Pandemic Paper Purchasing

One of the benefits of the pandemic is that I now buy paper goods in bulk.

I don’t know why I never did it before. Maybe because I live by myself and I never thought that I’d go through that much toilet paper to warrant purchasing 24 rolls at a time. But, when we experienced a national (or was it global?) toilet paper shortage, I kicked myself for only buying six or eight rolls at a time.

I remember walking into Target, Costco, and other major supermarket chains during the spring and summer of 2020 and blinking at the empty shelves. Furniture polish was plentiful but paper goods were gone.

Some 20 months after the pandemic began, my walk-in hallway closet’s upper shelves are stacked with rolls of toilet paper and paper towels, boxes of tissue paper, and non-paper surplus such as freezer bags, dishwasher detergent pacs, and (of course) disinfectant wipes.

I think I’m saving money by buying more at once instead of a little bit at a time. If nothing else, I know that I’m saving gas and mileage by driving to the store less.

Leave it to a pandemic to force me to change my purchasing ways — for the better.


My Continuing Saga of Vaccine Dosing

I wanted to get the Pfizer vaccine as a supplemental dose to my earlier J&J dose. I scheduled an appointment at a local Walgreens pharmacy. My conversation with the intake clerk or pharmacist, not sure of her role, went something like this:

Me: I’d like to get a covid vaccine, please.

She: Is this your first shot?

Me: No.

She: This is your second Pfizer shot?

Me: No.

She looked over at me and I explained what I recently blogged about, citing the San Francisco news. We both wore masks so I let my eyes do the talking. I tried to convey confusion and could she help? Now, keep in mind, she had my driver’s license in her hand. In hindsight, I’m unsure why I gave that. Massachusetts regulations or guidance or whatnot says that covid vaccines can be administered without ID.

I grasped that she was also confused. She said that I wasn’t the first person in the pharmacy asking for an mRNA vaccine after receiving the J&J one. Visiting the CDC website, and to my bewilderment, she said that I was able to get it. Minutes later, she said the CDC information was about San Francisco, not Boston; and, moreover, my insurance company denied the dose. This part of the conversation perplexed me as I neither gave her my insurance card nor specified the company; and I don’t remember using Walgreens in the past year for drugs, but hey.

So, I couldn’t get the vaccine.

The same day, I read about the first clinical results of a South African research study of nearly 480,000 people. The study indicated that the J&J vaccine offers 91-96% protection from death and 71% protection from hospitalization (specific to the Delta variant, compared to 67% protection from the Beta variant).

This is good news. It’s troubling that other vaccines have higher hospitalization efficacy rates than 71%, but, at this point, I’ll take what I can get.

In the meantime, I’m convinced that the U.S. federal government is frustrated with Americans taking second or third shots on their own; and I’m certain that public health agencies probably want to get in front of the chaos.

According to an August 6 story in the Washington Post, the FDA is reviewing CDC data to support vaccine boosters for immunocompromised adults. This represents about 7 million people. Data collection is also ongoing to determine extra doses for the general population who received Pfizer, Moderna, or J&J; and this rollout is estimated for October.


Pfizer Comes My Way

The San Francisco Department of Public Health is offering a “supplemental dose” in the form of an mRNA vaccine to any J&J recipient who wants it. This is a game changer, as a SF hospital is the first in the nation to do it.

I received the J&J shot in March. I’ve since learned from virologists that while J&J is very efficient at stopping severe disease and hospitalization, efficacy is reduced at stopping symptomatic infection especially from variants.

Across Asia, Europe, the United Kingdom, and Canada, it is accepted practice for people to mix vaccines, e.g., their first vaccine from AstraZeneca and their second from Pfizer or Moderna. As usual, the CDC and FDA are slow to follow the world.

My primary care physician says the choice is mine. I recently blogged about vaccine boosters and, with this latest news, I scheduled a Pfizer shot for Friday.


Thinking of Getting a Vaccine Booster

Four months after receiving the J&J vaccine, I want to know if it makes sense to get the Pfizer or Moderna vaccine as a booster shot. Unfortunately, living in the United States does not make it easy.

There are several issues that I am considering.

First: The Delta Variant

Some good news is that 49% of the U.S. population is fully vaccinated, with 57% partially vaccinated. My state of Massachusetts is 62% fully vaccinated. These numbers are slowly rising.

