#childsafety | Covid Vaccine’s Safety, Emerging Mutations

In this latest installment of FlaglerLive’s “Ask the Doctor” column by Dr. Stephen Bickel, the medical director at the Flagler and Volusia Counties Health Departments, the doctor takes on an intriguing question about covid and the Russian flu of the late 1970s, whether booster vaccine shots will be needed, how allergy shots or colonoscopies affect vaccination, and so on.

Dr. Bickel, featured almost weekly on WNZF’s Free For All Friday program since last March to update the community on the coronavirus pandemic and answer questions, will be doing so on a rolling basis here. The questions don’t have to be limited to the pandemic.

You are invited to submit your questions using the form below. The entire list of questions will be archived, indexed and linked to their answers on a separate page, here.

The “Ask the Doctor” column is a semi-regular feature of FlaglerLive. “Please feel free to ask any medical question you want,” the doctor says, “and I will do my best to answer it. In preparing my answer to your question, I may consult with some of my medical specialist colleagues or review the medical literature in order to come up with the best possible answer.

“Please limit your questions to general medical advice—I can’t give you specific medical advice since I don’t know your individual medical history. The emphasis of this column will be to provide information based on current scientific evidence while keeping speculation and politics to a minimum. If I don’t know something or the medical literature really doesn’t have much to say on a particular topic, I will tell you that.”

Previous installments of the “Ask the Doctor” column are available here, here, here, here and here.

By Stephen R. Bickel, M.D.

Covid and the Russian Flu: I received my first Moderna dose on March 16 and as expected, my arm is sore at the injection site. About 24 hours later, the only other reaction I had was difficulty sleeping because I kept waking up to a screaming sound in my ears. Here’s the strange part- when I was 7, I distinctly recall having the “Russian Flu.” I was a fairly healthy child- other than the chicken pox, that illness was the only time I remember being really sick. One of the most potent memories from that time was the same screaming in the ears I experienced last night. This is the first time that has happened since winter of 1977-78 and I became curious about that particular strain. I was surprised to read that the rhetoric around that flu was similar to that of Covid-19.

In a Washington Post article from that time, it mentions that most people over 26 were not impacted by the Russian Flu because they had immunity from a similar strain of flu 20-30 years earlier. I’m curious about research that may have been done correlating natural immunity/resistance and severity of symptoms with Covid 19 relative to exposure to the 1977 Russian Flu.

My daughter who lives with me is currently recovering from Covid. Prior to her positive test on February 26, we were in the same spaces on a regular basis. I assumed a positive test for my husband and I was imminent. We received PCR tests from your health department on February 26 and March 5. All were negative.

My benign but alarming reaction to the Moderna vaccine mirroring the most memorable symptom of my experience with the Russian Flu of 1977 has me wondering if it’s possible those antibodies could have protected us from Covid this month. Thank you.–Kendall Clark

what Kendall describes is very interesting and brings up some very intriguing unresolved questions about Covid and immunity. From the beginning of the pandemic last year, as soon as it was observed that the elderly did much worse than younger age groups, there was a fair amount of speculation about why, since the outcome severity seemed disproportionate to just the age-related effects that are normally seen with the immune system.

And around that time several scientists raised the possible explanation that it might be due to what’s called a cohort effect rather than strictly aging. The “cohort effect” has to do with the experiences that groups of people in your cohort or age group have, that may have shaped your immune system, rather than strictly age-related effects–in this case, was it due to different infections/exposures the elderly had (or possibly, didn’t have) when they were younger that had shaped their immune system to react in strange ways to Covid. And keep in mind, it may not just be under reaction to Covid that is the problem in this age group—a lot of Covid morbidity is due to immune system over-reaction. And it could even be a combination of the two—under reaction initially, so the virus spreads more in the body, and then over reaction late to magnify the systemic damage. So the issue was brought up maybe there was some immunity from prior infections that was related to certain time periods when people grew up that gave some groups partial immunity and others less immunity.

And something like that could be going on here except for the caveat that it’s unlikely there would be any cross-immunity to Covid coming from prior influenza infections—it would have to be from prior coronavirus infections, which are quite common (think the common cold) and share some of the same antigens. This is how the adaptive immune system works—it responds to specific antigens of the infectious agent. There is also something called innate immunity that can be boosted short term by recent prior infections, but that’s another issue and probably doesn’t play a major role here. But it is entirely possible that certain prior coronavirus infections, to which younger people may have been exposed more than older people, may have given them some cross protection so that not only are they benefited by being younger and healthier, but they also have some immune system priming that facilitates their immune systems responding more rapidly and in a more targeted way to SARS-CoV-2.

I haven’t read much research about this in the last six months—this is pretty esoteric stuff and not all that useful clinically so you won’t find it in the medical journals–if there is research on this it is probably in basic science journals, and in fact the research I read last year on this subject was in basic science journals.

