Coronavirus under microscope

SARS-CoV-2 still looks like Death Star in blue

Are you confused? You have lots of company. Here’s what is going on:

All people over 75 years are now vaccine eligible

Effective last Monday, the state authorized anyone over 75 years of age to receive a Covid-19 vaccine as the start of “Phase 2.” No other new groups (whether over 65, comorbid illness, or other) are yet eligible in Phase 2.

Available vaccines unchanged

Only Pfizer and Moderna vaccines are available right now. They are both highly efficacious with about the same side effect profile, including common local reactions (redness, tenderness at injection site) and also a strong minority who feel really badly (fatigue, muscle aches and joint pains, etc.) for 1-2 days. Two shots are required, 3 weeks apart for Pfizer and 4 weeks for Moderna. Second shot reactions may be slightly worse.

How do elders >75 get the vaccine?

Grandparents now have three options. Do it yourself by website, or wait for the Covid Fairy to call you, or the latest choice just announced Friday, call the Covid Fairy yourself. Our practice is not yet an option.

     1. Make your own appointment by website

Anyone over 75 can try to get a vaccination appointment through state authorized websites that link to the many many vaccination centers that have been set up around the state. These include downtown at Fenway, at Gillette stadium and other cozy places. The state website is COVID-19 Vaccine | Mass.gov. The website is widely acknowledged to be exceedingly difficult and frustrating to use. Tears and curses are regularly reported.  The poor website design is compounded by the short supply of vaccine and hence of appointments, regardless of location.

A dramatically better website to try is https://www.macovidvaccines.com/ which many members have recommended. Here they only show vaccination venues that actually have appointments available!

Should you use https://www.macovidvaccines.com/ to snag an appointment in Pittsfield or other distant location, please be aware you will need to return there for your second shot. That is standard practice at all sites. Consider this in your decision, although I might agree that a jaunt to the Berkshires could be a pleasant diversion.

     2. Wait for the Covid Fairy to call or email

A good number of our members have received calls or emails this week inviting them to make an appointment for a Covid vaccination at either a Mass General Brigham (formerly Partners Healthcare) or BILH (Beth Israel Lahey Healthcare) facility. Additional organizations calling now include pharmacy chains CVS and Walgreens. There may be others.

Essentially, the state has now supplied vaccine to larger health care organizations that have databases of people over 75 and charged them to reach out (email, phones by Covid Fairy) to those people and offer vaccination appointments. Medical practices, who normally provide most people their vaccines, are still largely excluded.

This process appears to be starting well and perhaps picking up speed. We can all be grateful. The reach-outs are being done randomly by all the organizations. Everyone of you will be on at least one organization’s database. If you get a call soon, you are lucky. Answer it. Unless they want your credit card, they are legit. Take the appointment and go.

   3. Call the Covid Fairy at 211 (a new state hotline)

Governor Baker announced Friday that anyone 75+ can call 211 for assistance booking a Covid-19 vaccine appointment weekdays from 8 a.m. to 5 p.m. He said 500 representatives will be available to make appointments using the same access at the state’s website mass.gov/covid-19-vaccine. This should be good news. Let us know if it really works.

All adult >75 shots should be underway this month

With the options now available (websites, you are called, you call), all people 75 and over should be able to get at least their first vaccination in February. The state should have enough vaccine in inventory and arriving to do so. (I plan to review the arithmetic in another post.) Similarly, over-75 vaccination should be done by the end of March. 

So no elder needs to panic. Please keep yourselves safe, listen to the phone or call 211 yourself, or try the https://www.macovidvaccines.com/.

Keep us at OHC informed

Please let us know by email to nurse@orchardhealthcare.com or adminohc@orchardhealthcare.com or phone to our office when you are scheduled for your shots or, more importantly, when you have gotten your first one and which vaccine it was.

If we are getting late into February and you are still having difficulty getting scheduled, let us know.

Finally, if we are unexpectedly given an allocation of vaccine this month, we will let everyone know the same day.

