COVID-19. What do we need to know?

COVID-19 vaccines are now available around the World. Which COVID-19 vaccine is best for me? In just a few month I have received hundreds of calls from our patients, friends and collegues. Finally, I have decided to share my knowledge with everyone. There is no perfect answer now, but more information becomes available every day on the safety and efficiency. Vaccines are all different, and hopefully strong enough to stop pandemics that not only killed millions, but destroyed so many businesses and economies. COVID is a virus, a pandemic, a disaster, and it shook all our lives upside down. The pandemic went around the Globe too rapidly and deadly for anyone to react normally, and we cannot be blamed for the panic and uncertainty this virus created. So, looking back to at least one year of COVID-19 pandemic, what do we know for sure? Lets take a look at the published data confirmed by best World scientists and physicians. I trust one source – PubMed (a National Library of Medicine), where only high-quality scientific data is published. I will try to analyze the articles for you, and give you links to read the full story.

What is COVID-19 virus and how is it transmitted?

COVID-19 is a SARS virus

In the first place, a coronavirus named SARS-CoV-2 caused the infection in Wuhan, China in December 2019. A pandemics has since spread like wildfire, killing more than 300,000 people worldwide as of May 2020. COVID-19 killed 2 520 653 people globally, and infected around 113 million by March 2021. It affected almost every country, some suffered much more then other for unknown reason. It is also not exactly understood why it affected China, where it supposedly originated, so insignificantly compared to Europe and Americas. https://covid19.who.int COVID-19 is a coronavirus, a member of a large family of fairly harmless viruses that infect many animal species and humans.

What type of virus is COVID-19?

Like influenza, coronaviruses are RNA viruses. The SARS-CoV-2 virus (a cause of COVID-19) belongs to the betacoronavirus family. This also includes the SARS-CoV-1 virus (Severe Acute Respiratory Syndrome – SARS) and MERS-CoV (Middle East Respiratory Syndrome – MERS). Another four seasonal human coronaviruses circulate annually, mostly causing mild upper respiratory tract infections.

Is COVID-19 the same as SARS and MERS?

SARS (2003) and MERS (2014) caused short-lived epidemics with a high case fatality. MERS still occurs sporadically, but SARS-CoV-1 has not been in circulation since 2008.

COVID-19 is most severe in the elderly and those with significant comorbidities (obesity, high blood pressure). Also, SARS-CoV-2 results in asymptomatic infection (positive test with no symptoms). Unlike SARS-CoV-1, SARS-CoV-2 can be very contagious before and shortly after symptom onset, which has helped drive rapid global spread.

What is COVID-19 origin?

The biggest question is the origin of SARS-COVID-19 virus that infected people in Wuhan. By now we only have theories, but no direct answers. Here are most likely versions of this virus origin:

• As it is naturally infecting animals, such as bats, there is a possibility of this coronavirus to mutate naturally and jump to humans
• As there are documented experiments with coronavirus in Wuhan research labs, there is a possibility of a man-made virus to escape experimental conditions and jump to humans
• As naturally viruses mutate, there is a possibility of this virus already traveling human societies and just suddenly gaining strength and causing pandemics. Such thing happen before with Spanish Flu and swine Flu, and there are various reports finding evidence of COVID-19 in samples much earlier than December 2019.

The identification of several novel beta-coronaviruses with similarity to SARS-CoV-2 in Malayan pangolins, which are illegally imported into southern China, suggests that these may be the host from which the virus was transmitted to humans. https://pubmed.ncbi.nlm.nih.gov/32380510/  

What are the symptoms of COVID-19?

What are the most common symptoms of COVID-19?

The most common symptoms of COVID-19 are:

• Fever
• Dry cough
• Fatigue

Other symptoms that are less common and may affect some patients include:

• Loss of taste or smell,
• Nasal congestion,
• Conjunctivitis (also known as red eyes)
• Sore throat,
• Headache,
• Muscle or joint pain,
• Different types of skin rash,
• Nausea or vomiting,
• Diarrhea,
• Chills or dizziness.

