Coombe And Get It

at

This morning.

In a statement, Minister for Health Stephen Donnelly said he was made aware last night of a situation with regard to the administration of vaccines on Friday at the Coombe Women and Infants University Hospital.

Via RTÉ:

“Trust in the vaccine programme is of critical importance and what happened should not have happened,” the statement added.

“Our vaccine allocation strategy clearly sets out a priority list for vaccination – and that’s currently for frontline healthcare workers and residents and staff of our long term residential care facilities.

“It does not include family members of healthcare workers.

“I will be speaking with the Chair of the Coombe Hospital Board for a full account,” the statement said.

‘Full account’ sought after family members of Coombe staff given vaccine (RTE)

Meanwhile…

Saturday.

Phoenix Park, Dublin.

The Moderna vaccine being administered at the HSE National Ambulance Service HQ in conjunction with HSE Public Health.

Sam Boal/Photocall Ireland

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73 thoughts on “Coombe And Get It

  1. Charger Salmons

    Just 16 vaccine doses.
    Which otherwise would have been thrown away.
    Going to family members of front-line staff at highest risk of infection worried about bringing home the virus.
    A Slaphead Smokescreen to cover up his own deficiencies.
    It’s funny how those 16 doses are easily accounted for when his own department is unable to provide daily figures of who has been jabbed.

    1. Joan Burton

      Sure sure !
      I’ve heard this is widespread. The pharmacist delivers too many does by accident then there just happens to be car loads of family and friends in the area , sure why waste them !!

  2. GiggidyGoo

    “……the Health Service Executive booking system and portal was not yet live and as such it was not possible to pre-book vaccinations and therefore be certain of the number of vaccinations required.”
    Keystone Kops

    1. Redundant Proofreaders Society

      It’s to stoke up Anglo-Irish division. Plenty of other fish here taking the bait!

      1. scottser

        yeah, too many. he takes up way too much oxygen on this site now and i’ve been as guilty as any of feeding the troll.
        i’m done now though, and i’d encourage everyone else to do the same.

        1. benblack

          Not you, scottser, but many reply to his banter/jingoism/trolling – call it what you like – with no banter and more jingoism and trolling.

          I don’t get it?

          It’s harmless, no?

          And, he is quite witty.

          1. benblack

            Think of the trees, scottser, they need the CO2.

            No trees, no monkeys, no scottser.

            Circle of life, man!

            But, I do – I get it.

            How can we compensate you for the cost of the troll feed?

  3. Brother Barnabas

    this is the actual policy in Israel – any spare vaccines at the end of the day are given on a first come, first served basis to the general public. you can sign up to a text alert system to be notified of likely availability at each vaccination centre – people queue in hope. surely makes more sense than having to discard.

    1. ReproBertie

      Definitely makes more sense than discarding. The Pfizer one has to be administered in a number of hours. This is mountain out of a molehill stuff and Donnelly should be concentrating on other aspects of the rollout instead of letting this distract him or others in his department.

    2. GiggidyGoo

      In this case it’s not what you know, but who you know.
      It makes sense not to dump them, but this (and the administering to the top knoobs in other hospitals before the frontline got them) smacks of the usual taking care of No. 1.

        1. GiggidyGoo

          So, why is he apologizing then?
          “In hindsight as Master I deeply regret that family members of employees were vaccinated and for that I wholeheartedly apologise.”

          Apart from that – I though that the vaccines were individually ‘bottled’ or that they were ready to use. This doesn’t suggest that.
          “The decision to use the vaccines that had already been made up was made to ensure that not a single reconstituted vaccine was wasted”. What does he mean by ‘made up’ and ‘reconstituted’

          1. Brother Barnabas

            I agree with you, giggz- absolutely nothing to apologise for

            (although donnelly should be apologising for not yet having a system in place for how best to handle such a situation, which surely should have been anticipated)

          2. GiggidyGoo

            There must be, if he did it.

