The COVID-19 virus has caused a worldwide pandemic that has already infected 25 million Americans, made many sick enough to require hospitalization, and caused more than 400,000 U.S. deaths over the last ten months.
Pre-existing chronic illnesses, including being overweight, breathing disorders (like asthma), diabetes, high blood pressure and other heart problems, and chronic kidney disease have all been associated with greater risk of more severe infections and death. Not surprisingly, advanced age (70’s and above) has also been associated with more severe illness. New lung and kidney injuries have been common, and some of the effects of the infection, such as fatigue and weakness, along with altered taste and smell, have been reported to be long-lasting.
Of course, there are also the indirect viral effects of the disruption of our “normal” lives and daily routines by the need for frequent hand-washing, quarantines/isolation, social distancing, the wearing of facial masks, school, church, restaurant and store closures: anxiety, insomnia, depression, and multiple new stresses that, in turn, make us more susceptible to other illness. Some reports have found increased suicidal thoughts and actual suicide associated with the disruption of our lives.
Although we still have much to learn about this viral illness and its long-term effects, the message to is clear: COVID-19 is not to be taken lightly. It is a real and present threat to all of us – and our children!!
HOW DO WE STOP THE SPREAD OF COVID-19 and END THE PANDEMIC?
We do know that the COVID-19 virus is transmitted from person to person in the form of viral particles in the air and secretions that one person breathes out and another person breathes in or comes into contact with by touching eyes, nose or mouth with hands contaminated with the virus. These viral particles reproduce themselves in very large numbers and can invade normal body cells (in the case of COVID-19 with particular affinity for lung and kidney cells), damaging and/or actually killing them. The result is a viral infection that can cause admission to the hospital and the need for intensive care, with an outcome that may be death with as much as a 1-in-5 or higher chance of that.
Frequent hand washing, avoiding touching one’s eyes or mouth, the wearing of masks to prevent the virus from being transmitted from person to person, and the maintenance of social distancing (at least 6 feet apart) have been essential and effective techniques in reducing the spread of the COVID virus. However, the experience of recent months has shown that these measures by themselves are not enough, especially, for example, where an individual’s job expose her/him to other people who may be carriers of the virus or where distancing in an over-crowded apartment may be impossible.
There has to be a better answer!
Stopping the spread of COVID-19, and ultimately ending the current pandemic, requires creating a VACCINE to protect people from the virus. What this means is creating immunity in each person so that the virus is destroyed before it can cause the illness that it does.
Creating immunity is what a vaccine does. Immunity can involve both cells that have “learned” to recognize disease causing bacteria or viruses and can literally “eat” them before they can do any harm, as well as antibodies, which are cell products that recognize particular markers on the bacterial or viral surface, bind to those markers, and thus end in the destruction of the infection-causing agent directly or by a cell designed to destroy the “marked” disease-causing object.
In the case of COVID-19 in the United States, there are now two FDA-approved vaccines (Pfizer, Moderna) that can create immunity to it and do so with a high degree of success — 95% prevention after the second or “booster” injection that is given within three or four weeks after the first, depending on the vaccine. Even in the unusual situation where the vaccines are not completely protective,the resulting illness is generally much milder than it would have been without the use of the vaccine.
Several questions are worth addressing:
1) What’s in the two available vaccines – Pfizer, Moderna?
The first thing to emphasize is that that there are no COVID-19 viruses or even parts of the virus (dead or alive) in either vaccine. There are vaccines for other disease that have used dead viruses to stimulate the immune system, but that is not the case for these two vaccines. You can’t get a COVID-19 infection from the vaccines. That is IMPOSSIBLE!
What is in the two COVID-19 vaccines being described here are large numbers of tiny beads (“nanoparticles”) that contain the chemical code/instructions (“messenger RNA”) for the production of a particular viral protein, the spike protein, which is found on the surface of the virus. The “beads” themselves are tiny, tiny structures that are broken down and disappear from the body. The virus is a tiny ball with the spike proteins sticking out of its surface. These proteins attach themselves, especially to normal cells in the lungs and kidney, as well as at least some nerve cells, thereby allowing the virus to enter the cells and damage or kill them, while producing and releasing more viral particles along the way and perpetuating or worsening the infection. By themselves, the spike proteins can do nothing. Specifically, they cannot cause COVID-19 infections.
