COVID Vaccine Distribution: What Can Virginia Learn from Florida?

Image used with permission of Coastal Cloud

Fiasco. From the start, Florida prioritized anybody 65 or older into its top tier for receiving the COVID vaccine. Virginia initially limited early access to the vaccine to those 75 and over. Last Thursday Gov Northam announced that Virginia would include people 65 and over in the current distribution of vaccines. That adds 9.5% of Virginia’s population, or 810,920 Virginians, to the “eligible now” list. What can Virginia learn from Florida about distributing the vaccines to a larger percentage of the population?

Florida’s initial efforts to distribute the COVID vaccine were widely described as a fiasco. Newspapers featured pictures of senior citizens in long lines waiting to get vaccinated. Just registering for a vaccination appointment was chaotic. Registration call centers were overwhelmed. CNN described the registration process as haphazard. If Florida is a benchmark … Virginia will soon enter the “chaos zone.” However, there is good news from Florida that could help Virginia. A Florida based technology company, Coastal Cloud, has started managing vaccine appointments using an application built on Salesforce.Com. I interviewed the husband-and-wife team that founded Coastal Cloud yesterday and they explained how their company is helping four counties in Florida get a handle on the scheduling of COVID vaccinations.

Coastal Cloud.  Coastal Cloud was founded by Sara and Tim Hale as a consulting, implementation and managed services provider focusing on Salesforce.Com projects. Tim grew up in Virginia Beach, graduated from Cox High School, attended the University of Virginia and lived for a number of years in Northern Virginia when he worked for Accenture. Sara hails from Birmingham, Alabama and is a graduate of Duke University. She also worked for Accenture in Northern Virginia before the couple relocated to Palm Coast, Fla., and founded Coastal Cloud. Tim and Sara maintain a connection to Virginia with two daughters presently attending college in the state. In addition, they told me that they have plans to locate their next expansion of fast-growing Coastal Cloud in Charlottesville, Va.

The vaccination problem. The rollout of COVID vaccines is a complex logistical process. One critical early step is the registration of patients to receive the vaccine and scheduling of appointments to get the shot. Tim and Sara described the problems Florida encountered when that state “threw open the floodgates” for COVID vaccinations. Florida, like Virginia, operates on a jurisdiction-by-jurisdiction approach to COVID vaccinations. Initially, Florida counties used a hodge-podge of call centers and lightweight web sites to schedule vaccinations for eligible citizens. The results were disastrous. Too many people were vying for too few appointment slots using technologies that couldn’t handle the scale.

The Coastal Cloud Solution. Coastal Cloud developed a solution to the vaccine appointment scheduling challenge by extending their existing COVID testing application to include vaccinations. The Care4COVID application is being used to schedule vaccinations in four of Florida’s most populous counties – Orange (Orlando), Hillsboro (Tampa), Pinellas (St Petersburg) and Pasco. Those counties have a combined population of just under 4.4 million with Hillsboro being the largest of the four at 1.474 million. In other words, the CARE4COVID application is handling vaccine appointments for a population equal to half of Virginia’s population with the most populous of the four jurisdictions being larger than any locality in Virginia. One eye-popping statistic quoted by Tim Hale was the application’s peak processing level of 1,500 appointments per minute. It’s no wonder that call centers in Florida were being overwhelmed  It should surprise no one when Virginia suffers the same fate. Four million, four hundred thousand Floridians now are better able to register and schedule vaccinations because of Coastal Cloud’s Care4COVID application. Virginia localities should consider that application or others like it before we descend into full chaos.

The Old Dominion. Tim and Sara describe the early rush to schedule vaccinations as the first moments of a tsunami. The wind picks up, the waves get bigger but the storm hasn’t really started. Then all hell breaks loose. I suspect that Virginia is in that early phase. What assurance do we have that Virginia localities will be able to handle the COVID vaccination process any better than the initial efforts in Florida? As a resident of Fairfax County I logged into the county’s Coronavirus vaccination webpage. In a bright red box was the statement, “ALERT: OUR CALL CENTER IS EXPERIENCING HIGH VOLUME.” In addition, the web page contains contradictory information as to who can get a vaccination – stating in one place 75+ years old and in another 65+ (the correct answer is now 65+). The pre-screening application incorrectly refuses information from people aged 65 – 74. To paraphrase the late astronaut Jack Swigert, “Richmond, we have a problem.”

