Episode 35 Shownotes - Covid-19: Vaccine Information for the Cancer Survivor

You are listening to Best Life After Cancer, Episode 35.

Hey, friends!  If you follow on my Facebook page or group, you know I got my second dose of the Pfizer Covid vaccine about 10 days ago (super excieted about that for sure!)  I am amazed that we have been able to get through 10 months with both my husband and I working in medicine, with 4 kids in at least a hybrid school program – my littlest in school full time since September – with no one in the family getting Covid.  It is a testament to the fact that masks work, and kids are capable of being responsible and masking well just like adults are.  I was tested several times over the intervening year, but my kids have not even had a cold!  I have been getting so many questions lately about Covid and the vaccine from my patients lately, and I thought this might be something that people would find really useful. I’d like to take a quick moment first to acknowledge the challenges of patients getting treated for cancer in the middle of a pandemic.  At a time when patients want their families with them the most, we are unable to be with people outside our immediate circle.  Patients are coming to consults, chemotherapy and radiation alone.  They are waking up from surgeries with no family able to sit with them and comfort them.  For this reason especially, I cannot wait for the end of this pandemic.  In medicine, we see your challenges, sympathize and are diligently working to come to an end of this for all of you.  You are doing a great job.  You are strong, and brave, and we applaud you. Keep up the good work.  The quickest end to this is for as many people to be vaccinated as quickly as possible.  If you are considering not vaccinating, I hope this podcast will ease your mind, answer some of your questions, and maybe allow you to make a different decision.

Without further ado, on to today’s discussion.  As almost everyone knows, Covid-19 is a coronavirus strain that is new to the human race.  Coronaviruses are named for spikes on their surface that look like a crown.  There are forms of coronaviruses known to us as humans – they have existed for a long time, affect people and animals including camels, cattle and bats, and some of the common colds are even types of coronaviruses.  Covid-19, however, is a totally new strain never before seen by humans.  The first time our bodies see any new virus, we have no immunity to it, and we can get much sicker.  Once we are vaccinated or have the virus, often future infections are less severe.  If you didn’t know, the naming of Covid 19 is as follows – co for coronona, vi for virus, d for disease, 19 for being identified in 2019.  Covid 19 has been quite unusual in its wide degree of symptoms in affected people.  People can be completely asymptomatic or they can have severe issues and even die.  What is really unusual is that high risk individuals are at risk for death, but rarely, there are also completely healthy young people who get extremely sick and even die.  Currently as of January 2021, we have had 400,000 deaths in the US and almost 2.2 million deaths worldwide.  Covid-19 is now claiming more lives than any other medical condition in the US.  Meaning, more deaths individually than heart disease, cancer.  More deaths than accidents and respiratory diseases COMBINED.  Almost 10 times the deaths of Flu and pneumonia.  Even more concerning are reports of a new strain, first identified in England, now confirmed to be present in the US, that is far more transmissible AND more deadly.  If you think this is a hoax, or overblown, or you are somehow immune, those stats should tell you otherwise.   I don’t tell you this to worry you.  If you take precautions, you are safe to be out for what you have to do.  I just want to encourage people to continue to mask, because the risk is real and even though we are starting to get people vaccinated, as my father-in-law says, no one wants to be the last soldier to die before the war ends.

So today – we are going to discuss quickly symptoms of the virus, testing for the virus, one of my biggest pet peeves that some pts may not even realize is like giving everyone around you the finger, and an overview of the vaccines.  Most of you have heard this 100 times, but this virus can present with URI symptoms or GI symptoms.  Most common are fever, dry cough and fatigue.  Less common are aches and pains, sore throat, diarrhea, headache, loss of taste or smell.  Most people show symptoms 5-6 days after infection, but it can take up to 14 days, making contact tracing quite challenging.  There are two types of tests for acute infection: nucleic acid amplification tests (NAATS), which are more accurate but take longer for results, and antigen tests (rapid tests with immediate results), which are not as sensitive, especially when done on people without symptoms.  What this means is that the rapid test has a higher rate of false negatives.  If you think you might have Covid, it is very important that you quarantine to help prevent further spread!  It is NOT OK to continue to be out in public wearing a mask, and assuming you are not spreading it if you and others have masks.  If you have high suspicion that you were exposed, a negative rapid screen should be followed by a more accurate NAATS test.  There is good data that if both parties are masked with regular masks (meaning not N95’s), and separated by at least 6 feet, the spread rate is quite low for asymptomatic individuals. 

