COVID-19 Update 11/11: Pfizer Vaccine, Rising Cases, Preventive Care, and More

Two big COVID-19 stories this week. First, Pfizer released promising results from their vaccine trial and appear to be headed toward an approval by the end of the year. And second, cases continue to rise and are a definite concern going forward. Hear about all this and more on this week's COVID-19 update with Dr. Steven Bishop. Watch the video below and read on for a full transcript. 

Pfizer Releases Promising Vaccine Results

So first some good news Pfizer released results. Many of you probably saw this in the news this week, but Pfizer has released some preliminary results from their vaccine trial, which is great.

They have almost 44,000 patients that they're planning to enroll. I think they've enrolled about 38,000 so far, and they released some preliminary data because they've had 94 confirmed infections across the trial group, which means placebo plus the vaccine trial side of things. And what they have said is that the vaccine is 90% effective. So essentially 90% of the people in the vaccine group appear to have been protected from COVID infection, which is great from the data they released so far.

Still waiting to see more information about adverse events, side effects, that being said, I haven't seen a lot in the news negatively talking about the Pfizer vaccine in terms of side effects. And I know that they released some preliminary phase two data back in the summer in July. And most of the patients in those groups had pretty low, mild side effect profiles. Some people had much worse side effects than most, but that was a much smaller number. I think, especially it was better than the Moderna vaccine and a couple of the others that were out there.

So the Pfizer vaccine is one of the mRNA platform vaccines, which is new technology again, but they had two versions of it. And the one that they moved into phase three, which is what the study is now, the phase three study had a much lower side effect profile than the other one. And so they moved forward with that version of it.

So I'm hopeful that those mild side effect profiles have translated over into this phase three, but, again, they haven't released the full data yet, but initial data looks really good for the Pfizer vaccine. I hope it holds the trial participants also seem like they said about 40%, up to 30% of the US participants are both racially and ethnically diverse, which is great because I think that will give us a much better view and a window into whether the vaccine is gonna work for the majority, for everybody in the population, rather than just a small subgroup. So I think that's great news.

They are saying that if all things continue, they've applied for an emergency use authorization, which would take effect at the end of November after they get a little bit more data out. And they're saying that if all that holds and everything looks fine, they would be able to produce 50 million vaccine doses globally in 2020, and then 1.3 billion doses in 2021.

Vaccine Rollout

So good news, that being said, it's still gonna be a little time before the vaccines really roll out. It's gonna just take time to make them.

I think my prediction is still gonna hold roughly accurate that it's probably going to be spring, summer before the vaccines are really widely available to lots of people. Maybe by January or late December, we'll have it available for some people in certain high risk categories. But I think it's really gonna be another six months or so before it's widely available.

Now, there are also a couple others that are still in the pipeline if you go and look at the New York Times COVID vaccine tracker, which is what I use, cause it's pretty comprehensive. You can see that there's a number of them, about 11, in phase three trials right now. So hopefully we'll get more than one COVID vaccine. That way we can have a better supply chain and some redundant supplies in case there's a problem there. And so we can roll out more of the vaccine faster.

Again, I'm really waiting for all the data to show up so we can see both the true efficacy numbers. You know, I mean, I want to trust what Pfizer is saying, but also, we need to verify what their data actually shows. So I'm waiting for them to release their data both on the efficacy side and on the adverse events side.

Vaccine Availability for Older Population

So we will see on that. Let's answer a question. Kristen says, "I know you said springtime before it's available to most people, what about older people?" And Julia has a similar question, hi Kathy. "Will the elderly be considered for the first round in the US and or other high risk populations?"

Yes, I think so I think it's gonna probably be spring summer for sort of the general population, my guess. And what's been stated in most of the states' rollout plans like Maryland, Virginia, some of the others, is that they plan to offer the vaccine to the highest risk groups first.

