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.
“Having these vaccines delivered in less than a year is a remarkable achievement of modern science and the result of a great deal of scientific research,” says Mark Nesbit, MD, an Emergency Department physician at Sentara RMH Medical Center who was the first person to receive the vaccine at the hospital. “The time frame for vaccine development is usually measured in decades, not months.”
For Sentara team members, the vaccines represent hope and progress during a pandemic that has changed so much about our way of life.
“I’ve had loved ones who have been affected by the virus, and I wanted to do my part to help stop the spread,” explains Sharon Peale, a frontline employee in the Sentara RMH gift shop who received the vaccine early this year. “I hear the daily reports of the virus, and I see the effects it’s having on people.”
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, PharmD, 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.
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.”
Engel and Laura Adkins, Sentara RMH 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, Engel 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,” Engel 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 RMH on Dec. 17.
“We were administering the Pfizer vaccine within a couple of days of receiving it, which is quite remarkable,” says Kim Stanchfield, RN, team coordinator for employee health at Sentara RMH. “Being a part of the vaccine distribution has been one of the most gratifying experiences of my 46 years at Sentara RMH.”
Stanchfield’s department educated hospital employees about the vaccines—which are voluntary, not mandatory. She also coordinated a complicated vaccine clinic schedule that 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.
Getting Vaccines to Clinic
To get Pfizer vaccines from the pharmacy on the second floor to the vaccine clinic on the first floor at Sentara RMH, employee health and pharmacy personnel orchestrated a complex, carefully scripted plan.
According to the manufacturer’s instructions, such a plan involves freezing water bottles and then thawing them to a specific temperature. The bottles are layered and packed with the vaccines in a Styrofoam container for the trip to the vaccine clinic, and pharmacy staff then moves the vaccines into the clinic refrigerator.
“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,” Adkins 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 staffed with a minimum of 10 team members, including a nurse, pharmacists to prepare the vaccines and staff to administer the vaccines.
“We get people registered in five minutes, and then they get the vaccine,” Stanchfield says. “After that, they move to an observation room for 15 minutes to be monitored for any side effects.”
Engel 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
When Dr. Nesbit received an email informing him that he could sign up for vaccination, he didn’t hesitate. In fact, just by chance, he ended up being the first one to receive the vaccine at Sentara RMH.
“I signed up for 6:30 a.m. on Dec. 17, so I would still have time to walk upstairs for my shift at 7 a.m.,” he says. “When I got the shot, I realized I was the first.”
Dr. Nesbit has been evaluating and treating COVID-19 patients in the Sentara RMH Emergency Department since March 2020. In the meantime, he says, healthcare experts have learned a great deal about the spread of the virus, its symptoms and effective treatments.
As a patient care supervisor at Sentara RMH, Cynthia Davis, RN, has worked directly with COVID patients and their families since the pandemic began. Even with all the cases she has seen, Davis wasn’t immediately sure that she would opt to get the vaccine, out of concern about potential side effects. She reconsidered her decision, however, as she saw the drastic increase in COVID-19 cases within the community after Thanksgiving.
“It was definitely a reality check that the virus wasn’t going away soon,” Davis notes. “I decided to receive the vaccine not only for my own benefit, but for the benefit of my family, the community and the patients I come into contact with daily.”
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).
“Those side effects are signs that your body is building an immune response,” Stanchfield explains.
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.
“However, it’s best that you never get this disease, especially if you can develop an immunity without getting infected,” Dr. Nesbit says. “Our treatments will never be better than the protection of a good vaccine. We don’t expect to manage smallpox, polio or tetanus with medicine—these, like many other diseases, are controlled with vaccines. The path forward in managing COVID-19 is through vaccination.”
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, according to Dr. Mark Nesbit, Sentara RMH emergency physician. 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. After the second dose, you may not have optimal protection from the virus for a week or two, according to the CDC.
Other pharmaceutical companies are manufacturing additional types of vaccines—some requiring only one dose—to join in the fight against COVID.