Thursday, May 6, 2021

Hospitals navigate the complexities of distributing COVID vaccines, which will tell us a lot about mass deployment

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The first one COVID vaccine has arrived.

The initial shipments of Pfizer and partner of BioNTech’s COVID-19 vaccine, which received emergency clearance from the Food and Drug Administration (FDA) on Friday, are already being deployed. And the first installments will go to those who are literally on the front lines: healthcare workers.

Hospitals, intensive care units and all manner of medical units overwhelmed by an outbreak of coronavirus cases, hospitalizations and COVID-related deaths, the country’s top medical experts face a crucial question: how to get vaccinated our own workforce?

It is not just a question of resource allocation – although it is a critical point. It’s a logistical conundrum the nation has not witnessed in modern times.

From safe transport and storage, to prioritizing people receiving a COVID vaccine, to managing vaccine side effects that can already exhausted and exhausted health workers With regulatory issues such as divergent approaches from different states and even keeping track of the vaccines people receive, the coming weeks will be a titanic draw for some of the country’s most critical workers.

Dr Melanie Swift, one of the doctors tasked with leading the famous Mayo Clinic healthcare system’s COVID vaccination campaign, is in the thick of it this week. And while she’s optimistic about Mayo’s plan, questions and challenges abound.

“The main concern is how you prioritize, among all healthcare workers, who would be eligible under the CDC’s recommendation as to who should be vaccinated, which the CDC advisory committee voted on Dec. 1,” says Swift, which focuses on professionals and interns. medicine in Rochester, Minnesota.

The distribution of COVID vaccines is a game of supply chains with several actors who must work together. The federal government coordinates with the state governments; state governments coordinate with local health systems; local health systems coordinate with pharmacies as CVS and small local hospitals; everyone coordinates in one way or another with logistics companies like UPS and FedEx and, of course, companies like Pfizer, which actually make these vaccines.

The operational chain of command is more like a spider web of decisions. And, ultimately, it will be up to individual organizations to figure out what to do with disparate boards, which is meant to increase flexibility, but can also be confusing.

“The CDC voted to recommend the vaccine as the first option for all health workers. It was more than we expected, ”says Swift. “We expected them to recommend it for a certain group of healthcare workers like those who work in hospitals. So we had to figure out how to allocate this finite resource fairly and equitably, knowing that healthcare workers want this vaccine.

The Mayo Clinic appears to be ahead of the curve. Several doctors Fortune spoke with in the Los Angeles area, where COVID cases are skyrocketing, said bluntly they have no idea what their vaccination roll-out plans will be in the coming weeks. It’s a wait-and-see game that will rely on local governments.

But Mayo, at the very least, has a plan in place. And that’s, rightly so, quite clinical.

“We provided a grid of different tasks and places our employees could work,” says Swift. “So the COVID-specific unit, for example, emergency services, an ambulatory COVID vaccine infusion center, etc.”

It goes further on an operational scale. There are non-medical workers who have to work in a hospital, and they are also essential to protect: the people who take out bedpans and clean ICUs. Systems must also take this into account.

“There are about 10 or 11 of these different risks and contexts. And this extends to outpatient clinics, non-direct patient contact staff and teleworkers. So we have this grid. We actually sent those lists to the appropriate level supervisor, ”says Swift.

“And over the last few days, they checked the risk box for each of their employees and fired it. So we have a spreadsheet with a bunch of columns, and there are X’s in the columns, “she says.” And then we can take all those who have an X in the first risk group, and maybe the second and maybe the third, depending on how many we have. ”

But as the leader of a sprawling healthcare system, Swift doesn’t even know how many doses of the vaccine will be given to various hospitals. She’s been given numbers for some places – a few thousand doses here, you have to know how many there – but it’s basically an ad hoc process.

She expects around six or seven waves of vaccines to be deployed to staff, with priority going to staff specifically assigned to COVID-related services, emergency services and their support staff.

It also provides for side effects. The Mayo Clinic has constructed a grid of what adverse events, such as a mild fever or headache or muscle pain, are associated with the vaccine versus what is clearly a symptom of an active coronavirus infection.

Swift explains that symptoms such as, for example, loss of smell or taste are things that do not manifest with the Pfizer vaccine. So, with a depleted workforce, those with only side effects directly related to the vaccine would likely still be asked to work, while being closely watched.

Mark, who asked to use only his first name, is an anesthesiologist who deals with emergency room patients in a large New York area healthcare system on a daily basis, and he echoes much of what Swift said with a hint of the local uncertainty thrown in.

When elective procedures at hospitals were halted to divert resources to COVID treatment, Mark and his colleagues had to use their training to do work they didn’t exactly sign up for.

“It was kind of a part of our skills to be involved in this treatment process,” he says. “As anesthesiologists, we are called to do intubations for patients, and we’ve had a kind of education and simulation around safe intubation for COVID patients. They therefore prepare us to be able to care for patients safely and to intervene safely. “

As for when Mark himself will get a vaccine? “As I understand it, the plan is to prioritize people who actually work, on a daily basis, with COVID or at risk patients, but not specifically.”

It’s a coordination problem, he says, and ties it to a pyramid distribution system. The federal government, together with manufacturers like Pfizer and logistics companies like UPS, will distribute the vaccines to various public establishments. State governments must then determine which health systems most need COVID vaccine doses and send them in their stead – and those health systems will then have to prioritize various personnel for immunization.

And then, as Swift says, larger, better performing hospital systems will have to coordinate with smaller local hospitals to serve as a hub to get their own vaccines in case they don’t have the staff or the storage capacity to. these delicate pharmaceuticals.

“We meet regularly with other hospitals in our area, some of which are small,” she says. “Because these are ultra-cold storage requirements, it’s a burden on small hospitals. The minimum package is 975 doses. So there are hospitals that couldn’t use it or would have the ultra-cold freezer to store it until they use it. Mayo is even ready to do storage and deliver daily shipments to other hospitals as needed. Swift compares the alternative option to going to Costco to buy a toothbrush. It just doesn’t make sense.

As difficult as the logistical headache is, it’s just as important to keep track of all data once staff have started getting vaccinated, especially once vaccines from multiple companies are available. Ruby, a computer analyst and trainer who works with major Baltimore-area hospitals, has the critical job of wading through pandemic data management. This includes managing vaccine data for major health systems through electronic health record providers like Epic.

“As for the details, our team have been involved in the Epic design of how the staff will distribute and administer the vaccine in our electronic health record,” says Ruby, who requested to use a pseudonym for privacy. . .

“Basically, employees will register online to receive the vaccine; they can plan on their own. And we’ve done that work on the IP side, and then when they come up for vaccine administration, we’ve done the build in Epic so that the actual vaccinators can document that employee.

This process also includes following up with some high-risk service employees to find out who they may have been in contact with and whether or not they have symptoms of COVID.

Health workers, medical staff and nursing home residents are the priority groups for COVID vaccinations, and they are the first groups to pilot this daunting task. There are many deadlines for other groups, but most public health officials seem to agree that a large rollout to get a COVID vaccine for your average non-sick American at a local pharmacy or hospital is unlikely to happen. before late spring or early. summer.

Much remains to be learned about how various states will tackle this distribution dilemma, similar to the problem the United States faced with testing at the start of the pandemic.

In short: it’s still a work in progress. But the silver lining is that we’ll know a lot, a lot more over the next month or so.

More health and Big Pharma coverage of Fortune:

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