So I guess the bottom line is that it is certainly possible that prior virus exposures (most likely to coronavirus) may confer T cell immunity or memory B cell immunity (i.e., probably more than just circulating antibodies), in addition to differences in innate immunity, that could protect people against Covid, and also that this protection could vary substantially between different age groups.

One last thing—as far as triggering the experience Kendall had with the screaming sound, that’s much harder to explain and may have no biological basis—but the body has lots of different ways of remembering things, both neuropsychological and biological, so maybe there was a biological activation of memory in some way that was triggered by her infection.

Thanks for bring up a very interesting issue.

Having had my allergies “shots” eight days after my first Pfizer vaccine effect the effectiveness of my Pfizer? [Gail Clemmer]

I’m assuming by allergy shots you mean shots you are getting to de-sensitize you to various allergens, and if that’s the case I would not expect that to have a significant effect on your Pfizer vaccine effectiveness, especially if you got those shots 8 days after your vaccination. I am not aware of any studies that have been done on this issue, so my answer is somewhat speculative, and for that reason I suggest you check with the medical provider who gave you the shots to confirm what I just said.

Dr Bickel, Thank you for your help dispensing quality info. If a booster becomes necessary after Pfizer/Moderna shots, (2), how long would it take for shot #3 to be available for the variants? [Corey Gollon]

Thanks for bringing up these issues, which are of great concern to the scientific community. Right now it’s too early to say whether a booster will be necessary and if so, will it be the current formulation (using the same spike protein template), a new formulation, or a combination of the two? The answer will depend on many factors, including how long immunity lasts after vaccination, whether the variants are the predominant virus in the population going forward, also which specific variants are predominating, and to what degree the variants can escape vaccine-induced immunity. The vaccine companies are already working on new vaccines that target the mutant spike proteins produced by the common variants that are now circulating, but that doesn’t mean these new vaccines will ever be introduced—it will depend on how much they’re spreading and whether they’re able to escape vaccine-induced immunity. To answer these questions it will be necessary to do genomic sequencing on more virus samples (which we’re starting to do more of in the U.S.) and also to continue ongoing surveillance of our vaccinated population to see how many of them are getting Covid infections in the future, and if they are getting infected, is it because their immunity is waning or because they’re getting infected by the variants?

How long after taking a Covid shot should I wait to schedule a colonoscopy?

There’s no particular reason in terms of the immune response to the vaccine that would require you to postpone having a colonoscopy, but since the prep for a colonoscopy involves a lot of fluid shifts in your body and reactions to the vaccine can include fever I would suggest waiting a week or so.

I had my first shot on 2/18.On 2/28 I had pains up and down my arm..It is now 3/16 and I still have the pain and is getting worst.Please advise [Jules Kwiatkowski].

That would be an extremely unusual reaction to the vaccine—it’s very possible something else is going on. I suggest checking with your health care provider and having your arm examined.

Do you know or have a guess on when 30- 40 year old will be eligible to receive a vaccine?

All Floridians 18 and over may get vaccinated starting April 5. Floridians 40 and older could access the vaccine starting March 22.

If I had the virus how long must I wait before I can get the shot? Will I have to get a shot every year or is this a one and done? [Peter Chichitano]

Anytime after you’ve recovered from Covid—so we’re talking a few weeks from the start of your illness in most cases—you can get vaccinated. If you had a severe Covid illness you may need to wait longer and in that case you should be checking with your healthcare provider.

Regarding the possibility of needing one or more booster vaccinations rather than just a “one and done” one time vaccination (whether it’s one or two doses), this is still to be decided. We need more data—we will have to see how the virus evolves and how long vaccine-induced immunity lasts.

Links to additional references:

CDC Guidance on Allergic Reactions

CDC Fact Sheet on Covid Vaccines

New England Journal of Medicine–Answers to Frequently Asked Questions

Please be safe.

For a full, archived and indexed list of questions, go here.

Dr. Stephen Bickel, M.D.

Dr. Stephen Bickel. (© FlaglerLive)
Dr. Stephen Bickel. (© FlaglerLive)

Dr. Bickel, currently the medical director of the Flagler and Volusia County Health Departments, treats HIV and Hepatitis C patients at both departments, treats internal medicine patients at the Volusia Volunteers in Medicine free clinic, and is the medical consultant to the Community Care program at 9 Advent Health campuses in Florida.Dr. Bickel has a BA from Brown University, an MD from Rush Medical College, as well as MBA and MPH degrees from UCLA. He did residency training in internal medicine at Rush, public health/preventive medicine residency training at UCLA, as well as an endocrinology research fellowship at the University of Chicago. He is board certified in internal medicine and preventive medicine, as well as being a credentialed HIV specialist and a certified hypertension clinician.

He is very interested in how the social determinants of health impact our community and how we can address health disparities by improving our safety net. He has been on the Board of Directors of Flagler Cares since its inception.

Disclaimer: The content in FlaglerLive’s “Ask the Doctor” column is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. Reliance on any medical information provided by FlaglerLive.com or medical professionals presenting content for publication is solely at your own risk.

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