‘Shot Dots’ and ‘Blue Martini Special’: Vaccine Site Races Time
(Bloomberg) -- Needles pierce minuscule vials. Plungers descend and draw back liquid. Gloved fingers flick the tubes, ridding them of air bubbles.
It’s early morning in Atlantic City. In the back of a cavernous, windowless convention hall, the eyes of a dozen pharmacists are locked on syringes filled with coronavirus vaccines that soon will course through the bodies of thousands of people.
Time is everything as the workers prepare the world’s most valuable substance. Each syringe takes just under a minute to assemble, and the team must ready an hour’s worth, about 400 shots, by a little after 8 a.m., when the first patient will roll up her sleeve in a day that will stretch until 6 p.m.
Minute by minute, vaccine by vaccine, what’s unfolding in these brick walls in Atlantic City is just one leg of a race to vaccinate enough Americans before coronavirus variants spread further.
New Jersey, where hospitalizations and deaths from Covid-19 have been rising, has some of the highest rates of the more-contagious B.1.1.7 strain, adding to the pressure on officials. It has vaccinated about 43% of its residents, above the U.S. average but still leaving millions to go. The task is complex: The state of nearly 9 million sandwiched between New York City and Philadelphia contains decaying industrial centers, wealthy suburbs and rural pockets — home to people from dozens of ethnic and language groups.
Each day, officials try to corral residents and funnel them through massive sites like the Atlantic City Convention Center, where the state partnered with the county and local health system AtlantiCare. The struggling gambling resort about 130 miles south of New York has outsize Black and Hispanic populations; almost 40% of residents live in poverty. The center is a landmark in its waterfront casino district, and the vaccination site draws people from the city, more prosperous coastal towns and the whole of New Jersey.
For the more than 100 nurses and National Guard troops in scrubs and camouflage gathered on a sunny Thursday in April, no detail of the intricate logistics is too small. Not a single minute can be lost. No syringe can go unused.
“We equate a syringe with a life,” says Sherrie Bragg, the AtlantiCare nurse who leads vaccination and other operations at the site. “You waste a syringe, you wasted a life.”
Nurses, Guard members and Federal Emergency Management Agency workers huddle, spreading out sleepy-eyed across teal folding chairs in the observation area, where people will later sit for 15 minutes after getting their shots.
There’s another briefing just for vaccinators at the other side of the hall, by their stations: Use only black or blue ink on vaccine cards. If you miss your break time, you miss it. Think of syringes like $100 bills — don’t leave them unattended.
Guard members radio colleagues downstairs to open the door, while blaring Ozzy Osbourne’s “Crazy Train.” There’s a different song each morning; they played LMFAO’s “Shots” on the day the facility administered its 100,000th.
“Time is zero eight hundred,” one guardsman says. “Officially open.”
In the break room, amid the hum of a refrigerator, Nancy Powell, an AtlantiCare nurse who oversees education and orientation of vaccinators, explains to a visitor how to give a shot. It should go in just inches below what’s known in anatomy textbooks as the “acromion process,” the bony end of one’s shoulder.
As Powell speaks, a bright video screen next to a coffee machine registers vaccines: 244 completed, with 113 people waiting.
“When we think about how excited we were to do 100 a day, and now we’re at 5,000 a day, it’s really unbelievable,” Powell says.
A line of people awaiting shots, spaced 6 feet apart, snakes around rope barriers. They’ll carry plastic cards through the long hall with black-and-white QR codes powering the analytics in the break room. Taped arrows on the floor lead them to vaccination stations and then to the observation area. Orange stickers, designating a completed vaccine, dot the sea of shirts. The staff calls them “shot dots.”
Ana Contreras, a 35-year-old who works at the convention center and a casino, tugs the sleeve of her maroon polo up for her second shot. In recent weeks, she says, she’s helped book appointments for two dozen Hispanic people who have struggled to navigate the language barrier. It has grown easier, partly because casino employees received a code to help them sign up about two weeks ago, she says.
Vaccine stations bear white or blue tablecloths, syringes are ferried over in white or blue trays, and some recipients wear blue wristbands. This color-coded system, used to visually distinguish between the Pfizer vaccine (white) and Johnson & Johnson (blue), is the kind of detail that would escape attention if you were shuttling through the site for your shot, but it keeps this place running smoothly.
