COVID-19 vaccine discussion

We're going to have to pay some rubes a stimulus check to get vaccinated and help create herd immunity. May be cheaper in the long run if it fully opens the economy.

40 minutes ago, wild_turkey said:

 

Pfizer and BioNTech said they expect to produce 50 million doses by the end of 2020 and 1.3 billion doses in 2021. If the 2021 production goal is distributed somewhat evenly throughout the year, that’s around 100 million doses per month. No idea how that would get distributed to various countries, obviously it won’t all be for the U.S.

I haven’t seen production goals for the Moderna or AstraZeneca vaccines.

Last I read, we need about 70% for herd immunity, either through vaccination or actual COVID infection. That’s 230 million people, but maybe 30 million have already had COVID, which I assume is a conservative estimate. So perhaps we need ~200 million people to get vaccinated, or 400 million doses.

I would be surprised if the U.S. isn’t quickly approaching that by next summer, which means a large percentage of people will be getting vaccinated in January-March timeframe.

 

agree although we are at least double that 30M number IMO.

10 hours ago, dcar00 said:

agree although we are at least double that 30M number IMO.

Right but if that's because 30m didn't realize they had it, they're still gonna use up a vaccination. 

More information on vaccination production 

https://www.fiercehealthcare.com/payer/azar-expects-40m-covid-19-vaccine-doses-ready-to-distribute-by-end-dec

Quote

Department of Health and Human Services Secretary Alex Azar expects 40 million doses of Pfizer and Moderna’s COVID-19 vaccines will be ready for distribution by the end of December as providers must gear up now to allocate the doses.

Pfizer has also said that distributors and providers can use dry ice to keep the vaccines cold. The drugmaker said last week that it expects to produce up to 50 million vaccine doses by the end of 2020 and 1.3 billion doses next year.

 

Is a "dose" one shot, or does it include both shots necessary?

Those numbers are fuckin' great, man. Especially if "dose" includes both shots and we end up getting 20+% of the population vaccinated by EOY. That alone is enough to put downward pressure on the cases and deaths.

14 hours ago, Lobo said:

23% were anti-vaxxers.  Half of them will change their tune.  Of that other half, we can expect a 2% mortality rate as everybody breathes on one another again.  

They'll do it when their employer tells them to or Disney refuses entry.

I'll be crass.  HCW should be first before nursing home patients.  Smite me down but their lives are worth more.  Same with teachers, essential workers, and garden variety olds sitting at home.  

Can't wait until people find out how the rich and connected will be able to cut in line.

7 minutes ago, Aqua Buddha said:

They'll do it when their employer tells them to or Disney refuses entry.

This is how you have to do it.  We won't "mandate" the vaccine, but to get on an airplane, or to go to the dentist, or to hit up Branson, or to attend a Luke Bryan concert, you have to have your vaccine card.  Stuff like that. 

Insurance will come to the rescue a bit by refusing to insure things unless the organizers restrict to vaccinated folks.  

So you are saying I need to get into the counterfeit covid vax card bidness, as some people would rather pay for a fake than get one free with the vax. 

I wonder how much of an side market there will be for the vaccine initially.  I guarantee you that there will be some vax channels funneling off vaccine for the right price.  I hope they get found out, drug out in the street and shot. 

1 minute ago, Anastasis said:

I wonder how much of an side market there will be for the vaccine initially.  I guarantee you that there will be some vax channels funneling off vaccine for the right price.  I hope they get found out, drug out in the street and shot. 

But, I mean.....not before we get a chance to buy one at a premium, right?  Because this is America, and "rules for thee and not for me" is our main rule.

Discussing sub-prioritization of healthcare workers now in ACIP meeting...inpatient vs. small and private practice, office staff, EMS, home health aides, etc. 

1 hour ago, BradInATX said:

Is a "dose" one shot, or does it include both shots necessary?

Those numbers are fuckin' great, man. Especially if "dose" includes both shots and we end up getting 20+% of the population vaccinated by EOY. That alone is enough to put downward pressure on the cases and deaths.

one shot. 40MM doses = 20MM people vaccinated fully. 

