COVID-19 Update 2/3: Vaccines, Variants, Second Doses, and More

On this week's COVID-19 update, Dr. Steven Bishop discussed the recent news on the AstraZeneca and Johnson & Johnson vaccines, provided an update on Moderna and Pfizer distribution, and talked about variants, second doses, and more. Watch the full video below and read on for a transcript. 

AstraZeneca Update

I want to just update everybody on the AstraZeneca vaccine and the Johnson & Johnson vaccine, which are two other vaccine candidates that are out there and have not been approved yet in the United States, but I suspect will submit for FDA approval at some point in the next few weeks to few months.

AstraZeneca released some updated data from their Phase III trials and showing that about 70% of the patients had good protection from the virus after one dose of the vaccine, which is excellent, and then went up to about 82% or so after the second dose.

I have not seen all of their data just yet because they haven't released everything, but they did release this sort of updated preliminary analysis. We haven't gotten into the details of what the side effect profile is and that sort of thing.

The AstraZeneca vaccine is being used already in the UK and some other places. There was a related question about this that came in on the blog about, the question was, "I read that AstraZeneca was not to be given to those over 65. Is that true?"

In the United States officially, no one's getting it right now because it's not an approved vaccine. Now in England, I think they are using it pretty widely. But in much of the continent, so France, Germany, Sweden at least, they have decided not to give the AstraZeneca vaccine to people over the age of 65, because of increased concerns about side effects.

So that is something that is going on over there in Europe. And actually, I've got a link to a news article about that. So different countries are taking different stances on that in terms of the AstraZeneca vaccine and who to give it to. But overall, again, we haven't seen all their data yet.

It hasn't been posted where I can find it to the FDA website or anything of that nature to look at the sort of pros and cons risks and benefits of that vaccine just yet. So hopefully in the next few weeks, that will settle out and we'll get some more information.

Johnson & Johnson Vaccine

Then Johnson and Johnson vaccine. They released some data as well showing a little bit disappointing effectiveness for the COVID vaccine — around maybe 66% to 70% after their single dose vaccine — which again, I think it's good that it's a single dose vaccine. I'll take 60-some, 70-some effectiveness over nothing.

But not as good as we would have hoped for it to be. So still some time to tell about those things. But those are the updates on the vaccines — two of the other vaccine candidates that are not approved currently in the United States, but are, either being tested or evaluated elsewhere. More coming on those in the next few weeks on those items.

Moderna and Pfizer Update

In terms of Moderna and Pfizer, there continue to be supply limitations across the country. And it's the same thing here in Virginia.

Our supply numbers are going up a little bit, according to the health department. We still don't have any, nor do we have any timeframe for getting them here at our offices.

But we did hear word and it was on the news that on February the ninth, you can go online and try to register for a vaccine through CVS. They are going to get some doses directly from the federal stockpile in CVS pharmacies in Virginia.

So you can try to register there and get the vaccine there if you want to try to do that in the meantime.

Again, other than that, the best thing to do is to register and fill out the information form with your local health department. That seems to be how most people are getting access to the vaccine right now, unless they're being called by one of the big local health systems that still have a few doses on hand.

Although I think our big local health systems have about run out of vaccine at this point. The majority of the doses that were on hand for first doses have been given out across the state at this point, which is good news.

India and COVID

"India is a nation of 1.3 billion people. Four times the population of the United States, more densely populated. And the occurrence of COVID has been decreasing rapidly towards almost gone. And the death rate is one third of ours. Again, with four times the population is this, so basically the question is, is this because as a people we are, we in the United States, are not acting responsibly and intelligently? As the cartoon character of the 70s said we have met the enemy and he is us."

Good question. There's a lot that goes on in terms of figuring out why case rates are different in different places.

I haven't delved into the data from India, but I will say we have done a lot of testing is kind of the first thing. We test a lot of people at this point. And so we are uncovering lots of cases.

The Indian healthcare system is nowhere near as robust or sophisticated because it is so densely populated and they do have so many people, they don't do as much. They're not doing as much testing, I do not think, as we are doing here. So we are probably finding a little bit more cases on a per capita basis.

And they're also doing other things different, too. In some parts of India, they've been using some of these medications more widely — the ivermectin and hydroxychloroquine and some of these other things. They've been doing this a lot more widely.

So I don't know that I would sort of say that it's because we're not as a country doing this or that, or the other, if you actually look at the mass compliance data, it's pretty high at this point across the country, not everywhere, of course, and not in all places is it high all the time, but the mask compliance data and the social distancing compliance data, outside of say, college campuses, it's actually pretty good.

And if you compare across states, across cities, where they've had more or less stringent lockdowns and more or less stringent mask rules and this and that, the differences between the case rates are not great.

