- Dear Dr. Nassar, Why is the COVID-19 Pandemic not over yet in the US?
I think the most important factor is that a high percentage of adults refused the vaccine. Other factors were (1) transmission by children and adolescents, at a time when vaccination of their age groups had not been approved yet, and is still low, (2) emergence of the “Delta Variant” with higher infectivity rates, thereby raising the threshold to reach “Herd Immunity”, (3) premature relaxation of public health measures such as “Masking” and social distancing, and (4) failure of the vaccines to induce immunity in individuals with compromised immune system.
- Why in your opinion are many individuals concerned about getting vaccinated?
These are the main reasons: (1) personal beliefs and convictions that are not founded in evidence-based science, (2) misinformation, rumors, and conspiracy theories disseminated by “Social Media” and “News Networks”, and (3) rare side effects of vaccination that sparked disproportionate fears.
- Dr. Nassar, please elaborate on vaccine side effects?
Let me categorize the side effects into 3 categories:
The first category is the common occurrence of fever, malaise, muscle pains, and chills that happen in the first 12-36 hrs after vaccination. These reactions are benign and self-limiting.
The second category are allergic reactions (anaphylaxis). These are very rare but serious and occur mostly within 15-30 min after vaccination. A 15 min of observation at vaccination sites has been common practice to promptly attend to such reactions.
The third category includes unexpected serious adverse events (SAEs) such as cardiac, vascular, or neurologic reactions. These are extremely rare and would need prompt medical attention.
- Dr. Nassar, speaking of SAEs, Lebanon times was told that individuals with the condition “Guillain Barre Syndrome” (GBS) are declined from COVID-19 vaccination. Is this correct and why?
GBS is serious and is an attack by the immune system on the nerves. Its early symptoms are numbness and tingling in the hands and feet but progresses to paralytic disease over 1-4 weeks. It requires prompt medical attention and hospitalization. Most people eventually recover from it with proper medical support. It is usually triggered by a viral or bacterial infection including COVID-19 infection. Since vaccines stimulate the immune system, it is feared that they could theoretically trigger antibodies that cause recurrence of GBS. Of note is that GBS has been reported as a rare side effect of the J & J vaccine. The risk of GBS from the J & J vaccine to be about 6 per 100,000 persons.
- What about the risk of another SAE, namely, Post vaccination “Myocarditis”?
Myocarditis refers to inflammation of the heart muscle. Myocarditis is a dangerous condition that can lead to heart failure and chest pain. It is usually triggered by inflammatory disorders or viral infections including COVID-19 infection. There have been rare instances of these conditions following the second dose of the Pfizer-BioNTech vaccine. Several recent reports estimated that myocarditis at about 4-6 cases per 100,000 vaccinations and has mostly occurred in young men. The good news is that it is treatable and reversible with proper medical care.
- Dr. Nassar, what about vascular clot formation which was reported as a side effect of the J & J vaccine and initially led to halting of the J & J vaccination for 2 weeks in April 2021?
Clot formation inside the blood vessels is dangerous and induces heart attacks, strokes, pulmonary emboli, and gangrene, and kills about 100,000 people annually in the U.S. Such clots typically occur in individuals who are bedridden, hospitalized, or are suffering from cancer, inflammatory or infections including COVID-19. In fact, about 20% of hospitalized patients in the ICU with COVID-19 suffer from clot formation. Rare cases of clot formation following the J & J vaccine in the U.S. were picked up in March-April 2021 by the Vaccine Adverse Events Reporting System (VAERS). By May 2021, a total of 28 cases out of 9 million doses were detected, with predilection to younger adult females. The clots were strange because they involved the cavernous sinus (vascular structure inside the brain) and were associated with low platelet counts. Hematologists were initially puzzled by such cases, but quickly learned their mechanism and found ways to treat them.
- Dr Nassar, should people be afraid that the vaccine would alter their genes or make them sterile?
There concerns are totally unfounded and there is no such evidence for either claim.
- Dr. Nassar, given the potential for side effects, how strongly do you advise people to get vaccinated against COVID-19?
I continue to strongly advise vaccination for several reasons: (1) COVID-19 carries a mortality risk that increases with advancing age, (2) COVID-19 carries a high risk of serious illness, hospitalization, and long-term complications, (3) COVID-19 is a public health Pandemic, and every individual has responsibility to be part of the solution, and (4) serious side effects of COVID-19 vaccinations are extremely rare and treatable.
- Dr. Nassar, do you believe that the Vaccines are losing their effectiveness after 6 months?
The titers of the anti-spike IgG antibodies are declining after 6-9 months of vaccination. It is not clear to what extent the memory B cells and T cells could make up for it by mounting a rise in the IgG antibodies when challenged by the SARS-CoV-2 coronavirus. Due to concerns about declining immunity, the FDA/CDC approved a booster vaccine injection for the elderly, the immunosuppressed, and health care professionals.
- Are the COVID boosters safe and effective?
The Pfizer-BioNTech booster is both safe and effective and has received FDA emergency use authorization (EUA) on September 22, 2021. Similar data by Moderna and J & J were presented to the FDA this week (mid-October 2021), received initial endorsement, and are expected to get EUA for their booster shots.
- How soon after initial vaccination should one get the booster shot?
It has been recommended to get the booster injection at about 6-9 months from the initial vaccination.
- Can one mix and match Vaccines?
In general, it is better not to mix vaccines, but the FDA has allowed it for COVID-19 vaccines. The Pfizer booster vaccine has been safely given after the Moderna and after the J & J vaccine with good results.
- If someone got COVID-19, and recovered, should they still get vaccinated?
The answer is yes. In general, the risk of new COVID-19 infection is low after recovery from previous infection, but such risk increases over time. Vaccination is safe after previous infection, and it is best to be taken after 4 weeks of recovery from previous infection.
- Can one get a COVID booster and flu shot on the same day?
Yes, this is acceptable and has been frequently done.
- Dr. Nassar, what should people do if they were vaccinated outside the US?
If the vaccine brand happens to be approved or authorized by the FDA, then it is considered proper vaccination by the U.S. If not, then a US authorized or approved vaccine should be taken.