Are vaccines the light at the end of the tunnel?

[Arizona Wildcat]

Fouremco - What is the plan in Canada for allocation of vaccines?

Friends in BC are not planning on coming to the desert this winter.  They estimate the border opening around April 1st.  Gonna be quiet in Yuma and Mesa!  Any thoughts from where you live?

Interesting in Arizona that 20-44 year olds now with 50%+ of total cases and older deaths significantly dropping.  The nursing home issue here almost at ZERO.

Edited September 26, 2020 by Arizona Wildcat

[Fouremco]

55 minutes ago, Arizona Wildcat said:

Fouremco - What is the plan in Canada for allocation of vaccines?

Friends in BC are not planning on coming to the desert this winter.  They estimate the border opening around April 1st.  Gonna be quiet in Yuma and Mesa!  Any thoughts from where you live?

Interesting in Arizona that 20-44 year olds now with 50%+ of total cases and older deaths significantly dropping.  The nursing home issue here almost at ZERO.

We are still in the planning stages, but it would appear that the groupings of priority recipients will be similar to those being discussed in the US. For the most part, I would imagine that priorities will be similar globally.

 

I don't know how closely your BC friends are following the details of the Canadian-US border closure, but at the current time they are free to fly to Arizona. They can't drive, but they can fly to any state, including Arizona, that has no travel restrictions.  When they return to Canada, they will either need to self-quarantine for 14 days, if the current regulations don't change, or meet the new requirements should they change.

 

We've seen a similar shift to a younger age group following relaxation of many of the restrictions that had been imposed. As a consequence, many of the restrictions are being reimposed, in whole or in part. Our nursing home and long term care facilities had seen a dramatic drop in cases. Unfortunately, here in Ottawa they have started to climb again, although I believe that the response to the renewed outbreak is faster and more effective than for the initial wave. 

[phoenix_dream]

3 hours ago, Fouremco said:

I wouldn't get too upset by this graphic. It's based on information from a discussion draft prepared by a committee formed by the National Academies at the request of the National Institutes of Health and the Centers for Disease Control and Prevention, to help in the development of federal guidance.

 

The final report will be considered along with other advice as the federal government determines how a vaccine will be allocated in the United States.

 

The report will also immediately be made available to the public free of charge. The report will contain information that may also be useful to state and local policy makers and health officials.

 

As the final report may well correct this apparent oversight with respect to seniors, and as the report will be but one of many sources contributing to the development of the final allocation plan, I wouldn't conclude that healthy seniors will be at the back of the line for the vaccine. 

 

 

Easy to get upset at so many things these days🙂.  I honestly don't think its an oversight though.  If I take all my emotions out of the picture, as well as what seems fair or not, and look only at what will get us to herd immunity the fastest, then one could argue that it makes logical sense for healthy, procedure following seniors to be last.  If most of us are already doing what is expected by wearing masks, distancing, and not hanging out in bars and so on, then we are not the ones spreading the virus.  We also are not essential to the economy in the sense of keeping people employed, as most (I know not all) are retired.  And as retirees, even if we don't like being stuck in our houses we have the ability to do that without losing our livelihoods. 

 

We are certainly more at risk of death or complications if we do get sick, but I would hazard an educated guess that the vast majority of senior deaths are those in nursing homes and other senior living facilities.  So as much as I would hate the fact of being last, and as much as I resent the fact that killers, rapists, and child molesters may get priority over me,  I think that could very well happen.

[Arizona Wildcat]

1 hour ago, Fouremco said:

We are still in the planning stages, but it would appear that the groupings of priority recipients will be similar to those being discussed in the US. For the most part, I would imagine that priorities will be similar globally.

 

I don't know how closely your BC friends are following the details of the Canadian-US border closure, but at the current time they are free to fly to Arizona. They can't drive, but they can fly to any state, including Arizona, that has no travel restrictions.  When they return to Canada, they will either need to self-quarantine for 14 days, if the current regulations don't change, or meet the new requirements should they change.

 

We've seen a similar shift to a younger age group following relaxation of many of the restrictions that had been imposed. As a consequence, many of the restrictions are being reimposed, in whole or in part. Our nursing home and long term care facilities had seen a dramatic drop in cases. Unfortunately, here in Ottawa they have started to climb again, although I believe that the response to the renewed outbreak is faster and more effective than for the initial wave. 

Yes, but they said they cannot get health insurance.  Being 70+ makes that a no go.  

Similar as I have dual passports.  Can travel most anyplace, but with the travel advisory in place my health insurance is a no.

