PUBLIC HEALTH & THE PANDEMIC-It is extremely important to me that those who can be safely vaccinated for COVID-19 be vaccinated.
I have been wanting to write this article for some time, but since the recent “pause” on the Johnson and Johnson vaccine, I decided to wait until the FDA and the CDC had resumed the use of this vaccine.
“FDA and CDC Lift Recommended Pause on Johnson & Johnson (Janssen) COVID-19 Vaccine Use Following Thorough Safety Review”: FDA and CDC Lift Recommended Pause on Johnson & Johnson (Janssen) COVID-19 Vaccine Use Following Thorough Safety Review | FDA
When COVID-19 vaccinations began, health care workers and others in the highest risk categories were being encouraged to take the Pfizer vaccine. Shortly thereafter, a second vaccine of the same type, an mRNA vaccine, the Moderna vaccine was released.
“Understanding mRNA COVID-19 Vaccines”: Understanding mRNA COVID-19 Vaccines | CDC
As these two vaccines were being released, I was learning about a clinical trial for the AstraZeneca vaccine at USC / Keck School of Medicine: “Keck Medicine of USC enrolling volunteers for Phase 3 clinical trial for COVID-19 vaccine”: Keck Medicine of USC enrolling volunteers for Phase 3 clinical trial for COVID-19 vaccine | HSC News
Also in the pipeline, I was reading about clinical trials at The City of Hope:” City of Hope opens clinical trial for coronavirus vaccine”: City of Hope Opens Clinical Trial for Coronavirus Vaccine | City of Hope | California
While this was all going on we also learned that Johnson and Johnson was also making a vaccine. From the media, I learned that the AstraZeneca and the Johnson and Johnson vaccines are what the CDC calls “Viral Vector COVID-19 Vaccines”: Understanding Viral Vector COVID-19 Vaccines | CDC
To me, the simplest thing to say about these two vaccines – the Johnson and Johnson vaccine which is currently approved in the United States, and the AstraZeneca which is not yet approved in the United States, is that these two vaccines were based on vaccines that had been used historically. To me, that meant they should potentially have fewer side effects than the newer mRNA vaccines.
While I fell into the over 65 category and as someone with pre-existing conditions that would make me more likely to be develop the more severe symptoms of COVID-19, I also fell into the category of the Immunocompromised.
COVID-19 Vaccines in the Immunocompromised
Back in December 2020, I had researched my pre-existing conditions on numerous websites. I want to thank the American Society of Hematology for making information available to me at that time regarding who is considered immunocompromised. This link is to their current update of that information:
“General Principles of COVID-19 Vaccines for Immunocompromised Patients”:ASH-ASTCT COVID-19 and Vaccines: Frequently Asked Questions - Hematology.org
“What SARS-CoV-2 vaccines are approved for use in immunocompromised patients?
Despite several vaccine candidates being in phase II/III clinical trials, no current clinical trial of a COVID-19 vaccine has published data on immunocompromised patients. Thus, the efficacy and safety of a SARS-CoV-2 vaccine has not been established in the different immunocompromised patient populations. There are no data that preferentially support one vaccine over another in this or any population.”
“Why might some hematology patients not respond to vaccines?
In order to generate optimal protective immunity following vaccination, intact host immunity is needed, particularly with respect to antigen presentation, B- and T-cell activation, and plasma B cell antibody generation. Therefore, hosts lacking functional adaptive immune cells may be unable to generate a fully protective immune response to a SARS-CoV-2 vaccine approved for use in the general population.
The following immunocompromised patient populations could have attenuated or absent response to SARS-CoV-2 vaccines:
Primary a. Primary and secondary immunodeficiencies involving adaptive immunity
Splenectomy or functional asplenia [e.g., sickle cell disease]
B cell directed therapies (e.g., blocking monoclonal antibodies against CD20 or CD22, bispecific agents like blinatumomab, CD19 or CD22-directed chimeric antigen receptor T cell [CAR-T] therapies, Bruton tyrosine kinase [BTK] inhibitors)
T-cell-directed therapies (e.g., calcineurin inhibitors, antithymocyte globulin, alemtuzumab)
Many chemotherapy regimens
High-dose corticosteroids (≥20 mg per dose or >2 mg/kg/day daily prednisone or equivalent)
Hematopoietic cell transplantation (HCT), especially within the first three to six months after autologous HCT and often longer after allogeneic HCT
Underlying aberrant immunity (e.g., graft-vs.-host disease, graft rejection, absent or incomplete immune reconstitution, neutropenia ANC <500/μL, lymphopenia ALC <200/μL)”
WHY IS THIS IMPORTANT?
