COVID-19 and the vaccine: FAQs

• By America Amplified and Side Effects Public Media

This story is produced by America Amplified using questions received from partners, which include WITF and StateImpact Pennsylvania, and working with partner Side Effects Public media to get answers. America Amplified, funded by the Corporation for Public Broadcasting, uses community engagement to inform and strengthen local, regional and national journalism. 

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Q: What responsibility does an employer have to all its employees when an employee tests COVID positive? Aren’t they obligated to inform everyone?

Zack Flood, associate attorney specializing in labor and employment law at Milwaukee-based Briesen & Roper: There is a patchwork of state and local guidance across the country with regards to employer responsibilities. The most important thing is the general duty under federal Occupational Health and Safety Administration laws to create and maintain a safe workplace.  The employer’s responsibility to other employees when they find out that they have a positive test is first to make sure that person is not coming into work, because that is going to create a threat.  But also communicating to the rest of the workforce that there has been a positive test,  but not disclosing the identity of that employee. The identity of the individual must be kept confidential.

Bob Simandl, chair of the Labor and Employment Group at Briesen & Roper: The employer should already have a policy that addresses what its role will be as it relates to an employee testing positive and in communicating with fellow employees about the risk and ways to remain safe. The overarching responsibility for the employer is to provide a safe workplace and to keep employees informed about those policies. The employer needs to communicate with employees where the exposure took place and how they are working with authorities to safeguard employees and families. Ultimately there has to be a post-mortem done on how the policy worked.

Q: [What are the] side effects [from the vaccines] for people with underlying health issues. Do they even know?

Dr. William Moss, Professor in the Departments of Epidemiology, International Health and Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health. He is also Executive Director of the International Vaccine Access Center: The two vaccines that we’re likely to see in use in the United States in the coming weeks are the Pfizer vaccine and the Moderna vaccines. Both of these use messenger RNA technology, a really novel vaccine platform. … There still remain many questions to be answered as we go forward. We need to know how these vaccines work in particular high-risk groups, older adults, those with underlying conditions. But also in pregnant women and children. We need to know the impact of these vaccines on transmission. … At this juncture, we’re only going to know about short-term side effects, but we need to know whether there are any potential rare, long-term side effects.  Short-term side effects that we know of now appear in about 5%  to 15% of participants. They include inflammation, soreness at the injection site, a low-grade fever, headaches, muscle aches and fatigue. These can last from 12 to 36 hours after vaccination.

Q: Is it safe for patients with autoimmune disease who take immunosuppressive medications to be vaccinated against COVID? Is it effective?

Dr. William Moss: There’s no doubt that we’re going to have to look very carefully at data on both the safety and efficacy because that too can be impaired in immunocompromised individuals. The vaccines that are typically not recommended routinely for severely immunocompromised individuals are what we call attenuated viral vaccines, where we take the natural virus and make it weaker. And this is a very old way of making vaccines. But for example, our measles, mumps, and rubella vaccines are attenuated viral vaccines. None of the front runners for COVID-19 or SARS-CoV-2 are that type of vaccine.  So I don’t anticipate problems with safety … but that will need to be studied going forward.

Q: Should organ (liver) transplant recipients who are taking anti-rejection medications (Prograf/Tacrolimus) be vaccinated for COVID-19?

Dr. William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine, Nashville, Tenn. and medical director of the National foundation for Infectious diseases: The short answer is yes. Although this population hasn’t been studied, we don’t think there is any chance of harm. It may be that the immune response is somewhat blunted, but it could do some good. The CDC advisory committee said it probably won’t hurt but it might help.

Q: Do any of the manufacturers know if their vaccine is safe for people with HIV?

Schaffner: The same answer applies to people with HIV. It probably won’t hurt, but it could help. The second vaccine in line — the Moderna vaccine — included a small study of people with HIV infection and we expect to see that data shortly. But in the meantime, if people with HIV are offered the Pfizer vaccine they should take it.

Q: I am a health care worker. I will be 62 years old next month. I have intrinsic asthma maybe twice a year. Can I/should I prep for the vaccine with just Benadryl? I have taken the influenza vaccine for the last 2 years without issue or prep.

Schaffner: No preparation is necessary for someone with asthma. That person should have the same sort of response of any 62-year-old without asthma.

Q: I am a 68-year-old snowbird that lives in Florida from November to April. However, I am a Pennsylvania resident. Will I be able to receive a vaccination in Florida when it is available for elderly people?

