You Need To Know This Before Getting The COVID-19 Vaccine
Board certified Allergist and Immunologist, Dr. Renuka Basavaraju, explains everything you need to know before getting the COVID-19 mRNA vaccine: from deciding if you are eligible for the vaccination to precautions you should take based on your medical history. There is a lot of information (some credible, some not) circulating about the vaccine. This episode condenses the research-based facts on the vaccine in a way that does not require a science degree.
Sources:
Learn about our guest here!
Episode Transcript
Anita Kirti (00:00):
Hey, you all. I'm here with my mom who is also a holder of many “-ists” Would you like to introduce yourself?
Dr. Renuka Basavaraju (00:07):
Hi, I'm Dr. Renuka Basavaraju. I'm an allergist, immunologist and rheumatologist. The logist, not ist, I need to correct Anita on this.
Anita Kirti (00:18):
Okay. And this is going to be fun. We're here to talk about the COVID-19 vaccine and everything you need to know, from who should be getting it, who should not be, and basically a walkthrough from deciding whether or not to get it all the way to the side effects at the end.
Anita Kirti (00:35):
So, yeah, we're excited to have you. Do you have anything else to add before we get started?
Dr. Renuka Basavaraju (00:39):
Well, since COVID-19... and this will sell through a spike protein, spike me with questions.
Anita Kirti (00:45):
Oh my God. No, we are not doing this. Okay. We're going to get started. This is The World We Inherit, and I'm your host, Anita Kirti.
Anita Kirti (01:04):
Okay. So first things first, can you explain to us what a vaccine even is?
Dr. Renuka Basavaraju (01:10):
So vaccines contain the same bacteria or viruses that cause the disease, but they're usually either killed or inactivated, or made weakened so that they don't cause the disease. So the purpose of doing this, is you're not actually exposed to the organism, but you actually activate the immune system and make antibodies.
Anita Kirti (01:29):
Wait, what are antibodies?
Dr. Renuka Basavaraju (01:31):
So antibodies are protective to the human. Once you're exposed to the virus or bacteria, your immune system gets activated and develops antibodies so that you get protection to them. The usual, normal ways you experience the bacteria or virus, or you get infected with it and get antibodies, that's called natural immunity. So you actually have to get sick and get natural immunity.
Anita Kirti (01:54):
Which... you have the possibility of also dying though.
Dr. Renuka Basavaraju (01:58):
Yes, if it is a dangerous virus, you actually succumb to it. But in a vaccine, it's actually kind of a primary prevention. So you don't succumb to the virus, but you get protected.
Anita Kirti (02:10):
Okay, so just to put this in really simple terms, a vaccine is like a training exercise. So the body sees what the virus or bacteria looks like, remembers it, practices how it would fight that bacteria or virus. So when it actually sees the virus and bacteria, when it really infects your body, the immune system looks at it and goes, "Oh, I know what that is. And I know exactly what to do." The vaccine is kind of like the body's way to learn how to fight the battle without the stakes of getting COVID-19 and experiencing the actual disease.
Dr. Renuka Basavaraju (02:46):
Correct.
Anita Kirti (02:47):
So I understand that there are different types of vaccines. You kind of alluded to that when you were talking about attenuated vaccines. What kind of vaccine is the COVID-19 vaccine?
Dr. Renuka Basavaraju (02:58):
So the COVID-19 vaccine is an mRNA vaccine. The M stands for messenger and RNA stands for ribonucleic acid. The important thing to remember, is twofold. One, both the mRNA vaccines which are now available in the market, both the Pfizer and the Moderna, they are actually the mRNA proteins for the spike protein.
Dr. Renuka Basavaraju (03:23):
The importance of spike protein, is it's responsible for recognition of the cell. So that's how the COVID-19 attaches and enters into the cell. So that's the most important piece of the COVID-19 virus. That's the reason they picked that portion of the viral protein to make the vaccine. So they picked that portion, and actually found the sequence of that to make the mRNA. So once it enters into the cell, you translate that information, and then your immune cells will recognize that and create antibodies.
