With virus toll grim and shots starting, knowledge about vaccines can be key

coronavirusshot-300x205The nation now has two potent vaccines to battle the coronavirus pandemic, and the federally approved Covid-19 vaccines are quickly getting into the arms of front-line health workers and vulnerable residents of nursing homes and other long-term care facilities.

Experts have hailed the speedy arrival of clinically tested vaccines as a turning point in the world’s response to the novel coronavirus.

But will the vaccine roll-out be fast enough and accepted by enough Americans to halt Covid-19’s unchecked savaging of the nation?

The stakes could not be higher, as infections, hospitalizations, and deaths break records each day and threaten to wreck the U.S. health care system. The shambolic federal response to the pandemic also has fueled extremists, eager to now spread falsehoods about public health measures — and especially vaccinations.

Inoculations, like any medical intervention, carry risks. But the evidence shows these are far outweighed by their benefits. Vaccinations, historically speaking, have revolutionized health care around the world. That said, decisions about medical care are deeply personal. You should consult with your loved ones and your own physicians.

Ample and credible resources, notably from seasoned journalists at respected news organizations, also now are available online to help us all sort out key issues with the vaccine and the persistent plague of the coronavirus:

411 about the vaccine

Public opinion polls have shown that many Americans may have hesitancy about the coronavirus vaccines due to the speed with which they have been developed and tested. The products from makers like Pfizer, Moderna, and Astra-Zeneca do represent remarkable advances in medical science. But this is the product of decades of toil by experts in labs worldwide, notably by scientists funded by us — U.S. taxpayers. The politicians may have tried to meddle in and coarsen the conversation about treating the coronavirus, including the push to develop a vaccine.

To their credit, the makers, and regulators — knowing it would be disastrous to the vaccines’ credibility and acceptance — have gone through multiple phases of randomized clinical trials, considered the rigorous “gold standard” for testing prescription drugs and medical treatments and devices. Tens of thousands of Samaritans have taken the prospective vaccines, which in two cases have won federal approval for their emergency use after showing they were safe and effective. To be clear, the coronavirus vaccines are different from inoculations that many patients may be familiar with: They do not use the virus itself or killed versions. Instead, as one expert as explained on social media, these innovative products rely on “messenger RNA,” in effect sending the equivalent to the body’s defenses, telling them a fearsome invader lurks and how to disarm the virus (attacking its now familiar spikes).

Health risks and cautions

The months of experiences with the army of clinical trial volunteers has suggested to experts that some warnings are needed with the vaccines that are going into use. They, among other things, can prompt a harsh reaction in some. That means they can leave patients with sore arms and maybe a day or two feeling crummy, including with aches and pains. More severe reactions have occurred. Those with susceptibility to significant allergic responses (e.g., people who have been advised to carry “epi pens” to deal with anaphylactic shock when exposed to insect bites or stings or allergens they know about) have been cautioned: When getting the coronavirus vaccine, they should take it in a facility ready to deal with an adverse reaction, and they should allow time (at least 30 minutes) after inoculation to see if it occurs.

More caveats

Some disagreement has emerged among experts about the Pfizer vaccine and older adolescents. This may be an issue to discuss with your pediatrician or family doctor. The clinical trials did not fully address the safety and effectiveness of the coronavirus shot for patients 16 and older, some experts say. They did not include children, and those studies are launching now that adult use has won emergency approval. The data suggest the vaccine works well for older patients, as well as black, Latino, and Asian American recipients.

One big issue that is under study now and is only hinted at in the available data: Don’t toss out all the other health precautions once vaccinated. Experts say we all will need to keep up the extensive hygiene (hand washing), distancing, face covering, and minimizing contacts with unfamiliar folks, especially in closed and crowded spaces. That’s both because it will take a while to get enough people immunized (or sick), so the country starts to experience the safeguard of “herd immunity,” meaning, roughly, an infection struggles to spread because its targets are so few.

It also will take time to determine if the vaccine not only prevents infection and reduces its severity but also blocks coronavirus spread, especially by asymptomatic individuals. Vaccines for other infections vary whether they curtail spread, with some doing so and others not. Medical scientists also will need more time and study to determine how long vaccines, and indeed getting sick with the coronavirus immunizes people. The virus also does not seem to be mutating quickly and significantly, meaning that new vaccines will need be developed and people might require annual shots, as occurs with influenza.

Costs

Taxpayers have spent billions of dollars to boost the development and acquisition of the coronavirus vaccine. We will spend billions of dollars more, so states and local governments can get this safeguard into hundreds of millions of our arms. This should mean that the immunization will be free for all recipients. Right? Well, patients may need, as always, to gird themselves to battle with providers over vaccine costs. They also should not be surprised, given the shiftiness of the federal administration that has been in power, for disturbing disclosures about the finances of “Operation Warp Speed,” the process by which we all got the vaccines.

