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Bill Klaproth (Host): We've all been living in a pandemic since March and after months of development, a COVID vaccine is now being distributed to the public, but there are many questions surrounding this vaccine. So, here to answer some of them is Dr. Helen Jacoby, Medical Director of Infectious Disease at St. Joseph's Health. Dr. Jacoby, thank you so much for your time. It is great to talk with you. So, first off, why should people get the COVID vaccine?

Helen Jacoby, MD (Guest): Well, that's a pretty straightforward answer. People should get COVID vaccine to avoid becoming ill with COVID, and to avoid transmitting illness to others. I would add, as a society, if we get enough people vaccinated against COVID-19, the virus will become dramatically less common. And we'll all be able to get back to our normal lives that we miss.

Host: So, if we achieve that level of vaccination, if you will, or inoculation, in the coming years, this could be like the flu. It will be out there, but it'll be tamped down basically to where it's not disrupting everyday life. Is that good way to look at it?

Dr. Jacoby: Exactly. I think that's the goal. We don't really think that we will make it disappear from the earth, but, if enough people have immunity, the virus won't have as many places to go. It won't be able to transmit itself as easily. And so, it'll become one of those background illnesses that we know people can get as you say, like the flu. But where we don't have a lot of seriously ill people and life returns to normal. So, that's the goal and getting everybody immunized gets us there much faster than if we just let the natural course of the illness take place.

Host: And we're seeing how that's wreaking havoc right now on our country and around the world, quite frankly.

Dr. Jacoby: Well, exactly. We're getting so many people who are dying needlessly. And our healthcare systems are being dramatically impacted. So, exactly, we can't let just everybody get infected and become immune that way. The vaccine is a much, much safer and faster way to do it.

Host: Right. And well, speaking of safety, there are questions though. People think, hey, this thing was rushed. How do I know what's in this thing? So, there is a big question. Is the vaccine safe?

Dr. Jacoby: I absolutely think the vaccine is safe. It was brought out quickly, but I will say that the rush was the right kind of rush, not the wrong kind. So, the usual safety protocols happened in these studies, all the correct things were monitored. I will tell you upfront that I was actually a volunteer in one of the trials that I thought that everything was being done very appropriately. They've collected safety data on tens of thousands of participants in the Moderna and Pfizer vaccine trials. Those are the two vaccines that are currently available in the United States. What was rushed was the companies went ahead and started producing the vaccine even before they knew that they would have official approval, so that they'd have it all ready to go when the time came. People worked day and night to get the trials going. And I should say in terms of the technology, this mRNA technology that's being used in the current vaccines has been being studied for over a decade. So, the technology was kind of ready to go and waiting for a virus for us to use it on. So that things happened fast, but that's what you want in a situation like this. And I don't think safety protocols were bypassed.

Host: Right. That's a really good point. This mRNA technology has been in the works for a long time. So, it isn't like hey, it's something new we're trying. It's been out there and from the people I talked to this mRNA technology really is going to change the way we develop vaccines in the future.

Dr. Jacoby: Yes, that's correct. So, this is the first mRNA vaccine that's been put into general use, the two of the Pfizer and the Moderna, but you have to start somewhere. And again, it's been in the works, as you say, for a very long time. And this is the right place to start using it.

Host: Absolutely. And as you said before, we need this to develop that herd immunity, if you will. So, this is another big question about women that are pregnant or nursing. Can women be vaccinated if they are pregnant or nursing?

Dr. Jacoby: We recommended that they go ahead and get the vaccine and that's something that's also recommended by the American College of OB GYN and I believe the American Academy of Pediatrics. Although pregnant and nursing women were not in the clinical trials and I need to put that out there because you know, nothing is studied first in pregnant women. There is really no biological reason to think why the vaccine would be an issue in pregnancy and nursing. And we have to remember that pregnant women are at increased risk of serious complications from COVID. By not getting vaccinated, a woman puts yourself at risk of actually getting COVID during her pregnancy or around the time of delivery and that itself is a risky situation.

Host: Right. And this particular vaccination, both the Pfizer and the Moderna is a two dose vaccination. Does everyone need to receive the second dose of the vaccination?

Dr. Jacoby: They really should. The statistics of the vaccines being 94 to 95% effective in preventing symptomatic illness, those are based on people who got two doses. And the data I've seen from the studies is that after one dose there was some protection. No significant protection, but it wasn't anything like that 94 to 95% protection. If people can get two doses, they should get two doses. I mean, that should be our goal.

Host: Yeah, that second dose apparently really kicks it in.

Dr. Jacoby: It does. And I will tell you, people do get more side effects with the second dose, I think because this vaccine is very effective at ramping up the immune system against COVID. I mean, honestly, we may find that mRNA vaccines are much more effective than the kinds of vaccines we've had in the past. That's kind of my hope. Because it's rare to find a vaccine that has this level of effectiveness that these two have quoted. But yeah, the side effects can be significant after the second dose.

Host: And then how long after receiving the vaccine, will people be immune? This is another big question and hard to answer, I guess we really don't know, but what do you think?

