By Ruth Werner
People continue to ask me about the COVID-19 vaccines, so I have compiled some information that is a bit more timely than the last time I addressed this topic in an ABMP podcast in November or the "COVID Vaccine and Massage: When is it Safe to Offer Massage?" blog post on January 8, 2021.
As of February 19, 2021, we are currently distributing and administering two vaccines against COVID-19 in the United States. One is manufactured by Moderna, the other by Pfizer. We are expected to have emergency use authorization for a third option, made by Johnson & Johnson, in the near future. Let’s talk about these vaccines in a little more detail.
The Pfizer and Moderna vaccines are similar in their construction and strategy. They both use messenger RNA (mRNA) to introduce an antigen into cells, and this process initiates an aggressive immune system response to that antigen.
There are a few things about the Pfizer and Moderna vaccines that are noteworthy:
- New technology. Although the technology used in these vaccines has been in development for many years, this is the first time it has been used on a widespread basis. However, just because the vaccines are new doesn’t mean they haven’t been rigorously tested for both effectiveness and safety—they have.
- Two doses. These vaccines require two doses to be fully effective. Those doses are usually recommended to be about four weeks apart, but this can be stretched up to six weeks.
- Storage challenges. As you may be aware, both the Pfizer and Moderna vaccines need to be stored at freezing, or super-freezing temperatures, and they have a limited shelf life. This is because the mRNA components are delicate and not resistant to environmental changes.
- Amazing effectiveness. Both the Moderna and Pfizer vaccines have shown to be 94–95 percent effective when used as directed against the development of symptomatic COVID-19. That is an incredibly high efficacy rate. Nonetheless, one in every 20 people (that’s 5 percent) who are vaccinated are still at risk for infection. (Note: There is some evidence that one or both of these vaccines may be slightly less effective against some of the virus variants. I’ll have more on that in an upcoming blog.)
- Vaccinated people may still be infectious. The Moderna and Pfizer vaccines protect the person who was vaccinated, but we don’t know yet whether they prevent that person from spreading the virus to others. In other words, a vaccinated person may be able to harbor some virus in their sinuses, and then sneeze or cough and release it into the air where an unvaccinated person may pick it up. This means we must continue to use masks. This is true, even when both people in a massage session room have been vaccinated: if one of them is carrying any virus in their sinuses, it could be shared with the other person, who could then share it with others.
mRNA Vaccine Reactions
The Moderna and Pfizer vaccines can cause a severe allergic reaction—anaphylaxis—in a small number of people. This can be solved with epinephrine, but it must be treated immediately. This is why people being vaccinated are encouraged to wait for 20 minutes or so to see if they have any swelling, lightheadedness, or difficulty breathing after the injection.
But we also see that a lot of people have an unusually severe systemic reaction in the first day or two following their vaccines, especially their second dose. This can involve intense soreness of the vaccinated arm, plus fever, chills, headache, body aches, and general malaise (e.g., feeling “craptacular”) for 24–48 hours after their shot. This is why I have recommended that people who have been vaccinated wait for a couple of days before they get a massage, just in case they have an uncomfortable reaction. We see this happen mostly with relatively young people, and with people who may have had some previous exposure to COVID-19. A reaction like this is a good thing—it tells us the immune system is serious about protection—but it is certainly uncomfortable while it’s active.
The Next Option—A Viral Vector
If all goes in the direction that public health officials predict, within the next week or two we will see another vaccine option, manufactured by Johnson & Johnson, be approved under emergency use authorization. This vaccine uses a different technology, and it has some different features than the mRNA vaccines.
The Johnson & Johnson vaccine uses a strategy called a “viral vector.” Here’s a thumbnail sketch of how this goes: A form of adenovirus is completely disabled and made harmless. Then a section of DNA from SARS-CoV-2 is inserted into these carrier adenoviruses. The loaded-up adenoviruses are injected into a person and taken up by target cells. The section of DNA is taken into the cell nucleus, where it changes the cell function to make copies of itself. This initiates an immune system response to this section of DNA, which protects the person from infection.
