How has the Pandemic affected you as a cancer patient/survivor

Anonymous

I failed to mention this when I posted that there were 10 anti-mandate protesters outside my hospital in Montreal. In normal times there is always a protest here about something. Big protests. It's pathetic that they could only muster 10 people to protest the vaccine mandate for HCWs.

exbrnxgrl

I agree however I have done some fairly extensive traveling through quite a few third world countries on almost every continent. Sadly, the essential structure of many are the same, i.e. authoritarian rule, graft and corruption at almost all levels of both the public and private sector. small upper class, minimal middle class, most in poverty and all of the attendant inequities that go along with such wealth imbalances.

Though I wish that reality was different, and I am always hopeful it might be, there is an uglier side to humanity that I have been both horrified and privileged to know first hand.This is not negative, simply pragmatic.

Speattle

Ugh, I am so sorry about the busted ankle! 3 years before my Cancer dx, I had a bad break in my foot. it too 2 major surgeries and a lot of hardware to put it together again, and about a year of my life was spent in a cast, and another year to get back to normal ambulation. I feel for you. it is very rough having that kind of mobility issue, and with the cancer and pandemic at the same time????? You have my totally sympathy.

Aram

In one third world country, yesterday, 1 million doses were administred. Not every third world country is Afghanistan without a stable state. And not every third world country is asking for donations or handouts. Rich countries are paying more to secure more vaccines and hoard them. Remember at the beginning US was not even giving Vaccines to Canada and Canada had planned and purchased all those vaccines well in advance. The result? While I was in chemo and vulnerable my healthy young US coworker got the vaccine and went to Hawaii.

Beesie

Aram, yes, good point.

On a per capita basis, Canada placed more orders for vaccines than any other country in the world. Canada got a lot of flack about that, but those orders were placed with the stated plan to donate all excess vaccines to COVAX. Where things got messed up early on was that Canada didn't get any vaccines. This was thanks to Trump, and then Biden, who continued what Trump had started. Trump mandated that all vaccines manufactured in the U.S. had to be distributed only to the U.S.. Sounds reasonable, right? Wrong, because this is not how global companies are set up. Global companies, including pharmaceutical companies, consolidate manufacturing to a limited number of sites which are each designated to supply a region, or to supply particular drugs or manufacturing components globally. Early on, there was a lot of angst in the Canadian media about the fact that we didn't have manufacturing sites for Covid vaccines (we do have sites that produce flu, diphtheria and tetanus vaccines but those use a different manufacturing process) and yes, political policy and decisions over the years may have had something to do with that, but it's also just how these companies work.

When Canada placed orders with Pfizer and Moderna, under normal circumstances and with any other product, those orders would have been manufactured by Pfizer's and Moderna's plants in the U.S.. But Trump, and then Biden, put a stop to that. They interrupted the normal supply chain for those companies. So those companies had to scramble to figure out how to supply countries that normally would have been supplied from the U.S.. Canada is getting our Pfizer and Moderna vaccines from Europe - from manufacturing facilities that normally would have not supplied Canada. Naturally EU countries have priority over that supply. Unlike the U.S., the EU fortunately did not ban EU manufacturing sites from supplying countries outside of the EU - although at one point they considered it. This is the long story as to why Canada got off to such a slow start with vaccinations. The U.S. hoarded all American-based manufacturing, to the point of making it illegal for U.S. based manufacturers to ship outside of the U.S.. And of course, this didn't just affect Canadian supply of vaccines but global supply, including supply designated to go to COVAX.

As an aside, from what I could find out, it appears that Pfizer have 42 manufacturing sites around the world, which gives them a fair bit of flexibility. Moderna have manufacturing at their site in Cambridge MA, and for all other manufacturing have contracted with a company called Lonza, who have plants in New Hampshire (which of course could only supply the U.S.) and Switzerland.

COVAX... here is some information:

Joint COVAX Statement on Supply Forecast for 2021 and early 2022

"In the critical months during which COVAX was created, signed on participants, pooled demand, and raised enough money to make advance purchases of vaccines, much of the early global supply had already been bought by wealthy nations. Today, COVAX's ability to protect the most vulnerable people in the world continues to be hampered by export bans, the prioritisation of bilateral deals by manufacturers and countries, ongoing challenges in scaling up production by some key producers, and delays in filing for regulatory approval.

