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Marching Forward: New Vaccines and What’s Next


COVID-19 Scheduling Update (2/26/21): Currently, OhioHealth is scheduling vaccinations for those 65 and above, or with qualifying medical conditions. You can schedule your appointment through OhioHealth MyChart, or by calling the OhioHealth COVID-19 vaccine hotline at 614-533-6999 weekdays from 8 a.m. to 4 p.m. For the latest information regarding scheduling, visit the OhioHealth COVID-19 Vaccination Page.

With the FDA’s review of the Johnson & Johnson COVID-19 vaccine right around the corner, we felt another Facebook live was in order to get answers to your pressing questions. Joseph Gastaldo, MD, OhioHealth’s system medical director of infectious diseases, updated us all things vaccines.

Note: The following is a written transcript of our Facebook Live event. If you want to hear Dr. Gastaldo’s answers to the questions, we’ve provided time stamps in our story, to help you get right to the answer in the video above.

As you read on, keep in mind that this information shouldn’t replace the advice of your doctor and was recorded on 2/24/21. If you have additional questions, visit the Centers for Disease Control and Prevention COVID-19 website.

Missy Gleason  03:45

Okay. So, what is the latest with the COVID-19 vaccine today? There was news today about the Johnson & Johnson vaccine.

Dr. Joe Gastaldo  03:51

Yeah, so the Johnson & Johnson trial data information was released officially today. Before, all we really had was a press release. And again, I’m a man of science. I want to review all that, I want to make my own judgment on things. So, the FDA subcommittee is going to meet on Friday and two days before the meeting, they released the data from the Johnson and Johnson trial. That vaccine looks amazing, and it really is a game changer. That vaccine was studied in three different continents and it was studied in countries where there’s a lot of variants. 44,000 people in the study, more so than Pfizer or Moderna, and the vaccine results, in a nutshell, show the following: 100% protection against dying (from COVID-19), 100% protection against being hospitalized (from COVID-19), 85% protection against severe COVID-19, and roughly 72% effective against symptomatic COVID-19 in our country. That is amazing; that is a great vaccine. The vaccine is one dose, it’s stored in a refrigerator, and we’re going to be able to reach more in our population in our communities who are going to have trouble coming back for their second dose, who live in communities where they don’t have the storage of the freezers, etc., etc. So, having more vaccines available for all in our community is so important. Johnson &. Johnson already said as soon as they get the authorization and the recommendation from the CDC, they’re prepared to ship out 2 million doses and in the month of March, they are prepared to produce 20 million doses. So, we’re going to have more vaccines, J&J has their vaccine, Pfizer and Moderna are going to be making more vaccines. So, we’re going to get to the point where more vaccines are available. Right now, in the state of Ohio, we’re doing a little bit of catch up, we want to vaccinate those most vulnerable: 65 and above. And if you are 65 and above and you haven’t connected yet, keep trying! Don’t get frustrated…don’t give up. Keep trying to get a vaccine. I’m fully supportive of what Governor DeWine is doing. He’s essentially doing a pause, so we can vaccinate those who have really been hit hard by COVID-19: the 65 and above crowd. But looking forward to the spring months, we’re going to get more vaccines from Pfizer, Moderna and J&J, we’re going to be lowering the age. And there will be a point sometime in the spring, maybe May or even June, where it’s going to be an open market for people to get vaccines.

Missy Gleason  06:31

And there is also an added group to the 65+: its people with certain medical conditions.

Dr. Joe Gastaldo  06:36

Yeah. So, there is another group. Thank you for calling it out Missy. There is another group, and this is confusing for people. There are certain medical conditions defined by ODH that include type one diabetes, people with cystic fibrosis, transplant patients…it has to be a medical condition that somebody was either born with or was diagnosed with as a child and has carried that into their adulthood. Again, that’s very confusing for people to follow. But you know, we have to follow the recommendations set out by the Ohio Department of Health. Governor DeWine yesterday made an announcement that he is planning…we don’t know when, but as we get more vaccines, he’s going to be lowering the age category for people to be vaccinated.

Missy Gleason  07:20

That’s great. And speaking of lowering the age category, do you see a time when we might see kids or teenagers be able to be vaccinated?

