University Health System reached a milestone Friday afternoon in its quest to deliver the COVID-19 vaccine in San Antonio.
In a back room at Wonderland Mall, pharmacy technician Vernice Ver drew the system’s 100,000th dose of the vaccine.
“Today is an exciting day for us,” said Elliott Mandell, senior vice president and chief pharmacy officer at University Health, moments after a syringe was filled, marked with an X, and placed in a shallow yellow bin.
With several camera operators following, Mandell and his team carried the bin into the vaccination hub and handed it over to Edna Fuster, a medical assistant who has been injecting the coronavirus vaccine into arms since the mall site opened in early January.
“Man, lucky me,” said Hank Cortez, age 72, reacting to the attention as he sat next to Fuster and rolled up his sleeve. The San Antonio native and retired investor said he didn’t feel a thing.
But the shot puts him closer to visiting his grandchildren in Houston again. Cortez said he hasn’t seen them in over a year.
University Health received its first shipment of vaccine on Dec. 17 and, the following day, began vaccinating its frontline health care staff at University Hospital. On Dec. 21, the hospital began vaccinating first responders and frontline workers from the community at the Robert B. Green campus downtown. That operation continues.
Its first rollout of vaccine to eligible people in the general public began Jan. 4 at Wonderland Mall, starting with 1,500 doses a day.
The massive operation happening on two levels of the mall is now up to more than 4,300 doses per day or 20,000 a week.
“This has been somewhat of a convoluted experience because it’s been a struggle finding out what we’re going to get from the state and when,” he said. “But right now the state is rewarding those places that are … getting shots into patients’ arms. And that’s been us.”
The efficiency of such an effort begins behind the scenes, he added, pointing to schedules mounted on the wall that tell a team of pharmacists what times throughout the day they should remove a batch of vaccine from the temperature-controlled refrigerator and how many doses to prepare.
Unlike most vaccines, such as for the flu, Pfizer’s COVID-19 vaccine must be stored at an ultracold temperature of -94 degrees Fahrenheit. It takes three hours to thaw the vaccine before it can be diluted. Once diluted, it must be administered within six hours. After that, it must be discarded.
“So we have to have a very complex plan,” Mandell said.
Since the start of the process, the pharmacists have managed to increase, from five to six, the number of doses they can draw from each vial. The difference comes not from any changes to the amount of vaccine in each 0.4-milliliter vial, but from the size of the needle and the type of syringe that’s used.
The dilution formula calls for pharmacists to add 1.8 milliliters of saline to the vial bringing the total amount of vaccine in each vial to 2.2 milliliters. Each dose is 0.3 milliliters, Mandell said.
“So you would think … I should get seven doses out of that, [but] because the liquid stays in that needle and the hub of the syringe, we get less,” he said. “But now we’re finding, if we have the right needle, we get at least six every time.”
Getting shots into arms continuously for 10 hours a day, five days a week, requires an operation that has been orchestrated by Bill Phillips, whose official title is chief information officer at University Health.
These days, however, he’s known as the chief vaccination coordinator, applying his analytical technology skills to develop a process that keeps the vaccine and the people flowing.
Phillips oversees the vaccination supersite and about 80 workers from the hospital system – support personnel, medical technicians, registered nurses, and pharmacists.
“Everything is to keep the flow going,” Phillips said. He added the second-story vaccination hub after successfully deploying the first-story operation early on. “The [Wonderland of the Americas] mall graciously donated the space to us, and I looked at it and I immediately laid it out.”
The 100,000th dose represented a milestone in a complex and ongoing effort to deliver vaccines and end a pandemic.
But the five or six pharmacists filling and tapping and capping syringes, one after the other, kept on with their task, and the moment went by mostly unnoticed in a former retail space where dozens of people came to be vaccinated.
Mandell expects to reach the 200,000th dose within a month.
Here’s how and where to get the COVID-19 vaccine in San Antonio.