COVID Vaccine Rollout
How Sentara Martha Jefferson Delivered This Precious Cargo to Help Fight the Pandemic
As some of the first COVID-19 vaccines began to reach people around the world, Sentara Healthcare took an early leadership role to distribute some of the first doses to healthcare workers, hospital staff and community members in Virginia.
Months before the first vaccines were delivered to Sentara Norfolk General Hospital, a systemwide coronavirus task force at Sentara developed intricate plans to transport the extremely temperature-sensitive Pfizer vaccine to hospitals across the healthcare system. The first shipment of Pfizer vaccines arrived in Norfolk just before Christmas.
The Pfizer and Moderna vaccines—the first COVID vaccines approved for use in the United States—have been revolutionary, both in terms of how quickly they were developed and in their use of “messenger RNA” technology to enable the body’s immune system to recognize and fight the coronavirus.
“The scientific community expended an incredible amount of time and effort to make sure a safe and effective vaccine was delivered to combat this pandemic,” says Andrea Chapman, an infection control practitioner at Sentara Martha Jefferson Hospital. “The timeline from start to completion is remarkable, and a testament to scientific innovation and fortitude.”
For Sentara team members, the vaccines represent hope and progress during a pandemic that has changed so much about our way of life.
“After months of seeing the worst cases of COVID patients, I was more than ready to help us move closer to the end of the pandemic by getting vaccinated,” says Sara Morris, RN, an intensive care nurse at Sentara Martha Jefferson. “I decided this vaccine was important not only for my own health, but also for the health of my family and community.”
Planning for the Vaccines’Arrival
Besides implementing a “hub and spoke” shipping plan across the healthcare system, the Sentara coronavirus task force also worked with hospitals to ensure they had the right equipment to store the highly sensitive Pfizer vaccine, which must be kept between -112 degrees Fahrenheit and -76 degrees F.
The Moderna vaccine also must stay frozen, between -13 degrees F and 5 degrees F. Since a medical-grade freezer can accommodate that range, the Moderna vaccines are shipped directly to hospitals, explains Jamin Engel, regional director of pharmacy for the Sentara Western Region.
If packed in dry ice, the Pfizer vaccine can be stored temporarily in its shipping container—but the preferred option is to keep it in an ultracold freezer. Sentara RMH Medical Center had an available ultracold freezer, so it transferred one to Sentara Martha Jefferson in preparation for receiving the vaccines. The pharmacy also had to make plans to handle the dry ice used for temporary storage and shipping of the Pfizer vaccine.
Regardless of the storage method or the brand of vaccine received, each vaccine requires extensive monitoring of storage temperatures. The Pfizer shipping container, for example, contains a GPS-monitored, wireless-connected device for temperature recording.
“Whichever vaccine came first, we were going to be ready for it,” says Engel. “At times like these, it’s good to be part of a healthcare system—we put our heads together, looked at what equipment was out there and figured out how to distribute the vaccine safely.”
Doug Paige, Sentara Martha Jefferson pharmacy manager, helped create the pipeline to ship the vaccine to Sentara hospitals in the Blue Ridge Region. Shipments traveled from Norfolk to Sentara Martha Jefferson, which was established as the regional storage hub. From there, vaccines were sent to Sentara RMH, Sentara Halifax Regional Medical Center and Sentara Northern Virginia Medical Center. To assist in community vaccination efforts, Paige also helped coordinate shipments of some of Sentara’s supply to various Virginia Department of Health clinics.
“Planning has been complex, and other patients of course also need our attention and treatment, but these vaccines are a light at the end of the tunnel,” Paige says. “It’s been exciting to be a part of the rollout, and it’s been a complete team effort.”
Setting Up Vaccine Clinics
Employee Health teams worked on the logistics of setting up vaccine clinics at Sentara hospitals. The first vaccines arrived at Sentara Martha Jefferson on Dec. 16.
The department educated hospital employees about the vaccines—which are voluntary, not mandatory. When setting up the vaccine schedule, planners had to take into consideration different shifts and workdays, as well as the shelf life of the Pfizer vaccine once it leaves the ultracold freezer.
“We are optimizing our vaccination clinic times,” Chapman says. “Overall, people are excited to have the opportunity to protect themselves and those around them. The vaccines are bringing a sense of hope that as a community and a nation, we’re taking one step closer to stopping the spread of COVID-19.”
Sentara Martha Jefferson set up the vaccine clinic next to the pharmacy, so moving the vaccine from the ultracold freezer to the clinic’s refrigerator went quickly.
“Once you take it out of the freezer and put it into a refrigerator, you can’t return it to the freezer, and you have five days to use the vaccine,” Paige explains. “We have to be good stewards of the vaccine, which requires careful coordination with employee health vaccination appointments—and even finding eligible employees to help fill canceled appointments, to minimize the risk of wasting vaccines.”