Anita Kirti (03:56):
Okay. So you said a lot of big scientific words. And for those of us who have not taken microbiology, or like me who has forgotten everything about it, you are saying that what's being injected in people in the COVID-19 vaccine from Pfizer and Moderna, is the genetic code for a small piece of the virus, correct?
Dr. Renuka Basavaraju (04:16):
Correct.
Anita Kirti (04:17):
So there's no way that an entire virus can be made out of this piece of genetic material?
Dr. Renuka Basavaraju (04:24):
Correct.
Anita Kirti (04:25):
Essentially, to break this down really simply, the genetic material is injected into our body. Our cells take that, reads the code out, makes the protein for itself and looks at it and shows the rest of the immune system. Hey guys, this is what we're looking for.
Dr. Renuka Basavaraju (04:43):
Correct. So basically, to give you a good analogy, if I told you the letters, ABC stands for the word spike. So instead of sending you the whole structure called spike, I just send you three letters called ABC.
Anita Kirti (04:59):
And our body knows what that means.
Dr. Renuka Basavaraju (05:01):
Yeah, and your body, your cell knows. Okay, because it likes less space, it's smart enough to know what that ABC is and immediately makes all the proteins for the whole spike.
Anita Kirti (05:11):
If I get injected with the COVID-19 vaccine. Would I test positive for COVID-19 after getting the vaccine?
Dr. Renuka Basavaraju (05:18):
No.
Anita Kirti (05:19):
So we went through the basics of mRNA vaccines. If you're still a little confused about it, the best way I explain it to my friends is if you and the virus were playing a game of battleship, you're giving the positions of all the battleships on the virus's side to your immune system, to say, "Hey, this is their game. This is how you fight it." So in real time, when you actually get infected, your body already knows, "I know what that is. I know how to fight it. And all my soldiers or antibodies are ready to go."
Dr. Renuka Basavaraju (05:49):
That's a good way to put it.
Anita Kirti (05:50):
Okay.
Dr. Renuka Basavaraju (05:51):
So this is not necessarily a very new technique, but it's a great technique. This has been studied for the past 10 years. We have studied while trying to get a vaccine for Zika virus. It's studied a lot in tumor biology. It's great that we have introduced that for COVID-19 vaccine. The advantage of using mRNA vaccines are you can create a large amount of vaccine in less time.
Anita Kirti (06:16):
I'm glad you actually said that, because this is not just new technology that we just found off the cuff in the past nine months and are just running with it.
Dr. Renuka Basavaraju (06:26):
No.
Anita Kirti (06:26):
Perfect. So now that you kind of know the scientific part, and you feel more confident with how this is going to work, I want to do a walk-through of what it feels like to go get the vaccine, all the steps, basically everything you need to know before you get vaccinated.
Anita Kirti (06:47):
Okay, so first things first. I'm going to leave a link in the description of the fact sheet that's been made for patients for both the Pfizer and Moderna vaccine. And I recommend you review that, and that be kind of your first step prior to going ahead and getting the vaccine. It has everything you need to know on there, and is a really good resource.
Anita Kirti (07:06):
So I'm not going to get into the logistics of how exactly to set up appointments and how to get the vaccine, because honestly it is different for every single place that's giving out vaccines. I can't give out instructions on how to really do that. So we're going to skip that part and just assume that you've gotten an appointment. you're ready to go.
Anita Kirti (07:26):
Okay, so to get us started with this, before you even decide to get the vaccine, there are two things you need to consider as to whether or not you should be getting the vaccine. A, your history of allergies and B, your current medical conditions. So the CDC has split who should get the vaccine and who shouldn't, into three different sections.
Anita Kirti (07:47):
So those who absolutely should not be getting the vaccination, are people who have had severe allergic reactions or anaphylaxis to a previous dose of the mRNA COVID-19 vaccination or any of its components. You can look up on the CDC website, the exact composition of the mRNA vaccine. If you've ever had any kind of severe allergic reaction to those, you absolutely should not be getting the vaccination. So what exactly is anaphylaxis?