According to its latest Supply Forecast, COVAX expects to have access to 1.425 billion doses of vaccine in 2021, in the most likely scenario and in the absence of urgent action by producers and high-coverage countries to prioritize COVAX. Of these doses, approximately 1.2 billion will be available for the lower income economies participating in the COVAX Advance Market Commitment (AMC). This is enough to protect 20% of the population, or 40% of all adults, in all 92 AMC economies with the exception of India. Over 200 million doses will be allocated to self-financing participants. The key COVAX milestone of two billion doses released for delivery is now expected to be reached in the first quarter of 2022."

And here you can find a country by country status of vaccine distribution: COVAX vaccine roll-out: country updates

Trishyla

Thanks for that info, Beesie. I wasn't aware t that Biden had continued that Trump era restriction on vaccine exports.

I will contact my representatives, both my Congresswoman and Senators, to ask them to support lifting the ban. If enough of us do that, we may get some action on it.

AliceBastable

Moat of the information on supply and distribution seems to be from several months ago. I'm not sure of the issue with the vaccines coming from manufacturing plants in Europe - with any multinational company, products can come from any of their facilities on a supply/demand basis. Considering the U.S. has a vastly larger population than Canada, why wouldn't it make sense for local products to be used in the U.S. first, as long as the European facilities could keep up the supplies needed to other countries? It looks like the Canadian vaccine rate is higher than that of the U.S., so it doesn't seem like there was a shortage at any point.

https://en.m.wikipedia.org/wiki/COVID-19_vaccination_in_Canada

Trishyla

was your comment meant for me, Speattle? If so, thanks for the sympathy. I'm doing much better after finally getting physical therapy. And I finished my active treatment in 2018, so fortunately didn't have to deal with that during the Pandemic.

Hope everyone is doing well this beautiful Tuesday. We're finally having a break from our horrible heat. It's a lovely day here in Sunny California as we head to the polls to keep our very competent governor.

If you haven't heard, there's an effort to recall our governor for doing all the right things during the Pandemic. He courageously shut us down early and provided a ton of financial assistance for citizens and businesses alike, as well as having the highest budget surplus in California history.

The Trumpers behind the recall want to replace him with an anti mask, anti vaccine, whackadoodle radio talk show host. And they wonder why they can't win statewide in California.

What a crazy, mixed up world we live in.

Trish

Anonymous

There was a huge shortage before April. It was very frustrating to wait until the middle of April before we could get our first shots.

wrenn

I was frustrated by our shortag of available vaccines in the beginning. It meant waiting longer than recommended cor 2nd dose so everyone could get first dose. I got 2nd 3 months after first.

Sadiesservant

And there were some longer term impacts due to policies, as there was another shortage of Pfizer in Canada in June at the time that I was approved for my second shot. As a result, I had Pfizer and then Moderna. While they say the coverage will be equivalent, there are many places that will not recognize my mixed dose status including much of the US. I had hoped that if things settled down I would be able to celebrate my 60th birthday in New York but that remains uncertain unless I get a third dose.

Anonymous

wrenn - The optimal delay between the first two doses of the mRNA vaccines is greater than the original recommended 3-4 weeks. According to this, it's around 9 weeks.

https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3001211

Beesie

"I'm not sure of the issue with the vaccines coming from manufacturing plants in Europe - with any multinational company, products can come from any of their facilities on a supply/demand basis. Considering the U.S. has a vastly larger population than Canada, why wouldn't it make sense for local products to be used in the U.S. first, as long as the European facilities could keep up the supplies needed to other countries?"

No, it wouldn't make sense, not if the American plants were designated within Pfizer and Moderna as being the supply sources for Canada. The American plants were built with capacity to supply the U.S., Canada, and maybe Mexico and some Latin American countries. The mandate by Trump/Biden put extra pressure on the EU sites, which were not supposed to be supplying Canada (and possibly these other countries) and couldn't keep up. Early on - February, March, April, even into May - Canada and many EU countries were significantly behind the U.S. in % vaccinated because of lack of supply. At a time when only those 65+ could get vaccines in Canada and many places in Europe, the U.S. had enough supply to open up vaccinations to all ages (of course, since they had all the vaccine production that should have gone to Canada and other countries normally supplied by the U.S. plants), and they were flooding drugstores with supply. I would watch the U.S. evening news every night with steam coming out of my ears.