[d9704011]

13 minutes ago, Arizona Wildcat said:

Yes, but they said they cannot get health insurance.  Being 70+ makes that a no go.  

Similar as I have dual passports.  Can travel most anyplace, but with the travel advisory in place my health insurance is a no.

They ought to check out Medipac travel/health insurance.

[tocruiseguy]

3 hours ago, phoenix_dream said:

Easy to get upset at so many things these days🙂.  I honestly don't think its an oversight though.  If I take all my emotions out of the picture, as well as what seems fair or not, and look only at what will get us to herd immunity the fastest, then one could argue that it makes logical sense for healthy, procedure following seniors to be last.  If most of us are already doing what is expected by wearing masks, distancing, and not hanging out in bars and so on, then we are not the ones spreading the virus.  We also are not essential to the economy in the sense of keeping people employed, as most (I know not all) are retired.  And as retirees, even if we don't like being stuck in our houses we have the ability to do that without losing our livelihoods. 

 

We are certainly more at risk of death or complications if we do get sick, but I would hazard an educated guess that the vast majority of senior deaths are those in nursing homes and other senior living facilities.  So as much as I would hate the fact of being last, and as much as I resent the fact that killers, rapists, and child molesters may get priority over me,  I think that could very well happen.

 

 At least in Canada in provinces the majority of deaths were in Long Term Care facilities. I would guess health care workers and then police/fire department would be first on the list.  I guess the bad thing with that, if the vaccine turns us into zombies because they rushed it, we would lose the most important first.....😃

 

I also suspect some companies will try to acquire doses for their employees so they can ramp up.  I agree (not a senior yet btw) that those who are employed and have to take public transit to work, for example, should get priority over a healthy senior.   We need to get our downtowns working again.  Also, if we want to relate this to cruising, how long will it take for cruise lines to get all their employees vaccinated, most don't live in North America?  I would guess the cruise industry will on the shelf longer than other tourism industries.

 

PS When you compare Canada, US and European rates of infection/deaths to places like Japan, South Korea, Taiwan, Vietnam etc. I wonder how they get it so right and we keep getting it so wrong?  

 

 

 

[TeeRick]

I think the "prisoner" priority in the vaccine phases will be the next political hot potato in the USA if it holds true after vaccine approval.  Buckling my seat belt for this one!😀

[mimbecky]

16 hours ago, phoenix_dream said:

Easy to get upset at so many things these days🙂.  I honestly don't think its an oversight though.  If I take all my emotions out of the picture, as well as what seems fair or not, and look only at what will get us to herd immunity the fastest, then one could argue that it makes logical sense for healthy, procedure following seniors to be last.  If most of us are already doing what is expected by wearing masks, distancing, and not hanging out in bars and so on, then we are not the ones spreading the virus.  We also are not essential to the economy in the sense of keeping people employed, as most (I know not all) are retired.  And as retirees, even if we don't like being stuck in our houses we have the ability to do that without losing our livelihoods. 

 

We are certainly more at risk of death or complications if we do get sick, but I would hazard an educated guess that the vast majority of senior deaths are those in nursing homes and other senior living facilities.  So as much as I would hate the fact of being last, and as much as I resent the fact that killers, rapists, and child molesters may get priority over me,  I think that could very well happen.

 

Phoenix, your words perfectly explain my sentiment and struggle.  My husband and I are only 63 so ......

M

[TeeRick]

Almost 80% of COVID deaths reported in the USA are from 65+ age group.

https://covid.cdc.gov/covid-data-tracker/#demographics

 

Almost 56,000 US deaths from Nursing Homes/Assisted Care.  But this is a soft (low) number because some states are under-reporting or not categorizing properly. 

https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/

 

NY Times recently estimated over 40% of US deaths are associated with these facilities.

https://www.nytimes.com/interactive/2020/us/coronavirus-nursing-homes.html?searchResultPosition=2

 

Track nursing home data by state:

https://www.aarp.org/caregiving/health/info-2020/coronavirus-nursing-home-cases-deaths.html

 

Also many of these deaths occurred in the first few months of the pandemic.  Many in NY and NJ.

