Moderna and Pfizer/BioNTech Ready to Test Out Their Vaccine Updates Against Covid-19 Variants

Illustration for article titled Moderna and Pfizer/BioNTech Ready to Test Out Their Vaccine Updates Against Covid-19 Variants

Photo: Hendrik Schmidt/Pool (Getty Images)

The arms race between the coronavirus and humanity continues to pick up steam. This week, Moderna announced that its modified vaccine meant to target a worrying variant first found in South Africa is now ready for testing. Pfizer/BioNTech is also set to test out their own contingency plan for new variants soon.

The variant discovered in South Africa last winter—known as B.1.351—has emerged as one of the most concerning to date. Like other recently discovered variants, such as B.1.1.7 (first found in the UK), B.1.351 is more transmissible than past strains of the virus. But B.1.351 has also shown more of an ability to evade a person’s immune response created by earlier infection or vaccination than other variants. Earlier this month, for instance, South Africa suspended its pending vaccination campaign with the Oxford/AstraZeneca vaccine, after early data suggested that it would only be minimally effective at preventing illness from B.1.351.


Moderna and Pfizer/BioNTech’s research so far has suggested that their vaccines will provide protection against B.1.351, but its effectiveness would likely be diminished. Out of an “abundance of caution,” Moderna announced last month that it would develop a version of their vaccine specifically tuned to B.1.351. On Wednesday, the company said that it has now shipped the new vaccine to the U.S. National Institutes of Health for testing in people.

Moderna initially plans to test out three different strategies against B.1.351. One study, already in progress, is testing whether a third booster dose of the original vaccine can improve a person’s immune response to the variant. The second will test a combination of the original and modified vaccine in a single booster dose. And the third will test the modified booster alone. They also hope to test whether the modified and/or combination vaccine can be effectively used as the primary vaccine series for people with no previous antibodies to the virus.

Not to be left out, Pfizer/BioNTech announced Thursday that they are starting their own clinical trial testing out a third booster dose with the original vaccine. They’re also in talks with federal regulators to have trials testing out their updated version approved as well.

The trials needed to vet these updated vaccines for public use won’t be anywhere near as large or lengthy as the ones that led to the original emergency use authorization for either mRNA vaccine. That’s because there’s plenty of data on the typical immune response created by the original vaccines from the large scale trials, so less work is needed to confirm the safety and effectiveness for any modified version. Additionally, researchers will be testing in the lab whether B.1.351 can evade neutralizing antibodies to the coronavirus collected from the blood of vaccinated volunteers.


Even before the emergence of these variants, scientists cautioned that any covid-19 vaccines we developed might need to be adjusted periodically, just to account for the evolution of the virus. Thankfully, the coronavirus doesn’t seem to mutate in relevant ways nearly as fast as the influenza virus, which requires a yearly-updated vaccine. So while it’s still important to keep ourselves as safe as possible from the pandemic for the time being, it’s also worth remembering that even these variants aren’t an insurmountable threat that we can’t do anything about.


Hopefully, we may not even need to rely on these modified vaccines for now, provided that daily new cases continue to drop sharply as more people get vaccinated.

What to Know About Johnson & Johnson’s One-Shot Covid-19 Vaccine

Illustration for article titled What to Know About Johnson & Johnson's One-Shot Covid-19 Vaccine

Photo: Luis Robayo/AFP (Getty Images)

The Food and Drug Administration is expected to soon grant an emergency use authorization (EUA) to Johnson & Johnson’s covid-19 vaccine, possibly as early as this weekend. That decision would make it the third such vaccine to become available to Americans. So it’s as good a time as any to go through the similarities and differences between J&J’s vaccine and the two already out from Moderna and Pfizer/BioNTech.

The most important similarity between all three is their high effectiveness at preventing life threatening illness from covid-19. In a FDA analysis of clinical trial data from around 40,000 volunteers released Wednesday, J&J’s vaccine was found to be 77% effective at preventing severe to critical illness 14 days after vaccination and 85% effective at preventing severe to critical illness 28 days later. Overall, it was deemed to be 66% effective at preventing moderate to severe illness 14 days or more out.


The topline numbers aren’t quite as impressive as what we saw from clinical trials of the mRNA vaccines developed by Moderna and Pfizer/BioNTech, both of which are upwards of 90% effective at preventing any symptoms. But the most crucial goal of any vaccine should be to keep people alive and free from serious complications of its target illness—a goal that J&J’s version seems to accomplish very well. In the clinical trials, there were no covid-related hospitalizations or deaths seen in vaccinated people after 28 days. It’s likely that none of these vaccines will be 100% effective at preventing hospitalizations or deaths, but they will all greatly reduce the chances of it happening.

The J&J vaccine does have its own clear advantages. Namely, it’s only one shot, unlike the two-dose schedule over a month recommended for either mRNA vaccine. There is ongoing research testing whether a second shot, taken two months later, could boost its effectiveness. But for now, it’s the one-shot version that people will first get access to, assuming it’s authorized by the FDA. It’s also more stable and durable at warmer temperatures, meaning it can be stored in a typical fridge for longer and without the immediate worry of spoilage once taken out. (That said, Moderna and even Pfizer’s vaccine don’t seem to need ultra-cold storage as originally thought.)

If you’re worried about the novelty of the mRNA technology behind the other vaccines (which, to be clear, is actually three decades old), the J&J vaccine might make you feel more comfortable due to its familiarity. It works by using a neutered adenovirus (meaning it can’t make more of itself like normal) to carry the DNA for the coronavirus spike protein, the key the virus uses to invade cells. The dummy virus gets inside a cell and prompts the body to marshal an immune response specific to the spike protein—one that should train it against the real thing.


