Inside the First COVID-19 Vaccinations Given at Long-Term Care Centers in the U.S.

Kate Latta didn’t get much sleep last night, but that’s understandable. The pharmacist and store manager at a Walgreens pharmacy in Columbus, Ohio, Latta learned just three days ago that she would be part of a historic vaccination program this morning (Dec. 18).

In the spring, the U.S. government contracted with retail pharmacy chains CVS and Walgreens to have pharmacists vaccinate residents and staff at long-term care facilities, some of the highest risk groups for COVID-19 disease. While people living in skilled nursing and other long-term care facilities only make up about 4% to 5% of the U.S. population, they and the staff at these facilities have accounted for 40% of the deaths from the pandemic as of November, according to data from the Kaiser Family Foundation.

Prioritizing these residents and staff members is a key to controlling the pandemic, so the Centers for Disease Control’s immunization group recommended in November that they be among the first to get vaccinated when the shots are authorized. These facilities were invited to choose their pharmacy partner, and since then, Walgreens has been working out the logistics of forming immunization teams, figuring out where and how it will store vaccines, and collaborating with the 35,000 facilities that have asked for their help to immunize some 3 million residents and staff.

On Dec. 15, Walgreens learned that the first doses of vaccines earmarked for some of its partner long-term care facilities in Ohio, Connecticut and Florida, would be arriving in a few days. When the first shipment was delivered on Dec. 17, Latta was told to be ready to start vaccinating the first long-term care residents and staff in the country against COVID-19 the next day.

So at 5:30 a.m. on Dec. 18, with her 30-40 page playbook outlining the months of planning and protocols for the shots in hand, Latta arrived at a Walgreens in Columbus about 10 minutes from her home. The night before, the pharmacist there had removed from the ultra cold freezer (which keeps the vials at -70°C) the specific number of doses Latta would need to vaccinate the 65 residents and staff at Crown Pointe Care Center in northwest Columbus. The vaccines, made by Pfizer-BioNTech, were thawed in the refrigerator overnight, and in the morning placed in a thick Styrofoam cooler that Latta and her team kept a keen eye on during the 10 minute drive to Crown Pointe and throughout the start of the day by monitoring the cooler’s temperature every hour. To keep the vials cold, they followed Pfizer’s instructions: packing the cooler with frozen water bottles, cardboard and bubble wrap so the vaccine vials themselves never touched water or ice.

Once at Crown Pointe, Latta and her four team members carefully broke the seal of each vial they would use, which contains enough COVID-19 vaccine to inoculate five people, and diluted them according to Pfizer’s instructions. “Once [the vaccines] are unfrozen, you’ve got only so many days they can be refrigerated,” says Latta, who talked to TIME from her car during a break in vaccinating today. “And once you puncture the vial with a needle and reconstitute it, you’re talking about hours. So you have to be very precise, and very exact. Pharmacists are great at this role—a lot of us have Type A personalities so we love to log, and have checklists and work through everything to a T.”

Knowing how many vaccines to defrost and thaw requires knowing how many people at each long-term care facility will get vaccinated on any given day, so Walgreens is matching each store with facilities so those pharmacists and their teams can maintain accurate appointment schedules.

Latta and her team quickly set up in Crown Pointe’s cafeteria, commandeering one of the tables with the few pieces of equipment they needed: a box of gloves, a bag of cotton balls, bandages and a waste container for the used needles. As soon as Latta was ready, the first long-term care resident in the country to get the COVID-19 vaccine was wheeled in for her shot. “I feel great, I’m happy to get it,” Rebecca Meeker, a 78-year-old grandmother of five, said after she got her jab. “It makes me feel good; it’s a comfort.”

Geneva Dennison, 76, was next, and admitted “I had a hard time sleeping last night. I’m pretty active and I’d like to stay that way. I think this shot is going to help me do that so I’m excited about getting the shot.”

As Latta headed back into the cafeteria to finish vaccinating the more than 50 people at Crown Pointe who were waiting for their shots, she knew these first vaccinees were only the vanguard of the millions that Walgreens’ pharmacists have committed to immunizing in long-term care facilities, and the millions more in the general public who will lining up at the retail stores for their shots in coming months. “Pharmacists know this is our moment, our time to really make the biggest impact we can ever make in our communities,” she says. “We haven’t been in the hospitals and experienced the fatigue that front line health workers are experiencing now. It’s our turn to take on that burden as health care professionals.”