Coronavirus

Art Vandelay

that's a shame
How could they possibly know that?
Exactly. I though it was very irresponsible, maybe just naïve, to proclaim that WDW is safe. Yes, WDW is taking a lot of precautions, but these precautions lessen chances of virus spread, they do not prevent the spread.
 

Nia

Well-known member
So, do we think that the pfizer vaccination is what will bring us closer to normality at some point next year?
 

George

wishes he had a pink frolicing llama under his tag
So, do we think that the pfizer vaccination is what will bring us closer to normality at some point next year?
Looks like it's going really well. Greg (infectious disease specialist) echoed 60 Minutes' reporting that it's not unreasonable to think that most Americans will have both vaccines (it's a two-step process, 28 days apart) by early summer. That sounds overly ambitious to me, but I'm hoping!
 

DopeyRunr

the jeweled acrobats only perform amazing stunts f
I can't imagine the logistics in remote parts of the US, let alone third-world countries, behind the distribution given the vaccine candidate's ultra-cold storage requirement (-112 F).
 

George

wishes he had a pink frolicing llama under his tag
I can't imagine the logistics in remote parts of the US, let alone third-world countries, behind the distribution given the vaccine candidate's ultra-cold storage requirement (-112 F).
Right, as there will inevitably be those who can't get to a vaccination site. But "most Americans" will.
 

bnoble

he's right
behind the distribution given the vaccine candidate's ultra-cold storage requirement (-112 F).
My PCP told me that hospitals in our area were told to increase their cold storage capacity a bit ago...so they are planning at least in the US, as George suggests.
 

geek1997

Member
It's positive news but they don't have evidence yet that it actually prevents infection, just that it appears to be minimize severity of symptoms. Which means getting community spread under control is still a priority.
 

Anne

Well-known member
My initial response to the news was skepticism because of the temp issues, potential production issues, limited data released so far, no peer review yet, and Pfizer's CEO is known for being more theatrical than a typical pharmaceutical head. But the experts appear uniformly optomistic and that is meaningful.

The main positive is that it looks like it's possible to get strong protection with a vaccine (much better than our flu vaccines). We didn't know for sure that was possible, we historically have had plenty of failed vaccines to other pathogens. It bodes really well for the other vaccine candidates. So even if Pfizer has production and distribution challenges, there will likely be more than one choice.

Our state health department is controlling vaccine distribution. Individual providers and institutions have to apply to become designated sites. Part of that application involves facility requirements and safe, reliable handling and storage (work flows we already have in place for other vaccines, but may need some adjustment). Here in the US the Pfizer vaccine is likely do-able from our hospitals, but a non-starter in some countries. Pfizer likely doesn't have production capacity for world-wide distribution anyway. At least not yet. They have 21 million doses now, anticipate being at 50 million by year-end. With a 2 dose series that's 25 million people world-wide to start.

One of my pediatric colleagues is on the vaccine review committee for our institution. Pfizer is not their first choice because of temperature requirements. So short of it being substantially better efficacy, or significantly earlier to market, it won't be our primary option.
 
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Anne

Well-known member
While it's nice to see a vaccine light-at-the-end-of-the-tunnel, current conditions locally are bad and getting worse. We have more and more staff out sick each week. We have had to expand our sick-clinic offerings. My department was relocated and primary care consolidated so we can cross-cover for eachother with staffing shortages due to quarantine and illness.

In order to conserve testing supplies we are no longer authorized to test asymptomatic people in our clinics, even those who are exposed. They have to be diverted to the health department testing sites which have longer lines and longer turnaround times.

This is particularly problematic for kids in school and daycare settings. We have many kids now with positive parents. They automatically go into 14 day quarantine for exposure. But daycare/school needs to know if those kids are also positive, because if positive, their classroom needs to shut down and quaratine for 14 days as well. With 40-45% of kids asymptomatic or minimally symptomatic when positive, those test results are really essential. Many people aren't willing to wait in a long public health line to test an asymptomatic child, and the results may come too late to be useful to the classroom. Without that information we are potentially missing a large number of possible exposures. In classrooms with mask requirements there is decreased spread and unlikely to be superspreader events. But they are still having some transmission, both of COVID and lots of other respiratory viruses and colds.