Dr. Renuka Basavaraju (08:18):
So anaphylaxis tongue, lip swelling, trouble breathing, chest tightness, sometimes abdominal pain. And that's where we really have to give them an epinephrine to improve the symptoms. So the entire immune system rejects the drug or the inactive ingredient. That's been called as anaphylaxis.
Anita Kirti (08:37):
And I don't want to scare people about this. So I do want to stress that this does not happen frequently.
Dr. Renuka Basavaraju (08:43):
Correct.
Anita Kirti (08:44):
According to the FDA report for Pfizer, in the trial itself, there were no anaphylactic reactions, but after being released, there were a few cases of anaphylactic reactions. But anaphylaxis is manageable. Is that correct?
Dr. Renuka Basavaraju (08:59):
Yes.
Anita Kirti (09:00):
The second group of people that the CDC has lined out, were the precaution to vaccination people. They define this group as anyone with a history of any immediate allergic reaction to vaccines or injectable therapies. When they mean precaution to vaccination, what are the precautions?
Dr. Renuka Basavaraju (09:18):
So they should be observed for 30 minutes after they come for the first shot. They should have a thorough questionnaire ahead of time, whether they previously had anaphylactic reactions, such as tongue, lip swelling, rash, ever had passing out spells, or they ever had to use an epinephrine for any other reason. And what were those circumstances. Such kind of history has to be taken. It's better to have a questionnaire at vaccination sites when they check in, so that the vaccinator will have the information upfront, so that there are no surprises.
Anita Kirti (09:49):
Let's say that there isn't a questionnaire at whatever place someone's getting the COVID-19 vaccine, but they have had a history of an anaphylactic reaction with an injectable therapy or vaccine. Would you recommend that they just see an allergist, immunologist ahead of time, or-
Dr. Renuka Basavaraju (10:06):
I would prefer they consult with their allergist and take their instructions, such as carry an EpiPen with them, and get more instructions such as watch them more closely after the vaccination, for longer periods of time than the routine 15-minute monitoring.
Anita Kirti (10:20):
Okay. And the last section is people who can proceed with vaccination normally, "had a history of allergies that are unrelated to components of mRNA COVID-19 vaccine, other vaccines, injectable therapy, or polysorbate." So things like allergies to oral medications or foods, pets, insects, basically anyone else on the allergy spectrum has been given the green light to get the vaccination.
Anita Kirti (10:47):
And the second part of triage, is the people with different conditions. There have been no conditions that have been identified that make people fall under the contraindication. And I think the conditions that have been worried about, are people with immuno-compromising conditions, pregnancy, or women who are breastfeeding. And largely the CDC has just threw out a blanket statement of, "Ask your doctor," or, "Refer to your doctor." You're a doctor. What are you telling your patients?
Dr. Renuka Basavaraju (11:16):
So the people who have autoimmune disease and immunosuppressive conditions obviously were not part of either of the trials. But technically speaking, all of them should be getting the vaccine so that they're protected against COVID-19. Sometimes there is a question whether you activate the immune system by giving the vaccine. So is that harmful to somebody who's... autoimmune disease? So this has been a big question in the immunology world for a long time. This is not a new question which COVID 19 vaccine has come up with. This has been a question when we were using influenza vaccine or any other vaccines, when we treat our patients with lupus and other autoimmune diseases.
Dr. Renuka Basavaraju (11:56):
But over time we have established that when the diseases are not very active, when we're treating them, it's better to vaccinate them against disease than not treat them, because we need to protect them against bacterial and viral infections. The only question is whether they'll form enough antibodies when we're treating them with immunosuppressive drugs. They may not form enough on the bodies, but we need some protection rather than no protection.
Anita Kirti (12:22):
Okay, that's for the immunocompromised patients. How about for women who are pregnant?
Dr. Renuka Basavaraju (12:27):
Again, the same thing applies. We did not have pregnant women in the trials. So we don't have data for it. Since we don't have data, we can't say, "Is it safe for pregnant women?" So I think after some more post-marketing experience, we can safely say yes, pregnant women can take it. We don't have data for that yet. And breastfeeding, there is an organization called MotherToBaby.org. They can always ask a query on that website about what is the status of COVID-19 vaccine with breastfeeding women.