Dr. Joe Gastaldo  07:27

Absolutely. So, let’s review what we know now. Pfizer is officially authorized for anybody 16 or older. Moderna is officially authorized for anybody 18 or older. Pfizer just announced recently that for their age category, from 12 to 15, they are completely enrolled. And I expect for that to be authorized and reviewed in the next few months. In addition to that, Pfizer is also now enrolling for the ages of five to 15. So, by the end of the year, I do see the authorization and the availability for vaccines for children. Again, we have to prioritize safety, allow the studies to be done, but we’re heading in that direction.

Missy Gleason  08:12

Great. So, talking about trials, the vaccines we have now are for emergency use. I-this is something I know nothing about-what would it take for them to get approved for general use?

Dr. Joe Gastaldo  08:22

That’s another great question. So eventually these vaccines need to get officially FDA approved. Right now, the vaccines are FDA authorized. The vaccines are also recommended by the CDC. So, the vaccine trials go on for two years. So, the trial for Pfizer and Moderna, that led on to the authorization, is still going on. But once that two-year trial ends, then they’re going to have to get FDA approval like a regular vaccine. That’s a while off. Again, we’re in the setting still of the pandemic. And in the setting of a, emergency, the FDA is allowed to approve things under emergency use authorization.

Missy Gleason  09:07

Moving into our next topic, we’re calling it, Why Vaccinate? So, we’ve been reminding our community to keep wearing masks and social distancing, even if you’re vaccinated. Do you think that message can make people ask, you know, “why bother getting the shot?”

Dr. Joe Gastaldo  09:22

Again, another great question. Let’s dissect that a little bit. Okay. So right now, in the public, we’re just starting to vaccinate people, and someone is considered fully vaccinated when they are two weeks out from the second dose of mRNA vaccine, and then, depending on what the CDC says, it’ll be two weeks out from receiving the first dose (of J&J). There is going to be a point in time when hopefully if enough people roll up their sleeves and get vaccinated, there’s going to be a point in time where the COVID activity drops really, really low. And there’ll be a point in time when we’re going to say “hey, when is the pandemic over? When is the guidance on de-escalation of masks and all those types of things?” There is a new director at the CDC, Dr. Rochelle Walensky. She’s an ID doctor from Harvard. I don’t know her, but I’ve heard her talk twice. I follow her on social media, I listen to her on podcasts and everything. As we get data, numbers and science back from what’s happening now, we will get new guidance from the CDC on de-escalation of the mitigation practices. So, for the time being, things stay the same. But the biggest thing that’s really going to impact de-escalation and mitigation practices are getting vaccines in the people’s arms. We need to get that and start thinking about that now, no matter how old you are. If you’re a healthy 25-year-old guy, think about the vaccine, get your questions answered now, because when it’s your turn in line to get a vaccine, you have access to a vaccine, I want you to really roll up your sleeve to help get our community back to a new normal. I want to go to concerts; I want to go see the Buckeyes play in Ohio Stadium. I want to go to my mom and dad’s house and eat for holidays. We all want to do that. And the trick to all of us getting there is getting vaccinated.

Missy Gleason  11:17

So, let’s talk a little bit about the side effects from those vaccinations. Is it normal to feel something or symptoms after getting vaccinated?

Dr. Joe Gastaldo  11:24

It is. And again, we’ll dissect that a little bit. So, when you get vaccinated, you’re developing an immune response to the spike protein. That’s the target all the vaccines are going for: the spike protein. When you develop an immune response, if you look at the side effect profile of mRNA vaccines, what’s described as the biggest side effects is discomfort at the injection site, fatigue, maybe a low-grade temperature elevation, a headache, muscle pain…those are all an immune response; those are side effects and that’s what we see mostly with the mRNA vaccines. It’s seen more so with a second dose compared to the first dose. It’s seen more so in people who have previously had COVID with the first dose, and it seen more so in those 50 and younger. My parents in their early 80s were vaccinated…no side effects at all. What we now know today from the information from the J&J vaccines, its vaccine side effect profile is a lot less compared to the mRNA vaccines.

Missy Gleason  12:28

Is that because you’re getting one dose?

Dr. Joe Gastaldo  12:30

Perhaps. We don’t know yet. It could be because it’s one dose, it could also be that it’s not an mRNA vaccine: it’s a different type of vaccine.

Missy Gleason  12:39

Okay. So now that more people are getting vaccinated, are we hearing about any other side effects than the malaise and you know, soreness at the injection site?

