As the global pandemic continues to rage, the death toll in our nation continues to rise. According to The Washington Post’s daily tracker of coronavirus deaths, the seven-day rolling average of COVID deaths as of June 30, 2020, was 812. As of Dec. 10, 2020, this number has risen exponentially to 3,347 daily COVID deaths in our nation. This is over four times the number of daily deaths in December than we saw in June. These numbers are abysmal and quite frankly unacceptable. According to the Louisiana Department of Health and Hospitals, we are seeing a spike in cases and deaths in the New Orleans community as well. Hopefully, there may be some light at the end of this year’s long, dark, and dreary tunnel. On Dec 10, 2020, scientists from an independent advisory panel for the Food and Drug Administration (FDA) recommended approval for an emergency use authorization of the nation’s first coronavirus vaccine which is to be administered to person ages sixteen years old and above. If the FDA subsequently gives the green light, the vaccine will be available for use immediately.
So, who will be the first in line to receive this vaccine? Previously, the Centers for Disease Control Advisory Council on Immunization Practices (CDC/ACIP) made recommendations regarding who should be offered COVID-19 vaccination during this initial phase–given that there will be a very limited rationed supply of vaccine. The ACIP recommended that hospital workers along with residents/staff of long-term care centers should receive the initial vaccine. However, each individual state can accept these CDC/ACIP recommendations or modify them. Therefore, the decision for vaccination priority is ultimately made by each individual state.
Governor John Bel Edwards said during a press briefing on Thursday December 10, 2020, that Louisiana is ready to administer the first batch of the newly approved Pfizer COVID-19 vaccines to critical frontline hospital workers; which includes not only physicians and nurses, but also hospital food service workers and custodial workers (Priority Group 1A). The governor also said other members of this group include nursing home residents and staff and those living in congregant settings. Louisiana is scheduled to initially receive 40,000 doses of the Pfizer COVID-19 vaccine which could be administered to hospital personnel across Louisiana as soon as Saturday December 12, 2020. Of note, the federal government entered into an agreement in October 2020 with Walgreens and CVS to administer coronavirus vaccinations at nursing homes across the country. It is not known at this time specifically when nursing home residents in Louisiana will receive this vaccine, however plans are underway to administer this vaccine to nursing homes with the assistance of Walgreens and CVS personnel disbursed to these facilities.
Although, we will soon have another tool to combat this deadly virus, still a word of caution: we cannot let down our guard now that a vaccine is on the horizon. This does not mean that we can simply return to life as we knew it. The vaccination process involves two steps. There is an initial vaccine dose and then 3-4 weeks later, one has to receive a 2nd vaccine dose. Hence, it is believed that 7-10 days after the 2nd vaccine is administered that immunity is conferred. In other words, it will take 5-6 weeks after the start of the vaccination process for one to be fully protected from this disease. Therefore, between the first and second vaccine dose and even after the vaccine process is completed, one must continue to practice safe prevention strategies until community transmission rates have fallen significantly resulting in herd immunity. Only then can we begin to think about the return of normalcy in our lives.
Nevertheless, there are still some challenges and unknowns about this vaccine:
• Researchers are uncertain exactly how long immunity lasts
• There is insufficient data regarding the potential long-term side effects
• According to the data reviewed by the FDA advisory panel, the vaccine is 95 percent effective in preventing disease in persons who are vaccinated. However, it is unknown if one can still transmit the virus to other people [who are not vaccinated] even after the completion of the two-step vaccine process.
• Although approved by the FDA advisory panel for persons sixteen- and seventeen-years old, there is insufficient data regarding vaccine safety in this age group
• Residents in the United Kingdom were the first people in the world to receive the Pfizer vaccine and some of the reported side effects were anaphylactic or allergic reactions. It is reported that these reactions occurred in patients who were already predisposed to allergic reactions. Therefore, careful consideration should be given to patients who are prone to developing allergic reactions
• Fear and Distrust: Distrust in this vaccine program by African Americans and other marginalized groups is a very real factor. Given the justified historical distrust of the American health system, Black Americans have repeatedly voiced their distrust and unease regarding government vaccine initiatives. To many Black Americans, the Tuskegee Syphilis Experiment and the injustice regarding the unapproved misuse of the proprietary cell lineage from Henrietta Lacks still looms large. The medical community will have to rely upon trusted organizations like the National Medical Association, the National Black Nurses Association, and other local community organizations to help bridge the gulf of distrust within the Black Community regarding the merits of this vaccine program.
For the last several weeks, I have been asked by my patients, family, friends, and medical students, if I would receive the coronavirus vaccine once it is available, and my answer is a simple one-word response: Yes. I am a front-line hospital worker who works in a high-risk environment treating coronavirus patients in the acute and critical care ICU setting. Although the long term data related to side effects is limited, and I am keenly aware of the justifiable historical distrust that African Americans have had regarding certain new government health initiatives, this is the one tool that is available for high risk clinicians like myself that can render some degree of protection from this disease. Commonly reported side effects are fever, muscle soreness, and fatigue. Again, this vaccine has been shown to be 95 percent effective in preventing disease for coronavirus. And for me, the benefit of protection from this disease outweighs the risks. However, I am advising that each person discuss their individual risks with their healthcare provider to decide if the vaccine is appropriate for them.
The coronavirus vaccine will not be widely available to the public at large until April/May 2021 which is yet another reason why we all must continue to adhere to safe prevention strategies.
Although we now have a coronavirus vaccine approved for use, we are still a long way from having our society fully protected from the surging death toll of this disease. In order to protect ourselves, we need to depoliticize the coronavirus vaccine and mask wearing and rely on the science. Period.
Constance M. Gistand, MD, MPH, FACP
Adjunct Assistant Professor of Clinical Medicine
LSU School of Medicine