COVID-19 questions

A reader of The Tribune-Democrat asked:

“I have memory loss and by accident got three doses of Moderna, each a month apart. Am I in trouble?”

The answer:

An interesting question.

Moderna is evaluating three approaches to increasing immunity. The first approach would use variant-specific booster shots, but at a lower dose than the original vaccine. The second one would combine the original vaccine with a variant-specific vaccine into a single shot. The third would test a third shot of the original vaccine.

In my opinion, you’re not in trouble, and perhaps your immunity is increased.

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

• • • • •

“I received my first dose of Pfizer-BioNTech vaccine on March 10. My second dose is scheduled for June 30. I recently tested positive for COVID-19 with mild symptoms. How soon can I or should I get my second dose of Pfizer-BioNTech vaccine after testing positive?”

The answer:

If you are not immunocompromised, 10 days of self-isolation is recommended since your symptoms first appeared. If you are immunocompromised, then at least 20 days of self-isolation is advised.

Defer the second dose of the vaccine until you have recovered from the acute illness and no longer require isolation. If you were treated with COVID-19 convalescent plasma or monoclonal antibody therapy, it is recommended to defer the second dose of the Pfizer COVID-19 vaccine for at least 90 days as a precaution.

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

• • • • •

“My second Moderna was injected too high. My arm still aches five weeks after the shot. I had an ultrasound and there is fluid in my bursa. I recently had an antibodies test – IgG qualitative, and it was not conclusive. My question: Is it safe and should I get one more Moderna shot, or start a second shot sequence, or not do anything?”

The answer:

I am sorry to hear about your experience with the vaccine.

Our immune systems are amazing. They only need a small amount to provide us with lasting protection. If you were vaccinated, you are protected. Even though the IgG antibody titer is low, it will ramp up when needed (when/if you are exposed to COVID-19).

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

• • • • •

“I’ve had both COVID-19 vaccine shots a couple of months ago. My stepson has been around his sister, who just came down with coronavirus and hasn’t had a vaccine. Their mother just died from COVID. When my stepson visited Sunday, we stayed outside. What is the chance of my husband and I getting COVID? I work in an assisted living facility.

“I’m very worried about it.”

The answer:

I am so sorry to hear what your family has been through.

A fully vaccinated person may still get COVID-19. The chances are between 5% and 20% depending on the vaccine and the strain of virus your stepson had. Good news is that if you get COVID-19, it will be mild and like the common cold.

You won’t be hospitalized.

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

• • • • •

“I have tried to get my second shot, but was sick when I was due to get it. Now that I am feeling better, can I still get it if it is Day 54 or later?”

The answer:

Yes, you can!

It is OK to delay the second shot by 12 weeks. You will still see the same protection levels.

Roll up that sleeve!

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

• • • • •

“I got my second Moderna vaccine on April 15. I was extremely sick from Thursday night until Sunday morning (running a fever between 101.4 and 103.5 during this time and only got up from bed to use the bathroom. I felt terrible). However, since April 15, I have had a headache, dizziness, nausea and jitters every day. As I write this today, exactly two weeks since my vaccine, I am still experiencing these symptoms. I weighed myself this morning (for the first time since getting the shot) and I have lost 13 pounds in 14 days. I am taking Meclizine to help with being dizzy and nauseous. What would you recommend? Is this normal to stay sick for so long?”

The answer:

In my opinion, what you are describing is not normal. I recommend you seek medical attention as soon as possible for an evaluation of your persistent symptoms.

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

• • • • •

“The CDC information says it’s OK for small groups of vaccinated people to gather without masks, but still mask in large, public groups. But what is a ‘small group’ and if everyone is vaccinated, does that mean we can mingle and eat together safely? A group of 12 senior citizen friends have all been completely vaccinated. We are, however, from 12 different households, some with family members not vaccinated. Would you consider it safe for us all to be together and socialize indoors without our masks on?”

The answer:

It is safe for you to gather together inside or out without masks if you are all vaccinated.

