COVID-19 Update 1/7: Dr. Bishop's Vaccine Experience, Vaccine Rollouts, and More

On this week's COVID-19 update, Dr. Bishop talks about his experience getting the Moderna vaccine, from the sign-up process to his side effects, and discussed the status of the vaccinations throughout the country, hospitalizations, and PartnerMD's readiness for a vaccine. 

Watch the video below and read on for a recap. 

Dr. Bishop's Vaccine Experience

Let me just kind of tell you how it worked for me and what I'm expecting to see in relation to vaccines in the coming weeks and months as the availability, hopefully, starts to increase in terms of vaccine doses.

We were able to get all of our employees who are healthcare workers here registered in VAMS, which is the vaccine administration management system, which is offered by CDC and in conjunction with the local health departments.

And so I registered actually through that system. And you put in kind of your demographic information, your health history, where you live or where you want to get the vaccine near, and then they provide you with locations and then a way to book an appointment.

So I booked my appointment, went out to a local middle school here. They don't let you in early. They let you in right at your time to come and get the vaccine. Got the vaccine right on time. There was really no line because all the registration was done over the web before I got there. There really was very little delay. They checked my ID, made sure I was who I said I was, confirmed some things and then gave me my vaccine.

I'll tell you about, kind of, my experience with the vaccine in a few minutes and the first 24 hours since I had it at this point.

But the whole process, again, was really smooth, went right from the check-in desk to the confirmation desk to the vaccine. And then they take you back to a place to wait for 15 or 30 minutes to make sure you don't have a severe reaction to the vaccine, specifically anaphylaxis.

That's the one that everybody's really worried about. There've been about 30 cases, 29-30 cases worldwide, of anaphylaxis to the vaccines at this point. And that's across the Pfizer and the Moderna vaccines.

I think actually more of those have happened with the Pfizer vaccine than the Moderna vaccine. So they do watch people for a bit afterwards.

Now anaphylaxis happens with many vaccines, in many drugs for that matter. It's not necessarily an uncommon thing. Now the rate of anaphylaxis is higher with this vaccine compared to flu vaccines, but it's still extremely rare.

And, again, it's happened to 29 people out of 5 million doses or more that have been given at this point of the vaccine. So again, very rare side effect.

And what it is essentially is it's a vast overreaction of the immune system to something that's introduced to it, and it can have all sorts of things. Many people will be familiar with this through like peanut allergies or beasting allergies, that sort of thing. It's very similar to that.

And that way is treated with epinephrine or an epipen. And everyone that I'm aware of who's had such a reaction has recovered fine. They've had to stay in the hospital for a bit, but they've recovered fine from those reactions. We'll keep monitoring that as time goes on.

And yeah, so again, the process was pretty quick. I then got an email after the fact saying, okay, you finished your first dose. Here's where to sign up for your second dose. I ended up getting the Moderna vaccine yesterday and everyone at the site where I went got Moderna.

I think that's going to prove out to be the more common vaccine in the long run. We've talked about this a little bit before, but I think it's mostly going to be related to the fact that it doesn't have to be stored at such a very sub-zero temperature compared to the Pfizer vaccine. I think it's going to be the more common one that's given as time goes on, just because it's easier to give.

New Data About Pfizer and Moderna's Effectiveness After One Dose

A couple other things. Some new data came out this week on both vaccines, but the Pfizer and the Moderna, and what they're saying is it looks like after the first dose of the Pfizer vaccine, about 50% or so of people have protection from the virus, which is great.

The Moderna vaccine is better in that way. Actually it's about 80-some percent who are having good protection from COVID after the first dose alone. So that's good news.

And that kind of explains why in the United Kingdom, and I think some other places they are considering this as well, they're just going to go ahead and roll out with the first dose of vaccine to start providing that protection as quickly as possible without necessarily worrying about scheduling people for their second dose.

They're going to tell people to come back and get their second dose at some point in the future. And there's some pros and cons to that.

It makes good sense to me, in general, based on the data. That being said, there's a lot of concern there from the FDA, from our people, that that might not be the smartest way to go because the protection might not be complete or as significant or as long lasting by just giving one dose to people.

