• Karen McPhail, RN, MSN

Covid Vaccine Update

Updated: Dec 31, 2020


It seems inconceivable, but the number of patients currently hospitalized across the US with Covid-19 is at its highest point sparking further concern for health care providers who may be forced in some areas to make difficult ethical decisions relating to the rationing of staff, critical equipment, and other aspects of care. As a result, everyone needs to be mindful and prudent as we move into the new year in following precautionary guidelines per the CDC - to stay at home if able, mask when needing to be out and about, avoid social gatherings, and continue to social distance. If we all do our part we can gain control over this situation and be able to move forward safety and happily.


Each day patients reach out to us with questions and of course concerns relating to Covid-19. The most recent questions are regarding vaccine specifics and distribution plans. Based on a variety of current sources, we will do our best to provide an overview of these aspects to provide guidance along the way.


The most recent figures show approximately 7.5 million doses of the Pfizer-BioNTech vaccine and 8 million doses of the Moderna vaccine have been made available for use in US. This supply will only cover around 5 percent of the US, meaning it is basically enough for about 3/4 of the medical workers and long term care , nursing home residents and staff, according to recent reports.


According to the US Centers for Disease Control and Prevention around 2.1 million vaccine doses have been administered so far in the US and more than 11.4 million doses have been distributed as of Monday.


According to Assistant Secretary for Health at the US Department of Health and Human Services Admiral Brett Giroi, another 4.7 million doses will be distributed by the end of the week.which would bring the total to approximately 15.5 million doses available for state use.


Both vaccines require a follow-up shot at approximately three - four weeks after the initial dose, so 2 doses per individual need to be ear marked for use. The Pfizer shot requires a second dose 21 days later and the Moderna shot requires a second dose 28 days later. Currently, those second doses have been held back by the federal government, so they will be available and administered when they are needed to provide those second doses.


Following the CDC guidelines, many states are prioritizing health-care workers and long term care, nursing home residents and staff members for obvious reasons. States are permitted to of course set their own vaccination guidelines and priorities however with some states placing an additional emphasis on the early vaccination of first responders, prison staff members, those deemed as essential workers, and individuals who received placebos as a part of vaccination trials. Once there are enough vaccines, the latest CDC guidelines recommend adding frontline essential workers (first responders, teachers, day-care staff, grocery store workers and prison guards), and then adults 75 and over as the next priority groups. After these groups, the CDC recommends everyone with a preexisting condition such as diabetes, heart problems or obesity, and older adults. These are provisional priority groups based on federal study groups.


Below reflects the state of Virginia priority groups as described so far. Please check your local state information online for more specific information.


Virginia


  • At least 19,943 doses administered

  • 3.23M people prioritized so far

  • 8.54M total

  • 190k first doses shipping

  • 390k by end of year

  • Virginia is expected to get about 190,000 doses in the first set of Pfizer vaccines, and a total of 390,000 of the Pfizer and Moderna doses before the end of the year. That is enough to vaccinate 4.5 percent of the state population.


The state of Virginia has approximately 390,000 health-care workers and 97,000 nursing home residents and workers, and the number of doses expected in December is enough to give 79 percent of them a single dose by the end of the year. The vaccine requires a follow-up booster around four weeks after the initial shot.

  • 390k Health care workers

  • 97k Nursing home residents

  • 340k Top priority essential workers

  • 51k First responders

  • 730k 2+ comorbidities

  • 1.6M One comorbidity

Virginia’s health department is first offering the vaccine to health-care personnel and long-term care facility residents and staff members.


Within health-care personnel, the state has provided subcategories of prioritization, and high-risk health-care personnel, including those who directly engage in the care of covid-19 patients or have direct exposure to potentially infectious materials, will be first.


The second phase will offer the vaccine to non-health-care essential workers and the third phase will offer it to high-risk adults. Virginia has yet to provide more specific details as to who is included in these two groups phase groups.


Over the last week, Virginia has seen an average of 3,612 confirmed cases and 30 deaths per day.


Virginia has the 28th most confirmed cases per capita among states and D.C. during the same period.


Virginia Vaccination Allocation Prioritization plan link below:


Currently in Phase 1A. Phase 1C which there is no timeline set for as of yet is high risk individuals. Many experts in the field project this for perhaps the summer of 2021, but this may change and be sooner or later based on vaccine availability / distribution aspects. There is still a great deal of uncertainty in terms of when the general public sector will receive the vaccine series.


https://www.vdh.virginia.gov/content/uploads/sites/6/2020/12/Revised-Vaccine-Allocation-Prioritization-12.4.2020.pdf


Since there is limited supply of vaccines you will be told at the time of receiving the first vaccine (in the series of 2), whether you are receiving the Moderna or the Pfizer.


