By Lily H-A
From PHN Issue 46, Spring/Summer 2021
On February 27, 2021, the Food and Drug Administration (FDA) approved a third COVID-19 vaccine, developed by Johnson & Johnson (J&J, sometimes called “Janssen”) under the same shortened process as the other two currently approved vaccines (Pfizer-BioNTech and Moderna).
The J&J vaccine only requires one dose instead of two, and doesn’t need ultra-cold refrigeration, so it’s easier to distribute. It also uses slightly different technology from Pfizer and Moderna’s vaccines. All three vaccines work by making the cells in your body produce harmless proteins that look like parts of the coronavirus, which teaches your immune system how to recognize and destroy the actual coronavirus if it enters your body. Pfizer and Moderna’s vaccines use a messenger called mRNA to do this, while J&J’s uses a deactivated virus called an adenovirus. This deactivated virus cannot infect you, and is not the same as the coronavirus.
The J&J vaccine was just as safe as the other two vaccines in clinical trials, and had slightly milder side effects. It may not be quite as effective as the other two, but it is hard to compare since the trials studying the vaccines were designed differently and took place at different times during the pandemic. The J&J vaccine was 66% effective in preventing any COVID-19 symptoms in a clinical trial, and 85% effective in preventing severe symptoms. The Moderna and Pfizer vaccines were 95% effective in preventing symptoms in clinical trials.
But, all three vaccines were 100% effective at preventing hospitalizations and death, meaning nobody who got any of the three vaccines in the trials was hospitalized or died from COVID-19.
Since the J&J vaccine was released, there have been a small number of reports of a rare type of blood clots in people who got the vaccine. Because of this, on April 13, the Centers for Disease Control and Prevention (CDC) and FDA recommended a pause on vaccination with J&J while they investigated. They found that there were 15 cases of these rare blood clots and 3 deaths in the millions of people who got the J&J vaccine. This means about 2 out of every million people who got the vaccine got these blood clots. Most of these cases were in women younger than 50. After looking at the evidence in detail and having several meetings, on April 24, the FDA and CDC recommended starting vaccination with J&J again, but with a warning on the label about the risk of blood clots. They emphasized that the risk of dying from COVID-19 is much higher than risks from the J&J vaccine, so the benefits of getting vaccinated still outweigh the risk by a lot.
A vaccine that was approved in other parts of the world, but not in the US yet, called the AstraZeneca vaccine, also had cases of blood clots reported in about 1 in 100,000 people who received the vaccine. Because of this, some countries paused or put limits on vaccination with the AstraZeneca vaccine.
Health authorities are still watching carefully for major health problems from the Pfizer and Moderna vaccines as well, and so far those vaccines still seem very safe.
Effectiveness of the vaccines in the real world
Now that many people have been vaccinated, studies of how the vaccines work in the real world (beyond the large clinical trials) are starting to come out. A recent CDC study showed that the vaccines were 90% effective in preventing people from testing positive for COVID-19. This means it can keep you from getting and spreading the virus to unvaccinated people, as well as keep you from getting sick. These results are similar to those from other studies coming out across the world.
There have been rare cases of people getting COVID-19 even after being fully vaccinated, which was expected since the vaccine does not offer 100% protection. Most of these cases have been mild or with no symptoms. On May 13, the CDC announced that fully vaccinated people have minimal risk of catching the virus and lower risk of transmitting it to unvaccinated people. They announced that in many settings, people who are fully vaccinated can stop wearing face masks and social distancing, but that vaccinated people in jails and prisons (including staff) should continue to wear a well-fitted face mask. This is because the risk is higher in settings where lots of people are crowded together (“congregate settings”), like jails, prisons and homeless shelters. As more and more people get vaccinated, the spread of COVID-19 will likely slow down, and these guidelines may change.
As of May 17, 47% of people in the US (almost half) have gotten at least one vaccine dose, and 37% (about 4 in 10) are fully vaccinated. The US currently ranks 10th in the world for vaccination rate by country; a few countries have vaccinated most of their adult population, but many others, especially poorer countries, have gotten very few vaccines so far. The New York Times estimates that at current vaccination rates, 70% of people in the US will be completely vaccinated by August 30. All 50 states made all adults eligible to get the vaccine by April 19.
The status of vaccination for people in jails and prisons varies a lot by state, and more than half of states are not publicly sharing data about vaccinations in jails and prisons. Many states took a lot longer to offer vaccines to incarcerated people than people on the outside, and in some cases it took public pressure or court rulings to make the vaccine available to incarcerated people. The percentage of people in prisons and jails who have gotten vaccinated varies a lot by state – out of states that share their data, it ranges from 76% in Arizona down to only 20% in Alabama. There have also been reports in many places about people in prison not being given good information or education about the vaccines, and of prison staff refusing to get vaccinated.
The New York Times reported recently that at least one in three people in state prisons and 39% (4 in 10) people in federal prisons have had COVID-19; the true number is likely higher because of lack of testing. Over 2,700 people in US prisons and jails have died from COVID-19. In October 2020, as a result of the pandemic’s death toll among people in prison, the American Public Health Association issued a statement supporting the abolition of prisons and replacing them with accountability and safety programs that don’t involve police, while investing more in public health, housing, and employment.
New COVID-19 variants
Every virus evolves, and new mutations in their genetic code appear over time. This process has been happening with the coronavirus since the beginning of the pandemic. Versions of the virus with new genetic mutations are called “variants.” Some of the variants of the coronavirus that have appeared in the past few months are making people worried, since some evidence suggests they are more contagious (spread more easily). It isn’t clear yet whether the symptoms they cause are more serious, or how they affect how well treatments work. Some of these variants have been called the UK variant, the South Africa variant, and the Japan/Brazil variant, based on where they were first discovered by scientists, but all of these have now been found around the world, including in the US.
The currently approved vaccines may not be quite as good at preventing infections and symptoms with the new variants, but even with the new variants, the vaccines seem to still be very good at preventing severe illness and death. Scientists are working on ways to keep vaccines effective over time as the coronavirus evolves.
Some people have reported that even after recovering from COVID-19, they have symptoms that outlast their infection. This has become known as “long COVID” or “long-haul COVID.” It has been known since the beginning of the pandemic that people with severe infections that require hospitalization can have long-term damage to their lungs, heart, and other organs. However, even some people who had milder infections have reported that they feel ill for weeks or months after their original infection with COVID-19. They have described a wide range of symptoms like fatigue, “brain fog” (trouble with concentration and memory), shortness of breath, cough, joint pain, and chest pain.
Scientists have begun to investigate long COVID, but so far, little is known about what is causing these symptoms, and how best to treat them. What helps may be different from person to person, but many people have found their symptoms do improve with time. Some people with long COVID have also reported they started to feel better after getting the COVID-19 vaccine, and researchers are studying this as well.
If you are having long-term symptoms after you recover from COVID-19, you are not alone. The National Institutes of Health, CDC, and World Health Organization have all recognized that people can have long-term symptoms after recovering from COVID-19. Researchers are working hard to find answers about what is causing them and how to help people with these symptoms feel better.