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COVID-19 vaccine discussion


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I thought it might be helpful to have a separate topic related to the vaccine.  If this is too much duplication, mods please delete this thread.  I thought it would be good to talk about who can get the vaccine, where they can get it, what side effects people are seeing, and in general what is going on with distribution.

The CDC has published vaccine distribution guidelines, and if you care, they are worth reading.  They are dividing the timeline into:

  • Phase 1 -¬†Potentially limited supply of COVID-19 vaccine doses available
  • Phase 2 -¬†Large number of vaccine doses available
  • Phase 3 -¬†Sufficient supply of vaccine doses for entire population

Who you are will determine if you are eligible for a vaccine in the various phases.

Phase 1 is divided into a Phase 1a and a Phase 1b:

  • Phase 1a - Mostly healthcare workers
  • Phase 1b - Other essential workers, people with higher risks, people over 65

If you are eligible to get the vaccine and they have in in stock and you want to get it, it is important to go get it.  Both of the first two vaccines can spoil, so if a dose is sitting there and you aren't there to get it, they might have to throw it away.

Both vaccines require two shots.  It is important to go get that second shot.

Who fits in phase 1b and who has to wait until phase 2 might be a sticking point.  The "people in higher risks" category includes a lot of folks, maybe more than you would think might be in that category.  Hopefully we can quickly get to phase 2 so that we don't spend too long arguing about who is or is not in Phase 1b.

Anyway, I'm interested in everyone's experience with the vaccine and especially getting the word out for those that can go get it, so that every dose ends up in an arm rather than in the trash.

 

 

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I'm pro-vaccine, obviously, but the fact that mRNA vaccines are brand new (they've never been given before) and we have no evidence on their long term safety, I'm a bit nervous.  I know the whitecoats tell me that, theoretically, the long run risks are small because the mRNA breaks down quickly, and efficacy is the real concern. However, jiggering around with our cells to produce virus spikes they weren't designed to produce gives me the heeby jeebies.  What could possibly go wrong?  

Anyway, I expect this will be the next great politicized nonsense that further tears away at the national fabric.  Personally, I'd rather wait for the traditional vaccines that are in the works. 

If I'm 80+ though, sign me up now bitches.  

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4 minutes ago, bschoolprof said:

I'm pro-vaccine, obviously, but the fact that mRNA vaccines are brand new (they've never been given before) and we have no evidence on their long term safety, I'm a bit nervous.  I know the whitecoats tell me that, theoretically, the long run risks are small because the mRNA breaks down quickly, and efficacy is the real concern. However, jiggering around with our cells to produce virus spikes they weren't designed to produce gives me the heeby jeebies.  What could possibly go wrong?  

Anyway, I expect this will be the next great politicized nonsense that further tears away at the national fabric.  Personally, I'd rather wait for the traditional vaccines that are in the works. 

If I'm 80+ though, sign me up now bitches.  

I totally get that perspective especially if you are younger and healthy.  You’ll have some time to wait for more folks ahead of you in line to get the vaccine to make sure there aren’t any concerning safety signals.  Plus, there will likely be more traditional vaccine types (inactivated/attenuated virus) come to market in 2021.  The rare and more severe vaccine side effects like transverse myelitis or Guillan Barre usually occur pretty quickly after vaccination and haven’t been seen with these mRNA constructs.  One very reassuring thing about the fantastic efficacy of the Moderna and Pfizer vaccines (both on par with HepB and MMR vaccines) is that is bodes very well for success of other vaccines that will be coming down the pipeline.

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5 minutes ago, Heme Doc said:

I totally get that perspective especially if you are younger and healthy.  You’ll have some time to wait for more folks ahead of you in line to get the vaccine to make sure there aren’t any concerning safety signals.  Plus, there will likely be more traditional vaccine types (inactivated/attenuated virus) come to market in 2021.  The rare and more severe vaccine side effects like transverse myelitis or Guillan Barre usually occur pretty quickly after vaccination and haven’t been seen with these mRNA constructs.  One very reassuring thing about the fantastic efficacy of the Moderna and Pfizer vaccines (both on par with HepB and MMR vaccines) is that is bodes very well for success of other vaccines that will be coming down the pipeline.

Yeah - I'm not worried about the short-term complications, which if they occur are likely to be the most acute.  We'll have (and already do have) some good data on short term adverse effects.  I'm more worried about long-term problems/unknowns (e.g., some chronic autoimmune condition that rears its head down the road).  I don't have that fear with the traditional vaccines because they've been around for decades.  

