Finally Got the Vaccine?
Six Suggestions from Dr. Mike
Dear Reader,
Michael S. Saag is a professor, author, researcher, commentator and globally recognized infectious disease physician. He’s also my hero and my cousin. In this column two months ago Dr. Mike set the COVID pandemic in the context of the AIDS epidemic he helped stem a quarter-century ago. Much has changed since then, and I asked Mike to describe where we are now in the pandemic, and where he thinks we’re headed. See his advice below.
But first, this personal note: Had the previous president told the truth about COVID, beginning more than a year ago, we would not count 500,000 dead Americans this week. I grieve over his lies, his insensitivity (“It is what it is”) and our lack of ability to hold him accountable.
And I welcome President Biden’s gifts of leadership including his ability to help us grieve. In his personal reflections on the deaths he has suffered, he’s brought us collectively into communal mourning for the hundreds of thousands we’ve lost already. As badly as we need a vaccine to stay alive, we need moments of national mourning to be human.
Mike’s assessment of where we are now, and where we’re headed, follows — with my thanks!
Mary
The development of safe and effective vaccinations against SARS-CoV-2, the virus that causes COVID-19, was our Christmas Miracle of 2020, a Deus-ex-Machina: a genuine rescue by the Gods pulling us out of peril. Imagine if the vaccine candidates had failed…we’d be watching the death toll in the United States scream past the 500,000 casualty mark with no end in sight. But the vaccines worked, exquisitely, with up to 95% efficacy and remarkable safety profile.
Since the issuance of Early Use Authorization (EUA) in December for both the Pfizer and Moderna inventions, millions of US citizens have been clamoring to gain access to the vaccine. The rollout has been slow but is now, with some national leadership, gaining speed. By the end of March as many as 100 million of us will have received at least one dose, and over 40 million will have been fully vaccinated. Then we can return to “normal,” right?
Not so fast my friend.
Several unknowns remain. Despite being fully vaccinated, folks can still be infected transiently with the virus — meaning, the vaccine protects against development of symptoms but does not necessarily prevent asymptomatic shedding of the virus, putting those not vaccinated at risk. You may be vaccinated but you can still infect others.
And no one knows how long the protective immunity lasts. A recent study out of Scotland shows that among those who received a single “jab,” but did not get the second dose as part of a strategy to conserve vaccine for others, the immunity started to wane in 6 to 8 weeks. In the US, we are still employing the two-shot approach for Pfizer and Moderna vaccinations, but the protection even after two doses will diminish with time. Best-guess and optimistic estimates are that immunity will last up to a year, but we need to observe vaccinated folks for at least that amount of time to know for sure.
We would, of course, want to eliminate the virus from our midst once and for all. For that to happen enough individuals in a community need to be vaccinated in order to shut down transmission, a concept referred to as “herd immunity.” Best estimates for this particular virus is that about 75% of our population will need to be vaccinated to achieve this magic state. If more infectious variants emerge prior to our achieving herd immunity against the initial viral strain, we might need 80–85% of the population vaccinated. And these estimates assume the vaccines remain effective against the newer variants we are now beginning to detect across the US. Early data suggest the vaccines still work against the British and South African strains, but are less robust indicating the immunity will diminish sooner than one year.
While we wait for answers, here are some common-sense suggestions on how to live post-vaccination while we wait for more of our fellow citizens to get vaccinated:
1. Continue to wear a mask in public, especially when encountering folks whose vaccine status is unknown (read: all public areas).
2. Keep social distance and avoid large crowds, especially those where others are not wearing masks.
3. On the other hand, masks are not necessary for small gatherings where all of those getting together are known to be fully vaccinated. This could be a bridge group, a family get together, or small religious service.
4. When gathering with family where not everyone is vaccinated, continue to wear masks, especially in indoor settings, to protect the unvaccinated from becoming infected.
5. Finally, recall that the vaccines are not 100% effective. If you’re a vaccinated person and you detect symptoms of COVID, get tested as soon as possible.
6. If found to be infected, explore the option of receiving monoclonal antibody treatment as close to the onset of symptoms as possible. This can be life-saving.
In 1987, Stephen Sondheim’s Into the Woods debuted on Broadway. It is not quite time for a sequel, “Out of the Woods,” to debut but at least it can go into previews at the Old Globe Theatre in San Diego like its predecessor did. There’s hope. Hang tight. Better days are ahead.
But in the meantime stay safe…and stay smart.
