One medic reveals the reality behind all the rhetoric

Problems by the armful… but at last we’re saving lives with Pfizer’s ‘pizza boxes from heaven’: Thousands of phone calls and up to a fifth of patients refusing jabs – one medic reveals the reality behind all the rhetoric

  • Louise Kyle, a nursing leader in a large inner-city practice, gives an insight
  • She tells of gargantuan effort required for just one vaccine ‘hub’ to play its part
  • The roll-out of essential Covid-19 vaccines is the logistical challenge of a lifetime

It is the logistical challenge of a lifetime: the roll-out of essential Covid-19 vaccines at a rate that, hopefully, will help free the country from the endless cycles of lockdowns. 

With 1.5 million doses dispensed so far — and the promise of two million a week to come — Louise Kyle, a nursing leader in a large inner-city practice, gives an insight into the gargantuan effort required for just one vaccine ‘hub’ to play its part.   

Mon, December 7

The usual business of a Monday morning is compounded by news that our proposed vaccine ‘hub’ has been given the OK to ‘go live’ in eight days.

We’d volunteered to be an active ‘wave one’ site for the Pfizer jab from the moment we were able. Now, here we were, at the coal face of this history-making exercise.

Louise Kyle, (pictured) a nursing leader in a large inner-city practice, gives an insight into the gargantuan effort required for just one vaccine ‘hub’ to play its part

It’s exciting, but daunting given the huge challenge that lies ahead, the scale of which becomes apparent almost immediately when, within a day of receiving our news, NHS England changes its guidelines to say that all vaccinated patients will have to stay behind for 15 minutes after receiving their jab, in case of an allergic reaction — something that simply isn’t possible in the site we’d prepared, given the need for social distancing.

It means a hasty pivot to a new arrangement, in our case asking our district nurses to vacate their clinical rooms — the best we can do at a week’s notice. Still, it gives us some practice thinking on our feet, which I’m sure, given what lies ahead, will prove useful.

Wed, December 9

With our vaccine site confirmed the focus is on logistics. Given the vaccine’s strict ‘shelf life’ once it comes out of its deep-freeze storage, we have a 90-hour window to vaccinate 1,000 people. That means reaching some 2,000 registered patients in our area who are aged over 80 to get those who wish to take up the offer booked in.

Time constraints mean there’s no time to reach them by post and, given that we can’t rely on the mass-texting system we use to reach younger patients, we have a team of 12 staff across our practices phoning patients solidly from dawn until dusk. I even recruit my 19-year-old son, now at home from university, to help man the lines.

It’s a complex business, not least because English is not the first language for some of our patients, while others are lonely and want to chat for hours.

It’s one reason we give our team a script to stick to. Happily, most patients are only too eager to accept their proffered appointment, but it’s dismaying that one in five of them either decline to have the jab at all, or say they want to wait a bit longer before making their decision.

It is the logistical challenge of a lifetime: the roll-out of essential Covid-19 vaccines. Pictured: Taking delivery of the first batch in its takeaway-style box

Fri, December 11

Two days of our first three-day vaccine schedule are now fully booked, with more than 600 patients scheduled to receive a jab on the coming Tuesday and Wednesday, leaving only Thursday to be sorted.

There’s a palpable sense of excitement among the team.

As I go home for a well-earned glass of wine I hope this is the moment that we turn the corner to combat Covid in our area, where it has been running rife.

Along with many of my colleagues, I caught the virus back in March — before the first national lockdown — and though I pulled through fine, it was still a wretched experience. For others, of course, it can be a matter of life or death.

I’ve lost several much-loved patients to this cruel disease over the past months.

Sun, December 13

I spoke too soon! My peaceful Sunday morning is overturned by an email informing us there’s been a 24-hour delay to the vaccine’s arrival. Cue a hasty scramble to get colleagues in to work to contact all of Tuesday’s patients and tell them to come in on Friday instead.

Since many of them had relatives or friends who had taken time off work to bring them in, it’s a major inconvenience, but mercifully most understand it’s not our fault.

Mon, December 14

Our ‘telephone terriers’ hit the phones again to book Thursday’s remaining slots, while I visit a local hospital to see how the vaccine vials arrive and are mixed to ensure the correct dosage.

