COVID-19 Update 3/24: AstraZeneca, Rheumatoid Arthritis, COVID Arm, and More

On this week's COVID-19 update, Dr. Bishop discusses the confusing data around AstraZeneca's trial results, if the vaccine is effective for those with rheumatoid arthritis, vaccine side effects, and more. Watch the full video below and reason on for a full recap.

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AstraZeneca's Confusing Data

The main thing I'm going to talk about today is just a brief sort of update on the AstraZeneca vaccine that you guys probably have heard about this in the news. But essentially it looks like the big concern, the big sort of kerfuffle going on, is that it appears that the data that AstraZeneca released in their press release around the effectiveness of the vaccine doesn't exactly match the data that they sent to the FDA as part of their data safety monitoring for their trial.

And so the NIH and other bodies, including Dr. Fauci, were rightly sort of questioning that discrepancy and saying, "what's going on here?"

I suspect we'll get to the bottom of this in the next couple of weeks and, you know, it's not that there was a massive discrepancy between the data, Essentially what AstraZeneca said in their trial was that the vaccine was 79% effective at preventing symptomatic COVID. And what the original data showed that they submitted to their data safety monitoring board was that it was 74% effective, 69 to 74% effective.

So we're not talking orders of magnitude or anything overly dramatic like that, but that being said, any kind of data discrepancies are significant cause for concern especially when we're talking about experimental treatments, experimental vaccines, things that we have never used before. So we've got to be very transparent about what's going on there and I think that's why the NIH released their subsequent statement saying, "hey, AstraZeneca, we saw your press release. This doesn't match what we've got from you on file. So please explain yourselves." So I think that's good.

Another thing that's going on with the AstraZeneca vaccine that you guys probably have heard about is that there have been some case reports here and there of blood clots going on with the AstraZeneca vaccine mostly in Europe.

And many European countries have actually halted use of the AstraZeneca vaccine to investigate those things further. It doesn't mean that the vaccine is causing blood clots, but it's one of those data safety signals that we need to take seriously and analyze and make sure that it's not actually a true safety concern. So those are the updates on the the AstraZeneca vaccine.

I suspect those data discrepancy issues will get resolved in a couple of weeks. And then we'll see the full reports come out for that one, just like we did for Moderna, Pfizer, and Johnson & Johnson. So we'll what time will tell with that.

All right. We've got a question in the chat. "Wasn't the main problem that the press release referred to an earlier data set, but the regulators had already had a more recent data set? If so, it doesn't sound like anything close to fraud and seems easily correctable."

Yeah. So I think it was the, the other way around, I think, and maybe I may have gotten this mixed up, that the FDA actually had had the older data set and the company referred to a newer dataset.

I agree with you, and I don't think anyone's trying to be fraudulent or anything like that. I think probably there was a mix-up in what was released to whom when, and probably the press office just made a mistake in reporting out the wrong stuff in the press release. I don't think there's anything necessarily nefarious going on.

But I agree with the NIH's stance on it, which is to call out the discrepancy and in the interest of being as transparent as possible so that people don't think there's something shiesty going on.

So yeah, I don't, I don't think there's anything untoward happening here. I think it's just a mix up of messages and they just need to all get on the same page before anything else gets released, so that way people aren't confused about what the actual data is.

So no, totally don't think there's anything anything malicious happening here. I think it's just a matter of making sure everybody's ducks are in a row because in this environment, as you know, it doesn't take much for people to kind of take a little bit of something that's a slight discrepancy and spin it off into a crazy conspiracy theory. That's unfortunately, just the world we live in right now.

Sedated Dentistry After Vaccination

"I'm getting my first dose of Pfizer today at 4:30. Can I safely undergo sedated dentistry on Friday morning?"

What I will say, you know, is talk to your doctor about that and your dentist. I don't know of any contra-indications or any reasons why you wouldn't be able to do what you would normally do in terms of sedation dentistry after the COVID vaccine. There are no published contra-indications related to that. But if you have further questions, definitely ask your dentist or your primary care doctor about that for sure.

