Vaccines in the dining room

CastelldefelsIn the dining room of her home, 81-year-old Pilar is anxiously awaiting the arrival of the nurse who is to vaccinate her. So much so that when Diana walks through the door, she already has her sweater sleeve rolled up. "It's to save time", she says matter-of-factly. The old woman's witticism makes the nurse laugh, but the truth is that she has done it consciously: Pilar was warned that she would arrive at ten in the morning and that she would go quickly because she has to vaccinate other people over 80 years old who do not leave the house. Like her, who, with the outbreak of the pandemic, has been hijacked at home.

"Did you feel any discomfort with the first injection?" asks Diana as she disinfects the skin on her arm with gauze. Because of her age, it is Pilar's turn to receive the Pfizer vaccine, in this case the second dose. "Just a little pain here the day after", she says, pointing to her shoulder, "but generally very well", she replies. The distraction technique always works: by the time Pilar thinks about it, the nurse has already jabbed her. "That's it? I didn't even notice!" the woman exclaims happily.

When she leaves the house, Diana follows a ritual that she will have to repeat at least fifteen more times in the course of the morning. She throws the used syringes into a container which she will return to her primary healthcare centre (CAP), takes off her plastic apron and gloves and washes her hands with hydroalcoholic gel.

Routes already planned

In a white car with the CAP Can Bou logo on the sides, the nurse drives up and down the streets of Castelldefels. Jessica, the colleague with whom she exchanges roles, drives the car: one day one drives and carries the syringes and the other vaccinates. The next day they will do it the other way round. The car is a mobile vaccination point: in the boot, in a blue cooler, there are three vials of Pfizer, equivalent to 21 doses. Bearing in mind that they have just given one to Pilar, the nurses still have twenty doses to inject.

"If there is a problem, such as the person not wanting to get the vaccine despite having said yes over the phone, or not being home when we get there, this dose will be administered to the next person on the list", says Diana. If no one else is available in home care, the vial will be returned to the CAP to vaccinate another person (80 years of age or older) within four hours of thawing. This time they are injecting second doses, and they are confident that they will use them all.

The team of nurses have drawn up a document with a sort of planned route to travel to the homes of their vulnerable patients, arranging them according to the proximity of their addresses. By grouping them into zones, they say, they don't go round in circles and get much more out of their journeys.

The next names on the vaccination list are Concepción, 100, and Tomasa, her daughter and caregiver. They live just a few meters from Pilar. Jessica sings the patients' characteristics to her before getting out of the car. And while Diana puts her gown and gloves back on, her partner reconstitutes the vaccine and extracts the next two doses.

The process has to be done very delicately so as not to spoil the vaccines: ten movements have to be made to remove the coldness from inside, without shaking the vial, add the saline solution and move it gently again to integrate the preparation. The nurse then loads two syringes and places them on a metal tray.

As the vaccines are very sensitive to heat and the sunlight cannot shine directly on the syringes, Diana has to carry them hidden under a paper sheet, the colour of the operating room gowns, until she reaches her destination. There are only a few meters between the car and the house, but the curious gaze of pedestrians is lost inside the tray. In the eyes of the population, Diana carries hope. She, on the other hand, is focused on not touching anything that could contaminate her gloves.

Protecting the most vulnerable

"I've put it on Concepción's right arm and Tomasa's left", Diana says in return. Jessica writes a "D" and an "E" next to each name with this essential information to keep track of any allergic reactions or adverse effects. Even though they've never been called in for vaccine discomfort so far, they have to document as much information as possible.

It is almost midday and after vaccinating a dozen other people it is the turn of Dirkje, a 100 year old woman, and her son, Wilhem, who is 80 years old and has underlying diseases. And after them, near the promenade, comes the appointment with Neus, also almost 100 years old, who lives in a small flat overlooking the sea. In less than four hours, the two nurses have used a total of 18 doses. "You spend more time going from house to house than vaccinating. That just takes a second", Jessica sums up.

Only 36.5% of people over 80 years old and 72.5% of those who are highly dependent are vaccinated with the first dose, according to government data. There are still many people in these cases who have not received any message from their CAP. The Department of Health began the vaccination of this population in mid-February and attributes this administrative silence to delays in the delivery of vaccines. According to the Government, the lack of stock has forced to prioritize second doses in the first 100,000 elderly people. "In mid-May we will have both doses administered", pledged the Secretary of Public Health, Josep Maria Argimon.

The aim of vaccinating the elderly is to protect the most vulnerable, since the risk of falling ill and dying from covid increases with age. For many, immunization stands as the window to a certain normality after months away from their loved ones. Like Herman and Maria Dolors. "Will we be able to see our grandchildren with a face mask?" they ask impatiently. "With a face mask, you can" insists Diana.

The data from the CAP Can Bou are slightly higher than the Catalan average: of the 1,155 people over 80 years old assigned to the CAP, 50% have already received the first dose. Jessica and Diana do not end the vaccination day with the doses of Herman and Maria Dolors, but they will continue vaccinating in the CAP to those autonomous patients who have been able to get to their vaccination point. "And we will use as many as we get. Also during Easter", they say.