When should I see a doctor with COVID-19?

You should see a doctor or call for emergency transport to the hospital if severe symptoms are seen. Symptoms of severe COVID‐19 disease include:

• Shortness of breath,
• Loss of appetite,
• Confusion,
• Persistent pain or pressure in the chest,
• High temperature (above 38 °C).

What are less common COVID-19 symptoms?

• Irritability,
• Confusion,
• Reduced consciousness (sometimes associated with seizures),
• Anxiety,
• Depression,
• Sleep disorders,
• More severe and rare neurological complications such as strokes, brain inflammation, delirium and nerve damage.

Can people who have no symptoms transmit COVID-19?

A systematic review of asymptomatic infections with COVID-19 was published in the Journal of Microbiology and Immunology Infections, Feb 2021. The group concluded: In the light of new research, the main mode of transmission of COVID-19 is through droplet and contact transmission and high-concentration aerosols. Droplet transmission occurs when nearby people ingest or inhale respiratory droplets (produced when an infected person coughs or sneezes). Equally important, a German team found that some people with COVID-19 had high levels of virus in their throat swabs when their initial symptoms were mild, meaning that the pathogen was quickly released and transmitted to others by coughing or sneezing (droplet transmission). This means that protective measures, including wearing protective masks, can prevent infection with new coronavirus to a certain extent. https://pubmed.ncbi.nlm.nih.gov/32425996/

Why people test positive after recovering from COVID-19 infection?

“Retest Positive” for severe acute respiratory syndrome‐related coronavirus‐2 (SARS‐CoV‐2) from “recovered” coronavirus disease‐19 (COVID‐19) has been reported and raised several important questions for this novel coronavirus and COVID‐19 disease:

• Can SARS-CoV-2 re-infect the individuals who recovered from COVID-19? This question is also associated with other questions: whether or not SARS-CoV-2 infection induces protective reaction or neutralized antibody? Will SARS-CoV-2 vaccines work?
• Why could some recovered patients with COVID-19 be re-tested positive for SARS-CoV-2 RNA?
• Are some recovered patients COVID-19 with re-testing positive for SARS-CoV-2 RNA infectious?
• How should the COVID-19 patients with retest positive for SARS-CoV-2 be managed?

There are no precise answers, although many theoretical guesses. It is possible that in every specific case the answer is different. For example, the PCR test is not perfect. As it turns out, a positivity of this test is 30-40%. It can miss some people initially, but then finally pick it up. Also, some people may continue to carry viral particles or parts even when there is no infection. Scientists say there is almost no chance a recovering person can infect others, as the viral load sufficient for infectivity is only high through the initial part of infection. So, people who retest positive after recovery can safely stay at home without a concern for relatives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300489/

Do I need to wear gloves to prevent COVID-19?

While scientist first found SARS‐CoV‐2 viral RNA to be stable on the surface of plastic and stainless steel in an experimental setting, real‐life studies investigating the infectious potential of inanimate material and patient fomites showed that they were not contaminated by viable virus, suggesting that contact transmission is unlikely to occur via contaminated surfaces. So, gloves are not needed. All you need to do is frequently wash your hands and built a healthy immune system!!!

Which test is best for COVID-19?

Normally, viral infections in humans produce certain immune responses that are measurable with antibody (IgM and IgG). In addition, scientists can isolate a virus from body fluids and replicate by a polymerase chain reaction – PCR.

What is the “gold standard” test for COVID-19?

The gold standard for COVID-19 diagnosis is reverse transcription-quantitative PCR (RT-qPCR) using nasopharyngeal (N) swabs, throat (T) swabs, or saliva. The truth is – there are no perfect tests. This is true also for ALL tests. Each testing system has various sensitivity and that is because different parts of virus are used in various PCR reactions, some of these are actually made to identify SARS virus of 2012… Not to mention that RT-PCR is a reaction used in research and was never intended for identification of sick people. Urgent situations require urgent measures – so we used what we could. Indeed, according to some publications, the test can only catch 30-40% of infected people.

