Inside Medicine. What Are You Seeing? [COVID-19 medical news]

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"I asked the authors of the Health Affairs study to put their findings into terms that we nonscientists could understand, and they were kind enough to do so. The estimates are fairly stunning:

At the current level of infection in the U.S. (about 200,000 confirmed new infections per day), a vaccine that is 95 percent effective — distributed at the expected pace — would still leave a terrible toll in the six months after it was introduced. Almost 10 million or so Americans would contract the virus, and more than 160,000 would die.

This is far worse than the toll in an alternate universe in which the vaccine was only 50 percent effective but the U.S. had reduced the infection rate to its level in early September (about 35,000 new daily cases). In that scenario, the death toll in the next six months would be kept to about 60,000."

But we won’t be raging continuously for the next 2 months. This does come in waves - at least regionally. Other scientists I have listened to have said that between the restrictions, the vaccine, and the already high rate of infection, this virus should start to really diminish in March. Think about it - in the south, there were very few restrictions after the initial March/April time frame and then there was a peak, and the numbers came down. This wave will peak and hopefully the infection rate and vaccine distribution will really tamper it way down.

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2742

March may be when the weather gets to the point where people do things outside instead of inside more.

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Both can be true. The feds can distribute enuf vials to vaccinate nearly all of the health care workers by Dec 31, but clearly that is a near impossibility as not every front line worker will be available to get vaccinated – some are on holiday leave, some are pregnant, some want to wait, plus dunno which day FDA will finally give approval – so its common sense that vaccinations will continue into January for this first group.

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With vaccines aren’t immune compromised people who can get a vaccine usually prioritized somehow? Where are they on these lists?

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That will be up to the states. Not to mention each patient and their doctor…we haven’t seen enough data to know how many immunocompromised people were in these studies, including their conditions. So, just for an example…we don’t know if lupus patients are ok to receive the vaccine (what if they are currently flaring?) or cancer patients (what if currently undergoing chemo or other treatments?), or transplant patients…and it goes on and on.

There will be people who can’t get vaccinated…certain immunocompromised individuals, pregnant women, young children with or without risk factors. That is one of the primary reasons for people to get vaccinated…to protect those who can’t get vaccinated. That’s the same with any vaccinations…and people don’t necessarily behave that way.

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“Unfortunately US did not contract for enough shots, so far” The 100 million doses covers 50mil folks. Not nearly enough. Now there’s spin news on the scramble to order more.

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This is just for the Pfizer vaccine. The US, like other countries, placed their ‘bets’ and orders…probably some of that was based on politics, including favoring companies who took Barda money and were part of Operation Warp Speed. US is in line for relatively more doses from Moderna and JNJ. This illustrates why we need more than one or two vaccines.

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2748

ACIP meets again on the 11th and 13th where the next priorities will be discussed?.

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Talking with med school boy and he says it’s really eye opening seeing all of the areas of his hospital that have been turned into ICU - and seeing just how many beds are in hallways. (He said there have always been some, but nowhere near this many.)

They’ve also pulled residents off of most (all?) side rotations.

It’s hard to believe everyone is able to get the best care possible when they are so strained.

Talking with ED nurse neighbor, he said locally they aren’t super high pressed, but not far from it - and he knows other systems around us are.

For both the issue is staffing as much as or more than space.

ETA: Med school lad also told us a 30ish year old lost their leg due to Covid. My heart goes out to them. Youngsters don’t die often, but there can be so much more than death for those who draw short straws.

ETA2: This came in his daily email:

Study Indicates Broad Range Of COVID-19 Complications

Healio (12/8, Welsh) reports that a study of 70,288 US patients with COVID-19 “highlights a broad range of complications.” Researchers wrote, “The more common complications that we identified – including viral pneumonia, respiratory failure, acute kidney failure and sepsis – were expected, as they have been well described in the literature. We also identified less common complications, previously described in case series or small studies, such as disseminated intravascular coagulation, pneumothorax, myocarditis and rhabdomyolysis.” The findings were published in the Canadian Medical Association Journal.

And this:

Stronger immune system, healthier blood vessels among reasons children are less likely than adults to have severe COVID-19, experts say

HealthDay (12/8) reports, “A stronger immune system and healthier blood vessels are among reasons kids are less likely than adults to have severe COVID-19, according to experts who reviewed research from around the world.” According to HealthDay, “the researchers explained that damage to the thin layer of endothelial cells lining various organs – especially the heart, blood vessels and lymphatic vessels – increases with age, and there’s a link between conditions that damage these cells and severe COVID-19.” The review was published online in Archives of Disease in Childhood.

