Delta Variant & Other COVID19 Q & A

1. Can I get COVID from the vaccine?
   • No, it is physically impossible to get COVID-19 or any of the variants from the vaccine. Some vaccines, such as the chickenpox vaccine we get as children do in fact give you a very weak form of the virus in order to make you immune. None of our COVID-19 vaccines do this. mRNA vaccines (Pfizer and Moderna) basically send a little piece of code into your cells and this code works to instruct you cells to make a spike protein. This piece of code (mRNA) is not the entire COVID DNA and thus cannot infect you with COVID-19. This spike protein looks like the spike on the coronavirus. So, your body sees this spike protein, and identifies it as foreign and creates antibodies to destroy it. Your body then knows to keep an eye out for that spike so that when it sees it again (when you actually get COVID) it can send in antibodies to destroy it before you get sick. J&J vaccine works different than the other two. It uses a disabled adenovirus that is in no way related to coronavirus. This delivers instructions to your body on how to defeat coronavirus, and a reminder that it can not give you an infection or replicate in your body[1]
2. So what’s this Delta variant that is in the news?
   • Delta is a variant of the original COVID-19 virus. This is a mutation that causes more infections and spreads faster than the original SARS-CoV-2 virus. It is twice as contagious as previous variants, infects more people, likely up to 8 people per infected person, compared with 2-2.5 for the original strain, and causes more severe illness. Two studies out of Canada and Scotland show that those with Delta are more likely to be hospitalized than with the original strain[2].
3. Is there a risk of myocarditis when someone gets the COVID vaccine? What even is it? Pericarditis?
   • You may have heard on the news or Facebook that COVID-19 vaccine causes myocarditis or pericarditis. Myocarditis is inflammation of the middle layer of your heart wall while pericarditis is inflammation of the area surrounding the heart. In order to understand the risk of these conditions, we look to data. So far there have been over 170 million individuals in the United States who have been vaccinated against COVID-19, and of those a little more than 1,000 cases reports of inflammation of the heart after an mRNA vaccine. Estimates show that the risk of this is highest in males 16 and older and even if it does occur, patients usually return to normal activities after their symptoms improved. The risk is estimated to be around 12 cases per 1 million vaccinated, while the risk of heart inflammation from people who contract COVID-19 is around 450 cases per million infected. A study conducted in 40 hospitals in the western US found that out of 2 million individuals who were vaccinated, there were 20 cases of myocarditis and 37 of pericarditis, a very small percentage of incidents[3]. If you are still concerned, the J&J shot does not have this small risk and should be the vaccine you choose. Please consult your PCP with any concerns.
4. Is there still a risk at blood clots in J&J vaccine? How does J&J work since it’s not mRNA that I’ve actually heard about on the news?
   • Blood clots are very serious issues and it’s completely reasonable to be concerned. However, let’s look at the science. The type of blood clot developed by J&J vaccine recipients is a clot in the brain, and the majority of risk is in women under 50. The numbers though are very small. When the CDC and FDA paused J&J distribution, there were 6 cases out of almost 7 million shots given. In May there were 9 million case and 28 cases of this rare blood clot. Compared with the fact that close to 20% of COVID-19 patients in ICUs develop blood clots, the risk of developing this rare blood clot is extremely low, while your risk of developing a dangerous blood clot from contracting COVID-19 is very high[4].
5. Does it even work? I see people dying even though they’ve been vaccinated.
   •  A breakthrough cases occurs when someone who is fully vaccinated against COVID-19 still comes down with it. This calls into questions whether the vaccines even work! But we knew this would happen and have been preaching this since before the vaccine even became available. A reminder that studies showed the Moderna and Pfizer vaccines were between 90-95% effective at preventing illness from COVID-19 while J&J vaccines were around 60-70% effective[5]. This still leaves a fairly large percentage chance that you can still get sick with COVID-19 while vaccinated. In addition, the delta variant has decreased these numbers even more. So, with Delta being the primary variant in the United States, healthcare professionals know that there will be more and more breakthrough cases. While studies are still being conducted on the efficacy of vaccines against the Delta variant, one study out of South Africa found that out of almost half a million healthcare workers, J&J vaccine had an efficacy of 71% efficacy against hospitalization and 96% efficacy against death[6]. Moderna and Pfizer appears to have even higher efficacy against hospitalization and death. This still means there will be cases, hospitalizations, and death among vaccinated individuals but it is at a far lower rate than among unvaccinated. While we want there to be no cases of COVID-19, the primary goal right now is preventing hospitalization and death. In Oregon, as of August 10^th, there have been 191 breakthrough hospitalizations, which is only 1.1% of all COVID hospitalizations. This is even more dramatic in states with lower vaccination rates such as Alabama. They only had 77 breakthrough hospitalizations, .3% of all COVID hospitalizations, and only 21 breakthrough deaths, amounting to ONLY .4% of all COVID deaths[7].
6. It’s not safe because it hasn’t been out long enough? Long term problems!! What did the government do to the vaccine?
   • We have been studying the vaccine for quite some time. This is no longer January and we only have 2 months of research. Over the past year we have tons of peer reviewed studies not just from the United States, along with the largest vaccine trial in history, with over 170 million Americans and close to 2 billion people worldwide being vaccinated. These different vaccines were created by private companies without the meddling of our government. The vaccine does not have microchips, nor does it cause you to be magnetic[8]. It will not alter your DNA, as both types of vaccine can not alter your DNA inside the cell nucleus.Regarding long term effects of the vaccine, we have been studying the vaccine for almost a year now. Serious side effects that cause long-term health problems are extremely unlikely in all vaccines, including the COVID-19 vaccine and in other vaccines historically happen within six weeks of your dose. This is why vaccines were studied for several months before given Emergency Use Authorization by the FDA and almost a year before the FDA likely will approve them for full use. This is happening soon, likely in a few weeks if not sooner for the Pfizer vaccine.

