vaccination

[robhwa]

Mortality is highly correlated simply with age. Interestingly, the 1918 pandemic was more equal among all age groups and had very high fatality rate for the youth. IIRC - more than half of the fatalities in 1918 were for people under 35 or 40 - and of those fatalities most occurred in a 3 month period.

It is true that mortality is correlated with age and co-morbidity (other serious medical conditions). However there have been enough young and apparently healthy individuals who have died from the COVID 19 that I would get a vaccination (when available) even if under age 30.

Another reason total deaths for Spanish flu and COVID are not comparable directly is demographics. US census data:

-------------Age
year----<44---44-64---65+
--- population distribution ---
--------- percent ---------
1910---81.0---14.6----4.3
2010---50.6---26.4 ---13.0

sorry about the hyphens...more than one space collapses to one space.

There just weren't that many 65+ to die, 4.3% vs 13% of the US population.

Now there are ten times as many people 65+, five times as many 44-64, and twice as many <44 years of age when you consider the USA has more than 3x as many people as then (330 vs 100 million).

This is why comparable statistics are reported per 100,000 population, not total.

BTW; 1957 (my wife's birth year) has the distinction of having the largest number of births (4.3 million) ever recorded in US history. This is the famous "baby boom". There have never been more births in the US, before or after.

Fertility rate (births per woman in her lifetime) of the US has absolutely tanked. It is currently 1.7, which wouldn't replace us over time. You need about 2.1 births per woman just to replace, and more to grow without immigration. Thank goodness people want to and do immigrate into the USA and stay, and few want to leave. We need hardworking young people to pay our Social Security & Medicare checks.

Probably many deaths associated with Spanish or COVID are complex. However, it is clear that younger people do die or have lifelong impacts, and certainly spread COVID to other people, and vaccination should reduce all of these. Life has risks and tradeoffs, and the benefits of vaccines for everyone likely greatly outweigh the risks.

 

[colbysmith]

Very good article Bob. Perhaps why our country had a knowledgeable team in place before the last administration shut it down!...

 

[colbysmith]

Rob, more interesting information.

BTW; 1957 (my wife's birth year) has the distinction of having the largest number of births (4.3 million) ever recorded in US history. This is the famous "baby boom". There have never been more births in the US, before or after.

My year of birth as well. Didn't realize there were so many of us. lol. We are living a lot longer than our ancestors. For good or bad. Colby

 

[krc]

The Great Influenza: The Story of the Deadliest Pandemic in History 
John M. Barry

Very interesting read as it also talks extensively about the state of medicine at the time (most doctors were doctors because of connections vs ability) and the beginnings of microbiology. First use of masks. How WWI clouded the response (due to secrecy) to the pandemic and perhaps led to the ending of hostilities (many too sick to fight), etc...

I still don't think there is any doubt this is highly correlated with age - regardless of the distribution by age historically. We should certainly see a much higher mortality rate in the young if this was not a primarily elderly disease.

In fact, if you look around the world, in populations such as Africa and parts of Arabia, the mortality rate is very low BECAUSE there are fewer elderly. Median age in Africa is an amazing 20 - nor do people live long enough to be relegated to "senior centers" where we see a bulk of the deaths. Last I checked, I think the total deaths in Africa were fewer than in just the UK - ALONE.

The further case for taking a vaccine however to me is more to prevent the arrival of a more virulent strain through a mutation. There were likely different mutations in 1918 that had different mortality rates (as noted in the previous posted article).

 

[bobjarrard]

I got my first COVID-19 shot yesterday here in Boulder City, Nevada - at 74 7/8s I was the youngest person in my group. The minute we add the "I" word to the decision to vaccinate or not, then the discussion ends for me. We vaccinate to control a disease in a general population, the personal benefit is of secondary importance. Keeping reservoirs of the virus is dangerous, look at Ebola and Polio. If all it takes is a shot or a sugar cube to keep even one child out of iron lung, then I am all in - Bob is right, we must look at all the data and not just the excerpts that fit our personal spin.
The concept of a "social contract" is not an easy one to understand or to follow but we know that without faithfulness to such norms and rules, we will not be able to sustain our society, much less our freedom.
I pray that this forum never falls to the level of negativity and antagonism so many groups see - often to the end of their profitable fellowship. In the end, it is about C-Dory and C-BRATS.
Fair weather and low fuel prices to you all. Bob Jarrard

 

[krc]

I anticipate that if you want to board a plane, go to an amusement park, enter a DMV you be required to have been vaccinated ... likely some identification card or a notation on your license.

