The End of the Pandemic!

The End of the Pandemic! 

With the approval this week of Emergency Use Authorization for the first COVID vaccine, and with the start of vaccination of the front-line healthcare workers taking care of COVID patients, this looks like the beginning of the end of the pandemic.  Soon, we will all have the opportunity to get the vaccine, too. 

As we contemplate that, it is interesting to consider the parallels and differences with the 1918 Influenza pandemic.  Although the tragic loss of life in the current pandemic has been significant, the 1918 pandemic was much more deadly, with at least 50,000,000 deaths worldwide, and about 675,000 deaths in the USA.  At that time, the US population was about 100 million, about a third of the US population today. 

So, how did we do that in 2020?  Is it safe to take a vaccine that was developed this quickly? 

Much has changed over the past century that has allowed us to control this pandemic so much more effectively than in 1918.  These first vaccines are based on “messenger RNA” (mRNA) technology, an outgrowth of DNA technology, but while DNA was discovered in 1869, the way it worked to produce proteins was not really figured out until the 1950s by Watson and Crick. 

Turns out that DNA is a double-stranded molecule, where each of the two strands acts as a template for the other.  When the two strands unzip, each one can generate its other half, and thus replicate, resulting in two copies of the same chromosome to distribute to each half of the dividing cell. 

But while it is important that DNA be able to replicate, the actual function of the DNA is to act as a template for mRNA, and thus for cellular protein.  The two DNA strands unzip, and one of the exposed DNA strands acts as a template for the mRNA, which is a single strand.  The mRNA is then used to create a specific sequence of amino acids for a specific protein.  A virus, with its own DNA or RNA, is able to enter a cell and hijack the cell’s machinery to both replicate the viral genetic material and get the cell to make the proteins the virus needs. 

The genius of an mRNA vaccine is that it skips the virus DNA or RNA, and that there are no virus particles in the vaccine, only mRNA.  This mRNA is able to enter the cells and direct the production of proteins that look like virus protein.  That virus-like protein causes the production of protective antibodies, but since the mRNA cannot replicate, it soon degrades and is not replaced.  In the end, we are left with only the antibodies. 

Although this vaccine was developed, tested, and released for emergency use within just a few months, that was possible because of decades of basic research that taught us how DNA and mRNA work, and because of the development of the mRNA vaccine platform over the past decade or so.

The other factor allowing rapid testing and validation of the vaccine was the prevalence of COVID. To test the efficacy of any vaccine, the vaccine is given to a test group, and placebo is given to another group.  Then, we have to wait until some of those people are exposed to the virus and see if the ones who develop the viral disease are in the placebo group or the vaccine group.  Because there is so much COVID out there now, that happened pretty quickly. 

Of course, with a vaccine developed over just the past few months, nobody can say with certainty whether there will be some adverse long-term effects from the vaccine, because nobody has gone very long after getting it.  But in deciding whether to take the vaccine, the question is not whether the vaccine is completely safe, but rather whether the vaccine is safer than coming down with the COVID virus without the vaccine, and without the antibodies you will develop from getting the vaccine. 

Although most people recover from COVID without any apparent long-term effects, as many as 10% of people develop “long COVID,” a number of respiratory, GI, and cardiovascular effects that stretch out over time. 

For myself, I chose to take the COVID vaccine as soon as it was offered to me, and I suggest the same to my family and my patients.  Whatever the adverse effects of the vaccine may be, I cannot believe that they will approach the adverse effects of this virus. 

What about after we are vaccinated?  Will we still need to wear a mask? 

Yes, we will.  We do not yet know the full extent of the protection the vaccine will provide, and this is a very tricky virus.  We have been doing COVID tests on all of our patients before surgery, and I have found two patients who were positive for COVID, but who had absolutely no symptoms; they could not even believe they had COVID.  Completely asymptomatic COVID is “a thing.” 

We do know that the vaccine is essentially 100% effective in preventing serious disease, but it is only about 90% effective in preventing viral infection, so it is possible that some who have been vaccinated will be asymptomatic carriers.  Therefore, we will probably need to continue using masks, even after vaccination, until most of the population has been vaccinated, to protect those who have not yet been vaccinated from asymptomatic carriers. 

So, stay safe, especially now that we are so close to bringing this pandemic to an end.  Soon, we can all be together again with our friends and family, doing the things we like.