MUSC provides updated information about the vaccine via Q&A
What did the box of vaccine say when MUSC Health employees opened it?
That was the scene last week when the pharmacy supply manager and his team looked inside the package of what was believed to be the second delivery of Pfizer doses and found themselves staring at a shipment of vaccine-related supplies that included gloves, syringes-needles, etc., instead.
Naturally, on week one, where vaccine amount and delivery frequency were abruptly changed on state vaccinators, a few curve balls were to be expected. And though that hiccup forced MUSC Health to make over 10,000 appointment adjustments, in the end, no one scheduled to get a dose – either first or second – missed out on being vaccinated. Ultimately, MUSC received nearly 18,000 doses, which is almost exactly what it requested. And they all went into arms.
Going forward, if consistency in quantity of vaccine and delivery time continues, Danielle Scheurer, M.D., MUSC Health System chief quality officer, says things like shifting appointments on the fly shouldn’t have to happen again.
“It feels like everybody is starting to get better at this,” she said. “That includes DHEC, Pfizer, vaccinators. Look, in the end we all want the same thing: to get as many people vaccinated as soon as possible. And it feels like we might be beginning to hit our stride.”
With the vaccine landscape changing almost daily, each week we are checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.
Q. Can we mix and match the Pfizer and Moderna vaccines, when it comes to first and second doses?
A. The CDC is willing to say that your first choice should be same as what you got originally, but they understand life happens and things don’t always work out perfectly. So, in a pinch, either is reasonable. Their mechanism is the same – both vaccines work the same way and are largely identical – so it really isn’t a big deal if you have to mix.
Q. Will MUSC Health begin offering the Moderna vaccine at some point?
A. Hard to say, but I do know that we have asked SC DHEC if it would be possible because right now there seems to be more of it available than the Pfizer. We’re not going to just make an abrupt change or surprise anybody with this; we’re just always trying to look for ways to get more people vaccinated, quicker.
Q. How does vaccine distribution work? What are the logistics?
A. Every week, we tell SCDHEC how much vaccine we’d like to receive and then – based on how much has been allotted for our state and who has asked for what amounts – they make the determination as to which vaccinators get what. They place the order with Pfizer and then it is shipped directly to us.
Q. Were we one of the states that recently got fake N95 masks?
A. We were not. But sadly, things like this keep popping up – and it’s a problem. I think it was last April or May we had to get creative with our personal protective equipment (PPE). We got more than a million KN95 masks that were defective and couldn’t use any of them. (Note: KN95 is the designation for Chinese-made N95 masks, which were given emergency authorization to be used in the U.S. due to PPE shortages.)
Q. Is immunity the same whether you’ve had COVID-19 and recovered or if you’ve gotten the vaccine?
A. That’s a great question. I don’t think we know yet for sure. My guess is that natural immunity – that is, getting COVID and recovering – is probably better, but we just can’t know for sure. And we might not ever know.
Q. Why do we recommend second doses being administered between 19 and 23 days later when the Pfizer guidance is 21?
A. Pfizer actually allows for a four-day grace period on either side of the 21-day window because of, well, life. We’re busy. Maybe your second dose falls on a weekend, and you can’t get it until the following Monday. Or maybe it’s easier to do it the Friday before. Pfizer is just taking that into account.
Q. Let’s say a person was in a clinical trial (for instance, the AstraZeneca one) and they became eligible to get the Pfizer or Moderna vaccine. After they requested to become unblinded, they discovered they had gotten the actual AZ vaccine, not the placebo. Should they still get the Pfizer or Moderna vaccine?
A. We recommend that if you got the vaccine in one of these trials, you should not get a second vaccine. Not only does it take a vaccine away from somebody else who needs one, but there is a theory that you could get a hyperimmune response, meaning you could end up with fairly severe symptoms because the body’s immune system is so hyped up for COVID-19.
Q. Why isn’t monoclonal antibody treatment as widely available or talked about? It seems like it might do almost as good a job as vaccine. I understand many people get it after the fact, but if you got it preventively, would that also be smart?
A. Monoclonal antibody treatment is more like a Band-Aid. These manufactured antibodies don’t last as long, so it’s not ideal. But because the vaccine doesn’t do somebody with active COVID-19 any good, it’s a great alternative. Right now, there are over 35 sites in the state offering it. Think of it as a fire extinguisher. It definitely helps, assuming the fire isn’t already out of control. There is some really good evidence that these treatments have reduced hospitalizations, so more people should be aware about what it is. It works best if given very early on in the disease, and is currently only approved to outpatient or observations patients (not those already hospitalized).
Q. Should cancer patients be concerned about getting vaccinated?
A. No, they shouldn’t be concerned. In fact, for the most part, patients who have or have had cancer should be vaccinated. Now if they’re right up against a chemotherapy regimen, maybe they should give it a little time. But for the most part, it’s a good move to do it, after talking to your cancer doctor about the best timing.
Q. Do you think that vaccine administration should be expanded to primary care providers?
A. I do, but logistics are at play a bit here. Right now, the ultra-cold storage required for the Pfizer vaccine makes it unfeasible for most doctors’ offices. But the Moderna and Johnson & Johnson vaccines – the latter of which should be given emergency authorization soon – can be stored in a regular refrigerator. So yes, assuming the supply is there, I think they should be getting it. And I think that’s going to happen soon.
Q. When will we know – or will we – whether getting as many people first doses (United Kingdom) or getting people both doses (U.S.) works better?
A. Boy, wouldn’t it be nice to know that? Truthfully, I’m not sure we’re ever going to know.
Q. Should people with allergies be concerned about getting the vaccine?
A. For the most part, no. The main thing we ask people with allergies to consider is if they have a history of anaphylaxis, especially as it relates to getting vaccinations or receiving injectable medicines. All that said, according to the extremely thorough data that has been collected throughout the vaccination process, any patient who has experienced a severe allergic reaction in the course of being vaccinated was subsequently treated and eventually recovered. And maybe people don’t know this, but each vaccination site is required to have epinephrine and other emergency supplies on hand should a patient experience a severe allergic reaction.
Q. How will we know when things are getting better?
A. That’s what we all want to know, isn’t it? I think the proof is in the pudding. The answer probably isn’t going to lie in the number of COVID-19 cases or hospitalizations as much as the sheer number of South Carolinians who have been vaccinated. That’s the number that matters, and in that regard, we still have a long way to go.
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