What is an antigen test for COVID-19?

Rapid antigen tests (RATs) for COVID-19, which does not require specific and expensive machinery, have been approved for clinical use in Japan and other countries, and the sensitivity of these tests has been compared with that of several kinds of RT-qPCR. So, research indicates that the current RATs are likely to miss some COVID-19 patients who are shedding infectious SARS-CoV-2. However, it is unclear to what extent such patients would transmit virus to others. Further studies are required to address this point. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764512/

How is COVID-19 vaccine made?

How are successful vaccine candidates selected?

Vaccination is only successful if vaccine development results in a product approved for use and delivered to the target population. The vaccine development process is stepwise, pyramidal and selective. If initial studies in the laboratory (in cell lines and experimental animals) are favorable, human vaccine trials enter the phase I stage which assesses safety, dosage and immunogenicity in small numbers of healthy people.

Typically, only a small proportion of vaccine candidates progress to phase II trials, which are designed to identify optimal formulations, numbers of doses and dosing intervals. These trials require hundreds to around a thousand participants. Subsequently, phase III vaccine trials evaluate protective efficacy against clinical disease as well as safety. Their study size depends on the expected number of cases but is usually many thousands. In addition, progress through all trial stages usually takes at least 10 years.

Is COVID-19 vaccine research different?

Naturally, the magnitude of the COVID-19 pandemic has led to funding for the development of ‘vaccines at pandemic speed’ by running some processes in parallel. As expected, many studies have combined phase I and II trials and a few have combined phase II and III trials to compress time frames. This has not compromised scientific rigors as safety, immunogenicity and efficacy outcomes are strictly assessed and safety monitoring will continue even after registration. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900269/

Which COVID-19 vaccine is best for me?

Although estimates of the degree of immunity in the population required to control the COVID-19 pandemic vary, most center around 60–70%.  As such, effective vaccines is an acceptable path to achieving this level of immunity. Undoubtfully, the effectiveness of the various COVID-19 vaccine candidates will depend on their ability to reduce infectiousness versus their ability to prevent serious disease if someone gets infected. Whichever vaccine you choose – we can help you. We provide all initial vaccinations and boosters in our Vaccination Clinic.

The vaccines in the World’s race to safety are:

• mRNA vaccines – they contain replicated “mutated” non-infectious mRNA fragments of COVID-19. when this material gets into the muscle (injection) it is then taken by immune cells and maybe some other cells and replicated into virus protein. This protein causes immune system to attack a “mock” virus and develop a protective immunity against real virus.
• DNA vaccines. They contain actual viral DNA that misses fragments capable of full replication and infection. Again, immune system will recognize it as a virus and will attack building a protective response
• Vector vaccines. These use another virus that is capable of causing real infections in humans (such as adenovirus) which carries the fragment of COVID-19 virus. Immune cells immediately attack these particles and produce protective antibodies against the virus
• Attenuated (inactivated or live-inactivated) virus vaccines. This is the most studied technology that produced many vaccines we already know (Hep A, Flu, MMR, polio, rabies). It contains full virus that has been heated so it loses an ability to cause real infection. Naturally, this vaccine causes strong response of the immune system and long-lasting protection that can be measured by antibody test.

Pfizer-BioNTech

This is a lipid nanoparticle-formulated, nucleoside-modified mRNA vaccine encoding the prefusion spike glycoprotein of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19).

BNT162b2

BioNTech/ Pfizer (Germany, USA)

mRNA (lipid nanoparticle)

2 doses schedule

Two doses protective 95%

Vaccination with the Pfizer-BioNTech COVID-19 vaccine consists of 2 doses (30 μg, 0.3 mL each) administered intramuscularly, 3 weeks apart. On December 12, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Pfizer-BioNTech COVID-19 vaccine in persons aged ≥16 years for the prevention of COVID-19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745957/

Moderna

Moderna is a lipid nanoparticle-encapsulated, nucleoside-modified mRNA vaccine encoding the stabilized prefusion spike glycoprotein of SARS-CoV-2.

