The Covid Vaccines

Covid Vaccine

I have been asked for my expert opinion on the vaccines against the virus that causes Covid. I am a retired academic physician, so I know medical science, taught medical science and understand research. As an academic endocrinologist I studied and taught about the immune system, as well as genetics and taught the basic classes on epidemiology. Since the end of January 2020 I have been closely following the medical literature on the novel coronavirus that first appeared in Wuhan, China. The specific virus is called Sars-CoV-2 and causes a disease called Covid-19. About 1.5% of those who contract the virus die, mostly older and medically frail, but also a few younger, healthy individuals. I work closely with many physicians who manage Covid patients in the hospital and clinics. Of much greater concern is the larger percentage of individuals who suffer multiple complications from Covid and especially the half of hospitalized patients who develop long-term neurologic complications that impairs thinking, as well as those who develop permanent lung problems, heart failure and kidney complications. Not all of these “long-hauler” patients are old or have pre-existing medical conditions. So it is a disease that should be avoided.

To slow the spread of Covid, government agencies have tried to limit the interaction between people, just as was done in the early fifties to slow the spread of polio and even more restrictively in 1918 for the H1N1 influenza pandemic. Avoiding being near others when indoors, not shouting or singing and most importantly wearing a mask over the mouth AND NOSE, decreases the spread of the virus. Over half of individuals who come infected with Covid never have any symptoms or are so mildly ill, they do not know that they are spreading the virus. Once the virus starts multiplying in a person’s nose and throat, they will spread the virus for the next 10-16 days when they talk, or even breathe. This could be any of us, but is especially true for those who are younger.

A new mutation of Covid is twice as contagious and has been found in Oregon. So there is a real urgency to get the pandemic stopped. The current vaccines are just as effective against these mutations in the USA, UK and Europe as the early form of the virus (we are not sure about a mutation just discovered in South Africa).

Wearing a mask over your mouth AND NOSE is the most courteous thing we can do when in public. It is our civic duty. It used to be considered polite to hold the door for others, but now with the need for physical distancing, do not hold the door for others, but do wear a mask.

If we all quarantined in a bubble for 60 days, we could rid the world of Covid, but that does not seem practical. So like small pox, influenza, polio and tetanus; vaccination is the best way to control the virus. Vaccines actually eliminated small pox and until Covid came along, the world was almost rid of polio.

There are currently five Covid vaccines being used in different parts of the world and several are far enough along to be soon available in the USA. Two vaccines are currently approved under the emergency use provisions of the FDA. It is not unusual for a vaccine to not have full FDA approval until it has been in use for at least six months. Even most medications have been administered to thousands of individuals under provisional approval before getting full FDA approval.

The Astra-Zeneca vaccine is not yet being widely distributed in the US and has so far only demonstrated an effectiveness of about 75%. It is a traditional vaccine that takes a protein from the virus and formulates that into a liquid that can be safely injected. The influenza vaccine is similar, although it is closer to a modified version of the virus and it therefore stimulates the body to make antibodies against the virus, but can give you a mild case of influenza-like illness. The protein in the Astra-Zeneca vaccine cannot give you a mild case of Covid, but the reaction to the inoculation can give you a fever, headache and stuffy nose.

All three of the vaccines can give you arm pain, just like the tetanus shot and some localized warmth and swelling.

The Moderna Vaccine and the Pfizer-BioNTech vaccine are unique from other vaccines. These are the first mRNA vaccines to be distributed widely, but the technology is nearly ten years old, so a lot of research has been done on mRNA vaccines. Because of the way they work, these vaccines are the safest that have ever been developed. The risk of side effects from these two vaccines is miniscule compared to any other vaccine currently being commonly used. These vaccines cannot give you a mild form of Covid, they cannot induce an autoimmune response like rarely occurs with the influenza vaccine, or cause you to pass the infection on to someone else, as often happens with the polio vaccine.

These vaccines contain mRNA that has been developed in a laboratory under strict conditions that do not allow for error. The mRNA will remain in your body less than 12 hours before is destroyed by the body. It does NOT in any way change your DNA. (Also there really is no nanochip in the vaccine). DNA is in the nucleus of cells and this mRNA remains in the cytoplasm outside the nucleus, so it never comes in contact with the cellular DNA and would have no effect on it if it did. The mRNA from the vaccine will be taken up by some of the muscle cells near the injection site. It will naturally attach to the ribosomes in the cytoplasm of the cell, because that is what mRNA does. A chemical bond naturally attracts the mRNA to the nearest ribosome and the ribosome is designed to pick up any available mRNA by one end. The ribosome then reads the mRNA and uses that code to create a protein. Muscle ribosomes normally read mRNA from the muscle cells and make proteins needed by the muscle, but ribosomes are simple and the same throughout the body and so when they pick up the mRNA from the vaccine, they make the protein coded in that mRNA.

