Oh Canada! We really miss you

[rkacruiser]

5 hours ago, iancal said:

I believe that our yellow jacket record booklet of immunizations will be as necessary for international travel as our passports. 

 

Perhaps as well for domestic travel from State to State.  OK by me; I still have my original Yellow Record Book and I have kept it up-dated for all required immunizations needed for international travel.  

[iancal]

We do exactly the same.   Including the usual optionals of Hep and Tetinus.  Passport, Immunization Record, and International D/L.

Edited October 25, 2020 by iancal

[Yodalicious]

We are in the Metro NYC area.  I will only consider a round trip US cruise at this point. A NY/NE to Canada and back.  I’m not willing to take a plane yet.  Once there is a vaccine or a therapeutic, I would love to go back to Alaska.  
 

And as a child of the 50’s,  I have to ask, what the heck is wrong with a vaccine? We did eradicate Polio, and I, personally, have not the flu, or Pneumonia since I started taking the shots.  
 

 

Edited October 25, 2020 by Yodalicious

[trivia addict]

As another child of the 50s, I see nothing wrong with a vaccine either.

Problem is, they used to be scientifically tested with many trials.
I still remember lining up for one of the first polio sugar cube vaccines.   And I am up to date on pneumonia, shingles and flu.
However, I am afraid of the expediency of the coming COVID vaccines that may appear. I do not trust those who are rushing the vaccine. I will take a vaccine when the scientists tell me that it is safe. 
BTW, I am fine with flights at the moment. I have flown cross country and also  have relatives that have traveled by plane, with no problem. Next month, I will have another long flight. The airlines are doing a good job. I feel safer on a plane than I do around people on the street that have no masks.

[KirkNC]

3 hours ago, rkacruiser said:

 

Perhaps as well for domestic travel from State to State.  OK by me; I still have my original Yellow Record Book and I have kept it up-dated for all required immunizations needed for international travel.  

I actually believe that requirements by businesses, both those you work for and those you visit or use for a service may ultimately require evidence of vaccination.  This will push the reluctant ones to get vaccinated (I hope).

[ABoatNerd]

Considering none of the trials have people who are operating in the real world - their exposure is therefore limited to this virus restricted configuration.

This will not aid in the accuracy of the vaccine.

This is a flaw in the vaccine process.

 

[nocl]

5 hours ago, ABoatNerd said:

Considering none of the trials have people who are operating in the real world - their exposure is therefore limited to this virus restricted configuration.

This will not aid in the accuracy of the vaccine.

This is a flaw in the vaccine process.

 

The people in the trial are acting in the real world as it exists today.

 

It makes absolutely no difference in the clinical trial process and the accuracy of the results.

 

When a clinical trial is run, the people doing the trial do not know who is getting placebo and who is getting the vaccine.  The lots used are blinded.  The people a merely told which lot of product to use.  As a result both groups are instructed on best practices  to avoid illness. So both arms are treated the same.

 

To put it simply, the way efficacy is determined is by comparing the numbers in the placebo arm vs treated arm.  You actually need a relatively small number of cases to occur in the trial population. Once a defined number of cases are reached.  It is reaching the minimum number of infections that is determines the time for data evaluation, it could take 1 month, it could take a year.About 150 for a trial of this size should be sufficient.  The number of people meeting the illness criteria (in this case moderate symptoms) is then totaled in each are and the ratio of the arms determines efficacy.  So if you have 150 patients in total and 75 are in the treated arm and 75  are in the placebo arm then you would have an efficacy of 0.  If you had 150 in the placebo are and 0 in the treated arm then you would have an efficacy of 100%. The analysis is a bit more complex but in simple terms that is how it works.

 

While you might have some individuals act different in each arm the large number pretty much balance out erratic behavior and overall you have similar behavior is both groups and as such the illness ratio would indicate efficacy of the product.

 

Clinical trial ethics requires that all participates be instructed in best practices to avoid the illness, for example with HIV participants were instructed in safe sex practices. The goal is to run the test by minimizing the risk to participants as much as possible.

 

I have personally been involved in the design, execution and analysis in several clinical trials while in senior management for a pharmaceutical company.