The use of viral vectors as a delivery system in medicine is older than the mRNA method and comes with a longer track record of safety. Though, like the mRNA vaccines, this would be the first adenovirus-based vaccine to see wide use. Adenovirus vaccines do have their potential limitations, such as preexisting immunity to the virus used that could weaken vaccine effectiveness. In the case of the J&J vaccine, it’s using a type of adenovirus that less commonly infects people, which is meant to work around those limitations. And because it was tested in different parts of the world, with similar success, that should relieve concerns that its effectiveness will wildly vary from country to country.

The J&J vaccine may slightly win out when it comes to potential side effects too. The most common adverse events linked to the vaccine were injection site pain (48.6%), headache (38.9%), fatigue (38.2%), and myalgia (33.2%). By contrast, more than 84% of people given the Pfizer/BioNTech vaccine experienced soreness around the injection site after the first or second shot, and 60% experienced fatigue. Potentially severe adverse events were rare for the J&J vaccine, and there was no difference in frequency between people given the vaccine or placebo, after accounting for potential covid-19 symptoms (0.4% in each group), which should further indicate its safety.


As with other vaccines, people under the age of 60 were more likely to experience any symptoms at all, which is probably because of a stronger upfront immune response. There was a possible but still rare risk of allergic reaction to the vaccine, but only five patients in the study who received the vaccine had any reaction shortly after the shot and none experienced a severe reaction that’s known as anaphylaxis. (One patient in the placebo group had a reaction.)

In its review, the FDA stated that more data would have to be collected before it’s clear whether allergic reaction is a real risk from the vaccine. But otherwise, it endorsed the vaccine as safe and effective, stating that their analysis “supported a favorable safety profile with no specific safety concerns identified that would preclude issuance of an EUA.”


Another consideration is that J&J’s vaccine was tested in the U.S., South America, and South Africa, during a time when important new variants of the coronavirus have started to turn up. The data suggests that the vaccine should still provide good, if slightly diminished, protection against the variant first found in South Africa, likely the most worrying variant of them all. And it may also offer some protection against asymptomatic infections, which is a great sign that it will cut down on transmission.


On Thursday, the FDA’s Vaccines and Related Biological Products Advisory Committee will meet to discuss the trial data and provide their recommendation for an emergency use authorization or not. And should things go as expected, the FDA will authorize it soon after. Once authorized, J&J has said they’ll be ready to ship almost 4 million doses immediately. By the end of March, it’s said it will have 20 million doses available—a timeline similar to Moderna/Pfizer’s early planned distribution. By then, all three companies have pledged to make 240 million more doses in total available to the public. Currently, 1.4 million Americans on average a day are being vaccinated.

In short, the road to mass vaccination is likely to get less bumpy over time, especially if other candidates enter the picture later this year as expected. And you shouldn’t worry too much about which specific vaccine to get when you’re finally eligible, since they’ll all protect you from the worst covid-19 can do (though J&J’s vaccine might be the most convenient for some). More importantly, they’ll all help end this pandemic as soon as possible.


Covid-19 Survivors Have a Low Risk of Reinfection, Study Suggests

Illustration for article titled Covid-19 Survivors Have a Low Risk of Reinfection, Study Suggests

Photo: Simon Dawson (Getty Images)

New government-funded research this week should offer some comfort to people who have survived covid-19. It suggests they have a low risk of reinfection from the coronavirus, at least around three months later.

Researchers at the National Cancer Institute teamed up with commercial testing labs and two healthcare data collection companies for this study, published Wednesday in JAMA Internal Medicine.

They analyzed de-identified data from more than 3 million Americans who had gotten a commercial antibody test for SARS-CoV-2, the coronavirus that causes covid-19, sometime between January to August 2020. Antibody tests, while not perfect, indicate whether someone has had a prior recent infection. These people were divided into those who had antibodies and those who didn’t, based on testing. Then the researchers looked at how many people in both groups later got a PCR test for covid-19, which is meant to diagnose an active infection.


About 10% of people in each group went on to get a PCR test. More people with antibodies tested positive for the virus within the first 30 days after their antibody test than those without antibodies. But that’s not surprising, since detectable traces of the virus can remain in the body for months, even after symptoms have passed and the person is no longer infectious. So it’s likely these positive PCR results were usually picking up the first infection. When the researchers looked specifically at the positive test rate after the first month and especially more than 90 days later—enough time for a positive PCR test to likely indicate a true reinfection—the results were encouragingly different.

After three months or longer, only 0.3% of people with an earlier positive antibody test tested positive for the coronavirus again, compared to 3% of those with a negative antibody test. In other words, having a past infection was linked to a much lower risk of infection three or more months later.

“People who have recovered from covid-19 should be reassured that being antibody-positive is associated with some protection against a new infection,” study author Douglas Lowy, the principal deputy director of the NCI, said in an email.


The findings do come with their limitations, though. For one, they can’t tell us exactly how much protection a past infection will provide against reinfection, or how long it’s expected to last (though other research has suggested that it may be years). Another factor this study can’t account for is the recent emergence of coronavirus variants. Some—like the one first identified in South Africa last year—are thought to raise the risk of reinfection, since they may be able to partly evade the immune response created by an earlier infection or vaccination.

Still, there’s no research showing that any currently spreading variants can completely evade someone’s natural or vaccine-provided immunity. Our immune system has plenty of weapons against a familiar germ, and it’s likely that most reinfections will turn out to be milder than the first time.


