Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.
Can you take a pain reliever to help mitigate any side effects from your COVID-19 vaccination? The studies on this question boil down to this: Don’t take a pain reliever like Tylenol after you get your vaccination if you don’t have to.
Until now, there has been a real question about whether you should take a pain reliever after you get a COVID-19 shot. You know by now that you might feel a little lousy with headaches and general aches for a day or two afterward while the vaccine does what it is supposed to do and develops a reaction that will protect you.
The Centers for Disease Control and Prevention and the World Health Organization advise you to not use pain relievers before you get the shot. If you have severe symptoms, then over-the-counter pain relievers can be used for relief. But the CDC advises you to talk with your doctor before using pain relievers after a vaccination. It is especially true if you take aspirin for heart disease.
A study done by Yale researchers that was published in the peer-reviewed Journal of Virology says nonsteroidal anti-inflammatory drugs, commonly known as NSAIDs, can reduce the production of antibodies and make your vaccination less effective. The study found that you should not take NSAIDs before or after you get the vaccine. But as Gothamist notes, “the research only looked at immune responses in mice and human cells growing in petri dishes.”
There is also a 2016 study looking at how anti-inflammatory drugs can inhibit the immune response. But that study, like others, does not definitively answer questions about this virus.
It might be useful to know why you are feeling discomfort after a shot. Generally, the soreness in your arm is from having a shot injected into your muscle. It is not so much from the tiny needle going through your skin. But when your symptoms feel like a mild case of the flu or a cold, that’s from the vaccine mimicking a virus that is invading your body. Your body is responding with an antibody counterattack.
Because COVID-19 is such a new virus, there will have to be more studies on this issue to give you a certain recommendation. For now, the prudent recommendation is to avoid pain relievers before you get your shot for sure, and after you get your shot if you can live without it.
If you are a person who generally has a strong reaction to vaccines, talk with your physician before taking the shot.
The GOP’s offer on a stimulus bill would cut out anybody who makes more than $50k
Over the weekend, Senate Republicans outlined their idea for a COVID-19 relief plan. It is way less than President Joe Biden is pitching.
The president proposed a $1.9 trillion package, and Republicans are thinking maybe $600 billion — about a third as much. (Who would have thought a year ago that we would be discussing a $600 billion bailout for anybody and wonder if it would be enough?) Both plans include money for testing, schools and supplies of personal protective equipment.
But a big difference that your audiences will care about is whether there will be a third stimulus payment coming their way. The Republican plan would stipulate that any stimulus payments not go to Americans earning more than $50,000 a year or to families with a combined income exceeding $100,000.
As a practical matter, it takes 60 votes to pass a bill like this in the Senate. If all 50 Democrats and the 10 senators who signed the letter this weekend offering this scaled-down stimulus vote for it, that would be enough. But cutting back the bill this far could cost some Democratic support, so it is fair to say there is a lot of work to be done before this goes forward.
Why journalists need to cover the new three-month ACA signup
In a couple of weeks, on Feb. 15, the insurance marketplace that covers 36 states will open for three months in an effort to get health insurance to the millions who lost coverage during the Trump administration and, more importantly, lost coverage when they lost their jobs in this pandemic.
President Biden’s flurry of executive orders may leave you a little dizzy because there are so many and because each one speaks to something important and complicated, from health care to climate change to the pandemic and civil rights. The executive order that he signed that establishes a special three-month signup for the Affordable Care Act needs your attention and coverage. Why? Starting his first year in office, President Donald Trump made it more difficult to learn how and when to sign up for ACA coverage. The percentage of Americans without insurance rose every year he was in office and now, with so many Americans out of work, the number will without a doubt be higher.
The ACA signup is usually in the fall. In most states, the open enrollment period for 2021 marketplace coverage ended on Dec. 15, 2020. The Biden administration says it will try to reach out-of-work Americans who lost coverage.
The Kaiser Family Foundation says about four million Americans who do not have insurance will be able to get coverage during this signup at no cost. 11 million more will be eligible for coverage.
Nationally, certain groups are overrepresented among the uninsured who are marketplace eligible. Kaiser lists who will likely benefit most from the special re-opening of ACA signups:
- 29% are Hispanic.
