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  • Writer's pictureDr. Bow Tie

12/23/20: COVID-19+Vaccines, Part II: Infertility, New Strains, and When Does Normal Return?

Updated: Jan 13, 2021

So, before we start, if you haven't read "COVID-19 and Vaccines" (Part I) from December 4th, I recommend that first. Since that was published, a number of questions have been raised and they're all good ones. We have answers to some of them. Not all.


ARE YOU TAKING THE VACCINE?

Already did! See my post from December 16th. My arm was quite sore the evening of and the next day, but it did not stop me from playing drums and doing a light workout that day (seriously, I need to build up my arms before dose #2). Others have reported warm/flushed moments, momentary lightheadedness, and mild fevers, all of which went away by post-vaccination day 2. It's a small price to pay for immunity against a virus that can do much, much worse. Stay tuned for January 5th, when I get my second dose.

WILL THE VACCINE MAKE ME INFERTILE?

This is far and away the most frequently asked, for good and obvious reasons. Thankfully, it was also answerable. You may have seen these next few lines before. As usual, I turned to my favorite scientific communicators. Scientist Laurel Bristow addressed it in one of her recent Instagram (@kinggutterbaby) stories - apparently the claim doesn’t come from any real research. It was proposed on a virology forum or blog post months ago but never followed up. The idea is that the coronavirus spike protein, which I mentioned in my most recent essay as the thing that the vaccine will be recreating and presenting to our immune systems in order that they recognize it for the immune response, resembles a protein that assists in creation of the placenta. However, while there is overlap in the genetic profiles, the actual parts that our immune systems are trained to recognize on the spike protein ARE unique. They are different enough that the immune system won’t identify the good protein, and the placenta should form normally. Dr. Danielle Jones, an OBGYN (@mamadoctorjones), also posted that the protein in question that helps form the placenta is actually from the fetus, so before the placenta forms, the maternal antibodies/immune system can’t actually cross into the fetus to affect that.

In addition, the Pfizer trial reported 12 people who got pregnant after the vaccine. They had asked trial participants not to get pregnant during the trial, but in the words of Jurassic Park's Ian Malcolm, "Life, uh...finds a way." (Yes, I did make this joke already to multiple people but it was worth repeating). This is a good sign that the vaccine does not affect fertility!

CAN I TAKE THE VACCINE IF I AM ALREADY PREGNANT OR BREASTFEEDING?

Unfortunately, we don't have a definitive answer on this yet. Initial human trials of any drug or vaccine do not include pregnant or breastfeeding people. Dr. Jones above and many other OB/GYNs have been posting about how, at least with vaccines, it would be much more beneficial much sooner to provide informed consent and include people in those categories. HOWEVER, until then, as with anything, it comes down to weighing risks. This is not a live vaccine, which traditionally have been the only vaccines we have avoided in pregnant/breastfeeding people. If you work in a job with a substantial risk of exposure (direct patient care, first responder, essential worker of any kind), your risk of catching COVID-19 and having long-term effects from the disease probably outweighs the theoretical risk of effects from the vaccine. If you are primarily working from home or away from people and you have concerns, the risk of waiting is lower. I urge you to communicate with your OB/GYN or primary physician/APP about this - there's no shame in asking questions.

WHAT ABOUT THIS NEW STRAIN? ARE YOU KIDDING ME?

Unfortunately this past week in the UK we saw the story of the country having to go back into lockdown because a new strain was wending its way through. First, it should be noted that multiple strains of a virus are not unexpected. There are concerns about the strain being more contagious (though this may be more of a reflection of human behavior in Europe, which was more open until now) and about it affecting children as much as adults (as opposed to the first strain). HOWEVER, the disease it causes does not appear to be more dangerous/deadly (the original is already dangerous/deadly enough). Further, we did think ahead and did expect this: MOST IMPORTANTLY, our vaccine is training our immune systems to recognize multiple parts of that spike protein. Even if the virus mutates, that spike protein is still an essential component, and this vaccine is going to train our immune systems to recognize it. So far it does not look like it will be like the influenza vaccination, required yearly because of the rapidity of mutation. The vaccine should still work on all present strains, though time will tell.

**** **** **** **** **** ****

Dr. Arthur Chang, my friend and med school classmate, now a pediatric infectious disease fellow, elaborates:

The new "strain" as you have rightly pointed out is not uncommon in any viral disease. But we do not know if this strain is "more contagious" yet. It's just one of the possible hypothesis. The epidemiological evidence suggests it *may be* more contagious because it became the dominant strain in the UK, but that fact alone doesn't prove that it is more contagious. There are also human reasons for geographical dominance of a new strain. One overly simple example would be if you had two people with different strains and one person kissed other people while the other one stayed at home the person who kissed people would be "more infectious" but the virus mutations may not have anything to do with the increased spread.

I should also add, we've actually seen this happen already in this pandemic with the D614G variant earlier in the pandemic. It was hypothesized that this is why we thought NY was hit faster than the west coast initially since this variant emerged out of Europe and came to NY. This has now become the dominant strain in the US. In the lab this variant was shown to make more viruses as compared to the original strain. But even that doesn't necessarily prove that that is more infectious, it just makes it more likely.

