'So many lives are changing': Inside the mass vaccination COVID-19 clinic at Circuit of the Americas
July 18, 2020, was supposed to be a magical day for Analysa Young. It was going to be her wedding day.
Then the COVID-19 pandemic happened, and she had to postpone. She couldn't put her parents and grandparents at risk.
On March 19, 2021, she sat in a long line of cars and pulled up to a table of volunteers. Her car window was open, and her arm was ready to receive the first dose of hope for rescheduling her wedding.
Young was one of more than 11,000 people who received their first Pfizer COVID-19 shot that weekend at the Circuit of the Americas racetrack.
She wasn't expecting to be so emotional about getting the vaccine, she said as she wiped away tears.
"It has just been horrible living like this," she said.
Her parents and grandparents also had recently received vaccinations.
"We can get back to living like normal," she said. "I'm grateful."
The vaccine has given her hope that this time her wedding, now set for July 10, will happen.
The mass vaccination site, which has been running for five weeks at COTA, is a collaboration between the Ascension Seton hospital network, CommUnityCare Health Centers, and Travis, Bastrop, Hays and Caldwell counties.
The partnership has tried to get vulnerable populations vaccinated by focusing on CommUnityCare's patients, school districts' employees and people identified by Ascension Seton hospitals as being most at risk for health reasons.
On this day, some of Dell Children's Medical Center's most vulnerable patients who are 16 or older, making them eligible for a vaccination, were transported from the hospital to the clinic to get shots.
On Monday, Texas will open up vaccination to anyone 16 or older, but this site will continue to focus on Central Texas' most vulnerable populations for now.
Creating a mass vaccination clinic
Travis County Judge Andy Brown said that when he was sworn in to office in November, other government officials began asking him, "What's your mass vaccination plan?"
He made calls to other county judges to ask the big question: How do you get as many shots as you can to the most people at once?
A drive-thru site made sense because you can get a lot of people in one space at one time and cars keep people socially distanced.
Travis County needed a health partner to receive and administer the vaccines. Brown reached out to Ascension Seton, where Toby Hatton had been looking at Circuit of the Americas as a potential mass vaccination site. Hatton is a nurse and the regional emergency management officer for Ascension Texas’ Infectious Disease Response Unit.
Ascension Seton and Travis County began to combine their efforts and work with neighboring counties. They have a plan to get as many as 50,000 people vaccinated in a week, but they have to work with the number of vaccine doses Ascension Seton is allocated each week as well as how many people are available to run the site.
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Each Friday, Saturday and Sunday that the site operates, about 350 to 400 people, mostly volunteers, are needed. The people who draw up the vaccine and administer it have to be medically trained.
Because it's run mostly by volunteers, it costs $100,000 each week, Brown said. Hiring a company to do it would cost millions, he said.
The site started with about 3,000 people vaccinated the first week and has worked up to almost 15,000 in one three-day weekend.
Like at many vaccination sites, people are desperate to get an appointment.
"It's been like a war trying to get it," Rubin Gonzales said as he was about to receive his vaccination. He was relieved that he had secured a slot. "I was very lucky," he said.
Chris Overath was very frustrated trying to find an appointment, he said. He was trying the Austin Public Health portal, but it crashed. "I kept waiting," he said, and he grew more frustrated by the day.
He has type 1 diabetes and was worried about what might happen if he got sick.
He said that though some people might think of trying to find a vaccination appointment as being like a game or the lottery, "it's a big deal to me."
He was just a few cars away from the tray that held his dose.
"It will be a big relief," he said. "My anxiety will be decreased. I'll feel much more safe."
Hope for those hit hard by the virus
This vaccination site doesn't sign up people through a traditional portal system, like some of those organized by government agencies such as Austin Public Health or counties surrounding Travis. Instead, targeted patients are given an online link or a phone number to call. Some counties other than Travis also have used the site to try to reduce the waitlists for their vaccination clinics.
"We're overwhelmed by the people who want to come here," Brown said, but his goal has been to reach the people who have been hit hardest by COVID-19.
