Merry Christmas ! I hope you are enjoying a peaceful and restful Christmas. I also hope that you are away from your email. However, when you return to read this week’s newsletter, here are some updates about COVID-19 and the currently available vaccines.
1 Million Vaccinated
As of Dec 23rd, over 1 million people had received the Pfizer or Moderna vaccine. The CDC is tracking covid-19 vaccines given here. The vaccines have been well received as large numbers of healthcare workers continue to show photos of themselves receiving their first dose. As vaccine distribution continues to increase, we expect to see more of the non-healthcare vulnerable population vaccinated.
To date, the CDC has reported 6 allergic reactions to the Pfizer vaccine. None have been fatal. All occurred in the recommended observation window. The CDC recommended these guidelines after two cases occurred in the UK early in their administration process. The recommended CDC time frame for observation after vaccination is 15 min, unless the person has a history of severe allergic reactions in which case it is 30 min.
Currently, the cause of the allergic reactions is unknown. The FDA information sheet for vaccine recipients notes that anyone with a known history of reactions to one of the ingredients should avoid the Pfizer vaccine. Those ingredients include:
- messenger ribonucleic acid (mRNA)
- lipids ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 2 [(polyethylene glycol)-2000]-N,N-ditetradecylacetamide, 1,2-Distearoyl-sn-glycero-3- phosphocholine, and cholesterol)
- potassium chloride
- monobasic potassium phosphate
- sodium chloride
- dibasic sodium phosphate dihydrate
Similarly, the FDA fact sheet for the Moderna vaccine lists the same warning and the following ingredients:
- messenger ribonucleic acid (mRNA)
- lipids (SM-102, polyethylene glycol [PEG] 2000 dimyristoyl glycerol [DMG], cholesterol, and 1,2-distearoyl-sn-glycero-3-phosphocholine [DSPC])
- tromethamine hydrochloride
- acetic acid
- sodium acetate
According to some reports (Science, Reuters, WSJ) , the lipid polyethylene glycol compound (PEG) is speculated to be the culprit. However, further data collection is necessary. The compound is used in other medications and is known to cause rare allergic reactions. One recent case series in the Journal of Allergy and Clinical Immunology reported 5 people with proven PEG allergies who were mistakingly labeled as allergic to multiple medications and products. Also, a recent editorial in the journal Allergy draws a connection between the Pfizer vaccine allergic reactions and PEG, published Dec 2020. The full text can be found here.
False Vaccine Claims
As vaccines become more readily available, many have turned to social media to answer questions about vaccines. Some false claims have surfaced like:
- Vaccines inject tracking devices.
- The formation of “non-neutralizing antibodies” can lead to an exaggerated immune reaction, especially when the person is confronted with the real, “wild” virus after vaccination. This so-called antibody-dependent amplification, ADE, has long been known from experiments with corona vaccines in cats.
- The studies into Covid-19 vaccines are too short to see if there are late effects. There were narcolepsy cases after the swine flu vaccination, and similarly this vaccine could put millions at risk.
- The mRNA vaccines from BioNTech/Pfizer contain polyethylene glycol (PEG). 70% of people develop antibodies against this substance—this means many people can develop allergic, potentially fatal reactions to the vaccination.
- The vaccinations are expected to produce antibodies against spike proteins of SARS-CoV-2. However, spike proteins also contain syncytin-homologous proteins, which are essential for the formation of the placenta in mammals such as humans
Is Your Community At Risk?
The CDC has developed an interesting visual based on 2018 data. It estimates the percentage of people in your county at risk for severe COVID-19 infection based on 5 reported medical conditions:
- Chronic Kidney Disease
- Heart Disease
The visual can be found here and allows you to look up your county by zooming in on its location on a map. You may be surprised how many people in your community are at higher risk of severe COVID-19 infection.
The Coronavirus Mutates
Mutations are expected. This is a normal part of the natural selection process. Viruses accumulate mutations as they undergo replication in the human body. This replication can be thought of as the primary goal of a virus. Viruses like SARS-CoV-2 have tremendous opportunity to accumulate mutations because they infect millions of people. Some of these mutations provide an advantage or disadvantage, and others are meaningless. Mutations that provide an advantage allow for things like easier transmission (more replication), or resistance to the human body’s immune system. Since our bodies have immune systems that are extremely complex, utilizing multiple methods to combat infection, these kinds of mutations are more rare.
SARS-CoV-2 has been shown to have several mutations, some of which are regional. This past week has brought reports of mutations in the U.K., South Africa, and Japan. The U.K. reports resulted in temporary travel bans to Europe. These same reports attributed increasing outbreaks in the U.K. and South Africa to these mutations. Is this accurate?
Truly, it is too soon to tell. More study is needed. There is evidence that some of these mutations might be advantageous, but again this is not surprising. Mutations that are advantageous are expected to be seen, since the disadvantageous mutations result in virus being unable to reproduce (wether due directly to the mutation or due to improved capture by the immune system). Is it possible that mutations may make treatments like antibody infusions useless? Yes, possible. Is it possible that mutations might also make our vaccines useless? Yes, but historically this has taken longer periods of time to occur.
So, we do not panic. But we do continue to study and track.
For more reading:
CDC – Implications of the Emerging SARS-CoV-2 Variant VOC 202012/01
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