COVID-19 Update 12/30: Vaccines, Cases, Immunity, and More

After a week off for the holidays, we're back with another COVID-19 update. This week, Dr. Steven Bishop discussed the latest on vaccines, including the U.K.'s approval of the AstraZeneca vaccine, the rollout of the Pfizer and Moderna vaccines in the U.S., and more. He also discussed the rise in cases related to the holidays, how long immunity is expected to last, and more. 

Watch the video below and read on for a full transcript. 

Vaccine Updates

Let's just start out with some good news. Both the Pfizer and the Moderna vaccines are rolling out across the country, which is fantastic. A lot of healthcare providers are getting vaccinated and doing very well with the vaccine.

There've been some folks who have had allergic reactions and things of that nature, which is bad, but it's not unexpected. Any medication has this potential as a side effect. There's always a certain number of people who are going to be allergic to any given drug, whatever it is, whether it's a medication or vaccine or what have you.

But by and large, they've all done well with it. Many of the physicians at our practices have started getting vaccinated and have done very well with the vaccines with overall pretty mild side effects, fatigue, sore arm, that sort of thing. I will be getting mine soon.

We are getting ours through one of the local hospital systems and we are still waiting, unfortunately, to hear from the health department in all of our states where we have practices when we will have vaccine available for our patients. So hopefully we'll be hearing something about that soon.

The Virginia Department of Health, for those that don't know, I don't know if the other states have done this yet, but they actually included a new vaccine dashboard summary, so everyone can see how many vaccines have been administered in the state.

And as of this morning, 54,000 vaccines have been administered across Virginia and there were 1,400 administered yesterday across the state. So that is good news.

And again, most of the people have received one. No one's gotten a second dose yet, but a lot of people have gotten their first dose. CVS and Walgreens started partnering up and delivering vaccines to many of the nursing homes and long-term care facilities this week. I know of one here locally where they were sent to. And so that is rolling out as well. And I think that's going to be a huge thing to cut down on the severe disease. And the mortality that we've been seeing is getting those folks that are in the highest risk basket vaccinated as soon as possible.

U.K. Approves AstraZeneca Vaccine

Other pieces of good news. The United Kingdom approved the AstraZeneca vaccine today based on their updated data of 95% effectiveness in their trials.

I'm assuming that our FDA will be reviewing AstraZeneca's data here soon in the next couple of weeks or so, and might make a determination to add that as a third option to the vaccine armament, which is fantastic. So we'll have hopefully three different options available to us in the coming months.

So lots of good, good, positive things. We're going to keep watching vaccine reactions and things like that. Probably people will have more side effects and things from the second dose when that comes around and that's to be expected based on the data we've seen and things of that nature. We'll kind of know more as that rolls out. I'm still expecting probably springtime before we really have sufficient supply of vaccine to start giving it out to our patients in general. So we'll see about that, but I'm expecting the springtime just because it is taking a little bit of time to ramp up the production.

Case Counts

Changing our focus a little bit from vaccines to just overall numbers in case counts, we had a pretty big peak over the last couple of weeks in Virginia in terms of case counts. And I think the other states have followed pretty closely to that. The hospitalization rate did go up a good bit. Didn't quite reach what was going on in the springtime in May or so, but it got up pretty high.

And I think people were nervous there for a week or so that numbers were gonna get pretty high on the hospitalizations. That has come back down.

Of course, we'll see how things go over the next couple of weeks. People did get together with groups for Christmas and probably will do so for New Years, so I think a lot of people are very worried about what's going to happen over the course of January.

Please continue to be careful. If you're going to gather with people, keep those gatherings small, under 10 people or fewer, and do the distancing when you're out in public. When you can't distance from people, do wear the masks, wash the hands, please keep doing all those things to keep those numbers down and the hospitalization rates down as much as we can.

The good news, if there's a sort of silver lining, we continue to do well with figuring out how to treat the disease. And there was an uptick in deaths from the virus in November, December, which corresponded pretty well with the increase in hospitalizations that we saw after Thanksgiving.