Link to the ACIP slide decks if anyone interested....the next presentation is going to go into more detail re: sub-prioritization.

https://www.cdc.gov/vaccines/acip/meetings/slides-2020-12.html

 

Last topic is going to be the safety surveillance plans...

2 minutes ago, Anastasis said:

Last topic is going to be the safety surveillance plans...

So except for our medical friends only Army Brat of the Surly cohort will get it in round 1?

43 minutes ago, Pato del Muerto said:

So you are saying I need to get into the counterfeit covid vax card bidness, as some people would rather pay for a fake than get one free with the vax. 

Hard to counterfeit implanted rfid chips

28 minutes ago, Anastasis said:

one shot. 40MM doses = 20MM people vaccinated fully. 

Millions will not get the second, thereby wasting the material. 

We eventually will need around 8-10 billion doses?  Or is inoculating the world population not the goal?  If it’s anywhere near that, we will need to engage the manufacturing capability of the world via licensing or something. 
especially if there’s a limited immunity from the vax, as seems to be the case with antibodies from an actual infection.  

Everyone on the ACIP call appears to agree with HC workers in 1a, some appear to have concerns about safety and surveillance capabilities in LTC setting.   Looks like 1a prioritization will pass as the per the interim recommendation, including HC workers and LTC facilities. No real surprise on this, but they are going to drag it out until 6PM or so with public comment period.

This is just guidance to state departments of health who make the ultimate decision. 

Are we taking bets to see if sports teams magically get the vaccine before others?

1a1 is Congress 

3 hours ago, Aqua Buddha said:

Can't wait until people find out how the rich and connected will be able to cut in line.

I'll keep you posted.

4 minutes ago, Pato del Muerto said:

1a1 is Congress 

I honestly think that some of the push to move essential workers as a group ahead of high risk categories is influenced by this exactly, putting a wide range of government workers ahead of the high risk categories. 

Edited December 1, 2020 by Anastasis

12 minutes ago, Pato del Muerto said:

1a1 is Congress 

What about A-1-A Beachfront Avenue? 

I wonder how much of an side market there will be for the vaccine initially.  I guarantee you that there will be some vax channels funneling off vaccine for the right price.  I hope they get found out, drug out in the street and shot. 

Maybe they should publicly auction off 1000 doses a week. That’s a very small percentage of the total vaccinations, but it would give rich people a legit avenue for getting vaccinated earlier and the money could be directly used for COVID assistance for financially disadvantaged people.

Not sure the ethical or financial considerations on something like that, but it seems there’s potential to use capitalism in a very limited manner for the greater good.

37 minutes ago, wild_turkey said:

Maybe they should publicly auction off 1000 doses a week. That’s a very small percentage of the total vaccinations, but it would give rich people a legit avenue for getting vaccinated earlier and the money could be directly used for COVID assistance for financially disadvantaged people.

Not sure the ethical or financial considerations on something like that, but it seems there’s potential to use capitalism in a very limited manner for the greater good.

Love the idea from an economic standpoint but from time to time healthcare can get weird about jumping the line for money. It’s also my understanding that the govt is controlling decisions about the initial and perhaps all distribution rounds. A hospital system that breaks the rules might find themselves in trouble. Still rules can always be slightly bent to help a friend.

15 hours ago, wild_turkey said:

Maybe they should publicly auction off 1000 doses a week. That’s a very small percentage of the total vaccinations, but it would give rich people a legit avenue for getting vaccinated earlier and the money could be directly used for COVID assistance for financially disadvantaged people.

Not sure the ethical or financial considerations on something like that, but it seems there’s potential to use capitalism in a very limited manner for the greater good.

they can ebay all the personal ventilators they bought and hoarded to pay for the early access vaccine

the optics on that would be 

 

They can receive the shots at Fyre island

1a1 is Congress 

Don’t forget , live tv

 

Hopefully some light at the end of the tunnel.

Edited December 3, 2020 by MagicSoccerSpray

https://www.nejm.org/doi/full/10.1056/NEJMc2032195?query=featured_home
 

Some good news about vaccine durability today

No discussion on the pfizer sitch this afternoon?