Even before these new variants were around, though, there had been documented cases of reinfection, including cases where symptoms were worse the second go-around. And the new study’s findings still suggest that reinfection does happen, if rarely. So no one should assume they’re impervious to covid-19 just because they survived an earlier infection with no problem. Ultimately, the best way to keep everyone safe from covid-19 is to vaccinate as many people as possible, including those who have already had the viral illness, according to Lowy. It’s a remedy that involves a lot less risk than getting a natural infection.


“People who have recovered from covid-19 should still plan to be vaccinated when they have the opportunity,” he said.

The NCI plans to continue funding research that will track the prevalence of reinfection in the general public, along with studies that will look at how our immune response to the virus may change over time and against new variants.


A Woman’s Tragic Covid-19 Death Traced to Tainted Donated Lungs, Report Finds

Illustration for article titled A Woman's Tragic Covid-19 Death Traced to Tainted Donated Lungs, Report Finds

Photo: Christopher Furlong/ (Getty Images)

Doctors say that a Michigan woman’s untimely death last fall was caused by covid-19 unknowingly spread through a double lung transplant. It’s likely the first clear case of covid-19 linked to transplantation. Another doctor contracted the viral illness through the procedure, but survived.

The woman’s tragic case was detailed in a report published earlier this month by doctors at the University of Michigan Medical School, in the American Journal of Transplantation. According to the report, the woman needed the transplant because of her chronic obstructive pulmonary disease. Her donor was a woman who had recently died of severe brain injury from a car accident. Standard screening, including a nasal and throat swab test for the coronavirus (SARS-CoV-2) on the donor and recipient, turned up nothing unusual and the procedure appeared to go off without a hitch.

Three days following the transplant, however, the recipient spiked a fever and began to have trouble breathing. A nasal swab test initially showed no traces of the coronavirus, but she obviously had pneumonia and a later direct test of her lungs came back positive for the virus. Over the next two months, the woman’s condition only worsened, and she developed septic shock. Though she was treated with antivirals, convalescent plasma, and ECMO (a last resort medical device that takes over for the heart and lungs), the woman succumbed to her illness 61 days after her transplant.


The donor had no history indicating recent exposure to the coronavirus or symptoms of covid-19 prior to her death, along with a negative nasal swab test. But doctors had held onto a fluid sample collected from her lungs and when they tested it after the recipient became sick, it came back positive. Genetic sequencing of the virus found in both the donor and recipient showed they were nearly identical, effectively proving the recipient’s infection came from the tainted lungs. A third person—one of the woman’s surgeons who handled the lungs—became sick and tested positive for the virus soon after the procedure, and this infection was also traced back to the donated lungs. The surgeon recovered, however, and no other member of the transplant team was affected.

There have been other suspected cases of covid-19 spread through transplantation, but this is thought to be the first known case to demonstrate transmission by using genetic sequencing. Despite the tragedy of this death, however, it’s likely still an incredibly rare risk. This same month, scientists with the Centers for Disease Control and Prevention looked into eight suspected cases of covid-19 linked to organ donation documented between March to May 2020. They ultimately concluded that the most likely source of transmission in these cases “was community or healthcare exposure, not the organ donor.”

Rare as it might be, the Michigan doctors do think more can be done to ensure the safety of organ recipients and their doctors during this time, particularly when lungs are being transplanted.

“Transplant centers and organ procurement organizations should perform SARS‐CoV‐2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for health care workers involved in lung procurement and transplantation,” they wrote.


You’re Far Less Likely to Spread Covid-19 If You Get the Vaccine, Real-World Data Suggests

A covid-19 vaccination clinic at the University of Michigan Stadium in Ann Arbor, Michigan, February 10, 2021.

A covid-19 vaccination clinic at the University of Michigan Stadium in Ann Arbor, Michigan, February 10, 2021.
Photo: Paul Sancya (AP)

Real-world data is offering hope that mRNA vaccines are highly effective at limiting infection and presumably transmission of the coronavirus, in addition to their already-known ability to prevent symptoms of covid-19. The findings, based on research from Israel and elsewhere, are good news for containing the pandemic sooner rather than later.

A study published in the Lancet last week looked at healthcare workers at Israel’s Sheba Medical Center. The study compared rates of covid-19—both with symptoms and without—among workers who received the Pfizer/BioNTech vaccine or not. As other research has shown, people were significantly less likely to contract covid-19 after receiving the first of two scheduled doses.

Within two to three weeks following the first dose, the risk of having symptomatic covid-19 was reduced by 85%. Importantly, the risk of covid-19 in general, including asymptomatic infection, in which a person has the virus but doesn’t feel sick, was also reduced by 75% in that same period, based on regular PCR testing. That’s crucial, because even people with silent infections can still transmit the virus to another person. But if a vaccine is largely preventing people from being sick and from carrying enough of the virus to test positive, that means it’s also lowering the risk of virus transmission from a vaccinated person to others.


The results of another recent study, not yet published, seem to show an even greater advantage for fully vaccinated people in Israel. Based on data analyzed by the Israeli Health Ministry, Reuters reported last Thursday, the risk of infection was reduced by 89% in people who received two doses of the Pfizer/BioNTech vaccine.

In the U.S, a preliminary study released last week by researchers at the Mayo Clinic points to similar benefits for the Moderna vaccine. They looked at workers at the Mayo Clinic and associated health care centers who had received the first dose of an mRNA vaccine at least 36 days prior. Compared to their unvaccinated colleagues, the workers were 89% less likely to test positive for covid-19 after they received both doses.

Many experts have been cautious about claiming that covid-19 vaccines will reduce transmission, arguing that the data simply wasn’t available yet to know for sure. But other experts have argued that it would be very unusual for a vaccine effective at preventing illness to have no effect on reducing transmission and that it’s not helpful to leave people worried about an unlikely outcome. In any case, the evidence from these and other studies should be reassuring to everyone.

