COVID-19 questions

A reader of The Tribune-Democrat asked:

“I was fully vaccinated in March and April (Pfizer) and my husband has chosen not to be vaccinated. Three weeks ago, we both got COVID. Now that we are well, we thought it would be a good time to visit family (in a couple more weeks), but they say because he is not vaccinated they are not safe. Is this true? It feels like now would be about the safest we can be.”

The answer:

Reinfection is uncommon within 90 days following initial infection, but possible.

Due to the severe health risks associated with COVID-19 and the fact that reinfection is possible, your husband should be vaccinated regardless of whether you already had COVID-19 infections.

COVID-19 vaccine booster shots are available for the following Pfizer vaccine recipients who completed their initial series at least six months ago and are:

• 65 years and older;

• Age 18+ who live in long-term care settings;

• Age 18+ who have underlying medical conditions;

• Age 18+ who work in high-risk settings;

• Age 18+ who live in high-risk settings.

If either of you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine.

Experts do not know how long someone is protected from getting sick again after recovering from COVID-19. The immunity someone gains from having an infection, called “natural immunity,” varies from person to person.

Also, we don’t know the effectiveness of natural immunity against variant strains.

Finally, I advise you and your husband to get a flu shot soon.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I had COVID in December, and was immunized twice – once in January and 21 days later.

“I had my booster shot four days ago. Now I have a cough, laryngitis and fever after my initial side effects of fever, achiness and headache. Could I have COVID-19 now? I’m 74 years old.”

The answer:

Yes, COVID-19 reinfection is possible.

You didn’t mention if you received the influenza vaccine.

According to the CDC, reduced immunity due to low influenza virus activity since March 2020 may result in an early and possibly severe influenza season in 2021-22.

Therefore, I recommend you get tested as soon as possible for both influenza and COVID-19 with a rapid influenza swab test and a COVID-19 PCR (Polymerase Chain Reaction) swab test.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I had both Pfizer shots in January, then a mild breakthrough in August. Question: Is a booster shot recommended?”

The answer:

It has been shown that immunity to COVID-19 does wane over time. The vaccine for COVID-19 is designed to prevent severe infection and to reduce the chance of infection.

These vaccines are designed to prime your immune system to make antibodies that will bind to the spike protein of SARS-CoV-2.

The spike protein is what the virus uses to enter our cells. You can think of the spike protein as a key and your cells as the lock. If you make enough blocking antibodies, the keys are unable to enter the lock.

The vaccines tell the immune system to make those blocking antibodies. So – you get exposed to someone with COVID-19. You will receive varying amounts of virus. Delta creates more virus to spread than the other strains. If you get more virus from the exposure than there are blocking antibodies, you will become infected. The amount of blocking antibodies you make depend on many different factors of your body. Hence, the vaccines are good at keeping you from getting severe infection.

You mentioned that you had COVID-19 and recovered. This means that you naturally boosted your immune response.

One of the most amazing things about our immune systems is the memory response. When we get a vaccine or get sick, our immune systems remember the infection for the next time. If you are re-exposed to something via a booster shot, that follows the original exposure by vaccination or natural infection, the memory response is even more vigorous than the original. A booster can only make the response better.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I tested positive for COVID on Nov. 4, 2020, and to this day, I am still struggling to breathe at times. I still can’t smell or taste. I have been to my doctor, and she took X-rays of my lungs and told me it’s COPD, and I feel it’s COVID because before catching the virus I was healthy as a horse. How long will COVID stay in me?”

The answer:

An excellent question.

Most people who have coronavirus disease (COVID-19) recover completely within a few weeks. But some people, even those who had mild versions of the disease, continue to experience symptoms after their initial recovery. These people are sometimes described as “long haulers,” and the condition has been called post-COVID-19 syndrome or Long COVID-19.

Older people and persons with serious medical conditions are most likely to experience lingering COVID-19 symptoms, but even young, or otherwise healthy people can feel unwell for months or longer after infection.

Particularly concerning for patients, doctors and scientists alike are long lingering COVID symptoms such as shortness of breath or difficulty breathing, persistent loss of smell or taste, cough, chest pain, fast or pounding heart beat, memory loss, dizziness, reduced attention, an inability to think straight, depression or anxiety, fever, headaches, sleep problems, extreme fatigue, joint pain, muscle aches and weakness, worsened symptoms after physical or mental activities, among many other side effects.

It’s estimated more than 2 million people are suffering from Long COVID. There’s also data suggesting many patients are still experiencing symptoms a year later.

Many large medical centers are opening specialized clinics to provide care for people who have persistent symptoms, and there’s a lot of ongoing research looking at specific treatments for Long COVID.

The potentially long-lasting problems from COVID-19 make it important to reduce the spread of COVID-19 by getting a COVID-19 vaccine, and following precautions, including wearing masks.

I suggest you consult a lung specialist (pulmonologist) regarding your breathing problem. For more information on post-COVID conditions, see the CDC (Centers for Disease Control and Prevention) Caring for People with Post-COVID Conditions webpage.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“I received my second Pfizer vaccine on Sept. 17. My daughter came to visit me that evening for the weekend. Just her; none of her children came. Is it a coincidence that she and my grandchildren all have COVID-19?”

The answer:

Your COVID-19 vaccination did not cause your daughter’s COVID-19 infection. You didn’t mention when your daughter tested positive.

It’s possible you were exposed when she visited and you were not fully vaccinated (i.e., two weeks after the second dose of the Pfizer vaccine). If you were not tested three to five days after exposure, I recommend you get tested now.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

“There are no facts out there, only rumors, so here’s my question:

“If someone has been vaccinated (in my case with Johnson & Johnson) and then contracted COVID-19, does he/she need a booster shot, or is having had the virus itself enough to boost the immune system? And if he/she does need a booster, how long after having the virus should the person get it, and which of the three vaccines should the person opt for?”

