Questions & Answers

Can someone explain the different technologies used in the three main vaccines: Pfizer, Moderna, and Johnson & Johnson; and how they work?

All of these vaccines have the same goal:  present the spike protein of the SARS-CoV-2 virus to the body in a safe way without causing infection so the immune system can learn and be ready if that person should ever be exposed to the real virus.  The differences between the vaccine technologies are how they present the spike protein.  For the mRNA vaccines (Pfizer & Moderna), the spike protein is coded in a molecule called messenger RNA, or mRNA.  This molecule is quickly turned directly into the spike protein after vaccination.  The J&J and AstraZeneca vaccines use a common-cold virus (Adenoviruses) to deliver DNA encoding the spike protein.  The DNA is then translated to mRNA, and from there the process is the same as the mRNA vaccines.  Regardless of how the spike protein is delivered, the immune system detects it and responds through cellular (e.g. T cells) and molecular (e.g. antibody and interferons) steps that protect against infection or greatly reduce severity of infection.  These protective responses are then recorded in long-lived cells to enable immune memory.

 Michael Yeaman, PhD, 3/13/2021

 

Is there any information yet on how long the immunity to severe illness lasts?

Most of the data we have at hand suggests that the protective effects of the vaccines against the COVID-19 virus will last at least 9 months to a year, and perhaps longer.  These data are consistent with what we know about durability of protective immunity to other similar viruses, such as those that cause the original SARS and MERS outbreaks.  That said, it will not be surprising if we need to receive regular (e.g. annual) booster vaccines for this virus, just as we do for influenza vaccines.

 Michael Yeaman, PhD, 3/13/2021

 

Is it safe for someone who has had Guillain-Barré syndrome in the past to get the COVID-19 Vaccine?

The U.S. Centers for Disease Control recommendations state that people who have previously had Guillain-Barre’ syndrome (GBS) may receive a COVID-19 vaccine.  No cases of confirmed GBS have been reported following vaccination in participants in the mRNA COVID-19 vaccine clinical trials. One case of GBS was reported in a vaccinated participant in the J&J clinical trial, but there was also one GBS case in the placebo group in that trial.  It is also important to underscore the difference between a clinical coincidence and a clinical cause.  Just because something happens after a vaccine was taken does not necessarily mean the vaccine caused it.  As with any immunization, it is always best for anyone who has had GBS, allergic reaction to food or a prior vaccine to speak with their doctor prior to vaccination.

 Michael Yeaman, PhD, 3/13/2021

 

Can a person get an MRNA vaccine now and a Johnson & Johnson vaccination later?

This is an intriguing question.  At the present time, the CDC and other expert agencies are recommending that people receive vaccination exactly as was performed in the clinical trials that demonstrated safety and effectiveness.  So, for now it is best to use the same brand of vaccine (e.g. Pfizer, Moderna, AZ) for the second dose as was used in the first dose.

There are some experts who have theorized using distinct types of vaccines for the first and second doses.  These ideas are based on the reality that these vaccines have slight differences in the part of the spike protein they encode, and in the way that they present the spike protein to the immune system.  It may be conceivable that using different approaches with dose one and dose 2 could provide broader protection than using the same type of vaccine for both doses.  For example, some believe such as strategy may help alleviate the emergence of variant viruses.  However, these ideas are only in trail stages at this point and are not recommended for routine use.

 Michael Yeaman, PhD, 3/13/2021

 

Are our COVID-19 rates still the worst in the world?

The answer depends on what rates are in question.  For example, if considering total number of COVID-19 cases, the U.S. has the highest number at present (29.3 million as of 3/12/2021).  The next highest countries are Brazil (11.3 million), India (11.3 million), Russia (4.3 million) and United Kingdom (4.2 million).  If considering death rate per 100,000 citizens, Belgium is highest (192.2 as of 3/12/2021), with the other top 5 being Czechia (190.6), Slovenia (183.7), United Kingdom (183.5) and Italy (162).  By comparison, the U.S. has approximately 155 deaths relative to 100,000 citizens.  Even though these numbers may seem small compared to 100,000 people, each death represents a life and a family suffering a loved-one lost, and even those who survive severe cases may have long-term challenges with breathing or cognition.