Just like vaccines for children, though, for some reason, the government does indeed allow opt-out and very high end communities (ie wealthy) tend to also have anti-vax views in general. Though not sure where the anti-vaxer crowd thoughts are on covid specifically.

 

[smckean (Tosca)]

We vaccinate to control a disease in a general population, the personal benefit is of secondary importance. Keeping reservoirs of the virus is dangerous.....

Here, here, Bob

 

[thataway]

We should certainly see a much higher mortality rate in the young if this was not a primarily elderly disease.

Yes it is a disease of high mortality in the aged for multiple reasons, including co-morbidiiy and crowed facilities. For instance there is a very high incidence of disease in prisoners, with a mortality of over 2,500 out of about 380,000 prisoners who had the disease. The carrier state can be at any age: Just a few minutes ago I read the following statement:

At least 65% of new U.S. infections originate from people 20-49, according to researchers at London's Imperial College.

There are multiple reasons to have the vaccination--as those above have well pointed out--however this means the vaccination to the point where the disease is under control. It is most likely that the Corona virus of this general type will be with humanity for a very long time--probably as long as the influenza virus (of various strains). It has shown a high rate of mutation. Most likely mutating more rapidly than the vaccines can be made and distributed. We don't know how that is going to pan out, but I believe that masking and social distancing are going to be part of our lives for some period of time. There will be other precautions, which will allow the economy to return to "normal".

The life expectancy in 1917 48.4 years for a male 54.0 years for a female.
In 1918 The male was 36.6 years and 42.2 years for a female.
In 1936 the year of my birth it was 56,6 M:ale and 60.6 Female.
In 1957 it wa s66.4 for a Male and 72.4 for a female
In 2019 Life expectancy was 75.3 years for White Male and 80.5 years for White Females. The expectancy has actually gone down slightly in the last few years in the USA.

Colby's life time has seen a gain of life expectancy of about 10 years. My lifetime a gain of nearly 20 years. These are huge gains of life expectancy.

Any figures from Africa or any third world country are suspect, as are those from China. but for different reasons. Brazil and India bear careful watching.

A seminal event In North American medical education was the Flexner report on Medical Education in both the US and Canada published in 1910. That had been preceded in 1904 by the American Medical Association's forming of the "Council on Medical Education". This began to standardize circular of medial schools. In 1908 the CME tasked the Carnegie Foundation to assess the 155 medical schools then in existence. Abraham Flexner (a non medical person) visited all 155 medical colleges and made his report that resulted in the closure of almost 2/3 of the medical schools The requirement of at least 2 years of undergraduate study, plus 4 years of medical school, with specific requirements became the standard.

 

[westward]

very high end communities (ie wealthy) tend to also have anti-vax views in general

KRC: Really? And your evidence for this inflammatory remark is? And the useful purpose of your making this remark is??

To your point: Holding anti-vax views (or not) is most strongly correlated with one's education level. So is wealth. Kindly provide the evidence behind what appears to be an illogical observation.

 

[krc]

I believe this is well known and no longer debated in the public health community (i.e professionals who make policy around generalized public healthcare). Public health professionals have had to deal with this for a long time. There have been numerous studies (google it). Some "anti-vax" also have high correlation to religion, but highest correlation is wealth. See links below...

Will we see the same with covid? The smart, wealthy families will rely on others to take the vaccine risk and then benefit themselves via heard immunity. Though, frankly, hopefully most will be too scared and will indeed vaccine. Ideally, it is simply a law with zero exceptions (but exceptions are, as always, created yet again by - yes - the wealthy. No poor person has ever told a lawmaker what laws to write).

https://sph.umich.edu/pursuit/2019posts ... ealth.html

https://www.theguardian.com/us-news/201 ... tion-trend

Just a snippet:
Research consistently indicates that vaccine exemptions are concentrated in wealthy areas, clustered particularly around private schools.6 A policy intervention in California required providers counseling families applying for vaccine exemption to inform parents of subsequent risks to their children. While the intervention was successful in reducing the overall number of vaccine exemptions, response to the policy change was clustered by socioeconomic status. Private-school children responded to the policy change with only a minimal decline in vaccine exemptions while families living below the poverty level responded at higher rates.

