How NY And NJ Hospitals Are Preparing For The Complicated Vaccination Process

The first shipment of what is currently the only approved COVID-19 vaccine in the United States is now arriving at hospitals across the country. The very first dose of the Pfizer vaccine was given to a nurse at Long Island Jewish Medical Center in Queens, and hospital staff around the region are working to make sure they can vaccinate their frontline workers as smoothly as possible. 

“It's not only making sure that that operation is like clockwork, that staff and every patient is scheduled, that the cycle time is efficient just to make sure folks get through and the schedule is adhered to. But we also have to tie that to the very complex logistics of the vaccine itself," Dr. Shereef Elnahal, CEO of University Hospital in Newark, NJ, told Gothamist/WNYC.

The Pfizer vaccine must be stored at ultra-cold temperatures. And, as New York Governor Andrew Cuomo explained in his unboxing video, a package of vaccines is packed with dry ice, a thermal monitor and a GPS tracking device. One package can hold up to five flat boxes—they look like pizza boxes—of vaccines; each flat box holds one tray containing 195 vials, and each vial has five doses, so a tray represents a total of 975 vaccine doses. 

Once the package reaches the hospital, the staff only has 90 seconds to unpack the boxes, check to make sure all the vials are intact, and put them into the ultra-cold freezers. In a video released by Mount Sinai, Dr. Susan Mashni, the hospital's chief pharmacy officer, told staff at Mount Sinai Queens that once the vials are in the freezer—which is kept at around negative 79 degree Celsius—they have to wait 20 minutes before they can reopen it. Mount Sinai Queens' ultra-cold freezer is only accessible by security card, and they can download a file every day and send it to the city to track their supply of doses. 

When hospitals are ready to administer the Pfizer vaccine, they need to defrost the vials, which takes three hours in a refrigerator or 30 minutes at room temperature. Once defrosted, saline is added to reconstitute the vaccine, and five doses can be prepared for recipients. Also, once the vaccine leaves the ultra-cold freezer, it cannot be re-frozen and must be used within five days. (If a hospital doesn't have an ultra-cold freezer and just has a regular refrigerator, the vaccine must be used within five days of being shipped.)

"This vaccine is only good for five days in the refrigerator and then only six hours after you mix it up. So then you have to make sure that you get through those doses during that time," Dr. Onisis Stefas, Northwell Health's chief pharmacy officer, explained to Gothamist/WNYC. This means pharmacy teams are "going to be continually mixing the vials and bringing it over to the site, as demand needs, because it's such a precious commodity at this point that we can't afford to waste any doses."

Healthcare workers at hospitals are in the first priority group who will get the vaccine—and those workers include doctors and nurses, as well as those in food, environmental services, transport, the pharmacy.

For instance, Mount Sinai is offering the vaccine to any staffers who work in the emergency room, intensive care, and EMT/EMS, and as more vaccine doses are available, all other health care workers, like faculty, trainees, and students, will be given the opportunity for vaccination. The Food and Drug Administration will hear testimony about the Moderna vaccine, which does not require ultra-cold storage, on Thursday, December, 17th, and could approve it as soon as the weekend. AstraZeneca and Johnson & Johnson are hoping to submit their vaccines to the FDA for approval in January. 

Hospitals have also been working on their plans to vaccinate staffers as efficiently as possible, thinking about long windows during the day that can accommodate different shifts. Stefas, of Northwell Health, expects each person's vaccination to take twice as long as a flu shot, maybe around 25 minutes, because the brand-new vaccine requires more time for explanation, as well as more time for observation immediately following the shot. 

Mt. Sinai's Mashni said so far the side effects generally appeared to be like other vaccines, where one might have a low grade fever right after or the day after the shot; side effects might be more pronounced after the second dose, which, for the Pfizer vaccine, would be 21 days from the first shot. (Two British health care workers who received the vaccine last week suffered allergic reactions after their first dose. Both had a history of severe allergic reactions and both recovered. U.K. regulators to issued a warning to anyone with anaphylactic reactions to food and medicine.)

At Newark's University Hospital, Elnahal said they are planning on vaccinating 16 hours a day, six days a week. While he's confident the process the hospital has set up will run efficiently, the one thing he worries about is the large number of staff who are reluctant to be among the first to take the vaccine.

“My most important task right now is to make that appeal and say ‘you not only will have brought us to this point successfully and heroically, but you will be the ones to get us across the finish line,'" he said.

At Long Island Jewish hospital, after the cameras stopped rolling, critical care nurse Stephanie Cal said it was a privilege to be among the first people vaccinated—and she would sleep a little more easily knowing that she has some protection against the coronavirus that killed so many of her patients.

"Most of them died," Cal said. "I would have a three-patient assignment, and I would be off a couple of days, and I'd come back, and they'd all be gone and there'd be another three in their place."

That trauma has kept her awake at night, but the vaccine gives her hope.

"It was a tough time, but thank God, we're coming on the out of it," Cal said, her voice choking. "And I just want everybody to get their vaccine and just to hang in there a little longer, and, hopefully, by next summer or fall, we'll be back to doing our thing again."