The answer:

The only vaccine that is currently FDA approved for COVID-19 booster shots is the Pfizer vaccine.

Johnson & Johnson performed a clinical trial over the summer. This trial showed promising data that suggested that a booster shot of the J&J vaccine would be beneficial. Moderna had similar results with the booster trial for their COVID-19 vaccine, as well. It is expected that both the J&J and Moderna vaccines will have approved booster shots soon.

Vaccination for COVID-19 is designed to protect the individual from severe infection. Scientific studies have shown that immunity after vaccination does decrease over time. This decrease is likely due to the combination of decreasing protection as time passes since getting vaccinated (what science calls waning immunity) as well as the greater infectiousness of the delta variant.

Waning immunity is something that is seen in many infectious diseases that we vaccinate for. Tetanus, influenza and pertussis (whooping cough) are among those that fall into this category.

Booster shots will provide a rapid and robust increase in antibodies (the immune proteins that block infection) to the spike protein of SARS-CoV-2. Even if you have recovered from COVID-19 and been vaccinated, a booster shot can only help your immune response.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

“I’m almost 14 and I was wondering if there is any way for me to get tested for COVID-19 without telling my parents. I can’t drive, and I’m not going to have a friend drive me when I think I may have COVID.

“Please help if you can. Thank you.”

The answer:

I am sorry you are going through this.

Given that you are a minor, you will need to have a parent or guardian provide consent for the testing. I suggest that you talk to your parents about the issue. If this is not possible, try reaching out to a trusted adult, a school nurse or a counselor, maybe.

An article online at jamanetwork.com/journals/jamapediatrics/fullarticle/2782024 talks about various states and their policies surrounding COVID-19 vaccination and testing.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

"I had both of my Moderna shots in February 2021. I am in my early 70s and had a semi-annual blood work done by my physician a month ago. When the blood work came back, it showed that I did not have any COVID antibodies. So what am I supposed to do until the FDA decides that Moderna can give boosters? I wear my mask whenever I go out and stay six feet away from people as much as I can."

The answer:

I can understand your concern; however, since you were vaccinated, your immune system did mount a response and will protect you if you are exposed to the virus that causes COVID-19 in the future.

COVID-19 antibody tests are not recommended for assessing vaccine effectiveness. I know that seems odd. Please let me explain.

Current SARS-CoV-2 antibody tests have not been tested to determine the level of protection provided by the immune response to COVID-19 vaccination. Rapid antibody tests only show whether antibodies are present, without providing any information on the number of antibodies present.

Scientists have not yet established the "correlates of protection." That is to say, they haven't determined the exact concentration of antibodies required to prevent infection or illness – so even a positive antibody test can’t confirm that someone is protected.

In other words, just because someone has a positive antibody test, that does not automatically mean that their level of antibodies is high enough to protect against COVID-19 infection.

Furthermore, antibodies vary in their ability to neutralize virus (make it unable to enter our cells) – a property not measured by routine anybody tests.

Lastly, antibodies are not the immune system's only form of protection against a future threat. Various types of white blood cells contribute, for example, by remembering the pathogen so that a faster response can be triggered next time.

– Jill D. Henning, associate professor of biology, University of Pittsburgh at Johnstown.

• • • • •

"I received my first shot of the Moderna vaccine, and about 20 minutes after the whole left side of my face felt numb like when your foot falls asleep, and I had shortness of breath. About an hour after that, I went back to feeling normal. Is that considered a severe reaction and can I still get the second shot?"

The answer:

An excellent question. If you had a severe or immediate allergic reaction after getting the first dose of an mRNA COVID-19 vaccine (Moderna or Pfizer), you should not get a second dose of either of the mRNA COVID-19 vaccines.

A severe allergic reaction is one that needs to be treated with epinephrine (EpiPen) or with medical care. An immediate allergic reaction means a reaction within 4 hours of getting the shot, including symptoms such as hives, swelling, or wheezing (respiratory distress).

I recommend you consult a board-certified specialist in allergies and immunology or infectious diseases for further advice.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

"My wife and I both got COVID-19 and quarantined for two weeks. I tested four times and finally got a negative result. She tested with me every time and is still testing positive. Since I'm still in the house can I get it again? She hasn't been showing any symptoms and it hasn't hit her hard at all. COVID was rough on me but she didn't get it bad and took care of me during our quarantine together."

The answer:

An excellent question. You didn’t mention if you and your wife were vaccinated. Re-infection is uncommon within 90 days following initial infection – however, re-infection is possible. Sometimes the virus is persistent in detectable levels up to 12 weeks or longer after infection, but likely isn’t infectious.

Due to the severe health risks associated with COVID-19 and the fact that re-infection is possible, you should be vaccinated regardless of whether you already had COVID-19 infection. If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Experts do not know how long someone is protected from getting sick again after recovering from COVID-19. The immunity someone gains from having an infection, called “natural immunity” varies from person to person. Also, we don’t know the effectiveness of natural immunity against variant strains.

Finally, I advise you and your wife to get a flu shot soon.

– Dr. David Csikos, chief medical officer, Chan Soon-Shiong Medical Center at Windber.

• • • • •

Have a question about COVID-19? We will ask the experts.

Send questions to tribdem@tribdem.com.

Note: Due to the volume of questions submitted, we will not be able to answer them all. Any questions of an urgent nature should be directed immediately to your primary care physician.

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