[phoenix_dream]

3 hours ago, TeeRick said:

I think the "prisoner" priority in the vaccine phases will be the next political hot potato in the USA if it holds true after vaccine approval.  Buckling my seat belt for this one!😀

Yes, that will likely bring out the best in people, pro or con.  (oops, didn't mean for that play on words!).  It frustrates me for sure - at the same time logic tells me that if that is where many of the multiple breakouts are, then that is where vaccines should be prioritized if the goal is herd immunity.  No one asked me (nor will they) but IMHO perhaps they need to differentiate types of prisons and perhaps even types of prison wards (or whatever they are called).  Those that hold prisoners convicted of heinous crimes who have life sentences, or 20+ years should go to the end of the line.  To prioritize them over keeping grandma and grandpa safe just doesn't sit right with me.  

[K.T.B.]

20 hours ago, phoenix_dream said:

Easy to get upset at so many things these days🙂.  I honestly don't think its an oversight though.  If I take all my emotions out of the picture, as well as what seems fair or not, and look only at what will get us to herd immunity the fastest, then one could argue that it makes logical sense for healthy, procedure following seniors to be last.  If most of us are already doing what is expected by wearing masks, distancing, and not hanging out in bars and so on, then we are not the ones spreading the virus.  We also are not essential to the economy in the sense of keeping people employed, as most (I know not all) are retired.  And as retirees, even if we don't like being stuck in our houses we have the ability to do that without losing our livelihoods. 

 

We are certainly more at risk of death or complications if we do get sick, but I would hazard an educated guess that the vast majority of senior deaths are those in nursing homes and other senior living facilities.  So as much as I would hate the fact of being last, and as much as I resent the fact that killers, rapists, and child molesters may get priority over me,  I think that could very well happen.

 

I agree with so much of what you've said, but herd immunity will never occur with this virus.  About 70% of the population needs to be infected for that to happen (opinions differ on that percentage, but it's generally held that 50-90% needs to be infected). Then we're talking approximately 6.8 million people dead in the US to achieve it.  Not worth the cost, IMO.  

 

We desperately need a viable vaccine (or two or three...) to be used by the majority of the population.  We need to keep wearing masks, maintain that distancing, act responsibly (not only for yourself, but for others you live with).  I freakin' hate not being able to go anywhere, being able to go out to grab a bite to eat whenever I feel like it.  I miss going on vacation.  I miss seeing my friends.  Hell, I even miss going into the office now.  But, in order to get past all of this, this is the sacrifice that needs to be made.  It's a shame that far too many other people do not feel this way.  They decided to make the mask a political issue, when it's actually a health issue.  SMH.

 

I agree with you about prisoners getting priority over the general populace, they should be last, IMO.  Those who work there, however, should be among the first.

[phoenix_dream]

3 hours ago, K.T.B. said:

 

I agree with so much of what you've said, but herd immunity will never occur with this virus.  About 70% of the population needs to be infected for that to happen (opinions differ on that percentage, but it's generally held that 50-90% needs to be infected). Then we're talking approximately 6.8 million people dead in the US to achieve it.  Not worth the cost, IMO.  

 

We desperately need a viable vaccine (or two or three...) to be used by the majority of the population.  We need to keep wearing masks, maintain that distancing, act responsibly (not only for yourself, but for others you live with).  I freakin' hate not being able to go anywhere, being able to go out to grab a bite to eat whenever I feel like it.  I miss going on vacation.  I miss seeing my friends.  Hell, I even miss going into the office now.  But, in order to get past all of this, this is the sacrifice that needs to be made.  It's a shame that far too many other people do not feel this way.  They decided to make the mask a political issue, when it's actually a health issue.  SMH.

 

I agree with you about prisoners getting priority over the general populace, they should be last, IMO.  Those who work there, however, should be among the first.

When I talk about herd immunity, I mean that which could be obtained in multiple ways - from exposure, and also from vaccine protection.  If the current vaccines continue to prove viable, we can certainly get there in the hopefully not too distant future.

[ch175]

5 hours ago, K.T.B. said:

 

I agree with so much of what you've said, but herd immunity will never occur with this virus.  About 70% of the population needs to be infected for that to happen (opinions differ on that percentage, but it's generally held that 50-90% needs to be infected). Then we're talking approximately 6.8 million people dead in the US to achieve it.  Not worth the cost, IMO.  

How do you arrive at 6.8 million deaths?

[d9704011]

17 minutes ago, ch175 said:

How do you arrive at 6.8 million deaths?

Try population of US x 70% contract CV-19 for herd immunity x 2.8% case mortality rate (as published by Johns Hopkins for USA).

 

So.... 330,000,000 x 0.7 x 0.028 = 6,468,000 deaths.  Close enough I think.

[K.T.B.]

39 minutes ago, d9704011 said:

Try population of US x 70% contract CV-19 for herd immunity x 2.8% case mortality rate (as published by Johns Hopkins for USA).

