Q&A: Your COVID-19 vaccine questions answered

3 experts visit News4Jax to answer viewers’ questions

JACKSONVILLE, Fla. – Questions about the COVID-19 vaccine are coming into our newsroom frequently these days via phone, email and social media messages. We aren’t doctors and hesitate to give answers beyond when and where vaccines are available and current advice from the CDC.

News4Jax invited Dr. Pamela Rama, a cardiologist with Baptist Health, and Mia Jones, the CEO of Agape Community Health Center, on The Morning Show on Friday to answer many of your specific questions.

More questions came into our phone bank and were submitted online, so we had Baptist Health’s Dr. Tra’ Chella Johnson Foy join us on News4Jax in the evening Friday to answer those also.

What exactly is in the vaccine?

Dr. Johnson Foy: That is a tougher question because 1) there is more than one vaccine, but there are two types that we, in our country, have available. You have two mRNA vaccines, and those vaccines are not the virus at all. Those are proteins that fool your body into thinking that it’s been exposed to the COVID virus, and it allows your body to create a little spike protein that immediately self-destructs after your body recognizes it. So some people think that they’re actually being given the COVID virus, and they’re not. It’s just a protein that is the genetic material that just fools your body into thinking, ‘Hey, here’s this virus,’ so that your body will make the soldiers it needs to fight the virus in case you actually are ever exposed to it. The Johnson & Johnson vaccine is a little bit different. It actually is a disabled or weakened virus that is present, but it also is NOT the COVID virus that is in the Johnson & Johnson. It is one that is a very similar look to what the coronavirus is so when you receive it, again, your body is fooled into thinking that it’s being exposed to infection, just so your body will make those protective antibodies to protect you if that virus comes along. But both of them have been shown to be very safe, millions of people have been vaccinated, so you can translate that into millions of lives being saved.

Can people pass the virus to others even if they’ve been vaccinated?

Dr. Rama: Yes. But less likely. So when they looked at patients who got the infection after they’d been vaccinated, their viral load is really, really a lot smaller than somebody who’s not been vaccinated. There’s always a possibility that you could pass it on, but the likelihood is very, very low.

If we don’t get at least 70% of the population vaccinated, we can’t get to herd immunity?

Dr. Rama: You need 70% of the population to be vaccinated to stop the cycle of transmission. If we don’t get that, it’s not going to work. We really need that for the pandemic. I think it was important to let people know that the vaccine is safe. It’s not that they rushed through this. They looked at the data and the data is very good about these vaccines.

If I had no symptoms from the first shot, what are my odds of having symptoms from the second shot?

Dr. Rama: Pretty high. The people who’ve had the virus or COVID vaccine, they usually see the virus the second time with the first vaccine. So, the first vaccine is when they get a lot of side effects. However, if you’ve never had COVID, it’s the second shot. It’s the second time that the body sees the virus particle that makes you (react). [In other words, if you’ve had COVID, your first vaccine shot is the second time your body has seen the virus and is, therefore, the most likely time you’ll have side effects. If you’ve never had COVID, your second shot is your most likely time to experience side effects from the vaccine because that’s the second time your body is experiencing the virus.]

I got my first dose of Moderna but missed my second. Do I have to start over?

Dr. Rama: No, you don’t have to start over again. You want to go ahead and get the second dose of vaccine for the Moderna. Really, you can do it within six weeks of getting the first shot. But any time that you can just get the second vaccine, go ahead and do that.

Why should someone who contracted COVID-19, got better and now has the antibodies get a vaccine? We don’t do that for other illnesses.

Dr. Rama: There are different levels of infections of COVID-19. Some people have mild infections so we don’t know the antibody response. Some people can have a robust response and some people can have a mild response. We don’t also know how long the response lasts. The good news about the vaccine is they are very consistent. A lot of them give you 95% infection and we know from recent studies that it extends up to eight months. So even if you’ve had the COVID infection, the recommendation is to get the vaccine when you’re out of your quarantine period.

Since neither Pfizer nor Moderna can say with any certainty how effective their vaccines are beyond six months, should I be tested for antibodies at that point? Or should we just expect a booster?

Dr. Rama: There is a lot of debate among virologists about that. Some people are hoping that is like the polio vaccine where you get one shot and you’re protected for life. More likely it’s going to be a shorter term. We’re hoping it’s not like the influenza (shot) where you get it every year. At this point, it is eight months immunity and it might extend. We’re following the first cohorts of patients who’ve received the vaccine and, hopefully, it will last longer than that, but, I wouldn’t be surprised if you’re going to need a boost at one year or somewhere down the line -- within a year or so. ... At this point, it’s looking like we might need it but we won’t really know until a couple of months from now when the first cohort of patients who received the vaccine has gone through eight months to nine months to see if the antibodies are still there.

