16 family members given vaccine

steddyeddy

Bass Reeves wrote: »

Now will you tell me WTF has a publication of there being extra doses in vials got to do with where the Coombe team found themselves especially when it was published in another country which they may or may not be aware of

Let me get something straight. You're asking what has the revelation that the Biotech/Pfizer vaccine has extra doses got to do with the fact that the Coombe should have known there was extra doses?

Bass Reeves

steddyeddy wrote: »

Let me get something straight. You're asking what has the revelation that the Biotech/Pfizer vaccine has extra doses got to do with the fact that the Coombe should have known there was extra doses?

Why would they have known??

Because of an article published in newspaper published in another country.

Did you read my post here the important bit



The Coombe would have notified the HSE about the number of people they had to be vaccinated not the number of vials they required. The HSE vaccine administration management issued the number of vials to the Coombe hospital.

The Coombe maybe ordered vaccine for maybe 900 staff. As they were vaccinating there staff they found out they has excess doses. They contacted the HSE who had no policy or proc SD for returning vaccine. They had to find recipients for these doses as they were carrying out the vaccination of the staff in the hospital.

Just to give you an idea of the logistics and I do not work in the HSE or in the medical area but I can guess the pressure that was on.

If you are vaccinating in a hospital you will carry it on on a day between a night shift change over if possible. This allow you to vaccinate both night shift rotas of medical and hospital staff as well as the staff in that day.

The night staff on Thursday night would be waiting on. Maybe 100+ staff. You will be under pressure early in the day to vaccinate these staff to let them go home. Then you will have the Consultants and there staff who will be on there morning run around the hospital looking to be vaccinated.

After that you will have nurses who will be on duty have to be vaccinated. Staff on 9-5 rosters, ambulance crews, hospital domestic staff, porters etc etc. As well as that you will have staff on days off coming in to be vaccinated. Finally you will have the night staff coming on that evening. These may be coming in early to be vaccinated.

I think they vaccinated 1100 people in what I guess would be a 12-14 hour day.

plodder

Bass Reeves wrote: »

https://www.google.com/amp/s/news.sky.com/story/amp/covid-19-vaccine-how-exactly-does-the-cold-supply-chain-work-12149118

Step 4 here states it can be transported to satellite centers such as nursing homes thawed

The link I posted earlier from the Ontario Dept of Health is a better reference than Sky News.
http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/vaccine_storage_handling_pfizer_moderna.pdf

Pfizer recommends that their vaccine be shipped in a frozen state as per the product monograph and specifications. A summary of Pfizer storage can be found at the end of this Appendix. Where this is not feasible, in the context of the public health emergency and assessment of population risk, the Pfizer vaccine (“vaccine”) may be transported beyond the initial point of delivery.

This document provides a range of options related to the movement of the vaccine. The operational plan should be tailored to local circumstances, with collaboration among the hospitals and public health units. For transport at +2oC to +8oC:
• It is recommended that the vaccine is packaged for delivery in a frozen state to be transported to the clinic/facility location using an insulated cooler (e.g., Playmate), that has been preconditioned to a refrigerated temperature of +2oC to +8oC.
...
• The time in transit at +2oC to +8oC should be considered part of the 5 days (120 hours) allowed for storage at refrigerated temperatures, even if the vaccine was placed into the cooler frozen.

Bass Reeves

plodder wrote: »

The link I posted earlier from the Ontario Dept of Health is a better reference than Sky News.
http://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/vaccine_storage_handling_pfizer_moderna.pdf

Read the complete paragraph if the bit you highlighted. They recommend transport frozen but understand that for operation reasons it may be necessary to transport at +2-+8C. They see the necessity of it so have recommended a coolbox

The HSE method of management of delivery is not an outlier

hynesie08

steddyeddy wrote: »

Let me get something straight. You're asking what has the revelation that the Biotech/Pfizer vaccine has extra doses got to do with the fact that the Coombe should have known there was extra doses?

So, you claim to have worked for the HSE for years, surely you understand the difference between a finding and a directive, and more importantly how jurisdictions work?

Bass Reeves

hynesie08 wrote: »

So, you claim to have worked for the HSE for years, surely you understand the difference between a finding and a directive, and more importantly how jurisdictions work?

A little knowledge is a dangerous thing.

There are a few posters on here that have read a few bits and pieces about the vaccine. They then presume they know more than the medical professionals that put these plans and processes in place.

There are those that think they know enough to second guess these people. I have read bits and pieces. This vaccine is temperature sensitive. It has different life spans in different senario's.

