Transcription:
COVID-19 Vaccine: What's Important to Know

Caitlin Whyte: If you haven't made up your mind whether or not to get vaccinated, it pays to learn as much as you can to make the best decision for yourself. Indecision or the state of not knowing decreases confidence and creates anxiety. And believe me, no one needs that right now.

So today, we're joined by Dr. Joseph Berg to discuss what you should know before you make your decision whether or not to get vaccinated. He is a family medicine physician at Upland Hills Health Mount Horeb Clinic.

This is the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte. So Dr. Berg, let's first get into some basic information on the vaccine. What kind of technology was involved in developing it? And what does RNA mean?

Joseph Berg, DO: That's a great question. The technology behind it is really cool and actually a pretty old technology. It was originally developed back in the 1970s. It was basically the idea of putting RNA into your body to make something. So some background, a vaccine generally is when we put something into your body. More specifically, most of the time, it's a protein. Proteins are like the building blocks of us, right? What makes up our muscles and our bones and all of our organs and all of our stuff. That's kind of the basic structure, is a protein. So we inject something like that from a virus or a bacteria into our body so that our immune system can take a look at it and say, "Hey, that's not supposed to be here. Let's make some special fighting proteins of our own called antibodies. So that if that comes back, we will recognize it and then quickly defeat it, get rid of it."

So the way that we've usually done that with vaccines is a couple of different ways. But usually, it's creating that protein outside of your body and then injecting it into you and then having your immune system make that response. What's really cool about the new vaccines is we let your own body make those proteins, right?

So again, for more background, RNA is kind of a blueprint for a protein. The blueprint comes from the master copy. That master copy, what has all the instructions for you, is your DNA. That is in the center of your cell in your nucleus, in all of your cells. And that doesn't go anywhere, it doesn't change, it stays stable, right? To make something, your body has to make a template or a copy of your DNA to go out into the cell and to make those special proteins. So it makes RNA which then floats out into your cell. It finds these special machines that then take pieces of protein and kind of puts them all together and then make a protein.

So what these new vaccines are doing is again instead of making the protein outside of your body and then injecting it, it's making these special blueprints, injecting those into your body and then using your cell's own machinery and all the protein parts you already have within inside of you to build that protein in you, and then present it to your immune system.

So it's really, really cool tech that honestly has probably revolutionized vaccine development for the future and will probably be a big part of all vaccines going forward, mostly because it is so easy to do and quick to develop. There are less challenges of, you know, figuring out how to make a protein, keep it stable and then kind of maintain it and then get it to you. There's lots of like workarounds that these big pharmaceutical companies use to develop a vaccine. For example, sometimes they'll take a virus and then they'll modify its genes to make a specific protein in that virus and then inject that virus into you, so that the virus is making the protein that then gets into you.

So with this new vaccine, we're basically cutting out a whole bunch of steps that we maybe needed to do before. And all we need to focus on is, "All right, what's the right RNA sequence, the right sequence for this specific thing we want to target?" We develop it. We make sure it's right. We package it up and then we inject it into you, and then your body does the rest.

Caitlin Whyte: You mentioned that the technology is actually from the '70s, but I know a concern for many is that the vaccine was developed too fast in their opinion. So can you tell us about that timeline, you know, from early COVID to now and how we got this vaccine in just over a year, I think, right?

Joseph Berg, DO: Yeah. There's a couple of things. One, I think it was something that the entire world was focused on, right? I know this is kind of unprecedented in human history, right? You know, we have a large, modern scientific community that has lots of access to technologies that just weren't heard of, you know, back in 2000, which is only 20 years ago or the early 2000s is when we first sequenced the human genome, and that was a huge achievement. Now, you know, we sequence the genome for COVID as soon as we found it, which is amazing. You know, so we have an entire world that is focused on one problem. I think that's one reason why it went so quickly.

