This is a rapidly changing topic. The information presented here represents the best information available at the time of writing. The views expressed herein are my own. I am not representing Vanderbilt University Medical Center in this forum. Finally, this article is not meant to provide healthcare advice. If you have any questions pertaining to your own health, including concerns about whether you are infected with COVID-19 or should receive vaccination, please consult your healthcare provider.
Now is the winter of our discontent. At the time of this writing, 19 million Americans have been infected with COVID-19 and over 330,000 have died. It is unclear how many may be left with chronic health problems, such as fatigue, brain-fog, chronic shortness of breath, and joint pain. Our best defense against this virus remains wearing a mask, social distancing and hand-washing.
Summer is coming. There is hope for a return to normalcy with the development of vaccines against SARS-coV-2, the virus that causes COVID-19. Two vaccines have been given Emergency Use Authorization by the U.S. Food and Drug Administration, one made by Pfizer-BioNTech and one by Moderna. Both use a new vaccine platform based on mRNA. The rapidity with which these vaccines have been developed is a testament to the power of science. However, one can be reassured that these vaccines have not been developed out of thin air in a period of less than a year. In fact, the way was paved by work that had already been done to develop vaccines against two other illnesses caused by coronaviruses, SARS and MERS. The rapidity of vaccine development was also facilitated by a compression of the normal timelines for vaccine development, wherein processes that usually occur in sequence, such as the conduct of clinical trials and vaccine production, occurred simultaneously.
Both the Pfizer-BioNTech and Moderna vaccines have been shown to be safe and effective in large, well-conducted clinical trials. Both require two doses. Full immunity requires about two weeks after the second injection. The main side effects that have been seen are local injection site pain or redness and flu-like symptoms. These side effects are common to many vaccines and are a reflection of the immune response to the vaccination. There have been some rare cases of severe allergic reactions that are likely caused by a component of the lipid coat around the mRNA molecule. There have been no serious long-term side-effects identified.
How do these vaccines work? The mRNA is coated in a lipid nanoparticle. No, that is not a “chip” with which to track you. It just means that the individual particles that contain the mRNA are really, really tiny, measuring between 1 and 100 nm. The lipid coat protects the mRNA from rapid degradation after injection and can fuse with the cell membrane, which is also largely a lipid coat, releasing the mRNA into the cell. The mRNA does not go to the nucleus and it does not fuse with your DNA. It goes to the protein producing part of your cell, called a ribosome, where it instructs the cell how to make the SARS-coV-2 spike protein. Once translated into protein, the mRNA is rapidly degraded. Meanwhile, the protein is sent to the cell membrane, where it induces an immune response, and itself is eventually degraded.
The goal of vaccination is to achieve herd immunity, that is having a sufficient percentage of people in the population who are immune that it becomes difficult for the virus to spread. To achieve herd immunity, 70-85% of the population will need to be vaccinated. Given the limited quantities of vaccine available, currently the vaccine is being given to healthcare workers, first responders, and patients and employees of long-term care facilities. Vaccination will roll out in waves to populations at less and less risk to experience severe disease if infected. Vaccination priorities vary by state. Vaccination of the general public will probably not begin until the end of March or the beginning of April 2021 and will likely not be completed until mid or late summer.
There has been recent concern over the emergence of a mutated strain of SARS-coV-2 that is more easily transmitted. It does not appear to cause more severe disease. There is no evidence that this new strain will not be covered by currently available vaccines.
What does this mean for me and my dojo?
- It is still crucial to follow the directives of public health experts in your area to reduce the spread of the virus. Depending on local regulations, this may mean not holding classes, holding only outdoor classes, and/or limiting the number of individuals who gather in one space. I would recommend against training with a partner, unless you are already household contacts. You should wear masks, keep 6 feet or more apart, and practice strict handwashing and sanitation practices. Hospitals all over the country are at critical capacity. We need to prevent further surges that may literally overwhelm our healthcare system.
- If you are a candidate, consider being vaccinated for COVID-19 when the vaccine becomes available to you. I have already had my first dose. Given what we know about SARS-coV-2, it is likely that we may need annual vaccination, much like influenza.
- Since we do not know if vaccination prevents asymptomatic carriage, it is important to continue wearing a mask, socially distancing, and washing hands, even if you have been vaccinated. Vaccinated individuals could train together, but should not train with non-vaccinated individuals.
- Be patient. I know we all want to get back to “normal.” But as I have said before, we may be tired of coronavirus, but coronavirus is not tired of us. I know that many of us are hoping to start having seminars again, to travel, and be able to see and train with our friends. It may be late summer or early fall before this is safe to do.
- Our understanding of COVID-19 is rapidly changing. Stay informed and educated from reliable sources, such as the CDC.
In the words of Wendy Sensei, “Stay Calm and Tenkan.”
Marta Ann Crispens, MD, MBA, FACOG