However in the few storage documents I have read about it one thing kept hopping out to me.

Repeated on them was minimise opening of fridge's, fridge boxes, freezer boxes or freezers. Do not be open and reopening storage equipment.

This is not a product that you can store in an ordinary fridge overnight it might or might not be viable the following morning.

The HSE have a process in place. They will adapt and readapt it as necessary. The planning of the rollout is to devise a method that can be adapted to a larger scale when we will be vaccinating 100-150k people a week if everyone is to be vaccinated by late Autumn.

The Phizer vaccine is the most complicated of the vaccines and it will more than likely require a higher skill set that Moderna or Oxford. However it will be the larger volume vaccine that we will use in the EU.

Bass Reeves

All this reminds me of the quote of Moltke the elder the great Prussian general

“No plan of operations extends with certainty beyond the first encounter with the enemy's main strength.”

Today it is shortened to

''No plan survives contact with the enemy''


It really apt, the WHO highlighted this at the start of the battle with this disease in a different way. It said perfection was not the answer speed of reaction was what mattered.

The important thing is to adapt plans to field conditions. This is especially true if the vaccination program. There will never be a process that will be completely field proof. Staff will have to make decisions in cases like that. Not all decisions will be 100% correct but they will be the correct decision at that time.

plodder

Bass Reeves wrote: »

Read the complete paragraph if the bit you highlighted. They recommend transport frozen but understand that for operation reasons it may be necessary to transport at +2-+8C. They see the necessity of it so have recommended a coolbox

The HSE method of management of delivery is not an outlier

I never said it was an outlier, but if they are thawing the vaccines completely before transport, that might be.

This is not a product that you can store in an ordinary fridge overnight it might or might not be viable the following morning.

Every single document that anyone has quoted, clearly says they can be kept in a fridge for up to 5 days. I quoted one of them above. Why do you keep denying this?

Bass Reeves

plodder wrote: »

I never said it was an outlier, but if they are thawing the vaccines completely before transport, that might be.


Every single document that anyone has quoted, clearly says they can be kept in a fridge for up to 5 days. I quoted one of them above. Why do you keep denying this?

I never denied it but they must be kept in a temperature controlled alarmed fridge. The fridge must be set to 5C with a +/-3C alarmed tolerance. They shouldn't be put into a fridge that is constantly open and closed ( average medical fridge in a hospital) all the time.

There is strict criteria for the approval of these vaccines as they were approved under emergency conditions by drug approvals agencies.

Phizer rushed there a bit IMHO as it seems there are redoing certification that may allow storage temperature and conditions to be changed.

What I am staying is they cannot be f@@ked into any fridge beside the butter and milk.

Another interesting thing I came across was there ultra cold freezers (-75C) are normally only found in medical research center's. These freezers are not in place in hospital's. That why transportation and storage in dry ice is important in larger countries where vast numbers have to be vaccinated and shipping distances are much lower longer than we encounter in Ireland.

davetherave

plodder wrote: »

I never said it was an outlier, but if they are thawing the vaccines completely before transport, that might be.


Every single document that anyone has quoted, clearly says they can be kept in a fridge for up to 5 days. I quoted one of them above. Why do you keep denying this?

He might mean like a pharmaceutical fridge, as opposed to "ordinary fridge".

Bass Reeves

davetherave wrote: »

He might mean like a pharmaceutical fridge, as opposed to "ordinary fridge".

As I posted above yours it a bit more complicated than that but you are more understanding of the issues

plodder

davetherave wrote: »

He might mean like a pharmaceutical fridge, as opposed to "ordinary fridge".

I'd be fairly sure hospitals have pharmaceutical fridges and maybe many nursing homes do too. In fact, we know that GPs in the UK have the right kind of fridge because they are storing the vaccine overnight in their surgeries.

Bass Reeves

plodder wrote: »

I'd be fairly sure hospitals have pharmaceutical fridges and maybe many nursing homes do too. In fact, we know that GPs in the UK have the right kind of fridge because they are storing the vaccine overnight in their surgeries.

Pharmaceutical fridge's would be common 99.99999999999999% ( I have exaggerated by 0.9999999999%)of GP's pharmaceutical fridge's are not reopened from 6pm-8am in the morning and if they are it's once maybe twice in the night. In a busy hospital like the Coombe they would be opened regularly.

