Coronavirus

[Puget]

I prefer that the vaccine be delivered AS Designed. 
I fear that people will drop their guard after getting the first/only shot and that things will be even worse.

I dont know that this mixes apples and oranges, but people who take antibiotics, but not finish the course allow the surviving germs to be resistant to the treatment. 

So, I would prefer that we do what we are doing... We can still increase production, attempt to vaccinate all that can be vaccinated.

The problem, as Spork mentioned above, seems to currently be that there are bottlenecks in the ABILITY to vaccinate large amounts of people.  Flooding more vaccine would not get more needles in arms as that is not where the bottleneck may actually lie. 

Those waiting on the vaccine to be administered can remain at home and self isolate.  The Biden folks re hoping that the second dose will be available as needed, when the problem may not actually be the shortage of vaccine (as the bottleneck may well be elsewhere).  Once the shot is taken, especially if/when the second dose is questionable, the isolation will break and EVEN MORE will get sick.

I really have a problem with this kind of logic. We've seen throughout this pandemic, a pernicious idea that people can't be trusted with correct information and our policies should and guidance should reflect what we fear people will do with information. Remember how part of the reason it took so long to advise people about the benefits of mask wearing was because there was lots of fear among experts that people would think if they were wearing a mask they didn't need to take any other precautions? We still haven't incorporated all the evidence about the hugely reduced risk if you socialize outdoors vs indoors into the guidance people are given. There's this fear that if you tell people some things are safer, they will use that information in an irresponsible way. The results of this kind of thinking have been disastrous.

Same thing here. Basically this is a logistical problem. If you can be pretty sure, that supplies will allow you to give second doses to people on the scheduled timeline even if you don't reserve them, it would make a lot of sense to give more first doses out. The first dose seems to provide pretty substantial protection, and might keep people from getting seriously ill even if they do get COVID. We shouldn't be worrying that if we give more people this thing that will save lives, they will "use it irresponsibly." People are fully capable of understanding that while their risk is reduced somewhat, the protection isn't near as good till the second dose. People who are trying to be careful will continue to try to be careful with that information. If people aren't taking precautions, it won't make any difference anyway. Regardless they will be less likely to get COVID and we could potentially speed up vaccination overall, saving lots of lives.

Exactly right-- this is the same type of "moral hazard" argument that has been made about other risk mitigation public health interventions (e.g., HIV prevention, needle exchanges), and which has been repeatedly shown by research to be untrue. People who engage in risky behaviors do so whether or not you mitigate the risk, so it is always better to mitigate the risk.

I think it is important to separate this moral hazard argument from the concern that there won't be enough second doses available on time if you don't hold them back. That's purely a logistical question, and one that the drug companies are in the best position to answer and presumably have said they don't think is a concern at this point.

What you want to know is (1) the probability of a drop-off in manufacturing rate that would prevent sufficient second doses being available, and (2) the relative risk of X people not getting a second dose on schedule vs. X people waiting Y more weeks to get their first dose. The probably of (1) doesn't have to be zero for the math to still favor not stockpiling the second doses, and a lot of experts who have done the math are favoring no longer doing so.

[Caracal]

Exactly right-- this is the same type of "moral hazard" argument that has been made about other risk mitigation public health interventions (e.g., HIV prevention, needle exchanges), and which has been repeatedly shown by research to be untrue. People who engage in risky behaviors do so whether or not you mitigate the risk, so it is always better to mitigate the risk.

Yeah, totally agree. The comparison to HIV prevention is something I've seen some very smart epi people make. The obvious example is abstinence based prevention strategies, but it actually goes far beyond that. Messages which focused solely on condoms also had real problems. That approach led to a lot of hesitancy in embracing drugs that dramatically reduce the risk of contracting HIV. What actually works is to give people the information about various ways to mitigate risk with behavioral changes and not to worry that if you use medical prevention strategies, that will result in people ignoring the behavioral advice.

Its weird to me that we get so hung up on the moral hazard thing with some things and not others. My car has automatic braking, but that doesn't make me tailgate people more or not pay attention when I'm on the freeway. It is an extra layer of protection if I make a mistake and we don't worry that its going to cause me to drive more recklessly.

[apl68]

Had a Zoom session at lunchtime in which our state health department's immunologist spoke.  She spoke of how the vaccines were developed, how they're being distributed around the state, etc.  And fielded some questions.  It was interesting.  The health department's site has a map of pharmacies around the state where the vaccine is available.  We already knew which one had it locally, but will be checking back with interest to see when and if other local pharmacies are added.  I also found out where the nearest ones are to where Mom and Dad are.

[clean]

Same thing here. Basically this is a logistical problem. If you can be pretty sure, that supplies will allow you to give second doses to people on the scheduled timeline even if you don't reserve them, it would make a lot of sense to give more first doses out. The first dose seems to provide pretty substantial protection, and might keep people from getting seriously ill even if they do get COVID. We shouldn't be worrying that if we give more people this thing that will save lives, they will "use it irresponsibly." People are fully capable of understanding that while their risk is reduced somewhat, the protection isn't near as good till the second dose. People who are trying to be careful will continue to try to be careful with that information. If people aren't taking precautions, it won't make any difference anyway. Regardless they will be less likely to get COVID and we could potentially speed up vaccination overall, saving lots of lives.