Another reason is inherent in the technology itself. Again, MRA has been around since the '70s, but it hasn't been until the last probably five years that it's become more viable for vaccines and use because a couple of really smart scientists made some discoveries. When the injection would go into you with the RNA strand, your body would quickly find out that, "Oh, That's different," and then it would get rid of it right away and it wouldn't be able to do its job.

So what they did was they slightly modified one of the nucleotides, so what the MRA was made out of, like put a little hat on it kind of, to be oversimplified, so that your immune system kind of let's it have a little bit of a pass. It still gets rid of some of it, but most of the time it lets it go and do its work this time. So that's been in the last, I think it's been five years, but I'm probably wrong. And it was used to help develop an Ebola vaccine, the technology was. So that was a kind of a quick development.

So there's several reasons, right? There's the world working on it. There's the technology itself. And then there's what most governments did was they put tons of money into getting this vaccine ready and they developed the vaccine kind of in parallel, like all at once, instead of like step-wise. So usually, when you're developing a vaccine, you figure out what you want to do, you figure out how to manufacture it and make it, you make some of it, you go do some clinical trials, then you're like, "Okay, it works. We're going to submit it to the FDA," the FDA approves it. Then you ramp up production, right? You get all the vials and the reagents and you make a whole bunch of the stuff and then you deploy it.

But we did that kind of all at once, right? So they're like, "Yep. This is the technology. We're going to start making it right now. We're going to get all this stuff ready and ramped up because we think it's going to work. We're going to get the pipelines. We're going to get everything going." So that's another big reason, is that operation warp speed that was maybe heard of a year ago when this was kind of getting going, was an effort to do all the steps at once so that when the vaccine did work, we could quickly get it out to everybody.

Caitlin Whyte: Well, that all makes sense, of course. Just doing it as fast as possible with the whole world focusing on it is a good point. So now that we have the vaccine and people have been getting it for about half a year, let's dive into those side effects. I know when I got my second shot, I was on the couch for a day. While my boyfriend, he felt completely fine after his second dose. So can you talk to us about the side effects that some of us are experiencing when we get that second vaccine and why?

Joseph Berg, DO: Sure. So it's like any vaccine, your vaccine is made to create an immune response. It's supposed to stimulate it so that it makes a whole bunch of antibodies. And if you get infected, that either isn't a big deal or you don't get infected at all, right? I mean, the large vast majority of side effects are mild, right? What you described, some muscle aches, a sore arm, a headache, fever, you know, the occasional vomiting and that's mostly it, 90%, higher than 90%. We'll just put it that the vast majority of people have very rare side effects.

There are lots of other side effects that have been like more highly reported in the media. And I think most of it is because, again, everybody's focusing on COVID for a good reason, but also to its detriment. So they're focusing on not just the effectiveness, but some of the side effects. And, you know, we can just highlight a couple and just so you can put these into context. Most of these like more severe side effects are super, super, super rare and aren't going to be a problem for you.

So one that you've maybe seen a lot of is myoarditis. Myocarditis is inflammation of the heart muscle, and this is a rare thing in the community, but it does happen most of the time with some type of viral infection. So if you get, you know, the flu or another virus that can cause just a respiratory infection, that can get all the way to your heart and cause inflammation of the muscle. That causes chest pain and shortness of breath and most of the time is mild and resolves on its own. And all we need to do is to take some ibuprofen and then you recover fully and it's no big deal, right? Just like if you had sprained a muscle, that can happen to your heart. Again, most of the time, it's mild and no big deal.

If you look at data for all causes of myocarditis, it's about nine per 100,000 and probably less than that. But the study that I was looking at said about nine per a hundred thousand in one population. And that includes vaccination. Actually in vaccination, I read two other studies where they looked at different populations of people and one population was two in a hundred thousand and then another was like 12 in a hundred thousand and it was based on age, but very low. So think of on average, like nine to 10 per a hundred thousand people get myocarditis.

