Goodbye 2020, Hello 2021!
Hi guys,
It's been a while since my last email and I'm really trying to keep this up. So I'm aiming to do 2 every month to keep in touch with all of you. To all the new patients - welcome to the email list. I've been doing this for the whole year to keep people informed about COVID19 in general, clinic, new health information and also for a little bit of fun. I think if this year has taught us anything - is that we all have a need to connect to each other. Human beings are inherently social animals and we all die a little bit everyday without contact. So here's a small part of me to help keep the contact going! :)
I'll like to go through:
COVID19 vaccinations and it's recent status - and how it will effect you and the world in general
General house keeping over Christmas time and clinic availability
Things I've found amusing these last few week - I'm easily amused :)
COVID19 Vaccinations
Good news in general - actually amazing news. 3 vaccine phase III trials have been completed and the results have been astounding. There are still multiple vaccines in trials now. The world is hoping for multiple winners. This is like Christmas coming early. To summarize:
Pfizer - 90% effective, mRNA, needs to be stored at -70 degrees, thaw before use - 5 days before it spoils
Moderna - 94.5% effective, mRNA, needs to be stored at -20 degrees
Oxford/AstraZeneca - 62% effective at 2 full doses, 90% effective at 1/2 dose then a full dose booster, adenovirus, needs to be stored at 2-8 degrees.
I'll try to explain the vaccines in the following way:
How do they work and what do the terms mean?
What's the good news?
What's the bad news?
How should you decide if you want to have the vaccine?
How do they work and what do the terms mean?
Vaccines work by introducing bits of the virus into the body, and then your body's immune system reacts to this and produces antibodies. Usually vaccines are designed to produce an immune response that is stronger than getting an infection - and this usually means the immunity is stronger and longer lasting. All the vaccines in trial target the spike protein found in the coronavirus. The coronavirus looks like a soccer ball with spikes on it. These spikes allow the virus to penetrate our cells and make us sick. By making antibodies against the spike proteins, the body prevents the virus from being able to enter our cells.
The way the virus bits are delivered into the body is different.
The oldest way of doing this is by injecting people with weakened live virus. This carries the risk of causing an infection in an immune weakened individual. The Chinese first used this technique against small pox in the 1500s.
The 2 main methods used now are more modern.
The adenovirus method uses a chimpanzee cold virus that has been designed so that it cannot make us sick. A bit of the virus genetic code is inserted in this virus. When the vaccine is given, the adenovirus infects our cells and the cells produce the spike proteins that our body will react to. The advantage of this method is that it's tried and true. Also - the Oxford/Astrazenica group had partially developed this vaccine for use in SARS so they were able to rapidly adapt it for use in COVID19 - which is a similar virus. The vaccine can also be stored at 2-8 degrees which is the temperature of most vaccine fridges in GP clinics and pharmacies.
The mRNA method is very new. RNA is the genetic code for viruses as opposed to DNA in animals, plants and bacteria. mRNA stands for messenger RNA - and it's a short bit of code for the spike protein. When the vaccine is injected into us, the mRNA enters the muscle cells and uses the cells to produce the spike protein for the body to react to. The main advantage of mRNA vaccines is that it's much quicker to develop because it's more like programming. Also the vaccine can be produced in large quantities more quickly. The main disadvantage is that it's unstable in lower temperatures and must be stored at very cold temperatures. This can be a logistical nightmare when you're trying to deliver the vaccine as standard GP and pharmacy clinics might not have the capacity to store and distribute it.
How is the efficacy calculated?
In the Phase III trials, tens of thousands of people were recruited into the study. Let's take for example the Pfizer trial. Roughly 30,000 people were recruited. They are then split into 2 groups. 15,000 each. One group is given the vaccine and the other group is given a control. Both the trial participants and the people giving the vaccine do not know who gets what - this is called a randomized double blind study. This is the gold standard way of conducting a study to reduce biases as much as possible.
Across the 30,000 participants, the figures are calculated once 95 people get sick. The efficacy is calculated based on the number of people who are prevented from getting sick. For example, in the non vaccine group out of the 15,000 - 90 people get sick. In the vaccine group - 5 people get sick. So you the efficacy is 90/95 - 94.5% effective. The reason for the magic number of 95 is that it's the minimum required for the figures to be statistically significant, meaning that the result due to random chance is less than 0.05%. All this basically means that it's super duper likely that the result is trustworthy.