There are families who have individuals who are not vaccinated. Take mine for example. I have a son who is 9, unvaccinated, and a stepbrother who is 14, unvaccinated. We gathered this weekend with my two sisters, father and stepmother who were all vaccinated. I, too, am vaccinated. 

We chose to not wear our masks because we know that we are being safe: wearing our masks in public, washing our hands and keeping our distance. 

This made the risk to my son and stepbrother low.

The CDC cannot say that all families are doing what mine is; so, they recommend that only vaccinated individuals gather.

I do hope this helps to clear it up a bit for you.

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

• • • • • 

“I got tested for COVID on March 23 and my result was positive. After 14 days of treatment with Vitamin C (1000iu) and Vitamin D (5000iu), I got another test (PCR), and the result was negative. On April 19, I got an antibody test and the result was SARS-COV-2 lgG (14.14)

“My question is if I should get the COVID vaccine? If yes, is it safe to my body? In my country, we have only China’s Sinopharm Verocell vaccine.”

The answer:

I am sorry to hear that you had COVID-19, but I am glad to know you recovered.

It is safe and effective to receive the vaccine after recovery from COVID-19. Our immune systems are amazing. Even though you had a natural response to the virus and made your own antibodies, getting the vaccine will boost that response. It can only help you.

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

• • • • •

“If I have been fully vaccinated and my friend will not get the vaccine, should I continue to be with her? She says she tests often.”

The answer:

Vaccinated individuals can still get COVID-19. 

There are many variants around and the vaccines provide anywhere from 67-95% protection depending on the strain you are exposed to.

Good news is that vaccinated individuals do have less severe disease. They are significantly less likely to be hospitalized and to suffer from long-haul issues.

I know talking to friends and family about vaccinations can be hard. Try asking her why she is unwilling to get the vaccine. Ask her questions about her knowledge, attitude, and beliefs. Meet her where she is. You may see that you can help her to change her mind.

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

• • • • •

“If you have mixed cryoglobulinemia, should you get the COVID-19 shot? I’ve been dealing with EMC for more than 20 years. Some years ago, I had to have the Hep-B Vaccine and it triggered the EMC. It felt like it started all over – as if I was sick again. My legs were very red, hurt more than normal, and my feet hurt so bad that it took over a month for it to calm down. 

“I’m not sure if I should get the shot. My doctor really does not have an answer for me.”

The answer:

Immunocompromised persons may have a diminished immune response to the COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) recommends vaccination of immunocompromised patients if there are no contraindications. Mixed cryoglobulinemia is believed to be an immune-mediated disorder or an autoimmune disorder.

Given your past medical history, I recommend you consider consulting a hematologist (specialist in treating blood disorders) for instructions and recommendations.

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

• • • • •

“I received my second COVID shot on March 11. 

“I have not felt myself since. Is this normal? I have aches and stomach issues.”

The answer:

There has been no reporting of long-term stomach issues surrounding the COVID-19 vaccines if you look at the Vaccine Adverse Reporting System.

If you are experiencing abdominal issues, I suggest that you see your primary care physician.

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

• • • • •

“I’m a male, 44 years old, fully vaccinated (Pfizer – received my second dose on Jan. 20). I’m an RN and have been working with COVID since the beginning of the pandemic. Now my family, wife (who is 44, received her first dose on April 18), 18-year-old son and 6-year-old daughter tested positive for COVID-19. So far, they are only presenting mild symptoms, except for my daughter; she is completely asymptomatic. My wife and son are presenting malaise, headache and sore throat, but nothing respiratory that I need to be worry of so far. My question is how may I be safe at home? Am I at risk to be infected, too? The virus is everywhere at home. So far the vaccine is working, I guess, but how effective could it be? I don’t have any other place to go. Do I need to expect the symptoms are worse on them?”

“I’m feeling lost because I can’t determine where and when they were exposed.”

The answer:

As for you, you are a fully vaccinated health-care worker.

The Pfizer vaccine is 95% effective. Fully vaccinated people can refrain from quarantine if you are completely asymptomatic.