If you get COVID-19, the virus, that is much, much higher, that's 150 per a hundred thousand. So everybody's freaking out because a few people have gotten myocarditis. And yeah, there's an increased risk of getting myocarditis if you get the vaccine, very, very small. Again, 10 per a hundred thousand. But if you get the infection, that's 15 times worse risk, so 150 per a hundred thousand. So the headlines are focused on a rare side effect just because it is kind of what's on everybody's lips right now, but it's super, super rare. And if you get COVID, it's much more common, you know, you would much rather want to prevent infection to prevent myocarditis than not get the vaccine to prevent myocarditis.

Another one we hear about, especially in like young women, is concerns about infertility. They're worried that if they get the vaccine, there'll be some kind of cross reaction that will affect their ability to get pregnant. And this has been studied extensively because there is a theoretical risk. In at least the Pfizer vaccine, there is. Proteins are just kind of a sequence of other molecules kind of linked together, right? It's like a chain of stuff. And how the chains fit together and fold is what makes a protein different in different people, but they're all made up of the basic building blocks.

And in that spike, what the vaccine is made out of, there's like a short run of those building blocks that looks kind of similar. The short run means like, I don't know, I'm not completely sure as to number, but it's like 12, right? Twelve building blocks that will correlate to a protein that's very important for your placenta. The placenta is kind of the interface between mom and baby. It like takes what's in mom and then gives it to baby like oxygen and sugar and everything that the baby needs to live inside of you, kind of filters through the placenta. So if the placenta isn't made or there's a problem with it, you know, the baby will die and you won't be able to get pregnant, right?

So again, there's like this short little sequence in that spike. That is the same as that short little run in this other protein that's involved in the placenta. So if your body makes an immune response to this little piece, it could also make an immune response to that little piece and then that could theoretically cross-react and then cause a problem.

This is a phenomenon we see in other illnesses, but those other illnesses are like actual whole proteins, like hundreds and hundreds of pieces that are cross-reactive that cause a problem. So this short little piece is not significant. There are antibodies to all those other little pieces. And when we look at the data, when we say, "Okay, let's see, who's gotten the vaccine and who hasn't gotten the vaccine, and let's look at pregnancy rates. Who has gotten pregnant and who's not gotten pregnant?" And the numbers are the same. So if you got a vaccine or you didn't get a vaccine, the same number of people are getting pregnant. So there is obviously no change in infertility and it's not been just like one place has looked at this, like so many places, so many countries and organizations have looked at this and it's over and over and over again. There is no change in fertility for both men and women. And there's actually been studies that if you get COVID in women and in men, it can actually impair your fertility more and cause problems. So if you're trying to get pregnant, don't get COVID and don't worry about getting a shot because it doesn't have any bearing on if you will get pregnant or not.

Caitlin Whyte: Love it. Okay. Good to know. Now, it seems to me that there's like three main types of prevention that have been talked about when it comes to COVID-19, right? So we have the vaccine that we've been discussing. Masks have been big and mandatory in some places over the last couple of years. And then there's even this idea of herd immunity, like if enough of us get and recover from COVID, that'll bring us to this kind of place that we're hoping for as a society. So can you kind of just go over each of these methods, the pros and cons of each and maybe which one you think is the best in the end?

Joseph Berg, DO: So ultimately, it's going to be a mix of all three. You know, herd immunity is the thought that if enough people get an infection, it will be more difficult for the infection to circulate in the community because it will infect one person, but then there'll be enough people that have been either had it or been vaccinated that there's nobody else to infect around it. And so that's the only person that gets it and then it quickly goes away. Usually, we can think about this in like other older infections, like measles and mumps as most people are vaccinating against measles or mumps. So if you see measles in the community, it's likely only going to be a few or handful of people that get it because everyone else is vaccinated, so it won't keep spreading.

Is that attainable for COVID-19? Honestly right now, I don't think so for several reasons. Most notably is that the virus changes. It is an art. It's kind of like flu, not exactly like flu, but kind of like flu. It's an RNA virus. You know, we already talked about DNA versus RNA. Remember DNA is very stable. It doesn't change. It stays the same. You know, your DNA even has like proofreading mechanisms to it and protection. It's in a special spot. So DNA again, it doesn't change. RNA, it can, right? There can be mistakes. It's floating around in the cell. It's not as stable. It goes away.