- 53% have a high school diploma or less.
- 38% are young adults.
Kaiser says 4 million uninsured people could get a free bronze plan (with a $0 premium payment, after accounting for subsidies). Nearly two thirds (62%) of the uninsured eligible for a free bronze plan have household incomes between 100-200% of the poverty level, making them eligible for significantly lower deductibles if they purchase a silver plan instead of getting a free bronze plan.
Here is an idea of where the most people who would benefit from signing up live:
In addition, Kaiser says:
4.9 million uninsured people could purchase Marketplace coverage for a reduced premium, partially covered by a subsidy. Although subsidies for this group do not cover the full premium, they may significantly lower the premium and/or out-of-pocket liability. (Kaiser notes that some people in this group may still find Marketplace coverage unaffordable or unattractive due to high deductibles.)
6.0 million uninsured people are eligible to buy Marketplace plans but are ineligible for financial assistance. Of this group, 2.6 million (43%) have incomes that would qualify them for a subsidy, but their unsubsidized premium is not high enough to merit financial assistance under the current ACA subsidy structure. The remaining 3.4 million (57%) people in this group are ineligible for subsidies because their income exceeds 400% of poverty.
Kaiser notes that people in this final group are often priced out of coverage under the ACA’s current subsidy structure.
Kaiser Family Foundation Vice President Cynthia Cox said, “The four million people who could be getting free coverage who are instead uninsured — that, to me, is just screaming out for outreach.”
Politico reports that “California and Washington state are also planning to reopen enrollment in their state-run marketplaces, and Biden officials expect the other dozen-plus states overseeing enrollment will likely reopen for business.”
Opening a special 120-day springtime ACA Marketplace signup could not be more opposite than the Trump administration’s efforts to shorten and not publicize recent ACA signups.
HealthCare.gov’s advertising budget dropped 90% under Trump. The Biden ACA signup campaign will spend about $50 million on publicity, so you may see this in commercials and social media messages. Last year, Kaiser surveys showed millions of Americans needed help finding a plan and could not find it. Some brokers who were supposed to help customers find ACA coverage tried to sell noncompliant policies, meaning policies that did not cover all of the things the ACA requires.
The timing of this special signup is something that ACA advocates have been asking for: to open the marketplaces at just about the same time people are filing their tax returns and may have refunds that could pay for health care coverage.
Moderna wants to put more vaccine in each vial
Over the weekend, Moderna laid plans to ask the Food and Drug Administration to allow it to put more vaccine in each vial to speed up the vaccination process. Moderna puts 10 doses in each vial now and would like to squeeze in 15. Think of it this way: They would be getting a 50% increase in doses with the same amount of work to ship, deliver and store them.
The manufacturing term for this part of the process is “fill/finish,” which refers to the process of filling vials with vaccine and finishing the process of packaging the medicine for distribution. In the future, drug companies may turn this process over to third-party companies that can get the job done faster.
The J&J vaccine heads toward approval — with both hope and concern
Probably this week, Johnson & Johnson will apply for FDA approval for its COVID-19 vaccine. This is a one-dose vaccine that does not require the extreme cold of the Pfizer vaccine. But, as we learned in the last couple of days, Johnson & Johnson says its drug has a 72% efficacy rate. And, more concerning, that efficacy drops to about 57% when protecting against the South African variant of the virus.
We have to put this in context. When the search for a vaccine began just a year ago, the FDA would have been satisfied with a vaccine that was as effective as the Johnson & Johnson drug. Moderna and Pfizer’s vaccines conditioned us to efficacy rates above 90%. By comparison, the annual flu vaccine is considered to be 40 to 60% effective in preventing infection.
And — and this is important — Johnson & Johnson says its vaccine is 85% effective in preventing severe disease, regardless of what variant caused it. Again, by comparison, Moderna and Pfizer’s vaccines are considered to be nearly 100% effective in preventing severe COVID-19 illnesses.
A drug that is potentially less effective could raise some difficult choices about who gets which drug. You could imagine, for example, a push to use the lower efficacy drugs to vaccinate younger people, who are less likely to show symptoms if they get COVID-19. Once everyone gets some version of the vaccine, it could be that the messaging will be that people who got the Johnson & Johnson vaccine could come back and get a dose of one of the others to increase protection.