     In addition, the risk of miscarriage is another common question that comes up regarding effects of the vaccine. All major health organizations including the CDC and the American College of Obstetricians and Gynecologists strongly advise pregnant women to get the COVID-19 vaccine. A recent study of 2,500 women found that the risk of miscarriage was no higher in vaccinated women than in unvaccinated women, and there have been no evidence showing that the vaccine causes infertility[9]. Another U.S. study found that the occurrence of miscarriage was around the same in vaccinated women as unvaccinated women before the pandemic, out of almost 4,000 participants[10]. As always, it is best to stay as healthy as possible during pregnancy, and thus if you are pregnant you should avoid getting sick with COVID-19 as best you can.

7. I or my child has severe allergies to peanuts, penicillin. Is it going to kill me?
   • Unlike some other vaccines, the COVID-19 vaccine does not come with things some people are allergic to. A full list of ingredients can be found on the CDC’s website[11]. Most ingredients are lipids (which provide a greasy exterior to help the mRNA slide into cells), salts (to balance acidity), or sugars (such as sucrose, which helps during freezing maintain shape). People who are allergic to penicillin, peanuts, and other common allergies can still get the vaccine. The only people who should not are those who are allergic to specific ingredients in the vaccine.  Looking at the data, for people concerned with anaphylaxis, a severe allergic reaction, the chance of this occurring is around 2-5 per million people. Anaphylaxis occurs with all vaccines and is very rare. As of august 16^th, there have been 6,789 reports of death in people who received the vaccine, out of 357 million doses given, making that a .0019% chance of death[12].
8. If I already had COVID-19, why do I need the vaccine. I have immunity. 
   • We luckily do see that individuals who have had COVID-19 and recover have a limited time immunity against reinfection for several months[13]. However, we still recommend those individuals receive the vaccine. A CDC study done in Kentucky looked at individuals who had COVID in 2020 and looked at reinfection rates in May 2021. They found that individuals who were not vaccinated were 2.3 times more likely to be reinfected than individuals who were vaccinated[14]. Another study from Rush University showed that one dose of vaccine in previously infected patients increased with antibody count to the levels of those uninfected who were fully vaccinated. A second dose had no further effect but no harm as well[15]. We want people to know that they should fully recover from COVID-19 before becoming vaccinated so that the vaccine can work to peak effectiveness.
9. Can I still transmit COVID if I get the vaccine?
   • Yes, you unfortunately can. We know from recent studies that individuals who are vaccinated can still transmit it to others, which is why masks are crucial for all[16]. A study in Israel found that people who received the Pfizer vaccine had a decreased amount of viral load in their throat (the main way people spread the virus to others)[17]. However, a decreased amount still means there is a chance of spread by vaccinated people. The issues continue with the Delta variant. Another study showed than people infected with the delta variant can carry 1,000 times the viral load as those infected with the original COVID-19 virus[18]. This shows that it is even more likely to spread and is much more contagious than the original virus.  For vaccinated individuals, when you receive the vaccine, this leads to a specific immunoglobulin A and G response in your body. This leads to G antibody types that circulate in high numbers in your blood, near tissues and are detectable in blood tests. The problem is that it does not produce as much Immunoglobulin A antibody response for long periods of time which would respond to virus at the surface of your body, your epithelial cells such as the throat mucosa[19]. That antibody response would prevent the virus from attaching in the first place[20]. So because of the IgG response, your body should respond once COVID is in your blood and eliminate it, but you could still have COVID in your throat and spread it to others. We do have some vaccines, such as the Flumist vaccine we give to some children, that makes a IgA response, but it is generally not as effective as a shot.

[1] https://www.vcuhealth.org/news/covid-19/johnson-and-johnson-vaccine-how-is-it-different

[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext

[3] https://jamanetwork.com/journals/jama/fullarticle/2782900

[4] https://www.yalemedicine.org/news/coronavirus-vaccine-blood-clots

[5] https://www.forbes.com/sites/nicholasreimann/2021/07/20/johnson–johnson-vaccine-far-less-effective-against-delta-variant-study-suggests/?sh=15f8984a4299

[6] https://www.wsj.com/articles/j-j-vaccine-highly-effective-against-delta-variant-in-south-african-trial-11628292645

[7] https://www.nytimes.com/interactive/2021/08/10/us/covid-breakthrough-infections-vaccines.html

[8] http://www.publichealth.lacounty.gov/media/Coronavirus/docs/vaccine/FactCheck_MicrochipNeedle.pdf

[9] https://www.researchsquare.com/article/rs-798175/v1

[10] https://www.nejm.org/doi/full/10.1056/nejmoa2104983

[11] https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C

[12] https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html

[13] https://jamanetwork.com/journals/jama/fullarticle/2782139

[14] https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm7032e1_w

[15] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782762

[16] https://publichealth.jhu.edu/2021/new-data-on-covid-19-transmission-by-vaccinated-individuals

[17] https://www.nature.com/articles/s41591-021-01316-7

[18] https://www.ucsf.edu/news/2021/08/421171/how-dangerous-delta-variant-heres-what-science-says#:~:text=Its%20high%20infectiousness%20could%20be,infected%20with%20the%20original%20virus.

[19] https://www.news-medical.net/news/20210330/Study-finds-rapid-increase-in-IgG-and-IgA-antibody-levels-following-COVID-19-mRNA-vaccination.aspx

[20] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249499

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