mRNA-1273

Moderna/NIAID (USA)

mRNA (lipid nanoparticle)

2 doses schedule

Effectiveness 94.1% (2 doses)

This vaccine is the second COVID-19 vaccine authorized under an EUA for the prevention of COVID-19 in the United States. Likewise, vaccination with the Moderna COVID-19 vaccine consists of 2 doses (100 μg, 0.5 mL each) administered intramuscularly, 1 month (4 weeks) apart. On December 19, 2020, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Moderna COVID-19 vaccine in persons aged ≥18 years. https://www.cdc.gov/mmwr/volumes/69/wr/mm695152e1.htm?s_cid=mm695152e1_w

Johnson & Johnson

A vector vaccine is a most recently approved for US distribution. A Johnson & Johnson new vaccine is approved for use and is being rolled out at current vaccination centers. Ad26.COV2.S, is a recombinant, replication-incompetent adenovirus serotype 26 (Ad26) vector encoding a full-length and stabilized SARS-CoV-2 spike protein.

Ad26.CoV2.S

Janssen/Johnson & Johnson (USA)

Viral vector (human adenovirus type 26)

1 dose

This multicenter, placebo-controlled, phase 1-2a trial randomly assigned healthy adults between the ages of 18 and 55 years (cohort 1), and those 65 years of age or older (cohort 3)in two groups. 90% or more of all participants developed neutralizing-antibody titers against wild-type virus on day 29 after the first vaccine dose (geometric mean titer [GMT], 224 to 354). After they reached 100% by day 57 with a further increase in titers (GMT, 288 to 488), regardless of vaccine dose or age group. Titers remained stable until at least day 71. A second dose increased titer by a factor of 2.6 to 2.9 (GMT, 827 to 1266). Spike-binding antibody responses were similar to neutralizing-antibody responses. https://pubmed.ncbi.nlm.nih.gov/33440088/

What are other COVID-19 vaccines available in the World?

Oxford-Astra Zeneca vaccine is a vector vaccine. It is in full use in England and some other countries.

Viral vector (chimpanzee adenovirus vector)

University of Oxford/ AstraZeneca (UK)

2 doses schedule

Half dose and then full dose effective 90% Two full doses effective 62.1%

Lancet published the study ChAdOx1 nCoV-19 vaccine (AZD1222) safety and efficacy. This analysis includes data from four ongoing blinded, randomized, controlled trials. Countries participating:

• Across the UK,
• Brazil,
• South Africa.

Here are findings:

11 636 participants (7548 in the UK, 4088 in Brazil) participated in the interim primary efficacy analysis. Interestingly, vaccine efficacy was 62.1% in participants who received two standard doses. Meanwhile, in a low dose followed by a standard dose, the efficacy was 90.0%. Researchers found overall vaccine efficacy across both groups to be 70.4%. From 21 days after the first dose infected people included:

• ten cases hospitalized for COVID-19, all in the control arm;
• two were classified as severe COVID-19, including one death.

Side effects were:

• 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group.
• Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext

Russian vaccine

Russia developed and successfully launched immunization with a vector vaccine – Sputnik V. This is a heterologous COVID-19 vaccine consisting of two components: a recombinant adenovirus type 26 (rAd26) vector and a recombinant adenovirus type 5 (rAd5) vector. Both vectors carry the gene for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein (rAd26-S and rAd5-S). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31866-3/fulltext

Gam-COVID-Vac

Gamaleya Research Institute (Russia)

Viral vector (human adenovirus type 26 and 5, sequentially administered)

2 doses schedule

Phase I/II completed

Russian scientists and physicians conducted two open, non-randomised phase 1/2 studies at two hospitals in Russia. They enrolled healthy adult volunteers (men and women) aged 18–60 years to both studies. In phase 2 of the study vaccine had two-dose schedule with rAd26-S given on day 0 and rAd5-S on day 21. These trials are registered with ClinicalTrials.gov, NCT04436471 and NCT04437875.

