CHICAGO — When someone gets a vaccine, how long will it take to become effective? What happens when groups of people are approved to be vaccinated? Are experts concerned about long-term safety? These are some of the many questions readers sent us that we’ve put to health and science experts.
Q. How long does it take before the vaccine is effective in the body?
A. The vaccine starts to work right away within the body, said University of Chicago Medicine infectious diseases expert Dr. Emily Landon. In a Chicago Tribune Facebook Live, Landon explained how it signals our immune system: “We create molecules that have our body make the proteins that basically act like a wanted poster for your immune system. They say, ‘This is what you’re looking for. When you find this, kill it.’”
Although the vaccine starts to work right away, how long it takes until you’re immune or able to fight off the disease is hard to say. Landon said with the Pfizer vaccine, about half of the time, data showed people had antibodies a few weeks after getting the vaccine. Researchers are still learning about how long this might protect people.
According to the Centers for Disease Control and Prevention, it typically takes a few weeks for the body to provide protection, so it is possible that a person could be infected and become sick with COVID-19 just before or just after vaccination.
Q. What will distribution of the vaccine look like?
A. The first thing to understand, Landon said, is “it’s not a single-file line.” Rather, when the vaccine is released to approved populations, it will be groups of people that are first priority, second priority, third priority.
“It’s not like Southwest boarding, it’s more like United boarding,” Landon said.
Groups of people will be able to get vaccines all at the same time. And this is important to understand because there might not be enough vaccines for everyone in those groups on the first day a group is able to be vaccinated. So there might be some waiting, but, Landon added, “It doesn’t matter too much in the grand scheme of things if you get vaccinated this Wednesday or next Wednesday.”
She added that you don’t have to go when your group is called. You can wait until the next group, if you still have some concerns about some aspects of the vaccine. For example, some people who are pregnant are assessing whether to get a vaccine. Landon won’t wait. “I am raring to go. I am signing up right away for my first time.”
Q. Given the speed with which these vaccines were developed and tested, what long-term safety concerns, if any, do you have?
A. Landon emphasized that there aren’t long-term consequences of other vaccines we already know more about. And for any issues that vaccines can cause, “They start upfront. They don’t start 10 years later.” So with the data we already have, we should have a good sense of what to expect.
“The short-term problems are all mild,” she said. “They may not feel awesome to you, because you have a pretty bad headache and you may feel really tired afterwards. But that is way better than having COVID.”
Headaches can be expected after the vaccine, she said, but with most people it goes away with Tylenol and within 24 hours, she said.
Q. What should people with allergies know about the Pfizer vaccine, now that British regulators are investigating 2 possible allergic reactions?
A. First, don’t panic, says Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center and former board member at the Infectious Diseases Society of America. The recent news of possible allergic reactions is “a bit of a surprise,” he said, as this did not occur during Pfizer’s clinical trials. But varying things can happen after a person is vaccinated — we are, after all, giving them to many different people.
The system is working as it should, he said. Experts have detected this issue, and British officials are going to investigate further. “And they’ve said in the meantime, all you folks who have had allergies to other things, stand aside for the moment, and we’ll call you when we’re comfortable with this,” Schaffner said.
Q. If someone has already had COVID-19, could they still get the vaccine?
A. Yes, Schaffner said. In fact, experts hope the vaccine will offer even more robust protection than whatever protection someone gets from the infection itself. “If you’ve had COVID before, that’s OK,” he said. “You’re not going to have a more severe reaction to the vaccine or anything like that.”
Q. How long will the vaccine give people protection from COVID-19?
A. It’s hard to say, Schaffner said, and he knows this might be an unsatisfactory response. He, too, is eager to find out. “Just as soon as we start vaccinating a large number of people that will be assessed, and we’ll just have to stay tuned for further information down the road,” he said. He would not offer any estimate, saying this is a new vaccine and a distinctive virus, and more data is needed.
Q. Should pregnant women get a COVID-19 vaccine? What about women considering pregnancy?
A. Pregnant women are commonly excluded from research, and have not been included so far in clinical trials for the coronavirus vaccine, despite groups like the American College of Obstetricians and Gynecologists calling for their inclusion. This is an issue, said Dr. Kathleen Neuzil, co-director of the National Institutes of Health’s COVID-19 Prevention Network, as many in the health care field are women.
A Society for Maternal-Fetal Medicine statement recommended that health care workers be offered the vaccine if pregnant, and that in general, pregnant women should have access to vaccines in future vaccine campaigns.
Dr. Emily Miller, assistant professor in the Division of Maternal-Fetal Medicine at Northwestern Medicine’s Feinberg School of Medicine, said unknowns have to be “balanced against the risk of not getting the vaccine, which is the risk of acquisition of (COVID-19), which has concrete and well-documented risks. ... Through that lens, if we can remember that there is no zero-risk option, then the balance at this point favors receiving the vaccine.”
