Community

Have You Two Been Vaccinated?

In the past couple of weeks, Renata and I have been asked “Have you been vaccinated?” by several different people.  Now I don’t mind saying yes – but I’m not sure that the question really is what it sounds like.  I think the question is “Can we visit your place with certainty that we won’t catch covid?”  Perhaps the question is “Have you been immunized?” 

Vaccinated and immune have two different meanings.  The history of smallpox vaccination shows the differences over a thousand-year timeline.  The first vaccinations recorded are in China, after 1000 CE.  They’d grind up the scabs from someone with smallpox, and blow the dust into your nostrils – along with something like a 2% mortality rate.  Since the death rate from smallpox was about 30%, it seemed like a decent risk.  This practice was variolation, not vaccination.

This development was state of the art until Jennings developed vaccination about 800 years later.   You remember, he took matter from the sores on a cow that had cowpox and injected it into people.  The latin word for cow – vacca – became the root of the word “vaccination.”  Since cowpox wasn’t smallpox, it took the risk of death down to about zero – but the minimal controls of the early 19th century kept the effectiveness down.  Jennings methodology didn’t guarantee the inoculation actually included cowpox.   Even as smallpox was eradicated, the vaccine was only 95% effective – but a 95% effective vaccine wiped out smallpox. 

Life is a game of percentages – the only certainty is death . . . but we don’t know when.  When my colon cancer was diagnosed in May, 2009, the prediction was June, 2012.  The prediction changed when Rick Holm convinced his colleagues to humor me and look at the 2002 chest X-rays.  Just old scars, no new metastasis.  It changed the diagnosis from stage 4 to early stage 3.  All from looking at one 7 year-old X-ray. 

CDC says my two doses of Pfizer should be 84% effective.  Israel’s health ministry rates it at 39%.   Personally, even 39% effective is worth getting the vaccine – I have made a point of getting flu shots that were no more effective.  But the answer to “Have you been vaccinated?” isn’t really a simple yes or no if the question is actually “Have you been immunized?”

I think my friends are happier visiting with the knowledge I’ve been vaccinated, and not knowing the percentage effectiveness.  Vaccinated generally translates to less chance of getting sick – but few vaccines are 100% effective.  The recent infectiousness of this last covid outbreak has demonstrated that vaccination is not synonymous with immunization. 

A Science for Everyone, Community

Other Vaccine Effectiveness

I got the Covid vaccine as soon as I could.  I think I might have been vaccinated earlier but for the manner in which the local government picked folks to vaccinate – I wasn’t sitting by the phone when the call came in, and that healthy, outdoors behavior put me a couple weeks later than I wanted.

I’m one of the people who was in line for the polio vaccine – and it wasn’t far out of the experimental stage.  A classmate who is with you in kindergarten one day, then gone, and the dread word polio makes for a willingness to step up for vaccination.  As a kid, I didn’t know that the Salk vaccine was only 65% effective against one strain, and about 90% effective against the others.  Multiplication and division were still challenges back then – but I got the vaccine.

I don’t need a perfect vaccine – the vaccine is to improve my odds.  I get flu vaccinations, and the table from CDC https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html shows how that works.   The important part is “Adjusted Overall VE (%)

Table. Adjusted vaccine effectiveness estimates for influenza seasons from 2004-2018

CDC calculates vaccine effectiveness estimates through the U.S. VE Network

Influenza SeasonReferenceStudy Site(s)No. of PatientsAdjusted Overall VE (%)95% CI
2018-19Flannery 2020 WI, MI, PA, TX, WA3,2542921, 35
2017-18Rolfes 2019 WI, MI, PA, TX, WA8,4363831, 43
2016-17Flannery 2019 WI, MI, PA, TX, WA74104032, 46
2015-16Jackson 2017 WI, MI, PA, TX, WA68794841, 55
2014-15Zimmerman 2016 WI, MI, PA, TX, WA93111910, 27
2013-14Gaglani 2016 WI, MI, PA, TX, WA59995244, 59
2012-13McLean 2014 WI, MI, PA, TX, WA64524943, 55
2011-12Ohmit 2014 WI, MI, PA, TX, WA47714736, 56
2010-11Treanor 2011 WI, MI, NY, TN47576053, 66
2009-10Griffin 2011 WI, MI, NY, TN67575623, 75
2008-09UnpublishedWI, MI, NY, TN67134130, 50
2007-08Belongia 2011 WI19143722, 49
2006-07Belongia 2009 WI8715222, 70
2005-06Belongia 2009 WI34621-52, 59
2004-05Belongia 2009 WI76210-36, 40

The important thing is that, in 15 years of data, the best record the vaccine had was 60% effectiveness.  The worst was down to 10% effectiveness.  If I’m playing blackjack, and I can get a 10% edge, that’s good.  If I can get a 60% edge, that’s great.  I don’t expect a vaccine -particularly one that had a rushed development-  to be 100%.

Smallpox was ended with a vaccine that was about 95% effective – “Effective smallpox vaccines have a vaccinia titer of approximately 108 pock-forming units per mL, and more than 95% of individuals develop a ‘take’ with neutralizing antibodies after primary vaccination. “ It’s worth remembering that it took several centuries to develop that vaccine.

