Dr. Paul A. Liguori discusses everything you need to know about the mRNA COVID-19 vaccine. Please scroll to the bottom of this post to access a PDF of CVS’s COVID-19 Vaccine Clinic Program Overview + Update for Long Term Care Facilities.
Hi everyone, I’m Dr. Paul Liguori and this is an overview on the COVID-19 vaccine. I’m going to talk to you about why the vaccine is important, what the vaccine actually is and it’s effectiveness. We’re going to go over side effects, the different types of vaccines as well, We’ll finish up on the specific COVID-19 vaccines that are probably going to come out soon and be provided for residents at long-term care facilities and for health care workers, as well as the vaccination plan of the United States going forward.
Here’s what we’re talking about, we’re talking about the two vaccines that are coming out which are Messenger RNA (mRNA) vaccines. This is a diagram of what mRNA will look like and it’s protected with the small fat bubble or lipid nano particle.
Why do we vaccinate? Well, we’re in the midst of the second wave of the COVID pandemic. To date, there have been over 66 million people afflicted by COVID-19 in the United States and of those over 14 million people have contracted the virus.
Globally, 1.5 million people that have died due to COVID-19 in the United States. 270 to 280,000 people have died this past year. Over last week, we’ve surpassed over 100,000 people that are presently hospitalized in the United States due to COVID-19 and that’s a record high.
Unfortunately, the people that are more at risk are the elderly and persons with chronic disease. People that are also at higher risk are those in congregated areas such as long-term care facilities and presently the plan is to vaccinate those residents but also health care providers.
And it’s important to know that as of November 30th of this year, at least 253,000 confirmed COVID-19 cases among health care providers has been recorded with 874 deaths.
A little bit of background on pandemic which is again “pan” meaning global. In 1918 there was the Spanish influenza pandemic or Spanish Flu and that was a different type of virus, it was an influenza virus that mutated and it affected over a third of the world’s population. Over 500 million people were affected and approximately 50 million people died from the Spanish Flu. It incurred in multiple waves and lasted two years. Vaccines were not developed at that stage.
A little bit about vaccine success. Vaccinations have saved hundreds and hundreds of millions of lives over the years and have prevented even more disabilities and disabling illness. Think about Small Pox and Polio before those vaccines came out.
Other successful vaccinations: Measles, Rubella, Mumps, Hepatitis, Meningitis, just to name a few. Again, hundreds and hundreds of millions of people have been saved through vaccination.
And to achieve or return to normal when there’s an illness that’s viral and spreads easily, it requires a vaccine that is approximately 70 to 80 percent effective being administered to 70 to 80 percent of the population and that’s in a community in a health care facility or hospital, that number needs to be higher.
Studies have shown that at least when it comes to influenza, that if you can vaccinate over 90% of staff and patients or residents within the facility, then you can significantly reduce the risk of having an outbreak and serious complications from the flu.
Again, why vaccination is important? It’s an important way and sometimes the most important way to prevent infection from the virus and the complications that you get from the infection decreases the severity of the illness and complications from the illness again, but it also decreases the risk of transmission to others so it doesn’t spread.
There’s a lot of different types of vaccines. Some of the more traditional vaccines are inactivated or killed virus where the virus is grown in a medium such as eggs. For the flu vaccine, it’s a (killed) inactivated virus. Those take time to make and to grow and to produce.
There’s another type of vaccine that’s made from live attenuated viruses. So the viruses are actually still alive except they’re treated with chemicals or temperature to lessen their ineffectiveness, they can stimulate an immune response cause a mild illness and then offer protection that way.
But the focus today is going to be on the Messenger RNA which is a new approach to vaccines and these vaccines use a small amount of genetic material called Messenger RNA and it’s kind of like a genetic software that instruct cells to make a specific protein.
And in this vaccine for the Coronavirus, it codes for a Coronavirus spike protein which is on the surface of the viral cell, the viral membrane and that spike protein stimulates an immune response in your body.
Another newer vaccines that’s being tested now is called a Vector vaccine, and AstroZeneca and Johnson & Johnson are currently in phase 3 of a trial for a Vector vaccine. What a Vector vaccine is it actually it uses a different type of virus and in this case they’re using an Adenovirus which is Adenoviruses cause like common colds and they alter that virus so it produces that spike protein that’s normally produced by the Coronavirus and that’s used as a vaccine again to stimulate production of that spike protein and your body can recognize that spike protein form an immune response to it and have immune memory against it so when you’re later subject or exposed to the Coronavirus, your body’s immune system will already have antibodies and immune cells that are ready to attack that virus and can sometimes prevent an illness from occurring or sometimes reduce the severity of the illness so it’s very mild but again the importance of it is to reduce the risk of complications or death and reduce the risk of spreading it to other individuals.