Women considering becoming pregnant will similarly have no available information on pregnancy after getting the vaccine. Miller said she will be watching closely to see if the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices offers any pregnancy-specific guidance. She encourages patients to discuss their options with their health care provider.
Q. Does alcohol compromise the immune system? If so, should people limit or stop drinking during the pandemic?
A. The Zoom happy hours have added up. With Thanksgiving in our rearview mirror and more holidays on the horizon, opportunities for drinking are all around us.
The full impact of COVID-19 on alcohol use is not yet known, but rates of alcohol usage have been rising during the pandemic. According to the World Health Organization, alcohol compromises the body’s immune system and increases the risk of adverse health outcomes. The organization suggests people minimize their alcohol consumption — particularly during the pandemic. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has issued communications warning people to avoid excessive drinking.
According to NIAAA Director George Koob, people who choose to consume alcohol should follow the U.S. Dietary Guidelines.
“A person’s pattern of alcohol consumption can have an impact on health,” he said. “The current 2015-2020 guidelines suggest limiting drinks to up to one drink per day for women or two drinks per day for men. Having one drink per day is not the same as having seven drinks all at once in a single day. It’s best to spread them out as recommended in the guidelines.”
Q. Need to get tested for COVID-19 during the post-Thanksgiving rush? Here’s how to find the most convenient and affordable options.
A. Health officials say that if you traveled for the Thanksgiving holiday, you should be tested for COVID-19.
To get the most convenient, affordable and reliable COVID-19 test possible:
Start with your primary care doctor; many doctors offer in-office testing. If you don’t have a doctor who does testing, then rapid testing, in-home testing or drive-thru testing are options. If an option is not affordable enough or closed to you due to restrictions, try crowdsourcing information to get up-to-date information about local testing sites, appointment availability, cost and wait times.
Looking for a rapid test with same-day results? Those tests are best for people who actually have COVID-19 symptoms, said Heather Keirnan, a nurse and vice president of operations for Northwestern Medicine Immediate Care. If you don’t have symptoms, the PCR test, which can detect very small amounts of the coronavirus, is a better choice, she said.
For those who care more about convenience than cost, private clinics offer shorter waits. Many require upfront payments of $175 to $300. If you want to submit a claim to your insurance company, check the rules for coverage. Your insurer may require that you are referred for testing by a doctor.
Q. Is it OK to travel if you’re in good health?
A. In a Nov. 19 “What The Health?” podcast from Kaiser Health News, Dr. Anthony Fauci said traveling “depends on your individual circumstances,” and that, “If you’re a 25-year-old person who has absolutely no underlying conditions, that’s much different than a 75-year-old person, a woman who’s on chemotherapy for breast cancer.”
Is it OK to travel if you don’t have any co-morbidities, and is it possible to do so safely? The short answer is no, according to Dr. Gregory Poland, professor of medicine and infectious diseases at the Mayo Clinic.
“It’s not a good idea,” said Poland, who is also director of the Mayo Vaccine Research Group. “What (Dr. Fauci) meant when he said that was your individual risk. But that’s only one side of the coin.
“The other side of the coin is the more times you bring more people together, the greater the risk for super spreader and transmissibility,” he continued. “So that healthy 22-year-old may have an upper respiratory mild symptom, or no symptoms at all, and yet can spread the virus to the people he walks by, or sits next to, or in that airplane with him. So it actually does add risk.”
Poland predicts that there’s going to be a “continued exponential increase” in COVID-19 cases, followed by increases in hospitalizations and deaths, he said. “So it makes absolutely no sense to be traveling right now — unless you have no possible alternative.”
Q. What about driving, instead of taking a train or plane?
A. To some degree, that does cut down on exposure, as it decreases the number of people you’ll encounter and who will encounter you, Poland said. Yet, the current surge stems from small gatherings, he said.
“Here’s what’s driving a lot of this current surge: It is this seemingly deceptively safe family gatherings and small group gatherings,” Poland said. “So when your relatives drive a day or two to come and see you, now both of you are trading whomever you’ve been in contact with at school, work, church (or) whatever it might be, and so you’re just giving more and more opportunity.”
Suppose everyone quarantines for two weeks before driving?
“The real question is: What could we do to be absolutely sure we’re not going to get infected or infect other people?” proposed Poland.
He set up a hypothetical scenario in which driving and quarantining could work, but acknowledged it’s a situation most people wouldn’t adhere to.
“You would drive, you would quarantine — as you say — the two weeks before,” he said. “You might even get a test to be sure that even though you’re asymptomatic, that you’re not infected. You would then drive without staying in a hotel or going to restaurants. You’d have a procedure for how you’d get gas and go to the bathroom.”
Once you arrived, you’d ideally not stay in the same house as other family members, or at least sleep on different floors, he said. When sharing common areas, everyone would wear masks and maintain their distance. Meals would have be to eaten in separate rooms.
