COVID-19 updates: March 2021
It has been a bit since the last update so this will be jam-packed with useful information! We’ll start with the latest vaccine news and then give our perspective on how this impacts our lives.
Office news: We are on Instagram (finally!) Follow us at @411Pediatrics and @AriBrownMD. Our social media channels provide timely information on child health issues, research studies, and our perspective on breaking news items. But if you want to know if the office is open during inclement weather, check our website at 411pediatrics.com. We change the top banner for urgent updates.
Finding COVID-19 vaccine: Local, state, and federal efforts are underway to streamline information on vaccination appointments. Once the vaccine is readily available, the experience should be as easy as getting any other vaccine in pharmacies and doctors’ offices. But for now, here are some useful resources to check out:
>CDC National online tool at VaccineFinder.org
>Austin Public Health pre-registration for COVID-19 vaccination at AustinTexas.gov
>Texas Dept of State Health Services list of vaccine providers statewide
When will children be eligible to get vaccinated? Right now, the only vaccine approved for ages 16 and up is the Pfizer vaccine. Teens ages 16 and up with certain health conditions can register to get an appointment (see links above). Moderna and Pfizer both have ongoing research studies for kids ages 12 and up. AstraZeneca is doing a vaccine study in the UK for children ages 6 and up. Once those studies and safety/efficacy data are complete, we will have a better timeline for vaccinating school-aged children. The endpoint on those studies is testing for antibody response to the vaccine, so we won’t have to wait as long for results. There is no news to report on how or when 0—5 year olds will be included in vaccine studies, so standby for updates on that.
Will your office administer COVID-19 vaccine? Eventually, yes. We have applied to be vaccine providers but because the vaccine is currently in limited supply and most of our patients are not eligible for it, we have not received any yet. We promise to share that exciting news once we hear something!
Is the new Johnson and Johnson (J&J) vaccine effective?
Yes! Their vaccine study had 45,000 participants, ages 18 and up. Key point: NO one in the vaccinated group was hospitalized or died due to COVID-19 infection. And that’s the goal, friends—staying out of the ICU and out of the morgue! Don’t get too hung up on the headlines focusing on the percent effectiveness (85% effective in protection against severe infection including mutant/variant strains), making it appear less effective than the Pfizer and Moderna. The J&J vaccine was studied in South Africa and showed great protection against that mutant strain. The Pfizer and Moderna studies were done before mutant/variant strains emerged, making it hard to compare them head-to-head. And, the beauty of the J&J vaccine is that FDA authorized it for emergency use as a single dose vaccine, making it easier and quicker to protect people. Protection is EXCELLENT in 28 days after just one shot. Of note: J&J has a study underway to see if doing a two-dose regimen, given two months apart, increases the effectiveness. If that turns out to be the case, the FDA will adjust their recommendations.
Is the Johnson and Johnson (J&J) vaccine safe?
Yes! There have been no significant adverse reactions in the study participants. Typical side effects for J&J vaccine are pain at injection site, headache and fatigue. While side effects are similar to the Pfizer and Moderna mRNA shots, people report experiencing milder symptoms with the J&J vaccine than the mRNA shots. There have been two cases of allergic reactions in their ongoing study in South Africa, but none during the original study.
How does the Johnson and Johnson (J&J) vaccine work?
J&J vaccine (as well as the AstraZeneca and Sputnik V vaccines) use an inert common cold virus called Adenovirus to transport and introduce genetic material (DNA) for the COVID-19 spike protein to human cells. The cells then mount an immune response to the spike protein. This vaccine technology has been used in research labs for 50 years as well as in the Ebola vaccine approved by the FDA in 2019, so it is not new technology. It has a well-established safety profile and side effects are minor. It is a little harder to produce and scale up adenovirus-vector vaccines, which is why the mRNA vaccines came out sooner and are more plentiful.
If I have a choice on vaccines, which should I choose?
Get whatever vaccine you can get. Do not wait to get one brand over another! The sooner you are vaccinated, the sooner you are protected. And then, the sooner we get past this pandemic.
The J&J vaccine appears to be more effective in healthy people ages 18-60 than in adults 60 and up with underlying health conditions. So, that may be the only consideration IF you are over 60 AND have more than one option. But remember, the J& J vaccine only requires one dose to offer extremely effective protection after 28 days.
How long will vaccine protection last?