This viral vector strategy has been used successfully with other vaccines and is being investigated for use against the HIV and Zika viruses too.
Advantages and Disadvantages
The Johnson & Johnson vaccine has some significant advantages over the mRNA vaccines. It requires only one dose, which is simply a more realistic expectation for many people. It can also be kept in a refrigerator and it has a long shelf life. This makes it easier to administer in rural areas, and much less expensive to store.
However, this vaccine has a disadvantage as well: efficacy rate. The efficacy of the Johnson & Johnson vaccine as tested in the US is 72 percent. That sounds low compared to the 95 percent we see with the mRNA vaccines. Still, for perspective, 72 percent is really high.
We are still collecting data on how well all the vaccines work on the main COVID variants—and I will discuss those in another blog. But one data point is coming through consistently: Even if the vaccines don’t prevent infection altogether, they do appear to prevent severe cases of infection. That is, someone who has been vaccinated may be unlucky and still contract COVID-19, but they are extremely unlikely to need to be hospitalized, or to have a serious, life-threatening experience.
What Kind of Vaccine Should You Get?
This is an easy one: whichever one you can. In many locations, massage therapists have already been vaccinated because they are classified as health-care providers. If that’s you, congratulations, and I’m jealous! Wherever you are, and wherever you fall on the list for vaccination, I hope you’ll take this step to safeguard your own health and the health of all the other people in your life. I can’t wait to step up myself.
Want to Learn More?
- Want to know more about how mRNA vaccines work? Here is the best explanation I’ve seen yet: “How mRNA Vaccines Work”
- Do you love sea shanties? Here’s a sea shanty about COVID-19 and vaccines: twitter.com/i/status/1352520281693310977
Do you want to get even more information on vaccines? Here is a resource list to get you started:
Centers for Disease Control and Prevention. “Frequently Asked Questions about COVID-19 Vaccination.” February 19, 2021. www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html.
Centers for Disease Control and Prevention. “Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Pfizer-BioNTech COVID-19 Vaccine.” February 19, 2021. www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html.
Corum, J., & C. Zimmer, C. “How the Johnson & Johnson Vaccine Works.” New York Times. (n.d.) Updated February 3, 2021. www.nytimes.com/interactive/2020/health/johnson-johnson-covid-19-vaccine.html.
Gavi. “There are Four Types of COVID-19 Vaccines: Here’s How They Work.” (n.d.) Accessed January 4, 2021. www.gavi.org/vaccineswork/there-are-four-types-covid-19-vaccines-heres-how-they-work.
Lovelace Jr, B. “J&J Says Its Covid Vaccine is 66% Effective, But the Single Shot May Fall Short Against Variants.” CNBC. January 29, 2021. www.cnbc.com/2021/01/29/covid-vaccine-jjs-one-shot-drug-is-72percent-in-the-us-but-less-effective-elsewhere.html.
Miller, K. “Here’s Why You’ll Still Need to Wear a Mask After Getting Vaccinated for COVID-19.” Prevention. January 4, 2021. www.prevention.com/health/a34904463/wearing-face-mask-after-covid-19-vaccine.
Pollard, A. J., & E. M. Bijker. “A Guide to Vaccinology: From Basic Principles to New Developments.” Nature Reviews Immunology. December 22, 2020. https://doi.org/10.1038/s41577-020-00479-7.
Solis-Moreira, J. “Who Should Get the Johnson & Johnson Vaccine Over the mRNA Vaccines? Livescience.com. n.d. Accessed February 19, 2021. www.livescience.com/which-covid-19-vaccine-should-you-get.html.
World Health Organization. “The Moderna COVID-19 (mRNA-1273) Vaccine: What You Need to Know.” n.d. Accessed February 19, 2021. www.who.int/news-room/feature-stories/detail/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know.
Zhang, S. “What the Vaccine’s Side Effects Feel Like.” The Atlantic. December 18, 2020. www.theatlantic.com/health/archive/2020/12/what-expect-when-you-get-covid-19-vaccine/617428.
Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (available at BooksofDiscovery.com) now in its seventh edition, which is used in massage schools worldwide.
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