What's the good news?
First generation vaccines are usually not that effective, so anything above 50% efficacy would be regarded as great. Therefore having vaccines that are 90% effective or greater is amazing. In fact you could call this a home run.
What's the bad news?
Rich countries have basically bought out most of the supplies of vaccines. Also - the mRNA vaccines are a logistical nightmare to deliver due to requiring extremely low temperatures. Dry ice (solid carbon dioxide) used to keep the vaccines cold is expected to be in short supply. The special glass to keep vaccines in are also in short supply - try making 16 billion little glass bottles. These glass bottles are special because they can be frozen and not break.
When are we getting the vaccine and who is going to get it first?
Don't know this one. I'm not sure the government has any of these effective vaccines secured. Also - I believe that they have tried to secure some of the other vaccines where the results haven't come out yet.
New Zealand is in a unique position - similar to places like Taiwan, Australia and China where there is virtually no community transmission. It means that our biggest risk is our borders. Logically this would mean that the people who should be vaccinated, in order of first to last should be:
1. Quarantine and border workers - such as flight crew, hotel staff, security, police, sea port crews etc.
2. Hospital, Testing centre, GP staff etc
3. Elderly people starting with over 80s, then 70s etc including the rest home staff.
4. People under 70 with chronic medical conditions such as cancer, autoimmune disorders, heart and lung conditions, etc
5. Everyone else in descending order of age decade - etc. 60s, then 50s, then 40s and so on and so forth.
How should you decide if you want to have the vaccine?
Your decision should be based on benefit vs. risk. Yes - I intentionally reversed the order. Language matters. When you put the word risk first, you automatically give it more credence.
Here are the questions you should ask yourself - How prevalent is this disease? If I get sick - is it possible to get really sick or to have prolonged illness? How likely am I to get really sick or die from this? In terms of risk - is it safe? i.e. have people died or gotten very sick from this.
Here are the answers. The disease in incredibly prevalent. If you get sick - depending on your age you can get very sick or die. Even if you don't die - you might get prolonged fatigue, cough or brain fog from this. It seems to be very safe based on studies on 100,000s of people. Reactions to the vaccine do not appear much different from any other vaccine - pain in the site of injection, mild flu like symptoms for a few days. Most reactions to the vaccines will occur in the first 42 days. We don't know if they are long term side effects to the vaccine - but this seems unlikely. In contrast - we do know that catching COVID19 can be pretty bad - and if not to you - to someone else close to you who is vulnerable.
Logically - there is no good reason not to have the vaccine. However - we make decisions with emotion and use logic to justify it.
I'm going to have this vaccine when it come out, and I'll be happy to post and share it when it's done.
It's important to get 60-70% of the population vaccinated to achieve herd immunity. There should be a moral obligation to eradicate this disease forever. This has been done before for diseases like small pox.
I hope this was informative for everyone. If you find it useful, please feel free to forward to friends and family.
General house keeping:
Our last clinic day will be Wednesday 23 December 2020. We will be close from Thursday 24 December 2020 to Sunday 10 January 2021. We will open again on 11 January 2021.
Please sort your prescription now if you think you might run short. Email the nurse for repeat prescriptions at:
Medical cover over the lock down:
Please ring our usual number 09 5286152 to receive advice from a nurse hot line.
If you require an appointment, and a virtual one will do - you will be directed to CareHQ between the hours of 7am to 7pm - 7 days a week.
If you need to be seen in person - please go to White Crosss Lunn Avenue.
I'll be checking my email regularly - so email me at:
if you need to ask me something if it's important but non urgent. I'll try to reply within 24 hours. If it takes longer - I might have poor reception at the beach etc. I'll be swimming, snorkeling, kayaking etc for the 2 weeks off. Just for fun....
I was driving to work the other day. I noticed the car in front of me was changing lanes without signaling and driving too slowly. I thought to myself - man - I hope this guy isn't Asian. The stereotype is annoying enough. Drove along side and sure enough - it's an Asian male that kinda looks like me. Sigh... Don't judge me.
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