Notes on the pause of Johnson & Johnson COVID-19 vaccines

A quick message to speak to the new public concern regarding Johnson & Johnson COVID-19 Vaccine:

For those who are not already aware, federal health agencies have called for an immediate pause in use of Johnson & Johnson’s single-dose coronavirus vaccine after six recipients in the United States developed a rare disorder involving blood clots within about two weeks of vaccination.

Nearly seven million people in the United States have received Johnson & Johnson shots so far. As such, this complication has occurred in approximately 0.00008% of all J&J vaccine recipients. This calculates to literally less than one in a million. Nonetheless, out of an abundance of caution, the single-dose Johnson & Johnson vaccine will be unavailable until more information on these 6 cases can be obtained and analyzed.

Pfizer and Moderna formulations of vaccination against COVID-19 will remain available, and outpatient administration of these two-dose regimens continue to be scheduled and administered.

*****However, please note the following with respect to homebound patients:*****

The issue with Pfizer and Moderna for homebound individuals has mostly to do with storage and handling requirements. Both vaccines must be stored at sub-zero temperatures, then once a vial is accessed it must be fully distributed within a short timeframe (I believe in the range of 10-14 hours) before it is considered unusable. Each vial typically contains 10 doses. So if there aren’t 10 recipients within easy access for a vial to be fully distributed within the time frame, all unused doses will be lost. This is a significant challenge for administering to homebound patients because not only must 10 doses be fully distributed within the opening of a vial, but temperature control between doses (with an administering provider e.g. nurse traveling between locations), is that much harder to control unless carrying a working freezer in their vehicle, so a vial might actually expire in shorter than the expected time.

In short, due to the risk of losing viable doses in the process, the Pfizer and Moderna vaccines are not appropriate for home administration at this time.

I know it is challenging, but I will continue to ask everyone to be as patient as possible as this massive process of immunizing the world’s population is pursued as efficiently and safely as possible. Public health officials are being called upon to get people safe from the virus while keeping people safe from potential risks of a quick mass-produced vaccine roll-out, and the demands are for all of this to be accomplished “right away.” The urgency is well understood at the level of those making things happen, but the fact that there is a process involved must also be understood by those who are waiting for things to happen. Let’s all remain supportive of one another, uphold safe social-distancing behaviors, and endeavor to exercise kindness and compassion. Rest assured, this whole thing will continue to happen one day at a time, and progress is indeed being made slowly but surely.

Thanks for understanding,

Dr M

Mary A. Medeiros, MD, MPH
Thrive Adult Primary Care
835 W Central St, Ste 4 | Franklin, MA 02038
Phone: 774-318-4205
Email: mary.medeiros@thriveapc.com
Web: http://www.thriveapc.com

COVID-19 Vaccination Advice

The Coronavirus Pandemic has been crippling in countless ways to our society. At long last, with the roll-out of vaccines, we are at a stage of working towards bringing things back under control.

I would advise anyone who has access to the COVID-19 vaccine to proceed with obtaining it when they have the opportunity. There are very rare exceptions to this advice, just as there are some rare exceptions to obtaining the flu vaccine.

At this point in time, while evidence is indeed limited, what we have overwhelmingly demonstrates that obtaining the vaccine is far less dangerous than being infected with the virus. One’s goal in becoming vaccinated is not only personal protection against COVID-19 infection, but also to diminish the risk of being an asymptomatic carrier, and passing along the virus without knowing it.

Once again, in summary, with very rare exception, I advise obtaining the COVID-19 vaccination when eligible.

A detailed outline of Vaccine Eligibility in the state of Massachusetts can be seen at this link:
https://www.mass.gov/info-details/covid-19-vaccine-distribution-timeline-phase-overview

The current state of Phase 1 is displayed on the attached graphic.

Our thoughts and prayers continue to be with all those who have lost loved ones or who are presently struggling amidst the pandemic. For those who have been able to steer clear thus far, please continue to prioritize your health and stay well.

COVID-19 vaccination update

Beginning February 1, 2021, individuals aged 75 and older are eligible to receive vaccines.

We are unfortunately unable to vaccinate patients at this time, but we would like to refer patients to other appropriate vaccination sites, and emphasize the importance of being vaccinated.

A map and downloadable list of vaccination sites can be accessed via this web link:

https://www.mass.gov/info-details/covid-19-vaccination-locations-for-individuals-in-eligible-groups-and-phases#find-a-location-to-get-vaccinated-if-eligible-

This includes the following types of sites open for online appointment scheduling:

• Mass vaccination sites launched by the Commonwealth.

