CORONAVIRUS DISEASE 2019 AND THE PD COMMUNITY

APDA COVID-19 INFORMATION & RESOURCES:

The American Parkinson Disease Association (APDA) continues to monitor the COVID-19 situation, particularly as it relates to our Parkinson’s disease (PD) community.

This page is updated regularly as new information becomes available.

What is a COVID variant? Do vaccines against COVID-19 protect against these as well? The COVID-19 virus, like all viruses, is able to mutate and create variants of itself. Many variants of COVID-19 have been identified around the world. Only a few of these variants have been of concern to public health however because they have a characteristic that makes the virus either more easily transmissible or more likely to cause significant disease. The Omicron variant is currently the variant of concern.

The vaccines approved in the US do offer protection against the variants, including Omicron, but not to the extent that was seen in the original trials. That means that fully vaccinated people are more likely to get infected with these variants of COVID-19 than the original strain. It has been shown that a booster vaccine at least six months from the second vaccine can significantly improve protection from contracting the Omicron variant. More importantly, the major goal of the vaccines is to prevent severe illness, hospitalization, and death from COVID-19 and the approved vaccines are very effective in preventing these consequences of infection.  Therefore, vaccination, with a booster dose, remains extremely valuable.

It is definitely possible for a future variant to emerge that outsmarts the vaccines to an even greater extent than the current variants. The vaccine developers are well aware of this likelihood. Some anticipate that an annual booster vaccine will be necessary to cover the prevalent variants, similar to an annual flu shot.

Overview of COVID-19 vaccines: Three COVID-19 vaccines have been approved for use in the United States — one manufactured by Pfizer/BioNTech, one manufactured by Moderna, and one manufactured by Johnson & Johnson.

The more people understand about how the vaccines are created and work, the more comfortable they may be about taking them.

How do the new COVID-19 vaccines work?  Vaccines work by introducing an element into the body that itself can’t cause illness but is recognized as an infection by the immune system. The immune system then responds to the element, giving the body the ability to defend against the actual infection should it encounter it in the future.

In the past, vaccines were created by taking the actual pathogen and weakening it to the point that it didn’t cause illness or by taking a piece of the pathogen that itself didn’t cause disease. This was then injected into the body, inducing the body to create antibodies, which were protective and long-lasting, and would work in the future, should the live pathogen enter.

Two of the currently approved vaccines, from Pfizer/BioNTech and Moderna, take a different approach and consist of a piece of the mRNA instructions for creating a piece of the virus contained within tiny lipid balls.  Once injected, our own cells turn these instructions into one of the COVID-19 proteins, which by itself is harmless. The protein is recognized as foreign by the body, triggering the protective immune response, which allows it to “remember” COVID-19 as foreign.

mRNA is easier to manufacture in a laboratory in large quantities than a weakened virus, and using mRNA technology allowed for the rapid creation of the vaccines, which typically take many years to develop.

The Johnson & Johnson vaccine works slightly differently. The genetic instructions for creating a piece of the virus are contained within a viral vector. It uses the shell of a virus for the common cold (in which the genetic instructions that cause the common cold have been removed) in order to deliver the COVID-19 genetic material instructions into the body. The lipid beads that contain the mRNA in the Pfizer/BioNTech and Moderna vaccines require extremely cold storage conditions which make distribution of the vaccine more complicated. The viral vector of the Johnson & Johnson vaccine can be kept in regular refrigeration for up to three months.

Are the vaccines safe?  The three vaccines approved in the US have been given to hundreds of millions of Americans aged 5 and up with excellent safety profiles. Worldwide, vaccines (those approved in the US and others) have been given to billions of people, again with excellent safety records.

It is important to note, that the CDC is continually on the lookout for potential rare problems that the vaccine may be causing. In order to monitor vaccine reactions, the CDC uses two systems, Vaccine Adverse Event Reporting System (VAERS) and V-safe. V-safe is a smartphone-based app that allows the public to submit their vaccine reactions.

Do the vaccines work?  The original clinical trials of the Pfizer/BioNTech and Moderna vaccines found that they were up to 95% effective in protecting people against the original strain of the virus – an astonishingly good number as compared to vaccines against other illnesses such as influenza. Those at particularly high risk of developing complications from COVID-19 infection, including those over 65 and with chronic medical conditions, were protected as well. To be protected to this degree, two doses of the vaccines were necessary, given three weeks (Pfizer/BioNTech) or four weeks (Moderna) apart.

Clinical trials of the Johnson & Johnson vaccine tested a one-shot vaccine. After one shot, its efficacy of protecting people from the virus was 66%. However, it was 85% effective against severe disease and 100% effective against death (that is, no one in the trial died of COVID-19.)

The vaccines do not protect against infection with the Omicron variant to the extent that they protected against the original strain of COVID-19. However, a booster vaccine, at least six months after the second vaccine increases protection substantially. In addition, vaccination remains very effective in preventing hospitalization and death from COVID-19.

