So I am an RN and I teach nursing at a Community College in Florida these days, though regular readers will recall that I comment a lot about Maine where I used to live, as well as Nepal where I’ve had a project to upgrade critical care skills since 2011.
It is my last few days of winter break before spring semester starts next week. I got an email last evening which galvanized me into action…..
Turns out that the immunization follow up in Florida is assigned to the various County Health Departments. County government here contracted with a private company to set up 12 drive-through sites with a pre-registration system. The phone-based pre-registration system crashed within twenty minutes of activation due to the overwhelming number of calls. The first few days of operating the sites were understaffed. People got very frustrated with long waitlines. The county decided to regroup, and called the Dean of the Health sciences department to see who might be there to help bolster the staffing, esp if there were nurses or nursing students.
So I got an email asking if I could help and also whether I could bring nursing students who could give intramuscular injections. I could choose one of the three sites at different locations in the county.
Hell to the YES!
I could choose the site, so I picked one in a shopping mall. It’s a drive-through site and they were expecting about 700 recipients. I sent out an email and two students responded with less than twelve hours notice, so I met the two of them at the site at 0700. The actual injection area would be on the second floor of a parking structure, giving us a roof over our heads.
The public health leaders and had obviously learned from their first few runthroughs and trainings, as to how to set this up. To operate a drive-through site requires a very large empty parking area and a plan for how to set up traffic cones so as to guide 700 cars through the process. ALso, and most importantly, on this day they had plenty of workers in addition to the nurses and paramedics who were actually giving the injection. With myself and the two students there was a total of eight people trained to give injections. BUT, I estimated the total number of workers to be about 80.
There were people assigned to:
1) enter all the hand-written data into a central database using laptops
2) reconstitute the vaccine
3) draw it up into the syringes
4) “runners” to replenish the supply at each of the tables;
5) direct traffic so that each of the four lanes was kept busy;
6) give the blank paperwork (downstairs) for people to complete
7) collect the paperwork and check it
8) give the injection
9) give a card to each recipient that told everyone when to return in three weeks.
10) monitor people who needed to stay around for a half-hour after getting their shot. ( any one with previous history of allergy).
I got there at 0700. At my station I had my own “runner” and a Fire Department guy to collect the paperwork, do the tally and check it; also a person just downstream to give the card for the second appointment. we each wore a reflective vest like a road crew would, to mitigate the possibility of an accident as workers mixed with cars.
So despite whatever concerns the County Health Department may have had, on this day they had enough people. I think it is easy to underestimate just how many people it takes for one of these sites to rev up and crank out the injections. It’s not just how many nurses you have — it’s the sum total of team members, many doing tasks that do not require advanced training ( such as directing traffic). We made good use of about a dozen helpers per person giving the injections.
The team at this location did the 700 immunizations. Hooray!
I assume the other sites each did 700 or so. In other words, a day of drive-in clinics, netted 2,100 newly vaccinated persons. (who still to come back in three weeks). Our little band of three at our one location gave about 250 of those shots.
Now here is some math. There are five million people in our county because it’s got a metro area. so, the numerator is 2,100 ( a respectable number) BUT the denominator is 5,000,000. That means we gave the shot to 0.00042% of the population. If I invert the number, I get 2,380.95. This last number is the number of days it will take to do the entire population, assuming that the drive-in clinics are open seven days a week.
This is like the book “A Day in the Life of Ivan Denisovitch” where you work hard to make a goal, then the next day you wake up realizing you still have to work hard.
Six and a half years at this rate. This corroborates the trajectory that President-elect Biden was talking about in a recent speech. It’s simply not fast enough.
The back-of-the-table-napkin figuring is not difficult. five million (population) divided by 180 ( six months) yields a number 27,777 — the number of immunizations per day you would need to reach in order to complete the mission in six month time frame.
Meaning? we would need more than ten times the daily rate we just did, to get on track to serve our assigned population over a six month period. And obviously more sites because each site can only hold a specified number of cars. And 80 to a hundred people at each site in order to do all the tasks as efficiently as possible. Totalling 800 people or more, fulltime.
This is no simple feat. Our county got through the day partly because they re-assigned dozens of people from other jobs for the day — and those jobs were also important. Our county had trouble getting enough nurses — partly because we already had a nursing shortage in the first place and many nursing candidates are already employed and scheduled elsewhere.
Several Tee Vee crews came, and naturally they focused on the young nursing students working so diligently. Being photogenic is the province of youth.
Not one recipient showed up with a MAGA hat. there were a few with Biden gear, and some of those insisted on getting a selfie with me when it was their turn. I too am a senior citizen, and we made a lot of small talk about the eagerness to develop immunity and see the grandkids. a universal ache among Americans I spoke with today. I felt like every injection I gave brought me a step closer to spending time with my two year old grandson, as opposed to watching him on my daughter’s Zoom like it was some sort of wildlife cam.
At the end of the time I told the students “you now have a story to tell your own grandchildren if they ever ask you what you did during the Great Covid19 Pandemic.” And I was proud of them.
There was a lot of hopefulness that Biden will get this organized and the Federal government will step up to the plate. I can’t wait!
