Here is some recent information on vaccines as well as information on availability. I haven’t included an online article from yesterdays’ New England Journal of Medicine indicating the dismal track record of Astra Zeneca’s vaccine in South Africa. That’s not approved in the US. The EU countries have put a hold on it due to concerns about possible increase in the risk of blood clots and bleeding. There is no proof of a causal effect and the risk is probably quite low.
Here is summary of an update in Physician’s First watch about the Covid 19 Moderna vaccine and allergic reactions If you have a large local reaction it is not a reason to avoid another dose of the vaccine.
March 16, 2021
Allergic Reactions to COVID-19 mRNA Vaccines
Richard T. Ellison III, MD, reviewing
Anaphylactic reactions to the mRNA vaccines are rare, and a delayed local reaction to the first vaccine should not preclude the second dose.
The small size of the phase 3 clinical trials of the Moderna and Pfizer-BioNTech COVID-19 mRNA vaccines limited the ability to define the incidence and management of adverse reactions. Now, two reports provide additional data on anaphylactic reactions and implications of delayed local reactions.
In a prospective study of 64,900 medical employees receiving the first dose of either vaccine, researchers documented reactions within the first 3 days. Acute allergic reactions were reported by 1365 participants (2.10%), significantly more commonly with Moderna (2.20%) than Pfizer (1.95%). Among 16 cases of anaphylaxis (0.02%), 9 and 7 occurred following Moderna and Pfizer, respectively, with one individual requiring hospital admission and ICU care.
The same group reported outcomes in 12 participants with large local reactions to the first dose of Moderna vaccine occurring a median 8 days after immunization. Reactions were associated with variable development of local pain, pruritus, warmth, and erythema (size range, 7.0–19.5 cm). Most patients received treatment with antihistamines and ice, several received topical or oral glucocorticoids, and one received antibiotics for cellulitis. Symptoms resolved a median 6 days after onset. All participants received the second dose in either the same or opposite arm (8 with antihistamine prophylaxis), and only 6 had recurring local reactions (none worse than the first episode).
These two reports reaffirm the low incidence of severe reactions to either mRNA vaccine — although we still need clarity about the mechanisms of anaphylactoid reactions and precipitating antigens. The case series on local delayed reactions suggests that these apparent T-cell mediated hypersensitivity reactions do not represent a contraindication to a second dose. More follow-up will help guide the management of such reactions (especially given the theoretical concern that more-intense anti-inflammatory therapy might blunt the immune response). I also hope we will soon learn the answer to one of the most frequent questions I’m asked: Does the development of allergic reactions to the vaccine mean the recipient will achieve a higher level of protective immunity?
I had three patients who got vaccinated through CVS. The interesting thing is that they each got three different vaccines. As I predicted several months ago, when CVS finishes it’s nursing home vaccinations they will roll out their pharmacy immunizations. It’s happening.
About the time of Snovid we sent out a survey asking for interest in the vaccine among our unvaccinated. We received about 50 replies from patients who wanted vaccine, but had been unable to find it. Yesterday a physician who is a friend and is in a large specialty clininc texted me to let me know that they had excess vaccine availbale. This morning we called, texted and emailed those patients who had expressed an interest in getting vaccinated. 90% of them had already been vaccinated.
Nevertheless, we will ask TDHS again tomorrow for vaccine. Stay tuned.
Here is the handy guide form the second page of the San Antonio Express News which is put out most weekdays. It has valuable contact information:
FAQ: When and where Texans can get the COVID vaccine
Updated: March 17, 2021 5:18 p.
Who can get it now?
Group 1A: Includes health care workers in hospital settings working directly with COVID-19 or high-risk patients, long-term care staff and residents, EMS providers and home health care workers.
Group 1B: A far larger group — anyone 65 or older, pregnant women and anyone 16 or older with a preexisting condition. These include cancer, heart issues such as heart failure or coronary artery disease, chronic kidney disease, solid organ transplant, obesity or severe obesity, sickle cell disease or Type 2 diabetes mellitus.
Group 1C: Texans 50 to 64 years old became eligible March 15.
School, child care staff: Teachers, staff and bus drivers for pre-primary, primary and secondary schools, as well as Head Start and Early Head Start programs, and those who work for licensed child care providers, including center-based and family care providers.
The Centers for Disease Control and Prevention is requiring retail pharmacies to “set aside all currently unbooked vaccination slots” through March 31 for those in this category.
President Joe Biden has directed all states to make every adult eligible for the vaccine by May 1.
If I qualify, where can I get it?
You can make an appointment with a pharmacy, hospital, clinic or other provider but will face delays. The city now offers text alerts about opportunities to get appointments with public providers — to sign up, text Vaccine to 55000 or, for alerts in Spanish, Vacuna to 55000.
Providers also are listed on a map on Texas Department of State Health Services vaccine information page. Scroll down to “Where to Get Vaccinated” and click on “Large Vaccination Hubs” or “Vaccine Availability Map.” Call ahead to make sure a provider has doses of vaccine.