Basically it feels like a raging fire and I have a garden hose and the fire department is stuck in traffic and occasionally someone walks by and throws a little gasoline on for good measure.
 

DopeyRunr

the jeweled acrobats only perform amazing stunts f
That's part of the logistical challenge of this Pfizer vaccine that I'm trying to wrap my head around. You have hospitals nearing capacity, banning visitation, but also they're the only ones with the ultra-cold temp infrastructure to store the vaccines for hundreds of thousands of people in their community? Who are the people on the ground actually administering the vaccine? In some states they're calling in health care workers who are currently out with COVID because they're so understaffed. Does every community have some untapped pool of nurses that can do nothing but administer vaccines 24/7 for 2-3 months (or more)?
 

DopeyRunr

the jeweled acrobats only perform amazing stunts f
This is particularly problematic for kids in school and daycare settings.
Here, if kids are out sick for any reason they have to have a negative test to return to the classroom. So a migraine headache or food poisoning means a test is required, even if there are symptoms a few hours after onset. Otherwise they have to remain out for 14 days.
 

Strangeite

Well-known member
We are truly living in different worlds and I am not sure what that means for the next couple of months. I need to rant a bit.

My wife is from South Dakota and have obviously been following the disaster that is the Covid response there. The school board in her hometown decided today to host an emergency meeting tonight about Covid procedures the superintendent had implemented. It was streamed over Zoom, so we tuned in tonight. OMG. JFC.

I can't tell you the last time I felt empathy for a person the way I did tonight for that poor superintendent.

The board at the end decided to "listen" to him and "meet him half way" by voting that IF a student has been in close contact for an extended period of time with someone that has tested positive at the school, then yes, those students can be excluded from school for 7 days (not 14 like the CDC says) but then can come back. However apparently this is a huge ask, those students then must wear a mask for another 7 days. But only if they are within 6 feet of someone.

This virus is going to literally wipe towns off the map.

Edit: I should have clarified that the meeting was called because students were being forced to stay home because multiple people in the schools had tested positive and those grades where someone tested positive were having to do virtual learning for two weeks. We are talking about a school district with less than 200 students. The high school has ~80, middle ~50, and the remainder elementary students.
 
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DopeyRunr

the jeweled acrobats only perform amazing stunts f
I read an Andy Slavitt Twitter thread today where he and another expert liken where we are today as similar to March 15th in terms of conditions for the disease to rip through communities. Except right now, we have 60,000 people already hospitalized. And a health care workforce that is exhausted. And a population (and government) that is largely resistant to doing the most basic things to stop the spread. Remember “flatten the curve?” Seems like a lifetime ago. It’s going to be a devastating few months.
 

Anne

Well-known member
That's part of the logistical challenge of this Pfizer vaccine that I'm trying to wrap my head around. You have hospitals nearing capacity, banning visitation, but also they're the only ones with the ultra-cold temp infrastructure to store the vaccines for hundreds of thousands of people in their community? Who are the people on the ground actually administering the vaccine? In some states they're calling in health care workers who are currently out with COVID because they're so understaffed. Does every community have some untapped pool of nurses that can do nothing but administer vaccines 24/7 for 2-3 months (or more)?
Each hospital/clinic/community is going to have an individualized plan. It will absolutely be a challenge for all the reasons you mention. We are going to have widening health disparity issues in the distribution of a vaccine in this country.

