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Contracting COVID-19 in between vaccination shots: What next? from Crain’s Detroit Business

April 22, 2021

When I locked in an appointment for my first vaccine shot in late March, the date couldn’t come soon enough.

Little did I know I’d be sick with COVID-19 within days of getting it.

Our family stayed healthy for the first year of the pandemic, but my husband began showing symptoms of COVID-19 after other cases at his workplace, just two days after my first vaccine shot.

I barely had time to think about any protection the first shot might have offered me, even at that early stage, before I, too, got sick. My graduate student daughter, who picked the wrong weekend to come home for a short visit, and her boyfriend also came down with it.

The first week was a blur, as we did little besides sleep and medicate in an attempt to get over the initial acute symptoms. But as we began to emerge from that fog the following week, I started to think about my second vaccine shot, scheduled for April 16. Could I still get it?

Jenna Urbauer, a Southeast Michigan fundraising consultant, wondered the same thing. She also got sick with the illness in March, 10 days after her first shot.

She believes she was exposed by someone who cut her husband’s hair, mask on, in their back yard two days earlier. She says she stayed 6 feet back and only stood in the yard talking with them for about 10 minutes before returning to the house. But it was enough, she said. The same day she came down with symptoms, the barber called to say he’d tested positive. Her husband, a teacher who’d been fully vaccinated, did not catch it.

Like me, Urbauer began Googling to find credible guidance on what to do about her second vaccine but information is limited and must be pieced together.

She called local health departments and the Michigan COVID line to get more information, but nobody could answer her questions.

“I wanted people to know … had this happened to people before … could I get my second shot and if so, what were the ramifications?

“I just couldn’t find much information on this out there at all,” she said.

After hearing back from someone at the Michigan Department of Health and Human Services but not learning a whole lot more, she spoke with her primary care doctor at Epoch Primary Care in Detroit. The physician told her she could get the second shot as long as it had been 10 days or more from the onset of symptoms and she was symptom-free, Urbauer said, because it would make her incredibly sick if she had any symptoms.

Symptom-free at that point, 10-11 days after the onset of her illness, she made the decision to go ahead with her second vaccine shot. For 24 hours she was very sick. “I could not move, couldn’t get out of bed, and the sick chills and achy body was so bad. I’ve never experienced that before,” she said.

“It’s hard to say if that’s because I got COVID in between or because I’m a woman. Who knows.”

The MDHHS said it isn’t tracking how many people contract COVID-19 between vaccine shots.

Given the latest surge in COVID-19 cases, the more contagious variants that have developed and the push to get people vaccinated, it’s likely there already are and will be others.

For information on getting vaccine shots after you contract COVID, MDHHS points to the guidance from the Centers for Disease Control and Prevention and the Immunization Action Coalition, which echoes the CDC, with advice that in general, people scheduled for COVID-19 vaccination who are exposed to the coronavirus and quarantined should reschedule vaccination after their quarantine period has ended to avoid the risk of exposing vaccinators to the coronavirus.

The CDC recommends people who had COVID-19 and were treated with monoclonal antibodies or convalescent plasma should wait 90 days before getting a COVID-19 vaccine.Those who contracted the illness but didn’t receive those treatments, despite symptoms, should wait to be vaccinated until they have recovered from their illness and have met the criteria for discontinuing isolation.

You have to jump to another page to figure out the criteria, but the guidance is that those who contract COVID-19 can end their isolation if it’s been at least 10 days since symptoms onset, at least 24 hours since their last fever without fever-reducing medications and other symptoms have improved. Those without symptoms should also wait until 10 days after the date of their positive test before getting vaccinated.

Some with severe illness may produce “replication-competent” virus beyond 10 days and need to extend their isolation for up to 20 days after the onset of symptoms, the agency notes.

The same guidance applies to people who get COVID-19 before getting their second dose of vaccine, the CDC said.

That guidance is vague at best, said Dr. Phillip Levy, professor of emergency medicine at Wayne State University and chief innovation officer at Wayne Health, who developed and oversees the WSU and Wayne Health mobile COVID-19 testing program.

“The CDC doesn’t do a very good job; they just say symptoms,” he said. “What they are referring to are the acute (or) initial symptoms.”

“The bottom line is it’s most important for people who get COVID after their initial vaccine to make sure that they recovered from symptoms before they even consider going back for their second dose,” he said.

That’s both to avoid infecting others and reigniting an immune response for those who may be poised for complications that develop around the 14-day mark, Levy said.

“A jolt of the immune system again at that point could potentially exacerbate the situation, because it’s the immune response that is thought to contribute to those somewhat delayed complications people develop.”

It’s tricky, though, when it come to symptoms, Levy said. With folks who aren’t back to baseline after the 10- to 14-day period, “we don’t know if what you’re experiencing is the virus itself, the immune response, still, or because your body went through a stress,” he said.

For people who have vague symptoms beyond the recommended isolation periods, it’s not unreasonable to let that ride out for another week or two before getting the second vaccine shot, he said.

“The challenge is we really don’t know the effectiveness if you go past the three or four weeks, but we think you can go up to six post weeks” from the first shot.

For those with lingering symptoms beyond that, the antibodies developed in response to the infection itself will give them an estimated 90-day window of protection, Levy said. “If they wait and have to get a third dose, maybe we’ll know more about that in a couple of months.”

As Urbauer experienced, those who’ve had COVID recovered and are no longer symptomatic might experience a more intense response to the second shot, he said.

Your body has seen the protein when you got vaccinated and when you got sick and is now primed to fight the infection much more quickly, he said. “So the immune response the third time around may be more profound.”

For those who’ve recovered from COVID but haven’t yet been vaccinated, it’s probably best to wait for 90 days to get the first shot because you’re already protected from natural antibodies, he said.

As for me, we make the best decisions we can, based on the information we have at the moment.

I’ve rescheduled my second shot for two weeks out to get past lingering symptoms. I’ll be taking the day off.

Read, “Contracting COVID-19 in between vaccination shots: What next?” from Crain’s Detroit Business.

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Contracting COVID-19 in between vaccination shots: What next? from Crain’s Detroit Business

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