Dr. Joe Gastaldo  12:49

Well, what I just reviewed are the big ones. You know, there’s other things that pop up. For example, you know, you and I have talked and emailed and talked about some things that come up. There is something called COVID arm. COVID arm is an area of redness. And if anybody’s interested, go to Google, type in “COVID arm COVID vaccine”, and you’ll see these pictures of really Redden areas around the injection site that can occur five to seven days after being vaccinated. People are asymptomatic. It’s what we call a delayed skin reaction; it’s benign, it goes away. If you get it with the first dose, you should still get the second dose. So that’s something that’s come up. Another thing that’s most recently come up is and we know this from the studies with Pfizer and Moderna that as part of that vaccine reactogenicity or that immune response, sometimes you can get an enlarged gland or lymph node in your armpit or axillary area. So, for women who have a history of breast cancer or for women who are very in tune with breast cancer, they know that if they feel an enlarged lymph node in their armpit area, that potentially is a concern for breast cancer. So that that we know about that. So, a new announcement from the Society of Breast Imaging, and I didn’t know such as society existed, but there is a Society of Breast Imaging. Their official recommendation is if you need a breast imaging study, and it’s not an emergency, get the breast imaging study done before you get vaccinated. But if you do get vaccinated, not to have a breast imaging study done for four to six weeks after vaccination.

Missy Gleason  14:29

So, we’ve got quite a few viewer questions coming in. One is asking about how does the vaccine affect those with auto-suppressed immune systems?

Dr. Joe Gastaldo  14:39

Great question. So, let’s talk about that. So, first of all for years, we have been giving people with weakened immune systems vaccines all the time. Flu shots, pneumococcal vaccination…the big risk is when we give live virus vaccines to people with weakened immune systems because those live to weaken viruses can cause problems for people with weakened immune systems. So, when it comes to giving vaccines, we don’t give live virus vaccines to people with weakened immune systems. That’s not the case with the mRNA vaccines or the J&J vaccine. So that’s the first thing. Second thing is, we know people with weakened immune systems are higher risk of dying from having COVID-19. So, this is me talking as an infectious disease doctor, if you have a weakened immune system, you should talk to your doctor because there’s some little tricks that you can do, and I’ll talk about that in a second. But you should still get the vaccine; some immunity is better than no immunity. Now, there are some people who take medicines that weaken their immune system, only twice a year or three times a year. There are medicines used for multiple sclerosis or MS that are what we call biologicals, that weaken your immune system. But most people only get those like twice a year. So, when those scenarios arise, talk to your doctor and try to plan to get your vaccine before the dose of that medication. So, when you get the dose of that medication, that’s when your immune system takes that weakness, and then it comes back slowly over time. So, you really want to get your immune response when your immune system is as robust as it can be.

Missy Gleason  16:21

Another question from a viewer, are there risks of heart problems for older adults after the COVID vaccine?

Dr. Joe Gastaldo  16:27

No, there’s not. And you know, when you look at the comorbidities in the medical conditions of people who have been vaccinated in the J&J trial, they do have people in there with conditions like diabetes, lung disease and heart disease. So, you know, COVID-19, when you get COVID-19, your blood is thicker. We now recognize that people can have a coagulopathy or thickened blood with COVID-19. So, there’s a higher risk of clots with COVID-19. But for people who have heart disease or people who have strokes, there is no special warning at all and in receiving the vaccine. We want those people to be vaccinated.

Missy Gleason  17:05

So, folks who have things also like AFib, they should be fine too?

Dr. Joe Gastaldo  17:09

Absolutely.

Missy Gleason  17:10

And somebody else asked about having COPD and getting the vaccine.

Dr. Joe Gastaldo  17:14

Absolutely. So, you know, if you have lung disease, if you have asthma, COPD, pulmonary hypertension…those are risks that puts you at a much higher level having a bad outcome from getting COVID-19. So, I know for certain, because I remember reading the Pfizer vaccine, Pfizer did have people in their study with lung disease.

Missy Gleason  17:35

Okay.

Dr. Joe Gastaldo  17:35

So, the mRNA vaccines are safe for people with heart disease and lung disease.

Missy Gleason  18:25

So, can you talk a little bit about taking painkillers before or after being vaccinated?

