COVID-19 in August 2021: Vaccine updates, booster shots, and the delta variant
COVID-19 Digest: August 2021
Section 1: VACCINES
Question 1: [Update for August 2021] Should I get the COVID-19 vaccine?
Check out this article for some basic info on the vaccines and how they work.
As of August 14, 2021, here’s what we know:
The way that the COVID-19 vaccine works is by enabling your body to respond quickly and effectively when it encounters the SARS-CoV-2 virus. You can think of a vaccine like a seatbelt - while it doesn’t prevent your car from hitting another car, it blunts the effect of the crash on your body. The amazing thing is that these COVID-19 vaccines seem to blunt the crash very effectively, significantly reducing the risk of serious illness or death.
The latest data on the COVID-19 vaccine continues to show a very low risk of any serious complications, and it continues to be the best protection we have against COVID-19.
You are most likely to experience mild side-effects in the first few days after you receive the vaccine, and a very, very small number of people experience more severe side-effects in the first few weeks, including myocarditis, Guillain-Barre syndrome, and rare blood clotting disorders. (source)
There are no known long-term side-effects of the COVID-19 vaccines at this time, and the CDC is continually monitoring for these.
Your risk of long-term side-effects from COVID-19 is much higher than the risk you’ll have any serious issue with the vaccine. Many people who end up with COVID-19 do have long-term effects - recent estimates suggest about 10-20% of all people diagnosed with COVID-19 end up dealing with some form of “long COVID”. (source)
Yes, the vaccines work on the delta variant too! More than 90% of recent COVID-19 cases, hospitalizations, and deaths occurred in unvaccinated people (source). It’s important to note that there are studies with different estimates of exactly how effective the different vaccines are at preventing any symptomatic disease from COVID-19 - but in all studies published so far, even those focused on the delta variant, the current vaccines do significantly reduce your risk of symptoms, severe illness, and death.
Ages 12+: There is now a vaccine available in the US for everyone aged 12 and up.
Ages 5-11: Pfizer is expecting to submit an application to the FDA for use by the end of September; Moderna also expects to submit this fall. (source)
Ages 6 months - 5 years: Current estimates put the application submissions at the end of the 2021. (source)
Ages 0 - 6 months: Unclear as of yet. However, it does seem that when a mom is vaccinated, there are antibodies to COVID-19 present in the umbilical cord and in breastmilk - so infants may receive some protection in this way. (source)
There’s a new booster shot approved for people who are immunocompromised - see Question 5 below for more info.
If you have one of a few specific types of allergies, you may need to be careful about which vaccine you get. Check out this information from Yale Health to understand which vaccine is best for you.
Question 2: Should my teenager get the COVID-19 vaccine?
There are a couple of brand-new studies with data that confirm that the Pfizer and Moderna vaccines are safe and effective for teenagers. In the most recently released study, it was shown that while many teenagers will experience some mild or moderate side-effects from the vaccine (injection-site pain, headache, fatigue), very few will have any severe side-effects. The current estimate is that 13 out of 1 million adolescent boys may develop myocarditis after COVID-19 vaccination. None have died as a result of this. (source) (another source)
COVID-19 is less dangerous in teenagers than in older adults, but there are still significant risks, and sadly, several hundred children in the US have died. Because of this, the FDA decided to approve the use of mRNA vaccines in this age group.
Some sources on COVID-19 in adolescents:
Question 3: I’m pregnant. Should I get the vaccine?
Study results are in, and it seems that pregnant people can safely receive the COVID-19 vaccine without worrying about increased risk of miscarriage or birth defects. This is important, because unfortunately, pregnant people are more likely to experience severe COVID-19 than other adults.
Here’s a helpful write-up on this topic.
Question 4: I have an immune deficiency - should I get the COVID-19 vaccine? Will it work?
This is a complicated question - it depends on the type of immune deficiency that you have, and the data is incomplete. For example, people with CVID are less likely to develop strong immunity from a COVID-19 vaccine, but those with Selective IgA deficiency may be more likely.
Consider signing up for a study to help develop better data on the effectiveness of COVID-19 vaccines in people with immune deficiences! Here’s info on one that began this spring.
The argument to get the vaccine:
Generally, the vaccine types that don’t use live virus, including mRNA vaccines and protein vaccines, are safe to take as a person with an immune deficiency. Many doctors recommend that you receive the vaccine, because it could boost your immunity. However, you may not develop as much protection as the average vaccine study participant, because your immune system may not respond fully to the vaccination.
Availability of COVID-19 protection in IgG replacement therapies:
The great news is - as soon as more people are vaccinated, there will be a higher level of COVID-19 antibodies available in plasma and IgG replacement therapies!
So far, we know that while some replacement therapies may have antibodies, others may not. We have heard through the grapevine that IgG available in hospitals through IVIG may be more recent than IgG received through SubQ, and so may have protection faster - check with your care team for more info.
How do I know if the vaccine worked?