Other answers. Coastal Cloud is not the only technology vendor selling a solution for COVID vaccination scheduling. Large organizations like Accenture and IBM both offer applications to help with the distribution of COVID vaccines. I focused on Coastal Cloud’s solution because I know the founders, the company has a great reputation and Coastal Cloud is in the process of expanding in Virginia (side note: Virginia already has Coastal Cloud’s second largest number of employees after Florida).

Dodging disaster  The New York Times rates Virginia as 40th out of 50 states in the percent of people who have received at least the first vaccination shot (2.5%). The CDC rates Virginia as 48th for the percentage of vaccinations used. We’re lagging and the vast majority of Virginians have not even started the process. Shouldn’t our counties be aggressively implementing the technology needed to facilitate the distribution of the COVID vaccine? The General Assembly is in session and this is an election year. One would think that accelerating the distribution of vaccines in Virginia would be a top priority for our state government. Perhaps somebody in Richmond ought to contact the Hales.  That can be done by following this link and clicking the “Speak to an Expert” button on the top right of the page.

Author’s note: While I am an ex-employee and current shareholder in two of Coastal Cloud’s competitors, IBM and Accenture, I have no financial stake in Coastal Cloud and I was not compensated in any way for writing this article.

–DJ Rippert


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40 responses to “COVID Vaccine Distribution: What Can Virginia Learn from Florida?”

  1. Awesome post, Don. Coastal Cloud sounds like an amazing company — it’s all the cooler that it has such strong Virginian connections — and it sounds like it could help bring order out of chaos. I hope someone in the Northam administrations reads this post and jumps on your suggestion to contact the Hales. Perhaps you should provide the contact information at the bottom of the post to make it all the easier to do so.

    1. djrippert Avatar

      Thanks. Coastal Cloud is an amazing company. I have stayed in contact with Tim and Sara from the start and been amazed at how well the company has done. The Hales’ thinking on why the pick the places to expand that they pick is fascinating. As for making the contact easier, I’ll add that to the post.

      1. John Harvie Avatar
        John Harvie

        Hopefully DeSantis and Palm Beach County will get wind of it.

        Nuff said…

        1. LarrytheG Avatar

          If I remember correctly, John Harvie should have been among the very first who got a shot and apparently still has not. SHADES of NORTHAM!

          1. John Harvie Avatar
            John Harvie

            Yep I couldn’t afford a multi million $ donation to Morse Health like some New Yorkers who came down to get theirs and then went home… VA is probably no worse than anywhere else.

            Hope you’re getting yours, Larry. Be well!

            We’re good; Ina is 82 and I’m only 92. Just being careful…

  2. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Thanks for this post, Don. Perhaps Danny Avula, the guy Northam has put in charge of coordinating the vaccination process knows about this vendor or others like it. I am astounded at what a hodge podge this whole process is–not only in Virginia, but the rest of the country. From what I have heard and read, our neighbor to the west, West Virginia, seems to have figured out better than other states how to do it.

    1. djrippert Avatar

      COVID has been pretty much of a failure of American government. The federal government did too little and passed the buck to the states. In Virginia, the state has done too little and passed the buck to the localities. I guess the buck stops there. West Virginia seems to be doing something right. If I have time I’ll try to look into what they are doing.

      Most states are off to a bad start but Virginia is among the very worst. 40th in percentage of residents that have received their first shot and 48th in terms of how many delivered shots have been administered.

      And, as Richmond.Com writes, “With testing, the state took four months to reach its targets.” We were also poorly rated as a state on testing.

      A poor showing in testing is sad but perhaps understandable. The virus hit everybody suddenly and without much warning. The vaccines are another matter altogether. Everybody knew that the race for vaccines was on. Everybody knew that vaccines would be the way out of this mess. However, it seems like our state government just didn’t learn the lessons from the testing shortfalls.

      Now we have the “double whammy” where the federal government will ship new doses of the vaccine based, at least in part, how effectively the state has used the initial shipments. Yikes.