Dr. Joe Gastaldo  18:31

This is a very common question I get. So as much as possible, we should stick to the CDC recommendations. The CDC is very conservative and if something has not been studied, they always have a cautionary statement. So, the official stance from the CDC is: only to take Tylenol or Advil if you develop symptoms after you’re vaccinated, and to not take them preventatively. And the reason behind that is because they don’t know with certainty that if you take those medicines, it’s not going to blunt an immune response. You know, I was on a CDC call and somebody asked that question. And they basically said, “Where’d that come from? Why did they say that?” They said, well, that hasn’t really been studied, so we want to be extra cautious. And there’s one random pediatric study from many, many years ago, an animal study, that says taking those medicines could potentially suppress an immune response. So again, we’re learning as we go along, and we want that to happen. So officially speaking, only take Tylenol or Advil, if you have symptoms. But, if you are on regular scheduled medications, if you’re on a blood pressure medicine, if you’re on a medicine for depression, if you’re on medicine for anything else, don’t skip any of those medicines you’re supposed to be on before you get vaccinated.

Missy Gleason  19:51

Got it. Somebody is asking if they’ve had COVID and fully recovered, how soon after that should they get vaccinated?

Dr. Joe Gastaldo  19:59

I wish I could honestly answer that. So, let’s talk about what is recommended and what we know about people who have recovered from COVID. The vast, vast, vast majority of people who have COVID have a degree of immunity for a period of time. We don’t know how long that period is. Is it six months, seven months, nine months? There are many studies that have that all over the place. The official recommendation from the CDC, and I do support this, is if you have previously had COVID, if it’s last month, last year, six months ago, if you’re in the category to be vaccinated, and you have access to be vaccinated, get vaccinated; don’t put it off. Because if you have access today, and you say, “you know what, I just had COVID last month. I’m going to put it off for a couple more weeks.” You don’t know what that access is going to be like in a couple weeks.

Missy Gleason  20:49

What about getting other vaccinations around your COVID vaccination?

Dr. Joe Gastaldo  20:53

So again, the official recommendation from the CDC is to separate any other vaccine by 14 days from the COVID-19 vaccine. That is the official recommendation. However, they also say to though, you know, if something, on an emergency basis happens, and I’ll give you a scenario. Let’s say you got your COVID-19 vaccine shot today. And then tomorrow, you have a really bad, dirty cut, and your last tetanus shot was over 10 years ago. Well, you need a tetanus shot then. And in that scenario, because this is an emergency basis, we would give you the tetanus shot. But the general guidance is not to receive any other vaccine within 14 days from the COVID-19 vaccine just because it hasn’t been studied.

Missy Gleason  21:35

Another viewer question: if you’ve had a reaction to another type of vaccine, like a DPT one as a child, should you still go ahead and get vaccinated?

Dr. Joe Gastaldo  21:43

Another great question and the answer that simply is yes. The COVID-19 vaccines, the mRNA vaccines, they only have four ingredients in them. And those four ingredients are not used in any other vaccines at all, there’s no preservatives in the vaccines, the rubber stopper in the vaccine does not interact with anybody with a latex allergy. If you have a history of an allergy to any medicine, to any other vaccine, you need to disclose that. If your allergy involves anaphylaxis or a severe allergy, you can be vaccinated. But, when you’re vaccinated, you have to disclose that, and you have to be monitored for 30 minutes for severe allergic reaction.

Missy Gleason  22:27

All right, I am checking on questions. So, we are officially a year into our COVID-19 work. Well, it’s been more than a year, but how are you feeling about where we are today compared to where we were a year ago?

Dr. Joe Gastaldo  22:43

Very, very happy. Very, very happy for the following reasons: we have safe and effective vaccines. Getting vaccines in people’s arms will end the pandemic. I wish I could go to a tall mountain in Columbus and yell that. And I feel that I’m very grateful for all the work of the scientists in the world, I’m very grateful for my OhioHealth family. I’m very grateful that in our community, in our country, in our state…COVID-19 numbers are going down, positivity numbers are going down, hospitalizations are going down, deaths are going down. I’m very optimistic. I also want to recognize and really reflect on all of the pain and suffering this last year has had on us. We have over 500,000 deaths attributable to COVID-19. COVID-19 effects mental health, suicides, domestic abuse, drug abuse, alcoholism, loneliness. You know, just COVID-19 sickness does not capture all the pain and suffering that we have had. In addition to that, the other news that recently came out from the CDC and a government agency was that the American life expectancy, because of COVID, has gone down by one year. And that’s 2.7 years in the African American community. COVID-19, due to health care disparities that have always been there, COVID-19 has really hit hard the minority community: Native Americans, African Americans and Latino community. And when you look at the effect on the American life expectancy, the African American community has had their life expectancy go down by 2.7 years. It breaks my heart.

Missy Gleason  24:28

Here’s another question from a viewer. So, are there any groups that shouldn’t get vaccinated?