This is part of my concern... You create MORE asymptomatic carriers!  But carriers that are now less worried about OTHERS. 
And that is only the assumption ... that the one dose folk will have SOME immunity... It may very well cause them to lower their guard and STILL end up in the ICU.

Didnt I see on the news that a congressman was just diagnosed EVEN THOUGH he had the SECOND dose 2 weeks ago?  How great is one shot, when some are sick even after 2, but not the full amount of time?

Bottom line... Im not upset that my concerns are ignored.  I am not pleased that the rules have changed mid stream.  I dont think that the problem is really that there are not enough doses available (as evidenced by the news that only 1/3 of the doses delivered have been 'put in arms'. )  Making more doses available doesnt seem to be the answer to the bottleneck. 

But hey... Im an anonymous contributor to a site made up of academics.... My advice is worth infinitely more than what you paid for it!  (as is yours!... but Infinitely more than worthless is still worthless!)

[Puget]

And that is only the assumption ... that the one dose folk will have SOME immunity...

It is not an assumption, that is what the clinical trials found-- substantial reduction in cases in the vaccine compared to placebo group even before the second dose.

It is also very likely to reduce transmission-- that hasn't been definitively demonstrated yet, but a strong immune response generally means the virus is stopped from replicating much and thus is transmitted less.

It was also never the plan to keep stockpiling vaccine past phase 1.

And if you don't think supply is the problem, why are you so upset about a change that only affects supply?

You seem extremely anxious about all this, and that is understandable. But you aren't following the science or thinking through your objections very clearly here. There are plenty of other things to be legitimately upset about (starting with everyone who won't take any precautions and won't take the vaccine either).

[clean]

You seem extremely anxious about all this, and that is understandable. But you aren't following the science or thinking through your objections very clearly here. There are plenty of other things to be legitimately upset about (starting with everyone who won't take any precautions and won't take the vaccine either).

Maybe it is my area... Wearing a mask is not entirely, but too often a Political Statement (infringing on their 'right' to NOT wear a mask - and denying them the 'right' to infect others).
Grocery Stores and Walmart have policies that REQUIRE masks, but DONT ENFORCE THEM! 
AS I have vented here or other places about them not following their own policies..., IF you complain to the stores, they simply say that they want their customers to be safe, BUT dont want to expose their employees/'partners' to potential physical violence. 

So, yes, maybe this is something that has been bothering me a bit disproportionately. 

[rusaga]

Had a Zoom session at lunchtime in which our state health department's immunologist spoke.  She spoke of how the vaccines were developed, how they're being distributed around the state, etc.  And fielded some questions.  It was interesting.  The health department's site has a map of pharmacies around the state where the vaccine is available.  We already knew which one had it locally, but will be checking back with interest to see when and if other local pharmacies are added.  I also found out where the nearest ones are to where Mom and Dad are.

Hi everyone,
did the immunologist say about how long it will take to get the vaccine to achieve group immunity?
Thank you!

[Caracal]

Same thing here. Basically this is a logistical problem. If you can be pretty sure, that supplies will allow you to give second doses to people on the scheduled timeline even if you don't reserve them, it would make a lot of sense to give more first doses out. The first dose seems to provide pretty substantial protection, and might keep people from getting seriously ill even if they do get COVID. We shouldn't be worrying that if we give more people this thing that will save lives, they will "use it irresponsibly." People are fully capable of understanding that while their risk is reduced somewhat, the protection isn't near as good till the second dose. People who are trying to be careful will continue to try to be careful with that information. If people aren't taking precautions, it won't make any difference anyway. Regardless they will be less likely to get COVID and we could potentially speed up vaccination overall, saving lots of lives.

This is part of my concern... You create MORE asymptomatic carriers!  But carriers that are now less worried about OTHERS. 
And that is only the assumption ... that the one dose folk will have SOME immunity... It may very well cause them to lower their guard and STILL end up in the ICU.

Didnt I see on the news that a congressman was just diagnosed EVEN THOUGH he had the SECOND dose 2 weeks ago?  How great is one shot, when some are sick even after 2, but not the full amount of time?

Bottom line... Im not upset that my concerns are ignored.  I am not pleased that the rules have changed mid stream.  I dont think that the problem is really that there are not enough doses available (as evidenced by the news that only 1/3 of the doses delivered have been 'put in arms'. )  Making more doses available doesnt seem to be the answer to the bottleneck. 

But hey... Im an anonymous contributor to a site made up of academics.... My advice is worth infinitely more than what you paid for it!  (as is yours!... but Infinitely more than worthless is still worthless!)