Chinese vaccines

United Arab Emirates (UAE) and Bahrain approved inactivated vaccine developed by Chinese state‐owned Sinopharm. Sinopharm announced 86% effectiveness in two‐dose regimen. The trial included 31 000 people in the UAE and 7700 in Bahrain. There are no publications about this vaccine. Sinopharm’s vaccine is also undergoing phase III trials in other countries including Egypt, Jordan, and Argentina. Notably, a double‐blind, randomized, placebo‐controlled phase 1/2 trial has reported: “vaccine was well‐tolerated at varying doses with the most common adverse reaction being pain at the injection site in only 15% of subjects”. The vaccine effectively induced antibody responses, but the longer interval between first and second injections produced stronger antibody responses. Of interest, according to Chinese state media, more than 100 countries have pre‐ordered Sinopharm vaccine despite the data gap, as this vaccine formulation is appealing over mRNA vaccines in their multi‐antigenicity, storage conditions, and availability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426884/

What are the side effects of COVID-19 vaccines?

As an allergist and Immunologist, I am always concerned with severe allergic reactions due to proteins injected (that applies to all vaccines). Because these are very recently developed vaccines with no other similar in mechanism, I am yet to form guidelines for all my patients with severe allergic responses. One of the contraindications to the vaccination is an allergic reaction to Polyethylene glycols (PEGs) – a chemical used in drugs, cosmetics, food industry etc. PEGs are polymers of ethylene oxide. https://onlinelibrary.wiley.com/doi/10.1111/cea.13822

What are the vaccine components?

Here is the most comprehensive list of the “other” ingredients that I used for my assessment of the allergic reactions. It contains every vaccine that is approved for use in humans. https://www.vaccinesafety.edu/components-Excipients.htm Here is the information available from CDC on reported COVID-19 vaccine reactions: As of December 23, 2020, a reported 1,893,360 first doses of Pfizer-BioNTech COVID-19 vaccine had 4,393 (0.2%) adverse events submitted to the Vaccine Adverse Event Reporting System (VAERS). https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm Among these, physicians still review 175 case reports, as possible cases of severe allergic reaction, including anaphylaxis. As we know now, twenty-one cases were determined to be anaphylaxis (a rate of 11.1 per million doses administered), including 17 in persons with a documented history of allergies or allergic reactions, seven of whom had a history of anaphylaxis. The median interval from vaccine receipt to symptom onset was 13 minutes (range = 2–150 minutes).

Who were people with anaphylaxis?

Here is data:

• The median age of persons with anaphylaxis was 40 years (range = 27–60 years)
• 90% cases occurred in females
• The median interval from vaccine receipt to symptom onset was 13 minutes (range = 2–150 minutes)
• 71% patients had onset within 15 minutes,14% – within 15 to 30 minutes, and 14% – after 30 minutes.

Here is how doctors treated anaphylaxis with COVID-19 vaccine:

• epinephrine: one patient received subcutaneous epinephrine, 18 received intramuscular epinephrine
• 4 (19%) – admitted to the hospital (including three in intensive care)
• 17(81%) – treated in an emergency department;
• 20(95%) – discharged home or had recovered at the time of report to VAERS.
• No deaths from anaphylaxis
• 17(81%) of 21 patients with anaphylaxis had a documented history of allergies or allergic reactions, including to drugs or medical products, foods, and insect stings;
• 7(33%) patients had experienced an episode of anaphylaxis in the past, including one after receipt of a rabies vaccine and another after receipt of an influenza A(H1N1) vaccine

What is true and what is false about COVID-19?

We all know how much mystery and misinformation is going on around COVID-19 pandemic. How do you separate facts and rumors? I find my mind safety in reading the published peer-review scientific papers where many different aspects are analyzed by scientists and physicians. I recommend reading this paper: COVID-19 breakthroughs: separating fact from fiction. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300672/pdf/FEBS-9999-na.pdf We will update you, as real facts become available. Stay safe and stay healthy! Check our remedies to boost the immune system from Dr Kushnir, and sign up for immune acupuncture with Dr. Lou!

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