If you want to see how well you might have reacted to the COVID-19 vaccine, you can ask your doctor to order an antibody titer - even though this is not currently recommended by the CDC for most people. This test is not conclusive, but can give you some information about your response. We don’t know yet whether T-cell immunity or antibody immunity is more important for COVID-19 responses, but if you’re someone who is generally pretty good at creating T-cells, understanding more about your antibody response can be helpful information in assessing your overall COVID-19 risk.
PID UK has developed a very helpful vaccine fact sheet for the immune deficiency community. Find it here.
There’s also a great recent update available on the Immune Deficiency Foundation’s website, here.
Interested in more info on selective IgA deficiencies and COVID-19? We’ll be doing an additional post on this topic, but for now, here’s a very detailed new study.
Question 5: I’m immunocompromised, and the FDA just approved a booster shot. Should I get it?
We know that vaccines can be less effective in immunocompromised people, and a booster shot can help to add a further layer of protection for those who responded some to their first vaccination, but not as strongly as the general public.
Here’s the list of people who are recommended to receive a booster shot by the CDC:
Been receiving active cancer treatment for tumors or cancers of the blood
Received an organ transplant and are taking medicine to suppress the immune system
Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system
Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
Advanced or untreated HIV infection
Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response
To receive your booster shot, you can go to any vaccination location near you. You should aim to get the same vaccine type (Pfizer or Moderna) as your first set of doses. Please note that people who received J&J aren’t included in the authorized group at this time.
One thing to note: according to a recent NPR report,”Immunocompromised people who get a third shot should still be aware they're not necessarily safe from COVID-19….In a presentation to the committee, the CDC's Dr. Kathleen Dooling said immunocompromised people, including those who receive an additional dose, should continue to follow prevention measures, including wearing a mask, staying six feet apart from others they don't live with and avoiding crowds and poorly ventilated indoor spaces. And she also urged close contacts of immunocompromised people to get vaccinated if they're not already.”
(source)
SECTION 2: DELTA
Question 5: Is the delta variant dangerous for vaccinated people? What’s my risk of serious illness?
The vaccines available in the US are also effective against the delta variant. More than 90% of recent COVID-19 cases, hospitalizations, and deaths occurred in unvaccinated people (source).
People who experience COVID-19 after being fully vaccinated have “breakthrough infections”. Here’s some info on breakthrough infections in the US during the late spring and early summer. The rate of breakthrough infections does seem higher for the delta variant, but the likelihood of severe disease is much lower. For instance, in the Provincetown outbreak in July, out of 469 people who had COVID-19, 79% of them were vaccinated; only 1.2% of the patients were hospitalized, and none died. (source)
It’s important to note that there are studies with different estimates of exactly how effective the different vaccines are at preventing any symptomatic disease from COVID-19 - but in all studies published so far, even those focused on the delta variant, the current vaccines do significantly reduce your risk of symptoms, severe illness, and death.
Question 7: How do I make decisions about fall activities, school, etc right now? What’s the most important information to consider?
What a great question! We all feel a bit lost at the moment, with all of the new information coming in and the situation seeming to change day-by-day.
As we approach the fall and start making decisions balancing the risk of COVID against the need to live somewhat normal lives, here are a few things to keep an eye on:
Your vaccination status, and that of your family - once you’re fully vaccinated, your risk of severe disease goes down. If you have kids who can’t be vaccinated yet, you’ll want to factor that in until the vaccine is available.
The current level of COVID-19 in your community - the simplest way to check this is by googling “COVID-19 Boston” or wherever you live. You’ll see a graph of recent COVID-19 cases, hospitalizations, and deaths that will come up right in the search engine. When the numbers are going up, you’ll want to be a bit more careful. When they’re going down, your risk is lower.
The relative risk of certain types of activities - As we’ve known for a while, outdoor activities carry much lower risk of spreading COVID-19 than indoor. As temperatures drop and indoor activities become necessary in most places, you’ll want to consider…
Mask-wearing rates - Masks have been found to decrease the risk of spreading COVID-19 (source). If you’re in a situation where other people are all wearing masks, you’re safer. If you’re setting up an event or activity, you should feel comfortable asking attendees to wear masks - even if they are vaccinated. Overall, for the vast majority of people, there’s no good reason not to wear a mask in indoor settings.
Wearing the right type of mask - Check out this helpful guide from the Mayo Clinic to figure out how to make your mask-wearing most effective.
Watching for symptoms & testing periodically - If anyone in your family or household starts to feel unwell, it’s always a good idea to test and to reach out to a healthcare professional. There’s a long list of COVID-19 symptoms and people don’t always experience the same ones - so don’t assume that because it’s just a runny nose, it’s not COVID-19.
Overall, it’s not a bad idea to plan on testing every week or two, especially now that over-the-counter antigen tests are available at pharmacies. We know that early detection and treatment of COVID-19 can be very helpful in making sure you recover completely. You might also consider asking friends or relatives to test before you see them for events or activities where you’ll be in close contact, even if they are vaccinated.
Most importantly, take care of yourself and your mental health. This continues to be an incredibly uncertain time - we feel you. Let’s all do our best to take care of each other this fall. <3