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UK issues allergy warning on Pfizer vaccine after 2 healthcare workers suffer adverse reactions:

Two staffers with Britain’s National Health Service suffered symptoms of “anaphylactoid reaction” when they received the jab Tuesday, the first day of a national immunization campaign, British media reported.

Such a response can include skin reactions, low blood pressure, constricted airways and dizziness or fainting. Both workers have recovered, health officials said. But new guidance from the Medicines and Healthcare Products Agency now states that “any person with a history of significant allergic reaction to a vaccine, medicine or food … should not receive the Pfizer/BioNTech vaccine.”

That’s going to be a LOT of people who can’t take the vaccine. Suprising that it didn’t show up in trials — is it it possible that people with a history of allergic reactions to vaccines, medications or food were excluded from the vaccine trials based on pre-screening protocols?

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This is obviously not great news.

Having allergies in general was not an exclusion criteria in the study (protocol is publicly available in multiple places on the interwebs). Section 5.2.3 of the protocol shows this exclusion criteria (the only one related to allergies):

“History of severe adverse reaction associated with a vaccine and/or severe allergic reaction (eg, anaphylaxis) to any component of the study intervention(s).”

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I read BBC’s article about it. It doesn’t sound like it’s all that bad and only affects those who carry epi-pens. It’s worth watching, but not a red flag. I know people who have similar reactions to other shots. They have to wait in the doctor’s office for a little bit to be sure they are ok before leaving.

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Many people are at risk of anaphylaxis and do (or should) carry epi-pens. In the US, it’s around 5M-6M people (due to allergies of various origins), so not an insignificant number of people. It’s unclear to me if there were any severe allergic reactions in the clinical trials. Regardless, there are employees of Pfizer and BioNTech whose sole job today is to find out what happened with these patients.

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It’s going to be interesting for sure. I would guess about 1/4 of my kids’ friends carry epi pens for food allergies. These are college age kids.

On a different note, we have a family member who lives in independent living at a continuing care community. The facility has been told by the state that these people are not considered long term care residents and will not quality for early vaccine. Only those in assisted living and nursing care qualify. They will be fighting the decision.

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I think this is a common stratification in many states’ vaccination plans. Even if the independent living residents aren’t in the first round, they should be in the next round or two, assuming 65+ age.

In the CDC recommendations, Phase 1a is Health care workers and long term care residents, 1b is essential workers, 1c is adults with high risk conditions, and those age 65+. States do not have to follow CDC (or ACIP) recommendations.

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Wow, it’s nowhere near 1/4 of the students at my school. Doing quick math in my head without looking at the nurse’s list to actually count, I could guess about 1/50 and probably not be too far off.

Now I’m wondering what the national average is. Does anyone know?

I’m also wondering if it’s regional. We’re rural and I’ve read that there are more allergies in cities.

This site says about 15,000,000 adults and 6,000,000 kids have food allergies:

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that’s interesting. Sounds like his apartment is attached to long term care facilities. I assumed anyone in that situation would get the vaccine along with those needing more care. I hope it won’t be too long. Many healthy older folks in these types of situations haven’t been able to leave their rooms for months even if their part of the community is considered “independent living”.

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“Independent living” encompasses a wide range of ages/medical needs. Many families choose to leave their loved ones in independent living with 24 hour, 7 day a week care if they can afford it, rather than move to assisted living.

Our family member is in their 90’s, doesn’t drive, and has 16 hours/day care. Not really independent. But it’s not congregate living, either.

One of the draws of these types of places, and what people pay for, is that residents can move seamlessly from one level of care to another. If they aren’t all vaccinated, that goes away.

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21 million is 6.4% of the US population.

According to:

about 7.7% have experienced anaphylaxis (not necessarily from food, since there are other causes like bee stings), but according to:
https://www.goodrx.com/blog/goodrx-care-now-refilling-epipen-prescriptions-for-anaphylaxis/
only 3.6 million (about 1.1% of the population) were prescribed an epinephrine auto-injector.

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If we use even the 7.7% as unable to get the vax, there are still enough who could, that if it works as stated we’d have essentially conquered the pandemic I think.

It will be interesting to see if Moderna’s is better - or if AZ’s (different style) is better for those prone to reactions. Ditto with J&J and everyone else out there with a potential vax.

I see two big things - getting people to get a vax and if they work as studies seem to imply. No need to push those with potential issues to take the risk with this one. I’m glad the two were fine with treatment.