So there are some pros and cons, but at the same time, then you do get more protection out to more people faster in that way. And in the UK, I know they're very worried about the more transmissible variant that has come across here of late, which we are starting to see here in the United States as well unfortunately. So time will tell. I don't think our FDA or any of our health departments are going to be changing their strategy at this point. I think they are pretty much committed to the two-dose series for folks. And they're going to stick with the timelines that they have, that they have had related to that. We'll talk about timelines here in a second.

Dr. Bishop's Side Effects

How did I do with the vaccine? I had a little bit of difficulty, I'll be quite honest with it, the first little bit. So just full transparency, for those of you that know about this, I have something called pots, which is a postural orthostatic tachycardia syndrome. It's a mild version in me. Many people have much worse, but the bottom line is my heart rate is a little jumpy sometimes.

So the vaccine did trigger a little bit of that with me. I had a high heart rate for a few hours after getting the vaccine, but that's something very unique to me and it's not going to be an issue for the vast majority of people. So again, that's something that did occur with me for a few hours afterwards.

But other than that, I have a sore arm. My arm does hurt a little bit today and I'm a little fatigued. But other than that, I have done well in these first 24 hours. And so hopefully that will continue.

Everyone that I know of who has gotten the vaccine, including most of my colleagues here, they have done very well with the vaccine. A few people have felt a little under the weather for the first day or two, a little nausea, little of things of that nature. And then pretty much everybody's had a sore arm. We'll see how things go the next couple of days, but by and large, for the most part, pretty similar to a tetanus shot in terms of the arm pain, the soreness, that sort of thing.

If anyone's had that before or the shingles vaccine, the Shingrix vaccine, which is a pretty common vaccine we give out to folks who are 50 and up, pretty similar side effects in that way. So that's that to date.

The Vaccine Rollout

Right now, in most places, they're still working on the Phase 1A group, which is the long-term care facility residents and health care personnel. And they essentially are waiting to move from, we actually spoke with some people from the health department this morning, some of our physicians did, and they are not going to move forward with anybody in Phase 1B until they are pretty much finished with Phase 1A is what they're telling us at this point.

So 1B is frontline essential workers, people 75 and up, people who live in correctional facilities, homeless shelters, migrant labor camps. And then that's going to also include police, fire, shelters, and then childcare workers and teachers are in that group, too. Food staff, manufacturing, postal workers, and it kind of goes down.

There's actually eight subgroups in Phase 1B. Now, based on what we heard this morning from the health department, they are not anticipating moving into Phase 1B until early February.

So basically we're looking at about another month before we move into Phase 1B. and that really is just because of vaccine availability issues.

Now we have about 500,000 doses in the state and they have only given out about a little over 100,000 of them. I know they are trying to ramp that up and move faster, but it is looking like it's going to be several more weeks before we really start rolling this out to other people.

And then 1C is people 65 and up, and then other essential workers. So my guess for most people is that you are looking at really March before you have access to the vaccine, unless you're 65 or older, and then you may get it in February or early March, but it's probably going to be March-April before most people get access to the vaccine. So it's going to be a little bit slow, painfully slow.

People Getting COVID Despite Extreme Precautions

I know some people that have COVID, even though they took extreme precautions due to health issues. What are your thoughts?

Yeah, and I think this is why it's so important that eventually our really only answer for this is to eventually get most people vaccinated. That is going to be the only way to stop the transmission ultimately of the virus, because the virus is going to continue to evolve in certain ways that make it more transmissible.

And even if people are being very careful and doing all the right things, you can still get infected unless you are just essentially locked in a sterile room and not interacting with anyone ever or doing anything at all. And it's really hard to do that.

It's almost impossible to do that. And so there's still a chance for infection for folks, even if they are following extreme levels of cautiousness and things.

Unfortunately, in the end, vaccination is going to be the only way to get through this issue. And it may be too that those folks that have health issues are even more susceptible than others. And as these more transmissible strains appear, those people are going to be more vulnerable than your average person. So, yeah, unfortunately I hope that answers your question.

The Race Between Vaccination and Infection

"About the race between vaccination and infection, do you expect yo either the UK or South Africa more transmissible variants to become rife in the US? If so, how much extra danger does this create for us? Also, how much harder would that make it to bring infection under control using the mitigation methods we have been using?"

Yeah, so I think my guess unfortunately is, I believe these variants are already here. At least the UK variant is here. I don't think they've identified the South African variant just yet in the US, but it is unfortunately only, probably, only a matter of time.