We will probably see another bump of that after Christmas slash New Years. I hope not. But probably will. So that unfortunately will probably be the case here in the next few weeks. Again, I hope that's not the case, but it most likely will because we'll probably see more hospitalizations happen.

That being said, those who are at the highest risk for hospitalizations are that elderly population. And those that are getting vaccinated in the nursing homes and such. So it may be that we blunt that increase that we might have otherwise seen by starting to vaccinate those people. And in many states, I think Florida, for example, and Texas, they're actually going to go ahead and start vaccinating their elderly population before they finish vaccinating their central workers.

So I think that's actually beginning now. So we may see a blunting of this from the vaccine, which would be a really fantastic news. Hopefully we will see that come to fruition here that the vaccine will take, there is some protection after the first dose.

I know Pfizer updated their fact sheet and said that there was 83% protection roughly after the first dose. So there is some protection after the first dose. So I would hope that over the next few weeks we would begin to see as those vaccines do get rolled out into the nursing homes and such that it takes about two weeks to take effect, but by mid-January, we would start to see a blunting of hospitalizations, especially amongst that older, highest risk population who are hopefully gonna start to get vaccinated here in the next few weeks

Vaccinating for Herd Immunity

"How quickly can we feasibly expect to get two doses in the arms of enough people to achieve herd immunity? President-elect Biden's goal was 1 million doses per day over the first hundred days of his administration. But if you do the math, it would take about 17 months to vaccinate the population at that rate. Is it feasible to vaccinate 3 million doses per day or more to get the population vaccinated by the fall? Why or why not?"

Yeah, I think that is really the sort of the limiting step here, is the manufacturing and the distribution of the doses. So that's going to be the main limiting step in terms of how quickly we can vaccinate people.

I think we can give the shots pretty quickly. The local health systems organized their vaccine campaigns for healthcare workers pretty rapidly and offices and health departments can do the same for people out in the public when the vaccines become available, but the constraint is really going to be supply.

So if the supply is there, I mean, we can give out the vaccines is almost as fast as they give them to us. So I think, if President Biden's goal is to have that number of vaccines or more per day, then it's really going to be dependent on the manufacturers being able to produce that number of doses in those times. I think I saw something recently, he was planning to use the National Defense Production Act to help you know sort of marshal some resources to make sure that those vaccines do get produced as rapidly as possible.

And that was similar to what President Trump did back in the spring summer when they sort of used that act to get GE and some other companies to make ventilators. So they may be able to recruit other manufacturing facilities to assist Moderna, Pfizer, and hopefully AstraZeneca with producing doses of the vaccine using that law. That's what I'm guessing they will do.

But I don't think there's near enough doses at this point to vaccinate anywhere near a million people a day, let alone 3 million people a day. So they really are going to have to focus on ramping up production in the next few weeks to a month or so in order to reach those goals. At this point, I'd say I'm not sure that that's realistic. But time will tell, we'll see what happens with the manufacturing rates though. That's a very good question.

Contact Between Vaccinated People and Unvaccinated People? 

How confident could we be with the two doses of vaccine, if others with whom we may have contact not having had the vaccine and may not be taking any precautions? I feel timid enough to just stay inside until most everyone's vaccinated, but I know a large group of people have decided not to get the vaccine. I'll say, what precautions will you take in public for the next two years?

I think that the good news from the vaccine, what it seems to be once you get the vaccine, what we fairly well know from the data at this point, is that the person who gets vaccinated is pretty well protected from severe COVID disease and COVID disease in general.

What we don't know is whether people who are vaccinated can still transmit the virus to other people. We don't know that yet. We just don't know, and it's going to take a little time to figure that out.

I think once you're vaccinated and you've had the two doses and it's been the, basically, the month or so that it takes to develop the immunity from the two doses. I think you can be pretty confident that your risk is lower.