COVID Rates Fluctuate

The COVID rates continue to kind of fluctuate. In some places they're up a bit, some places they're still going down. In our home state of Virginia, things continue to trend in a downward direction and the percent positive rate has stayed low the last couple of weeks, which is good. It's about 5.6% at this point and cases, hospitalizations, and deaths have all trended down, which is good news.

And I think for the most part, that's what we're going to see across the board in the coming weeks and months as the weather turns, as more and more people get vaccinated, and this sort of thing.

Like we've talked about before though, I think the big issue is going to be getting people vaccinated as quickly as possible. Because that's the issue in terms of racing all these various variants and sort of things. So getting the vaccines rolled out is the issue at this point.

Additional Doses if Supply Allows?

"A hypothetical question. If we come to a point where vaccine supply outstrips demand, might there be medical benefit for already vaccinated people having another dose of the same or perhaps a dose or doses from a second vaccine platform? Also, do you think we will reach a point of greater vaccine supply than demand? I've seen predictions that we will?"

Yeah, so that's a multi-part question and I'll kind of take it apart piece by piece. The first piece in terms of having a repeat dose at some point of the same vaccine platform will depend on how long the immunity lasts.

So if we feel like the original vaccine you got has good, long lasting immunity, then I'm not sure that you're going to get a lot of benefit out of a repeated dose at some point, because it's just going to cause more side effects than it's worth.

Now having a different vaccine platform in terms of coverage of a different variant or something like that, that makes a lot of sense to me. And that probably will come to pass either in the near future in terms of having, say you had Moderna before and it doesn't cover the South Africa variant very well, but the the Pfizer one does, so you should get a booster with Pfizer in a year or whatever.

That being said, I think many of the platforms are developing their own boosters to cover their variant gaps. So like Moderna is doing that with their South Africa variant. I bet that Johnson Johnson will do that as well with the same thing and develop boosters for those variants.

I'm not sure that we'll see a lot of cross-platform utilization. I think we'll just see boosters, which is probably simpler and safer in terms of the side effect profiles and stuff like that. 

Do you think we'll reach a point of greater vaccine supply than demand? Yeah, I do. Eventually we will more than likely. I think we've actually reached saturation rate in certain demographics already. You've seen, we've started seeing a lot of the health departments reaching out multiple times to people who were in that like 65 and up group. And we've kind of hit a saturation point.

All the people who want to get it at that this point, they pretty much have been able to in most places if they're 65 and up. Now, that's not true for lower age groups. So I think eventually we will reach a saturation point and a point at which we have got more supply than demand probably in the next few months I would guess.

So you are welcome, Caroline. Good questions. All. What other, what other things are you guys curious about today? I got plenty of time. So feel free to put the questions in the chat there. As always, if you guys are coming to this video after the live is over, that's totally fine. Just put your comments in the questions and I will come back and answer those later on.

Vaccine Effectiveness Against Variants

"Am I right that all three vaccines are reasonably effective against the B117 variant?"

If that's the U.K. variant, yes. The South Africa variant, however, no. The Moderna vaccine and J&J don't work well against the South Africa variant, but Pfizer does as far as I'm aware.

Rheumatoid Arthritis & Vaccines

"I have RA. Is the vaccine less effective for me?"

I don't think so, but if you're on immunosuppressing medicines, any kind of immunosuppressing medicine like steroids, methotrexate, things like that might affect how well the vaccines work because the whole purpose of the drug is to suppress your immune system.

So if you're on an immunosuppressant, yes, the that medication may make the vaccine less effective for you, but the disease itself, rheumatoid arthritis, won't. So yes, the methotrexate could potentially have some effect there, but I would still encourage you to get the vaccine because some effectiveness and some protection is still better than none in that case.

Racing Against the Variants

"Now that vaccinations are running 2.5 million per day, are you more sanguine that we will win the race between vaccines and variants?"

I am. I'm feeling better about it. I think there's still a good way to go on it, but if we can really get all of our 50 and ups vaccinated pretty quickly over the next few months then yeah, I think we will probably be okay.

The virus may continue to spread, specifically the variants may continue to spread in younger populations, but that won't have as much of an impact on them as the older populations. And then if we can delay things enough so that we can have boosters developed again for the older populations by, say, fall or early next year for whatever variants are still around, then I think we can at least get to a good stalemate with COVID in general.

