Hospitals gear up for vaccine
Some bought freezers to store invaluable vials, avoid waste
Hospitals across the state have been preparing for weeks, if not months, for the coronavirus vaccine to arrive, which could be as soon as Monday.
The Food and Drug Administration approved the vaccine for emergency use late Friday.
Hospital administrators say they are expecting a first shipment of 975 doses of the Pfizer vaccine, which will be delivered directly to medical facilities from the manufacturer in packaging about the size of a pizza box. This week, those doses could start going into the arms of frontline workers who have the most exposure to covid-19 patients.
One of the main components of the preparations has been procurement of a special type of ultra-cold freezer needed to store the Pfizer vaccine, which must be kept at minus-94 degrees before it is thawed, mixed with a diluent and administered in someone’s arm.
During pre-pandemic times, this type of freezer was rare, mostly found in major
hospitals or research institutions, where it was used to store things like tissue samples from humans or types of bacteria, even viruses.
With the race to approval and distribution of the Pfizer vaccine, hospitals have been scrambling to ensure they have the super-cold iceboxes to adequately store vials of the medication.
It’s a process that has been nothing short of nerve-wracking for administrators as thousands of other medical facilities across the United States also place orders for the machines, resulting in price gouging and delivery lead times of two to three months or longer.
“Now, if we contact a manufacturer and ask for one of these, they quote you, and then there is a delay, and then they tell you when the release date is going to be,” said Jeff Cook, an assistant dean at the University of Arkansas for Medical Sciences College of Pharmacy. “Typically, it is further out than a month or two.”
UAMS already had eight of the ultra-cold freezers before the pandemic, Cook said.
“We are blessed that we had them, and we are not paying these price gougers for some of these items, as the market is now short on supply,” he said.
The units range from mini-refrigerator size to household kitchen refrigerator size to small-car size, Cook said. The freezers can store items at a level of cold that’s comparable to the coldest temperatures in the Arctic.
Another reason for the national shortage of the freezers is directly related to consumer trends in the U.S. since the pandemic started in March.
Home improvement stores have been raking in millions of dollars as people stuck indoors have decided to remodel bathrooms, replace floors or upgrade appliances, like refrigerators. Some components in the average household refrigerator are the same as those needed to make the ultra-cold machines, Cook said.
“There are appliance shortages right now, so some of the same parts that go into making these negative-80-degree Celsius [minus-112 degrees Fahrenheit] freezers are also going into making your home refrigerators and freezers,” Cook said. “So there is a manufacturer bottleneck.”
“There is a low supply right now,” he said. “Typically the market does not bear needing this volume, so yes there is going to be a shortage.”
Baptist Health ordered seven of the freezers around the middle of September. They arrived in the middle of November, said Cody Walker, vice president of hospital operations for Baptist Health Medical Center in Little Rock.
“We knew we needed to react quickly,” Walker said. “The name of the game is how can we best plan for the future knowing what we know today?”
In August and September, when promising reports were coming out about possible imminent approval of a vaccine, Walker said he and his colleagues knew they needed to start getting ready.
“We just knew that someone would eventually be successful,” he said. “We knew we needed to plan for that.”
The freezers are at Baptist’s Little Rock, North Little Rock and Fort Smith campuses, he said. Each unit can store at least 2,000 vials of the vaccine, with each vial containing five doses, Walker said.
“It could potentially be more than enough [storage],” he said. “We really won’t know until we get the vaccines and start working on it.”
“The entire pandemic, so far, a lot of this is monitor and adjust,” Walker said.
Such freezers are constantly monitored on-site and remotely for any changes in temperature, with alarms that go off where the freezers are located and even remotely via phone apps and other devices.
“It is pretty impressive,” Walker said. “There is a key specific to each freezer, and then video surveillance, and then another key to the room and then badge access only to licensed personnel.”
St. Bernards Medical Center in Jonesboro also ordered a freezer preemptively. It arrived about six weeks ago, said LeAnn Morrow, St. Bernards vice president of ancillary services.
“As soon as the specs came out with what would be required of the Pfizer vaccine, we went out and ordered that,” Morrow said. “If we had ordered one today, it might be a little bit different situation, but since we ordered early on in the game, we did not have that supply-demand issue.”
Morrow said the freezer could hold up to 10,000 vaccine doses.
It cost about $12,000. Prices can range from $5,000 for smaller units to more than $30,000 for larger ones.
“I don’t think we will have to get another freezer,” she said.
At Unity Health’s White County Medical Center in Searcy, administrators were scrambling to see if any of their clinics and other hospitals had the freezers, said Rodney Lochala, chief medical officer.
“I just knew these things were very, very scarce,” Lochala said.
He said he discovered that the hospital’s orthopedic program had one, which was being used to store bone grafts.
Then, he said, he had the idea of asking nearby Harding University if it, by chance, had one somewhere.
It turns out, it did. “One of them was sitting in a storage room across from the biology lab,” Lochala said. “I go over there, and in this storage room, in the corner, you have an ultra-cold temperature freezer sitting right there, not doing anything, and has not been plugged in for five years.”
“We pulled it out, plugged it into the wall, and the compressor comes on,” he said.
Now, Unity Health has two ultra-cold freezers.
Unity Health also operates Harris Medical Center in nearby Newport, which because of the town’s smaller size and location in a more rural area, will not be receiving direct shipments of the Pfizer vaccine this week.
Lochala said a specific number of doses that are thawed, mixed and ready to administer will be transported to the Newport campus daily to start vaccinating the front-line workers there who qualify to receive the vaccine based on guidelines from the state Health Department and federal drug regulators.
There are numerous other small hospitals in Arkansas that may not qualify to get the first 975-doses allotment, or, if they do, may not have ultra-cold freezers or be able to afford to buy them.
The Pfizer vaccines will be shipped in a container of dry ice, which can keep them at the necessary temperature for 15 days, said Jennifer Dillaha, the state’s epidemiologist.
The vaccines will be shipped with an extra box of dry ice, as well.
There are now reports of possible dry ice shortages nationwide as medical facilities stock up on that, too.
“An ultra-cold freezer is not required to receive this vaccine,” Dillaha said. “We are not recommending they [hospitals] buy these freezers. If they plan in advance, they can receive the vaccine and use it without requiring an ultra-cold freezer.”
The Department of Health has been working to make sure rural hospitals can receive the necessary doses and that none of the vaccine goes to waste.
That effort has involved coordination of nearly half a dozen community pharmacies that have the special freezers for storage and will deliver doses that are ready to administer via mobile pharmacies to smaller hospitals that need them, Dillaha said.
When the doses are delivered, they will be thawed, diluted and ready to give to employees that day, Dillaha said. Pharmacy staffs will be available to give the shots, or hospitals can opt to do it themselves for their employees, she said.
“These community pharmacies are treating the whole state like their community now,” she said. “The burden of vaccinating staff can be lifted from the shoulders of the hospital if that is not something they are in a place to take on right now.”
Once the vaccine is thawed, it can remain in a refrigerator for five days. Once it is mixed with the diluent, it has to be used within six hours and cannot be refrozen, Dillaha said.
“Of course, with this covid vaccine, we will have limited doses so we cannot afford to waste any,” she said. “It is a challenge.”
With the race to approval and distribution of the Pfizer vaccine, hospitals have been scrambling to ensure they have the supercold iceboxes to adequately store vials of the medication.