December 14, 2020

Make Up Your Own Mind About The Vaccine

15 minutes

Where I'm coming from (compared to most of my colleagues):

Master's in Public Health with a concentration in Health Policy from Yale Medical School.

FT Faculty at GWU School of Medicine & Southern Connecticut State University MPH Program, and long-time adjunct faculty at NYMC MPH program in Health Policy.

Assistant Commissioner of Health at the NYC Department of Health & Mental Hygiene during the first SARS outbreak.

Served as State EMS Director, Consultant to Public Health Canada, Connecticut Department of Public Health, Local Health Departments.

(So in other words, I'm not a vaccine expert, but I'm pretty well versed in this stuff)

Flu vaccine is bad example, most vaccines are ~80% effective

One dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps. MMR is an attenuated (weakened) live virus vaccine.

The Hepatitis B vaccine is 80% to 100% effective in preventing infection or clinical hepatitis in those who receive the complete vaccine series.

TDAP vaccines is 80-90% effective after fifth dose, but this decreases to 30-40% after four years.

Flu efficacy in the US, by year:

2004

10%

2005

21%

2006

52%

2007

37%

2008

41%

2009

56%

2010

60%

2011

47%

2012

49%

2013

52%

2014

19%

2015

48%

2016

40%

2017

38%

2018

29%

2019

45% est

https://en.wikipedia.org/wiki/Influenza_vaccine#:~:text=A%202012%20meta%2Danalysis%20found,24%20months%20(66%20percent).

https://www.cdc.gov/vaccines/vpd/mmr/public/index.html#:~:text=One%20dose%20of%20MMR%20vaccine%20is%2093%25%20effective%20against%20measles,(weakened)%20live%20virus%20vaccine.

https://www.cdc.gov/vaccines/pubs/pinkbook/hepb.html#:~:text=The%20vaccine%20is%2080%25%20to,receive%20the%20complete%20vaccine%20series.

https://www.cdc.gov/pertussis/about/faqs.html#:~:text=CDC%20estimates%20that%20in%20the,4%20years%20after%20getting%20Tdap.

Time to Develop Vaccine?

Fastest time to develop vaccine: four years https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html

Average time to develop vaccine: 10 years https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31252-6/fulltext

Historical Vaccine Problems?

Cutter Incident (1955): Active polio administered to 200,000, with 200 cases of polio, and 10 deaths. This was a live vaccine, compared to the Pfizer and Moderna COVID vaccines that are Messenger RNA (mRNA) which is just a set of instructions that tells your body to make the protein that resembles part of the Coronavirus...(but not a Recombinant DNA vaccine like I said.)

https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/

https://www.cnbc.com/2020/12/08/pfizer-moderna-covid-vaccine-side-effects-trials.html

COVID vaccine

Does it work? Yes, it appears to work pretty well. But no way is it going to be 95% effective in the real world....

What does 95% efficacy mean? Eight out of 18,198 vaccinated with two doses of vaccine got symptoms and a positive COVID test from seven days after their second vaccination through November 14th, 2020. One hundred and sixty-two out of 18,325 vaccinated with placebo got symptoms and a positive COVID test from seven days after their second vaccination through November 14th, 2020.

What we don't know:

How many of the people in the study were exposed to the COVID virus?

If people who got the vaccine can be asymptomatic spreaders?

What we do know:

You need two shots, and you're going to be sick after your second shot...."The most common solicited adverse reactions were injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%), fever (14.2%); severe adverse reactions occurred in 0.0% to 4.6% of participants, were more frequent after Dose 2 than after Dose 1, and were generally less frequent in participants ≥55 years of age (≤ 2.8%) as compared to younger participants (≤4.6%).” https://www.fda.gov/media/144245/download

2020 Flu vaccine will probably be even less effective because there was not much flu in Australia to base the vaccine on. But get the flu vaccine anyway this year, because you don't want to get the flu and COVID at the same time....https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm#Flu-Vaccine

Emergency Authorization isn't the same as regular approval....they are going to continue to gather data. https://www.fda.gov/vaccines-blood-biologics/vaccines/emergency-use-authorization-vaccines-explained

What's the priority for EMS clinicians?

