Are vaccines the light at the end of the tunnel?

[D C]

12 hours ago, TeeRick said:

I'm not sure if it is a fatal flaw.  But the priority should be more data-driven at this point.  I agree it is definitely frustrating to those (of us) just a bit away from 65 to be lumped in with much younger healthy adults in vaccine priority.   In fact some countries will use a different range.  Why does the US focus on the mid-ranges like 65?  Maybe because we have been conditioned as a society that 65 is a magic number for retirement and SS benefits and Medicare? But not really relevant for COVID except that is how data is collected, cut and reported.    It seems to me that for priority by age we should be using four age ranges (70+, then 60-70,  and then 50-60,  followed by 18- 50) which are are the better ranges to address severe COVID disease and death risk.   Of course the age priority in some cases conflicts with the designated risk categories of occupation and institutional status and health status.  And then the states make their own rules too.  This will never be satisfying to everybody.  

 

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm

The age number is irrelevant. 65, 61, 68, 62.25643.  It doesn't matter, and if you're writing a paragraph about it, you're putting way too much thought into some abstract about 'age and society' which might make a lovely liberal arts thesis, but has nothing to do with who is dying as a result of covid. 

 

If this is about preventing deaths, then you vaccinate those most likely to die. It's really that simple.  If people die unnecessarily = a fatal flaw. 

 

There should no consideration of occupation or 'essentiality' .   We know who is most likely to die from covid. Vaccinate them first.   Pareto charts are pretty easy.  20-something grocery store cashiers aren't on them. Vaccinating anyone other than high-death-risk means that deaths are perfectly acceptable so long as we can prevent temporary illnesses in others. 

[mayleeman]

@D C Focusing on occupations is crucial if you want to have anyone around to provide necessary services to literally everyone. Sick people may not die as readily in the younger ranks, but they can spread it to the vulnerable. Further, many older people are retired and may not need to break distancing protocols. Your grocery clerk, or meat packer, may have little choice about going to work and getting exposed.

Edited December 27, 2020 by mayleeman

[DreadPirateRobert]

I certainly hope that the vaccine combined with socially responsible behavior will begin to turn the tide.

Got my first shot a week ago. (I’m an OR nurse)  No ill effects at all. A little injection site discomfort as with any injection but even that was gone in a day. 
My wife isn’t in healthcare so there’s no telling when her turn will be. 

[Doubt It]

On 12/24/2020 at 3:15 PM, D C said:

 

This is the literal fatal flaw in the distribution plan.  

 

It begs the question "what is the problem we're trying to solve?".  If we're trying to prevent deaths, then we should vaccinate those most likely to die if they fall ill.  If we're trying to protect the ability of hospitals to function, then we should lessen their workload by vaccinating those most likely to fall seriously ill.   

 

DW and I are not in high-risk demographics in any way.  She's slated to receive the vaccine soon as a result of her employment.  Neither of us would get the vaccine ahead of our loved ones in high-risk groups if given a choice. 

 

I'm afraid that we'll continue to watch the media dwell on the death toll of the disease, yet nearly every death will have been preventable once we hit ~50 million TEDs (thanks markeb)

 

 

 

DC, thank you so much for your comment - the issue is "what is the problem..."

 

You are totally correct and the current distribution plan I see in Canada and elsewhere is not based on this fundamental question.  As yes, TeeRick, it should be data driven - ie triage: highest % for death, those that take care of the 1st group, then the group that has the worst lingering issues after the virus:

1) Elderly

2) Hospital staff

3) Staff taking care of elderly

4) Immune compromised

 

So why is my 93 year old father in a retirement home not receiving the vaccine ahead of the staff?  He is more probable to die from the virus, therefore, he should be ahead of them.

My dad is also more probable to end up in the hospital from the virus, so there again, he should be first.

 

Not pleased what so ever with the distribution plan and I most certainly been politically active making my displeasure known.

 

Thanks to everyone for the sharing of their amazing knowledge and analysis.

