Approximately 700 Routt County residents have received 2nd dose of COVID-19 vaccine | SteamboatToday.com
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Approximately 700 Routt County residents have received 2nd dose of COVID-19 vaccine

Dr. Nathan Anderson, an emergency medicine physician at UCHealth Yampa Valley Medical Center, receives his first COVID-19 vaccination Dec. 17. (Photo courtesy Nathan Anderson)

STEAMBOAT SPRINGS — Getting the second COVID-19 vaccination shot “comes down to the biology of how the vaccine works,” said Dr. Nathan Anderson, an emergency medicine physician at UCHealth Yampa Valley Medical Center.

Because the body has never seen this virus before, “it has to be taught what to look for,” Anderson said. “The purpose of the first shot is to give the body a genetic blueprint of what to recognize. Once it is taught to recognize it, that needs to be exercised so the body can do it independently — that’s the purpose of the second shot.”

While close to 2,000 people in Routt County have received their first shot, as of last Thursday, 667 second doses have been administered by either the hospital or Routt County Public Health, according to UCHealth Communications Specialist Lindsey Reznicek. Of those, one person declined a second dose, Reznicek said.



No doses are going to waste, said Eli Nykamp, director of hospital operations.

The Pfizer-BioNTech vaccine, for which a second dose is recommended after 21 days, is roughly 52% effective after its first dose, and 95% effective after the second dose, according to data published by Pfizer in December.



The Moderna vaccine, which recommends 28 days between doses, is 80.2% effective after one dose, and about 94.1% effective after the second dose, according to the company.

“It’s not unusual for vaccines to require back-to-back doses to be most effective,” writes Dr. Carlos Malvestutto, an assistant professor of infectious diseases at Ohio State University. “The first dose primes the immune system while the second dose induces a vigorous immune response and production of antibodies. The bottom line is that you want your immune system to produce a robust enough level of antibodies that, if you’re exposed to a virus, your body can effectively fight it. Sometimes that means taking two vaccine doses.”

Across the country and globe, there is a debate about whether it is better to get as many people as possible their first doses — even if there is uncertainty about a second dose being available at the recommended intervals — or whether to withhold second doses to ensure everyone who receives a first dose stays on schedule.

On Tuesday, U.S. Health and Human Services Secretary Alex Azar said the federal stockpile of millions of vaccines being held for the booster shots would be released. But on Friday, the Washington Post reported that stockpile had already been released in late December, and there were no remaining reserves.

“I’m shocked we were lied to, and there is no national reserve,” Colorado Gov. Jared Polis wrote on Twitter on Friday. “Federal announcements that 2nd dose being held in reserve was going to be released led us to expect 210,000 doses next week, other Govs made similar plans. Now, we find out we’ll only get 79,000 next week.”

Michael Pratt, a Health and Human Services spokesman, said states are still getting the second doses they need.

A World Health Organization advisory group said it is ideal for the two doses of Pfizer vaccine to be given three to four weeks apart, but the second dose could be delayed up to six weeks in countries “experiencing exceptional epidemiological circumstances.”

The U.S. Food and Drug Administration (FDA) does not support changing vaccination schedules at this time, saying such actions are “premature and not rooted solidly in the available evidence.”

On Friday, the South Florida Sun Sentinel reported more than 40,000 people in Florida were overdue for their second shot, and that number was growing steadily.

Cases have been reported of people getting COVID-19 and dying before they get their second dose.

At Wednesday’s Board of Health meeting, Routt County Board of Commissioners and public health officials made the point that Colorado is doing better than most states, and Routt County has a higher number of people vaccinated than the state as a whole.

Anderson said it just isn’t known at this time whether it matters if the two doses are stretched out or by how much. “It might have no effect, or it might wreck the immune response we are hoping for,” he said.

According to Malvestutto, “There’s some wiggle room in this based on clinical studies. You can go three to seven days past when you’re supposed to get the second shot. However, you really should try to get that second dose as close as possible to the recommended schedule.”

At this time, Routt County is getting enough needed for the second doses, said Routt County Chief Medical Officer Dr. Brian Harrington at Wednesday’s Board of Health meeting.

“There is some uncertainty, though,” Harrington said, adding it is not entirely clear if there is always a matching second dose supply of vaccines corresponding with shipments of first doses.

At the hospital, Nykamp said they’ve had no issues thus far with second dose supplies. He said the Centers for Disease Control and Prevention was holding the second batch in numbers mirroring the first doses, though that was in an interview Wednesday, prior to the news the federal reserves had already been depleted.

Also Wednesday, Lyon’s Corner Drugs pharmacist and owner Matt Johnson said he would be using his own system to ensure second doses, based on his experience with previous vaccine rollout programs.

If you got a first dose, there really shouldn’t be any reason not to get a second, Anderson said.

For people who had a reaction to the first shot, they may have a reaction to the second shot, and it could be worse than the first shot, he said. But a day or two of feeling under the weather is “no comparison” to getting COVID-19.

The immune response triggered by the vaccine can be hard on the body, he said.

As millions of people have now received COVID-19 vaccines across the globe, Anderson said there isn’t any mounting evidence about adverse affects. The rare cases of anaphylaxis are treatable, he added.

In the FDA report published in December on the Moderna vaccine, the most common side effects were pain at injection site (91.6% of patients), fatigue (68.5%), headache (63.0%), muscle pain (59.6%), joint pain (44.8%) and chills (43.4%).

The FDA report published on the Pfizer vaccine showed the most common reactions were injection site reactions (84.1%), fatigue (62.9%), headache (55.1%), muscle pain (38.3%), chills (31.9%), joint pain (23.6%) and fever (14.2%).

Anderson said he felt no reaction from either shot and had no hesitancy about getting the vaccine. He was considering joining the Moderna trial, but said he decided against it because he didn’t want to risk getting a placebo when he needed to be protected as soon as possible to treat his patients.

“If we are asking people to get the shot, we have to put our money where our mouth is,” Anderson said. “I am showing I believe in this and am willing to put myself on the line for it. In the end it’s not only for our protection, but for the population’s protection.”

The 95% immunity is supposed to take full effect about a week or two after the second shot, Anderson said. Even at that point, however, he said he won’t be changing any of his behaviors in terms of hand washing, social distancing and mask-wearing.

For one, it still isn’t known whether vaccinated people can be asymptomatic carriers.

The data does show being vaccinated keeps people from developing severe disease, he emphasized.

However, a vast majority of the population remains unvaccinated, and herd immunity is still a long way off.

Among his colleagues at the hospital, Anderson said with the vaccines has come “such a sense of excitement and exhilaration. For the first time in 10 months I saw hope — something that was going to get us through this. Up until then it was just endure and endure and endure. … People work so hard to treat their patients, and finally, here is something to help protect them. It’s the closest thing we have to a silver bullet.”

 


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