CDC COVID-19 vaccination program interim playbook

Jurisdictional considerations for Phase 1 subset groups may include, for example:

-Phase 1-A: Paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials

-Phase 1-B: People who play a key role in keeping essential functions of society running and cannot socially distance in the workplace (e.g., emergency and law enforcement personnel not included in Phase 1-A, food packaging and distribution workers, teachers/school staff, childcare providers), adults with high-risk medical conditions who possess risk factors for severe COVID-19 illness, and people 65 years of age or older (including those living in LTCFs)

There may be insufficient COVID-19 vaccine supply initially to vaccinate all those who fall into the Phase 1-A subset, so jurisdictions should plan for additional subsets within that group (see CISA guidance for categories of healthcare personnel).

https://www.cdc.gov/vaccines/imz-managers/downloads/COVID-19-Vaccination-Program-Interim_Playbook.pdf

CISA guidance on essential critical infrastructure workers (explicitly listed in both categories)

Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response

Health/Public Health

-Healthcare providers including, but not limited to, physicians (MD/DO/DPM); dentists; psychologists; mid- level practitioners; nurses; emergency medical services personnel, assistants and aids; infection control and quality assurance personnel; phlebotomists; pharmacists; physical, respiratory, speech and occupational therapists and assistants; social workers; optometrists; speech pathologists; chiropractors; diagnostic and therapeutic technicians; and radiology technologists.

-Workers required for effective clinical, command, infrastructure, support service, administrative, security, and intelligence operations across the direct patient care and full healthcare and public health spectrum. Personnel examples may include, but are not limited, to accounting, administrative, admitting and discharge, engineering, accrediting, certification, licensing, credentialing, epidemiological, source plasma and blood donation, food service, environmental services, housekeeping, medical records, information technology and operational technology, nutritionists, sanitarians, etc.

--Emergency medical services workers including clinical interns.

--Prehospital workers included but not limited to urgent care workers.

Law Enforcement/Public Safety/Other First Responders

-Public, private, and voluntary personnel (front-line and management, civilian and sworn) in emergency management, law enforcement, fire and rescue services, emergency medical services (EMS), and security, public and private hazardous material responders, air medical service providers (pilots and supporting technicians), corrections, and search and rescue personnel.

https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce

American College of Emergency Physicians supports EMS Clinicians being included in Category 1A

https://www.acep.org/corona/COVID-19-alert/covid-19-articles/acep-statement-on-ems-professionals-priority-access-to-the-covid-19-vaccine/

American Paramedic Association and the National EMS Managers Association supports EMS Clinicians receiving a COVID-19 vaccination "as soon as possible."

https://www.nemsma.org/resource/resmgr/covid-19/covid-19_vaccination_conside.pdf

EMS included in Category 1A from AIPC and CDC, states may vary.

New York: "ICU, EMS, ED top priority" (other first responders were Phase 2)

https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/NYS_COVID_Vaccination_Program_Book_10.16.20_FINAL.pdf

New Jersey: "Who are "healthcare personnel" in Phase lA? Healthcare personnel are paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials. This includes any type of worker within a healthcare setting. Examples include, but are not limited to...personnel with variable venues like EMS, paramedics, funeral staff, and autopsy workers."

http://nj.gov/health/legal/covid19/12-10-20_PopulationPrioritizationPOD_memo.pdf

What should we do:

Taking the vaccine is your individual choice based on your own circumstances

Even if you don't want the vaccine, or want to wait, you should support EMS clinicians, both public, non-profit, and private, being in Category 1A

Even if vaccine is offered, we still need:

Adequate respiratory PPE (half face respirator c P100)

Face Shields, Goggles, Gloves, and Gowns

Negative pressure ambulances

Equipment and Supplies for Cleaning

High-level decontamination with UV or Hydrogen Peroxide

...more

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By JEMS

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