Q&A - #8: When can I get the COVID vaccine? (and similar questions)

Since my last post, one vaccine has been approved for use during the pandemic and another is likely to be approved within the week. This is great news and makes me hopeful for a more normal Christmas season next year.

The question we keep getting asked, is 1) Will you get the vaccine? 2) Will your office give out the vaccine? and 3) When can I get the vaccine?

-1) Yes I will get the vaccine, as will my family. Because of my job I’ll end up getting it before them (see below)

-2) Yes I think we will give out the vaccine. I’m not entirely sure how the roll out will be handled once there is enough to start giving out to the general public. I have applied for the ability to do so (for my own patients), but they could certainly decide that it makes more sense for small practices like mine to refer our patients to a more centralized location for efficiency sake.

-3) This is a longer answer.

Here are Michigan’s phases of vaccine rollout.

Phase 1A is to health care workers and nursing home residents. Just like when the stewardess tells you to put your own oxygen mask on first before helping others, we have to protect the frontline healthcare workers. Because this is the first phase, it will be the one with the least amount of vaccine to go around and so it is broken down even further into more specific priorities. For example, I’m one of the last to be vaccinated due to my comparatively low risk, outpatient office job, compared to my colleagues that work directly with COVID in the hospital who will be some of the first.

Phase 1B is to essential workers. It appears that teachers and critical infrastructure workers will be first in line here, the people that keep society running and can't do it from home.

Phase 1C would be those with high risk conditions(diabetes, obesity, etc), high risk environments (jail, homeless shelters, etc) and older adults (over 65).

Phase 2 is everyone else, over age 16.

Keep in mind these phases are not completely distinct - that is to say that 1A probably won't be completely finished when 1B starts, there will be overlap. The point here is that those at highest risk will be prioritized to get the vaccine first.

No one really knows for sure, and it depends on how many vaccines become available in the next couple months (and how many manufacturers are producing them), but based on what I’m reading, I would think phase 2 will happen in April at the earliest, potentially May.

Another question I get: Will I be forced to get the vaccine?

No, I think not. I’ve seen absolutely nothing indicating that anyone in any level of government is advocating mandating the vaccine. Even my own hospital system is not mandating it, but simply strongly encouraging it. I would encourage you to get it, when you are able to. I think its a good thing.

References:

https://www.michigan.gov/documents/coronavirus/MI_COVID-19_Vaccination_Prioritization_Guidance_710349_7.pdf

Q&A- #7: Should I get a COVID vaccine, if and when one becomes available?

I’ve gotten a lot of questions in the office from patients about the news these past couple week about Pfizer’s and now Moderna’s early results. Its pretty common for a vaccine trial to take an early look at results before the trial finishes and these early results were a welcome bit of good news, efficacy that far exceeded what we had hoped for and a side effect profile similar to other vaccinations (injection site reactions mainly). I get asked a lot if the COVID vaccine is something I will recommend/take myself/give to my family. My answer until 2 weeks ago was “We’ll see” , and now I’m cautiously optimistic that the answer will be “Yes”. If the final data when it comes out is as promising as the preliminary data, I will take it without hesitation.

Keep in mind there are other vaccines in the works as well. What is exciting to me is that most of them share the same target on the virus, which could mean good things for their efficacy as well. We will need as many manufacturers as possible operating at full capacity to vaccinate as many people as possible. There are a lot of people out there and it takes time to make these things.

Q&A- #6: What is contact tracing and why should I let an app do it?

Contact tracing means tracking down possible exposed contacts of those known to have COVID.

Currently most contact tracing is done by a real person, usually from the health department, making a real phone call to everyone who has COVID and then finding out from them who else they have been around. Realistically, we don’t have enough Contact Tracers to do this job 100%. We also are getting only partial information - our memories are not 100% accurate and even when we do have a good memory of where we’ve been and who we were around, we may not know all the names of everyone we were around.

There aren’t enough contact tracers out there, out memories are poor…If only there were a way to keep track of our movements automatically and anonymously and get in touch with those who have been unwittingly exposed to COVID. Turns out- there is. That phone you carry around with you everywhere you go, does more than take pictures and make phone calls. The state of Michigan just recently released an app that will anonymously and securely inform you if you have been exposed to COVID. Its an idea that makes a whole lot of sense, way more than making thousands of phone calls to sick people. Get the app here: MI COVID Alert App

Q&A- #4: What does it mean to quarantine or isolate?

Quarantine is what happens when you are avoiding others because you were exposed to someone with the disease, even though you are not necessarily sick yourself.

Isolation is what happens when you are avoiding others because you are known to be sick.

A COVID positive person should isolate for at least 10 days* because that’s about how long it takes after symptoms develop for the disease to no longer be contagious. We also make sure they’re no longer feverish and that they’re improving overall..

Some exposed to that person should quarantine for 14days after their exposure. This is longer than the isolation period because symptoms usually don’t start for a few days after exposure and 14 days gives the infection time to run its course in the exposed person.

How to Quarantine or Isolate:

• if at all possible live apart, or in different parts of the house, ideally in separate rooms, using separate bathrooms

• Avoid contact with pretty much anyone in your house or out of it. Even pets!

• Wear a mask while around others (even those in your house!)

• Monitor your symptoms. If you have trouble breathing, go to the ER

• If you were exposed to COVID, you should be tested after 3-5 days of quarantine . Waiting allows the viral levels to grow and decreases the chance of a false negative test.

• If you are isolating (you have COVID) and you can’t avoid close contact with someone, they will need to begin a quarantine period after your isolation period is over

• If you are quarantining (you were exposed to COVID but thus far don’t have it) and you can’t avoid close contact with someone, they do not need to quarantine….unless you develop symptoms or you have a positive test.

