An ongoing dialogue on HIV/AIDS, infectious diseases,
December 20th, 2020
With Vaccine Rollout, a Mixture of Gratitude, Envy, and Cautious Hope
I. Gratitude
Did I think we’d have two vaccines for COVID-19 available for distribution before 2021? Two vaccines with 95% efficacy in preventing disease, and nearly 100% in preventing severe disease? Vaccines that work across different patient populations, including the most vulnerable — especially older people?
Not a chance. I’ve probably been quoted half a dozen times saying that we likely wouldn’t be seeing vaccines before next year. Some “expert,” ha.
And yet, here we are. In this interview yesterday, you can clearly hear the excitement in my voice as I discuss the second emergency use authorization for the Moderna vaccine. Giddy.
Yes, it’s time to celebrate, to shed tears of joy when receiving the vaccine, to display happily the image of a bare biceps and the injection taking place, both vaccinator and vaccinated clearly smiling beneath the masks.
It’s even time to dance!
https://twitter.com/JournalsDance/status/1339875341628821506?s=20
II. Envy
Several friends and family members have asked — have you received your COVID-19 vaccine?
Answer: Not yet.
Can’t blame them for asking — I’m an ID doctor, after all, and finished a rotation of inpatient service just before Thanksgiving, and am about to start another over the the Christmas holidays. Most of us have been working solidly since March, no encampment to our country estates.
They might also ask after my wife, a primary care pediatrician who sees sniffly and coughing kids every day in her office practice, kids accompanied by their parents — many of them young adults at high risk for community acquisition of COVID-19.
Not yet for her, either.
The harsh reality is that there’s not yet enough vaccine to go around. Not even close.
In my hospital system, the overwhelming volume to sign-up for “Wave 1” of vaccine administration (of which I’m a part), initially caused the process to crash. It then reopened for approximately 15 minutes before the schedule filled. The supply is limited due to distribution issues beyond the hospital’s control.
Some did successfully sign up, but the first-come, first-served nature of the process allowed people to time their participation — you can be sure many set their phone alarms to go off at the precise moment the schedule came online again. Perhaps this process excluded those working the hardest, with the irony of this disconnect not lost on some.
But problems notwithstanding, I (and others in this first wave) likely will get the vaccine soon — I’m optimistic since with this second vaccine’s authorization, our hospital system’s supply should increase quickly.
My wife can’t be so certain. She and her partners own their practice, and their primary hospital does not have enough vaccines for affiliated primary care pediatricians or their staff.
Meanwhile, thousands of doctors (including several of our friends), nurses, respiratory therapists, and other frontline workers around the country have been vaccinated. Hooray! Plus, notably, some politicians blue and red — even Santa Claus.
Good for them. We’re happy for them.
But we’re envious, too. And if we feel this way, imagine how the broader public feels — those sequestered away the last 9 months, tired of the isolation, many older and at risk for severe COVID-19 and terrified. No accurate timeline for their vaccines. No wonder people are trying to jump the queue.
And yes, it’s hard to see those vaccine selfies, ouch.
https://twitter.com/DrSandman11/status/1339565524213182464?s=20
III. Cautious Hope
Hard to be hopeful right now. Cases continue to increase across the United States — now well more than 200,000 a day, with our country’s cumulative death toll over 300,000.
And unlike earlier surges, which targeted different regions at different times, this time it’s everywhere.
For the first time.
All red USA, now including Hawaii, for out of control covid.https://t.co/BpmBybV8U5 pic.twitter.com/Zyt8Uiaeq8— Eric Topol (@EricTopol) December 16, 2020
Public policies may be different from earlier surges — no extreme shutdowns — but that doesn’t mean things are safe, which is why so many caution against large holiday gatherings.
With these discouraging facts before us, how can we have any hope?
First, we have these two amazing vaccines cited above. An additional promising candidate — the Johnson & Johnson vaccine — has completed enrollment, with results expected in January. That vaccine requires only one dose and has way less stringent cold storage requirements. The AstraZeneca/Oxford vaccine is on a similar timeline for availability, provided there are no further safety or efficacy setbacks.
Second, after months of logjams, rapid home testing for COVID-19 quietly advances. Two such tests have recently garnered approval — the Ellume and the BinaxNOW; others are in the works, and I increasingly hear people broadly supporting “flooding the market” with these tests. Here’s a letter sent to Congress summarizing why we need them, and how to get them approved and supported.