The answer to the former, I discover, is that they come in what looks strangely like a small pizza box — rather different to the sci-fi cube emitting clouds of dry-ice that I’d half been expecting.

We’re similarly underwhelmed back at base by the arrival of the storage fridge, which we’d all pictured as some futuristic number but, in reality, is like a small under-the-counter affair you might keep your drinks in at home: ‘A G&T or a dose of Pfizer, darling?’ With the delivery of all the aprons, syringes and wipes we’re going to need, things are gearing up, although I’m anxious that with just hours to go until ‘V-Day’ we’re still awaiting the national protocol which allows our healthcare assistants and other junior staff or ‘lay vaccinators’ to help us administer it quickly and safely.

Ralph Evans, 88, receives the vaccine in Merthyr Tydfil. He is among the 1.5million to have been given the NHS jab

Tue, December 15

It’s here! The vaccine arrives mid-morning, and given all the fuss, I’d been braced for an elite squad of specialists, bearing it forth with all the awe of a holy relic. Instead, it’s a man-in-a-van: more Amazon delivery than Indiana Jones. Nonetheless we’re all excited to have what one colleague quips is the ‘Pizza Box from Heaven’.

Inside are 195 precious vials, each containing five doses, meaning 975 separate vaccines.

We’re all keenly aware that every second now is vital, as the countdown to beat the strict five-day expiry date has already begun, starting from the moment they leave the laboratory freezer.

Unlike the vintage pots of hummus in my fridge back home, there’s no wriggle room on ‘best before’ dates here.

Our schedule is based on three vaccinators working 9am to 7pm, giving a jab every five minutes. On paper, that looks do-able, until you think about the reality of dealing with elderly, sometimes frail, patients who need time to move around, remove their layers of winter clothing and so forth.

Throw in the strict social distancing requirements and it becomes trickier still, especially when you consider the additional personnel in the building required by the guidelines: as well as our three vaccinators, there has to be a GP on site, two healthcare professionals and a team of five marshals to shepherd the patients around.

Wed, December 16, V-Day One

The big day arrives. My job is to take the vials and convert them into syringe-dosages, following a labyrinthine series of procedures which require such delicate handling we have taken to calling them our little ‘V-babies’.

First the vials are removed from the fridge into a light-proof bag — they are light-sensitive as well as heat-sensitive.

I then take out the first six vials, mark them with a special time label, and leave them for ten minutes to get them to room temperature, before inverting each vial ten times and adding 1.8 millilitres of sterile saline and withdrawing the same amount of air.

They then have to be inverted another ten times before another date and time label is added.

With over 20 years’ experience, I’m used to this kind of painstaking procedure, but I can’t help thinking that for many of the groups proposing to join the ‘vaccine army’ it would be somewhat daunting and time-consuming. Unlike the flu jab, which comes ‘arm-ready’ as it were, this is more complicated. If the Government’s going to hit its targets, there will need to be some swift training factored in.

I’m intrigued by the instruction to only take five 0.3 millilitre doses out of each vial and throw away what’s left.

Out of interest I drew the last dose out of one vial and discovered it was 0.5 millilitres, which strikes me as a dose wasted. But rules are rules.

The day passes quickly, and it’s heartening to learn from my vaccinating colleagues that every single one of their patients was so grateful to receive it, although some of them expressed guilt at being at the front of the queue and said they felt key workers and teachers should have been vaccinated first.

The day ends on a happy note when we learn that the traffic warden we’d spotted hovering outside wasn’t handing out tickets, but helping our elderly patients out of their cars and taxis.

It’s a Christmas miracle!

Thu, December 17

Another change from NHS England: overnight they decide we can now take six doses from each vial. That means we suddenly have 65 extra doses spare, and can vaccinate more patients. Our team hit the phones again. Every dose used is another life protected.

One step forward . . . two little hiccups back. Our IT system goes on the blink for an hour and a half, while we learn one of our marshals has called in sick with Covid.

Fri, December 18

Another busy day, and by 4pm, as we count the number of patients left waiting, with a handful of no-shows through the day, we realise we’ll have a few vaccine shots left over.