wrenn, yes, the reason that Canada's vaccination rate eventually (in May/June) jumped past other countries was the decision to give out as many first doses as possible before starting in on second doses. To be honest, I think that worked in our favour. From my reading, it's my understanding that a 3-4 month window between vaccine doses is generally believed to be optimal. With the Pfizer and Moderna vaccines, the recommended interval between doses was much shorter, but this was driven solely by the fact that they were rushing to market; in the clinical trials, to save time, they only tested the shorter interval. AstraZeneca did test both 4 week and 12 week 2nd dose intervals in their clinical trial, and 12 weeks was far superior. I seem to recall reading recently that a trial result came out on Pfizer at 12 weeks, and the results were improved versus having the 2 doses at the shorter (and officially recommended) interval. So despite not having specific information about Pfizer and Moderna vaccines, Canadian officials made their decision to delay second doses based on a lot of vaccine history. With AstraZeneca, they made the decision on 12 weeks for second doses based on the AZ clinical trial results.

I don't know this for fact, but I suspect that part of the reason why the efficacy of the vaccines is fading so fast in Israel and U.S., both countries where they got 2nd doses into people quickly, is because those second doses were given at 3-4 weeks, versus a more optimal extended timeframe.

Despite the major mess-up that was the vaccine roll-out in Canada, in the end I think I got lucky. At a time when only those 80+ could get a Pfizer or Moderna vaccine in Ontario, AstraZeneca (which did not have enough seniors in their clinical trial) was made available to those aged 60-65. That allowed me to jump the line and get my first dose sooner. 12 weeks later, by the time I was eligible for my second dose, I had the choice of AZ, Pfizer or Moderna. Based on several clinical trials that found that AZ followed by Pfizer was more efficacious than 2 doses of AZ or 2 doses of Pfizer, I opted for Pfizer as my second dose. Mixed doses appear to be better than 2 doses of the same. Check. 12 weeks between doses appears to be better than 3-4 weeks. Check. A double win for me, but only after a lot of frustration, thanks to the supply issues and very slow roll-out.

Edited to add: SerenitySTAT, I had not seen that study. Very interesting. It appears that they are saying that the interval should be "at least" 9 weeks, with delays of anywhere from 9 weeks to 15 weeks being optimum. This is consistent with my earlier reading about intervals on other types of vaccines.

Anonymous

Beesie - There have been different studies, and it depends on which intervals they tested. The earlier ones I saw recommended at least 6 weeks. My husband was like you and got AZ then Pfizer 9 weeks later. I had Moderna (15 wks). My adult daughters had Pfizer with 5 weeks in between. They could have gotten their doses earlier, but they waited as long as they could before they had to start commuting. With Delta they needed the second dose sooner.

moth

We had NAFTA, now we have USMCA https://en.wikipedia.org/wiki/United_States%E2%80%...

We have intertwined our economies so much and suddenly when push came to shove, protectionist forces prevailed and shut Canada out of both N95 masks by 3M and from vaccines. 3M has opened up a new plant in Ontario to make masks in Canada. I'm not sure where we are with getting a domestic vaccine manufacturer up again also but given how this played out, I'm wary of being dependent on other countries. Our closest ally shut us out. Everyone wanted free trade when it helped create jobs and build a huge economy but then suddenly it's "this is mine, you can't have it"

I think it's been a frustrating chapter for Canada but a good eye opener to stop relying on others for some things.

Teedoff

I have gotten used to the flow of fairly frequent updates to CDC guidance about vaccine intervals and age expansion. Back in February 2021 in my area it was difficult to get a vaccine appointment. The government was rolling out eligibility based on various criteria including age. When it was our turn, there was a rush to be vaccinated. Second shot was recommended 28 days later and appointments were made. Some of those appointments couldn’t be fulfilled because pharmacies and government vaccine centers did not get their promised supply on time. Many people traveled to more distant locations if they could obtain an appointment. By the time vaccines were offered to the general public it was end of March, early April. People without appointments would go to a location towards the end of the day to see if there were unfulfilled appointments. By the time we started hearing about surplus vaccine it was early May.

I looked at my card to confirm my dates and know how much time we spent on the internet getting our chain pharmacy appointment. This was our experience. I remember texting with friends back and forth sharing information if we heard that a location was taking appointments. We would rush to the computer to try and get an appointment. In retrospect we would have probably have been better off with a longer interval between shots!

This is only our experience and doesn’t challenge or refute anyone else’s

Aram

I don't know how many of you had issues with Trump's "America First". Biden continued the policies based on that principle. Logically if you were against it before, you should feel the same now.

And as a Canadian I do expect my government not to hoard vaccines.