That's why Travis County partnered with CommUnityCare, the area's largest federally qualified health program, which means it provides care for people with and without insurance and uses a sliding fee scale. Its core constituents are from underserved populations, including communities of color.
"They are more impacted by the virus," said Yvonne Camarena, the chief operating officer at CommUnityCare. The organization has more than 25 locations in Central Texas and serves more than 100,000 people a year.
CommUnityCare had both the demographics and the scale the county was seeking to target for a mass vaccination site.
"It was a good way to accomplish what we were hoping to do," Brown said. "We want to be helping people forced to go to work and with higher death rates."
The first week, Brown said, 77% of the people they vaccinated were Hispanic. At the same time nationally, 9% of the people with at least one vaccination were Hispanic.
CommUnityCare sends an email link to its patients and calls some patients to get them signed up for the COTA clinic. Sometimes a link has been texted to friends or shared through Facebook. Site organizers have tried to prevent that and shut links down when it has happened.
Getting to the finish line
Each vehicle that arrives at COTA first lines up for check-in to make sure at least one person inside has an appointment. A volunteer verifies the information for whoever is getting a shot and uses a chalk pen on a vehicle window to write the number of people inside who will receive a shot, as well as which language they use if it is not English. The clinic has volunteers who know American Sign Language, Spanish and Vietnamese.
The people receiving shots are given paperwork to fill out, and volunteers can help with that, too. Vehicles then loop around to the next station, which is by a series of open white tents.
People stay inside their vehicles the whole time, but they do not have to have a vehicle to attend this clinic. Capital Metro buses will bring people here, as will Lyft, which provides free rides to vaccination clinics through a special program. Sometimes people don't know about that program and will take a cab or another ride-hailing service.
If someone arrives without a vehicle, volunteers will use a golf cart to take them to the next station and give them a chair to wait at each station. Everyone wears a mask the whole time.
The COTA vaccination site "has been a big success," said Camarena, but she knows not every patient will be able to get to this site. It will take continued direct outreach to get everyone vaccinated.
"One size doesn't fit all," she said.
At the next station and set of white tents, a volunteer checks over the paperwork and asks questions to make sure it's complete. A trained medical professional then administers the vaccine through the rolled down vehicle window into the arm of that person's choice.
The shot, "is kind of like getting off your curse," said Amand Pandey, who was with his wife as they waited for their vaccinations.
Once they get their second shots in the coming weeks, they will plan a trip to India to visit their family, whom they haven't been able to see in a year and a half.
Volunteers get many blessings watching people come through the line, said Nicole Higginbotham, a nurse practitioner at Dell Children's. "People are so thankful. It's wonderful."
"They get a little bit more peace of mind," volunteer Veronica Berryhill said.
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After the shots, another volunteer writes the time plus 15 minutes on the vehicle's window. Staying for 15 minutes is required to make sure there is not an allergic reaction, and the new time alerts the people inside the vehicle and the next set of volunteers when the observation period is over.
The vehicles then move to the final station, where volunteers look for anyone who is having an adverse reaction to the shot. After the observation period is over, that vehicle is free to go.
The average time to get through the process has been 45 minutes, but it has been as little as 25 minutes. That first Saturday, though, it was three hours, Brown said.
They keep refining the process and moving the flow of traffic around to avoid a jam.
The biggest variables are how many volunteers they can get each week, especially medical personnel, and how quickly they can prepare each dose and get it from the makeshift pharmacy they set up inside COTA's grandstand building down to the tents where the vaccinations are happening.
Preparing the doses
Nothing at the COTA site can happen until the pharmacy staffers are on site. They start at 7 a.m. before the first shot appointment at 9 a.m. The clinic runs until the last people, scheduled for 4:45 p.m. appointments, are through the line.
The vaccine is shipped to Ascension Seton and kept in an ultralow freezer at minus 80 degrees Celsius. The hospital pharmacists pull the vaccine vials from the freezers the night before to begin thawing. Once the vaccines are taken out of the ultracold freezer, they go into a refrigerator and can be used for up to five days.