So that's actually gonna be healthcare workers and mostly healthcare workers who are working in a sort of hospital environments, probably followed by healthcare workers in less intensive environments, outpatient places, things like that. And then probably simultaneously with that, they will offer it to patients in nursing homes or other community living settings, assisted living facilities, things like that, rehab facilities.

And then they'll probably start rolling it out to people in order of risk profiles. So again, healthcare workers, people in community living settings first, and then it's gonna go, so the elderly general population and then probably work its way down people with high risk conditions and then younger and younger as we go down the line there.

That's my expectation. And that's consistent with some of the vaccine rollout plans that I had seen. That's the way we're expecting it to work here at our practice. We had to apply through the CDC to be able to even potentially be a site to administer the vaccine and the state governments. And the CDC will basically be deciding how many doses we get and to whom we can give them. So it's not really going to be necessarily up to us exactly how that rollout goes.

Vaccine Storage

The other piece of that is that we're going to have to figure out the vaccine storage problem, the Pfizer vaccine, and several of the others that are based on this mRNA platform, they have to be stored at negative 80 degrees Celsius, which is really, really cold and normal freezers can't do that.

We actually are trying to figure out now how to procure some of these special freezers and most practices are gonna have to figure out how to do that. That's another sort of practical issue that we're gonna have to figure out is the supply and availability of the freezers for the, this vaccine, which are special freezers.

Vaccine Immunity

"Do we know how long the immunity will last yet?"

No, unfortunately we don't. And that's going to take probably another year or more for us to figure out as we follow the vaccine trial participants and then sort of the public as the vaccine is released. We'll have to just wait and see, unfortunately.

Some of that's going to depend on how quickly the virus mutates in terms of the region that's targeted by the vaccine, the region of the genetic code that is targeted by the vaccine in terms of the protein that the mRNA produces. So if that region of the DNA doesn't mutate very quickly, then the vaccine might be expected to provide longer lasting immunity, because the virus is not changing, unlike the flu, which the DNA or RNA of the flu changes rapidly from year to year, and that's why the vaccine doesn't last, per se. That's the biggest issue.

Cost of Vaccine?

"As a concierge service, is this an added benefit for members?"

So my understanding from, again, I have just as much info as you guys do about some of this, my understanding both from what I've heard from the President Trump and from probably future President Biden, his administration, say that they're all planning for the vaccine to be free for people.

So it doesn't really matter where you get it, how you get it, it's not gonna cost you anything out of pocket, at least it's not supposed to. So I think that's the plan. So it's not gonna be any different for patients at PartnerMD or wherever else you may be getting the vaccine should be free.

I've heard that both from, from President Trump, President-elect Biden. So hopefully that's going to stay consistent and be the case, and that'll be good for everybody.

And again, you know, unfortunately, or fortunately, it depends on how you look at these things. It doesn't really matter that we're a concierge service. We're sort of in line with everybody else to get access to the vaccine. We will basically get it when the government gives it to us and they let us have it. We're sort of at the mercy of the availability and what the government ends up deciding both at the national and state level in terms of how we can get the vaccine. So that's gonna be a little different probably at all of our practices across multiple states, so a good question from Julie.

COVID Through the Winter

"The vaccine use is so promising. The virus transmission seems so awful right now, US COVID hospitalizations are at a record high. You have a sense of how bad the pandemic might get this winter?"

That was actually the next thing I wanted to talk about. I am very concerned about the way the numbers are going, and I have gotten more concerned over the last several days with the way the numbers are trending, not just with case counts, but with hospitalizations in general and the death numbers have started climbing again, which I think is really concerning for a whole lot of reasons.

I know some areas, particularly Texas, and a couple of other places there hospitals, in Iowa, their hospital systems are pretty much close to being maxed out and overrun. So those places have gone back to more stringent social distancing. I think we're probably gonna see that in more places.