95 percent effective still means that 5 percent of the people vaccinated would be able to get COVID even after the vaccine has had time to work. We should expect to hear stories about people who were vaccinated and still got sick. Seems like there is some evidence that those people probably will be less likely to get really sick, but I'm sure there will also be stories about people who got vaccinated and died. It won't mean there's any cause for alarm, it will just mean a bunch of people have got the vaccine and the expected rare events will be occurring. The preliminary evidence combined with experience from other vaccines, suggests that you would dramatically reduce the number of asymptomatic  and pre-symptomatic carriers, not increase it.

One of the frustrating things for me about so much of the discussion around COVID is that there is so much focus on individual choices and actions when so many people have very limited ability to make choices because of their financial and personal circumstances. People are working shoulder to shoulder in meat packing plants and everyone spends their time worrying about how risky it is to have coffee six with a friend outdoors. We should worry about whether we can get as many people as possible the two doses as quickly as we can and stop worrying about the rest.

I agree with you about the bottlenecks, but those have lots of causes. Not setting aside second doses isn't going to solve everything in isolation, but that doesn't mean it won't help.

[Puget]

You seem extremely anxious about all this, and that is understandable. But you aren't following the science or thinking through your objections very clearly here. There are plenty of other things to be legitimately upset about (starting with everyone who won't take any precautions and won't take the vaccine either).

Maybe it is my area... Wearing a mask is not entirely, but too often a Political Statement (infringing on their 'right' to NOT wear a mask - and denying them the 'right' to infect others).
Grocery Stores and Walmart have policies that REQUIRE masks, but DONT ENFORCE THEM! 
AS I have vented here or other places about them not following their own policies..., IF you complain to the stores, they simply say that they want their customers to be safe, BUT dont want to expose their employees/'partners' to potential physical violence. 

So, yes, maybe this is something that has been bothering me a bit disproportionately.

Those all fall under the "other things to be legitimately upset about". None of them have anything to do with whether all available doses should be distributed now vs. stockpiled. In fact, you are making my point for me: People who engage in risky behavior are going to do it with or without risk mitigation, so it is always the best public health policy to mitigate risk.

Plus, who gets a first dose faster if they are released now? Not the non-mask wearing shoppers most likely (even if eligible, they are likely to not want it), but rather the poor grocery workers and other front line workers who have no choice but to interact with them, and people over 65 and with risk factors. Let's get them at least partial protection as fast as possible.

[nebo113]

I am not in my "home" state and won't be for several more months, and can't get the vaccine where I currently am, as I am not a resident.  I could get it at home, but the logistical difficulties of returning and then coming back are......W need a NATIONAL plan, not by state or county....or whim.

[Caracal]

I am not in my "home" state and won't be for several more months, and can't get the vaccine where I currently am, as I am not a resident.  I could get it at home, but the logistical difficulties of returning and then coming back are......W need a NATIONAL plan, not by state or county....or whim.

Are you sure about that? The details vary enormously, but in some states non residents can be eligible.

[apl68]

Had a Zoom session at lunchtime in which our state health department's immunologist spoke.  She spoke of how the vaccines were developed, how they're being distributed around the state, etc.  And fielded some questions.  It was interesting.  The health department's site has a map of pharmacies around the state where the vaccine is available.  We already knew which one had it locally, but will be checking back with interest to see when and if other local pharmacies are added.  I also found out where the nearest ones are to where Mom and Dad are.

Hi everyone,
did the immunologist say about how long it will take to get the vaccine to achieve group immunity?
Thank you!

All we know at this point is that it will be several months yet before the vaccine becomes available without restriction.  Which means we're going to be far into the year before we see the pandemic truly receding.  I know that libraries around the country are assuming that our summer reading programs will still  have to be virtual.

[Harlow2]

According to the Washington Post the supposed reserve of vaccine being held back does not exist "and was already exhausted when the ....administration vowed to release it. 
https://www.washingtonpost.com/health/2021/01/15/trump-vaccine-reserve-used-up/

[clean]

I am not in my "home" state and won't be for several more months, and can't get the vaccine where I currently am, as I am not a resident.

My county has/is 'a hub'. The news reports that as the vaccine was purchased by the government there are NO residency restrictions.  The hub is to distribute to anyone, regardless of residence. The news specified that IF a Canadian or a Mexican national came, they would get vaccinated. 

The national news had an article about an elderly couple living near their county's hub that can not seem to get registered, but watches all sorts of out of state license plates go through the location.

[clean]

Those all fall under the "other things to be legitimately upset about". None of them have anything to do with whether all available doses should be distributed now vs. stockpiled. In fact, you are making my point for me: People who engage in risky behavior are going to do it with or without risk mitigation, so it is always the best public health policy to mitigate risk.

The bottom line is that I believe that the vaccine should be given AS DESIGNED. I believe that there are risks of unforeseen complications because of the lack of testing (hence unforeseen).  and In Conclusion.... Dale Carnegie said, "A man convinced against his will, is of the same opinion still". 

What I think about is that the vaccine production began months before the approval was given so an inventory was available. Are they able to double that inventory in 3/4 weeks in order to ensure that people get the second dose AS Designed? 

Im going to  agree to disagree at this point.  I will circle back in 3 or 4 weeks and see what the news is reporting about the availability of the second dose and the ability to continue giving the first shot.