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CommentaryCovid-19 EpidemicPreventive MedicinePrimary Care

Covid-19 Vaccines Will Help Q2-3, But Pandemic Surging Now

By December 14, 20203 Comments

Covid 19 with red colors

The mRNA vaccines for Covid-19 developed by Pfizer and Moderna are terrific. They represent an amazing feat of modern biological science in the speed of development (well under a year) and efficacy (95% or so). Bravo!

When available to us, take either vaccine promptly! Safety data seem excellent. We are fortunate.

Our staff is prepared to administer the vaccine to our members when (and if) it is supplied to us. We purchased a larger vaccine refrigerator and -40C freezer just for this purpose.

But pandemic surging now

Realistically, the vaccines will not help the general population (including healthy adults over 65) until springtime. Yet the pandemic is exploding now, with 20 times the daily cases (close to 5000) in Massachusetts compared to late summer.

We have seen more cases in Orchard Health Care members in the past six weeks than the total since the beginning of the pandemic. Most came from family gatherings and a few from restaurant exposures. We had three new cases just today!

I am fearful of post-Christmas infections. We must continue to rigorously protect ourselves throughout what will clearly be a long and dangerous winter.

Initial vaccine distribution only to high-risk

The Pfizer vaccine, as everyone knows, has just been FDA approved. Initial doses have shipped and will be administered to front-line hospital and medical personnel, followed by nursing home residents and staff. Our office staff may be immunized late January or February. Other high-exposure groups may get vaccine in March.

The Moderna vaccine, expected to be approved this week by the FDA, will be distributed in same priority as the Pfizer vaccine.

General risk distribution not till Q2

Meaningful mRNA vaccine distribution to general populations most likely will begin around April. Older people and those with more medical risk (“preexisting conditions”) will be first.

Even if we have sufficient availability of vaccine, general vaccination certainly will stretch through the summer. We are not likely to have widespread population coverage that might constitute herd immunity until next fall even if vaccine “hesitancy” is overcome.

Limited vaccine availability a real possibility

Be aware that, after all the appropriate excitement about the release of the Covid-19 (SARS-CoV-2) vaccines, vaccine supplies may limit the speed and reach of general population coverage. There are three worries:

  1. Commitments: The US does not now have firm commitments for continuation of large-scale deliveries of Pfizer’s or Moderna’s mRNA vaccines beyond the initial supplies targeted to the highest risk populations in Q1. Other countries have large contracts with the same companies as well. So who gets how much and when is now under contention.
  2. Supply constraints: There may be world-wide raw materials shortages that limit the overall production of the mRNA vaccines. In essence, PCR tests use some of the same key chemicals as are needed to manufacture the vaccines. Test or prevent? We are hopeful, but it is unclear that the reagent supply issue has been resolved.
  3. Other vaccines slow or faltering: What about all the other vaccines under development? Where are they? In fact, other major vaccine candidates are much slower (Johnson & Johnson-BethIsrael, Novavax) or are faltering (AstraZeneca-Oxford) and are unlikely to be of help at least until Q2 next year.

What do you do this winter?

Your risk of Covid-19 will remain high throughout this winter. The pandemic has surged and will get worse, not better, in January and perhaps February as well. Most of you will not get a vaccine, likely an mRNA vaccine, until Q2 or Q3. Even then, lots of others will be unimmunized and precautions will still be needed in public and in crowded locations.

So the mantra is the same for this winter. Stick with immediate family. Follow Fauci:

  • Wear your mask whenever with people other than immediate family.
  • Wash your hands (and face) frequently
  • Keep distant from others (if not immediate family) inside and outside
  • Do not linger in closed spaces other than with immediate family or others in your circle of safety.
  • Gatherings inside with friends and non-nuclear family are especially risky now, even with masks. Skip the Christmas and New Year’s parties.

Eventually we will all be able to get the vaccines and return to something of a normal life, but that most likely will be next summer or fall. We must get safely through the winter and spring.

Do not despair. But do be prudent.





  • Jim Graham says:

    Excellent discussion. Harvard must be proud. 😉



  • Tom Myers says:

    I find all of this fascinating. We have known that COVID is highly contagious almost since “Day One.” Initially, we has no preventative, no treatment, and no cure. The data was scary—particularly scary as it was misinterpreted. Our public health officials claimed to have a solution tested in China: lockdowns: stay home (if you could, else “social distance” if you could, else wear a fabric face covering) and wash your hands.