On Tuesday, a rare blood-clot complication linked with Johnson & Johnson’s vaccine led the U.S. to urge pausing its use, a recommendation the Atlantic City site followed. On this day, though, it’s a popular item.
“Blue martini special,” National Guard Staff Sergeant Julio Abreu calls out as people file forward. He says the Johnson & Johnson vaccine is cold and everyone wants it.
Around lunchtime, the big room takes on the subdued hum of a dentist’s office waiting room.
The dozens of stations are staffed by a medical provider and a National Guard member. With those in camo serving as scribes, each table can register and vaccinate people simultaneously. Consolidating the administrative and medical steps several weeks ago quickened the pace to a minute per patient from six, says Captain Jiahua Ye, the Guard officer in charge.
The site has done 2,323 vaccinations so far today, and more than 180,000 total since it opened in late January. Appointments are booked solid for the next few days. But this week the site also has openings for the first time — about 11,000 through the rest of the month, says Bragg. The state still has to inoculate about 2.5 million residents to reach its goal of fully vaccinating 70% of adults by the end of June. New Jersey plans to open shots to everyone 16 and older Monday.
“As the numbers grow and volumes grow, we just pivot,” Bragg says. “We’re resilient.”
They’ve had to be. The state was prepared for hurricanes and other disasters, but had no mass-vaccination playbook, says Laura Connolly, spokeswoman for New Jersey’s six megasites.
“This is the light. This is the hope. That’s the feeling you get when you come in here,” Connolly says. “Day to day, that’s what really keeps us going.”
Between vaccine appointments, National Guard Sergeant Lavone Graham recounts reassuring a woman who was afraid of needles. “So I held her hand, and she broke my hand,” he says.
“I offer all the time. I held two hands today.”
In the afternoon lull, the chair by Nancy Raniszewski at vaccination station No. 10 is free. She’s a paramedic who is also administering shots that day, a pile of adhesive bandages and alcohol pads resting on the table not far from her sparkly orange nails.
Vaccination is about “gaining their trust and talking to them on a personal level,” she says. When a young woman sits down, Raniszewski chats with her as the needle sinks in.
Behind Raniszewski, in the corner where the pharmacists were in a flurry of preparation that morning, action has ground to a halt. That’s to avoid wasting doses, explains Rob Walters, a pharmacist who brought the vaccines this morning from an AtlantiCare facility nearby. His team has prepped 3,240 syringes already, and will fill more as needed.
The site has begun using fewer vaccination stations. There are only 24 now, a multiple of six because there are six doses in a vial. Workers also start letting each vaccine station clear out before seating additional people, and give out a new syringe only once a recipient is seated.
It’s been slow, but a small line is now building up by the door. Vaccinators and vaccine-seekers wait at tables for syringes to be delivered. The latest tally: 3,799 shots and counting.
Staffers gather in the break room to debrief. They talk about switching vaccinators between one-shot and two-shot regimens. Someone proposes storing vaccines near an area where those who need special accommodations have been getting their shots, because staffers have spent the day bringing syringes down a flight of stairs and running up again.
The wristbands for Johnson & Johnson vaccines, which are used to direct would-be recipients to a separate line, can get covered up by coats, so it helps to explain to people why they need to be visible, a National Guard member says. Then nurse Rachel Davis Bohs gets a call: “That’s good news. All the 5:45s are done. It’s 5:48.”
Blaring from a walkie-talkie: “We’ll be locking the doors down in five minutes.”
Mary Beth Holmes, 56, is last to walk in, clad in blue jeans and driving moccasins, and late for her second shot. Her fiance, who came on time, is already done and waiting in the parking lot. The vaccinator wipes Holmes’s arm down. The needle glides right in.
Holmes, who leads a group of test engineers for the Oceanic Air Traffic Control System, has been working from home for the past year. (“All of the time, all day long, all of a sudden it’s nighttime.”) She’s seen her father, who is 88 and lives with her sister nearby, only from outside the house. She remembers tearing up on her way to the Atlantic City site for her first dose, and recalls that two of her children went to prom here.
The Convention Center will vaccinate 3,884 people by the end of today, almost tenfold what it was doing early this year.
Holmes says she doesn’t know who organized the clinic, but she’s impressed. As an engineer, she knows: Everything has to go right to pull this off.
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