Vaccines are more a statisticians game, or a gambler’s science.  Today’s polio vaccine is about as close to 100% effective as you can get.  The vaccines aren’t magic bullets – but they are better bullets.  It may take a while – but I’m betting the Coronavirus vaccines will become increasingly effective.  The problem is that the scientists are working on better vaccines, and politicians and administrators are working on press releases.

Community

Board of Health Meeting: Reports, Vaccines, and more

In a meeting that lasted the better part of three hours, the board of health appointed officers, selected a candidate to recommend to the commissioners for replacing a board member, heard reports and answered questions.

After an hour and forty minutes (when the audience had, admittedly, started to thin substantially), reports began.

Team 56: It’s not entirely clear why Team 56 reports to the health board, or what their precise relationship to the board is. However, it was reported to the board that Team 56 delivered masks to high schools, “spread kindness, not covid” posters, as well as delivered thank you notes and balloon bouquets to the ER staff.

Covid Response Report: Jeff Peterson (yes, this is the same Jeff Peterson that the board recommended the commissioners appoint to the board) reported on the work he’s doing for the county (on contract). It sounds as though most of Peterson’s time has been spent filming videos for the website. The current focus is on frequently asked questions and “translating the science”.

Medical Provider Summary: Provided by board member Dr. Sara Mertes. Many of the first responders have received their first vaccine and the second will be administered soon. The vaccine used was the Moderna vaccine, and they hope to be administering vaccines to the community in the next several weeks.

Covid 19- Vaccinations– The county health department is working with clinics and hospital to put together a central list so that when vaccines arrive, people will be on the list for vaccines. They are prioritizing age and underlying conditions. The public can call the health department to get on the list, and the county will ask only for age and name (though information about a qualifying health condition could be provided). While there is a CDC program people can opt into for tracking symptoms/side-effects, it’s totally optional.

They were very blunt on the current states of vaccines in Lincoln County. They county has no idea how many vaccines we will receive, where they will arrive, or when. We can, however, expect that it will be the Moderna vaccine.

ChemPACK plan– No changes, but the plan is reviewed annually. This is part of the emergency medical counter measure plan. The chempack is a CDC owned cache containing nerve agent antidotes. Board approved the plan.

Liaison (George Jamison, county representative, leaving the board in order to devote more time as a volunteer with the asbestos program ): The PEN regulation– property valuation notification process- was formally adopted last March. One of the provisions was deferment on when it would become effective. This evening’s action item was to make it effective, as of February 1st. This regulation will impact the folks down in the Libby Asbestos Superfund Site.

Health Officer: Dr. Black spoke. He stated that while vaccines are not that far away, it’ll take time to get enough people vaccinated in the community. Dr. Black imagined looking at people’s faces with out masks in 6 or 7 months, but says we won’t be there until we get 80% of people vaccinated. He thinks that a high participation in vaccination will be necessary in order to get back to normal.

At 8:40, Jim Seifert discussed the rating system he’d proposed at the last meeting. He had decided not to put it on the agenda. One reason is that the health department is already overwhelmed and he didn’t want to add to their burden. He says he still believes that if one hospitalization or one death would be prevented, a rating system would be worthwhile. However, implementation would take several months and the vaccine is coming out.

Proposed update to operating procedures– tabled (It’s getting late. The room is cold)

Public Comment:

DC Orr: DC Orr critiqued Dr. Black’s response to someone’s question on vaccine safety (Dr. Black responded to a question by telling the person asking to read the vaccine studies). DC Orr suggests that Dr. Black could present on the topic. He also noted that the board is not familiar with its bylaws and did not follow the rules of order. He suggests they read a handbook on board membership. He then asked why Team 56, not being a governmental unit, was on the Agenda. Quoting Jim Seifert at the previous meeting, he described Seifert’s words as “demonizing” the community and called for him to apologize.

Trista Gillmore: Trista Gillmore, as Lincoln County Public Health Nurse would like to answer people’s questions about mRNA vaccines and provided her email (she may need a few days to answer questions): tgilmore@lincolncounty.org

Diane Watson: Diane Watson noted that the website for the county health department states that it says the public has 7 days to submit questions if they want them discussed at the meeting. She asked when the agenda and minutes would be posted?

The board clarified that the agenda must be posted 48 hours (2 days) in advance of the meeting but will be posted at least the Friday before the meeting). Draft minutes are always posted with the agenda.

While there seemed to be some confusion on how to answer the question (the problem of having to ask questions 7 days in advance of the meeting with the agenda not yet posted). Finally, Jan Ivers (board chair) explained that it is what the board is looking at with revising operating procedure number 2.

With that, the meeting was adjourned. The meeting times have been changed to 6 pm on Tuesdays, the second Tuesday of the month. The next meeting will be February 9th.

Demography

Vaccination by the Pyramid

The term “population pyramid” goes back to a time when plotting populations by age really did produce a triangle, with a large base of young people and each older age cohort narrowing, until there were very few at the top.  As diseases became more controlled, and birth control entered the picture, the population pyramids changed shape,  The pyramid below is for the US in 2010.

