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When a broken freezer at a hospital in northern California threatened the viability of 830 doses of the Moderna vaccine, it was like one more example of COVID-19 vaccine distribution. But in 2 hours, Mendocino County Adventist Health managed to deliver the sights before they left, an immediate demonstration that it is possible to deliver vaccines quickly and efficiently.
As of Jan. 11, about 25.5 million doses had been dispensed to states, but only about 35% were dispensed in vaccines, according to the Centers for Disease Control and Prevention (CDC). While numbers fluctuate throughout the day, vaccination success varies widely across the country, from a low of about 19% of available doses administered in Georgia to near on 73% in North Dakota. Weak time is embedded in CDC data as health providers report their vaccines up to 72 hours after delivery.
It is difficult to deliver the vaccine. States determine which health professionals can provide vaccines – usually physicians, nurses, physician assistants, dentists, and pharmacists – and many of those workers are already depleted by the increase. in COVID patients.
Patients must also be monitored for 15 minutes after the injection (or 30 if they have a history of severe allergic reactions), with medical care available in case anaphylaxis is experienced.
Workers are a key issue nationally, and vaccine providers are needed at “large public health clinics and smaller outreach teams for rural areas and high-risk communities where transport is a challenge,” Kelly L .More, MD, MPH, deputy chief said director of the Vaccination Action Consortium Medscape Medical News.
The slow pace of vaccination has been a painful point across the country. Andrew Cuomo in New York became so upset that he threatened to fine hospitals up to $ 100,000 if they did not use their lots in the week in which they receive it. It had a list of hospital systems that had managed most of their fleets and those that had managed the smallest number.
Vaccine or other
Northwell Health, a system of 23 hospitals based in Long Island, New York, was on the “good” list, after vaccinating about two-thirds of its 72,000 employees. But ramping up has been a learning process, says Mark P. Jarrett, MD, MBA, MS, senior vice president and chief quality officer. New challenges await as Northwell helps establish large vaccination sites in Nassau and Suffolk counties.
Initially, each vaccine was scheduled to be taken every 15 minutes, taking time to ask people about their allergy history and to respond to any concerns. These soon rose to six per hour, and as clinicians become more accustomed to doing the safety checks, that could rise to eight per hour, says Jarrett, who also deputy chief medical officer.
To staff the circulation points for community vaccination, Northwell is reaching out to retired physicians and nurses and to medical and nursing students. “We’re looking everywhere to organize people and they’re coming forward,” Jarrett says.
They require training related to both vaccines, and systems are being set up to handle prescriptions and create stop lists so that no doses are used at the end of the day. “We are preparing everything we can so that we are ready to move,” he says.
Twice to deliver
Back at a California hospital with hundreds of vaccines dissolved, workers faced a use-it-or-lose-it. The team at the Ukiah Valley Adventist Health Medical Center in Mendocino County discovered the freezer problem at 11:35 AM on Monday. The Moderna vaccine can stay at room temperature for no longer than 12 hours, and a sensor showed that the vaccine had reached room temperature at 2 AM. Freezer alarm had also failed.
No one wanted to take doses, and that meant overcoming the obstacles – quickly. Adding to the situation, a jack-knifed tractor trailer had cut a major highway leading to a sister facility 30 minutes away.
Health Adventist Mendocino County president Judson Howe immediately rushed to the local public health department and delivered 200 doses to the county, which they used to vaccinate prison and public workers. Hospital leaders contacted skilled nursing facilities nearby and the largest mobile care provider in the community. Then they made a strategy.
Bessant Parker, MD, MBA, chief medical officer at Mendocino County Adventist Health, personally delivered 70 doses to nursing homes and delivered them to health care workers there. The hospital quickly established four vaccination clinics: one on the hospital campus with nine vaccination stations and three other sites in the community.
Mendocino County is full of forests and mountains, and the community is undergoing a battle test from responding to wildfires. The hospital issued a warning to all staff. Over 70% of them had already received the first dose of the vaccine, but anyone who did not and wanted one could come immediately.
The warning urged volunteers to help with vaccination and provide clerical support. The hospital also wanted to spread the word throughout the community for people to come and get the vaccine.
Ro 1:45 PM, all doses were given. The decentralized approach allowed more doses to be administered at the same time, while still monitoring each individual for adverse effects, Parker said. “It has changed the way we look at how we get our vaccinations going,” he says.
The hospital will try to deliver the vaccine in the near future, although “it may not be as short as this,” Parker says.
Nationally, hospitals have struggled with vaccines, amid concerns about how at-risk workers have been prioritized. But they were well equipped to manage the vaccines and communicate with staff.
When some vaccinated states expanded into the community (usually older adults and adults with medical conditions), the resulting uproar seemed like a big rush for the most prestigious concert tickets.
So hard to get as concert tickets
In Lee County, Florida, public health officials first decided to issue tickets on a first-come, first-served basis for people 65 and older; they had 300 doses per site. Although county officials urged people not to go up before the first site opened at 8 AM, dozens were camping out on lawn chairs overnight. Lee County is now taking telephone meetings.
Palm Beach County, Florida, opened a call line, but fell from the intense demand. In Tallahassee, people began emailing and texting a local newspaper reporter when they could not get through to the health department. Within a few days, she had found 167 calls and 75 text messages.
Houston created an online portal and a call line, but January posts were quickly filled. The Texas State Department of Health Services provides an online interactive map of clinics, hospitals, long-term care facilities, health departments, medical practices, pharmacies, and other facilities that provide the vaccine, but most list what is available as “waiting.”
Everyone should expect a gradual ramp up at the start of the major vaccine, says Rebecca Wurtz, MD, MPH, an infectious disease physician and population health informant at the University of Minnesota School of Public Health in Minneapolis.
She was previously deputy director of the Illinois Department of Public Health and led the smallpox vaccine campaign in 2003 amid biological concerns. She was part of a vaccine distribution advisory committee in Chicago during the H1N1 pandemic in 2009. She is aware that conventional COVID vaccines face particular challenges – for example, the Pfizer vaccine requires ultracold storage – and the first doses were administered during holidays. Nevertheless, by January 11, approximately 9 million Americans had been vaccinated.
“Some states are a little more aggressive than others, but it’s a little hard to hear that we failed,” says Wurtz, who is not involved in the routine vaccination programs. “I think that’s a big win and it’s just going to be up there.”
Many of the initial doses have been identified for long-term care centers, says Moore of the Vaccine Action Consortium. “As soon as these doses were redistributed to the pharmacies that ran that program within the state, the pharmacies had at least 2 weeks to prepare and administer vaccine rounds. recording, “she says.” These vaccines have been going strong since January, and you’ll see numbers administered with rapidly rising doses as a result. “
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