A doctor’s greatest fear, full FDA approval and other things you need to know about the COVID-19 vaccine

Breakthrough cases of COVID have been a hot topic lately. Sure, when it comes to news, people tend to be drawn to the unusual or the one-off, but the truth is breakthrough cases of COVID that lead to serious health issues are still quite rare. 

How rare? According to the South Carolina Department of Health and Environmental Control (SC DHEC), the odds of someone who’s been fully vaccinated getting COVID and ending up in the hospital are around 1 in 6,000 – or 0.02%. So, yeah. Super slim. But let’s take that unlikely scenario a step further. The odds of that same person getting COVID, becoming hospitalized and then dying? A mere 0.004%, or roughly the same likelihood they’ll be attacked and killed by dogs while out on a walk.

“It’s just such a low percentage chance that someone who is fully vaccinated will get seriously ill with COVID,” said Danielle Scheurer, M.D., MUSC Health System chief quality officer, who oversees all things vaccine for the hospital system. “Every time it happens, it’s newsworthy, sure, but it’s nowhere on the scale of what we’re seeing with the unvaccinated population.”

Scheurer said vaccines were created to prevent serious disease, not be bulletproof. And this one is no different. “We never thought it would completely prevent COVID,” she said, “but the breakthroughs are still way less severe than native infections.”

With the vaccine landscape still in a state of flux, we are periodically checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. Can people get the booster at MUSC now? How do they do that?

A. Yes. And the drill is exactly the same as the first time around. The people who are eligible now are those that are immunosuppressed (from a disease or a medication). Soon to come will be the ones who were first to receive the original vaccine – health care providers, residents of long-term care facilities and older adults will likely be eligible by mid-September. To schedule a booster, patients can work through MUSC Health’s MyChart or simply call 843-876-7227 to set up a time. 

(NOTE: If you are receiving a third dose of the vaccine but your first or second doses are not documented in MUSC Health's system (MyChart), we request that you bring your valid vaccine card with you to your appointment.)

Q. Have we seen an uptick in appointments in the past couple of weeks?

A. We aren’t seeing a huge one. We’d love to have seen more. Previous to this recent surge in positive cases, we were averaging around 100 to 150 doses administered per day. Now we’re averaging around 200 doses per day in the month of August. Back in the heat of the pandemic, we were seeing more than 1,000 people a day. But still, you take what you can get. 

Q. How have things changed since the FDA gave full approval to the Pfizer vaccine? 

A. I think the only thing that will substantially change is that employers and schools and businesses will be able to mandate getting vaccinated. This governmental backing emboldens them to say, “Look, it’s not us; it’s the FDA saying you have to do this.” So it allows them essentially to say, “If you don’t like it, you can work, learn or take your business somewhere else,” without having to be the bad guy.

Q. Are some of these breakthrough cases/variants more dangerous or are they simply more contagious?

A. Everything is Delta now. Right now, 98% of all of our cases are Delta. Yes, you’re more likely to have a breakthrough with this variant than the ones before. But that’s how mutations work. The variants that stick around the longest are usually the nastiest ones. I’ve always said that this is a race against the variants. The longer it takes us all to get vaccinated/immune, the more likely it is for this virus to beat the vaccine. It’s super frustrating to think that we’re still talking about this in August of 2021. Many people just won’t get vaccinated. 

Q. If you feel crummy but you’re vaccinated, should you get tested?

A. Absolutely, yes. 

Q. How easy is it to get tested still? And is it free?

A. Symptomatic testing is still covered. The governmental and private payers are picking up the tab for this, so there’s no reason not to get tested if you think you might be showing symptoms. If patients come to us to get it done, we are still using PCR tests – these are hands-down the most reliable ones out there – and turnaround time is usually within 24 hours. 

Q. How worried should we be for our kids right now? How likely are we to pass the virus to them? 

A. I think, all told, the actual risk to an individual child getting very sick with COVID is still very, very small. Of all the pediatric patients we see at MUSC Children’s Health, we’ve only seen 180 hospitalized COVID cases since the pandemic began nearly a year and a half ago. In that time, we’ve only seen 30 cases of multisystem inflammatory syndrome in children (MIS-C), which is one of the main ways the virus manifests itself in kids. And of those 30, none of them were vaccinated – of course, some weren’t because they are too young – but still, kids getting really sick from COVID is still thankfully rare. That said, I think we’d all feel better if we could get our younger kids vaccinated, because one hospitalized child is too many. 

Q. So then, should parents be worried about in-person learning? 

A. We have seen more cases in the Charleston County School District this year than last year. Last year, we had good compliance with distancing and masking and barriers. And keep in mind that 30% of the kids weren’t physically there last school year. This time around everybody is on campus, there are no barriers and some schools are having a tough time enforcing the mask mandate. But even with all that going on, no, parents shouldn’t be afraid to send their kids to school. They just need to make sure their kids understand the importance of hand hygiene, distancing, masking – that sort of thing – and to let their parents know if there aren’t feeling quite right so they can get tested.

Q. Any guesses as to when the vaccine will be available for the 11-year-old and younger group?

A. Realistically, I think we’re looking at winter. End of calendar year, first of next. 

Q. As a doctor, what scares you the most about the pandemic?

A. I’d say it’s the inability to help patients to make good health care decisions based on science. Because there’s no way for me to combat that problem. There is no solution outside of mandates. That honestly scares me the most – that there is the belief that the vaccine is unsafe to the point that people will go to great lengths to avoid it. And there’s no data that I can show them that will change their minds. In the early days, we were hopeful that with solid data and spreading the word that we would be able to overcome this hesitancy, but it didn’t work out that way, and now we’re coming up on nine months since the vaccines were released, and only 1 in 2 Americans are vaccinated. Also, I can’t help but to think, “What is the next mutation going to do?” We’re giving this thing way too much time to mutate. And every time it blows through a new human it gets an opportunity to mutate. 

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line "Vaccine Q."