Dr. Jacoby: We think after let's say two or three weeks, they should have the full level of immunity. And I suspect that the people running the trials have more data on that. I know they have been measuring people's antibody levels and the trials are going on actually for two years to monitor the participants in terms of, how long the immunity lasts and so on. But I would say within two or three weeks of the second dose, people should have the full immunity. And some immunity probably starts within a couple of weeks of the first dose.

Host: Okay. That's really, really good to know. So, then I'm hearing certain things that, almost like the flu people are saying, you know, gosh, will it give me COVID-19 like people are afraid to get the flu shot because they think it gives them the flu when it doesn't. So, will the vaccine give people COVID-19 or shed the virus.

Dr. Jacoby: No, the vaccine cannot give you COVID-19. And I will also say the flu vaccine cannot give you the flu. That's a misconception. I mean both vaccines can ramp up your immune system and make you feel a little bit like you have a viral infection. But, they can't give you the actual virus. The way, this mRNA vaccine works, is it basically instructs your body to make the little spike proteins that stick off the outside of the COVID virus that you see in pictures. And you'd make, your body makes those little spike proteins and then makes antibodies against the spike proteins. But the vaccine doesn't include the whole virus or RNA for the whole virus. It would be completely impossible for it to give you the actual virus, it just couldn't happen.

Host: Right. It's not like the flu shot where it can be a dead virus that they're actually.

Dr. Jacoby: Right. It's not a dead virus, But I want people to know for sure that the flu vaccine also cannot give you the flu virus at least the standard injection. But this is even more far removed from a whole virus, because as I said, it's only mRNA for the spike protein. It doesn't contain any other component of the COVID virus.

Host: Right. So, really good to know, the vaccine will not give you COVID-19. And speaking of the flu, since we touched on it, the flu shot cannot give you the flu. That's it's a big hurdle that we have to go through every fall in this country it seems like. And then, everybody's human with this. Once they get the vaccine, people are probably going to be like, woohoo, let’s go. I mean, do people still need to follow safety protocols after they get the vaccine?

Dr. Jacoby: Yeah, they do, for the time being. There's a few reasons for that. One is that for a long time, people who have been immunized are going to be in the minority and if people start seeing people running around without masks on and behaving differently, suddenly we have a society where people aren't all following the same protocols, people get suspicious of each other. They wonder who's safe who isn't. How do you know who's been vaccinated, who hasn't? So, there's just a practical aspect there. The second is that although we know that the vaccine is very good at preventing symptomatic illness, we don't know as much about what it does to prevent asymptomatic illness or possibly being temporarily colonized with the virus when you're exposed to it without being sick, but could you still pass the virus to somebody else? If that makes sense. So, we don't know for sure if it prevents asymptomatic illness. And that's probably the most important reason that people need it for now, keep wearing masks to keep social distancing.

Host: Absolutely these silent carriers or what's are extremely problematic because you don't know, somebody can feel fine and look normal and here they are, shedding the virus. Is that the right term or it’s -?

Dr. Jacoby: That's the correct term. And the estimates I've seen are that at least half of transmissions of COVID, are from people who are asymptomatic. Again, I hope that vaccinated people will not be able to spread the virus to others if they're exposed, but we don't have those kinds of data yet. And so, until we know that, people should follow the same protocols.

Host: So, once we reach that level of herd immunity, if you will, where 60, 70, 80% of the American population has been vaccinated, our medical professionals will start to tell us, okay, it's time, you don't have to necessarily wear masks in these certain situations, but you may still need to wear a mask if you're in a crowded area. I mean, we'll get that guidance as we go along. Is that how it's gonna work?

Dr. Jacoby: Oh, I'm sure that's how it'll work. Much as we did, let's say this past summer with kind of gradually opening up. Okay. Now, you know, before you could have - yeah, exactly. So, I'm imagining that there will be phases. You know, restaurants will be allowed to open, but with limited capacity and then gradually more people at a table and indoor gatherings can have more people. And we're doing this for the first time, we, as a society, but that's exactly what medical professionals will recommend. And as long as rates stay low, then we can start doing more and more and more things.

Host: Right. So true and we all need to follow the guidance too. If we all did that, we'd be in a much better place right now. And then with that, at that point, people can then start to travel as well, right? Once these, as you said, it'll probably be in phases, and the restriction levels go down. People will get to resume normal life in increments as we go along until we get back to normal after this.

Dr. Jacoby: Yeah, I see it as a process of we monitor the rates and as it people get immunized, and continue to practice safe behaviors, the rates will go down. And as the COVID rates drop lower and lower and lower, then every individual activity is less risky for you. So, it's not so much a matter of I've been immunized, so I can do all these different things and you haven't, so you can't, it's a matter as a society of getting everybody immunized, so, the whole society's rates go down so that it's not as much a threat to anybody.

Host: Right. Great point. Well, that's a great place to leave it. Dr. Jacoby, thank you so much. This has really been informative and helpful as we all kind of navigate our way through this. So thank you so much for your time. We really appreciate it.

Dr. Jacoby: Well, you're very welcome. I'm glad I could help.

Host: That's Dr. Helen Jacoby. And you can find up to date information on the hospital This email address is being protected from spambots. You need JavaScript enabled to view it./coronavirus. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library of topics of interest to you. This is St. Joseph's Health Medcast from St. Joseph's Health. I'm Bill Klaproth. Thanks for listening.