ARI SHAPIRO, HOST:

Yesterday was the deadliest day of the pandemic yet here in the U.S - 2,804 new deaths were recorded, exceeding the single highest daily death toll from April 15.

MARY LOUISE KELLY, HOST:

More than 100,000 people in the U.S. are now in the hospital with COVID-19. And the CDC predicts that not only is it going to get still worse, but we are staring down what will be, quote, "the most difficult time in the public health history of this nation." That's even as the first doses of a coronavirus vaccine are on the horizon.

SHAPIRO: We're going to talk more now about how states are preparing to distribute those vaccines as they become available. And to do that, we're joined by Dr. Rachel Levine. She is the Pennsylvania health secretary and also president of the Association of State Health Officials. Dr. Levine, welcome to ALL THINGS CONSIDERED.

RACHEL LEVINE: Thank you very much. I'm very pleased to be here.

SHAPIRO: Will you walk us through the logistics for when Pennsylvania first receives its initial shipments of vaccines? I mean, where does it go? How do you keep it cold? What do you actually have to do?

LEVINE: Sure. So we're all awaiting the meeting of the FDA on December 10. And then they will consider all of the data submitted by the Pfizer corporation for the first vaccine. When they issue their emergency use authorization, or EUA, then Operation Warp Speed will distribute the vaccine to hospitals in Pennsylvania and throughout the nation.

SHAPIRO: Just to get specific, is the federal government or Pfizer Corporation sending it to the state of Pennsylvania to distribute it to hospitals? I ask because this vaccine has to be kept incredibly cold. It's not just like you can send a bottle of aspirin, right?

LEVINE: So you are correct. This is an ultra-cold-chain vaccine that has to be kept at minus 80 degrees centigrade or Celsius. So it will be Operation Warp Speed that will be sending it to the hospitals that we designate. Now, it will depend, of course, upon how much we're going to get. And it comes in trays of 975 vials. So these have to be hospitals that can deal with the cold chain and can deal with that amount of vaccine to then administer.

SHAPIRO: Now the CDC recommends that health care workers and residents of long-term care facilities should get first access to these vaccines. That's a large number of people. Have you decided whether you're going to start with older health care workers or people with underlying conditions or only doctors and nurses who see COVID patients? I mean, how are you going to prioritize within the priority groups?

LEVINE: Sure. So we're going to be developing a decision tree for hospitals to use, and we'll be finishing that this week. I want to point out that the distribution for the nursing home and other long-term care facilities goes in a different way. So Operation Warp Speed, working with Walgreens and CVS, will be receiving the vaccine with those two pharmaceutical companies. And then they will be working to administer the vaccine in nursing homes and other long-term care facilities.

SHAPIRO: Do you have a sense of how many doses the first shipment is likely to include and how that compares to the number of people in this top-priority-first group?

LEVINE: So we don't exactly know how many doses we're going to get in the first shipment. So, you know, we've had lots of discussions with Operation Warp Speed. You know, we'll be looking at the end of next week or certainly when they're going to be sent out to know exactly how many doses we're going to get in the first week. And then the expectation are weekly shipments to the hospitals and to Walgreens and CVS for those distributions.

SHAPIRO: I got to ask - a lot is depending here on the ability of Operation Warp Speed to carry this out effectively. And with coronavirus testing, the federal government kind of fell down. I mean, there weren't enough tests. Some of the tests were not accurate initially. How confident are you in the ability of this Trump administration program to get this very difficult job done?

LEVINE: We have heard directly from General Perna. You know, we have confidence in them, but I'm sure it'll be a significant logistical challenge. This has to occur throughout the United States all at the same time to all of the states, the territories and then some specific large cities.

SHAPIRO: And are you also concerned about the smooth handoff from one administration to another? I mean, if the distribution depends on Operation Warp Speed, which is a Trump administration program, well, the Trump administration only has so many more weeks in office.

LEVINE: Now, the Department of Defense under General Perna, you know, will still be there in terms of continuity. But in terms of the representatives from Health and Human Services and the administration, we would like to think that they'll be robust conversation and communication as the administration transitions. Obviously, that has not happened as much as it should have yet, but we're hoping that all those communications will be going on forthcoming.

SHAPIRO: Just to get back to the scale of the logistical challenge here, this is a vaccine that requires two doses, weeks apart. Do you have the infrastructure to track and time who has had a first dose when?

LEVINE: Yes, we do. But that is a - an information technology challenge in terms of making sure that we get the right vaccine to the right person at the right time. And then not only the Pfizer vaccine, but the Moderna vaccine. That also is a two-dose vaccine.

SHAPIRO: We've heard so many states talk about the extreme budget pressure that they are under, and this is an expensive undertaking. Do you have the money you need to do it? And if not, do you think the federal government is ready to provide it?

LEVINE: Well, it will be essential for the federal government to provide more funding to the states, territories and cities that will be tasked with administering the vaccine. Operation Warp Speed cost billions and billions for the development of the vaccine. Only $340 million has been allocated for the next part of the mission - the distribution and the administration. So clearly, states and territories and cities are going to need more funding from the federal government to finish and accomplish this mission.

SHAPIRO: These issues you're talking about could occupy you for more than 40 hours a week every week. And you are at the same time dealing with a spike in coronavirus cases and having to contact trace people who may have come in contact with exposed individuals, overcrowded hospitals. How are you juggling all of this at once?

LEVINE: Well, again, this is the public health challenge of a lifetime. I don't think any of us have seen a 40-hour week, you know, in our memory.

SHAPIRO: (Laughter) Fair. Yeah.

LEVINE: So, you know, there are three ways...

SHAPIRO: I stand corrected.

LEVINE: There are three ways to deal with the pandemic. You can work on containment. That involves the testing and contact tracing. It's very hard to contain a virus that has spread this far. For example, today we are reporting 11 - over 11,000 new cases in Pennsylvania. It's impossible to contact that many people. So we have to prioritize. And we prioritize to congregate settings, such as nursing homes and other long-term care facilities, correctional institutions, schools, et cetera.

Then we have mitigation - basic mitigation, such as masks and hand-washing and social distancing. And then in Pennsylvania, you know, we have a stay-at-home advisory. And, you know, we have really tried to recommend that people avoid not only large gatherings, but small gatherings. And then there'll be the vaccine. Those are the tools in the public health toolbox that we have to work with.

SHAPIRO: When you're dealing with community spread on the level that we are seeing now, where there is so much of this disease and so much transmission of it, do you have to change your approach? I mean, it's like gone from hand-to-hand combat to fighting an army, I would imagine.

LEVINE: It has. And so the basic public health tool of containment, which we would do for a small measles outbreak or for an outbreak of tuberculosis - that is extremely difficult for public health to do when we're seeing this type of widespread community transmission. And then we have to pivot to more and more mitigation. It's very unpopular. It has made public health officials sometimes unpopular throughout the nation. But they're absolutely essential to try to stop the spread. And then we have the light at the end of the tunnel, which is the vaccine. But there's no quick fix to COVID-19.

SHAPIRO: Dr. Rachel Levine, Pennsylvania health secretary and president of the Association of State Health Officials, thank you for talking with us in the middle of everything else that you are doing.

LEVINE: My pleasure. Thank you very much. Transcript provided by NPR, Copyright NPR.