1 hour ago, Heme Doc said:

https://www.nejm.org/doi/full/10.1056/NEJMc2032195?query=featured_home
 

Some good news about vaccine durability today

Yeah, lots of interest in this. 120 days out a good sign.  Gonna just take some runway, but I hope we can get at least a year out of it.  An annual vaccination process is tenable, regular, and something that can be integrated with influenza scheduling. 

5 minutes ago, bluto said:

No discussion on the pfizer sitch this afternoon?

I think that this was already largely baked into the numbers?  In combing around for details on projected number of doses available this wasn't surprising, but maybe first time a major media outlet trumpeted it. 

11 hours ago, Anastasis said:

Yeah, lots of interest in this. 120 days out a good sign.  Gonna just take some runway, but I hope we can get at least a year out of it.  An annual vaccination process is tenable, regular, and something that can be integrated with influenza scheduling. 

Agree. The other good news is it could even be longer, we just don't know yet. No data. Additionally, if this doesn't mutate every year like the Flu, they can develop better vaccines that either are one and done, or protect you for multiple years and only require a booster once in a while. (mainly wishcasting here, but whatever)

1 minute ago, Neonmoon said:

Agree. The other good news is it could even be longer, we just don't know yet. No data. Additionally, if this doesn't mutate every year like the Flu, they can develop better vaccines that either are one and done, or protect you for multiple years and only require a booster once in a while. (mainly wishcasting here, but whatever)

These are pretty much the first vaccines which are targeted against a single protein, the spike protein of this coronavirus. There is good (fewer side effects) and bad (easier for the virus to mutate to make the vaccine less effective) to such an approach. It will be an interesting case study.

1 hour ago, Bevo said:

These are pretty much the first vaccines which are targeted against a single protein, the spike protein of this coronavirus. There is good (fewer side effects) and bad (easier for the virus to mutate to make the vaccine less effective) to such an approach. It will be an interesting case study.

Right, but the spike is crucial to cell entry so if that region mutates, the virus should become less infectious. Insert lifefindsaway.gif

 

 

2 minutes ago, Anastasis said:

Right, but the spike is crucial to cell entry so if that region mutates, the virus should become less infectious. Insert lifefindsaway.gif

 

Most likely you are correct. Plus, despite the conformation of the virus, the antibody response will be multi-epitope, meaning that we are not talking about a single antibody but many antibodies against many sites on the protein. The result is that the virus would have to mutate in lots of regions to circumvent the immune response.

My BIL is not all that smart about covid, and has been in the "I'm going to live my life and enjoy my freedom" boat from day 1. No masks, btw.


His latest outburst is that getting the vaccine is pretty much pointless bc you're only immune for 6 months and unless everyone continues getting revaccinated that frequently you'll still have plenty of contagious and vulnerable people running around.

I have read that antibodies may only last 6 months or so, but I have no idea if his claim about the vaccine is true or not. I'd still get it either way, just curious if he's actually correct here or talking out of his ass as he often is.

I may have asked this upthread, but are we attempting to eradicate the virus, or do we expect it to stick around and we get vaccinated as needed/wanted?

I wondered the same thing. Obviously hoping for eradication but preparing for the possibility of long term management through repeat vaccinations.

FWIW, Fauci apparently thinks it will be chronic management, not eradication any time soon.

https://www.cnbc.com/2020/11/12/coronavirus-dr-fauci-says-he-doubts-whether-covid-can-be-eradicated.html

“I doubt we are going to eradicate this. I think we need to plan that this is something we may need to maintain control over chronically. It may be something that becomes endemic, that we have to just be careful about,” he continued.

“Certainly, it is not going to be a pandemic for a lot longer because I believe the vaccines are going to turn that around.”

One of y'all remind me again why Fauci needed to be fire and/or killed?  Most level-headed adult in the history of our country and some of y'all felt he was somehow 'in the way'???

 

Durability of the vaccine is unknown. I think that we are headed towards an annual vaccination that will be coupled with influenza. Unlike something like small pox there appears to be reservoirs for this virus. I don’t think eradication gonna happen. Stop eating bats and ant eaters dip shits, and certainly stop commingling them in meat markets. 

I think it becomes endemic.  But let’s at least get shit under control before we talk about eradication.  