*in the severely sick (hospitalized) and those with certain conditions that weaken the immune system, we increase this to 20 days

References:

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html

Q&A - #3: How does COVID compare to the Flu in terms of survival?

Short answer: its worse.

The following numbers are rough*, but I think make the point the questioner was asking about.

So far in the U.S. there have been an estimated 10.5 million cases of COVID and 240,000 deaths as a result.

Last year it was estimated that in the U.S. around 38 million people got influenza. Of those around 400,000 ended up in the hospital, and around 22,000 people died as a result of the flu.

So that means that 2.3% of those with COVID died, while 0.057% of those with influenza died. That’s a big difference. Again rough numbers. And keep in mind, with flu we’re talking about something that we give a vaccine to hundreds of millions of people, we’ve been treating it for years so we know a bit about what we’re doing, there is some immunity in the population from previous infection, etc. With COVID we have no vaccine (yet), limited experience treating it, and hardly anyone has had it when you consider that if there have been 10 million cases, that means there are 320 million to go in the US.

*Very rough, but I think good enough to get a good idea. Both flu and COVID case and death numbers have a lot of caveats, more than what I want to deal with in this question. One significant caveat is that these COVID numbers are not including cases that are not reported or cases that were not even suspected. Some think this number could be 5-10 times the number of known cases. Additionally, there are also likely more deaths than are represented by this number.

Follow up question - What are the survival rates by age?

Here is a link to the CDC's data on how the cases and deaths break down by demographic factors.

As it relates to your question: when you compare the cases and the deaths between various age groups, only 14-15% of the cases are in those aged over 65, but 80% of the deaths are in that group.

References:

https://www.cdc.gov/flu/about/burden/past-seasons.html

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

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

https://twitter.com/trvrb?lang=en

Q&A - #2: Why are things getting worse right now?

After a summer of low COVID case numbers (in most of Michigan), we are now joining the rest of the country in significantly increased numbers. I’m sure there are lots of reasons, but from what I can tell here are the main drivers:

• This virus is very contagious. Without full lockdowns and strict adherence to quarantine (and we’re not doing those things) it WILL spread, somewhat slowly at first, and then extremely rapidly, exponentially, until something happens to slow it back down (either a lockdown temporarily stalls the growth, or more definitively, we reach a certain level of community immunity) . This is the number one reason.

• The weather is getting colder. SarsCoV2 - the virus that causes COVID-19, is from a family of viruses called Coronaviruses. These viruses are always worse in the winter time when the temps go down, partially because they last longer in lower temperatures, and partially because we all tend to congregate inside in the winter.

• Schools? Not sure about that one. But, probably. Kids just don’t show the symptoms as much as adults do and so it is easily spread among them without them even knowing it. And then they bring it home to us.

• Masking helps, but only somewhat. Its a bit like wearing a helmet so you can go out and play in traffic. Sure you’re safer with the helmet on, but ideally you would have stayed home in the first place. But it DOES help, so please keep wearing a mask when you’re out in public, particularly in enclosed spaces.

• Finally, and this one is important - Its been almost a year since COVID became a thing. It was hard to lock everything down this spring and no one wants to do it again, even when they know we should. This pandemic “fatigue” is really getting in the way of being able to control it.

Q&A - #1: Do I need a flu shot?

The last time I wrote a post here, it was the beginning of June. Michigan, particularly the East side, was coming down from its COVID peak in April and overall things for our state were looking as good as to be expected. Michigan was starting to “reopen” and part of our life returned to normal. But only parts. We still had to deal with masks, which were and are annoying, and we still couldn’t do everything we really wanted to do, like join large groups of people for fun.

At that point in June, depending on where you lived in the state, you might have lost multiple family members or friends to COVID, or you might not have known a single person to have had it. You might have thought it was here to stay forever, or you might have thought it was going to go away on November 4th. Maybe you thought masks didn’t work and never wore them, or maybe you wore them just so you wouldn’t get yelled at. Or you maybe you thought masks worked and wore them religiously.

Then we went through the summer. Michigan, on the whole did pretty well for a lot of the summer.

But now its fall, in fact its closer to winter now than to summer. Schools have been in session for months, both K-12 and higher education. The temperatures have started to get cool. And we’re all sick of not seeing one another, sick of “distancing”, sick of wearing masks. And all these things together have meant that our numbers are going up. This time they’re not just going up in the Detroit area, its all over the state. And the country. And the world.

We are in a much different place than we were in June. As we head into what looks to be a far worse time than what we went through in April, I solicited questions on Facebook to try to get a pulse on what needs answering among my patients. I’m gonna try to pump out answers in the order they arrived, one at a time, every day or so. If you would like to suggest a question, find that thread on facebook, or shoot an email to us.

Do I need a flu shot this year? We’re all wearing masks, do I still need one?

Short answer: Yes.

I suspect that the measures we’re taking for COVID will help curtail our flu season, but not enough for me to skip the flu shot. Right now I am doing everything I can to keep my patients from landing in the urgent care or ER - both because that’s good for them in general, and because right now our hospitals are nearing or at capacity. If you get influenza it looks very much like COVID(remember “flu” is a respiratory bug- not a stomach bug) - so the flu shot is one of those things that can help avoid an ER visit or hospital stay.

And remember - flu shots are not 100% effective. (if they were 100% effective, you wouldn’t need to worry about anyone else taking the shot, your shot would be enough). When you get a flu shot you are helping to form a barrier around those who are most vulnerable to flu - our elderly, our pregnant women, our young children. The more people that take the shot, the stronger that barrier.

Reference: https://www.cdc.gov/flu/weekly/