large urban hospitals are buying ultra-cold freezers to store Pfizer vaccine, rural can't afford

[Demovictory9]

Link to tweet

Wealthy hospitals are buying up ultra-cold freezers to store the Pfizer vaccine, but poorer rural hospitals can't afford to, creating a huge access divide. "The optics are horrible... we're being left behind."

https://www.statnews.com/2020/11/11/rural-hospitals-cant-afford-freezers-to-store-pfizer-covid19-vaccine/

Large urban hospitals across the U.S. are rushing to buy expensive ultra-cold freezers to store what’s likely to be the first approved Covid-19 vaccine. But most rural hospitals can’t afford these high-end units, meaning health workers and residents in those communities may have difficulty getting the shots.

The vaccine, developed by Pfizer and the German firm BioNTech, seems to provide 90% immunity according to early data released on Monday. But there’s a catch: The vaccine has to be stored at -70 degrees Celsius. Typical freezers don’t get that cold, making distribution of this vaccine a logistical nightmare.

The Centers for Disease Control and Prevention has advised state health departments against purchasing ultra-cold freezers — which cost $10,000 to $15,000 each — saying other vaccines with less demanding storage requirements will be available soon. Hospitals with money to spare are flouting this guidance. Four major health care systems, from North Carolina to Ohio, North Dakota, and California, told STAT they had bought additional ultra-cold freezers, while Jefferson Health in Philadelphia said it has leased five units

[KewlKat]

1. I remember the Polio vaccines...the vaccine went to the communities, not the patients to the doctors

We didn't have to worry about social distancing and the doses were give at schools. We formed long lines and they just went down the row and dispensed the medicine. Why couldn't they have like some mobile vehicle that had such a freezer that would make the rounds in the rural communities to vaccinate everyone? We're doing drive up testing, why not drive up shots of vaccine?

It would make more sense and make distribution easier...to the rural public.

[Hortensis]

22. I was also one of the kids in lines in schools. I'm sure the

pros will work this out also. With a Democratic president, there is absolutely no chance rural communities will be abandoned, even if some red governors wanted to continue the genocide in some a while longer. Some may be served later, though. And some rural residents who are unwilling to wait will drive to larger towns to get vaccinated.

[Karma13612]

23. Yes, I remember those lines!

And I also remember getting a sugar cube with a purple area on it from an oral dose of some kind. Not sure what that was.

Your idea makes too much sense. /s

[crickets]

34. I remember those too.

They're a good idea: the method is efficient and effective, at least at getting all of the kids and school employees vaccinated in one go, school by school. If mobile versions of the freezers or some other viable cold storage are available, it would make sense to do it.

[Blue_true]

42. Distribution of vaccine to far flung parts of the USA is a job that

the National Guard should excel at, it can likely come up with ultra cold, refrigerated trucks or tanker cars to transport the vaccine and troops to insure that it make it to where needed. All it takes is a real President who isn’t out to punish sone areas, fortunately we will have that a President soon.

[Rstrstx]

2. That's strange, I remember hearing it could be stored at -18C

Basically 0F, which is not so bad. But the same article that says it needs to be kept at -70C goes on to say it can be kept for a few days at refrigerator temperatures. Am a bit confused.

Ok, found it, this is where I got the -18C number from (at the 8:13 mark):

[MoonlitKnight]

44. Makes sense

I doubt they inject it at -70. So it must be able to last at a higher temp for some time.

Also, people are a little too excited by 90% efficacy over just a week. It can take up to two weeks just to show symptoms.

[Brother Buzz]

3. My son's God grandmother stored her prize bull's semen in our doctor's liquid nitrogen bottle

I don't know how the economy of scale would work, but it doesn't hurt to think outside the box.

Just an idea.

[mopinko]

18. that would work.

at least short term. long enough to get out there and do a big drive.
no idea how long they stay that cold, but long enough to get a small community vaxxed.

[Brother Buzz]

28. The bulk could be stored at centralized freezer banks, and withdrawn as needed

The clinic bottles would last indifferently as long as they get recharged. It's not rocket surgery, just logistics and planning.

