if they don’t fit neatly into one of the state’s phases.

Researchers may not have studied the effect of COVID-19 on individuals with rare disabilities, but that doesn’t mean they’re not vulnerable to the virus, she said. Giving room for doctors to use their own discretion gives much-needed nuance to the distribution process, she said.


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Local Republicans condemn Capitol violence, but don't necessarily blame Trump
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Local Republican officials last week condemned the storming of the U.S. Capitol Wednesday by rioters supporting President Donald Trump’s efforts to overturn his election defeat, but area GOP leaders generally stopped short of saying Trump is responsible for inciting the violence.

“I don’t know if he’s to blame or not, and I imagine that will be debated for the next 10 years,” said Rep. Steve Smith of Charlestown, who represents Sullivan District 11. “... He certainly didn’t help. But here’s the biggest point of frustration to me: No politician ever made me go attack something.”

The people who breached the Capitol made their own choices to do so, he said, but Trump should have intervened quickly to stop the riot.

“I wish that President Trump had immediately gone on TV … and said, ‘Stop this. Go home.’ That was the biggest disappointment to me,” Smith said.

Former Cheshire County Republican Committee Chairwoman Kate Day noted, “It must be stated those in D.C. [Wednesday] who were violent were the exception, a small fraction of the many, many hundreds of thousands who peacefully protested.”

The Sentinel spoke with seven area Republican elected officials and party leaders since the breach of the Capitol Wednesday afternoon. Messages left for nine additional local GOP officials were not returned as of Monday morning.

Of those reached for comment, Rep. John Hunt of Rindge, who represents Cheshire District 11, spoke most strongly about his view of Trump’s role in inciting the riot.

“Of course he did” provoke the crowd, Hunt said. “There’s no doubt that he told them to march down to the Capitol. He might not have said, ‘Break in,’ but he certainly gave them the concept of being there.”

Thousands of people, including at least two area residents, gathered in Washington, D.C. Wednesday to protest the results of the presidential election. During a speech at a rally near the White House that morning, Trump repeated unsubstantiated claims that widespread voter fraud cost him the election, and encouraged supporters to march to the Capitol, where a joint session of Congress was meeting to certify President-elect Joe Biden’s Electoral College victory.

“... We are going to the Capitol, and we are going to try and ... give our Republicans, the weak ones because the strong ones don’t need any of our help, we’re ... going to try and give them the kind of pride and boldness that they need to take back our country,” Trump said in the conclusion of his speech Wednesday.

The demonstration turned violent shortly after Trump’s remarks. Rioters clashed with U.S. Capitol Police, shattered windows, ransacked congressional offices and occupied the House and Senate chambers, which had been evacuated. The violence caused the deaths of five people, including a Capitol Police officer.

“I am straight-up saddened by the loss of life [Wednesday],” said Rep. Jennifer Rhodes of Winchester, who represents Cheshire District 15. She declined to answer any further questions on the violence at the Capitol.

“The whole thing’s upsetting,” said N.H. Sen. Denise Ricciardi of Bedford, whose district includes the local communities of Dublin, Fitzwilliam, Greenfield, Hancock, Jaffrey, Peterborough, Richmond and Troy. “… I am heartbroken whenever I see such violence, but such violence in our nation’s capital is the most disturbing.”

Ricciardi declined to comment on whether or not Trump bears any responsibility for the riots, saying “I don’t have all the facts.”

Rep. Matthew Santonastaso of Rindge, who is serving his first term representing Cheshire District 14, felt similarly.

“It’s too soon, I don’t really know what caused it,” Santonastaso said Saturday, noting that the violence in Washington came at the same time he and the rest of the N.H. House met for the first session of the year in a parking lot at the University of New Hampshire campus in Durham.

“I wouldn’t say that [Trump] caused it or didn’t,” Santonastaso said. “That’s not a position I would take one way or the other.”

Rep. Jim Creighton of Antrim, who represents Hillsborough District 38, said he also wasn’t following Wednesday’s events in the nation’s capital closely because he was focused on the N.H. House session. Creighton did say that the protesters who stormed the Capitol were “absolutely wrong,” and that all Americans need to respect the result of the presidential election.