• Retail pharmacies who are enrolled with the Commonwealth to receive COVID-19 vaccine.
o Vaccinating CVS pharmacies also have phone-based appointment scheduling by calling 1-800-SHOP-CVS (1-800-746-7287)

• Certain hospitals, health care providers, and local boards of health that will offer vaccination sites open to all who are vaccine-eligible in Massachusetts.

• Some local boards of health will offer vaccination sites open to those who live and work in their communities.

Appointment scheduling for these individuals will start to become available as early as TODAY (Wednesday, January 27th) and must be scheduled WITH THE VACCINATION LOCATION site. We are unfortunately unable able to schedule vaccines on anyone’s behalf at this time.

We will continue providing updates as further information becomes available.

COVID-19 vaccination update: Phase 2 Massachusetts

It is already being widely published that in the state of Massachusetts, the first group of individuals included in the “Phase 2” roll-out of COVID-19 vaccination are currently eligible to receive doses. This includes all individuals aged 75 and older who are well enough to travel out of their homes to a location where COVID-19 vaccines are being administered.

Please note this is in addition to ALL Phase 1 eligible individuals:
Listed in order of priority:
– Clinical and non-clinical health care workers doing direct and COVID-facing care
– Long term care facilities, rest homes and assisted living facilities
– First responders
– Congregate care settings
– Home-based health care workers
– Health care workers doing non-COVID-facing care

Other groups within Phase 2 are still pending eligibility. **If you are waiting, the most appropriate approach is to be patient.** Everyone’s turn is coming, and tremendous efforts are being made to ensure the steps are ordered so as to optimize the safety of the entire population, relative to the capacity of production, shipping and storage. We all have the same goal and want to see an end to this pandemic. As long as we remember that we are all in this together, WE WILL ACHIEVE THIS GOAL.

Attached to this message there is a document attached listing further details on the current phase of the vaccine roll-out in Massachusetts.

Unfortunately, due to supply limitations, we are still not able to obtain a supply of doses at the Thrive Adult Primary Care office at this time. Just as I requested above, we endeavor to remain patient and will simply continue submitting requests at reasonable intervals until the supply can meet the demand.

I am personally happy to report that I received my first dose of the Moderna vaccine last month at Gillette Stadium in Foxborough, am scheduled for my second dose in a couple weeks, and that it was all an impressively seamless experience, although I understand I was among the lucky ones who managed to schedule online without any issues.

Having explained principles of preventive vaccination to patients for many years, having regularly surveyed information updates on the current mass vaccination effort, having heard stories of others who also completed at least one dose, and now having had my own experience, please allow me to offer the following insights:

1) The objective of mass vaccination is a phenomenon called “herd immunity.” That is, in the interest of *public* health, we understand that amplifying antibody generation in as many members of the general population as possible helps to decrease the viral burden across the board, and thereby hinder (or ideally eliminate) spread of infection. While it is extremely difficult to completely wipe a micro-organism from existence because of the ability of viruses to mutate rapidly, by strengthening immune systems with vaccines, we achieve this to the best of our ability **as a population**. I have explained this principle in-depth year after year on my blog, here is a link to what I had posted on it most recently (yes, it has been a while since I regularly blogged):

http://www.thriveapc.com/2018/09/flu-shots-2018/

2) There is little to no utility in getting up in arms about the lack of availability of the vaccine, nor on the flip side to get bent out of shape regarding associated risks. Let’s face facts, please: YES, the vaccine supply remains limited. YES, the vaccine is not 100% risk-free. Oh, and YES, there are studies to prove its efficacy and safety, and YES, these studies have limitations. But why do I recommend universal consideration of the vaccine? Because YES any and all risks associated with the vaccine have been widely demonstrated to be far fewer and less consequential than risks associated with actual infection and contagion with COVID-19, especially in certain populations. YOU ARE CERTAINLY FREE TO DECLINE VACCINATION, BUT IF YOU DO, PLEASE REMAIN MASKED AND SOCIALLY DISTANCED FOR THE SAFETY OF OUR VULNERABLE POPULATIONS.