    Quarantine—sequestering the sick and those who’d come in contact with them—had been a useful tool for dealing with infectious diseases for centuries. Now, totalitarian China had introduced “lockdown” where everyone is sequestered. Everyone stays home except politicians and other “eesential” people and apparently non-essential people doing “essential” functions.

    Initially, with the goal of slowing the spread so as not to overcrowd hospitals, the medical professions recommended sick (but not really sick) people stay home. Yes, they sent people home from hospital emergency rooms. Roughly 40% of early deaths can be directly attributed to sending sick people “home” to nursing homes and assisted living facilities where they transmitted the disease to vulnerable populations. This promoted rather than limited the spread. The decision makers were state and local politicians—-governors and mayors. The data that they saw was poorly understood. Today, we know that one patient infects an average of two others each day. Those three infect six. Those nine infect 18. This process is limited by Our God-given immune systems—much like all other infectious diseases that plague humans, animals, and plants and have done so forever. The fact that life exists is a tribute to immune systems not healthcare systems. They cranked up production of virus and/or antigen testing. Antibody testing continues to be rare and really valuable in making pandemic policy. Conspiracy theorists note that as contagious as COVID is and as long as it has been around some very large fraction of the population has had COVID with no symptoms or symptoms too mild to warrant a pointless visit to an ER or doctor. “Surges” appear to occur when the virus finds a new vector—an introduction to a population that is rich in people who have not had contact with transmitters. Cities with dense populations and confined spaces like apartments, public transportation and elevators were ideal for spreading COVID. (Cities with international airports provided early access for COVID.) What folks call “surges” seem more like numerous clusters caused by the highly contagious nature of COVID. This highly contagious nature leads to the disease “burning out” as the vulnerable fraction of the local population is infected. Once infected a small fraction of those infected die and the rest recover. If your are old and/or fat, your chances for getting the disease are much higher than average. Likewise your chances of dying are higher than average. But as the disease has infected as many as it can, the surge recedes. The “daily tripling” of cases slows. The forest fire is contained once the forest has burned down.

    It’s important to note that clinicians have made astounding progress in treatment so that getting COVID, which had never been the death sentence that public health officials, politicians, and the media wanted us to believe, is becoming even less lethal.

    Now, radically new vaccines, long promised to readers of Scientific American, are available. They go first to healthcare workers who have been working in environments literally saturated with the virus despite millions of us doing what we were told would slow the spread—pushing today’s cases and deaths into tomorrow, next week, and next month. It is also going to the institutionalized elderly racing against the virus that is most contagious and most deadly among the elderly.

    Of course, our politicians at our FDA waited till about two weeks after their UK counterparts approved the vaccine and began immunizing Brits. No one at the FDA seems to want to apologize for the tens of thousands of American deaths caused by the FDA’s delay. The advisory panel (that allowed the FDA to share the blame should something go wrong) was itself split on their favorable recommendation—17 aye, 4 nay, and one abstention. We don’t know anything about the abstention. One of the nays wanted two more months of data (120,000 deaths) so she could be “more comfortable” with an aye vote. Another thought making a decision about 16- and 17-year-olds was not justified with the data the vaccine makers provided (based on a trial approved months ago by the FDA). The FDA committee process, at this point is the third more deadly event in American medical history (following the Spanish flu and COVID itself).

    Politicians continue to exploit the fear that they have created in the population. Polling, notoriously corrupted in recent years, suggests that people hugely overestimate their chance of getting COVID and dying from it. The media has attempted to fuel these fears by highlighting rare cases of adults suffering from the disease long after they think they’ve recovered, people getting reinfected, and extremely rare cases of infants who have had COVID developing a rash and dying. Even the new season of TV shows focuses on young, attractive victims of the disease.

    The “elites’” exploitation is closing houses of worship, forbidding dining indoors and outdoors, locking down retail and commercial office space. Is there any proof (to the level of “scientific certainty required by the FDA) that these lockdowns are effective. Before you say, “Of course,” please consider the alternative explanations for the data based on how extraordinarily highly contagious the diseases is and the largely unpublished results on contact tracing and antibody testing (serology) that shows the number of “confirmed cases” is already five times the Johns Hopkins count and the number of deaths is overstated by roughly 20%. Also reflect on how lockdowns are increasing deaths that aren’t traced back to bad policy.

  • Linda M. Johnson says:

    Many thanks for this very helpful post. Really appreciate the time you take to keep your patients informed. I frequently share your posts with my parents in SC. Take care and stay well!

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