            I found the reconstituted/made up details here. Nothing to worry about. https://www.ohsu.edu/sites/default/files/2020-12/Vaccine%20Prep%20and%20Reconstitution%20%28Pfizer%29.pdf

            From that. ‘Allowing vial(s) to thaw in the refrigerator [2°C to 8°C (35°F to 46°F)]. A carton of vials may take up to 3 hours to thaw, and thawed vials can be stored in the refrigerator for up to five days (120 hours)’

            Which does in fact bring into question his decision.

          3. Brother Barnabas

            thawed vials can be stored for up to 5 days…

            and when did the coombe take delivery of these vials? they say monday… in which case, they would expire Friday night.

          4. Cian

            There are 2-steps before it can be used. The stuff is thawed and then diluted.
            Once thawed it is usable for 5 days; but once diluted it needs to be used in a few hours.

            I don’t know if this is the same vaccine or a different one:

            – After dilution, it is possible to obtain six doses from a vial if you use low dead-volume (≤35 μL) syringes and/or needles for all doses.
            – Discard the vial and its contents if the amount of vaccine left in the vial is not enough for a full sixth dose (0.3 ml).
            – Do not pool from multiple vials to make up an extra dose.
            Discard any unused vaccine 6 hours after dilution.

            https://www.ema.europa.eu/en/news/extra-dose-vials-comirnaty-covid-19-vaccine

            (my emphasis)

          5. GiggidyGoo

            @Cian. Then obviously you then dilute what you’re going to need. The instruction leaflet suggests to me that you can dilute quickly, as necessary. No waiting time.

            No need to pre-dilute in quantity. If you see 10 people waiting, then you dilute for 10 people.

            The actual vaccine itself holds for 5 days. That means that 3 or 4 vials of it could have been used the following day still. So the reference you made in bold ‘Discard any unused vaccine 6 hours after dilution’ doesn’t really exempt the Coombe from anything. They should have only diluted the number of vials that were actually required.

          6. Cian

            No need to pre-dilute in quantity. If you see 10 people waiting, then you dilute for 10 people.
            Fine, but if you have 11 people waiting you dilute for 15 people. Then you have 4 left over that have to be used within the 6 hours.

            I think this is very shoddy that yer man’s children were vaccinated… and he should have found other staff (cleaners/receptionists/admin/cooks/second-line staff)… although that could have caused a HR nightmare if some members of staff get the vaccination too soon!

            LOL [ninja edit] I just saw this on RTE:
            “The Health Service Executive has said it issued guidance on 12 January on the sequencing of vaccinations of frontline healthcare staff and what to do if there were vaccines that might expire.

            The guidance was issued four days after the events at Dublin’s Coombe Hospital on 8 January, where 16 family members of staff were given the vaccine.

            In its guidance, the HSE said that centres should establish standby lists of frontline healthcare workers later in the sequence order.

            They should be available at short notice and are to be randomly selected from the lists for vaccination in the event that frontline healthcare staff earlier in the sequence order do not attend or cannot receive the vaccine.

            The HSE also advised that centres should consider establishing standby lists of other health staff (provisional vaccine allocation Group 4).”
            https://www.rte.ie/news/coronavirus/2021/0118/1190394-coombe-virus/

          7. GiggidyGoo

            4 vs 16.
            I think we’re pretty much in agreement on it though. It was shoddy to say the least.

  4. Andrew

    I bet the Master of the Coombe didn’t ask cleaning staff or canteen workers before getting his college going kids in to vaccinate.
    James’s Hospital is literally 5 minutes away on a bike. Could he not have rang someone there?

    I’m amazed at the excuses being made by ordinary members of the public defending what was going on here.
    A tolerance for low standards, no wonder we have such a pathetic health service.

    1. Brother Barnabas

      “Could he not have rang someone there?”