I think it seems like our governor here in Virginia and some other places are gonna find a good middle way to approach it this time around. I think we're going to have to get more stringent with the social distancing piece here in the next few weeks in terms of individual behavior, but leaving more businesses the option to stay open as long as they follow these guidelines so that people can work if possible, but really being a lot more careful in terms of keeping that distance, doing the masking, washing the hands, all that sort of thing.

The numbers are not going in a good direction, and I am concerned about it even in Virginia, which has done better than many states. Our percent positivity has crept up a little. It's not that in and of itself isn't bothersome to me. What's bothersome to me is that the percent positivity has crept up while the number of testing encounters has gone up.

If the test encounters had gone down and not a larger percentage of them were positive, that wouldn't surprise me. That's sort of, you know, if there was a cross in the data like that, but they're both going up together, again, not dramatically here in Virginia, but in other places they are going up together dramatically, again like El Paso, and I think that's really concerning.

Our hospitalization rate here in Virginia just started to tick up over the past couple of days, but the case rates are, I mean, they are just astronomical across the country and continuing to go higher. So I think we're gonna have to figure this out here in the short term for the next few weeks, probably be a little bit more stringent on some of these social distancing things throughout the holiday season.

Hopefully again, we'll get the vaccine rolled out, at least for the highest risk groups here in the next couple of months. It does appear that luckily the case fatality rates and all that stuff, and the population that's most at risk, seems to still be the same as the elderly people with lots of underlying comorbidities.

So I think if we can target those people with the vaccine first, we're going to really make a huge dent in the mortality rate and probably in hospitalizations too. And I think that's the most important.

I am hoping that even if it takes till next summer for the vaccine to be widely available, we're going to get the vaccine at least available to the highest risk people pretty quickly, and that's going to I think take care of 80 to 90% of the mortality rate. This is my hope and my optimism speaking. I hope that's going to take care of 80 to 90% of the mortality from the virus over the next few months.

There will be a lag in the effectiveness of the vaccine. So from what I have seen, it appears that it takes about 28 days for the vaccine to be effective. It's a two-dose regimen. You get one dose at day zero or day one, and then another dose a couple of weeks later and then it takes another two weeks for everything to be totally effective.

It's about a month lag time between when the vaccine is first distributed to when we'll probably see a difference made in the numbers on in terms of mortality, hospitalizations, and all that sort of thing. So, yeah, at this point, I'm really concerned about the way things are going in a lot of places. And I think we're gonna have to take each day as it comes. So it's gonna be touch and go here for the next couple of weeks in a lot of areas, I think.

Communicating Vaccine Plans

"How will PartnerMD practitioners educate patients on this information in a way that will be best understood by demographics and populations?"

I think like everything we try to do here at PartnerMD, it's probably going to be lots of individual conversations between physicians and their nurses and the patients. We'll put out some general information in newsletters on Facebook like we do here, an email, sort of email blanket campaigns with some general info as we get it.

And I think an email will come out with some preliminary stuff about the fact that we've applied to be a vaccine site and all these sorts of things as sort of the preliminary info, but it's probably going to be lots of one-on-one conversations about, A) whether the vaccine is even available for you yet, and B) if it is available for you, whether it makes sense for you to get it or not. 

Preventive Care as Cases Spike? 

"Have your recommendations for preventative care like dental cleanings, vision screenings, annual checkups change in light of the current spike?"

No, not yet, and we are continuing to do preventative care here, and I think as long as the health care provider that you're going to, whether it's the dentist, the GI doctor, whatever it is, as long as they are following good screening protocols, wearing the mask, checking the temperatures, asking for symptoms in many areas, wearing the face shields in areas where the community transmission is high, I think you are okay to continue to do that for someone who is at a, what I consider a reasonable risk level.

If you're someone who is 85 years old and you're dealing with active cancer diagnosis, something like that, I think probably it's going to in the next couple of weeks, we're probably going to need to rethink about whether those extremely high risk people should come out for those sorts of things.