Also, fully vaccinated healthcare personnel with higher-risk exposures who are asymptomatic do not need to be restricted from work. Asymptomatic healthcare personnel with a higher-risk exposure, regardless of vaccination status, should have a series of two viral tests for SARS-CoV-2 (COVID-19) infection. In these situations, testing is recommended immediately and five to seven days after exposure.

As for your wife, son and daughter, I’m understanding that your wife, son and daughter all tested positive. If that’s correct, they all need to self-isolate.

There’s no problem in having multiple people isolate together, as long as we’re sure they’re all positive. If none of them are immunocompromised, then at least 10 days of isolation is recommended for your wife and son since their symptoms first appeared, and at least 10 days of isolation is advised for your daughter since the date of her positive test. If any of them are immunocompromised, then at least 20 days of isolation is recommended.

Defer your wife’s second dose of the COVID-19 vaccine until she has recovered from the acute illness and no longer requires isolation. If she is treated with COVID-19 convalescent plasma or monoclonal antibody therapy, it is recommended to defer the second dose of the vaccine for at least 90 days as a precaution.

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

• • • • •

“I was advised by a friend in the medical field not to get my second vaccine shot because I did have COVID-19 three weeks ago. Is this something I should be concerned with? I rescheduled just to do some research on this concern. Hope you can help.”

The answer:

If you are not feverish, you can get your vaccine. When the pandemic started, if someone had had COVID-19, they were asked to wait 90 days to get the vaccine. This was to allow those who had not developed a natural immune response (from being sick) to get protected.

Vaccines are available now.

You do not need to wait.

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

• • • • •

“I had my second Moderna shot on March 29. On April 21, I started taking Nitrofurantoin Monomcr 100-milligram capsules twice daily. Will this antibiotic have an effect on the effectiveness of my Moderna vaccine?”

The answer:

No.

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

• • • • •

"I had COVID-19 and have been healthy for seven days now. I got my first dose of vaccine on April 29. My mother is 90 and received her second dose March 25. Would it be safe to visit her on Mother’s Day if I’ve recently recovered from COVID and have only had one dose?”

The answer:

Your mother is fully vaccinated, but you are not. Based on current evidence, reinfection is uncommon within 90 days following initial infection.

In my opinion, it’s probably safe to visit your mother on Mother’s Day. However, I recommend both you and your mother wear a mask.

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

• • • • •

“My husband insists on doing and going anywhere he wants. I had COVID and have heart disease, COPD and pulmonary hypertension. I almost died. We argue all the time. What can I do to save my marriage?”

The answer:

I am so very sorry to hear that you and your spouse are struggling with the many issues surrounding COVID-19.

This pandemic has become so polarized that it can be difficult to see each other as we once did. Often when people are argumentative it can be because of fear. I am not a therapist, but I do have strife with family. The best advice I can give you is to actively listen to your spouse and ask questions about why he is resistant to wearing a mask.

Start with where he is and work from there. Let him know that you are trying to see it from his point of view.

As for you, you can do many things to keep yourself safe. 1. get vaccinated. 2. wear your mask when indoors 3. read a good book.

Best of luck with your coming conversation. We are all in this together.

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

• • • • •

“I had a severe rash after getting the first shot of Moderna. This rash/hives started developing after nine days of getting vaccinated (first shot). On Day 11, rashes turned to blisters under my arm on the vaccinated area. Day 12, I consulted my PCP, and he confirmed it as shingles. (I am a 36-year-old male.) I have the below questions/concerns:

“1. Is this a known side effect of the vaccine?

“2. Should I be getting my second shot at all? Really worried if I would have more episodes like this again. I am still recovering from shingles, but have the date for my second shot in next four days.”

The answer:

When your shingles rash has no blisters, wait two weeks before you get the second COVID-19 vaccine dose.

I’m not aware of any known evidence of a link between getting shingles and the COVID-19 vaccine. Almost one out of three people in the United States will develop shingles in their lifetimes.