 

 

 

 

[TeeRick]

11 hours ago, D C said:

The age number is irrelevant. 65, 61, 68, 62.25643.  It doesn't matter, and if you're writing a paragraph about it, you're putting way too much thought into some abstract about 'age and society' which might make a lovely liberal arts thesis, but has nothing to do with who is dying as a result of covid. 

 

If this is about preventing deaths, then you vaccinate those most likely to die. It's really that simple.  If people die unnecessarily = a fatal flaw. 

 

There should no consideration of occupation or 'essentiality' .   We know who is most likely to die from covid. Vaccinate them first.   Pareto charts are pretty easy.  20-something grocery store cashiers aren't on them. Vaccinating anyone other than high-death-risk means that deaths are perfectly acceptable so long as we can prevent temporary illnesses in others. 

I think I was trying to point out the very same thing.  Sorry if I was not clear.  Data-driven.  We know who is at risk of death and hospitalization.  This can be correlated with some occupations (like HCW's) and certain medical conditions and older ages in nursing homes.  So yes they all get the vaccine first.  But then what?  I was trying to point out that in the general population in the last phase, the data still suggests that there is an age-related risk profile.  Sorry if you think I have a liberal arts thesis.  

[TeeRick]

19 minutes ago, Doubt It said:

 

DC, thank you so much for your comment - the issue is "what is the problem..."

 

You are totally correct and the current distribution plan I see in Canada and elsewhere is not based on this fundamental question.  As yes, TeeRick, it should be data driven - ie triage: highest % for death, those that take care of the 1st group, then the group that has the worst lingering issues after the virus:

1) Elderly

2) Hospital staff

3) Staff taking care of elderly

4) Immune compromised

 

So why is my 93 year old father in a retirement home not receiving the vaccine ahead of the staff?  He is more probable to die from the virus, therefore, he should be ahead of them.

My dad is also more probable to end up in the hospital from the virus, so there again, he should be first.

 

Not pleased what so ever with the distribution plan and I most certainly been politically active making my displeasure known.

 

Thanks to everyone for the sharing of their amazing knowledge and analysis.

 

 

 

 

I would think that a 93 year old in a retirement home would be amongst the initial groups to get the vaccine.  He would in the US.  First doses went to front line health care workers.  Now the retirement/assisted care/nursing homes are being visited here by pharmacists from CVS and Walgreens who are vaccinating all residents who sign a consent (or have a family member sign one).  This will still take weeks as the vaccine is still in very limited supply.  What are the rules and priorities in Vancouver B.C.?  

[Ken the cruiser]

Some good news about the AZ/Oxford vaccine in the UK!

 

https://news.yahoo.com/astrazeneca-covid-vaccine-winning-formula-102823220.html

[mimbecky]

1 hour ago, TeeRick said:

I would think that a 93 year old in a retirement home would be amongst the initial groups to get the vaccine.  He would in the US.  First doses went to front line health care workers.  Now the retirement/assisted care/nursing homes are being visited here by pharmacists from CVS and Walgreens who are vaccinating all residents who sign a consent (or have a family member sign one).  This will still take weeks as the vaccine is still in very limited supply.  What are the rules and priorities in Vancouver B.C.?  

 

Yes, he would be first in the US and it looks like the same in the UK.  But then again, in the UK it appears the only vaccine priority based on occupation is for "front line health and social care workers". All other phases are based on age (the younger the later the phase-imagine that!), and underlying risks.

Vaccine rollout timeline: When can you get the vaccine? Full order | Express.co.uk

 

Good news is that it appears your father will be soon in British Columbia.

British Columbia

B.C. plans on immunizing 400,000 people against COVID-19 by March 2021, with priority given to residents and staff of long-term care homes and health-care workers.

As more doses of the vaccine become available, priority will be given to seniors over 80 and people with underlying health conditions.

By April, front-line workers including teachers, grocery store workers, firefighters and people working in food processing plants will be prioritized.

