COVID-19 precautions are covered in a good informational article from the CDC. The article’s major points are:

1. Spread is often person to person, and carrier of COVID-19 may be asymptomatic.
2. Wash your hands often.
3. Avoid close contact with persons who are sick, even in your home.
4. Cover your mouth and face with a mask, keep 6-foot distancing.
5. Cover coughs and sneezes.
6. Clean and disinfect.

Coronavirus symptoms

Coronavirus symptoms can be varied, as per the CDC guidelines. These symptoms may include fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea, vomiting or diarrhea.

COVID-19 precautions at our office

• We will screen patients and may take your temperature as required.
• We require patients and staff to wear masks or other kind of face coverings while in the clinic.
• Following CDC guidelines, we ask all of our patients to maintain 6-foot space from other patients as well as staff.
• We will give priority to elderly patients.
• To allow proper cleaning and disinfecting we space appointment times generously.

Recent news

-Staff and Doctors at TJCAAI, Theodore J. Chu, MD Allergy and Asthma, Inc.

Pfizer vaccine for COVID-19 news

Allergies and the Pfizer BioNTech COVID-19 vaccine.

Kari Nadeau and Sharon Chinthrajah, sent me an email 12/4/20 summarizing the above link, and adding some notes about polyethylene glycol allergy. They stated that:

1. Allergic reactions to vaccines , in general, are rare with the incidence of anaphylaxis estimated at 1.31 in 1 million doses given. With the emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine by the FDA on December 11, 2020, the ACAAI COVID-19 Vaccine Task Force recommends the following guidance for physicians and other providers related to risk of an allergic reaction on vaccination. These recommendations are based on best knowledge to date but could change at any time, pending new information and further guidance from the FDA or CDC. 
2. The Pfizer-BioNTech COVID-19 vaccine should be administered in a health care setting where anaphylaxis can be treated. All individuals must be observed for at least 20-30 minutes after injection to monitor for any adverse reaction. All anaphylactic reactions should be managed immediately with IM epinephrine as the first line treatment.
3. The Pfizer-BioNTech COVID-19 vaccine should not be administered to individuals with a known history of a severe allergic reaction to polyethylene glycol as it is a component of this vaccine known to cause anaphylaxis.
4. Data related to risk in individuals with a history of allergic reactions to previous vaccinations and/or mast cell activation syndrome/idiopathic anaphylaxis is very limited and evolving. A clinical decision to administer the Pfizer-BioNTech COVID-19 vaccine should be undertaken by the physician or other provider administering the vaccine using their professional judgment and in consultation with the patient, balancing the benefits and risks associated with taking the vaccine. 
5. Individuals with common allergies to medications, foods, inhalants, insects and latex are no more likely than the general public to have an allergic reaction to the Pfizer-BioNTech COVID-19 vaccine. Those patients should be informed of the benefits of the vaccine versus its risks. 
6. Anyone with questions related to the risk of an allergic reaction to the Pfizer-BioNTech COVID-19 vaccine should contact their local board-certified allergist/immunologist.

References from Dr. Nadeau and Chinthrajah’s email

McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016;137(3):868-878. 

Dreskin et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organization Journal (2016) 9:32. 

Wylon, K., Dölle, S. & Worm, M. Polyethylene glycol as a cause of anaphylaxis. Allergy Asthma Clin Immunol 12, 67 (2016). 

Stone CA, Liu Y, et al. Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized. J Allergy Clin Immunol Pract. 2019; 7(5): 1533–1540.

Below is a Table adaptation: Algorithm for triage persons for Pfizer vaccine 12/15/20 From: CDC Webinar, what Clinicians Need to Know About the Pfizer-BioNTech COVID-19 Vaccine, presented by Amanda Cohn, MD, and Sarah Mbaeyi, MD, MPH.

