Do you want the good news or the bad news first?

No question has been more pervasive during the past year鈥檚 pandemic than this one. It鈥檚 almost as if it鈥檚 left all of us hesitant to celebrate any victories, even big ones (like, we have three really amazing vaccines) in the war on COVID because we know there鈥檚 always going to be a 鈥測eah, but 鈥︹�� right after it. For the past year it seems like for every step forward, there鈥檚 been an accompanying step back. With each victory, a demoralizing caveat.听

Vaccinated people can hang out with more people now. (Yay!) But they still have to wear masks. (Dang it.)

Social distancing and masking are really making a difference. (Sweet!) Texas is open for business! (D鈥橭h!)

Almost a quarter of the United States population has now been vaccinated. (*Pats self on back*) Social inequities have never been more apparent. (*Face palm*)

So just as this pharmaceutical freight train is starting to pick up steam and crank out massive quantities of vaccine, here comes the inevitable next wave.听

And here we go again. Or do we?

听

鈥淲e are not out of the woods yet,鈥� said MUSC Health System chief quality officer. 鈥淚t鈥檚 up to us as to whether we鈥檙e going to remain vigilant 鈥� by continuing to wear masks and practice social distancing 鈥� or relax too soon. We can do this. We just have to be smart. Nobody wants to lose all the ground we鈥檝e gained.鈥�

Maybe it鈥檚 another 鈥渂ut the bad news is鈥� scenario all over again. But maybe, just maybe, this time we get to have a say in what the future holds.听

With the vaccine landscape changing almost daily, each week we are checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. How were things last week? How are they looking this week in terms of number of vaccines we鈥檙e receiving? Are we seeing that uptick yet?

A. You know what? It鈥檚 actually getting better. Last week, we got 20,000 doses and we鈥檙e expecting 24,000 this week. Our waitlist is gone. Our scheduling links are open. We鈥檙e into second doses with schools. It鈥檚 all good. We鈥檙e only scheduling like a week or two in advance, just to be safe. We鈥檝e learned a lot from how things have gone in the past. We don鈥檛 want to get out over our skis. Going forward, I only expect our shipment numbers to go up.听

Q. Is the demand for vaccine appointments dropping?听

A. Yes and no. Some sites are slower to schedule than others. For fixed sites, like Florence at the Civic Center, people should come. I鈥檓 not afraid to put that out there. That鈥檚 a good spot to get a vaccine. If you鈥檙e willing to travel, it鈥檚 worth a look. On March 31, anyone over 16 will be eligible for a vaccine, so I don鈥檛 think we鈥檙e going to see a lull in in demand.听

Q. What a seesaw the AstraZeneca story has been. In light of all the recent news do you see it getting an Emergency Use Authorization (EUA)?

A. It鈥檚 pretty close to the other viral vector vaccines (specifically, Johnson & Johnson), so I don鈥檛 see why it wouldn鈥檛. The only thing I can鈥檛 figure out is the efficacy against the was extremely low. It鈥檚 weird to even say this, but we might not even need it, given how much of the existing three vaccines are expected to be delivered in the U.S.

Q. I have heard some people are asking these companies (Pfizer, J&J, Moderna) to make their recipes public so other companies can make these things. What do you think about that?

A. I don鈥檛 know why they would. I think there鈥檚 more than one way to accomplish the goal. Like the Merck deal is a good example. (Merck partnered with Johnson & Johnson to help to manufacture its single-dose vaccine.) So forcing these companies to publish their recipes doesn鈥檛 make sense. I mean, who says, 鈥淭hat great new breakthrough drug you just made? Yeah, now it鈥檚 generic.鈥� We鈥檝e got enough vaccine that that just isn鈥檛 necessary.

Q. What are you seeing as far as long COVID symptoms go? Are we getting patients with lingering symptoms, like fevers, breathing trouble, cognitive/psychiatric problems, stuff like that?听

A. We are in the process of setting up a long-hauler clinic 鈥� you know, for people dealing with lingering and long-term aftereffects of COVID. It鈥檚 desperately needed. These people need to be able to seek care and advice. I think some of them are made to feel like they鈥檙e crazy. We know it鈥檚 a really complicated virus. We can detect it in almost every organ in the body, so it鈥檚 not that big of a stretch that you would have prolonged symptoms.

Q. The U.S. government is committing to expanding screening to students returning to in-person schooling. Does screening really help or is that just one of those things that makes us feel better because at least we鈥檙e doing something?

A. It depends on the type of tests they use. If they use an antigen test, it鈥檚 not really that helpful. But if it鈥檚 a PCR (polymerase chain reaction) test 鈥� what we refer to as the 鈥済old standard鈥� 鈥� then it might be actually helpful. At MUSC, we鈥檙e switching almost exclusively to deep nasal, which might sound bad, but believe me, it is so much better than the nasopharyngeal test. It basically just goes midway up your nose. It might tickle but it doesn鈥檛 hurt. And it works just as well as nasopharyngeal swabbing.

Q. Is MUSC involved in any vaccine trials for children?

A. We are getting close, but right now we don鈥檛 have any up and running.

Q. Once that happens, how hard is it to get enrollees? Seems like a bit of a leap of faith for parents to put their kid in a trial, isn鈥檛 it?

A. Well, you鈥檙e asking a doctor, so I鈥檓 going to say no. (*Laughs*) But you鈥檙e right. It can often be hard to do a pediatric trial. Sometimes they have to offer incentives to give families compensation. What helps sometimes is, with a lot of these trials geared to younger people, there is a 2 to 1 enrollment, meaning there鈥檚 a 67% chance their children will get the vaccine. For me as a parent 鈥� and both my kids are in a trial, by the way 鈥� knowing there鈥檚 that good of a chance versus, say, 50%, is what swayed me.听

Q. How do the vaccines they are using in these kids鈥� trials differ? Are they the same? A diluted version? Completely different?

A. That鈥檚 a good question. It鈥檚 the exact same vaccine, but they typically adjust the dose, just like you would with any medicine. The smaller the person, the less of it they need.听

Q. Right now COVID cases in Britain are down 90% from its peak versus 79% in the U.S. From a vaccine standpoint, Britain has given nearly 45% of its population at least one dose versus 25% here. Do these numbers, looked at together, show that Britain鈥檚 approach (give as many people as possible at least one dose) is a better than ours (give people both first)? If so, do you think it鈥檚 worth changing course 鈥� and is that even possible at this point 鈥� in this country?

A. I don鈥檛 think so. I think we鈥檒l have enough vaccine going forward that it won鈥檛 be an issue. I think we are too far along to change course now. The U.K. took a huge gamble there 鈥� thank God it worked.听

Q. I know I鈥檝e asked this before, but what if, say, a new variant pops up that renders current vaccines ineffective. Do these researchers 鈥� the same ones that came up with the current batch of vaccines 鈥� feel confident that they can solve the new riddle fairly quickly?

A. I think the two mRNA ones (Pfizer and Moderna) have expressed confidence that they could adapt to that. The logistics would be a giant headache 鈥� like distribution, scheduling, etc. 鈥� but as far as making it goes? Yeah, they could make it, no problem.听

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line 鈥淰accine Q.鈥