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Steve E. Bishop, M.D.

By: Steve E. Bishop, M.D. on April 21st, 2021

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COVID-19 Update 4/21: COVID Data, Vaccine Effectiveness, Boosters

COVID-19 | Facebook Live Recap

On this week's COVID-19 update, Dr. Steven Bishop discussed the latest COVID data on cases and vaccines, why the vaccines are not perfect but still really good, and the timeline for booster shots. Watch the update below and read on for a recap.

Looking for the latest vaccine information? Check out our COVID-19 Vaccines resource page, as well as our resource pages for Virginia, Maryland, South Carolina, and Georgia. You can also find all of our COVID-19 update recaps here or follow us on our Facebook page to watch each week.

COVID Numbers Trending in the Right Direction

So let's start with good news. The cases in Virginia continue to in general trend down. We're still running around 500 or so cases a day across the state in Virginia.

Hospitalizations have trended down as well. They're running about 20 to 30 hospitalizations a day across the state. And deaths thankfully have really gone down quite dramatically to about under 10 or so per day.

In general, things are going much better than they have been in the past months and certainly better than they were going in December, January, and February.

That is all good news. Vaccines, by the same token, that's another number we can talk about.

Virginia has administered about 5.5 million vaccines at this point, which is great. A lot of folks in Virginia have been able to get vaccinated at this point, and those numbers are fairly similar across different states.

There's been quite a lot of vaccination going on across the country, which is good, and that I think is really showing up in our numbers. A) Cases going down, but B) hospitalizations going down and staying down, and deaths going down and staying down.

And as we vaccinate more and more people, I would hope that those numbers would stay suppressed and continue to trend downward over the next few months.

Johnson & Johnson

And of course, we were stymied a little bit in our vaccine efforts by the fact that Johnson & Johnson has been taken off the market for now. There is supposed to be a data review I believe and an update this week.

So we'll see hopefully some movement on that one way or another in terms of whether that's going to come back on the market anytime soon and let us keep using that to vaccinate folks.

I know that that was a convenient option for a lot of people. It being sort of a one-and-done vaccine, which is fantastic. But we're going to make sure that it's safe and the data review system's going to do its function and we'll see what they come up with.

The vaccines are not perfect. But they're really good. 

The next thing is I just want to talk about, and this was prompted by an email from a colleague earlier, I know there's a lot of viewpoints on vaccines and especially on the COVID vaccine. And I think something just to put out there to remind people about vaccines, in general, is that they're not perfect instruments, right?

They're not perfect tools. They do not work 100% of the time, and they don't work for 100% of people. And the COVID vaccines are no different. All vaccines have a failure rate, whether it's the measles vaccine, the polio vaccine, whatever it is. They all have a failure rate.

And again, these vaccines are no different. They have about a 5% failure rate, as far as we can tell right now, in terms of preventing infection. So about 95% effective, which is very good for a vaccine.

What that means is that about 5% of people who get vaccinated may still get sick with COVID. But the good news is, as we've talked about before, even if they do get sick, the strong likelihood is that they're going to only have mild symptoms if the vaccine has "failed" to prevent infection in that person.

If someone does get sick with COVID after vaccine vaccination, then they should only be mildly ill. And that's consistent with the study data that has come out and shown that the vaccines are about 100% effective in preventing severe COVID, but only 95 or so percent at preventing COVID infection, period.

We're going to hear cases as the months go on of individuals getting sick with COVID after vaccination. This is not a sign that there's some grand failure of the vaccine or that the vaccines aren't effective or that they don't work or that it's a scam. Nothing like that.

This is the expected outcome. Some people will still get sick, unfortunately, about 5% of people will still get ill. But the good news is, like I said, most of those people should do very well with the virus.

We will probably see some people who will still not do well. And you're going to find that, as we vaccinate millions and millions of people, we will find the occasional rare person whom the vaccine is not going to take well at all.

There will be "non-responders" to the vaccine, most likely. That's true of all vaccines. Not just these. And some people will still get sick, unfortunately, and pass away from COVID, most likely because, again, no vaccine is perfect and some people's bodies are just different than others.

So you will hear this. But again, it doesn't mean the vaccines don't work. It doesn't mean we should not trust the data that's coming out, so don't let that dissuade you or make you overly concerned about the effectiveness.

Timeline for Boosters

"Boosters... are we thinking like September-October or December-January? How would they decide when to say, 'Okay, that's the variant we need to make sure the booster covers' and begin booster production?"

I don't know how they're going to make those decisions. My guess is that we're probably going to need to do this in September or October because we seemed to have a really big surge over November, December, January, in sort of the peak respiratory virus season.

My guess is we're going to have to, if we have boosters, we're probably going to need to do it in the fall timeline as we do with the flu shot, right? September, October timeframe.

That would make the most sense. And my guess is in determining which variants that they need to target, they'll have to screen the variants as they become prevalent and figure out if they're covered by the current vaccine. And if not, then develop a booster for those.

Again, that speaks to the speed and the flexibility of the mRNA platforms. They can produce these vaccines pretty quickly for these variants. So I think it will probably only take a few months to go from variant detection to production in most cases.

What it's going to really involve is lots of genetic surveillance of the infections as they come across, especially those that happen in people who are vaccinated.

That would be my sort of main target group for doing genetic surveillance. Active COVID infections in that 5% of people who have been vaccinated. Surveilling them and checking the genome sequences of those people to see if it is a match or if it's not a match to the standard viral RNA sequence. And if it's not, then trying to figure out if it's a variant of concern.

That would be my guess, is they're going to heavily monitor those people and get samples and surveil those sorts of folks for escape variants to the vaccine.

Same Vaccine for Boosters?

"Do you think it's likely that we'll have to continue boosters at the same vaccine we initially received, or might there be an opportunity to switch in the future?"

My guess is you probably could switch at some point. If you finished the initial series and you find that you need a booster at some point to cover some particular variant, I'm not sure that it's going to matter if you switch companies or switch products or whatever. I think that that would probably not be an issue in terms of safety profile, things like that.

That's just my guess. We'll have to see what the data looks like when it comes out, but I don't think it would be a problem to switch manufacturers per se, as long as the new one is targeting the variant of issue, that's of relevance to you if that makes sense.