[Hlitner]

9 hours ago, ABoatNerd said:

Considering none of the trials have people who are operating in the real world - their exposure is therefore limited to this virus restricted configuration.

This will not aid in the accuracy of the vaccine.

This is a flaw in the vaccine process.

 

Nocl spoke the truth about how it is done and why it is not flawed.  Also understand that there is nothing new to this process and Phase 3 Trials are "old hat" to the pharmaceutical companies and follow strict protocols (necessary to get the trials accepted by the various government review committees such as the panel at the FDA.    What is different about the COVID vaccine trials are the speed and this is something that concerns more then just myself.   It is more common for phase 3 trials to be ongoing for many months (sometimes more then a year).  Rushing through these trials leaves some questions unanswered regarding possible longer term untoward effects and how long any acquired immunity will last.   The answer to these questions will come with time, but not until an approved vaccine has already been given to many folks (perhaps over a billion).  

 

Are we talking about potential vaccines that will need to be boosted on an annual basis or will immunity last for multiple years?  Nobody is going to be sure based on trials that only lasted a few months.

 

Hank

[kazu]

57 minutes ago, Hlitner said:

Are we talking about potential vaccines that will need to be boosted on an annual basis or will immunity last for multiple years?  Nobody is going to be sure based on trials that only lasted a few months.

 

 

Since immunity does not last long after one contracts covid (several reported repeat cases of covid), it appears that it will need to be an annual vaccine just as the flu shot is.

[Hlitner]

7 minutes ago, kazu said:

 

 

Since immunity does not last long after one contracts covid (several reported repeat cases of covid), it appears that it will need to be an annual vaccine just as the flu shot is.

That is also what I am thinking (have posted that thought elsewhere) but it will take definitive studies to make that clear.  The Pharm companies would also need to research the optimum doses..and this takes time and phase 3 testing.  A great example of the complications can be found in the flu vaccines.  It is only recently that is was determined that most seniors need a more powerful flu vaccine (about 4 times the strength of the normal dose giving to those under 65).  The immune system of older folks (who happen to also be at great risk from COVID) often needs a much stronger vaccine dose to generate the required antibodies.  This is the kind of thing that takes time (not just a few months) to research.

 

Just consider the Shingles vaccine.  The original vaccine was expensive (over $200) and only had an efficacy rate of about 50% (at best).  With a little more research the vaccine was tweaked and now offers a much higher efficacy rate (and also costs a lot less).  Bottom line is that rushing Phase 3 trials has an upside (we get a vaccine sooner) and may also have multiple downsides.

 

Hank

[kazu]

2 minutes ago, Hlitner said:

It is only recently that is was determined that most seniors need a more powerful flu vaccine (about 4 times the strength of the normal dose giving to those under 65). 

 

The vaccines may be different here than in the U.S. but we were assured we didn’t need the higher dose and the higher does here is not 4x the strength.  It’s only a bit stronger and recommended for the severely elderly and those with suppressed immune systems.

I asked about it and DH is a physician and we were fine with the regular shot as we have no compromised systems to require the higher one.  We prefer they go to the people that need them 😉 

But ours here is definitely not 4x higher.  Our flu shot is pretty strong so perhaps we are using different vaccines?  I don’t know.

 

In any case, I avoid the flu vaccine as when I got it, I got the flu.  And haven’t since I didn’t but with covid, I felt it was the responsible thing to do.

[Hlitner]

1 hour ago, kazu said:

 

The vaccines may be different here than in the U.S. but we were assured we didn’t need the higher dose and the higher does here is not 4x the strength.  It’s only a bit stronger and recommended for the severely elderly and those with suppressed immune systems.

I asked about it and DH is a physician and we were fine with the regular shot as we have no compromised systems to require the higher one.  We prefer they go to the people that need them 😉 

But ours here is definitely not 4x higher.  Our flu shot is pretty strong so perhaps we are using different vaccines?  I don’t know.

 

In any case, I avoid the flu vaccine as when I got it, I got the flu.  And haven’t since I didn’t but with covid, I felt it was the responsible thing to do.

