February 2, 2021 Vol. 8: 2021 Update – COVID Vaccines Offer Impressive Efficacy and New Safety Recommendations

We are off to an impressive start to 2021. Not only do we have a highly competent new administration in the White House working to repair many aspects of our country, we also have at least two vaccines (e.g. Pfizer and Moderna) with 94% or better efficacy after two doses and their availability is rapidly ramping up. And, I expect that the Johnson & Johnson vaccine will receive emergency use authorization this month.

That being said, virus mutations, which make COVID about 2 times more infectious than previous, present new challenges which is why now is the time to double down on safety protocols such as wearing higher quality masks, increasing social distancing to 10+ feet (when outside of your social bubble) and continuing to practice frequent hand hygiene.
 
There is a lot of information (and misinformation) about COVID vaccines swirling around right now, and it can be challenging to separate fact from fiction. This post shares the best information I have to date about the safety and efficacy of COVID vaccines, the importance of not only continuing to wear masks but also upgrading them, and key ways to be proactive in safeguarding your family’s health and boosting immunity.
 
COVID Vaccines Are Safe and Effective
At this time the two vaccines being offered in the United States for COVID protection are mRNA based (e.g. Pfizer and Moderna), which some of you have expressed concerns about. In fact, scientists have been studying the use of mRNA technologies in vaccines since the 1990s and the main goal of any COVID vaccine, traditional or mRNA, is to teach the immune system what the SARS-CoV-2 virus looks like so that an effective immune response can be mounted. Once educated by the vaccine, the immune system vigorously attacks the actual virus, if it ever enters the body.
 
I am quite confident that the mRNA vaccines are safe for almost all adults and the Pfizer vaccine has already been approved for 16 and 17 year olds. Every medical authority I trust has been vaccinated in recent weeks and has provided reassurance as to the vaccines’ safety. I’ve had my first jab and many of GetzWell’s staff will have already had their second doses. Medical and public health authorities anticipate there will be boosters by early next year to cover mutations or virus variants. Additionally, as reported in the NY Times, of 75,000 individuals who received vaccines in trials in the last few months, not a single person died and only a few were hospitalized! One benefit of mRNA vaccines is they can be tweaked relatively easily to cover changes in the virus’s spike proteins and thus ensure protection from variants, and they can also be produced more quickly than traditionally manufactured vaccines. This is a real game changer.
 
It would be ideal if all of us had access to the vaccine now, but there isn’t adequate supply.  Admittedly, the distribution process to date hasn’t been ideal and we are seeing objective data showing structural inequality in distribution to lower income and minority populations. Fortunately, the federal government has adopted a comprehensive COVID response plan and they are taking steps to address structural inequalities. Further, we expect that vaccines will be widely available in California by mid to late April. Thus far, roll-out plans seek to prioritize those individuals who are most at risk of severe disease from COVID and in California it appears that vaccines will soon be offered based on age. Register here with the State of California to find out when it will be your turn for COVID immunization and here with the City of San Francisco. I urge you not to succumb to pandemic fatigue and continue to vigilantly practice safety protocols. See the discussion below about upgrading your masks.
 
Children will be the last group to be approved because the process for verifying safety of these vaccines necessarily follows proof of safety in adults. In my view, it is likely the Pfizer and Moderna versions will be approved for 12 – 15 year olds by early summer. For example, Pfizer has fully populated a study for safety and immunogenicity among 12 – 15 year olds and Moderna is close to commencing a study for 12 – 17 year olds.
 
The Johnson & Johnson vaccine (not based on mRNA technology) which I expect will soon be approved in the US, issued preliminary data in recent days which indicates it is safe for adults and prevents severe illness and death in almost all recipients. The fact that it can simply be refrigerated for up to 3 months suggests it will be easier to distribute in primary care medical offices, rural areas and in less-developed nations. My hope is that by the summer of 2021 one or more vaccines approved for children 9 years and older will be available in the US and it is possible by the end of 2021 that GetzWell will have the Johnson & Johnson vaccine since we already possess adequate refrigeration capability.
 
For a thorough Q&A and Myths & Facts about the COVID vaccines, see this thread and this thread from Megan Ranney, MD, MPH.
 
