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story.lead_photo.caption Dr. Margaret Day

As Missouri expands access to the COVID-19 vaccine, physicians are hard at work spreading reassurance and accurate information about the vaccine.

Dr. Margaret Day, family medicine physician and co-chair of MU Health Care's COVID-19 vaccine committee, answered common questions during a Facebook Live presentation Thursday.

The information below shouldn't be considered medical advice; consult your doctor or conduct your own research using trusted sources when making medical decisions.

Who is currently eligible for the vaccine?

Missouri is currently vaccinating people included in Phase 1A, Phase 1B-Tier 1 and Phase 1B-Tier 2.

Phase 1A includes front-line medical personnel and congregate community health care settings staff and residents.

Phase 1B-Tier 1 includes first responders, people in emergency services and other members of the public health infrastructure who aren't front-line health care workers.

Phase 1B-Tier 2 includes anyone age 65 or older and any adults with cancer, chronic kidney disease, COPD, heart conditions, weakened immune system due to organ transplant, severe obesity (BMI greater than 40), sickle cell disease and Type 2 diabetes. It also includes pregnant women and people with intellectual and/or developmental disabilities such as Down syndrome.

Missouri authorities haven't yet announced when vaccines will begin for people in Phase 1B-Tier 3, Phase 2 and Phase 3.

For a more detailed breakdown of which Missouri residents each tier includes, visit Missouri's vaccine website, covidvaccine.mo.gov.

According to MU Health Strategic Communications Executive Director Teresa Snow, there are currently no plans to check the medical records of people who sign up for the vaccine to ensure they truly fit the current eligible tier. However, patients will have to sign an attestation stating they're being honest about their health status and eligibility.

"Think of your fellow man and tell the truth when you're getting vaccine," Snow urged.

What does it cost?

The COVID-19 vaccines will be free to all Missouri residents, including those with no health insurance.

What about children?

Both COVID-19 vaccines currently approved for emergency use in the United States — those manufactured by Pfizer and Moderna — are currently restricted to teenagers and up. The Pfizer vaccine is approved for use in people age 16 and older, while the Moderna is for age 18 and up.

"There are ongoing studies for children in younger age groups," Day said.

She said the Pfizer vaccine may soon be approved for children ages 12-15, but it could be a while before any vaccine is approved for small children — even those who would otherwise qualify due to other risk factors.

How do I sign up for the vaccine?

Because the categories encompass so many Missourians, those who are currently eligible might have to wait to receive the vaccine.

Everyone, even those who aren't currently eligible for the vaccine, can sign up to receive alerts and further information when the vaccine is made available for their priority phase.

The Cole County Health Department is working to make a self-scheduling link for the COVID-19 vaccine available on its website.

MU Health Care will administer the vaccine to people within its service region. Their sign-up form can be found at muhealth.org/vaccine-survey.

Do I need both doses?

Both the Pfizer and Moderna require two doses for maximum efficacy.

The second dose for the Pfizer vaccine should happen 21 days after the first, and 28 days for the Moderna vaccine.

"It's very important to follow through with receiving the second dose," Day said. "Receiving one dose probably does offer you some protection, one of the things we will learn about as vaccines are given in real-world conditions."

She said studies of the Pfizer vaccine found that after receiving one dose, study subjects were half as likely to contract COVID-19 compared to people who received a placebo. After two doses, efficacy increased to 95 percent.

A patient's appointment to receive the second dose should be set during or even before the appointment for the first dose.

MU Health Care currently does not plan to hold back vials of the vaccine to give second doses.

"Right now, federal and state governments are pushing for vaccine administration — they're saying, when you receive doses, by all means just give them to people who are ready," Day said. "We're going to have faith in the process of manufacturing and distributing to be able to give the second dose."

She doesn't expect shortages or shipment delays to prevent people from receiving their second dose.

"There is some risk that three weeks later, when you're ready for the second dose, it may be a bit delayed," she added. "I think that's unlikely given the pattern and cadence we seem to be in right now. When we request vaccines, we've been receiving them, for the most part."

