The COVID-19 Vaccine: Considerations for Dancers
On this episode of The Dance Docs I sit down with Dr. Kathleen Davenport MD to discuss information on the two COVID-19 vaccines currently being offered in the US. We dive into answering some of our listener questions, discuss our experience receiving the Pfizer vaccine, as well as some considerations in returning to class, rehearsals or treating after your first and second dose of a vaccine. As with all of our episodes we do our best to provide you with the most current information and what we discuss on the show is not considered medical advice, if you have any concerns regarding the vaccine we recommend that you speak directly to your physician.
What is a Vaccine-
A vaccine is a substance used to simulate the production of antibodies and provide immunity against one or more diseases.
It is prepared from a causative agent of the disease, its products or synthetic substance are treated to act as an antigen without inducing the disease.
It stimulates formation of ANTIBODIES, not pathogens
The current vaccines on the market are teaching your body to create antibodies against the spike protein
Three main categories of vaccines
Protein-based vaccines
Generate target antigens in vitro such as inactivated virus vaccines, virus-like particles and protein subunit vaccines
Gene-based vaccines
Deliver genes encoding viral antigens to host cells for in vivo production such as virus-vectored vaccines,
DNA vaccines and mRNA vaccines
Pfizer and Moderna
Combination of both protein-based and gene-based approaches
Produce protein antigen or antigens both in vitro and in vivo, typically represented by live-attenuated virus vaccines
What is an mRNA vaccine
An mRNA vaccine provides one specific part of the RNA code, specifically the part for the spike protein
Think of a a viruses RNA as a stack of lego blocks
Yellow Blocks
Blue Blocks
Sequence of red and white blocks ← This is the spike protein
Green Blocks
The vaccine does not give you the entire code (RNA) for the full virus
The vaccine only gives your body the information to recognize the spike protein on the outside of the virus
The next time your body sees the code for the spike protein, from an actual COVID-19 virus, it will know how to respond
Think of the vaccine like bootcamp for your body
The vaccine is training your body to identify what is not supposed to be there and have a quick response to get rid of it more efficiently
To produce an mRNA vaccine, scientists create a synthetic version of mRNA encoding the spike protein. This is packaged inside fatty parcels, to make it easier for the mRNA to cross the outer membranes of cells, which are also made of fatty material.
mRNA vaccines are relatively unstable
RNA is relatively unstable and can only stay active in a cell for 72 hours
Need to be stored at cool temperatures
Benefits of mRNA vaccine
The use of mRNA has several beneficial features over subunit, killed and live attenuated virus, as well as DNA-based vaccines.
First, safety:
mRNA is a non-infectious, non-integrating platform,
it does not integrate into your body’s DNA
there is no potential risk of infection or insertional mutagenesis.
mRNA is degraded by normal cellular processes,
its half-life can be regulated through the use of various delivery methods
Second, efficacy:
various modifications make mRNA more stable and highly translatable
Efficient in vivo delivery can be achieved by formulating mRNA into carrier molecules, allowing rapid uptake and expression in the cytoplasm
mRNA is the minimal genetic vector; therefore, anti-vector immunity is avoided, and mRNA vaccines can be administered repeatedly.
Third, production:
mRNA vaccines have the potential for rapid, inexpensive and scalable manufacturing, mainly owing to the high yields of in vitro transcription reactions.
compared to traditional vaccines, mRNA vaccines can actually generate a stronger type of immunity: they stimulate the immune system to make antibodies and immune system killer cells — a double strike at the virus.
Does an mRNA vaccine alter DNA
NO an mRNA vaccine will not alter your DNA
DNA is a double stranded molecule with 4 bases
adenine, thymine, cytosine, and guanine
RNA is a single stranded molecule with 4 bases
adenine, uracil, cytosine, and guanine
Some viruses, such as HIV, are able to integrate into out DNA, but they require the virus to carry a specialised enzymes with it
SARS-CoV2 does not carry enzymes with it that alter DNA
COVID-19 Vaccines do not carry the enzyme that will alter DNA
Quick development of vaccine
All the Vaccines have had to complete phase III, double blind, placebo controlled clinical trialswent,
Financial backing and urgency of finding a solution helped to move things quicker
mRNA vaccines first showed promise in the early 90’s in animal (rat) studies but no significant money was invested into them
been investigating use of mRNA vaccines for ~30 years
Pfizer/bioTech and Moderna had already built platforms that, theoretically, could be used to create a vaccine for any infectious disease simply by inserting the right mRNA sequence for that disease.