Anyway the UK is rushing everything to do with this. They f@@ked up with there strategy from the start. They have 75k extra people killed compared to the strategy the Irish government, NPHET and the HSE rolled out. So sorry I won't be taking any guidance from UK planing and consider it as best practice

plodder

Bass Reeves wrote: »

Pharmaceutical fridge's would be common 99.99999999999999% ( I have exaggerated by 0.9999999999%)of GP's pharmaceutical fridge's are not reopened from 6pm-8am in the morning and if they are it's once maybe twice in the night. In a busy hospital like the Coombe they be opened regularly.

Anyway the UK is rushing everything to do with this. They f@@ked up with there strategy from the start. They have 75k extra people killed compared to the strategy the Irish government, NPHET and the HSE rolled out. So sorry I won't be taking any guidance from UK planing and consider it as best practice

Yeah, whatever. Who are you anyway? Expert in everything from GP fridges to analysing the UK Covid vaccination strategy. Good night.

astrofool

plodder wrote: »

Yeah, whatever. Who are you anyway? Expert in everything from GP fridges to analysing the UK Covid vaccination strategy. Good night.

I wouldn't be hesitant to say that he's someone who understands this a lot better than you do, and hopefully won't resort to attacks on a persons character.

Bass Reeves

plodder wrote: »

Yeah, whatever. Who are you anyway? Expert in everything from GP fridges to analysing the UK Covid vaccination strategy. Good night.

No I would not claim to be an expert in anything. But generally I try to understand why a decision is made whether it dropping a nuclear bomb on Hiroshima or putting my knee on George Floyd's neck. In both cases I have done the same but I think When GF was handcuffed I have got up off him.

So here my wearing the shoes of the master of the Coombe. I sought to get my staff vaccinated just like every other hospital management. Just a little anecdote maternity hospital's gave suffered a lot because of staff having to isolate because bid expectant mothers testing positive for COVID or even in a situation I am familiar with not informing staff on being admitting that they were COVID positive.

So I take the responsibility of bring on site and helping managing the rollout. From 7.30 am I am on-site. All vaccination staff are arriving and gearing up. The night to day change over is starting and the vaccine cold box arrives. Unlike most doctor I may not micro manage this as I am as much an admistrator as a doctor. I delegate. I am probably looking to get the rollout started and the night staff vaccinated and off site as quickly as possible.

I might watch the first few vials reconstituted and the first few vaccinations and the selfies by both vaccinators and recipient's. I will chat or engage with staff I know over the years.

It 10 pm where has the time gone I got back to the office check emails update on the progress of the rollout maybe contact senior board members. Around lunchtime I am contacted that there is more vial's than we should have. I go down to the vaccination center. At this stage I check and recheck numbers . Yes there is extra but we are unsure how many.

I contact the HSE vacination admin about returning procedures, ''they be back to me'' . I go back and try to recheck with staff but it's busy. I am back to vaccination admin over and back check and recheck. There must be a mistake. The data is coming now 6-7 doses per vial as opposed to 5.

HSE has no returns policy or no storage policy and no reserve group to be called. There advice is to layer down the administration program to secondary staff. I start to roll out this. However we need to allow for night staff. I assertain what this number will be. It 4pm I authorize the administering to all clerical and admin staff in the building and contact all off duty staff that tho can be vaccinated.

My son's who work here are looking for a lift home they can wait. Now We have control 150 due on nights +/- 10 allowing for staff that may be working OT or agency staff that may have being done in the morning.

I discuss with a few members of the vaccination team just as I have done all day and on the program over the last few days. We need a reserve panel. We need 2 vials in reserve on case our night figures are incorrect or staff ( agency staff) are on we have not accounted for.

Someone suggest s first and second reserve however all tiers in the hospital look like they're done. Different senario's are looked at however these may on get a second vaccine. Someone suggests older people. We put a group of 10 in place. Second reserve no point in really but as my son's are around someone suggests (I think they are group 4 status) we look at a non critical grouping that more than likely not get a second dose.

By 9 pm I am surviving on adderlin.

Bass Reeves

astrofool wrote: »

I wouldn't be hesitant to say that he's someone who understands this a lot better than you do, and hopefully won't resort to attacks on a persons character.

TBH I can put the boot in now and again but I pick my times

plodder

astrofool wrote: »

I wouldn't be hesitant to say that he's someone who understands this a lot better than you do, and hopefully won't resort to attacks on a persons character.

Too late. You obviously haven't been following the thread.

This is the internet and anyone can claim to be anything. I'm interested in people though who can back their opinions up with authoritative references. So, when someone says that all the UK GPs are doing the wrong thing, then if they can't back that up, I take it with a pinch of salt.

is_that_so

Bass Reeves wrote: »

No I would not claim to be an expert in anything. But generally I try to understand why a decision is made whether it dropping a nuclear bomb on Hiroshima or putting my knee on George Floyd's neck. In both cases I have done the same but I think When GF was handcuffed I have got up off him.