 Priorities for immunization

Common sense and need are two characteristics that are supposed to govern the order in which Americans get the coronavirus vaccine. Experts hope to put a high priority on protecting society’s most vulnerable. Really. We’ll see.

The first doses, correctly, were supposed to go to front-line health workers and the aged, injured, and sick who are institutionalized. The folks at Stanford, however, showed how smart people can be doggone dumb. Officials insisted they wanted an equitable way to vaccinate their institution’s medical staff, so they turned to a mathematical approach, employing a selection algorithm. It took an employee strike before the dunces who run the joint discovered that they had stacked the deck, so older, more senior doctors — many of whom were staying at home — were scheduled ahead of residents and younger clinicians who were in the building caring for the sick and dying. Other hospitals, to their credit, have vaccinated, along with doctors and nurses, their cleaning and food staff, recognizing them as “essential employees.”

In Los Angeles, doctors and hospital administrators say their phones already have started to ring off the hook with calls from the rich and famous, hoping to jump the line with the promise of significant donations.

Tussles already are breaking out over ensuring that communities of color — which have suffered a disproportionate burden of illnesses and deaths — get robust vaccination programs. How quickly should teachers be vaccinated, versus airport security screening personnel, or farm or packing house of grocery employees? Just who are the most essential of “essential workers?” Outbreaks have been all too common and deadly in the nation’s prisons and jails, but what kind of public response will occur if public health officials vaccinate the incarcerated early? Will affluent suburbanites sit still while the growing ranks of the unhoused get vaccinated in big cities?

Roll-out concerns

Signs abound already about the significant challenges that are part of getting hundreds of millions of Americans inoculated with what may be a two-shot vaccine that requires specialized handling. The Pfizer vaccine must be super cooled and shippers and locales storing it hit early bumps, including locks on thermal controls for some company product containers. The Moderna vaccine, which has just won federal emergency approval and will start to go out with haste, requires refrigeration but not at the same temperature extremes. Officials hope that millions of Moderna doses will add to Pfizer’s more constrained supply.

Pfizer officials have tangled with the Trump Administration over negotiations for more vaccine, this after the maker contended the White House rebuffed earlier offers to increase supplies. Pfizer, governors, and the administration have argued about supplies in the days ahead, after a first round of vaccines went out. The governors say allotments to the states suddenly have been cut, while the administration has denied this. Pfizer said it has warehoused supplies that it has not gotten federal instructions about. The administration has fessed up to its gaffe, saying that it had given states based on dosages produced, not supplies that were quality checked and ready to ship. That will slash the Pfizer doses soon anywhere from 20% to 40% the states say. The Moderna shipments will be even more welcome, as a result. Meantime, owners and operators of long-term care facilities should not have been surprised that their residents would be high on the vaccine priority list.

That said, nursing homes have struggled to overcome patient hesitancy and to secure consent to vaccinate individuals who may be too frail or cognitively impaired to properly assent. Facility staff also may pose vaccination challenges. They may be hesitant about the vaccine, especially because so many of them are so poorly paid that they do not want to risk having to take time off if they have strong reactions to a shot. The campaign to vaccinate the vulnerable in long-term care has another level of complexity, because the federal government has contracted with CVS and Walgreens, not with health agencies or the facilities themselves, to conduct it.

On the horizon

Johnson and Johnson and AstraZeneca have vaccines in the works, with J&J potentially presenting data to federal regulators in January and a potential emergency approval and roll-out in February. Federal officials have said AZ will follow in a February-March timeline. Dr. Anthony Fauci, the nation’s leading infectious disease experts, has cautiously opined that vaccines will be widely available and inoculations reaching full force in the spring, with greater normality returning by late summer of fall in 2021.

Fingers crossed!

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of treatments and prescription medications, too many of which turn out to be dangerous drugs. The coronavirus pandemic has laid further bare the U.S. health system’s weaknesses — and strengths.

That said, we have a dangerous time ahead of us before vaccinations show they can help us turn the tide of the tsunami of sickness and death unleased on the world by the coronavirus. Please keep your guard up — maintain the excellent hygiene (hand washing), face covering, and distancing. During the holidays, especially, please stay at home when possible and only with members of your immediate household. We need to avoid closed, crowded spots. We must research carefully, analyze well, and defeat counter factual and emotional responses to a plague that has inflicted an unacceptable toll, worsened by the extreme embrace of foolishness and nonsense. We’ve got work to do, so we are in a far better place when the battle is won against the Covid-19. That day cannot come too soon.

Photo credit:  Northwell Health. Sandra Lindsay, a critical care nurse at Long Island Jewish Medical Center, received the coronavirus vaccine from Michelle Chester, Northwell’s director of employee health services. This was reported as the first inoculation in the nation using the Pfizer vaccine given emergency approval for use by federal regulators.
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