More research will continue to be done to understand just how effective the mRNA vaccines are at preventing transmission. Other vaccines are based on different technologies, and some are less effective than the mRNA vaccines at preventing illness, so they’ll need to be studied closely as well. And the spread of new coronavirus variants may complicate matters, since at least some vaccines have been shown to be less effective against certain variants.


All that said, this is undoubtedly good news if you’re hoping for an end to the pandemic as swiftly as possible. Vaccines that prevent illness and transmission of covid-19 will only make it harder for the coronavirus to spread as more of the population is vaccinated, and they should speed up the time it will take for life to return to some semblance of normalcy.

Vitamin D Supplements Don’t Seem to Help People Sick With Covid-19

Illustration for article titled Vitamin D Supplements Dont Seem to Help People Sick With Covid-19

Photo: Christopher Furlong (Getty Images)

The results of a new clinical trial suggest that vitamin D supplements don’t help people hospitalized with moderate to severe covid-19. Elsewhere, a controversial and preliminary paper that had suggested vitamin D did offer a benefit has now been pulled by the Lancet due to “concerns” over the research design.

Vitamin D has emerged as a new covid-19 panacea for some on social media, displacing past favorites like hydroxychloroquine. There is plenty of evidence that many people could use more daily vitamin D in their lives, especially during the winter. A deficiency in this vitamin, which can be taken as a supplement or synthesized in the skin under strong sunlight, can certainly affect people’s overall health. But the evidence that vitamin D plays a major factor in the severity of covid-19 or that supplementing it could help treat ongoing cases is much less solid.

In late January, a study released on the preprint server SSRN—run by the journal the Lancet—seemed to change that picture. The authors claimed to have found that calcifediol (a byproduct of vitamin D) reduced the risk of mortality in covid-19 patients hospitalized in Spain by a whopping 60% compared to people given standard care. For comparison, the arthritis drug tocilizumab was recently found to reduce mortality in severe covid-19 patients by 4% in a large UK trial—modest results that are promising enough to likely enshrine it as a standard treatment along steroids for critical cases.


But it wasn’t long before outside scientists started to raise issues with those results. For instance, the study’s design was described as both a randomized and an observational study by the authors at different points in the paper—two very different things. Randomized trials, in which some people are randomly assigned to receive a treatment, are considered the gold standard of clinical evidence because they can better confirm that a drug is having a real, beneficial effect on an illness. Observational studies, in which scientists simply observe the differences between groups of people who are getting different care, are important in medicine, but their conclusions are generally viewed with more caution, because it’s harder to know whether a particular treatment actually caused the effect. Other criticisms of the paper included missing relevant data on patients (like some patients’ baseline vitamin d levels), as well as potential statistical flaws. And of course, the findings would be still preliminary no matter what, not having gone through the peer review process yet.

On Friday, the Lancet removed the paper from its preprint server, citing “concerns about the description of the research in this paper.” It also announced that it would launch an investigation into the study.

Meanwhile, the results of what seems to be a genuine randomized trial on vitamin D for covid-19 were published Wednesday in the Journal of American Medical Association—the largest study of its kind to date. Researchers in Brazil said they randomized 240 people with moderate to severe covid-19 in the hospital to receive a single large dose of vitamin D (200,000 IU, compared to the 600-800 IU daily dose recommended for the average adult) or a placebo.


All told, they found no difference in the length of hospital stay between people who took vitamin D and those who didn’t. There was also no difference in the mortality rate or other important metrics, like the likelihood of someone needing invasive ventilation. And while the treatment did appear safe, one patient did have an episode of vomiting likely tied to it.

“The findings do not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19,” the authors wrote.


The JAMA study is still just one trial, and nothing should be decided in medicine on the basis of a single study. And again, too many people aren’t getting as much vitamin D as they need anyway, so there’s nothing wrong with checking up on your levels with the help of a doctor. But the pandemic has seen countless other potential treatments come and go with little effectiveness to show for it. 


In general, it’s hard to test for the specific effect of vitamin D intake on any condition, because it’s often an indicator of other things. Someone with high vitamin D levels might also be someone who exercises outside often, for instance, and it might be the exercise or their overall good health that’s really providing a protective boost.

If vitamin D does have a benefit for covid-19, it’s likely to be modest at best. And the lack of enthusiasm over this treatment is certainly not evidence of a grand conspiracy in which doctors are downplaying vitamin D just so they can charge for more expensive drugs, as some have suggested. After all, the most successful and lifesaving drug for covid-19 to date is dexamethasone, a generic steroid that can cost less than $10 per treatment.


How to Improve Your Chances of Scheduling a COVID-19 Vaccine Appointment

Illustration for article titled How to Improve Your Chances of Scheduling a COVID-19 Vaccine Appointment

Photo: James Andrews1 (Shutterstock)

When not one, but two safe and highly efficacious vaccines received Emergency Use Authorization from the Food and Drug Administration in December 2020—less than a year after the first confirmed case of COVID-19 in the United States— it almost seemed too good to be true. (Which is not to imply that corners were cut in the research or trials; everything happened with unprecedented cooperation and speed, but the process wasn’t rushed.)

After months of hearing that aspects of our pre-pandemic lives could return “once there’s an effective vaccine widely available,” learning an effective vaccine existed felt like a huge milestone. We were—at least in theory—one step closer to normal.


The rollout began with healthcare workers and those living in long-term care facilities, where the appointments were made internally. But once it got to the point where “regular” people—like older adults and essential workers—had to start making appointments for themselves, the problems began immediately and have continued ever since.