Experimenting with a bottle of liquid nitrogen is on my bucket list.

[mopinko]

29. yeah. in mine, too.

list is long. ty for reminding me of this item.

[MrsMatt]

36. Could a semen tank be

modified for vaccine storage? Lots of those out in rural areas.

[Brother Buzz]

37. Just about every medical clinic already has one.

I would think size would be concern, but it looks like Pfizer already has it covered, and they are going with dry ice.

Pfizer designed suitcase-sized shipping containers that will keep its doses at ultracold temperatures for up to 10 days. Each container holds between 1,000 and 5,000 doses, charged by dry ice. The shipping containers are reusable.

https://www.fiercepharma.com/manufacturing/pfizer-designed-new-container-and-plans-to-tap-shipping-companies-for-covid-19

I wonder if there is going to be a run on dry ice, and price gouging is going to become a story.

[Blue_true]

43. Since dry ice is CO2, a run on dry ice is not a bad thing.

Plants will be pulling CO2 out of the atmosphere 24-7 to keep up. We get short-term sequestering of CO2.

[Brother Buzz]

47. I wonder how much carbon dioxide is released producing the electricity to make the dry ice

[Blue_true]

55. If my understanding is correct, the process is a mass one that is relatively energy efficient, not

like automobiles, which are point sources. Plus plants can more efficiently use energy sources like wind and solar than automobiles can. So, my napkin calculation belief if that there is a net positive to needing more dry ice.

[intrepidity]

4. I find it hard to believe that *any* hospital wouldn't have -70 freezers

Now, maybe they can't afford to buy a dozen new ones, but making it sound like some sort of advanced technology that only state-of-the-art facilities have just doesn't ring true to me.

[Brother Buzz]

5. Hell, a boatload of bait shops have them for storing dry ice

[intrepidity]

7. Really?

I didn't know you could store dry ice in a freezer, due to the evolving gas pressure.

[Girard442]

9. I've brought ice cream to picnics in a regular old picnic cooler with dry ice.

It's not like transporting antimatter or anything.

[intrepidity]

11. Freezers have tightly sealed doors

Dry ice sublimates into gas.

Not antimatter, but physics is still physics.

[BumRushDaShow]

12. When frozen food companies like Omaha Steaks ship their products

they are using dry ice in foam chests and that gives you a couple days of at least keeping the food below freezing and up to the 40F refrigerator temp to give time to get it transferred to a regular 0F home freezer.

With a bit more of a medical-type insulated chest, it's conceivable that a rural area could schedule a vaccine "day" and have it transported to a specified site in such a container for distribution that day - either scheduled or "on demand" (depending on how far away the source hospital is). It might also be possible to have a larger farm that maintains animals, serve as facility to host a rental freezer and be a central distribution point for an area. Many of them already store some animal drugs and/or work with vets who store and distribute animal meds, including antibiotics and other injectables. This might also apply to dairy distributors on or near farms, that would have refrigerated tanks for milk storage and would thus already have 220V electrical hookups at their facilities that could handle a ("shared" ) -70F freezer.

[mopinko]

20. as noted above. semen.

this is a tempest in a teapot.
we're not talking africa here.

[BumRushDaShow]

25. There's a difference

between semen and the nucleic fragments being transported into the body within an artificial carrier substance that makes up this vaccine, that is designed to trigger an antibody response. Semen can easily survive at body temperature for some time. The concern here being that what they have manufactured is obviously a very fragile configuration and if the cost of that manufacture is high, then you want to minimize the "waste" of loss of efficacy before it is even injected.

[csziggy]

51. Semen can survive for about two days at body temperature

During that time the viable semen is reduced for every hour - sort of like a half life.

Frozen semen lasts longer but there is an immediate decrease in the potency. The freezing process kills a percentage, the frozen semen can last a short period - a few days - and then another significant percentage dies during the process of thawing and bringing to the temperature needed before it is used.

I have bred mares with non-frozen semen. It's been years so the procedures may be better, but considering that most collection, packaging, and shipping techniques are done on farms by non-professionals, the impregnation rates were pretty low compared with live cover.

