Opinion by Richard Sternberg M.D.
Boosters will provide additional protection
Raise your hand if you are as confused as I have been digesting information about COVID-19 booster shots that has come out in the last month. Every day there seems to be something new. As a friend of mine pointed out to me, the media is so desperate for something to publish that they have been writing about the arguments that have led up to the current recommendations. The following is from a CDC release from Friday, Sept. 24.
“CDC recommends that the following groups should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least six months after completing their Pfizer-BioNTech primary series (i.e., The first two doses of a COVID-19 vaccine).
On Friday, Jan. 29, Janssen/Johnson & Johnson announced its vaccine had proven effective in Phase 3 studies. This brings a third vaccine on line in the fight against COVID-19 and potentially increases the pace of vaccinations by 50 percent.
Additionally, the J&J protocol is for a single dose and the storage requirements are much less stringent than those of the two vaccines already available in the United States, Moderna and Pfizer.
On the other hand, the statistics on efficacy for the J&J vaccine are not as high as those reported for the other two. It is reported as 85 percent effective globally against severe disease and 70
percent effective against moderate to severe disease.
Many scientists consider this on balance very good news.
If we remember back to last year the goal for efficacy was 70 percent which would have made that equivalent to the flu vaccine. Only because of higher numbers with Moderna and Pfizer do 85 percent and 70 percent seem low.
Furthermore, the J&J vaccine is a one-dose regimen and requires only basic refrigeration to last for weeks, making it much easier to distribute and complete a course of vaccine (i.e., only one shot).
This should especially help in people hesitant to get a shot at all.
In a daily press conference Monday, Jan. 4, Governor Cuomo called out Fox Hospital: If the Oneonta facility doesn’t use its anti-COVID vaccine allocation more quickly, it won’t get any more.
The governor said Fox had only used 18 percent of the doses it has.
Bassett Healthcare Network’s spokesman, Karen Huxtable-Hooker, said that figure is actually 30 percent as of Tuesday the 5th, both at Fox and its Tri-Town Campus in Sidney.
In all, she said, more than 2,000 Bassett Network staffers had been vaccinated, with 52 percent of the Moderna virus supply used up. The network employs 5,200 people over nine counties.
Bassett Hospital received its Moderna allotment Dec. 23, and immediately began vaccinating, Huxtable-Hooker said, and continues “to offer vaccination clinics for our health care staff, as do all of the hospitals in the Bassett network.”
The pace of vaccinations is just one challenge Bassett is facing, along with rising hospitalization – “double what it was in November,” she said. “The continued escalation of COVID-19 cases is challenging resources, but (at Bassett Hospital) we are managing.”
“Fortunately, with five hospitals in the network, we are able to make use of all available beds to meet patient needs to identify space within our hospitals that can appropriately be converted for patient care needs as demand dictates,” she said.
On a “case-by-case basis,” she continued, some elective surgeries that require hospital says have been postponed “ to have those beds available for seriously ill patients,” Huxtable-Hooker said.
Despite such challenges, healthcare workers see the vaccine as a light at the end of the tunnel.
Some staffers have declined the vaccine, “but this has been the exception,” the spokesman said. “Most staff members are anxious to receive the vaccine as soon as they are eligible and can be scheduled.”
While there are two bills in the state Legislature seeking to mandate that healthcare workers and others be vaccinated, they have not yet been acted on. (See related story, Page A1).
Nor has the state Department of Health issued any such order, so “we cannot require staff to get the COVID-19 vaccine, but we are strongly encouraging it,” Huxtable-Hooker said.
Meanwhile, she said, masks, social distancing, hand-washing and the like is being encouraged to reduce transmission, she said.
At his Sunday, Jan. 3 press conference, Cuomo said 70-90 percent of New Yorkers need to be vaccinated to push back COVID-19, part of his dismay at the vaccination rate.
If hospitals do not use up their allotment they may face fines and/or possible disqualification from future vaccine distributions, according to Cuomo’s statements.