Within weeks of identifying the responsible virus, scientists in China had determined the structure of all of its genes, including the genes that make the spike protein, and published this information on the Internet.
Within minutes, scientists 10,000 miles away began working on the design of an mRNA vaccine. Within weeks, they had made enough vaccine to test it in animals, and then in people.
Just 11 months after the discovery of the SARS-CoV-2 virus, regulators in the United Kingdom and the US confirmed that an mRNA vaccine for COVID-19 is effective and safely tolerated, paving the path to widespread immunization. Previously, no new vaccine had been developed in less than four years.
Had been studying mRNA for vaccine use for other infectious agents, such as Ebola, Zika virus, and influenza.
Part of the quickness of the development is due to cutting through the red tape.
One person described this as TSA pre-check before anyone had it.
You still had to go through the same security, but you just got to move to the front of the line.
That’s what happened with every single process for this vaccine - approval to start a study, front of the line,
approval to go to phase 2, front of the line,
approval to phase 3, front of the line,
approval to FDA, stop every other meeting and front of the line.
In research, each of these phases is usually months and months of simply waiting in line, all of that was removed for this vaccine effort. But the vaccine still had to take their shoes off and walk through the metal detector (and that one part had to get wanded).
Many times the obstacle to new vaccines is not the effectiveness of conventional approaches but the need for more rapid development and large-scale deployment
The government essentially paid for overlapping phenomena,
as phases were progressing they allowed them to begin moving forward as the information was being reviewed.
Pfizer and Moderna were able to overlapped the phase III trials with the mass production, which would normally not happen
How were these Vaccines funded
Combination of government and private funding
Pfizer was all privately funded, they felt that it was their responsibility as a company to develop this vaccine without help or restrictions from the government
Approximately 1 Billion dollars of funding into finding a specific working vaccine within the last 11 months
What vaccines are on the market and what are being developed
As of December 2020, the WHO has documented more than 214 COVID-19 vaccine candidates, with 51 of them in clinical evaluation, 13 in phase III trials and several vaccines now being authorized for use in some regions
2 approved Vaccines in the USA- Pfizer and Moderna
Pfizer- 2 doses given 21 days apart
Moderna- 2 doses given 28 days apart
AstraZenica’s Vaccine- limited use in UK, Mexico and India
Uses an adenovirus (chimpanzee cold virus) with Spike Protein information to trigger immune response
Also 2 dose
Johnson and Johnson- not approved yet (Jan 23, 2021)
1 dose
Current efficacy of the Vaccine
For the two vaccines approved by the FDA, they are 94.1% (Moderna) and 95% (Pfizer) effective at preventing COVID-19.
Twice as effective as the flu vaccine, 40% effective
Will I need to get a COVID-19 vaccine yearly like the flu vaccine
Not entirely sure yet, but scientists and medical professionals believe that this is not a rapidly evolving virus that would require a yearly booster.
New strains- is vaccine effective
It is the nature of all viruses to mutate
Corona Viruses tend to evolve or mutate slowly
This New strain discovered in England in September 2020 is now the most common version of the coronavirus, accounting for about 60 percent of new COVID-19 cases.
Mutations in the new strain seem to affect the coronavirus’s spike proteins, making the virus more “sticky”. But no clear indications at this time as to why it may be more contagious
Easier to bind to the cell
Tighter bond
Although the mutated coronavirus may spread faster from person to person, it does not appear any more likely to cause severe disease or death
The vaccine appears to be effective against this new strain
The scientists will continue to examine new versions of this coronavirus’ genetic sequencing as it evolves
Limiting the spread of the virus through maintaining COVID-19 safeguards give the virus fewer changes to change
Wear your mask wearing,
Maintain physical distancing
Practicing hand hygiene
If you had COVID, do you need to get the vaccine?