VIA Metropolitan Transit offers free rides to or from an appointment at a city- or county-sponsored COVID-19 vaccination site. Check VIAinfo.net for the latest service updates.
Listings are in alphabetical order. This section will be updated as information is released by area providers.
CentroMed: Registration is temporarily unavailable. Once more vaccines are received, a link to sign up for an appointment will be available at centromedsa.com/cv19vax/.
Christus Santa Rosa Health System: Has an appointment system for some clinics and outpatient care sites; vaccines have been dispensed only at a couple of its New Braunfels locations. An online chat function at vaccinate.christushealth.org screens for eligibility — if it does not appear, no appointments are available.
City: All first-dose Pfizer vaccine appointments that Metropolitan Health District offered online have been taken. Check the city’s website in case openings become available due to cancellations. Appointments still available through 311, option 8, but those are only open for seniors or residents without internet access. Community health workers working in the city’s most vulnerable neighborhoods also are signing up people. More information is at the city’s official FAQ.
Comal County: The county’s vaccine standby list has been reopened. Seniors 65 and older are urged to register, as are people in groups 1B and 1C. The list was opened to people 50 to 64 years old Monday. A link to register for the list is posted on the Comal County website, and the county’s social media sites. Those without computer access or needing help can call 830-620-5575.
CommuniCare Health Centers: Will contact current patients who are eligible to schedule appointments while supply lasts.
CVS: Vaccines offered at 180 locations around the state, including sites in San Antonio, Balcones Heights, Cibolo, Schertz, Selma, Universal City and New Braunfels. Check availability at CVS.com or through the CVS Pharmacy mobile app; registration is required. Those without online access can call CVS customer service at 800-746-7287. Appointments required; no walk-ins accepted.
H-E-B: Check availability at vaccine.heb.com. Customers due for second doses will be contacted directly.
Methodist Healthcare: Vaccinating its employees, providers and transplant patients, along with health care workers in the community. Call 210-575-0580 or visit exne.ws/sahealth for more information.
San Antonio Military Medical System: Brooke Army Medical Center has booked all available vaccine appointments for next week. BAMC will announce appointments for upcoming weeks every Tuesday evening on its Facebook page. Beneficiaries may check www.tricareonline.com anytime to look for open appointments due to cancellations or can call the Consult Appointment Management Office at 210-916-9900 or 800-443-2262, option 8, from 6:30 a.m. to 4:30 p.m. weekdays. Military and civilian personnel in groups 1A or 1B should schedule vaccine appointments through their unit’s chain of command. BAMC’s vaccine site is on the main post of Fort Sam Houston in the Training Support Center, Building 4110 at 2536 Garden Ave. The Wilford Hall Ambulatory Surgical Center site is located in Building 4554, 1100 Wilford Hall Loop, on Joint Base San Antonio-Lackland with check-in at the “C-Wing” entrance. Updates at bamc.tricare.mil and through social media.
Schertz: The city of Schertz is a registered COVID-19 vaccine provider. If the city’s waiting list for appointments is open, you can sign up on its website. You do not have to be a Schertz resident. Go to Schertz.com/Alerts to get CivicReady alerts — that tool will send notifications when the wait list reopens.
University Health: Registration is ongoing, with notification weekly if enough doses are available to confirm appointments. Updates will be on the system’s Go Mobile app, which sends notifications when new appointments open up, and its newsletter, available at HealthFocusSA.net. Or go to wecandoitsa.com or call 210-644-1960 for information.
UT Health San Antonio: Scheduling anyone who falls in groups 1A, 1B and 1C. Register and check availability of first-dose vaccine appointments at UT Health website.
Walmart, Sam’s Club: Vaccines are being offered at eight Walmart stores in San Antonio, one in Universal City and one in Cibolo. Check for availability and schedule appointments online at walmart.com/cp/1228302 and at samsclub.com/pharmacy. The eight Walmart pharmacies to receive doses so far are at 6703 W. Loop 1604 North, 8030 Bandera Road, 5555 De Zavala Road, 1603 Vance Jackson Road, 5626 Walzem Road, 2100 SE Loop 410, 8923 W. Military Drive and 3302 SE Military Drive. The Walmarts at 510 Kitty Hawk Road in Universal City and 602 Cibolo Valley Drive in Cibolo also have received vaccines.
WellMed: The phone hotline, 833-968-1745, will remain open from 8 a.m. to 8 p.m. daily until appointments are filled. The shots are given at the Cisneros Senior Community Activity Center and the Treviño López Senior One-Stop Center. Appointments required, no walk-ins. Visit wellmedhealthcare.com/vaccine or WellMed’s Facebook page for updates.
How much does the vaccine cost?
The vaccine is free, regardless of insurance status.
Do I have to show proof of eligibility?
DSHS has not offered guidance on how providers should check for proof that a person qualifies for a shot.
Some providers have created their own policies. H-E-B said patients can provide an ID or a prescription, while University Hospital has said it will take people at their word if they say they have underlying conditions.