      – he’s quoted in the article saying:

      “Had they not been used they would have been discarded. I was keenly aware of that and throughout the evening and from 9.30pm onward I personally made every effort to prioritise and identify additional frontline workers and followed all measures available to me at the time.”

      and they werent “college going kids” – 9 of the 16 were over 70 years of age

      1. Andrew

        Two of the Master’s own children who ARE college going got the vaccine. You, along with quite a lot of the Irish public are apparently okay with this.
        I can only laugh. It’s utterly pathetic

        1. Brother Barnabas

          if that’s true, whatever

          I’d imagine they were struggling to find 16 people who could attend at such short notice

          I’m pleased to see that there’s a marked reluctance within the health service to waste something that’s in such short supply

          1. ( ̄_, ̄ ) AKA Frilly Keane

            Think it must be considered that they couldn’t be used unless medical history etc was known
            And they were within a very narrow and getting narrower window

            In fairness, they did exactly what I would have done

            Whether it was the right thing or not
            Time will tell
            but if I was still there, and they discarded the surplus there would have been words

            I’ve no doubts about the Medical Profession’s, particularly at Consultant level, capacity to look after themselves
            But this is a soft story tbh

            Anything that can divert from M+B coverage and the Vaccine Roll Out logistics and negotiations with ‘Third Party Dispensers’ is given the full roll out

            ‘that’s what I think anyway

        2. Masked

          Better to use a vaccine dose than throw it in the bin.
          It’s one more person vaccinated which most likely means one less person who can get sick from or spread Covid

        3. Fergalito

          Oh my God, imagine that ! The horror … society is crumbling and you can only laugh !

          Will you ever cry again? Or love again ? Must be terrible to be stuck cackling inanely with no end in sight. Get a white furry cat to accent the look.

          1. Andrew

            Why did the Master of the Coombe apologise then?

            You are typical of the forelock tugging, apathetic, smartbotty in this country. Not just a tolerance of sharp practice, nepotism and corruption but you actually admire it.
            The Health Service in this country is crumbling and has been for years.
            The next time you are queing in A&E for 14 hours you might think about that. You probably won’t.
            I’ll leave you to it, I’m not in to a back and forth on this.

          2. Fergalito

            Just because you say I am what you say I am does not mean I am what you say I am.

            Hysterical pointless nonsense about a non-story.

        4. Daisy Chainsaw

          If this hadn’t happened, the alternative headline would have been “Hospital wastes16 useable vaccines at a cost of €XXXX!!” and you’d probably be clutching your pearls over that too. Nobody was conned out of or deprived of their vaccine and better they be used than discarded.

          Anything to distract from the rubbish job this government is doing though, right?

  5. SB

    Another problem with this is that these 16 people will have to skip the queue again to get their second dose

  6. Masked

    Well done Coombe hospital !
    They carefully managed their vaccine allocation and achieved 6 and in some cases 7 doses out of each 5 dose vial.
    They made every effort to contact the most appropriate people to give some extra vaccines to and were successful in this, vaccinating vocal GPs and healthcare workers.
    Nonetheless, late in the day, they still had a small number left over and they decided not to throw these in the bin. 
    But what’s now happened is that they have been condemned from all sides and the upshot is that no other vaccination agency will have any incentive to try to achieve similar increased vaccination rates but rather will be discouraged from being so innovative.
    Once again strict bureaucracy outweighs common sense.
    Again, well done Coombe !

    1. broadbag

      I await the next scandall a few months down the line when it turns out that contrary to what they thought, it’s physically impossible to get 7 doses out of a 5 dose phial and all those vaccinated need to be recalled for a proper dose except there’s no real record of who got what so we’ll probably just vaccinate everyone again.

        1. alickdouglas

          There are a range of reasons to put ‘too much’ vaccine in a vial. First is your confidence regarding how much antigen is in your batch in the first place (remember the Astra problem with half doses? that was partially because they didn’t know how much antigen was present in the batch: that was rather dramatic, but even a well-practiced supply organization will account for measurement error). Next you need to account for loss over time, the antigenic material breaks down, more slowly if frozen, but still. Then, a certain amount of antigen may preferentially stick to the glass or stopper. And finally because you can never remove every drop from the vial. Add all of those factors together and you have an idea of how much error needs to be considered. The fill team are focussed on worst-case scenarios, such as use in 2 years time. So the vaccine is filled as if it’s being used in 2 years, but we are now in this weird situation (basically unprecedented) where vaccine is used the instant it rolls out of the warehouse. Therefore, all vials should contain the full estimate, so using every drop of the vial is fine. Mixing vials is a recipe for disaster, either sterility, or mix up. When I reflect on the complaints we used to deal with with singe dose syringes, I dread to think what stupidity might go on with mixing the dregs of 5 dose vials, yuck.