For many, even those in at-risk groups, the limited supply of the vaccine, coupled with the confusing process of scheduling an appointment to obtain it, has made actually getting immunized seem impossible. Here are some strategies to help you prepare for and maybe even improve your chances of getting a COVID-19 vaccine appointment online.

There’s a lot here, so we’e broken it down into sections:

Challenges of making a COVID-19 vaccine appointment online

How to prepare to book an appointment online

Tips for the actual booking process

Strategies to avoid

The challenges of making a COVID vaccine appointment online

Technically, in most cases, it’s “possible” to make an appointment by phone, but more often than not, that means waiting on hold for hours only to find out there are no appointments available. That leaves the option of attempting to book online. It’s easy to dismiss older adults as not having the tech skills necessary to navigate these sites, but really, between all the glitches, crashes and site outages, it’s a challenge for anybody.


“You have to be computer-savvy and be able to take time to work to get an appointment,” says Dr. Sonja Rasmussen, a professor in pediatrics and epidemiology at the University of Florida’s College of Medicine, and the former Director of the Center for Disease Control and Prevention’s Division of Public Health Information Dissemination.

Not everyone has the privilege of being able to spend hours at a time scouring pharmacy sites and refreshing health departments’ scheduling system—including essential workers, like grocery store, pharmacy, or food service employees.


“Groups like essential workers who are at higher risk of COVID-19 may not have time to get online to get an appointment for vaccine,” Rasmussen tells Lifehacker. “That means that some people who need to be protected against COVID-19 aren’t able to get the vaccine.”

Given the time commitment and effort required to make an appointment for a COVID-19 vaccine, here are some strategies that might help, whether you are booking one for yourself or someone else.


Before you attempt to book an appointment

It may seem like all you’d have to do to book an appointment for a COVID vaccine would be to fill out a few quick fields on a webform, submit it with a few clicks, and presto: appointment! If only. In most cases, it involves some prep work before you even get started.


Figure out if/when you’re eligible

If you’re making an appointment for an older relative, chances are they’re eligible—but double check on their state’s website to confirm. If you’re younger, and making an appointment for yourself, it’s all about paying attention. If you’re under the age of 65, your chance to get vaccinated will likely either come when appointments are open to adults in the general public, or if you have certain preexisting conditions.


If you think you might have a preexisting condition, check your state’s eligibility list (they vary) to see if your ailment(s) qualify. If it looks like they do, the next step is seeing what you’ll be required to produce at the appointment as proof of the health conditions—typically a letter from your doctor or lab results indicating your comorbidities. You won’t need the documentation to make your booking, but it’s good to ensure that you’ll have access to it when your appointment rolls around.

Then, pay attention! If you’re not in the habit of watching, reading or listening to your local news, now’s the time to start. Every state (and county) is different, so sign up for email and/or text alerts with news of which prioritization group is currently eligible. Set a Google News alert for vaccine news in your area.


Locate and make note of your state’s booking rules and procedures

But because every state (and in some cases, local) health department can make up its own rules, you should probably find out what they are. This resource, from the Wall Street Journal, provides instructions for each state.


Make a list of all the places where you can make an appointment

You may think there is one central location for making all the COVID-19 vaccine appointments in your area. That would certainly make sense, but it’s not necessarily true. And while having multiple sites for booking appointments can get confusing, that’s actually a “good” thing if you’re tech-savvy, because it gives you more places to try.


As you’re preparing to make an appointment, make a list of all the different systems you’re potentially able to book through. There is usually a statewide site, but certain cities, counties, or hospital systems may have separate booking sites of their own. Don’t assume that one statewide website is your only option—it’s probably not. Open a Google doc for all your prep work, and paste all the potential booking links there.

You may need to register first

In some cases, you may have to register online before you can make an appointment. (Other states won’t allow you to go near any forms until you officially qualify.) But if, for example, your parent registered with the state, they may assume that they have done everything they can do to secure an appointment—when in fact they could also register with the county’s department of health, a local hospital, or the Department of Veterans Affairs, if applicable. Also, keep track of all your login information for each site.


Don’t forget about pharmacies and grocery stores

If your vaccination strategy involves attempting to get one at a pharmacy or grocery chain like CVS, Walgreens, Rite Aid, Walmart, or Publix, those sites may require you to register and open an account with them in order to book an appointment. You can always delete it if you don’t end up getting vaccinated there, or after receiving both doses. The key in all of this is to give yourself as many options as possible.


Make a list of all your important information

Using the same Google doc where you’re stockpiling the links to different booking sites, make a list of all the relevant information you might need while filling a booking form. If you’ve registered with any of the booking sites ahead of time, make sure to have those usernames and passwords listed on your doc for easy access.


While you probably have no problem recalling your own basic personal info, if you’re making the booking for someone else, you might not know every detail offhand. Have the following typed out and at the ready:

  • Full name
  • Address
  • Phone number
  • Email
  • Date of birth
  • County of residence
  • Health insurance plan, along with the member and group ID
  • The name, address and phone number of the person’s primary care physician (this may not be required, but in the event that it is, have it ready)


Given how quickly the slots go once they’re available, anything you can do to shave even a few second off your booking time—like copying and pasting the information into the form instead of typing it manually—can be helpful.

Call to find out when booking starts

In situations where there are thousands of people suddenly eligible for the vaccine on the same day—as was the case in New York last weekend, when people with preexisting conditions could first make an appointment—it’s best to go in with as much information as possible.


Sometimes, news stories or press releases from the health department will indicate a time that online booking starts. Other times, they don’t. If you don’t have a confirmed start time, make a quick phone call to the organization behind that booking site and get one.


The actual booking process

Whether you want to make sure you or a loved one are first in the virtual line when a new block of appointments opens up, or you’re on your 328th attempt to book whatever you can get, here are some things that could improve your chances of getting one of the coveted slots.