These transmissible variants, once they emerge, it's really difficult to control them, if not impossible. And it will probably become the dominant variant over the coming months, which is why I've kind of thought about this as we're sort of in a race between these variants and getting everybody vaccinated.

I don't know. I suspect that what we'll find is that our mitigation strategies are going to become less effective because these variants are more transmissible than before. And short of locking everyone in a room and keeping people completely separate and going back to the style of lockdowns that we had in March-April, I don't know that that our current medication strategies are going to work for these strains.

There's a whole lot wrapped into that comment. I don't know that our governments are going to go there. They may well, we'll see. Time will tell. It's really going to depend on the hospitalization rates and hospital capacities in terms of what the governments do in the coming months. So we'll have to see what happens.

I know that hospitals in the Richmond area here are fairly full. I'm not sure that they're full just with COVID. I know there has been an uptick of patients in the hospital with COVID, but I think there's also just been an uptake in hospitalizations in general. It's a little bit difficult to tease that out.

We're going to have to see the next month or two, it'll kind of be a day-to-day thing. We'll see how things go. But the bottom line is we will continue to advocate and urge that the health departments rollout the vaccines as fast as they possibly can because that ultimately is going to be the answer to this problem.

Will PartnerMD be administering the vaccine when it is available?

Yes. And that's part of why we were on the phone with the health department this morning, basically begging them to give us some doses of vaccine. And they essentially said it's not going to happen until early February at the earliest for that 1B group. So that's again 75 and up and they said it's not going to happen until then. So basically you're going to have to wait. So yes.

Signing Up for Vaccines?

"Can people sign up on the same website you did?"

Currently only if you are in one of those categories. Again, your employer can register you if you're in one of those categories. So someone had to register me on that website as a healthcare worker, and then I had to go in and confirm all that information and things like that.

I imagine as they go through the categories, 1B, 1C, etc., and start vaccinating more people, they will allow more and more people to register using that website.

It was very convenient. It was simple to do. But no, the general public cannot just go on register and sign up for the vaccine. And your employer has to put you in the system at this point to register you.

Expectations for COVID-related deaths? 

"We are close to 4,000 reported COVID deaths yesterday, which feels devastating, and I also see hospitalizations reaching new highs. How do you expect daily deaths to go? And when might we hope deaths to decline?"

Yeah, I don't know the answer, Andy. I wish I did. I think it's really, at this point, everything is going to hinge on the vaccine. I expect things to stay bad for a while. Especially as these more transmissible variants take hold and spread through the country. I don't think there's, honestly, I don't think there's anything that's gonna stop that.

And I'm not sure even if we did a March-April style lockdown, if that would stop the spread of these highly transmissible variants. I think it's going to continue to be bad for some weeks. And I think again, I really just urge all of our public health authorities to release vaccine as quickly as possible and to move through these phases as rapidly as possible. Because it's going a little bit too slow in my opinion, to be quite honest.

AFIB and Vaccines

"I have AFIB. Is that an issue for taking the vaccine?" 

It's not known to be an issue. You should be fine if, as long as, everything is well controlled in terms of medication, et cetera. There has been no issues in that regard. So yeah, no problems with AFIB.

PartnerMD and Pfizer Freezers

"Do all PartnerMD facilities have freezers sufficient to store the Pfizer vaccine? Do you think the Moderna vaccine will be more widely used because the storage requirement is less stringent?"

We have ordered and have on the way the freezers to store the Pfizer vaccine for all of our facilities. But I do think that ultimately the Moderna one will become the more common one, just because of ease of use and the storage requirements are simpler.

Concerned About Hospitals?  

"With the level of infection we have seen, the level of hospital usage, and the new danger posed by the more transmissible variants, how serious is the risk of hospitals becoming overwhelmed across the nation and in areas PartnerMD serves?"

Yeah. So I'm worried about that. Currently, I've been watching, what's a little bit interesting is I'm trying to tease out in the data, and I don't have any special data that you guys can't see, that's not publicly available in terms of hospitalizations and things like that.

But interestingly, the hospitalization rates have been declining the last several weeks according to the department of health website in Virginia as a whole. But many of the ambulance providers and hospitals are on either high-level alerts or codes that essentially are indicating that the hospitals are extremely full.

Now, there are three possible, well, three likely explanations for this.

