Recently, there has been a lot of information in the news about COVID-19 boosters in people that have already been fully vaccinated. There is some evidence that vaccines may start to lose full effectiveness after a few months, but there is other evidence that protection may last for years. With the current outbreak of the Delta variant, a fair number of people who have been fully vaccinated are still contracting COVID-19, but it is important to note that these breakthrough infections are almost always mild and do not lead to severe disease or death. These are my thoughts on COVID-19 vaccine boosters:

• First, I want to emphasize that people that have not yet been vaccinated should get their vaccine now. Many people feel that they are healthy and are unlikely to catch it. However, the Delta variant is much more transmissible and can still severely affect healthy individuals. I recently admitted somebody to the hospital who was a healthy unvaccinated 60-year-old man taking no medications. His daughter’s boyfriend’s boss came down with COVID, and his daughter and boyfriend both tested positive even though they had no symptoms. The patient unfortunately caught it from his daughter, got admitted to the hospital, and is now in the intensive care unit because of respiratory failure. Had he been vaccinated, he likely would NOT have required hospitalization.

• I agree with the World Health Organization that, with rare exception, people who are fully vaccinated do not need a booster at this time, and it is important that the rest of the world receive their first vaccine doses. Unvaccinated countries can lead to widespread transmission of the virus in their populations, causing more virus mutations and then potentially spreading to people who have fully been vaccinated. These mutated strains may not respond to the current treatments for COVID-19. To this end, the US has already shipped more than 110 million doses to other countries to aid in the worldwide vaccination effort.

• We are still conducting studies to see if certain population groups would benefit from a booster shot, and once the recommendations come out, those people would be eligible.

• If you have been fully vaccinated, and you do end up contracting COVID-19, you have a less than 0.01% chance of being hospitalized from it, and less than 0.001% chance of dying from it.

• Because vaccinated people can still catch and transmit COVID-19, I recommend that everyone who has cold-like symptoms or unexplained fevers to still get tested, either through the traditional testing sites, or through at-home antigen self-testing (click the COVID-19 tab above to read more).

• Likewise, if you have cold-like symptoms or “allergy” symptoms, please do not come into our office for your regularly scheduled appointment without calling us first.

Having said all this, is also true that there have been over a million doses of COVID-19 vaccines that have gone to waste in the US because they have expired or not enough people are choosing to get them. Our office is currently receiving only excess vaccine doses from health facilities that cannot use them, and we are not ordering them directly from the government. From my standpoint, instead of letting these doses go to waste when they expire, I would rather have someone receive them as a booster shot, even before we have definitive evidence that they are beneficial. I feel that as long as there is a chance that a booster shot will be beneficial, and any risks from the shot are negligible, it would be worth putting that vaccine in someone’s arms as opposed to in the trash can. To that end, we are now accumulating a list of people who are interested in receiving a booster shot. Because the data have not come back yet, we cannot say if it would be better to get the same manufacturer as your first vaccine or a different one. We will prioritize individuals over age 65 and those on immunosuppressive medications first, as these individuals are likely going to be the first that will receive approval for a booster shot if and when it is needed. If you are interested, please send us a message through the portal or email us at  drsuncovidvax@choice.md and let us know your name, phone number, and which vaccines you are willing to come in for.

By now, most people who have wanted the COVID-19 vaccine have probably already received it.  If you haven’t, or know someone who hasn’t, please read on.  With the increasing number of infections in the US right now, it’s important to know the following information:
​

• The increase in infections is largely because of the Delta variant of the virus, first detected in India.  This variant is definitely more contagious, so it spreads more quickly than the original strain, although most studies show that it is NOT more deadly.  However, even if a virus is not more deadly, it can still lead to more deaths.  If a virus kills 1% of people that it infects and is transmitted to 1000 people, you would have about 10 deaths.  But if the same virus is more contagious and is transmitted to 1,000,000 people, you will have 10,000 deaths, even though it is not more deadly.

• All 3 vaccines currently available in the US are extremely effective at preventing hospitalization and death from COVID-19.  Of the people that are currently hospitalized or die from COVID-19, more than 95% of them have NOT been vaccinated.  If you are fully vaccinated and still happen to get COVID-19, the overwhelming odds are that you will have mild symptoms and recover without any long term consequences.