I wouldn't unnecessarily test it out if you don't need to, especially if you're in a higher risk category. So once you get vaccinated, and that month or so has elapsed and you have antibodies, I think it would be reasonable for you to go out, do some things, continue distancing from other people and being careful about washing hands and things like that. But I would be more concerned about myself being a vector for the virus rather than me getting ill from it.

From my standpoint, after I get vaccinated, I'll feel more protected for myself, but I'm still going to be concerned about potentially transmitting it to other people. Which could be the case if, you know, even if I don't have any symptoms. That's the big concern. I think that time will tell. We just don't know the science on that just yet. But I think for those that are vaccinated, they will be pretty well protected. But you may be more of a danger to the unvaccinated people than the other way around after the vaccine rolls out pretty heavily.

AstraZeneca Vaccine

"Now that Britain's authorized AstraZeneca, what's your take on it?"

Yeah, I'm waiting to see all their data. I haven't seen AstraZeneca's data released to the FDA just yet. So once they release that and put that out and have their hearing, I'll feel more confident about my thoughts on that vaccine just yet.

I had an opportunity, because they posted it publicly, to review Moderna and Pfizer's 50-some page documents that included all their data about the efficacy of the side effects, that sort of thing. I haven't seen all that from AstraZeneca just yet.

I mean, I think it's a good sign that the British have approved it, the British have a pretty robust drug regulatory mechanism like we do, so I would trust that they they've done a thorough review of the data. And so I feel good about that, but I want to see all the data released here and let our FDA look at it and see see what they think of it too.

How different will 2021 be vs. 2020?

"If we don't vaccinate to herd immunity, how different will the pandemic be in 2021 from how it had been in 2020?"

Yeah, I think it's going to be interesting to see in one way. My guess is what we're going to see is that people over that 65 and up group are probably going to get vaccinated at really high rates. I think most of those people will probably get vaccinated. And I think that's going to really hopefully blunt the most severely ill people in terms of hospitalizations and deaths.

So what we may see is, well, my guess is that the younger folks are going to be more hesitant about getting vaccinated and won't get vaccinated as as frequently as those in the older or high risk group.

And so my guess is we'll continue to see large numbers of cases throughout 2021, but hopefully the hospitalization and the death rate will start to tick down in the coming weeks and months as those highest risk people get vaccinated.

And so, you know, it's not going to go to zero, obviously. But that's my guess, is you'll still see large numbers of cases. It'll probably come down but you'll still see big numbers of cases that will probably continue to come in waves, but that'll be mostly the younger crowd getting it and hopefully not getting as sick. And then the hospitalization and the death rate, hopefully start to fall off as those high risk groups start to get vaccinated.

Herd Immunity Without Vaccinating Children?

"What's the plan for children and the vaccine since it hasn't been approved for those under 18. Can we get to herd immunity if we don't vaccinate children?"

I don't know the answer to the question. The Pfizer vaccine has been approved for those 16 and up, so 16 and up can get the Pfizer vaccine. Moderna's is 18 and up. I don't know what Pfizer will get approval for. I do know they have started doing trials on those 12 to 16 to determine safety and efficacy.

So my guess is in the next few months, we'll have more information on that. And then there may be a subsequent amended approval for the vaccines for the younger age groups.

As far as getting to herd immunity without vaccinating children, I'm not sure. I have to look and see exactly what percentage of the population children make up.

Many children probably will get vaccinated when the approval comes, but the main thing will be protecting people from hospitalization and mortality. So if we can really blunt down those curves on the hospitalizations and the deaths for those who are highest risk and protect those people from a bad outcome from the virus, I think that's going to be a huge win. It's going to take a while to get to that 70 to 80% vaccination rate that Dr. Fauci and others are discussing.

COVID-19 Variants

"If the new variant of coronavirus is more transmissible, but has roughly the same virulence, wouldn't that make it more dangerous than the current strain? Should we be concerned that the variant will put even more pressure on the hospitals if it spreads here?"

If the variant, I think the variant is here at this point, and if the disease does spread faster, I think that you, to your point, that will result in more people being hospitalized. It basically accelerates the pandemic in terms of we're now racing against that - the vaccine and that new, more transmissible variant are sort of in a race at this point. That's the way I'm viewing it.