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I have been mulling the short-term and long-term risks of getting an mRNA vaccine vs. not getting an mRNA vaccine. Without a vaccine, given my age/risk profile, I have a very low risk of severe covid infection in the short term. With a vaccine, I probably have a very low risk of severe adverse vaccination reaction in the short term. Both options carry short term risks, but on balance, I feel safer getting the vaccine.

My evaluation of long-term risks is similar. Covid presents unknown long-term risks, including cardiac risks. The vaccine also presents completely unknown long-term risks. On balance, I lean slightly towards favoring the long-term risks of a covid infection, but this is mostly a blind guess. As the vaccines become available, I expect to see a lot of discussion and analysis of potential long-term risks and will be paying close attention to this subject before making a decision.

If I had to guess, I will eventually decide that all risks are sufficiently low and will get vaccinated to have peace of mind about returning to normal.

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1 hour ago, bschoolprof said:

I'm pro-vaccine, obviously, but the fact that mRNA vaccines are brand new (they've never been given before) and we have no evidence on their long term safety, I'm a bit nervous.  I know the whitecoats tell me that, theoretically, the long run risks are small because the mRNA breaks down quickly, and efficacy is the real concern. However, jiggering around with our cells to produce virus spikes they weren't designed to produce gives me the heeby jeebies.  What could possibly go wrong?  

Anyway, I expect this will be the next great politicized nonsense that further tears away at the national fabric.  Personally, I'd rather wait for the traditional vaccines that are in the works. 

If I'm 80+ though, sign me up now bitches.  

Most vaccines have some level of risk. Think about the technologies - dead virus, inactivated/weakened virus, recombinant proteins in a viral vector, naked mRNA, mRNA with nanoparticles, recombinant protein grown in culture and administered with adjuvants. mRNA seems fairly safe on such a spectrum. I do understand that it is new though and with anything new there is risk.

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I have an aunt I never met, she had a bad reaction to a polio vaccine, developed blood cancer, and died when she was a child. 
 

My grandma, when I had my first kid, sat me down and made sure I was going to vaccinate (it was never a question).  She saw first hand how important vaccines had been (born in the 1920s, remembered being worried about her kids getting polio, knew people who died from it) and even having lost a child to a one in a million side effect, understood that the benefits to society as a whole outweighed the risks to individual outliers like her daughter.
 

She also told me not to put screens in front of my kids, but I failed that one. Some things are different than they were in the 50s grandma!
 

Anyway; long story short: I’m getting vaccinated as soon as I can, and my kids are too. I’d take it today if I could. 

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21 minutes ago, NorthLoop said:

I like this Heme Doc guy. 

Can we have him battle it out with ChiTownDoc? I mean I like ChiTown.. but he is a sooner fuck. But then again he does love clowining Trump dumbasses on the reg. 

I like ChiTownDoc and wish to subscribe to his newsletter.  I too enjoy clowning Trump dumbfucks.  

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59 minutes ago, NorthLoop said:

I like this Heme Doc guy. 

Can we have him battle it out with ChiTownDoc? I mean I like ChiTown.. but he is a sooner fuck. But then again he does love clowining Trump dumbasses on the reg. 

Yeah where’d he come from?  Nice change of pace from new/idle members suddenly coming into CR spewing wild shit before being crowdsourced.  And isn’t Sawbonz a doc?

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8 hours ago, Homercles said:

Yeah where’d he come from?  Nice change of pace from new/idle members suddenly coming into CR spewing wild shit before being crowdsourced.  And isn’t Sawbonz a doc?

Sawbonz is a carpenter.

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11 hours ago, Heme Doc said:

Healthcare provider here.  

Got vaccine (no doubt about it due to symptoms below) on Pfizer trial about 3 months ago

Arm sore for 2 days after first shot

2nd shot given 3 weeks later.  The day after had arm soreness, headache, fatigue, chills/fever (102) and some body aches.  Lasted 24 hrs then felt fine.  Felt strange to be happy about feeling  kind of crappy for a day.   

Even though I’ve had the vaccine, I still am still very cautious at work (I prescribe chemo and see lots of immunosuppressed patients) and outside of work.  I still do everything I can to protect my patients and family.  The vaccines are not 100% effective and the trials only looked at symptomatic COVID infections, so I guess one could technically still carry it and be asymptomatic.  However, recent data suggests that antibodies truly do prevent infection and not just making COVID infections asymptomatic.    