So here my wearing the shoes of the master of the Coombe. I sought to get my staff vaccinated just like every other hospital management. Just a little anecdote maternity hospital's gave suffered a lot because of staff having to isolate because bid expectant mothers testing positive for COVID or even in a situation I am familiar with not informing staff on being admitting that they were COVID positive.

So I take the responsibility of bring on site and helping managing the rollout. From 7.30 am I am on-site. All vaccination staff are arriving and gearing up. The night to day change over is starting and the vaccine cold box arrives. Unlike most doctor I may not micro manage this as I am as much an admistrator as a doctor. I delegate. I am probably looking to get the rollout started and the night staff vaccinated and off site as quickly as possible.

I might watch the first few vials reconstituted and the first few vaccinations and the selfies by both vaccinators and recipient's. I will chat or engage with staff I know over the years.

It 10 pm where has the time gone I got back to the office check emails update on the progress of the rollout maybe contact senior board members. Around lunchtime I am contacted that there is more vial's than we should have. I go down to the vaccination center. At this stage I check and recheck numbers . Yes there is extra but we are unsure how many.

I contact the HSE vacination admin about returning procedures, ''they be back to me'' . I go back and try to recheck with staff but it's busy. I am back to vaccination admin over and back check and recheck. There must be a mistake. The data is coming now 6-7 doses per vial as opposed to 5.

HSE has no returns policy or no storage policy and no reserve group to be called. There advice is to layer down the administration program to secondary staff. I start to roll out this. However we need to allow for night staff. I assertain what this number will be. It 4pm I authorize the administering to all clerical and admin staff in the building and contact all off duty staff that tho can be vaccinated.

My son's who work here are looking for a lift home they can wait. Now We have control 150 due on nights +/- 10 allowing for staff that may be working OT or agency staff that may have being done in the morning.

I discuss with a few members of the vaccination team just as I have done all day and on the program over the last few days. We need a reserve panel. We need 2 vials in reserve on case our night figures are incorrect or staff ( agency staff) are on we have not accounted for.

Someone suggest s first and second reserve however all tiers in the hospital look like they're done. Different senario's are looked at however these may on get a second vaccine. Someone suggests older people. We put a group of 10 in place. Second reserve no point in really but as my son's are around someone suggests (I think they are group 4 status) we look at a non critical grouping that more than likely not get a second dose.

By 9 pm I am surviving on adderlin.

If they do identify issues with the process in their review the damage was more likely done when they got news they would be getting it and the plan they subsequently drew up.

Bass Reeves

plodder wrote: »

Too late. You obviously haven't been following the thread.

This is the internet and anyone can claim to be anything. I'm interested in people though who can back their opinions up with authoritative references. So, when someone says that all the UK GPs are doing the wrong thing, then if they can't back that up, I take it with a pinch of salt.

Read my post I did not say that UK GP's were doing the wrong thing. What I said was that I would not consider UK policy on COVID as best practice in general.

I also pointed out that GP's fridge's are a different storage device simply from the fact that they would not be reopened overnight generally.

Yes you posted references and I pointed out that the he reference material did not hold up your points as they actually have the methods that the HSE is using and that there technical details contradicted your supposition about overnight storage

Bass Reeves

is_that_so wrote: »

If they do identify issues with the process in their review the damage was more likely done when they got news they would be getting it and the plan they subsequently drew up.

IMO there was no damage done what did happen was more doses were on hand than they requested due to excess doses in vials. They had to manage that scenario

is_that_so

Bass Reeves wrote: »

IMO there was no damage done what did happen was more doses were on hand than they requested due to excess doses in vials. They had to manage that scenario

There are clearly a lot of moving parts in this. Get a good responsive plan and deal with all the "what if" questions at the start and you'll deal with it better. That includes drilling down on any concerns with the HSE guidance with the HSE, first. We've seen 70,000 HCWs vaccinated almost wholly without any of this drama so that points to local systemic failings. We'll see what the review says.

plodder

One media report I saw seemed to say that the Rotunda was taking the dregs from vials to give to people not on the official list on the same basis of not wasting any vaccine. Not sure if this was exactly what was happening or they were only using a seventh dose when they were able to get one, but drawing vaccine from multiple vials is very definitely indicated against in the Pfizer documentation. If this were to continue then we will have an ongoing issue with what happens with these people when they are due to get the second dose, and who is being bumped down the queue to facilitate that,

steddyeddy

hynesie08 wrote: »

So, you claim to have worked for the HSE for years, surely you understand the difference between a finding and a directive, and more importantly how jurisdictions work?