Anita Kirti (12:57):
Okay. Now that we cleared up those two big things, the allergies and conditions that either exclude or include you into the group of people that should be vaccinated. Again, I'm going to stress, the number of people that should not be getting the vaccine is very few, but please, please refer to the CDC guidelines that I will be posting on my website about whether or not that includes you or not.
Anita Kirti (13:20):
So where are we? We decide we want to get the vaccine. And now it's a question of which vaccine. Is there a difference between getting the Moderna or Pfizer vaccine.
Dr. Renuka Basavaraju (13:32):
There's no head-to-head comparison between the two vaccines.
Anita Kirti (13:35):
So whichever vaccine that you can get first, is the one you should go with.
Dr. Renuka Basavaraju (13:39):
Yes.
Anita Kirti (13:40):
Okay, cool. So you make your appointment, you get there, they inject you with the vaccine. And this is an intramuscular injection?
Dr. Renuka Basavaraju (13:49):
It's an intramuscular injection, it's given in your right or left arm, into your deltoid.
Anita Kirti (13:54):
Like a flu vaccine.
Dr. Renuka Basavaraju (13:56):
Mm-hmm (affirmative).
Anita Kirti (13:56):
Okay. And right after, you're given a vaccine card, which will have the date when you should get your second dose and which vaccine you got. Now, you're being observed for 15 minutes, if you are in the category of people that get vaccinated without extra precautions that we had discussed previously. Afterwards, you go home.
Anita Kirti (14:18):
And for those of you who don't know, that there is a patient reporting site where you can report any adverse reactions that you have. It's called V-safe. Again, I'm going to put that in the resources on my website that you can look through. Basically what V-safe does, is it allows CDC to monitor more people who have gotten the vaccine and a place for you to report any adverse reactions. The link, by the way, is www.cdc.gov/vsafe.
Anita Kirti (14:46):
So anyway, post vaccine, you have your V-safe link ready to go if you want to report anything. What are the side effects like?
Dr. Renuka Basavaraju (14:55):
So some people may experience arm pain, local swelling, or redness, or the injection site. Sometimes low-grade fever, aching in the muscles, joints. Sometimes symptoms lasting almost for three to four days, but nothing more than that.
Anita Kirti (15:11):
Yeah. I wanted to read from the FDA report for the Pfizer vaccine. Of the 10,841 people that got the Pfizer vaccine, 84.1% had pain at the injection site, 62.9% had fatigue, 55.1% had headache, 38.3% had muscle pain, 31.9% had chills. There are a few other side effects that were mentioned, but pretty manageable side effects.
Anita Kirti (15:38):
And for Moderna, most of the symptoms were mild to moderate. And the most common ones were pain at the injection site at 91.6%, fatigue at 68.5%, headache at 63% and muscle pain at 59.6%. There are other side effects as well.
Anita Kirti (15:55):
Again, I'm going to put all of this stuff into resources, so you can look through that. But those are kind of the breakdown of some mild to moderate symptoms you'd have after getting the vaccine. Do you have any recommendations as to what you can take or how to deal with them?
Dr. Renuka Basavaraju (16:12):
I typically advise my patients to take two Extra Strength Tylenols before they go get their vaccine, and actually stay on two Tylenols every eight hours in the first 24 hours, whether they have any complaints or not. Probably that's the best bet so they can wade through the post-vaccination days without any complaints.
Anita Kirti (16:32):
Okay. So now that you have gotten vaccinated, you got through the few side effects, am I now free to go to the club?
Dr. Renuka Basavaraju (16:41):
You don't get a passport to go to the club just because you got two doses of vaccine. You still have to follow precautions of wearing a mask, avoiding crowds. The purpose of vaccination is to prevent serious infection, please remember that. You're still at risk of getting some infection, you're still at risk of getting asymptomatic infection and transmitting virus, to some extent, to sick people. The purpose of doing all this is to provide herd immunity. You can't just-
Anita Kirti (17:09):
Go back to normal.
