Just the Vax, Ma’am: What You Need to Know About the COVID-19 Vaccines

Wow, what a year 2020 proved to be. This time last year, as I wrote this article in March, I had been to Sixers and Flyers games at the Wells Fargo Center. We were looking forward to a trip to Miami for the kids’ spring break. And then events that seemed like they were out of a sci-fi movie occurred and COVID-19 shut down a lot of the world as we know it.

It’s been a rough last 12 months, in so many ways. But now, finally, we’re starting to see the light at the end of the tunnel. The data suggests that the combination of compliance with Centers for Disease Control guidelines, protocols for treating infected patients and, most recently, the approval of COVID vaccines, are driving down the incidence rates of hospitalization and death.

While there has been some concern about the speed with which the vaccines were developed and approved, the tracking data is unambiguous that the vaccines are safe and effective in preventing disease. This new information is providing reasons for optimism that vaccines offer a route out of a pandemic that has sickened tens of millions of people worldwide, as well as turned our lives upside down.

At time of this article going to press, the data was showing us that COVID-19 cases at nursing homes across the nation plummeted 89% from early December through February.

Despite all this positive momentum, many people are unsure of how the vaccines work, if they’re all safe, and whether they can be effective against newer strains of coronavirus.

At our wellness medicine practice, where we are focused on disease prevention, immune system optimization and diagnostic testing (including COVID-19), we are often asked about these vaccines: Are they safe? Are they efficacious?

Because we believe in evidence-based medicine and because there is now good scientific evidence at hand, this is an opportune time for a quick overview of the facts regarding these vaccines.

The Pfizer and Moderna vaccines are both mRNA vaccines. Although hailed as breakthrough technologies, mRNA has actually been in development and testing for 30 years! The simple explanation is that mRNA COVID vaccines teach our own cells to make the spike protein that makes SARS-CoV-2 so infectious, which triggers our own immune system to recognize this as an anomaly and create antibodies against the protein. Two injections of the Pfizer and Moderna vaccine are required to achieve 95% protection from infection.

More recently, Johnson & Johnson received approval for a single-dose COVID-19 vaccine. The technology used in the J&J vaccine is a more traditional viral vector vaccine. That simply means J&J used a harmless virus known as adenovirus and inserted a small portion of coronavirus genetic material related to the SARS-CoV-2 spike protein. Similar to the mRNA approach, once the cells in our body get instructions from the viral vector to produce spike protein, our immune system goes to work to shut it down and, in the cases of all the vaccines, create memory so that if you were actually infected with COVID-19, your immune system would react and prevent the virus from harming you.

A quick note on the use of a virus in a vaccine. Adenoviruses are responsible for producing classic cold symptoms; however, to make the vaccine, the virus was modified so that it can enter cells but not actually replicate inside them – so this vaccine cannot make you sick.

The J&J vaccine using the traditional viral vector approach has a slightly lower efficacy rate than the mRNA vaccines but it only requires one injection to create an immune response and memory. In addition, the J&J vaccine is stored at refrigerated temperatures, whereas mRNA vaccines require frozen storage.

The bottom line is that all three vaccines have been proven effective and are safe. After receiving the vaccine, your body now has a mechanism to protect itself once it is exposed to COVID-19. So, even if you are infected, the immune system has been primed to attack and neutralize the virus, so the severity of disease will be much less.

While it is perfectly appropriate for there to have been some worries about the speed of development of the vaccines, we have seen acceptance rates in the general public rise as more people are getting vaccinated and disease rates are dropping. However, a primary concern on people’s minds is side effects. So, let’s address that.

All vaccines have side effects – this is actually required because we are intentionally trying to create an immune response to a foreign agent. Some side effects are related to the injection site, others are more systemic and evoke or mimic the symptoms of the disease we are trying to prevent. Again, this is normal and an indicator the body’s immune system is priming itself to fight off the virus.

Keep in mind, viruses don’t want to be discovered. They are constantly trying to find ways to avoid detection by our immune system, to trick our own cells into multiplying their destructive effects and spreading to other hosts.

So, the major adverse effects are pain and swelling at the injection site, fatigue, headache, muscle aches, chills, joint pain, and fever. Fever is more common after the second dose. This adverse effect profile is similar to that of other adult vaccines.

Most people fare well after the first dose but are much more likely to have side effects after the second dose – specifically, symptoms of chills, aches, a slight fever and a headache. All are signs that the body is responding to the vaccine and creating immunity.

I must point out that, as with all vaccines, there are cases of severe allergic reaction to the COVID-19 mRNA vaccines. The CDC reports that in approximately 11 cases per million, there have been reports of severe allergic reactions – called anaphylaxis. These typically occur within 15 minutes of vaccination and mostly in people who have a documented history of allergies. For that reason, it is recommended that anyone receiving a COVID vaccine be screened prior to injection and monitored for a period of 15 minutes post-injection. These types of reactions can be treated by a medical professional, so if you have a history of allergies, make sure you tell your vaccine provider before receiving your first dose.

So, with all this information, let’s see if we can summarize the current state of COVID and how we should view the role of vaccines.

COVID-19 (SARS-CoV-2) is a novel coronavirus that seeks to invade a host (us), and trick the body into replicating the virus with a spike protein that enables it to spread quickly to other hosts. We can protect ourselves from being infected by practicing CDC guidelines on social distancing, mask wearing, quarantining, and reducing direct contact with others. These guidelines have helped reduce the spread but don’t prevent the deadly outcomes of COVID-19 in some people once infected. Our best defense against viruses is for our immune system to recognize them as invaders, create antibodies to fight them off, then store a memory of the makeup of the virus so that anytime we are exposed, we can fight it off. The approved COVID-19 vaccines help our immune systems recognize, defeat, and remember the spike protein specific to COVID-19, thus creating immunity.

Should you get the COVID-19 vaccine? In a time of pandemic, it is appropriate that everyone who is eligible and medically cleared to receive it should do so.

Does it matter which vaccine you get? You might not have a choice. The goal is to vaccinate as many people as possible in as safe a way as possible. Because all the approved vaccines have high efficacy rates and low side effects, you can be comfortable knowing you will gain some level of immunity.

Am I certain to never get COVID-19 if I get vaccinated? No. Unfortunately, no vaccine is 100% effective in preventing disease. Furthermore, we still do not know how long our immune systems will store memory of COVID-19 and whether the memory will translate across new variants and strains of coronavirus. However, this is no different than the seasonal flu and other types of viruses that mutate and change over time. The goal here is to reduce severity of infection, reduce transmission, and reduce overall infections. The more we do that, the more time scientists have to develop more effective treatments for this and other deadly viruses.

Hopefully, the information in this article will help you understand how the COVID-19 vaccines work, and what you can expect when it is your turn to get one. If you want more information, your best source remains the CDC website and consultation with your health-care provider. We are all in this together. Let’s win the war against COVID-19 and hopefully return to things in our lives that bring us joy.