COVID-19 Update 1/27: Vaccine Distribution, Monoclonal Antibodies, and Variants

On this week's COVID-19 update, Dr. Steven Bishop discussed the vaccine distribution problems affecting the country right now, a new treatment, the logistics of monoclonal antibody treatments, the spread of variants throughout the United States, and much more. Watch the full video below and read on for the complete recap. 

Vaccine availability update

First, just updates on vaccines, look across everywhere, vaccine availability remains a serious problem. More so unfortunately in Virginia than in other states and I won't even say that it's availability necessarily. It's that there are problems with it actually being distributed and administered to people. We are on the phone with the health department, or email, almost on a daily basis, trying to get updates from them.

There is still a discrepancy between the number of doses that Virginia is saying that it has and the number that have actually been given to patients. So there's a lot of slowness going on there.

Last I checked, we were about 50th in the nation for vaccine rollout. And that I don't think has changed significantly in the last 24 to 48 hours. So lots of problems there.

If you're trying to get vaccinated pretty much anywhere including Virginia, your best bet is to go Google your local health department website and find out if they have an interest form that they have posted and fill that out.

Most of the local health departments have put those up at this point and they say they will contact you when they have vaccine available for you. Now, keep in mind that may take weeks or months.

Like we told you guys last week, we are expecting, unfortunately, not to get vaccine in our practices at this point, in Virginia, at least for six to eight more weeks. Now we'll be following the other states as well and we are on a call every Friday with the health department in Virginia, locally here, trying to figure out if that timeline is going to change, hopefully for the better.

But we're keeping as close an eye on that as we possibly can. But a few things I would say, go to your local health department website, sign up for any interest forms that they have.

(Editor's Note: You can also check out our state-by-state vaccine resource pages for local health district links and contact information and our best suggestions for trying to get an appointment elsewhere. We've done the googling for you. Find them for Virginia, South Carolina, Georgia, and Maryland on our main COVID-19 vaccine page here).

If you are a patient in the Richmond area, you may be contacted by either VCU or by Bon Secours system. They are contacting some patients who have been received care there in the last few years. And if they have vaccine available, they are giving it to those who are 65 and up, in particular. They're starting with their older patients and working their way down. So you may be contacted by one of those health systems if that's available in, again, in the Richmond area.

I know folks up in Northern Virginia, some people had appointments scheduled with Inova and a lot of those got canceled due to lack of vaccine. So there's still a lot in flux here.

The governor is, in Virginia, giving an update at some point today with some details on updates on vaccine rollout. Hopefully we'll get some more information today, and then in the next couple of days.

New potential therapy = colchicine

For treatments, I know there was a press release out on the 21st and it's gotten more press in the last few days about colchicine seen as a new potential therapy for COVID-19 and, like with everything new, just looking at the data now, there's been just one or two trials on colchicine with COVID.

It does make sense that this drug may be helpful for COVID, and I think it's been being used by some people for some months. It's an anti-inflammatory. So colchicine is usually a drug that's used to treat gout. So it's an anti-inflammatory in that way.

And most of the drugs that are being used for COVID up until now are all, they kind of fall under this class of either antibiotics or anti-inflammatory drugs, and there's some overlap there because many antibiotics also have anti-inflammatory properties.

So it makes sense that that would potentially help. I'm waiting on the data to come out. It was just a press release with a few stats in there, but they didn't really show all of the data behind all of those stats that they sort of just put in a brief press release. So I think it's a little premature to make any judgments on colchicine as a therapy.

I think it probably is, in the running like a lot of other things — azithromycin, doxycycline, even going back to hydroxychloroquine , ivermectin — they're all sort of these, they have anti-inflammatory properties, so it makes sense that they would help. More data hopefully will be forthcoming in the coming weeks and months. So that will be good. Good news.

Access to monoclonal antibody treatments?

"Maryland's Department of Health put out a press release today encouraging physicians to use monoclonal antibodies for mild and moderate COVID patients. Do PartnerMD physicians have access to this treatment? What do we know about its effectiveness?"

So we do have access to that, but it's only through a local hospital. We have to fill out some special forms and coordinate with the local hospital because people have to come in to get an infusion essentially, and people do have to meet criteria.

