The Sociology Phase Begins + J&J Setback
The vast majority of COVID-related information has been positive since our last blog with increasing availability of the vaccine and decreasing rates of hospitalizations in most parts of the country. However, we encountered a setback yesterday with regards to the Johnson & Johnson vaccine so let’s start there before diving any further.
What’s up with this J&J news? If I got the J&J vaccine what should I do?
The CDC and FDA put out a joint statement yesterday announcing a pause in the J&J vaccine administration after having administered 6.8 million doses and observing 6 cases of blood clots develop 6-13 days following administration. Of note, a similar phenomenon has been seen with the Astra Zeneca vaccine which had yet to be approved in the U.S., but is notable since both the J&J and Astra Zeneca vaccines use an adenovirus vector as compared to Pfizer and Moderna which are mRNA vaccines.
For those interested in an excellent deeper dive into the technical/scientific data of what we’ve observed so far, I’d encourage you to read this blog post by a colleague of mine who’s a cardiologist in New York who expertly breaks down what we know about the J&J clotting side effect to date.
The short story is that the 6 observed cases of clots occurred in women aged 18-48 with clots developing in their brain with no obvious predisposing factor as to why they developed. While this is an extremely rare side effect, it is a very serious one, making it appropriate to hold off on administering until we learn more.
The other rare element to this is that the type of blood clot being seen has a different mechanism than the more common blood clots we typically treat. Generally, when we see blood clots in the hospital we treat them with a heparin-based blood thinner. But, for these clots giving a heparin-based product can actually make things worse. Don’t worry, we have other treatment options that don’t include heparin. Further, clots are developing in the setting of low platelet counts which is also a less common finding when patients develop blood clots. The overarching point is that this is not only a rare side effect, but the specific type of blood clot that forms is rare as well.
What do you do if you’ve received the J&J vaccine in the last two weeks? First, take a deep breath and reassure yourself the odds of developing a blood clot from the vaccine are very low. Second, be on the lookout for new symptoms such as severe headaches, abdominal pain, chest pain, or shortness of breath in the first 2 weeks after getting the shot. If any of these symptoms develop, take them seriously and get checked out. If its been more than 14-20 days since you got the J&J shot, it’s unlikely you’re still in the window as every case thus far has occurred in days 6-13 following the shot.
While this is certainly a setback, it should give us confidence that the post-surveillance monitoring and oversight systems are working as intended and appropriately halted administering the vaccine at the first sign of trouble. We’ll hopefully learn more over the next few weeks as researchers dig further into this.
The Sociology Phase Begins
Despite the above setback, we’ve made a lot of progress in the past few months. As we discussed in our last blog, exiting the acute phase of COVID-19 relied on solving three sequential bottlenecks starting with a scientific problem where we needed a vaccine, a supply chain squeeze of ensuring we had adequate distribution, and finally a sociology challenge of convincing as many people as possible to get the vaccine when it became available (admittedly, the job of convincing folks to get a vaccine likely became more difficult on the heels of the J&J news yesterday).
Regardless, we are fortunate that as we enter mid-April, most states have entered the sociology phase where vaccines are available to most adults and uptake, as opposed to availability, will be the last hurdle to jump.
This chart from the New York Times projects 70% of adults having been vaccinated by June 12 and 90% by July 18.
Whether we hit those exact dates or not, the point is that the acute phase of COVID-19 is coming to a head. However, this does not mean COVID-19 will be eradicated by the late summer, but rather, that we will enter the chronic phase of COVID-19 where the virus will continue to exist, but not at pandemic levels defined as exponential, uncontrollable spread.
No matter how hard we try, we will not get 100% of people in this country (no less the world) vaccinated. This means that there will be plenty of hosts for the virus to continue replicating and mutating. COVID-19 will be with us for a long time, but in the chronic phase we learn to live with it, just as we’ve learned to live with other viruses.
In summary, if you had told me 6 months ago back in October of 2020, where we’d be by April of 2021 and that we’d already be approaching the sociology phase, I’d be thrilled. We’ve made tremendous progress.
I am seeing reports of fully vaccinated individuals coming down with COVID-19. Is this breaking news?