Proceed with Vaccination	Precaution to Vaccination	Contraindication to Vaccination
Conditions Immunocompromis-ing conditions Pregnancy Lactation Actions Additional counseling 15 Minute observation period	Conditions Moderate/severe acute illness Actions Risk assessment Potential deferral of vaccination 15 Minute observation period if vaccinated	Conditions None Actions N/A
Allergies History of food, pet, insect, venom, environmental, latex, etc. allergies History of allergy to oral medications (including the oral equivalent of an injectable medication Non serious allergy to vaccines or other injectables (e.g., no anaphylaxis Family History of anaphylaxis Actions 15-minute observation period	Allergies History of severe allergic reaction (e.g., anaphylaxis) to another vaccine (not including Pfizer-BioNTech vaccine) History of severe allergic reaction (e.g., anaphylaxis) to an injectable medication Actions Risk Assessment Potential deferral of vaccination 30 minute observation period if vaccinated.	Allergies History of severe allergic reaction (e.g., anaphylaxis) to any component of the Pfizer-BioNTech vaccine) Actions Do Not Vaccinate

*See Special Populations section for information on patient counseling in these groups (addended below)

The link below shows original table which was in the presentation:

What Clinicians Need to Know About the Pfizer-BioNTech COVID-19 Vaccine Amanda Cohn, MD Sarah Mbaeyi, MD, MPH December 13, 2020

Immunocompromised persons

§ Persons with HIV infection, other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19

§ Data not currently available to establish safety and efficacy of vaccine in these groups

§ These individuals may still receive COVID-19 vaccine unless otherwise contraindicated

§ Individuals should be counseled about: – Unknown vaccine safety and efficacy profiles in immunocompromised persons – Potential for reduced immune responses – Need to continue to follow all current guidance to protect themselves against COVID-19.

Pregnant women

There are no data on the safety of COVID-19 vaccines in pregnant women – Animal developmental and reproductive toxicity (DART) studies are ongoing – Studies in humans are ongoing and more planned

§ mRNA vaccines and pregnancy – Not live vaccines – They are degraded quickly by normal cellular processes and don’t enter the nucleus of the cell

§ COVID-19 and pregnancy – Increased risk of severe illness (ICU admission, mechanical ventilation and death) – Might be an increased risk of adverse pregnancy outcomes, such as preterm birth

§ If a woman is part of a group (e.g., healthcare personnel) who is recommended to receive a COVID-19 vaccine and is pregnant, she may choose to be vaccinated. A discussion with her healthcare provider can help her make an informed decision.

Considerations for vaccination: – level of COVID-19 community transmission (risk of acquisition) – her personal risk of contracting COVID-19 (by occupation or other activities) – the risks of COVID-19 to her and potential risks to the fetus – the efficacy of the vaccine – the known side effects of the vaccine – the lack of data about the vaccine during pregnancy

§ Pregnant women who experience fever following vaccination should be counseled to take acetaminophen as fever has been associated with adverse pregnancy outcomes

§ Routine testing for pregnancy prior to receipt of a COVID-19 vaccine is not recommended.

Breastfeeding and Lactating women

There are no data on the safety of COVID-19 vaccines in lactating women or the effects of mRNA vaccines on the breastfed infant or milk production/excretion

§ mRNA vaccines are not considered live virus vaccines and are not thought to be a risk to the breastfeeding infant

§ If a lactating woman is part of a group (e.g., healthcare personnel) who is recommended to receive a COVID-19 vaccine, she may choose to be vaccinated

Moderna vaccine for COVID-19 news

• This vaccine has been granted an EUA and approval from the CDC/ACIP.
• Results from the clinical trials are very similar in efficacy and safety compared to the Pfizer vaccine. The FDA Briefing Document can be found here. This document presents both interim analysis using a data cutoff of November 7, with a median follow-up of 7 weeks post-dose one, and the final scheduled analysis from a data cutoff of November 21, with a median follow-up >2 months post-dose two. This summary covers the final scheduled analysis.
• Efficacy: Vaccine efficacy was 94.1% (95% CI 89.3%, 96.8%) with 11 cases of COVID-19 in the vaccine group and 185 cases in the placebo group. Unlike the interim data, the vaccine efficacy when stratified by age group was 95.6% (95% CI 90.6%, 97.9%) for participants 18 to <65 years of age and 86.4% (95% CI 61.4%, 95.5%) for participants 65 years of age or older.
• Safety: The most common adverse reactions: injection site pain (91.6%), fatigue (68.5%), muscle pain (59.6%), joint pain (44.8%), chills (43.4%), fever (14.8%). Most of these were mild to moderate, began on day 1-2 and lasted 2 days. A small number of participants reported systemic reactions longer than 7 days, but there was no difference between vaccinated and placebo groups.
• This vaccine also contains PEG (polyethylene glycol) in the lipid capsule.