Yes, you should get the vaccine. But current research is showing that you may have antibodies for a few months so you may be able to wait
New Study published on 1/14 in BJM https://www.bmj.com/content/372/bmj.n124
People who have previously been infected with covid-19 are likely to be protected against reinfection for several months, but could still carry the virus in their nose and throat and transmit it to others, according to a study which regularly tested thousands of healthcare workers.
Early data from this study-
Study dates- between 18 June and 24 November 2020.
researchers detected 44 potential reinfections and 409 new infections.
This equated to an 83% rate of protection from reinfection,
Protection lasted for at least for five months from first becoming sick.
The study team stressed that these results give no insight into the effects of vaccines or the new more transmissible variant in the UK, because of the time period analysed. These factors will be considered in later stages of analysis.
Due to supply shortage of the vaccine, if you have been infected in the last 90 days or have recently been tested and showed antibodies may want to consider waiting.
Can I give the Virus to someone from getting the vaccine?
No
You are not receiving a live virus, you are receiving a snip of mRNA created in a lab that codes for the spike protein ← what initiates the immune response
Remember this vaccine is teaching your body how to respond to the virus should a live virus enter your system
Can you carry the virus and give it to other people even if you get vaccinated?
Not a sterilizing vaccine
Can still get COVID-19 even if you have had the vaccine
Can still transmit COVID-19 so masks will still be required
This vaccine works best, similar to masks, if everyone in a “pod” has gotten it. Therefore, if dancers are dancing in a company pod, it would be best if all dancers agree to get the vaccine.
May need to continue testing
Do I need to continue wearing a mask after I get the vaccine?
Yes, we need to continue practicing 3 W’s
Wearing a mask
Washing your hands
Watching your distance
You still have about a 5-6% chance of contracting the virus
Your reaction might not be as severe because your body understands how to recognize and combat the virus
Need “herd immunity” Expected that for COVID-19 most models are currently showing 60-70% of the population would need to be resistant before herd immunity kicks in and the infection rates start to go down.
Long term health implications
From the COVID-19 Virus
Unfortunately we do not know yet, if there are any long term health implications from having COVID-19.
This is a new virus so we probably won’t know for some time
Viruses do have the potential to cause other diseases later in life like:
Chicken pox/shingles
There are increasing reports of chronic headaches, smell and taste loss, neuropathy that may be permanent
From the Vaccine-
Many of the vaccine conduites have been studied for years, so they are assumed to be safe.
If you are concerned about the mRNA vaccines, there will be new vaccines out using other methods of delivery.
Paul Offit- “Vaccines can cause serious rare side effects … that’s true. But that all occurs within 6 weeks of a dose.”
After 3 million doses have been given without any significant side effects we can assume they are safe
Since distribution began on of Dec, 14, 2020 approximately 33 million vaccinations have been given
Our experience with young individuals who have had the virus
Young, healthy people who are trying their best to take appropriate precautions have ended up in the ICU.
Dancers who have gotten it months ago are still dealing with higher levels of fatigue and inflammation than their peers
Some days they feel ok, others they feel like they are hitting a wall
Unable to maintain an elevated HR
If you are coming back from the virus and feel that you are unable to progress it is important to get in to see a sports cardiologist
Many of Dr. Davenport’s colleagues in general rehabilitation have seen young, healthy people with severe career ending strokes who had minimal respiratory symptoms.
There are increasing reports of chronic headaches, smell and taste loss, neuropathy that may be permanent
Current expected side effects from Moderna/Pfizer Vaccines
This is not like the flu shot where your arm may be a little sore from the injection
Medical professionals are expecting you to have a response. It means that your body is responding appropriately.
first dose most people report a sore arm
second dose people report, fever, chills, muscle aches, tiredness, headache
People 55 and over have reported fewer side effects than those in the 18-55 range, possible because their immune systems are more active
Bells Palsy- same percentage as within the normal population
The CDC is continuing to monitor individuals who receive the vaccine through Vsafe
Daily survey sent to you for 1 week post injection, then weekly follow ups.