The second type of testing to know about with Covid is antibody testing.  This is a blood test to see if you have antibodies to Covid.  The presence of antibodies means that you have had a strain of Covid in the past and have immunity to that strain.  We are unsure yet how much resistance this will give against other strains, but believe that further infections may be less severe.  There are case reports, though, of people getting a different strain, and being sicker with the second infection, which to me is an argument for all people to get vaccinated, even with documented evidence of prior infection. 

So, if you have symptoms or a known exposure, you should be tested.  The CDC guidelines with an exposure are for close contact.  This is 15 minutes spent 6 feet or closer to an infected person.  It is recommended that after an exposure, you should quarantine for 7-10 days.  The CDC guidelines are for quarantine 7 days if you have a negative test and 10 days without a test.   Multiple studies have shown that we are most infectious in the first week of illness and infectiousness/virus shedding last about 10 days after symptoms begin.  It is important to understand that you can be infectious AND have minimal or no symptoms. 

This leads into my biggest pet peeve with the whole covid thing.  Ever seen the masks with a valve in them?  This helps you breathe a bit easier, right?  Do you know why?  Because the valve is a one way valve.  It lets your breath out unfiltered.  So your full breath is exiting with no filtering and no decrease in viral particles.  So really, if you are wearing a mask with a valve, you are saying, I want to stay safe from you, but I don’t give a crap if you are safe from me.  These are forbidden on airlines, in hospitals, and many other places, but should be prohibited everywhere.  When I see them, I always feel like the person is just giving me the finger and their germs.  So please, if you have masks with vents, either get rid of them or cover them with a second mask. 

On to vaccines.  We currently have 2 vaccines approved for EUA (emergency use authorization).  These include the Pfizer and Moderna vaccines.  These are both 2 shot vaccines. Moderna and Pfizer are both  mRNA vaccines, 2 shots given 1 month apart for Moderna and 21 days apart for Pfizer.  Both are egg, preservative and latex free, good news for those with egg allergies.  Moderna has a 94.1% effectiveness and Pfizer 95% effectiveness (pretty amazing considering the regular flu shot hovers at 40-50%).  It is thought that it will be effective against new strains.  Moderna tested its vaccine on 30,000 people with no severe cases of covid in the vaccine group and 19 severe cases in the placebo group.  Pfizer tested its vaccine in 43,000 people.  Both can come with side effects, mostly mild to moderate, and more common after the second dose.  I received the Pfizer vaccine, because that was what my hospital received.  I had some mild symptoms, which did lead to me laying down a few hours the day after my second dose, and having some aches and pains for a few days.  It did not require me to actually miss work or reschedule patients, although I purposely scheduled a light day the day following the second shot.

The Johnson and Johnson/Janssen Pharmaceutical vaccine is an adenovirus vector vaccine.  I am sure this was true about Pfizer and Moderna’s vaccines as well, but J&J committed $1 billion toward development of a not-for-profit vaccine.  It is based on early work with the Ebola vaccine.  (not effective against ebola, just using some of the research already completed for Ebola).  It is a single dose, which could be a big boost to supply.  It also is not a vaccine that needs to be kept at super low temperatures, which will help in getting this to the community.  J&J is seeking EUA the first week in February of 2021.  I didn’t find numbers with Moderna and Pfizer, but the J&J vaccine trial included 40,000 volunteers.  The study showed 90% effectiveness at day 29 and 100% at day 57 in people aged 18-55.  The data for those over 65 was not yet available when I produced this podcast.

