© CB Schmelter / Associated Press
The delivery of Covid-19 shots at locations across the country is just the first step in vaccinating the population. It’s another journey to get it out of the freezer, complicated by the special handling that the doses require, but also due to cumbersome data management systems. Websites should take precautions to ensure that it does not contribute to the spread of the virus, measures that may delay the administration of shots. And in many places, the demand for doses exceeded supply.
The vaccination site at Tennessee Riverpark in Chattanooga, Tennessee, gives the vaccine to about 3,500 people each week, typical of a site of its size and the amount of doses it receives. The health officials have been running since December 23, as the weeks go on. A careful examination of the distribution center brings to light the many people and processes that must be matched before doses can be administered quickly and efficiently.
The vaccines from Pfizer Inc. and Modern Inc. contains different handling requirements, storage protocols and guidelines for thawing and time dosing.
Storage: Facilities that handle both vaccines must be equipped with three types of freezers and refrigeration units. One can store Pfizer’s vaccine at deep freeze, one for storing the Moderna vaccine and then a refrigerator used for thawing. The important components of the vaccines can easily destabilize if not stored at the right temperature.
Healthcare workers at vaccination centers constantly manage freezing, refrigeration and thawing. At the same time, they should note that thawed vaccines do not remain unused beyond their expiration date. The Pfizer vaccine can remain thawed for six hours after dilution before expiration. For the Moderna vaccine, the time limit is also six hours.
Managing and registering the temperature of vaccines is time consuming. In outdoor areas, vaccines must be transported to the outside by hand as needed, so that workers can ensure that the doses are not too hot or cold in the elements. Before shots are fired, doses are thawed to room temperature.
Handling: A thawed Pfizer vaccine requires several steps before it can be placed in an arm.
Workers should place a five- or six-dose vial at room temperature for up to 30 minutes before preparing. Then the vaccine must be inverted ten times to mix the contents thoroughly. Workers then draw a diluent into a syringe and inject it into the Pfizer vaccination vial. They turn the tide over ten more times. The mixed solution is then drawn up into five or six syringes for dosing. The Moderna vaccine does not require dilution, but must be turned by hand before drawing doses. Each vial of Moderna contains 10 doses.
The Pfizer vaccine is sensitive to light. Inside the trailer where health workers prepare doses at the Chattanooga site, window panes are usually closed to block the sun.
They place loaded syringes on pickups and sometimes use paper bags to cover the pickups. They wrap the bowls in plastic in case of rain.
Vaccines have been in high demand, and many vaccination sites are struggling with limited supplies, leading to hiccups.
Safety: Fear of stolen or knee-jerk vaccines has led provincial departments and hospitals to pay local police to introduce doses between storage facilities and vaccination sites. Some sites pay law enforcement to monitor doses 24 hours a day.
Crowd management: While states, provinces and vaccination sites have put certain vaccination groups first, ineligible people often show up without appointments and expect to get shot. Some people lie to get an appointment, health officials say. In Chattanooga, the national guard is on the premises and people have to prove that they are eligible for appointments they have booked. The paperwork is meant to be pre-filled, but many end up filling it in on the site. Verifying that someone has an appointment and is qualified requires extra time. No one may come more than 15 minutes before an appointment to avoid pressure.
Immediately after receiving shots, people should walk to a waiting area for at least 15 minutes so that they can be monitored for possible allergic reactions. On many sites, large indoor spaces are needed that can provide long-distance seating or large parking spaces.
Scheduling and data: even with a proper scheduling system, scheduling appointments for two doses of two different vaccines is complicated to manage. On many sites there are ‘first dose’ days and ‘second dose’ days, Pfizer days and Modern days. Many vaccination sites prefer a system of separate days to avoid errors involving the different protocols for the vaccines.
Initially, there was hiccups. Vaccinations are not there or are not consistent. Some health departments say they are still not sure they will receive vaccines before receiving a notification from FedEx Corp. will not receive – and will first plan the first dose appointments before the doses are on site.
As doses are administered, there are different documentation requirements, such as recording the demographic data of the recipients of the shots and recording what vaccines they receive. Most health departments have to manually enter the information into cumbersome databases that are often separate from the scheduling systems.
Write to Julie Wernau at [email protected]
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