But as the clock runs down, we’re nearing the use-by deadline. Quick! We hit the phones to rally local healthcare professionals within a one-mile radius who, unlike more elderly patients, can get here pronto. We want to ensure not a precious drop is wasted.

We finish at 9pm, following an exhausting 12-hour shift: everyone had fitted the equivalent of a standard full NHS working week into three days.

We’ve administered 1,031 doses, we’re all knackered, and my knees hurt, but there’s a real buzz.

I spend much of Saturday morning trying to catch up on the Christmas shopping I’ve had no time to do, only to discover that afternoon that my area is to be plunged into Tier 4 rules, meaning non-essential shops will have to close. Sorry, kids, Santa’s been a bit busy.

Mon, December 21

It’s a return to normal business, as I try to catch up with all the patients I’ve had to cancel from my usual clinics to work on the vaccine roll-out.

That means everything from smear tests to ‘frailty reviews’ — managing elderly patients’ end of life plans, and whether or not they would like to be resuscitated in the event of cardiac failure. There’s a slightly grim irony in undertaking the latter with a patient who, just a few days earlier, had been given a life-saving jab.

It feels like saying: ‘We’ve helped save your life, now how would you like to die?’

Wed, December 23

I thought I was off for Christmas, a time to recharge the batteries, but lo and behold the holiday’s interrupted with another goalpost-moving missive from NHS England, this time informing us they are going to extend the period between the two vaccine doses from three weeks to 12 weeks.

This means that any area which started administering their vaccines on or after Wednesday 16th needs to cancel those patients due their second jab, and book a thousand new patients in for their first instead.

Oh, and we can’t even tell the first thousand when they should come back, as the vaccine supply is so patchy at the moment we can’t make plans that far ahead.

How on earth can we make those 2,000 phone calls in time? On a good day, one ‘telephone terrier’ working flat out can reach about 120-150 patients a day.

Frantic conversations between health chiefs ensue, until a pragmatic solution is reached. Huge relief!

Nonetheless, given all the coverage in the media, we still have to call all 1,000 patients to reassure them their appointments are going ahead.

Tue, January 5, 2021

Hallelujah! The second lot of vaccines arrive at our hub on schedule. This time I’m at least expecting a man-in-a-van, not the Messiah.

Wed, January 6

Round two gets under way. It feels calmer this time as we’ve established a good working rhythm. With a fair wind, we’ll pick up speed, but the fiddly nature of the Pfizer jab means it’s surely going to be a huge challenge to scale-up on a national level.

The Government are making promises to have administered 12 million doses by mid-Feb.

As my eye-rolling teenager would say: good luck with that.

Fri, January 8

Another day of mixed news. Our final tranche of Pfizer jabs is marred by the IT system used to register all vaccinations — called Pinnacle — going down for most of the morning.

Now all 480 patients due in will have to be logged by hand and inputted onto the database at a later date.

I worry the system is struggling to cope as more and more hubs join the national roll-out.

On the plus side, we get the first arrival of 400 doses of the alternative ‘Oxford’ or AstraZeneca vaccine, which are to go to local care homes as they’re more transportable and require less gentle care than our Pfizer V-babies.

On paper, this is good news — if only we weren’t all so hampered by NHS England’s obsession with running all vaccinations through specific designated ‘hubs’ like ours.

The reality of this is that the maximum number of front-line vaccinators we can have working from the hub at any one time is four, whereas if we were allowed to give it out at our usual local GP surgeries too, I could have two vaccinators working at each of our ten sites — taking that number up to 20.

That’s a huge potential to upscale, if only NHS England would listen. Overnight, we got another missive from them saying the Oxford vaccine can at least be delivered to different sites, but still no clarity on whether it can be administered there, too.

If it can’t, then I’m afraid Boris’s pledge of delivering two million doses a week doesn’t stand a chance, especially given the baffling reality that by the time you read this, our hub will stand empty and unused.

At the time of writing, we have no further vaccine deliveries scheduled. And so we wait . . .

After all our efforts, it’s disheartening. And very worrying.

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