Dr. Johnson Foy on needing a booster: What I try to educate my patients on is that it’s not uncommon for a vaccine to often need a booster later on because we want your body to be able to make the best immune response possible, which means as many soldiers as it can make to fight off this infection. So sometimes, those soldiers start kind of dwindling a little bit inside your body -- those antibodies, so a few months later, six months down the road, just to give your body a renewed set of forces is what that booster vaccine will do. But right now, just focus on the two that you’re supposed to get if it’s the Moderna or the Pfizer and the one that you’re supposed to get if it’s the Johnson & Johnson. And then we’ll handle those things up the road. But right now, get the first one, get the second one if you have already had the first one so that you can have complete immunity now. That’s what we want to focus on.

How long should you wait to get the second shot? Can you get it early?

Dr. Rama: What they’re recommending for the Pfizer, wait 21 days and for the Moderna, it’s 28 days. You could do it four days ahead of time. If you miss the second dose, you could wait another two weeks to get the second dose.

We have seen a dramatic drop in those who have been interested in going to Gateway, as an example, to get the Johnson & Johnson vaccine. Do you think that the decision to pause it and now reinstate its usage has hurt the effort to get more people vaccinated?

Jones: I think it has, but it’s one of those things that you would rather be safe than sorry. And we know that once you pause the use of it, it’s like, ‘Well, wait a minute. You did it on an emergency basis. You put it out and said it was good, and then you pause it. Why should I trust that this is the right thing to do?’ And so we have to make sure that the community understands that even if they don’t feel comfortable getting the Johnson & Johnson because it was paused that Moderna is still available and also Pfizer.

I had the second Moderna shot on April 14 and I’ve been tired every day since then. I am 87 and normally have several good days weekly that I can do many things. Since the second shot, I have not had a good day.

Dr. Rama: With the vaccine, you will expect some reaction because you’re building up some immunity to the coronavirus. Usually, the side effects last about five days to seven days. So if have symptoms beyond that, you may have to seek medical attention to make sure nothing else is going on.

I got the Moderna vaccine and experienced different side effects, like sensitivity to smells, headaches and it affected my hearing. Are those normal?

Dr. Johnson Foy: The normal side effects are going to have more to do with injection site reactions, so for instance, because you’re getting a shot in the arm, there may be redness and swelling that occur in the arm. Sometimes, though, you will feel that immune response that your body is making, so with that comes a little bit of fever, head achiness, chills and sometimes sweats. Now, everybody’s body is different, so there are going to be those who may experience things that aren’t necessarily common, so if she experienced a little bit of ringing in the ears or some hearing, that may be something that is a new thing just for her and some others may recommend it, so we have vaccine surveillance, so if a person has unusual types of symptoms or side effects, then they can reach out to a provider and say, ‘Hey, this is what I experienced,’ and that provider can let those who are monitoring this know. But usually, it’s very simple things like swelling, redness in the arm and a little bit of achiness.

If you are taking blood thinners, can you still get the Johnson & Johnson vaccine?

Dr. Rama: Absolutely. It might actually protect you from the venous thrombosis that we’ve seen with the J&J -- but actually, that (side effect) is very, very rare. The only people that would have second thoughts doing the J&J is if you are a young female and you are on oral contraceptives because these are the people at highest risk for that rare complication of cerebral venous sinus thrombosis.

If you had a heart attack or have diabetes, should you be vaccinated? Could heart palpitations after getting the vaccine be a normal reaction?

Dr. Rama: If you’ve had a heart attack or diabetes, those are the highest-risk patients -- they are the ones that tend to run into trouble with the COVID infections. So definitely have the vaccines. As far as the heart palpitations, we are seeing that in patients who’ve had the COVID vaccine. I think that’s one of the reactions to the vaccine -- especially if it’s within a week of getting the virus. If it’s beyond a week or so, you need to seek medical attention to make sure nothing else is going on.

If you have health conditions, like epilepsy or COPD, is it safe to get the vaccine?

Dr. Rama: First of all, you have to ask your doctor about that, but right now there is no contraindication for people with underlying medical problems, seizures, COPD. COPD especially, you should get the vaccine because the virus is not good to people with COPD.

My daughter has a shellfish and peanut allergy. Is it safe for her?

Dr. Rama: It is safe. The only true allergic reactions to the vaccine are the people who had an allergic reaction to the first vaccine. Because it really is a very novel compound. Just because you’ve had a peanut allergy doesn’t mean you’re going to be allergic to the vaccine. The only thing is that if you have had a history of allergies, you want to stay probably and be monitored for 30 minutes after you’ve had the injection.

Are there any studies that show that this could affect a woman’s fertility?

Dr. Rama: With the first cohort of patients who got the vaccine, 53% of those females got pregnant, and they were evenly divided between the group who got the placebo and the group who got the vaccine, so it hasn’t affected fertility.

What about arthritis?

Dr. Rama: Rheumatoid arthritis, there’s always been an issue about that. They have included 133 patients with autoimmune disorders in the first cohort of patients who’ve had the vaccine and safety-wise, there’s no issue about that. The only thing is that some of the disease-modifying medications that they give to people with rheumatoid arthritis or lupus might lessen your antibody response to the vaccines, so it’s not as effective in these patients, but they’re still able to mount a reaction, so that’s a good thing. But not as good as somebody who is not on those medications.