What side effects are common?

Day has received two doses of the Pfizer vaccine.

"When I received the vaccine, I had a sore arm; I could feel that right away," Day said. "That lasted a couple of days, just like a flu shot. The second dose, three weeks later, was just fun. Again I had kind of a sore arm, and that was about it."

Mild reactions like that are common in people who receive the COVID-19 vaccine, according to Day, with around 80 percent feeling pain at the injection site in the first one to three days after the vaccine.

Other common side effects have to do with how the vaccine works: though it doesn't contain any particles of the virus that causes COVID-19, it does teach a handful of cells how to produce a specific protein found on the outside of the virus. Those unfamiliar proteins, in turn, provoke an immune response from the body before swiftly being destroyed.

If that response is strong enough, it can cause a fever, fatigue, headache, chills, GI symptoms, muscle aches and joint pain. Those side effects are more common after the second dose of the vaccine.

"It doesn't mean you get sick. It's evidence that your immune system is reacting to the vaccine and doing what it's supposed to," Day explained.

Day said people younger than 55 tend to react more strongly to the vaccine. Serious adverse effects are exceedingly rare; you're much more likely to get severely ill from catching COVID-19 than from getting the vaccine, she added.

However, if the side effects last longer than a few days — or are accompanied by a cough or sore throat — they may not actually be related to the vaccine. You may have, instead, caught COVID-19 or another disease and should contact your physician, Day said.

What if I have allergies?

People who have a history of allergies — even those who have reacted poorly to previous vaccines, in some cases — can still get the COVID-19 vaccine, according to Day.

The U.S. Centers for Disease Control and Prevention has provided information about potential risk factors for the COVID-19 vaccine.

Nothing in the COVID-19 vaccine should set off an allergic reaction for people with allergies to food, animals, stings, latex, or other allergies not related to vaccines or injections. Someone who has had a mild allergic reaction to a vaccine or injection in the past, or has any history of anaphylaxis, should undergo a 30-minute observation period after receiving the shot.

Someone who has previously had a severe allergic reaction to a vaccine or injection (other than the COVID-19 vaccine) should undergo a risk assessment beforehand and 30 minutes of observation after receiving the vaccine. Or they and their physicians may decide it's best to defer receiving the vaccine.

Anyone who gets the vaccine can stick around the vaccine site for 15 minutes for observation. Health care workers on site will be prepared to deal with any allergic reactions that may arise.

"The only absolute contraindication — do not give this vaccine to someone — is that you've had anaphylactic reaction to the (first dose of the) COVID-19 vaccine or its components," Day said.

Anyone who is unsure about receiving the vaccine should consult with their primary care physician or allergist.

For more detailed information about clinical considerations for receiving the COVID-19 vaccine, visit bit.ly/397YXZP.

Will it protect me from new mutations of COVID-19?

According to Day, yes; experts currently believe emerging new strains of COVID-19 are similar enough to the previously identified strain that vaccines will still protect against them.

"Viral mutations are expected," Day said.

It's possible that, like the flu vaccine, the COVID-19 vaccine will require updates in the future, she added.

What if I've already had COVID-19 or catch it before or after getting my first dose of the vaccine?

People who have already recovered from COVID-19 likely have antibodies that will linger for at least 90 days, conferring some degree of immunity, according to the CDC. Day said those people may choose to delay receiving the vaccine for those 90 days but should get it eventually.

Someone who is actively ill with COVID-19 or catches it after getting their first dose but before receiving their second dose of the vaccine should put off their appointment until after they meet criteria to end their isolation period, Day said.

Where can I learn more?

For more information about the COVID-19 vaccines, including additional details about potential side effects, efficacy and how the vaccine works, visit the CDC's COVID-19 vaccine website (cdc.gov/vaccines/covid-19/index.html), Missouri's website (covidvaccine.mo.gov), or MU Health Care's COVID-19 page (muhealth.org/conditions-treatments/coronavirus).

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