 

So.... 330,000,000 x 0.7 x 0.028 = 6,468,000 deaths.  Close enough I think.

 The last mortality rate percentage I saw was 2.95%.  

[d9704011]

Just now, K.T.B. said:

 The last mortality rate percentage I saw was 2.95%.  

Could be.  I was looking at a graphic and my cataracts aren’t helping with the print.... I sort of guessed at the number.

[Porky55]

On 9/27/2020 at 11:24 AM, tocruiseguy said:

PS When you compare Canada, US and European rates of infection/deaths to places like Japan, South Korea, Taiwan, Vietnam etc. I wonder how they get it so right and we keep getting it so wrong?

These countries used masks at the first sign of an illness long before Covid-19 was an issue.

So ramping up safety and healthy hygiene practices was simple for all these countries. And they made use of the bio-cleaning disinfection spraying of public transport / enclosed spaces etc without a fuss, (whether it works or not - it hasn’t hurt). 

Have a brother living in Taiwan. He says it didn’t  shut down businesses either, just used masks and gloves to serve the public and keep social distance. 
Well done to them IMHO.

Edited September 28, 2020 by Porky55

[TeeRick]

12 hours ago, d9704011 said:

Try population of US x 70% contract CV-19 for herd immunity x 2.8% case mortality rate (as published by Johns Hopkins for USA).

 

So.... 330,000,000 x 0.7 x 0.028 = 6,468,000 deaths.  Close enough I think.

Sorry to disagree my apologies but IMO you are not close at all really.  You are making a very basic calculation without considering the risk groups.  The mortality rate is different (very different) by age group in the US and elsewhere.  For starters about 16% of the US population is 65+ so that is about 50 million people.  Many of them are not in nursing homes or assisted care facilities so the majority are not at much risk overall.

https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS  

 

The infection rate in the overall population is maybe 1% so if that holds true for every 65+ in the population maybe 5 million of them exposed/positive.  Then 2% death rate for that entire  65+ population would be 100,000.  But the subset in nursing homes/assisted care is a much smaller number.  And these facilities have come a long way since March too.

 

Remember that even with the virus running unabated since February in the US there are just over 200,000 deaths cumulatively, many in the very early days in the northeast.  Before anybody knew anything really.  So much better situation now.

Furthermore even without a vaccine the care and treatment for COVID-19 disease has much improved over the past 6+ months and it is not anywhere near as much of a death sentence (or death rate)  in this population as it was back in March.  

 

Natural Herd Immunity is almost never attained with a virus like this in a short timeframe.  But Acquired Herd Immunity can definitely be attained with a vaccine as phoenix-dream stated in the post #913.  Particularly since a good portion of the population has enough pre-existing immunity (the asymptomatic folks) for whatever reason that a vaccine needs to achieve even less.  

[TeeRick]

21 hours ago, phoenix_dream said:

Yes, that will likely bring out the best in people, pro or con.  (oops, didn't mean for that play on words!).  It frustrates me for sure - at the same time logic tells me that if that is where many of the multiple breakouts are, then that is where vaccines should be prioritized if the goal is herd immunity.  No one asked me (nor will they) but IMHO perhaps they need to differentiate types of prisons and perhaps even types of prison wards (or whatever they are called).  Those that hold prisoners convicted of heinous crimes who have life sentences, or 20+ years should go to the end of the line.  To prioritize them over keeping grandma and grandpa safe just doesn't sit right with me.  

I think that prioritizing by severity of crime will be a constitutional issue and not likely.  Even those on death row.  Very interesting legal and human rights battles ahead I think.  However if prisoners are simply treated like the general US population, then they can be prioritized based on age and health just like the rest of us.  Prisoners over 65+ for example.

[mimbecky]

I read another article that will certainly stir things up down the line...

 

"Should young, healthy athletes be a priority for the vaccine, which would help the IOC hold the Olympics and fulfill lucrative contracts with broadcasters who have paid billions for the rights?"

https://www.sfgate.com/sports/article/Tokyo-Olympics-Q-A-Should-athletes-be-priority-15602097.php

So many wanting a shot (pun intended) at the vaccine.  It is going to get interesting for sure.

 

M

 

 

 

[Ken the cruiser]

6 minutes ago, mimbecky said:

I read another article that will certainly stir things up down the line...