(Data from http://www.proximityone.com/chartgraphics.htm )

Now, if we look at covid death rates by age cohort, Florida’s governor released survival rates back in September:

The numbers for the age cohorts are below – no need to extrapolate from the bars in the pyramid.  We’ll just take the complement of the survival rates, assume the vaccine is 100% effective, and calculate the potential lives saved in each cohort.

AgePopulationDeath RateLives Saved by Vaccination
70+22.8 million5.4%1,502,967
50-6985.8 million0.5%429,045
20-49127.5 million0.02%2,550
0-1983.3 million0.003%250
The Death Rate is 100% minus the survival rate for each age group. Lives Saved by Vaccination is the population of the age group multiplied by the death rate.

If everyone over the age of 70 were vaccinated (and the vaccine worked perfectly) 1,502,967 Lives would be saved. If everyone under the age of 20 were vaccinated, 250.

No editorializing here – just simple addition and multiplication with data from the census.  I know where I would put the first vaccinations if I had a limited supply.

Community, Laws, Ordinances & Regulations

Lincoln County Board of Health Informative Meeting- Part 2

The County Board of Health met Wednesday, December 16th for an informative meeting. It wasn’t just an informative meeting though- it contained a proposal (one which the board anticipates discussing at the next meeting). The proposal (by Jim Seifert of Troy), while at the end of the meeting, was sufficiently surprising that we included it in part 1 last week.

The meeting began with Jan Ivers (board chair) discussing viruses and predicting another pandemic. Then, County Commissioner Mark Peck presented on the legal foundations of the Board of Health and gave a brief “how it all works” explanation. After, Kathi Hooper (Director of the County Health Department) explained the board’s budget.

Presentation about Testing: Lyn Thompson, a laboratory scientist, spoke via zoom about testing for the virus. She spoke with great enthusiasm about her topic, three tests: Molecular Diagnostic, Antigen test and Antibody test. According to Thompson, the four important characteristics of a lab test are: accuracy, timeliness, sensitivity, specificity.

A couple big things about the molecular part of it [testing], what it does not do: It does not tell you if the patient is infectious. It does not tell you if the patient is contagious. “

Lyn Thompson

Thompson clarified that the test itself simply detects or does not detect the virus. Antigen testing looks for a protein, rather than DNA, and is less specific and less sensitive but a quicker test. Antibody tests, meanwhile, are more useful for determining if someone has had a virus than if they are currently infectious.

A lot of these tests are only supposed to be done on symptomatic patients. Specifically the antigen test is really dependent on the person has to be symptomatic with covid-like symptoms in the first five days.”

Lyn Thompson

Thompson continued to explain that delaying an antigen test could result in a negative result, even in someone who had Covid-19, if they delayed long enough. Furthermore, an asymptomatic patient with Covid-19 could still have a negative result with an antigen test.

Presentation on Collaborative Medical Care: Sara (presumably Dr. Sara Mertes of Cabinet Peaks Medical Center, new member of the health board) spoke about the procedures used to both care for patients and avoid potential exposures. When a patient tests positive, the information is given to the Health Department, which does follow-up and contact tracing with the patient.

Cabinet Peaks Medical Center is able to send patients home with a monitor, which checks for drops in oxygen levels or tachycardia (rapid heart rate). Unfortunately, these monitors require WiFi or cell service, so are of limited utility.

Presentation on Contact Tracing: Jenn McCully, Lincoln County Public Health Manager, discussed what happens when the Health Department is notified of a covid case. Contact tracing assumes that someone is contagious either two days before symptoms, or two days before the positive test (whichever is sooner). Isolation is supposed to be at least 10 days, and to include being isolated from other household members. It will also include occasional calls and check-ins from the department.

Presentation on Vaccinations: Dr. Kelli Jarrett, of the Northwest Community Health Center, gave an overview about how vaccines work. Then, she went into more detail about the Covid-19 vaccine. The vaccine is an mRNA vaccine, which makes it somewhat different from the vaccines we are used to.

The reason that mRNA technology is actually really nice, especially in this circumstance is that it can be scaled up much faster than our current vaccine technology.”

Dr. Kelli Jarrett

Dr. Jarrett provided a detailed overview of the safety data for the Pfizer vaccine, and observed that the number of adverse reactions seen in the trials is comparable to commonly used vaccines (adverse reaction can include pain, fever or muscle aches; it needn’t be severe). The efficacy rate of the vaccine seems to be quite high.

The presentations wrapped up with contact information: Anyone with questions for specific presenters should contact Kathi Hooper, the director of the County Health Department.

Finally, the meeting closed with a comment from Jim, the Board of Health member representing Troy. Seifert proposed giving businesses an A/B/C/D rating, primarily based on mask wearing (both of employees and customers). His proposal seems to entail members of the county health department inspecting and rating businesses.

The Board of Health next meets on January 13th. According to Board Chair Jan Ivers, Seifert’s proposal will probably be on the agenda.