There has been a lot of online traffic regarding COVID vaccines between discussions about the vaccine itself, as well as the ability of eligible folks to actually navigate the system to receive their shot.  So here is your first cut for the day, Shootout at the Fantasy Factory by Traffic.  Hopefully getting everyone vaccinated will become more like a Sunday drive than rush hour traffic soon and less of a fantasy for all.

Shootout at the Fantasy Factory

Today’s blog is intended to be a quick COVID update for you.  Will sprinkle in a little science and sarcasm, simply because I can’t help myself.  Oh yeah, some tunes too.  Gives me something to listen to when I write, and for you when you read.  When turned loud enough, it also helps drown out the sounds of children screaming with their friends while playing their favorite online games.

The Numbers Game

The Numbers Game will provide you a quick overview of both national and local trends.  Spoiler alert, we are currently heading in a nice direction, and the Numbers Game will not become the crying game this week (nor ever confused with The Crying Game).  Will try to channel my inner Zoltan for you and project what remains ahead for us in this pandemic.  I apologize that I do not currently have the Continuum Transfunctioner (a device whose mystery is only exceeded by its power), which would help immensely.  But I am betting that I will be better than the boardwalk version.  On the topic of boardwalks, wouldn’t it be nice to spend some time this summer on one while there are activities open?

National Numbers

The national numbers have been improving for weeks now with respect to the number of positive cases.  It has been a couple of weeks since we have had 100,000 cases in a day.  This is great to see.  The rate of decrease is definitely slowing and it appears that the number of daily cases is starting to plateau again to the rate seen in October before the big wave started.

As we have been expecting for a few weeks, we finally saw a week with markedly lower rates of death as well.  Rates are now about half what they were at the peak.  They are still quite high though with an average of 2000 deaths per day.  These rates are still more than double that of October and are thankfully expected to decline over the next few weeks.  If they do not continue to do so for the next several weeks, it could be an early warning indicator that there is a more malicious strain out there with respect to disease severity though not necessarily easier to spread.

Local Numbers

The local numbers do not differ much from the national.  The graphs below are courtesy of the Newsday COVID Tracker.  We are way off our peak number of cases these last few weeks and seeming to stabilize around 700 cases in Suffolk County per day.  The percentage of folks testing positive is also markedly improved and about half what it was a month ago.  Hospitalizations are far lower and continuing their decline as well.  There are still over 400 individuals in Suffolk County hospitalized at this time, so disease burden is not trivial.  The rate of death is also slowing finally and is again in single digits on a daily basis for the first time in months.  Overall, a much nicer picture to paint that some prior blogs.

What Do The Numbers Mean?

The numbers seem to indicate that the most recent wave is passing.  Even then, there are still a ton of folks getting sick and dying from this illness.  We have cleared the 500,000 mark for deaths in this country from COVID in less than one year.   Is there another wave coming?  When?  Will it be a nastier strain?  Thought you were getting an answer to this?  I would have better luck picking the winner of the next Knicks game against the spread (who by the way are so much more fun to watch for the first time in a decade).  That being said, there is a silver lining to be found today that I do feel comfortable predicting and will address after presenting the update on vaccinations.

Some live Rush for you.  One of the better songs from their later albums.  Chosen for its title “Stick It Out.”  As in roll up your sleeve and stick your arm out.  Time for your poke.  Nervous?  Close your eyes and picture walking on that boardwalk or other happy place.

COVID Vaccine Updates

And Then There Were Three….

Since our last post, the Johnson and Johnson COVID vaccine received Emergency Use Authorization from the FDA.   This vaccine is currently recommended as a single dose unlike the Moderna and Pfizer vaccines already approved for emergency use which both require two doses.  I will emphasize currently recommended as the vaccine schedule for all vaccines is subject to change with the passing of time (potential need for booster doses).

The data from the Johnson and Johnson clinical trial was quite impressive.  They enrolled 43,786 participants in their trial.  The vaccine reduced the number of individuals contracting moderate-to-severe COVID infection by two-thirds (66%) in the trial.  More importantly, there were zero hospitalizations or deaths among participants in the trial.  Worth repeating, ZERO HOSPITALIZATIONS OR DEATHS.  For completeness, if you do go to the source to read more about the study, keep in mind that statistics for vaccine trials such as above are using the data beginning one month post-vaccination.  Shots take some time to generate an immune response.  You do not get poked and have immediate protection.