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

• • • • •

“I received the first Pfizer vaccine in February and was scheduled to return in 18 days for the second. I was a bit skeptical, as I had read and seen answers in your column, that the time frame between doses is minimally at 21 days. Would this make it less effective or maybe cause more side effects? I did call the CDC as well as the FDA with my concerns. Both people I talked with were very willing to explain to me. I found out that there is a ‘grace period’ of four days before the 21 days for the Pfizer vaccine, which would take it back to 17 days between, and the vaccine would still be considered ‘valid.’

“No problem with efficacy of it. Although, it also says that people should not be scheduled to receive the vaccine earlier than the recommended three-week time for Pfizer and the one month for Moderna. The woman at the FDA told me there were long discussions of the time frame when making the decision to give the vaccine the ‘green light.’ I was just wondering if you had heard or read of this issue. I did look at the CDC website and it took a while to find this item.

“Thank you for taking the time to read my comments/questions and thank you for providing the informative column on COVID-19.”

The answer:

Thank you for your inquiry and for choosing vaccination.

As with any medical treatment, there is guidance and there is what is done in practice. The vaccines are no different.

The clinical trials showed that the best wait time was between 17-21 days for the boost in immunity to be seen. Science also showed that you can wait up to 12 weeks to give the second dose and still see a boost in immunity that is no different than waiting 21 days.

We are in the middle of a global pandemic.

If we were not, most of this science would have been worked out and the messaging would have been consistent. However, we (the public) are learning right along with the scientists and medical professionals. That can make things seem like we are on an amusement park ride.

Keep asking questions and keep an open mind about the answers.

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

• • • • •

“My wife and I had taken the first dose of COVISHIELD on March 17.

“We both were positive for RT-PCR on April 9. We are well now after receiving treatment. My question is: Do we have to take the second dose of vaccine and when?”

The answer:

Thank you for choosing vaccination.

It is important to complete the course of any vaccination. Our immune systems are amazing. The second dose will only help your immune response to make more cells to fight off the infection. Like adding more fuel to the fire, the second dose will make the response more effective.

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

• • • • •

“Three weeks after my second Pfizer dose, I took an antibody test. Specifically, it was the Roche’s Elecsys Anti‑SARS‑CoV‑2 S assay, which is apparently a “semi-quantitative” test that can measure antibody levels resulting from COVID vaccination.

“According to Roche, the analytical measuring interval is 0.40-250 U/mL. Numeric values are interpreted as “negative”(< 0.8 U/mL) and as “positive” (≥ 0.80 U/mL).

“My results were just over 1,700. At first, this sounded great! However, when I looked at the Pfizer data, it appears that, in their clinical trials, typical antibody levels following the second dose were typically much, much higher. Typically 10,000 or higher.

“Given that my antibody levels are much lower than was found in the clinical trials and the fact that I had absolutely zero side effects (not even a slightly sore arm) after my second dose, I am very concerned.

“Should I be worried?”

The answer:

In my opinion, your vaccine antibody results are positive, and I would not worry. From a clinical prospective, I’m not sure that higher vaccine antibody levels (titers) correlate with better protection and/or less risk of infection.

Also, I don’t know if the vaccine antibody levels measured in the Pfizer clinical trials was the methodology as your testing.

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

• • • • •

“I got shingles five days after getting the first COVID shot. I asked my doctor whether I should put off getting the second shot, but he has not returned my call. I don’t know what to do now.

“I have read in many sites that the first shot did not cause my shingles, but I am scared now and afraid to get the second shot, which is due in two more weeks. I’ve had the shingles now for 10 days and it is still excruciatingly painful. ”

The answer:

An excellent question concerning shingles, COVID vaccination and the shingles vaccine.

When your shingles rash has no blisters, wait two weeks before you get the second COVID-19 vaccine dose.

There is no evidence of a link between getting shingles and the COVID-19 vaccine. You probably received the old single dose shingles vaccine, Zostavax. Two doses of the newer shingles vaccine, Shingrix will prevent shingles in 91-97% of adults.

There is no specific length of time that you need to wait after having shingles before you receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated with the shingles vaccine, Shingrix.

You should wait a minimum of 14 days after administration of the mRNA COVID-19 vaccine series to give a patient Shingrix.

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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