Your Covid-19 questions answered
With Dr George Kassianos
Dr George Kassianos, CBE and national immunisation lead at the Royal College of General Practitioners has been a regular on BBC Radio Berkshire since the start of the first lockdown. We are delighted that he has agreed to answer your questions on Covid 19. To get the call rolling, our Management Team put the first questions to him. Please follow the link if you have a question you would like him to help with.
A: They both aim to carry to our cells the ’spike’ (S) glycoprotein. Once the S glycoprotein is in our body, our immune system produces antibodies against it but also puts in its memory everything about the S protein so, if we were to get infected with the SARS-Cov-2 virus (that causes COVID-19) again, instantly our immune system recognises the viral assault and immobilises the virus’ spikes, blocking them with our antibodies, thus not allowing the virus to enter our cells and multiply, in short, not to infect us.
The two vaccines differ in the way they transport the S glycoprotein. The Pfizer vaccine uses a genetic code (the messenger mRNA) made in the laboratory, that decays very quickly – within a couple of days. The manufacturer has put the messenger RNA that carries the S glycoprotein in a fat globule to protect it but it needs to be kept at minus 75 degrees Celsius until it reaches the pharmacy fridge of the Vaccination Centre. From then on, we have 3.5 days to give the vaccine. Once injected in the arm, the S glycoprotein is transported to our cells and the mRNA decays.
The AstraZeneca/Oxford vaccine uses an adenovirus to carry the S glycoprotein to our cells. This is a virus that causes cold in chimpanzees but totally harmless to humans. In addition, the scientists remove the part of the virus that allows it to multiply so once in our arms, the virus transports the S glycoprotein to our cells but, itself, cannot multiply. The immune system then attacks the S glycoprotein by producing antibodies against it. These antibodies are then ready to attack the real virus if it was to try to infect us.
A: I can understand the urge and need to visit a loved one, especially now that we are in lockdown, but the first (or the second) dose of the vaccine does not change the conditions for visiting somebody else’s house if, what you are doing, is simply visit that person. If your elderly relative lives alone and provided s/he has no similar arrangement with another household, you can form a ’support bubble”. Further, if you have a child under 14 years of age and your elderly relative is willing to provide your child with unpaid informal childcare, you can form a ‘childcare bubble’. Failing that, you may meet (alone) your elderly relative (depending on their mobility) outdoors, just the two of you, once a day, for exercise and 2 metres apart. By ‘outdoors’, the regulations do not mean your or their garden. They do mean a park, countryside accessible to the public, a forest, public garden (whether you pay or not to enter), in the grounds of a heritage site, or even in a playground but definitely not in a private garden.
I would like to also add that whether unvaccinated or vaccinated, we must all continue to strictly obey the rules aiming to avoid contact with the virus. Please remember that in some vaccinated people the vaccine may fail to induce immunity. Also, there is still the question of transmission of the virus, the vaccine prevents generally infection but is it possible that a vaccinated person can get infected, have no symptoms, but is able to transmit the virus? We have not answered this question as yet. Oxford and AstraZeneca did a small study that showed their vaccine prevented transmission, but larger studies are needed to show for each individual vaccine whether transmission of the virus is prevented.
A: The second dose of the Pfizer/BioNTech vaccine is exactly the same as the first dose.
A: Currently, Public Health England recommends we use the same vaccine for the second reinforcing dose. Theoretically, these two vaccines are interchangeable, but we will follow the instructions we were given and not mix the vaccines, other than in cases where it is not known which vaccine a particular individual has had and it is important to protect that individual, for example, a patient with heart disease, or where the vaccine given for the first dose is not available when the second dose is due.
A: I cannot give you that assurance although current indications point to both vaccines ben able to cover the two variants, the one identified in the UK and the other identified in South Africa. The UK Government as well as the vaccine manufacturers are continuously testing the vaccines against the various variants. Tests are also being carried out on the ‘South Africa variant’, which shows a greater mutation (change) than the “UK variant’.