As in the statement above, there may be groups of people that have pre-existing conditions that may prevent them from being vaccinated. Or if they are vaccinated, they may have what is called an attenuated (reduced) response or no response to the vaccine at all. For this reason, we need those who are healthy to be vaccinated for us to reach what our government is calling “herd immunity.” If the vast majority of not only Americans, but those around the world are not vaccinated for this virus, there is a greater risk of this virus mutating which we are seeing today.
What I want to bring to the attention of everyone is that we as Americans should have been given more of what is known as “Informed Consent” before being vaccinated. For example, we have heard that cases of COVID-19 are higher today in some countries more than others based upon vaccination rates.
But one thing that I think that is not being asked of those who are being vaccinated is their personal health histories.
Why are we not being given fact sheets like this one prior to being vaccinated?
“FACT SHEET FOR RECIPIENTS AND CAREGIVERS EMERGENCY USE AUTHORIZATION (EUA) OF THE JANSSEN COVID-19 VACCINE TO PREVENT CORONAVIRUS DISEASE 2019 (COVID-19) IN INDIVIDUALS 18 YEARS OF AGE AND OLDER”:
“WHAT SHOULD YOU MENTION TO YOUR VACCINATION PROVIDER BEFORE YOU GET THE JANSSEN COVID-19 VACCINE?
Tell the vaccination provider about all of your medical conditions, including if you:
have any allergies,
have a fever,
have a bleeding disorder or are on a blood thinner,
are immunocompromised or are on a medicine that affects your immune system,
are pregnant or plan to become pregnant,
have received another COVID-19 vaccine,
WHO SHOULD GET THE JANSSEN COVID-19 VACCINE?
FDA has authorized the emergency use of the Janssen COVID-19 Vaccine in individuals 18 years of age and older.
WHO SHOULD NOT GET THE JANSSEN COVID-19 VACCINE?
You should not get the Janssen COVID-19 Vaccine if you:
had a severe allergic reaction to any ingredient of this vaccine.”
A Really Big Concern to me
From the American Society of Hematology link above, they reference “functional asplenia” and sickle cell disease. Not being a physician, I was not aware that people with sickle cell disease have “functional asplenia.” This made me research the incidence of Sickle Cell Disease in the United States population.
“Data & Statistics on Sickle Cell Disease”: Data & Statistics on Sickle Cell Disease | CDC
“In the United States the exact number of people living with SCD in the U.S. is unknown. Working with partners, the CDC supports projects to learn about the number of people living with SCD to better understand how the disease impacts their health.
It is estimated that:
SCD affects approximately 100,000 Americans.
SCD occurs among about 1 out of every 365 Black or African-American births.
SCD occurs among about 1 out of every 16,300 Hispanic-American births.
About 1 in 13 Black or African-American babies is born with sickle cell trait (SCT).”
Demographics of Los Angeles County:
As we vaccinate those who are most at risk of serious illnesses which are often our minority communities, are we as a Nation giving these people an “Informed Consent” and asking them if they have Sickle Cell Disease or any of the other conditions listed above under the immunocompromised?
I chose the Johnson and Johnson vaccine because I had done my research. I am also one of the lucky ones who was able to consult not one but two physicians using the information above from the American Society of Hematology to guide my decision. But not everyone has access to medical care. This is why everyone who is assisting the residents of Los Angeles in getting vaccinated should have access to the fact sheets like the one I have linked above on the Johnson and Johnson vaccine.
My experience in getting vaccinated at Los Angeles Pierce College.
Los Angeles Pierce College map shows the Mason entrance at the top of the page. This parking lot – Parking lot 7 is just south of Victory Boulevard.