Another type of vaccine that’s being investigated are Protein Subunit vaccines, and they use little pieces of the target virus and it circulates and stimulates your immune system to recognize it and find it if the true virus you get exposed to later on.
Nice thing about the Messenger RNA is that it’s a small genetic code and it’s very easily synthesized. You don’t have to incubate it or grow it, and it’s a lot quicker to produce a vaccine of that nature. It’s also not a live virus or an inactivated virus so it’s thought that the Messenger RNA vaccines which will be safer in the long run.
So on the left here again is a picture of vaccines that’s being produced. It has a small piece of genetic material that Messenger RNA in the center and it’s coated with that lipid nano particle and that lipid bubble protects that Messenger RNA and ensures that it gets delivered to the cell where it’s targeted.
And on the right here is the SARS-CoV-2 virus, and you can see it’s started with these spike proteins and those spike proteins helped it attached to human cells and attack it. And these are the spike proteins that that Messenger RNA produces so your body will form antibodies and immune memory cells against it so when it is exposed to the entire virus, it’s able to attack the viruses very quickly.
This next slide again is an overview of how the Messenger RNA vaccine works. That Messenger RNA it protected in a lipid bubble is able to enter into human cell and that human cell will use that Messenger RNA as a template to produce the spike protein, and the spike protein gets delivered to the cell membrane and exposed to your immune system to recognize it and attack it or sometimes fragments of that spike protein or can be excreted from the cell or if the cell dies it will be exposed and that’s another way where immune system can recognize it as foreign and generate an immune response against it.
I wanted to point out a couple of things and that again the Messenger RNA type of vaccine works in the cytoplasm of the cell. It doesn’t enter the nucleus of the cell where your genetic material is housed so it does not get into your own DNA, and all of our cells are constantly using Messenger RNA to produce protein so this is a very normal type of cell behavior. It’s not something that’s strange or foreign.
So again, we’ll go quickly over this but after injection that Messenger RNA will be incorporated into a cell and that Messenger RNA will attach into a ribosome and produce these spike proteins and these spike proteins can be fragmented or whole delivered to the cell surface or excreted out into extracellular areas and then your immune system will start to recognize it and attack it.
And here is a diagram of an antigen presenting cell which are key in the immune response and it’s delivering that spike protein to a T helper cell which is this health cell here. I think what I’ll do is I’ll have a separate talk that talks more in detail about this for those that might be interested. You vaccine geeks out there can kind of check into that but for the purpose of brevity we’ll move forward.
And just… I wanted to let you know that this type of vaccine stimulates two types of immunity: one is cell mediated, where cells are produced that can recognize those spike proteins in the future; and also an antibody mediated immunity, where actually antibodies are produced by some of your immune cells and those antibodies can recognize and attach to the spike proteins in the virus and help destroy it.
This slide reminds us that the COVID vaccines that are coming out—the Messenger RNA ones—are going to be two-phase and that you get the first vaccine and then you get a second vaccination three or four weeks later.
It’s also important to remember that getting that second vaccine is not an uncommon situation for vaccines. Some of the vaccines that we talked about earlier actually have second and some even third phases to it to ensure both a robust immune response and you know high effectiveness but also the hope of long-lasting immune response.
And here’s a quick overview again where the injection of the mRNA into intramuscular region usually it’s in the shoulder, and then it stimulates a cascade of events and an immune response. It’s important to remember that the vaccine itself this the lipid protective layer quickly dissolves, the mRNA naturally degrades over time but also was attacked by enzymes in your cell and those will be broken up and destroyed relatively quickly. So really the remnants of the vaccine quickly disappear and what’s left is your immune system that’s enabled and ready to recognize that spike protein should it be should it infiltrate your body.
So enough about your immune system and vaccines, we’re going to talk shift gears and talk more about what’s going on with vaccine production in the United States and actually globally, Coronavirus aid relief and economic security or cares act along with the family’s first Coronavirus response act is supposed to ensure that anyone who desires a vaccination will get it without an economic burden.