I think protective immunity will last at least a year.  Antibody levels may decline to a point where you are susceptible and need a booster.  But even if your antibodies wane and you get it, your disease will likely be mild or asymptomatic because your body already knows how to mount an immune response against it (thanks memory B cells and T cells!) so you’ll ramp up antibody production very quickly before it can cause as much trouble

My hospital (2nd largest in large Texas city) says they will have vaccine Dec 14 and be off to the races.  

3 hours ago, Heme Doc said:

I think it becomes endemic.  But let’s at least get shit under control before we talk about eradication.  

I think protective immunity will last at least a year.  Antibody levels may decline to a point where you are susceptible and need a booster.  But even if your antibodies wane and you get it, your disease will likely be mild or asymptomatic because your body already knows how to mount an immune response against it (thanks memory B cells and T cells!) so you’ll ramp up antibody production very quickly before it can cause as much trouble

My hospital (2nd largest in large Texas city) says they will have vaccine Dec 14 and be off to the races.  

If it’s endemic, and kids can get it but very rarely severely, does that mean that after all of us adults get it or get the vaccination, that will be the end of deaths from it as it is like a cold for kids, and those memory cells you mention will mean it remains relatively harmless as they age?  And the vax won’t be needed any longer?

If it’s endemic, and kids can get it but very rarely severely, does that mean that after all of us adults get it or get the vaccination, that will be the end of deaths from it as it is like a cold for kids, and those memory cells you mention will mean it remains relatively harmless as they age?  And the vax won’t be needed any longer?

With duration of immunity from the vaccine or even infection being an open question there’s no straight answer here. I agree that the best guess is you probably end up with annual vaccination, and between that and some level of natural immunity in the population from infections it probably does start to resemble the flu in terms of impact. Flu season can stress hospitals too so there could very well still be periods where things like mask wearing come into play in order to help keep numbers manageable during peak periods.

The Travis County Medical Society and Dell Medical School hosted a town hall on vaccines featuring local leaders Mark Escott and Stephanie Hayden.  It's about 30 minutes of powerpoint followed by 30 minutes of Q&A.  Some takeaways:

• They are developing a points based ranking system to determine priority for the vaccine -- it is still under development.  They didn't specify if this was countywide, statewide, or nationwide.
• The vaccine will be free, but providers may charge an admin fee similar to an office visit to cover their costs.  The amount might be set by the provider, still TBD.
• The AstraZeneca vaccine is cheaper than the mRNA vaccines (like $4 a dose vs $20 a dose) and may be available in higher quantities worldwide.
• Guidance for those under 18 and those who are pregnant/lactating is not complete.  Maybe adults get vax but kids do not?
• I would not expect large vaccination centers.   The state is enrolling existing providers (pharmacies, hospitals, etc) instead.

 

2 hours ago, Texas Jeff said:

The vaccine will be free, but providers may charge an admin fee similar to an office visit to cover their costs.  The amount might be set by the provider, still TBD.

I am not sure this is totally accurate. Insured and Medicare members have no out of pocket and there is a fund for uninsured. I don’t think anyone is suppose to have to pay for the admin and balance billing is specifically prohibited. There may be some narrow gap, the they vast majority of Americans if not all should have no out of pocket. Admin costs are covered by either the insurer, CMS or the Medicaid program. 

Edited December 6, 2020 by Anastasis

I think you both are saying the same thing. The provider is going to be able to charge for administering the vaccine but either the insurer or govt will pick up the tab. I’m not sure the govt has set the amount to be paid.

my guess that the highest profit motivated organizations like the private urgent care centers will avoid having the vaccines. 

41 minutes ago, Nice Guy Eddie said:

I think you both are saying the same thing. The provider is going to be able to charge for administering the vaccine but either the insurer or govt will pick up the tab. I’m not sure the govt has set the amount to be paid.

my guess that the highest profit motivated organizations like the private urgent care centers will avoid having the vaccines. 

Right.  I was referring to patient out of pocket.  People need to know that they should not have to pay anything for the administration.  CMS has set the Medicare rates for reimbursement, but insurance rates are dependent on either their negotiated rates or a reasonable reimbursement for out of network, and none of the above should result in any out of pocket cost.