A medic reveals the reality behind all the rhetoric

It's the logistical challenge of your life: rolling out essential Covid-19 vaccines at a rate that will hopefully help free the country from endless cycles of lockdowns.

With 1.5 million doses dispensed so far – and the promise of two million a week – Louise Kyle, a director of nursing at a large inner-city practice, shares a glimpse into the gigantic effort it takes to add just one vaccine hub play his part.

Monday December 7th

The usual Monday morning business is compounded by the news that our proposed vaccine hub got OK to go live in eight days.

We had volunteered from the moment we were able to be an active "Wave One" site for the Pfizer jab. Now we were at the forefront of this historic exercise.

Louise Kyle, a nursing director at a large inner-city practice (pictured), shares a glimpse of the gigantic effort it takes to make only one vaccine hub play its part

It's exciting, but daunting given the great challenge that lies ahead. The extent will become apparent almost immediately if, within a day of receiving our news, NHS England changes its policy to require all vaccinated patients to stay 15 minutes after receiving the shock in the event of an allergic reaction – something given on the website we prepared the need for social distancing just isn't possible.

This means a hasty move to a new regime. In our case we are asking our district nurses to vacate their clinical rooms – the best we can do with a week's notice. Even so, it gives us some thought-provoking exercise on our feet, which is sure to come in handy given the developments ahead.

Wed, December 9th

After our vaccination site has been confirmed, the focus is on logistics. Given the strict shelf life of the vaccine after it has been frozen, we have a 90-hour window to vaccinate 1,000 people. This means that around 2,000 registered patients in our region who are older than 80 years will be reached in order to reach those who want to accept the booked offer.

Time constraints mean we don't have time to reach them in the mail. Since we cannot rely on the mass text system with which we reach younger patients, we have a team of 12 employees in our practices who give patients solid calls from morning to evening. I'm even recruiting my 19 year old son who is now home from university to manage the lines.

It's a complex business, not least because some of our patients don't have English as their first language, while others are lonely and want to chat for hours.

This is one reason why we give our team a script to adhere to. Fortunately, most patients are just too eager to take their offered appointment, but it's dismaying that one in five either refuses to get a sting at all or says they'd like to wait a little longer before making their decision.

It's the logistical challenge of your life: introducing essential Covid-19 vaccines. Pictured: Delivery of the first batch in a take-away box

It's the logistical challenge of your life: introducing essential Covid-19 vaccines. Pictured: Delivery of the first batch in a take-away box

Fri, December 11th

Two days of our first three-day vaccination schedule are now fully booked. More than 600 patients are to receive a stitch next Tuesday and Wednesday, so that sorting only has to be done on Thursday.

The team is noticeably excited.

When I go home to have a well-deserved glass of wine, I hope this is the moment we turn the corner to fight Covid in our area where it is widespread.

Along with many of my colleagues, I caught the virus in March – before the first national lockdown – and although I got through well, it was still a pathetic experience. For others, of course, it can be a matter of life or death.

I have lost several popular patients to this cruel disease in the past few months.

So, December 13th

I spoke too early! My peaceful Sunday morning is overturned by an email telling us that the arrival of the vaccine has been delayed by 24 hours. Make a hasty fight to get coworkers to work to contact all patients on Tuesday and tell them to come on Friday instead.

Since many of them had relatives or friends who took the time to bring them in, this is a major inconvenience, but luckily most understand that it is not our fault.

Monday December 14th

Our "phone terriers" phoned again to book the remaining slots on Thursday while I visit a local hospital to see the vaccine bottles arrive and mix to ensure the correct dosage.

The answer to the former is how I find out they come in an oddly small pizza box – very different from the science fiction cube that emits dry ice clouds that I half expected.

Similarly, we've been hit back at the base from the arrival of the refrigerator, which we all imagined as a futuristic number, but in reality it's like a little under the counter affair that you might have to keep your drinks at home: " A G&T or a dose of Pfizer, darling? " With the delivery of all the aprons, syringes, and kerchiefs we will need, things are gearing up, though I'm afraid that there are only hours to "V-" Day, "we are still waiting for the national protocol to make ours Enables health workers and other junior workers or lay vaccinators to help us manage it quickly and safely.

Ralph Evans, 88, receives the vaccine in Merthyr Tydfil. He is among the 1.5 million given the NHS push

Ralph Evans, 88, receives the vaccine in Merthyr Tydfil. He is among the 1.5 million given the NHS push

Tuesday, December 15th

It is here! The vaccine arrives in the morning, and with all the excitement, I was prepared for an elite group of specialists who spawned it in awe of a sacred relic. Instead, it's a man in a van: more Amazon shipments than Indiana Jones. Nevertheless, we are all happy that a colleague is joking about the "Pizza Box from Heaven".

Inside there are 195 valuable vials of five doses each, i.e. 975 separate vaccines.

We are all well aware that every second is now of the essence as the countdown to adhere to the strict five day expiration date has already begun, starting when you leave the lab freezer.

In contrast to the vintage pots of hummus in my home refrigerator, there is no scope for best-before dates here.

Our schedule is based on three vaccines that work from 9 a.m. to 7 p.m. and give a prick every five minutes. On paper, this looks doable until you think about the reality of dealing with older, sometimes frail, patients who need time to move around, remove their layers of winter clothing, and so on.

If you adhere to the strict social distancing requirements, it becomes even more difficult, especially when you factor in the additional staff in the building required by the guidelines: in addition to our three vaccines, there must be an on-site GP, two health professionals and one Team be present of five marshals to guard the patients.