Schaffner: The short answer is yes. You should be able to get the vaccine in Florida when it is available. But be mindful that you have to get 2 doses separated by 3 weeks and it has to be the same vaccine (i.e. Pfizer or Moderna). It would be most advisable for you to go back to the same provider because the records there will be the clearest and there will be no confusion. If you get the first vaccine in Florida, stay there for 3 weeks to get the second vaccine there as well.

Q: I am 65 and live in a 55+ community. When do you feel I can realistically expect to be able to get the vaccine?

Schaffner: The determining factor will be your age, not your community. You’ll be in the second or third group to receive vaccine, likely by sometime this spring. We know health care providers are first, and then residents of long-term care facilities. We are waiting on advice from the CDC Advisory committee on who should go next — essential workers, or people who are 65 or older.

Q: Does your visa status affect the chances of you getting the vaccine?

Dr. Mary Anne Jackson, Dean, UMKC Medical School and a member of the National Vaccine Advisory Committee: There are no restrictions on vaccine provisions to anyone on a visa.

Q: What are the logistics for actually getting it to elderly with underlying issues?

Jackson: CVS and Walgreens will be administering vaccines in senior living facilities. For those who cannot consent, relatives who have power of attorney can do so.

Q: What is the cost if you don’t have insurance? Is there a way to donate to cover the cost for people who can’t afford it?

Jackson: There is no cost for vaccine. There is an administrative cost of up to $25 (that can be covered by medical insurance) but no one will be turned away who cannot afford this fee.

Q: Can I take the vaccine if I’m pregnant?

From Meedan’s Digital Health Lab’s learnaboutcovid19.org, a global team of public health experts: None of the three leading vaccines manufacturers (Pfizer, Moderna, and AstraZeneca) have reported data about the COVID-19 vaccine on knowingly pregnant or breastfeeding individuals. As a result, we have a limited understanding of how effective the three leading vaccines are for pregnant and breastfeeding people, and if there are risks specific to them. Before more data is available, it is best for pregnant and breastfeeding individuals to speak with their doctors about the best way to proceed. While it is unlikely that a doctor would recommend a pregnant or breastfeeding person get vaccinated before more data is available, every risk profile is different and is worth discussing with a care provider. Read more here.

Q: What’s the research on how it affects breastfeeding mothers?

Meedan’s Digital Health Lab’s learnaboutcovid19.org: None of the three leading vaccines manufacturers (Pfizer, Moderna, and AstraZeneca) has reported data … on knowingly pregnant or breastfeeding individuals. As a result, we have a limited understanding of how effective the three leading vaccines are for pregnant and breastfeeding people, and if there are risks specific to them. Before more data is available, it is best for pregnant and breastfeeding individuals to speak with their doctors about the best way to proceed. While it is unlikely that a doctor would recommend a pregnant or breastfeeding person get vaccinated before more data is available, every risk profile is different and is worth discussing with a care provider.

Q: Do I still have to wear a mask once I have the vaccine?

From NPR’s Shots: Yes. Studies of the new vaccines only measured whether vaccinated people developed symptoms, not whether they got infected. It’s possible that they got mild infections — not enough to make them ill, but enough to pass the virus on to others. The CDC is calling for those who are immunized to continue wearing masks and practicing safe physical distancing until more is learned.

Q: Does a person who has had a positive COVID-19 test need to receive the vaccine? Does a person who has tested positive for coronavirus antibodies need to receive the vaccine?

From Meedan’s Digital Health Lab’s learnaboutcovid19.org: Positive COVID-19 antibody tests and a prior COVID-19 infections do not guarantee immunity to the virus, making the COVID-19 vaccine recommended for individuals who have tested positive for the COVID-19 virus and/or for COVID-19 antibodies.

Q: EMS is supposed to be tier 1 in PA, but with hospitals getting the distributions there is no method to coordinate vaccinations for non-hospital-based EMS providers (fire, nonprofit, municipal owned). How are EMS providers who aren’t based at a hospital supposed to be vaccinated?

From Meedan’s Digital Health Lab’s learnaboutcovid19.org: The prioritization of initial COVID-19 vaccinations varies widely from location to location, with decisions being made at the federal, state, county and facility level. Emergency medical services (EMS) personnel are often included among the groups receiving the highest priority for the first shipments of the COVID-19 vaccine. Since the initial supply is not sufficient to vaccinate everyone within the highest priority groups, however, difficult decisions are being made about who is to receive the COVID-19 vaccines first. Some places are choosing to include EMS personnel outside of hospitals, such as in the fire department, in the first wave of COVID-19 vaccinations. Other places are distributing their first shipments of the COVID-19 vaccine straight to hospitals first. Read more here.

