Opening Up with Adults Unvaccinated.

 I argued here Vaccinate the old fast that the old had such higher Covid fatality rates that it was worth trying to vaccinate as many of them as fast as possible as possible.

But what happens to adults 18-50 if they are unvaccinated. The risk of being hospitalised is about 3% across this age group. 

There are about 1.5 million Irish people in this age group. 3% of this is about 50,000 people who would be hospitalised if we all got it. Though herd immunity might drop this a bit.

The Irish Hospital system went pear shaped in January at '1,846 people with Covid-19 in hospital' which means 50k even if spread out a bit would be really bad for fatality rate of hospitalised cases. Even just for non covid cases if the hospitals are overrun you won't get the other treatment you might need. And we shouldn't traumatise medical workers with the awful conditions that many sick people at once would cause.

All this means I don't think we can have really high rates of covid even in healthy 18-50 years olds without causing so much lack of care that death rates would rise sharply. And we have to make sure we keep the rates low until vaccination rates are much higher in this age group.

FDA Vaccine Approval

 If you do a search on twitter for unapproved vaccine you will find loads of people saying some version of

A: I will not take an unapproved vaccine

The FDA explains why and how it uses Emergency Use Exemptions for Vaccines here

What will they do when the vaccine gets full FDA approval? 

I can imagine three responses.

1. Then I will be reassured and take it

2. That will increase my chances of taking it but I am concerned still about B,C,D...

3. No I am concerned about B,C,D...

3 is strange as if B,C,D are actually your worries then why say full FDA approval is your worry initially? I have asked a few people who expressed A what they will do after full approval. Not one of them has said 1 or 2 only some version of 3. That looks more like they are using FDA approval as an excuse rather than an actual real criteria they believe.

Needle Phobia and Covid Vaccinations

Between 10-20% of adults are really scared of needles. Anti Vax people are really hard to persuade. But anti needle people might be easier. And a fair number of people claiming to be vaccine skeptics might just be shy to admit a fear of needles is a big factor.

"Avoidance of influenza vaccination because of needle fear occurred in 16% of adult patients"  Soon we will have enough vaccines for all adults but if 10-20% of them do not get vaccinated due to Trypanophobia thats a lot of unnecessary deaths and it makes reaching community immunity levels impossible.

Trypanophobia is classed as a phobia with a known process of medical treatment. The steps to get over it seem to be three types
1. Cognitive behavioural therapy, hypnotherapy and other psychological techniques 

2. Nice relaxing location. comfy seats etc for where the injections happen.

3. Topical cream to reduce pain on the injection site.

These are described here, here and here.

Tech people think there should be an app for everything. But in this case it might work. A Cognitive Behavioural Therapy (CBT) app that gradually helped people get over their fear of needles might really help increase uptake of the vaccine. There are loads of CBT apps out there. If you know a good one that deals with needle phobia please comment.

There will be vaccinations for covid that do not need needles in the medium term. But for the moment getting people over their fear is needed. 

The needle phobia apps I can find I can find are aimed at kids to explain to injections to them. Rather than steps to get adults over a fear of needles.

The vaccinations created and tested in under a year are amazing. And we are going to get a lot more of them soon. Helping people get over the common fear of needles is an important step if we want to get as many people vaccinated as possible.

Vaccinate the old fast

The CDC give Infection Fatality Ratios for people of different ages as

0-19 years: 0.00003
20-49 years: 0.0002
50-69 years: 0.005
70+ years: 0.054

This mens 5.4% of all over 70s who are infected with Covid they believe will die.

The number of people in these age groups in Ireland is

425k over 70s

55-69 year olds =720k 

18-54 is 1,350,000

0-18 about 1,200,000 people

The ages do not quite line up but they are close enough.

If all over 70s in Ireland got infected with covid 23,000 would die. Assuming the infections were spaced out enough that the medical system stayed working.

All 55-69 about 3,600 would die

All adults 1350000 * 0.0002= 270 deaths 

Children=36

This ignores long term issues that Covid could cause. But hospitalisation numbers track Deaths pretty clearly. And long term issues seem to track hospitalisations.

The numbers are pretty stark though and indicate to me we should rapidly vaccinate older (and vulnerable) people as quickly as practical.

Short Supply of Flu Vaccines

 

On February 21, 2020 i blogged here about how 'Ireland should make the Flu Vaccine Free for All'. I thought this because the risk of Covid was high enough to make it really worthwhile this year.  It seems that there is now not enough flu vaccine to meet demand in Ireland this year. 

I wrote to various politicians. Including current Health Minister Stephen Donnelly.

	22 Feb 2020, 17:58
to Stephen.Donnelly

Dear Mr Donnelly 

Congratulations on your reelection as a TD. 

I would like you to consider it be Fianna Fáil policy for the government to offer free flu vaccines to everyone in Ireland this autumn. 

Firstly, Research from Canada says offering such free flu vaccination is cost effective[1]. Secondly, Ireland has particular issues with hospital overcrowding during flu season which makes reducing these cases very valuable to us. Thirdly, possible covid19 spread means any spare capacity we can get in our health system is particularly valuable this year[2].

Orders for doses of flu vaccines have to be made relatively soon. I understand the process of forming a government at the moment makes making such an increased ordering decision for use this Autumn more difficult.

Thank you for your attention.

   Best regards,

[1] Systematic review of the cost-effectiveness of influenza immunization programs by Eon Edward Kwokho Ting https://tspace.library.utoronto.ca/bitstream/1807/70706/1/Ting_Eon_201511_MSc_thesis.pdf

[2] http://liveatthewitchtrials.blogspot.com/2020/02/ireland-should-make-flu-vaccine-free.html

And his office replied

Dear David,

 

We thank you for your correspondence, and considerate thinking.

I have raised your concerns and proposals with Stephen Donnelly.

 

Kind regards,

 

 Office of Stephen Donnelly T.D.

There could be many reasons that there is not enough flu vaccine this year. But I think this exchange shows that 'No one thought or suggested before March that we would need more flu vaccines' is not a reason.