· I waited until the Johnson and Johnson vaccine was available at Pierce College.
· I used this link to find an available appointment:
· I was asked to create an account with Carbon Health.
· I set up an appointment for Pierce College which is within about 10 minutes of my home.
· The email that I received asked me not to arrive early.
· I entered from Victory to the Mason entrance shown in the above Google map screen shot.
· I arrived at Pierce College about 2:35 pm for a 2:50 pm appointment.
Sign directs traffic to the vaccination area at Pierce College’s COVID-19 testing and vaccination center in Woodland Hills on Feb. 16. Photo by Benjamin Hanson. From The Roundup (Pierce College)
· As I entered the Mason entrance, I could see that there were two lanes. The right lane was designated for those who were being tested for COVID-19.
· The left lane was designated with signs and a table at the first stop sign. I was asked if:
1) I had an appointment.
2) I could stand in line for 30 minutes.
3) Would I prefer to be vaccinated in my car!
Since my husband was driving me, and since I could see a line with a number of people, and due to my pre-existing conditions – I opted to be vaccinated in my car.
4) I was directed where to park to be vaccinated.
5) Within about 2 minutes someone was by my car window to get my name to check me in.
6) Within about another 2 minutes, there was a nurse at my car door!
7) By 2:46 p.m., I had been vaccinated!
8) We were asked to move to a handicapped parking area to wait for 15 minutes to see if I had a reaction. There were numerous vested and masked workers – staff or volunteers on this parking lot.
9) At 3:02 p.m., we started our car and headed for home.
My reaction to the Johnson and Johnson vaccine:
On the day of my vaccination, I felt fine for about the first 8 hours. I had no local reaction in my arm where I was vaccinated. I showered and I ate a normal dinner.
However, about 8 hours later, I did begin feeling quite chilled. I started to take my temperature, and it went over the course of about 3 hours to a peak of 100.7. I opted to take a small dose of medication to control my fever.
I stayed up most of the night to make sure that my fever did not go any higher. And I rested the next day.
It has now been more than two weeks since my vaccination. I am happy that I had the vaccine, and that I did not have any unusual side effects. I am hoping that my response indicates that I have built up some immunity to this virus.
I want everyone that CAN be safely vaccinated to be vaccinated to protect those who cannot be safely vaccinated. With the access we have to international travel today – for ourselves and for visitors to our country, we need to be vaccinated to protect all of us so that we are not all at risk for more surges.
Once again, I want to thank President Alexis Montevirgen (photo at top, left) for opening parking lot 7 to our community to be both tested and vaccinated for COVID-19.
I want to thank Councilmember Blumenfield (photo at top right) and any other elected officials who may have been involved with implementing this vaccine program at Pierce College.
I want to thank Carbon Health for handling our appointments.
I want to thank the nurses who vaccinated not only me but my husband at this location.
I want to thank the LAFD for their efforts in helping to vaccinate the City of Los Angeles.
I want to thank the Los Angeles County Sheriff’s Department that secures the Los Angeles Pierce College campus at all times.
And last, but not least, I want to thank anyone who has taken the time to volunteer at these vaccination sites or who has taken the time to assist anyone in getting vaccinated.
BE SAFE! WEAR A MASK!
(Chris Rowe is a 43-year resident of West Hills, California. She is a Public Health and Environmental Health Advocate. She was employed at Northridge Hospital, Tarzana Medical Center, and West Hills Hospital while in pursuit of her college degrees. She has a B.S. in Health Education from CSUN. Chris is a former member of the West Hills Neighborhood Council and she has served on committees of the Woodland Hills Warner Center Neighborhood Council. She has a blog on the USC / Annenburg School of Health Journalism site: Christine Rowe - Member | Center for Health Journalism Chris has written for the Daily News, OURLA.ORG, RonKayeLA.org, and for CityWatch.) She is also the editor of a series of children’s textbooks on animal life written by her husband Bruce M. Rowe – Emeritus Professor of Anthropology at Los Angeles Pierce College. These books are written to educate the youth of our world about the need to protect all animals and to protect their habitats. Photos: Benjamin Hanson. Edited for CityWatch by Linda Abrams.