WASHINGTON — The Trump administration on Tuesday directed state officials to expand who is getting vaccinated for COVID-19, and announced that all available doses will be distributed to states instead of holding back a reserve of follow-up doses.

However, the message from Iowa public health officials Tuesday was still: “Be patient.”

Under the policy changes outlined by Health and Human Services Secretary Alex Azar, states should begin vaccinating anyone age 65 and older and those under 65 who have underlying health conditions that put them at increasing risk of severe COVID-19 symptoms.

States also are urged to expand the sites being used for vaccinations, and will see their allocation of doses change. The number of vaccine doses sent to states each week will no longer be based on population, but rather on the pace of vaccine administration and the number of residents 65 and older.

“Every vaccine dose that is sitting in a warehouse rather than going into an arm could mean one more life lost or one more hospital bed occupied,” Azar told reporters.

The shift in federal policy guidance comes amid frustrations over the slow rollout of vaccinations as case counts and deaths from COVID-19 hit new highs. Instead of the 20 million doses that Trump administration officials had estimated could be administered by the end of 2020, that tally was just over 3 million.

State officials also have expressed exasperation at changing figures on the amount of vaccines they will receive each week.

A group of Democratic governors — including those from Michigan, Kansas, Minnesota and Wisconsin — last week called on federal officials to accelerate distribution of the available vaccines, so that the second dose of the two-shot regimen isn’t held back. President-elect Joe Biden had pledged to make that change as soon as he takes office next week.

Azar said Tuesday that the decision to release all available doses was made due to increased confidence that pharmaceutical manufacturers will be able to produce enough doses to keep up with demand.

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Another 83 virus deaths boost Iowa total to 4,222

DES MOINES (AP) — Iowa posted another 83 coronavirus related deaths on Tuesday, increasing the state total to 4,222 deaths during the pandemic.

Another 1,199 confirmed cases were identified, boosting the total number of cases in Iowa to 298,065.

The seven-day rolling average of the positivity rate in Iowa has risen over the past two weeks from 34.7% on Dec. 28 to 41.8% on Jan. 11, according to researchers at Johns Hopkins University.

The death count is the 17th highest per capita rate in the United States, the researchers said.

More than 50 Iowa counties have a 14-day average positivity rate above 15%, three times the level considered safe by the World Health Organization and the U.S. Centers for Disease Control and Prevention.

Polk County, where lawmakers on Monday convened the legislative session, has a rate of 15.1%, a level indicating significant community virus spread.