I know locally here, yes, we are using it even for those with mild to moderate symptoms. And if there's a hospital up in Owings Mills area they would probably have to go through a similar process. But again, you have to be sort of in a higher-risk category. So either over age 65 or have a comorbidity or one of those other things.

You have to be sort of mildly ill, but at moderate to high risk. You can't be too sick, because if you require oxygen or something like that, then they won't give it to you either.

The trouble we've been running into here is just dose availability. There just aren't a lot of doses available of the monoclonal antibodies. But we have been able to get patients those treatments in in the past month or so, so I suspect that the Maryland docs would need to use a similar process locally with a hospital there.

Quick warning, reminder, if you get monoclonal antibody therapy, you can't get a vaccine for 90 days after the fact. So just for some people that that may be something to keep in mind. I don't think it would change necessarily your decision in the point of time whether it gets the antibody therapy or not, but just something to remember after the fact. You can't get vaccinated until 90 days have passed since monoclonal therapy.

Clinics and physicians specializing in COVID long haulers?

"Are there any clinics and physicians in the Richmond-area specializing in long haulers? Those who are dealing with COVID symptoms months after testing positive?"

I know that VCU is trying to build something like that, but they have not put it off the ground just yet, so I suspect that you'll see it first in academic centers before you see it in private areas just because of the research focus. That will be probably a major area of interest in the long haulers. So if you're local here in Richmond, I would check with VCU first. But it's probably going to be some months before those types of clinics are ready to go.

Same vaccine for both doses?

"If you get your first shot of Moderna, can you be guaranteed Your second shot will be Moderna?"

Yes, they will not, as far as I know currently, the advice remains from FDA, from CDC, from the companies themselves, whoever you start with in terms of your vaccine, whether it's Pfizer or Moderna, you have to get the second dose from the same company. Don't mix and match vaccines.

Testing positive for COVID between vaccine shots

"Just found out my mom has tested positive for COVID. No symptoms yet. How long will she have to wait for the second shot because of a positive COVID result?"

Oh, so she's had the first shot already. That's good. So hopefully that means she's already got some immune response and she won't get very sick with it. She'll need to wait until her isolation period is over. So whatever day that is probably 10 days from her test. And at that point she could get the second dose.

Being a carrier despite immunity? 

"I have a few questions. I don't understand how if I have both vaccines and have immunity, I could still be a carrier. Also. I had the first vaccine on 1/21, second on 2/16. When should I be safe to visit family? What precautions are necessary?"

Ok let me take these kind of one at a time. I don't understand if I have immunity, how could I be a carrier?

Yeah. So, what's kind of an outstanding research question is whether the antibodies and the immune response to the vaccine prevent you from getting ill in terms of just prevent you from having bad disease or if they can prevent you from getting infected period.

So those are kind of two different things, right? Because you can be infected and have almost no symptoms if your immune system controls the virus, just like, you know, a lot of the young people who are getting it now, 18-19 year olds, and they get the virus and have minimal symptoms because their immune system is taking care of the virus before it gets really bad, but they still can transmit and carry and give it to other people. So it's kind of a similar concept.

The vaccine may give you the ability to overcome the virus easily in terms of not getting sick. But you could still be infected with it and transmitted to other people.

Safe to visit family after vaccination?

So I would think, in terms of safe to visit family, I think, in general, two weeks after you have your second dose.

All that being said, most of what we're reading, most of the experts expect the vaccines to reduce transmission as well and reduce that carrier status. We just can't officially say that because the data hasn't come out on that and they haven't completed the studies.

So best guess once you're about two weeks out from your second dose, I think the odds of you transmitting it to other people are going to be pretty small pretty small. So in terms of necessary precautions, I don't think you would need to do anything extraordinary. I think you probably would be fairly safe to do that after the second dose.

Masking with new strains? 

"Third question, with all the cautions about new strains, should we still be double masked after having both vaccines and for how long do you estimate wearing masks with all the new strains being discovered?"

I think this is going to be an ongoing, very challenging problem to deal with. I think at some point when the transmission rate gets low enough, we're going to have to make the decision about what to do about masks. We're not going to be able to wear masks forever, for years and years and years. It's just, it's not going to be feasible. It's not going to be enforceable. It's just not something we're going to be able to do. So we're going to have to figure this out.

