Preparing for potential ‘twindemic’: Local pharmacy students pressed into flu, COVID-19 vaccine education

Health officials across the U.S. are urging more people to get flu shots this year – and early – citing concerns about a potential “twindemic” if a severe flu season merges with COVID-19 cases.

To prepare, the Centers for Disease Control and Prevention ordered 9.3 million flu vaccine doses for uninsured people compared with its typical half-million doses, says the American Medical Association. Drug companies hiked overall production of influenza vaccine this year. The goal is to reduce flu cases and thus lessen impact of respiratory illnesses on the population and burden on the health care system during the pandemic, the CDC says.

Locally, Washington State University instructors had to rethink how to evaluate and certify Spokane pharmacy students this month so they can give some of those extra flu shots – perhaps even a COVID-19 vaccine – in helping at pharmacies and vaccine clinics. Although in-person certifying occurs at the start of school, professors initially thought it would have to be postponed. But students repeatedly asked to be put into service, instructors said.

“The CDC predicts manufacturers will provide between 194 million and 198 million doses of influenza vaccine, which would be more than any flu season ever,” said Kim McKeirnan, associate professor at WSU College of Pharmacy and Pharmaceutical Sciences. “Typically, pharmacies receive the stock of flu vaccine in August, so most pharmacies in Spokane already have the influenza vaccine.”

Students are aware of the demand this year for flu shots and potentially a COVID-19 vaccine.

“They see an unprecedented opportunity in our future because when there is a COVID vaccine, everyone in the world who wants it will need to be immunized,” McKeirnan said “The more immunizers we have in the community, the more people we’ll be able to reach quickly, so our students were excited to be a part of that. They wanted to be out in the community immunizing and being a resource.”

Second-year pharmacy students complete an early, compressed course for Pharmacy 530 for a week that ends with a show of skills to give vaccine shots. “So by the end of the first week, they’re all immunization certified,” said Nicole Rodin, a department of pharmacotherapy assistant professor who helped develop the session.

“But with this year, it’s been a little different with the accommodations for coronavirus.”

In the course, students also learn to do tests such as for strep throat. This year, COVID-19 testing was added. The new show of immunization skills under coronavirus precautions required more extensive protective gear and staggering of arrivals, with only two students at a time watched by an instructor as the students gave saline shots to each other.

What previously took a few hours jumped to about 10 hours in two days.

“There is no theoretical training that can get you ready to stick a needle in,” McKeirnan added. “We have sponges that are designed for immunization injection practice. They’ve had all the theory, and this will be their first hands-on approach. It’s a requirement of this to give shots – two intramuscular injections and one subcutaneous injection – to another person.”

Rodin said the college partners with the national American Pharmacists Association for the certification, and students completed 12 hours of study now online. They usually get an on-campus visit from an association trainer who did a Zoom session this year. Students then show they can give a shot and offer vaccine guidance to patients.

“We go one step further and give students a little extra training on how to do these immunization techniques for adults as well as pediatric patients,” Rodin said because the state allows pharmacists to give shots for kids as young as 6 months old. Elsewhere, it might be age 3.

About 65 pharmacy students planned to go to the evaluation sessions, mainly in Spokane but also on the Yakima campus. Other students who couldn’t be on campus can do the evaluations later or through a partnering pharmacy that has WSU students helping at sites, Rodin said.

“For the assessment itself, not much has changed; we’re still holding them to the same standard of quality. Truthfully, the biggest logistical challenge is giving students the time so we don’t have a bunch of students congregating, then getting them properly fitted with all the PPE necessary to keep them and faculty safe.”

The college will follow full CDC guidelines for health care providers, including use of disposable gowns over clothes along with gloves and masks, as well as face shields. It required regular hand-washing and sanitizing of surfaces.

“Two student partners will come in, and each will give an injection to their partner sequentially,” Rodin said. “In a normal year, we get all of our students, which averages about 120 students here in Spokane, done in one single day … it usually doesn’t take more than five or six hours.”

The higher demand for people seeking a flu shot most years tends to be October and November, but McKeirnan suggests that early is better. Even if immunity decreases a bit six months from now, it’s worth getting the vaccine soon for two reasons, she said.

“In general, my recommendation would be just go get a flu shot because we don’t know year to year when influenza is going to hit Spokane,” McKeirnan said. “Sometimes, you see back-to-school outbreaks in September. Sometimes, it’s not until spring.

“The flu vaccine takes two weeks to take effect from the time you’re stuck with the needle to getting the full effects of the vaccine. That’s another reason I recommend getting it early.”

Rodin said the push for more flu shots is expected to help.

“The reason for that is we want to decrease any risk for any respiratory complications if a person happens to get COVID,” Rodin said. “One of those respiratory complications is the flu, so if we can have any preventative measures in place, we’re certainly going to try to do that. Nationally, we’re seeing an increase in demand for flu shots for our patients, so that means an increase in immunizers for those patients.

“Our students in Spokane do this really well every single year. They partner with local organizations including our health district to provide vaccines to our community on a normal basis. So when there is an instance where we would have an increased demand, they’re certainly on board for that more than ever.”