If you are interested in getting the vaccine, we now have them available to give at our office, so please call us to schedule an appointment. 

For those of you who are still hesitant, here are my responses to several of the issues that people may be concerned about:

The vaccine approval process was conducted too quickly

It is true that most vaccines have taken much longer to receive authorization or approval.  This is because when a vaccine company starts testing a vaccine, they start off with smaller trials, and only when they are shown to be successful, do they move on to larger and larger trials.  Vaccine companies don’t want to spend a lot of money up front since they don’t know if their vaccine will be successful.  After their final trials are successful, they then have to manufacture the vaccines, which also takes a lot of time.  However, the Trump administration correctly offered to help fund several of the trials to allow them to be conducted much quicker (although Pfizer did not take any such money for their vaccine development), as well as guaranteeing to purchase millions of doses for all their vaccines.  This allowed the companies to produce millions of doses even before they knew if their vaccine was going to be successful.  If their vaccine was NOT successful, the government would have paid for those doses anyway, they just would not have been administered to people.  What this allowed was the immediate distribution of millions of doses that were already manufactured, ready to be given as soon as the Emergency Authorization was received.  So while it seems like the time line for the vaccine development and distribution was so short, this was NOT because scientific corners were cut, as all the proper steps were still followed, but instead, this occurred because we conducted and performed all of these steps at the same time, as opposed to waiting for each step to finish before moving on to the next step.

One other important reason why we were able to conduct these studies quickly was because of how prevalent COVID-19 was while the studies were going on in 2020.  If you are testing a vaccine against Ebola, you give half the people the vaccine and half the people placebo, and then you have to wait for a while so that enough people get Ebola, and then you can compare the two groups to see if the vaccine group contracted the disease less often.  For COVID-19, the disease was so prevalent last year, and we had many high risk groups such as nurses and doctors caring for sick COVID-19 patients in the hospital on a daily basis, that we didn’t have to wait very long before we could see the benefit of the vaccines.

The vaccine is experimental and we don’t know the long term side effects

While it is true that the Pfizer and Moderna vaccines are the first vaccines that utilize messenger RNA (or mRNA) to generate the immune response, that is really not a big deal.  Scientists have been researching mRNA vaccines for HIV and Zika virus for years – COVID-19 is just the first mRNA vaccine that has received emergency approval.  You should first realize that our genetic material is encoded by DNA in our cells, and in order to translate that DNA into proteins, we use mRNA that our body produces.  Therefore, mRNA is not a new substance, and it’s certainly not something that we don’t know anything about.  It’s something that is already in each and every one of us right now.  The Johnson & Johnson vaccine is called a viral vector vaccine, and it is the same method that the current Ebola vaccine utilizes.  This video does a good job explaining the various types of vaccines that are currently being evaluated as ways to deliver the COVID-19 vaccine.

With regards to side effects, it is important to know that other vaccines that we currently use (and that already have FDA approval) do not have any real long-term side effects.  There are certainly short-term serious side effects that are possible with the COVID-19 vaccines. However, they are still very rare, so it is important to know about them, but they should be put into perspective.

• The Pfizer and Moderna vaccines have been associated with inflammation of the heart muscle, mostly in males under age 30.  However, this has occurred in about 12 cases per 1 million vaccine doses given, the condition is self-limited, and people usually recover fully.

• The Johnson & Johnson vaccine was found to be associated with the possibility of blood clots associated with low platelet counts in the body.  This was mostly found in women under age 50 and occurred at a rate of about 3 cases per 1 million vaccine doses given. The reason the vaccine administration was halted temporarily was not because of how common this side effect was, but because the treatment of these blood clots is different than the usual treatment of using a common blood thinner, which would actually be harmful for patients with blood clots from the vaccine.  Therefore, it was important for all practitioners to know about the possibility of this side effect so that the wrong treatment was not used.  By stopping the administration of this vaccine for several days, this information got out to all practitioners so that physicians would know the right way to treat these types of blood clots.

