Here are some expert takes on what people with a history of heart conditions should know about COVID-19 vaccines. In a review published in October 2020 in the American Journal of the Medical Sciences, researchers blamed the increased risk of COVID-19 complications in people with underlying cardiovascular disease on abnormally high amounts of a receptor that serves as a bridge for the virus to jump into the lungs and heart. “Folks with underlying cardiovascular disease hands down have a higher risk of severe or fatal COVID-19. The only way to prevent that is to not get COVID-19, and the best way to do that is to get a COVID-19 vaccine,” says Eduardo Sanchez, MD, MPH, the chief medical officer for prevention at the American Heart Association (AHA). Learn more about how COVID-19 impacts the heart, and what that means for people with underlying heart disease here. Preliminary data from the University of California, published in March 2021 in the New England Journal of Medicine, found that of the 28,184 healthcare workers who received two doses of a COVID-19 vaccine, 7 tested positive for COVID-19 15 days after receiving their second dose. The number was higher among those who had received only one dose or who were infected during the two-week period that vaccinated people must wait to have a full immune response and be considered fully vaccinated. In any case, the COVID-19 vaccines are very good at preventing serious illness and death due to the disease. “The vaccines teach your body to fight the virus off quicker and more effectively, preventing serious illness. Vaccinating as many people as possible will prevent a second wave of the virus and will protect those who cannot get the vaccine for medical reasons from getting the disease,” says Antonio Abbate, MD, a cardiologist at the Virginia Commonwealth University Pauley Heart Center in Richmond. New research has found that the two-dose vaccines are also quite good at preventing infection, and therefore transmission, of the virus. The latest CDC interim report, which was conducted on healthcare workers and first responders and indicates how the COVID-19 vaccines are working in the real world, found that the two-dose Pfizer-BioNTech and Moderna mRNA vaccines are 90 percent effective at preventing COVID-19 infection after full vaccination, and 80 percent effective after the first dose. This means the vaccines appear to be very effective in preventing people from spreading the virus, but it’s not impossible. “Because the virus is still rampant in our society, we ask those who have been fully vaccinated to wear a mask to prevent COVID-19 from spreading while we are still waiting to get everyone vaccinated,” says Dr. Abbate. Three COVID-19 vaccines are currently authorized for emergency use in the United States, and states are expected to receive larger amounts of the Johnson & Johnson vaccine, the most recently authorized and the only single-dose COVID-19 vaccine in the United States, as significantly more shots become available throughout the coming months. Clinical trials showed that the Johnson & Johnson vaccine is almost 67 percent effective at preventing illness globally, and is even more effective in the States. As more people in the general public receive this vaccine, the CDC will be able to gather more information about how well it prevents transmission.
3. Am I at Higher Risk for Vaccine Side Effects?
According to Abbate, people with underlying cardiovascular disease are not at a higher risk for developing vaccine side effects, which commonly include temporary fatigue, headache, muscle aches, chills, fever, and nausea, according to the CDC. These are common signs that your body is building immunity, but they don’t appear in everyone, the CDC reports. If you receive one of the two-dose vaccines, know that you may feel worse after your second shot, the CDC advises. Abbate explains that this is because your body has already developed a partial immune response to the virus after the first shot, which is why people who have had COVID-19 before also may be more likely to feel sick for a couple of days after getting vaccinated. In addition, none of the vaccines being administered in the United States is a live vaccine, meaning none actually infect people with the SARS-CoV-2 virus. Since there is no complete virus in the vaccine, but rather proteins that teach your immune system to recognize COVID-19 and fight it off, you cannot get infected with the disease from the vaccine. “Some of my patients have expressed concerns about not wanting to feel sick and say they’re concerned that having a fever or an inflammatory response may make them ill. The way I explain it to them is if you are concerned that a protein in a vaccine will make you feel sick for a couple of days, imagine what the full-blown virus would do,” says Abbate. He also advises people to go to healthcare appointments, rather than skip them out of fear of getting COVID-19; keep up with medications; work on maintaining healthy blood pressure levels and weight; and exercise regularly to be in good health when a vaccination opportunity comes. Allergic reactions to the COVID-19 vaccines are both very rare and easy to treat. According to Abbate, allergic reactions are related to some components in the vaccine and have nothing to do with the viral proteins themselves. “If a reaction does occur, it’s usually in people who have had an allergic reaction to other vaccines or people who are predisposed to have allergic reactions. They also occur very quickly after the vaccine is administered, within about 15 minutes, which is why every vaccination site is equipped to treat an allergic reaction.”
4. Are COVID-19 Vaccines Free for People With Heart Disease?
Yes. According to the CDC, COVID-19 vaccines are completely free for anyone living in the United States regardless of immigration or health insurance status. A vaccine provider cannot charge you for the vaccine, for administration fees such as copays, or charge for an office visit. If you are insured, your vaccine provider may bill your insurance, but providers cannot charge you for any remaining balance on your bill. If you are uninsured, the provider may seek reimbursement from the Health Resources and Services Administration’s COVID-19 Uninsured Program, but cannot ask for any money from you for the COVID-19 vaccine.
5. When Can I Get Vaccinated?
Each state is in charge of its own vaccine rollout, so who is currently eligible for a COVID-19 vaccine differs by state and even by county. Federal guidelines recommend that adults with “underlying medical conditions which increase the risk of serious, life-threatening complications from COVID-19” be prioritized for vaccination. This includes cardiovascular disease, but the guidance doesn’t further define whether or not some types of cardiovascular disease should be prioritized over others. States have all created their own guidelines as to which heart diseases qualify a person for early vaccination, and whether or not people must have multiple underlying conditions to fall into a priority vaccine group. “Having cardiovascular disease is not one-size-fits-all, so what we have done locally is look at whether patients have more than one high risk condition, whether they have been recently hospitalized, or are older, because age seems to be an important risk factor as well. If you combine these factors you can come up with a score that can tell you which patients are more high-risk,” says Abbate, who is based in Virginia. If you have a well-controlled heart condition that has not led to hospitalization in years, and don’t have any comorbidities such as diabetes, “you’re not super low risk, but certainly aren’t very high risk,” says Abbate. Currently at least 12 states — Arizona, Colorado, Connecticut, Kansas, Louisiana, Minnesota, Montana, North Dakota, Ohio, Oklahoma, South Carolina, and Texas — have opened vaccines to all adults, and the list of states is growing. While demand still far outpaces vaccine availability, people with underlying conditions may still be able to get priority placement when vaccination slots become available. Your individual state health department will be your best resource for determining which vaccination phase your county is in and when you may be eligible. Pharmacies, healthcare systems, and community vaccination sites in a state may also be at different stages in vaccine rollout, so it’s not always obvious where you can go. Check your state health department website or call your state’s COVID-19 hotline for more information about how you can get in line for a vaccine. You can also contact your primary care physician or cardiologist’s office to ask if they are a vaccination site and if so, how you can get your name on the list.
6. I’m Still Not Sure. Where Can I Get More Information?
Dr. Sanchez says that he understands people’s concerns and urges everyone to make sure they are getting information from credible sources and to question what they read on social media. “There is so much misinformation, and it’s critically important for people to ask themselves where this information is coming from and is there any way to verify that information,” says Sanchez, who notes the importance of speaking with an expert, such as a healthcare worker, whom you trust and who makes you feel comfortable. You can also find answers to common questions on GetVaccineAnswers.org. “If you have been vaccinated, share your story with friends who you think may be fearful, and that may encourage them. If you think someone is particularly hesitant, offer to go with them,” says Abbate. “People might need special encouragement, so try to understand what their barrier is. Vaccination is the way out of this pandemic.”