I personally have friends - white, liberal, wealthy - who have refused to vaccine their children (obviously, you can tell I am SF Bay Area). Their view is why take the risk if they can get the benefit of heard exposure without actually exposure to any vaccine risk. Of course, this was for measles, etc... They are not sure what to do about Covid w/ kids - and I don't know if there are under age vaccines available yet. My understanding is there is still development or testing required? Chime in if you know...


As to thinking that there is a debate that covid is more dangerous than the influenza in 1918 (or not) - either way it is bad. My point is that we are making a risk management decision to, again, protect the aged who tend to be wealthy and have resources. Meanwhile we close schools and limit sports and basically retard the opportunities and growth for those in their teens and twenties (in particular). No one speaks for them.

 

[Foggy]

These times where vaccine is scarce, there is extra vaccine. Some don't want it.
This may be an opportunity for others.

Two days ago, my son (age 50, Denver) somehow got wind there was extra
vaccine, from no-show appointments, available on a "first come, first served"
basis. He drove 400+ miles to Amarillo, TX, waited amongst 100s of people
over 2 hours and got his first shot of Moderna vaccine with an appt to return
in 27 days for the second shot. I say, "Bravo".

Out of sequence, sure. Sometimes being alert to opportunity pays off, no harm
done vs wasting. VIPs, the entitled self-absorbed wealthy and the connected
receiving preferential vaccine compared to 'the rest of us', is a different matter.

Awareness takes on new meaning in these times.

Aye.

 

[krc]

To an earlier poster's point, prisons are a good example I think to determine true mortality in covid via age. Closed environment, lots of covid exposure, equal medical care, etc...

This looks interesting but I didn't see a mortality rate via age that I was hoping - I just scanned it though, will read deeper later. Perhaps it is there or in one of the references...

https://cdn.ymaws.com/counciloncj.org/r ... Federa.pdf

 

[ssobol]

A good point to consider is that if you jump the line and somehow get an ad hoc inoculation, do you now get to jump the line to receive the second dose? Seems like this would be another way to complicate the distribution system (such as it is).

 

[bobjarrard]

In most jurisdictions as far as I can see, when you get your first shot it is tied to the date and time of your second shot. The person who lost their place in line cannot get the second shot in any case. My first shot came with a second shot date and time (both made clear at the time of making the appointment and also at the hospital where I got my first shot). Here in Boulder City, Nevada they are using a Federal tracking program on a voluntary patient basis that sends you a text message every day at first and then weekly plus you get a reminder or two about your second shot. I also got a CDC pocket card with the info on my first shot and a date and time for my second shot. I think it is pretty well organized all things considered. I am grateful that I was able to get the first shot and am hopeful that my wife who turns the qualifying in Nevada age of 65 this coming Saturday will get her first shot in short order. Bob Jarrard

 

[thataway]

My experience is identical with Bob Jarrard's. We have our second vaccination on Saturday, and had a confirmation by US Mail, and a second consent form. We have the CDC card--which for now acts as a "vaccine passport" in the US.

I am aware of others who have gotten "end of day" vaccinations, and then got their second vaccine as per scheduled.

There is a second camp which is pushing for delayed second vaccination. I just listened to an hour presentation by a public health expert who feels that in fact there may be/most likely are, advantages to the second vaccination at some delayed point-even up to a year. It does leave the person who is primary vaccinated at some minor disadvantage, with a 5 to 15% greater chance of acquiring an infection and disease. However there is evidence that the disease will be milder.

The other topic covered is if persons who have had the disease should be vaccinated at this time.

There is very good evidence that we will all be getting vaccines a year or so from now. for a 3rd or 4th "booster/other variant".

There is another issue not mentioned here, but there are a number of cases where health care providers (NP, Aids, RN's and physicians) have not been able to get vaccination because they were either remote from or not part of a hospital based practice. These people are at significant risk.

 

[bobjarrard]

Yup - we will be seeing third and fourth round booster/amended COVID-19 vaccines and I think that it will be either in combination or coordinated to our flu shot. Here in Nevada almost everyone got a quad valent/four strain flu shot for free if they wished. If you look at the reduction in influenza infections and deaths this year you can see that the same protocols we are attempting to enforce might have saved as many as 20,000-40,000 or more lives a year in the past. "And as it is appointed unto men once to die...." but the text does not say how we must pass. I do not want to go out hooked up to a ventilator isolated in an ICU room. Much better to just graduate sitting on the porch in my favorite rocking chair with a nice big bowl of peach cobbler in my lap and my dog at my side. We are blessed here on our forum with so many level heads with decades of life experience they will share with us. I should change my name from Bob Jarrard to Iam Gratefull!!!