Our Experience with the Pfizer Vaccine
Dr. Kat
First dose-
sore arm within 30-40 minutes of receiving vaccine
Decreased ROM, minor fatigue, and muscle aches the following day
All symptoms completely gone within 72 hrs
2nd dose-
Day 1 (unmedicated)
Injection around 8:00 am
Significant chills beginning at 9:00pm
Fever in the 100.00-100.9 range for most of the night
Significant joint pain, and mid back/low back pain
Day 2 (unmedicated)
low grade fever 99.0-99.9 for most of the day, a few spikes into the 100.0 range
Significant fatigue and back pain continued until 5:00pm
No appetite
Fever broke around 7:00pm
Day 3- (unmedicated)
Returned to light work schedule
Still fatigued, but no longer had any pain, muscle aches or fever
Day 4- (unmedicated)
Mild fatigue (how easily do I wake up to my alarm)
Dr. Davenport
Soreness and minimal fatigue for 36 hours the first dose
A similar time frame but worse symptoms for dose 2.
Took Tylenol post injection to help with expected side effects
If I had to do my second dose over, I would have definitely cancelled my clinic for 2 days, and I don’t even have to lift anyone over my head!
All that being said, I would have been more upset NOT having symptoms than having them.
Having had the expected response to the vaccine gave me comfort that my body was doing what it was supposed to be doing to protect from a deadly virus.
Other Clinicians experience with the Moderna vaccine:
Most clinicians experienced
fever 10-12 hours post injection
body aches
fever
felt like they had the flu
major symptoms lasted 8-24 hours
Dancer Specific Vaccination Considerations
These vaccines tends to have more effects on the body compared to a flu shot
many people have reported having a strong immune response, especially 10-12 hours after the second dose.
This immune response means that your body is appropriately responding to the vaccine but it does not necessarily feel great to go through the immune response.
It usually lasts 1-3 days and different people have different severities of response. The older you are, usually the lower the symptoms.
For dancers:
being required to teach a full day, rehearse, or even take class may not be feasible, especially after the second dose.
Even after the first dose, it may not be safe to do partnering, or really push through a long rehearsal day.
when you are unable to lift your arm normally due to post injection pain you are most likely going to compensate and put yourself at risk for a shoulder injury if you undertake upper body work
Consider staggering vaccination within your company or staff so an entire group is not out at the same time.
For a dance company,
an entire pod may want to be on the same vaccination schedule so rehearsals can be modified for the entire group.
For example, pod 1 would get vaccinated together and rehearsals/classes canceled for the 2 days after the vaccine.
Pod2 would use that time in the studio and they would get vaccinated one week after Pod1.
This way, any performance opportunities or rehearsal needs could be met with one pod if another was recovering from vaccine symptoms.
For Dance Instructors
Dance teachers should plan ahead to have someone demonstrate, or be ready to make modifications
after first injection depending on arm pain
You may consider having a substitute teacher around time of the second vaccination.
Given the chaotic roll out of vaccination, none of these considerations may be possible for dose one, but should be a very strong consideration for dose two since you will have 3-4 weeks to plan ahead.
Pre vaccine tips:
You tend to feel more symptoms than a flu shot, so plan accordingly for days off etc.
You do not want to have an injury because you were recovering from the vaccine, and fatigued
Drink lots of water and avoid alcohol pre and post vaccine days (48-72 hours pre and post)
Avoid anything that weakens your immune system, like a steroid medication/injection, 2 weeks pre and post vaccine
Consider planning meals prior to your vaccine so you are not trying to cook when you are not feeling well
Try get your normal amount of rest the night before, and keep yourself in a stress free environment after
Additional thoughts
Note what happens with your first dose and plan on it happening with more severity for your second dose.
Be gentle with yourself around the vaccine.
Your body is working hard for you, just be nice to yourself and know it will pass relatively quickly and then that’s that!
Continue to wear your mask, wash your hands, and socially distance until we know enough people have been vaccinated to slow the spread