February 28, 2021

And then there were three. We have a third vaccine available for Covid-19 approved for emergency use as of this weekend meaning it can be shipped and available for willing arms as early as tomorrow. This one, from Johnson & Johnson has several distinct advantages over the previous vaccines from Moderna and Pfizer. It is a single dose vaccine. Once you have your first shot you’re done – no need planning to come back within the necessary window of time for a second shot. It’s also much more stable and does not require the cold temperatures of the mRNA vaccines and can be kept in an ordinary refrigerator. This combination of factors will make it much easier to distribute, especially to more isolated populations. The homebound elders I take care of, outside of the VA who has a separate system, have for the most part been out of luck at obtaining vaccine as no good system for getting vaccine out into the community without compromising the cold chain had yet been devised locally. That will no longer be an issue.

The reason for this ease of use is that the Johnson & Johnson shot is a very different technology than that of the earlier vaccines. While the two in circulation are based on a method of getting mRNA that encodes for spike proteins into our cells and letting our own immune systems then take over to produce antibodies against those proteins and, therefore, against the corona virus, this vaccine works more akin to an inactivated virus vaccine such as for flu. This vaccine uses a modified adenovirus (a type of virus that causes a range of respiratory and GI viral illnesses) that cannot cause human illness. These viruses are DNA based viruses (unlike the coronavirus which is RNA based). DNA that encodes for spike protein is added to the adenovirus and, with the immunization, the introduced adenovirus is taken up by human cells. The virus itself is destroyed but the DNA in question is taken up by the nucleus and the cell makes mRNA for the spike protein which is then recognized by the immune system as foreign, priming the body to react against coronavirus should it be exposed later.

The numbers in regards to protection for the Johnson & Johnson vaccine aren’t quite as spectacular as for the two prior vaccines but still plenty high enough to prevent significant illness in someone who is later exposed. Cold symptoms we can tolerate. Shutting down of the respiratory system we can’t. WIth all three vaccines now approved and in circulation, we really have a chance of getting ahead of the virus and its spread and we may be able to have a semblance of normal life again this summer. I’m dreaming of sitting on a patio with a cocktail and a bunch of friends having adult conversation.

The deccline in cases nationally no longer continues to decline, but appears to have plateaued. The numbers are far below that they were at their January peak but they remain worse than they were in the early fall before cases really started to skyrocket. I am not an epidemiologist but my guess is the rapid fall was a result of picking the easy fruit. The rapidity of vaccination of seniors in congregate living is the likely driver as their chances of acquiring and becoming seriously ill was so high. With that particular population stabilizing, we’re probably looking now at numbers for the general population and those will be much tougher to get under control, especially as roughly 1/3 of the adults in the country are living in a political fantasy land where such things as facts and how biology works just doesn’t matter. The new variants which are more contagious continue to spread, but the vaccines appear to be as effective against them as they had been against original strains. Just to be on the safe side, the vaccine companies are working on boosters and tweaks should they be needed.

The biggest issue is one that has not yet reared its head but very well could. The coronavirus is a very simple organism genetically. It’s RNA code is not that many base pairs and it has very few parts. As RNA and DNA are constantly mutating as nature tries things out (evolution exists whether you choose to believe in it or not), and those mutation rates are relatively constant, there will, over time, be more and more variants and eventually one of those variants may develop a resistance to vaccine, or a quality that makes it much more lethal to humans. And if that starts to spread in the midst of our current political climate, there may be hell to pay.

I haven’t been feeling great the last couple of days. (I’m pretty sure it’s not Covid but UAB, from an abundance of caution, is going to test me in the morning and have me work from home tomorrow). This is one of the few times since the pandemic broke that I haven’t felt up to snuff. Covid avoidance as kept me away from all of the other mild ailments that I usually get. There is a code in medicine that you don’t take sick time when you’re under the weather as it means your workload will simply be added to someone else’s when you’re out. It’s instilled during med school and residency which is full of stories about residents putting in their own IVs and making their rounds dragging an IV pole when they’ve been so sick and dehydrated that they can barely stand up. These stories are told in such a way as to make trainees feel that they should have a constitution of iron and they are unworthy if they don’t. I’m not sure that’s a healthy attitude and I’m pretty sure I’ve gotten or given viral illness to and from colleagues and/or patients in the past. Maybe a gift of the current pandemic is a change in the culture to make it a positive move to stay home when we are sick and thus lessen the chances of iatrogenic infection.

Checklist for tomorrow: Drive through Covid testing. Telemedicine from my dining room table. Keep hands washed. Wear mask outside condo. Keep my distance. Drive through dinner. Early to bed.

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