3) While I am on the “yes” track, let me add that YES, most of us feel something after receiving the vaccine dose. For me, my arm hurt in the area where I received the shot for about 2 days afterwards. A lot. And the day after my vaccine dose, I was quite fatigued. Was it worth it? In my mind, a thousand times YES. Do I expect to feel sick after my second dose? Absolutely, YES. Will it hinder me? A thousand times, NO. I’m not personally afraid of the virus. If I were to catch COVID-19 I feel quite confident that with or without the vaccine I would feel bad for a few days then move on with life. But I would not be able to live with myself if I thought for a moment that I might be a vector passing the virus along to someone who winds up with a bad outcome. And there are many of those people whose health is my responsibility. So I personally see this as much my civic duty as voting. That’s my personal perspective.

4) Finally, because I have a number of patients who are chronically ill and homebound, there have been several queries as to whether they might be able to receive vaccine doses at home. If this situation applies to you, please be assured that as soon as I am aware of vaccine doses being available for any visiting health or medical service, I will prioritize efforts to get the vaccine into your arm at home. In the meantime, PLEASE STAY SAFE AT HOME, as you have been for the past several months. Your turn is coming, and I will continue to advocate for you until supply can meet the demand.

Thanks kindly for your attention to this long message. Hang in there, and stay tuned for further updates.

Double Down on Protection

When it comes to defense, does it get better than this?

Only if you have properly vaccinated against Influenza!!
(Come on, this is a medical website — bad jokes are inevitable)

Visit our Open House 10/17/19 and get protected!

We are excited to partner with MBs Pharma Care
in hosting our First Annual Flu Clinic
at the Thrive Adult Primary Care office
on Thursday 10/17/2019 from 9am – 5pm

This event is OPEN TO THE PUBLIC, and ALL INSURANCES are accepted
for coverage of your annual flu vaccine!


Yes, in the medical field we recommend annual flu shots for everyone.  We do this for a phenomenon called herd immunity, meaning that we aim to reduce the exposure of individuals who are susceptible to severe disease by immunizing everyone.  Influenza is not your typical cold virus.  It has been known to cause fatal outcomes in certain populations, generally the very young, the very old, and the chronically ill — that is, people whose immune systems tend to be weaker than average.  Healthy individuals with strong immune systems can contract influenza and have it manifest as nothing more than a really bad cold.  However these people are still contagious and therefore may potentially spread the virus to others who are at risk for a worse outcome.  I am typically pushier about advising someone to get the vaccine if they have regular contact with these susceptible individuals, all the more for someone who is one of them.

I have heard the argument that, “every time I get the flu shot, I get the flu.”  Let’s make it clear that it is impossible for this to happen with the injected flu vaccine.  In this formulation of the immunization, it is as if the virus particle has been broken in half before being introduced to the patient.  A broken virus cannot replicate and therefore cannot generate infection.  However the whole purpose of the vaccine is to activate your immune system to generate antibodies so that if the real flu comes along, your body will be prepared.  The activation of your immune system feels a lot like how it would feel when your immune system is trying to fight off the flu in the case of an actual infection.  So some people will potentially develop low-grade fevers, body aches, weakness and fatigue.  This should last no more than a couple of days, and be assured that it is not an actual infection with influenza.  The nasal flu vaccine (“Flumist”) does in fact contain a live virus, enough to trigger an immune response but rarely enough to cause infection.  For several years in a row, Flumist showed no protective benefit against contraction of the flu virus, and was not recommended for the 2017-2018 season, but for the 2019-2019 season, protection against H1N1 virus has been added to the nasal flu vaccine and is felt to be beneficial for appropriate individuals.

I do advise patients who are actively ill to avoid the flu shot.  Again, this is not because the vaccine can cause an infection with the actual flu virus, because it cannot.  However, when a person is sick, their immune system is already busy trying to heal them from their current illness.  Giving a flu shot under these circumstances only adds strain to the immune system when it has a job to do; as a result, it may both prolong the active illness and reduce the likelihood of developing an effective immune response against Influenza.

Rare adverse effects are possible with the flu vaccine.  Probably the scariest of these is known as Guillain-Barre Syndrome which is a type of short-term paralysis that starts in the feet and legs and may ascend to the upper body.  This is exceedingly rare, but of course anyone who has had this type of reaction to the flu vaccine in the past should avoid it in the future.  Also, the majority of available flu shots are prepared using eggs, so folks with an egg allergy should ask whether an egg-free preparation is available where they are planning to receive the flu shot.  In general, anyone who has been able to tolerate the flu shot in the past should have no problem with the shot this year, either.

