LEXINGTON, Ky. (Sept. 9, 2021) — On Aug. 24, 2021, University of Kentucky senior Zakeya Baker sat down with health experts Becky Dutch, Ph.D, and Alice Thornton, M.D., to ask questions about COVID-19, vaccines and UK’s response to the virus. Dutch and Thornton addressed concerns common to students as well as many individuals across the globe.
Dutch is a research scientist who has studied viruses for the past 30 years. Most of her research focuses on RNA viruses that infect the respiratory track. She is also a member of the UK START Team, a group of public health and infectious disease experts that provides recommendations to the university for COVID-19 protocols.
Thornton is the chief of infectious diseases at UK. Like Dutch, she has devoted most of her life to studying infectious disease. She has been at UK for the past 23 years.
Can you describe what you're seeing in the hospital right now and what that says about vaccines?
Thornton: We have seen a huge uptick in cases, just like everyone has seen in the numbers. In our hospital, we have anywhere from 80 to 90 patients infected with COVID. About half of those patients are in the medical ICU. We're not completely maxed out, but we are really straining the hospital with these COVID patients. We're seeing more people being hospitalized this time around, particularly people who have not been vaccinated. As an infectious disease doctor, it's really scary to see so many people hospitalized with COVID, and a large percentage of those are unvaccinated.
Another percentage of those people are on ventilators — probably a third. Of the patients that are on ventilators needing assistance to breathe, only 6% of those are vaccinated. So 94% of the people that end up on a ventilator in our hospital right now are unvaccinated, meaning that was preventable. It's just heartbreaking as a physician and infectious disease doctor to see someone admitted when that most likely could have been avoided.
Why is it significant that the Pfizer vaccine was just granted full approval from the FDA? And can you explain the process for creating an mRNA vaccine?
Dutch: Full approval means that the FDA has enough safety data over a long enough period of time to confidently say this vaccine meets all of the safety standards equivalent to any vaccine approved in the past. Prior to this, we were on what's called Emergency Use Authorization (EUA). That came about because it met all the safety standards they could see, but they needed more time and more patients to track and make sure they weren't seeing anything that came up rarely — and they don’t. We're at a point when the vaccine is deemed to be as safe as any other one. We get all sorts of other vaccines, like the polio vaccine, for example, and this one is just as safe.
It's been more than a decade that they've been working on these mRNA vaccines. The strategies were developed quite a long time ago. They did some of the initial work on a series of different viruses, and they were looking at whether they could make a mRNA vaccine for those. So sometimes people will claim that this vaccine is too new, but the technology is not new. The only thing that changed from previous vaccines is which messenger RNA they put in this particular vaccine.
An mRNA vaccine is pretty simple to explain. Think of messenger RNA as a little sentence that tells your cell how to make something. In this case, it's something called a protein. The building blocks of life are these proteins that we use. Our cells make thousands of messenger RNAs that make thousands of proteins — so do viruses. So, what we do is we put a little messenger RNA that encodes one viral protein called the spike protein. That's one that sticks out on the surface because we want our antibodies to see it. We put it inside something that's going to be able to be taken up into cells just like this lipid particle. Lipids make up our cell membranes normally anyway. And when you inject it and it gets into a cell, the cell for a very short period of time for a day or two, makes that one viral protein, a spike protein. Your body then recognizes it as foreign and reacts to it, making your immune system come on. It turns on antibodies, starts to make the memory B cells you want for later response and you get a T cell response.
That’s what the vaccine does, and the second one gives you what's called a boost. Our immune system sees something for the first time and starts to get prepared. When it sees it a second time, it boosts it to be fully prepared. That's why it's a two-shot protocol. And if we had not had all those years of preparation, this would not have worked this fast. But because we did, they just had to switch what that messenger RNA was, and they were ready to go.
Thornton: It’s almost like if you were in a factory making a car and you already had the template to make it. But now that you have this new virus, you take that template and substitute it. So, if I was making a Chevy 10 years ago but wanted to make a Cadillac, I could take that template to make a different car.
If someone has previously contracted COVID-19, what level of immunity does that provide afterward, and how does that compare to the level of protection offered by the vaccine?
Dutch: This is a great question, and it’s one that’s debated across the nation. We see with people who have contracted COVID-19 that their level of immunity varies. There are people who get COVID-19 and have almost no sustained immune response to it afterward, but we don’t know why.