What about everyone else? Group 2?

The next group to be eligible for vaccination will be everyone over 65 and younger people who have at least two of a short list of specific complicating medical conditions that are thought to raise the risk of bad outcomes from Covid-19.

This is a much larger group. I think it unlikely that appointments will open up for this group before the end of March when the over 75 group should be completed. How quickly this group can be immunized will be heavily dependent on whether additional vaccine stocks become available to allow a high daily rate of immunizations. Think Johnson and Johnson, for example. But two months (April-May) for these Group 2 vaccinations seems a reasonable guess at this time, hoping for some additional vaccine.

Healthier and younger people?

The start time for younger and healthier people now seems unlikely before June, but it is really too uncertain to try to predict at this time because of the constantly evolving development and approval of new vaccines.

How are we doing now?

Lots of good news. The viral prevalence in Massachusetts is diminishing. Daily new cases in Massachusetts are now about 3,000, down from about 4,500 in December. We are making real progress. But we can’t succumb to Covid fatigue and let our guard down. Getting vaccinated is not yet a get-out-of-jail card. Remember, in the summer, daily cases were 200-300, ten times less. Indoor gatherings (like SuperBowl parties, which I hope you are not having) remain sizeable risks. Don’t.

In closing, let’s underscore some extraordinary good results

In the Phase 3 trials of all major SARS-CoV-2 vaccines to date (Pfizer, Moderna, Johnson & Johnson, Novavax, and likely still AstraZeneca), there were no reported cases of hospitalization or death in vaccinated volunteers. These trials added up to around 100,000 people. These results appear to be holding up with the variant strains, at least so far.

Regardless of the efficacy (94-95% for midlife adults for the first two, somewhat lower for the others), any Covid-19 cases that did arise were milder and treated as outpatients. I think that is extraordinary, since ICU care and death is what has from the beginning differentiated this terrible disease from what some people last year dismissively called just “a bad flu.”

While we have a long way to go to get everyone immunized, or to relax our guard on masks, social distancing and avoidance of prolonged indoor congregating, I believe we can realistically expect to be safe by sometime this fall. I find that thought truly uplifting in the dead of our winter with another heavy snow falling. I hope you do, too.

 

 

Postscript: Some extras for the data-driven

If I reprise the same risk analysis from my early January post, when I calculated the likelihood of having an unknown and asymptomatic but infectious person in group gatherings of different sizes, the February numbers are more favorable, but still not good.  With daily new cases in Massachusetts now about 3,000 (resulting in a prevalence of asymptomatic infectious people of 0.0033), down from about 4,500 (prevalence 0.0050) in December, we can see a reduction in the risk in group gatherings.

Unfortunately, I think (and believe most of you would find) that risk to be unacceptable. For example, in a group of 10, the risk is 3.3% (down from 4.9%). Do you think that is safe enough? In a larger group of 20 (think house party for the SuperBowl), the risk is 6.4% down from 9.5%. That doesn’t make me feel safe. That’s breeding ground for a superspreader event.

Group Size=N and likelihood of at least one person with Covid-19 in group who is asymptomatic but infectious
Prevalence  N=6 N=10 N=15 N=20 N=30 N=50 N=100
December 0.0050 3.0% 4.9% 7.2% 9.5% 14.0% 22.2% 39.4%
February 0.0033 2.0% 3.3% 4.8% 6.4% 9.4% 15.2% 28.1%

And to lay on a bit of crepe, there is literally just-breaking not-good news this evening that the AstraZeneca-Oxford vaccine appeared to fail to limit infections in South Africa with the B.1.351 variant of SARS-CoV-2 prevalent there. That is clearly troubling, although it is possible that there will be benefit shown in limiting severe cases and deaths, as has been shown for other vaccines. That variant is just showing up in the U.S. So we clearly have uncertainty and challenges yet to come. Lots to be thankful for. Lots still to be concerned about.