 

"Should young, healthy athletes be a priority for the vaccine, which would help the IOC hold the Olympics and fulfill lucrative contracts with broadcasters who have paid billions for the rights?"

https://www.sfgate.com/sports/article/Tokyo-Olympics-Q-A-Should-athletes-be-priority-15602097.php

So many wanting a shot (pun intended) at the vaccine.  It is going to get interesting for sure.

 

M

But you would think 6-9 months from now with 9 companies and counting in stage 3 trials, there would be plenty of vaccines to go around.

[TeeRick]

23 minutes ago, Ken the cruiser said:

But you would think 6-9 months from now with 9 companies and counting in stage 3 trials, there would be plenty of vaccines to go around.

yes fingers and toes crossed

[cangelmd]

7 hours ago, TeeRick said:

I think that prioritizing by severity of crime will be a constitutional issue and not likely.  Even those on death row.  Very interesting legal and human rights battles ahead I think.  However if prisoners are simply treated like the general US population, then they can be prioritized based on age and health just like the rest of us.  Prisoners over 65+ for example.

 

7 hours ago, mimbecky said:

I read another article that will certainly stir things up down the line...

 

"Should young, healthy athletes be a priority for the vaccine, which would help the IOC hold the Olympics and fulfill lucrative contracts with broadcasters who have paid billions for the rights?"

https://www.sfgate.com/sports/article/Tokyo-Olympics-Q-A-Should-athletes-be-priority-15602097.php

So many wanting a shot (pun intended) at the vaccine.  It is going to get interesting for sure.

 

M

 

 

 

Sadly, I think both of these situations are interesting speculations, but ultimately won’t matter. There will be enough naysayers to allow plenty of vaccine, I think. Prison in particular, I think should be vaccinated according to age, comorbidities and living conditions. People in solitary confinement or high security situations might not qualify unless they are old or ill, so their offense might be a non-problem.

More interesting to me is children under say age 5. Should they be vaccinated, or should they get infected and parents and teachers be vaccinated, so that the kids can develop enough immunity that for them Covid becomes like any other coronavirus? We obviously don’t know the answer, and won’t for awhile (at least a couple of years). My advice to my children about their kids (all under 5), will be to consult their pediatricians, plan on vaccine this time, but monitor the situation carefully, especially if Covid turns out to need a booster often.

[markeb]

21 minutes ago, cangelmd said:

 

Sadly, I think both of these situations are interesting speculations, but ultimately won’t matter. There will be enough naysayers to allow plenty of vaccine, I think. Prison in particular, I think should be vaccinated according to age, comorbidities and living conditions. People in solitary confinement or high security situations might not qualify unless they are old or ill, so their offense might be a non-problem.

More interesting to me is children under say age 5. Should they be vaccinated, or should they get infected and parents and teachers be vaccinated, so that the kids can develop enough immunity that for them Covid becomes like any other coronavirus? We obviously don’t know the answer, and won’t for awhile (at least a couple of years). My advice to my children about their kids (all under 5), will be to consult their pediatricians, plan on vaccine this time, but monitor the situation carefully, especially if Covid turns out to need a booster often.

 

Sadly, I think you're probably right.

 

And I think you vaccinate the institutionalized population as soon as possible to stop transmission in that population, and to reduce the risk they infect staff, who infect their grandparents, etc. And you take that population rapidly out of the susceptible population.

 

I'm doubtful there will be data on under 5 at licensure, but maybe? So that may be a theoretical point for a few months. But that's going to be a heck of a conversation with a pediatrician if there is no data. I think you vaccinate them regardless of immune status, if the data supports 'regardless of immune status' at entry into kindergarten, once the data supports the age group.

 

But I'm a public health guy these days, not in human patient care...

[cangelmd]

38 minutes ago, markeb said:

 

Sadly, I think you're probably right.

 

And I think you vaccinate the institutionalized population as soon as possible to stop transmission in that population, and to reduce the risk they infect staff, who infect their grandparents, etc. And you take that population rapidly out of the susceptible population.

 

I'm doubtful there will be data on under 5 at licensure, but maybe? So that may be a theoretical point for a few months. But that's going to be a heck of a conversation with a pediatrician if there is no data. I think you vaccinate them regardless of immune status, if the data supports 'regardless of immune status' at entry into kindergarten, once the data supports the age group.

 

But I'm a public health guy these days, not in human patient care...

I should definitely clarify that my speculations are based on an assumption that the vaccine is highly efficacious, because I’m proposing a situation where you let virus circulate in A population presumably to improve their immunity in the future, while another sizable segment of the population remains at risk, protected only by vaccination.

 

And I definitely think everyone should get vaccinated this first round, I’m thinking years down the line.