Examining logistics behind coronavirus vaccinations
The unfortunate and untimely death of freshman Congressman Luke Letlow from Louisiana is another painful reminder that youth and good health are not impenetrable shields against the curse of this virus. When we trivialize COVID-19, we choose avoidable disease and death.
Preliminary 2020 estimates suggest a 15 percent jump in mortality, relative to 2019. Life expectancy in 2020 fell by nearly three years.
Here in Kern County, we have been compelled to redirect most of our efforts and hospital resources to tend to the virus afflicted — again!
This time, a surge in infections threatens to overwhelm our expanded efforts. We need help from all of you. Personal behavior is a medical, civic, social and moral imperative. Let’s be responsible citizens.
We applaud the stunning victory of science in developing multiple, highly efficacious and safe vaccines in an incredibly compressed timeline. We have been fortunate that the viral genome has remained stable, allowing us the opportunity to develop vaccines. COVID-19, unlike influenza, has a larger genome equipped with proof reading capabilities. Proof reading maintains genetic fidelity of progeny, minimizing mutations that may compromise vaccine efficacy. Additionally, the mRNA based platform empowers scientists to recustomize vaccines expeditiously, if mutations threaten to mitigate efficiency.
The assiduously developed COVID-19 vaccines have safety profiles that compare favorably with previous vaccines. Standardized protocols to catch and treat rare occurrences of transient side effects are in place to further enhance safety. The trade-off between virus or vaccine is now a no-brainer: get vaccinated!
The bridge to the other side is yet long. A lot of damage can be inflicted if we rush our celebrations and loosen up on preventative measures.
Vaccine manufacturers across the globe have been scaling up efforts to produce vaccines at mass scale. The distribution and storage of the BioNTech/ Pfizer vaccine has special challenges because of fragility of the mRNA-based biologics. The Moderna vaccine has less stringent storage requirements. In due time the Johnson and Johnson vaccine will get authorization. If the trend holds up, this vaccine should also be highly efficacious with significant advantage in ease of storage and lack of logistical challenges of a booster dose. It’s likely to be a single shot. The AstraZeneca/ Oxford vaccine already has approval in a number of countries.
COVID-19 variants with increased contagiousness will likely require a 90 percent vaccination rate even with 95 percent efficacy of these vaccines.
The infrastructure required to administer vaccines is resource intensive.
Resources necessary to tend to the sick are needed to vaccinate. Strained resources are getting stressed further. Then state-mandated COVID-19 pay allowed health care workers 80 hours of paid time over and above standard salaries and benefits (a California exclusive). This provision, in some instances, encouraged a few to call in sick and avail paid free time, punishing the more committed to carry additional burdens. Also, it had the ungainly incentive for some to refuse vaccination. Vaccinated by definition are unlikely to get COVID and be “denied the benefit” of COVID pay.
A once-in-a-century pandemic demands shared sacrifice, not political bribery. COVID pay thankfully has not been renewed for 2021.
In round numbers, if 300 million people are to be vaccinated in the U.S. with the two dose regimen, it adds up to 600 million shots. At a fairly ambitious goal of vaccinating two million people a day, the process will take 10 months. We have to raise our targets and exceed expectations. The more time we take in universal vaccination, the more time the virus has to possibly mutate and send us back to the drawing board.
The thrust of vaccination has to be vaccination. Algorithms drawn to vaccinate people based on age, preexisting conditions, nursing home residency, socioeconomic issues, front-line and health care work, etc. are useful guidelines. These guidelines should be adhered to. But the thrust of vaccination has to be vaccination!
Guidelines should not become impediments to expanded and accelerated vaccination.
Vaccines should not sit in refrigerators and dosages should not be wasted in commitment to compliance. Vaccines should be administered with guidelines and efficiency in mind.
Threats to impound licenses and assign million-dollar fines on health care workers is a compliment we can do without. Political leadership should instead model good behavior and dedicate itself to putting out the raging pandemic. Real scandal is not that some scattered health care worker or administrator “broke the line.” That behavior, if it occurred, is reprehensible. The real scandal is that vaccines sit in freezers. The real scandal is that blind adherence to guidelines will compel trashing the unused vaccine.
It’s too late in the pandemic to play the blame game and threaten the committed. There is a solution: vaccinate, vaccinate, vaccinate.
Dr. Brij Bhambi specializes in cardiac and vascular intervention, nuclear cardiology, consultative and general cardiology and holds board certification in interventional cardiology, cardiovascular disease and internal medicine. He is a chief medical officer at Bakersfield Heart Hospital.