COVID-19 vaccines should still be effective against variants of the coronavirus, according to an expert.
Dr. Gregory Polland, a physician and scientist who is the director of the Mayo Clinic Vaccine Research Group, said the biggest concern currently is the effect of virus variants, which have caused case numbers to increase throughout the nation. He spoke during a virtual news conference Friday morning from the University of Kansas Health System.
That increase of positive cases in the community is being seen at the Mayo Clinic as well as in the Kansas City area, he said, while the number of patients in the hospital and in the intensive care unit has decreased recently.
It’s true the variants are not any more lethal than the original virus, but the number of deaths and hospitalizations has increased exponentially because so many more people are infected, he said. It’s easier to get the COVID-19 variants because they appear to be 40 to 50 percent more transmissible, he said. When that is the case, there is an increased number of people hospitalized in intensive care units and dying, he said.
Vaccines should still work on the variants, although it’s a very hard question now, and there is a lot to learn yet, Dr. Polland said. It appears from lab testing that some of the variants might have their neutralization reduced by 40 to 50 percent, although no one is sure at this time, he said. A pseudo virus, tested with the Pfizer vaccine in a lab, found no reduction in neutralization by vaccine induced antibodies, he said.
Dr. Dana Hawkinson, medical director of infection prevention and control at KU Health System, said while 80 to 85 percent of people who get the coronavirus will not need medical attention, about 15 percent will, and a smaller percentage will move on to hospitalization and death. With more cases, the total numbers of hospitalizations and deaths will increase.
Pfizer tested one mutation, and there is another concerning variant that hasn’t been looked at, Dr. Hawkinson said.
Dr. Polland said there is also a third variant or mutation they are concerned about, and what the combined effect will be is unclear.
“I liken it a bit to how we think about cancer,” Dr. Polland said, “that is, the transformation from a normal cell to a malignant cell. It takes multiple hits or changes before that transformation occurs.”
What they’re seeing here is the accumulation of not only RBD mutations, but mutations in the S-protein and in other locations, he said. That’s a concern because all the vaccines being developed in the West are S-only vaccines, which they would never do with any other RNA virus, he said. It may turn out long-term to be the Achilles heel of the vaccine, he added.
Dr. Polland compared it to a car that can go 110 miles an hour, but something happens to the engine and it can now go only 100 miles an hour. That has no functional effect on what the car is used for, he added.
“I’m hoping that’s what the case will be with these mutations and perhaps, mild reductions in antibody,” Dr. Polland said. “Long-term, could that have a more significant effect, like immunity not lasting as long, or having to give a booster more frequently, or like we do with flu vaccine, having to change strains on a periodic basis? All those are possibilities.”
But none of those is a reason not to get a vaccine now, he said, because the threat now is neutralized by getting the vaccines available now, he said.
“So wisdom would dictate when you balance risks, benefits, long-term unknowns but concerns, get your vaccine as soon as it’s available to you,” Dr. Polland said.
While there are unknowns currently and in the future, the context is the pandemic, where one out of every 850 Americans has died, where one out of every 15 Americans has been infected, he said. They’re seeing what is happening in L.A. County, where they’re concerned about running out of oxygen to oxygenate their patients, he said.
“The threat before us is the one that we have to attend to,” Dr. Polland said. “The longer-term uncertainties are what people like I myself worry about as a vaccinologist, but that has no bearing on the importance of delivering and receiving vaccines that are available to us now.”
Dr. Hawkinson said other companies are researching and developing other COVID-19 vaccines using different, and some older platforms.
They are in a really great spot because they anticipate having a menu of different vaccine options that can be used in different ways and different populations based on their effectiveness and immunogenicity in those populations, Dr. David Wild, vice president of performance improvement at KU Health System, said. It’s not the normal process for vaccine development.
“Never in the context of a pandemic have we had the luxury of multiple different vaccines and more to come,” Dr. Polland said.
By February, they may see an emergency use authorization for the Johnson and Johnson vaccine, followed shortly thereafter by the AstraZeneca vaccine, he said. That will be three different kinds of vaccine and four total available, he said.