Johnson & Johnson is expected to be able to produce its vaccine very quickly. If the FDA approves it, it could also alleviate supply pressures and, since it is easier to store and only requires one shot, it could be ideal for people in rural and remote areas. Johnson & Johnson hopes to produce 100 million doses by the end of June. Importantly, the company says it can produce a jaw-dropping 1 billion doses per year. Keep in mind there won’t be a huge amount of the vaccine available until April, and that’s if the FDA approves it fairly quickly.
Again, the fact that it is a one-dose vaccine could be critically important in getting as many people fully vaccinated before the variants moving across the world arrive in the U.S. in larger numbers. It is a race not just against the virus we know, but against the variants we do not have much experience dealing with.
The fact that this Johnson & Johnson vaccine comes out after the coronavirus mutations began spreading adds some information that we do not have for the Moderna and Pfizer vaccines that came out pre-mutations (or at least before we knew much about their existence).
And deep in Johnson & Johnson’s announcement is the insight that the immune response seemed to improve over time, with no cases in the vaccinated group after day 49 post-injection. We will need to know more about how these vaccines all mature. Remember, they all spark an immune response in your body and some responses may get better over time, some not so much.
This is the kind of learn-on-the-fly experience we get when we rush to develop vaccines versus working on them for years. In this case, we don’t have the luxury of being able to work on them for years.
What about AstraZeneca?
There are still other vaccines in the pipeline. The Oxford-AstraZeneca vaccine just got European Union approval to be used on all adults. The approval is going much slower through U.S. channels as researchers here raised concerns about how the drug affects senior citizens. Only 7% of AstraZeneca’s drug trial participants were 65 years and older and American regulators worry that the sample was not big enough to produce the data they need to feel comfortable recommending it. German officials will only recommend the vaccine for persons under age 65 for now.
Why have some states and small counties been so much more efficient in vaccinating people?
A White House COVID-19 adviser called out some states that he said are doing a good job in getting vaccines to a greater percentage of their population. Andy Slavitt named Alaska, West Virginia, New Mexico, Connecticut, North Dakota, Oklahoma and South Dakota as states that have all vaccinated at least 10% of their populations.
You probably notice that all of these states have relatively small populations, and that helps in this effort, but another factor is that larger states have turned control over to underfunded county health departments that are now struggling. California, for example, is going to centralize its disjointed vaccine efforts in February.
West Virginia leads the country in the percentage of people being vaccinated. The governor says if his state could get enough doses of the vaccine, he could have the entire state vaccinated by Valentine’s Day. Gov. Jim Justice told CNBC, “We didn’t necessarily take the federal approach, we took a practical approach, and we took an all-in approach. We brought our National Guard, our local pharmacies, our local health care people, and our local health clinics and everything.” West Virginia also set up a system that notifies the next person on the waiting list when somebody does not show up for an appointment or if a pharmacist can get one more dose out of a vial.
“If they have 500 people scheduled for a location and only 400 people show up, we don’t want to waste another 100 doses,” (says Brian Toolan, senior director of digital platform Everbridge.) “So they have the ability to go right into the system and send out a message in a two-mile radius of that vaccine site, and say, ‘hey, we have an available dose for you right now if you’re able to come to this location in the next two hours’.”
The latest pandemic shortage: Grape-Nuts
Everything is complicated right now. The process of producing Grape-Nuts cereal was apparently too much for the pandemic supply line, so there is now a shortage that may not resolve for a month or two. Some heartless opportunists have jacked up the prices online.
Grape-Nuts is one of those divisive kinds of products that people love or hate. A big debate broke out a few months ago when a columnist asked for the best and worst cereals and Grape-Nuts made both lists. Alcohol was involved and a fight broke out.
For the record, Grape-Nuts are not made from grapes or nuts, but you try to come up with a name for rock hard barley and wheat nuggets and see if you can sell it for 134 years.
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Correction: Andy Slavitt is a White House COVID-19 adviser, not acting CDC director.