As moth said after this experience, one of my biggest demands from Canadian government is to ensure we are self reliant when it comes to manufacturing vaccines and other essential products. The trust is broken.

Latte123

I am appreciating this thread and the variety of perspectives. I need help understanding this conversation about the U.S. distributing the vaccine to other countries. Here is the official White House strategy for distributing excess vaccines, published June 3, 2021. I am assuming they are following this strategy, am I wrong? Is the issue that not enough of the U.S. vaccine supply will be shared? Official recommendations on a booster are still not set in stone, so it is not clear how many people will qualify and get the booster and how that will affect the number of excess doses. If anyone can enlighten me on this, I would appreciate it and if not, I know we are all busy with lots of stuff and I am not demanding your educational services at this time! I mean that last sentence in the friendliest way possible as I know it can be tiring to educate others . . .

https://www.whitehouse.gov/briefing-room/statement...

Trishyla

Thank you for that info, latte123. That sounds much more like what I would expect from the Biden Administration. It just didn't sound right that they would continue Trump's policy of hoarding vaccines.

They may have been slower getting off the mark than we would like in regards to sharing the surplus vaccine with other countries, but I'm glad that they're finally ramping up programs to distribute them where they are needed most. They know as well as we do that this Pandemic won't be over until all countries have enough vaccinated citizens.

AliceBastable

Over 11,000 deaths in my state of Backasswardstan. The hillbilly governor is fighting any vaccine or mask mandates. Rat bastard.

"Missouri on Tuesday surpassed 11,000 COVID-19 deaths, including the death of a child, as early data indicates August was one of deadliest months of the pandemic."

Full article:

https://www.stltoday.com/lifestyles/health-med-fit/coronavirus/death-of-child-added-to-toll-as-missouri-tops-11-000-covid-19-deaths/article_18a7e310-e974-55e9-acf6-a0b9ff013814.html

Teedoff

I too am glad we will be sharing now. We in my state did not have an ample supply until late April early May 2021. Once production and distribution ramped up we started hearing about surpluses and waste. Vaccines were readily available. No excuse for hoarding. If boosters wind up being recommended for almost everyone including vaccines for younger children, the US now has the production capacity to meet that need and export as well. I may not be here to see how it goes and my crystal ball hasn’t been so great either. My hope is that we will do what is right and good

Chowdog

This is from the state department about the # of doses US has donated.

https://www.state.gov/covid-19-recovery/vaccine-de...

Beesie

"Is the issue that not enough of the U.S. vaccine supply will be shared?"

No. The issue is that the U.S. government over-ruled the normal workings of corporations in the U.S. by forcing these companies to keep all product manufactured in the U.S..

Here's an example. To my understanding, currently, the U.S. has virtually no capacity to make the standard antibiotics used to treat ear infections, strep throat, pneumonia, UTIs, etc.. These products are imported mostly from China and India. Now suppose that a new disease is spreading around the world. It's discovered that a tweaked version of one of these antibiotics is a successful treatment for this disease. To get a supply of these antibiotics for the American public, the U.S. government places orders on companies in China and India - these are the same companies from whom U.S. government has been buying antibiotics for decades. The companies accept the orders and plan to produce the supply for the U.S. at their manufacturing plants in China and India, the same plants that have produced antibiotics for the America market for years. But then the Chinese government steps in. They say, "No, for this tweaked antibiotic, it is illegal for any companies manufacturing in China to ship any product out of the country." And the Indian government does the same.

That's what the U.S. government did. They stopped any manufacturer in the U.S. from shipping any Covid vaccines out of the country, even if the manufacturer normally supplied other countries and had orders from other countries. For this one drug only, they in effect changed the definition of "U.S. supply" from "product that the U.S. government purchases and pays for" to "any product manufactured on U.S. soil". The most absurd example of this came with the AstraZeneca vaccine. Most of the world has approved this vaccine, but the U.S. hasn't. AstraZeneca manufactured some vaccines in the U.S.. Because they were not allowed to ship vaccines outside of the U.S., those vaccines rotted in a warehouse. At one point Biden did kindly "loan" a few million about-to-expire vaccines to Canada and Mexico. I thought that was pretty funny. Canada was being "loaned" AstraZeneca vaccines that we had on order from AstraZeneca and that normally would have been supplied to us from that very facility. Actually, not funny at all.

