“Shared expectations lead to predictability.”
166. Public health measures are still required of vaccinated people.
Q. I hear that anyone who is vaccinated must still wear a mask. This makes no sense!
A: It makes a great deal of sense – if you understand the meaning of public health. Many people use the term as synonymous with medicine or personal health. But they are not the same. Personal health is what we deal with every day. Actions taken to stay well and healthy. Individual decisions acted on that just affect ourselves. In medicine, the accepted practice is to not impose a curative therapy or healing procedure when the patient does not want it. A prolonged therapy to treat cancer may become overwhelming with limited success, and if the patient wants to stop such treatment, it will cease. To the contrary, public health is when the community at large is facing an unhealthy situation. Tainted community water supply, bacterial infection of food supplies, and infectious diseases are examples where many people are affected. In public health, decisions are needed that go beyond the individual. If a disease is spreading, it cannot be up to each person to decide if they want to take the risk of getting infected, because individual decisions won’t stop the spread to others who want to avoid the contagion. In public health, collective decisions are required, usually by government, that can be imposed so that all members of the community can benefit.
In a classic case, an immigrant, Mary Mallon, came from Ireland to New York in 1883. She worked in several different homes as a domestic servant and a cook over the next several years. By 1907, more than two dozen individuals had become ill from the bacterium Salmonella typhi. Affected homeowners hired George Soper, the sanitary engineer at the New York City Health Department to track down the cause. Contaminated water was found to be the source of the illness, and Mary Mallon was identified as being present in each affected household. Mary was ordered to go into an isolation center in the Bronx. An appeal to the U.S. Supreme Court failed to release her. She died in isolation in November 1938. She was immune from this typhoid fever, but did infect over 50 people, 3 of whom died. She earned her legacy by becoming known as “Typhoid Mary.”
Last Thursday, the independent FDA’s Vaccine and Related Biological Products Advisory Committee recommended approval of the Pfizer’s vaccine. This decision was based on demonstrated effectiveness that outweighed any actual or potential risks from its use. The key word here is “effectiveness.” Pfizer’s Phase 3 clinical trials measured effectiveness as “showing no evidence of infection.” This was measured by signs and symptoms of COVID-19 being displayed by the participants. Data was not collected if the participant had become infected without symptoms, thus being contagious and capable of spreading the disease to others. Further testing will be done to learn of this possibility. But for now, anyone who receives the vaccine must continue to guard against becoming later infected and spreading the disease to others even while they are protected from becoming sick themselves. This is Public health as opposed to personal health.
167. Further study needed before certain people should become vaccinated
Q: Are there individuals who should not be vaccinated at this time?
A: Yes! The Pfizer Phase 3 clinical trials did not include several groups of people – hence these people are not covered by the FDA approval at this time and should not become vaccinated. Further studies for these groups will be made and guidance offered when ready to revise the appropriate guidelines:
- Pediatrics – under age 16.
- It is planned that these studies and revisions will be made soon to permit children to become vaccinated before school begins again in 2021.
- Pregnancy
- Immunocompromised – as defined as people whose immune system is impaired or weakened as by medications or illness.
Other studies are anticipated by Pfizer to improve the future administration of its vaccine include vaccines that allow refrigeration instead of super-cold storage and transportation Also being researched is simultaneous administration with the seasonal influenza vaccine. All changes proposed must first be approved by the Vaccine and Related Biological Products Advisory Committee and then approved by the FDA before being allowed.
- Current Connecticut timetables for vaccinations
Q: What are the current plans for groups in Connecticut to become vaccinated?
A: Connecticut has released a recently updated schedule for different groups to become vaccinated. 31,000 doses are expected to be received from Pfizer on December 14, and 61,000 doses from Moderna (if FDA approved) on December 21. Some aspects from previous expectations have remained the same. Currently, in priority order:
- Immediately:
- Health care workers
- Long-term care facility residents
- First responders (fire, police and EMS)
- Starting by late January 2021
- Senior citizens over age 65
- Anyone who is at risk (with comorbidity)
- “Critical workforce”
- Teachers
- Daycare workers
- Foodservice workers
- Those who deal on a daily basis with the population on a critical basis
- Starting in June 2021
- The rest of the population
The stated goal is to vaccinate everyone in Connecticut by “early fall of 2021.”
- Known and anticipated barriers to reach effective vaccination levels.
Q: What can go wrong?
A: The assumption is almost universal – vaccinations are the “light at the end of the tunnel and we can finally get back to normal!” Even leaders can’t wait and end up projecting idealistic expectations. Several states projected last week that Pfizer’s shots would be given by Friday, the very day the FDA approved its use. The time to move millions of doses to hundreds of locations nationwide was overlooked. The public will soon become unhappy, even angry, if expectations are not realistically established. There are several anticipated delays that lie ahead, and many more that will appear on their own.
- Supply chain shortages – Pfizer has already announced the quantity of doses ordered in the future will be held up because of delays in getting the supplies needed to manufacturing the vaccine. It turns out an essential ingredient used in its manufacture is the same reagent used for testing. With the explosion of the COVID cases, testing has dramatically increased, restricting the quantity needed for timely vaccine production. Perhaps president-elect Biden can invoke the Defense Production Act to secure an adequate future supply – but that can’t be done for more than a month, and president Trump is no longer running this program.
- The vaccine is fragile. It cannot be shaken, and if its deep-freeze is interrupted in transit or in storage, it cannot be refrozen. If doses are thawed and not used in a few days, it must be destroyed. This “slippage” should be calculated in the number of people that can be vaccinated per number of doses ordered.
- Two shots are required. Many people who receive the first dose may experience mild side effects such as soreness, muscle aches or a temporary fever. If they become discouraged, they may not return for the second shot and immunity will not be achieved.
- “Anti-vaxers” are significant in their numbers. A recent poll shows that as many as half the population won’t show up for their vaccinations. It will require at least 70% of the population to be vaccination to eliminate this disease.
“Shared expectations lead to predictability!”
- Celebrating Christmas and New Years
Q. I usually party New Year’s Eve with friends? With vaccinations under way is this OK?
A: No. Look what happened at Thanksgiving! Many people ignored the advice to spend that holiday with just member of a household that live together. The incidence of COVID-19 has sharply risen and as many as 3,000 people a day are now dying. Vaccinations can protect an individual in just over a month, but even vaccinated people may still be spreading the disease if they become infected later. (see FAQ #166, above.) No, the vaccine cannot give you the disease – that is impossible. But there is a chance that once vaccinated, you can be infected by another person and then become contagious!
Remember, if you think it’s worth the risk to your personal health to party with others on Christmas or New Year’s Eve, think of the risk to others and the public health by doing so.
Don’t let the light at the end of the tunnel lower your vigilance. You might just find it was a fast-approaching train!