But I think for now, as long as the place you're going is doing a good job of those screening and other protocols, I think you're okay to keep doing annual screenings. And I say that because I know that back in the spring, during the lockdown period, we saw a huge dives in cancer screening, vaccines, preventative care. And I think that's gonna have a really negative impact on people in the next 12 to 18 months, as we discover things that got missed, because people didn't come out and do those things. So I think for now, I think people should continue to do their preventative care.

Temperature Requirements for Vaccine Storage

"How confident are you that the temperature requirements for the vaccines can be maintained? What happens in the event of a temperature excursion?"

The good news first is that it seems to be that the vaccine, once you thaw it out, it lasts for a couple of days. So it's not that it has to stay at minus 80 for every single second, but it would be good for a couple of days after you thaw it out, so that's good news. That's going to make some things a little bit simpler.

I'm not sure how to answer how confident I am about the temperature requirement issue. I think it's really going to depend on whether the medical supply companies can procure and deliver enough of these minus 80 freezers everywhere for us to be able to administer the vaccine. I think that's going to come down to a supply chain question. I mean, assuming that is fine, I think that we probably will be okay in terms of being able to maintain the temperatures, but it's really going to hinge on the minus 80 freezer supply chain problem.

So that's why we've gone ahead, and we're in the process of ordering those now so that we have access to them because we're worried that the supply chain will get tight in the coming weeks. As people start to realize they're gonna need these freezers for the vaccines.

Surgical Masks vs. Cloth Masks

"I got an email from your office stating that surgical masks work better than fabric masks, how did you get this info? Is this the best practice everywhere? And should we always use surgical masks?"

I'll actually post the link, let me find the link a few minutes here. The Annals of Internal Medicine has been doing a rapid review and updating it on what's called a living rapid review on mask data that's coming out.

And so I, and others, have been following that pretty closely to look at mask information and the long and short of it is this: There's not a head-to-head trial or a clear piece of scientific evidence saying surgical masks work better than cloth masks. The problem is that that data is still really shaky. The data we do have that's out there really doesn't seem to show that the cloth masks or the community masks are really very effective.

And so the conclusion we can draw from that is to say, okay, if the cloth masks are not super effective, what we need to do is go back to something that we know is effective in the healthcare environment, which is the surgical type masks. We know that's been effective before. We know those are effective in the operating room, and so the cloth masks were always introduced as a second line option. It was always, these are better than nothing, right? And I think that's still true.

I think the cloth masks are probably still better than nothing, but they were never really intended or designed to be superior or equal to the actual medical type surgical masks. And I think there's a couple of things going on there.

First of all, I think the surgical masks are just designed differently and they're more designed to prevent transmission. And that's the whole reason they were invented in first place. To keep doctors and operating room surgeons from transmitting things to the vulnerable patients on the operating room table.

Second of all, the surgical masks get thrown away after one or two uses or something like that, and so they don't collect the level of grime and dirt and other things and germs that the cloth masks do cause people really don't wash them or replace them as often as they should.

I think that's a lot of it. Because what happens is you got a dirty cloth mask that you've worn for several days. You touch it, you touch your face, and then the whole efficacy of the mask is destroyed versus the surgical type masks where you know it's gonna get thrown away after a day or two, because it's not designed to last longer than that. I think those are the issues there. That's how we came to that conclusion.

We're going back to what we knew was always probably better, which is the surgical masks, because they were always designed to be better than simple cloth mask. So it's a couple of steps of inference based on the data that is out there.

I personally think it's probably a best practice to wear surgical masks, especially in very high risk environment like healthcare facilities, including doctors offices, which is why we, in our practice, we're just switching back to surgical masks for all staff and for patients. We want to provide the best protection that we can now that the supply chains are good and we can get access to more of these surgical masks, both as a medical facility and the public.

We should, I think, move back to, if we're gonna wear masks, I think we should wear the appropriate masks, which would be something that's actually designed to prevent disease transmission, and not the sort of cloth masks that we were using, but sort of as a stop gap. I think we should move back to something that's higher quality if we can and that's why we made that decision.

