Decatur Morgan Hospital hit a new record of COVID-19 patients Tuesday even as it was taking steps, including the ordering of an ultralow-temperature freezer, to provide COVID-19 vaccinations to front-line hospital employees and area first responders.

Hospital CEO Kelli Powers said she ordered a $6,000 freezer that will store the Pfizer-BioNTech vaccine at temperatures of about negative 100 degrees Fahrenheit, and she is working with the Alabama Department of Public Health to compile a list of employees and first responders who would receive the first round of vaccines when they are available.

As of Tuesday, 36 hospital employees were in quarantine.

“We’re sort of at the mercy of the Department of Public Health on how many (vaccine doses) we will get. We have signed up to receive the vaccines; right now we’re just preparing to get them,” she said.

The hospital had a record 82 confirmed or presumed COVID-19 patients Tuesday. The previous record, 69, came Monday. The hospital’s intensive care units were full both days. On Tuesday, eight of the hospital’s 19 ICU beds were occupied by COVID-19 patients, including three on ventilators.

"We’ll just have to do a makeshift (ICU) somewhere. We already have a plan, it’s just making sure we have everything in place," she said.

The hospital set up a COVID unit at its Parkway campus, and on Tuesday patients were being transferred to the unit to reach its current maximum capacity of 15 patients.

“If we didn’t have that Parkway unit, I don’t know what I would do,” Powers said, although the facility does not have ICU beds.

While the timing of vaccinations depends on when and if the Food and Drug Administration grants emergency use authorization to Pfizer and to Moderna, which has developed a vaccine that does not require ultralow storage temperatures, Powers said she hopes to have the first dose of the vaccines to front-line hospital employees and first responders by the end of the month.

“We wanted to get our own freezer so we’ll get our own vaccine here. We’re working with the local Department of Public Health to come up with a plan to vaccinate all of our first-line medical staff, nursing staff and others on the front line, and all of the first responders like ambulance, police, fire — people who are responding and picking up patients when they have no idea if they’re infected, just like we are,” she said. “I’d love to be able to do all of them at least by the end of the year. Maybe we can do it sooner; it just depends on how much vaccine we get.”

Powers said she hopes to begin solidifying the vaccination plans when she receives input from ADPH later this week.

"The medical staff and leadership here want to be ahead of the game. We want to vaccinate as many people as we can to help Morgan County and our surrounding counties to get this crisis under control," she said.

Both vaccines require two doses, either three or four weeks apart. The vaccines are not expected to be available to the general public until at least spring.

According to Pfizer, its vaccine can be stored up to six months at negative 94 degrees Fahrenheit (negative 70 degrees Celsius). In can be stored in hospital refrigeration units, at about 35-40 degrees Fahrenheit, for five days. The company plans to ship the vaccine in thermal containers with dry ice, and the vaccine can be stored in the containers for 15 days if the dry ice is replenished.

The Moderna vaccine, also awaiting FDA approval, can be stored for 30 days at typical refrigerator temperatures and can be stored six months at negative 4 degrees Fahrenheit, according to the company.

Vaccine safety

Powers said she has confidence that the vaccines that receive emergency use authorization will be safe, in large part because doctors at the hospital have said they plan to take it as soon as it’s available.

“What gives me comfort is knowing that these doctors — who are very smart, who understand science — are going to take it. If they’re going to take it, you know I’m going to take it,” she said.

Dr. Jeanne Marrazzo, director of UAB’s Division of Infectious Diseases, on Tuesday also expressed confidence in the safety and efficacy of the Pfizer and Moderna vaccines, but she said vaccine side effects are similar to the shingles vaccine and are not pleasant.

“In the trials, the main side effects the vaccine showed was a sore arm, not surprisingly, but also fevers, also fatigue, also muscle aches,” Marrazzo said. “It’s not a picnic. … We’re going to have to prepare people for not feeling particularly good for a couple of days. We can’t sugar-coat this vaccine.”

She said the quick roll-out of the vaccines means no long-term safety data has been compiled, and there also is no data on the vaccines’ impact on pregnant women or children.

While the Pfizer and Moderna vaccines appear promising, she said, it is important that development of other vaccines continue.

“We’re never going to get enough supply just from those initial vaccines. We need more than one platform, more than one vaccine. We also need alternatives in case there does turn out to be a safety issue with these first vaccines,” Marrazzo said.

While the Centers for Disease Control and Prevention on Tuesday recommended that health care workers and nursing home residents receive the vaccine first, Marrazzo said epidemiologists are also looking at different approaches aimed at reaching herd immunity — immunity of enough of the population to minimize the likelihood of community spread — as quickly as possible.

“Are you vaccinating people to prevent them from getting sick and dying, or are you vaccinating them to prevent them from being the most efficient spreaders? Those are two very different targets,” she said.

If the focus is on those most vulnerable to serious COVID-19 complications, people who are over 65 or have preexisting conditions are the best candidates for the vaccine, but Marrazzo said they generally are not the people most responsible for spreading the virus.

Once the most vulnerable are protected, she said, there is an argument for changing the focus to herd immunity.

“For herd immunity you really might want to target people who are the most likely to be the sources of the spread in the community,” she said. “… For a community-based, herd-immunity-promoting approach, you might want to go into the younger folks who we know are fueling a lot of the community spread.”

ADPH on Tuesday reported 103 new COVID-19 infections among Morgan County residents. The county first exceeded 100 new cases Oct. 30. Since then, it has broken the 100-per-day mark seven times, including each of the last three days. One new COVID-19 death was also confirmed in Morgan County on Tuesday, bringing the cumulative death toll to 51.

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