The promising news of three separate COVID-19 vaccines nearing U.S. Food and Drug Administration approval has the state and healthcare systems working on plans for distribution.
At Beebe Healthcare and statewide, the first batch of vaccinations will be prioritized for frontline workers who work with COVID patients. Dr. Karyl Rattay, director of the Division of Public Health, said people at the top of the list include those who work in a healthcare setting who are in contact with COVID or possible COVID patients, including doctors, nurses, EMS and first responders, and long-term care facility workers.
If there is a surplus – which is unlikely – the vaccine will then be distributed to high-risk populations.
Right now, there are three vaccines that have progressed to or past the third phase of development and will soon seek review by the FDA. The vaccination that is closest to approval is being produced through a collaborative effort by Pfizer and BioNTech. If approved, it could be made available for distribution as early as mid-December.
The other vaccines close to approval are being developed by Moderna and AstraZeneca.
Rattay estimates the state could receive as many as 8,000 doses of the Pfizer vaccine and 7,000 doses of the vaccination produced by Moderna.
“It’s going to be a small amount to start with,” she said.
Dr. Paul Cowan, Beebe’s emergency medicine specialist and chair of the Lewes Board of Health, estimates a vaccine will not be widely available to the public until late first quarter or even second quarter 2021.
The Pfizer vaccine requires storage between -60 and -90 degrees Celsius. Cheryl Hopple, Beebe’s emergency management coordinator, said Beebe has placed an order for a freezer to accommodate those temperatures. Beebe also has equipment in its lab to accommodate vaccine storage until the freezer arrives, she said.
The vaccinations produced by Moderna and AstraZeneca do not require storage in such a cold environment, Hopple said.
Dr. Bill Chasanov, Beebe’s expert in infectious diseases, says not all vaccines are 100 percent effective. The annual influenza vaccine varies and is sometimes only 40 percent effective. By comparison, the measles, mumps, and rubella vaccine is greater than 90 percent effective, he said.
While it may seem a COVID vaccine is being rushed, Chasanov said all stages of approval are being followed. In order to expedite a COVID-19 vaccine, he said, companies are beginning to manufacture the vaccine while it is being reviewed by the FDA and then the Advisory Committee on Immunization Practices. If the vaccine passes all reviews, it will be ready to go for distribution. If it does not, it will be destroyed, Chasanov said.
The Centers for Disease Control and Prevention has created a vaccination playbook on how states should plan and operationalize a vaccination response. The State of Delaware has created a plan of its own that’s been approved by the CDC, and Beebe has developed a vaccination distribution playbook using both CDC and state plans for guidance.
“We’re not sure how much of the vaccine we will get,” Chasanov said. “That uncertainty lies with the state too, as they are unsure how much vaccine they are going to get. We don’t have those answers at this point.”
Chasanov said he’s often asked if he has any reservations about getting vaccinated immediately after it becomes available. He said he does not.
“If the vaccine meets all the phases and all stages of review, and all the clinical trials say this is a safe vaccine, then I am absolutely going to get that vaccine when it is available to me,” he said.
The Pfizer and BioNTech vaccine has proven to be about 95 percent effective. The two-dose vaccination has been administered to about 45,000 people over the last several months. Chasanov said it’s been at least two months since the last group was given the vaccine, so there are several months’ worth of data available about side effects, he said.
Just because a vaccine may be rolled out slowly beginning in December doesn’t mean requirements for face coverings and social distancing will go away anytime soon, Cowan said.
“We are in the phase of face masks and social distancing for the foreseeable future,” he said during a Nov. 24 Lewes Board of Health meeting. “I don’t see anything in the near future to change that.”
Cases continue to rise statewide
Sussex County has followed the recent national trend of increased COVID-19 cases. Cowan said the positivity rate in the county has doubled since late September, from 3.5 percent to 7 percent.
“That’s certainly not good news, but probably not unexpected,” he said.
Hospitalizations at Beebe Healthcare have remained stable the last two weeks, and are only about a third of what was seen during the peak in the spring, he said.
Statewide hospitalizations reached 183 on Nov. 24, which is similar to where the state was in early April. It’s still much less than the peak of 337 hospitalizations on April 17; however, hospitalizations have risen nearly every day since Nov. 4.
Cowan said he is concerned about the continued increase in hospitalizations in New Castle County.
“History tells us diseases tend to spread from north to south in Delaware,” he said. “Next week will be really telling here in Sussex County.”
History also tells Cowan that there is traditionally a spike in respiratory illnesses between Thanksgiving and New Year’s Day.
Rattay said she understands the desire to be with family and friends during the holiday season, but she wants everybody to resist the urge.
“The virus doesn’t care if we’re tired,” she said. “The virus wants to spread, and when we let our guard down, that’s when the virus will spread.”
Beebe using same treatment Trump received
While discussing COVID-19 during a Facebook town hall Nov. 21, Chasanov said Beebe offers the same treatment that President Donald Trump received during his stay at Walter Reed.
Remdesivir, an antiviral drug shown to reduce length of hospitalization for patients, has been used at Beebe for several months, he said. They’ve also used steroids, which he said research has proven beneficial in treating the coronavirus.
Trump was also the recipient of the antibody cocktail known as Regeneron, which just received emergency-use approval by the FDA and will be used by Beebe staff when it becomes available, Chasanov said.