Back in December, I put out a quick blog about Covid 19 vaccines–the only ones we knew much about at that time were the currently available mRNA types–and I was pretty hopeful.  I’m still hopeful about their importance overall in quelling this pandemic, but it’s clear now that it’s a complicated issue that should be taken on an individual level.  I’d like to go into some of that detail now.  Much of what I’ll be talking about can be found on the Institute for Functional Medicine’s website, which they have been kind enough to make available to the public.  Feel free to go there for further details (see below).

So let’s take this in stages, first regarding the currently available vaccines.

What we know vs what we don’t know:

We know that the current vaccines do a good job creating antibodies.  They appear to do a good job preventing severe disease and hospitalization.  If you actually have the disease, you’ll create Th1 immune response (don’t worry about the details) but if you get the vaccines, you’ll get both Th1 and Th2.  This is a good thing, unless you have a tendency toward autoimmune disorders, or currently have one that is not stable.  This degree of immune reaction can cause an autoimmune flare in some people, and has actually caused Immune Thrombocytopenia in some individuals (a blood disorder).  We also know that both of the mRNA vaccines contain polyethylene glycol (PGE) which can be highly allergenic for some people, causing an anaphylactic response.

What is less clear:  do they really prevent transmission of disease?  There is a difference between “carriage” and “transmissibility”.  In a recent webinar from Harvard that I watched, they pointed out that although many folks after vaccination will still have + nasal swabs (“carriage”), they do not exhibit a high enough level of virus to cause transmission.  This is still preliminary data, but is fairly reassuring.  There is also absolutely zero data on pregnancy and breastfeeding, long term effects, etc, so keep that in mind if it pertains to you. I am currently counseling anyone currently pregnant or considering pregnancy, or currently breastfeeding, to avoid the vaccines unless they are at extreme risk.

So what does this mean for the currently available vaccines (Pfizer and Moderna)?  

First, if you’re really at risk–you work in a hospital or nursing home, or you have significantly compromised lungs and are exposed to the public regularly, or you have uncontrolled diabetes/hypertension/heart disease and are exposed to the public regularly–then you should consider getting vaccinated right away with one of these.  If you’re at risk but have low contact with the public, then you could consider waiting.  If you have an autoimmune condition, you might want to consider waiting, especially if you have little exposure in your life.  If you tend to easily react to things, then either wait or at least warn the facility, make sure they have an epipen available, and stay for a minimum of 30 minutes for observation after your inoculation.  If you’re planning to wait, please be sure to take actions to prevent infection (see supplement recommendations).

What about vaccines that are coming out soon?

Both the Janssen and Oxford vaccines are using old fashioned technology that we know well, using an adenovirus vector that has been modified to prevent replication.  Their efficacy in preventing severe disease and hospitalization is good, but less than the mRNA vaccines.  By that I mean that they appear to create lower levels of antibodies.  However, our T cell response to the vaccine is actually even more important than the antibody production, and that information for these vaccines is unclear but should be promising.  They do not appear to cause autoimmune responses.  They do not appear to be as effective in the older population (>65 for Janssen and >55 for Oxford).  And we have no data at all for children, pregnancy or breastfeeding.  Not sure when these vaccines will actually hit the market, but if you’re concerned about the mRNA vaccines and you’re not at risk, you could consider waiting for one of these.

New SarsCoV-2 variants

This virus, not surprisingly, is mutating fairly rapidly in order to continue spreading among the human population.  When a person has been vaccinated against the original virus, what happens when they get exposed to a variant?  Well, the difference with these variants are the proteins around the spike protein matrix–which is what the original vaccines focus on.  So, there appears to be decreased ability of the antibodies from the vaccine to block the virus, but there is still some action present.  Also, the second line of defense, our T cells, clears the body of infection and the variants don’t change this reaction at all.  So, on the Harvard webinar, the specialists stated that the current vaccines should still work against variants, just to a lessor degree.  That is corroborated by findings in the UK.  Individuals with autoimmune disorders do not appear to be at higher risk to these variants, but if they do contract the disease from these variants, they may carry the virus longer.

While You’re Waiting for Your Vaccination

There are active things you can do to improve your immune response to these vaccines.

  1.  If you only have a few days, make sure you get good sleep for several days ahead of time, and avoid getting vaccinated in the morning or when you are under extreme stress (high cortisol levels block the immune response).  Avoid taking any anti-inflammatories for the 2 days prior to after the inoculation.  That means even stop high doses of turmeric, quercitin and resveratrol (and obviously avoid aspirin and other nonsteroidal anti-inflammatories).
  2. If you have weeks or months, use this time to improve your overall health as much as possible.  Make sure you’re sleeping.  Eat a colorful, anti-inflammatory diet and avoid starchy/sugary comfort food and excess alcohol.  Move your body every day.  Work on stress management.  And take the preventative supplements I discussed in my prior blog.

Other specific questions

1.  “I already know I have antibodies present, so what do I do?”   This is still a bit controversial, but it appears that if you are at low risk, you can hold off a bit.  However, it is recommended that at some point you get vaccinated, as some of the vaccines appear to give you even better immunity than what you develop after contracting the disease.  It is recommended that you wait 3-6 months after the illness to get vaccinated.  Also, if you’ve had Covid 19 and you get a really big reaction to the first injection, you don’t need to take the second one, as it implies your immune system has already done a fairly good job creating the T cell response.

2.  “We’ve both been vaccinated but our adults kids and grandkids haven’t.  Can we take off our masks indoors around them?”  This answer depends on whom you are concerned about.  If you’re concerned about your own risk, you can take off your masks.  If you’re worried about spreading it to them, best to keep your masks on for now.

3.  “When will we get to stop wearing masks?”  Once we can effectively block transmission (at about a 70% herd immunity), then we can take off our masks.  When that will be depends on how many folks develop immunity either through vaccination or through contracting and surviving Covid 19.  Most experts I’m hearing say that will be anywhere from 6-12 months from now.  Yep, that is a pain.  But the good news is that this past flu season has been the mildest ever since we’re wearing our masks and not spreading influenza either!

Things on the horizon other than vaccines

There are a number of drugs in pill form that are being created to be used both for treatment of and prevention from Covid 19.  Specifically, these are monoclonal antibodies.  As one expert pointed out, “the spike protein of the virus is the hood of the car, but the enzymes in the virus itself is the engine”. These enzymes are critical to replication of the virus, so if they can be blocked, the virus dies. Importantly, they tend to remain the same when the virus mutates.  So, it’s simple:  block these enzymes.  Remdesivir is a currently available drug in IV form that blocks viral polymerase and shows promising evidence as a treatment for Covid 19.  Similar drugs are being formulated to be taken in tablet form for ease of use.  It could be that in the future, we all take a few pills rather than get a vaccine!

Resources

I’m forever indebted to my friends and colleagues at IFM for continuing to provide covid-related information.  Check here for a great chart about the vaccines as well as a recording of a really good webinar they did.  My friends Patrick Hanaway and Joel Evans are involved, and Dr Heather Zwickey does a fabulous, easy to understand discussion.  I have a great deal of respect for her.

And if you’re feeling really nerdy, consider taking their online course.  It’s aimed at health professionals but can also easily be understood by smart consumers.  And as always, if you have specific questions regarding your own situation, please contact me directly at drwarner@medicineinbalance.com.

Stay safe, stay healthy, stay positive.