The SARS-Cov-2 (’the corona’) virus is an RNA virus, which means it is a not so stable virus, able to mutate (change). There will be further mutations, but our vaccines are not attacking the whole virus. They just block the virus’ spike S glycoprotein (the ‘key’) the virus uses to attach onto the ACE2 receptor (the ‘lock’) of our cells in our respiratory tract. Once the spike S glycoprotein attaches to our cells’ ACE2 receptors, the virus is able to enter our cells. Once inside, it instructs our cells to produce many copies of itself and that is how it multiplies. This virus has no other reason to live other than multiply but, in the process, it infects us (and some other animals). If we make it difficult for the virus to enter our cells to multiply, it invents ways to do so by changing (mutating). This is why the constant battle we are going to have to fight with this virus. We do the same with the influenza viruses, which also can mutate, hence the reason why we have a different flu vaccine every year. The SARS-Cov-2 virus that causes COVID-19 mutates less often than the flu viruses.
A: No, not at the moment. The Government has not decided to issue ‘vaccination passports’. You will receive a vaccination record card when vaccinated, but this is simply a record indicating you have had the vaccine. Both doses are recorded on this card so do remember to take the card with you when attending for your second dose.
Please note the European Union countries are currently discussing whether to introduce vaccination passports.
A: The Vaccination Centre will contact you. If your GP practice is carrying out vaccinations, then your GP practice will contact you. Please do not ring your GP Practice as they may not have the answer you want and, in any way, you will not be forgotten.
A: Yes, it is. You may get vaccinated and later fall pregnant. Based on the information we have today, the vaccine does not affect male or female fertility.
A: The second dose is not really a booster. It is a reinforcing dose because you have never come in contact with the virus before, therefore, we need to give you two doses. The first dose will prime your immune system and produce antibodies and the second dose to induce long-term immunity. In subsequent years, if we need revaccination, it should be just one dose for this coronavirus.
Once you are fully vaccinated, you must not ease in the precautions you take to avoid infection with this coronavirus. You may be one of those few people that do not mount an immune response to the vaccine, therefore, you remain susceptible to COVID-19 infection. Further, we have not clarified as yet whether you may get infected, although vaccinated, have no symptoms but be infectious to others. For these reasons wash hands, wear a mask, keep your distance, and avoid meeting others outside your household other than when it is legally allowed.
A: Having had the vaccine (one or two doses), does not allow you to change your behaviour. You should comply strictly with all the public health rules and regulations. Please take into consideration that a number of people that have received the vaccine will not mount an immunity to the virus. In the case of a vaccine that is 95% effective, 5 out of 100 people vaccinated can get infected and have symptoms if they come in contact with the coronavirus. One of those 5 people can be you.
Therefore, if you come in contact with somebody who has tested positive, or has COVID-19, or the NHS App asks you to self-isolate, you should do so irrespective of whether you have had the vaccine (or the infection) in the past. You should isolate for 10 days – start counting as your first day the day after you came in contact.
A: The Vaccination Centres may get the same vaccine all the time but there can be situations when a different vaccine is used than the one previously used because of supply problems. The UK has ordered 100 million doses of the AstraZeneca vaccine and much less of the Pfizer vaccine, just 40 million doses, so there is a greater chance of having the AstraZeneca available than the Pfizer vaccine simply because of the number of vaccines ordered. Vaccine supply problems can make it even more difficult to ensure the same vaccine is available at each Vaccination Centre. We know that Pfizer needs to increase production this year from 1.2 billion to 2 billion doses and to do that they now need temporarily to reduce production of vaccine at their Belgium factory.
Still, there is a possibility a Vaccination Centre may have both vaccines when you get there. Theoretically, it is possible to ask for a specific vaccine but these centres are very busy, both vaccines give superb immunity, so best to follow the vaccination position you are led to. This way, you do not delay others and you make our work much easier.
Both currently authorised vaccines are based on the spike S glycoprotein. The Vaccination Centre may have to give you a different vaccine when the time comes for your second dose, simply because of vaccine availability. It is likely that even if the vaccine given for the second dose is different to the first, it should boost the response to the first dose. Studies are ongoing to confirm this.
A: During the vaccine trials, the vaccine ‘efficacy’ is calculated, which is different than the vaccine ‘effectiveness’. Vaccine efficacy is calculated by comparing the reduction of infection in a vaccinated group of people compared to an unvaccinated group (the placebo group that does not receive the real vaccine). This is expressed in percentages. There is a certain number of people that are entered into such a trial, under strictly controlled conditions, and a number of parameters may be measured like disease attack rates, medical visits, hospitalisations, deaths, etc. Vaccine effectiveness shows how well the vaccine works when we give it to the general population (many thousands or millions of people).