There are small differences, if any at all. I'm not really sure that it's down to the the behavior at this point. I think it's, unfortunately again, continues to be things we don't understand about the virus.

We're doing a lot more testing than other people per capita, and we're not using some of the other therapies that we have considered to be experimental, but some other countries have gone ahead and used them much more widely. And it may be that some of those are very beneficial. We just don't know yet. And so there's a lot of variables involved essentially is what I'm trying to say.

North Carolina Vaccine Process

"My brother lives in North Carolina. He is an elder who's eligible for the first available vaccine. No other special circumstances. Got his first shot 10 days ago from his private doctor and already has his second shot scheduled. What is North Carolina doing right that Virginia is apparently doing wrong?"

Well, the long and short of it is, I think a lot of other states distributed their vaccine quickly to private practices and to the private health systems and let them handle the distribution. And I think because of that, it has gone a lot faster in many places. I think that's the bottom line.

I think they did not distribute the vaccine fast enough from the stockpiles that they got. And so, because we did not distribute and get it fast enough, we did not then get more from the federal stockpiles because the federal government was not going to give us more doses if we didn't use the ones we had.

So I think that's the main difference in terms of how this was handled and accounts for why things have been so slow here in Virginia.

Antibody Tests

"If someone wanted to get an antibody test, where and how do you recommend doing that? Also any idea of the cost?"

You should be able to get it as pretty much any doctor's office at this point or through LabCorp or Quest. Most physician's offices have access to that testing at this point. We have not had any problems with it getting covered by insurance.

When we've done it, we've done it for people after they've had an illness or just part of their routine physical. They wanted to check for antibodies to see if they've been exposed at some point and we've had no problems that I'm aware of getting that covered in terms of costs.

But if you're paying cash, I think it's about 50 bucks for the test.

Monitoring Variants in the U.S.

"How good a handle do we have on the prevalence of coronavirus variants in the U.S.? What data do we collect about this? Do we collect enough to track the movement of the variants throughout the country?" 

Good question. I know a lot of places are tracking this pretty aggressively in screening for variants all the time. I don't think we have a good handle on the variants.

I think they're probably spreading pretty rapidly. That being said, what's good is despite the fact that they're spreading, I would think, pretty rapidly, the overall number of cases and hospitalizations and deaths, etc., are on the decline despite the fact that these variants are transmitting most likely everywhere.

I know the U.K. variant at least and I think the South African variant has shown up in multiple states at this point. I know the U.K. variant has been in Virginia now and I think the South African one is in Maryland. So that means if we're detecting it, it's out there in pretty high numbers already.

So yeah, I don't think we have a good handle on it. I don't think we're going to get a good handle on it until we get a good handle on it as an overall situation in terms of getting enough people vaccinated, etc. 

Home Tests

"Do you recommend the home tests that are coming out? If so, how much should we buy to have on hand and how often and what circumstances should they be used?"

Yeah, I think those were potentially helpful earlier on. Some of them are still helpful. For the most part, I think they're probably helpful for people who don't have access to testing through their own doctor or can't get access quickly to testing through their own doctor.

Or someone who has a planned travel, etc., and they know when they need to be tested and they can order those kits and have them at home.

But I think for most people, they're probably not that useful if, again, if they have access to tests through their physician. Some of them are fairly expensive, but the one that's called Pixel that's through LabCorp, you can order directly. You can use your insurance, Medicare, etc., and they'll cover it and mail it to your house and you can mail it back to them.

That's probably one of the better ones out there, but most of the ones off Amazon, etc., I'm not sure that they're beneficial for most people, so probably don't need them. By the time you order one, if you're sick and you order one, you wait days for it to show up, and then days for the result to come back, I'm not sure it's going to be all that helpful to you in terms of getting treatment or anything like that. So there's not a lot of circumstances that I would recommend those in general.

Masks

"Do you have any new recommendations about masking? I’ve seen quite a bit of talk about the desirability of using higher-filtration masks or using more layers of lower-filtration material."

There's been a lot of talk about that over the last week or so. The problem that I'm having with it is that the data on masks, period, has continued to be pretty questionable across the board there.

We still don't have a lot of definitive evidence that masks do a whole lot in general and there's just another update on this from the Annals of Internal Medicine, where they reviewed all the available literature and they couldn't come to any conclusions on it that it was that it was beneficial in most cases, especially out in the community.

So I don't know that switching to even more layers of masks or more masks is actually going to make a significant difference in things. I'm just not convinced of it based on the lack of data that we've seen so far, and the fact that mask compliance has been pretty high across most places and we still see the same rises and falls in cases across different districts where they have more or less stringent mass requirements.

I'm just not sure that I'm convinced of the utility of using either more masks or higher filter masks at this point out in the community at least. Healthcare is different. You still need N95s and surgical masks for that.

Guaranteed Second Dose?