And it also recognizes the importance of beginning to manufacture a vaccine at a large industrial scale so that we can start to attack this Coronavirus through vaccination. And it’s governmentally funded and the government started to fund over 100 pharmaceutical companies to not only work on vaccination but also to work on medicines which could combat to Coronavirus and its complications.
And we’ll talk a little more about emergency use authorization in a little bit, but just know that these pharmaceutical companies were heavily funded to provide as much support as possible to producing a safe and effective vaccine. So these pharmaceutical companies never had this much funding and resources to produce such a vaccine and that contributed to how quickly it could be developed.
And the other novelty and why these vaccines are being produced so quickly is that with the financial funding there was very little financial risk these companies were incentivized to come up with not only come up with a safe and effective vaccine but also mass produce it so it can be supplied to a large population.
How they did this was that they were instead of doing things sequentially where you go through the research phase and then small study phase and then gradually go up on the amount of subject in the study and then you come up with a safe and effective vaccine and then you start to look into mass producing it and packaging it and delivering it, instead these things are happening all in parallel all simultaneously.
So when for example the Pfizer vaccine and the Moderna vaccine when they completed phase 3 of their trials and it showed a safe and effective use, they were already in the process of producing enough vaccine to start vaccinating the population through emergency use and again we’ll talk about that more in detail.
But a lot of people are concerned of you know how quickly these vaccinations were produced and this is a big reason why; also it’s important to point out that even the flu vaccine is a different vaccine every year and it’s studied and identified and then mass produced within in less than a year over essentially 8 to 10 months and ready for the public in mass production. It’s also important to know that there’s been a lot of oversight into these vaccines and their safety.
Operation Warp Speed is a partnership amongst components of the Department of Health and Human Services or HHS including the Centers for Disease Control or CDC, the National Institute of Health or NIH, the Biomedical Advanced Research and Development Authority or BARDA, and some of these agencies such as National Institutes of Health (NIH) have sub divisions or subcommittees such as the NIH’s Accelerated COVID-19 Therapeutic Interventions and Vaccines partnership were active NIH’s Rapid Acceleration of Diagnostics Initiative or RADx.
It’s important to know that the vaccines and related biological products advisory committee oversees all vaccine development and research as well. And those are on the federal level on the state level we have the Massachusetts Department of Public Health, and their Mass COVID Vaccine Program or MCVP through Mass. Department of Public Health they’ve organized a Massachusetts Immunization Information System or MIIS which is coordinating with health care provider sites and it’s a web-based registry to kind of monitor vaccination and vaccination programs within healthcare providers and where Whittier the rehab hospital on Bradford is registered with the MIS they want to know all of our vaccinations or who we vaccinated with the flu, our numbers, and then going forward with the COVID vaccine and all of this is to kind of track the numbers of who’s vaccinated and monitor its effectiveness but also looking out for potential adverse effects as well. Again, with the importance of looking into both effectiveness and safety.
And this part I put here on the slide just to remind myself to talk about the fact that all of these agencies both state and federal have websites where you can gather information if you’re curious on your own. For example CDC.gov has a lot of information on vaccine safety and its effectiveness as well. It talks about different types of vaccination programs not only the COVID vaccine.
Again, this is the typical vaccine production cycle. It typically starts with basic research and moves on. Again, normally these things are done sequentially; one gets completed before the next one starts, but again with Operation Warp Speed a lot of these things were happening simultaneously to shorten the amount of time.
And again all of these agencies are overseeing how the studies are conducted and potential dangers and looking into effectiveness the advisory committee on immunization practices oversees much of this.
A little bit more in detail of what the phases mean, you know, you hear a lot out there about phase 1 and phase 2 and phase 3. Phase 1 is again looking back kind of in the middle phase of vaccine production and phase 1 is usually a small groups of people and the focus is on safety, so they’re given the vaccine and really monitoring for how it’s tolerated and safety when it’s shown to be safe in small group it’s the companies are allowed after approval by those regulatory agencies to proceed to phase 2 which looks at both safety and efficacy it’s a larger group usually in a few thousands of people and when that’s demonstrated again to be safe and effective enough, it’ll be approved for phase 3. And phase 3 is large groups you know in the Moderna study there was 30,000 people; in the Pfizer’s phase 3 trial, 44,000 people I believe.