“So do you really want to do all that?” Poland asked. “Or do you want to say, like our family is saying, ‘We’re really thankful that everybody’s in good health, and we want everybody to stay healthy’?”
Q. I tested positive. I isolated. Now what?
A. Once all symptoms are gone, people can return to work and be with others 10 days after testing positive, said Mercedes Carnethon, vice chair of preventive medicine at Northwestern University Feinberg School of Medicine. A negative test isn’t needed, unless someone’s workplace or school requires it.
If people test positive, they should isolate themselves immediately, said Robert Citronberg, Advocate Aurora Health’s executive medical director of infectious disease and prevention. Isolate for 10 days from the onset of symptoms. If someone tested positive but never had symptoms, they should isolate 10 days from the date of the positive test.
Here’s the good news: those who test positive can still go outside. “Truthfully, if you’re cooped up inside your house for 10 days you may go a little stir crazy,” Citronberg said. They should wear a mask and avoid being close to people, but it’s OK to get some fresh air.
What can college students do to best protect themselves and their families when they come home for the holidays?
Colleges are tightening protocols ahead of Thanksgiving, including things like requiring students to take a COVID-19 test before leaving campus.
No matter what students do, it won’t be without risk, Citronberg said. If any family members at home are high risk, students should be especially cautious. He recommends two layers of testing — one test before leaving campus and another three days after returning home.
Here’s what he acknowledged will be the tough part: Until you have passed the 14-day incubation period, everyone should remain masked inside the home except while eating. Families should try to eat separately. He recommends remaining masked until 14 days after the student last had other social contact.
“This is awkward,” he said. “It’s not something people are used to when kids come home.”
Most importantly, college students should be limiting their social gatherings now. “Every day you do that will decrease your chances of having infection,” he said.
Q. I isolated for 14 days before seeing family. Is that enough?
A. Citronberg said if people isolate themselves for 14 days and do not experience symptoms, that should be fine, even without a test.
Northwestern Medicine pulmonologist and critical care physician John Coleman said people often plan to isolate for two weeks in order to feel secure in visiting loved ones.
“But in my experience, this degree of caution doesn’t happen,” he said. “The minute you leave the house, even just for a coffee or gas, that invalidates the quarantine.”
Q. Should a vaccine be mandated?
A. Chicago’s health commissioner Allison Arwady recently said there likely won’t be enough doses of the vaccine to go around when it first becomes available.
Q. But eventually, should a vaccine be mandated?
A. It might be mandated for people at high risk, but likely not for the general population, said Tina Tan, pediatric infectious disease physician at the Feinberg School of Medicine. She noted there is not enough information about how these vaccines might impact children or pregnant women, for example, who have not been included in trials.
“The vaccines can be strongly recommended but (it) probably would not be a good idea to mandate their use,” she said.
Lori Post, director of Northwestern’s Buehler Center for Health Policy and Economics, said vaccines can sicken people with some autoimmune disorders, and there is little information on adverse effects at this point.
“Better strategies than a blanket vaccine mandate would be to prohibit children from attending schools or universities, employees from presenting to the office or block people from group events who are unvaccinated,” she said.
Q. Pfizer says its COVID-19 vaccine may be 90% effective. The vaccine uses genetic code that trains the immune system to recognize the spiked protein on the surface of the virus. How does it work?
A. Pfizer Inc.’s Nov. 9 announcement comes on the heels of the pandemic having killed almost a quarter-million people in the United States, according to The Associated Press. Dr. Anthony Fauci, the U.S. government’s top infectious-disease expert, said the results suggesting 90% effectiveness are “extraordinary.”
Pfizer, which is developing the vaccine with its German partner BioNTech, is among four candidates already in huge studies in the U.S., with still more being tested in other countries. Another U.S. company, Moderna Inc., also hopes to file an application with the U.S. Food and Drug Administration this month. Neither company’s shot is made with the coronavirus itself.
Instead, the vaccine contains a piece of genetic code that trains the immune system to recognize the spiked protein on the surface of the virus. It’s called a messenger RNA vaccine. (A refresher on basic biology: DNA is transcribed, or copied, into RNA, which then makes proteins that carry out the actual work of living cells. Molecules called messenger RNA are couriers that carry instructions from DNA to proteins.)
Chemist and biochemist Chuan He, the John T. Wilson Distinguished Service Professor in the Department of Chemistry and Department of Biochemistry and Molecular Biology at the University of Chicago, says what Pfizer has done has taken advantage of the basic knowledge about messenger RNA generated in the last several decades.
“mRNA therapy in the vaccine field supplies proteins that mimic viral proteins to induce an immune response,” he said. “mRNA comes in, will express the encoded protein for a period of time to elicit an immune response, then the immune cells will keep this memory. The RNA is gone and your body goes back to its normal state, but your immune cells have been trained by the presence of this foreign protein produced from the delivered mRNA.”
