Q&A - #8: When can I get the COVID vaccine? (and similar questions)

Since my last post, one vaccine has been approved for use during the pandemic and another is likely to be approved within the week. This is great news and makes me hopeful for a more normal Christmas season next year.

The question we keep getting asked, is 1) Will you get the vaccine? 2) Will your office give out the vaccine? and 3) When can I get the vaccine?

-1) Yes I will get the vaccine, as will my family. Because of my job I’ll end up getting it before them (see below)

-2) Yes I think we will give out the vaccine. I’m not entirely sure how the roll out will be handled once there is enough to start giving out to the general public. I have applied for the ability to do so (for my own patients), but they could certainly decide that it makes more sense for small practices like mine to refer our patients to a more centralized location for efficiency sake.

-3) This is a longer answer.

Here are Michigan’s phases of vaccine rollout.

Phase 1A is to health care workers and nursing home residents. Just like when the stewardess tells you to put your own oxygen mask on first before helping others, we have to protect the frontline healthcare workers. Because this is the first phase, it will be the one with the least amount of vaccine to go around and so it is broken down even further into more specific priorities. For example, I’m one of the last to be vaccinated due to my comparatively low risk, outpatient office job, compared to my colleagues that work directly with COVID in the hospital who will be some of the first.

Phase 1B is to essential workers. It appears that teachers and critical infrastructure workers will be first in line here, the people that keep society running and can't do it from home.

Phase 1C would be those with high risk conditions(diabetes, obesity, etc), high risk environments (jail, homeless shelters, etc) and older adults (over 65).

Phase 2 is everyone else, over age 16.

Keep in mind these phases are not completely distinct - that is to say that 1A probably won't be completely finished when 1B starts, there will be overlap. The point here is that those at highest risk will be prioritized to get the vaccine first.

No one really knows for sure, and it depends on how many vaccines become available in the next couple months (and how many manufacturers are producing them), but based on what I’m reading, I would think phase 2 will happen in April at the earliest, potentially May.

Another question I get: Will I be forced to get the vaccine?

No, I think not. I’ve seen absolutely nothing indicating that anyone in any level of government is advocating mandating the vaccine. Even my own hospital system is not mandating it, but simply strongly encouraging it. I would encourage you to get it, when you are able to. I think its a good thing.

References:

https://www.michigan.gov/documents/coronavirus/MI_COVID-19_Vaccination_Prioritization_Guidance_710349_7.pdf

Reopening

As Michigan and the rest of the country ease the restrictions that we’ve placed during the worst of the pandemic, how do we as individuals and families safely and responsibly engage with society? I want to briefly outline some common sense, practical things to keep in mind:

1. Be ok with a change in plans.

It’s going to happen. And if you don’t flow with it someone could get sick. Our pre-COVID19 culture taught us never to miss work for a mild cough. We can’t tolerate that right now. It’s not an easy shift to make. It means telling grandma we can’t come visit because Johnny has a fever. It means postponing a birthday party because you have a new cough.

2. If you are traveling, be aware of the situation in the area.  

Within Michigan, this website can give you an idea of how the various regions in the state are doing controlling the pandemic, and how significant the restrictions are or aren’t.   If you are planning travel out of the state, this organization grades states on how they are doing with COVID cases, testing and hospital capacity, contact tracing and then collates it all into a color coded map.  This doesn’t necessarily tell you whether you should go there or not, but it will give you an idea of how another state is doing compared to us/others. A quick google search for the states health department will likely inform you of any restrictions. Some parts of the country are doing pretty well (MI for example) and others seem to be turning for the worse.

3. Remember what risk is.

Risk does not mean certainty, it’s a probability. Risk applies better to large groups of people, to populations. It’s hard to apply risk to one person or family. We all take risks every day. When we get in our car and drive to work, there is risk. Over the next year, there is a 1 in 106 chance that you will die in a car accident. That doesn’t mean we don’t drive cars anymore. It does mean that we recognize that there is a chance that things could go very wrong, and we do what we can to mitigate that risk - we wear seat belts, we stay sober, we don’t text while driving, we tell our kids to be quiet in the back so they don’t distract us.