Over the years - and I bred horses for over twenty five years - I bred to two different local stallions with collected and short term stored semen. With the live cover by my own stallion, I had a 75-85% conception rate and very few miscarriages. With short term stored semen the conception rate was closer to 50% and that is with semen collected by veterinarians and stored under closely monitored conditions for less than 24 hours. I thought about trying to bred to non-local stallions from operations that shipped frozen semen, but I was told the conception rate was about 25% at that time.

Impregnation with frozen bull semen is very often used in cattle operations, but they tend to rely on repeat procedures to ensure as close to 100% conception rates as possible. In horses this creates a risk of uterine infection, but apparently cattle are less prone to infections than horses.

Vaccines that require such a low temperature are equally likely to break down, or even more as you said.

[mopinko]

19. they dont seal that tight.

c'mon. have you seen it happen?
yeah, cuz it doesnt. it's a slow process. and to access the stuff, you open the door.
it's a small molecule. unless they have a nasa grade seal, it's gonna leak out.

[intrepidity]

40. see posts just below nt

[jmowreader]

31. They sell special freezers for it

They have pressure relief valves.

[intrepidity]

33. Ah, that makes sense, thanks nt

[ProfessorGAC]

39. They Have Relief Vents

Very simple mechanism.
A weighted cone shaped flapper in a cone shaped hole, sealed with a viton ring, on a calibrated spring loaded hinge.
Pressure (spring tension) is set to inches of water column. IIRC, 5 or 6" WC. Around 0.25psig
As that tiny amount of pressure builds, the flapper is pushed open. Pressure goes down to around 10% of starting pressure.
Repeat, as cryogen continues to gas.
The one caution they provide is that because CO2 is more dense (around 2/3rds higher) than air, the vent is expelling air.
So, upon opening the cooler fairly rich CO2 is released.
Supposed to open, stand back for several seconds, then take stuff out.
Liquid nitrogen dewars do the same thing, but the relief valve design is different.
Did a fair amount of work using cryogens.

[Karma13612]

26. Remember they are talking

-70 degrees Celsius. Not Fahrenheit.

-70C is equal to -94F

That is 126 degrees below freezing on the F scale. That’s pretty darn cold.

I don’t know about the workings of Freezers in hospitals, but I wouldn’t have thought anything needed to be kept that cold. Maybe in specialized labs, but not standard hospitals.

I found this on the CDC website for vaccine storage recommendations:

Regular temperature monitoring is key to proper cold chain management. Store frozen vaccines (Varicella, MMRV, and Zoster) in a freezer between -58°F and +5°F (-50°C and -15°C). Store all other routinely recommended vaccines in a refrigerator between 35°F and 46°F (2°C and 8°C). The desired average refrigerator vaccine storage temperature is 40°F (5°C). Exposure to temperatures outside these ranges may result in reduced vaccine potency and increased risk of vaccine-preventable diseases.

That’s probably why the heightened concern. The requirements for Pfizer’s seems to be outside the normal range that hospitals are used to.

[PoindexterOglethorpe]

6. The need for very low temperature storage is an issue.

Not really so much in this country, but in the rest of the world. If everyone needs two doses, that's some 14 billion doses. And that's assuming that the keeping at the cold temperature is a trivial issue, which is absolutely not the case in a lot of third world countries.

[Girard442]

8. Dry ice sublimates at -78.5 C.

Sounds a bit marginal, but do-able.

[Eugene]

14. Doable, but with what funding?

Affordability at scale is the concern stated in the OP. Many rural hospitals are in financial distress.

This kind of resource and logistics heavy lifting is traditionally a job for the federal government, administered by competent and responsible persons.

[Girard442]

30. True that. If the first priority is to drown government in a bathtub, kinda hard to do anything.

[Blue_true]

45. The Military can do it, with President Biden at the whip point giving the order. nt

[JustABozoOnThisBus]

10. Maybe Kushner could send goons to take the freezers from the city hospitals.

Then they would be available to, well, I don't know, whoever is buying the N95 masks he stole. Saudis? Turks?