Probably have EUA for both Pfizer and Moderna vaccines in about....2 weeks 

If you can get the vaccine...Fucking get it.  Side effects aren’t that bad and honestly feels great to not not worry as much about catching this shit.  Also, there’s a bunch of patients in my clinic (and about 500,000 total in the US) who can’t get vaccinated because they’re on chemo or other medications or have some other immunodeficiency. We protect those people by getting vaccinated and getting to herd immunity.  

I can attest to all the above.......

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18 minutes ago, Lobo said:

Worse, he somehow managed to go against the grain both going up and going down.  How is that even possible?  

Then you should ask for a referral to Dr. Denson (Austin Urology)

She did a great job with my¬†digital exam and very close junk inspection several years ago. Very gentle fingers with well-trimmed nails..¬†ūüôā
 

 

8DACDD7E-B22D-4841-B91B-58DB3937164C.jpeg

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I want the vaccine as soon as I can get it. I’m a physician but not a front line worker. Mainly private practice, operate at a couple of surgery centers, occasionally see patients in a hospital.

I‚Äôm not sure where that puts me in line. Everyone seems to agree that healthcare workers are first, but that should obviously be subdivided into type of healthcare worker where frontline docs, nurses, and support staff will get it ahead of people like myself. That makes complete sense but when my ‚Äúgroup‚ÄĚ is given the opportunity, I will be ready to go.

My motivations are twofold:

1. I work directly with elderly patients and my biggest fear from the start has been getting sick and unknowingly transmitting it to a high risk person. I do my best to socially distance and be responsible, but I’ve certainly let my guard down at various points, and I’d like the vaccine to increase protection for everyone I come in contact with.

2. Like everyone else, I want life to return to normal as soon as possible. The only way I see that happening is with a successful vaccine and I want to do my part and also be an example to friends and family, kind of like wearing an ‚ÄúI Voted‚ÄĚ sticker. In fact, I wish they would get marketing campaigns to create ‚ÄúI‚Äôm Vaccinated‚ÄĚ pins or wristbands or something that could be a source of pride for people to demonstrate that they did their part to help the world out.

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Wife and I have been on the fence about getting the family vaxed ASAP vs waiting a bit and monitoring. 
one thing that a doc could probably answer for me here is- is there anything novel about the delivery media?  Or will it be a solution that’s been used before with no issues, relatively speaking?  So the only novel material being injected is the active?

since it may be months before we are even able to get vaxed, I hope I feel confident that any longer term issues will have developed in trial patients and stage one recipients. 
 

I’m also wondering if, since there’s flu like symptoms for a day, my wife and I should stagger our injections so only one of us feels bad at a time and can convalesce while the other handles household business for that day. 

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On the front lines, had Covid 3 months prior. Not at high risk but will get when fellow frontline health care workers who are higher risk get the opportunity. I am no more scared of this vaccine than getting complications from a common cold. Side effects might kinda suck since I already was sick. I don't know of data on immunizing those who were sick and symptomatic already.  There's lots of stuff in life with long term risks. Like living.

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55% by when though?  55% by April isn't too bad.  55% in total.   Then we are proper fucked.  Seems weird that a vaccine that's gonna be named after a national hero will be avoided so many of his minions.  /noCR------just stats 

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2 hours ago, NotActuallyALonghorn said:

Where do pregnant women fall into this spectrum? Isn't it like an auto hospital admit if you test positive while pregnant?

Unknown.  They aren't clearly in a high-risk category and aren't clearly not in that category, according to the CDC.  The CDC guidelines said that their guidance would be updated as new info arrives, and specifically mentioned pregnancy, so I don't think they've figured that out yet.  If you are rural, obese, incarcerated, homeless, or have another underlying condition AND pregnant, well, you're high risk and a Phase 1b'er.

Each state is going to come up with their own guidelines based on the CDC guidelines, and counties are going to have guidance based on the state and CDC, so the eventual rules and recommendations could vary from place to place.

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OK, some numbers:

Thinking a bit about logistics, we just had an election in Travis County and about 610k voted.  To get to 100% COVID vaccinated in Travis County, we're going to have to hit 1.3 millon people 2 times each.  That's about 2.6 million shots ... about 4x the number of people who voted.