2) What does the vaccine do?
The COVID-19 vaccine, whether the Pfizer or Moderna version, is injected into your upper outer arm (into the deltoid muscle). Once it is injected into your arm, the tiny beads containing the instructions for producing the spike protein enter into some of your cells such that they begin to produce the spike protein. The spike protein so made is then released into your blood stream where it is picked up by two types of immune system cells (B and T cells). These cells, in turn, make antibodies to the spike protein. These antibodies are capable of binding to the spike proteins on the surface of the whole COVID-19 virus. When they do bind to the spike proteins of the virus, they prevent the virus from infecting more of your cells and the virus is destroyed and removed from your body – without any infection being allowed to develop. You are IMMUNE. You stay HEALTHY!
NOTE: For both vaccines, studies have shown that two injections of each of these two vaccines are necessary to achieve the desired 95% level of immunity. Somewhere in the range of two weeks after the first injection, approximately 50% immunity is acquired, although it should be added that any COVID-19 illness that does occur after the first dose of vaccine, and before the second dose, will likely to be milder than it would have been without the first dose. After the second dose (booster dose), the protection against the COVID-19 infection is 95%, which is as good as it gets with virtually any vaccination.
Given the time to get most of America vaccinated and the time required between doses of vaccine, we must all still continue frequent hand-washing, wearing face masks, and social distancing. We owe that to ourselves, our families and our neighbors until the pandemic has been brought under control or fully ended.
3) What about side effects?
To date, the side effects that have been reported (both from the studies and the more than 2,000,000 doses of these two vaccines that have been administered) have been those expected to occur after any effort to stimulate immunity to any infection such as that of the variants of the “flu” every year. These include:
- soreness at the injection site in the upper arm
- mild fever and chills
- aching muscles
These symptoms vary from individual to individual, with some people experiencing nothing at all. However, on the positive side, these symptoms indicate an activation of your immune system, which is actually a good thing. Your body is being stimulated to make those antibodies against the spike proteins on the surface of the COVID-19 virus and thus those symptoms are indicative of a good response.
It should be added that, as with any vaccination, there can be severe allergic reactions (“anaphylaxis”) that are very rare (literally a few people out of every million). The best advice is to wait at the injection site for about 15 minutes after you have received the dose – just to be certain that you don’t have that type of reaction. This reaction is quite treatable, and every vaccine administration site has what is needed to combat such a reaction. Of course, anyone with a history of severe allergic reactions to any of the components of the anti-COVID-19 vaccine should consult a healthcare provider prior to taking the vaccine.
What about long-term effects? After all, these vaccines have not been around very long, and were produced and approved under Operation Warp Speed. The honest and straightforward answer is that we don’t have any information about what might occur six months, a year, or even longer after the two doses of the vaccine. It is worth saying, however, that there are no indications of any such long-term effects at this point. More to the point in the overall decision as to whether or not to get the vaccination is consideration of the very serious and long-lasting effects of a COVID-19 infection (effects which are increasingly being reported) and the possible negative effects (seemingly very small at this point) of the two vaccines available now in the U.S.
4) Should I get the vaccine if I had the COVID-19 virus before and recovered from it?
If you recovered from the COVID-19 infection more than one month ago, you can (and should) get the COVID-19 vaccine because it is possible to get infected with this virus again.
5) If I am currently positive for the COVID virus, currently have symptoms of the infection, or recovered from an infection less than one month ago, what should I do?
The best information available currently says that you should not get the COVID-19 vaccine until one month after you have been tested as virus negative and have fully recovered from the signs and symptoms of an infection for at least one month. Checking with your healthcare provider to ask about the optimal way to proceed is necessary.
6) How long does the immunization effect of the available vaccines last?
Here again, we don’t have solid answers. It is possible that the antibody levels could fall with time, as has been seen with other vaccines for other diseases, such as diphtheria, typhoid and tetanus, for many years. An additional booster of the COVID-19 vaccine-induced immunization could be conceivably required in the years to come. To date, studies done with both available vaccines shows there is no significant decrease in the anti-COVID-19 antibodies for at least 71 days after completion of the second (booster) vaccine dose. We need to wait for more time to pass with the large number of immunizations made in recent weeks to learn more. Again, stressing what we do know, even with less that an optimal level of antibodies, there is a level of protection for you that may fully protect you, or at worst, make any COVID infection milder.
