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COVID-19: What happens when you don’t show up for your vaccine appointment?

By Sudhiti Naskar
A Washoe County public health nurse administers the COVID-19 vaccine.

En Español

Out of 333 people scheduled with Washoe County Health District to receive the second dose of COVID-19 vaccination on Wednesday, only 310 people showed up at the POD at the Reno Livestock Events Center. 

In usual times, a small number of people not turning up for a vaccination appointment might not be a major concern for the district. But this isn’t usual times, and distribution of the COVID-19 vaccine isn’t a routine effort.

Pfizer’s COVID-19 vaccine has a relatively short shelf life. Kept in ultra-cold refrigerators, the vaccine needs to be thawed ahead of time to be administered. Once thawed, its shelf life is limited to five days. 

Shelf life of the Moderna vaccine is longer; it can stay refrigerated for 30 days. 

But considering that the health district and community partners like Renown Health and Saint Mary’s Regional Medical Center are working around-the-clock to meet the high demand for COVID-19 vaccine in the community, a no-show presents added logistics and a scheduling nightmare for the officials. 

During the vaccination hours on Wednesday when some people did not show up for their second dose of vaccine, the district used those doses to vaccinate people scheduled for Thursday morning, said James English, from the health district. English was joined by Renown Health’s Chief Nursing Officer Melody Osborne at a media call on Thursday.

“Currently we experience anywhere from 3% to 10% of no-show rates at our location,” said English.

The health district has been pleading with Nevadans for weeks to not be a no-show when getting a COVID-19 test or vaccine. “Please cancel ahead of time,” has been a repeated appeal from district health officer Kevin Dick during weekly media calls. 

Troubleshooting in a fluid situation

The health district is currently scrambling to troubleshoot on a daily basis to make sure that the limited doses of COVID-19 vaccines don’t go to waste. 

One of the tactics is through scheduling. The district has been overscheduling the POD based on no-show rates. 

James English, from the Washoe County Health District, is part of the team dealing with the logistics for scheduling and distribution of the COVID-19 vaccine. Image: Trevor Bexon

It is also maintaining stand-by lanes. In case of a no-show, the district calls the staff representing groups of health care workers, educators and childcare workers that are currently in the queue for vaccination. The school and childcare staff “work into our online scheduling system,” said English. “Our saving grace is we vaccinate more days a week. So, we just utilize that vaccine the following day.”

“We also have that [process] with the University of Nevada, Reno, right now, too, to send people down if we have that [type of situation]” he added.

About half an hour before the POD ends vaccination for a day, the staff start counting cars and individuals to determine how much vaccine they need to have out. “We are also lucky because our vaccines are stored on-site. So we only bring out what we think we are going to use,” said English.    

A large scale no-show took place Jan. 15, last Friday, when staff from multiple childcare facilities were scheduled to be vaccinated. The staff administering the vaccine were using the Pfizer version that were set to expire at 10 a.m. on Saturday, said English. The district had to bring in multiple groups that were waiting for the vaccine but had scheduling issues. A dedicated district crew on-site made sure to use all of the vaccines.     

As far as the second dose is concerned, a no-show further complicates matters. When someone doesn’t show up for the second dose, the health team uses up the second dose by vaccinating people who have not yet had the first dose. But this is not standard practice and adds to the challenges, as the district is already “much further behind than our acute care hospitals” in administering the second dose, said English.

“State guidance is not to plan on using that (second dose) as the first dose [for others],” said English. “But that is a huge concern because we have been told there is no guarantee you would get what they consider ‘the third dose.’” 

“But, because we are vaccinating so many people in such a shortage of vaccines, we are taking those extra second doses that weren’t used and using them as first doses right now,” he added. 

Renown Health says it’s keeping a close watch on scheduling and communicating with its clients to avoid the problem of no-shows, said Osborne.

Still, Renown has had cases of no-shows. 

“We did have an instance at the end of our event where we have drawn up [the vaccine] in the syringe,” and people did not show up, said Osborne. The vaccine is only good for a certain amount of time. “So, those vaccines were given to volunteers on-site.”

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