 Michael Yeaman, PhD, 3/13/2021

 

If you get the first vaccine and skip the second, how protected are you from getting COVID?

For most of the vaccines currently approved or authorized, if a person takes only the first of two-dose vaccines the data to date suggest there is about 50% protection against death due to COVID-19.  Compare these numbers to a nearly 100% rate of protection if both doses are taken.  This difference is consistent with the recommendations of the CDC which state it is best to get both doses as soon as possible.

 Michael Yeaman, PhD, 3/13/2021

 

Do you think that COVID-19 will become as endemic as the “regular” flu, in that we’ll need to get annual vaccinations against variants each year?

We can use a some real-world points of reference to address this interesting question.  First, the SARS-CoV-2 virus is a beta coronavirus cousin of other common-cold viruses.  We know that common cold viruses are endemic, and so it may stand to reason that the SARS-CoV-2 virus that causes COVID-19 will also be in the community for at least the foreseeable future.  Also, we know that influenza is an RNA virus just as SARS-CoV-2 is, and both viruses have error-prone proofreading of the RNA.  In other words, they “want” to make mistakes when replicating their RNA because mutations advantageous to these viruses may arise.  In this respect, the variants we are seeing in the COVID-19 virus are not a surprise and can increase likelihood for endemic duration.  On the other hand, it is reassuring that most of the data thus far suggest the current vaccines may have good to excellent efficacy against even the most contagious variants, in part because antibody is only one arm of the immune system activated by vaccination.  Even if it is endemic and ongoing vaccinations are needed, it is would not be such a hardship to have a booster vaccine for COVID-19 and influenza annually.  It might also be noted that updating immunization is key to good preventive health.  For example, several cancers can be avoided by vaccination that prevents their infectious causes.

 Michael Yeaman, PhD, 3/13/2021

 

Why is it that people who have had COVID-19 don't develop antibodies all the time?

The immune system is part miracle and part mystery, and the truth is we do not know exactly why some people generate high levels of antibody against the SARS-CoV-2 virus and some do not.  However, we have some experience and some clues to help in this regard.  First, the cells that make antibody (called B cells) do not function the same in every person.  Some people have B cell dysfunction that is inherited, others due to medications for unrelated conditions.  For example, medicines that lower B cell numbers are often used in certain blood cancers, as well as in autoimmune diseases such as multiple sclerosis.  However, it should be reassuring that even if B cells and antibody levels are low, the immune system may still be very much at work protecting against COVID-19.  For example, some people have a rare inherited disease called X-linked agammaglobulinemia (XLA).  Their B cells do not make antibody normally.  The good news is that patients who have XLA are at no higher risk of getting COVID-19 disease, and those who do are able to recover from COVID-19 just as well as anyone.  This fascinating findings suggest that while antibody contributes to protection against COVID-19, it is not the only and may not even be the primary type of protection induced by infection or vaccination.

 Michael Yeaman, PhD, 3/13/2021

 

My family has had pancreatic, cancer of uterus, breast cancer, and leukemia.  Am I doomed?

You should get a referral to a genetic counselor to evaluate your family history and genetic risk.  This is a lot of cancer in the family, but a lot depends on whether they are all on one side of the family or not, and the age of onset.  Breast and uterine cancer are very common, so they are not necessarily inherited risk.

Patricia Ganz, MD, 11/20/2020

 

Are there legitimate institutions that study emergency, nonconventional treatments for terminal patients that have exhausted all other treatment options? Can hard, criminalized drugs kill tumors without killing patients? Can induced comas help fight tumors?

