We’ve spent so much time in perpetual COVID panic that the default reaction to any news feels like it should be negativity.
The Pfizer and Moderna vaccines work really well? Oh, well they have some side effects, people don’t want to take them, and we can’t make enough anyway.
The risk of dying from COVID is going down as we learn to treat it better? Well, we still have 2,000 Americans dying each day, which is unacceptable.
Cases and hospitalizations are falling across the country? The new variants are going to take over and the antibody response in vaccinated people isn’t as strong with these new variants.
The Johnson and Johnson vaccine also works? Yes, but it’s not as effective as the other ones that we have and I don’t want the knockoff version.
And on and on.
But this is really a time to be optimistic. We are in the home stretch of the pandemic. The days are getting longer, we’re vaccinating more people, and none of the variants (maybe we should start calling them scary-ants!) seem to evade the vaccine response.
These vaccines are freaking miracles
I’m not exaggerating here. Each of these vaccines are simply remarkable.
Think about this for a second.
It was only a year ago that we started having the first cases of the SARS-CoV-2 virus appear on our shores.
Since that time, multiple vaccines have been developed (including two vaccines using brand new mRNA technology that’s never been used before), tested in Phase 1, 2, and 3 clinical trials, demonstrated effectiveness, and brought to market.
You can spent a lot of time scrutinizing the data from the different vaccines. I know that I have. I’ve read the FDA briefing documents on the Pfizer, Moderna, and now, Johnson and Johnson vaccines.
I’ve written before about Pfizer and Moderna in this newsletter. They’re safe and effective. They start protecting you about 7-10 days after the first dose, and after the full protocol are more than 90% effective at stopping symptomatic COVID infections. They prevent death from COVID with essentially 100% effectiveness.
Let’s talk a bit about the Johnson and Johnson vaccine
This one is great too!
We knew a few months ago that this vaccine elicits an antibody response, but now we know that it’s effective at preventing symptomatic COVID cases.
The really fantastic part about the J&J vaccine - it’s only 1 dose. No multi-dose protocols, no keeping track of your vaccine card, no making multiple appointments.
While the media reports generally mention the 66% effectiveness, that undersells the big picture here. Look at this from the FDA briefing document:
Ad26.COV2.S is highly effective in the prevention of severe/critical COVID-19 (see Table 1), particularly in prevention of hospitalization and death, across all countries and all ages (see Sections 7.1.6 and 7.1.7). Vaccine efficacy (adjusted 95% CI) against molecularly confirmed severe/critical COVID19 diagnosed at least 14 days after vaccination was 76.7% (54.56; 89.09) and increased to 85.4% (54.15; 96.90) at least 28 days after vaccination (see Table 1). The vaccine prevented COVID-19-related medical interventions (defined as hospitalization, ICU admission, mechanical ventilation, ECMO; 0 vs 7 participants in the Ad26.COV2.S and placebo groups, respectively) and COVID-19-related death (0 vs 5 deaths in the Ad26.COV2.S and placebo groups, respectively) at least 28 days after vaccination.
Translated into English: 4 weeks after vaccination, zero people in the vaccine group died from COVID, zero people in the vaccine group needed intensive care, and zero people in the vaccine group were admitted to the hospital.
Similar to the the other vaccines, this one starts working about 2 weeks after the shot, and you can see the placebo versus vaccine (Ad2) curves start to separate at about two weeks:
Protection against severe infection starts even sooner, about a week after vaccination:
And the Johnson and Johnson vaccine seems to protect against asymptomatic infection as well. I don’t see much bad news here. I can’t imagine this doesn’t receive FDA emergency use authorization when they meet today.
So once you’re vaccinated, you’re really protected
After you’ve been vaccinated, your chance of dying from COVID is so close to zero, that it’s zero for all intents and purposes. Your chance of getting a severe infection that requires hospitalization is also basically nothing.
And the data is accumulating that the risk of an asymptomatic infection drops quite a bit. So while you may still be able to spread the virus, the risk of that drops too.
That means I don’t see a compelling argument to have restrictions spending time around others who are vaccinated.
If your family has been vaccinated, why can’t you have a mask-less get together? If grandma and grandpa have had both doses of Moderna and waited two weeks after the second dose, why can’t they hug their grandkids? If your friends are all vaccinated, why can’t you all have drinks and dinner without physical distancing?
The discussions of vaccine effectiveness really undersell the miracle
The goal here isn’t COVID zero.
It’s not reducing risk to nothing. It’s reducing risk. If you aren’t going to be hospitalized from COVID and you aren’t going to die of COVID after you’ve been vaccinated, why shouldn’t you change your behavior?
You couple the effectiveness of the vaccine with the fact that we’re seeing a huge drop in cases and hospitalizations everywhere, and I just don’t see the argument that you should continue to restrict everything you do after you’ve been vaccinated.
Public health officials are going to talk about risk alone. The CDC doesn’t do tradeoffs. Of course the CDC won’t “clear” you to go to a restaurant after you’ve been vaccinated because the vaccine isn’t 100% effective at preventing all COVID cases and stopping all transmission.
But it’s pretty damn good.
It’s clear that after you’ve been vaccinated, your risk is really low, even with the new variants.
I think that wearing a mask when you’re indoors in public still makes sense. It’s not just about you, it’s about the example you’re setting. But outside in a small group? Dinner with friends? A party with others who are protected? Seems like a no-brainer to me.
Once we’ve achieved more broad vaccination - probably in another 2 months or so - I don’t know that there’s much argument for even wearing masks in public if you don’t want to.
Keep in mind - I’m not a public health official. I’m a doctor. I’m thinking about the risk-benefit analysis, not just the risk. Getting our lives to feel a little bit more normal as quickly as we can seems like the right thing as long as we aren’t being crazy with risk.
Once you’ve been vaccinated - whether it’s Pfizer, Moderna, or Johnson & Johnson - I think you can start to approach the concept of “back to normal.”
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