This update will be in the format of questions that addresses current vaccine options and trials and the mutations/variants that are being followed. Another post to address covid-19 in kids and current treatment options will be done soon.

What are the vaccines currently available in the US?

Pfizer vaccine which is 2 shots, 3 weeks apart, and Moderna vaccine which is 2 shots, 4 weeks, apart are the current options.

What about the Johnson and Johnson vaccine that is only 1 dose?

This vaccine is not currently available in the US. It uses a viral vector, or adenovirus, with instructions to our cells to produce a spike protein on the surface of the cell (like the Pfizer and Moderna vaccines). Our immune system recognizes the spike protein as not belonging and this triggers a response of antibodies and other immune cells to fight off what it thinks is an infection. So, if we are exposed to covid-19, our immune system remembers this response and acts quickly to fight it. The J&J vaccine works similar to Pfizer and Moderna, but sends the instructions to our cells via a different delivery method. (the virus vector instead of mRNA)

One dose is easier to administer than 2 doses and the J&J vaccine is more stable. It can last in a normal freezer for up to 2 years and a refrigerator for 3 months. This will help with distribution to rural areas and countries with less resources.

I hear the Johnson and Johnson vaccine has a lower efficacy rate than Pfizer or Moderna. Should I be worried about this?

The studies that J&J did were with different parameters and in different locations, so we cannot compare this vaccine directly with the Moderna and Pfizer vaccines. J&J looked at moderate or severe infection prevention. One of the trials was in South Africa where the B.1.351 strain (which is more transmissible) was prevalent. This strain wasn’t around when the earlier studies were conducted. The J&J vaccine showed an overall efficacy of 66% and an efficacy of 72% in the US. This vaccine delivers full protection against severe disease, hospitalization, and death (which is good!)

When will the Johnson and Johnson vaccine be available in the US with good protection and only one dose needed?

To be determined. Likely it will be another 2-4 months before it is available.

I heard that the Astra Zeneca vaccine trial had to be stopped? What is up with that?

In South Africa where the variant B.1.351 was prevalent, it was found that the mutation possibly made it easier to evade our immune response with the AZ vaccine. This hasn’t been confirmed yet as the number of cases were too small to draw a firm conclusion. However, Astra Zeneca is modifying their trial parameters to look at severe disease and death, not just prevention of mild to moderate cases. They also may make other modifications as needed. This is an example of how closely these vaccines are being followed and how protocols are changed as needed.

How does the Astra Zeneca vaccine work and how many doses does it require?

The Astra Zeneca vaccine works similar to the Johnson and Johnson vaccine which uses a viral vector with instructions to make the spike protein of covid-19 recognizable by the immune system. It is a 2 dose system. The 2nd dose may be on a delayed time schedule and studies are ongoing.

How long does the protection to covid-19 last after getting a vaccine?

We don’t know yet. We have 6 months of data on Pfizer and Moderna and the trials will go on for at least 2 years. It is possible that we may need a booster shot like the tetanus vaccine or an annual shot like the flu vaccine. The immunity may last a long time and not require a follow up shot.

What are the variants or mutations that have occurred and how worried should we be about them?

Mutations have been relatively slow so far, but at least 3 have been shown to increase transmission and vaccine efficacies to decrease. The 3 big ones are the UK variant (B.1.17), South African variant (B.1.351), and the Brazilian variant (P.1). According to the CDC, studies suggest that antibodies generated through vaccination recognize these variants and are still effective in reducing severe disease, hospitalizations, and deaths. So, while scientists are concerned enough to monitor these mutations closely, the vaccines are still working. The South African and Brazilian variants may reduce our treatment options, but studies are ongoing.

What is our best defense against these new variants or mutations?

Our best defense is to get as many people vaccinated as possible to reduce the number of people that can be infected with covid-19. The virus needs a host to replicate and produce mutations, so reducing the number of people that are potential hosts will help a lot. We also can reduce transmission by continuing to wear masks, social distance when possible, and wash our hands.

If I get a vaccine, can I stop wearing masks and social distancing?

Not yet. The vaccines are not 100% effective and studies are ongoing to see if they can reduce transmission, not just prevent severe disease, hospitalizations, and deaths. There are studies tracking people who get covid-19 after the vaccine, the timeframe of infection, and exposure. So, for now, continue to cover your face and social distance to protect yourself and those around you.

What are the demographics of the people taking the vaccine?

Roughly 55% of healthcare workers are taking the vaccine. 90% of MDs and DOs are taking the vaccine, 75-80% of nurses, and of the remaining healthcare workers, the number of those taking the vaccine are low. Black and brown communities are also more hesitant to get vaccinated. Science is real, but so is history. We have work to do to help people feel safe getting the vaccine.

Most states are currently offering the vaccine to healthcare workers and those over the age of 65. When will they offer it to frontline essential workers?

To be determined. Some states are already offering the vaccine to essential workers. All states are different with the vaccine rollout at this time. It will depend on supply which has been limited. For NC the vaccine will hopefully be offered to Group 3 essential workers in 2-4 weeks. NC has included in Group 2 those family members that take care of medically fragile people.

What is the definition of medically fragile?

No clear answer on this. Example of what would classify as medically fragile are people with a primary immunodeficiency or have a trach to help them breathe. Example of what would not classify would be a person with asthma that isn’t severe.

I have multiple health issues and am considered high risk, but am younger than 65, when will I be eligible?

For now, essential workers will be ahead of the high risk younger than 65 group. This group is very large as it includes grocery workers, police officers, teachers, child care workers, IT workers, etc. So, it could be a couple of months or more before it is available to people with high risk health problems. Guidelines may change, so continue to check eligibility.

When will kids be able to get the vaccine?

Currently the Moderna vaccine trials are studying kids ages 12 and up. Pfizer vaccine trials are studying kids age 6 and up. Until there is enough data, only those age 16 and up can get a vaccine currently.

What side effects are seen with the vaccine now that a lot of people have gotten them?

As expected, some arm soreness, feeling tired, muscle aches, mild fever, and rash around the site of injection have been seen. Most side effects are gone within 48 hours. Overall, the vaccines have been well tolerated.

If I don’t experience any side effects from the vaccine, does this mean that I didn’t produce an immune response and the vaccine won’t be effective for me?

No, it is possible to not have any side effects and still have an adequate immune response after getting any of the vaccines currently available.

Some key points to remember are that the vaccines to covid-19 that are currently available are proving to be effective. We need as many people as possible to be vaccinated when their turn comes to protect not only themselves but those around them. The mutations/variants are expected and concerning. But, they are being followed closely and scientists should be able to make adjustments as needed. The more vaccine options we have, the better our fight against this pandemic will be.

For now, whether vaccinated or not, continue to cover your face, wash your hands, and be excellent to each other.