Is he missing out on a business opportunity here?

[Demovictory9]

17. "Those are our freezers" said with botoxed lips sneering

[Klaralven]

13. A guide to dry ice shipping

https://www.ups.com/us/en/services/knowledge-center/article.page?kid=art16a454e6661

Also https://www.fedex.com/content/dam/fedex/apac-asia-pacific/downloads/fedex-dry-ice-job-aid-en-jp.pdf

[woodsprite]

15. Storage temp of Dippin Dots ice cream is -40.

Daughter mentioned that last night. Would those freezers be a possibility?

[ProfessorGAC]

16. Our CVS Just Got One

About twice the size of a microwave oven.
We're a far exurb of about 6,000 people.
Not sure that many hospitals can't afford them. If CVS can make sure a store at the fringes of a collar county has one before they even need it, it's hard to fathom there are many barriers to obtain them.

[Blue_true]

46. CVS is a very, very rich corporation. It can do stuff little hospitals can't.

You have 6,000 people in a relatively small area. Some of these rural places may have that many people spread over a large area.

[ProfessorGAC]

53. Not Agreeing With Your Point

There's a city with a metro population of 240,000, 22 miles north.
There's another with a metro pop of around 90,000, 18 miles south.
Farmland, state parks, prairieland, and warehousing in between. IOW, at least semi-rural.
Driving 18-22 miles for a vaccine against a deadly virus is not a huge burden on all but the infirmed.
Yet, they found it financially viable to be sure that the store in the little town in the middle have a cryofreezer.
That suggests that the cost impact is low. They may be a bit g company, but they still only exist to make money. If adding this expenditure wasn't going to have a positive ROIC, they wouldn't do it.
ALL capital expenditures are measured by & decided upon against ROIC values, except in cases where the costs are right to operate issues. (Upgrading or replacing pollution abatement systems, for instance.)
I think this concert is an extrapolation of some whining by hospital and clinic operators.
The money is there. If it wasn't, the "big companies" wouldn't spend it either. Big business doesn't work any other way, especially in the last 30 years.

[Blue_true]

54. Disagreeing with you again.

You sit literally within a stone’s throw of close to 400,000 people. CVS likely is doing what it is doing for a number of reasons, none altruistic. It could simply want uniformity across it’s store platforms for the area. It may realize from zip code data that it collects that residents from the more populated areas often or sometimes shop at your local CVS. I can promise you that a truly isolated population of 6,000 WILL NOT have a CVS or any other chain, well maybe a Rite Aid, which seems to clean up the small town spew from CVS and Walgreens feeding in populated areas (it typically doesn’t go toe to toe with the biggies in populated places).

[ProfessorGAC]

56. Totally Missed The Point

You're willfully missing it, as well.
The point is (I'll type slowly) investments such as this PAY FOR THEMSELVES! It's how capital investment works in business.
No return? Don't spend the money. But, if there is a positive net return as DCF, it's a wise investment.
Also, your population point is also specious.
The very fact that there are MANY CVS stores within driving distance would the be the reason why CVS wouldn't put one in a town of 6,000. That density would be causative to not bothering to buy one.
If it were a bad investment, they'd save the money, because the potential for customer loss due to them having to drive a half-hour once or twice for a potentially life saving vaccine.
There's no serious downside to not doing it, but it must be long term profitable.
If it's profitable for one company, it's profitable, admittedly less so, to any.

[Blue_true]

57. Do you have access to the customer zip code data at the CVS in your area?

I can promise you that it blows your theory out of the water. You are lecturing a business person who understands supply and demand dynamics. CVS wouldn’t have a store in your area at all if it didn’t make sone type of business sense, it is not a charity, at the end of the day, each branch makes a defined profit or it closes, I have seen CVS stores get closed down in my area that is 70 times larger than yours.

[Hortensis]

21. The states will do their thing, and making it work for everyone

where they fall through is a job for Democratic Superpresident. The usual in a very large nation with extremely varied needs and realities. Including widely varying levels of competence at state and local levels.