• Recently, the Johnson & Johnson vaccine was also found to be associated with a rare auto-immune neurologic disorder known as Guillain-Barré syndrome that was found to occur at a rate of about 7-8 cases per 1 million doses given, mostly in men over age 50.  This is a disorder that can cause weakness and paralysis and has also been associated with getting an infection with certain bacteria or viruses such as influenza or Zika virus.  On average, we see approximately 17 cases per 1 million patients hospitalized with influenza.  Once again, the chance of getting this side effect is extremely rare.

The important thing to know after reading about these possible side effects is that the COVID-19 vaccines are the most studied vaccines in our history.  We are constantly on the lookout for possible side effects, and all the data to this point shows that these vaccines are extremely safe.  The major side effects occur in less than 10 cases per 1 million people, which is 0.00001%.  Putting it another way, every year, more than 100 people out of 1 million in the US will die in a car accident, so your chance of dying in a car accident each year is significantly higher than a serious side effect from the COVID-19 vaccine, and yet people are willing to take that risk and drive every day.  The benefits of being protected with the vaccine far outweigh the risks associated with any possible serious side effects.
​
So for those of you who have not yet been vaccinated, please reconsider and get vaccinated to protect yourself and those you love.  Please call our office if you want to schedule a vaccination or would like to set up an appointment to discuss it further.

​For those of you who may not have heard, Scripps Health was hit with a cyber attack this past Saturday.  Patient care has not been affected, but the Scripps portal and appointment system is down.  If you have appointments, labs, or radiology scheduled early this week, be sure to call them beforehand to make sure things do not have to be postponed.  Getting labs and reports back from Scripps may be delayed.  Our portal does not run through the same system as Scripps, so we are still up and running, and all of our appointments are still going to occur as scheduled.  Hopefully everything will be resolved with Scripps early this week.

​Beginning April 1, all adults ages 50 and above are eligible to receive the vaccine.  Beginning April 15, all adults ages 16 and above will be eligible.  Studies for the vaccine in children under the age of 16 are still being conducted, and the vaccines will hopefully be available soon.  For information about booking your appointment, please see the updated COVID-19 tab above.

In another last minute change, San Diego County has expanded the criteria for eligibility to receive the COVID-19 vaccine starting March 15.  In addition to the more stringent criteria listed in my last blog entry, they have now added new criteria listed below.  The biggest increase would be for people with hypertension and those who are overweight.  If you're not sure if you fall into the overweight category, you can calculate your body mass index online with a BMI calculator or log into your portal to see what your last documented BMI was.  In addition, YOU DO NOT NEED A NOTE FROM OUR OFFICE.  When you show up for your vaccine appointment, you simply have to confirm that you have one of the eligible conditions. To make an appointment, click on the COVID-19 tab above to see the different ways to access appointments, specifically through the county at www.VaccinationSuperStationSD.com or at individual pharmacies.

•  Asthma (moderate-to-severe)
•  Cerebrovascular disease (affects blood vessels and blood supply to the brain)
•  Cystic fibrosis
•  Hypertension or high blood pressure
• Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
•  Neurologic conditions, such as dementia
•  Liver disease
•  Overweight (BMI > 25 kg/m2, but < 30 kg/m2)
•  Obese (BMI > 30 kg/m2, but < 40 kg/m2)
•  Pulmonary fibrosis (having damaged or scarred lung tissues)
•  Thalassemia (a type of blood disorder)
•  Type 1 diabetes mellitus

Side effects:  We encourage everyone to report any side effects to the vaccines through the Vaccine Adverse Event Reporting System.  If you want to help out even more, you can also sign up for V-safe on your cell phone. This phone-based app will check in with you daily after you receive your vaccine to see how you’re feeling, and it helps us document the various possible side effects the vaccines may have.  Just go to vsafe.cdc.gov on your smart phone and follow the prompts.  One important thing to know is that NONE of our patients have had any long term side effects from the vaccine.  You may not feel well for a few days after getting the vaccine because you are tricking your body into thinking it is fighting the real COVID-19 virus, but because there is no virus there, you quickly return to normal.
 
If you’ve already had COVID-19:  Many people have already been diagnosed with COVID-19 this past year.  Although there are no official recommendations, if you have been diagnosed with COVID-19 in the last 3 months, I would recommend waiting to get your COVID-19 vaccine.  Having had the infection, you will most likely have at least 90 days of protection from getting re-infected, and getting the vaccine soon after having had the infection may give you more side effects from it.