Virginia Prioritization resolution link:

https://www.vdh.virginia.gov/content/uploads/sites/6/2020/12/VDMAC-Prioritization-Resolution-12-4-20-Amended.pdf


The big question: How effective are the vaccines overall and any concerns?


Both vaccines have shown essentially equivalent degrees of efficacy, at least in the early stages after vaccination. Long term outcomes clearly still remain to be seen overtime. 


Please note that the chances of most individuals being able to choose one vaccine over the other are not realistic especially in the initial rollout. The vaccine available is the one that you will receive.


The Moderna vaccine was shown to be 94.5% effective in preventing COVID-19 among those who were tracked for a median of seven weeks after their second dose.


Five of the 13,934 study participants who received the vaccine developed COVID-19, compared with 90 of the 13,883 participants who received the placebo.


The Pfizer vaccine was 95% effective in preventing COVID-19 among those who were tracked for a median of two months after getting their second dose.


Eight of the 18,198 study participants who received the vaccine developed COVID-19, compared with 162 of the 18,325 participants who got the placebo.


Did the vaccines prevent severe cases of COVID-19 from developing?


The Moderna vaccine was 100% effective at preventing cases of severe COVID-19.


Eleven people in the trial developed severe disease, and all of them were in the group that received the placebo. Three of those patients were sick enough to be admitted to a hospital.


The Pfizer vaccine was 66.4% effective at preventing cases of severe COVID-19. Of the four study participants who developed severe illnesses after receiving two shots, one had gotten the vaccine and three got the placebo. Two of those in the placebo group were hospitalized, including one who was admitted to an intensive care unit.


Were the vaccines shown to be effective in older adults?


The simple answer is yes! In its Phase 3 trial, the Moderna vaccine was 100% effective in people ages 65 and up. It was also 93.4% effective in people between the ages of 18 and 64.


In its Phase 3 trial, the Pfizer vaccine was 93.7% effective in people ages 56 and up. It was also 95.6% effective in people between the ages of 16 and 55.


How well did the vaccines work in people with higher risk groups and those with preexisting medical conditions?


Both vaccines performed slightly better among people who had preexisting conditions that make them more vulnerable to COVID-19 than in people without them.


The Moderna vaccine was 95.9% effective in people with a select group of health issues — chronic lung disease, significant cardiac disease, diabetes, liver disease, HIV and severe obesity. For people without these conditions, it was 94% effective.


The Pfizer vaccine was 95.3% effective in people with a wider range of health issues and 94.7% effective in people without them. In addition to the health problems considered in the Moderna trial, the Pfizer trial also examined the vaccine’s performance in people with cancer, kidney disease, dementia and vascular disease, among other ailments.


Did the vaccines show any differences in effectiveness in specific racial groups?


All five of the people in the Moderna trial who developed COVID-19 after receiving the vaccine were caucasian.


The Moderna vaccine was 100% effective in Black, Asian, and Latino Americans, as well as in people with mixed racial backgrounds.


Vaccine efficacy could not be determined for Native Americans or Pacific Islanders because there were no cases of COVID-19 in either the vaccine or the placebo groups.


In its Phase 3 trial, the Pfizer vaccine was 100% effective for Black study participants and 94.5% effective for Latino participants, slightly below the 94.7% effectiveness for white subjects. In addition, it was 74.4% effective in Asian Americans, and 100% effective in Native Americans and Pacific Islanders. Among people described as multiracial, it was only 10.4% effective, with one case of COVID-19 among those who got the vaccine and one case among those who got the placebo.


Was there any difference in vaccine effectiveness in men and women?


Both vaccines performed slightly better in men than in women.


The Moderna vaccine was 95.5% effective in men and 93.5% effective in women.

The Pfizer vaccine was 95.3% effective in men and 93.9% effective in women.



What are the potential side effects?


The most common side effects for both vaccines were fatigue, headache, muscle pain, chills and joint pain. These were reported more often in the Moderna trial than the Pfizer trial.


Short-term pain at the injection site was extremely common for both vaccines. Roughly 90% of those who got the Moderna vaccine reported such pain after their two doses, as did roughly 80% of those who got the Pfizer vaccine.


It has been almost year and we are still here to help and guide you through this public health emergency. Please reach out at any time via our contacts area on our home page.


Sources:

CDC

VDH

CNN

Mayo

NIH

Washington Post

Stat news

LA Times



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