On the issue of whether more vaccine doses should be released immediately and second doses should not be held back, Dr. Polland said the context is the pandemic that is sickening millions and causing deaths in the hundreds of thousands. Estimates by the CDC are that as a result of the variants and the holiday travel, in the next three weeks they should see almost another 100,000 deaths, he said.
The clinical trials, where they have data, suggest to get two vaccine doses, three weeks apart by Pfizer and four weeks apart by Moderna.
“We know that that is safe and effective,” Dr. Polland said. “What we don’t have data for is any variation from what happened in the clinical trials. But we have biology, and we have understanding, and in fact, were no vaccine available In the U.S., is a longer interval between doses detrimental in terms of ultimate antibody response.”
During the time period, at least some people would remain susceptible, but a longer dosing interval doesn’t lead to less efficacy, he said. While they don’t know that with the vaccines, they have that understanding of the immunology, he said.
In some of the clinical trials where they did have longer intervals between doses, up to 12 weeks, people developed better immune responses, he said.
“We don’t know that about all the vaccines, but we have some hints of preliminary data,” Dr. Polland said.
“With that understanding, when you look around and you see the number of cases that are occurring, you have two choices. We stick, just black and white, with the data we do have, or you say, the important thing is to get as many people on the road to immunity by providing as many people with the first dose as possible, then catch up with your second dose as supply allows, given that the manufacturers have said they will be able to increase the number of doses that they make available,” Dr. Polland said.
“With that understanding, my own sympathies lie with beginning to immunize as many people as we can, particularly in the high-risk group, where you see the majority of the real morbidity and mortality,” Dr. Polland said.
Dr. Wild agreed that there was a very good argument for taking whatever doses they can and getting them into arms in whatever way they can.
Dr. Polland said he believes that may turn out to be the opening strategy of the new administration.
Dr. Hawkinson said those who get the first doses should make sure they go back and get the second dose and not just leave it.
“You need that second dose to have the highest level of immunity and to boost T-cell immunity, which long-term may turn out to be very important in protecting us,” Dr. Polland said. “Two doses is critical.”
One of the newer vaccines, the Johnson and Johnson vaccine, may just have one dose, but the other vaccines require two doses.
Dr. Wild said they know from other vaccines that a longer delay between the first and second shots does not reduce the immune response generated by that vaccine. So if the interval between the shots is five weeks instead of four, that should not make a difference.
Dr. Polland distinguished between those who are vaccine hesitant because they have questions, and those who reject science. Those who reject science will have a difficult life, he said, because they will make decisions based on something that is not repeatable or generalizable, so they will be guessing all their lives.
People who have questions and hesitancy about the vaccine, it may be legitimate to be unsure about something new, he said. They can make decisions based on unqualified opinions on the internet, or they can make it up as they go along based on what they read, or they can listen to experts who have spent their lives studying this, he said. The experts have a deep understanding of viruses, immunology and the value of vaccines, he said.
Wisdom resides in balancing the risks and benefits to your benefit, Dr. Polland said. The data say these vaccines are very safe, he said. While not perfectly effective, they are as close as anything he’s ever seen at 95 percent, he said.
“For me, the answer is easy,” Dr. Polland said. “I got my first dose of vaccine nine days ago.”
The only reason not to get a vaccine is if a person had an anaphylactuc reaction history to a component in that vaccine, which is a very small number of people.
COVID-19 case numbers
Dr. Hawkinson said 66 people with the active virus were hospitalized Friday morning at KU Health System, a decrease of three from Thursday. There were 21 patients in the ICU, no change from Thursday. Ten of the ICU patients were on ventilators, no change from Thursday. Another 54 patients were still hospitalized because of COVID-19, but were out of the acute infection phase, an increase from 48 on Thursday. The total number of COVID-19 patients was 120, an increase of three from Thursday.
Wyandotte County reported an increase of 77 COVID-19 cases on Friday, Jan. 15, according to the Unified Government’s COVID-19 webpage. There were a cumulative 16,000 cases. There was a cumulative total of 210 deaths.