“Bassett Healthcare Network continues holding vaccination clinics with the goal of using the vaccine allocated to us,” Huxtable-Hooker said.
Meanwhile, on Saturday Jan. 9 and Jan. 16, asymptomatic rapid testing will be available to the public as long as supplies last at Bassett’s Oneonta location on 125 Main St.
Reservations are required by calling 607-433-6510 from 8 a.m. to 5 p.m. Monday through Friday.
The network is working to schedule other locations and dates for asymptomatic testing.
Dr. Anush Patel, Bassett Hospital’s chief of medical oncology and radiology, expressed relief on receiving the first of his two Pfizer vaccinations.
“This is the light at the end of the tunnel,” he said.
Patel was one of 350 Tier One Bassett employees who received the Pfizer vaccine last Saturday through Monday at Arnot Ogden Medical Center, Elmira, and Faxton-St. Luke’s Campus, Utica.
“People were overwhelmingly excited to receive the vaccine,” said Karen Huxtable-Hooker, Bassett Healthcare Network spokesman. “It’s energizing health care workers; for them it means the beginning of the end.”
Tier One healthcare employees are staff members in clinical and nonclinical patient-care areas considered to be of high exposure, according to the state, including emergency room and Intensive Care Unit employees.
Some 170,000 doses of the Pfizer vaccine were shipped across New York State this week and received by Bassett’s Tier One employees.
Going forward, however, Bassett has opted for the Moderna vaccine, which has a similar efficacy against COVID-19, but doesn’t require the extreme refrigeration the Pfizer one does.
“Because it doesn’t need the ultra-cold storage like the Pfizer vaccine, (Moderna) is easier to store and transport throughout our region, so we can reach more patients in our service area,” said Kelly Rudd, PharmD, the Bassett Network’s pharmacy director.
Although Arnot Ogden and Faxton-St. Luke’s are not in the Bassett Network, they are medical campuses designated by New York State as regional hubs for initial vaccine administration.
“We have been able to help them and they were able to help us; this really takes everybody working together,” Huxtable-Hooker said.
“We are proud to be part of the state’s efforts to vaccinate front-line healthcare workers as we move through the vaccination distribution phases outlined by the CDC,” said Jonathan Lawrence, Arnot president/CEO. “We look forward to working with hospitals in our region to achieve the goal of vaccinating as many people as possible, as quickly as possible, in our efforts to contain the spread of COVID-19.”
According to Huxtable-Hooker, all five Bassett Network hospitals have received their first allotment of the Moderna vaccine and vaccinations of Tier One staff will begin this week.
“Schedules for inoculating staff are in development,” she added.
Those that have already received the Pfizer vaccine at one of the two locations in Utica or Elmira will be returning to those sites to receive the booster for the vaccine after three weeks.
Those that will receive the Moderna vaccine will return for their booster after 28 days.
And with 350 staff members on their way to completing the vaccination process against COVID-19, Heidi Bond, Otsego County public health director, says she hopes this will speed up the timeline for getting the vaccine to the public.
“Hopefully the vaccine will begin to come at a fast pace,” she said. “We can vaccinate our front-line healthcare workers, then increase out to the next tier and vaccinate other essential workers.”
Bassett’s attending physician of infectious diseases, Dr. Charles Hyman, suggested last week that the public will likely not have access to the vaccine until the end of April, but adds that planning as to how best to distribute it is already underway.
COOPERSTOWN – Six Tier One Bassett employees elected to receive the Moderna vaccine in Bassett Hospital’s Clark Auditorium this morning.
Housekeeper Eddie Cook, among the six, was “excited and a little nervous” about receiving the vaccine. “If it helps stop the spread and will keep his wife safe,” he said, “I am happy to do it – I will be glad when the vaccine is widely available.”
The other five were: Dr. Lewis Brinton IV, Fly Creek, an emergency-room doctor at Little Falls Hospital; Keith Velasco, Milford, nursing associate; Suzanne Evans, Cooperstown, surgical resident; Liz Burns, Oneonta, R.N., and Dr. Travis Hodgdon, Cooperstown, critical-care physician at Bassett.