As doses increase, Provincial Health Officer Dr. Bonnie Henry says vaccines will be distributed, moving down the population age range in increments.

Here's the COVID-19 vaccine rollout plan, province by province | CBC News

 

***I really don't understand why United States roll out jumps from those 65 plus to 16-30 before those 50-64. Not the case in UK or Canada....

I guess because they spread.  BUT, if you vaccinate those 50-64 after essential workers, it wouldn't matter so much that the young were spreading. IMO...but I'm not making the decisions- I will wait somewhat patiently.

 

[mimbecky]

37 minutes ago, Ken the cruiser said:

Some good news about the AZ/Oxford vaccine in the UK!

 

https://news.yahoo.com/astrazeneca-covid-vaccine-winning-formula-102823220.html

 

Hummmmm.....this sounds great. I wonder when/how our FDA will respond here in the US.  

[phoenix_dream]

10 hours ago, mayleeman said:

@D C Focusing on occupations is crucial if you want to have anyone around to provide necessary services to literally everyone. Sick people may not die as readily in the younger ranks, but they can spread it to the vulnerable. Further, many older people are retired and may not need to break distancing protocols. Your grocery clerk, or meat packer, may have little choice about going to work and getting exposed.

I don't think your comments are necessarily totally wrong.  I do want to comment a moment though on the sentence about older people being retired and not needing to break distancing protocols.  There is certainly some logical truth to that.  There is also another aspect.  Much more so than younger people (and granted, no one knows when our number will be up so to speak), we retirees don't know how much longer we have to live our lives.  We may only have a year or two or five left to do our traveling.  Much more important, we may only have that amount of time to be spending with our families and friends.  Younger people (generally) have their whole lives ahead of them.  We have much more limited time and having to stay inside, isolated from any outside enjoyment or social interaction is extremely difficult and definitely affects both our mental and physical health.  Additionally, many seniors have downsized and live in small condos or apartments.  Can you imagine for a few minutes what it would be like to spend a full year cooped up in that environment, unable to go out except for walks (if you are fit to do so) and a trip to the doctor?  Unable to see family and friends because you are high risk?

 

And beyond that, we cannot stay inside all the time from a practical perspective.  We have to visit doctors offices (often much more so than younger people), dentists, gas up our cars, perhaps have people come to our house for repairs.  So even if we continue to be hermits for yet another few months of our limited lifetime, we are still at some risk of catching the virus.  If we do, according to the CDC, we are 90% more likely to die or need hospitalization than 20-30 year olds.  90% is a very, very significant number!  20 year old grocery clerks may in fact be at higher risk of catching the virus at their jobs, but we are much, much more likely to not survive if we do.  They are thus likely to recover in a couple of weeks and then be able to be back at work - a strain on essential services to an extent, but in many cases not as big a strain as is being made out to be. (I am talking the 1b and 1c priorities, not the 1a)

 

I know there are no perfect answers, and not everyone will be happy with the priorities.  I just wish when people make their opinions known, they dig a bit deeper and consider the unintended consequences of those opinions.  

Edited December 27, 2020 by phoenix_dream

[TeeRick]

1 hour ago, Ken the cruiser said:

Some good news about the AZ/Oxford vaccine in the UK!

 

https://news.yahoo.com/astrazeneca-covid-vaccine-winning-formula-102823220.html

That's nice that the CEO believes this.  But hopefully the actual data will support what he says.  In the US, the phase 3 trial is ongoing and hopefully the doses used will confirm the efficacy claims of the CEO once unblinded.  I really hope so !  

[Ken the cruiser]

43 minutes ago, TeeRick said:

That's nice that the CEO believes this.  But hopefully the actual data will support what he says.  In the US, the phase 3 trial is ongoing and hopefully the doses used will confirm the efficacy claims of the CEO once unblinded.  I really hope so !  

Thinking on the optimistic side, with the "hopefully" pending UK approval of the AZ/Oxford vaccine next week along with J&J's "single dose" vaccine "hopefully" getting FDA approval in early February, that would "hopefully" really heighten the potential for a significant "flow" of vaccines to ramp up around the world by early Spring.   

