Iowa Specialty Hospital

COVID-19 Update from Dr. Michael McLoughlin 12/22/2020

December 22, 2020

On the whole, we continue to have multiple reasons for hope on the COVID-19 front. We’re seeing a gradual downward trend locally and across the state in both infections and hospitalizations. Many more people have been taking reasonable precautions to limit the spread over the last month, and while it is always challenging to determine exactly what has caused a change, it appears to be working.
Perhaps most significantly, Iowa Specialty Hospital anticipates receiving our first vaccinations for COVID-19 on Tuesday, December 22nd, when most people will read this. Wright County Public Health also should receive vaccines in the next few days. Across the country, 7.9 million doses of vaccine are expected to be distributed this week. That’s a far cry from the estimated 60-70% of the population that is anticipated will need to have immunity before the pandemic will die out, but another way to look at it is that nearly 8 million people will receive vaccines this week, whereas all year just shy of 18 million people in the country have tested positive for COVID (certainly many more have had it but not been tested, for various reasons). This means nearly half as many people who have been proven to have COVID will start to develop immunity this week without having to take the risk of getting the disease. Many more doses will be coming soon. Estimates currently are that all healthcare workers, long-term care residents, people over 75, and “essential workers” who want the vaccine could receive the first dose as soon as the end of February. There is valid ongoing controversy about who qualifies as an “essential worker,” but the point is that a lot of people should have the opportunity to receive a vaccine soon.
So that leads us to more information about how the vaccines work and what to expect after being vaccinated. Many have heard that it is a messenger RNA (mRNA) vaccine and immediately think something like “ooh, that sounds genetic, I don’t want something that messes with my genes!” In our cells, most essential functions are carried out by proteins. Our DNA carries the instructions for how to make these proteins and mRNA is the molecule that carries the instructions out of the nucleus (where DNA stays) to the protein factory (called a ribosome). After it does that job, it is broken down very quickly. It has no ability to edit DNA. The mRNA doesn’t even enter the nucleus when given in a vaccine.
How does the vaccine work? The mRNA in the vaccine is protected in a “coat” of fatty particles when injected. When it gets to cells, they take it in and the fatty coat falls off. Then the mRNA finds the protein factory ribosomes just like it is supposed to and gives them instructions to make one single protein (the spike protein) that the COVID-19 virus needs to be effective. Once this protein is made, it is moved to the cell’s external surface, where the immune system recognizes that it isn’t supposed to be there. The immune system then does what it is supposed to do to things it doesn’t recognize – learn how to destroy them. It starts to make antibodies and train special cells. This process causes the soreness that we should expect with the vaccine. By about 12 days after the vaccination, the vaccinated individual starts to show signs of immunity. The mRNA from the vaccine itself is broken down and gotten rid of in as little as a few hours after it is injected. How do we know all this? Though these are the first vaccines that have been authorized using this technology, mRNA vaccines have been studied for several years as potential treatments for other infections (ebola and zika virus, for example). Figuring out how to make it work has taken many years before that. So in one sense it is new, but the reality is that there have been decades of research that led to being able to develop these vaccinations.
Another question that many will have is “do I still have to wear this *%&# mask after I’m vaccinated?” Trust me, I’m ready to be rid of it too. Besides that it prevents infections, the only good feature in my mind is that nobody can tell when I haven’t shaved for a few more days than usual. So here’s the deal – we don’t know whether someone who has been vaccinated can still transmit the virus to others. This will take at least a few more months of study to be certain. However, with a vaccine that is 95% effective it is unlikely that vaccinated people will carry and transmit the virus to others who haven’t been vaccinated to any significant degree. 
Even though we do not think that vaccinated people are likely to be transmitters of the virus, my recommendation to those who have been vaccinated will still be to wear masks in public until we are sure or until enough people have been vaccinated that the pandemic is dying out. This is partially because of the chance that transmission will still be possible and partially for social reasons. For at least a couple months, there are still going to be many people who are at high-risk for getting severely ill and can’t yet receive the vaccine themselves. They won’t have any way to know whether they should feel safe talking to a store clerk or waiter who isn’t wearing a mask. The high-risk person won’t know if it is because that worker has been vaccinated or if they should be concerned they are putting themselves at risk. Also, we’ve all felt how much easier it is to wear a mask when everyone is doing it than when we are the only one. This is still a battle we win together and the best way to get more things back to normal is to keep infections down.

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