"f I can get the first shot, can I be guaranteed a second shot? And will it be the same manufacturer as the first?" 


In most places, if you get the first shot, they have a second shot earmarked for you that they have stored away, so you should be good.

And yes, it should be the same manufacturer. Don't mix doses. Don't mix the different products and they won't do that to you pretty much anywhere.

Precautions After Vaccination

"Can you comment on precautions we still need to take after our second vaccination?"

All the current recommendations right now are that none of the precautions change after your vaccination. Everything stays the same. It's as if you haven't been vaccinated in terms of the precautions.

I think this may change over time, but the reason is we just don't have enough data to know yet whether you can still spread it to other people even though you might not yourself get sick. So that's the main issue there.

Booster Shot Needed

"Do you believe that we will have to get a booster once developed to protect against variant virus progression?"

I do. At this point, what I'm guessing is going to happen, is that this is going to become something seasonal, kind of like the flu vaccine. As variants arise, we may have to to kind of boost people up once a year or something like that if new variants show up and continue to show up.

And I know actually, I think Moderna is already working on a booster for their shot for one of the variants. So yeah, I think this will probably continue, unfortunately, continue to be an issue in the coming years.

Worse Symptoms After Second Dose

"If I felt bad after dose one, will I feel way worse after number two?"

There's no way to say unfortunately. Many more people feel badly after dose two, period. So I think it's likely if you felt badly after dose one, you're probably gonna feel at least as bad if not worse on dose two, because you're getting a stronger immune response with the second dose compared to the first dose.

I think you can at least bank on feeling as badly, if not worse, for the second one. But it's hard to say.

Everyone is sort of unique in this way. Some people have had hardly any symptoms at all from either vaccine dose.

So it's just tough to say, but by and large, what I'm seeing out there in the data and colleagues and friends, etc., is that the second dose is making people pretty sick. Fever, chills, muscle aches for one or two days. Just really not feeling well.

So I think that that's something that, unfortunately, most people can probably expect to happen with a second dose, especially if you're on the younger side. It Seems that people under that 50ish range are getting more side effects, which sort of makes sense. Their immune systems are reacting a little bit more strongly.

Super Bowl Food Risk

"We're having virtual Super Bowl party with two couples. Everyone is preparing food to be delivered to each couple. Not everyone is as cautious as I am while preparing food, maybe not wearing masks. Tell me food other people prepare is okay to eat if I don't smell it too deeply or touch it to my eyes. I think you answered this a few weeks ago."

I think as long as you have kind of wiped down the outside of a container, your risk is pretty minimal in that particular setting, if it's, you know, if it's a cooked food the odds are pretty minimal that you're going to have transmission from that.

And even from touching the outside of the food or anything like that, it's pretty unlikely that you'll get transmission from that. The contact transmission of the virus is much lower than direct sort of airborne exposure. So that should be a pretty safe activity ever.

Gathering With Other Vaccinated People

"Follow up to previous question, after the second vaccine can I gather with others who have also been fully vaccinated?"

The short answer is we don't know because there's no data yet, but I think likely, yes, this should be fine. The problem is right, if all of you are transmitting it amongst yourselves, even though you're not getting sick, you could still be a carrier. So you could still expose someone else sort of secondarily.

But if you're just going to gather with those people, I think that's probably reasonably safe. Again, we're sort of outside the realm of data at that point, but I think generally you probably are okay to do that as long as you're not going to be necessarily exposing other people, secondarily, that might be high risk.

First Dose Harder for People Who've Had COVID

"I've heard the first dose is harder for people who've already had COVID compared with people who have not had it."

I have heard that too. I have heard just anecdotally heard some people had kind of strong response to the first dose if they've already had COVID. But I haven't seen that in any hard data. Just I've heard that from some patients and colleagues, etc.

"Also there's a suggestion that maybe people who've already had COVID can get just one dose and not two. Any thoughts?"

The manufacturers, the data, none of the trials has anything to say about that. There's no data either way. I know that with both vaccines, a certain percentage of people have good antibody responses after the first dose. The Pfizer vaccine is about 54% of people. The Moderna — it's about 80% of people after the first dose have antibodies and presumed immunity. I've had one dose of the Moderna and I checked and I have antibodies to COVID after just the one dose of Moderna. So there there's some truth to that, but we just don't know at this point.

Relaxing Restrictions in Virginia

"What are your thoughts on what Virginia might be doing to relax restrictions on gathering of people and timeframe?"

I doubt that the governor will make any significant changes before April. I don't know for sure, of course. I don't have the governor's ear on these things, but I doubt they will make any significant changes until they have been able to roll out the vaccine, at least, to everybody 65 and up.

I'm expecting that to take through March and maybe into, into mid to early to mid April. So I wouldn't expect to see any changes from the Virginia government in that regard until April at some point.