"We sacrifice our free time in order to vaccinate citizens"

Girona"Let's see if you can get rid of the bug", "Can we go out now?", "Finally, I'm going to get a shot!" These are some of the sentences that most of the 22,737 elderly people living in nursing homes, who have received their first dose of Pfizer in the last few days, whisper in their ear. "When you arrive with the vaccine, you are welcomed as if you were the Three Wise Kings! They have had a very bad time, and they are very happy when they get their shots. We all feel that we are living through a historical moment, a very beautiful and emotional one", Joana Cabezas, one of the nurses in charge of the vaccinations in the region of Lleida, describes.

Like her, more than 5,000 nurses across the country volunteered to participate in the vaccination campaign that began on 27 December. They give injections outside of their working hours, and that includes many days after several working days. "I was supposed to do 8 a.m. to 3 p.m., but they asked me if I could stay in the afternoon, as they are short of staff. And when I leave at 9 pm, I will go to Bellvitge Hospital, where I start work at 10 pm and work until tomorrow morning", Anna Bou, 36, says, who works in the Bellvitge emergency room and now also in the primary healthcare unit CAP Alhambra in Hospitalet de Llobregat, in the vaccination campaign. However, Bou does not complain or critizice, she simply describes and gives examples of the commitment felt by those in her profession. "You do it because it comes out of you. Because we are people who take care of people and we have suffered a lot in the last few months, we have been through a lot". "We all sacrifice our free time and our rest days in order to vaccinate all citizens", Cabezas also states.

Organizing vaccinations

When she starts her vaccination day, Bou arrives at the CAP Alhambra, where she finds the refrigerators prepared with the exact number of doses for the day, the list of care homes and the disabled that must be vaccinated, and an emergency team in case someone has an allergic reaction. "So far, no one has had any reaction, apart from redness or discomfort of the injection", the Barcelona native stresses.

Each health region is divided into areas, with a coordinator who distributes and organizes the daily injections. In the case of Girona, it is divided into two areas, and the one in charge of the north is nurse Ruth Martín, 27. "We have 10 nurses in the morning and 10 in the afternoon, and 6 administrative staff who accompany them. And we have to plan, with the delegates of each home, the day we will go and what order of doses we will need", she says.

The Pfizer vaccine has some characteristics that complicate the logistics of vaccination, and the professionals who have to inject it have received previous and specific training of about three hours. The doses must be kept at -70º, but by the time they reach the primary healthcare units and hospitals for distribution, they are already thawed. Then, if kept at 2-8 degrees, they can be used for five days. "They come in coolers that control the temperature 24 hours a day, with cold accumulators and plates that prevent them from moving during transport", Martín continues. In fact, one of the most important points in order not to damage the vaccine is to avoid any shaking or sudden movement. "When we take them out of the van, we try to transport them between two nurses so that the container always goes straight. And we always repeat that the doses should be treated like cotton wool, very gently".

Most vaccines arrive ready to be administered in individual doses. But the Covid Pfizier one comes in vials of five doses and this - according to the nurse - means that each centre can only vaccinate a multiple number of five: "In homes, we always give priority to the users. And if three workers remain unvaccinated, we come back the next day".

Once they open the vial, they must prepare the doses: the vaccine RNA must be diluted with serum and mixed with ten very gentle movements that must be repeated twice, halfway through the vaccination process at first. "And everything has to be very carefully planned because, once you have reconstituted the vial, you have to put the doses to five people at once, they cannot be moved from one centre to another", Bou adds.

Injections seven days a week

As for the criticism that appeared in the first days because of the low rate of vaccination, the three nurses say they have not stopped since December 27. "I've gone to vaccinate on Sundays and even on the Epiphany Day" the nurse from Lleida explains. And the one from Barcelona adds: "It's no use having 100 vaccinations if you don't have staff, but it's normal that at the beginning it's difficult to organise because we hadn't done it before".

However, the coordinator of Girona North admits that they have not yet received any indications on how they should organise the vaccination with the doses of Moderna, which is expected to start arriving in Catalonia this week. Unlike Pfizer's, this vaccine can be kept at 20 degrees below zero for six months and in a standard refrigerator for one month, which will facilitate its distribution. However, both vaccines require two doses to achieve immunity, and if a person receives the first of a brand, the second must be of the same brand. As of January 8, the first dose has been injected to 53,343 Catalans, including residents and health care providers.

There is still a long way to go before the entire population is vaccinated, but all three are living the historic milestone with "enthusiasm", "responsibility" and, above all, "with a lot of excitement". "We only ask that we be valued more, that we nurses always give everything, and we have shown it" Bou asks, and Cabezas encourages vaccination: "We have a duty for the elderly, for those who are not here, and for those who are".