Medical Director’s Corner

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Dr Valena Fiscus

As COVID-19 cases increase state wide and here locally, many probably have questions or concerns about COVID-19 vaccinations. I would like to provide information that may be helpful.

By now we all know that the COVID-19 is a novel type of coronavirus that infects through respiratory droplets or aerosols causing a variety of symptoms most commonly of the upper and lower respiratory system.  These symptoms can range from mild to life threatening and currently it cannot be predicted who will have worse symptoms. 

The virus has a spike protein that binds to receptors within the respiratory tract to hijack cells into propagating the virus. The spike protein is very important in the infection process of the virus and the target for current vaccines. The genetic material of COVID-19 is RNA. Why is this important? RNA viruses are prone to shift their genetic material to adapt to their environment or the hosts they infect. The more chances that virus has to go through different hosts, the more chances it has to change or mutate. These mutations’ aim is to: evade the immune system so it can produce more, produce more rapidly so it can infect more people before the host becomes too ill and dies, or to be able to infect the host more efficiently. 

Why is this important? Well, the more people infected, the more risk of the virus getting stronger, more contagious and unresponsive to treatment. Unfortunately, natural herd immunity through infection greatly increases all of these risks. There has been evidence that during the horrible delta variant outbreak in India, a new variant, named delta+ was found after discovery of reduced response to monoclonal antibody treatment in many patients. The failure risk of our current treatments is very real. And while scientists scramble to find new treatments or repurpose old treatments that may be effective, there are ways in which we can help reduce transmission ourselves.

How can we do that? We know that social distancing, hand washing and mask wearing work well to reduce the risk of any viral transmission and are very effective with COVID-19 as well. Masks reduce the particle size and distance traveled when someone an infected individual coughs or sneezes. So you don’t get a large load of virus particles smack in the face and nose.

There are vaccines available, mRNA vaccine from Pfizer and Moderna and the adenovirus vector vaccine from Johnson and Johnson, that are very effective and safe. These viruses use particles of the virus to elicit an immune response and cannot be incorporated into our DNA or replicate into the COVID-19 virus.

Historically, when drugs or vaccines were made during our parents or grandparents’ generation (or for some people, your own generation) there were no rigorous guidelines in place. Some of the doctors gave their family, including their children, their creations to see if they worked. Dr. Jonas Salk’s polio vaccine was one. But those vaccines saved millions of lives over the decades. Current drug and vaccine research are very regulated due to some of the severe side effects we have seen when they were not. Each step looks at all side effects that can occur. At the end of the trail in phase 3, tens of thousands of people have participated. There is a phase 4 which every medication and vaccine goes through which is continued surveillance of use in the general public. These observations last decades and some of the medications you may be taking are still considered under investigation. But they have been deemed safe for use given the rigorous safety evaluations during the initial steps. 

The data that has been collected and published in many vetted and prestigious journals (such as the New England Journal of Medicine) have shown the COVID-19 vaccines to be both effective and safe. Side effects were as frequent or less than with other vaccinations such as influenza vaccine or similar to what would occur without vaccination. 

Currently most people hospitalized or dying of COVID-19 have not been vaccinated. People who have been vaccinated can still get the virus but not as severely. Our immune system will already be primed from the vaccine to respond and rid the virus before it has time to replicate and cause severe symptoms or replicate enough for the vaccinated person to spread. This is what vaccines are designed to do. This reduces the ability of transmission so the virus cannot mutate into a more virulent or stronger virus that we cannot fight. But this can only be achieved by having enough people vaccinated which currently, there is not. Adair county sits at only 33% which is unfortunately not enough.  

While getting vaccinated is a personal choice, a choice I made as a physician and scientist, I encourage those who have not been vaccinated to strongly consider doing so to protect our families and to protect our community. 

If there are specific questions or concerns, I would be happy to answer them. Please feel free to reach out. 

Valena Fiscus, DO, MPH

Public Health