Some Minnesota health care providers large and small are questioning the allocation of the first COVID-19 vaccine doses in the state, especially for high-risk health care workers.

The Mayo Clinic in Rochester said its 2,300-dose shipment last week would only be enough for 6% of its front-line health care workers.

"We need to make sure that our staff receives the doses that they need," said Dr. Amy Williams, executive dean of Mayo Clinic Practice. "We have voiced our concerns and we hope that this will be addressed in a way that enables our staff to be vaccinated at the same pace as other health care workers in the state."

But a network of 17 safety net clinics whose patients are testing positive for COVID-19 at rates three times above average said they've received no doses and haven't been notified when they will receive any.

A leader of one of the clinics said Minnesota's vaccination plan resembles a "trickle down" model that perpetuates long-standing health inequities in the state.

Vaccine shipments are sent to large medical centers, which then redistribute them to other facilities as determined by regional health care boards.

"I think it would be unfortunate if the state decided to use the large medical systems to provide the vaccine exclusively," said Mike Holmes, chief executive of Scenic Rivers Health Services in northern Minnesota.

"It will continue the gaps or the cracks that we have in the system that tend to leave behind communities of color and low-income people," he said.

Without the vaccine, the safety net clinics say their workers are at a continued risk for infection for a longer period of time. Since most clinics operate with a handful of staff at a time, they are at a danger of shutting their doors if too many get sick or exposed.

The vaccine is the greatest hope for ending the pandemic, which so far has led to the deaths of 4,896 Minnesotans, including 24 new fatalities announced by the Minnesota Department of Health (MDH) on Tuesday.

The state also surpassed 400,000 cases Tuesday, with 1,714 more infections reported, bringing the total to 401,011 since the COVID-19 outbreak started in Minnesota in March.

Last week, 46,800 doses of the Pfizer vaccine were shipped to Minnesota and another 42,900 are expected this week. That's a fraction of what is needed for 500,000 people that the state estimates are in the highest priority group of health care workers and long-term care residents.

Nearly 95,000 doses of the Moderna vaccine, which received federal regulatory emergency use authorization last weekend, are scheduled to arrive in Minnesota on Wednesday and are earmarked for nursing home residents.

State health officials acknowledge that demand far outstrips supply in the early stages of the vaccine rollout.

"Certainly we are aware of the questions and are working to dig into those and see if any changes are needed or not," Minnesota Health Commissioner Jan Malcolm said.

"Our goal is to make sure that anybody who wants to be vaccinated can," she said. "Assuring an equitable distribution of vaccine is very very critical."

The Minnesota Association of Community Health Centers, which represents the 17 clinics that primarily serve uninsured, Medical Assistance and MinnesotaCare patients, says that advancing health equity should be a component of equitable distribution.

"We are seeing more of these patients before they end up in the ICU. We think it is really important to get our staff vaccinated," said Steve Knutson, chief executive at Minneapolis-based Neighborhood HealthSource. "There has been radio silence from MDH and we just don't understand it."

When asked at a news conference Tuesday about when the clinics could expect vaccine doses, state infectious disease director Kris Ehresmann said they were in "tier three" of the first phase, meaning they would come after other groups that are waiting, including hospital workers not on the front lines, assisted living facility residents, and urgent care and dialysis center workers.

"It is not that they won't get vaccine it is just that the initial focus is for acute care settings and for some of the long-term care settings," she said.

Most safety net clinics provide community testing, whose workers are in the highest priority group, as well as urgent care, but their status is uncertain.

"We don't know if we qualify as a testing site," said Shawna Hedlund, director of access and advocacy at St. Paul-based Minnesota Community Care, which has tested 4,000 patients. Overall, 33% of its tests have been positive, including 72% of the tests given to Hispanic patients.

"Our patient population has risks and when they reach our care ... the situations we find them in are often urgent," she said.

The Mayo Clinic should be up to a total of 6,800 doses for its workers after another shipment this week, a state spokesman said.

"We deeply value everything Mayo brings to the state," said Nicholas Kimball, communications director for the state's COVID-19 response.

"In this case, we have a different point of view of how to approach vaccine distribution," he said. "The supply of vaccine is currently extraordinarily limited and does not allow for the immediate vaccination of every person."

MDH did not respond to questions Tuesday about its communications with the safety net clinics.

"We are just perpetuating disparities in the state," said Jonathan Watson, executive director of the clinic group upon learning that his members were placed in "tier three."

"We just keep doing this and I don't know why we are surprised when we are one of the worst states in terms of disparities," he said.

The pressure on the state's hospitals has eased, with 228 COVID-19 patients in intensive care beds, down from the 399 when the month began. Another 832 patients were hospitalized in non-ICU beds.

Most people who require hospitalization have underlying health conditions, such as heart, lung or kidney disease.

About 33,000 test reports were sent to the Health Department on Monday. About 2.9 million Minnesotans have taken at least one COVID-19 diagnostic test.

Of those who are known to have been infected, 376,354 are considered to no longer be infectious and are no longer required to isolate.

Glenn Howatt • 612-673-7192