This protein is identical to a protein that forms a part of the spike on the Coronavirus that causes Covid. The virus uses the spike to invade our cells, but if our body attaches an antibody to the spike, then the virus cannot get into our cells and our white cells will come along and destroy the virus.

To make sure our white cells react to this protein that a few muscle cells in our body are making, the vaccine includes an adjuvant. These chemicals (which already have FDA approval and are used in other vaccines) tell the body that there is a problem going on where the injection occurred. White cells come from all over our body to investigate. Some find this protein and recognize that it does not belong in our body. These cells signal other white cells to make antibodies that will attach to this protein. Other white cells are designed to identify antibodies that have attached to a foreign substance and destroy it, but most importantly Memory white cells pick up the protein and encode it so that if it ever shows up again, it can alert the white cells that make antibodies to start making a lot.

The mRNA cannot do any harm to us. This is the safest vaccine made. However, to be effective, the vaccine needs the adjuvant chemicals and this is what causes most of the reaction we get to the vaccine. This can in rare case cause anaphylaxis. Vaccine centers are prepared for this extremely rare event and there have been no deaths or long-term side-effects from the few cases of anaphylaxis in the US. Everybody will get some arm pain from the vaccine injection and this could last for a day or even up to a week in some individuals.  If you get no pain or swelling, then the body is not producing an inflammatory reaction and you won’t be making any antibodies, so think of the pain, swelling and redness at the injection site as a good thing. It’s working. A few individuals get a second reaction to the adjuvant 3-5 days after the injection with an itchy rash. This can be annoying, but is not dangerous.

Headache, muscle ache or stiffness are seen in some individuals after the first shot, less so after the second. Acetaminophen or ibuprofen will usually ease the discomfort. A few people get fatigue for a day or even two. Younger individuals seem to have more of a reaction, especially localized, as they have better immune systems.

The main benefit of the vaccine, is that if you get infected, you won’t get very sick, or maybe not ill at all. The full effectiveness starts about two weeks after the second injection. Will the vaccine stop you from spreading it to others? We do not yet know the answer to this, but some preliminary studies show that vaccinated individuals who have been exposed to the virus seem to produce much fewer virus laden particles when they breathe or speak and appear to only spread the virus for 3-5 days instead of 10-16. It may be that they are not spreading a contagious form of the virus, but we do not know yet.

How long will the vaccine be effective? We do not know that yet and probably won’t for another year. Early studies show that those who got the vaccine in trials 3 months ago have detectable antibodies and a very small study showed they had active memory cells for the protein coded by the mRNA.

So even after being vaccinated, you still need to wear a mask.  With the new mutation spreading in the US, it is important to wear a mask over your mouth AND NOSE. A fine material is better, such as 400 count sheet material or better. The ubiquitous blue disposable masks are really well designed to block the spread of the virus.

The most assured thing the vaccine will do is decrease severe illness and hospitalizations. The supply of the vaccine is currently limited so it makes sense to inoculate the most vulnerable and most essential. Many hospital workers have gotten very ill, or even died from Covid. When exposed, they often get a huge viral load. So it makes sense to vaccinate the front line workers first. Some hospitals in LA are overwhelmed, not just from the number of cases, but because so many physicians and nurses are out sick with Covid. Most people who end up in the hospital due to Covid are older, so it makes sense to inoculate the elderly and those with underlying medical conditions next. Hopefully the supply will soon increase and everyone can be inoculated, but after the vulnerable, it makes sense to immunize those who must work with the public, including teachers, bus drivers and cashiers for essential businesses.

The goal of most people is that the vaccine will make it so the virus stops spreading and we can reopen businesses, concert halls, churches, sports venues and gyms. Other vaccines stop the spread of the virus, so we can assume the Covid vaccine will do the same. For that to happen, we need herd immunity, that is so many people have either been infected and maintain a long-term immunity (some do and some don’t), or more importantly so many people have been vaccinated that the virus cannot easily replicate and spread to others. Most experts feel that means at least 80% of the population needs to be immunized. So of course, we will need to vaccinate children. Very preliminary studies are underway to determine safety and efficacy in children. The vaccine is currently approved for those 16 and up, although the studies so far published were 18 and up. Vaccines are safe, even in newborns, but time will tell how young we can vaccinate children with each of the three currently available vaccines and the Johnson & Johnson vaccine that will soon be approved.

 

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