What you need to know about the COVID-19 vaccine second dose: timely appointments, adequate supplies, knowledge of side effects
When Brian Fogarty received his first shot of a COVID-19 vaccine at a Cook County Health clinic in suburban Ford Heights, he was given a slip of paper with a website and phone number and told to make his appointment for his second dose.
But when he called the number, Fogarty, a suburban school principal, was told there were no appointments at the site at Cottage Grove Medical Center. The website too, visited while Fogarty was still in the waiting room, showed no available slots.
Increasingly worried about not receiving his second shot in the appropriate time frame, Fogarty called the phone number 115 times. He was eventually able to make an appointment for a second dose.
Meanwhile, Fogarty heard from colleagues who received their shots from sites that would not let them leave without making their second appointment — the preferred modus operandi at most vaccine locations, including at Cook County Health, which says the clinic erred in not making Fogarty an appointment while on site.
As health care providers are ramping up first doses and preparing to administer second doses for the large, phase 1b contingent of senior citizens and essential workers, they are performing a complicated, logistical dance that involves signing patients up for appointments within the proper time frame, offering help to make sure patients can come to that appointment and carefully tracking inventory to be sure they have the second doses on hand.
As of Monday, just under 2% of the state’s population had received both vaccine doses, according to data from the Illinois Department of Public Health.
Many clinics are making second dose appointments while people are on site, but at least one health care provider has received calls from people such as Fogarty, who were told they may not be able to receive a second dose at their original location, revealing cracks in a complex system.
“I was left on my own,” Fogarty said. “Why isn’t it the same procedure at every site?”
Health care experts are telling people to prioritize their appointments for their second shots, and not be afraid of any side effects that come during the next dose, which has resulted in a stronger reaction for some people.
“It’s normal,” said Dr. Emily Landon, an epidemiologist at the University of Chicago Medical Center. “Their immune system is doing a lot more work the second time.”
What does the second shot do?
Landon likened the two-dose system to learning a new software. A new user might feel reasonably confident after the first day of learning the software, but it takes a second day of using it to completely catch on to the new program.
“That’s where the memory kind of sticks,” she said.
Because the immune system is doing that work, some people have reported feeling crummier after the second shot.
Landon herself was tired and spiked a fever for about a day, but she knew that was a normal response.
“Don’t be hesitant,” she said.
The Moderna vaccine recommends administering the second shot about 28 days after the first, while Pfizer’s recommendation is 21 days. A Johnson & Johnson vaccine that may soon be approved by the FDA only requires one dose.
The CDC recommends adhering to that time frame as closely as possible, but says the second dose can be given up to six weeks later.
“We want to them to stay as close to that three-week or 28-day cycle as possible,” said Kristin Ramsey, senior vice president and Wood-Prince Family Chief Nurse Executive at Northwestern Memorial Hospital. “It’s very important that we get them within the time frame.”
But there is likely some wiggle room, experts say.
Landon said the CDC’s bench mark of six weeks seems realistic.
“A couple weeks here or there is fine,” she said.
In the United Kingdom, health officials decided to delay the second shot to 12 weeks to give more people the first dose in the short term. Landon, though, said this approach is “a little bit more risky” because it is not yet totally clear how much immunity the first dose provides.
Another important factor for the second dose of the vaccine is the manufacturer. Experts have maintained that people should not mix and match vaccine brands.
“The short answer is, we don’t know how important it is so we are really encouraging people to get the same brand,” Landon said.
She recommended that people take a photo of their vaccination card so they have a digital copy with the first dose date and manufacturer information.
Logistics of the second shot
In the meantime, health care providers are closely monitoring their vaccine availability to balance first and second doses, as well as make sure people have the ability to show up to their appointments.
One health care network with clinics in the Chicago area has a fleet of vans that it uses to bring people in for appointments, while also partnering with ride-share companies.
“We recognize that transportation is one of the biggest barriers,” said Dr. Ali Khan of Oak Street Health, a national network of clinics that focuses on low-income seniors.
Oak Street also has mobile teams that can administer vaccines at people’s homes for those who aren’t able to come to the clinic, he said.
A number of hospitals and clinics spoken to by the Tribune say they make second-dose appointments while people are on site to avoid logistical problems later, and use text alert systems to make sure patients don’t forget the date.
Cook County Health spokeswoman Deb Song said vaccine sites are not supposed to let patients leave without making their second appointment. She did not know why Fogarty wasn’t given the opportunity to make an appointment on site.
“We are extremely sorry that happened,” she said.
Providers also need to be sure they have enough doses for everyone coming back for a second dose.
“The city, who supplies the doses, has assured us we will get second doses in time. So far that has happened,” said Dan Fulwiler, president & CEO of Esperanza Health Centers, a network of federal qualified health clinics in Chicago. “It could be that at some stage, there would be a supply interruption and we would have to reschedule (appointments).”
Fulwiler said the clinics send the city supplier numbers each week that includes the number of second doses needed.
The White House on Monday urged providers to not keep a vaccine reserve for second doses, CNN reported, saying that the “efficiency of doses” should improve.
Doctors expressed hope that the White House’s commitment to sending three weeks of vaccine projections will better help them make appointments and plan ahead.
Landon said the U. of C. was previously receiving texts from FedEx with vaccine information 48 hours before arrival.
“You can’t really schedule and plan based on that,” she said.
