Hospital workers and vulnerable patients at the Veterans Affairs Palo Alto Health Care System are among the first people in the country to receive their first dose of the COVID-19 vaccine on Wednesday, marking a turning point in the fight to control the coronavirus pandemic.
The local VA hospital is one of only 37 facilities run by the U.S. Department of Veterans Affairs to get an early batch of the long-awaited vaccine, developed by pharmaceutical partners Pfizer and BioNTech and approved just last week. The hospital received 2,925 doses, and the hope is to expend all of it over the next 21 days.
Development of a COVID-19 vaccine has been a linchpin in the public health response to the pandemic, with widespread immunization being the key to preventing the spread of the disease and easing public health restrictions that have shaken the U.S. economy. Hospital leaders at the Palo Alto VA say the slow churn of patients and staff getting shots Wednesday could very well be the turning point.
"I am ecstatic about this, and I am so honored to play the small part that I'm playing in this," said Kelly Robertson, the hospital's chief of pharmacy services. "I think this is the beginning of hopefully the end of this global pandemic that has been devastating."
With demand far outstripping the initial supply of the vaccine, federal regulators have tightly controlled who can receive early doses. On Wednesday, the goal was focused narrowly on vaccinating patients with spinal cord injuries or who live in care homes — along with immunizing staff who work with these extremely vulnerable residents.
Among the first to receive the shot was Dr. Doug Ota, chief of spinal cord injury services at the VA hospital. He said he was confident that the vaccine was both safe and effective and felt he could set an example for others by getting vaccinated early.
Patients with spinal cord injuries are at much higher risk of getting sick or dying from COVID-19, in part because their catastrophic injuries often lead to impaired breathing, Ota said. The muscles required to push air out of the lungs are either paralyzed or cease to work, exacerbating an already dangerous respiratory disease.
Ota said he didn't see his immunization as a green light to return to normal and that public health precautions are going to remain a reality for some time.
"It's not a sudden pivot to life completely the way it was before COVID," he said. "We still need to be protective; we still need to ensure that they didn't have a concurrent exposure at the time they got their vaccination."
Also receiving a dose of the vaccine was Karen Hopkins, a coordinator for the hospital's home care program for spinal injury patients. In normal times, her job takes her inside patients' homes to check on them, monitor their injuries and keep close tabs on those recently discharged. But over the last nine months, all of that was thrown out the window.
"Since the COVID restrictions started, we have not been able to see any of our patients in the home setting," Hopkins said.
Telehealth has kept a semblance of home care going this year, but Hopkins said it's hardly the same thing. She can observe wounds over a video meeting, but it's hard to get a full assessment unless it's done in-person. While the vaccine means she could very well return to patients' homes, Hopkins said it's uncertain when she'll get the all-clear.
The first round of vaccines will also be available to Palo Alto VA's senior care home residents, who are among the most vulnerable to the disease. Santa Clara County data shows that COVID-19 cases in skilled nursing facilities make up only 5% of the total cases but account for 44% of the deaths. Those receiving the inoculation at the Palo Alto facility did so voluntarily through an interest form sent out prior to the arrival of the vaccine.
Any veterans interested in receiving a vaccine are asked to check the VA's COVID-19 vaccine webpage.
A race against the clock
Managing the Pfizer vaccine is difficult and cumbersome to say the least. The vaccine comes in 975-dose pods, often referred to as "pizza boxes," and must be kept at 70 degrees Celsius below zero. Part of the reason the Veterans Affairs Palo Alto Health Care System got an early start with the vaccine is that it has specialized freezers able to keep all those doses at a stable temperature. Pharmacy staff have a special alert system in the event the temperature ever falls out of the correct range.
But once it's time to crack open the freezer, a whole new set of logistical challenges pop up, Robertson said. Pulling out the doses starts a rigid six-hour timer to administer the vaccine to patients, meaning it's a race to thaw the vaccine, gently shake it, dilute it and draw it into syringes. Any no-show vaccine recipients must be replaced by another eligible patient, who will be called to come in to ensure none of the vaccine is wasted.
The rush is so significant that, when the vaccine is transported to the hospital's facilities in Menlo Park and Livermore, it's going to need a police escort with the lights flashing to rush through traffic with Robertson on board.
"This is a logistics nightmare," she said. "I've been here 28 years and I have never dealt with something that has to be so highly, highly coordinated."
Santa Clara County will receive a grand total of 17,550 doses of the Pfizer vaccine this week, with many hospitals getting their fair share on Friday. Stanford will be receiving 3,900 doses and El Camino Hospital will be receiving 975, and both are expected to begin administering the vaccine to frontline health care workers on Saturday.
Though the initial focus is on health care workers, residents of skilled nursing facilities will be offered the vaccine through retail pharmacies Walgreens and CVS Pharmacy beginning the week of Dec. 28, according to county health officials. Larger shipments of a second COVID-19 vaccine developed by Moderna are also expected to be available next Tuesday, following tentative approval by the U.S. Food and Drug Administration.
The Pfizer vaccine has been deemed safe and effective for people over the age of 16, including those who previously contracted COVID-19. Those who have a history of severe allergic reactions to vaccines or injectable therapies may have an adverse reaction to the COVID-19 vaccine and are asked to stay at the vaccination site for at least 15 minutes for observation.
On Thursday, Dec. 17, the FDA's Center for Biologics Evaluation and Research's Vaccines and Related Biological Products Advisory Committee recommended the emergency use authorization of the Moderna Inc. COVID-19 vaccine for anyone 18 years and older by a vote of 20 in favor and one abstention.
The decision, which was made after an eight-hour hearing by video conference, could increase the nation's vaccine supply. Moderna is now the second company to have reached this stage and could follow Pfizer-BioNTech as soon as Friday or this weekend with approved authorization.
Some committee members who had not voted in favor of recommending the Pfizer authorization last week said on Thursday that they were impressed with Moderna's data and transparency.
"We're in an unparalleled crisis," Dr. A. Oveta Fuller said.
"Moderna gave a very transparent and thorough study from the beginning," she said, noting that she didn't say yes to the Pfizer study the last time. She also felt that Moderna took care of the study participants and planned to monitor them closely for adverse effects.
Dr. Michael Kurilla, the lone abstainer, said he could not vote in favor of the recommendation.
"I'm very uncomfortable with the language in the midst of a pandemic and with a limited supply of vaccine available. A blanket statement of individuals 18 years and older is just too broad. I'm not convinced for all of these age groups the benefits do actually outweigh the risks, and I would prefer to see it more targeted for people at high risk of serious and life-threatening COVID disease," he said.
Rather than an emergency use authorization, he preferred to have recommended an expanded access program, which would have been more targeted.
Dr. Arnold Monto, the committee's acting chair, said that even though the approval was more sweeping than for the Pfizer vaccine, people should not think that one vaccine is thought better than the other. The decision was weighted in the way information was presented and the nuances of the panel's scientific inquiry, he said.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.