  3. djrippert Avatar

    @LarrytheG – The facts speak for themselves on the Northam Administration’s success with testing, distributing unemployment checks, getting Virginians their first shot and the percentage of shipped vaccines used to date. We are among the worst states in all of those categories.

    The ship has hardly sailed. First, only 2.5% of Virginians have gotten even their first vaccination shot. Second, it seems to me that doctors, first responders and now teachers have been prioritized. Managing that is relatively easy. Get the e-mail list from Inova and schedule shots for all of their employees. Do the same for teachers in any given school district. Vaccinate the teachers in the schools. Now comes the hard part – everybody else. This will require self-registration, self-scheduling of appointments, finding the right place to get the shot, getting to that place, etc. As Sara and Tim said – it’s like a tsunami – a small storm at first then a real fiasco.

  4. LarrytheG Avatar

    Well, the ship that sailed was the one where vaccine plan was set up right PRIOR to starting.

    Now, it’s started and we’re talking about changes while it is ongoing.

    Florida did it. Maybe we can too.

    If what happened in Florida happened in Virginia, the criticism of Northam would have gone off the charts…

    One thing about WVA. Fully a third of their population is on Medicaid and others are on Social security disability and other entitlement programs.

    That means good electronic records kept as to who, what age and where they live.

    In Virginia, the folks that are in multi-provider HMOs or on Hospital shared electronic records are easier to contact than those who go to private providers with in-house-only records. How they “find” these folks? Does each private practice have to be contacted and told to contact everyone in their practice?

    1. djrippert Avatar

      “How they “find” these folks? Does each private practice have to be contacted and told to contact everyone in their practice?”

      You’re on the right track with this question. I think people find the vaccine rather than the vaccine finding them. The state and localities advertise the websites where residents can go sign up for a vaccination. People sign up and then go get vaccinated.

      My question is whether proof of vaccination should be issued. I’d have no problem with that. For some time … if you can’t show your vaccination card then you don’t get to eat in restaurants enforcing that rule. Or, there’s a vaccinated area and an unvaccinated area – like the old smoking vs non-smoking areas of Virginia restaurants.

  5. Awesome post, Don. Coastal Cloud sounds like an amazing company — it’s all the cooler that it has such strong Virginian connections — and it sounds like it could help bring order out of chaos. I hope someone in the Northam administrations reads this post and jumps on your suggestion to contact the Hales. Perhaps you should provide the contact information at the bottom of the post to make it all the easier to do so.

    1. djrippert Avatar

      Thanks. Coastal Cloud is an amazing company. I have stayed in contact with Tim and Sara from the start and been amazed at how well the company has done. The Hales’ thinking on why the pick the places to expand that they pick is fascinating. As for making the contact easier, I’ll add that to the post.

      1. John Harvie Avatar
        John Harvie

        Hopefully DeSantis and Palm Beach County will get wind of it.

        Nuff said…

        1. LarrytheG Avatar

          If I remember correctly, John Harvie should have been among the very first who got a shot and apparently still has not. SHADES of NORTHAM!

          1. John Harvie Avatar
            John Harvie

            Yep I couldn’t afford a multi million $ donation to Morse Health like some New Yorkers who came down to get theirs and then went home… VA is probably no worse than anywhere else.

            Hope you’re getting yours, Larry. Be well!

            We’re good; Ina is 82 and I’m only 92. Just being careful…

  6. LarrytheG Avatar

    Not only an appointment problem but as you said, a logistics problem.

    Think of each site as one that has some supply of vaccines that is getting drawn down as they give shots but then gets plumped up when a new supply arrives. So there is a supply that dynamically varies as shots are given and new supplies coming in and you’re trying to schedule appointments without giving out more than there is current supply for.

    That’s for one site. Multiple that out to hundreds or more…

    Right now, in Fredericksburg, there is no coordinated approach regionally, much less at the state level.

    I just heard that in NC, anecdotally, they’re giving shots to those 75 and older tomorrow, but the actual caregivers of those older are not yet scheduled.