Wear Your Mask–and Upgrade It!
Despite all this encouraging news about COVID vaccines, we don’t yet have confirmation that being vaccinated will effectively prevent viral spread and the new mutated variants from the UK, South Africa and Brazil are up to twice as transmissible compared to earlier versions. While the vaccines will prevent severe illness and death, we still don’t know if fully immunized individuals  could transmit the virus to non-vaccinated adults and children. Moreover, while you wait to receive a vaccine, some experts are saying we face the equivalent of a “category 5 COVID hurricane” in the next few weeks due to these new variants. So, vigilance is critical. All of us, even if we have received two vaccine doses, need to keep wearing our masks.
 
A recent study in Israel highlighting the dangers of pandemic fatigue revealed that of 189,000 adults who received the first vaccine dose, over 6% (or 11,300 persons) contracted COVID before they received the second dose. I recommend that if you have to go to an indoor location (outside your home) you should try to reduce such indoor exposures to less than 5 minutes (some compelling data comes from within the NFL!), and if you use a cloth mask, you should do so only as a second layer over an approved surgical, KF94, N95 or KN95 type of mask.

John Brooks, MD, chief medical officer of the CDC’s COVID-19 Response stated, “It’s thought that this specific combination of a cloth and a medical mask could block over 90% or more of those respiratory droplets and particles.” If you want to keep using a cloth mask outdoors, strongly consider putting a coffee filter between 2 cloth layers and make sure the mask is well-fitted to your face. Here’s a good explanation of the importance of proper mask wearing. And if you really want to geek out, this mechanical engineer has tested a variety of mask options available in the United States and offers recommendations based on his results.
 
Avoid COVID and Stay Healthy With Nasal Washes and Immunity Boosting
This might seem obvious, but I’m going to say it anyway (and again): You really don’t want to get COVID. A recent report from Leicester University and the Office for National Statistics in the UK found there is a “devastating long-term toll on survivors of severe coronavirus, with many people developing heart problems, diabetes and chronic liver and kidney conditions.” They concluded that “almost a third of recovered COVID patients will end up back in hospital within five months and one in eight will die.” Researchers are exploring how the COVID spike proteins cross-react with human tissue proteins and antigens, causing autoimmunity. Their research sheds some light on the multisystem disease that some patients continue to suffer from.
 
In addition to wearing (upgraded!) masks, you may also do the following:

  1. Nasal Spraying/Washing: I continue to believe that this practice is undervalued and that we should all be doing it at least once a day. Xlear, which has applied to the FDA for emergency use authorization as an anti-COVID hygiene tool, is one option. Briotech and Sterimar are additional brands that have proven virucidal in vitro. I, personally, spray Briotech on my hands (it’s not desiccating or irritating like alcohol), face, as well as in my nose.
  2. Vitamin D: Research shows low vitamin D levels almost certainly increase the risk of COVID-19 infections, hospitalizations, and deaths. Given its safety, physicians have called for immediate widespread increased vitamin D intake. Please contact GetzWell for individualized advice on appropriate vitamin D supplementation for your child.
  3. Take Care of Your Gut Microbes: Several studies are beginning to indicate that a healthy gut may help prevent severe COVID outcomes and it looks like the gut is critical to defending against COVID. Eat “the rainbow,” choose prebiotic and fermented foods and consider supplementing with a high-quality probiotic (like the ones we carry in our offices). Limit your intake of sugar and processed foods and try meditation or box-breathing for 5 minutes everyday.
  4. Be Proactive: We are learning how supplements, diet, and some medications can mitigate the risk of not only contracting COVID but also contribute to recovering from it. One compelling example comes from the Front Line COVID-19 Critical Care Alliance (FLCCC) which has developed protocols for COVID-19 that include ivermectin (a drug historically used to treat parasites which also has highly potent antiviral and anti-inflammatory properties against COVID-19), combined with masking, social distancing, hand hygiene, Vitamin D, Vitamin C, quercetin, melatonin and zinc that could help prevent high-risk patients from contracting COVID, could effectively treat patients who have been exposed to COVID, and could also be an early treatment approach for patients in the early stage of COVID illness.

At GetzWell, we are happy to assist you in putting together these protocols.
 
As always, let us know if you have any questions about the above. And, I will be in touch with additional information as the COVID science evolves and more information becomes available.