Q: There are different companies producing coronavirus vaccines. Will all of them require people to get two doses? And do they need two doses of the same vaccine? How will people avoid getting two different vaccines?

Schaffner: The two current vaccines each require two doses. Other vaccines are being studied; one of them is a single dose vaccine. You do need to have two doses of the same vaccine. Ideally you should visit the same health practitioner who will be keeping a record of who is vaccinated with what vaccine.

Q: I have had hives all over my face and body and puffy lips from shellfish. Should I take Benadryl before the COVID vaccination?

From SideEffects Public Media: If you’ve had allergic reactions to vaccines in the past, you should talk to your primary care provider about the vaccine. People who have had severe allergic reactions may need to be monitored after receiving the vaccine. Polyethylene glycol has been pointed to as what has triggered some anaphylaxis. The most common allergic reaction — especially in flu shots — are in people with egg allergies. The most common flu vaccines are developed with egg-based technology, but the FDA and CDC said common food allergies and medicines shouldn’t prevent most people from receiving the vaccine.

Q: How long are people who have tested positive for COVID-19 protected from subsequent coronavirus infections? If they are reinfected, will their disease process be milder?

From Meedan’s Digital Health Lab’s learnaboutcovid19.org: We are still learning a lot about what kind of natural defense, also known as immunity, a person has after being infected with COVID-19, and how long that immunity lasts. A a small number of people have reportedly become reinfected with virus following an initial infection and research is ongoing. Currently researchers believe that most people will be protected from reinfection for up to six months following infection. Read more here.

The vaccines show 94-95% effectiveness. What were the outcomes for the 5-6% of people for whom the vaccines were ineffective?

From William Schaffner MD, medical director of the National Foundation for Infectious Disease. In these large clinical trials, half the people got the vaccine, the other half got a placebo. Let’s say in the placebo group,100 people got sick. But in the vaccine group, only 5 got sick. That’s how we calculate the effectiveness. The 5-6% of people for whom the vaccine was ineffective contracted COVID to some degree or another.

What will be the process for administration of vaccines for phase 1B and 1c — and beyond? Will people need to request the vaccine through a primary care physician? Local health department?

From William Schaffner MD, medical director of the National Foundation for Infectious Diseases: So, 1A was vaccine distribution to health care providers on the frontlines at major medical centers, and people in long term care facilities. The second group, people 75 and older and essential workers are much harder to identify. Different states are already deviating from the CDC guidelines and distributing the vaccine differently. We hope the Moderna vaccine – which doesn’t have to be stored at super cool temperatures — will soon find its way to doctor’s officies, pharmacies and local health departments. We think towards the end of this month and through the early spring the Moderna vaccine will be out there in the community and you should be able to request an appointment or even drop in and get a vaccine.

Will children be receiving doses of the vaccine? If so, in which age groups? What is a projected timeline for the administration to children/toddlers?

From William Schaffner MD, medical director of the National Foundation for Infectious Diseases: Trials in children are now beginning and we should have results in mid-summer in terms of safety and doses appropriate for children. Children are not free of the complications of this disease, but they are much less apt to get the serious complications that we see in older adults. We are hitting populations most severely affected first and, when we get the data, we will expand the vaccine to the children. In the meantime, essential workers who should receive the vaccine soon include those who work in schools – teachers, cooks, custodians. That will provide a sigh of relief if we can get those people vaccinated and the kids back in school.

Why is Janssen starting a trial with 2 doses now? Was the effectiveness of the single dose vaccine disappointing?

From the Learn About COVID-19 Health Desk: Janssen Pharmeceuticals designed a COVID-19 vaccine candidate to be delivered in a one-dose regimen. The company also started a clinical trial for a two-dose regimen that is intended to be complementary to the ongoing clinical trial for the one-dose regimen, “erring on the side of caution in case two doses have the ‘potential to offer enhanced durability in some participants.’” Due to the urgent nature of the COVID-19 global pandemic, many phases of vaccine development and testing have been implemented in parallel. Scientists will be able to say more about the effectiveness of the one-dose and two dose regimens after more data from the parallel phase 3 trials become available.

What happened to the miracle pill EIDD2801? This is intended to cure Covid-19 and it is no longer discussed in the media.

From the Learn About COVID-19 Health Desk: EIDD-2801, also called Molnupiravir, is an oral antiviral drug that was developed by the Emory Institute for Drug Development (EIDD). It was originally developed to treat influenza. It is in Phase II/III of its clinical trials as a treatment for SARS-CoV-2 infection. Similar in function to Remdesivir, EIDD-2801 targets the enzymes in the COVID-19 virus and replaces them with another compound. This switching creates mutations in the virus that make it incapable of functioning. The nonprofit biotechnology company owned by Emory University, Drug Innovation Ventures at Emory (DRIVE) partnered with a biotechnology company in Miami, Ridgeback Biotherapeutics to start the clinical trials for this treatment. Ridgeback has partnered with Merck & Co. to develop and distribute EIDD-2801.

