INJECTIONS OF HOPE
Maeve Sheehan goes behind the scenes as the vaccine roll-out ramps up
EMILY Walshe had a momentary wobble when her name was called for the optional Covid-19 vaccine at the Mater Hospital in Dublin last Thursday morning. For one thing, even though she is a nurse, she is “terrified of needles” and she wondered: “Do I really want to be the first to get it?”
A newly qualified theatre nurse, she spent the final months of her training as a ward nurse in the Mater.
“In our ward, a lot of staff got ‘knocked out’ by a patient who swabbed negative three times for Covid-19 but turned out to be positive,” she said.
She was “knocked out” for 10 days. “The long-term effects are phenomenal. I still get the shortness of breath. Concentration is off, mentally you’re not the same. Directly after it, the anxiety I felt made no sense to me, but apparently a lot of people were getting severe anxiety after it.”
She “kept being told” that because she’d had the virus, she would be immune, but that’s not necessarily true either, she said.
She pushed the fear of needles to one side, started “thinking rationally” and by 11.30am on Thursday, Emily was in the recovery room in the upstairs ward that has been transformed into the hospital’s vaccination centre.
“It was fine. It’s not a sore one,” she said, rubbing her arm.
The surge of Covid-19 patients expected to hit hospitals in the coming days helped concentrate the mind. She will not get immunity until after she receives the second dose in three weeks, but she hopes to get some benefit from it.
“We are probably going to get relocated to the [Covid-19] wards given the way things are going,” she said. “I am hoping with this vaccine that we will have some immunity. At least we can feel some layer of protection.”
Outside the recovery room, a socially distant queue snakes down the corridor, a constantly replenished line of people, most of them in scrubs, waiting for the jab.
Catering assistant Denise Loftus is smiling ear to ear having just received it. She will still have to take precautions, she said, but like Emily she is embracing that first shot as adding to her armoury when she goes to work.
There is no greater advertisement for the “ray of light” the vaccine has brought just as a third wave pushes the country’s hospital system to crisis point.
The first delivery of 195 vials of vaccine arrived last Monday, with a second batch of 195 expected by the end of the week.
According to Dr Eavan Muldoon, a consultant in infectious diseases who is leading the vaccine roll-out programme, preparations began on New Year’s Eve and continued through the bank holiday weekend.
A ward was designated, priority lists drawn up of staff most exposed to Covid-19 and one of the biggest tasks, according to the operations manager, was plugging into the HSE’s IT system for vaccine registration.
The first vaccination took place at 3pm on Tuesday, with Dr Muldoon its first recipient. This was not queue jumping. As a breastfeeding mother of a 14-month-old son, she wanted to demonstrate to other mothers that the vaccine is safe.
“A very large proportion of healthcare workers are women and are young women. We had a lot of questions around pregnancy and breastfeeding.
I decided to be an advocate for breastfeeding mothers because I believe this vaccine is safe if you are breastfeeding and it is the right thing to do. That’s why I spoke up,” she said.
The pace of vaccinations escalated quickly. On Wednesday, 437 people were vaccinated — roughly 10pc of hospital staff. Working 8am to 8pm, Monday to Saturday, the Mater looked on course to administer the first shot to more than 5,000 people working across the organisation well within two to three weeks, before starting over again to administer the second dose.
Dr Muldoon reckons the uptake in the hospital will be “phenomenal”.
“It’s fair to say we overachieved. We were aiming to do 250 on Wednesday and we ended up doing 437.”
The vaccination teams — all nurses — operate with military precision. With a shelf life of 120 hours once removed from ultra-cold storage, and a shelf life of two hours once a vial is opened, they work against the clock.
Batches of vaccine are mixed 10 at a time to prevent wastage. Initially they were drawing five 0.3ml doses from each vial. Then the guidance from the National Immunisation Advisory Committee changed to six 0.3ml doses per vial, extending the reach of the previous vaccine.
The newly vaccinated are observed in a recovery room where they must remain for 15 minutes. There have been very few reactions.
“So, a sore arm, which is usual with any vaccine. Some people feel a little bit light-headed for a short time afterwards — I think we’ve had two in the last 24 hours,” said Dr Muldoon.
“People are really enthused by it, you can feel it here in the hospital, it’s been seen as a ray of light,” said Keith Carroll, the nursing lead for the vaccination programme.
The glow of optimism has been tempered by criticism of the slow start to the programme, global uncertainty over supply, a complex online registration system that has taken time to go live, and issues of consent.
In Ireland, the vaccinations of 582 nursing homes got off to a slow start last week but will escalate from tomorrow. Hospitals have been turning over thousands of vaccinations a day for the past week.
Two recurring questions are: when will the population at large be vaccinated, and when can normal life resume without restrictions? That depends on when Ireland receives the 15 million doses of five different vaccines it will be allocated, and how fast the health authorities can assemble teams to administer them.
Two vaccines have been approved by the European Medicines Agency — PfizerBioNtech and Moderna. Both require two shots and require sensitive handling. Just 4,000 doses of the Moderna vaccine are expected initially. A third, AstraZeneca, which may be approved by the end of the month, is being hailed as the “game-changer” because it dispenses the need for ultra-cold storage, can be delivered direct to GPs and pharmacists, and will speed up the process.
As of this weekend, however, Ireland has received just 81,900 doses of the PfizerBioNtech vaccine since the first delivery on St Stephen’s Day; 35,000 people have been inoculated, 32,000 of those staff across the seven hospital groups. The HSE expects weekly deliveries of 42,000 doses between now and the end of February — almost 300,000 doses.
The vaccine will be used as soon as it comes in, with one week’s supply held back in contingency to make sure a second dose is available if the supply chain is disrupted.
Taoiseach Micheál Martin has said 135,000 people will be fully vaccinated against Covid-19 by the end of February.
‘It’s a real credit to us that we got this up and running’
The vaccination programme is expected to ramp up from March onwards, but there is uncertainty over supply and which vaccines will be on the market.
A graph circulated by the National Covid-19 Vaccine Task Force last week suggested deliveries of between one and two million doses of vaccines by the end of March, rising to between four million and five million doses by September. But officials said the figures came with too many caveats and assumptions.
What is certain is that for life to return to normal a level of herd immunity will be required. The World Health Organisation says we still don’t know what percentage of a population needs to be vaccinated to provide herd immunity. Some experts reckon around 70pc for Covid-19. In Ireland, that translates to 3.4 million of our population of 4.9 million. But administering just one shot of a vaccine to 3.4 million people over 12 months requires 65,000 vaccinations a week. Opposition TDs who received a briefing last week raised concerns about a potential shortage of vaccinators and the infrastructure in place for widespread administration.
For now, the HSE is mobilising 65 vaccination teams, drawn from hospitals, public health and the National Ambulance Service. Health Minister Stephen Donnelly claimed on Friday they will vaccinate “seven days a week and into the night”.
In the past week, acute hospitals like the Mater have shown how it can be done.
“On New Year’s Day, we were organising lists of staff to be vaccinated for the HSE. I think in terms of teamwork and flexibility in the health service, without blowing our own trumpet, it is a real credit to us that we managed to get this up and running, starting on a bank holiday Friday,” said Dr Muldoon.
The vaccine will not stop the current surge and, until a majority of the population is vaccinated, restrictions will be the primary weapon against the virus.
But even that one shot of vaccine has been a boost for exhausted health workers facing the next battle. “I would prefer to take a chance than be in a world like this. Nothing is going to get better without it,” said Emily Walshe.