A vaccination Q&A: Dartmouth doc addresses myths, concerns, about vaccines
Apr. 18—As the state's mask mandate expires and restrictions on businesses ease, public health officials continue to implore state residents to get vaccinated against the virus that has killed 1,266 of our neighbors and sickened more than 91,000.
More than 600,000 Granite Staters have received at least one dose of a COVID-19 vaccine, and nearly a quarter of the population has been fully vaccinated, according to the state health department.
But some vaccine-related headlines last week injected worry and confusion into the landscape.
Federal agencies issued a "pause" on use of the Johnson & Johnson vaccine, one of three COVID-19 vaccines approved for emergency use by the Food and Drug Administration. That came after six people in the U.S., all women, experienced rare blood clots within weeks of getting vaccinated, and one died.
Closer to home, a Plymouth State University student reported testing positive for COVID-19 a few weeks after getting vaccinated, and experiencing mild symptoms of the illness.
And a Lempster man reported he was accidentally given a different brand of vaccine for his second shot than he received the first time. State health officials issued a statement saying mixing vaccines is safe.
We turned to Dr. Michael Calderwood, chief quality officer at Dartmouth-Hitchcock Medical Center, to help explain the science and clear up some of the confusion around the COVID-19 vaccines.
Calderwood expressed concern that the number of COVID-19 cases and resulting hospitalizations have doubled in the past month. The rate of positive tests is back up to what it was in November, he said.
"As that percentage goes up, it means that the number of individuals with undiagnosed illness in the community is on the rise, and so there are more people out there who are infected and don't know it," he said.
It is encouraging that there has not been an increase in the rate of deaths, he said.
"A lot of people have attributed that to the fact that we have vaccinated those who are at highest risk of dying, meaning those who are elderly or have other illnesses that predispose to severe disease," he said.
"But time will tell," he said. "We know deaths tend to lag about two weeks behind the rise in everything else. As we see the case counts go up and hospitalizations go up, I think the next two weeks will tell us a lot."
Questions and answers have been edited for clarity and length.
Q: What do you say to New Hampshire residents who got the Johnson & Johnson vaccine and who now may be nervous about possible side effects?
A: What I would say is that the side effects ... are very rare. The pause of the J&J vaccine nationally is based on six individuals who developed an unusual form of blood clotting, but that's out of a total of 6.8 million doses that have been given. So it's being reported that the risk is one in a million for developing one of these clots.
Just to put that in perspective, the risk of developing a blood clot from COVID itself is one in five. We've seen a lot of really bad blood clots, including stroke in young individuals, and individuals that have had clotting that has led to heart attacks and other significant complications from the virus itself.
I actually think this is good news around J&J, that it actually means our surveillance is working, that this was detected early and they're going back to make sure they understand everything about it.
Q: The six individuals who developed blood clots were all women, aged 18 to 48. What is the potential connection to use of birth control, which can carry its own risk of blood clots?
A: That is one thing that is being looked at.... You'd have to look at other risk factors for blood clots, and that would include oral contraceptives as well as smoking as well as obesity and some other things.
They're doing a very deep dive into all of the cases. The fact that they decided to wait an additional week just means they wanted to make sure they fully understood what was causing these clots so that they could provide the best guidance.
Q: What is the latest data on whether someone who is completely vaccinated and showing no symptoms can still potentially spread the virus to someone else?
A: The vaccines are not 100% effective. They are very effective in terms of reducing someone's viral load, so if they get infected, the virus is multiplying less so they have a lower amount of virus, which means they can have much less severe symptoms.
If you're vaccinated, it is possible that you can still get the virus and if you do, you will be less severely ill, and so you may be out and about and at risk to transmit it to others.
One thing we definitely are seeing is that people are wearing masks less often, and that as individuals get vaccinated and feel more comfortable being out in the community, we are going to have less physical distancing. And we have to think about how that is going to affect our rates of infection, particularly while we still don't have a significant percent of the population vaccinated.
Q: What should we be doing, or not doing, once we are vaccinated?