Lot of questions here:  Most cancer centers funded by the NCI have experimental treatments of various sorts. They can also obtain compassionate use of some drugs that are in the development pipeline.  That is for active cancer treatments.  If you are referring to comfort care at the end of life, many institutions use integrative and complementary therapyies.
Criminalized drugs do not have a role in cancer treatment as far as I know, and coma does not play a role in treatment.

Patricia Ganz, MD, 11/20/2020

 

Regarding heredity: father’s sisters has cancer, grandmother had colon cancer—is that important?

It depends on the age of onset and types of tumors.  Best to get a consult from a cancer genetic counselor.

Patricia Ganz, MD, 11/20/2020

 

What diet adjustments can be made to promote gut microbe diversity?

It is pretty simple:  eat the largest variety of fruits and vegetables on a daily basis.  There are hundreds of different fiber molecules contained in different vegetables and fruits, and thousands of different phytonutrients (in particular polyphenols), so the more variety of plant based foods you eat, the more you incentivize your gut microbes to diversify in order to be able to metabolize this food. 

Emeran Mayer, MD, 11/20/2020

 

Is UV needed for your body to produce Vitamin D?

I often hear people say, “I need to lay out in the sun because I need to get vitamin D.” To that, I’d say, there are many different ways of getting vitamin D. Yes, the sun is one way of doing this, but it’s not good for your melanocytes. Why tempt fate when you can take a supplement?

Delphine Lee, MD, 11/20/2020

 

How closely correlated are one’s cancer risk and the ingestion of acrylamides?

The debate on the potential carcinogenic effect of dietary acrylamide remains open. There were a total of 32 publications on this topic reviewed in 2015. The summary relative risk (RR) of cancer sites for the highest versus lowest level of intake and for an increment of 10 µg/day of dietary acrylamide were examined. No meaningful associations were found for most cancers considered including  oral and pharyngeal, esophageal, stomach,  colorectal, pancreatic, laryngeal, lung, breast, endometrial,  ovarian, prostate, bladder and for lymphoid malignancies. The RR was of borderline significance only for kidney cancer (RR = 1.20; 95% confidence interval, CI, 1.00-1.45). All the corresponding continuous estimates ranged between 0.95 and 1.03, and none of them was significant. Among never-smokers, borderline associations with dietary acrylamide emerged for endometrial (RR = 1.23; 95% CI, 1.00-1.51) and ovarian (RR = 1.39; 95% CI, 0.97-2.00) cancers. Therefore, dietary acrylamide is not related to the risk of most common cancers. A modest association for kidney cancer, and for endometrial and ovarian cancers in never smokers only, cannot be excluded.

David Heber, MD, 11/19/2020

 

Does periodic fasting help the epigenetics that lead to an increased risk of cancer?

Intermittent fasting is part of normal physiology and does move about 40% of genes to support fasting metabolism every night while you are sleeping. Intermittent Fasting as a diet plan only helps by eliminating late-night eating after dinner which could help maintain normal body weight.  Obesity and overweight including abdominal obesity have been associated with an increased risk of common forms of cancer.

David Heber, MD, 11/19/2020

 

How do you identify thyroid cancer and type of test to plan ahead?

Screening for thyroid cancer is not recommended unless you have an inherited genetic risk or have had radiation to the neck in the past.

Patricia Ganz, MD, 11/20/2020

 

Is leaky gut syndrome a real thing? Should we take probiotic supplements every day?

Leaky gut is NOT a disease or a disorder.  It refers in lay terms to a situation where gut microbes come into close contact with the gut associated immune system. This can occur either if the mucus layer covering the inside of your gut is thinned or compromised, and/or if the tight connections between the cells lining your gut have been loosened.  Both situations can result from a diet low in fiber, high in sugar and fat, as well as from chronic stress.   In the great majority of people the condition is asymptomatic, but it can result in the activation of the gut associated immune system.  Probiotics alone will not help, but switching to a largely plant based diet, and a positive mindset and stress reduction are the best way to address it.

