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Coronavirus Vaccine

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By Leah S. Dunaief

Leah Dunaief

The days of 2020 are running down now, with only half of December still remaining, but the BIG news stories certainly aren’t letting up. Just this past Monday, two historic events were reported. One was the first vaccinations in the United States against the novel coronavirus. The other was the ratification by the Electoral College of the vote for our next president. Both were climaxes to enormous efforts,  but they were not ends in themselves.

Many people will continue to be angry with the election result and keep protesting. And many will still become ill and some will even die before universal vaccination, victims of the worst pandemic since the flu of 1918.

We watched both memorable occurrences happening in real time on television this week, and we know they are turning points for us in the new year. Probably like you, I have had enough of the political scene, but I would like to dwell on getting tested for the virus until we are able to be vaccinated, perhaps a matter of some months. There is a lot of fresh and interesting information to share. The following comes from The New York Times:

There are four reasons to get tested. The most obvious one is if you feel sick. Symptoms of the virus include fever, dry cough, fatigue, headache or loss of smell and taste. Many tests are most reliable during the first week of symptoms.

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Another reason is if you think you may have been exposed to an infected person or if you were in a risky situation like an indoor gathering or on an airplane. If so, quarantine and get tested five or six days after the possible exposure to give the virus a chance to be detectable. Quarantining should be for at least seven days.

Some people are tested simply as a precaution, especially if you are going for dental work or another medical procedure. Colleges and boarding schools test students before they leave campus and again when they return. They have largely had good outcomes following this procedure. And finally, some people will choose to be tested if there is a high level of infection in the community.

There are different types of tests, but they all use a sample from the nose, throat or mouth. Most widely used is the PCR test that looks for pieces of the virus’ genetic material. This is the most accurate but takes the longest — three to ten days — for the results to come back from the lab.

The antigen test detects coronavirus proteins and is among the cheapest and speediest with results in about 15-30 minutes. This is recommended as often as several times a week, since the results, both negative and positive, are less accurate. In one study, this rapid test missed 20 percent of the infections.

Then there is the rapid molecular test, which combines the reliability of molecular testing with the speedy results of an antigen test. Abbott’s ID Now and Cepheid Xpert Xpress use portable devices that process the sample right in front of you. This test is highly sensitive and can detect the virus a day sooner than the antigen, but it is not quite as reliable as the lab test, and while rapid, may take a little longer. Again a negative result is not foolproof, and you should continue to wear a mask and practice social distancing.

If you test positive, you should stay home and isolate. Tell others you have been with so that they may get tested. You should wait 10 days after symptoms started and 24 hours after a fever ends before going out. If results are negative, you might still be infected. Test again. False negatives happen.

Home testing kits are starting to be available, and Dr. Anthony Fauci likes the idea. New Jersey is one state that is offering them. Results are delivered in a day or two after being sent in, and one company that has received the FDA green light for at-home testing is Lucira.

There are walk-in testing sites in the area, although they usually have long lines. Appointments can be made on Stony Brook University campus by calling 888-364-3065.

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By Daniel Dunaief

Daniel Dunaief

What are we all waiting for? A vaccine ranks high on the list, if you read the newspapers and hear the dialog and diatribes from that epicenter of anger, hostility and finger pointing known as Washington, D.C.

But, really, how much will a vaccine change our lives? If a vaccine were available tomorrow, would you take it? For a vaccine to create herd immunity, a majority (70 percent or more) of the population would need to take a safe, effective treatment.

In an unscientific survey of 18 people to whom I promised anonymity, eight of them said they would take a vaccine if it were available tomorrow, while the other 10 said they would wait anywhere from several months to a year to take it. Several of the respondents elaborated on the rationale behind their decisions.

Jody said she would take it because “absolutely anything that helps us get kids back into school and the world moving again” is worth the effort.

Melissa said she would also take a test. Her husband is currently in a clinical trial and doesn’t know if he received the vaccine or a placebo.

While Sheila suggested she usually waits a month or two after a new vaccine comes out to determine if there are any side effects, she would take it whenever it’s available “as long as the [Centers for Disease Control and Prevention] backs it.”

A health care worker, Doug explained that his company won’t let him work without getting a flu shot. He wondered whether the company’s policy would be the same after a COVID vaccine comes out. Indeed, a vaccine would create a college conundrum, as schools that require a new vaccine before students return for the spring might cause some students to choose remote learning or to take a semester off.

Stephanie would only consider taking a vaccine if Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said it was safe and effective.

Matt would not rush to get a vaccine. He said he doesn’t “buy the first model of a car or wait in line to get the newest cell phone. Let’s see how it works.”

Jacob was much more adamant, expressing concern that the urgency to get a test on the market would create a potential health hazard.

John shared Jacob’s concerns, saying he’s nervous about anything new. “I would consider taking a vaccine a year from now,” John said, but not until researchers and doctors know more about it.

Cindy, who is suffering with several other health problems, said she wouldn’t take a vaccine for a year or more. She doesn’t know if the vaccine might interact with medications she’s currently taking, while she’s also concerned that any change in her body might alter her overall health. Mindy wouldn’t rush to get a vaccine. “Testing takes time and if it were available that quickly, I would not trust the effectiveness and/or safety,” she said.