“I think the president was in his rights to go through the legal questions, but clearly once the decision is made, you have to respect the rule of law, and that’s not what happened [Wednesday].”

Trump has disputed the outcome of the Nov. 3 election, without providing any factual evidence, since the race was called for Biden four days later. The president’s campaign and other allies have filed approximately 50 lawsuits alleging voter fraud, nearly all of which have been dropped or dismissed by courts, according to the Associated Press. The Supreme Court also declined to hear cases aimed at invalidating election results in some states, the AP reported.

Hunt said Trump’s rhetoric since the election has been disheartening to him as a Republican.

“I’m disappointed right from the get-go when he kept talking about the fraud and the stealing the election,” Hunt said. “... I think that his insistence of saying that this election was stolen somehow was totally inappropriate and wrong.”

Since Wednesday’s violence at the Capitol, several Trump administration officials, including Education Secretary Betsy DeVos and Transportation Secretary Elaine Chao, have resigned in response to the president’s rhetoric and actions surrounding the riot. Additionally, more than 200 federal lawmakers, including the entire all-Democratic New Hampshire delegation, have called for Trump’s removal from office, either by impeachment or the 25th Amendment.

Locally, Hunt said he does not support Trump’s removal from office with less than two weeks left in his term, but added that he is ready to move forward.

“At this point, it’s time for him to move on, and the nation to move on,” Hunt said.

Sentinel reporters Mia Summerson and Caleb Symons contributed to this story.


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Troy Town Hall open by appointment only following threats
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TROY — Town hall will be open by appointment only until further notice after officials received threats from people upset about Police Chief David Ellis’ presence at last Wednesday’s rally in Washington, D.C.

Richard H. “Dick” Thackston III, chairman of the Troy selectboard, said Sunday that town officials have received numerous expletive-laden emails and voicemails, some containing threats of “general violence,” though no specific threats.

“Because of the concern, as an open building — which is what we like to have — and because of the irrational nature of some of these communications, we just felt it was better at this time” to make town hall appointment-only, Thackston said. He added that the Troy Police Department has been made aware of the threats.

Ellis, who has been the town’s police chief since 2013, attended President Donald Trump’s “Save America” rally in Washington last Wednesday, though he has denounced the violence that took place at the U.S. Capitol following the event. He told NHPR on Thursday that he left the rally before Trump supporters began rioting and storming the Capitol. The violence caused the deaths of five people, including a Capitol Police officer.

U.S. Capitol Police on Sunday announced the death of a second Capitol Police officer, according to The Washington Post. Two law enforcement officials told The Washington Post that off-duty officer Howard Liebengood, 51, died by suicide over the weekend, days after being on the scene of Wednesday’s violent siege of the Capitol building. It’s not clear whether Liebengood’s death is related to the storming of the Capitol, according to the Associated Press.

Since Wednesday, Thackston said several dozen people, most from outside of Troy, have contacted the selectboard demanding Ellis be fired (the police chief is a position appointed by the selectmen). Thackston said Sunday that he does not anticipate the board will take any action against Ellis.Jack Rooney can be reached at 352-1234, extension 1404, or jrooney@keenesentinel.com. Follow him on Twitter @RooneyReports.


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Local school nurses: COVID-19 vaccine process running smoothly

Nicole Boudle was on the lookout for the email, and once it arrived the week of Christmas, she texted fellow Keene High School nurse MaryAnn Boynton to make sure she saw the message, too.

The email, which came from the N.H. School Nurses’ Association, notified them that they were eligible to receive a COVID-19 vaccine, and included instructions on how to register for an appointment.

“That’s when we were kind of like, ‘Oh my God, it’s here, it’s here,’ ” Boudle said.

They both filled out an online application, which was a bit cumbersome, Boynton said, before scheduling an appointment to receive their first doses of the Moderna vaccine at a state-run site on the Keene State College campus on Jan. 2. From there, Boynton said, the process was smooth.