Here is an example. The vaccine efficacy of the Pfizer vaccine and after two doses, was calculated as 95%. They enrolled 43,538 people in the trial, 38,955 of whom received two doses of the vaccine. Half received the vaccine, the other half the placebo. When the trial was stopped, 170 people that had an injection contracted COVID-19. Of them, 162 had received the placebo (95% of the 170) and 8 had received the vaccine (5%). The vaccine was able to reduce the infection in 95 out of 100 people vaccinated.
We cannot give the effectiveness of our two currently available vaccines. We shall have to wait until we vaccinate (with two doses) a large number of our population and then see how many of those vaccinated contract COVID-19.
A: After about two weeks from receiving your second dose of the COVID-19 vaccine, the production of antibodies against SARS-Cov-2 virus will increase considerably. Can you then hug your grandchildren?
If the efficacy of the vaccine you have had is, say, 95%, it means that 5 out 100 people that received the vaccine will still be susceptible to infection because the vaccine did not ‘take’ – failed to induce immunity. You have no way of knowing in which group you are. If you are one of these 5 out 100 vaccinated, you are definitely susceptible to infection with the SARS-Cov-2 virus. Your grandchildren and their parents may also be susceptible to infection. In addition, we do not know whether you can get infected, have no symptoms but still able to pass on the virus after vaccination – asymptomatic transmission. The most probable scenario after vaccination is that you are immune.
Have you considered whether you qualify for a ‘Support bubble’ or a ‘Childcare bubble’?
A: Having the vaccine (one or two doses), does not allow you to change your behaviour. You should comply strictly with all the public health rules and regulations. Please take into consideration that a number of people that have received the vaccine will not mount an immunity to the virus. If, say, a vaccine is 95% effective, 5 out of 100 people vaccinated can get infected if they come in contact with the coronavirus. One of those 5 people can be you.
Therefore, if you come in contact with somebody who has tested positive, or has COVID-19, or the NHS App advises you to self-isolate, you should do so irrespective of whether you have had the vaccine in the past or not. You should isolate for 10 days – start counting as your first day the day after you came in contact.
A: The vaccine is given to protect us from contracting the SARS-Cov-2 virus that causes COVID-19, with all the dreadful complications and suffering that may follow such infection. These may include time in hospital unable to breathe easily, or even on a ventilator. Sometimes the outcome can be fatal, other times we continue having symptoms of COVID-19 months after we contracted the infection. Those who have gone through this suffering will tell us how low the quality of life can be.
The vaccine does not always protect us all from getting infected and developing COVID-19. Until most of the UK population is vaccinated, we shall need to strictly follow all the measures Public Health England advises us to do. If at any point of widespread vaccination, we also manage to contain the virus, we shall then see a return to a near-normal life.
This virus will stay with us for years. We have the means to control it, similarly to what we do with the influenza viruses. Until then, we need the co-operation of the whole nation to allow us to get this virus under control. That is why, for now, our lives will not return to ‘normal’. Vaccination does not mean relaxation. Vaccination will help us speedily return to a near-normal life in the near future.
A: Individuals taking immunosuppressive medication may not make a full immune response to vaccination. We need to understand better what happens when the immune response to the COVID-19 vaccine is reduced, as it may happen in people who are immunosuppressed because of disease such as cancer or medication.
Until further information becomes available, vaccinated patients with immunosuppression should continue to follow advice to reduce the chance of exposure to the virus. For people in the ‘extremely vulnerable’ groups, Public Health has given specific advice as regards to shielding [ https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 ]. In all cases, strictly adhering to Public Health advice is very important. Continue been careful and adhere to the rules until there is a specific announcement to the contrary by the Department of Health & Social Care.
A: Diabetes is a chronic disease, and you will be considered for vaccination once all those age 65 years and over have been offered vaccination, assuming you are not age 65 years and over. This is because it is recognised that people with chronic disease are at increased risk of COVID-19 and its complications. This time, you have not been asked to take any particular extra precautions. Only those in the extremely vulnerable groups have.
A: The decision of the Joint Committee on Vaccinations & Immunisations (the JCVI – a committee of experts) was to advise the Government to prevent infection and death among the population and protect front line health and social care staff, before any other consideration. For this reason, priority 1 are staff and the residents in care homes for older adults. Our 2nd priority are all those 80 years and over as well as health and social care workers.
Your age falls in risk group priority 4. You will be called for vaccination once all those in priority group 3 are called, that is all those 75 years and over. Vaccination Centres and GP Practices undertaking COVID-19 vaccinations have recently been advised to extend their invitations to everybody age 70 and above and all the extremely vulnerable, once they have vaccinated the majority of their 80+s.