As we see these strains and they're going to keep coming up, there are going to be new strains that are going to come up on a persistent basis. And we are probably going to have to get booster vaccines at some point.

I know Moderna is already working on a booster vaccine for one of the South African variants. So this is something that's going to be with us for some time.

At some point when the vaccines, these initial vaccines get the waves of transmission pretty low, I think we're probably going to have to make the decision about not wearing masks at some point. Because again, this is not something we can all do for the rest of our lives, unfortunately. So we're going to have to keep reassessing this and see how things go over the next few months once the first wave of vaccines actually gets out to the population.

In-person instruction in classrooms

"I saw the CDC now recommends resuming in-person instruction for pre-K through 12 with the rationale that data showed little transmission occurred in masked and socially distant classrooms. How clear is the data? And does this stand up for adolescents as well as kids?"

Yeah, there's a number of studies that they're basing this on. In one of the more recent ones that came out was a study done in North Carolina with about 90,000 students across a number of districts. And they found actually no cases of transmission, or I think one or two, excuse me, within the school systems. And those were all between adults. It was one teacher giving it to another.

There were no documented cases of the students giving it to the teachers or vice versa for that matter, but it was the two, it was teachers giving it to one another. So I think the data's pretty solid on this at this point that, that the students don't seem to be major sources of disease transmission when you're doing all the appropriate, safe, mitigation practices in the schools. So I feel pretty comfortable with that.

Suggestions for getting a vaccine now

"Do you have any guidance tips on how to get a vaccine appointment?"

Yeah, unfortunately Chris, welcome, we have no vaccine at our practices and it's limited in availability everywhere. The best thing you can do right now is actually Google your local health district.

(Editor's Note: You can also check out our state-by-state vaccine resource pages for local health district links and contact information and our best suggestions for trying to get an appointment elsewhere. We've done the googling for you. Find them for Virginia, South Carolina, Georgia, and Maryland on our main COVID-19 vaccine page here).

So whatever County you live in and see if they've put up an interest form on your county's health department webpage and fill that out and wait for them to call you and see if that pans out. I know some people are getting called but they are not promising anything in terms of when you might get called.

Vaccines giving out excess doses at the end of the day? 

"Is it true that vaccine centers may give out excess vaccines at the end of the day to anyone who is waiting in line?"

I know there have been some instances where they have some doses that like people didn't show up for or whatever and they have given them to people who were just around. So I know that's happening anecdotally.

I wouldn't recommend people to go and hang out at a vaccine distribution center just to see if they can get a dose at the end of the day.

I don't think that would be a good idea, just A) for crowd control reasons and B) just because you may end up waiting the whole day or even hours and get nothing, so I'm not sure that's a good idea, but that has happened from time to time.

That being said, I think that's going to become more and more rare as the time as time goes on, because they're being pretty meticulous about how they schedule people for vaccines.

Which vaccine is being distributed?

"Which vaccine is being distributed locally?"

Both Pfizer and Moderna. Pfizer, more so, there's more doses available. But out in the community, I think it's probably going to end up being more Moderna over the long-term because of the cold storage issues. So it's both, it's both.

Variants

"It seems like troublesome variants are coming pretty frequently now, but once the transmission decreases won't it take longer for variants to breakthrough as the virus in general has fewer hosts to mutate in, or can we expect, as it is now, three troublesome variants within about a year?"

I don't know. I don't know. What you said makes sense. Your logic is sound. You would think as it transmits through fewer people, that there would be less chance of mutation. That being said, viruses kind of do what they want, so it'll be a little bit hard to know how frequently it will mutate. The flu mutates pretty quickly and pretty frequently and there are lots of strains of the flu every year. That's why we have to get vaccinated every year, so it may wind up being like that, unfortunately.

Vaccines at PartnerMD

"A nurse at PartnerMD told me six to eight weeks before vaccine is available. Is that what you've heard? None available at Walgreens that I'm aware of?"

Yes, that's correct. That's what the health department's telling us, is that we will not, we should not expect to get any vaccine in our offices to give to our patients from our offices for at least six to eight weeks from now, or from last week.

