Vaccines, vaccines, vaccines...

Is one dose enough?

Maybe. We don’t know, of course, since the phase 3 or clinical efficacy trials gave each subject two doses (Pfizer and Moderna vaccines). However, the data show that the antibody response against either of these vaccines is very prompt and nearly universal. Protection against infection is seen as early as 14 days after the first dose. The degree of protection after a single dose at 28 days or beyond simply isn’t know. However, the antibody responses to each of these vaccines is very impressive.

My guess is that one dose for the healthy is fine for a certain period of time and that a booster will be needed some months after the first dose, but that’s just an educated guess, meaning one based on the data. Of course, one dose may enough for some and not for others since those with weaker immune systems presumably will respond less well.

The new CDC director, Dr. Rochelle Walensky, is concerned about the supply of vaccines and is worried that in February, we may (presumably briefly) run out of vaccines to give.

I can’t comment on the production of the vaccines. However, I will point out contradictory statements.

Chief of Staff, Ron Klain, complained that the roll out of the vaccine and stated ““We're inheriting a huge mess here, Jake, but we have a plan to fix it, the president-elect put out that plan on Friday," Klain told CNN's Jake Tapper on "State of the Union.", according to the Hill and several news outlets.

Meanwhile, Dr. Walensky, is very concerned that the USA will have given all of its vaccines dose in a few weeks.

They both cannot be true. If distribution were a “huge mess”, then we would have plenty of vaccines just sitting there in the freezers. If production is the problem and supply cannot keep up with demand, then distribution or roll out has been a success.

I guess it’s just politics - Say conflicting statements to lower the bar two, conflicting ways.

I really would like the truth to be the truth, but I can only “Imagine” a world like that.

How many people have to get vaccinated for the pandemic to slow down or end?

Like the number of licks to get to the center of a Tootsie Pop, the number is 3.

https://www.youtube.com/watch?v=NnuHGeCMd4E

Horrible jokes aside, the truth is, we don’t know. The experts who say that we need to vaccinate 95% of the populous to end the pandemic are basing that on measles modeling. But come on, seriously, it won’t be a pandemic is 5% or even 10% of the US population is not immunized. I am stunned by this misrepresentation. If 50% of the US is still not protected, the rate of severe Covid infections will still drop to very, very low rates.

We really don’t know how many Americans have immunity after recovering from symptomatic or asymptomatic infection, but certainly that number is well over 20 million.

We do know that people, who recover from Covid are protected for many months and that the rate of severe re-infection in this group is very, very low.

Further, infections spread via network, which have high risk “nodes”. If we get the people in the nodes vaccinated, then the spread of infection slows down very quickly. As mentioned, smallpox was eradicated by vaccinating those around the infected person and those around those around the infected person. Such a strategy could be employed, perhaps, in reverse. Vaccinate areas not affected by Covid currently and work your way in. In other words, by vaccinating areas around areas experiencing high rates of Covid, you prevent spread. Further, you surround the areas of the country with high infection rates with immune areas. For political reasons, this won’t be done, but this is how you should use the vaccine if supply is limited. You use the ring vaccination approach but use it in reverse.

Finally, no matter how we give 100 million Americans the vaccine, the rate of serious Covid infection will be much, much lower than it is now. It’s time for the Yellow Journalism to stop.

What about taking a different vaccine for the second dose?

Stop whining. We all have taken different second, third or fourth doses of different vaccines. Vaccines are improved over time. The DipTet, made famous in “Raising Arizona”, for instance, was improved upon.

https://www.youtube.com/watch?v=jO93iNoAXdA

(Disclaimer – Frances McDormand and the Cohen brothers were wrong about the smallpox vaccine being used. We stopped giving that in the USA in 1972, if memory serves)

So, we adults, as kids, got the DTP vaccine. This vaccine has been replaced with the DTaP. And DTaP is given to pregnant women (each pregnancy). No one who got the DTP and then the DTaP had weird things happen as a result. There are many other examples people getting a different version of a similar vaccine. I know of no example that a person who takes two different versions of a vaccine against the same virus or bacteria having unexpected side effects.

Listen, no one likes to go “off script”. We doctors are a conservative bunch because WE KNOW WE DON’T KNOW MUCH. So, if we stay “on script”, meaning following the same protocol that was studied, we know what to expect and we have an excuse if something bad happens.

Could something untoward happen if you got the Pfizer first and the Moderna vaccine second? Sure, but you could also win the Powerball lottery. I like following the script as much as any doctor, but I agree with CDC Director Walensky, that if push comes to shove, just take the vaccine offered for the second dose.

A priori, there is no reason to think that a weird side effect will happen if your second dose is a different type of vaccine, especially when the two vaccines are the Moderna and Pfizer vaccines.

What condition is our condition is in?

Our condition is in excellent condition. This thing is over. This is not the end of the Beginning. It’s midway through the End. This is a fact. Forget about the yellow journalism. Forget about new viral variants. These variants arose naturally and not secondary to vaccine pressure. What’s that mean? It means these variants are expected and that since the vaccine was not in use in the areas where they developed, that these slightly different strains are still protected against by the vaccine. Escape from a vaccine only occurs after a vaccine has been in place for a long time. The virus doesn’t know the vaccine is coming. It doesn’t think ahead of time and say, “Hey, maybe I should change this amino acid or that one to avoid the antibodies induced by the vaccine”. Viruses are like many sensationalist “reporters”, they don’t have a brain.

What about the masks?

Perhaps the biggest mistake in American Medical history was the promotion of masks as protection against Covid-19. My concern that people would falsely feel protected against Covid by the masks was sadly proven correct in New Jersey. If you still think masks help, you clearly have your head up your ass. This second wave or surge in Jersey occurred when everyone wore masks. These pts I have cared for, now I have to care for them without HCQ, these pts wore masks, people where they worked wore masks. There are so many very sad aspects of this pandemic tragedy. The promotion of masks gave people a false sense of confidence.

But you “maskers”, y’all don’t see what we ID docs see. You get to stay home and read the yellow journalists.