In Operation Warp Speed or with certain situations after phase 3 completion showing good efficacy and safety, a pharmaceutical companies can sometimes apply for emergency use and we’ll be talking a little bit more about that going forward.
Emergency Use Authorization or EUA is a way for under serious life-threatening situations such as the pandemic, another instance was when the Ebola virus was affecting and people in highly deadly and contagious, a vaccine was being developed for emergency use. So in those grave situations, there are ways for vaccines and other medicines to be approved quicker than the normal processes that typically involves a serious or life-threatening situation.
It has to be based on evidence on safety and effectiveness, the benefits greatly have to outweigh the risks and there has to be no adequate FDA approved alternative. So Pfizer Pharmaceuticals recently completed their phase 3 trial with their Messenger RNA vaccine and has applied for emergency use authorization, and is under review by the CDC. And there should be a ruling on that on December 10th and Moderna filed as well and there should be a decision on that a week later.
It’s also important to know that that’s within the United States, in other countries the vaccines have already started being used. The Pfizer vaccine in the UK is one instance where that was started actually this week, December 7th.
A little bit more detail about the Pfizer and Moderna vaccines. Those are being reviewed for potential emergency use and under phase 1 of the administration or vaccination program the population that’s targeted are residents in long-term care facilities along with health care workers.
Both vaccines are mRNA vaccines the phase 3 trials for both showed high effectiveness in the 90 to 95% range in Pfizer and 94.1 percent effective. They’re both intramuscular, I am sorry, but they’re going to hurt.
The uniqueness about the Messenger RNA is that it needs to be… it’s very fragile and can break down very easily and it needs to be in a deep freeze for it to survive. The Pfizer and Moderna vaccines differ a little bit in that the Pfizer vaccine has to be kept at -60 to -80 degrees celsius extremely cold not just in a traditional freezer but in a deep specialized deep freezer and specialized dry ice packaging. The Moderna vaccine can be kept at -25 to -15 and lasts longer so it’s a more stable product.
The companies are packaging their vaccines in 100 units for the Moderna in a packaging and 975 for the Pfizer, so the Pfizer packaging is much larger. It’s very unique in that if you have a deep freezer that can keep to store things this cold that’s great, but many facilities don’t have that capability, if you don’t, you’re able to store it but then within its original packing for up to 15 days as long as you can replenish the dry ice every 5 days and there’s details about how it should be packaged and stored and tested. After the 15 days, it can be or whenever it’s reviewed, removed from the original deep freeze it can be stored in a traditional freezer -2 to -8 degrees celsius for up to 5 days after it’s taken out of the freezer or deep freeze when it’s at more ambient temperature and being used for let’s say a vaccine clinic it can be good for up to 6 hours.
And again both of these vaccines are two doses, three to four weeks apart. And it can… it should be targeted you know the Pfizer vaccine after 21 days but there is a little bit of leeway with that but then it’s again it’s important to get that second dose to have a higher effectiveness and hopefully more long lasting protection from the COVID.
Let’s kind of shift gears and talk about side effects because that’s a big concern in a lot of people and it’s important to differentiate between side effects and adverse events.
Side effects are very common they’re benign and usually very self-limiting meaning they don’t last very long and they’re also expected when you’re exposed to a vaccine or when you get exposed to any type of virus or bacteria an immune response is generated and when your body’s immune response is stimulated you notice it you feel it and sometimes it’s unpleasant where you’ll feel fatigue or have a headache or have muscle aches or Myalgias or joint aches like Arthralgias, you’ll sometimes get feverish or chills feel like you’re coming down with something.
It’s important to know that that’s the vaccine working, that’s your immune system being stimulated and that’s what you want when you’re taking a vaccine is for immune system to be stimulated, produce antibodies, and memory immune cells so when you are exposed to that potentially deadly virus your immune system is going to be able to act quickly, and either prevent illness limit, the severity of the illness, decrease the risk of a complication from the illness, and decrease the likelihood of it spreading to other people.
I also wanted to point out that these side effects are very common with any type of vaccine including the flu vaccine which hopefully you’re all getting on a yearly basis. And it’s important to understand that the difference to these two adverse events, things like Guillain-Barre Syndrome which is obviously not benign and not self-limiting and not go away quickly after hours or a day or two.
It’s an unexpected response of the immune system which can happen after a vaccination but also can happen after a virus classically you think of Guillain-Barre after a virus especially a gastrointestinal virus or a cold or flu type virus but it can also happen after a vaccination and the incidence is 1 in 1.3 million people, so it’s very rare after vaccination.