The new U.K. and South African variants of the virus:
At this time, the thinking by experts is that the present Pfizer and Moderna COVID-19 vaccines should protect you from infection with these variant strains of virus. To stay one step ahead of the virus, however, Moderna is beginning to study whether an additional or new booster shot engineered specifically against the South African variant might be necessary. Stay tuned!
7) Is the push to immunize all Americans with one or the other of the currently available vaccines (or perhaps one of those that are still coming along) just another attempt by the major pharmaceutical companies like Pfizer to make more money?
There is no question there will be profit from the vaccine, even if, as it is now, the vaccine is “free” – provided by the government. Indeed, the pharmaceutical and biotech companies making the vaccine cannot carry out the lab and clinical research, the production, and distribution of the vaccines on a large scale without enormous costs. However, it is important to look at the societal cost of the COVID-19 pandemic. Twenty-five million Americans are estimated to be infected, and there have been more than 400,000 deaths since early 2020 – with many more to come before the vaccination rate is sufficiently high (producing the so-called “herd” immunity, which means that enough people are immune so that the COVID-19 pandemic cannot continue, even though there are unvaccinated citizens). Business closures (including restaurants and bars) represent an incalculable loss, as is the loss of employment for so many. This is only a very rough beginning to counting all the true costs, let alone the disruption to our lives and mental health. The ability to conduct business virtually and the boost to telemedicine /telehealth have been pluses, but the net cost is high on the negative side.
8) What about racial disparities/inequities in COVID-19 vaccination? Is this just another way to take advantage of the economically disadvantaged and people of color?
This is a very important and fair question. There is a large body of evidence that economically disadvantaged individuals and communities, as well as people of color, have been hit much harder by the COVID-19 virus than other comparable groups. This includes the number of people infected, as well as the death rate. This is not just about skin color, but also the co-existence of chronic illnesses such as diabetes, high blood pressure, obesity, and chronic kidney disease. Given the long history of the discrimination abuse of minorities and people of color by our healthcare system, including those of the deliberate Tuskegee experiments with syphilis, skepticism and uncertainty about whether to take the COVID-19 vaccines is understandable. It must be made clear that there is no evidence that there is any difference in effectiveness or safety of the COVID-19 vaccines for any person.
In this regard, again, one has to balance for himself/herself the known risks of COVID-19 infections against those that are known or are possible with the available vaccines. Given the experience with COVID-19 infections, the balance is far favorable for the vaccine. This is true not just for us as individuals at-risk, but also for our families and the community around us. We have a chance to stop the pandemic and bring a greater degree of “normalcy” back to our lives and society. We have to work together (all races, ethnicities, religions, whatever) because we are all dependent on each other. It is interesting to note that, if we can get something close to 80% of our population vaccinated, we may see the end of the pandemic because of what is known as a herd effect of immunity. We don’t want to have to depend on that, but the closer we get to immunizing everyone, the better off we will be with respect to all of our individual and societal health.
There is, too, another larger lesson here. We need be working to improve the health and quality of life in general for resident of low-income communities. Our state of health is dependent on the functionality or dysfunctionality of all the sectors of the society around us. When one realizes that only about 10% of our health depends on doctors, clinics, and hospitals, while 30% is due to our genetic heritage. The remaining 60% is a result of the environment around us, as well as the lifestyle choices we make. We can make our communities both more resistant to pandemics and resilient in terms of recovery. Physical activity and nutrition are two of the most important factors in this regard, but employment, housing, transportation, emotional health, stress levels, and all the other facets of our society are critical. We need to work on them all to be able to ward off future pandemics, as well as to control the present one.
The bottom line is that we have to stop the present pandemic. Vaccination against COVID-19 is essential, if we are going to achieve that.
Every one of us has to make a choice in this regard. What is at stake are our own lives, those of our families, and our society in all its aspects where human interaction is important and/or unavoidable. It is clear that none of us know all that we would like to know about the safety of the COVID-19 vaccines. We do know how serious the threat of COVID-19 infections is to our own health and lives, but also to that of our families and to all the community and world around us. In that light, the choice to proceed with COVID-19 vaccination makes good sense.
Barry H. Smith, MD, PhD