The hospital may be the site of storage and distribution, but it isn't going to be hospital nursing staff administering vaccine. And likely it will be drive up so people don't need to go into the building. In our clinics it is primarily medical assistants and LPNs who administer vaccines. My health system is integrated hoslital/clinic. They will likely pull MA/LPN staff from clinic sites to administer vaccines and hospital RNs will continue to do higher skilled care in the inpatient setting. There is still a staff shortage in the clinic setting due to illness and quarantine, but the clinic is able to absorb shortages better than the hospital.

Right now we are in flu vaccine distribution season. It's a very different work flow from prior years. There are 4 clinic drive up flu sites by appointment every Saturday that can each handle 300-400 per day (and we are one of 3 health systems/hospitals in the community, each doing something similar). It's staffed by MAs and LPNs from the clinic. I give the administration credit, they pay overtime for the flu clinics and staff have signed up voluntarily for those extra shifts. Even with a certain percentage of staff out sick we can manage that staffing. It will likely be a similar model for COVID vaccine distribution. But not as high volume. Instead of distribution over 2 months, COVID vaccine distribution is going to be in phases, starting with highest risk, over 4-6 months. There are a lot of people who are not interested in getting the vaccine. I don't know that the initial acceptance rate will be as high as we hope.

For those without insurance or a primary care "medical home" the health department will have a certain number of free doses. They may do distribution from trucks in a parking lot, probably not the pfizer version because of storage issues. Although hypothetically if Pfizer could partner with health departments and allow distribution directly from the transport trucks (my understanding is that Pfizer is doing their own distribution, although early on UPS was investing in cold storage and trucks as well) it might be possible. But I'm not sure they will have the supply to move into that part of the market early on.

Unfortunately once we get everyone vaccinated who would like it over the first 4-6 months it will likely be time to start over with boosters for the initial group.

ETA: I forgot to clarify, the nursing staff called back to work when COVID positive are only those who are asymptomatic and working only with COVID positive patients. Not that I'm saying this is a good thing, but it's very limited in scope in very few hospitals across the country.
 
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Anne

Well-known member
Here, if kids are out sick for any reason they have to have a negative test to return to the classroom. So a migraine headache or food poisoning means a test is required, even if there are symptoms a few hours after onset. Otherwise they have to remain out for 14 days.
I wish we had the testing capacity and community buy-in for a similar policy. Right now it is hard enough to get a test, if this were the policy, a large segment of people would send their kids to school no matter what to avoid an automatic out for 14 days.

I spoke to a family yesterday who went to the community testing site at open and there was a multi-hour line. They gave up. I was able to test 1 family member who had symptoms but not the other 2 who were exposed at the same time but without symptoms. I trust them to all quarantine appropriately, but it's crazy we are still in a limited-testing situation this far into the pandemic.
 

Anne

Well-known member
I can't tell you the last time I felt empathy for a person the way I did tonight for that poor superintendent.

The board at the end decided to "listen" to him and "meet him half way" by voting that IF a student has been in close contact for an extended period of time with someone that has tested positive at the school, then yes, those students can be excluded from school for 7 days (not 14 like the CDC says) but then can come back. However apparently this is a huge ask, those students then must wear a mask for another 7 days. But only if they are within 6 feet of someone.
Wow! That makes our mask and testing resistant residents here look like amateurs.
 

Strangeite

Well-known member
9 months into this, I don't understand why there are still such disparities in access to testing from state to state. I just looked it up, here in KY we have 336 testing locations, including large capacity drive-thru in the two largest metropolitan areas and 6 mobile units that are rotating around the state to the most underserved areas. Our governor is begging everyone, and he means everyone, to get tested every two weeks and sooner if you have been at risk of exposure.

Until last week my in-laws had no ability to get tested without a doctor's approval and they were only granting that if someone was symptomatic. Exposure wasn't a qualifying reason for getting a test. Their state did announce last week that there will be locations that anyone can get tested, but there are only 9 of them. Most are only going to be doing the testing for a single day. The site with the largest population will do testing for 3 days. The closest location to my in-laws is an hour drive and their area isn't considered remote.

It is madness.
 
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