There are other strains people are monitoring including one that's emerging in South Africa, but as you have correctly pointed out none of these appear to have major clinical implications (e.g. vaccine won't work, produces a different disease, is worse or milder than before etc). In fact at least one product was designed specifically address multiple strains this such as the Regeneron polyclonal antibody which has antibodies that attack different parts of the virus making it much harder for rare mutations to suddenly make any single antibody useless.

===

A great paper with a nice figure that is now "old" by 4 months, but a nice figure none the less of the strains of COVID we've been monitoring for awhile. https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-emerging-variant.html


If anyone wants to "play" with the real time open source data people are tracking of viral strains there's a fun website as well. Also can give you a sense of genetically how this has spread: https://nextstrain.org/ncov/global


12/24 edit: I leave the above as is, but already 24 hours later, as science does there's new evidence suggesting that human factors cannot account for all of the increased spread. the NYTimes has a nice summary of the paper: https://www.nytimes.com/2020/12/23/health/coronavirus-uk-variant.html

*********END Dr. Chang's Additions**********


WHEN WILL I GET THE VACCINE?

The Advisory Committee on Immunization Practices met this week to finalize this plan. As you've probably heard, they are starting with healthcare workers in direct exposure. In my opinion, this should absolutely include EMS and other first responders, as well as medical/health professions students rotating on wards with COVID-19 patients, as well as custodial and environmental staff on those wards (but I'm not important enough to be in on those decisions). Next up will be residents (and staff, I hope) of long-term care facilities (most vulnerable due to their age and chronic conditions, close quarters). After that, based on gubernatorial decision-making, it will go to the general public (estimates have it starting by spring, with the hopes of getting a majority of people vaccinated by fall 2021). This will take time.


CAN I GET THE VACCINE IF I HAVE A SEVERE PEANUT ALLERGY?

Yep! The current warnings are that anyone who has had severe (anaphylactic) allergic reactions to the vaccine's components, including polyethylene glycol (which in the vaccine is part of the lipid nanoparticles that stabilizes the mRNA, but is more commonly seen, among its many uses, as the main component in Miralax when taken orally). There are no peanut or other nut components.


DO I GET THE VACCINE IF I HAVE ALREADY HAD COVID-19?

There is evidence that, in some cases, post-infection immunity is not guaranteed long-term. Reinfection has been rare, this is true. Still, at this time, it would seem appropriate to err on the side of caution and get vaccinated to ensure immunity, especially in high-risk/high-exposure situations. So far, I have known a few people who have been previously infected and have since gotten vaccinated because they work in direct patient care and are continually exposed.


HOW SOON AFTER I GET THE VACCINE CAN I GO BACK TO PRE-PANDEMIC BEHAVIOR?

CAN I STILL SPREAD THIS TO OTHER PEOPLE EVEN AFTER GETTING VACCINATED?

These questions go hand-in-hand. The answer is that this is not going to be an overnight change. Even after getting vaccinated, I am still masking and distancing, and I am not seeing my family this holiday season. This is for three reasons.

1) I have only had one of two vaccinations. My immunity isn't complete yet.

2) The vast majority of people have not yet been vaccinated, even at my workplaces.

3) We honestly don't know what this is going to do for contagion. Immunity should be present, but this virus doesn't follow the contagion rules. Most vaccinations prevent spread, but only time will tell with this one. Maybe I'm being overly cautious, but over 300,000 people are dead. This also means we still need to invest in adequate testing and contact tracing, which we still do not have, to monitor the spread and see if it goes down.


How do I know we still need more testing/tracing supplies? I've never been tested for COVID-19. I got tested for the antibodies in early summer (and was negative), but unless I develop symptoms or have a known exposure without PPE (maybe?), I don't get tested. That's not the fault of my employer or the hospitals - it's because we do not have enough. Nationwide, we do not have enough to keep up with demand (we do not even have enough to keep up with patient demand)! We absolutely need to invest in COVID-19 infrastructure because this is not over yet.


WELL, I AM LOW RISK. WHY DO I NEED THE VACCINE?

If there is one thing this pandemic has taught us, it is that we need to look out for each other. We need to think of others, not just ourselves. We need to protect each other. Right now, that means continuing to wear a mask, maintain distance, and avoid large gatherings. It means getting the vaccine when it is available (and asking questions about it if you have them)! For this holiday season, it means not getting together for indoor meals with people who do not live in our immediate households. It means even if we think we can take exception to that rule, we need to reexamine what we have been doing for the past couple of weeks and really ask ourselves if we have adequately quarantined and avoided intimate gatherings and/or exposure to others. It means having a less fun holiday this year, in order to still be able to see everyone and have a better time next year and onward. Over 300,000 people are dead and more are dying every day from this disease. We saw a post-Thanksgiving surge and hospitals are FULL. We do not have staffed beds to deal with a post-Christmas surge. We must each do our part to prevent further deaths.

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