A year to the day after the Delaware Division of Public Health (DPH) recorded its first case of COVID-19—on March 11, 2020—the state toll stood at 89,911 infections and 1,496 deaths. For now, there is an inkling of hope, thanks to the availability of multiple effective vaccines.
At press time, the U.S. had authorized three COVID-19 vaccines for emergency use, including two-dose messenger RNA (mRNA) shots from both Pfizer/BioNTech and Moderna, and a single-dose viral vector shot from Johnson & Johnson/Janssen, with others in various stages of testing. Delawareans age 16 and older were eligible for vaccination as of April 6.
Despite these enormous gains, our state health experts warn that we must remain vigilant about mask-wearing, hand-washing and social distancing, especially as the coronavirus mutates and its more contagious variants spread.
Delaware Today spoke with DPH Medical Director Rick Hong, M.D., and DPH Chief Physician Rick Pescatore, D.O., in early spring about how the First State is faring.
Dr. Hong: I think our approach to focus on the science throughout this pandemic has been key. We are thrilled to see our COVID-19 metrics going down, which includes positive cases, hospitalizations and deaths.
Dr. Pescatore: We anticipate it will be a boon to our delivery of vaccine in the state of Delaware and nationwide. Certainly, the addition of the Johnson & Johnson vaccine to the vaccine armament provides logistical benefits, as well as an additional supply line to increase vaccines. It’s an exciting innovation and one that we’ll take full advantage of.
Dr. Pescatore: Tremendously important question.
When we look at efficacy, we always have to look at endpoint, and in public health, one of the things that we’re most concerned with is severe disease, hospitalization and death. Those tangible hard endpoints will impact both patients as well as the healthcare infrastructure. The Johnson & Johnson vaccine has shown tremendous efficacy in preventing severe disease and hospitalization, very similar to both the Moderna and the Pfizer vaccines. And what we know is that the logistical benefits—easy access, easy transport and with single-dose administration—all of those likely combine to make the Johnson & Johnson vaccine a similar cousin, and one with similar targets to the Pfizer and Moderna vaccines.…All three of these vaccines demonstrate a superior efficacy in preventing hard endpoints of severe disease, hospitalization and death. And that is the ballgame when it comes to preventing illness here in the First State.
Dr. Hong: Our message to the public is: Don’t be focused on the numbers. Given the limited vaccine supply that we are seeing from all three types, we do urge the public to get the vaccine when it is available.
Dr. Pescatore: That’s a fair assessment. And at the same time, we have emerging data that not only do the vaccines prevent severe illness and transmission but also suggests that the vaccines prevent contraction of the asymptomatic virus as well. Well, not 100 percent, but in a large degree of people.
Dr. Hong: There’s some vaccine hesitancy out there, but we are putting a lot of resources and effort to share valid information, to allow the public to make an informed decision about whether they get the vaccine or not. From a public health side, we don’t see any reason not to get the vaccine, unless you have a severe allergy to the vaccine or the components of the vaccine.
Dr. Pescatore: The Johnson & Johnson more closely resembles a common cold virus. That common cold virus, which was actually a non-human common cold virus, has been altered and had genetic information for the coronavirus spike protein added to it. So it’s not an mRNA vaccine. It’s very much a vaccine that’s more in line with vaccines that we’ve become used to.
Dr. Hong: We’re still waiting on data. It’s really not the same thing as the influenza virus, so it’s hard to say we definitely expect a yearly shot. Time will tell to see how long we anticipate still having the immunity after completing a series, whether it’s a one-shot or two-shot vaccine.
Dr. Hong: Using influenza as an example, [we] have the ability to make more effective vaccine on a yearly basis based on what we’re seeing the season prior. So there, we will continue to follow the number of variants that appear, but there should be no surprise that mutations can occur with COVID-19. As a result, there are benefits to getting a yearly injection to account for those mutations. And I think that’s a possibility.
Dr. Pescatore: Most of the major vaccine makers are examining delivery of the vaccine in children down to the age of 12. … It is possible that we’ll see shots delivered into the arms of individuals under the age of 16 or 18 as early as this fall. [Pfizer announced March 31 it would seek EUA of its vaccine for 12- to 15-year-olds.]
Dr. Pescatore: About 25 percent to one-third of individuals who are receiving the vaccine experience side effects, such as muscle cramping, fatigue, nausea and even fever. And a larger percentage of individuals experience effects following the second dose than the first. What people are experiencing is a natural immune response, one that is typically a larger immune response with the delivery of the second shot because the immune system has already been primed to respond to certain invaders. It’s completely normal. Not experiencing those symptoms is also completely normal, but all of them are indicative of the immune system having an expected, natural and appropriate response to the vaccine.
Dr. Pescatore: That question is still one that’s not settled, but we have emerging data that suggests that these variants have mutations in what’s called the RBD, the receptor-binding domain of the spike protein. And what that ultimately means is that these variants seem to attach to the body more effectively, raise the viral levels that an individual may be infected with and also increase the duration of time that individuals may be infected as well. All of those contribute to the possibility that it can spread the virus more effectively.
Dr. Hong: Mutations happen to increase the survivability of the virus. Evolution happens as well. …So, we do anticipate that the variants occur because it allows the virus to survive longer, whether to attach to the host more effectively, or to be able to spread more effectively.
Dr. Hong: The infection control measures are meant to decrease transmissibility of any pathogen (viral, bacteria). So regardless of the mutations, as long as you continue to social distance, as long as you continue to wear face masks and you wash your hands, those are your basic infection control measures.
Dr. Pescatore: I would say exactly that. The variants reinforce the importance of those measures but shouldn’t raise any significant concern. But it absolutely should reinforce those of us who perhaps have become a little fatigued about these recommendations that we’ve been following for a year.
Dr. Hong: It’s hard to say exactly when that’s going to happen. It really depends on how the vaccine supply continues, but also how the public is dealing with this. This is why we’re urging the public as being part of the solution that they continue to use face masks, social distance and washing hands. That we might get to that point quicker.
Dr. Hong: We want them to get vaccinated if there are no significant clinical reasons not to get vaccinated. …And we urge people to continue with the infection control compliance.
Dr. Hong: Absolutely. Right now, the trends are doing better. We’re getting more vaccine. So everything looks promising and we just have to continue what we’re doing. The numbers are going down, [but] it doesn’t mean we should just kind of forget everything. That gives us more reason why we need to focus on those infection control measures, focusing on vaccine, focusing on testing and so forth.
Visit coronavirus.delaware.gov or dhss.delaware.gov/dhss/dph/index.html for the most current information on COVID-19. Find out more about the vaccines at cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.