 

This might also "hopefully" give the incentive the cruise lines need to start maximizing efforts to get their US port "starter" ships CDC certified by the beginning of Spring, especially if the "flow" is significant in Canada and the Caribbean to the point where they would feel safe reopening their cruise ports.

 

 🤞🤞 🤞

 

What can I say. I'm an optimist and really love cruising. But, I'm also really ready to stop worrying about other people not wearing their mask properly!! 

[Crazy planning mom]

3 hours ago, TeeRick said:

That's nice that the CEO believes this.  But hopefully the actual data will support what he says.  In the US, the phase 3 trial is ongoing and hopefully the doses used will confirm the efficacy claims of the CEO once unblinded.  I really hope so !  

When do you think the data from the phase 3 trial will be ready for US regulators?

[mimbecky]

1 hour ago, Crazy planning mom said:

When do you think the data from the phase 3 trial will be ready for US regulators?

It doesn’t look like there is any data published yet for anyone

“We think we have figured out the winning formula and how to get efficacy that, after two doses, is up there with everybody else,” the chief executive said, while saying only that data would be published at “some point.”

Edited December 27, 2020 by mimbecky

[Arizona Wildcat]

18 hours ago, D C said:

The age number is irrelevant. 65, 61, 68, 62.25643.  It doesn't matter, and if you're writing a paragraph about it, you're putting way too much thought into some abstract about 'age and society' which might make a lovely liberal arts thesis, but has nothing to do with who is dying as a result of covid. 

 

If this is about preventing deaths, then you vaccinate those most likely to die. It's really that simple.  If people die unnecessarily = a fatal flaw. 

 

There should no consideration of occupation or 'essentiality' .   We know who is most likely to die from covid. Vaccinate them first.   Pareto charts are pretty easy.  20-something grocery store cashiers aren't on them. Vaccinating anyone other than high-death-risk means that deaths are perfectly acceptable so long as we can prevent temporary illnesses in others. 

You need to remember that each state sets its own policy.  Some states have older people with or without comorbidies second.  Others doing front line workers second.

I certainly agree with medical workers first as without them the system breaks down and causes more deaths.  Those in care facilities follow and makes sense as they have a death rate that is massive.  In our town those with comorbidies are next along with those over 75 followed by front line workers.

Seems logical.  Just hoping J&J and AZ vaccines available in February.  Certainly await their data in January so they can be submitted to the CDC.

FWIW - my wife should be able to be vaccinated about February 1st.  Myself likely not until March or April.  

Edited December 27, 2020 by Arizona Wildcat

[LGW59]

3 minutes ago, KnowTheScore said:

 

This is flawless logic imo.

 

No question the most vulnerable, at risk of dying, should be the ones getting the vaccine right now. No-one else until that's done.

 

Notions that health workers and emergency services staff should somehow trump the vulnerable is a nonsense.   

 

It doesn't matter how likely you are to catch Covid.  It doesn't matter if your profession makes you more likely to catch Covid.  What matters is who is at most risk of dying.

 

Covid rules don't discriminate in regards to how much you are suffering from Covid.  It doesn't matter

if you are asymptomatic or having serious symptoms,  you are still Covid positive in that moment and therefore would be required to stay at home and isolate for 14 days or whatever it is now.

 

Vaccination does not stop you getting Covid.  It stops you getting serious symptoms and hopefully stops you dying from it.  So what's the point of vaccinating health workers before the most vulnerable?

 

If health workers can spread Covid to vulnerable patients then that's just a re-inforcement of the need to first vaccinate the vulnerable.

 

We should note also that it is not known at this point whether vaccination prevents the person from being able to carry and spread the virus to others.   That wasn't tested in the Pfizer trial.

So vaccinating health workers isn't any kind of guarantee that they won't spread Covid to patients.

 

There is simply no excuse whatsoever for not vaccinating the vulnerable first.