Which Vaccine Should I Get?

This is one of the easiest answers ever.  It is like arguing over which company makes a better mousetrap.  All three of the vaccines are nearly completely effective at preventing you from ending up in the hospital or worse.  And by worse, I don’t mean my wife’s feeling when she elected to join me for a Phish Concert a few years ago.  You take whichever of the three COVID vaccines they have available when you are eligible and standing in front of the administrator with the syringe in their hand.

I know everyone has the same questions.  You would love to know if one of the options provides longer-term protection.  You would love to know if one of the options provides slightly better protection in the short-term.  You want to know if one has better side effect profiles than the other.  I get it.  Me too.  Fact is, you will not get any of these answers for awhile because it requires living it and then taking a retrospective look.

Again, the facts you have to work with today are that all three of the vaccines in the short-term provide outstanding protection from being hospitalized or killed by this virus.  All three of the vaccines have been shown to do so without causing any side effects of common concern.  Yes, there are allergic reactions.  Unless you are on a toddler diet, you likely try new foods periodically.  You don’t overthink such, though your likelihood of an allergic reaction to the new food is a comparable risk. And while you can eat yourself to death, COVID will kill you faster.  It’s worth the allergy risk.  Plus they monitor at vaccination sites and have epinephrine on hand in the rare event it is needed.

Based on the experiences of my colleagues and friends (and myself), the side effects of the Moderna and Pfizer vaccine have been similar.  Some felt a bit ill after the first dose for a day or two.  Most felt worse after the second dose.  Again, only for a day or two.  Some fevers and chills.  Some muscle aches.  Headaches.  Malaise.  I felt a bit like a space cadet for a day.  Take home message:  for a couple of days total you may feel sick from the shot.  Acetaminophen be thy friend.  And then in a month COVID is not likely to be a major concern for you on a day-to-day basis.

Red Hot Chili Peppers performing the Hendrix classic “Crosstown Traffic”

How Do I Know That They Won’t Find Out It Causes [Insert Your Worst Fear Here] In Five Years?

You don’t and you won’t for 5 years.  I can give you about 500,000 reasons this year that are lethal though.  I can speculate with you about long-term heart and lung damage from getting COVID even if it doesn’t hospitalize or kill you.

What always amazes me is that the same level of concern is never given to other remedies that people take without a second thought, despite known dubious safety data.  Did you know that five years ago, over the counter teething remedies were responsible for 10 infant deaths and 400 serious illnesses?  Guess how many died from teething itself?    Remember ephedra to help with weight loss?  It caused so many severe health problems it was ultimately banned.   There are no long-term studies about Elderberry safety.  There are few short-term studies showing it does anything worthwhile.  Yet I couldn’t begin to count the number of folks that chuck it down the hatches of their kids without a second thought.

What I can tell you at this point in time is that many MILLIONS of people have taken the vaccine with extremely few concerns.  Historically speaking, with vaccines in particular, if there have been safety issues, they were rapidly identified when the vaccine hit the general population.  This is a VERY LOW LIKELIHOOD event at this time.  It’s all about risk-reward on a population level.  Back in the day, people received a vaccine for smallpox.  Prior to the push to vaccinate the world against smallpox, a few million people would die per year.  The vaccine itself killed about one in a million.  To that one person it would appear to be a poor choice, though they could have gotten smallpox and died regardless.  On a population level it was a no-brainer type decision.  They stopped vaccinating for smallpox in the 1970’s because the program was so effective it was eliminated as a disease.

What About the Children?

At this time there are NO recommendations to vaccinate children.  The trials are underway to evaluate the vaccine in children.  These trials are needed to make an appropriate decision.  Children are not “little adults” when it comes to physiology.  It is not just calculating a smaller dose or some other parameter to account for their size or age.  In theory, it would be great to immunize 100% of the population, but in reality there have been vaccines that have been beneficial for adults and detrimental for children.  The Dengue vaccine being the prime example of such.  Consider this topic a work in progress, and please stop worrying about whether schools are going to mandate something that is not even an option at this time.

