Covid Vaccine

[Chris Kern]

The first dose confers a substantial degree of immunity: not as good as two, but not insignificant. From a public health point of view, it at least arguably makes sense to use limited supplies to give as many first doses as possible. This is a live debate in the UK.

It's not clear to me how Pfizer and Moderna selected their respective intervals of 21 and 28 days between doses for the clinical trials.  Was there some preliminary testing that indicated those intervals produced the optimal immune responses?  Some experts here have suggested that a longer interval (e.g., six or even eight weeks) might work just as well, but they admit they don't have the science to support their guess: they are extrapolating from experience with other vaccines.

[Alan Klein]

Someone who takes a decision that you either don't understand or don't agree with (or both) isn't necessarily a "dope". Public health officials take decisions based on the good of the population, and those decisions don't always match those which might be taken for the benefit of particular individuals.

The first dose confers a substantial degree of immunity: not as good as two, but not insignificant. From a public health point of view, it at least arguably makes sense to use limited supplies to give as many first doses as possible. This is a live debate in the UK.

The BBC interviewed a woman whose mother was likely not to get her second dose for a while, wailing "but she won't be able to hug her grandchildren without it!". The reporter didn't point out that her mother's ability to hug her grandchildren might be gained, from a second dose, at the expense of the life of someone who as a result wouldn't get a first.

Jeremy

Two-thrids of the people who died in my town were over 65.  I have friends who are 80 who can't get appointments because there are none left.  Meanwhile, they're giving the vaccine to people 16 years and older who smoke.  Because of the change in policy, my state of New Jersey now has 4 million people eligible.  The state is supposed to get 100,000 doses a week.  That's forty weeks some people are going to have to wait.  Unfortunately, my 80 year old friend didn't get to the internet or phone fast enough. 

Yes, the people who changed this policy are dopes, worse, they're going to kill more people than if they left the policy as it were. 

here are the people they are lumping together with people over 65
Licensed healthcare professionals and health care staff (including paid and unpaid health care workers)
First responders, sworn law enforcement and firefighters, and essential workers
Individuals ages 65 and older.  So they'r putting people who are overweight and let's say 25 years old ahead of 65-year-olds.  That's dumb. Meanwhile, Nj is all out of vaccine already.  No one's making more appointments, who knows for how long. 

Individuals ages 16-64 with medical conditions, as defined by the Centers for Disease Control and Prevention, that increase the risk of severe illness from the virus. These conditions include:

Cancer
Chronic kidney disease
COPD (chronic obstructive pulmonary disease)
Down Syndrome
Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
Severe Obesity (BMI ≥ 40 kg/m2)
Sickle cell disease
Smoking
Type 2 diabetes mellitus

[Alan Klein]

There's no triage putting first on line people who are old and who also have comorbities.  Here's from one of the places providing the vaccine:

Due to supply limitations, vaccination appointment availability is extremely limited at this time. Once registered, it may be some time until you receive your link to schedule an appointment.
Once You Register:

Because of the massive number of vaccine registration forms we have received; you will be in our queue to receive the scheduling link based on your place in line and the number of people who requested a vaccine before you.
When you are next in the queue, the link will automatically be sent as a text message and email to the phone number and email address you entered in the registration form. Then you can schedule your appointment.
If you incorrectly entered information into the registration form, you will need to fill out a new registration form.
We do have a limited number of appointments at this time due to vaccine supply, with more opening up. We are not scheduling appointments over the phone.
Please do not call or send a message to your local hospital about vaccine scheduling.
Thank you for your understanding.

[jrsforums]

Alan, one could call them “dopes”, but definitely foolish enough to believe a prior CDC administration which was proven to be disorganized and ‘loose’ with the facts.

The AP, on 1/12, reported, “... Azar also said the government will stop holding back the required second doses of the Pfizer-BioNTech and Moderna vaccines, practically doubling supply. Both those shots require two doses to achieve optimum protection.
Health and Human Services Secretary Alex Azar says the government will no longer hold back second doses of the COVID vaccines, practically doubling supply. He’s also urging states to immediately start vaccinating people age 65 and older. (Jan. 12)
Additionally, Washington is urging states to immediately start vaccinating other groups lower down the priority scale, including people age 65 and older and younger people with certain health problems...”

