By Dr. Leo Hattrup, FAA Medical Officer
Guidance for COVID-19 prevention and treatment has evolved throughout the pandemic, often rapidly. In May, the FDA (Food and Drug Administration) and the advisory committee on immunization practices (ACIP) expanded the Pfizer vaccine as an EUA (emergency use authorization) for those 12 and older. The CDC (Centers for Disease Control) eased many restrictions for those who are fully vaccinated. In addition, individuals can now receive the COVID vaccines at the same time as other vaccines. Additional changes are likely. Pfizer is seeking full approval for its vaccine (as opposed to the current EUA (see the May/June 2021 issue at bit.ly/CIMayJun21)) for adults (18 and over). Vaccine manufacturers are conducting vaccine trials for children under 12.
COVID-19 occurred as early as November 2019 in China and appeared in the United States in January 2020. As of this writing, there have been over 33 million cases and over 600 thousand deaths in this country alone. Most of the deaths have been in individuals at increased risk. High risk criteria include a body mass index of 35 or greater (bit.ly/BMITables), chronic kidney disease, diabetes mellitus, immunocompromising condition or treatment, age of 65 or greater, age of 55 or greater and cardiovascular disease, hypertension, or a chronic respiratory disease. Different criteria exist for those under 17.
Prevention to control the spread of COVID (and other diseases spread via respiration) includes minimizing contact with the virus and getting vaccinated. The risk of spread is dependent upon the level of exposure, limited by the now familiar practices of social distancing, sanitation, mask wear, and frequent handwashing. The historically low rates of influenza this season demonstrate the benefit of these practices.
COVID-19 vaccines are safe and effective, but other preventive measures augment the protection.
Evidence shows that the vaccines effectively reduce susceptibility to infection and serious disease as well as the risk of transmission. The vaccine is nearly 100% effective in preventing serious disease and death. However, some will decline vaccination and others cannot receive the vaccines. Therefore, some individuals will remain susceptible. Mutations naturally occur in virus replication, leading to variants. The best way to reduce the number of new variants is to reduce the number of infections. Although the CDC recently revised its recommendations for fully vaccinated individuals, keep up the good habits acquired during the past year. Frequent handwashing, not touching your face, and staying home when ill are always good practices. Note that while the current vaccines also work against the variants, vaccine experts are reviewing the need to revise the vaccines and the need for a booster.
While the risk of vaccine complications is very low, the Johnson and Johnson vaccine recently came under scrutiny. Some, primarily women, developed blood clots after vaccination. The individuals were between 18 and 60; many had other risk factors for a blood clot. While the risk of a blood clot complication from the vaccine is real, it is much less dangerous than having COVID-19. In fact, the risk of death if you contract COVID-19 is 1,000 times greater. Consider also that oral contraceptives, commonly used, pose a greater risk of a clot complication than the vaccine. After reviewing the data, the FDA determined that the vaccine remains safe.
Others have been concerned about vaccine safety in general due to a lack of understanding the Vaccine Adverse Event Reporting System (VAERS). VAERS is simply a warning system for potential adverse effects from a vaccine and documents an association, not causality. After analyzing these reports, vaccine experts determined that the COVID vaccines are safe.
Unfortunately, treatment for COVID-19 remains challenging. This is a “novel” coronavirus, and there is much we still don’t know. The current options are limited unless you meet very specific criteria for a clinical trial. You and your physician should discuss what is appropriate for you should treatment be necessary.
The take home message is that vaccines are safe and effective, but other preventive measures augment the protection. As a reminder, the FAA allows airmen to use the Pfizer, Moderna, and Johnson and Johnson EUA COVID vaccines, but mandates a minimum 48-hour grounding after any of these (note: 14 CFR section 61.53 still applies).
Leo M. Hattrup, M.D., received a bachelor’s degree from Wichita State University, a master’s in public health from Harvard University, and a doctorate from Vanderbilt University. He is retired from the U.S. Air Force in which he spent the majority of his career in aerospace medicine. He is board certified in aerospace and occupational medicine. He is a certificated flight instructor and enjoys flying airplanes, helicopters, and gliders.