A: People without spleen are at risk of infection. Both currently available vaccines in the UK act in a similar way; they deliver the spike (S) glycoprotein of the SARS-Cov-2 virus against which we produce antibodies.
For this reason, it makes no difference which of the two available vaccines you receive.
A: People who contract COVID-19 with symptoms but also those who do so and do not have symptoms, but they test positive to SARS-Cov-2, can produce antibodies against the virus. Once our immune system recognises the viral invasion, it ‘kicks’ into action and produces not only antibodies but also cells that remember the virus structure (the memory cells) for any future reinvasion.
The question we cannot currently answer is once you had the infection (with or without symptoms) and produce antibodies, how long will these antibodies against the virus last. Individuals who develop asymptomatic or mild disease tend to produce lower level of antibodies than those who develop severe infection.
A: From our statistics, we know that fewer than 5% of COVID-19 infection cases are amongst children. In general, children appear to experience milder symptoms than adults. So, the risk of infection in children is lower than in adults but it is not a zero risk. Many children van get infected but have no symptoms.
Further, we have noticed that some children that contracted COVID-19 infection went on to develop a syndrome very similar to what you might have heard of in the past, namely ‘Kawasaki syndrome’. The World Health Organisation has named it as a “multisystem inflammatory syndrome temporarily associated with COVID-19 in children and adolescents”.
In short, children are at risk of contracting COVID-19 infection. This risk is lower than in adults and involves all ages, including children under 1 year of age. The steps to take to protect a child are similar to those one would take to protect all others in the same household.
A: I think you are asking about people who have never been vaccinated, whether they have any immunity to the SARS-Cov-2 virus that causes COVID-19. You can only develop immunity to this virus if you are vaccinated, or you contract the infection. Both, the infection or the vaccine, induce various degrees of immunity to the virus. Without a prior vaccination or infection with the SARS-Cov-2 virus, you do not produce antibodies against the virus. The best option for us is to avoid coming in contact with the virus and in addition get vaccinated, according to the priority list.
It is possible to check in a blood sample the creation and level of antibodies to the SARS-Cov-2 virus caused by vaccination. This test is not available routinely on the NHS. It is possible to get it done privately but I am unable to give you a specific recommendation as to where to have this done as the NHS does not currently recommend it.
A: I can understand your dilemma. Every Vaccination Centre has the list of vaccine excipients, that is the substances each vaccine contains. I do have these, but I cannot give you advice on this forum. You will be able to access this information before vaccination, the latest at the point when you are informed about the vaccine and you are asked to consent for vaccination.
Any member of the public that has specific allergies and wishes to know whether they can receive the vaccine is able to discuss these before vaccination. The excipients in each of the two currently available vaccines in the UK are not the same. Have a list of your allergies when you attend for vaccination. You will be able to get appropriate advice before a vaccine is offered to you.
A: It is not possible to quantify the risk of contracting COVID-19 in any individual case. Some mothers are able to carry out their work from home after their maternity leave comes to an end, others need to access their work premises to do so. In both case, parents may need to arrange for childcare.
It is important that mothers that need to leave home in order to go back to work, as well as those who will care for a child at home, adhere strictly to the rules on “hands-face-space” as well as avoid coming in contact with other people that are not part of their household or support or childcare bubble.
In the case you describe here, and as regards to the risk of getting infected from an 11-month-old baby, I must indicate that the risk may be higher in bringing the infection to the baby’s home than contract the infection from the baby. It is important for you as well as the baby’s parents, that you adhere to the advice on how to avoid contact with the virus. Wash your hands on arrival frequently and thereafter. If you or any member of the household develop any suspicious symptoms, isolate immediately and get a test.
A: The Pfizer/BioNTech vaccine does not contain a virus. The messenger RNA (mRNA) has been synthesised in the laboratory of BioNTech in Germany. Its purpose is to carry the Spike S glycoprotein to our immune system. Once injected into our arm muscle, the mRNA naturally degrades after a few days.
The AstraZeneca/Oxford vaccine does contain a live virus. It is one that affects chimpanzees but harmless to humans. This adenovirus has been modified in the laboratory in Oxford so that it cannot replicate (grow and multiply by making copies of itself) in human cells and, therefore, cause infection – we call this “a replication deficient virus”. Once injected into our arm muscle, the adenovirus helps the immune system recognise the spike S glycoprotein it carries. We then produce antibodies against the S glycoprotein. The adenovirus has no further purpose and cannot multiply.