What cell types in the body take up the mRNA after it is injected? What do we know about how an mRNA vaccine interacts with human cells?

From the Learn About COVID-19 Health Desk: The human body has lots of different types of cells, and they serve many different purposes. MRNA vaccines like Pfizer and Moderna’s vaccines interact with multiple types of cells once they enter the human body, including immune cells, which are the cells that launch a response to the virus and help us build immunity to COVID-19. Additionally, “T-follicular helper cells” (T cells) are a type of immune cell that is activated by the mRNA vaccine. “Germinal center B cell responses” (GC B cells) are also activated by the mRNA vaccine. mRNA vaccines also interact with dendritic cells. Dendritic cells help our bodies with transporting foreign invaders, like a virus or a vaccine, to the body’s immune-boosting T cells, so that we can build up immunity to that foreign invader. Lastly, the mRNA vaccines also interact with cells in our muscles when the vaccine is injected.

How will I know when and where the vaccine is available for me?

This question came from a Pennsylvania resident. In Pennsylvania, there is a phased rollout plan dependent on the number of vaccines available and type of population. You can find a detailed document here. You can also call the PA Health Hotline at 1-877-724-3258 for more information or visit this site. In other states, it is best to start by checking with your local health department.

After quarantining 14 days due to testing positive for covid 19 my employer will not allow me to return to work unless I retest and it comes back negative. Is this legal?

There is no national regulation when it comes to employers taking COVID-19 precautions. Some states may have their own rules on testing employees before they return to work. The CDC recommends businesses work with local health department officials on COVID-19 precautions. You can find more here.

I am a healthy 77 year old man. If I get the vaccine, do I have to keep away from my 50 year old son, who received a kidney transplant over 20 years ago?

From Beverly E. Sha, MD, of Rush University Medical Center’s Division of Infectious Diseases: None of the COVID-19 vaccines contain any live virus and thus recipients pose no risk to their contacts by receiving these vaccines.

What is the wait time after you get a PREVNAR13 vaccine before you can get Covid vaccine?

From Beverly E. Sha, MD, of Rush University Medical Center’s Division of Infectious Diseases: Many clinical trials delayed vaccinations other than the flu shot for 30 days before or after a COVID-19 vaccine. This is to make it easier to assess side effects of the COVID-19 vaccine and was not due to concerns about safety or efficacy. In general inactivated vaccines, which Prevnar13 and the COVID-19 vaccines are, can be given at any time interval to each other, but it may be prudent to separate the doses by several weeks.

My husband is 83 and I am 87. We both have chronic obstructive pulmonary disease (COPD) and I have contrast dye reaction. Should I take benadryl before getting the vaccine?

From Beverly E. Sha, MD, of Rush University Medical Center’s Division of Infectious Diseases: Per CDC, “all people who get a COVID-19 vaccine should be monitored on site. People who have had severe allergic reactions or who have had any type of immediate allergic reaction to a vaccine or injectable therapy should be monitored for at least 30 minutes after getting the vaccine. All other people should be monitored for at least 15 minutes after getting the vaccine.” The benefit of pre-medicating with anti-histamines is unclear. Benadryl or cetirizine/loratidine/fexofenadine, which are all over the counter anti-histamines, should not interfere with the response to the vaccine. We would not expect there to be cross-allergenicity between contrast dye and either the Pfizer or Moderna vaccines so pre-medicating is likely unnecessary.

Did the Pfizer vaccine trial capture all of the potentially asymptomatic patients with Covid 19?

From the Learn About COVID-19 Health Desk: Clinical trial researchers have standard definitions for routinely detecting COVID-19 cases for both symptomatic and asymptomatic individuals. COVID-19 cases are recognized by the presence of one or more symptoms and a positive test; asymptomatic individuals are tested for COVID-19 antibodies. A positive asymptomatic case is defined as the presence of antibodies in an individual who had a prior negative test.

I tested positive for COVID between my first and second vaccine doses. I’m asymptomatic. Can I still get the second dose?

From the Learn About COVID-19 Health Desk: The CDC does recommend that people who have had COVID-19 still get vaccinated. However, this recommendation typically applies to people who have recovered from COVID-19, rather than people who are still sick. For people who currently have an active COVID-19 infection, health experts recommend waiting until after recovery for vaccination.