The bad news is COVID-19 cases are skyrocketing. Over the span of a month, the U.S. quintupled the number of daily positive cases – from 10,000 in June to 50,000 in July. The CDC says the Delta variant is responsible for 83% of new cases. Other variants such as Lambda are also making news, albeit on a smaller level.

Second: The J&J Vaccine

Johnson & Johnson announced data at the beginning of July that indicated immune response lasts for eight months, and that its vaccine protects people from the Delta variant.

While published in a scientific journal, the study used a small sample of 20 participants. Critics argue that more people are needed.

A subsequent independent study from New York University concluded that the J&J vaccine may reach less than 50% protection against variants.

The New York Times interviewed scientists on both sides of the issue and explained why nobody is in agreement.

CNN published a well-written profile of doctors who recommend supplementing the J&J vaccine with a mRNA vaccine. Other doctors in the piece suggest that until federal agencies authorize or approve booster shots, the status quo should be maintained.

Third: Mixing Vaccines

While U.S. agencies research the reliability and safety of mixing COVID-19 vaccines, this practice is already in place around the world. German Chancellor Angela Merkel made waves last month when she received a Moderna dose two months after getting an AstraZeneca one.

J&J and AstraZeneca built vaccines with a similar architecture that use a modified adenovirus. After injection, the body creates a spike protein and then develops antibodies. Pfizer and Moderna vaccines use mRNA.

Canada Prime Minister Justin Trudeau and Italy Premier Mario Draghi also received mixed vaccines of both AZ and either Moderna or Pfizer.

Italy, Germany, Spain, South Korea, and Thailand are among many countries that allow residents to get second doses of other vaccines.

The New York Times wrote on July 20 that the AZ vaccine has 33% protection against the Delta variant. (This is aligned with the above-mentioned NYU study about the J&J vaccine having less than 50% protection.)

Fourth: Breakthrough Cases

Breakthrough cases are defined as people who test positive after being fully vaccinated.

Here in Massachusetts, the latest weekly data indicated breakthrough cases represented 43% of new positive cases. In other words, nearly half of new COVID-19 cases are from people who are fully vaccinated.

The numbers may be low in contrast to the total vaccinated population, but looking at data from earlier this month, 303 breakthrough cases were hospitalized and 79 died.

Next Steps

While it’s true that about 99% of Delta cases are among the unvaccinated, does this mean that I should wait for breakthrough case numbers to increase before pursuing additional vaccination?

The National Institute of Allergy and Infectious Diseases (which Dr. Anthony Fauci directs) is recruiting J&J vaccine recipients for a clinical trial to investigate long-term effects of mixed vaccines.

The kicker is that the estimated study completion date is in May 2025.

If that’s my benchmark, that’s a long time to wait for the U.S. government to decide if 13 million U.S. residents who received the J&J vaccine should be able to get another vaccine.

In the meantime, I asked my primary care physician for his thoughts if I should get a booster. He implied that the government may recommend it in the future and added, “Until then, it’s up to you.”


Mask Off, Mask Back On

I still don’t wear a mask walking through the hallways and staircases of my apartment building to do laundry or check the mail, but I am once again donning a mask when entering supermarkets, retail stores, and other indoor businesses.

My reasoning is simple:

The people who live in my building are analogous to cohabitants in a bubble. We let each other pass with distance when applicable; but, usually, I’m alone when walking to and from. Also, many of my neighbors are older or live with young kids and, while that doesn’t mean anything, I take comfort that they presumably practice safe behavior.

In other places, though, such as grocery stores and healthcare offices, I don’t know the lifestyles of those strangers. I don’t know if they’re unmasked because of vaccination or because they want to be perceived as vaccinated. I’m also cognizant of virus variants.

While I embraced the freedom of shopping while unmasked for the past few weeks, I am masked again. Echoing the dogma of 2020, the three-layer mask protects me and, in the chance I’m asymptomatic, I’m also protecting someone else.


Mask On, Mask Off

I used to wear a mask while walking through hallways and up and down staircases to get to the communal laundry room of my apartment building. I carried disposable gloves for touching anything that could be touched by someone else. I frequently brought disinfectant wipes for cleaning machine lids, coin push trays, and folding surfaces.

Thinking back, I smile about the days of 2020 when nobody knew what to do.

That was then. That was before I was vaccinated and adjusted my vigilant behaviors.

It’s now July 2021 and I did laundry this week. I didn’t wear a mask. I didn’t bring gloves. I didn’t disinfect anything. Instead, between washing machine and dryer trips, I reentered my apartment and washed my hands.