The vaccines were administered by Kelly Rudd, Bassett Health Network’s chief of pharmacy, as well as Michele Taurisano, Utica, and Allen Light, Westmoreland.
Yesterday, today and tomorrow, approximately 350 employees in the Bassett Healthcare Network’s Tier One group are traveling to the state-established hub-hospital system in Utica and Elmira (Arnot Ogden Hospital) to receive the network’s allotted doses of the Pfizer vaccine, spokeswoman Karen Huxtable-Hooker confirmed a few minutes ago.
Many people have asked me to explain vaccines to them, and specifically the ones for COVID-19. They are most concerned with how they work, when they will be available, and if they will be safe.
Hopefully, this column will help.
The terms vaccine and vaccination derive from the Latin name Variola vaccinae, which means small pox of the cow. Vacca is Latin for cow.
The term vaccine was first devised by Sir Edward Jenner in 1778 based on the fact that he used an inoculation with cowpox to elicit a protective reaction to smallpox.
In 1881, Louis Pasteur proposed that the term vaccine be used to cover all new protective inoculations that were developed in order to honor Jenner.
There are multiple types of vaccines and at least one of each type has been tried or is being developed for SARS-CoV-2 (the virus that causes COVID-19).
The following are the different types of vaccines that are administered to a subject to induce a protective immune response along with examples of each.
►INACTIVATED: a dead copy of the infectant, e.g., polio
►ATTENUATED: A weakened version of the infectant, e.g., yellow fever, measles, mumps
►TOXOID: an inactivated form of the poison made by the infected cell, e.g. tetanus and diphtheria
►SUBUNIT: a portion of the protein of the infectant that cannot cause the disease by itself, e.g., hepatitis B and HPV (human papillomavirus, causes genital warts and cervical cancer).
►CONJUGATE: Weak version of the infectant, coupled with a strong antigen for something benign to increase the immune response to the weakened version, e.g., Hemophylus influenza.
►RECOMBINANT DNA, where a stand of genetic material for part of the infectant is inoculated into the host’s cells and teaches the cells to make an antigen for part of the infectant.
►RNA: This is the approach that right now is the most promising in treating SARS-CoV-2. A portion of messenger RNA is inoculated into the host cells and tells the host to make a portion of the infecting virus. This technique has not been used for human diseases clinically before.
Typically, it takes 15-20 years to bring a new vaccine to market, and less than 5 percent of candidates will succeed. The speed in which the SARS-CoV-2 vaccine has come to be distributed really is warp speed.
The first regular immunizations begin a week ago Monday in Great Britain. This is less than a year from recognition that there was a new disease and 10 months from identifying the genetic code of the virus causing it.
Currently there is only one vaccine approved for use, the one made by Pfizer and BioNTech. This is awaiting approval along with that of Moderna in the United States. Pfizer’s was approved, distributed Sunday, and injection began Monday. Approval for Moderna may come later this week.
Both of these are of the RNA type.
There are several reasons that things have moved with lightning speed.
One, the unprecedented cooperation between pharmaceutical companies and academic and government research labs.
Two, the approval of governments to allow fast-tracking such that steps of the development are done in parallel. In my mind, there is no doubt the government’s Warp Speed initiative helped move the process along.
Three, scientists have been working for 10 years on what they call pandemic preparedness. In this case they had developed a template that would allow the development of vaccines for newly emerging diseases quickly. Essentially as one scientist called it, plug and play.
In my next column I will discuss plans for the roll out and how it has gone up to that point.
Normally, the time from submission of data to approval by a government agency takes two years. In the case of SARS-CoV-2 vaccines it is one week.
After approval, time to distribution takes more than a year while the pharmaceutical companies develop and implement manufacturing plans.
Amazing what we can do when everyone is desperately pulling in the same direction.