There are other even more rare neurological conditions that occur that sometimes your immune system goes haywire after a virus or vaccine, and attacks the central nervous system. There’s also a phenomenon called “immune charging” which people with immunologic diseases such as lupus are a little bit more at risk from after vaccination where immune system can be charged or stimulated and you can actually have an exacerbation in in your autoimmune disease. It’s again very rare but an unexpected and that’s the difference between adverse events versus an expected side effect.
When these vaccinations were being studied in various phases there was careful observation for potential adverse events and none of those, neither the Moderna nor the Pfizer vaccine had a reported adverse event but they did have the side effects that we’ll talk about.
And this is a slide I borrowed from my influenza vaccine talk to understand that and demonstrate the difference between local reactions and more systemic reactions local reactions are at the site of injection typically it’s pain, redness, and swelling. And then you have your immune system kicking in sometimes causing fatigue, muscle aches, headaches, joint aches, chills or fever.
Older vaccines that used egg protein to incubate or preservatives such as thimerosal or even older vaccines had small amounts of antibiotics in them would sometimes cause allergic or hypersensitive reactions. None of the mRNA vaccines demonstrated that, they don’t have any egg protein or antibiotics or other preservatives. Again, it’s just a small piece of Messenger RNA in a small lipid bubble. Again, the neurological or other adverse events are very very rare can be triggered by a vaccine or a virus.
I wanted to really talk a little bit more about what to expect and really just this slide the next two slides differentiate the difference between the first vaccination and the second one that you get three or four weeks later. And this is borrowed from a study that was published in the New England Journal of Medicine back in July and it was looking at the Moderna vaccine and side effects. And this was a small like a lower phase and all the subjects were either given 25 microgram dose, 100 microgram dose, or 250 microgram dose and you can see where the side effects were higher in the higher dose individuals.
I wanted to point out too that the vaccine that’s being produced for the population is 100 micrograms, so nobody’s getting this high dose but you can see where the higher dose will sometimes have a bigger response of side effects. But it’s what’s more striking is the differences between side effects with that second vaccination. So again the first vaccination primes your system and then that second vaccination you get a more robust immune response and a more robust immune response means more side effects.
So I think we should all anticipate having some sort of ill-feeling, muscle aches, pain, fatigue, that sort of thing especially with that second dose and plan on maybe taking it easy that day, scheduling the vaccine at the end of the day, and not before work or maybe on a day before a scheduled day off. Those are some things to consider
It’s also important to point out that with these studies none of the subjects were allowed to use anything like Tylenol or Motrin to help them feel a little bit better after vaccination which I’m sure would help with some of the side effects.
The next slide focuses on more local symptoms and again it’s very common to have pain at the site of injection and sometimes swelling or redness and again we’re not no one’s getting this high a dose it’s in a 100 microgram and anticipate again a little bit more of a robust immune response and side effects potentially with that second dose.
Typically traditionally, the Center for Disease Control and Prevention or CDC and the FDA work together and jointly established a Vaccine Adverse Event Reporting System or VAERS and it’s a way to keep track of and report any type of adverse event from a vaccine or any vaccine, and the CDC and FDA also worked together to have a Vaccine Injury Protection Program which is a funding program which can provide relief for people who have suffered from an adverse event from a vaccine such as Guillain-Barre, there’s way to get funding for hospitalizations and illness.
The CDC also has other systems in place to monitor vaccine safety—Vaccine Safety Datalink or VSD is a collaboration between the CDC and nine healthcare organizations across the country to work on a information gathering system and oversee potential adverse events in vaccinated people. And there’s also the Clinical Immunization Safety Assessment and that’s collaboration with the CDC and seven medical research centers which look at vaccine safety as well.
What’s New with the COVID Vaccine is a program called V-safe, and it’s a smartphone-based system where you can register after the COVID vaccine and it’s a way to report symptoms, and signs, and potential not only side effects but potential adverse events. And it’s also a way to have get/obtain web-based information on what’s going on with the vaccination programs across the country, so that’s unique.
The Advisory Committee on Immunization Practices (ACIP) has worked very hard on trying to figure out how to allocate the vaccine in a scientific, safe, and ethical way, and what they’ve deduced is that the delivery of the COVID vaccine is going to be in different phases and phase one is broken down into Phase 1a, 1b and 1c.