I do not think that COVID is going to go away ever potentially. I think it's probably going to continue to circulate indefinitely. I don't think we're going to get rid of it.

My gut tells me it's going to become an endemic virus and part of our seasonal respiratory viral illnesses. And my gut tells me it's going to become part of our annual seasonal vaccine campaign for flu. And it'll be just, okay, it's time for your flu and your COVID shot. I think that's probably where we're headed over the next couple of years.

Side Effects from the Vaccines

"As a middle-aged person, I had major side effects from my second shot. Does that mean I have an overactive immune system? I heard younger people have these types of reactions, not older people."

No, it's very random in many ways. I'm on the younger-ish side and had a moderate side effect profile for my second shot. I know older people that have had pretty bad side effects and younger people that have had almost no side effects. It's not that your immune system is either underactive or overactive. It's just, there's certain randomness to how your body reacts to the vaccine. So I wouldn't take it as either a bad sign or anything else. It did its job and that's good. And the side effects are over now, hopefully. And that's just a random luck of the draw in a lot of ways.

Worry About Spring Break Superspreaders

"How much should we worry about spring break celebrations and other potential superspreader events among those who seem to have given up on mitigation?:

I think if you're somebody who's high risk, you definitely should be concerned about it. I think, again, it kind of goes back to overall risk level and my sort of inkling that I don't think this is going anywhere ever.

I think it's going to become an endemic virus. I think somebody who hasn't been vaccinated and they're high risk, they need to be cautious being around people who've been to these big events, like, what's going on down at Miami Beach and things like that.

But for the younger, the healthy, I don't think it's critical to worry about it, except they should be wise and not be exposing high-risk people. So don't go to spring break in Miami and then come hang out with your unvaccinated 85 year old grandmother. Okay. That's not not a good idea.

I think most places in most states are going to find that we can't sustain these mitigation measures forever, and we just can't for a whole lot of reasons, social economic, political. It's just not possible to sustain them indefinitely. I'm surprised we sustained them as long as we did.

The vaccines are the answer to this. And so we've got to get even faster at doing it. And then coming up with boosters for the variants, that's really the only way to manage this long-term,

Worse COVID Arm After Second Shot? 

"I got COVID arm after my first shot. Is there any data showing where I might get a worse reaction once I get my second shot?"

No. For those who don't know, COVID arm is something that seems to be particular to the Moderna vaccine where some people get this red-raised rash that has a little bit of heat and pain to it up to a couple of weeks after you get your dose of Moderna.

It is harmless and it will go away in almost every case. And no, there's no evidence to suggest that that means you're going to have worse side effects the second time around. I've seen a number of patients with this side effect at this point. It's harmless. It can be distressing but it's not harmful in any way and it will resolve.

Mitigation Strategies for Future Respiratory Illnesses

"Do you think mask wearing or other mitigation will be medically advisable (maybe for the most vulnerable) in future respiratory disease seasons -- say Winter in flu and perhaps Covid if it becomes endemic and more prevalent then?"

I think, yes. I think that's always been kind of a reasonable approach for high risk people to take. The problem that we have and then we continue to have, is that there just isn't any good data supporting the use of masks for any respiratory virus, flu, COVID, whatever.

There just isn't any good data on this. All of the studies that have been done have mostly come out negative showing minimal or no impact of mask wearing in the community. I think it's something that's reasonable to do. The data does not appear to support that as an actual mitigation strategy.

And if you look at most of the areas around the country and look at their charts and in terms of cases and how those correlate with mask mandates, there's really no correlation with mass mandates and case drops either in most places. Again, it's a reasonable thing to do. I just don't think that data really supports it at this time.

Advil Before Second Dose?

"Will loading up on Advil before the second vaccine ward off potential side effects?"

That is a fine thing to do if you want to take an anti-inflammatory before and for the day of, day after your vaccine. it will probably lessen your side effects and it won't affect the effectiveness of the vaccine, so totally fine thing to do. I took Aleve and Zyrtec before my second dose of Moderna just to ward off side effects and that was fine. Didn't cause any problems with the vaccine.