*Side note:  The Dengue vaccine caused issues due to an immune phenomena called antibody dependent enhancement.  Basically having had the vaccine generated antibodies that when faced with the real infection the vaccinated individual had a worse outcome rather than experience protection.  So far, the coronavirus vaccines do not appear to cause a similar issue.

How Are We Progressing In Getting the Vaccine In Arms?

Let’s say we are getting a bit better about getting our population protected.  Could we have done better to date?  Yes.  Can we still do better? Yes.  But we are progressing.  At this point in time, we have managed to vaccinate slightly more than 1 in 5 individuals (21%) in the United States.  Would have loved to see numbers akin to Israel (92%) or the United Arab Emirates (60%), but consider that the European Union has only managed to vaccinate (7%) of their population.   Suffolk County is currently reporting a 16% vaccination rate which is worse than the nation as a whole.  It is unclear as to whether this is an artifact of reporting timing or a real difference in rate.  It is double however the percentage reported two weeks ago, and that is fantastic.

Jane Wiedlin’s “Rush Hour” to keep on theme and provide that occasional 80’s pop tune fix 

Where Can I Get My Poke?

At this time, the best place to go hunting for a vaccine is still using the government eligibility tool.  If you are over 65 years of age, you might additionally choose to look at some of the pharmacy websites such as Walgreens or CVS, as they have been authorized strictly for that age bracket.

The number of individuals eligible is still way higher than the number of doses available.  Hopefully the addition of a third vaccine option will assist the lack of availability in the short-term.  At this time, the state has approved many other sites (such as ours) to administer the COVID vaccine but has yet to have enough supply to provide stock.  We continue to maintain a list in our office of those who are interested in receiving the vaccine here when available to us.  We order every Monday as per the requirements.  If interested, you may email iwantmyshot@pedsfirst.com (please include name, contact information, and how you are eligible at this time – such as “I am 73 years old”).  Please do not assume we will ever be granted stock.  If you can get vaccinated elsewhere sooner, please do so!!!

Guess I did need an 80’s fix.  Tracy Chapman performing “Fast Car.”  One of my favorite tunes from the decade.  Feels as fresh today as then. 

Silver Lining

I promised a silver lining earlier, and I won’t fail to deliver.  I said earlier that I cannot predict if there will be another wave or if other strains could emerge.  I do expect there will be other strains emerging and other waves/increases in cases.  The silver lining is that a rapidly increasing percentage of the population is getting vaccinated.  More importantly, we have now vaccinated half the population over the age of 65.  Unlike the influenza vaccine that does not work well in the elderly, the COVID vaccine appears to work very well in the elderly.  This means that even in the event that there is another wave of cases, the highest risk portion of our population is not likely to bear the brunt of it, and we would not expect to see our hospitals filling up or funeral parlors overwhelmed with new customers.

Right now, what I recommend to all is to continue to protect yourselves and families in the manner you have.  Please do not look at the dropping numbers and start increasing activities that bring additional risk thinking its safe.  As mentioned a couple of weeks ago, I think we could be in the homestretch.  Be thankful the severe wave has subsided.  The hope is that by the time the next wave starts, our high risk are protected and we do not live through another horror show.  When we finish the job vaccinating our high risk population, I do believe we are going to be able to safely re-engage society as we proceed in vaccinating those who are at lower risk with the goal of eradicating this disease or reducing it to no more of a nuisance than the common cold.  I am hopeful this summer is going to much closer resemble what you would expect from one rather than one spent in relative isolation like last year.  I am further hopeful that Bob Weir will be touring this summer.   If he is, you know where to find me.

Bonus Cut:  Paul McCartney performing the Beatles tune “Drive My Car.”  And for an eclectic deeper dive…..Van Halen performing the same tune.

Post authored by Jason Halegoua PhD, MD, MBA, FAAP.  Jason is the founder of Peds First Pediatrics in 2009, and has been a practicing general pediatrician since completing residency at Schneider Children’s Hospital in 2004.  In addition to earning his medical degree from the Medical College of Pennsylvania, Jason earned a PhD in Molecular Pathobiology for his work contributing to the understanding of the genetic regulation of immune responses to murine leukemia viruses from Hahnemann University in Philadelphia and an MBA in Finance from Hofstra University.