I do respect the medical care in Canada.  But in the US we have few shortages of the high dose (often called Fluzone High Dose or FLUAD) and like the regular flu vaccine it is available from physicians or almost any pharmacy in the country.  A few years ago there were studies that showed that more then 70% of flu related deaths were those over 65 and the regular flu vaccine was just not doing a good enough job with the aged population.  Several studies showed that a much higher dose (up to 4x) could reduce morbidity and mortality among we seniors without any appreciable increase in side effects.  When I worked in healthcare one physician friend said to me that using that higher dose vaccine for seniors was a "no brainer" as it did some good with little down side.  Now, it is the norm in our country.  When we go to our local CVS to get our flu shot the pharmacist simply gives us the high dose.  It is not even a question or not mentioned unless one were to ask.   The cost to me is no different (free) so why not?  I did just notice, looking onl

 

But the research was pretty clear that our immune systems weaken as we age.  Whether other vaccines should be given at higher doses to seniors is something to be explored by researchers.  Will this apply to COVID vaccines?  I have no clue but it is something that must be explored and is a legitimate issue  in drug/vaccine trials.

 

Hank

[kazu]

29 minutes ago, Hlitner said:

I do respect the medical care in Canada.  But in the US we have few shortages of the high dose (often called Fluzone High Dose or FLUAD) and like the regular flu vaccine it is available from physicians or almost any pharmacy in the country.

 

I never said there was a shortage of that vaccine here.  There isn’t.  We don’t need it.

I suspect our vaccine is different than the one you are getting?  The difference between the two is minimal.

29 minutes ago, Hlitner said:

 

  A few years ago there were studies that showed that more then 70% of flu related deaths were those over 65 and the regular flu vaccine was just not doing a good enough job with the aged population.  Several studies showed that a much higher dose (up to 4x) could reduce morbidity and mortality among we seniors without any appreciable increase in side effects.  When I worked in healthcare one physician friend said to me that using that higher dose vaccine for seniors was a "no brainer" as it did some good with little down side.  Now, it is the norm in our country.  When we go to our local CVS to get our flu shot the pharmacist simply gives us the high dose.  It is not even a question or not mentioned unless one were to ask.   The cost to me is no different (free) so why not?  I did just notice, looking onl

 

But the research was pretty clear that our immune systems weaken as we age.  Whether other vaccines should be given at higher doses to seniors is something to be explored by researchers.  Will this apply to COVID vaccines?  I have no clue but it is something that must be explored and is a legitimate issue  in drug/vaccine trials.

 

Hank

 

DH is well aware of the studies you refer to.

There is a difference here in that some of us are not challenged immune wise if we exercise and do things that are right.  (We have 2 large dogs - trust me we get exercise 😉 )  

But as I look at what you say contrasting to my own doctor, pharmacist and DH (I was just at my doctor’s Friday when they offered me a flu shot and they gave me the same reassertion the other one was no biggie for someone in my shape) I do think our flu shots may be different from yours.

Our normal flu shot is very strong and only recommended to go to the other one if you are not active, in a home, have a health condition, etc.  

We are working hard to stay healthy and no, we are not in our basement 😉 

[T8NCruise]

This is the second year that I tried to get the higher dose flu shot, and it is in short supply here, so no luck and I got the regular shot.  Right now in BC it is available to anyone in long term care, whereas other seniors have to pay for it..  If you can get it.  But I have had the regular flu shot every year for as long as I can remember and it has been effective.  The real flu will knock you off your feet completely for at least a week, don't want to repeat that.  It annoys me when someone who is walking, working or sniffling, says they have the flu.  Nope, you do not.
I am hoping a vaccine for Covid will be safe and effective, but think I will wait awhile when it does come out.  In the meantime, we mask, stay home as much as possible and follow all the other common-sense rules.

[iancal]

We got ours (Alberta) at the pharmacy ten days ago.  Seniors and those  risk were able to go early.  Our surprise was that  we were the only ones there.

 

DW was in rage grocery store last week.  She heard ar least three  announcements  from the pharmacy to come over for the flu shot-no line ups.    Surprising to her.  Yet where DD lives, in the north, some pharmacies ran out for a day or so..  Could be a distribution issue.