“It was very efficient, and they were very courteous. They did a great job,” she said of the National Guard members overseeing the vaccination site. “... It just felt like a flu shot. It was very easy.”

The state considers school nurses like Boynton and Boudle front-line health care workers, making them among the highest priority group to receive a COVID-19 vaccine, along with first responders and nursing home residents and staff. Throughout the Monadnock Region, school nurses have begun getting their first of two doses of the shot, and say the process is working well thus far.

Alexis Heaphy, the nurse at Emerson Elementary School in Fitzwilliam, received her first dose of the Moderna vaccine, which requires a second dose 28 days after the initial shot, on Dec. 31.

“It was super-easy for me,” Heaphy said. “I just followed the instructions that the email provided. And then when I went, it was very well organized and went very smoothly.”

She added that all six of the nurses in the Monadnock Regional School District have either received their first dose, or are in the process of setting up an appointment.

Heaphy said the vaccine gives her some peace of mind. “I was really happy to be able to get the vaccine so quickly,” she said. “Working at a school around students, we obviously are social distancing and wearing masks, but there’s still a risk. So it was nice to be able to get the vaccine early, and make sure I’m protecting myself, my students, my colleagues and my family.”

Heaphy added that she hopes the arrival of the coronavirus vaccine will help schools begin to return to normal operations. The majority of schools throughout the area have been holding a mix of in-person and remote classes this academic year. Most local districts are fully remote at least through next Tuesday due to the uptick of cases in the region.

Teachers and other K-12 school staff, along with child care workers, are in phase 2A of New Hampshire’s vaccine rollout plan, which officials unveiled last week, and are slated to be eligible for vaccination sometime between March and May, depending on the amount of vaccine the state receives from the federal government and how many eligible people get vaccinated. The state expects vaccines to become available to everyone sometime in the late spring or summer.

Beyond the practical implications of school nurses beginning to receive the COVID-19 vaccine, the shots also hold some symbolic significance as the coronavirus outbreak nears the one-year mark in the state, Monadnock Superintendent Lisa Witte said.

“We’ve known that there’s a light at the end of the tunnel, but we have not been able to see it,” she said. “And now I feel like we can see it. We still don’t know how far away it is, but at least we can now actually see it.”

Though the vaccines do provide some hope, Boudle, the Keene High nurse, noted there’s still a long way to go before the pandemic subsides.

“People need to know that just because you’re getting a vaccine doesn’t mean that everything’s over,” she said. “I think some people think that just because they get the vaccine that we don’t have to wear masks and we don’t have to social distance and everything’s going to go back to ‘normal’ again. And that’s not the case.”

Beth Fries, the interim chief medical officer for Keene State College’s Health Services, said all seven of her staff members will have received the COVID-19 vaccine by the time students return to campus for the spring semester on Feb. 15. Even so, Fries added that Keene State will continue its coronavirus prevention strategies, including frequent testing, requiring masks and limiting gatherings, throughout the upcoming term.

“My realistic expectation is that not much is going to change before May or June,” Fries said. “I don’t think the students will be vaccinated [before then]. We can all make a guess of when that will happen, but I don’t know exactly. But until a good percentage of the whole population is vaccinated, I don’t think we can lighten up on our mitigation strategies.”

In the meantime, Heaphy, the nurse at Emerson Elementary, said she encourages everyone in the community to do their own research and decide if receiving a COVID-19 vaccine is the right choice for them when they are eligible to be inoculated. And while people do that, school nurses like Boudle and Boynton at Keene High say they hope to give their communities confidence that the vaccines are safe and effective.

“We’re the medical professionals, so people might look at us for guidance,” Boudle said. “And again, we want to model that behavior and show everybody that we did this, we believe in this.

“... It does make you feel hopeful that, if we continue to get people vaccinated, to social distance, to wear a mask and do all the things that we’ve been doing ... that we will be able to come back to school and somewhat be able to have our lives go back to the way they used to be. That’s ultimately our goal. We can’t be school nurses without our students, so we really want everybody back in school.”

Do you have questions about the COVID-19 vaccine? Let our staff know at https://www.sentinelsource.com/news/coronavirus/vaccine/.


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