 

Postpostscript: Covid Fairy and Tooth Fairy

When some older members last week gleefully reported the unsolicited calls from hospitals or pharmacies offering them prompt appointments for Covid-19 vaccine, the unexpected external happy intervention they described struck me, perhaps idiosyncratically, as a child might respond to the divine and secretive intervention and reward of the Tooth Fairy upon loss of an incisor. I thought those agents of vaccine access mercy should not remain anonymous, even though they were. The moniker Covid Fairy immediately struck me as a way to personalize them. We all do know they are real people, of course.

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9 Responses to Covid-19 Shots Starting for >75, Distribution Improving, Confusion Still Reigns

  1. Marcy Goldsmith says:

    For those who are eligible there are still 5,500 appointments available at Gillette Stadium from 2/11 to 2/14! At least as of Monday at 7:30am. The Gillette Stadium vaccination site is very well run. Good experiences have also been written about other large state vaccination sites. Yes, a person who needs assistance can be accompanied by someone. And yes, the website registration is tough. Have your medical insurance cards handy. If you say you have insurance, you will need to have pdf images to upload of the front and back of your cards. It wants to know your group name or number too. For Medicare, say SSA (Social Security Administration). You can say you have no insurance. Shots are free, they may bill insurance for the personal to do the injection. Practice using the site so when your turn comes up it is not as stressful. If you are not yet eligible you can practice by “saying” you are a phase one medical person. Go all the way through and just don’t hit that final button. If you hit it by mistake, you will get an email that will let you cancel. Most of the new appointments get loaded on Thursdays, as early as 12:01 am. As new vaccination sites are added they become live at random times. Good luck! Be persistent!

  2. Nancy Stager says:

    Hi Dr. Kanner,

    Why is 65 and older group not opening up sooner?

    Every day, when I look at available appointments there is
    always available appointments at Gillette and other sites.

    Gillette Stadium
    Foxborough
    02/08/2021: 2 slots
    02/09/2021: 3 slots
    02/10/2021: 1 slot
    02/11/2021: 887 slots
    02/12/2021: 1681 slots
    02/13/2021: 1227 slots
    02/14/2021: 1853 slots
    MORE INFORMATION
    02/08/2021

    • DrKanner says:

      Nancy, there are approximately 490,000 individuals over age 75 in Massachusetts (US Census data 2019). About 40,000 are in assisted living, I believe, who have been or are being separately immunized. That leaves 450,000 or so, for whom 900,000 shots are needed. Drop some who are out of state or who decline or will wait, just administering the shots will take till middle of next month, assuming we have adequate vaccine supply, which fortunately does seem likely. Projections beyond the approximate start time for >65 group get difficult because of the uncertainty about how much vaccine (and ?new ones like J&J) will be available and when, in April and after.

  3. Debbie Sarajian says:

    I thank you for the update. it is unacceptable to me that Gov Baker has not followed the CDC guidelines when other states have Harry had is first shot in needham after a phone call on a Sunday from the vaccine fairy.
    Everyone I know under 75 in other states have gotten the vaccine.
    It is a travestry on all fronts that a state of software companies cannot have an easier process to sign up.

    Why does friend in RI have an opportunity to get a shot at walgreens
    In Ma when I cannot. Is that fair..No

    • DrKanner says:

      Deb, I agree with concerns about equity and disparity among the states, but have no real answer. The choices made so far (including excluding physicians’ offices from the supply chain after requesting our participation, which I think is a major error) certainly raise questions, but only Baker and DPH can answer them.

  4. Charles W Moores says:

    From the above, am I understanding correctly that Orchard Health Care will NOT be providing vaccine for its patients?

    • DrKanner says:

      We want to provide vaccine, we have purchased expensive new vaccine storage equipment, we have trained our staff additionally to provide vaccine, we have applied to the state in December and were approved to provide vaccine, and we are ready to do so now on a day’s notice from the state. What is missing is an allocation from the state, which has not yet come and about which we have no definitive information. I hope will will get vaccine by later this month, but have no way of confirming that now. Consider complaining to your state rep and senator about the situation. I have. That might help.

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