by Michael D. Cohen, M.D.

The pandemic was more widespread than ever in the United States, as PLN was going to press. Almost every day records were being set for the daily number of new cases (240,000), hospitalizations (over 100,000), and deaths (nearing 4,000). News articles say the two deadliest days in American history were the Galveston hurricane and flood of 1900 (8,000 dead) and the civil war battle of Antietam (3,600 dead). Antietam is now number 3 since more than 3,600 died  from coronavirus on December 16. Total U.S. pandemic deaths now exceed total Army and Airforce deaths during World War II, and it will surely get worse the next six weeks as people infected during social gatherings on Thanksgiving, Christmas and New Year’s get sick, are hospitalized, and die.

Keep Staying Safe

We must continue to use all available means to reduce the risk of acquiring or spreading the infection: Always wear a mask when outside the home; wash or sanitize your hands frequently; avoid large groups, especially indoors; limit time face to face with others; keep at least 6 feet away from others (more is better) even when you are masked; and remember that well-ventilated rooms or vehicles are less risky than poorly ventilated spaces, etc.

No one practice to reduce the risk will work by itself. But, when multiple behaviors that reduce risk are done at the same time, substantial reductions in infections do result. Recent articles have referred to this as the “Swiss Cheese Model” of disease prevention. Each slice of cheese is full of holes. With one slice, you can see through the holes. With two slices, fewer holes line up, and with many slices, there is no path through the cheese barrier in spite of all the holes in each single slice. One diagram listed the preventive behaviors for each slice: physical distance; stay home if sick; masks; hand washing, cover coughs; avoid touching your face; limit time in crowded situations; widespread testing and tracing; ventilation, stay outdoors or air filtration; government messaging and financial support; quarantine and isolation; and finally, vaccines.

What Do Vaccines Do?

At this time there are two vaccines becoming available in the U.S. that have been shown to prevent COVID-19 disease with symptoms. The trials done so far did not test if the vaccine prevents all infections (with, and without symptoms). We may hope and guess that vaccination ought to prevent all infections, but guessing is not a reliable way to make policy. Vaccination to prevent all infections has not yet been fully studied in a clinical trial. So, in spite of vaccination, all the other precautions are still necessary at this time, even for people who have been vaccinated. Vaccinated individuals should still wear masks.

Though it may seem obvious, I must state clearly that vaccines are not a treatment for COVID-19 disease. Once someone is already sick, the vaccine will not help them get better. Vaccines only help prevent serious infection. Vaccines are powerful tools for prevention, and that is important. But the release of these vaccines is not a reason to stop other preventive measures. All prevention tools are needed now more than ever because community spread is rampant.

Vaccines Are Coming
Later for Most of Us: Where Do Prisoners Fit In?

The U.S. Food and Drug Administration gave emergency use approval to the Pfizer vaccine and front-line health-care workers began to receive the first vaccine shots on December 14. Full immunization requires two shots, three weeks apart. The Moderna vaccine also received emergency use approval, and others will follow. Other companies have vaccines in testing (AstraZeneca-Oxford; Johnson & Johnson; Novavax and others) and other countries have already released their own vaccines (China and Russia).

Supplies of vaccines in the U.S. will be limited at first. With approval of the Pfizer vaccine, the federal government has determined that each state will receive an allocation of vaccine based on the number of health-care workers and nursing home/assisted living residents. The states are responsible for establishing priorities for who gets the available doses in their jurisdiction. As production ramps up and more vaccines are approved, the supply will likely become plentiful. Experts predict that vaccines will be widely available by June.

Determining priorities for who is to receive the vaccine is a subject of continuing debate. The CDC recommendations are for front-line health care workers and residents of nursing homes and assisted living residences to be first. There is little argument about these highest priority groups. Health-care workers must be protected in order to maintain health services during the pandemic. About 40% of the deaths have occurred among residents of nursing homes and assisted living facilities.

New York includes nursing homes and assisted living staff in the first priority group, too.

It is likely that essential workers and then people at higher risk for severe disease will follow.

It looks like many states will provide vaccines to guards and staff earlier in the rollout because they are deemed to be essential public safety workers. On the other hand, prisoners are likely to be further down the list, with other higher risk congregate living groups, or maybe even later with the rest of the general population.

There are good reasons to assign prisoners a higher priority. Almost all of the largest outbreaks have been in prisons. Risk of infection is greater among prisoners than the general population. At least six states have already prioritized prisoners, officers and staff in their highest priority groups: Connecticut, Delaware, Massachusetts, Maryland, Nebraska and New Mexico. Under pressure, maybe more will.

Vaccinating guards and other staff should benefit prisoners because fewer officers will get sick and bring the virus into work with them. Fewer sick guards and other staff should help reduce outbreaks in prisons. Screening for fever and symptoms at the beginning of the shift has not effectively excluded the coronavirus from prisons because people without any symptoms can still be infected and spread the disease to others.

My Choice

I will take the vaccine whenever it becomes available to me. I want to be protected from severe COVID-19 disease. I also want to help stop the pandemic by becoming immune and stopping the spread. Maybe the current vaccines will do that, too. These are the same reasons I wear a mask, actually: protect others, protect myself.

I encourage everyone to do the same. The harm of the pandemic to individual people and to populations is clearly much greater than any theoretical “risks” of the vaccine. I would rather take my chances with the vaccine than with the coronavirus. I know the coronavirus is harmful. There is no evidence that the vaccines are harmful at all.

By the time the rollout of the vaccines reaches the general population, there may be three or more to choose from. Then I might try to weigh the known differences, risks or benefits among the vaccines. But I will take whatever vaccine is available when my turn comes. 

Michael Cohen was the Medical Director for the New York state juvenile justice system for 20 years and previously provided medical care for incarcerated adults at the New York City Rikers Island jail and at Greene CF in Coxsackie, N.Y. For 10 years, he participated in a support group for people with diabetes at Great Meadow CF in Comstock, N.Y. With the group, he co-authored the Prisoner Diabetes Handbook published by SouthernPoverty Law Center and distributed by Prison Legal News. Heal the sick. Raise the fallen. Free the prisoners.

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