COVID-19 vaccine follow-up

With multiple versions of the COVID-19 vaccine rolling out, new questions are emerging that are different than the ones I had addressed in my initial vaccine post. Here are answers to some of the most common questions I’ve received recently from residents and families.

What should I expect from the second dose of the COVID-19 vaccine?

There are reports of more frequent reactions to the second dose of the mRNA vaccines. However, their reactions are usually not severe and typically do not last for more than about 48 hours. Redness, pain, and swelling at the site of injection are common. Fever, muscle/joint aches, malaise, and fatigue have also been reported. These symptoms are not allergic reactions, but rather NORMAL immune responses to the vaccine. These are signs that your immune system is responding to the vaccine and mounting a strong defense against the coronavirus. If you develop severe symptoms or your symptoms persist beyond 48 hours, then you should seek guidance from your physician.

Have there been any serious reactions related to the vaccines?

Now that millions of people are being vaccinated globally, we have additional safety data that the FDA continues to review. Serious reactions are extremely rare and are being thoroughly investigated. No vaccine can eliminate all risks and it is important to weigh the small risks of vaccination with the significant risks of COVID-19, especially for older adults and for individuals with chronic medical conditions.

Is there anyone who should not get vaccinated?

The only group or people who definitely should NOT receive the COVID-19 vaccine are those individuals who had a severe (anaphylactic) or immediate allergic reaction to the first dose of the mRNA COVID-19 vaccine. Individuals who have a history of other serious allergic reactions, including allergic reactions to other vaccines, should discuss their personal risk of vaccination with their physician and should be more closely monitored after receiving the COVID-19 vaccine. Vaccination is still recommended for people who have recovered from COVID-19 infection.

How long does it take to develop immunity to the coronavirus after vaccination?

Based on the clinical trials, immunity developed in 1-2 weeks after the second dose of the mRNA vaccine. Partial immunity was observed after the first dose, but it is important to receive the second dose of the vaccine to get the most protection from COVID-19. Although the vaccines were shown to be highly efficacious, no vaccine can provide 100% protection from infection. Fortunately, vaccinated individuals who later became infected with COVID-19 had much less severe illness.

Will I need additional (booster) vaccination after the second dose?

It is not yet known if or when an additional booster dose of the vaccine will be required after the second dose of the mRNA vaccine. Since these vaccines are new, we are still learning about the duration of immunity. It is possible that repeated vaccination, much like influenza vaccination, may be needed, but we just do not know yet. Available data is encouraging, and it seems unlikely that booster doses will be needed this year.

Will other COVID-19 vaccines be approved? Will I need to get one of them too?

There are several other vaccines in the final phase of clinical testing and their developers will likely seek Emergency Use Authorization (EUA) from the FDA in the coming weeks and months. The leading vaccine candidates use a different approach to producing an immune response to COVID-19, but just like the mRNA vaccines, their safety and efficacy data will be scrutinized by the FDA before Emergency Use Authorization. If you received both doses of an mRNA vaccine (Moderna or Pfizer), you will not need additional vaccination with any newly authorized vaccines.

Why is the vaccine roll out going so slow?

Vaccinating millions of Americans is a huge challenge. Although there are certainly administrative problems at federal, state, and local levels, there are still significant logistic challenges to vaccinating large groups of people, even with optimal planning and preparation. The mRNA vaccines require specialized refrigeration and handling. Identifying safe and accessible locations for vaccine administration also presents challenges during a pandemic. Medical and pharmacy staff are needed to prepare vaccines and administer injections. Limited staffing is one of the challenges for vaccine administration, especially at a time when many healthcare workers are staffing sites for COVID-19 testing and caring for the surge of patients with COVID-19 in hospitals.

Despite these challenges, vaccination rates in the greater Charlotte region exceed many other places in the United States. Local partnerships between health departments, healthcare systems, and private industry promise to deliver an astounding number of vaccinations to the Charlotte region in the coming weeks and months.

Why do we still have to wear masks, social distance, and adhere to restrictions after vaccination?

It is important to continue wearing a mask, practicing physical distancing, and adhering to COVID-19 restrictions, even after vaccination. Remember that vaccination is only one tool to help protect you and other people from infection. The COVID-19 vaccines have shown to be highly efficacious, but no vaccine provides 100% protection. Being vaccinated does not make you invincible. Instead of armor, think of the vaccine as a safety net. If you continue to practice safe behaviors, you are less likely to be exposed to the virus. Despite your best efforts, if you happen to be exposed to coronavirus, the vaccine will hopefully prevent clinical illness. If you happen to get sick from COVID-19 despite vaccination, you are less likely to have serious illness, be hospitalized, or end up in the ICU.

We also do not know if vaccination prevents a person from spreading the coronavirus to other people, since the clinical trials were designed to look at protection from COVID-19 for the individual receiving the vaccination. Many people in the community will not be vaccinated for many months and others will decide never to get vaccinated. We are nowhere near the rate of vaccination that would achieve “herd immunity.” Therefore, it is still important for us to protect others by wearing our masks and keeping our distance.

Why are some healthcare workers deciding not to get vaccinated?

Many healthcare workers are receiving the COVID-19 vaccine. It is also true, however, that some healthcare workers have decided not to receive the vaccine or delay their own vaccination. There are a variety of reasons for these personal decisions. The history of unethical clinical research in minority populations continues to undermine trust in government-sponsored health programs. Some healthcare workers have expressed concerns about receiving newly developed vaccines and have decided to defer vaccination until more clinical data is available.

Unfortunately, there are also healthcare workers who hold fixed personal beliefs about the COVID-19 vaccine that are not supported by the best available scientific data. Education and role modeling are important strategies to increase the rate of healthcare worker vaccination. Personally, I believe that the most compelling reason for healthcare workers to get vaccinated is to protect the patients they work with, especially when they work with vulnerable patients at high risk of COVID-19 complications.

Anthony J. Caprio, MD, is medical director at Sharon Towers and geriatrician at Atrium Health. The opinions expressed by Dr. Caprio in this article are his own and not necessarily those of Atrium Health.

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