The vials are stored in what's known as a "green box" that has two sets of cool freezer packs and two sets of ultracold freezer packs. In between are three "pizza boxes." Each box has 195 vials with six doses each of vaccine. One green box has 3,510 doses. On this day the pharmacy has three green boxes out.
The green box has a vial of liquid that detects when the vaccine has gotten too warm. A thermometer on top of the box also reads the temperature inside. The pharmacists keep the boxes closed to avoid exposing the vials to too much light.
Inside the COTA pharmacy, about two dozen paramedics from area fire departments and emergency medical services sit at two sets of long tables. They've created an assembly line to draw up the vaccine and the sodium chloride diluent into a syringe, where it is mixed together. Once a vial is taken out, it has two hours to be mixed with diluent before it goes bad.
Each filled syringe is tagged with a bar code sticker that has the lot number of the dose. The medics write the time at which that dose will go bad on the the tag. Each mixed dose has six hours to get into an arm. A pharmacist oversees the vials and the drawn-up doses at several quality control check stations. By 2 p.m., the team in the pharmacy had prepared 2,301 vaccines.
"It takes care and attention," said Lyndrick Hamilton, a clinical pharmacy specialist at Dell Children's who was overseeing the operation with Jodie Pepin, the director of pharmacy at Ascension Seton Williamson Medical Center. "We have to keep the integrity of the vials."
The Pfizer vaccine takes "significantly more planning," Pepin said, than the Moderna and Johnson & Johnson vaccines, which do not need mixing with a diluent. If the pharmacy had received the other two vaccines, this site would be able to prepare the same number of doses with about half the paramedics.
"Johnson & Johnson is what we need for these megaclinics," Hatton said. Johnson & Johnson is the easiest vaccine to prepare and doesn't require a second dose.
Even with Pfizer, Hatton said, each weekend it becomes a little easier to predict how many doses Ascension Seton is going to receive. The next few weekends they will concentrate on second doses.
The pharmacists have to be extremely careful about how much vaccine they take out at a time. Even though they start the day knowing how many people are signed up to receive a shot, 13% to 17% don't show up for their appointments.
One Sunday, the site ended up with 200 doses left over. To avoid wasting any, the pharmacy sent a firetruck to a nearby grocery store and told the people inside that if they stayed there they could get vaccinated and that they could call their friends to come. By the time the rest of the team arrived an hour later, 100 people were in line and more were on their way.
The staff was able to distribute all the extra doses as well as register people for their next shots. Many of the people who came were exactly the population this clinic is trying to reach. Many would not have had access to technology to receive a vaccination another way, and many might have been afraid to register because they are undocumented.
Most of the time, there isn't that much left over, but anyone who volunteers is offered a vaccination if one is available.
Changing a life with one shot: 'They are so emotional'
Hatton said that even though it is hard work setting up this clinic and getting all the volunteers in place, "it's a party; it's a celebration. We have people coming through that haven't left their house in a year. This is the first time they got in a car. ... There are tears the whole time."
That joy is what keeps volunteers coming back. "It's a spirit of community and collaboration," said Geronimo Rodriguez, the chief advocacy officer for Ascension Texas. "When we tell them they have the opportunity to vaccinate, they say yes."
Every morning starts with a circle of volunteers reflecting on how blessed they are to do this work.
The clinics have been emotional for his staff and the volunteers, Rodriguez said.
"Everybody knows that every shot is going into someone now not likely to go to the hospital and definitely not pass away," he said.
Every week, Lori Kuhl, a nurse in administration with Ascension Seton, has been coming out to COTA.. "It fills my cup," she said. "This is very rewarding. People are so gracious. I love it. That's why I keep doing it. ... This is the one time everyone is happy to see a nurse. They are so emotional."
Some of the volunteers who help people fill out their forms now are being paid to come back each week so that the record-keeping is more consistent, Brown said. Nursing student Amanda Rose is one now getting paid, but she said she still would come back for free.
"Your heart gets full," Rose said. "I get the chills. So many lives are changing. It's a good day."
Nicole Villalpando writes about health care and families for the American-Statesman. She can be reached at email@example.com.
How to volunteer
Fill out the form at https://centraltxvaccs.org/volunteer.php.