So if my non-scientific sample is reflective of the overall population, a vaccine, even if it’s effective and safe, would take more than the typical few weeks after it is available to provide a benefit to both the individual and the greater population.

While an available vaccine might be a relief, it also causes concerns about whether the process moved too quickly. Assurances from the CDC, the Food and Drug Administration and Dr. Fauci might help ease those worries. To borrow from the sports world, the population is eager for an umpire to call balls and strikes after the pitch is thrown, and not before, to satisfy a timeline for people eager to return to the life of handshakes and hugs.

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Susan V. Donelan, MD, FSHEA

Dr. Susan Donelan, medical director of Healthcare Epidemiology at Stony Brook University Hospital, spoke by phone with TBR News Media about reopening schools, the importance of face coverings and host of other issues related to COVID-19. Here are her thoughts on the pandemic and the virus.

TBR: At what point would the spread of the virus be contained?

Donelan: Let’s look at it this way: If you accept the concept that even if the virus doesn’t change or change so significantly that any exposure before will be useless going forward, if it remains static and doesn’t morph or mutate, you need 70 percent of persons to be infected in such a way that the vast majority don’t get repeatedly infected. That’s a whole different story. It takes time for the world population to reach that 70 percent.

TBR: How do you get to that level?

Donelan: You can get to that 70 percent, being a relatively typical cutoff [for herd immunity], by one of two ways: by natural infection, or you can get it from a successful vaccine. 

TBR: How does the process of distributing the vaccine work?

Donelan: Having enough is not the same as having it equitably distributed throughout the world. Ideally, [it would be] given to all of those who have reliably never been exposed. [There are a] lot of logistics: Having enough and having it distributed well and having it distributed equitably are different parameters. While this all gets figured out, the virus will hop along and continue to spread to the extent we give it the opportunity to spread. 

TBR: Are people who get the virus getting reinfected? Are some antibodies not providing resistance?

Donelan: That is not clear. There are different kinds of antibodies. With a neutralizing antibody, you get infected or you get vaccinated, the antibody you develop neutralizes the virus when it comes calling again, or when it comes calling for the first time. There are antibodies that are just kind of bumper stickers in your immune system. They show that you’ve been exposed. This is early in the pandemic, It’s really not clear at this point what types of antibodies most people are going to develop and how helpful they will be when the virus comes knocking at their door. 

TBR: Anecdotally, we’ve heard that some people may be less susceptible to the worst of the viral symptoms, if they have a certain blood type, for example. Do you know if any of that is true?

Donelan: I’ve seen tidbits here and there — you can be willy-nilly and not careful. I would caution anyone who picks up these reports to not assess their own individual risk in such a way that would make them less likely to follow the basics of trying to avoid getting sick or transmitting it.

TBR: Would a second wave be milder than the first because more people would have some resistance?

Donelan: I’m hesitant to declare if we had a milder second wave it’s the virus as opposed to other factors. In the 1918 [Spanish flu] versus the 1919 wave, the 1919 wave was bigger.

TBR: How did the protests affect infections?

Donelan: The protests are one of many, many instances of people with lacking social distancing, perhaps not wearing masks or wearing masks incorrectly. It’s maybe the most public one, not the only one. Every time I go out, I see people being noncompliant. As I understand from recent data, New York has an R0 [the average number of people who will get a disease from a single infected person] of under 1. We know that there’s going to be a slow creep in the infection. We’re right up against 1. That’s clearly less than the R0 of 2 or more that was early in the pandemic. By the time we see a bump in hospitalizations, a bump in positive cases, the protests are going to be muddled in with the graduations, the beach parties, the bars and the restaurants. 

TBR: What don’t people know about the disease?

Donelan: The biggest misconception about utilization of face coverings, is that the face covering is for me. I think it must be really be emphasized. I wear my face covering to protect you. You wear it to protect me. 

TBR: What do you think of the risks in youth sports, which are starting up again?

Donelan: There’s no uniform understanding of what’s right or wrong. There are other countries that have been ahead of us in terms of the pandemic and then are now easing themselves back into a more normal society. I think that those of us who are interested in what happens in sports, might keep a clear eye on what’s going on in those countries. Any time you interact, it’s not a zero-risk concept.

TBR: What do you think about schools?

Donelan: I’m working with the state and the campus and my own local school district on what school will look like. I have two kids that are heading to college, another one heading for a Ph.D. program. I have a particular interest in what’s going on. I think the schools have been working hard to optimize social distancing, with mouth and face coverings to the extent that each student at different levels is able to. I told them a couple of months ago, at the state and local level, I don’t see how schools cannot plan on having a hybrid learning platform [one that includes a mix of in-person and remote classes]. 

TBR: What advice would you give schools?

Donelan: The most important thing is to make sure however school looks like for the next two or three semesters, [that there is] a hybrid learning platform, with the ability to pivot quickly to a full-distance learning plan.

TBR: How do you think this will play out for colleges?

Donelan: [Many schools will] start in August. Come Thanksgiving, kids will go home and don’t come back [until the next year as influenza-like illness starts to circulate.] Thanksgiving is the first great cross-pollinator event in the winter season, with people traveling, coming back, picking up whatever is going on wherever they traveled to. I wouldn’t want students coming back to school after Thanksgiving recess, then cross-pollinating more. If there’s anything that people should be encouraged to do, it’s get a flu shot — and get it early.