COVID-19 AND VACCINES, PART IV: A ROUND-UP
Well, I've been putting up a lot of political Facebook statuses and lately, so I decided it was time to check back in with COVID news. Also, I've been feeling self-conscious about the length of my essays, so this is going to be a two-parter! AND we're changing up the format! WHOA! Q&A style, here we go.
Q: Any new vaccines? A1: We're now seeing more viral vector vaccines (which use an inactive cold virus that is made to resemble the coronavirus - just plug in the spike protein). These include Oxford/AstraZeneca (discussed previously), Janssen/Johnson & Johnson (JJJ), and, in Russia, Sputnik V.
JJJ utilizes ad26 (an inactivated adenovirus). It's only one shot! Its overall efficacy was only 66%, BUT that's still better than we had initially expected with a vaccine! 72% in the US, only 57% in South Africa. Variant B-1.351, first found in South Africa, is giving our vaccines a run for their money. BUT! If these numbers are only after one dose, a booster can almost certainly help. And when you only look at preventing severe infection and hospitalization, the efficacy was much higher (85% in preventing severe disease), which at least is good in terms of controlling burden on healthcare systems and keeping COVID manageable.
In Russia, Sputnik V uses ad26 in its first dose and ad5 in its second. Scientists questioned the choice of ad5, since that was a more common virus that (when active) had caused colds in people (there was a chance of previous exposure), so the risk of already having an immune reaction to the vector was present. Still, it seemed to go well - efficacy was strong! But with 2 caveats: the data isn't very transparent, they haven't shared all the info about their methodology. The other is that the study population was 98.5% White - that is not exactly transferable to the US.
A2: Novavax has created a vaccine that is a viral spike protein on a nanoparticle - more of a traditional vaccine, similar to HPV and the influenza vaccines. In a trial of nearly 16,000, It showed a strong 95.6% efficacy against the wild type, and 85.6% against B-1.1.7 (first found in the UK). However, vaccine efficacy was lower against B-1.351 (49.4% overall, 60.1% in those negative for HIV). An important takeaway is that 1/3 of the study patients in South Africa (4,400) had had a previous COVID-19 infection - getting infected with the wild-type COVID doesn't necessarily protect against B-1.351. NovaVax is now considering a bivalent vaccine (containing spike proteins of both wild type and B-135.1) or a reformulation. Shout out to my friend, pharmaceutical scientist Kayla Andrews, for lending me a hand with summarizing these (she did most of the work so I didn't have to)!
A3: Merck and Sanofi were also making vaccines but unfortunately suffered some major setbacks (grateful for transparency!). Sanofi is actually starting to devote resources to help Pfizer's production. I'm hoping that this administration will use the Defense Protection Act and other means to get other companies to follow suit. But these companies are also still trying to make money (that will be for a different essay), so we need to use the vaccines we have and soon.
The bottom line is, GET WHATEVER VACCINE IS AVAILABLE TO YOU FIRST. Look out for news of booster doses (Moderna is already putting trials into action, as are others) to better protect against B-1.351.
Q: What about adverse effects to new vaccines? A: So for the most part, it is as we predicted - arm pain is the most common, chills and muscle aches for many. Some people's second dose has wiped the floor with them on day 2. By the following day, all is better. That said - there are some people who have been laid up for longer. Some have developed "COVID Arm" where the area of the vaccine turns red and swells (or in the closest armpit) for several days - not necessarily painful, but not pretty. This has been seen pretty frequently, but it goes away! Thankfully.
There is some evidence to suggest that those with previous COVID infections may have worse side effects - your immune system is already primed, so the vaccine has a stronger reactogenic effect.
Over 10,000 pregnant women have received the vaccine and there have been no major adverse effects to them or their fetuses. Huzzah!
Finally, there have been documented cases of anaphylaxis, which is why we observe people after they get their vaccine. NO ONE has died from any vaccine-related complication so far. Given how many vaccines have been given, this is comforting! But we must still be vigilant.
Housekeeping: An old friend of mine, a nurse, pointed out that when getting an intramuscular vaccine, it is better to stretch the skin rather than pinch it together (more often used for subcutaneous injections). Gotta hit that muscle layer!
Tomorrow: Ivermectin, Colchicine, Reopening, and Racism (in the context of COVID-19). Until then, continue to wear a mask, maintain distance from others when outside of your bubble, wash your hands, and ask questions.