So COVID or the coronavirus is an RNA virus. When it's made in your cell, that's kinda what it does, it gets in you, it replicates itself and then it breaks out. When it gets in you, it makes a whole, whole bunch of copies, kind of a majority of those that don't work because they were made with the wrong piece here or the wrong piece there or whole sections are missing. So there's lots of mistakes in the RNA, but some of those mistakes are actually helpful. And if you infect enough people over enough period of time, those mistakes make it easier for the virus to get into your cell or to make you sicker or maybe even make you less sick so that you get sicker for longer and you spread it.

So we've heard about the variants and that's what's been happening. This RNA virus has changed and become easier to get into you and last longer, and has maybe even evaded some of the vaccines. So, will we get to herd immunity right now? I don't think so. So it's going to take a mix of natural infection, vaccine and, you know, those non-vaccine or infection methods like masking and social distancing and quarantining to eventually get to a place where this virus isn't ruling our lives.

The vaccine is really good at two things. One, preventing infection, you know, if you get two Modernas or two Pfizers in a row, as you're supposed to, you'll reduce your risk of infection by like 90%, which is really good. If you get the Johnson & Johnson, it's less. But it's still something. So one, it reduces the risk of infection.

The other thing it does is it significantly reduces your risk of a severe infection, hospitalization, and death. It basically takes what could kill you and makes it into a cold or even a flu where you have the sniffles a few days or a cough or maybe some muscle aches and a fever, but you get better very quickly and then you get back to your life, which happens when you get a cold. So take away the spread of infection. I try to focus on, "Hey, you get the vaccine. You're not going to die. The chance of death is 0.001% or something very, very, very low for most people. If you're old and have lots of illnesses, you know, you could get this and die. But if you're old and have lots of illnesses, you can get the flu and die. You can get a cold and die. So it takes this virus and it makes it not a big deal.

Natural infection does something similar, but you have to have the infection, right? And so, you know, again, if you've not been vaccinated and you get sick, I think the majority of people again are going to be fine. But if you're over 65, if you have high blood pressure or diabetes or asthma or some kind of other medical problem, you have not a zero risk of getting really sick, having to be in the hospital, which sucks, but you could live through that, but then that would cause a lot of, you know, that costs money, that makes you lose time at work, or, you know, heaven forbid, you could get really sick and die. And it takes all kinds. It's a new infection, so if you haven't had it and you get it, it's not 100% that it's going to be no big deal even if you're 31 and healthy or you're otherwise well.

So vaccine is probably best because it prevents infection in the first place so that you don't get sick. You don't possibly go in the hospital and die or have some kind of long-term consequence where you can't smell or taste for months where you have terrible fatigue for months and months, all of those things. You know, kind of a second best is to get infected and survive, hopefully not to die or have some severe consequence of that infection. And then kind of the last thing is to prevent spread without those things by masking, by socially distancing and quarantining if you're sick. Those things aren't as good, of course, as a vaccine or infection, but they do work.

And, you know, we see this in kind of the patterns of infection across this pandemic. You know, if you like watch the news or look at data, you'll see like one part of the country has been masking and doing really well. And then their numbers go down and they're like, "All right, well, we're going to relax our mask mandate" or "We're going to let people go back to, you know, normal life." and then you slowly see the numbers come back and then they go back to masking and then it comes down, then it goes up. It's kind of up and down. And there's countless examples of that.

So masking and social distancing and closing things and making those changes does work, it just sucks and everybody's kind of sick of it. And I understand, I don't love wearing a mask all the time at work. But it's kind of how it goes right now and you got to just kind of do it, you know, not just for you, but for people that you love and to be a good member of society.