    1. djrippert Avatar

      My post was at 1,000 words so I couldn’t really afford to go into the logistics without making it too long a read for the loose guidelines at BaconsRebellion. However, Sara and Tim did say that Florida hired 1,000 nurses to administer the shots, focus on drive-through inoculation and have gotten local firefighters to help with traffic control for the drive-through centers. All in all it sounds like Florida has taken serious and sensible actions in the wake of a poor start to the process.

      1. LarrytheG Avatar

        Right – but WHERE is the vaccine coming from and WHO is getting it to those nurses and drive-throughs?

        If you give an appointment to someone – do you actually have the vaccine after they stand in line?

        That’s no mean trick no matter the state. It’s a mega cloud database application.

        DO you give out appointments based on ANTICIPATED vaccine to arrive or do you say “check back often” or take their name, put on a list, then contact them when new supplies arrive?

        Do this at hundreds of sites 24/7.

        If they are doing that – it’s a real success story and if I’m reading right, the Gov of Florida turned this over lock, stock and barrel to this company trusting that they would do it right.

        Northam has not done that … I’m not sure how many other states have done it.

        1. Steve Haner Avatar
          Steve Haner

          Government always does it better and nobody better than Northam in Larry World.

          1. LarrytheG Avatar

            No… the problem is in BR “world” is that any/all claims of “bad Northam” are the gospel truth… no matter the reality.

            He is by no means at the top of the heap of Governors but He’s also not on the bottom.

            The real truth is somewhere in between not withstanding Kerry and DJ and company want us to believe.

            “Larry’s world” just tries to keep the la la land folks at bay.

        2. djrippert Avatar

          Like I said, I didn’t want to write a 3,000 word essay on “all things Florida” regarding the vaccination process. Florida seems to have righted the ship. Like Virginia, the management of the vaccine distribution details are left up to the localities in Florida. Any company seeking to be the reservation / appointment technology provider for a locality must win that business with the locality. Coastal Cloud has won four large counties so far. Other vendors have also won business.

          As far as I know, COVID federal funds are controlled by the state. As Jim Bacon reported, the state has $608m in new federal money for the vaccination process. I assume (but don’t know) that the state will have to establish how these funds are distributed to localities.

          https://www.baconsrebellion.com/virginias-covid-federal-grants-now-at-5-8-billion/

          On the reservation and appointment front – I tried to get an 82 year old friend (living in Virginia) with significant health issues an appointment for their first COVID shot. What a mess. The county websites were useless. A doctor showed me a way to schedule an appointment that a “normal person” never would have found. The earliest possibility was mid-February. By setting up the registrations and appointments correctly the state and local governments know how many doses need to be where and when. That seems like the start of a competent logistical process.

          If Northam had any sense he’s ask for 50 student volunteers from UVA and assign each of them to research every other state and DC regarding their approach to COVID vaccine distribution. He would then take the best ideas and apply those ideas to Virginia. That whole process would take about four days.

          Finally, people who know they have a vaccination appointment are much more likely to be safe in their actions. Nobody wants to get COVID the day before they are scheduled for their first shot.

          1. LarrytheG Avatar

            to a certain extent, the thing of “setting up a process”, that ship has sailed and now we’re trying to change the tires on the car as it rolls down the road!

            Looks like Florida got some of their tires done but to Northam’s credit no elderly sleeping for hours in lawn chairs…

  7. LarrytheG Avatar

    Not only an appointment problem but as you said, a logistics problem.

    Think of each site as one that has some supply of vaccines that is getting drawn down as they give shots but then gets plumped up when a new supply arrives. So there is a supply that dynamically varies as shots are given and new supplies coming in and you’re trying to schedule appointments without giving out more than there is current supply for.

    That’s for one site. Multiple that out to hundreds or more…

    Right now, in Fredericksburg, there is no coordinated approach regionally, much less at the state level.

    I just heard that in NC, anecdotally, they’re giving shots to those 75 and older tomorrow, but the actual caregivers of those older are not yet scheduled.

    1. djrippert Avatar

      My post was at 1,000 words so I couldn’t really afford to go into the logistics without making it too long a read for the loose guidelines at BaconsRebellion. However, Sara and Tim did say that Florida hired 1,000 nurses to administer the shots, focus on drive-through inoculation and have gotten local firefighters to help with traffic control for the drive-through centers. All in all it sounds like Florida has taken serious and sensible actions in the wake of a poor start to the process.