Other people who get COVID-19, may still have a nice sustained immune response a year and a half later. What this means is that with natural infection, just as Dr. Thornton talked about, there’s a wide variety in how well you respond to the virus. In contrast, when you’re vaccinated, there’s a very similar level of immune response among different people after they are fully vaccinated.
Now, some people who have issues with immunosuppression may lose it faster, but most people keep it for a long time. So even if you've had COVID-19, unless you know exactly, you're testing yourself all the time, and you aren’t sure how immune you are. We also know that if you take someone who's had it, it's like that first shot. They get a shot and a really nice boost — right up to the same level of antibodies and other things that we see in people who've had two doses.
That’s why it's really important — even if you've had it — to go ahead and get vaccinated. As I said, unless you want to test yourself all the time and see how immune you are, you should get vaccinated. You just don't know. You could be one of those people who has very little residual immune response, even though you've had COVID-19, and that means you're at high risk.
Can you touch on how long that natural immunity lasts for people who are unvaccinated?
Dutch: So most people who have been infected will have some level of immunity, some will have great (immunity) and it’ll last a long time. Some will have immunity and it will wane. Others will have almost none. Vaccinated people will be having constant higher level that lasts longer. And that’s where the complication comes from. It’s not a simple question where I could give you an exact time, but I can tell you most people who have it don’t have any idea how protected they are if they’ve just had COVID.
A common fear seems to be that the vaccine may have unexpected health consequences or impact fertility. What would your advice be to individuals who hold that concern?
Thornton: That's a fair question for people to ask that are looking at fertility. We definitely want to protect the unborn. When the vaccines first came out, I think there were more questions about that. But now that we're a year and a half, almost two years into this, we have some very nice data.
One of the first things I will hit first is sperm. There was a small study done where they looked at the sperm of men before vaccination and afterward, and there was no difference in the amount of active sperm that someone had before or after vaccination.
There's also been some very nice papers that have come out about women who are either pregnant, breastfeeding or anticipating pregnancy. In those studies, there is no difference in the amount of bad outcomes, as far as miscarriages or affecting the baby, in those that have been vaccinated versus those unvaccinated.
There are no signals to say that it's unsafe in pregnancy or in breastfeeding, which is exciting. To put a plug in here, for the breastfeeding individual and for the person that is pregnant, you may be able to give your baby some of those antibodies. What a nice gift when that baby is born or whether babies being breastfed when they're too young to get the vaccination, they're actually going to get some of mama's antibodies, which is a great thing!
Dutch: One other thing I'd point out is, particularly with the delta variant, having COVID when you're pregnant is dangerous. We have had a lot of pregnant women in the ICU. You do not want that. So, there's another reason to make sure if you're pregnant, get this vaccine.
We know that the in-person experience is crucial to our student success and the well-being of all members of our community. How can we balance this with prioritizing health and safety at UK?
Dutch: This is a really important point. As we deal with a pandemic, we also deal with life. For many students, isolation has made things incredibly stressful. Prior to the pandemic, we already had rates of anxiety and depression that were around 40% in college populations. They have skyrocketed. I remain very concerned about the rates of anxiety, depression and suicide, so I've been a huge advocate, as have many people here, for getting people back on campus.
If we do the things we're supposed to do, we get vaccinated and we wear masks at times when there's a high community transmission, like right now in Lexington, we can navigate this safely. At the same time, we can get students back in the classroom where they can interact, where students who may not have resources at home can get them here and for students who, frankly, this environment is going to help them deal with anxiety and depression, can get back engaged in life.
Thornton: It's all about learning how to live with this problem. It's not immediately going away, so it’s important to use the tools that we have — and our tools have changed. When we first became aware of this new virus, we only knew to use masks, but now we have more tools. We have vaccines, we have monoclonal antibodies. We have treatments that work in the hospital. And so, I think it's all about living in this environment currently and utilizing the best tools that we have at this time.
What general advice do you have for the students and the UK community?
Thornton: If we want to have our students back, which we very much want to, we want to have young people launching their careers, we do have a tool — it's vaccination. Then, we can go back to those old tools, which are masks when we need to wear masks, if when we have high transmission or if you're unvaccinated, or even vaccinated. Think about those closed spaces that don't have good ventilation. If you find yourself in that, wear a mask. Crowded places, indoors and close contact face to face — wear a mask. Use the tools that you have, because we can't just stay locked up in our rooms. We must emerge. But we can emerge safely and use the tools that we have, which include vaccinations.
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