What the U.S. is doing now, in donating a portion of the vaccines they purchase to COVAX, has nothing to do with what they did to hoard all vaccines manufactured in the U.S.. Good that the U.S. is donating 80 million vaccines. As an FYI, Canada, a country 1/10th the size of the U.S., has committed to donating 40 million vaccines to COVAX (provided that our vaccine purchase orders are fulfilled by the manufacturers, of course). And we've committed $545 million to COVAX for vaccine procurement, distribution and delivery.

Edited to add: Reading back over the recent posts, I see quite a few comments about the U.S. "sharing" supply with other countries. So to explain my frustration and make my point as clear as possible, let me put it this way. As I see it, the issue isn't about how many vaccines the U.S. has shared or the timing of when they've shared vaccines; the issue is that the U.S. stole vaccine supply that should have gone to other countries who, in good faith and in accordance with previous business practice, in 2020 (before the vaccines were approved and before Trump changed the rules) had placed purchase orders with U.S. based companies.

Betrayal

I would like to say that your claim that vaccine was so readily available to all Americans is in direct conflict to my experience. Age and immunosuppressed criteria were used and I was not eligible for the first wave of vaccine because even though I met the immunocomprised criteria, I did not meet the age criteria. I was too young. I tried for nearly 2 months to get on the list, putting my name on county and hospital sytem lists and was not able to get an appointment even at a distance from my home. So I got my first vaccination in mid-March and the second in mid-April. Each state had a different rollout based on the amount of vaccine they had available per population. Some of the smaller counties with low population and low infection rates got their vaccine supply earlier than counties with larger populations and a higher infection rate. They also, unfortunately, were in some counties that were inhabited by anti-vaxers.

I think one of the laws of supply and demand is what the purchaser is willing to pay. Perhaps this had an impact on availability as well. I do not profess to be an economist but I do know that the price of drugs in the US is higher than in Canada and I wonder if price control measures had some impact on who had their orders met? I don't know.

Just out of curiosity, where does Canada purchase their antibiotics and generic meds?

Chowdog

Beesie, stole seems to be a strong word. While I do agree the us could have shared the astra vaccine sooner, I don't believe pfizer and moderna were pumping out unlimited doses during the early months of vaccine launches. The us was supply constrained too. I remember reading tons of tweets from experts trying to convince the government to vaccinate as many ppl with 1 dose only as possible & delay the 2nd dosedue to the supply issue, around feb/early March. It wasn't until late March early April that we started to see more supply.

https://www.npr.org/sections/health-shots/2021/02/01/962954518/moderna-increases-covid-19-vaccine-shipments-while-pfizer-lags-behind

https://www.oregonlive.com/coronavirus/2021/02/big-jump-in-covid-vaccine-supply-expected-by-the-end-of-march-companies-say.html

MinusTwo

Trishla - Hooray - looks like you'll get to keep your sensible, science based governor.

moth

Canada placed an order with US companies as we do with so many items under existing trade agreements, the company agreed, and the US govt overruled it. This is protectionism & kind of flies in the face of all the free trade and special relationship talks...

Btw, Canada does manufacture some medicines. Theres a pretty notorious 2017 murder case surrounding the owners of Canada's largest generic drug manufacturer .. still unsolved. Apotex makes generics which are sold around the world. We also have brand name drug manufacturing. The feds have invested lots in a new Sanofi plant for flu vaccines which is supposed to have capacity to switch production for any new viral or bacterial threat.

Trishyla

I had much the same experience as Betrayal. It took me over a month of constant searching to finally secure an appointment at Dodger Stadium on March 15th. I waited in line for hours to get that first shot.

I'm sensing a lot of hostility directed at US policies by our lovely neighbors to the north. We may have dropped the ball initially but from everything I'm seeing we are getting back on track to do what we had been doing for the seventy years prior to Trump's election; be one of the top countries dispensing financial aid to less wealthy countries.

Trishyla

Yes, MinusTwo, the recall failed miserably, as I knew it would. We're a very blue state, with Democrats outnumbering Republicans two to one. All this did was cost 300 million dollars of taxpayer money because of Republican sour grapes. That could have been better used to house the homeless of provde school lunches to hungry kids. What a waste.

Newsom, and his handling of the Pandemic, is very popular here. As far as I'm concerned he's done just about everything right.

MinusTwo

Oh well...as you can see I'm in Texas. No point even discussing what we could have done with surplus funds that were spent filing lawsuits against the feds & passing laws that limit everything except drilling for oil & eating apples (but maybe that will come). It breaks my heart.