Sen. Mike McGuire started an online Town Hall Thursday evening, March 18, by saying that for the first time since the pandemic began there’s a light at the end of the tunnel, but continued to assert that all Californians need to work together to overcome the virus.
“Longer term, the outlook for vaccines looks incredibly promising,” he said, noting that the federal government is telling rural California to get ready to receive 4 million vaccine doses per week. “We’ve been meeting with all counties on the North Coast and the north Bay every other week. Public Health officers, county administrators, directors of Health and Human Services, ensuring that each of their individual foundation expansion plans will be submitted on time to the state of California by the end of March.”
McGuire said the plan is to greatly expand vaccination operations from May into June. However, federal distribution levels will remain flat for the next few weeks. He said the state is expecting about 1.8 million doses per week, which does not include those directly allocated to CVS and Walgreens pharmacies.
The good news
“About half of all Californians, age 65 and up, have now received at least one dose of vaccine,” McGuire said. “The second bit of good news? The last 48-hour period here in the Golden State was the highest for shots into arms since vaccine distribution started.”
McGuire said it took the state 2.5 months to get 10 million doses administered, 3 million of them since the beginning of March.
“Are things improving? Yes. Should we be satisfied? Absolutely not,” he said. “We know we must do better and I can promise you we will.” McGuire said people have a right to be frustrated that the vaccine rollout was “less than smooth,” on the state and federal levels.
Dr. Timothy Brewer, UCLA Fielding School of Public Health and Geffen School of Medicine, has spoken at previous town halls and McGuire called him “one of the best infectious disease physicians in America.”
Brewer said the world is seeing about 400,000 to 500,000 cases of SARS-CV2 infection per day.
“To put that in perspective, that’s about half of what we were having at the beginning of January,” he said. “The good news is that we are way down from where we were at the peak. The challenging part is that the number has stayed flat since about the middle of February and actually has been creeping up a little bit.” Brewer explained that some overseas countries numbers are dropping while others are increasing.
“Italy is probably going into another surge right now with 20,000 to 25,000 cases a day,” he said. “Here in the United States, it’s a similar picture.” Michigan, Alabama and New Jersey are seeing increased numbers, while in California, Florida and Texas, numbers are dropping, he said.
California is seeing 2,000 to 3,000 cases per day, down from 40,000 cases per day when numbers began to drop. Brewer said the state’s test positivity rate is about 2 percent, from about 20 percent, namely in the Los Angeles area, he said.
“In the northern counties, like Humboldt County, running at about 2.9 percent, Sonoma County at 2.4 percent positivity, so while you’re better off than you were in January, you’re lagging a bit behind the rest of the state, so we still need to be aware that coronavirus is in our communities.”
He said wearing masks, washing hands and maintaining physical distance have brought the numbers down, but need to continue.
Brewer said the Johnson and Johnson Vaccine is the latest approved for use in the U.S., and warned people not to choose one vaccine company over another.
“You may have heard that the Pfizer and Moderna vaccines are 94 to 95 percent effective, and the Johnson and Johnson is only 66 percent effective,” he said. “The problem is that you can’t really compare these vaccines that way because these trials were done in different locations. For example, the Johnson and Johnson vaccine included studies in Brazil and South Africa. Secondly, if you look at serious disease, hospitalization and death, all of these vaccines are highly effective against preventing those terrible outcomes.” Brewer encouraged people to get vaccinated, regardless of which vaccine is available to them and talk to their doctor if they still have concerns.
“You cannot get COVID-19 from these vaccines,” he stressed. “These vaccines do not cause disease. They cause side effects. You might get a sore arm, you might get muscle aches but you cannot get COVID-19 from any of these three vaccines.”
In the clear?
For those who have been fully vaccinated with two shots and two weeks of immunity-building after the last shot (or one shot of J&J vaccine), life will be somewhat more free than it has been.
“You can get together with other people who have been fully vaccinated,” he said. “If you want to visit your grandchildren and you have been vaccinated, and nobody in the house is at high risk for having serious COVID disease, you can visit them without wearing a mask.”
He said masks are still required for all people when out in public.
Brewer said the virus mutates as it spreads from one person to another, and most of the time it has no effect on the virus. However, it will sometimes make it easier to spread or make it more deadly.
“Right now, there are five variants of concern that the CDC is tracking,” he said. “United Kingdom, Brazil, South Africa and two in California. By variants of concern, it means that something about this virus is worrisome.” He said all five variants are easier to transmit and predicted the UK variant will become the dominant strain in the United States over the coming months. He said vaccines may be a bit less effective against the Brazil and California variants but the level of provided protection is still adequate to prevent serious disease, hospitalization or death.
Lori Nezhura is the Deputy Director Planning, Preparedness and Prevention from the State Office of Emergency Services and also serves as the Co-Chair on California’s COVID-19 Vaccine Task Force.
Nezhura said she hoped to clear up confusion regarding distribution and criteria.
She said the system can currently vaccinate about 3 million people per week if all vaccination sites are open.