This is flawless logic imo.  I am kind of thinking you mean flawed...not that I agree with you, I rarely ever do but just saying...

[Fouremco]

2 hours ago, Arizona Wildcat said:

Seems logical. 

And that's the problem. There are many sound, logical approaches to distribution and setting priorities, not a single best solution. At the same time, such factors as storage temperatures and actual vaccine availability have a strong influence on actual plan implementation.  As I said some weeks ago, I've no idea when my turn will come, or that of my loved ones, but I'm not going to lose sleep worrying about it. I'll continue to take all the necessary steps to minimize the chance of being infected.

[Cachecara]

2 hours ago, KnowTheScore said:

 

This is flawless logic imo.

 

No question the most vulnerable, at risk of dying, should be the ones getting the vaccine right now. No-one else until that's done.

 

Notions that health workers and emergency services staff should somehow trump the vulnerable is a nonsense.   

 

It doesn't matter how likely you are to catch Covid.  It doesn't matter if your profession makes you more likely to catch Covid.  What matters is who is at most risk of dying.

 

Covid rules don't discriminate in regards to how much you are suffering from Covid.  It doesn't matter

if you are asymptomatic or having serious symptoms,  you are still Covid positive in that moment and therefore would be required to stay at home and isolate for 14 days or whatever it is now.

 

Vaccination does not stop you getting Covid.  It stops you getting serious symptoms and hopefully stops you dying from it.  So what's the point of vaccinating health workers before the most vulnerable?

 

If health workers can spread Covid to vulnerable patients then that's just a re-inforcement of the need to first vaccinate the vulnerable.

 

We should note also that it is not known at this point whether vaccination prevents the person from being able to carry and spread the virus to others.   That wasn't tested in the Pfizer trial.

So vaccinating health workers isn't any kind of guarantee that they won't spread Covid to patients.

 

There is simply no excuse whatsoever for not vaccinating the vulnerable first.

I’m a retired nurse.  
I lost 4 past co-workers, all nurses and only one had a co-morbidity, to Covid.  Only one was older than 60.  That’s the thing with Covid, it’s very unpredictable and doesn’t really care who it gets.  

My daughter works in LTC in ancillary health and will get her vaccine Jan 6th.  I can’t wait.  

 

[TeeRick]

Info on the AZ vaccine trial in the USA.

 

The AZ phase 3 US trial details can be found here.  The primary completion date is listed as March 23, 2021.

https://clinicaltrials.gov/ct2/show/NCT04516746

 

But that date can change depending on the number of cases in treated and placebo.  So it has been reported by Operation Warp Speed that both the AZ and J&J trials will release data in February sometime.

https://www.fiercepharma.com/pharma/covid-19-shots-from-astrazeneca-and-j-j-must-succeed-to-meet-us-vaccination-goal-slaoui

 

If all goes well for these vaccines in the US, they might get EUA approval perhaps early March??

[phoenix_dream]

There is just no absolutely no perfect answer to who should get vaccinated in what order.  To me this is a perfect example  - in Germany the first person to get vaccinated was a 101 year old.  Putting emotional reactions aside, and realizing if this was my mother I would likely feel differently  but what logical sense does it make to vaccinate a 101 year old person ahead of someone 30 years old with comorbidities?  In no universe does this make logical sense IMHO.  I am not saying seniors don't matter - I am one myself!  But this person's likelihood to survive 2021 with or without a vaccine is statistically very, very slim.  Sometimes in these types of situations we need to make hard decisions based on logic, and not based on emotions.  I know there is much more to factor into the equation, and arguments to be made that this was the right thing to do, but this just struck me as wrong.

[Moby Jones]

16 hours ago, KnowTheScore said:

 

This is flawless logic imo.

 

No question the most vulnerable, at risk of dying, should be the ones getting the vaccine right now. No-one else until that's done.

 

Notions that health workers and emergency services staff should somehow trump the vulnerable is a nonsense.   

