Medical Examiner

Inside the Emotional Roller Coaster of Administering the Vaccine

In the foreground, a purple-gloved hand drawing vaccine out of a vial. In the background, a person with their sleeve rolled up to expose their arm.
Photo illustration by Slate. Photo by Alvaro Laguna/iStock/Getty Images Plus.

Vaccine Diaries is a series of dispatches exploring the rollout of COVID-19 immunizations. This as-told-to essay is based on a conversation with Betsy Elswick, a pharmacist and associate professor at the West Virginia University School of Pharmacy who has been administering the COVID-19 vaccine at pop-up clinics. The conversation has been transcribed, condensed, and edited for clarity by Rachael Allen.

I’ve been in practice 20 years, and this past week was the most emotional but satisfying workweek I’ve had in my entire life. We knew the vaccine was coming, and we were prepared to give it as soon as it arrived. When we got the vaccine, there were definitely some tears shed.

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We were assigned the Sundale nursing home, which was the first place in West Virginia to have documented community spread of COVID-19. We wanted to make sure that facility got the shots as soon as possible because they had really suffered with the pandemic early on. When we showed up in the facility with the big cooler of the vaccine last Tuesday, there was a feeling that hope was finally being restored. I’ll never forget the face of the first person I vaccinated—they were elated. Here we have the vaccine we’ve been waiting on for months. We didn’t get it in time to save some of the lives at that facility, but we’re now getting it there to save the rest.

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The very first person at the facility that we gave the vaccine to was the first patient at the facility to have COVID. She was so excited to get the shot that afterward she just held her vaccine record card in her hand like it was the best gift she’d get this holiday season. There was clapping. There was laughter. One of the residents played Christmas music on the piano for more than five hours. There was a sense of, you know what, we’re going to get through this.

We did 170 shots that first clinic. We left the nursing home about 8 p.m. on Tuesday night. We didn’t take a break, sit down, or eat—we just got as many shots in as many arms of people that needed it. We’ll go back in three weeks because it requires two vaccines to be fully effective.

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At the clinic, there were six pharmacists, the medical director, and the head of the facility. We all had different roles. I was in charge of reconstituting, which means diluting the vaccine that comes from manufacturers, a process you have to do before you draw the doses. Every reconstituted vaccine vial provides five shots, but we noticed that we sometimes had vaccine left over in the vials after drawing up the fifth dose, meaning we could draw a sixth or, in a very rare instance, seventh dose. The Pfizer vaccine was labeled for only five doses, and because the Food and Drug Administration and our state hadn’t yet said that we could use the sixth dose in the vials, we had to waste several extra doses that we found, which was heartbreaking. We reported these extra doses back to our state as well as to Pfizer. Other pharmacists throughout the country also reported the same, and this past Wednesday, the FDA announced that there may indeed be extra doses in the vials and that we could use these extra doses as long as we didn’t pull vaccine from different vials to make a full extra dose. This was super exciting news, as these extra doses have the potential to give us many more vaccines across the country.

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Because of the rural nature of West Virginia, we use a “hub and spokes” model to make sure we can get these vaccines out to the tiny towns that need it the most. Once the vaccine gets to hub by the National Guard, it has to be very carefully documented and checked by the team there. The hospitals get vaccines for their staff on the front lines, and, at the same time, the 16 local pharmacies in West Virginia have been assigned to provide vaccines to nursing homes and long-term care facilities throughout the state. When vaccine is received by the hub, they call the pharmacy and let us know when they’ll be delivering it. Once the vaccine is received by the pharmacy, we carefully take it off dry ice using special gloves and goggles and put it in the refrigerator. We log it and make sure all of our records are straight.

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There are special transportation guidelines to transport the vaccine to the clinic. You put partially frozen water bottles on the bottom of a hard-sided or Styrofoam cooler, then you have a layer of corrugated cardboard, 1 inch of packing foam bubble wrap, and then the vaccine on top of the bubble wrap—you don’t want the vaccine directly touching the frozen bottles. You put a thermometer in the center of the vaccines. Then you do the process again, in reverse: bubble wrap, cardboard, partially frozen water bottles, and your temperature log. You have to make sure that that vaccine stays at the needed refrigerated temperature for the day, at least for Pfizer’s vaccine. Each vaccine that may be subsequently approved may have slightly different storage or transportation requirements.

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Once at the nursing home, you figure out how many vials you want to bring out. You have to let the Pfizer vaccine come to room temperature before you can do the reconstitution process. Once you’ve reconstituted the vaccine in the vial, it’s stable for a little bit of time, but once you draw up the vaccine in the syringes, it has to be given immediately.

At these clinics, most people will ask if the vaccine is safe. My answer is yes. It is safe and effective, and if both doses are given within the appropriate timelines, we know that for this Pfizer vaccine it can be upward of 95 percent effective. We’re also asked about side effects. It doesn’t hurt to get the shot, but your arm will potentially be sore the next day. That is normal for this vaccine—it triggers the immune response in your body, which is exactly what we want it to do. Your body mounts an immune response that can make you feel a little achy or run a very low-grade fever for the first one to three days, but that’s normal. If you don’t feel better or your symptoms get worse, you absolutely need to see a health care professional to make sure perhaps you weren’t infected with COVID-19 before you got the shot. Of our six immunizers that got vaccine, five had only a sore arm. I had a very mild fever. I took Tylenol and felt fine.

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After administering the vaccine, we observe all patients for 15 minutes to make sure they’re feeling OK. If patients are deemed to be at high risk for a reaction—meaning that they’ve had a previous anaphylactic reaction to a vaccine or other injectable medicine that caused them to seek medical treatment, such as an EpiPen—they are observed for 30 minutes. I’d like to stress that this group of people does not include people who have allergies to food products, such as peanuts, eggs, shellfish, or allergies to pets, dogs, cats, dander, pollen, anything environmental. These allergies do not put you at any higher risk to develop a reaction to this vaccine.

I think more people will get the vaccine if they know what to expect. I have been telling people this: “Look, I know new things are sometimes hard. We don’t know much sometimes in this world, but I do know this: We have lost too many Americans to this disease. We have not been able to save the lives that I wish we could have saved. You now have a chance to save a life—your life and those around you—by getting the vaccine. You have to put politics aside. Until you put public health first, the rest of the stuff doesn’t matter. If you’ve ever wanted to step up and do something bigger than yourself, now is the time.”

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