 

[dotnmarty]

There are a number of "reasons" why some people hesitate or simply refuse to be immunized. These vary from family or group experience of negative effects, to religious beliefs, to playing the herd immunity card. The history of public health has been a tightrope between governmental enforcement and individual freedom. One of my first jobs in public health was locating tuberculosis patients who failed to return for their regular checkup and medicine. At that time, the early 60's, many of the patients who refused to answer the door were concentration camp survivors and were afraid that they might not return home. I would always knock lightly and speak softly. During the measles outbreaks of the 90s contact tracing always led ultimately to a super spreader like a religious summer camp or even a musical event. With the waning immunity of previous immunizations many parents declared religious reasons, (whether truthful or not) for not getting their kids immunized. If I recall correctly those kids were kept out of school or day care where a case had been reported. The history of the HIV/AIDS epidemic beginning in '81 up to now is itself an example of the successful maturation of medicine and public health combatting a communicable disease.
Perhaps it's interesting to note that the US Public Health Service commissioned corps was founded to enforce quarantine of ships and provide medical care to seamen, hence the naval uniforms and ranks.

 

[thataway]

One of my first jobs in public health was locating tuberculosis patients who failed to return for their regular checkup and medicine.

I trained at UCLA Harbor General, and we had one of several Tuberculosis ward sections--in our case overr 250 patients kept in old army barracks in Torrance Ca. The patients were there on court order. If they violated that order they actually went to a tuberculosis prison facility. We have come a long ways.

One of my last jobs involved student health consultation,, as well as athletic medicine and environmental medicine. We had a number of students for Asia who submitted some one else's X ray, when they had active tuberculosis. Although generally under control in the USA, it was not until only 50 years ago. A number of my forebears had tuberculosis--it was not at all unusual. When I was a kid in Long Beach Ca.where I spent weekends with in my grandmothers house, Two houses on that block had the red stickers of quarantine because of Tuberculosis. It was also the era of Iron Lungs for Polio. We have come a long way---or have we?

When one sails internationally, when arriving in a foreign port, the "Q" all yellow flag is flow from the port spreader, until you have cleared in with the health authority in each each country. At the first port one is often given a cruising permit-which still has to presented at each port one stops at.

 

[dotnmarty]

One of my first jobs in public health was locating tuberculosis patients who failed to return for their regular checkup and medicine.

I trained at UCLA Harbor General, and we had one of several Tuberculosis ward sections--in our case overr 250 patients kept in old army barracks in Torrance Ca. The patients were there on court order. If they violated that order they actually went to a tuberculosis prison facility. We have come a long ways.

Every answer brings a whole new set of questions. I remember when every county in NJ had a tuberculosis sanitorium. The development of anti-tb drugs led to the emptying of the sanitoriums and the need for active surveillance and education of outpatients. In the HIV'AIDS epidemic, in the early 80s, if you were infected, you soon became ill with an opportunistic infection and died. Today HIV infected people can live a long normal life as long as they maintain their drug regimen. Lessons learned have helped not only the primary infected person, but also their sextual partners, hemophiliacs, and babies born to infected mothers. Even diagnostics, like the CT and MRI are relatively recent inventions. Today, people who complain about waiting times for these tests would have undergone exploratory surgery not too long ago.
Today I'm hunkered down, wash my hands and wear a mask. I will get my second shot next week. I have so much to be grateful for.

 

[smckean (Tosca)]

In the HIV'AIDS epidemic, in the early 80s, if you were infected, you soon became ill with an opportunistic infection and died. Today HIV infected people can live a long normal life as long as they maintain their drug regimen.

Don't I know it! One of the great tragedies of my life was when my best friend from high school and beyond died of AIDS in 1993 at 48 years old. He lived in San Francisco and was an early contractor of the disease. Had he been born 30 years later, he could have lived.

dotnmarty, as you say "so much to be grateful for"....certainly in the medical field. Had I been born 50 years before, I likely would have died at age 55. I needed a mitral valve repair in 2001 or I would be dead in 2 years. My heart was stopped for 5 hours during the operation while a heart-lung machine did my heart's job. Some 50 years before such a thing would not have been possible. Now, just last week, I had a pacemaker installed....another little miracle of modern medicine!