      1. LarrytheG Avatar

        Right – but WHERE is the vaccine coming from and WHO is getting it to those nurses and drive-throughs?

        If you give an appointment to someone – do you actually have the vaccine after they stand in line?

        That’s no mean trick no matter the state. It’s a mega cloud database application.

        DO you give out appointments based on ANTICIPATED vaccine to arrive or do you say “check back often” or take their name, put on a list, then contact them when new supplies arrive?

        Do this at hundreds of sites 24/7.

        If they are doing that – it’s a real success story and if I’m reading right, the Gov of Florida turned this over lock, stock and barrel to this company trusting that they would do it right.

        Northam has not done that … I’m not sure how many other states have done it.

        1. Steve Haner Avatar
          Steve Haner

          Government always does it better and nobody better than Northam in Larry World.

          1. LarrytheG Avatar

            No… the problem is in BR “world” is that any/all claims of “bad Northam” are the gospel truth… no matter the reality.

            He is by no means at the top of the heap of Governors but He’s also not on the bottom.

            The real truth is somewhere in between not withstanding Kerry and DJ and company want us to believe.

            “Larry’s world” just tries to keep the la la land folks at bay.

        2. djrippert Avatar

          Like I said, I didn’t want to write a 3,000 word essay on “all things Florida” regarding the vaccination process. Florida seems to have righted the ship. Like Virginia, the management of the vaccine distribution details are left up to the localities in Florida. Any company seeking to be the reservation / appointment technology provider for a locality must win that business with the locality. Coastal Cloud has won four large counties so far. Other vendors have also won business.

          As far as I know, COVID federal funds are controlled by the state. As Jim Bacon reported, the state has $608m in new federal money for the vaccination process. I assume (but don’t know) that the state will have to establish how these funds are distributed to localities.

          https://www.baconsrebellion.com/virginias-covid-federal-grants-now-at-5-8-billion/

          On the reservation and appointment front – I tried to get an 82 year old friend (living in Virginia) with significant health issues an appointment for their first COVID shot. What a mess. The county websites were useless. A doctor showed me a way to schedule an appointment that a “normal person” never would have found. The earliest possibility was mid-February. By setting up the registrations and appointments correctly the state and local governments know how many doses need to be where and when. That seems like the start of a competent logistical process.

          If Northam had any sense he’s ask for 50 student volunteers from UVA and assign each of them to research every other state and DC regarding their approach to COVID vaccine distribution. He would then take the best ideas and apply those ideas to Virginia. That whole process would take about four days.

          Finally, people who know they have a vaccination appointment are much more likely to be safe in their actions. Nobody wants to get COVID the day before they are scheduled for their first shot.

          1. LarrytheG Avatar

            to a certain extent, the thing of “setting up a process”, that ship has sailed and now we’re trying to change the tires on the car as it rolls down the road!

            Looks like Florida got some of their tires done but to Northam’s credit no elderly sleeping for hours in lawn chairs…

  8. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Thanks for this post, Don. Perhaps Danny Avula, the guy Northam has put in charge of coordinating the vaccination process knows about this vendor or others like it. I am astounded at what a hodge podge this whole process is–not only in Virginia, but the rest of the country. From what I have heard and read, our neighbor to the west, West Virginia, seems to have figured out better than other states how to do it.

    1. djrippert Avatar

      COVID has been pretty much of a failure of American government. The federal government did too little and passed the buck to the states. In Virginia, the state has done too little and passed the buck to the localities. I guess the buck stops there. West Virginia seems to be doing something right. If I have time I’ll try to look into what they are doing.

      Most states are off to a bad start but Virginia is among the very worst. 40th in percentage of residents that have received their first shot and 48th in terms of how many delivered shots have been administered.

      And, as Richmond.Com writes, “With testing, the state took four months to reach its targets.” We were also poorly rated as a state on testing.