Make sure your computer is ready to roll

Let’s say your computer has been working perfectly for weeks. No problems at all. It will somehow be able to sense that you’re doing something important and time sensitive, and will decide that the minute you start registering for an appointment is the ideal time to restart and update. Don’t even give it that option—get that part over with the day before. Also make sure you have a stable internet connection.


The more devices, the better

If you happen to have a tablet, second computer, or another person around who can help, make it an all-hands-on-deck situation. Just be sure to coordinate with each other in case someone does manage to book something.


And speaking of devices, if you’re not using your phone for booking purposes, you can always call one of the booking hotlines and sit on hold while trying to find an appointment online. Reportedly, some people have had luck making appointments on the phone, so it’s not a bad idea to have that the hold music on speakerphone in the background. (Ideally, it’ll be some calming smooth jazz.)

Start checking the sites

You may want to keep multiple tabs or even browsers open for this part, so you can try your hand at getting an appointment through different sites at the same time. Of course, that does not mean you should book an appointment on more than one site—it’s all about increasing your odds.


There’s a good chance the sites will crash, take forever to load, be missing entire sections, and time out while you’re filling out a form. Keep tabs on your tabs and refresh as needed.

Look to the future

Some places only post their vaccine appointment slots a few days in advance. Others go up months in advance. Of course you want that shot in your arm ASAP, but instead of trying to get one tomorrow, look a week or two down the line—you may have a better chance of finding available appointments.


Another option that might work is clicking directly on a particular date on a booking calendar (if the site has an option like that), instead of scrolling through each day at a time until you find an open slot. So, for example, if you were trying to make an appointment today, don’t start by looking for openings tomorrow and then clicking through day-by-day until you see something. Jump right to March 4th (or any random date when appointments are available) and go from there.

Only fill out the required fields on the booking form

If you get lucky enough to make it to the page where you enter your information to make an appointment, only fill in the required information. This will all be located in your handy doc, but if some fields are optional—like entering the name and address of your primary care physician—skip them. It’s not uncommon for slots to disappear after you’ve gotten to the point of filling out the booking form, so get through it ASAP and with the minimum information required.


Be cautious about where you’re clicking

In the mad dash to attempt to book vaccine appointments, it can be easy to be a little lax when it comes to internet safety. For example, only click on links to official booking sites—like a health department, pharmacy or hospital system—even if a friend sends you something else and swears it works.


And while you probably already do this, double check to make sure that there’s a little lock just left of the web address in your browser, so you know the data you enter is encrypted.

Remember: The vaccines are free

Although you’ll likely be asked for your health insurance information, the COVID vaccine itself is free—even if you are uninsured or underinsured. So if any booking site asks for your credit card or any other payment information, delete anything you’ve already entered on the page and close the tab. If you do happen to get a bill for your vaccine, here’s what you can do to deal with that.


Use crowdsourced vaccine appointment finders

Some cities and states have volunteer-led crowdsourced sites that provide real-time information on where appointments are available in a given area. Here is a helpful list of those sites, compiled by The Verge:

  • An NYC site called TurboVax pulls “the latest appointments from 43 city and state-run vaccine sites in the NYC area” and puts them on Twitter. Followers who set their Twitter notifications for @turbovax can quickly find out about newly opened appointment slots.
  • Another called NYC Vaccine List uses a combination of scripts and checks by volunteers to scour various sites for openings.
  • In California, VaccinateCA checks pharmacies and hospitals for information about open appointments.
  • Vaccinate NJ also uses volunteers to try to help state residents find vaccine opportunities.
  • Covid 19 Vaccine TX is a crowdsourced resource for registering with local counties and finding locations where vaccines may be available.
  • The MA Covid Vaccine Appointments site offers lists of and links to sites with available appointments.
  • A volunteer group in the state of Washington has launched the WA Covid Vaccine Finder as an aggregation resource for vaccination appointments.


Use a tool to detect changes in websites

You may also want to try using a service that will monitor websites of your choosing and alert you when changes are made—in this case, when a vaccine appointment booking site or pharmacy updates their availability. Two options are and Visualping, each of which has its own features and fee structures—including limited free options.


Check Twitter

In a situation like this past Sunday morning, when thousands of New Yorkers were all vying for a very limited number of appointments at the same time, Twitter can be an extremely useful tool. People will often post screenshots of issues they’re having with different booking sites—which doesn’t necessarily help you directly, but at least confirms that you’re not the only one having that problem.


But what is most useful are real-time tips people post for various sites, like what to enter to get around a particular glitch, or an unpublished link that somehow bypasses the logjam of people in virtual waiting rooms and takes you directly to the booking. If someone is lucky enough to score an appointment and did something slightly different to be able to get through this one time, they may be generous enough to let others know about it. This is where the search function and “Latest” section of your Twitter feed will come in handy.


Look for patterns in availability

In some cases, different booking sites—including pharmacies— will be on some type of schedule, adding their new appointments at the same time every day. Here’s another tip from The Verge:

One thing that sometimes helps is to look for patterns in the appearance of new appointments. For example, when I heard that the pharmacy chain Walgreens was going to begin giving out vaccines in my area, I spent a couple of days going onto the site, and suddenly realized that there was a pattern: the company was only scheduling appointments two to four days in advance and was adding new appointments each day just after midnight. Once I understood the pattern, I was able to get appointments for a couple of friends, and let others know about it as well. (Note: since vaccine supplies and scheduling methods can change on a dime, this particular strategy may no longer work by the time you read this.)


Like everything else here, that is certainly no guarantee that these tips will work, but again, anything you can do to increase your chances of getting an appointment is worth a try.