Apparently NJ was “silly” enough to to believe add’l supply was available (which it wasn’t) and to fully open the gates as Azar recommended, causing, as you report, massive demand without any means to prioritize appointments.

NC only “opened the gates” to include 65+ (to the existing healthcare providers).  The two major healthcare centers in the state had already set up very efficient scheduling operations and injection centers.  Each county is setting up add’l operations beyond that.  My county has an appointment system where you register and they will prioritize scheduling based on risk factors such as age, comorbidities, and zip code (Covid reporting density).

[Alan Klein]

Alan, one could call them “dopes”, but definitely foolish enough to believe a prior CDC administration which was proven to be disorganized and ‘loose’ with the facts.

The AP, on 1/12, reported, “... Azar also said the government will stop holding back the required second doses of the Pfizer-BioNTech and Moderna vaccines, practically doubling supply. Both those shots require two doses to achieve optimum protection.
Health and Human Services Secretary Alex Azar says the government will no longer hold back second doses of the COVID vaccines, practically doubling supply. He’s also urging states to immediately start vaccinating people age 65 and older. (Jan. 12)
Additionally, Washington is urging states to immediately start vaccinating other groups lower down the priority scale, including people age 65 and older and younger people with certain health problems...”

Apparently NJ was “silly” enough to to believe add’l supply was available (which it wasn’t) and to fully open the gates as Azar recommended, causing, as you report, massive demand without any means to prioritize appointments.

NC only “opened the gates” to include 65+ (to the existing healthcare providers).  The two major healthcare centers in the state had already set up very efficient scheduling operations and injection centers.  Each county is setting up add’l operations beyond that.  My county has an appointment system where you register and they will prioritize scheduling based on risk factors such as age, comorbidities, and zip code (Covid reporting density).

Thanks for reminding me.  Yes, the CDC now recommending this younger age policy, is the same group who told us masks aren't needed for the general public.  They also had the testing procedures all fowled up because the testing chemicals had either expired or were just ineffective.  So now these same 'experts" have opened the flood gates so the old people who most need the vaccine stand online before behind younger people who need it less. That's criminal, not disorganized.

And now, the federal government says is going to jump into the fray and control the giving of these shots over the states and local communities and local medical establishments and hospitals.  Are they kidding?   I know we can't talk about politics here.  But this isn't medicine.

[Alan Klein]

Just to be fair about the second shot.  When my wife and I got our first shots yesterday, I asked the nurse if she has our second shots knowing what the government is up to.   She smiled knowingly and said "yes" they're keeping all of them in reserve.  But I think that's their local policy.  They're not following any CDC requirements by shifting the second to first.  I just hope that holds.

[jrsforums]

Just to be fair about the second shot.  When my wife and I got our first shots yesterday, I asked the nurse if she has our second shots knowing what the government is up to.   She smiled knowingly and said "yes" they're keeping all of them in reserve.  But I think that's their local policy.  They're not following any CDC requirements by shifting the second to first.  I just hope that holds.

Me, too.  My wife & I are due for 2nd on Thursday.

[jrsforums]

Thanks for reminding me.  Yes, the CDC now recommending this younger age policy, is the same group who told us masks aren't needed for the general public.  They also had the testing procedures all fowled up because the testing chemicals had either expired or were just ineffective.  So now these same 'experts" have opened the flood gates so the old people who most need the vaccine stand online before behind younger people who need it less. That's criminal, not disorganized.

And now, the federal government says is going to jump into the fray and control the giving of these shots over the states and local communities and local medical establishments and hospitals.  Are they kidding?   I know we can't talk about politics here.  But this isn't medicine.

I think the states are still in control and the federal govt is offering more planning &resource assistance.

