May 17, 2021

What You Need to Know About COVID-19 Vaccines

By Maddie Lionberger, RLS Foundation Research Coordinator

In March of 2021 the world passed the one-year mark since the coronavirus pandemic was declared a Public Health Emergency of International Concern by the World Health Organization. As of May 17, nearly 34 million cases have been confirmed, with over 600,000 deaths attributed to COVID-19 in the United States alone. Amid the devastation and tragedy, communities and organizations have pulled together in unprecedented ways to overcome the challenges of the pandemic – the development of COVID-19 vaccines is an extraordinary example. Thanks to the concerted efforts of the medical science community, the world has gone from identifying a novel coronavirus to developing safe and effective vaccines in less than 12 months. To add perspective, in the past the fastest vaccine to go from development to deployment took about four years. Unfortunately, misinformation has created a lack of confidence in scientific evidence regarding COVID-19 and about the vaccines designed to fight it.

If you’re on the fence about getting vaccinated, it is important to recognize that anyone of any age can experience severe illness and even death if they contract COVID-19, and certain factors put some groups at greater risk than others. Because people who are age 65 and older are at a higher risk of severe illness from COVID-19, and restless legs syndrome (RLS) is significantly more common among older individuals, it is important for members of the RLS community to review the most up-to-date facts about COVID-19 and vaccines.

The Basics of COVID-19

COVID-19 is caused by coronavirus 2 (SARS-CoV-2). It is predominantly a respiratory illness, but it can also affect other organs. People with COVID-19 experience a wide range of symptoms from mild to severe, including fever, chills, loss of taste or smell, cough, shortness of breath, fatigue, muscle or body aches, headache, sore throat, congestion, runny nose and diarrhea. The incubation period for COVID-19 is estimated to be up to 14 days, with symptoms appearing on average four to five days after exposure. COVID-19 spreads from person to person mainly through the respiratory route; the closer people interact and the longer they interact, the more likely they are to transmit the virus, even if they are not showing symptoms. In a study with a large cohort of 44,000 people with COVID-19, 81% of individuals exhibited mild to moderate symptoms, 14% developed severe symptoms and 5% were reported to be in critical condition. According to the Johns Hopkins Coronavirus Resource Center, the United States is experiencing a 1.8% observed case-fatality ratio, which means the number of deaths for every 100 confirmed cases (almost two deaths per 100 persons infected).

Yet, despite the grim numbers, things appear to be looking up. In mid- February, the director of the Centers for Disease Control and Prevention, Rochelle Walensky, MD, PhD, reported that COVID-19 cases in the US had been in decline for five consecutive weeks. Furthermore, new hospitalizations have consistently gone down since early January. The downward trend is multifactorial, resulting from a combination of behavior changes (masking, social distancing and restricted travel), seasonality, past infections, and vaccinations. To date, three vaccines have been issued Emergency Use Authorization by the US Food and Drug Administration for the prevention of COVID-19. However, the speed at which these vaccines were developed has raised questions in many people’s minds about how they work and how effective they are.

How the Vaccines Work

First, to understand how vaccines work, it helps to look at how the human body fights disease. When pathogens invade the body, the immune system deploys several tools to fight them. Specialized white blood cells recognize foreign substances (antigens) as dangerous and launch an attack on infected cells. Meanwhile, the immune system produces antibodies that allow the body to remember the antigens specific to that disease. Vaccines work by injecting a weakened or inactive virus that triggers an immune response and allows the body to build up a disease-specific memory, so that it’s ready to fight should an infection occur.

The most basic difference among the three vaccines available for COVID-19 has to do with how the vaccine prompts the body to launch an immune response. The Moderna and Pfizer-BioNTech vaccines are both mRNA vaccines, which means that they contain strands of genetic material, called mRNA, that give cells instructions on how to make a harmless version of the protein (the “spike protein”) that is unique to SARS-CoV-2. The immune system recognizes the protein as foreign and builds a defense to fight the antigen specific to COVID- 19. The Johnson & Johnson (J&J) Janssen vaccine is a viral vector vaccine. Instead of using mRNA to provide cells with instructions on how to make the spike protein, vector vaccines contain a harmless adenovirus inserted with DNA genetic material specific to COVID- 19. The DNA then produces mRNA, which causes the same immune response as the Moderna and Pfizer-BioNTech vaccines. Because none of the COVID-19 vaccines contains the live (either weakened or inactivated) virus that causes COVID-19, none of the vaccines can make you sick with COVID-19.

All the vaccines that have received Emergency Use Authorization have been carefully evaluated in clinical trials to ensure that they are safe and effective. The Pfizer and Moderna vaccines have shown astonishing degrees of effectiveness (95% and 94.1%, respectively) in preventing symptomatic COVID-19 infection after two doses of vaccine. The Pfizer and Moderna vaccines require two doses (21 and 28 days after the first shot, respectively). The second dose of the same vaccine is important to ensure that you get robust, long-term protection from COVID-19 soreness at the site of the injection, swelling, body aches, fever, chills, tiredness or headache. Such side effects are normal; they are a sign that your body is building up protection. They are not a sign of infection from COVID-19. Comparing the efficacy of the Pfizer and Moderna vaccines to the efficacy of the J&J vaccine is challenging because of differences in the timing of the trials (the J&J vaccine had to face the more virulent African and British strains, which were not present during the earlier Pfizer and Moderna trials). Overall, across eight countries, the J&J vaccine was shown to be 66% protective (72% in the US) against moderate to severe disease, and 85% effective in protecting against severe disease after a period of at least 28 days.

Another distinction of the J&J vaccine is that it requires only one dose, which has significant public health implications in terms of vaccine distribution. What’s more, the J&J vaccine proved to be 64% effective against moderate to severe or critical disease in South Africa, where coronavirus variants have raised concerns.

COVID-19 Variants

To date, three notable variants of COVID-19 have been documented in the United States and globally: B.1.1.7, B.1.351 and P.1. Virus variants emerge when one or more mutations occur, differentiating the new virus from the wild-type (the term in genetics referring to the typical or predominant form). Mutations can have different characteristics. For instance, these three variants of COVID-19 share a specific mutation that gives them the ability to spread more quickly. It is not surprising that variants have developed, because viruses are constantly evolving; however, the development of variants underscores the importance of keeping up measures that stop the spread of infection and getting the majority of the population vaccinated before more virulent mutations can occur.

Protecting Yourself and Your Loved Ones

As demand for the vaccines has skyrocketed, it has proven difficult for many people to be vaccinated as soon as they would wish, in part because distribution differs from state to state. Many resources are available to help people find vaccine appointments. For example, National Public Radio created a tool in which you can search by your state to find step-by-step instructions as well as tips for signing up and receiving the vaccine. See below for links to this and other resources. In addition to protecting individuals, the goal of wide-spread vaccination is to achieve “herd immunity,” which only happens when enough people in a community are protected because they’ve already had the disease or because they’ve been vaccinated against it. Pass along the helpful, science-based information to your family, friends and neighbors as well. In the meantime, while waiting for your vaccination(s), you can work to stop the spread of COVID-19 by taking four simple actions: 1) Wear a mask, 2) wash your hands, 3) stay at least six feet away from others who don’t live with you, and 4) avoid crowds.

More Information

For the most up-to-date information on COVID-19, visit:

• https://www.cdc.gov/coronavirus
• https://www.npr.org/sections/health- shots/2021/02/18/967448680/how-to-sign-up-for-a-covid-19-vaccine- in-your-state
• https://www.cdc.gov/vaccines/covid-19/reporting/vaccinefinder.html