[intheflow]

24. Wait for the folks who claim the virus is a hoax to now claim

the wealthy liberal elite are punishing rural red states for not voting for Biden.

[jmowreader]

32. I would be very surprised indeed...

...to find there was a hospital in America that didn't have a tank of liquid nitrogen on the premises.

Just throw the shit in the cryo storage facility, dude.

[Eugene]

35. U.S. states race to buy ultra cold vaccine freezers, fueling supply worries

Source: Reuters

HEALTHCARE & PHARMA
NOVEMBER 13, 2020 2:04 PM UPDATED 17 HOURS AGO

U.S. states race to buy ultra cold vaccine freezers, fueling supply worries

By Lisa Baertlein, Carl O’Donnell
6 MIN READ

LOS ANGELES/NEW YORK (Reuters) - U.S. states, cities, and hospitals are scrambling to buy ultra-cold freezers that can safely store Pfizer Inc's PFE.N COVID-19 vaccine, ignoring advice from the U.S. Centers for Disease Control and Prevention (CDC) to hold off.

The push reveals a lack of infrastructure to support a super cold vaccine campaign, including equipment to store millions of doses of Pfizer’s vaccine at temperatures of minus 70 degrees Celsius (minus 94°F), significantly below the standard for vaccines of 2-8 degrees Celsius (36-46°F).

Some specialty freezer makers warn of months-long waits for units.

It also marks widespread wariness of the advice from the CDC, which on Aug. 26 urged healthcare providers not to purchase ultra low temperature (ULT) freezers, saying it was working on solutions for Pfizer’s “very complex storage and handling requirements.”

A CDC spokeswoman on Thursday said the agency expects the first vaccine doses will be in limited quantities and rapidly deployed, reducing the need to store them in specialized freezers.

-snip-

Read more: https://www.reuters.com/article/us-health-coronavirus-freezers-focus/u-s-states-race-to-buy-ultra-cold-vaccine-freezers-fueling-supply-worries-idUSKBN27T2S6

[Demovictory9]

38. Thank you

[Hekate]

41. Oh gods."Optics" my ass. As several DU fishermen have pointed out, every bait shop has dry ice.

And every fertility clinic has liquid nitrogen. Hell, even my dermatologist has liquid nitrogen.

How about the “optics” of the goddam Trump admin, enablers, propagandists and liars?

I just want to scream and scream. These people didn’t need to get sick and die in the first place. So now someone is going to use the preparedness of city hospitals to to stoke further division between rural and urban? Because optics?

[Yavin4]

48. Obviously, Trump and the Republicans in congress will run to the rescue of these rural hospitals and

dispense the money to get them the facilities that they need to store the vaccine because, you know, the Republicans are the ones in touch with rural America. Right?

[Hermit-The-Prog]

49. Um, large urban areas need it sooner than those of us in the sticks.

I'm just fine with waiting until urbanites are protected before I make a trip to the city to get a vaccine that hasn't arrived yet.

Let's start in hospitals and work outward, taking care of everyone who keeps hospitals working.

Sure hope this gets prioritized instead of 'politicized' by shitstirring in the media.

[Silent3]

50. Ordinary refrigeration is good enough for about five days

So large urban hospitals, or perhaps state/federal agencies, could act as distribution hubs, shipping out the vaccine on a just-in-time basis to rural areas. It doesn't sound practical for every doctor's office or the local drugstore that gives you flu shots, however, to keep their own supply on hand, so you'd probably need to have people go to specialized vaccination clinics that handle higher patient volumes.

https://time.com/5911543/pfizer-vaccine-cold-storage/

Once they’re out of the box, the shots can last for about five days in standard refrigeration. But the boxes hold from 200 to 1,000 vaccine vials, each of which contains about five doses of the shot—more than most doctor’s offices could reasonably expect to use before some doses start to defrost and become useless, as ProPublica recently reported.

[NickB79]

52. Our dairy factory has several ultra-cold freezers

We need to keep our yogurt and cheese cultures at -80C.

They run around $15,000-$20,000 each.