No.
Remember, the vaccines were shown to reduce the risk of severe illness requiring hospitalization and death, not to prevent ever catching COVID-19. It is likely that during the vaccine trials that several participants caught COVID-19 after vaccination, but they rarely progressed to having symptoms, much less hospitalization and death. It is to be expected that some percentage of vaccinated adults will still catch COVID-19, especially with escape variants which are more contagious, but the key to remember is that a fully vaccinated person’s risk of developing severe illness or death from the virus is very low.
Thus, the better frame for a vaccinated individual is to recognize you could conceivably catch COVID-19 and transmit it, but your chance of dying from it is very low. This may vary if you are immune compromised or have other underlying medical conditions such as an organ transplant, but for the average individual you’re in good shape.
This is why public health officials are giving different guidance to fully vaccinated individuals versus non-vaccinated individuals. If you’re only around vaccinated individuals, even if you do happen to be an asymptomatic carrier, you’re only spreading it to other vaccinated individuals. However, if vaccinated individuals are sharing airspace with unvaccinated individuals, it is possible for vaccinated individuals to spread COVID-19 to these folks who might become severely ill and or die.
Moral of the story, get vaccinated with one of the mRNA vaccines (and encourage your neighbors to do so as well) if you want to reduce your risk of severe illness or death.
If I’m fully vaccinated, do I need to keep wearing a mask inside?
We all know wearing masks has been a hot-button issue since the beginning the pandemic and continues to be at this stage, but the short answer is yes when you’re inside public spaces like the grocery, drug store, airport, etc. Why? Because I know I could spread COVID-19 to unvaccinated folks even though I’m vaccinated and masks work really well at preventing spread. Let’s look at flu rates from this past winter as compared to prior years:
If you’re having trouble seeing the small bar over 2020-2021, it’s not because your vision is bad, it’s because there was a shockingly small amount of flu this year. In the last flu season B.C. (Before COVID) there were 129,997 positive cases through January 30th. In that same time frame this past year, there were only 1,316 cases.
This is remarkable.
Now, there’s no way to give masks all the credit as we know other confounders were at play such as social distancing among others, but masks make a difference when dealing with a viral respiratory infection.
I’ll leave it to the politicians to sort out mandates and other fun topics such as that, but my individual choice will be to wear one indoors in public spaces.
I keep seeing news about the variants. Anything new?
Not really from my perspective. Again, for every ‘headline news’ story about COVID-19 and the variants, very few in my opinion are truly breaking news. As we discussed in our prior blog, they are more contagious and they do seem to make up the preponderance of ‘breakthrough’ cases where vaccinated people do catch COVID-19, but I have yet to see compelling data that they lead to more death, and the vaccines still appear to work well in protecting against severe illness and death which is ultimately what we care about.
More research is underway so this is certainly subject to change, and the horse race between variant spread and vaccinating as many people as possible continues.
On that note,
What can we do to get more people vaccinated?
Healthcare is local and built on trust. We trust our families, friends, neighbors, and for some of us our doctors to influence our decision making. Thus, I’d think we’d want to identify what areas we’re not seeing uptake and reach out to community leaders in those areas to understand the barriers and identify solutions. No one will have a better idea of what needs to be done to get people vaccinated than the folks who live in that community. The solutions should not come from conference rooms or conversations that don’t include the folks on the ground in those areas.
Anything else?
Yes, one more thing. For those of you who are unvaccinated or know someone who is unvaccinated who is diagnosed with COVID-19, make sure to have them contact their healthcare provider to see if they should receive a monoclonal antibody infusion. It’s particularly important if they are older, overweight, or have underlying medical problems like diabetes, hypertension, or lung disease.
These can be really helpful and reduce the risk of developing severe disease from COVID if given early in the disease course soon after symptoms start (ie - within the first 5-7 days after symptoms).
I still see too many patients land in the hospital who were unaware of this treatment option until they were too sick and/or out of the optimal treatment window so we’ve got to do a better job on the PR front making sure patients and healthcare providers don’t overlook this option.
Stay safe,
Harry