You're asking a question with no relevance to what I'm saying.

The HSE were aware that there was a high likelihood of there being extra doses. They had no effective back up list or this.

steddyeddy

Bass Reeves wrote: »

Why would they have known??

Because of an article published in newspaper published in another country.

Did you read my post here the important bit

Because it was being discussed by the EMA, FDA and numerous other countries. Medical knowledge isn't confined to countries. It's that simple. It had previously been reported that there was extra doses and the HSE would have been aware a ruling was imminent from the EMA on the usage. They should have had a back up list for this reality.

That's the way medicine works. You're not talking about changing someone's dosage we're talking about a well publicised fact that the Pfizer vaccine contained more doses than originally thought.

Just to give you an idea of the logistics and I do not work in the HSE or in the medical area but I can guess the pressure that was on.

Well I did and it's highly incompetent not to have a back up plan that doesn't rely on nepotism.


[/QUOTE]I think they vaccinated 1100 people in what I guess would be a 12-14 hour day.[/QUOTE]

Yes and it's bloody impressive. It doesn't account for what happened though.

plodder

Bass Reeves wrote: »

Read my post I did not say that UK GP's were doing the wrong thing. What I said was that I would not consider UK policy on COVID as best practice in general.

I also pointed out that GP's fridge's are a different storage device simply from the fact that they would not be reopened overnight generally.

Yes you posted references and I pointed out that the he reference material did not hold up your points as they actually have the methods that the HSE is using and that there technical details contradicted your supposition about overnight storage

So, it's okay for GPs to keep vaccines overnight, but not hospitals because they open their fridges more often?

Bass Reeves

plodder wrote: »

One media report I saw seemed to say that the Rotunda was taking the dregs from vials to give to people not on the official list on the same basis of not wasting any vaccine. Not sure if this was exactly what was happening or they were only using a seventh dose when they were able to get one, but drawing vaccine from multiple vials is very definitely indicated against in the Pfizer documentation. If this were to continue then we will have an ongoing issue with what happens with these people when they are due to get the second dose, and who is being bumped down the queue to facilitate that,

The Coombe figures are 120 doses they had to find candidates. They vaccinated about 1100 hundred people. Not that's only an oversupply of 10% or an average 5.5 doses per vial.

But they indicated they were getting 6 from vials and 7 from some vials. At 6.5/vial you are looking at 30% extra doses. IMO 120 is only the number of extra doses supplied outside the Coombe vaccination criteria. At 30% extra doses per vial they would only have been technically supplied with vaccine for 850 staff.

Yiu seem to be indicating again that vaccine should be binned with your issue with the 7th dose. I imagine staff administrating the vaccine are we trained. Using the best practice syringes and gauge needles will put you at 7 doses a lot if the time.

As policy should be to supply the same number of vials per site. Then vaccination should be prioritized to staff and lowest priority people vaccinated in first round should nit get second dose

Bass Reeves

plodder wrote: »

So, it's okay for GPs to keep vaccines overnight, but not hospitals because they open their fridges more often?

Either case would be outside Phizer's vial management criteria. However GP's fridge are less likely to be opened and closed multiple times. This is an issue with storage in fridge's.

At least one of documents you supplied set the criteria for fridge storage.

plodder

Well I think the idea that hospitals wouldn't have the same flexibility as GP surgeries sounds daft and not credible, for the sake of re-organising a few refrigerators.

As regards the dregs after 6 doses are extracted, then they should be binned unless there is enough remaining for a seventh dose. It's what Pfizer has said ... unless they have qualified that advice since..

lucernarian

Bass Reeves wrote: »

Pharmaceutical fridge's would be common 99.99999999999999% ( I have exaggerated by 0.9999999999%)of GP's pharmaceutical fridge's are not reopened from 6pm-8am in the morning and if they are it's once maybe twice in the night. In a busy hospital like the Coombe they would be opened regularly.

Anyway the UK is rushing everything to do with this. They f@@ked up with there strategy from the start. They have 75k extra people killed compared to the strategy the Irish government, NPHET and the HSE rolled out. So sorry I won't be taking any guidance from UK planing and consider it as best practice

This is faulty logic. May as well bring Brexit up and the fact that they're a monarchy in why we shouldn't follow practices from the UK.