Travis County set up 37 early voting places for about three weeks for the 2020 vote.  There were lines, but the lines were not that bad.  If we had a goal of getting 100% inoculated over six months at 37 sites county-wide, that would mean about 380 shots per day per site, say 400 per site.  Put 10 competent injectors at each site plus another 10 people to process paperwork and each person would have to inject 40 people per day, about one every 12 minutes for an 8 hour shift.   That's 800 people county-wide just to inject shots and handle paperwork, for six months.  Maybe another 200 people to handle receiving the vaccine, mixing it up, and keeping the sites stocked with stuff.  A big effort but doable.

The county would be consuming about 15,000 shots a day at that rate and 7,500 people per day would be newly immune, starting about a month after this starts.

The US population is about 328 million.  About 1 in 257 live in Travis County.  So, for Travis to get 15,000 shots per day we need to be making 3.8 million shots a day nationwide, or about 118 million per month.  Hmmm, that sounds a little high.  I'm not sure what Pfizer/Moderna are going to be able to pump out but maybe that's in the ballpark, maybe by February.

So, that's what it looks like with 100% vaccination from January 1st to July 1st.  Seems possible.  If 30% don't take the vaccine, lines are going to dry up sometime in April.  Anyone who wants a vaccine should be able to get one then.  We will reach 50% vaccinated around April 1st, and 50% "immune" around a month after that.  Activities should shift outside again by March, which will slow the spread.   Life looks good starting sometime between Easter and the end of the school year, if this model matches the eventual numbers.

It is probably going to be easier for the urban centers to set up vaccination centers and plans than rural areas.  Maybe we have really big centers in the cities and people drive in to get shots.  Even with the rural folks driving in, I bet this plague goes away in the cities faster than in the country just because it will be easier to get to a vaccination site.

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Can totally understand the fears of a 'new' vaccine - though my fears are more around the logistics and handling of it as it's so new (though apparently Moderna has some shit figured out, so bravo). 

The important thing to remember is that mRNA vaccines are by their very nature transient - this doesn't integrate into your genome, rather it hangs around in your cells and spits out protein. 

For me the only other fear is that being vaccinated does not make you COVID 'sterile' - this is particularly the case when you have a respiratory disease and vaccinate intramuscularly, rather than intranasal. There's good evidence from the flu and other similar diseases that while you may be vaccinated, you could still harbor and carry it. I think this is a far lower spreading risk than the unvaccinated asymptomatic carrier, but it's a thing. Not sure what that means going forward with COVID protocol in nursing homes, for instance.

Great review of mRNA vaccines here :¬†mRNA vaccines ‚ÄĒ a new era in vaccinology (Nature)

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https://www.cnbc.com/amp/2020/11/23/oxford-astrazeneca-covid-vaccine-is-70percent-effective-trial-shows-.html?__twitter_impression=true
 

Mondays are vaccine efficacy announcement days, it seems.

More good news from AstraZeneca.  90% efficacy in large phase 3 trial in group getting half dose vaccine followed by full dose one month later.  Interestingly, the group that got two full doses of vaccine one month apart only was 62% efficacious.  This is probably due to vector immunity.  The delivery method for this vaccine is an Adenovirus, so  some people probably mount more response to that and not Spike protein.  

Another benefit of this vaccine is that it can be stored in regular refrigeration temperatures.  

Starting to see the light at the end of the tunnel.  Not sure exactly how long the tunnel is, but there’s light at the end.
 

 

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18 minutes ago, Heme Doc said:

https://www.cnbc.com/amp/2020/11/23/oxford-astrazeneca-covid-vaccine-is-70percent-effective-trial-shows-.html?__twitter_impression=true
 

Mondays are vaccine efficacy announcement days, it seems.

More good news from AstraZeneca.  90% efficacy in large phase 3 trial in group getting half dose vaccine followed by full dose one month later.  Interestingly, the group that got two full doses of vaccine one month apart only was 62% efficacious.  This is probably due to vector immunity.  The delivery method for this vaccine is an Adenovirus, so  some people probably mount more response to that and not Spike protein.  

Another benefit of this vaccine is that it can be stored in regular refrigeration temperatures.  

Starting to see the light at the end of the tunnel.  Not sure exactly how long the tunnel is, but there’s light at the end.
 

 

My fervent hope is that the light at the end of the tunnel is the beginning of the summer.  I say that selfishly, because we have folks who want to travel.  I REALLY hope that the light at the end of the tunnel is by August, as the girl is really shooting for a yearlong study abroad starting in the fall, and I suspect that will only happen if she is vaccinated (foreign country won't let her in otherwise).