All of the currently approved vaccines offer at least two months of protection, but this is based on the original studies done prior to emergency use authorization. This continues to be monitored. Experts believe that even if antibody levels decline over time, our immunologic memory will last much longer than that because other parts of our immune system (T and B cells) will still recognize the COVID-19 spike protein and be able to mount an immune response to it. But like flu vaccine, we may ultimately need an annual shot to protect us. That strategy will also help protect us as the COVID-19 continues to mutate and change over time.
Can a vaccinated person still get COVID-19 infection and spread it?
It is possible, but appears unlikely. Experts do not have enough data to say definitively yet, but current studies are encouraging! What this means: Vaccines prevent serious infection, but vaccines may also significantly reduce the risk of acquiring an asymptomatic infection and then spreading it unknowingly to others. A recently observational study on Israeli healthcare workers vaccinated with Pfizer vaccine demonstrate this effect and the J&J data presented to the FDA is also promising.
What’s the deal with the mutant/variant strains?
Viruses abide by the basic rules of nature—survival of the fittest. They must adapt and change to survive. This is Virology 101 and not surprising. Every time the COVID-19 virus gets into a human host, it modifies itself (mutates), makes multiple copies of itself (replicates), and then goes on infect someone else. That is why it is a race to vaccinate as many people as quickly as possible, reduce infection rates, and ultimately beat the virus from mutating too much from its current state. Fewer infected people means less ability for mutations to occur during replication.
If I already had COVID-19, will I be immune to the newer variants?
Unfortunately, there is no guarantee of that. It is theoretically possible to have already had the original COVID-19 infection and then get infected with one of these mutant strains. But good news, your immunity to the original strain appears to last for several months.
How will mutant/variants impact vaccination efforts? The challenge with some of the emerging variants, particularly the South African one, is that the newer virus has alterations to the spike protein that has the potential to look slightly different than the original virus, which is what our antibodies are made to recognize. At this point, this slight change is not different enough to completely evade detection by antibodies. And, vaccination also causes the body to make T cells that can still recognize and fight off the virus. But as long as the virus continues to circulate, it will continue to mutate and scientists are preparing for that. Pfizer and Moderna are working on modified versions of their original vaccine to potentially use as a booster dose for those already vaccinated or as primary vaccination going forward.
Are the variant strains more contagious?
The same rules apply to reduce exposure risk (masks, distancing, etc). It’s not like the virus is any more transmissible in the air or that you need to stand further away from someone than you already are! The variant strains seem to be ‘stickier’ to the human cell ACE 2 receptors which allows the virus to bind, enter the cell, and cause infection. The original COVID-19 virus was more likely to fall off and not enter the human cell.
Are we learning any more about Long-COVID syndrome?
Well, we have an official name for this entity now, called PASC—Post Acute Sequelae of Sars-COV-2. About 30% of people who participated in a recent US study continue to have symptoms such as fatigue, shortness of breath, intermittent fevers, sleep issues, anxiety, depression, and brain fog up to nine months after their initial illness. The National Institute of Health is now studying PASC so we hope to learn more soon. Want to participate? Head to the NIH website.
With more people getting vaccinated, what activities are safe?
Once grandparents and other high risk loved ones are vaccinated, it is certainly safer to plan family gatherings. It will be a while before children (*especially under age 12) are able to get vaccinated, but they are less likely to get infected and less likely to transmit the virus to others. While everyone’s individual situation may vary, in general, people who are all vaccinated can also feel a little safer gathering as well. We still have a long way to go before returning to our pre-pandemic “normal” but there is definitely hope and optimism given the effectiveness of vaccines.
Is it safe for schools to re-open?
This has been a controversial topic, but politics aside, the answer is yes. Children’s need for both education and socialization in school and safety for all in the school community should be the priority. The Centers for Disease Control released new guidelines to re-open all schools. Guidelines are based on the best scientific evidence and the experience with schools that successfully remained open and did not lead to viral transmission/spread in the classrooms. We all held our breath when schools (and daycares) reopened in Austin and remarkably, the mitigation strategies to reduce exposures have worked! Most children getting infected with COVID-19 have been from household contacts or at social and extracurricular events that do not employ the same clear-cut strategies that schools have used.
Whew, that was a lot! All this news is overwhelming so we hope can help in curating and explaining it. Please share with others. Stay healthy! From 411 Pediatrics and Dr. Ari Brown