COVID Transmissions for 4-5-2021
Travel guidance for the vaccinated: caveats and considerations
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 504 days since the first documented human case of COVID-19. 504 is the number used to designate an educational support plan for a child with a disability so that they can learn alongside their peers. This includes children with learning disabilities, which can include things like ADHD and anxiety. It’s important for society to recognize and accommodate disabilities, including mental health impairments that harm people.
There’s no COVID tie-in here. Just a spotlight on the need for equity in an area relevant to public health.
Welcome back from the weekend.
Today, I talk about new changes to travel rules for fully-vaccinated people, and the global COVID-19 surge. Also, a reader comment thread that had a nice, multi-person conversation about vaccine strategies.
As usual, bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
Global COVID-19 Surge
In South America and Europe, COVID-19 cases are on the rise. Things appear to be especially bad in Brazil and in certain Eastern European countries.
CIDRAP has details here: https://www.cidrap.umn.edu/news-perspective/2021/04/covid-cases-surge-south-american-european-hot-spots
I’ve heard stories of people in the US acting like the pandemic is over. It isn’t over, not even in the US, but I’m particularly concerned about the global situation while the US vaccination campaign continues to accelerate.
As the second half of that link indicates, we need to get serious about global vaccine availability.
US CDC says it’s OK for fully vaccinated people to travel
The CDC issued guidance for fully-vaccinated people regarding travel, saying that they are OK to travel domestically in the US, without quarantining or extensive COVID-19 testing (unless the destination or origin points’ local laws require it).
Please keep in mind that this isn’t without caveats, though:
This is only if you are fully vaccinated—this means you have received all doses that are required to complete a full course of any available vaccine, and you have waited two weeks after receiving the last dose in the course
Travelers should still wear a mask over nose and mouth when traveling
They should continue to maintain 6-foot physical distance from others
Frequent handwashing is still encouraged
Travelers, even those who are fully vaccinated, should still observe local laws with respect to isolating/testing and should also still monitor themselves for symptoms of COVID-19
These guidelines are meant to apply broadly to vaccinated people. It is possible that you, specifically, reading this, may be an exception to the assumptions being made here, and that it’s still possible for you to catch or spread COVID-19. That is the reason that you still need to be watchful for COVID-19. The efficacy numbers we saw from clinical trials—“95% efficacious,” for example—do not mean that each vaccinated person is 95% protected. They mean that on average, 95% better protection was seen in the vaccinated group than in the placebo group. So that means there are people who get the vaccine who are still 0% protected, and as many as 5% of the people in that particular example may be unprotected. Those are 1 in 20 odds, which means it’s a lot more common than you may think.
Admittedly, the odds are not fully random. Certain conditions can make you less likely to be well-protected, if they interfere with the immune response. But there is still some very small chance, in every person, that the vaccine either did not have a strong effect or that it didn’t really work well at all. This is unlikely and rare, but still not so rare that we can all throw caution to the wind.
So while you can do a lot of things if you’re fully vaccinated, you still need to be careful. The CDC guidance takes that into account, and is worth reading in full: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html
What am I doing to cope with the pandemic? This:
Cooking with: Horseradish and Parsley
For some reason (reader, the reason is Passover), I have a lot of extra horseradish and parsley.
Horseradish and parsley are stars of the Seder Plate, a ritual object that contains small amounts of symbolic items that are relevant to the Passover story. It’s a little bit like if Lunchables were designed to remind you of things instead of provide snacks.
Anyway, horseradish is typically not sold in the tiny quantities that are used on a Seder Plate, but more in quantities like this:
So, you can imagine I’ve been trying to find ways to use this. At first, I thought it could be handy for killing vampires. Those being in short supply, I’ve turned to using it in salad.
Along with the parsley that I have too much of, chopping some of this up finely and tossing it with a salad creates a nice herbed profile that definitely makes a salad less boring. However, I wouldn’t recommend it if you hate sharp flavors. Don’t like wasabi? Wouldn’t suggest you try this. But if you love a sharp kick in the mouth, then I’m really starting to like this and think you’d like it too.
Reader Lisa Hertel wrote the following, which kicked off a whole conversation:
I got the J&J vaccine on March 7, and now my health care provider is offering me an mRNA vaccine. Would a double vaccination help? Hurt? Waste a dose?
