Karen Miller’s week started a little earlier than planned, when an automated call came in: a clinic had lost power.
At least it was around 7 a.m., and at the Englewood clinic, where she’d already planned to work that day. In her 14 years with the Tri-County Health Department, she’d had 11 p.m. and 3 a.m. calls, some of them from the other side of the department’s territory.
Still, the clock was ticking: the vaccines would stay at the correct temperature for two hours, but if the power outage was going to continue, she and anyone who was available would need to start packing coolers.
“It’s at that time where we have to start making some decisions,” she said on a Monday morning in October, shortly before the electronics in her office clicked back to life, roughly an hour and 15 minutes into the outage. Crisis averted, but there were more fires to put out: the WiFi and printer were still down, and the first patient was due to arrive in 15 minutes.
Miller, a nurse manager for the Tri-County Health Department’s immunization program, oversees the department’s five clinics that offer shots in Adams, Arapahoe and Douglas counties, and helps the team coordinating its COVID-19 vaccination rollout and messaging. Douglas County formed its own Board of Health to get out of Tri-County’s public health orders related to the virus, but the health department still runs immunizations clinics there.
On that day, Miller was working with nurse Hanna Kundert, who had started in May and completed most of her training, but still needed to double-check how to handle patients who were off the typical vaccine schedule.
While overseeing vaccinations may seem simple to those of us who primarily remember our inoculations as a brief pain followed by a cartoon-themed Band-Aid and maybe a lollipop if we were brave, it’s anything but.
Doses have to be stored at different temperatures. Some go into the muscle, some into the fat under the skin. And heaven help you if you give a dose meant for uninsured children to someone with private insurance, or vice versa — it doesn’t harm the patient, but you’ve just bought yourself a paperwork nightmare.
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Given all of the complications, it takes months before a new nurse is comfortable working alone, and they’ve had more trainees than usual. No one left the immunization program in the two years before the pandemic, but five have left since: two to move closer to their families, and three for other public health jobs in Colorado, Miller said. They’ve also had to bring on 45 temporary clinical and clerical workers, first to help with contact tracing, then to distribute COVID-19 vaccines, she said.
The Englewood clinic operates two vaccination stations out of what look like repurposed cubicles, with screens they can pull across for privacy. It’s a relatively spartan space, apart from two Van Gogh-style paintings on the mustard-colored walls, though the sticker and snack trays are evidence that the primary clientele is young.
After Miller and Kundert had vaccinated a combined five children and two adults, there was a brief lull, which Miller used to answer some emailed questions about boosters and to schedule a time for the state health department to pick up Moderna COVID-19 doses being stored at Tri-County’s warehouse. It’s unusual to have any downtime in October, when schools are notifying parents that their children’s shots aren’t complete, Miller said.
“This is typically a really busy time of year for us, and it’s weird that we have a break now,” she said.
The break wasn’t long; an older couple arrived shortly afterward for shingles shots, and Kundert called an interpretation line to convey the possible side effects in Mandarin Chinese. After vaccinating them and bidding them good day, Kundert joked that the clinic had seen the full range of patients that morning, except for an infant or someone with a shot record in another language.
Less than 20 minutes later, a mother and son came in. The boy’s records were spread across several sheets of paper, some in English and some in Spanish. Based on the English-language records, he was in for quite a few pokes that day, but after Miller and Kundert translated and cross-referenced the papers, he got away with only two: one for measles, mumps and rubella, and a winter flu shot.
Most people end up at the health department after something has gone wrong, Miller said: they’ve lost their job and insurance, or life got complicated and their kids fell behind on their vaccines, creating complications for school. Sometimes, it’s as simple as that their pediatrician ran out of the doses that the federal government provides, and sent them to a place that could vaccinate eligible kids for free.
“We’re sort of the last resort for them,” she said.
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