Plain talk on the Covid-19 vaccine

Plain talk on the Covid 19 vaccine – answers to common questions

There are a lot of questions about the Covid vaccine right now so as a registered nurse (And something of a nerd) I wanted to share the facts so we can all make healthy decisions about our vaccination status.

What is the bottom line? This is the safest and most effective vaccine we have ever seen, and as people with diabetes, our risks from Covid vastly outweigh any risks that vaccination can present so vaccination is overwhelmingly recommended.

How does the COVID-19 vaccine work?

Vaccines work by presenting our immune system with a foreign body (antigen) so it can both mount an initial immune response to fight off the invader when it arrives “for real” but it also gives our immune system the identity of the invader so it can be recognized and reacted to far more swiftly in the future. The Pfizer and Moderna vaccines currently in use in the US do this by causing a select number of our own cells to produce the spike protein on the outside of the Covid 19 viral particle. This allows our immune system to build antibodies to this vaccine to attach to it and prevent it from entering cells to replicate. It also allows our body to recognize those protein spikes to more swiftly mount a response if the virus is encountered in the future.

What makes the COVID-19 vaccine different from others we have seen before?

In the past, we could only vaccinate by presenting our bodies with either weakened (Attenuated) or parts of dead bacteria. However attenuated vaccines have been troublesome because they can not be used on some populations because they can carry a small risk of infection. And partial or dead antigen vaccines are problematic because they take a long time to produce. The new vaccines are called mRNA vaccines, they work by introducing a string of communication to our own cells (In a limited number) this communication piece tells the cell to use its normal protein-making processes (That’s how we make insulin, hormones, and other proteins in the body) to make the spike protein that is present on the Covid 19 virus. Then our immune system can mount its defensive process just like it does with other vaccinations.

The BIG difference between mRNA and DNA

(Image credit: Drug Discovery World)

Many people are concerned about this form of vaccine because it uses our own cells to create the spike protein. However, this process is very safe and short lived. When the mRNA communication piece enters the cell it can not travel into the nucleus of the cell where DNA is stored. This means that it does not alter the cell itself, only the protein produced by that cell. Then when those cells die the introduced mRNA strand is disassembled along with that cell and so the process stops.

The mRNA does not duplicate, DNA in the nucleus duplicates and then the new cells have the original mRNA sequences released and used to produce normal needed proteins again.  This means that the stimulated immune process has a very limited window of function, and does not have the ability to multiply or spread through the body.

DNA writes RNA strands, no the other way around. The introduction of new RNA strands to cells ahs been used in the pharmaceuticals and industrial manufacturing sectors for decades safely and effectively and at no time in that history of protein strand production has it caused a DNA mutation or for the original cell to alter in its structure, only in its function in a temporary fashion. When those cells replicate the introduced mRNA is gone and the induced protein production stops.

(Image credit: National Cancer Institute)

How did this new vaccine roll out so fast?

Many people don’t trust the apparent speed of this science. But again, these techniques have been widely known and in use for decades. In fact, this form of vaccination has been known for more than 30 years. What held it back from widespread use was that it was so difficult to get the mRNA introduced to last long enough to do its job. It was in and gone before the immune response was mounted. Due to the focus and intensity of international collaborative research and unprecedented funding of vaccine efforts, the solution was able to be bridged and production started on a larger scale than any other vaccine effort in history. Because the production and processing of full viral particles are not required, but simply the rapid sequencing of mRNA strands, the production of this vaccine method is far faster. (In the past the fastest development form virus sequencing to production was 4 years for mumps in the 1960s)

What are the risks of this vaccine?

Risks with these vaccines are minimal, there is absolutely no way of contracting Covid from these vaccines. What one may experience is the immune response. This is not a side effect but actually a desired effect of immunization. It can cause flu-like symptoms for a few days including aches, low-grade fever, Gi upset headaches and mild fatigue. These can be mitigated effectively with hydration, rest and over the counter medications like acetaminophen and ibuprofen.

