You're right about hospital workers needed to get tested. When I began working in a hospital, I was tested for both TB and rubella. I knew my rubella titer was good, because it's also routinely tested in women when you get married. (I am older than the MMR vaccine, and was of the era when it's predecessor had questionable effectiveness. I actually had mumps and chicken pox.)
In the future, I suspect if the COVID-19 vaccine works, it will be one of those things that colleges require, much as they do the meningitis vaccine today. The question is, how long will immunity last? One problem with hurrying the data is that we only know for as long as we've been giving the vaccine, which is a few months.
It's a great question. We do know that immunity induced by the virus appears to have a relatively long duration, but that's from a handful of small studies. We also know from earlier results that the vaccine from Moderna, at least, induces more consistently high immune reactions than are seen in patients who had natural infection. I'm hopeful that we'll get at least a year of immunity out of this crop of vaccines, if not longer. But ask me again in a year.
There’s a raging pandemic and it’s not well-controlled in places across the country. How do you administer vaccines to people who may already be infected? Could inoculating someone who is currently-infected make the vaccine more dangerous than for someone with no detectable trace of the virus? Would there be a need to get tested for the virus first, wait forever the result (which could be minutes, hours or days) and only then get the shot? And what about the booster - is there some likelihood of becoming infected between first and second shots?
Thanks, as always, for an excellent newsletter, Dr. Skylar!
Generally speaking, you don't give vaccines to people who are sick with the thing the vaccine is against. It is often recommended not to give vaccines to sick people at all, because the existing illness may leave the immune response somewhat weakened in response to the vaccine. This is not true for all vaccines, however, and I suspect that advice will be provided in the prescribing information for COVID-19 vaccines about how to evaluate sick patients for potential vaccination.
I don't think that vaccinating a currently-infected person could add risk of negative outcomes for them, to answer your second question. The dose of vaccine is smaller than the amount of virus that is running around being produced, and it also is not competent to cause cell damage or death. I might be hesitant to give the vaccine to a patient with severe COVID-19, because they already have a pretty damaging immune response, but I don't expect that this will ever be a consideration. When someone has severe disease, you know.
Anyway, I doubt that a negative test for COVID-19 will be a prerequisite for vaccination. As will be described in tomorrow's newsletter, the vaccine was given to about 500 COVID-19 positive patients in the Pfizer trial. I don't believe they had any meaningful problems from receiving the vaccine, though unsurprisingly it was less effective at preventing COVID-19 in the group of patients who were actively sick with COVID-19. However, it may well have prevented future disease, a year from now. We're not quite there with the follow-up yet.
There IS a chance of becoming infected between the shots. However, at least for the Pfizer vaccine, it looks like the first dose provides protection starting about 7 days after it is administered. Don't go burning your mask and running around in the streets kissing people once you're vaccinated. Give it some time. Maybe a lot of time, for that specific activity.
You're right about hospital workers needed to get tested. When I began working in a hospital, I was tested for both TB and rubella. I knew my rubella titer was good, because it's also routinely tested in women when you get married. (I am older than the MMR vaccine, and was of the era when it's predecessor had questionable effectiveness. I actually had mumps and chicken pox.)
In the future, I suspect if the COVID-19 vaccine works, it will be one of those things that colleges require, much as they do the meningitis vaccine today. The question is, how long will immunity last? One problem with hurrying the data is that we only know for as long as we've been giving the vaccine, which is a few months.
It's a great question. We do know that immunity induced by the virus appears to have a relatively long duration, but that's from a handful of small studies. We also know from earlier results that the vaccine from Moderna, at least, induces more consistently high immune reactions than are seen in patients who had natural infection. I'm hopeful that we'll get at least a year of immunity out of this crop of vaccines, if not longer. But ask me again in a year.
There’s a raging pandemic and it’s not well-controlled in places across the country. How do you administer vaccines to people who may already be infected? Could inoculating someone who is currently-infected make the vaccine more dangerous than for someone with no detectable trace of the virus? Would there be a need to get tested for the virus first, wait forever the result (which could be minutes, hours or days) and only then get the shot? And what about the booster - is there some likelihood of becoming infected between first and second shots?
Thanks, as always, for an excellent newsletter, Dr. Skylar!
Thank you for reading!
Generally speaking, you don't give vaccines to people who are sick with the thing the vaccine is against. It is often recommended not to give vaccines to sick people at all, because the existing illness may leave the immune response somewhat weakened in response to the vaccine. This is not true for all vaccines, however, and I suspect that advice will be provided in the prescribing information for COVID-19 vaccines about how to evaluate sick patients for potential vaccination.
I don't think that vaccinating a currently-infected person could add risk of negative outcomes for them, to answer your second question. The dose of vaccine is smaller than the amount of virus that is running around being produced, and it also is not competent to cause cell damage or death. I might be hesitant to give the vaccine to a patient with severe COVID-19, because they already have a pretty damaging immune response, but I don't expect that this will ever be a consideration. When someone has severe disease, you know.
Anyway, I doubt that a negative test for COVID-19 will be a prerequisite for vaccination. As will be described in tomorrow's newsletter, the vaccine was given to about 500 COVID-19 positive patients in the Pfizer trial. I don't believe they had any meaningful problems from receiving the vaccine, though unsurprisingly it was less effective at preventing COVID-19 in the group of patients who were actively sick with COVID-19. However, it may well have prevented future disease, a year from now. We're not quite there with the follow-up yet.
There IS a chance of becoming infected between the shots. However, at least for the Pfizer vaccine, it looks like the first dose provides protection starting about 7 days after it is administered. Don't go burning your mask and running around in the streets kissing people once you're vaccinated. Give it some time. Maybe a lot of time, for that specific activity.