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54 minutes ago, Heme Doc said:

https://www.cnbc.com/amp/2020/11/23/oxford-astrazeneca-covid-vaccine-is-70percent-effective-trial-shows-.html?__twitter_impression=true
 

Mondays are vaccine efficacy announcement days, it seems.

More good news from AstraZeneca.  90% efficacy in large phase 3 trial in group getting half dose vaccine followed by full dose one month later.  Interestingly, the group that got two full doses of vaccine one month apart only was 62% efficacious.  This is probably due to vector immunity.  The delivery method for this vaccine is an Adenovirus, so  some people probably mount more response to that and not Spike protein.  

Another benefit of this vaccine is that it can be stored in regular refrigeration temperatures.  

Starting to see the light at the end of the tunnel.  Not sure exactly how long the tunnel is, but there’s light at the end.
 

 

Pos rep, Doc.  

Now for those of us who received their medical training at Julliard...what is "vector immunity"? 

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19 minutes ago, Lobo said:

Pos rep, Doc.  

Now for those of us who received their medical training at Julliard...what is "vector immunity"? 

He's referring to your body mounting an immune response to the viral vaccine vector, in this case an adenovirus. The vector vaccines use a virus as the vector to deliver the genes coding for the spike protein to your cells.  Your body will try to mount an immune response to the vector. The lower response rate with the higher first dose may suggest that a lower first dose followed by the higher second dose is less likely to stimulate the immune response to the vector.  

 

I personally will line up day 1 my number comes up for an MRNA based vax.  Not as comfortable with the vector vaccines until more data come out.  Haven't decided what we are going to do with the kiddos (5-11) yet. 

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38 minutes ago, Lobo said:

Pos rep, Doc.  

Now for those of us who received their medical training at Julliard...what is "vector immunity"? 

An adenovirus (common cold) is used to deliver the spike protein of the coronavirus. The presence of preexisting adenovirus immunity and the rapid development of adenovirus vector immunity effects their clinical use. Innate inflammatory response may lead to systemic toxicity, drastically limit vector transduction efficiency and significantly abbreviate the duration of transgene expression. Heme doc is referring to the latter two issues.  Personally, I hate the approach and would lean towards mRNA vaccines or recombinant protein approaches. The main historical vaccines, attenuated live virus and dead virus, have their own issues.

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So is the plan to provide as many of these vaccines to as many places as possible so that there’s a menu and the customer gets to choose which one they receive?  Or is it more of a you get what you get, maximum coverage type of deal?

or will it quickly devolve into typical pharm sales competition for orders by bribing and charming doctors?

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13 minutes ago, Brisketexan said:

If there's anything I hate, it's abbreviation of the duration of transgene expression.

Well, that, and the Dutch.  I also hate the Dutch.

So the spike protein gene needs to make protein so that we can develop antibodies against the protein. Expression of the gene (making the protein) could be shortened or rather less protein could be made because of the immune response to the adenovirus vector.

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2 hours ago, Brisketexan said:

If there's anything I hate, it's abbreviation of the duration of transgene expression.

Well, that, and the Dutch.  I also hate the Dutch.

Similarly, there’s only two things that scare me.  The risk of transverse myelitis or Guillan Barre after vaccination with an adenovirus vector.  

That, and carnies.  Small hands.  Smell like cabbage.

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2 hours ago, Anastasis said:

He's referring to your body mounting an immune response to the viral vaccine vector, in this case an adenovirus. The vector vaccines use a virus as the vector to deliver the genes coding for the spike protein to your cells.  Your body will try to mount an immune response to the vector. The lower response rate with the higher first dose may suggest that a lower first dose followed by the higher second dose is less likely to stimulate the immune response to the vector.  

 

I personally will line up day 1 my number comes up for an MRNA based vax.  Not as comfortable with the vector vaccines until more data come out.  Haven't decided what we are going to do with the kiddos (5-11) yet. 

Top notch description of ‚Äúvector immunity‚ÄĚ

I tell everyone that the only thing I’ve noticed since getting the Pfizer vaccine is that my cock is huge (average size for Surl).  I don’t mention that it was like that pre-vaccine.  

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1 hour ago, Heme Doc said:

 

I tell everyone that the only thing I’ve noticed since getting the Pfizer vaccine is that my cock is huge (average size for Surl).  I don’t mention that it was like that pre-vaccine.  

You had me goin’ there for a minute.

Mrs. Brat will be disappointed.

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