This is not an easy question to answer, but it’s a good one. I responded with my opinion, and another reader gave some additional information that I think made a very good point. Here’s my comment:
Good question.
The answer scientifically is that I don't know, and nobody knows for certain. I don't see why it would be *harmful*. I can see a logistical argument that it would take a dose from someone else.
Let's look at the regulatory position on this. The EUA for the Pfizer vaccine, as an example, says the following: "There are no data available on the interchangeability of the Pfizer-BioNTech COVID-19 Vaccine with other COVID-19 vaccines to complete the vaccination series. Individuals who have received one dose of Pfizer-BioNTech COVID-19 Vaccine should receive a second dose of Pfizer-BioNTech COVID-19 Vaccine to complete the vaccination series."
This does not currently directly address your question. However, it suggests a spirit of avoiding the mix-and-match approach or using different vaccines in the same person. In the strictest sense I support this approach given the absence of data.
One thing I would mention is that, if you are concerned about the slightly lower reported efficacy of a single dose of the Johnson and Johnson vaccine compared with Pfizer or Moderna's vaccines, you shouldn't be. There are no head to head trials of these products and we cannot compare them directly. Even more importantly, there is an ongoing trial of two doses of the Johnson and Johnson vaccine. This trial is called ENSEMBLE 2. Once it reads out the Johnson and Johnson EUA is likely to be updated to include the results of this trial and I anticipate that a 2-dose regimen may be offered to people who received one dose. I would wait for this to happen, if I were you, especially given the labeling language I quoted. I think the data are just too murky right now to be sure of whether or not this is a good idea, and the vaccine you have already received is adequate to protect you from the most serious outcomes.
Vicka Corey, PhD, left two more comments on this thread, with one point in particular that I think is informative on the decision-making here:
it's not j&j but there is a current study of astrazeneca and pfizer in the uk, and some other discussion of mixed vaccines here: https://www.nature.com/articles/d41586-021-00315-5
I'm in the same position (were you also an eventually-unblinded placebo arm subject?) and after looking around at the literature, I've decided to not decide until day 57 post injection (the interim used in ENSEMBLE2). For now, let your immune system make use of what it has.
That last point about the 57-day interval in ENSEMBLE 2 is a really good one. For patients who recently got one dose of the J&J vaccine, it’s possible that before their 57-day mark postvaccination, we will actually have the results of that study. That would mean if the results are favorable, this patient population would still be on track for the 2-dose regimen. I do think it’s prudent to wait until ENSEMBLE 2 reads out. There’s a lot of future ahead in which you can decide, based on better information, to get a supplementary mRNA vaccine on top of one dose of the J&J option, in the event that looks like a good idea.
There’s so much local variation in the logistics that it’s hard to capture the situation holistically, except to say that I hope universal vaccine availability comes soon! We really need vaccination against COVID-19 to be cheap, easy, and available everywhere.
You might have some questions or comments! Send them in. As several folks have figured out, you can also email me if you have a comment that you don’t want to share with the whole group.
Join the conversation, and what you say will impact what I talk about in the next issue.
Also, let me know any other thoughts you might have about the newsletter. I’d like to make sure you’re getting what you want out of this.
Part of science is identifying and correcting errors. If you find a mistake, please tell me about it.
Though I can’t correct the emailed version after it has been sent, I do update the online post of the newsletter every time a mistake is brought to my attention.
No corrections since last issue.
See you all next time.
Always,
JS
I’d like to respond to the questions about getting a second vaccine. Not to sound indignant, but I haven’t been able to get one vaccine. People line up for extra doses. Why should an already vaccinated person get a second vaccine? I’m fine with waiting my turn, but it seems unfair that someone could get multiple vaccines while others wait for one.
Quote from India's Ministry of Health and Family Welfare's press release: "The analysis of samples from Maharashtra has revealed that compared to December 2020, there has been an increase in the fraction of samples with the E484Q and L452R mutations. Such mutations confer immune escape and increased infectivity. These mutations have been found in about 15-20% of samples and do not match any previously catalogued VOCs. These have been categorized as VOCs but require the same epidemiological and public health response of “increased testing, comprehensive tracking of close contacts, prompt isolation of positive cases & contacts as well as treatment as per National Treatment Protocol” by the States/UTs."
https://pib.gov.in/PressReleasePage.aspx?PRID=1707177
Virologist, please assist: are those known mutations, e. g. from P.1? How concerning is this?