One dose vs two, social gatherings and other things you need to know about the COVID-19 vaccine

Let the hugging begin.

This week, the U.S. Centers for Disease Control and Prevention (CDC) released new guidelines for people who are vaccinated, and it includes inoculated grandparents being able to spend time with their grandkids. Of course, as with all things pandemic, the guidelines come with strings attached and lots of fine print. 

According to the new rules, people who are fully vaccinated against COVID-19 can safely visit with other vaccinated people and small groups of unvaccinated people in some circumstances – and here’s where it gets nuanced – if the unvaccinated people are at low risk for severe disease (provided they have a pet iguana and are left-handed.) 

But the best part? All of this can be done without masks. 

This is not to be confused with the actions of states like Texas and South Carolina, where restrictions are being lifted across the board for vaccinated and unvaccinated alike.

“It’s not party time yet,” said Danielle Scheurer, M.D., MUSC Health System chief quality officer. “There will be a time and a place for relaxing broader restrictions, but we just need to tough it out for a few more months. Look, I get it, social distancing can be hard sometimes. But wearing a mask is not.” 

With the vaccine landscape changing almost daily, each week we are checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. First off, how were things last week?

A. Not great. We got a small amount of vaccine. Around 8,000 doses. And I was really hopeful we were going to get a lot more this week, but, sadly, it’s not looking like that will be the case. 

Q. How close is MUSC to opening things back up to first dosers?

A. We really can only go as fast as supply will allow. I’d love to say close, but honestly, we just don’t know week to week. By the end of last week, because we had so few second-dose appointments, we were able to start vaccinating people who had signed up for the first dose but had been temporarily put on a wait list. We are now chipping away at that, but, even still, we’re looking at around 50,000 who still need to be taken care of. 

Q. Not to pile on, but now South Carolina is adding 55-year-olds to those who are eligible under Phase 1b. That’s 2.7 million more people. How do you approach that?

A. The demand is so high right now. It’s just so out of proportion to what any facility or state can manage. I get it; they needed to start somewhere because we are starting to approach the point where most of the eligible 1a people who actually want the vaccine are being taken care of. But to open it up to that much more volume is a bit overwhelming. 

Q. Because viruses change constantly and these genetic variations can lead to new variants, scientists are working to decode the genes, in a process called sequencing, to learn more about the differences in the variants. With that in mind, how important do you think it is for us as a state or country to begin sequencing as many samples as possible or should that be left to other bigger entities?

A. Good question. Right now, we are sending any post-fully-vaccinated, COVID-positive samples to the South Carolina Department of Health and Environmental Control for sequencing. MUSC Health also has the capability to do some sequencing. That is in addition to the random sampling that DHEC is doing weekly. Right now, it’s a race between the vaccine and the variants. We need to focus on getting the vaccine to the finish line first.

Q. Speaking of variants, are any scarier than the others? How are they different?

A. B.1.351 – the South African variant – appears to render the Pfizer vaccine less effective, so that’s a little alarming. But the fact that none of these have been proven to render vaccines completely ineffective is what really matters to me. When it comes to variants, I’m less concerned with transmissibility and more focused on whether vaccines still prevent severe disease and deaths from COVID variants. 

Q. Have you heard of any people who were vaccinated getting COVID?

A. I can’t speak to the broader population, but just amongst our MUSC Health team members, we’ve had seven of our own who were fully vaccinated and got COVID, though none got really sick. That said, I think it’s important to remember that just because we have the vaccine doesn’t mean we can’t get infected; but there is good evidence that we likely won’t get a severe infection or die from COVID after being fully vaccinated. 

Q. President Biden is saying that by the end of May there will be enough vaccine for all U.S. adults (but it will take longer to administer all those doses). If that’s the case, what sort of dose deliveries per week would that mean? And could we handle that?

