COVID-19 Vaccines

by Kenneth W. Wilkins, Jr, MD, FACP
Chief Medical Officer, CCHC

By now most of you are wondering when you’ll be getting your COVID vaccine, and we realize that is the biggest question of the moment.  It is not, however, the only question you need to be considering.  CCHC is committed to (eventually) providing vaccination to all our patients who want it, and at present the demand far outstrips the supply of vaccine.  We have chosen to focus on our patients who are 65 and over, based on CDC and NC state guidelines.  As of this writing, we have given just over 2000 first doses, and some 700 of those have had their 2^nd dose.  If you have been to one of our vaccine clinics, you know that they run about as smoothly as could be, with little or no waiting (except for the 15 minutes after the shot).  When we begin patting ourselves on the back, though, we realize we’ve vaccinated less than 15% of our patients in that 65+ age group. Many of you are frustrated and wonder when you’ll be called.  We share that frustration, and our answer, unfortunately, is that both you and we need to remain patient.  (If you find an alternative site to get vaccine, please go ahead.)

Just last week CCHC was approved by the state to be a vaccine administrator, but we were not allocated any vaccine for the week of Feb 1.  We are hopeful that will change, and quickly, but we will not know until late each week.  Please know that we hear you loud and clear. We are just as interested as you in getting a high percentage of our patients protected, and the sooner the better.  Now, to those other questions:

So far we’ve had two vaccines approved for emergency use in the US, developed by Pfizer/BioNTech and Moderna.  Both are 2-shot vaccines; Pfizer’s 2^nd dose is given 21 days after the first, and Moderna’s, 28 days.  Johnson & Johnson hopes to have its vaccine approved for emergency use this month.  You may have heard that the first 2 vaccines were “95% effective” and that J & J’s is 70% effective.  All three vaccines, however, are nearly perfect when it comes to preventing severe disease.  No vaccinated patient in any of the trials (including 2 others) died from COVID, and there have been only a few cases that required hospitalization.  For practical purposes, then, each is terrifically effective.  Experts say that if one has the opportunity for the J & J vaccine now, but could wait a month and get one of the others, to by all means get the J & J one.  Protection cannot come soon enough.

Another question concerns what some are calling vaccine hesitancy.  So far, only a very small percentage of patients we’ve contacted have not wanted to get the vaccine, but that number will likely go up as we move into younger age groups.  Worries include side effects, the speed with which the vaccines have been developed, effects on pregnancy, fertility, and breastfeeding, and long-term adverse effects.

There have definitely been some serious acute reactions to each of the currently used vaccines, at a rate of about 1/million doses.  We have been prepared for such reactions at our clinics, and fortunately have had none.  There are other adverse events, and many people feel ill for a day or two, especially after the second dose.  There are also a number of patients who have had a local rash after Moderna’s vaccine. This has been self-limited, at times itchy and moderately painful, but there have been no other consequences and the rash resolves on its own within a few days.

With the Pfizer and Moderna vaccines, there is little or no theoretical basis to worry about effects on fertility.  The mRNA is gone from our bodies within a few days, and the spike proteins that are made based on the mRNA last only a bit longer.  Nothing is incorporated into our DNA, and there is no chance of contracting COVID from either of these vaccines.  The evidence regarding use in pregnancy and in breastfeeding women is sparse, but again at least in theory no ill effects would be expected.   Pregnancy is also a risk factor for a more severe illness from COVID.  Each woman, therefore, should assess her risk of severe illness versus the unknown effects of the vaccine and proceed accordingly.  Officially, pregnancy/breastfeeding is not a contraindication to vaccination.

Thank you in advance for your patience and understanding.  Please be aware that we want to get the vaccine out just as fast as you want to receive it.   We think this is the best way to get our economy, our schools, and our very lives back.