Pharmacist drives through winter storm to vaccinate homebound Donegal woman

It was 19 degrees, but Ed Christofano had his GMC Acadia in four-wheel drive, climbing the snow-covered roads through the Allegheny Mountains. Also in his car was a cooler, and inside that was precious cargo: three doses of the Pfizer-BioNTech vaccine.

“It’s just par for the course,” said Christofano, owner of Hayden’s Pharmacy, a chain with locations in Youngwood, Mt. Pleasant and Donegal. The weather conditions were extreme, but house calls like these haven’t been unique to him since the vaccine rollout began.

It was a Tuesday evening, approaching 7 p.m. Christofano had a few leftover doses from a vaccine clinic in Youngwood, and they were about to expire. He drove his SUV 20 miles through the winter storm to Donegal Township to deliver them to a couple over the age of 65 and their daughter, a 34-year-old woman who is homebound and at extreme risk of dying from the virus.

Knowing he wouldn’t have a place to change once he arrived, Christofano was already decked in personal protective equipment: a mask and face shield, latex gloves and a bright yellow medical gown.

As Pennsylvania’s vaccine distribution continues to lag from supply issues, shifting guidelines and major bureaucratic errors, community pharmacists often are the most reliable point of contact for eligible people struggling to get the vaccine. Yet they say they’ve gotten little support from state and federal agencies allocating doses, struggling with irregular deliveries and frequent miscommunication.

“It’s upsetting because this proves the importance of community independent pharmacies,” Christofano said. “Your independent pharmacies are vital to the communities we serve. We know our population, and we’re able to act quickly and efficiently.”

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For weeks, Paula Blevins had been searching frantically, looking for a provider who could fit her daughter, Amanda, onto its waiting list. She called her doctor, who told her they had no doses. She reached out to independent and chain pharmacies. But it seemed like no one had doses, and the few that did were focusing on people older than 65.

Amanda Blevins is one of millions of people across the state at an extreme risk for dying of covid-19 because of a health condition. She was born with multiple congenital abnormalities, starting with omphalocele, a condition that caused many of her organs to develop outside of her body and required surgery when she was only 6 hours old. She lives with arthrogryposis, which causes joint stiffness and limits her movement. There’s an irregularity in her brain stem.

Amanda is immobile except for head movements. She is nonverbal; her parents communicate with her by watching her facial expressions and monitoring her respiration, heart rate and muscle contractions. She’s always attached to a host of machines, including a ventilator. Although she can breathe on her own, she doesn’t have the muscle capacity to take deep breaths.

“If Amanda would get the virus, she would not survive,” her mother said. “Somebody needs to be thinking about these people.”

The Blevins family established a reliable routine for the past 34 years, working with trusted nurses and caring for their daughter in their home on a quiet private road. The house has plush carpets and massive windows overlooking the bare trees of snowy woods. Pictures of Amanda as a child are on the bookshelf and the side table. It is peaceful.

But with the threat of covid-19, suddenly it didn’t feel safe enough.

Paula worried, even if she found somewhere to inoculate Amanda, there would still be the challenge of transportation. To go anywhere, Paula said she must arrange a non-emergency transport with the ambulance, and the cost for the round-trip excursion would be $1,400, at a minimum.

Without a Westmoreland County health department to turn to, she started contacting county commissioners and state elected officials in the region. She’s been in contact with state Sen. Kim Ward’s office, she said, and has been communicating with county Commissioner Doug Chew almost daily.

Still, it was starting to feel hopeless. Despite being eligible for the vaccine since mid-January, her family was having little luck finding Amanda a dose — until Christofano arrived at their doorstep.

“When he showed up at the door … it’s hard to even describe the feeling,” she said. “It’s really going to happen! All of this hard work, all of my phone calls, all of my pleas to everybody actually paid off.”

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Amanda had been on Christofano’s radar for about two weeks. But until Tuesday, he didn’t have a dose to spare.

Community pharmacists across the region have lamented their lack of vaccine supply and the unreliability of allocations. Meanwhile, large pharmacy chains continue to receive regular deliveries from the state and have established partnerships with the federal government. Officials laud the partnerships as a concrete path to increasing efficiency in the rollout. Community pharmacists, however, say the trust is misplaced.

“The chain pharmacies are going to be getting the federal supply. Meanwhile, the community pharmacies, with the proven track record, are not,” Christofano said. “It’s heart-wrenching to hear that the government would make that decision.”

The day before Valentine’s Day, Christofano received a call from Department of Health officials asking if he could accept an unexpected shipment of 1,170 doses. He accepted the vials, and within 24 hours had administered 900 doses. He only had ones available for the Blevins family after the winter storm caused a handful of no-shows to a clinic. He immediately thought of Amanda — and started driving.

Only the small, independent shops are able to administer such large quantities of vaccine this quickly, he contends.

A Department of Health spokeswoman said providers use an online system to input data on vaccine administration, which they’re required to do within 24 hours of giving a dose. The department did not respond to questions about if any group has proven to be faster than the others.

“We encourage people to have patience,” spokeswoman Maggi Barton said. “Right now there is not enough vaccine to meet the demand in Pennsylvania or any other state.”

Meanwhile, the Pennsylvania Department of Health is trying to streamline its approach to vaccine distribution. This month, the department announced a litany of new requirements for providers, including to administer 80% of doses within one week of receiving them, or risk smaller allocations in the future. But the day after Amanda got her first dose, state officials announced an upcoming shortage of up to 55,000 first doses of Moderna, saying providers had mistakenly administered what were intended to be second shots as first doses. The mixup will cause up to 60,000 second-dose appointments to be pushed back.

Providers are struggling to keep up with shifting guidelines and what feels like contradictory instructions. The change in guidelines a month ago, expanding the phase 1A priority group to include a total 3.5 million Pennsylvanians, is chief among the moves that made vaccine distribution harder on pharmacies.

“They’ve made it very difficult to keep any sense of order or prioritizing,” Christofano said.

Pennsylvania residents are likewise frustrated with the disorganization and inconsistencies in how certain groups are prioritized over others, as many who are eligible still can’t find an appointment. Many providers, including the region’s major hospital systems and the Allegheny County Health Department, are focused on people older than 65. Health experts have said this is intentional — older individuals, even those without health problems, have made up more of the region’s death count from covid-19. But Paula still spent weeks in exasperation, confused as to why her daughter, plagued with severe health conditions, couldn’t get a vaccine appointment because of her age.

“I don’t think a very good job is being done,” she said quietly. “I just don’t think our state did a very good job of planning for this.”

The pandemic is far from over, but now Paula feels a sense of relief she could hardly put into words. Her immediate family is now partially-vaccinated, with second doses guaranteed.

But she knows others who have been less fortunate. She imagines there are countless people with severe health conditions who are still online all day, making phone calls, searching for vaccine availability in hospitals, pharmacies and elsewhere.

She feels like the vaccine rollout has been rushed and disorganized, as if state officials didn’t put much thought into the distribution before doses became available, and is now scrambling to catch up.

“I’m relieved, but I’m still concerned that there are other people out there like Amanda, who need the same thing we got for her. There’s a lot of people out there that don’t have a voice for themselves,” Paula said. “I spent a whole month on this to try and make it happen, but there are many, many people out there who don’t have anyone to speak for them.”