[Eric Myrvaagnes]

I am 81 years old and recovering from a kidney transplant last March. By the current Massachusetts schedule I would be eligible for my first Covid vaccination in February. However, I just received a notice from Mass General Hospital that I can make an appointment now, because organ transplant patients are eligible a month after their surgery.

I will get my first shot next Friday, and at that time my second shot will be scheduled.

On the whole, I'd rather live here than in New Jersey.   

[Jeremy Roussak]

Just to be fair about the second shot.  When my wife and I got our first shots yesterday, I asked the nurse if she has our second shots knowing what the government is up to.   She smiled knowingly and said "yes" they're keeping all of them in reserve.  But I think that's their local policy.  They're not following any CDC requirements by shifting the second to first.  I just hope that holds.

Well, that's jolly nice for you. I trust, as you receive your second dose, you will give a thought to the 80-year-old who may die because you are depriving him of his first.

The job of public health officials is to maximise public health. That is done by using a finite resource in the most efficient way, by vaccinating those most at risk of death or serious disease as a result of infection, not by giving second doses to people who selfishly think they are more deserving than others.

Jeremy

[KLaban]

On the whole, I'd rather live here than in New Jersey.   

Understandable given the neighbourhood Sopranos and Kleins!

[jrsforums]

Well, that's jolly nice for you. I trust, as you receive your second dose, you will give a thought to the 80-year-old who may die because you are depriving him of his first.

The job of public health officials is to maximise public health. That is done by using a finite resource in the most efficient way, by vaccinating those most at risk of death or serious disease as a result of infection, not by giving second doses to people who selfishly think they are more deserving than others.

Jeremy

I am afraid, Mr. Aministrator, that your statement is opinion and not based on any scientific fact.  I do not believe there have been any peer based studies on the efficacy of only one shot of either Pfizer or Moderna.  Nor any studies of extending 2nd shot from 3/4 weeks to 6 weeks.  (Edit: plus you made a personal attack, which is against the rule, isn’t it? “ people who selfishly think they are more deserving than others.”)

In addition, if you give current 2nd shots to first timers, there is concern on what the supply will be down the road as the need for 2nd shots is increased at the same time need for 1st shots has not diminished.  I have not seen any numbers on future deliveries, but they do not seem to be ramping up.  In fact, in Europe, Pfizer will be delivering less until Feb. due to rebuild of plant.

Alan’s main complaint was the inclusion of the 16-64 group which swelled the NJ demand to 4 million people.  If you read my earlier post & referenced article, the 65+ group has 80% of the deaths.  Including the 16-64 group diminishes the “80-year-old who may die” from getting the vaccine, much more than Alan having gotten his.

Public health officials, I am sure, are trying to do their best.  However, they are also under tremendous pressure from people, businesses, and political.

[Alan Klein]

Well, that's jolly nice for you. I trust, as you receive your second dose, you will give a thought to the 80-year-old who may die because you are depriving him of his first.

The job of public health officials is to maximise public health. That is done by using a finite resource in the most efficient way, by vaccinating those most at risk of death or serious disease as a result of infection, not by giving second doses to people who selfishly think they are more deserving than others.

Jeremy

You're conflating the issues.  The problem is that they opened up the younger group of people who aren't as affected.  There would be enough shots for the 80-year-old otherwise.  The original plan was to vaccinate everyone over 65 first, not 16-year-olds who are overweight.  If they wanted to move up the younger group, fine.  But they should arrange the appointments so the older group gets the injections first.  Right now it's whoever calls in first. 

Additionally, what you're recommending is to effectively do away with the second shot.  No one will get it until everyone gets their first shot.   Well, how many old people will die because they only got the first shot?  What will a program like that do to the plan for herd immunity? Will anyone actually start living normally knowing they only had one shot so our lives and the economies can get back to normal? 

I haven't heard any discussion in public about this new plan.  It was instituted by some unknown people without the public being informed, all at the last minute, just as the first doses were being given.  It makes the CDC and governments seem like they again don't know what they're doing.  Who could trust them?  Everyone was told you'll be about 95% safe when you get two shots, which is what everyone is counting on. 