 

It doesn't matter how likely you are to catch Covid.  It doesn't matter if your profession makes you more likely to catch Covid.  What matters is who is at most risk of dying.

 

Covid rules don't discriminate in regards to how much you are suffering from Covid.  It doesn't matter

if you are asymptomatic or having serious symptoms,  you are still Covid positive in that moment and therefore would be required to stay at home and isolate for 14 days or whatever it is now.

 

Vaccination does not stop you getting Covid.  It stops you getting serious symptoms and hopefully stops you dying from it.  So what's the point of vaccinating health workers before the most vulnerable?

 

If health workers can spread Covid to vulnerable patients then that's just a re-inforcement of the need to first vaccinate the vulnerable.

 

We should note also that it is not known at this point whether vaccination prevents the person from being able to carry and spread the virus to others.   That wasn't tested in the Pfizer trial.

So vaccinating health workers isn't any kind of guarantee that they won't spread Covid to patients.

 

There is simply no excuse whatsoever for not vaccinating the vulnerable first.

Flawed logic in my opinion. 

If you lose too many front line medical workers due to the pandemic then the elderly and most vulnerable won't have people to care for them. This has already been seen in multiple countries. 

You need to strike the right balance between the vulnerable and those delivering care to the vulnerable. 
 

[TeeRick]

The Novavax phase 3 trial for their purified SPIKE protein subunit vaccine is enrolling now.

 

https://www.nih.gov/news-events/news-releases/phase-3-trial-novavax-investigational-covid-19-vaccine-opens

[Fouremco]

41 minutes ago, phoenix_dream said:

There is just no absolutely no perfect answer to who should get vaccinated in what order.  To me this is a perfect example  - in Germany the first person to get vaccinated was a 101 year old.  Putting emotional reactions aside, and realizing if this was my mother I would likely feel differently  but what logical sense does it make to vaccinate a 101 year old person ahead of someone 30 years old with comorbidities?  In no universe does this make logical sense IMHO.  I am not saying seniors don't matter - I am one myself!  But this person's likelihood to survive 2021 with or without a vaccine is statistically very, very slim.  Sometimes in these types of situations we need to make hard decisions based on logic, and not based on emotions.  I know there is much more to factor into the equation, and arguments to be made that this was the right thing to do, but this just struck me as wrong.

The design of any successful plan has to be based on large groupings of people, not on individuals. It makes sense, for example, that most priority lists include front line medical practitioners as a top priority. But what about the doctor working in an COVID-19 ICU who plans on retiring in six months? Do you skip over him, just because he won't be part of the priority group in a few months?

 

It's easy to sit back and nitpick individual cases when systems have been designed to vaccinate billions of people in the most efficacious manner. As you said, there is absolutely no perfect answer, so finding fault on a micro level really benefits no one.

 

[Ken the cruiser]

40 minutes ago, TeeRick said:

The Novavax phase 3 trial for their purified SPIKE protein subunit vaccine is enrolling now.

 

https://www.nih.gov/news-events/news-releases/phase-3-trial-novavax-investigational-covid-19-vaccine-opens

Interesting that they finally started the Phase 3 trial in the US today while the same vaccine, NVX-Cov-2373, has been in Phase 3 trials in the UK since late September. I guess they finally figured out their US manufacturing issues. I wonder if the FDA will allowed them to include the data gathered in the UK trial, especially if it gets approved over there sometime during the first quarter of 2021?

 

https://ir.novavax.com/news-releases/news-release-details/novavax-initiates-phase-3-efficacy-trial-covid-19-vaccine-united

[Fouremco]

My apologies if this question has already been answered and I missed it, but what are the characteristics of the COVID-19 variant that enable it to spread more quickly and easily? If a maskless person who is infected sneezes, do the particles fly further? If they land on a hard surface, to they live longer? Or is the mechanism of transmission not the issue?

 

As there is a case here in Ottawa, I'd like to be better informed. Googling the question provides a lot of information on the "what" but nothing on the "why".