Preventive Care for Enhanced Risk People? 

"On preventative care, what about enhanced, but not high risk people, for example, 55 year old with high blood pressure asthma?"

Yeah, I think that category, it's going to be somebody who you're going to have to make your personal risk benefit decision. I think, for most people, getting the preventative care done is still gonna be in your best interest. Again, assuming that both you and the healthcare facility you're going through are following all of the protocols that we've talked about here.

I think for most people in those situations, sort of medium risk, I think the benefit of getting the preventative care done is going to outweigh your risk of getting the virus in most places. Now, if you're in an area where community transmission is very high, such as like, again, going back to El Paso, I think the calculus is a little bit different in a place like that. But for the places where most of our practices are - Virginia, Maryland, South Carolina, Georgia - I think for most people, even in the medium risk category, it's probably a good idea to keep doing your general preventative care.

How to Know Which Surgical Masks to Buy

"I see many masks that look like a surgical mask on Amazon. How do I know which ones are best to purchase?"

Yeah, we've heard that question a few times. I think any of them that are designed to be that single use or maybe one day use are okay to buy from Amazon as long as they are that style of mask. I think they're good, they're fine to use.

Transmission Risk from Children

"Early on, there was a thought that children may not be as contagious or may not be passing the virus on to adults. Do you have, any more info on that? I'm thinking of how safe it is for my kids for going to school, to see their grandparents."

Yeah, I think we do have a lot of data on this. There was an article not too long ago. I think in The Atlantic actually, there's been quite a lot of data followed on schools as a source of outbreaks and transmission, and by and large, other than some isolated cases, schools are not actually being a source of outbreaks and transmission, which is great news for a lot of reasons.

I think that, in general, I would not be too worried about it. Assuming your children are of average risk and all that general sort of caveats, but, and then we've seen that in Chesterfield and in my local area, we've had a school or two have a few cases, but there have not been major outbreaks linked to schools either amongst the children or amongst the staff.

So that's really good news, and actually I'll link the article here. There's an article from the Atlantic, schools aren't super spreaders. You guys can review that when you have a chance. I think that's really good news.

I hope that data continues to trend in that direction. My kids are back in school two days a week. Both of my children are at this point. And I think a hybrid schedule is really probably as far as we need to push things at this point. 

I do not agree that all children should be back in school five days a week at prior capacities. We do need to keep it limited and for less time for social distancing reasons. So I think that that is still very reasonable. I think a hybrid approach is probably as far as we need to push things for now and let things settle and see how the next few weeks ago. And I think that that's the better part of wisdom at this point. 

Interactions Between Grandparents and Grandchildren

"Is it okay for grandparents and grandchildren to interact when it's among different States?"

You mean like, if they live in different states? I think that's going to depend on a lot of factors, probably the risk level of the grandparents, the comfort level of the grandparents. I think is probably what I would use to determine those things.

If the grandparents are comfortable and you all feel well, I think that it is okay to do that, but again, I think that's an individual family choice at this point, same thing as with holidays coming up, I think we need to be reasonable.

Don't get together with 50 people for Thanksgiving or Christmas, And let each family decide what makes the most sense in terms of risk level for especially the older family members and those with medical problems.

I think each family is really gonna have to unfortunately figure that out to a certain degree on their own with the knowledge that the older you are and the sicker you are, the higher your risk. And everybody's gonna have a little bit of a different threshold of where they're gonna draw that line. So I think, take a look at what the risk of the lives of the grandparents in your case, and then decide based on that. Alrighty, thank you guys so much. Y'all have a great week. And again, we're gonna take a little break next week, but then we will be back the following week, probably with lots more updates, hopefully more vaccine data and some good news on that front. And otherwise everybody stay safe out there and hang in, hang in there one day at a time. We're gonna get through it one day at a time. Have a good day. Bye.