In addition to the five-day time frame, the clinic has six hours once a vial is diluted with saline and the vaccine is pulled into syringes, whether they are at room temperature or in a refrigerator.
These time constraints require an extraordinarily efficient, well-run clinic. After checking in for the appointment, the staff member receives the vaccine, then goes to a waiting area for 15 minutes to be monitored for any side effects.
Paige notes that resourceful pharmacy staff at Sentara and across the country quickly discovered that they could use a specialty syringe to extract six doses out of each Pfizer vial, rather than the five doses initially anticipated by the manufacturer. This allows providers to get the most out of each vial and enables more people to be vaccinated with a limited supply.
Among the First to Get the Vaccine
ICU nurse Sara Morris has been taking care of COVID-19 patients since the beginning of the pandemic.
“There was a lot we didn’t know, and we had to prepare ourselves quickly,” Morris recalls. “That included hands-on training on how to take personal protective equipment on and off, how to preserve supplies, and how to transport patients.”
Before deciding to get the vaccine, Morris spoke to physicians and studied information Sentara provided on the vaccines’safety. As a wife and mother to five children, she was grateful to receive her first dose of the Pfizer vaccine on Dec. 21 and her second dose on Jan. 13.
As reported in the clinical trials, some initial recipients of the COVID vaccine have reported mild side effects. After the first dose of the vaccine, many people report soreness at the injection site. After the second dose, some people experience fatigue, headache, muscle pain, chills, joint pain and fever, according to the U.S. Food and Drug Administration (FDA).
“This means the immune system is responding to the vaccine and is working to build immunity,” says Chapman.
Annie Brown, who works in the Environmental Health Services Department at Sentara Martha Jefferson, has seen her responsibilities increase since the pandemic began, with an enormous emphasis on disinfecting and keeping surfaces clean.
“You have to wipe down anything people touch,” says Brown. “I was one of the first in my department to get the vaccine. The first dose made my arm sore for a couple of days, but I didn’t experience any side effects after the second.”
Receiving the vaccines has been a relief and a positive experience for Jaidy Polania, who works as a buyer for Sentara Martha Jefferson. She says that during her vaccination, she was too excited to feel any pain from the needle prick.
“There are so many reasons I wanted to get the vaccine,” Polania says. “I want to keep myself healthy. I also want to encourage people in the Latino community to get the vaccine as soon as it’s available for them.”
Building Herd Immunity
As the FDA approves more vaccines and a higher percentage of the population is immunized, the country will inch closer to herd immunity, according to the Centers for Disease Control and Prevention. Once that threshold is reached, the disease won’t be able to spread as easily from person to person, due to the high numbers who will have been vaccinated or already will have had the disease. At the current time, since herd immunity varies by disease, experts do not know what threshold is needed to control COVID-19.
In the meantime, health experts advise everyone to continue wearing masks, observing social distancing and practicing good hand hygiene. New treatments likely also will emerge to combat the virus.
“Vaccines are not going to be a quick solution because it will take some months to roll them out to get a sufficient proportion of the population immunized,” points out Chapman. “In the meantime, we need to focus on COVID-prevention strategies and be vigilant to do what we know is effective in preventing the spread of this disease.”
To learn more about COVID-19 vaccine safety, see the article that begins on page 11.
How Does the COVID-19 Vaccine Work?
Most vaccines trigger an immune response by using a weakened or inactivated version of a given virus, which imitates an infection. With this method, the next time the body runs into that virus, it knows how to fight it.
Unlike traditional vaccines, the coronavirus vaccines do not use a weakened or inactive virus to spark an immune response. Instead, they use messenger RNA (mRNA) to target the “spike proteins” that enable the coronavirus to latch onto and infect healthy cells. The mRNA technology instructs our cells to make a piece of the spike protein that is unique to the COVID-19 virus. Since only part of the protein is made, it triggers an immune response without harming the vaccinated person, according to the Centers for Disease Control and Prevention (CDC).
With this method, the body views the spike proteins as invaders and builds antibodies against them. Later, if a vaccinated person encounters the actual virus, the body will recognize the spike proteins and respond accordingly to destroy them.
Both the Pfizer and Moderna vaccines, which require two doses each, are about 95 percent effective in fighting the COVID-19 virus, says Andrea Chapman, infection control practitioner at Sentara Martha Jefferson Hospital. Although both vaccines appear to provide limited (and potentially only short-term) protection after the first dose, a second dose is required to achieve the maximum benefit.
“It takes up to two weeks after the second shot for your immune system to fully respond to the vaccine and provide protection against COVID,” she explains.
Other pharmaceutical companies are manufacturing additional types of vaccines—some requiring only one dose—to join in the fight against COVID.