Early this week Mary Fisher spoke about the COVID pandemic with Dr. Michael S. Saag, distinguished professor at the University of Alabama at Birmingham Medical School and an Infectious Disease researcher, clinician and commentator. Some of Mary’s questions rose from her own experience; others came from readers of this column. “Dr. Mike” offered some rare insights and perspective. (The interview was edited for length.)
Mary: Everybody seems nervous because we can’t get simple, clear answers to “what now?” questions. Frankly, we want this thing over. Now.
Dr. Mike: Understood. I do too. If everyone works together and follows common-sense advice, we may be closer to the end than many people think.
Mary: I have a friend who got the first dose of vaccine but didn’t get dose #2 in the recommended window of time. What should she do?
Dr. Mike: She should get the second dose as soon as she can. After eight weeks, the immunity from the first dose may begin to wane. Getting the second dose will bring her immunity back in line.
Mary: Was getting the first dose a waste?
Dr. Mike: No, no…she’ll get some protection from that dose, just not all the protection she’d have with doing it as prescribed: Two doses about 4 weeks apart. We know that works. We don’t know for sure what happens when only one dose is given; it wasn’t tested that way. Two doses. Simple.
Mary: Why do we have to wait four weeks after the first dose of, say, Moderna?
Dr. Mike: You could get the second dose sooner than four weeks but it may not work as well. Trials have shown highest efficacy with a second dose about 4 weeks after the first.
Mary: If I’ve had COVID, how do I know when I’m no longer immune?
Dr. Mike: You won’t know for sure. The commercial antibody tests, which measure immunity, are not terribly reliable. We do know that immunity induced by actual COVID infection lasts at least ninety days. It’s possible you’ll be immune for at least ninety more days. So you’ll get about a half-year of pretty good immunity. But I’d get vaccinated after 3 months have passed from original infection. We may learn that a booster (one shot) is all you need; but for now, full vaccination with two doses of Pfizer or Moderna (or one dose of J & J) is the ticket.
Mary: Someone told me they’re avoiding the vaccines because they have live viruses. Is that true?
Dr. Mike: Nope, not true. No live virus in any of the vaccines being used.
Mary: Can I be a spreader after the vaccination?
Dr. Mike: Well, theoretically, it’s possible. Someone could get fully vaccinated and later get infected but show no symptoms of infection. While they’re asymptomatic they could shed virus for a few days. Theoretically possible; practically not too likely…but we don’t know for sure now. That’s one reason we recommend continuing with mask wearing in public and social distancing.
Mary: Why are we lowering standards on quarantining?
Dr. Mike: Because the more people are vaccinated, the less likelihood of spread. And people who are vaccinated have no reason to quarantine after an exposure.
Mary: So here’s one of my favorite questions: If ten of us are vaccinated and we’re having lunch together outdoors, do we need to mask.
Dr. Mike: No. And eating through a mask is a mean way to lose weight.
Mary: From a reader: If you are asymptomatic after getting the vaccine, can asymptomatic COVID produce long-term problems, something that’ll pop up in a year or two?
Dr. Mike: Highly — highly! — unlikely. I doubt this would happen.
Mary: So how good are these vaccines, really?
Dr. Mike: They are incredibly good, among the best vaccines in history. When most of us in the field saw that trials were proving efficacy approaching 95% we could hardly believe it! A Christmas Miracle!
Mary: But they’re only 90-some percent effective.
Dr. Mike: Most vaccines — typhoid, malaria, dysentery, influenza — are lower than 90% but, because nearly everyone was vaccinated, that’s good enough to prevent infection in the community at large. The vaccines we’re using in the U.S., as I said above, qualify as “Christmas Miracles” from a medical point-of-view. Incredible.
Mary: But what about the variant strains of virus that we’re seeing now?
Dr. Mike: The vaccines we’re using are quite good against the variants that have emerged so far, certainly much better than no vaccine. Nothing’s perfect but all the vaccines are effective to some extent. Even though there are a couple of Brazilian variants so far. And we know how many a Brazilian is, right?! (LOL)
Mary: You think the risks of being vaccinated are lower than the risks of not?
Dr. Mike: ARE YOU KIDDING ME?!?! Way lower. Besides, we now know the vaccines not only protect against infection in the first place but, if we’re infected, they also dramatically protect us against the worst symptoms. They reduce severity of the illness, a lot. In all of the vaccine studies, (Pfizer, Moderna, and J & J), not a single vaccinated subject in any of the studies was hospitalized or died due to COVID infection. Zero mortality. None.
Mary: Can I mix-and-match vaccines, maybe use Moderna once and then switch to Pfizer’s for a second dose or booster?
Dr. Mike: It’d be unwise. To the best of my knowledge, it hasn’t been tested. And you don’t want to experiment with the unknowns.
Mary: You seem pretty confident that the vaccine program will work in the next few months.
Dr. Mike: Within four to five months, we’ll have so much vaccine we’ll turn our focus to those who are hesitant to get the vaccine. We need folks to stop dithering and spreading misinformation…and use common sense. The vaccines work — they’re really good. We just need people to give us their arms!
Mary: Some folks believe the vaccines can’t be all that good because they were developed so fast. Is there something to that? How did we get vaccines in months when it usually takes years?
Dr. Mike: We applied what we’ve learned from previous epidemics, especially Ebola and SARS, and HIV/AIDS. We know how to do this efficiently and well: identifying risks, enrolling people, getting informed consent, monitoring, and measured outcomes. Statistically, we could have gone faster; we only needed about 400–600 people in trials to “prove” the vaccine’s efficacy (especially with 90+ percent efficacy). But out of high regard for safety, we didn’t do 400. We didn’t do 4,000. We did trials with 40,000 in each study.
Mary: Do you think that much testing was necessary?
Dr. Mike: Certainly not from an efficacy standpoint, but it was wise. Now we’re confident there won’t be any surprises. Over 100 Million people worldwide have received the vaccines already, barely a handful are having serious adverse reactions, and so far there are no surprises regarding safety. That’s because the studies were done well, despite their speed.
Mary: If we could get these vaccines so quickly, why can’t we get an AIDS vaccine? It’s been forty years!
Dr. Mike: The HIV virus isn’t like COVID. HIV replicates and mutates so quickly, it’s a wildly moving target. And the virus attacks the immune system itself and activates it; when we activate the immune system the cells can become, ironically, more susceptible to infection with HIV. We haven’t figured out how to get around this and the high degree of variation yet, although we do have some long-acting treatments on the way that can prevent infection. We haven’t solved the entire problem but we’ve made significant progress.
Mary: If I’ve been vaccinated, do I need to keep getting tested?
Dr. Mike: Nope. No need unless you develop symptoms of COVID.
Mary: And should I still avoid large crowds?
Dr. Mike: Absolutely, because you don’t know who has and who hasn’t been vaccinated. If an infected person is in a crowd — especially if they are shouting, screaming, yelling, or singing — the virus can travel a long way and “get ya…” The vaccine helps protect against symptomatic infection, but it is not 100%. The good news, as I said earlier, should symptomatic infection occur, the course of the disease will be milder and shorter than without the vaccine.
Mary: Any single, common-sense advice for folks who’ve been vaccinated?
Dr. Mike: Wear a mask. Wash your hands. Avoid crowds, especially indoors or where others aren’t wearing masks. And don’t turn out the lights until the show’s over. We’re not there yet.