Don’t be a dick

We get it: desperate times call for desperate measures—especially when it comes to your own health, or the health of a loved one. But also keep in mind that the whole point of all of this is to end a pandemic that has resulted in a public health crisis. It’s in all of our best interest that as many people get vaccinated as possible, so try not to do anything to jeopardize that. A few examples:

Don’t make multiple appointments for one person

By all means, register on as many websites as you can in order to nab an appointment. But once you have a confirmed appointment, stop. You’re done. Don’t keep trying and book additional appointments through through health departments, hospital systems, or pharmacies. If you do so by accident, cancel the redundant booking right away (there should be instructions on how to cancel an appointment in your booking confirmation email).


Yes, you may mean well. Maybe you thought you might try your luck at booking additional appointments to give to friends and family members, but that’s fruitless; the appointment is tied to your name and information. That means that when someone who is not you shows up, they’ll likely be turned away—and that wastes everyone’s time. You can always check with your state in the event that they allow this type of thing, but don’t hold your breath.

Don’t share a booking link

If you get an email notification from a health department or hospital system letting you know that you’re now eligible to book and there are slots available, it may come with a link. That link is not public and is not meant to be shared. If people who were not sent the link directly use it to book appointments, they’re taking the spot of someone who is eligible and did receive the link.


On the flip side, be cautious about any links other people send you. For example, back in January, up to 20,000 people on Long Island booked spots using a widely-circulated link that wasn’t supposed to have been live yet, and they all had their appointments canceled.

Don’t lie about your eligibility

This one should be a given, but it’s been happening: If you’re not an essential worker, don’t indicate that you are. If you don’t have one of the preexisting conditions that makes you eligible for earlier access in your state, don’t lie and say that you do. Yes, this rollout has been a shitshow, but please, wait your turn. Don’t take an appointment away from someone in a higher-risk group.


Survivors of Severe Covid-19 Should Get Their Eyes Checked, Study Suggests

Illustration for article titled Survivors of Severe Covid-19 Should Get Their Eyes Checked, Study Suggests

Photo: William Thomas Cain (Getty Images)

Doctors are warning that covid-19 may be capable of causing lingering eye problems. A new study suggests that some people who survive a severe infection can develop growths in the back of their eyes that could lead to vision loss. It is not yet clear how covid-19 might cause these growths, or if people with milder covid-19 are also at risk of this complication.

Researchers at the French Society of Neuroradiology looked at medical records from certain patients with severe covid-19. These patients had all gotten a brain MRI at some point during their illness, which allowed the researchers to look for potential abnormalities in and around the eye.

In total, they looked at data from 129 patients across 16 hospitals who were infected during the first wave of the pandemic in France, between March and May 2020. Nine of these patients (7%) had evidence of nodules around the back of the eyeball, with most having growths on both eyes. Eight patients had also been in the intensive care unit.


There have been occasional reports of people with covid-19 with abnormal test results or health issues related to the eye, such as conjunctivitis (pink eye). But the authors say theirs is the first study to try estimating how commonly this might be happening through MRI data. The findings should be enough to convince doctors to look for potential eye problems in patients with severe illness, they add, especially since they could be hard to spot at first.

“Severe eye problems might largely go unnoticed as these patients are often treated in intensive care units for much more severe, life-threatening conditions,” they wrote in their paper, published Tuesday in the journal Radiology. “Our data support the need for a screening and follow-up of these patients to provide appropriate treatment and improve the management of potentially severe ophthalmological manifestations.”

The results do have their limitations. They can’t conclusively show that having covid-19 led to these eye growths, nor can they explain how it might have happened if the disease was responsible. One theory voiced by the authors is that the infection reached the eyes and directly damaged the retina. Another is that inflammation indirectly caused by infection is the main culprit. It’s even possible that the practice of laying patients on their stomachs (the prone position)—a common intervention that’s been shown to help patients breathe more easily—could have contributed to faulty drainage of veins connected to the eye. Pre-existing circulation problems, common in patients with diabetes, might also be a factor.


The researchers are already working on future studies to better understand these potential complications. This includes proactively studying severe covid-19 patients from more recent waves of the pandemic, which would confirm whether these growths and other eye problems are really the result of the illness and not an earlier, hidden issue. Survivors with these growths are also being tracked to see if they’re at increased risk for long-term vision problems. And the researchers are pursuing a similar study, focusing on patients with mild to moderate covid-19.

“We have launched a prospective study with dedicated high-resolution MR images for exploring the eye and orbit in patients with light to moderate COVID,” said lead author Augustin Lecler, a radiologist and associate professor at the University of Paris, in a statement released by the Radiological Society of North America, which publishes Radiology. “Therefore, we will be able to know whether our findings were specific to severe COVID patients or not.”


Ebola Has Returned to Africa and Officials Are Racing to Contain It

The gates of the Matanda Hospital in Butembo, found in the North Kivu province of the DRC. The hospital is where the first case of a new Ebola outbreak in the country died earlier this month.

The gates of the Matanda Hospital in Butembo, found in the North Kivu province of the DRC. The hospital is where the first case of a new Ebola outbreak in the country died earlier this month.
Photo: Al-hadji Kudra Maliro (AP)

The deadly viral disease Ebola has once again surfaced in Africa, and health officials are rushing out vaccines and other measures to stop its spread. As of Tuesday, there have been at least 11 cases and seven deaths in two countries, including Guinea, which had a massive outbreak in 2013 that ultimately left 11,000 dead. Several other African countries are now on high alert.

In Guinea, at least seven cases have been reported since early February, with three victims having died so far. It’s the first outbreak in the region since the 2013-2016 epidemic that swept across West Africa and even briefly made its way to countries outside of Africa, including the U.S. It was the largest and deadliest outbreak of Ebola in recorded history, with almost 30,000 cases and 11,000 deaths reported.