4. Keep in mind that some settings/events are significantly riskier than others.

Higher risk: indoor events, large groups, being around others without masks

Lower risk: outdoor events, small groups, being around those wearing masks

5. Keep in mind the personal risk factors.

 These are things that should make you think twice about visiting certain people. Note what I said there – “think twice” - not a hard “don’t go”.   These are people who are more likely to die or have a harder time if they should catch COVID-19, and you should have a candid discussion with them about how much risk everyone is comfortable taking.  People you should think twice about are those:

• over age 50 but especially over 60,

• those with chronic lung diseases Such as asthma or COPD

• those with diabetes

• those with chronic liver or kidney disease requiring dialysis

• those with immune systems that are somehow compromised

• those with severe heart  Conditions

• those who are severely obese

6. Look out for others.

Keep in mind the things that you and your family do may put others at risk when you are around them. The family with children having  sleepovers every night with a different friend is placing Grandma at much higher risk than the family that has been fairly isolated in the past 2 weeks. Going out with any symptoms immediately increases the risk for those around you. When asymptomatic (without symptoms), wearing a mask is annoying, but definitely decreases the risk of you spreading COVID-19 to someone else before you know

7. Testing is wide open

Michigan has made it a goal to test 30,000 people every day, about double what we are currently doing. Testing sites are all over the place, and are free most of the time. Anyone with symptoms can get tested, anyone who has been exposed can get tested and a large number of people without symptoms can get tested if they meet certain criteria, such as leaving the house to go to work.

Sorry this went on so long. I hope it’s helpful as you think about the upcoming summer.

Business as usual

In case you’re just joining us, business as usual is out the window for a while. Unfortunately the best scenario here, is one that, by slowing spread/transmission of COVID-19, helps to avoid massively overwhelming our hospital system. This will also inevitably increase the duration of this outbreak.

This post is not about estimating the time frame. I suspect the best answer to that question right now is “longer than you think”.

No, I set out to write this post to encourage you during this time. None of us has lived through anything like this before, something so potentially life changing that it drove me to blogging. And no one really knows how to do it, how to get through it. Some are very scared right now. No one quite feels ready. This has led some to do silly and damaging things like hoard food and household supplies. It’s led others to take unprecedented steps toward new models of business and education.

Keep in mind:

• There is good evidence to suggest that symptoms of COVID-19 are must more likely to be present as we age, and that under 30 the infection may be present without any symptoms at all. This means that these stay at home recommendations apply to everyone, not just those with obvious symptoms.

• Minimize your own risk. As much as is in your power, that your job and household needs allow, stay home. I know you keep hearing this. If you have to go out, keep physically isolated and wash well when you get back home. By the way, going to the store to buy food for the next day only is not worth the risk, you can’t be heading to the store every day. I’m looking at you, baby boomers buying only 5 items at Meijer.

• Minimize the risk of others. Consider checking with your neighbors and family before you go out to see if you can turn three trips into one.

View fullsize

Social Distancing

I’m not a fan of buzzwords, but it is what it is. Social Distancing is a concept shy of full quarantine, meant to keep us from large groups of people where viruses spread like crazy. It means canceling large group meetings like church, sporting events, parties and certain types of vacations (e.g. cruises) and its not popular at all. A lot of the time it means someone is going to lose money and that’s never popular. No one wants to be the one to say “we’re going to cancel”, but we need more to say this.

If you are a civic leader, a business leader, a community leader, if you are in charge of your rotary club, your neighborhood watch, your PTA, this is the time to step up and cancel or postpone your next meeting, or move it online. If you’re not the leader, its time to start talking to them about this.

Why do this now? Maybe you think this is all overblown, or its too early to be worried yet. That’s the problem with exponential growth. By the time the problem is obvious, its already way too late.

This graph is from a well written article by Tomas Pueyo with lots of helpful graphs if you are a graph person. It showing the effects of implementing social distancing and the large effect even one day can make. The black line is business as usual. The red line is starting social distancing on day 21 of the outbreak and the green line is starting just one day earlier. The effect is profound, a 40% reduction in the number of cases. Another model I saw this week showed that just a 25% reduction in social contact would result in a 50% reduction of cases. Don’t like models? Want real world data? John Burn-Murdoch has taken data from Johns Hopkins and graphed out the case loads of the various countries battling COVID-19 with fairly predictable results. The only countries that have fairly flat curves are those with very strict quarantine rules. Everyone else is following the course that Italy is taking (we’re about 2 weeks behind them)

The point of all this data? Social distancing/quarantining can work, but it needs to be done now or it will soon be too late. Even a day can make a difference.

So there it is, I posted twice in 2 days. Given my loathing of most social media, that in an of itself should tell you something. Forgive me if I have grammar mistakes. If you need a reference for something I mentioned let me know and I’ll add it. I couldn’t find one of the graphs I mentioned, so I’ll keep looking.