Finally, on rare occasion a savvy patient will bring up the presence of a mercury compound in the flu vaccine. This is thiomersal, or thimerosal, which is a widely used antiseptic preservative that suppresses the growth and reproduction of common bacteria. It does metabolize the the human body to a form of mercury that can be toxic in significant amounts. However the quantity of thimerosal in a dose of flu vaccine is less than 2.5% of what is considered safe daily intake. Meanwhile a flu shot is needed only once a year. If you want to reduce your body’s exposure to toxic chemicals you would be better off monitoring your daily intake of sugar, salt, or artificial sweeteners. But that is a blog entry for another day. 😉

All of that said, recommendations are merely that. In medicine, we base our advice on the science of statistics. What we recommend IN GENERAL will offer protection against bad outcomes in the population. But each person needs to make a well-informed decision for his- or herself about what advice they will follow or decline. It is my goal to ensure that the decision you make rests on a foundation of solid information.  In all cases, my wish for you as a reader is that you STAY WELL this cold-and-flu season!

Oh, and feel free to check out the latest post from the CDC on flu as well:

https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm

The Secret to Longevity is Pliability – and change is on the horizon

Despite having grown up in New York, I am a proud and mildly obnoxious fan of the New England Patriots and the intensely competitive while ever-classy Tom Brady.  I mean, what can we say: they’re awesome, no matter what you throw at them.  Kinda makes you want to emulate their habits.

My favorite lesson from my favorite Quarterback is one I’m not sure I’ve heard him say in so many words, but it is the title of this post.  Any fans who are paying attention will be aware that TB12’s new key word is “pliability.”  In other words: flexibility, the capacity to adjust and adapt.  As he keeps demonstrating through victories that defy age, the Fountain of Youth for athletes is not a rock-hard exterior, ironclad power, or even talents like speed or agility.  No, indeed: remaining competitive with young guns is all about rolling with the tide even when it comes after you like a tsunami.

I have come to two conclusions of my own based on this concept:

  1. There is always and only one standard worth achieving: BETTER.
    No matter how much or how little improvement has been accomplished, there is never a ceiling to how much further improvement can be achieved, and there is also no reason to dwell on shortfalls compared to an idealized goal.  As long as the average trajectory on any path moves upward –even if it moves down a little before moving up a little more– I believe it is safe to call it “the right track.”
  2. Pain is only relevant to the extent that it points to danger.  Once danger is eliminated from the equation, pain that is endured rather than eliminated leads to strength.
    Discomfort of any sort tends to lead to a hard stop for many, if not most, people who were otherwise on a journey towards personal betterment.  I’m going to call it a fortunate circumstance for myself to have grown accustomed to pain, depression and anxiety through various circumstances in life… fortunate, because despite some hard hits, I’m still here.  That simple fact opened up an opportunity to understand that even some unthinkable horrors thus far have not stopped me, until I came to a point of realizing I can CHOOSE to not be stopped, regardless of painful circumstances.

    I’ve learned this mostly from my new experiences with athletic performance doing CrossFit.  As long as the pain doesn’t point to some hidden threat, or as long as any potential threats are mitigated expeditiously (e.g., ice is applied immediately to a muscle or tendon strain), I keep on coming out stronger and stronger… more flexible… more capable… in spite of subjecting myself to the transient pain of the workouts.  Upon reaching this epiphany, I began to push myself harder, then developed acumen at understanding the limits beyond which I should not push lest I risk danger of injury, then rapidly identified the limits so as to practice nudging just a little more with each workout…

    Then my new epiphany was that I can do this in other areas of my life.  Mental and emotional discomfort became the new frontiers of limit-testing.  Until they have become the new frontiers of emboldening strength and endurance.

The ability to change when faced with challenges is the Secret to Longevity… The Fountain of Youth, if you will.

Well, change is on the horizon at Thrive Adult Primary Care.

First: a new website is under construction.  Please click here to check out our new Home Page.

Second: starting on October 1, 2019, we will be accepting Medicare!  This will continue to be the only health plan through whom we will process third-party payment for the foreseeable future.  This will mean lots of different things to different patients who carry Medicare plans, but for our active member patients whose insurance does not involve Medicare at all, NO CHANGES will be made to the current Direct Primary Care (DPC) memberships.  More info will be shared in the weeks to come.

Third: our DPC pricing plans will also change significantly starting October 1, 2019.  Once the rate schedule is finalized, information will be posted.  But our current published rates will only be valid through September 30, 2019.  So if you’d like to take advantage, contact us soon!