Would you want to only get one shot after being told you need two?

[Alan Klein]

Understandable given the neighbourhood Sopranos and Kleins!

You're nasty and personally insulting and have been added to my Ignore list.

[LesPalenik]

Would you want to only get one shot after being told you need two?

Why all the fuss and whining? They can take the vaccine dose for the second shot from the next shipment, One or two weeks delays don't matter.

[Alan Klein]

Why all the fuss and whining? They can take the vaccine dose for the second shot from the next shipment, One or two weeks delays don't matter.

That's not what Jeremy suggested.  He suggested giving up the second shot entirely and settle with some benefit less than the vaccine manufacturers' studies provided and with doses less than recommend by them.  Apparently, the CDC knows more than the pharmaceutical companies. 

[Alan Klein]

Why all the fuss and whining? They can take the vaccine dose for the second shot from the next shipment, One or two weeks delays don't matter.

Also, it won't be one or two weeks of delay.  If they're going to give out first doses to everyone first, it could be months up to a year before they have enough supply to start giving second shots. Meanwhile, there are 80-year-olds who can't get their first shots because 16-year-olds are now in the same group.  Many of the old people I know where I live, are still trying to figure out email and messaging.  Meanwhile, the 16-year-olds, are on the web making appointments for their shots thumbing away on their phones.  I spoke to my friend last night trying to help him out to get an appointment.  He doesn't know all the ins and outs.  He's 80+ and has Parkinson's. So if he gets on a list now, he's going to be weeks if not months away from his first shot. Meanwhile the fat 16 year old will get theirs, and stop for a Dunkin' Donut on the way home. 

[Jeremy Roussak]

That's not what Jeremy suggested.  He suggested giving up the second shot entirely

No, I didn't. I suggested that it might be appropriate to use a finite resource to maximise the benefit to be derived. That may mean delaying the second dose to some in order that others can get a first. I have neither the knowledge of vaccines nor the background in public health necessary to reach a decision as to which course of action would be preferable from a public health point of view. Of course, those individuals who are able to obtain a second dose benefit themselves; but the purpose of public health is to benefit the population, not individuals. Comments on obesity are moral judgments, implying that those who are at risk because of their self-indulgence (if that is the cause of their obesity) despite their youth are somehow less entitled to protection. There are no doubt some who hold this view - Alan clearly does - but it's not universal and again is not the concern of public health decision-makers.

Jeremy

[jrsforums]

No, I didn't. I suggested that it might be appropriate to use a finite resource to maximise the benefit to be derived. That may mean delaying the second dose to some in order that others can get a first. I have neither the knowledge of vaccines nor the background in public health necessary to reach a decision as to which course of action would be preferable from a public health point of view. Of course, those individuals who are able to obtain a second dose benefit themselves; but the purpose of public health is to benefit the population, not individuals. Comments on obesity are moral judgments, implying that those who are at risk because of their self-indulgence (if that is the cause of their obesity) despite their youth are somehow less entitled to protection. There are no doubt some who hold this view - Alan clearly does - but it's not universal and again is not the concern of public health decision-makers.

Jeremy

I’m sorry, but I read your response the same way.  In addition, without an increase in weekly supply, delaying 2nd dose for 2/3 weeks only gives a short term advantage to 1st dose supply, but creates, then, an expansion of 2nd dose demand, downstream, which will reduce doses available for 1st shot.

While Alan’s example could be chosen better (😀 he’s from Jersey, so English is not his first language 😀 ), the fact is ‘...the single largest predictor of death is clearly age, and single comorbidities are lower than that...” (https://www.newyorker.com/news/q-and-a/deciding-who-should-be-vaccinated-first)

[jeremyrh]

Would you want to only get one shot after being told you need two?

Because the second shot would do more good to someone else than to you. If there are (for now) only 2 shots available, shall we give one each to you and your wife, or shall we give both to you?