And 1a is involves healthcare workers and support staff, so anybody within a healthcare provider facility such as a hospital, along with residents in long-term care facilities such as skilled nursing facilities and assisted living facilities, along with healthcare workers who help care for those individuals, and it’s thought that that involves approximately 21 million health care workers and support staff along with 3 million residents.
And again, going back to the beginning of the talk is where the health care workers are at high risk of exposure, they’re also important in the workforce to take care of patients who are ill and are coming now at COVID-19, and also residents in those facilities are extremely high risk again encompassing 6% of people are affected by COVID-19 but represent approximately 40% of the COVID related deaths. So these patients/residents (I’m sorry) are very high risk and that’s the reason for the protection.
Phase B will involve first responders, CMTS, police officers, firefighters and essential workers, teachers, workers involved in transportation, so anybody who’s assigned an essential worker and that’s a much larger population approximately 87 billion.
And then Phase 1c will be individuals at high risk, and people over 65 and again those folks are at high risk for more serious complications. It’s a much higher population a larger population I should say as well but all those folks are involved in that first phase which again may start this December as early as next week and then progress going into January and so on.
And it’s really going to be a tremendous coordinated effort between government and the federal legislature, cooperating with the pharmaceutical companies and then allocation on the state level and then the state left from the state level, working on allocation and delivery to the individuals in the those phase groups. And the delivery system is going to be a little bit different to long-term care facilities compared to hospitals and other health care provider facilities.
On the skilled nursing facility level or long-term care levels, many of those facilities are contracted with a pharmacy program and that pharmacy program typically is responsible to vaccinations such as the flu vaccine and delivering medications to those residents.
So it only makes sense that they will be overseeing the COVID vaccination programs at those facilities and essentially housing going to the facility from facility to facility and having COVID vaccine clinics. Right now, facilities are being asked to complete surveys and register for the programs, then clinic dates, and times are going to be set and there’s a lot of communication back and forth. Electronically there’s a system in place for consent forms to be taken care of before the clinic date in registration along with setting up that follow-up second vaccination thereafter.
So that’s the model within many of the long-term care facilities on the hospital level or facilities like Whitter or Bradford those respective facilities or hospitals will receive the vaccination packaging and they will oversee the storage and handling and administration.
So right now, Whittier Bradford along with other hospitals in the area are working diligently on again registering and working on ways to safely store and handle and then administer the vaccine safely but also obtaining the information that’s needed to register everyone that gets the vaccine, along with setting up a follow-up and again within long-term health care facilities their usual preferred pharmacy provider and locally here for our facilities at CVS Health will establish on online clinics.
And it looks as though through the emergency activation that this may happen as early as the middle of December. So it’s most likely going to happen in the near future there’s that first vaccine and then three or four weeks later depending on the vaccine type that second vaccine.
What happens after vaccination? What’s next? Well unfortunately, mass wear and use of precautions and safe habit doesn’t change at least not right away. So you’ll continue to use precautions with safe distancing mask, use of cleaning agents, avoid touching your face and eyes, avoid crowded areas and typical things, again the success rate of the vaccines is 90 to 95% and it usually occurs a few weeks after that second vaccination you are partially protected after that first one.
But it’s not a hundred percent, it’s not guaranteed, so it’s real important to continue to safely practice. Immediately after your vaccination, it’s important to take care of yourself, and hydrate well, get proper nutrition, proper rest, and sleep that helps your immune system be more efficient and you’ll get a better response, and hopefully a quicker recovery from the potential side effects that you may experience after vaccination.
It’s okay to use Acetaminophen or Tylenol or NSAIDs. It’s important to kind of plan your day accordingly knowing that you may not feel 100%. All people who get register and get that first vaccine will get a vaccination card and will be immediately scheduled for that second vaccination and again there’ll be a reporting system V-safe and there are other avenues to report potential adverse effects or side effects if they should occur. Again, it’s very rare and I know I’m encouraged and looking forward to the vaccine and its administration.
I looked at all the information it appears very safe and highly effective a lot more effective than most people were thinking or hoping for and I’m going to conclude my talk at this point but also offer up any if there are any questions or concerns or things you want to discuss about I’m available here via email or voicemail here at Whittier Rehabilitation Hospital in Bradford.
Thank you very much for your attention. Take care and stay safe.