I’m fully vaccinated and I’m scheduled for a procedure where I’ll be under anesthesia. Will the vaccine cause any problems during my surgery?

Dr. Rama: No problems at all. You can have the surgery and there’s no issue at all with that.

I experienced enlarged lymph nodes for six weeks after my Moderna shot. Was that because of the vaccine?

Dr. Rama: If the lymph node enlarged right after you got the vaccine, it’s probably COVID vaccine-related. It will go down over time. It’s just in her case it’s lasting longer than what we see normally.

Which vaccine is better if you’re on an autoimmune medication?

Dr. Rama: If you’re on autoimmune (medications), they’re studying particularly the mRNA vaccines, so Pfizer and Moderna. Moderna in particular has a study looking at patients with rheumatoid arthritis and lupus and the safety and efficacy in these patients, so I would go with an mRNA vaccine.

I had a heart valve replacement recently. Should I get vaccinated?

Dr. Rama: Absolutely. There is no contraindication. She needs to have it.

Should I get the vaccine if I have Guillain-Barré Syndrome?

Dr. Johnson Foy: That’s a common question because people know that there’s a potential low risk of having it with the flu vaccine. So a lot of patients who have had Guillain-Barre want to know is it safe for them to go ahead and get the COVID vaccine. What the CDC says is yes. There isn’t any signs or associations with Guillain-Barre patients. When they were doing the clinical trials, it didn’t show anyone who developed Guillain-Barre in both the Moderna and the Pfizer trials. In the Johnson & Johnson trials, there was only one person. So, because of this, it’s believed that it’s safe to go ahead and proceed with the vaccine. The committee that recommends cautionary terms when it comes to vaccinations has not provided any recommendations that patients shouldn’t get the vaccine if they’ve had Guillain-Barre.

I had the Moderna shot several weeks ago and now I’m having trouble breathing. Could this be related to the vaccine?

Dr. Rama: If it’s over two weeks, I’d say it’s something else. You have to go to your doctor and see if this is any – it’s probably not vaccine-related.

Is itching and swelling under my arm a side effect of my Moderna shot?

Dr. Rama: Yes, that is a side effect. So if you get it immediately within a couple of days of getting the vaccine, it is a side effect of the vaccine.

Can people with Type O Blood get COVID?

Dr. Rama: There’s preliminary data that show that people who are O-positive are 28% less likely to get the disease, but they still get the virus, yes. And they still need the vaccine.

I’m a 45-year-old heavy smoker. What side effects of the vaccine should I expect?

Dr. Rama: The usual side effect, the most common one is arm pain from the vaccination site. Some people can have some malaise and fever. These are actually good signs that your body is building antibodies against the virus protein. We welcome these side effects.

Dr. Johnson Foy on side effects for smokers: When it comes to heavy smoking, although it’s a habit you want to try to break, it’s not one of those things that increases your risk of side effects or at least that hasn’t been shown so far. … I wasn’t able to find any types of evidence that people who are heavy smokers have more to be concerned about if they get the vaccine. As a matter of fact, they want to make sure that they get vaccinated because the fact that they’ve had this damage to their lungs from smoking actually puts them at a higher risk (for complications from the virus) so they want to make sure that they’re fully protected.

I have a compromised immune system from a kidney transplant. Should I get the vaccine?

Dr. Rama: First of all, you have to talk to your physician regarding that. So far there really very few patients who’ve had transplants who are involved in the trials but these are the sickest patients and I would imagine that they can get the vaccine when they’ve had transplants and they’re immunocompromised.

Can I get a colonoscopy if I’m vaccinated?

Dr. Rama: Absolutely. As far as the policies, I think that most hospitals are still checking your COVID status before doing the procedures. That might change, but at this point they still require COVID testing prior to any of the procedures, even if you’ve been vaccinated.

Should I get the vaccine the day after having a colonoscopy?

Dr. Johnson Foy: Getting the colonoscopy, important. Getting the vaccine, equally as important. By the time the next day arrives, because the colonoscopy procedures are pretty straightforward, you’re not really usually going to have any problems. A colonoscopy isn’t suppressing your immune system in any way that should cause you to be more susceptible to the problems that may be -- any side effects that come from the vaccine, so it’s safe to go ahead and get that vaccine the day after the colonoscopy.

What was stopping members of the Black community from getting the vaccine at the start?

Jones: A lot of the community was simply waiting to see how things would pan out for others who might get it first. They did not want to feel as though they were Guinea pigs. They didn’t want to feel as though the vaccines were being given to them and not being given to the whole of the community, and so that is one of the things we have tried to make sure everybody understands is that we need everybody to get vaccinated.

Have you found that that feeling and those thoughts have changed now over the last few weeks?

Jones: I think they change daily as people see and hear that more and more people have gotten the vaccine and that they have not had problems or that the problems that they did have were minor. You never know what circle of influence a person has, and so we all kind of look to that person we trust to say is this the right thing for me, and when they see that right person, then they go ahead and say, ‘OK, it’s time for me now.’


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