UPDATE 2/1:  The vaccine is 66% effective in preventing moderate and severe disease in all patients worldwide (including England and South Africa strains) 28 days after vaccination in all ages.  It is 85% effective in preventing hospitalization and death in all regions tested.  While this is not as good as the Moderna and Pfizer data, I want to point out that it is day 28 numbers – just about when the other 2 vaccines are giving their boosters.  The data for the J&J vaccine does show continued improvement in its protection in younger people, though I did not find data on that for the older than 65 group.  It is a non-replicating viral vector vaccine, meaning they take a bit of the covid DNA and put it in a weaked version of  adenovirus 26.  This can enter our cells, but not make us sick.  Our cells make part of the spike protein, and then our immune system makes antibodies against the spike protein. 

One of the questions I often get is how the vaccines got made so quickly, and if that worries me.  For starters, let me say that I have a family member by marriage who was involved in the moderna production.  (His wife, by the way, is Katie, whose story was featured  in Podcast 22).  One of the ways we got the vaccine so quickly was the superhuman efforts of the researchers.  They across the board worked 16-18 hours a day, 6-7 days a week, with no vacations from the start of the pandemic, and most of them continue on this grueling schedule still.  They got 3 years worth of work done in 9 months by litereally working 3 times more than they ever did before that!  We owe them a debt of gratitude we can likely never repay.  The second reason these vaccines were able to be made so quickly is that the mRNA vaccines have been researched for decades.  Much of the knowledge we have came from early trials of vaccines for Zika.  These early trials didn’t pan out, but continued work has honed the understanding of these molecules, and paved the way for this pandemic.  If we hadn’t been working on these, trying them and failing in the past, our vaccine would likely be another year or more away.  Interestingly, for my cancer population, there have been trials for mRNA vaccines in cancer, and I hope that the knowledge we have gained with Covid will lead to better cancer vaccines as well!  Some of the real benefits of the mRNA vaccines is that they do not use an infectious agent (live or killed) so there is no possibility of infection from the vaccine.  They take less time to manufacture (thank god, bc even with this, the rate is so much less than we would like!).  Finally, the immunity will likely be good against multiple strains. 

The next question is who should get vaccines.  In my mind, ALL people should ultimately get them, because that is what will give us enough immunity in the community to let us go back to life without masks and distancing.  Most states have a plan of who will get vaccinated in what order.  I am recommending that ALL of my patients consider the vaccine, as we know that cancer treatment can affect immunity and make people more susceptible.  In many states, supercenters are opening.  You should register on your state’s website, but should also research options in your area – google vaccine supercenter, and sign up on those websites as well.  I also encourage patients to make appointments more than one place, so if an appointment gets cancelled, they have a backup.  BUT PLEASE, once you get a shot, cancel your other appointments so other people can take advantage of them!  Currently, the vaccine is available to all people ages 16 and older.  As there have been EXTREMELY RARE cases of immediate reactions to the vaccine, it is required that you stay for 15 minutes after to be monitored.  As my father and my son both have an significant shellfish allergy, I was a bit worried about an anaphylactic reaction personally.  I will tell you, I stayed in the monitoring area for 30 minutes, and in the parking lot in my car for an additional 30 minutes.  I had a long drive home from the site, and really didn’t want to have a reaction alone in my car on the highway.  Not even a whiff of an issue, but better safe than sorry, right?  There is limited data on the vaccine in preganacy, but that is also a group with worse outcomes if they get Covid-19, so currently, it is up to an individual’s decision – they are not prohibited.  mRNA vaccines are thought to be very safe in pregnancy as they have no live virus and no ability to change DNA in a person.  It has not yet been tested in transplant patients, those with severe immune compromise like HIV.  These are not prohibited, but again, discussion with their doctor is recommended.  I think one of the groups I would have some caution in is those with prior severe cases of Guillan-Barre associated with a vaccine.  It should be noted, though, that to date there have been NO cases of Guillain-Barre syndrome, and they are candidates according to the CDC.  The same with Bell’s Palsy – the rates were the same in trial as regular population, so NOT felt to be due to the vaccine.

OK, my friends, lots of Covid info – hope this is helpful!  If you have questions about your candidacy for the vaccine, reach out to your primary doctor or cancer team.  Let’s kick this virus to the curb and spend at least part of 2021 hugging all of our friends and families!  Stay safe, folks, and I’ll speak with you soon!