The Mid-America Regional Council’s COVID-19 dashboard reported 137,703 cumulative COVID-19 cases on Friday. There were 1,674 deaths, and 159 was the daily average of new hospitalizations.
The state of Kansas reported 256,134 cumulative COVID-19 cases statewide on Friday, an increase of 4,093 cases since Wednesday, according to the Kansas Department of Health and Environment information. There were an additional 147 deaths since Wednesday, for a cumulative total of 3,502.
The Johns Hopkins University COVID-19 dashboard on Friday reported 23,530,463 total cumulative cases in the United States, with 392,106 total deaths nationwide.
Free COVID-19 testing available Saturday
COVID-19 tests will be available Saturday at the Pierson Community Center parking lot, 1800 S. 55th St., Kansas City, Kansas. Hours are subject to change depending on the weather and other factors. These tests are through WellHealth Management. For more information and to schedule a test, visit www.GoGetTested.com/Kansas.
The Unified Government Health Department’s COVID-19 test site at the former Kmart building at 78th and State will not be open Saturday through Monday. Monday, offices will be closed for Martin Luther King Jr. Day. Testing will reopen on Tuesday, Jan. 19, at the former Kmart building, from 9 a.m. to 3 p.m.
The UG Health Department recently added flu testing to the COVID-19 test at the Kmart building. Only one swab is used for the two tests. The Health Department estimates a two to three day wait for COVID-19 results. For the flu, the department only contacts people if it is positive.
Tests from the Health Department are free for those who live or work in Wyandotte County. The tests are nasopharyngeal swab tests. The Health Department no longer uses saliva tests.
The tests now are open to asymptomatic people as well as those who have symptoms or have been exposed to COVID-19. Check with the UG Health Department’s Facebook page to see if there have been any changes in the schedule. Bring something that shows that you live or work in Wyandotte County, such as a utility bill.
Wyandotte County residents who are interested in getting a COVID-19 vaccine may sign up at https://us.openforms.com/Form/2f2bcc68-3b6a-450b-9007-d39819db6572.
For more information about the testing site at the former Kmart location, visit https://alpha.wycokck.org/files/assets/public/health/documents/covid/10092020_newtestingsitewyco.pdf.
The KU doctors’ news conference is at https://www.facebook.com/kuhospital/videos/449094836121385.
The new health order on hours for bars and restaurants is at https://alpha.wycokck.org/files/assets/public/health/documents/localhealthofficerorder011221.pdf.
Information about the new health order on extended hours for bars and restaurants is at https://alpha.wycokck.org/files/assets/public/health/documents/covid/01112021ugissuesnewbarrestaurantorder.pdf.
The school health order is online at https://alpha.wycokck.org/files/assets/public/health/documents/covid/localhealthofficerschoolorder01042021.pdf.
A letter explaining the school health order is online at https://alpha.wycokck.org/files/assets/public/health/documents/covid/schoolletter_01052021_english.pdf.
To see information about the UG giving vaccines to health care workers, visit http://wyandottedaily.com/ug-to-start-giving-covid-19-vaccines-to-health-department-and-ems-personnel-next-week/.
The KDHE vaccine report is at https://www.coronavirus.kdheks.gov/DocumentCenter/View/1708/COVID-19-Vaccine-Updates–123020-FINAL-PDF?bidId=.
Cards and letters of encouragement for caregivers at KU Health System may be sent to Share Joy, care of Patient Relations, 4000 Cambridge St., Mailstop 1021, Kansas City, Kansas, 66160. Emails can be sent to ShareJoy@kumc.edu.
Wyandotte County is under a mandatory mask and social distancing order.
The UG COVID-19 webpage is at https://alpha.wycokck.org/Coronavirus-COVID-19-Information.
The KDHE’s COVID-19 webpage is at https://www.coronavirus.kdheks.gov/.
The KC Region COVID-19 Hub dashboard is at https://marc2.org/covidhub/.
The Wyandotte County page on the Johns Hopkins COVID-19 website is at https://bao.arcgis.com/covid-19/jhu/county/20209.html.