Emeran Mayer, MD, 11/20/2020

 

Fifty years ago President Nixon declared the war on cancer.  Has there been adequate research money, or does the research process just take so much time that money is not the issue?

We can always use more money for research, but overall, cancer funding is quite high due to federal and philanthropic organizations.  The research just takes a long time to mature and be translated into new treatments.

Patricia Ganz, MD, 11/20/2020

 

What is the current scientific thinking regarding whehter cell phone use contributes to brain cancer?

The short answer is that, at this time, there is no definitive evidence that the use of cell phones causes brain cancer or cancer in any other tissue (eg, salivary glands).  The concern for cell phones potentially causing cancer is based on the exposure of cell phone users to radio waves.  Three early clinical studies yielded contradictory results: one reported increased incidence of cancer in cell phone users while two others did not find any association between cell phone use and cancer.  A very large ongoing study known as the COSMOS study was started in 2010 and is following participants for over 30 years.  Hopefully, this study will provide an answer to the question.  While awaiting results, it is important to note that the FDA stated that  “based on this current information, we believe the current safety limits for cell phones are acceptable for protecting the public health.”

 Joaquin Madrenas, MD, PhD, 11/20/2020

 

Has Dr. Heber updated his great book?  I have the original and wonder if it is still current?

"The  What Color Is Your Diet?" is in 11 languages and is still current. Appendix 1 which includes my recommendation of 1 gram of protein per pound of lean body mass and its relationship to resting energy expenditure remains the main message I am launching around the world through my Instagram site @drdavidheber and my website drdavidheber.com. I have edited and written many of 24 chapters in a new book to be published in 2021. It is heavily referenced and entitled "Nutrition and Cancer: Prevention, Treatment, and Prevention of Relapse" (CRC Press, Taylor and Francis). 

David Heber, MD, 11/19/2020

 

In addition to a healthy diet, any thoughts on whether regular consumption of probiotics may be helpful for cancer prevention?

To my knowledge, no such benefit of probiotics has ever been demonstrated.

Emeran Mayer, MD, 11/20/2020

 

Since we're all spending so much time at home, do we still have to replenish sunscreen on our face every two hours if we're sitting near a window?

Typical car, home, and office windows block most UVB rays but a smaller portion of UVA rays.  Even if you don’t get sunburned sitting in the sunlight behind a window, the UV rays that get through can theoretically still damage your cells.  Tinted windows help block more UVA rays, but this depends on the type of tinting.  In addition to causing DNA damage that can lead to mutations and skin cancer, UV light also contributes to photoaging, so it is not a bad idea to wear sunscreen if you are exposed to UV rays.  As my dentist tells me, you don’t have to floss your teeth, only the ones you want to keep!

Delphine Lee, MD, 11/20/2020

 

Are there any vitamins someone could take to help protect the skin?

Nicotinamide (vitamin B3) has protective effects against ultraviolet damage caused by sun exposure, which enhances DNA repair and reduces UV‐induced suppression of immunity.  Randomized controlled clinical trials have also shown that nicotinamide reduces the development of new non‐melanoma skin cancers in patients at high‐risk.

Delphine Lee, MD, 11/20/2020

 

How much of the development of the current front runner vaccines (Moderna, AstraZeneca & Pfizer are funded by public funding (e.g., NIH grants)?  Will the pricing eventually reflect this collaboration?  Or should we expect the initial dose to be discounted, then subsequent doses be inflated?

There are 5 COVID-19 vaccine development programs that have received substantial funding from the U.S. government as part of “Operation Warp Speed”.  These vaccine development programs include (in order of stage of clinical trials:  Moderna / NIH; AstraZeneca / Oxford; Pfizer /BioNTech; Johnson&Johnson; and Merck).  Most of these efforts reflect public/industry or industry/industry interactions.  There are also U.S./International collaborations reflected in this list.  As part of U.S. government funding, vaccine development programs typically must adhere to U.S. government policies on making the vaccines available to U.S. citizens as a priority, and at a cost that is different from that if the companies were to have funded their development without U.S. government aid.  For example, as part of the Pfizer/BioNTech funding agreement, the U.S. government secured 100 million doses (i.e. vaccine for 50 million Americans) at a cost of about $40 for the vaccination regimen (2 doses).  Whether the cost of vaccines will inflate after the pandemic “crisis” period is over remains to be determined.     