She said that while supply is the number one issue in vaccine distribution, Blue Shield is putting infrastructure in place so that when supply is no longer an issue and vaccine criteria are dropped, unvaccinated people will have immediate access to it through several means.
“One is creating a statewide network of providers, the other is siting geographically diverse mega-sites,” she said. “They’re also bringing on additional mobile providers. They’re creating a plan for vaccinating the homebound, and they are ensuring that as many pharmacies, both chain and independent, are providing vaccinations.”
She said before Blue Shield was hired as a third-party administrator, the state’s vaccination effort was being conducted by counties, health care providers, clinics, pharmacies and more, using different data systems that didn’t communicate with each other.
“So we had no statewide picture on the vaccine efforts,” she said, noting that there was no single system for data collection. Even data as simple as how many vaccines were administered in a single day wasn’t available.” She said Blue Shield will put all providers on a single system, so administrators can identify gaps and move resources there.
She said that while large city mega-sites can vaccinate thousands in a day, not all want to go to them or has the ability.
“For them, local or pop-up clinics are preferable,” she said, noting that the state has contracted two companies to provide mobile clinics. One company, Optumserve, has been doing COVID-19 testing and will transition to vaccine administration. Nezhura said counties can contract with the state for the service.
Nezhura said vaccinating the homebound is an area that has not yet been addressed, so Blue Shield is working with counties to develop programs to serve them.
Since pharmacies are in every community and regularly provide flu vaccines, Blue Shield is trying to get as many as possible to join the state network, she said.
Nezhura added that Blue Shield will also be focused on equity and providing access to those most vulnerable and disproportionately affected by COVID-19. She said the state has to do better when it comes to equity, since it’s shown that wealthy people are being vaccinated at twice the rate of lower income communities which are also at higher risk of serious complications. She said Blue Shield will change the allocation formula to correct that.
She said the provider have been vaccinating those in particular tiers, based on age or occupational risk, but now may use “clinical judgment to vaccinate individuals who are 16 to 64 years of age and deemed to be in the very highest risk for morbidity and mortality from COVID-19.” She said homeless and public transit workers were recently added to the current tier for vaccination, based on risk of community transmission.
“The Federal Emergency Management Authority is picking up a very large portion of vaccine costs as part of their disaster assistance programs,” Nezhura said. “That’s really good news for the state of California.”
Questions and answers
McGuire read questions aloud to Brewer and Nezhura, some of which were answered previously or again later.
Asked what a person should do if they miss their second shot of Moderna or Pfizer vaccine, Brewer said the data shows a longer gap between shots does not diminish the effectiveness of the vaccine. However, he recommended not skipping the second dose, as it’s needed to build full immunity.
Another question was what someone should do if they had a mild allergic reaction to the first dose, Brewer said one should avoid the second dose only if reactions were severe, such as severe swelling or difficulty breathing. Some soreness and a rash have been observed in some patients but goes away after a couple days. He said one should then talk to a doctor about possibly getting the Johnson and Johnson vaccine as a second-dose alternative.
Asked how long the vaccine will last, Brewer said there’s no evidence to suggest that immunity will diminish over time, but at this point, only eight months of data is available. Asked if Americans will need a yearly booster similar to a flu shot, Brewer said boosters are designed to deal with mutations. He said the flu virus mutates more than coronaviruses. Based on available data, he said it’s believed a booster will not be necessary unless the coronavirus changes or immunity diminishes.
Asked if vaccinated people can carry and transmit COVID-19, Brewer said it’s not yet known. However, there is some data that suggests the vaccine may prevent that. When asked, Brewer said the state is not testing people after they have been fully vaccinated.
Asked when 50 to 64-year-old people will be eligible for the vaccine, McGuire noted that supply is still an issue and they are not expected to increase in the next few weeks, but President Joe Biden has directed that all Americans need to be eligible by May 1.
Asked if pregnant women can receive the vaccine, Brewer said there is no reason to suspect that it generates a risk to the mother or baby, but said there isn’t a lot of data on it yet. He suggested women speak to their OB/GYN if they have concerns.
Asked when kids under 16 will be allowed to receive a vaccine, Brewer said he was not aware of clinical trials for children but noted that schools have a very low transmission rate. He said the Centers for Disease Control recently changed its determinations for safe classroom distancing from six to three feet.
Asked for an estimate of how long it will be before the U.S. is done with COVID-19, Brewer explained that herd immunity means enough people have been immunized or infected in a community that when an infected person comes into that community, the virus cannot find a susceptible person to infect. He said it’s estimated that when 70 to 90 percent of the population are immunized or protected, we may reach herd immunity. He said the U.S. could reach that by July if it ramps up vaccinations. Has said areas hit hardest by the disease may reach herd immunity sooner.
However, he added that the world will never completely go “back to normal,” but hoped that the lessons taught by coronavirus will remain in practice.
“I think that by July of 2022, we all won’t be wearing our masks all the time, but hopefully, even in July 2022, we’ll be remembering to stay home when we’re sick, to do a good job washing our hands, and if we are around someone who is sick, then we will wear a mask in that situation,” he said.