Caitlin Whyte: Yeah. I mean, that's something that I still have to remind myself day to day. You know, this isn't just about me or even my family and friends. It's about people I don't know in my community, people with those comorbidities and just about making society a safe place for everyone.

Joseph Berg, DO: Yeah. I mean, that's maybe more in the top of like my mind, because it's, kind of my job, right? Is to think about what's best for not only the person sitting across from me when I'm seeing a patient, but for their family, for my community, for my hospital system, for my family. So it's more like in the front of my mind. And I think a lot of people have kind of lost that, and not for any fault of theirs, but you know, it's been a year and a half or longer now of thinking about everybody else, right? Of making changes to your life, to protect people that you probably will never see or know. So I get the fatigue, I get the angst. But, you know, it does make a difference.

Caitlin Whyte: So doctor, wrapping up here, what do you think the future of COVID-19 vaccination will be? I know right now we're seeing certain populations get booster shots. What should we be expecting looking ahead?

Joseph Berg, DO: So I think looking ahead, eventually COVID-19, like we talked about is going to keep changing and keep coming back. It's my thought. And I think some of the science supports this, is that it will be an endemic virus, meaning it's just always going to be around kind of like the flu. And every year, a new variant will come up and it'll start circulating around the planet and vaccine makers will do their best to pick the one that's the worst and create a new vaccine for it, and we'll get a booster probably every-- I mean, I can't put a number on it, but maybe every year like the flu and that's my thought, is that eventually we'll just get a combination COVID flu shot or, you know, something like that, because again, it's that RNA virus that it keeps changing and becoming new and finding better ways to infect you and so we got to kind of keep on top of it and keep getting repeat vaccinations, which, you know, as time goes on and people continue to see like, "Hey, yeah, these vaccines work. They're super safe. They're very effective," there'll be less resistance to getting the vaccine in general because it's such a good vaccine. It's really, really cool technology.

And I mean, again, I think this is going to be all vaccines going forward. It's going to really revolutionize it and we're going to get more and more mRNA-type technology in our vaccines and maybe even drugs and therapies. And now that we've seen that it works well and these companies have gotten a windfall from, you know, huge vaccine orders, they'll be able to invest in other areas of health and maybe revolutionize cancer treatment, and I think they've been trying that, but, you know, you never know.

Caitlin Whyte: Yeah. Yeah, exactly. With all this research, you know, something else good will most likely come of it it seems, even more than it already has.

Joseph Berg, DO: Right. And maybe this trial run will, you know, make it so if something like this happens again, you know, we can quickly identify a pathogen, like a virus, and then we can quickly make a new mRNA vaccine. We'll have like a pipeline where we can quickly deploy it and get people vaccinated right away to prevent terrible infection and death, you know?

Think about this. This pandemic has been mostly a pandemic of older adults. Everybody gets it and can get pretty sick, but the majority of people that have been dying have been older adults. If we look back at like the 1918, the flu pandemic many, many years ago, that was young people dying. That was 20-year-olds and 30-year-olds that would get it and quickly die. Now they probably wouldn't have died at larger numbers with modern technology, but, you know, if we had a huge influx of young people coming to hospitals, they'll again get overwhelmed and have lots of problems like we did this time.

So again, imagine if the next pandemic is a pandemic of young people, that would be a big deal and having something in place, you know, having this technology already here and tried and true and recognized and accepted is going to go a long way into preventing that huge, terrible pandemic from happening again. I didn't think I'd ever see a pandemic in my lifetime. This was not how I thought my practice would go.

Caitlin Whyte: Well, thank you so much, doctor. This is such a hot conversation right now, but it's always reassuring to hear the facts from a trusted source.

But if this conversation has still not laid your concerns to rest or if it hasn't addressed your specific health situation or question, it's always important to talk to your doctor.

You can find more about Dr. Joseph Berg and how to make an appointment with him and all of Upland Hills Health family medicine physicians at uplandhillshealth.org. This has been the Inspire Health Podcast from Upland Hills Health. I'm Caitlin Whyte. Stay well.