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DOC, SHOULD I GET THE COVID-19 VACCINE?

by Family Medicine Exam Prep Course |Dec 10, 2020 | Comments Off | CCFP | ccfp, ccfp exam, cmaj, fmep, practice, samps, sogc, ssos

Doc, letâ€™s talk about the COVID-19 Vaccine!
One of the MOST ambitious and complex vaccine deliveries in Canadian history – a game-changer?

A 68-year-old healthy male books a virtual appointment to discuss the COVID-19 vaccine. â€œDoc, whatâ€™s your take on the vaccine – do you recommend it?â€

Below is a Q&A to help guide your discussion! Enjoy :)Â

(Remember this is evolving so continue to stay tuned with the latest updates)

1. Who is eligible for the vaccine at this time?

- Anyone above the age of 16

2. Who should avoid the vaccine at this time?

- People under the age of 16
- Pregnant women
- Breastfeeding women
- You should not get the vaccine if you are unwell with infectious symptoms
- Autoimmune conditions – exercise caution here as there is little information available for this population. Generally not recommended in these groups, however, you can do a risk assessment based on exposure risk.

3. If I was infected with COVID-19 in the past, am I still eligible for the vaccine?

- Yes, as long as you are feeling well but those who have never had COVID-19 should take priority.

4. How does the vaccine work?

- Itâ€™s all about the SPIKE PROTEIN. Spike proteins decorate the surface of the virus-like a crown (hence, the name â€œcoronaâ€). The Pfizer vaccine (our currently approved vaccine) is an mRNA-based vaccine; it has a lipid layer made of nanoparticles that deliver the mRNA gene that codes for the spike protein. The mRNA gets translated in the cytosol by the ribosome and a spike protein is created. The spike protein is then presented in the outer membrane of the cell and an immune response is induced creating antibodies.

5. What other vaccines are under review?

- AstraZeneca
- Moderna
- Janssen

6. Doc, how do I know if I am allergic to one of the components of the vaccine?

- In the UK, there have been several reports of allergic reactions to the Pfizer vaccine – the likely allergen is polyethylene glycol. As a healthcare provider, it is important to ask about an allergy to polyethylene glycol (it can also be found in some cosmetic creams, laxatives, cough syrups, foods, and drinks). Consider referring to an allergist for formal testing if you are clinically suspicious that the patient may have this allergy. At the time of the second dose of the vaccine, ask your patient if they had any reactions to the first dose.

7. How many doses are required?

- 2 doses are required, 21 days apart, for the highest level of immunity for Pfizer
- 2 doses are required, 28 days apart, for the highest level of immunity for Moderna

8. Doc, what are the known side-effects of the Pfizer vaccine?

- In Pfizerâ€™s clinical study, 38,000 patients were monitored for 2 months after the administration of the COVID-19 vaccine. Only minor side-effects were observed over this short timeline (2% of patients experienced headaches and 3.8% experienced fatigue). The post-market analysis will be critical as the vaccines have only been monitored for a few months to date.

9. Doc, can I stop wearing a mask if I get the vaccine?

- It is important to continue to wear your mask. Most experts say that even with the vaccine being widely available, additional measures with masks will be necessary until the public health threat has been addressed.

10. Doc, I havenâ€™t gotten my flu shot yet. Can I get my flu shot at the same time?

- Be careful with concomitant vaccination. It is recommended that you wait at least 14 days from the preceding vaccine before offering the COVID-19 vaccine. Do not let your patients receive any other vaccines for 30 days after administering the second dose of the COVID-19 vaccine (except for post-exposure prophylaxis).

11. How long do I need to stay in the clinic after I get the vaccine?

- 15 minutes, with masks on and distance of at least 2 meters from others.

12. Doc, I am retired and mostly at home. I am healthy. Will I have the option to get the vaccine as soon as itâ€™s out?

- As of now, NACI recommends that initial doses of authorized vaccine should be offered to the following populations:
  - Residents/staff of centers that provide care for the elderly
  - People over the age of 80, then decreasing the age limit by 5-year increments to the age of 70 as supply becomes available
  - Health care workers (those who have direct contact with patients)
  - Adults in Indigenous communities
- After that, as more vaccine becomes available:
  - All other health care workers
  - People who live in congregate centers (e.g. homeless shelters, correctional facilities, migrant workers)
  - Essential workers

13. What should you talk to patients about?

- Benefits of the vaccine
- Efficacy of the vaccine
- Safety
- When to return for the second vaccine
- Emphasize the importance of following public health advice

14. Helpful tips:

- Usual pre-screening criteria for vaccines apply (e.g. inquire about bleeding disorders, anti-coagulants, etc.)
- Ask about a history of syncope
- Have an emergency kit near you (including epinephrine for anaphylaxis)
- How to handle the Pfizer vaccine:
  - Store at -80 to -60 degrees C (6 months from manufacturing)
  - Store at 2 to 8 degrees C for up to 5 days
  - Do not refreeze the vaccine
  - The diluent can be stored at room temp
  - Protect the vaccine from light
  - When the vaccine is received in a thermal shipper – within 24 hours it will need to be packed with dry ice
  - Storing options:
    - Maintain in an ultra-low freezer for up to the expiry date
    - Replenish the dry ice in the thermal shipper initially (within the first 24 hours), then repeat up to 5 additional times, 5 days apart for up to a total of 30 days
    - Put in the refrigerator at 2 to 8 degrees C for up to 5 days
  - Transport to another site is not currently permitted

Take the Itch Out of Atopic Dermatitis

by Family Medicine Exam Prep Course |Nov 29, 2020 | Comments Off | CCFP | ccfp, ccfp exam, cmaj, fmep, practice, samps, sogc, ssos

Thank you to all our participants who virtually attended the Family Medicine Exam Prep Course in the fall. We are excited to see so many of you join our spring classes. Several of you have requested we continue to post more practice SAMPs, so here you go!