March 5, 2021 Covid update

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With the approval of the Johnson and Johnson vaccine, the US now has 3 vaccines available raising the hope that everyone in the US could be immunized by mid-summer. This new vaccine differs from the Moderna and Pfizer vaccines in many ways and has certain advantages over them.

First off, it is a single shot rather then two. It is easier to transport and store, requiring only regular refrigeration rather than a freezer, and it can also be stored for longer.

It uses a different approach then the other two as well, utilizing an older method of using an inactivated virus to deliver the Covid spike protein, rather than a piece of RNA. Side effects though are similar with a sore arm the most likely reaction. However, just like with Moderna and Pfizer, headaches and flu like symptoms can occur for up to 48 hours after the vaccine.

Some perceive the Johnson and Johnson vaccine as less protective since in studies it was only shown to be effective at preventing symptomatic Covid19 infections 72% of the time (in the US) compared to 95% for the other two vaccines. This perception is inaccurate though. With regards to preventing someone from ending up in the ICU or dying from Covid19 all three vaccines show the same success. The difference in the efficacy numbers relates to the fact that the Johnson and Johnson vaccine was tested in areas of the world where there are more resistant variants. It is unlikely that the current formulations of the Pfizer and Moderna vaccines would show the same high effectiveness rate if they were to be retested in those areas of the world now.

As I have mentioned over the last several weeks the variant strains of Covid19 continue to remain a major concern, as they may reduce the protectiveness of the vaccines. At the moment, the most worrisome variants are the ones from Great Britain, South Africa and now Brazil. Currently, the British strain is the variant most isolated here in the US.

These variant strains represent genetic drift, which is the slow accumulation of mutations that ultimately result in a confirmational change to the virus. This change causes the virus to appear different to our immune systems (sort of like putting on a wig as a disguise) and can lead to reduced immunity. It does not necessarily lead to increased virulence or deadliness.

On the other hand, genetic shift occurs when two strains of the same virus combine to form a brand-new virus. These super mutants are often more deadly and may not even be protected against by existing vaccines. A super mutant consisting of the British variant and a California variant has been isolated by labs in California and Los Alamos New Mexico. For the moment, this super variant strain does not appear to be circulating in the population, yet if it ever does, we may be back to where we were when the pandemic began or even worse.

I have always been bothered by the fact that in the 6 hours between the signing of the Armistice ending World War I and the actual ceasefire, up to 10,000 soldiers were wounded or killed. Many of those casualties were avoidable. I cannot help but feel we are in a similar situation with Covid19. We are potentially seeing the beginning of the end of the pandemic, yet a very real danger still exists for infection and death. I do believe that in another six to eight weeks we will have a much clearer picture, yet for now please continue to remain vigilant and continue to practice social distancing and wear masks while in public.

Take care.