A: To get out of this, a lot of us are going to need to step forward and be vaccinated when our time comes.
So for those who have already had that chance, that is great, they can feel that they are protected. They can begin to have small gatherings with their families. They can begin to gather with others who are vaccinated.
But we still need to think about: What about when we are out at the grocery store? What about large events? Holidays and sports events? We're not at a point yet where we can let our guard down in those situations. It's to protect those in the community who have yet to be vaccinated.
Q: There have been reports of some people who were vaccinated later getting COVID-19. Explain why that can happen and why that is or isn't a concern.
A: There are two parts to that. Whenever we've talked about the effectiveness of the vaccines, either in the trials or in the post-FDA approval period, we have recognized that there will be individuals who are vaccinated who will still be infected ....
The second aspect is there are variants of the virus that are in circulation... In most of the cases of the common variants that are circulating, the vaccine is still very effective in terms of severe disease, but there may be some breakthrough mild illness related to some of these variants.
Q: There's some confusion about whether people who are vaccinated need to wear masks. Can you explain why or why not?
A: So again, we know that the vaccine is not 100% effective. We know that people who are vaccinated and get infected may have milder illness to the point where they don't know they may be shedding virus.... We also know there are variants that can break through the vaccine protection. So for all of those reasons, and because we still are seeing cases on the rise, not going down, I will continue to wear my mask when out in public and not able to physically distance from others.
We've all learned to be comfortable in a mask. Would I love to take it off and be done with it? Absolutely. Do I long for the days where I don't need to wear it? Yes. But can I go through my daily life with it, knowing that I'm protecting others? Yes.
It is not time to remove that mask. That time will come, but that time is not today.
Q: There was a recent report of a man who accidentally was given a second dose of a different vaccine than the one he got the first time. How much of a problem is that?
A: There are vaccinologists who actually think it may be beneficial to get a dose of Moderna after Pfizer or a dose of Pfizer after Moderna.... There are people that have advocated and are recommending we study those, but we don't have that evidence to say if that is a better option, or a safe option.
Q: Talk about some of the myths and misunderstandings about the vaccines that concern you most.
A: We are vaccinating hundreds of millions of people. And on any given day, people regardless of vaccination die, get cancer, get all sorts of other illnesses. But because we're now going into a period where we're vaccinating so many people, there is a risk of having a misattribution and to say that something is because of the vaccine where it actually would have happened regardless of vaccination. This is always the issue with mass vaccination campaigns.
What I would say to folks is vaccines are incredibly effective and incredibly safe. These have been studied, and the fact that the J&J vaccine has been paused actually speaks to the process, that when we have concerns we actually take a pause and we look at the data and we're transparent with that data.
You are at much higher risk of getting side effects if you get infected with the virus than if you get vaccinated.
Q: So is it safe to travel, go on vacation, get on an airplane?
A: If you had asked me this question a month ago, I would have felt more comfortable. I think that we're seeing areas around the country where things are on the rise. ...
I would encourage people to think about what they're doing to protect themselves during travel and also when they get to their destination.
Is this the right time to rent a home with some other families? Is it the right time to go and visit other family members? Maybe. I think you can do that safely. Is this the right time to visit large theme parks or travel to a large event? No, I don't think that is safe as of yet. I think we are months away from when that will be safe, just based on the numbers of people who are vaccinated.
We've been in a very long tunnel, and we're near the light at the end of the tunnel, but we're not there yet.
Q: What other public health messages do you want to share?
A: I think my biggest concern in the next couple weeks is we are coming into a period where schools are ... going through the vacation period. And so individuals that have been traveling for vacation really do need to think about what they did to prevent their risk of disease.
And while you can now travel domestically without quarantine, it can be beneficial, particularly if you are going back into a school environment, to either delay your return to school or at least get tested in the three to five days after you return.
Q: Would you take your family to Disney World for school vacation?
A: I would not. Disney has done everything that they can, as many of these places have ... but personally it's not something I would feel comfortable with. Other people may make a different choice.
