January 30, 2021: COVID-19 AND VACCINES, PART III: MORE Q&A, AFTER THE VACCINE, AND NEW VARIANTS
As with the previous vaccine-related message, I encourage you to take a look at COVID-19 and Vaccines Part I (How It Was Not Rushed, How It Was Developed, Side Effects), and Part II (Infertility, New Strains, and When Does Normal Return). I'll update a few of those topics here:
CAN I TAKE ACETAMINOPHEN/IBUPROFEN FOR VACCINE REACTOGENIC EFFECTS? So there have been questions about anti-inflammatory medicines interfering with the vaccine-induced immune response. There is not a whole lot of hard evidence for this, but the general recommendation is NOT to take any fever-reducing/anti-inflammatory medications BEFORE your vaccination. Afterwards, don't be a hero. I do recommend trying to schedule the vaccine before a day off if at all possible, but that is not usually the case. If you're hurting or feeling chills or malaise, take the acetaminophen or ibuprofen. Keep it to a minimum and try to use it only when you first feel the symptoms coming on rather than premedicating (but again, don't feel the need to suffer). Also, if you have less reactogenic effects, do not worry! It's not a direct correlation.
WHAT IF I HAVE ALREADY HAD COVID-19? The CDC guidelines state that you must isolate for at least two weeks after your positive test and if at the end of those two weeks your symptoms have resolved (except the loss of taste and smell, which can persist) and you no longer need any anti-fever medications, you can stop isolating. That is also when you can get your vaccine. There is no waiting period outside of that. The 90-day period that was sometimes discussed was for resource allocation: since post-infection immunity is generally thought to last at least 3 months (possible drop-off after that for some folks, but evidence is sort of sparse), if vaccine supply is short, someone who is just getting past COVID-19 can wait until supplies become more plentiful (I have more thoughts on vaccine rollout below). But the vaccine does ensure you get higher titres of antibodies and more firm immunity than post-infection immunity provides, so definitely do get the vaccine when it's available to you!
CAN I GET VACCINATED IF I HAVE AN AUTOIMMUNE DISEASE OR I AM IMMUNOCOMPROMISED?
Generally speaking, yes. So far that is still recommended, but I would talk to your rheumatologist or other specialist if you have one, of course. Since the vaccine is not live and you cannot get COVID-19 from it, there is no concern for getting infected from it.
Dr. Fauci, at a recent American Society of Hematology virtual meeting: “It is clear that if you are on immunosuppressant agents, history tells us that you are not going to have as robust a response as if you had an intact immune system that was not being compromised…But some degree of immunity is better than no degree of immunity. So, for me, it would be recommended that these people do get vaccinated.” In addition, at the 2020 Advances in Inflammatory Bowel Disease (AIBD): gastroenterologists said they would recommend the COVID-19 vaccine to people with inflammatory bowel disease (Crohn’s and ulcerative colitis, who may be considered immunocompromised).
This is why high vaccination rates among those not immunocompromised will be important! Get your vaccine!
CAN I GET RID OF MY MASK AFTER I GET VACCINATED? CAN I FINALLY TRAVEL AGAIN?
1. Not yet. Here's why: Most vaccinations, in addition to decreasing symptomatic infection, also decrease asymptomatic infection and transmission. There are a few notable exceptions to this rule, including the pertussis vaccine (which is why as vaccination rates have declined over the past several years, pertussis is one disease which has seen newer outbreaks). We do not yet know if the COVID-19 vaccine will decrease transmission from those vaccinated to those not vaccinated. The hope is that it will. It should. But COVID-19 doesn't follow rules. Until we know for sure, we need to keep our masks up, maintain distance, avoid gathering outside our bubbles, and frequently wash hands. That doesn't change yet...it will. The light is visible at the end of the tunnel, but we are not at the end yet.
2. How will we know about vaccine-reduced transmission? It is my sincere hope that this information will be coming in the next 2-3 months. I hope that President Biden will mobilize resources in a real way to increase production of high-quality PPE (for protection) and to get effective testing and contact tracing. The latter is the best way to determine if we see a drop in transmission, but it's been underutilized so far. Furthermore, for all the speed we saw in development of the vaccine, the rollout and distribution have been WOEFULLY inadequate. We just reached 1% of the US population being fully vaccinated (both doses). Even if you take into account that it's a staged distribution, that is unacceptably low. We have do better and get more people vaccinated as soon as possible, and that means ramping up distribution centers, volunteers, and supplies. Please get the vaccine when it's available to you.
WHAT ABOUT THESE NEW VARIANTS? IS THE VACCINE GOING TO BE ENOUGH?
1. In COVID-19 and vaccines part I, my friend and med school classmate Dr. Chang provides some great information on how coronaviruses do not mutate as completely or as quickly as the flu vaccine. However, there is justified concern regarding the new variants we have seen sprout up around the globe - variant B1.1.7 (first seen in the UK), variant B.1.351 (first seen in South Africa), and variant P.1 (first seen in Brazil). So far, it does appear that our vaccines (designed to go after the spike protein) will still get us immunized against these variants. B.1.351 was particularly concerning because it had more changes to its spike. However, both Pfizer and Moderna are reporting that their vaccines, while they do not create as high of antibody titres, they are still above the threshold needed for protection. This is good! Moderna is also starting trials of a possible booster shot as well. Again, we're watching science happen in real time! And before the conspiracy theories start - no, this is not scientists or the government "moving the goalposts." COVID-19 is moving its goalposts. We're just adapting to meet them.
2. Again, I have to stress - please keep wearing masks, maintain physical distance, and avoid gathering with people outside of your bubble. We still need to take these precautions to stop spread, because that will hopefully prevent variants from spreading and more new variants from developing. P.1 absolutely RAVAGED a city in Brazil because they thought they had reached "herd immunity" without widespread vaccination (which is not how herd immunity works) and they let their guard down. P.1 has been identified in the US - we canNOT let our country fall into the same trap. More recent research has again confirmed the value of wearing a multi-layered mask (I posted about this back in May). For example, if you wear a surgical mask (you can buy them in multi-packs at grocery stores) and then a thick-woven cloth mask over that, that's better protection than either mask alone. I did that just the other day when I had to go to the store. It was no different than wearing a single mask. There are very few excuses not to wear a mask outside of your home these days.
Especially as states begin reopening further (Erie County, NY just lifted the orange and yellow zone restrictions - hospitalizations are going down, thankfully, but we cannot let our guard down yet or they will go back up again just like before) we must do these things for each other and help each other get through this.
CDC Guidelines regarding vaccination after COVID-19 infection: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
Moderna Pre-Print Regarding Addressing the New Variants: https://www.biorxiv.org/content/10.1101/2021.01.25.427948v1