Because if people are going to get together — and they will — some testing is better than no testing, and lots of frequent testing is better yet.
Could we envision socializing safely with friends and family by the early spring, all of us recently vaccinated, and having a negative home test as a safeguard? And schools opening in the fall in ways that seem somewhat normal? Absolutely.
Third, starting early this week, the days start getting longer.
See, was that so hard?
10 Responses to “With Vaccine Rollout, a Mixture of Gratitude, Envy, and Cautious Hope”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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Never thought I would experience utter delight in seeing photos of people getting vaccinated. But I did. And a profound sense of relief, even knowing I will have to wait a while to get my own vaccination.
Here’s a link to just your interview. Easier than trying to find it in the middle of the entire show.
https://www.wbur.org/news/2020/12/19/moderna-vaccine-joins-fight-against-pandemic
Thanks for finding that! Will modify the link.
-Paul
Some hospitals have chosen to stratify within group 1a, and vaccinate higher-risk groups first. UCSF based their stratification on intensity of workplace exposure (and they are notifying people when it’s their turn). Others have considered primarily the risk of complications if infection does occur. Since the major risk factor is age, that has not necessarily gone over well with younger workers. Someone is always going to be unhappy, but I think it does make sense to do this in light of the supply limitations, rather than a first-come, first-served approach for all 1a vaccine candidates.
Is sinovac submitting their results in USA?
Folks we have to remember that globally, about 500 million people were infected with the 1918 flu and at least 50 million died without a vaccine. Todate, 77 million people have infected with Covid 19 world-wide. Comparatively, we lost 1.7 million lives to Covid 19 in 2020 (325, 000 lives in US alone- 18 million people have infected with the Covid 19). We all have to be much grateful to our eminent scientists those who have worked tirelessly and compassionately to develop the COVID-19 vaccine. Good news is that we were able to start administered this life saving vaccine worldwide during the 2020, many will have to wait several months to be vaccinated. Until we get our chance to vaccinate ourselves and our families and friends we have to keep up mask-wearing, hand washing and physical distancing (avoiding indoor gatherings), so that we can celebrate the holidays with our families and friends together next year. These proven public health measures are crucial to slowing the spread of this deadly virus. “The science around mask-wearing is clear…but we now know you can have COVID without having any symptoms. You can have it without having any symptoms to know you have it. That is why it is so important to wear your mask,” The US Surgeon General Jerome Adams.
Thank you for this article. I can relate. I have been asked over and over-when are you getting it? And as I smile patiently and say, there is no rush. We are tier 4 in our hospital, after ED, frontline, hospitalists and specialty clinics, to name a few. We are outpatient primary care. We can still make do with some telehealth visits. Let the frontline workers get it first. Until..a podiatrist proudly showcased her biceps on facebook covered with a band aid and proclaimed she was among the first to get the vaccine in her hospital. A podiatrist. Over primary care. Over our surgeons. Over our GI docs. At the same time as our ED docs. That’s when the anger and perhaps envy, but mostly confusion set in. We are still going in to see patients. I just swabbed a COVID suspect. But we have to wait our turn while a podiatrist jumps the line. It is frustrating and irritating but it is also bureaucracy in a lot of places. I am just thankful my spouse got it (interventional endoscopist). I, meanwhile, will just wait patiently. But hey, at least, if my foot hurts, my podiatrist will be protected.
My friend has been told by her doctor that there is a danger of the mRNA vaccines causing autoimmune disease, a potential long-term complication – he will wait for J&J or AstraZenica and advises her to do the same. Is there any truth to this? I have heard this from lay people but was surprised to hear that a physician has worries.
This morning while listening to the news a question occurred to me regarding the covid vaccine. I know there is some concern about people getting the first shot and not following up with the 2nd. I’ve seen some discussion about whether getting the first shot will provide some protection even if people don’t follow up. What I haven’t seen is any discussion in the general press about whether getting just the first shot could allow the virus to mutate and become resistant to the vaccine. I’ve been living with HIV since the 80’s so the need to take all my medicine all the time to prevent resistance has become gospel to me. Does it apply with covid?
Can you say something about vaccine hesitancy among health care professionals? I know more than one person whose doctor says they won’t take either of the mRNA vaccines and advises waiting. I know nurses who have declined the vaccine. What are they afraid of and why?