      A poor showing in testing is sad but perhaps understandable. The virus hit everybody suddenly and without much warning. The vaccines are another matter altogether. Everybody knew that the race for vaccines was on. Everybody knew that vaccines would be the way out of this mess. However, it seems like our state government just didn’t learn the lessons from the testing shortfalls.

      Now we have the “double whammy” where the federal government will ship new doses of the vaccine based, at least in part, how effectively the state has used the initial shipments. Yikes.

  9. djrippert Avatar

    @LarrytheG – The facts speak for themselves on the Northam Administration’s success with testing, distributing unemployment checks, getting Virginians their first shot and the percentage of shipped vaccines used to date. We are among the worst states in all of those categories.

    The ship has hardly sailed. First, only 2.5% of Virginians have gotten even their first vaccination shot. Second, it seems to me that doctors, first responders and now teachers have been prioritized. Managing that is relatively easy. Get the e-mail list from Inova and schedule shots for all of their employees. Do the same for teachers in any given school district. Vaccinate the teachers in the schools. Now comes the hard part – everybody else. This will require self-registration, self-scheduling of appointments, finding the right place to get the shot, getting to that place, etc. As Sara and Tim said – it’s like a tsunami – a small storm at first then a real fiasco.

  10. LarrytheG Avatar

    Well, the ship that sailed was the one where vaccine plan was set up right PRIOR to starting.

    Now, it’s started and we’re talking about changes while it is ongoing.

    Florida did it. Maybe we can too.

    If what happened in Florida happened in Virginia, the criticism of Northam would have gone off the charts…

    One thing about WVA. Fully a third of their population is on Medicaid and others are on Social security disability and other entitlement programs.

    That means good electronic records kept as to who, what age and where they live.

    In Virginia, the folks that are in multi-provider HMOs or on Hospital shared electronic records are easier to contact than those who go to private providers with in-house-only records. How they “find” these folks? Does each private practice have to be contacted and told to contact everyone in their practice?

    1. djrippert Avatar

      “How they “find” these folks? Does each private practice have to be contacted and told to contact everyone in their practice?”

      You’re on the right track with this question. I think people find the vaccine rather than the vaccine finding them. The state and localities advertise the websites where residents can go sign up for a vaccination. People sign up and then go get vaccinated.

      My question is whether proof of vaccination should be issued. I’d have no problem with that. For some time … if you can’t show your vaccination card then you don’t get to eat in restaurants enforcing that rule. Or, there’s a vaccinated area and an unvaccinated area – like the old smoking vs non-smoking areas of Virginia restaurants.

  11. John Harvie Avatar
    John Harvie

    Meanwhile life goes on:

    Palm Beach police said Trump will arrive in South Florida on Wednesday morning, the same day President-elect Joe Biden is due to be inaugurated in Washington.

    In a letter sent to residents last Friday, Town Manager Kirk Blouin and Police Chief Nicholas Caristo said they expect road closures around Mar-a-Lago to be in place for “several days.”

    “On Wednesday, January, 20, 2021, we expect Secret Service to have a final road closure near Mar-a-Lago,” the letter said. “The road closure will last several days for safety and security reasons. Beyond this, we do not foresee any future road closures related to the presence of a former president.”

    1. LarrytheG Avatar

      Good Luck John Harvie and hope you guys get your shots soon!

    2. Nancy_Naive Avatar
      Nancy_Naive

      Just don’t look at the needle.

  12. John Harvie Avatar
    John Harvie

    Meanwhile life goes on:

    Palm Beach police said Trump will arrive in South Florida on Wednesday morning, the same day President-elect Joe Biden is due to be inaugurated in Washington.

    In a letter sent to residents last Friday, Town Manager Kirk Blouin and Police Chief Nicholas Caristo said they expect road closures around Mar-a-Lago to be in place for “several days.”

    “On Wednesday, January, 20, 2021, we expect Secret Service to have a final road closure near Mar-a-Lago,” the letter said. “The road closure will last several days for safety and security reasons. Beyond this, we do not foresee any future road closures related to the presence of a former president.”

    1. LarrytheG Avatar

      Good Luck John Harvie and hope you guys get your shots soon!

    2. Nancy_Naive Avatar
      Nancy_Naive

      Just don’t look at the needle.

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