People who get vaccinated may still spread the virus — and other things to know about COVID-19

Dr. Michele Carbone, of the University of Hawaii Cancer Center and Department of Pathology, and an international team of colleagues recently wrote an article — a kind of state-of-the-research summary — for the “Journal of Thoracic Oncology” that provides reliable, easy to understand information about COVID-19 that is both important and not readily ascertainable in the circus atmosphere of our news media.

Here are some highlights:

First the correct terminology: The name of the novel coronavirus is “SARS-CoV-2,” and it causes a disease called “COVID-19” in approximately 30 percent of the people who are infected.

Masks and social distancing help prevent infection, but the only way to be sure that you won’t get the virus is to stay home and not have visitors. It’s that simple.

But this would require us to sacrifice our normal living routines, such as spending time with friends and family, going to restaurants and shopping centers, doing our jobs in a social setting with colleagues — the things that define our lives.

Is it worth it? How to manage the risk?

Infections occur almost exclusively in enclosed environments

The virus floats in the air as aerosol. Open the windows and the risk of infection drops drastically, according to Carbone and his colleagues.

The more crowded the environment, the higher the risk of infection — for example, the risk is very high in a crowded, air-conditioned bus with closed windows. However, the crowded environment of a modern airplane is comparatively safer, they say — because the air in the cabin is filtered and it is exchanged entirely with outside air every 2 to 3 minutes.

Because we congregate inside with closed windows during cold winter months, the risk of infection is higher and more likely then.

Unintended consequences

We currently are diverting our attention and resources to trying to contain SARS-CoV-2 infections, which in turn is reducing efforts to prevent and treat cancer and other critical diseases. This could cost many lives.

Carbone and his colleagues note that the National Cancer Institute (NCI) estimated that this could be responsible for approximately 10,000 additional colon and breast cancer deaths because early cancer screening for those diseases has largely been suspended.

Moreover, NCI’s estimate did not consider other cancer types, and it assumed that all would revert to normal by January 2021 — which didn’t happen. The actual number of collateral deaths may be much higher.

Misleading statistics

According to Carbone and his colleagues, approximately 70 percent of SARS-CoV-2 infections are asymptomatic — but testing largely targets people who have symptoms; consequently, we are underestimating the magnitude of infections.

We also are overestimating the deaths caused by COVID-19, they say. Anyone who dies who has tested positive for COVID-19 is counted as a victim of the virus. We do not determine whether the virus was the main cause of death.

Three in four seriously ill patients are men, and most fatalities occur in older individuals with pre-existing conditions. COVID-19 deaths in those younger than 40 with no pre-existing conditions are very rare.

Vaccines

Three vaccines recently have become available.

Astra-Zeneca produced the “Oxford” vaccine, which currently is distributed only in the UK.

Pfizer and Moderna have each produced an RNA vaccine. These vaccines are available in the U.S. and Europe. RNA vaccines use new technology that has not been applied to mass vaccinations previously.

Antibodies are the proteins produced by the immune system that protect us from infection. Approximately 95 percent of the vaccinated subjects have developed IgG-antibodies which should protect them from the virus.

But these vaccines have been tested mainly on healthy adults younger than 60. The few older individuals who have received the vaccines produced fewer IgG-antibodies.

The vaccines haven’t been tested on children.

These vaccines will not stop the spread of COVID-19

IgG antibodies circulate in our blood and protect us from a systemic infection, i.e., from viruses spreading inside our body and making us sick.

A different kind of antibody, called, “IgA,” protects the body’s mucosal surfaces, such as the nose, pharynx, and intestine.

So far, no clinical trials are being performed on vaccines that produce IgA antibodies. The vaccines being tested only produce IgG antibodies.

This means that the SARS-CoV-2 virus can still infect the mucosal surfaces of vaccinated individuals.

This should not be a problem for people who are vaccinated. The IgG antibodies from their vaccinations should stop the virus from spreading inside their bodies, but virus that grows on the mucosal surfaces in their bodies can spread to other people.

However, people who are infected produce both IgA and IgG antibodies, so once they have recovered from the infection, they are “safe.” Re-infections are extremely uncommon.

When more than 60 percent of the population have antibodies that protect them from the virus, viral spread will decrease because the virus will not be able to find susceptible targets easily. This is called “herd immunity.”

No one knows how long herd immunity will last, but for SARS, which is caused by a closely related virus, it lasts several years.

Children

The main — or only — reason to vaccinate children is to protect adults, according to Carbone and his colleagues. Children — except those with some serious diseases or genetic conditions — generally do not get sick with COVID-19.

COVID-19 vaccinations cause pain, fever and headaches that last a few days in most adult recipients. We don’t know what the side effects would be in children.

Will people vaccinate their kids knowing these things?

When will it end?

The fact that the vaccines currently being tested will not produce IgA-antibodies would not be a big problem if everybody were to be vaccinated, but that isn’t likely to happen.

Therefore, these vaccines alone will not get rid of the virus in the immediate future.

SARS-CoV-2 is spreading rapidly. Ten to 20 percent of the tests globally turn out to be positive. 

Therefore, according to Carbone and his colleagues, a combination of vaccinations and infections should produce herd immunity soon, possibly by June, when COVID-19 will decrease and — hopefully — almost disappear soon after.

Meanwhile, more effective treatments are being developed; thus, the death rate from COVID-19 should decrease in coming months.

Nolan Rappaport was detailed to the House Judiciary Committee as an executive branch immigration law expert for three years. He subsequently served as an immigration counsel for the Subcommittee on Immigration, Border Security and Claims for four years. Prior to working on the Judiciary Committee, he wrote decisions for the Board of Immigration Appeals for 20 years. Follow his blog at https://nolanrappaport.blogspot.com.