A. I think we’ve had enough time to get enough organizations that are willing and able to vaccinate up to speed that I can’t imagine us as a state getting overwhelmed. In particular the pharmacies. They have been pumping out such a tremendous volume. Which makes sense, since most Americans live within a couple of miles of at least one pharmacy.

Q. The European Union is now toying with the idea of the “Green Pass,” like we discussed with Israel, where vaccinated people get special privileges. Do you think we’re headed there any time soon?

A. I do. In some ways, I think it’s already started. For instance, a friend of mine has been trying to volunteer for an organization, and they said they weren’t accepting new volunteers, but when she told them she was totally vaccinated, they changed their tune and signed her up. So it’s coming. The question that remains is how it will be addressed, specifically. 

Q. Speaking of special privileges, how do you handle people who have had COVID? Shouldn’t they be treated similarly to vaccinated folks? And how do we as a nation verify that status in a way that mirrors a vaccination card?

A. Right now, the CDC is saying anybody who is 14 days post-symptoms of a confirmed case of COVID is considered “immune” for 90 days. So, for instance, to fly internationally, you have to show you’re either vaccinated or had a negative COVID test in the past three days. Maybe they’ll start to include those with a former positive test and a negative test in that window – more than 14 days but less than 90. It’s tricky, but I think we can come up with a way to cover those people.

Q. Any updates on Moderna or J&J? Are we getting any of either?

A. In reference to Johnson & Johnson, the only thing I know is the state got a bulk shipment of 41,000 doses and is in the process of sending those to small independent pharmacies. So for now, MUSC Health probably won’t see any of it. As for Moderna, they have been doling out doses with a focus on counties in greater need, so occasionally we get some doses of Moderna, but they are specifically targeted to given in certain counties. 

Q. Will we be making any changes to where we offer the vaccine or the scale of the operation?

A. Assuming that, finally, we do start to see an uptick in the number of doses we receive in the coming weeks, I expect we’ll do more rural community pop-up events. Of course, we’ll still have the fixed sites. But some of them might be rolled into others or moved altogether. For instance, we secured the old Department of Motor Vehicles building on Lockwood Boulevard, and we are slated to start vaccinating there on March 15. So we’ll probably consolidate some of the fixed sites to there. And we have another site, the Verizon building in North Charleston – that one was ours already. Originally, when we took ownership of it, pre-pandemic, it was going to be a workspace for off-campus workers, but soon it’s going to be another vaccine site.

Q. The Johnson & Johnson vaccine uses something called a viral vector to get the job done versus messenger RNA in Pfizer and Moderna. Is one way better than the other? Why do they only need one dose? I hear side effects aren’t as likely because it’s a one-dose vaccine. 

A. Yeah, one isn’t better than the other. It just boils down to the fact that there’s more than one way to skin a cat. The method of how it gets into the body doesn’t really matter. As for why it’s one dose, that’s just the way they studied it. Pfizer and Moderna split theirs into two doses. Because all these manufacturers are administering and studying them differently, it’s really comparing apples to oranges. All these vaccines could all work just as well as the other; and we know they are all extremely effective at preventing severe disease and deaths. As for why you don’t get as sick with the Johnson & Johnson vaccine, it’s the same reason most people don’t show major symptoms after the first dose of the others. It’s because the body hasn’t had a chance to build up a defense yet. 

Q. Do you think we should be able to mandate that everyone in the country gets vaccinated?

A. That’s so tricky. I don’t really know how I feel about that. But I will say a couple of things: No one – not even the countries that mandate getting vaccinated – has enforced those rules. Second, yes, these vaccines are amazing, but they’re still here through emergency use authorization, so they haven’t been reviewed as rigorously as vaccines of old. So I think we need to know more before we start saying people have to get them. But as for us at MUSC Health, I think we as a health care provider – specifically, the ones who are in contact with our patients – we owe it to our patients to get vaccinated. People look to us to guide what they’re going to do. If they see some of us who are not getting the vaccine, how can we hold them to a different standard? 

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line “Vaccine Q.”