Choice of vaccine?

"Do we have a choice of which vaccine when you register?"

No, you do not. You register for an appointment and whatever vaccine they're giving out that day is the one you you will get. That being, said by and large, it appears that most of the community vaccine slots are using Moderna. And the big health systems are using Pfizer. So if it's out at a community location, you're probably going to get the Moderna, most likely just again, because it's easier to store and transport.

Transmission in college classrooms? 

"One more about classroom transmission. Is there data about transmission and college classrooms? My daughter starts her first term on campus soon. School in Massachusetts has strict movement restrictions. My wife will teach college in person several days per week. So college safety is on my mind. "

Yeah, these are good questions. I have not seen any papers or data about that and it's probably because it's more difficult to study, right?

Elementary and middle school and even high school kids. They're kind of much more of a captive audience, so it's easier to track them and do contact tracing and things like that in terms of doing research studies.

College students, as you know, they're kind of, they do whatever and they come and go, it's very fluid, so it's harder to track. So I haven't seen as much good data on that at that level, but it's just hard to say. I suspect the risk is higher than an elementary school classroom just because there was more community movement amongst college-aged kids. But it's just hard to know right now.

Numbers Update

So while we're waiting for any more questions just a smidge of good news is that the numbers over the last couple of weeks in general, especially in Virginia, but other places, too, have started to come down a bit in terms of overall cases hospitalizations and deaths, which is great.

Then the national numbers reflect a downtrend in the number of cases. Hospitalizations are roughly stable. Deaths have not come down yet. That will lag.

So I'm hopeful that that's a good trend and as we hopefully start to really roll out vaccine that will really start to accelerate. So that will be good.

And I'm wondering, too, a lot of nursing home patients have been vaccinated at this point, which is fantastic. So I'm wondering if that's really making the difference in terms of the hospitalization numbers and then hopefully the death numbers as they will hopefully come down to the next couple of weeks, because we vaccinated a lot of the very elderly and those at the very highest end of the risk range in the nursing homes. So hopefully we'll see that bear out in our data over the next few weeks here.

Johnson & Johnson vaccine updates and is one dose harder on seniors than two?

"Any updates on the Johnson & Johnson vaccine? Any advice on whether one dose is harder on seniors than two dose vaccines?"

Updates, I heard again, it's kind of rumor, that Dr. Fauci said something on TV the other day about he expects to see their data in a couple of weeks, but I've been hearing that for a couple of weeks now. So I'm hoping that they will present their data to the FDA soon so we can get some more information. (Editor's Note: It is expected that Johnson & Johnson will announce data early next week). 

And that way I could actually answer the second question, advice on whether the one dose is harder on seniors than the two dose vaccines. I'd have to see the side effect profile on the vaccine trial data to answer that question more completely or at all. So hopefully once they release that data, we'll be able to start figuring out that stuff. Good questions though.

Monoclonal antibody treatment waiting period vs. COVID positive waiting period

"So the monoclonal antibody treatment, you have to wait 90 days for a vaccine, but if COVID positive between vaccine, then no 90 day waiting period?"

That is correct. That is correct. And I think that the thought there is that the monoclonal antibodies, it may interfere with the way the body responds to the vaccine.

Vaccinations by age

"Will someone who is 75 years old get a vaccine before someone's 65?"

In most cases, yes. That's the way it should go. Again, the vaccine rollout' been pretty messy, pretty chaotic everywhere. So it's hard to know, but in general, yes, that should be the case.

AstraZeneca vaccine update

Any timetable on AstraZeneca decision in the U.S.? No, I haven't seen anything new about that either. I think it's the same thing. We're really waiting for the FDA to receive and then review their data. We're just waiting on that process. It would be great. I would love to see these vaccines get approved so we have more vaccine available, because we have so much dose availability problems right now. So hopefully soon, hopefully soon.

Do we have enough supplies?

"Do we have enough syringes and other supplies after more vaccines are?"

I don't think so, which is why I think the president is talking about using the Defense Production Act to produce those items, too. So things like needles and syringes and all that, because I think we're short on those things, too, in addition to just vaccine doses. So no, I don't think we have enough with any of those things just yet. Good questions.