By Dr. Vivek Sinha
As the COVID-19 pandemic rages on, advances in mRNA vaccines have been a source of optimism and hope. Millions of people have been vaccinated and each day mass vaccination sites are administering vaccines to thousands of people. As a primary care physician, I have had many conversations with patients over the past few months about COVID-19 vaccines, and I often hear the same questions. Who should get them? Do they work? What are the side effects?
These are important questions that deserve a full discussion and comprehensive answers. According to the Centers for Disease Control and Prevention, now that approximately half of Americans older than 18 years of age have had at least one COVID-19 vaccine, we are seeing many questions evolve about what the vaccines do and what things people should do next. Let’s cover some of the more common questions that health care providers across the country are answering every day.
Do I need to wear a mask after being vaccinated?
To properly answer this question, we first have to discus what exactly we know the COVID-19 vaccine does. We know that people who have been fully vaccinated – if it has been two weeks after their completed course of vaccination – have a lower risk of catching COVID-19. We also know that they have a lower risk of having severe illness from COVID-19. The bottom line is that we do know that people who are fully vaccinated have a decreased chance of dying from COVID-19.
What we do not fully know yet is if vaccinated people can still spread the virus. We know that asymptomatic illness can occur in many people and while they may not suffer outwardly from the effects of COVID-19, they can unknowingly spread COVID-19 to people who may have serious consequences from the virus.
At this point, we also do not know how long the vaccine provides protection from COVID-19. Therefore, even if a person is fully vaccinated, it is advised that they continue to wear a mask, especially if they are attending medium sized or larger gatherings or if they are visiting indoors with people at increased risk for severe disease. In the future, as our knowledge base widens on COVID-19, this guidance may change, but for now, this is the general recommendation.
However, now that we have seen the effectiveness of the vaccines, there is some good news. The CDC has recently released some guidelines for activities that fully vaccinated people can safely do once they are two weeks out from their last shot. Vaccinated people can visit in a private setting, i.e. a home, with other vaccinated people without masks; travel within the country without a test or quarantining; and travel internationally without a test or quarantine, depending on their destination and that country’s requirements.
Who should not get the COVID-19 vaccine?
There are very few absolute indications for not receiving the COVID-19 vaccine. The only reasons not to give someone the COVID-19 vaccine is 1) a severe allergic reaction after a previous dose or to a component of the COVID-19 vaccine or 2) immediate allergic reaction to a previous dose or a known allergy to a component of the vaccine.
Both the Pfizer and Moderna COVID-19 vaccines contain polyethylene glycol, or PEG, a laxative that is used often to treat constipation and is available over the counter under various brand names, including Miralax.
I’ve had other vaccines recently. Can I still get the COVID-19 vaccine?
Oftentimes, vaccines are given as combination shots or multiple vaccines are given together. There are certain vaccines that may not work as well when they are given together or within a short time of one another.
Vaccines are designed to stimulate one’s immune response and build up antibodies to protect against future illness. If a person is given these certain vaccines close together this process may be hindered and the person may not achieve the best immunity possible. Therefore, it is recommended that the COVID-19 vaccines not be given within two weeks of receiving any other previous vaccination.
I’ve had the Johnson & Johnson vaccine. What does the recent “pause” in that vaccine administration mean for me?
At the time of writing this article, the FDA and CDC have recommended pausing the administration of the COVID-19 Johnson & Johnson vaccine. This pause was advised on April 13 after it was determined that of the 6.8 million doses given out of the J&J vaccines, six women between the ages of 18 and 48 had suffered a specific type of blood clot six to 13 days after the vaccination.
While this specific type of blood clot is very rare and only a small amount of people had this side effect, this pause will allow scientists to study and review the data to decide if there should be any changes in who receives this vaccine.
This type of issue has not been seen with either the Pfizer or the Moderna vaccines. For people who have received the J&J vaccine more than three weeks ago, the risk of developing a blood clot is very slim. People who have received this vaccine within the last three weeks are advised to seek medical attention if they have any of the following symptoms: shortness of breath; pain or swelling in their legs; abdominal or chest pain; severe headaches; fainting; seizures or blurred vision.
While the number of incidents of people who developed this side effect is extremely small, it is important to be diligent if one develops these symptoms after receiving the J&J vaccine.
I’ve already had COVID-19. Do I still need a vaccine?
We do know that once someone has become infected with a disease and they recover, their body can potentially build protection in the form of antibodies against the disease. This is a type of immunity. We do know that this type of immunity can occur with people who have had and recovered from COVID-19, but we do not yet know how long this immunity can last.
We also know, from studying other disease processes, that the level of immunity built from having a disease can vary from person to person. It is due to these reasons that the CDC is recommending that people who have had and recovered from COVID-19 still receive the COVID-19 vaccine.
One variable to consider is that if someone had received specific treatments for COVID-19 such as monoclonal antibodies or convalescent plasma, they should wait three months prior to receiving the vaccine. This should be further discussed with one’s primary care provider.
The writer is the chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.