Edited October 27, 2020 by iancal

[bennybear]

I’ve had the high dose two years ago and again this year and I’ve paid for it both times.   Last year it wasn’t available until much later as there were shortages.  My understanding is that it is three or four times the strength  of the regular flu shot and prompts a better immune response.   Some provinces give it to all seniors,  ours just to those in care.  I wonder if it’s a question of cost.   

 

However, our pharmacist said some studies had shown that for healthy seniors there was no difference in immune response.  So this could explain the different recommendations.  

 

 

[Mary229]

6 hours ago, bennybear said:

I’ve had the high dose two years ago and again this year and I’ve paid for it both times.   Last year it wasn’t available until much later as there were shortages.  My understanding is that it is three or four times the strength  of the regular flu shot and prompts a better immune response.   Some provinces give it to all seniors,  ours just to those in care.  I wonder if it’s a question of cost.   

 

However, our pharmacist said some studies had shown that for healthy seniors there was no difference in immune response.  So this could explain the different recommendations.  

 

 

The senior shot in the US does have an additional component, in lay language, called a T-cell booster which helps the body fight any and all inflammations and infections. I am sure that is the same in Canada, right?   They were telling seniors to wait until October to get them but by October the senior version was already in short supply.  We got ours the last week in September, the DH's was free with Medicare, I am uninsured so I paid $19

Edited October 27, 2020 by Mary229

[bennybear]

I went to our province’s website,  and the high dose is four times the strength and has been paid for by the federal government for seniors in long term care. It is not adjuvanted.  Ontario has provided it for all seniors:

 

“HD TIIV is an influenza vaccine targeted towards seniors 65 years and older.
The vaccine is un-adjuvanted and contains four times the amount of antigen content per dose than the standard dose inactivated trivalent influenza vaccine (SD TIIV).
The National Advisory Committee on Immunization (NACI) recommends that any of the four available influenza vaccines should be used for seniors 65 and older in the absence of any specific product. For this age group, HD TIIV should be used over SD TIIV. NACI does not make comparative individual-level recommendations on the use among HD TIIV, SD QIV and adjuvanted TIIV.
The evidence available includes data comparing the efficacy and effectiveness of HD TIIV to SD TIIV and not to other vaccines available for use in Canada. In addition, NACI has not conducted a cost-effectiveness evaluation on HD TIIV.” 

 

They go on to say say that it was 24% more effective in one year but needs more study in other years.  The standard flu shot is quadrivalent, so is for four strains while the high dose is for three strains.  Two A and one B. 

 

 

[Mary229]

1 hour ago, bennybear said:

I went to our province’s website,  and the high dose is four times the strength and has been paid for by the federal government for seniors in long term care. It is not adjuvanted.  Ontario has provided it for all seniors:

 

“HD TIIV is an influenza vaccine targeted towards seniors 65 years and older.
The vaccine is un-adjuvanted and contains four times the amount of antigen content per dose than the standard dose inactivated trivalent influenza vaccine (SD TIIV).
The National Advisory Committee on Immunization (NACI) recommends that any of the four available influenza vaccines should be used for seniors 65 and older in the absence of any specific product. For this age group, HD TIIV should be used over SD TIIV. NACI does not make comparative individual-level recommendations on the use among HD TIIV, SD QIV and adjuvanted TIIV.
The evidence available includes data comparing the efficacy and effectiveness of HD TIIV to SD TIIV and not to other vaccines available for use in Canada. In addition, NACI has not conducted a cost-effectiveness evaluation on HD TIIV.” 

 

They go on to say say that it was 24% more effective in one year but needs more study in other years.  The standard flu shot is quadrivalent, so is for four strains while the high dose is for three strains.  Two A and one B. 

 

 

That is exactly what the senior vaccine is here in the US.  It is free to seniors on medicare.  Maybe it is a good thing that they are in short supply - does that mean greater compliance?   We had to call 4 or 5 pharmacies to find it for DH.  I qualified for the lesser vaccine

[trivia addict]

Very interesting topic. Thank you everyone for your input!