Elsewhere, the Democratic Republic of Congo—located in Central Africa—has reported four cases during the same time period, with two deaths so far. The DRC has faced the bulk of Ebola outbreaks since the virus was first discovered in 1976, including an outbreak that ran from 2018 to 2020 and left over 2,000 dead (the second-largest death toll ever). It is not yet known whether the outbreaks in Guinea and the DRC are connected. But according to Reuters, DRC officials have confirmed through genetic analysis that their current cluster can be traced back to the earlier outbreak in 2018. Genetic analysis of the virus found in Guinea is still underway and should provide answers soon.

On Monday, Guinea officially declared an Ebola epidemic, while the DRC had done so on February 7. The World Health Organization has also now alerted six countries bordering Guinea to be on the lookout for cases, including Liberia and Sierra Leone. Those three countries were the hardest hit during the 2013-2016 epidemic.

Much has changed since then—namely, the development of a highly effective vaccine by the company Merck as well as antiviral drugs (Merck’s vaccine was briefly deployed at the tail end of the 2014 outbreak but didn’t see wide use until 2018). But Africa, like many parts of the world, is still grappling with the covid-19 pandemic. The WHO said Tuesday that stockpiled supplies of vaccines and drugs are being sent over to Guinea and nearby countries. The United Nations also announced today that it will allocate $15 million in emergency relief funds to aid the response in both countries.


Ebola is a zoonotic disease, meaning the virus is natively found in wildlife (likely bats) and then spills over to people. If the DRC cluster is connected to an earlier outbreak, though, that may indicate it was somehow started through a human survivor. In people, it’s spread through close contact with an infected person’s bodily fluids, which can include sex. Some people are known to carry the virus months after surviving their ordeal, usually in parts of the body less monitored by the immune system, like the eyes and sperm. At this point, it is not known how either outbreak began.

Symptoms of Ebola include fever, headache, and muscle pain that can quickly progress to severe and fatal internal bleeding. The mortality rate of Ebola can range from 25% to 90%, though it usually hovers around 50%.


Promising Gene Therapy Trials Suspended Over Potential Cancer Risk

Illustration for article titled Promising Gene Therapy Trials Suspended Over Potential Cancer Risk

Photo: Taimy Alvarez (AP)

On Tuesday, Biotech company Bluebird suspended its trials of gene therapy as a treatment for blood-related disorders over concerns of a possible increased risk of cancer. The company cited the recent discovery of two patients given the experimental treatment who developed a form of blood cancer, along with a similar case documented in 2018. At this point, though, it is not clear that the treatment is truly connected to these incidents.

Gene therapy has emerged as a potential breakthrough for treating diseases largely or entirely connected to genetic mutations. Typically, the goal is to create long-lasting or even permanent changes to certain cells by knocking out or replacing faulty genes. In 2017, the first gene therapy targeted at a specific mutation—one that causes vision loss—was approved by the Food and Drug Administration.

One appealing application for gene therapy has been sickle cell disease, a genetic disorder that causes a person’s red blood cells to be misshapen, rigid, and unable to travel easily through the body, leading to chronic anemia and often a shortened lifespan. People develop sickle cell disease because of a mutation (one that has to be inherited from both parents) that alters their production of hemoglobin, the oxygen-transporting protein that gives red blood cells their color. Bluebird’s gene therapy treatment, called Lentiglobin, introduces a modified version of the gene responsible for hemoglobin into a person’s bone marrow, hopefully making them produce a form of hemoglobin that directly reduces levels of the diseased version.


In early clinical data, the results have looked promising, with patients experiencing a drastic reduction in related symptoms and improved blood work. But in December 2018, Bluebird reported that a patient given Lentiglobin developed myelodysplastic syndrome (MDS), a blood cancer that leaves blood cells unable to grow properly. At the time, the company determined that the patient’s condition was likely due to the chemotherapy they received before the gene therapy, which is used to condition the body to accept the treatment, since MDS is a known complication. The patient died last year.

However, at least one other patient in the sickle cell trials has since developed MDS, while a third patient has developed acute myeloid leukemia. Both patients had received the gene therapy years earlier, and the company said it learned of their cases last week. The culmination of these reports has led the company to suspend all of its ongoing gene therapy trials, including a Phase III trial for sickle cell, and notify relevant health agencies in the U.S. and Europe.

“The safety of every patient who has participated in our studies or is treated with our gene therapies is the utmost priority for us,” said Nick Leschly, Bluebird CEO, in a statement from the company. “We are committed to fully assessing these cases in partnership with the healthcare providers supporting our clinical studies and appropriate regulatory agencies. Our thoughts are with these patients and their families during this time.”

The company noted that no similar cases of blood cancer have been seen in concurrent trials of a similar gene therapy for thalassemia, another inherited disorder characterized by unhealthy hemoglobin. But they and the independent safety board that oversees these trials will now investigate whether the delivery method used for Lentiglobin, which relies on a modified lentivirus to deliver the therapy to cells, had any role in these cases (one notable lentivirus is HIV).


As promising as these gene-therapy treatments are, scientists have worried about their potential long-term risks and the aggressive chemotherapy often needed to make them work. Another concern has been that virus-based gene therapies may wear off over time. These therapies are also likely to remain exceedingly expensive for most to actually use.

The suspension of a clinical trial for safety reasons is common and not necessarily a sign of a treatment’s failure (last year, several covid-19 vaccine trials were suspended but eventually restarted). Time will have to tell whether these reports are evidence of a real heightened cancer risk from this treatment.