          1. benblack

            @alickdouglas

            Any thoughts on the mRNA ‘vaccine’ and the comparison to traditional vaccines – which would be your area of expertise because there has never been a mRNA vaccine to date – or do you view both as essentially the same? Even though the mRNA vaccine is genetically based.

            I hope my question is clear enough to be answered.

          2. alickdouglas

            @BenBlack

            Balancing side effects vs. prevention of disease is what modern vaccine design and testing is about. It’s one of the reasons for the reference to ‘risk benefit’ in drug licensure. The smallpox vaccine prevented disease, but with a reactogenicity profile that would be completely inacceptable today:

            “In the 1960s, serious adverse events associated with smallpox vaccination in the United States included death (1/million vaccinations), progressive vaccinia (1.5/million vaccinations), eczema vaccinatum (39/million vaccinations), postvaccinial encephalitis (12/million vaccinations), and generalized vaccinia (241/million vaccinations). Adverse events were approximately ten times more common among those vaccinated for the first time compared to revaccinees. Fatality rates were also four times higher for primary vaccinees compared to revaccinees”.

            These side effects weren’t in the elderly, it was the general population. People with any skin conditions, immune disorder, pregnancy or any allergy were contraindicated, as they were if they had any close contacts with those issues.

            mRNA vaccines are designed to elicit the effectiveness against disease without the side effects. Are they successful at it? As far as we can measure it, the side effects are not significantly worse than any other technology, and the impact against disease is better than any of the inactivated or adenovirus candidates.

            Am I qualified to attest to the efficacy and safety of mRNA vaccines? No I’m not, but then again, no individuals are. That’s why the license is issued on the recomendation of a well qualified committee, and why it took them 5 days of discussion at EMA to come to a decision. I think they are smarter than me. But for some reason, there are a lot of people who hang out on forums and youtube who think they are smarter than them. As I alluded to in my post, I think their job would have been much easier if governments and public health authorities had paid more attention to vaccine licensure before the pandemic rather than running about like crazy people afterwards.

          3. benblack

            “mRNA vaccines are designed to elicit the effectiveness against disease without the side effects. Are they successful at it? As far as we can measure it, the side effects are not significantly worse than any other technology, and the impact against disease is better than any of the inactivated or adenovirus candidates.”

            Let’s just take the first sentence of that paragraph, if you don’t mind, alick.

            “mRNA vaccines are designed to elicit the effectiveness against disease without the side effects.”

            Can you direct me to the accredited site where this is stated as a peer-reviewed fact with scientific data to support it?

            I will pay the paywall costs that may accrue.

          4. benblack

            I would advise readers that this comment was not his original reply to my initial question.

            The chronological order can be obtained by the dates and times of the posts.

            A certain editorial bias has facilitated this.

            Thank you.

        2. alickdouglas

          @BenBlack On paper, I think the mRNA technology is brilliant, and is a logical progression of decades of research. Many people argue that the technology is not tested. Ironically, I think one could argue that for the fist time ever, with an mRNA vaccine, we actually know every single component that’s in the syringe. Consider a 1930s smallpox vaccine. It contains a peculiar mix of smallpox-like virus, cellular and non-cellular stuff from cows and various antibiotics. In contrast, the modern mRNA vaccines contain specifically coded strands of genetic material, a lipid carrier and some buffer. Because of the relatively limited content, it is (theoretically) possible to model what the impact should be.
          I remain cautious however. This pandemic was waiting to happen, and governments and public health agencies did a bloody despicably awful job preparing for it. They were warned constantly, and they didn’t pay any attention. Instead then the research agenda has been driven by corporations. It does not surprise me for an instant that the company that generates the highest cash revenue from an individual vaccine product was the ‘first past the post’ and is now shaping the agenda for the late arrivals. This is the ‘free market’ in action and it is not healthy. Does it mean the vaccines are bad? No. Does it annoy me? Yes. I don’t believe that there are ‘major’ data gaps for mRNA. Neither am I too worried really about side effects that might appear in the distant future. There ‘might’ be some, but the reality is that I cannot think of any that have ever reliably been associated with vaccination: if one regards narcolepsy as vaccine induced the peak of onset was within about 2 months of first dose. Allergic reactions are instant, with already some suggestions of the cause. GBS-type reactions also tend to manifest within weeks of vaccination. MS has been gossiped about in France for Hep B and of course autism for MMR, but these are evidence-free rumors. On the contrary, I think many of the ‘what if’ horror fantasies are poorly informed and driven by people with little experience in immunology.