Pfizer’s news, however, doesn’t mean a vaccine will be here soon. Pfizer’s study is continuing, and the company cautioned that the protection rate might change as more COVID-19 cases are added to the calculations. Scientists have warned for months that any COVID-19 shot may be only as good as flu vaccines, which are about 50% effective and require yearly immunizations. Earlier this year, Fauci said he would be happy with a COVID-19 vaccine that was 60% effective.
Many questions still need to be answered, including how long the vaccine’s effects last and whether it protects older people as well as younger ones.
Confirmed COVID-19 infections in the U.S. eclipsed 10 million on Nov. 9, the highest in the world.
— Katherine Rosenberg-Douglas
Q. Is a person likely to catch COVID-19 a second time? Is immunity real? If so, how long does it last?
A. “There have been proven cases of repeat infection (or ‘re-infection’) with COVID-19, although it remains rare,” wrote Dr. Mai Tuyet Pho, an infectious diseases specialist at University of Chicago Medicine, in an email.
Like other viruses, immunity is real, explained Pho, but the question is how long it lasts. In the case of COVID-19, it’s unclear.
“At this time the CDC estimates that on average immunity to COVID-19 lasts about 3 months, making re-infection before that time unlikely,” wrote Pho. “Chances go up the more someone is exposed to the virus.”
Is there any way to safely have an indoor holiday gathering with a small group of family, around six people? Should we quarantine for two weeks prior or get tested before the gathering?
“Unfortunately, there is no risk-free gathering,” wrote Dr. Benjamin Singer, a pulmonary and critical care physician at Northwestern Memorial Hospital, in an email.
But, if you do choose to congregate with loved ones for the holiday season, he suggests keeping groups small and spending most of the time outside. Masks should be worn, said Singer, and social distancing rules should be followed. The risk isn’t gone, but these precautions can “reduce the risk of spreading COVID-19.”
Illinois Department of Public Health Director Dr. Ngozi Ezike said Nov. 5 that even though we all desire to spend the holidays with friends and family, it’s best to sit it out. If not, she said previously, it could result in a funeral down the line.
“Perhaps this holiday — as we have already done for most of 2020 — we are going to have to do it COVID-style, and that means virtual,” she said. “We’ll have to stay at home and forego the large gatherings so that we will have future events that we can be with our friends and family.”
Ezike urges people to not travel unless it’s a must, and if so, to drive if possible.
“Travel will increase your chances of contracting and spreading COVID-19, as will going to a crowded event, as will having multiple people in your home for Thanksgiving,” she said. “So in terms of travel, we do recommend avoiding travel to areas of higher risk, but as you are seeing, that is almost everywhere.”
Q. What is the risk of eating or meeting outside, and not socially distancing from people sitting at the table, especially when we’re all from different households and all have been following different levels of precautions?
A. While spending time outdoors has been said to lessen the risk of spreading COVID-19 to some degree, Singer reiterates that there is no “risk-free gathering.” In May, when the state was beginning to reopen and loosen restrictions after the quarantine period, the general rule of thumb for meeting up with friends was that outside is better than inside, and masks are better than no masks, said Dr. Emily Landon, executive medical director of Infection Prevention and Control at the UChicago Medicine.
Q. Is it safe to visit your doctors if you’re at higher risk now? What about colonoscopies and other scoping procedures?
A. “Patients should not defer necessary medical care, as long as it is provided in a safe environment,” wrote Pho.
She suggests finding out what safety measures your doctor’s office is taking, like remote check-in to limit waiting room time, screening before entering the facility, visitor restrictions, increased cleaning procedures, and 100% masking of staff and patients, among other things.
“The same rules apply for procedural areas,” she said. “Additionally, some providers require that patients undergo COVID-19 testing prior to procedures. For less urgent medical issues, some providers offer telehealth (or) video visits, which is the safest option.”
Q. Could we make a big difference in hospitalization rates and death tolls by changing our diet and health habits? How does your personal health increase or decrease your chances of COVID-19 complications or death? Which health conditions are mostly linked to higher death tolls?
A. While pursuing a healthy lifestyle with good eating habits and regular exercise can be beneficial, Pho says prevention methods are the best way to evade COVID-19 and the complications that can come with it.
“Avoiding exposure to the virus through masking, social distancing and hand sanitizing are essential,” she wrote. “There is a theory that even if masks aren’t 100% effective at preventing all infections, they reduce the amount of virus ... that is inhaled, leading to an overall milder illness.”
Older age, pregnancy, medications that weaken the immune system and medical conditions including diabetes, chronic kidney disease, heart disease, obesity, sickle cell disease and more can increase the risk for severe complications or death in someone who has contracted the virus, said Pho.