Dr. Joe Gastaldo  24:35

Yes. So, the true contra indication in not getting the vaccine…it’s very simple. So, number one: if you have a history of anaphylaxis, or a severe allergic reaction to the first dose, you shouldn’t get the second dose. And if you have a severe known history of an allergic reaction to something called polyethylene glycol or something closely related to it called polysorbate, you should not be vaccinated. Those substances are part of the lipid nanoparticle, the piece of fat, around the mRNA. So really, if you have a history of anaphylaxis to any other shot, any other vaccine, any other IV medication, penicillin, peanuts, or God forbid puppies, you can still be vaccinated. You disclose that; they’ll ask you when you register, “do you have a history of allergies? Anything regarding anaphylaxis?” And if you do, they monitor you for 30 minutes. One of the safety signals that came up is that there’s a very, very, very low incidence of people having anaphylaxis from the mRNA vaccines. And guess what? anaphylaxis is something that’s recognized, it’s part of the ebb and flow and the mechanism of being vaccinated, and there are EpiPens there. In our country, over 44 million people have received an mRNA vaccine, and nobody has died from receiving an mRNA vaccine from anaphylaxis. Those who have had anaphylaxis, have been given an EpiPen, they were treated, and they did fine.

Missy Gleason  26:15

Good to know. So earlier this morning on OhioHealth social channels, we promoted this event, obviously, and we asked people if they had questions. So, I have a few of those that came in earlier today. You ready?

Dr. Joe Gastaldo  26:24

Yep.

Missy Gleason  26:24

Okay, so how long after your first round of vaccine doses will your antibodies drop? Or would you need another vaccine? Do we know that yet?

Dr. Joe Gastaldo  26:33

We don’t know that yet. So, in 2021, in addition to us learning more about COVID-19, when it comes to vaccines, there’s some things that we need to learn too. And one of them has to do with when you get vaccinated, what is the durability or the duration of the immunity that you get. It’s more than 90 days, it’s more than six months. But beyond that, we still need to study that. That’s why the trials go on for two years. So, we will get there. The other thing too is remember, there’s more to the immune system in the immune response than just an antibody level. There’s your B cell response or your antibody response, but another part of your immune system is what we call T cells, and those don’t involve antibodies. The antibodies that we have in the lab, we don’t use those as a marker of immunity for this virus. You know, we’re all very familiar with things like measles, and rubella to check your antibody. If you have a measles antibody, you’re immune to measles. That’s not the way these antibodies work with this particular virus.

Missy Gleason  27:36

Got it. So, should we be-this is another viewer question: should we be concerned about vaccine efficacy with the South African variant in the US?

Dr. Joe Gastaldo  27:46

So, let’s talk about variants a little bit. So, all I’ll say is variants scariants. You know, what we’re talking about here in getting vaccines in the people’s arms, we need to continue doing that. We need to learn and science the variants; we need to learn about them. Variants are a reflection of mutations. This is an RNA virus; RNA viruses mutate all the time. This RNA virus has mutated since it was discovered, and it’s going to continue to mutate. The concern about the variants are these variants all involve the spike protein. So, in the setting of these different variants that are out there, we have some…there’s three variants in the news that were discovered and first identified in different countries. There’s the B.1.1.7 variant that was first identified in the United Kingdom. There’s a South African variant that was first identified there. And a Brazilian variant that was first identified there. Guess what? All of those variants are here. They have been here, and we continue to learn that we have other variants. We need to learn about the variants, we need to study those in the lab. What we know about the current vaccines that we have, specifically regarding the UK variants is that the vaccines work well. When the vaccines don’t work anymore, we call that immune escape. When that happens with viruses, it’s not an off/on switch; it’s a gray dimmer switch. So, when that vaccine immune escape happens, it’s not going to happen entirely for a while. We know, for example with the J&J vaccine in their trial, that study was done in the United States. It was done in South Africa, and it was done in Brazil. And guess what? With their variants there, the J&J vaccine still provided 100% protection against death, being hospitalized and a higher severity of illness. So, the vaccines performed well with the variants. We need to watch them; we need to learn about them. But, you know, the scariant discussions in the news, you know, that’s a very complicated topic to put out there in the news in a short paragraph that we all watch in our daily news.

Missy Gleason  30:03

True, very true. So, with the Johnson & Johnson vaccine’s anticipated approval on Friday, how do you think that approval will affect the vaccination timeline?