Wed, December 16, V-Day One

The big day is coming. My job is to convert the vials into syringe dosages through a maze-like series of procedures that require such careful handling that we have called them our little "V-babies".

First, the vials are taken from the refrigerator into a light-tight bag – they are both light-sensitive and heat-sensitive.

I then take out the first six vials, mark them with a special time label, and let them sit for ten minutes to bring them to room temperature before turning each vial ten times, adding 1.8 milliliters of sterile saline, and venting the same amount of air .

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

With over 20 years of experience, I am used to this type of meticulous procedure, but can't help but think that it would be a bit daunting and time consuming for many of the groups that want to join the "vaccination army". In contrast to the flu vaccination, which is, so to speak, “ready for the poor”, this is more complicated. Rapid training must be considered if the government is to achieve its goals.

I am intrigued by the instruction to take just five 0.3 milliliter doses from each vial and throw away the leftovers.

Out of interest, I pulled the last dose out of a vial and found it was 0.5 milliliters, which strikes me as a wasted dose. But rules are rules.

The day goes by quickly and it is encouraging to learn from my fellow vaccinators that each and every one of their patients was so grateful to receive it, even though some of them voiced their guilt for being at the front of the line and said they felt as a key worker and teacher should have been vaccinated first.

The day ends happily when we learn that the traffic cop we saw outside wasn't handing out tickets but helping our elderly patients out of their cars and taxis.

It's a Christmas miracle!

Thursday, December 17th

Another change from NHS England: Overnight they decide that we can now take six doses from each vial. That means we suddenly have 65 extra doses left and can vaccinate more patients. Our team called again. Each dose used is a different life protected.

One step forward. . . two small hiccups back. Our IT system flashes for an hour and a half while we learn that one of our marshals has called in sick with Covid.

Fri, December 18

Another busy day, at 4 p.m., when we count the number of patients waiting, with a handful of no-shows during the day, we find we have a few more vaccinations left.

But when the clock runs out, we are nearing the expiration date. Fast! We're on the phone to gather local health professionals within a mile radius who, unlike older patients, can get here quickly. We want to make sure that no precious drop is wasted.

We finish at 9 p.m. after a grueling 12-hour shift: everyone had fitted the equivalent of a normal full NHS work week into three days.

We've given 1,031 doses, we're all caught, and my knees hurt, but there's a real buzz.

I spend much of Saturday mornings catching up on the Christmas shopping that I didn't have time for, only to find that afternoon that my territory should be immersed in Tier 4 rules, meaning non-essential stores must close. Sorry kids, Santa has been a little busy.

Monday December 21st

It's a return to normal business as I try to catch up with any patients I had to cancel from my usual clinics to work on the vaccine roll out.

This means everything from smear tests to "vulnerability checks" – managing end-of-life plans for elderly patients and whether or not they want to be resuscitated in the event of heart failure. It is somewhat grim irony to do the latter with a patient who had received a life-saving shock a few days earlier.

It feels like saying, "We helped save your life. How would you like to die now?"

Wed, December 23

I thought I was gone for Christmas, a time to recharge the batteries, but lo and behold, the holiday is interrupted by another goal post-moving letter from NHS England this time telling us they have the time between the two vaccine doses will extend from three weeks to 12 weeks.

This means that any department that started giving their vaccines on or after Wednesday 16th will have to cancel those patients due to their second push and instead book a thousand new patients for their first.

Oh, and we can't even tell the first thousand when to come back as the vaccine supply is so patchy right now that we can't plan that far ahead.

How on earth can we make those 2,000 calls on time? On a good day, a “phone terrier” working at high pressure can reach around 120 to 150 patients a day.

There are hectic discussions between health managers until a pragmatic solution is found. Great relief!

Despite the media coverage, we still have to call every 1,000 patients to assure them that their appointments are happening.

Tue, January 5, 2021

Alleluia! The second batch of vaccines arrives on time. At least this time, I'm expecting a man in a van, not the Messiah.

Wed, January 6th

The second round begins. This time it feels calmer because we have set a good pace. We get faster in good winds, but the fiddling of the Pfizer push means that scaling at the national level will certainly be a huge challenge.

The government promises to have given 12 million doses by mid-February.

As my obvious teenager would say, good luck with that.

Fri, January 8th

Another day of mixed news. Our final batch of Pfizer shocks is being affected by the IT system that keeps track of all the vaccinations – called pinnacles – that are out for most of the morning.

Now all 480 due patients have to be registered manually and entered into the database at a later time.

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

On the positive side, we are receiving 400 doses of the alternative vaccine, Oxford or AstraZeneca, for the first time to go to local nursing homes as they are more portable and require less gentle care than our Pfizer V babies.

On paper, this is good news – if we weren't all hampered by NHS England's obsession with getting all vaccinations through certain designated "hubs" like ours.

The reality is that the maximum number of front-line vaccines we can have from the hub at one time is four. However, if we could also drop them off at our usual local family doctor offices, I could have two vaccines working on each of our ten locations – up to 20.

There is great potential for appreciation if only NHS England were listening. Overnight we received another letter from them stating that the Oxford vaccine can at least be delivered to different locations, but it is still not clear whether it can also be administered there.

If this is not possible, Boris' promise to give two million doses a week unfortunately has no chance, especially given the startling reality that our hub will remain empty and unused at the time of reading.

At the time of writing, no further vaccine shipments are planned. And so we wait. . .

After all of our efforts, it's daunting. And very worrying.

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