Dr. Renuka Basavaraju (17:10):
... can't go.
Anita Kirti (17:11):
And how long does it take to actually develop immunity? Is it like right after you get it? Is it a day after?
Dr. Renuka Basavaraju (17:17):
The onset of antibody formation is at least up to two weeks after the second vaccine.
Anita Kirti (17:23):
And I believe the Moderna vaccine, you wait for about 28 days between the two vaccines, and for Pfizer, you have to wait three weeks?
Dr. Renuka Basavaraju (17:33):
Yes.
Anita Kirti (17:33):
So it's the first dose, three weeks or 28 days in between, the second dose, and then two weeks, and then you have approximately 95% immunity.
Dr. Renuka Basavaraju (17:44):
Correct.
Anita Kirti (17:45):
Okay, so is there anything else you would like people to know about the COVID vaccine or questions that people ask you?
Dr. Renuka Basavaraju (17:51):
So I do get questions from my patients. "What about getting other vaccines along with COVID-19 vaccine? My doctor tells me to get a shingles vaccine. Can I get both on the same day, or is there a gap I should have between the two vaccines?" So the current recommendation is to have a two week gap between any other vaccine and COVID-19 vaccine. If your doctor says, "Get a shingles vaccine," or if you're too late for your influenza vaccine, or you were recommended pneumonia vaccine or some other vaccine, for some other reason, there should be a two-week gap between the COVID-19 vaccine and your other vaccine.
Dr. Renuka Basavaraju (18:27):
The other question I often get pretty much in the clinic, is "Will the COVID-19 vaccine cause genetic alteration inside me? Will I get DNA mutations?" Especially I get this from young people. "If I get pregnant, will I get any problem with my babies in future?" So this is very, very important for everybody to remember, that this little piece of RNA information, which is getting into your cell and the lymph node, is not getting into anybody's DNA and altering their DNA at all. Probably that should be written in big capital letters, somewhere on a package insert. First time I got my COVID-19 vaccine.
Dr. Renuka Basavaraju (19:04):
Including some healthcare workers who asked me, "Doc, we are going to grow a third limb." And I really looked at them and I thought, "Are they joking?" But they had some kind of understanding that because this is genetic material, it's going and getting incorporated into our DNA. So this is genetic material for the RNA, which is coding for the spike protein. It's a piece of genetic material off the RNA, coding the spike protein, gets translated into the spike protein outside of the DNA in our cell, okay?
Anita Kirti (19:37):
That's a lot.
Dr. Renuka Basavaraju (19:37):
So if somebody gets that very clearly, then they won't be under this impression, "Well, I'm going to get a genetic mutation and end up getting cancer."
Anita Kirti (19:46):
Thank you for being on the show.
Dr. Renuka Basavaraju (19:47):
Thank you, Anita.
Anita Kirti (19:49):
Okay, that was like so fake. Anyway, if you have any questions again, we recommend that you talk to your doctor, I'm going to make sure to leave all of the information that was talked about in this episode. Again, this was all sourced from the CDC and the FDA. So no need to fear about me pulling information from Reddit threads. Yeah, that's that. Thank you for listening. This is The World We Inherit, and I'm your host, Anita Kirti.
Works Cited
Federal Drug Administration. “Emergency Use Authorization (EUA) Of The Pzer-Biontech COVID-19 Vaccine To Prevent Coronavirus Disease 2019 (COVID-19).” Federal Drug Administration, Jan. 2021.
“Interim Clinical Considerations for Use of Pfizer-BioNTech COVID-19 Vaccine.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 21 Jan. 2021, www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html.
“V-Safe After Vaccination Health Checker.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 21 Jan. 2021, www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/vsafe.html.
Vaccines and Related Biological Products Advisory Committee. “Vaccines and Related Biological Products Advisory Committee Meeting Presentation.” Federal Drug Administration, 17 Dec. 2020. Moderna
“What to Expect after Getting a COVID-19 Vaccine.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Jan. 2021, www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html.