Dr. Roger Hicks: Community immunity
There is more good news on the COVID-19 vaccination front. Johnson & Johnson’s vaccine was recently given an Emergency Use Authorization (EUA) by the FDA, making it the third vaccine available in the U.S. Johnson & Johnson’s vaccine has advantages because it requires only a single dose and can be stored in a normal refrigerator, unlike the Pfizer and Moderna vaccines, which require two jabs and must be kept frozen- the Pfizer at supercool temperatures.
How do they work? The BioNTech-Pfizer and Moderna are both mRNA vaccines. They have a chemically synthesized piece of messenger RNA that enables our own cells to make the SARS-CoV-2 spike protein. Viral vector vaccines, like the Johnson & Johnson, Oxford Astra-Zeneca and Sputnik V products, use a harmless virus to deliver the gene to make the spike protein to our cells. With both mRNA and viral vector vaccines, our immune systems respond by creating antibodies and longer lasting cellular immunity to the spike protein. None of these vaccines can cause COVID-19 because they do not carry the codes necessary to make the entire SAR-CoV-2 virus.
More than 2 million Americans are getting vaccinated every day now, bringing the total of those who have received at least one dose to nearly 60 million. Vaccine production looks better than ever with the announcement that the drug company Merck will help manufacture the Johnson & Johnson vaccine. This is an historic partnership between two fierce competitors at a time of great need. Right now, there is still a shortage of vaccines, but it appears that will change in May, when supply is expected to exceed the demand.
All three of these vaccines are proving to be nearly perfect at preventing serious illness and death from COVID-19. As more and more people get vaccinated, the question many are asking is “When can we go back to normal?” There has been no crystal clear answer nor definitive date from Dr. Fauci or the CDC, not because information is being withheld, but because it largely depends on what we, as citizens, do. There are two major factors that we can affect: the portion of our community with vaccine immunity and the amount of virus circulating here.
As most everyone knows by now, COVID affects people in very different ways. About 40% have no symptoms, some have what they think is a cold, while others become very ill and many die — over 525,000 in the U.S. so far. The vaccines were not developed to stop cold symptoms or nor were they expected to block infections 100%. Like other vaccines, they train our immune systems to recognize the virus and prevent it from multiplying enough so that it can’t cause serious illness. Vaccines typically don’t prevent the recipient from getting infected, but they do prevent that person from getting sick and enable our bodies to clear the virus faster.
While vaccines do not eliminate the chance of a person getting infected, they do decrease the risk of spreading it to someone else. We don’t yet know how common it is for vaccinated people to have asymptomatic infections — the vaccine trials were not set up to answer that question. Studies are underway to determine this, but even if viral material is found in them, it doesn’t mean they are capable of infecting someone else. The vaccines are thought to prevent serious illness and death by lowering the amount of virus — the viral load — in a person’s body, and they likely lower the risk of transmission by the same means.
Medical experts estimate that 60-80% of us need to have immunity to stop the virus. Since the vaccine is not yet approved for children, only 75% of our population is eligible to receive it. That means we need almost every adult to be vaccinated or have some immunity from being infected to end the pandemic.
As we come closer to herd or community immunity, the chance of a vaccinated person both carrying the virus and having close contact with someone who has no immunity dramatically decreases.
The amount of virus circulating in the community is reflected by the number of new cases and the proportion of tests that are positive. These are the numbers that the California Department of Public Health and other public health experts track to determine our county’s risk level. Nevada County is currently in the purple or widespread tier. We can lessen the county’s risk by getting vaccinated when it’s our turn and by still taking the preventive measures we have been asked to for the past year: wearing masks, socially distancing, and avoiding large crowds. New research from the CDC shows that mask wearing is linked to fewer COVID-19 infections and deaths, and that counties across the U.S. that allowed restaurants to reopen saw a rise in COVID cases and deaths about six weeks later. These prevention measures work.
The new COVID viral variants have not yet been detected in Nevada County, but many have been confirmed to be present in California. It is common for viruses to develop new mutations or variants through a process of evolutionary selection. Several are known to be more transmissible than the original virus; some seem to be more likely to cause serious illness or death, and there is concern that vaccines may not be as effective against these new strains. The longer the pandemic continues, the more time the virus has to develop new variants with resistance to the vaccines. The more people who are vaccinated as soon as possible, the less risk of additional variants.
I know everybody has COVID fatigue. We are all tired of wearing masks, not being able to go to school, eat at our favorite restaurants, gather with our friends and family like we used to, and so many other things. We can and will beat this, but it’ll take all of us working together to make it happen. This is not the time to take our foot off the gas. Case numbers are down, but still high compared to last fall. As long as there is a lot of virus circulating in the community and many people are not vaccinated, we can’t let our guard down. Please get your “Fauci Ouchie” as soon as you can and continue to stay in place, keep your space, and cover your face.
Dr. Roger Hicks is the Medical Director for Yubadocs Urgent Care in Grass Valley and the founding president and current Director of the California Urgent Care Association.
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