It was late January and Maine was emerging from what would be the peak of the COVID-19 pandemic so far. At the Cross Insurance Center, a team of Northern Light Health staff members were busy building what they believed to be the Bangor region’s best weapon against the coronavirus.

With the help of only a few contractors, Northern Light transformed the site from an entertainment arena to a mass vaccination site in just three days leading up to its Feb. 2 opening. A whole new generation will be vaccinated at the site starting Wednesday, when all Mainers 16 and older become eligible for the vaccine.

While Mainers hear stories from across the country of people waiting hours to get their shots, few who get vaccinated at the Cross Center have had a negative thing to say. The average time from door to door is less than 35 minutes, including a 15-minute monitoring period after patients receive the shot, said Dr. James Jarvis, who leads Northern Light’s COVID-19 response.

“It’s all about efficiency,” Jarvis said. “That’s the only way you can move people through the line.”

Some have gone through even more quickly, including 61-year-old Martha Gladstone of Bangor, who got the first of her two Pfizer-BioNTech shots last month in about 20 minutes.

“It was absolutely flawless,” Gladstone said. “From the minute I walked in the door, I didn’t stop walking.”

Marietta D’Agostino, 63, of Bangor said she was happy that the process required virtually no waiting. She also noted the friendly atmosphere.

“The volunteers were great,” D’Agostino said. “They really made it a positive experience.”

Planning began long before January. Northern Light officials first eyed the Cross Center for a role in the pandemic response in March 2020. However, they originally envisioned using it not as a vaccination site, but as an alternative care site for people sick with COVID-19 if their hospitals became overloaded, Jarvis said.

Northern Light facilities manager Tim Doak, who helps Northern Light build its hospitals across the state, and his team created blueprints that would involve running a hospital off the Cross Center arena floor.

Northern Light never had to put that plan into place, however, because its hospitals never became overwhelmed by COVID-19 patients. Yet, the plans were easily transferable, because running a mass vaccine site involved many of the same logistical challenges as running a satellite hospital.

Dr. James Jarvis (top left), who leads Northern Light’s COVID-19 response, talks about the logistics behind the unprecedented undertaking of turning the Cross Insurance Center in Bangor into a mass vaccination site. Signage directs Mainers through the vaccine clinic at the arena. Credit: Linda Coan O’Kresik / BDN

Around June, long before any vaccine had earned federal authorization, staff had shifted their focus to designing a mass vaccination site. They performed timing studies to determine how long each stage of the process — check-in, inoculation and observation — would take. They continue to stick to similar formulas.

The most significant change to the plans came when Northern Light moved the vaccination site from the arena floor to the concourse. The floor was 2 1/2 stories below the arena entrance, down dozens of stairs, posing accessibility challenges, especially for the 70-and-over group who would be the first to get the shot. The concourse had less space but was far easier — and faster — to access.

The concourse’s wide hallways allowed people to quickly get into the building instead of waiting in line outside, Doak said.

In early January, Northern Light signed a lease with the city of Bangor to use the municipally owned Cross Center. It recognized that the site, with its capacity and parking, was the ideal location for inoculating thousands each day. Northern Light considered other sites, though Jarvis and Doak declined to say which ones.

Safety and efficiency have been the keywords for staff since the site opened on Feb. 2, Jarvis said. This has required attention to small details, such as speeding the check-in process to 30 seconds a person so shots can get in arms more quickly. Thursday’s clinic was the first where patients received a QR code at the check-in table and brought it to their vaccinators, who could scan it and learn of any necessary health information before administering the shot.

Such mechanisms shave seconds off the process for each patient, but untold hours in the macro that allow Northern Light to book more vaccine appointments. Everything comes down to a ratio: from staff-to-patient ratio to the number of parking spaces needed at each moment.

Northern Light facilities manager Tim Doak (left) talks about the logistics behind the unprecedented undertaking of turning the Cross Insurance Center in Bangor into a mass vaccination site. Credit: Linda Coan O’Kresik / BDN

Jarvis and Doak expect the process to move even faster in the coming weeks. The younger people who will become eligible for shots are more mobile, and the changing weather will allow people to get the shot without needing to remove their jackets. It’s another small detail integral to running an efficient mass vaccination site.

“That 10 or 15 seconds may not sound like much,” Doak said. “But across 3,000 people in the course of a day? All of a sudden, it’s meaningful.”

Typically, it takes 80 to 120 volunteers and staff members to get the job done. Most of the staff come from within the Northern Light system, with many hourly employees working overtime. The system has also enlisted local nursing students who receive course credit and, eventually, a paycheck as they administer the shots as temporary workers.

As other states faced logistical nightmares at their vaccine clinics, Jarvis said it was a point of pride that he and his team had created such an efficient system. He noted that Maine’s slower start to vaccinations allowed Northern Light to observe what didn’t seem to work, such as drive-thru vaccinations.

“People saw on television these huge lines everywhere else in the country, waiting two, three, four hours just to get in the door,” Jarvis said. “That’s never happened here.”

Northern Light has replicated the model it pioneered in Bangor at its other mass vaccination sites across the state, including at the Portland Expo, the Piscataquis County Ice Arena in Dover-Foxcroft and a former Family Dollar in Ellsworth.

“It’s a recipe that we’re proud of,” Doak said. “And we’re working hard every day to refine it and make it even better.”

Cross Insurance Center in Bangor is operating as a mass vaccination site. Credit: Linda Coan O’Kresik / BDN

As the pandemic pushed Northern Light into the new role of containing COVID-19 in Maine, not everything has been smooth. Its online appointment portal, for example, crashed shortly after new vaccine appointments became available in February, and its virtual waiting room malfunctioned in March, though those technological issues have since subsided.

Spots at vaccine clinics across Northern Light’s system quickly filled up Thursday in the hours after Gov. Janet Mills announced that everyone 16 and over would become eligible on April 7. Practically every shot over the course of the next week was accounted for by Friday morning, Jarvis said. As more than 9,000 people registered, there were no major technical problems, a Northern Light spokesperson said.

Through it all, the Cross Center has seen few, if any, problems. While there is on-site security, there has been little need for it, Jarvis said. Northern Light has not felt the need to use the on-site metal detector.

While Jarvis once predicted that Northern Light would be vaccinating people at the Cross Center through October 2021, he said the changing landscape, including the FDA’s emergency authorization of the Johnson & Johnson vaccine in February, had made it increasingly likely that the last shots will happen in the summer instead.

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