OU Chief COVID Officer Dr. Dale Bratzler discussed the rare blood-clotting disorder some have experienced after receiving the Johnson & Johnson vaccine, as well as vaccine hesitancy, in a Thursday livestream.
Bratzler explained the Johnson & Johnson vaccine, a viral vector vaccine, uses the same technology as the AstraZeneca vaccine, which has been distributed across Europe. The use of AstraZeneca vaccine has also been put on hold for the same reason, but “it’s not completely clear” why both vaccines have been causing blood clots, Bratzler said.
“There are some very good articles from researchers, particularly about the AstraZeneca vaccine, that show that some aspect of the vaccination — whether it's the viral vector, the DNA within the virus (or) the immune response you get from the vaccines — activates your (blood) platelets,” Bratzler said. “(The platelets) are responsible for blood clotting, and they typically don't stick together and don't clot, but something about getting these vaccines seems to activate those platelets (which) come together.”
Bratzler said the platelets of the patients who showed blood clots appear to have been “consumed,” ending up with clots and low platelet counts.
“We don't know the reason for that. It's very rare, less than one person out of a million doses of vaccine have had these reactions in the United States, but I completely understand why FDA and CDC decided to take the time to study the cases very carefully, and to see what is happening,” Bratzler said.
Acknowledging some may be hesitant to vaccinate following the stoppage of Johnson & Johnson doses, Bratzler encouraged those who still have not been vaccinated to get either the Pfizer or the Moderna vaccines.
Bratzler said the rate of breakthrough infections from the vaccines is very low and emphasized “no vaccine is perfect.” He said the breakthrough cases that are occurring are predominantly caused by the UK variant.
“Just remember that although the UK variant spreads easier, it doesn't seem to cause more severe disease,” Bratzler said. “But the problem is if somebody's not vaccinated, they're more likely to get infected. And again, these vaccines simply are not 100 percent perfect, and you could get infected with any COVID strain that happens to be circulating in the population.”
It is important that individuals continue to wear masks because the vaccines don’t protect from COVID-19 completely, Bratzler said. There are populations of people, specifically immunocompromised patients, in which the vaccines “aren't going to work as well.”
“When the companies did the studies that showed that these vaccines were 94 to 95 percent, effective, they typically did not enroll immunosuppressed patients, patients with cancer who are on chemotherapy or others who may not respond to the vaccines very well,” Bratzler said. “Once again, just remember (that) whether it's in your family or in your community, there are going to be people who have cancer, who are immunosuppressed who may have been fully vaccinated, but they're not going to be nearly as well protected as others.”
Though COVID-19 cases have remained relatively low in Oklahoma, with 302 new cases reported by the Oklahoma State Department of Health on April 15 and a plateau in hospitalizations, Bratzler emphasized the pandemic is not completely ended as the state positivity rate has gone up slightly.
Although experts are still unsure, Bratzler said there’s a possibility COVID-19 will be seasonal.
He explained the drop in the number of cases over the past couple of months may be due to seasonal characteristics of the virus. He said a lot of people, including the Institute for Health Metrics and Evaluation, have suggested the number of cases in the fall and winter might increase, leading to a possible outbreak.
It is very likely COVID-19 will still remain endemic, which means there will be periodic isolated cases and outbreaks, Bratzler said.
Higher numbers of vaccinations could save money through eliminating the need to treat as many COVID-19 patients, Bratzler said. According to a study by the Kaiser Family Foundation which analyzed whether the cost of healthcare will go up if a large amount of people are not vaccinated. According to the study, the cost of treating uninsured COVID-19 patients would range from $13.9 to $41.8 billion.
Bratzler said assessing whether the U.S. is close to reaching herd immunity is a “complex” issue. He also said the protection people get after contracting and recovering from COVID-19 may not be as strong as the protection they will receive from the vaccine.
“There's reasons for that, but the vaccine causes you to explicitly develop antibodies against spike protein, which is how this virus spreads from one person to another, and how it attaches to your body, so it appears to be much more effective at generating immunity,” Bratzler said.
He added the protection acquired by individuals who have gotten infected with COVID-19 and developed natural immunity may not be as effective as the protection provided by the vaccine.
“So I don't think we're (at) herd immunity yet,” Bratzler said. “Our epidemiologic models that have been developed by Dr. Wendelboe suggests that by summertime — maybe late summer — we may be approaching herd immunity in Oklahoma, but again, that assumes that the immunity from previous infection holds up, and right now the studies are suggesting that maybe that immunity isn't quite as good as being vaccinated.”
Bratzler emphasized the importance of getting vaccinated and continuing to wear masks in order to protect immunocompromised individuals. Amid disagreements on mask mandates and the spread of misinformation during the pandemic, he said he believes the vaccinations have served as a form of unity.
“I think our system has given more than 50,000 doses now, and it's been remarkable to watch the people that come in to get the vaccine so happy to finally be able to get the vaccine and take some of that weight off of them that they can be around family, children, grandparents, things like that,” Bratzler said. “So, I think that has been something that's brought a lot of us together. It's been fun working in these multi-group events where you bring community partners together and healthcare workers to deliver the vaccine ... I think that's been uplifting for a lot of us. We just can't slow down yet. We need to get the vaccine out more.”