Dr. Joe Gastaldo  30:13

Well, it’s going to make things a lot easier. So, Johnson & Johnson already has said that as soon as they get the FDA authorization and the CDC recommendation, they are prepared to ship out 4 million doses of vaccine. In the month of March, they are prepared to make a total of 20 million doses. So that’s more vaccines. We have other signals from Moderna, for example, the Moderna vial only holds 10 doses in the vial. They recently got approval from the FDA to put 15 doses in the same vial. And they’re going to be operationalizing that soon in the next few weeks. Pfizer, two positive things about Pfizer, number one, Pfizer is asking for permission from the FDA because they have data that they have done showing that in a regular freezer, not these ultra-cold freezers, their vaccine does a-okay stability wise for 14 days. Pfizer also recently announced that due to improved efficiencies, they’ve cut by 50% their manufacturing process. So, another way of putting that, if it takes them one day to make 100 vaccines, one day they’re going to make 200 vaccines. So really, those three companies really paint a very positive story on us getting more vaccines heading into March, heading into April, heading into June. And we haven’t even talked about the other vaccines are likely to be authorized by then too, and those include AstraZeneca and Novavax. So again, we’re going to have a lot of vaccines rolling into May and the summer. And as we get more vaccines, that age is going to come down more and more and more, where it’s really going to be the open season. And that’s why we need to start taking this vaccine safety and efficacy message to all communities and all ages so they can think about it. So, when they get access to a vaccine, they roll up their sleeves.

Missy Gleason  32:13

So, I got the privilege of volunteering at one of the OhioHealth vaccination clinics last week, and it was interesting to see the people that came through and asked, “well, which one are you giving out today?” And I know that one thing we like to tell people is the best vaccine is the one you can get.

Dr. Joe Gastaldo  32:29

That’s correct- Absolutely. You know, what really counts in a vaccine is does the vaccine prevents you from dying, and does it keep you out of the hospital? Does the vaccine prevent you from getting severely ill? And that’s what we really want to keep track of when it comes to getting a vaccine. You know, if we all get vaccinated, and the result of the vaccination means that if you get COVID, it’s a cold. That’s wonderful! You know, if somebody with comorbid conditions gets the vaccine and they get COVID, and they get a minor cold, instead of being hospitalized or dying, that’s wonderful. We need to get vaccines into people’s arms. The vaccines perform well. And as you stated so eloquently, the best vaccine to get is the one for which you have access.

Missy Gleason  33:17

When can the general public expect to get their first dose? So, you kind of just touched on this…like soon? Spring?

Dr. Joe Gastaldo  33:23

Soon. Again, no one really knows, you know, we’re all at the mercy of the manufacturing process. You know, we were talking earlier before we talked about this, making these vaccines. It’s not like a car factory. Because these vaccines think of them as Moore’s crops, you have to grow them, you have to develop them. And there is a supply chain issue with the raw materials and making the vaccines. So again, and also Pfizer and Moderna, they’re making vaccines for other countries in the world too. So, but still, nonetheless, when you see all these signals and the things we just talked about, we’re going to have more vaccines. The United States is very blessed, because our country, our government has spent the money to pre order all these vaccines from six different companies.

Missy Gleason  34:12

So, I want to go back to what you were saying about, you know, getting the vaccine and if it makes it just like a bad cold. That’s fabulous. I was reading an article today from the New York Times that talked about COVID zero, and how a lot of people are like, well, it’s awful if we don’t get to zero cases.

Dr. Joe Gastaldo  34:28

Yeah, thanks for asking that Missy. You know, this coronavirus, so when it’s all said and done., this virus is going to be like other coronaviruses where there’s seasonality to them. We typically see more coronavirus, colds, in the fall; they peak in the winter months, and then they start to peter out a little bit now with coronavirus as the cause of the common cold. There are going to be people-vaccines do not work in 100% of all people. There’s going to be people with weakened immune systems, there’s going to be people who choose not to get them vaccine, but no vaccine is 100% effective. We are never likely going to have zero COVID-19. We’re never going to have zero COVID-19. We’re going to have a new normal, but if we can give everybody a shot that prevents you from dying, that keeps you out of the hospital…that is a great place to be. It’s going to be like influenza. Every year, influenza kills thousands of people in our country. And a lot of people choose not to receive that vaccine. But, you know, influenza and coronavirus are two different diseases. But when enough people get vaccinated, then we’re going to start talking more about COVID-19 behaving more like influenza, meaning that there’s less people dying and it’s going to be more of a seasonality type virus that we see.

