Clinic beset by the butterfly effect Various issues bog down 'highly sensitive' vaccine-delivery model in use at convention centre, provincial task-force official says By: Katie May and Danielle Da Silva Posted: 12:26 PM CDT Wednesday, Mar. 31, 2021 Last Modified: 12:50 PM CDT Wednesday, Mar. 31, 2021 Updates

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A vaccine-distribution model that is “highly sensitive” to disruptions, people showing up more than an hour ahead of their appointments and short-staffing.

Provincial health officials offered a list of reasons Wednesday to explain why Manitobans continued to experience long waits at the RBC Convention Centre immunization supersite earlier this week, despite assurances the issues were being resolved.

Johanu Botha, the operations, logistics and planning lead for the Manitoba COVID-19 vaccine task force, said the long lines patients experienced at the downtown Winnipeg clinic over the past five days are unacceptable and the province has brought in temporary staff to improve operations.

“It’s not what we like to see,” he told reporters. “The more that we lock in the process and the protocol, we’ll have no lineups… we’re sorting out the issues, but I think we will get there.”

The province’s vaccine-distribution model is “highly sensitive” to disruptions, he said. That, combined with short-staffing and patients showing up more than an hour ahead of their appointments at the convention centre clinic, contributed to extended waits this week, Botha said.

On Monday evening, retired engineer Brian Lanoway trudged up three floors amid several hundred people as lineups snaked throughout the convention centre. He showed up 15 minutes early to his vaccine appointment, but ended up spending two hours waiting there. As he would have done in his line of work, he tried to track the bottlenecks in the process, and saw that inefficient scheduling and consent forms being checked multiple times — not a lack of staff — were leading to delays.

“You went from floor to floor and you always thought it would be just around the corner, and what was around the corner was yet another line, so you had no idea how far you had to go. You were just in this endless line,” Lanoway said.

There was no indication that the process had been carefully planned.

“There’s a science to this; it’s well-known in the engineering field,” he said. “I didn’t see any apparent design or science being applied to the process being used.”

Joy Cooper described a similar experience waiting two hours to get her shot Tuesday afternoon. Earlier that day, provincial officials had said the average wait time was 45 minutes.

Triaging at the entrance and better communication advising people of the current wait time may have helped, said Cooper, who eventually made her way to the front of the line and was immunized.

“I’m very, very happy to get the vaccine. It was an emotional moment; I think it is for many people,” she said. “But the fact that we were crowded in like that is kind of scary.”

The risk of contracting COVID-19 while standing in line with hundreds of others is low, task force medical lead Dr. Joss Reimer, said Wednesday.

“I would say it’s incredibly unlikely that we would see COVID spreading in the RBC site, and that’s for a few reasons,” that include the use of masks, physical distancing and ventilation, she said.

Infection-prevention experts evaluated the building’s ventilation before it was selected as the clinic location, along with other design elements, such as flooring material, ceiling heights and walkway widths, Reimer said.

“We’ve put a lot of thought and effort into ensuring that these are safe places for people to go,” she said.

As of Wednesday morning, the clinic was running on time, Botha said. Last week, the province introduced a new model on the third floor designed to speed up the process, but client volumes quadrupled over the weekend and Botha said the task force realized the clinic didn’t have enough “navigators” — people to assist with crowd control and patient flow.

“This new model has moved to requiring even more navigators — generally speaking, the support staff at every site,” he said, adding that the province continues to face challenges with staffing, and fine-tuning scheduling and recruitment are ongoing.

Small delays in filling syringes with vaccine, rearranging lines or even a shift change can also result in severe bottlenecks, he said.

“There is a rather steep learning curve for everyone working on site,” Botha said. “What we discovered is that (the accelerated vaccine program) is highly sensitive to ad hoc adjustments.

“This model… is much more susceptible to the butterfly effect. A 10-minute delay to have all the doses drawn from vials to be ready to go to immunizers… can cause a massive full up of people for a period of time.”

Some clients are arriving too early — as much as two hours ahead of scheduled appointment times Tuesday — which contributes to the lineups, he said. Part of the reason the clinic was shorthanded is that navigator positions are casual and people were unavailable on short notice; the province has now asked city staff to temporarily fill about 40 positions.

Despite the lengthy waits, everyone with an appointment received a vaccine dose, he said.

Botha said the accelerated vaccine program will continue to be used at the convention centre and in Morden, and will likely be deployed at clinics that will open in April or early May.

danielle.dasilva@freepress.mb.ca

katie.may@freepress.mb.ca

Danielle Da Silva
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Danielle Da Silva is a general assignment reporter.

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Katie May
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Katie May is a general-assignment reporter for the Free Press.

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