A:It is not possible to give you specific advice on the state of products and packaging we obtain in shops or have delivered to our homes. Every case is different. I can only give you advice on how long approximately we expect the virus to live on a particular infected surface.
On our skin, the virus lives for approximately 9 hours, in the air 3 hours, on copper surfaces 4 hours, on cardboard and print 24 hours, on plastic or stainless steel 2 to 3 days, although the Americans have found it present after 7 days. In Australia, they found the virus was still present on banknotes and mobile phone screens 28 days later.
Most important is to wear a mask or face covering and sanitise hands on entering a shop or when using public transport. Some people chose to wear gloves too. While in the shop, only touch what you are going to buy. Pay with a card, not cash. This ensures you do not receive change. Once you finish shopping, safely dispose of the disposable mask and gloves. At home, wash hands, unload shopping, and wash hands again. I have heard of people who are ultra-careful as they (hot) iron their newspaper and mail delivered. Whatever you handle from outside, spend 20 seconds afterwards washing your hands with water and soap – if not available use a sanitiser gel that contains at least 60% alcohol.
A: You are probably thinking of September 2021, when we will start again vaccinating at-risk patients against influenza and possibly having to vaccinate against COVID-19 at the same time. In fact, we face this problem now with people not as yet vaccinated against influenza or needing to receive other vaccines.
The worry here is whether one vaccine will interfere with the uptake of the other vaccine/s, thus resulting in slightly weaker response to one of the two vaccines. There is no evidence of any safety concerns, although it may be difficult to attribute any possible side effects to one or the other vaccine, if the vaccines are given at the same visit.
Public Health England advises that in the absence of data on co-administration with COVID-19 vaccines, COVID- 19 vaccine should not be routinely offered at the same time as other vaccines. They advise an interval of at least 7 days to avoid incorrect attribution of potential side effects.
If an individual presents for COVID-19 vaccination (with either vaccine currently available in the UK) and having received or requiring another vaccine, we are advised that COVID-19 vaccination should still be considered. In most cases, vaccination should proceed to avoid any further delay in protection and to avoid the risk of the individual not returning for a later appointment. If more than one vaccine is given, it is the vaccinator’s responsibility to inform the person receiving the vaccinations about the likely timing of potential adverse events relating to each vaccine.
A: Only one of the two vaccines has an emergency authorisation from 16 years and above. It is the Pfizer/BioNTech vaccine. The AstraZeneca/Oxford vaccine, as well as the Moderna vaccine we are hoping to have available in the UK by the spring, are both authorised from 18 years and over.
In the future, we are hoping to have vaccines licensed for children but the trials in children have not as yet been done.
A: In the UK, we recommend that you do get vaccinated even if you have had COVID-19 in the past. This is because we do not know how long the antibodies will last after contracting COVID-19. A person who has had COVID-19 infection recently, will need to wait until they are well and, in any way, no earlier than 28 days after a positive test before they receive the vaccine. A person who has received monoclonal antibodies may have to wait longer – in the USA they wait for 90 days. Always discuss such matters with your medical adviser because every case is different.
The asymptomatic person is the one that has no symptoms whatsoever but tests positive as they have the virus, which they can pass on to other people. We can identify such individuals by testing people without symptoms. The person that has symptoms will also test positive and, of course, is able to transmit the virus to other people. Once identified and tested, both need to self-isolate so that they do not infect others.
A: In view of the fact that you had palpitations, I must advise you to consult with your GP as other causes may have to be excluded. I cannot, therefore, give you specific advice. Palpitations as a side effect have been reported with both the Pfizer as well as the AstraZeneca/Oxford vaccines in the first and second day following vaccination. Another reason why you need to contact your GP is they fact they will want to report the symptoms you have experienced, to the Medicines & Healthcare Products Regulatory Agency (MHRA) via the Yellow Card system.
The advice I have given below is general and in no way specific to the person asking the question. Following receipt of the Pfizer/BioNTech vaccine, fever was reported in over 10% of vaccine recipients, and chills in over 30%. The severity of the solicited systemic events increased after the second dose and they were more common among younger participants (18 to <65 years of age) than among older participants (≥65 years of age).
AstraZeneca/Oxford reported fever and chills in over 30% of vaccine recipients. They reported that side-effects were less both in intensity and number in older adults and after the second dose.