Missy Gleason  36:31

We just have a couple more questions unless more come in in the next few minutes here.

Dr. Joe Gastaldo 36:36

Send your questions in!

Missy Gleason 36:37

*Laughter* Somebody is asking what are the side effects of the monoclonal antibody therapy and does this treatment affect the efficacy of the COVID vaccine?

Dr. Joe Gastaldo  36:47

So monoclonal antibodies: they are antibodies made in a lab. And the monoclonal antibody binds to the spike protein of the virus and it prevents the virus from causing infection. That’s how they work. Monoclonal antibodies are given intravenously, although there is one that’s being studied for intramuscular injection, but they’re given intravenously. And they are officially authorized to give to people who are symptomatic with COVID-19 with at-risk conditions. And, clinically, we do that to give them to people earlier on in their disease process to keep them out of the hospital and prevent them from dying. I’m going to toot our horn a little bit. At OhioHealth, we have given over 2000 doses of monoclonal antibodies, and again, we give them to at risk individuals with symptomatic COVID-19 who are not sick enough to be hospitalized. And when we give those to people, over 95% of the people who have received those monoclonal antibodies, required no hospitalization. So, I’m very proud of the work that OhioHealth did in operationalizing something that is very complicated. So, the monoclonal antibodies, they’re pretty well tolerated. You know, the infusion just got changed. It used to be an hour; the FDA says now you can do it in a shorter period of time. The infusions are, for the most part, very well tolerated. There are some people who will have minor allergic reactions like itching, or maybe a rash after they get it. There have been some people who’ve had a severe allergic reaction…anaphylaxis from it. But again, that’s something that’s treatable with an EpiPen. For the most part, they are well tolerated. Oh, one other thing I forgot to say. When it comes to getting a vaccine, so the monoclonal antibodies, when you get a monoclonal antibody that stays in your body for a long time, it has what we call a long half-life, that’s passive immunity, and you actually get a good level of protection for a while. So, there’s really no need to get the vaccine. Just because it hasn’t been studied, theoretically, the monoclonal antibody could interfere with the immune response you get from the vaccine. So, the official recommendation from the CDC is, if you have had a monoclonal antibody, knowing that you have a level of protection for a while, and that the vaccine can interfere with an immune response, you should not be receiving a vaccine for 90 days after receiving the monoclonal antibody.

Missy Gleason  39:17

Good to know. Going back to the vaccines and allergic reactions, somebody had asked, what do you suggest for patients who have a reaction to the polyethylene glycol?

Dr. Joe Gastaldo  39:30

Well, if it’s a history, if it’s anaphylaxis, that is a do not receive this vaccine. And then in that scenario, we have to see really what the recommendations are for the Johnson & Johnson vaccine. So, if somebody has a history of anaphylaxis to polyethylene glycol, or something closely related to it called polysorbate, they should not receive the vaccine. If they don’t know if their allergic reaction is anaphylaxis, they should really go to an immunologist or an allergy specialist to get clarification on that.

Missy Gleason  40:03

Here’s a question and you might not have the answer this one. Somebody is asking if you have T-cell lymphoma, should you get vaccinated?

Dr. Joe Gastaldo  40:09

You should be vaccinated. So again, talk to your doctor. But this is what we’ll say. People with T-cell lymphomas, they are in the category of people with weakened immune systems. People with weakened immune systems should not be given vaccines with live weakened viruses. That’s not the case with an mRNA vaccine or the Johnson & Johnson vaccine. We give people the flu shot every year; we give people with weakened immune systems other vaccines all the time. So, if somebody has a T-cell lymphoma, a B-cell lymphoma, many many types of lymphomas, it is possible for you safely to get the vaccine. The immune response you may get may not be as robust as somebody with a normal immune system, but you’re likely to get some immunity and some immunity is better than no immunity. And, you know, people with weakened immune systems are at significantly higher risk of having a bad outcome from contracting COVID-19. So really, a lot of the questions that come up, have to come down with a risk versus benefit ratio. So, in the setting of the question you just asked, there is no risk in getting an mRNA vaccine or the J&J vaccine, but there’s potentially great benefit of getting the vaccine for somebody with a weakened immune system.

Missy Gleason  41:26

So, we’re right now in 65 or older and then certain medical conditions. Do you anticipate or can you kind of speculate, I would say, going forward as the age range drops do you think the medical conditions will get wider?