          1. f_lawless

            The associate editor of the BMJ feels we need more details and the raw data

            Peter Doshi: Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data

            While some of the additional details(released 04/01/2021) are reassuring, some are not. Here I outline new concerns about the trustworthiness and meaningfulness of the reported efficacy results…

            ….We need the raw data

            Addressing the many open questions about these trials requires access to the raw trial data. But no company seems to have shared data with any third party at this point.

            Pfizer says it is making data available “upon request, and subject to review.” This stops far short of making data publicly available, but at least leaves the door open. How open is unclear, since the study protocol says Pfizer will only start making data available 24 months after study completion.’

          2. benblack

            Thanks for your reply, alickdouglas.

            It’s not what’s in the syringe that concerns me, alick, it’s the effect of what’s in that syringe with regard to human genomics.

            Smallpox vaccine and this new mRNA vaccine are completely different theoretical methodologies – one works, smallpox, the other has never been tested successfully – yet, you are ‘cautious’, ‘annoyed’, but not too worried about side effects that might appear with a vaccine that has not undergone the usual animal testing. My guess is that previous animal testing did not provide the results required.

            Do you really believe you are qualified to attest to the efficacy and safety of mRNA vaccines, at this stage?

            If, yes, then by all means please inform us.

            If, not, then why cloud an already murky sea?

            Nothing personal, alick.

          3. alickdouglas

            @f_lawless

            Doshi’s article is very well observed, and I think he’s right on most points. He goes through seven or eight areas where he thinks clarity is needed in reference to the Pfizer analysis, and I think he’s correct. I think the data dossier in the public domain would be unfeasible though.

          4. benblack

            Sorry, alick, didn’t see your reply above – chronologically disordered, of course.

            Fair enough.

            I’ve just skimmed it, give me a minute.

      1. Cian

        6 doses out of a 5-dose vial is okay – as there is surplus in each vial to ensure that there can be 5 full doses (this allows some wastage for the dead-volume in syringes).

        7 doses would suggest that they are mixing the dregs from multiple vials – which isn’t recommended.

  7. Micko

    Good they weren’t wasted.

    It’s human nature to look after your own.

    Anyone here saying they would have done any differently is talking BS

  8. Gringo

    That’s a lot of extra doses. But surely those honest administrators of the Coombe would never stoop so low as to shortchange the frontline staff? Or would they?

  9. Kevin Quinn

    This is not a new issue. Everyone knows that there is always some vaccine left over at the end of a day, because there is always more than 5 doses per vial, and because there are always no-shows.

    In New York, for example, hospitals are fined if they waste the left-over vaccines — and fined if they give them to people who are not on the priority list.

    Stephen Donnelly and his officials would surely have known this, and should have put in place a transparent and fair system to ensure that vaccines were never wasted…but he didn’t. He should be ashamed — he’s a management consultant, this sort of thing is very straightforward for him.

    The culture at the Coombe should have been ethical enough to create a fair and transparent way of administering left-over vaccines…but it was not. They should be ashamed — how can we be expected to trust in the hospitals ethical standards after this?

    The urgent question is: What system has NOW been put in place to make sure this does not happen everywhere else?

    1. Cian

      hospitals are fined if they waste the left-over vaccines — and fined if they give them to people who are not on the priority list.
      So what would you do if you were running a New York hospital and had left-over vaccines but nobody on the priority list?
      Do you waste the vaccine (and get fined for having left-over) or give it to non-priority people (and get fined for that)

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