We're in a race to get people vaccinated before this new variant catches them. Especially again, those high risk people. But to your point is well taken that even if it's not worse, per se, in terms of making people sicker, it's still gonna get more people faster than it otherwise would have, so we have less time to roll out the vaccine and other measures.

So we're sort of in a race to vaccinate again, those highest risk people, before these new transmitted highly transmissible versions really take hold all over the place. So yeah. Good question. All right. What other questions do you guys have today?

Safe to See Someone Who Already Had COVID? 

"If a friend or relative has already had COVID, is it safe for me to see them?"

Probably. Probably. There's no settled science on that, but probably yes, because they have immunity and we think they're probably unlikely to be a source of transmission, so that's probably true.

Which Vaccine Will PartnerMD Get? 

"Which vaccine do you think you will get in your offices?"

I really don't know. We're kind of at the mercy of the health department in each state to tell us which ones we're going to get. We've prepared for either one, so we've got the sub-zero freezers on the way. Waiting on those. Those have been shipped. We haven't received them yet. But we will be prepared for both the Pfizer and the Moderna vaccine, whichever one we get in each office we should be prepared for.

Measuring Length of Immunity

"How will we be measuring the length of immunity from the vaccine?"

What I'm suspecting is that people who've been in the initial trials, they will monitor their antibody levels over time and see how long they last, and they will also keep track of people in the future in terms of whether they get COVID or not over the coming next couple of years. It's going to take us another six to 12 months before we really know how long the immunity lasts from the vaccine, unfortunately.

Surge from Holiday Travel?

"Did you comment on the holiday travel? Do you expect to surge based on that?"

I do, unfortunately. I think we probably will see a surge like we did with Thanksgiving. Hopefully not as bad, because I think we've continued to get the message out and I think people saw what happened after Thanksgiving, so hopefully there will be less of a surge, but I think we probably will see a surge in some places.

Now what I'm hoping is that the surge will be blunted by the fact that we've started vaccinating some people. Now have we vaccinated enough to really blunt a surge? I'm not sure at this point, but I would suspect that we will see an uptick in cases and hospitalizations over the next couple of weeks because of the holidays, most likely, unfortunately.

Is Immunity Forever? 

"Is immunity is forever?"

We don't know. Unfortunately we really just don't know yet. I know there are folks actively investigating that both from evaluating antibody levels and from evaluating T-cell activity, which is the other major component of the immune system. So we just don't know yet and we just really don't know...either immunity from natural infection or from the vaccine. We just have no idea how long it will last just yet.

Good question. Many inquiring minds want to know the answer to. Lots of good stuff today. Let me scroll up and just make sure I didn't miss any other questions up here. I think. Okay. I got them all.

Has Dr. Bishop Been Vaccinated? 

"You may have mentioned this, but have you been vaccinated yet? Any reaction?"
I have not yet. I'm actually getting it next week. I'm on the schedule to get it next week, but many of our physicians have gotten it already and have done well. Most of them have had a sore arm. One or two had a little of some fatigue and kind of feeling a little crummy for about 12 hours. But by and large, most people have just complained of a sore arm from this first vaccine. So most people have done very well with it to date. So that's good.

How Can We Get Back to Normal Without Immunity?

"If we aren't sure about the length of immunity, how can we ever go go out without a mask and distancing?"

I just don't have a good answer to that yet. I think that we're just going to have to wait and see how things play out in terms of the studies. I think we can be reasonably assured that the immunity will last a good while. Whether it lasts longer than a year or so, who's to say, we just don't know yet, but I think once we get this initial wave of vaccines out and get things under control, I think we'll be better able to start figuring out if the immunity is going to wane and then we'll have a better gauge on when some of these measures can be lifted, so to speak.

So, yeah, it's just gonna take a little more time. Slower than we'd like, that's for sure, but that's okay. We got to wait and let things take their time. Make sure they are safe in terms of the vaccines and such. So I understand both sides of that that concern.