What are the guidelines for those who are vaccinated?  The CDC continually updates its guidelines in response to evolving public health conditions. Here are some additional points:

• To reduce the risk of becoming infected COVID-19 and potentially spreading it to others, everyone, including those who are fully vaccinated, should wear a mask in public indoor settings if they are in an area of substantial or high transmission. The CDC constantly updates the map of US counties for which this applies. You will need to refer to your local public health authorities to determine whether your area is one with substantial or high transmission
• Fully vaccinated people might choose to mask regardless of the level of transmission in their area, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated. People who are at increased risk for severe disease include older adults and those who have certain medical conditions, such as diabetes, overweight or obesity, and heart conditions.

Should a person with PD get a booster vaccine?  

The CDC has recommended a vaccine booster for anyone 18 or older. A booster dose significantly increases protection against the Omicron variant.

Are there any reasons why a person with PD should not get a COVID-19 vaccine?  There are no substantiated scientific concerns to suggest that the vaccines have a different safety profile in people with PD as compared to the general population, so what we know about the vaccines for all-comers would hold true for those with PD.  There is also no evidence that people with PD should receive one vaccine over another. It is best to receive whichever COVID-19 vaccine is available to you.

Why should a person with PD get the COVID-19 vaccine?  Having PD might lead to a more complicated infection should you contract COVID-19, plus people with PD also tend to be older which further increases risk for complicated COVID-19 infection (see below). Because of these issues, vaccination for COVID-19 for people with PD is a good idea. Discuss with your doctor any concerns you have about the COVID-19 vaccine.

Do the vaccines make you feel ill?  While there have been some varied reactions, the most common is a mildly sore arm (similar to receiving any other shot) and that is it. There are some who may have a more noticeable reaction and feel chills, body aches, headaches and/or fatigue for 1-2 days, but these generally clear up quickly. Some people report a temporary worsening of their PD symptoms after the vaccine.

Weighing the chance of someone with PD getting COVID-19, as well as the significant downsides of all the pandemic-related restrictions on social and physical activities for someone with PD vs. the potential for side effects from the vaccine; the positive aspects of getting the vaccine despite the side effects outweigh the negative ones.

You can also view our Q&A with Dr. Joel Perlmutter about the COVID-19 vaccine and PD.

When will life get back to normal? This Q&A with Dr. Joel Perlmutter discusses navigating the challenges of returning from COVID lockdown, which you might find helpful.

In addition, visit APDA’s virtual events calendar to stay supported, engaged, and informed at home!

For answers to additional COVID-19 questions please visit Dr. Gilbert’s recent blog post. 

(Updated Dec 29, 2021)

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Basic Information About COVID-19 & the PD Community:

There have been a number of studies conducted that probe the relationship between COVID-19 and PD which you can review.

The literature supports that:

• People with PD demonstrated more anxiety and depression as well as decreased levels of quality of life and physical activity as compared to controls during the COVID-19 lockdown.
• People with early- and mid-stage PD and COVID-19 demonstrated outcomes that were similar to others of the same age with COVID-19 who did not have PD.
• People with advanced PD did not fare well in the face of COVID-19 with mortality due to COVID-19 among people with PD correlating with more advanced disease.
• In people with advanced PD, a rapid worsening of PD could mean onset of COVID-19 infection.

What features of PD could increase complications from coronavirus?

PD motor- and non-motor symptoms can be exacerbated by any medical illness, including COVID-19. This means that in addition to the respiratory symptoms of the virus, people with PD may feel that they are slower and stiffer than usual and that their medications don’t seem to be working as well. Hallucinations may start in a person who never experienced that symptom before. Recovery from the illness can be more drawn out.

In addition, some people with PD may have restrictive lung disease which refers to an inability of the lungs to fully expand with air. Restrictive lung disease can occur in PD because of rigidity of the muscles of the chest wall, as well as bradykinesia, or slowness of the muscles responsible for chest wall expansion and contraction. People with PD may also have abnormalities in the posturing of their trunk including head drop, stooped posture, tilting of the trunk and bending at the waist. These postures can restrict the amount that the lungs can fill up with air. PD can also predispose a person to dysfunction of swallow and difficulty clearing secretions from their airway. These issues could contribute to development of complications during a respiratory illness.

People with advancing PD also may start to experience decreased mobility, with more risk of falls. As PD advances it can cause additional problems including urinary dysfunction and weight loss. All of these elements can contribute to general frailty and increased risk of infection, including increased risk from COVID-19.

All things considered, people with PD, because of age and because of their underlying PD symptoms, should consider themselves at increased risk of complications from COVID-19.

Questions?

If you have a question about COVID-19 and PD that is not answered here, please submit your question to our Ask A Doctor web feature.