A) The data on the VDH website is not accurate, and there are more COVID hospitalizations than we realize.

B) There are declining new hospitalizations for COVID, but people who are going in the hospital are basically staying longer. Hopefully because that means they're getting better and they're not dying, which that would coincide with the fact that the death numbers in Virginia have been ticking down over the last couple of weeks.

And then the third explanation is that the hospitals are full because of things COVID related and things not COVID related.

So those are kind of the three things that I'm just not sure which of those scenarios is the truth. Could be all, could be a little bit of everything in there. So it's a little hard to say, but I think the hospitals are extremely full. I know some of our local hospitals have opened surge units and surge areas. I am concerned about that and we'll all be watching that closely over the next couple of weeks for sure.

Does the Vaccine Prevent Spread?

"Any news on the whole, 'does the vaccine prevent people from spreading it or just getting sick from it' question?"

No. No new news on that. I think it's gonna be awhile before we know that...Probably a few more months to be honest whether we know whether the vaccine just prevents bad disease or whether it prevents disease plus transmission. I think it's just going to take a little time to sort that out. My guess is we won't really know that until the fall.

Treatment Improvements

"Has there been significant improvement in treatment, both for those hospitals and those treating themselves at home?"

I think there have been improvements in treatment and in general, how we take care of COVID patients. And of course, some medications have come online. Most of them are for hospital use for the most part.

Now, there have been more areas where we've been able to get access to the monoclonal antibody treatments. And locally here we've been able to send some patients to do that. You do have to go to an infusion center for those things, and I think they are available in a number of places, in several states around here.

I think there are improvements and I think that's reflected somewhat in the fact that the number of deaths, at least in Virginia, has been on the decline of late.

That being said, the number of deaths overall across the country is way up. And my concern is that's because the disease is just spreading so much faster and getting to the most vulnerable people before we can get to them with a vaccine. So that's, I think, unfortunately, what's going on. What we're seeing there.

Not Enough Use of Monoclonal Antibodies?

"I saw a report indicating monoclonal antibodies are being under utilized. What are your thoughts?"

I have no doubt that that's true, because it is difficult to get that treatment. So there's a couple of things going on there. First, they are IV infusions. So you have to go to an infusion center or a hospital to actually get this treatment. So that's kind of the first problem, so there's a lot of logistical hurdles with that.

It's expensive. It's difficult to arrange. It takes a lot of time to get it arranged. So that's why, part of why, it's underutilized. B) there aren't unlimited doses of it. So only certain people can get it. You have to meet certain medical and comorbidity criteria in order to be eligible for the monoclonal antibodies. That's another barrier as well. So that's the things going on there that are keeping those from being as well utilized as we might like to see.

Next Vaccines Getting Approved? 

"Any updates on the next wave of vaccines that might get approved? Which ones are next in line and your take on them?"

My guess is the AstraZeneca one will be approved next. It just got approved in the UK and they're going to start using it there. I suspect our FDA will look at it next for approval. It will probably get approved.

Again, I haven't seen their data at this point just yet, but it seems to be about as effective as the other two. And just about as safe. So we'll again, but we need to see all the data on that as well. So I suspect that'll be the next one. Beyond that, I don't know which ones may be next. There are a number kind of in the pipeline but that's probably the next one that I see....

Doug says, "J&J is reporting data at the end of January for hopefully February EUA." Okay, great. That's super helpful. So Johnson and Johnson is the maker of the AstraZeneca, or not AstraZeneca now, excuse me, they have another vaccine as well. So hopefully that one, that one's separate from the AstraZeneca one, so hopefully we'll see data on that one, too. So that one may be next after the AstraZeneca.

Clinics for Vaccinating Larger Populations? 

"Are clinics being set up to vaccinate larger populations?"

When we get to that point I suspect they will use the same model that they're using to vaccinate the healthcare workers now. And there will be some sort of registration system and you'll go to a local site. So where I went was a middle school gym. They had the whole thing set up in the gym.

I imagine that they will do that for many people. We are hoping that they give doses to clinics, to doctor's offices and such, so we can administer them ourselves rather than just relying on these big sort of site setups. Just because those things are logistically challenging for folks, but I suspect there'll be a little bit of both. I suspect that clinics will get doses to use. And there'll be a lot of use of these large-scale clinics sites, like gyms and public libraries and things of that nature to deliver the vaccine.