 Michael Yeaman, PhD, 8/1/2020
 

 

Can you clarify why recent blood donation would exclude a potential subject from participation in the vaccine trials?

The SARS-CoV-2 virus that causes COVID-19 disease is known to cause abnormalities in blood coagulation in some infected patients.  This effect, known as coagulopathy, can lead to blood clots and blockages to small blood vessels essential to delivering oxygen and nutrients to tissues.  For individuals donating or receiving blood products, some of the vaccines being tested require a waiting period (often up to 3 months) before they could receive the vaccine.  The reasoning is that individuals who have less blood volume (e.g. having donated blood) or have received other’s blood products (e.g. blood donation recipient) may have a slightly higher risk of adverse outcome.  A key aspect of all the vaccine trials is safety, so out of an abundance of caution individuals who have donated or received blood products are restricted from participating in some of the trials for at least some period of time, even if risks of adverse outcome from the vaccine are extremely remote.

 Michael Yeaman, PhD, 8/1/2020

 

I have heard that one can get infected through the eyes.  Is it as important to protect your eyes as it is your nose and mouth?

Yes, cases of people contracting COVID-19 infection through the eyes have been reported.  The CDC now recommends that eye protection should be worn by health care providers who interact with patients in areas with moderate to substantial community transmission.

 Scott Filler, MD, 7/31/2020

 

Is research being done on how long immunity lasts, either from having had COVID-19 or receiving a vaccine?

Yes, research is being done on finding out how long antibodies against the SARS-C0v2 virus last, as well as whether they are neutralizing or not.  Research is also examining the development of memory T cells in the presence and or absence of antibodies against the virus.  The emerging evidence suggests that immunity is developed, both in terms of antibodies and T cells, and that there is some degree of cross reactive immunity with other coronaviruses.  How long will immunity last is still unknown.  For other coronaviruses, immunity usually lasts between 1 to 1.5 years.

 Loren G. Miller, MD, MPH, 7/31/2020

 

Is it possible that something that appears as a second round of infection is merely the first with a slight remission?

Yes.

 Scott Filler, MD, 7/31/2020

 

I take Ocrevus for MS and I’m wondering if it might help me by tamping down my immune response in the event I’m exposed to COVID.

This medication targets B cells expressing CD20 molecules on their surface.  How the medication works is uncertain but it is likely that it down-regulates the function of these cells.  B cells are the cell type responsible for the production of antibodies. Thus, the use of this medication down-regulates immunity and it has been linked to an increase risk for infections, including COVID-19.

 Joaquin Madrenas, MD, PhD, 7/31/2020

 

If we come down with this, what medicines help it heal?  Why hasn't there been more information on how to handle the disease when someone first gets it?

Currently, the best studied drugs for treating COVID infections are remdesivir and dexamethasone.  Unfortunately, remdesivir can only be given intravenously and so it is not practical to give it to patients who are at the initial stages of infection, before they become very sick.  Dexamethasone works best in patients with severe disease.  Scientists are working on new treatments that can potentially be given to patients as soon as they are diagnosed with COVID, but these treatments are still in development.

 Scott Filler, MD, 7/31/2020

 

Is it known to what degree a congenital heart defect would make someone high-risk for COVID-19 complications?

It is prudent to say that a person with a congenital heart disease might be at risk for severe COVID-19 but as of July 30, 2020, there is no firm evidence of the magnitude of the risk for severe COVID-19 in a person with congenital heart disease. 

 Joaquin Madrenas, MD, PhD, 7/31/2020