There is a small risk of an allergic reaction, however, there is a risk of an allergic reaction to everything we put in our bodies from foods to medicines! This risk is rare, quickly recognizable and fully treatable. Vaccination practices include a 15-minute post injection waiting period to monitor for onset of allergic reactions.

Are there risks for people with diabetes?

There are no additional risks for people with diabetes. The immune response period may cause blood sugars to elevate temporarily much as one might see from getting a cold and an increase in basal insulin to offset this elevation may be needed. However risks to people with diabetes, should we contract Covid are exponentially higher than any risks from the Covid vaccine.

What’s the difference between these doses?

One major benefit of mRNA vaccines is that, since they do not include viral particles they do not need many of the preservatives and chemicals found in traditional vaccines that cause many people to avoid them (there are no formaldehyde or mercury derivatives in these vaccines) and doses are quite small.

The Pfizer vaccine is 30 micrograms, the Moderna dose is 100 micrograms

To give that some perspective there are 10 micrograms in a single unit of insulin. So the doses of these vaccines are TINY.

What are the side effects of this vaccine?

Aside from the immune response of the vaccine side effects include injection site pain/redness and allergic reaction. There is a rare side effect to ANY vaccination called Guillaume barre syndrome which is an autoimmune attack on the nervous system that can be triggered by the immune response to vaccination, but that can also be triggered by the immune response to infection itself.

What if there are supply issues and I can’t get the booster dose?

Safety and efficacy studies are underway in the EU where immunizations have been underway for about a month ahead of US efforts. There has been no indication that “mix and matching” doses present a safety risk or reduces the efficacy of the vaccines. In fact, early signs point to a possible increased efficacy with one dose of one marker and one dose of the other. However, supplies are being distributed in such a way as to already have the booster dose available at the time of the initial dose and this has not proven to be an issue in the supply chain at this time.

As a person with diabetes should I get this vaccine?

There are no additional risks for people with diabetes when it comes to ANY vaccination. In fact, there are overwhelming benefits since our risks, should we get Covid we are FAR higher than anything the vaccine has been shown to present.

After any vaccination, we can get flu-like symptoms as our body mounts an immune response. This can have a mild to moderate impact on blood sugars similar to what we’d see with a cold so using an increased temp basal for a couple of days if you experience symptoms, and you can use ibuprofen or acetaminophen to reduce those symptoms as well as keeping good hydration.

As an RN I’m getting my vaccine, as are all my family members as it becomes available. If you have a history of vaccine reactions or allergic reactions to injected medications reach out to your prescriber regarding your risks, but at this time there is not any population that is contraindicated for this vaccine. It has not been studied in pregnant women, but because the vaccine itself does not cross the placental barrier, nor is it passed in breast milk it is believed safe and effective and has gotten the support of the American College of Obstetrics and Gynecology for pregnant and lactating women to get vaccinated. In fact, while the mRNA vaccine is not passed on, the antibodies to Covid are! So new and expectant mothers can give their babies a leg up by getting vaccinated.

What about mutations in the Covid-19 virus?

All organisms evolve, and viruses evolve fastest of all. Early studies are showing that particularly the Pfizer vaccine is showing efficacy against early mutated strains of Covid 19 and that all vaccinations are showing to greatly reduce the severity of illness by the mutated strain. When it comes down to it vaccination is our best tool against these mutation forms of Covid 19. These mutations typically occur in the “Long haul” patients who have it for a long period of time and have a long period of time to transmit that mutated virus to others. It is also a more common occurrence in asymptomatic populations where the vaccine can continue to spread and evolve unchecked because the population is not aware of its presence. Vaccination means that we are going to have fewer “long haul” patients and far fewer asymptomatic patients carrying and transmitting this disease to others and allowing it to have time to mutate. It also means that when it does, the population that it encounters will have a better chance of fighting it off quicker while infecting fewer people in the process.