Dr. Joe Gastaldo  41:41

I do. As we get more vaccines, I do see Governor DeWine liberalizing those conditions. You know, if we had unlimited access to vaccines, it’d be open season for vaccines. But you know, when I reflect on 65 and older, and my parents, you know, a lot of the scheduling is being done through smartphones and computers, and this-that-the other, and, you know, people who don’t have access to that, who aren’t technology savvy, people who are visually impaired, and those people need more help in getting scheduled for the vaccination, that’s where the senior citizens are. But as we get more vaccines, I do see Governor DeWine, the Ohio Department of Health, opening up the floodgates: lowering the ages, opening up the medical conditions. But we still have to be sensitive and make an effort to reach out to those in our community who don’t have smartphones, don’t have Wi-Fi access, don’t know how to use a phone, can’t read or write, don’t have English as their first language. You know, there are still barriers that you and I take for granted, that exists for a lot of people in our community, and all healthcare systems, OhioHealth, all the healthcare systems in Central Ohio, in our region, are really making an effort to reach out to those communities who have barriers.

Missy Gleason  43:00

That’s true. I think somebody has just joined us because they just asked, “I have severe allergies. What do I need to know or consider when selecting a vaccine option?”

Dr. Joe Gastaldo  43:10

Well, I want to know really, what are those severe allergies? So, the only true contra indication, do not receive this vaccine, is if you have a history of a severe allergic reaction to polyethylene glycol or polysorbate. If you have a history of severe allergic reaction to anything else, penicillin, peanuts, God forbid puppies (I always like saying that), you can still be vaccinated. You need to disclose that when you get vaccinated. Everybody with a history of a severe allergic reaction goes under a precautionary period where they’re watched for 30 minutes. And if they have anaphylaxis, it’s recognized, and they’re given an EpiPen.

Missy Gleason  43:54

This is the last question I have on my list unless something else pops up. So, what about people receiving chemotherapy or radiation for cancer?

Dr. Joe Gastaldo  44:02

They can receive the vaccine and again people receiving radiation chemotherapy, they’re in the bucket of people with a weakened immune system, their higher risk of having a bad outcome from COVID-19. These are not live virus vaccines; you cannot get COVID from these vaccines. That also includes J&J. The immune response you get receiving chemo may not be as robust, but some immunity is better than no immunity. Now, we talk about chemo. There are different types of chemo where for example, people only get once a month, once a quarter, every six months. And when you get immunosuppression from chemo, it occurs right after you get the chemo. So, talk to your doctor who’s giving you your chemo or your biological or the medication that weakens your immune system, and see if you could time it. So, you get your vaccine before you get your chemo, when your immune system is not as weak.

Missy Gleason  45:03

So, we are at the end of our viewer questions, but I wanted to ask you: any final thoughts for tonight?

Dr. Joe Gastaldo  45:08

Final thoughts for the night: I’m an optimist. I’m an eternal optimist. I already reflected upon all of the pain and suffering our community, in our country, in our world has had from COVID-19. There are so many positive signals out there: numbers are down, hospitalizations are down, deaths are down. And we are really at a point where the main emphasis needs to be on putting vaccines in the people’s arms. There are two wild cards. The first wildcard is the variants. I told you not to worry about the variants, let’s study those, but the variants will be of more concern if people don’t get vaccinated. The more people that get vaccinated takes us back to the new normal, where we can do things, spend time with our families, go to restaurants, go to concerts, go to sporting events…not live in this environment of fear and shame. So please, get your questions answered, your concerns answered from somebody that you trust someone who’s following the science and can talk to you in a manner that you understand in a respectful and non-judgmental way. All of the questions that were asked, were asked by people who had a concern that was pertinent to them. So, they can gather the information they need to be vaccinated. A lot of the people who had questions are vulnerable individuals and I appreciate that. But we’re going to get to the point where there are people who don’t have any vulnerable conditions, who are going to say, “you know what? Why should I get vaccinated? For me, I’m low risk. I don’t have any health care conditions. So, what do I have to worry about?” My answer to that is we want the numbers to bottom out. And if you do have COVID, and you have minimal infection, minimal symptoms, you can spread it to somebody who is vulnerable. So please, we all are connected by our community immunity, and our community immunity is as strong as it can get if everybody in our community is vaccinated.

This article is based off of a live interview conducted on Facebook on February 24, 2021. Due to the changing nature of COVID-19, some information might be dated. Always check with the CDC for the latest changing information concerning COVID-19.

 

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