C/O Jason Wilson, MD
By Jason Wilson, MD
Less than a year ago, I had no idea that a novel coronavirus had emerged.
Today, Ive taken care of hundreds of patients with that virus, redesigned an emergency department to safely care for patients with and without COVID-19, helped roll out 3D printed swabs to make up for a short supply of test kits, studied numerous potential viral therapeutics, found ways to virtually care for COVID-19 patients using wearable monitoring devices and telemedicine, and worked daily to show that data from our local community demonstrates that masks save lives and that we should stay out of crowded, indoor bars, restaurants and nightclubs when case numbers are high.
I can even hold my own speaking in R0 (pronounced R-naught) and exponential growth curves. Most stunningly thoughless than a year after the SARS-CoV-2 virus was genetically sequencedI have received my first dose of a COVID-19 mRNA vaccine. If given the chance, I think you should, too. Heres why.
Jason W. Wilson, MD is a clinical emergency medicine physician and critical medical anthropologist at Tampa General Hospital and the University of South Florida. Follow @tampaERdoc on Twitter.
Essential workers and vulnerable populations dont have the same option
The risk for who gets infected and who does not is partly structural and partly cultural (driven unnecessarily by heated political rhetoric and disinformation). Some people can stay at home, often struggling through web meetings, or with kids that have opted out of brick-and-mortar" for the year. Some of you have kidslike my 11-year-old currently playing Xboxon a mandatory two week quarantine after being exposed to another positive student.
Healthcare workers never could opt for safer at home, but have better access to PPE than other workers also deemed essential for service (some of whom are simultaneously deemed less essential for protection). Essential workers cannot choose to stay home. We need food and groceries, and incomes must be earned. Those essential workers are both at higher risk for contracting COVID-19, but also for transmitting the virus because of survival decisions that mean showing up to work even after exposure. Those same essential workers may also return to life in densely packed houses.A second relief packageespecially one that gives workers the tools (read: money) to stay home and not have to go out to earn a living to pay for food and rentwould help small business owners, workers and the unemployed make decisions that protect us all.
Vaccinations shouldnt be political
Equating mask requirements to an assault of freedoms, political rhetoric and disinformation are all weapons that could doom a large-scale rapid vaccine distribution campaign even before it ramps up. Couple that with more factorshistorical racism, trust of science, the vulnerability of undocumented residents, plus those weary of healthcare and Big Pharmaand you risk falling short on the herd immunity vaccines are supposed to help us reach so we get back our lives and stop this suffering.
In other words, while vaccine distribution may be political, we must ensure that vaccination remains medicine, allowing public health experts to speak loudest, tamping down on information that takes away from the clear message.
Almost everyone should get a COVID-19 vaccination
Almost everyone should get the vaccineunless you have had a significant allergic reaction to vaccines in the past. Eventually, there may be different vaccines best suited to different individuals, but right now mRNA-based vaccines are what is available and what I received. Some should get the vaccine before others (healthcare workers, long term care facility residents, EMS workers, teachers, and then older, more vulnerable people,further stratified by Centers for Disease Control and Prevention guidelines).
While there are still questions about how effective a vaccine will be for people who have weaker immune systems or take certain medications (chemotherapy, drugs like Humira, transplant meds, daily steroids), this does not mean that the vaccine is unsafe in people with weaker immune systems. It just means that the protection may not be as much given the lessened ability of immunosuppressed bodies to produce an immune response.
What about pregnant women and the COVID-19 vaccine?
We dont have a lot of data on pregnant and women who are breastfeeding since kids, pregnant,and lactating women are routinely excluded from clinical trials. However, the CDC and theAmerican College of Gynecology (ACOG)have both stated that the vaccine can be administered to pregnant and breastfeeding women and should be offered. If anything, an mRNA vaccine that leads to antibody production in a mom may convey benefit to an infant by passing antibodies through the placenta and breast milk.
What does an mRNA vaccine do?
There is a saying you learn in biology class: DNA makes RNA, and RNA makes protein. Hang with me for a second and lets do some quick Cell Bio 101.
A human cell has a nucleus inside of itlike the little rubber ball inside a baseball. That nucleus is where DNA lives. That DNAthe genetic sequence or genomeis constantly churning out a sorta mirror image middle step particle called RNA. That RNA is called mRNA (messenger RNA) because it acts as sort of a message with instructions telling the cell what to do next. The mRNA leaves the nucleus and hangs out in the celllike in the inside of the baseball, but not in the deep rubber part, just under the white leather surface.
What does mRNA do exactly? The millions of various mRNA sequences act as different instruction booklets for your cells to build all kinds of different proteinsproteins that move things around, attach to other things, make antibodies, pretty much all bodily functions.
Turns out, the surface of the coronavirus has an important protein on it called the spike protein. That spike protein is responsible for all this damage because it works by attaching the virus to human cells, allowing the virus to enter the cell, camp out and steal your cells tools to make copies of coronavirus. Spike proteins have become the major target of most of our therapies as well. The monoclonal antibody infusions people receive right now are synthetic versions of antibodies that attack spike protein.
The mRNA vaccine has the instructions to make its own spike protein to help your body mount an immune response should the coronavirus spike protein enter your system . Thats itthere are no viral particles in the vaccine, period.
What happened in the Pfizer-BioNtech vaccinestudy?
Phase three clinical trials are the big studies that directly test a new drug against a placebo or an existing treatment. On Dec. 10, the phase three study for the Pfizer vaccine was published in the New England Journal of Medicine. The major takeaway is that over 21,000 people received the vaccine and about the same number received placebo. The trial didnt examine whether a person gets COVID-19 or not, but whether a person gets sick from COVID-19 (this is why we still need to wear masks for now, even if were vaccinated). Instead, participants were followed after receiving the vaccine and were tested for coronavirus if they had COVID-19 symptoms. The mRNA technology alone was a moon-level landing breakthrough, but the results themselves matched the rigorous scientific awe! In the placebo groupthe group of people who did not get the vaccine169 people got sick with COVID-19. Among those who received the vaccine, only nine people developed COVID-19 symptoms and a positive test. In laymans terms, this means the vaccine was 95% effective in the phase three trial.
But it gets better.
Of those in the trial who had severe COVID-19requiring hospitalization, ICU level care and oxygen support, aka the really sick peoplenine were in the placebo group and only one was in the vaccine arm. Clearly, this vaccine prevents people from getting sick from COVID-19. Data released for the Moderna vaccine looks similar. And since the mRNA vaccines do such a good job of preventing symptomatic COVID-19, even those whove already had COVID-19 should be vaccinated.
C/O Jason Wilson, MD
You dont need to get tested before getting the vaccine
And, yes, getting the vaccine is definitely better than getting COVID-19 in order to obtain immunity. Having COVID-19 can not only make you very sickit also makes you very infectious.
Myth busting
How about the dangers of a new technology? Certainly, there are side effects? A few internet myths say the mRNA becomes part of your genome, or that the mRNA causes infertility (some healthcare workers who are often women of child-bearing age often fall prey to the latter).
Let me say this for the people in the back: The mRNA in this vaccine wont become part of your genome.
Remember, the mRNA is outside the cell nucleus (the inner rubber part of the baseball where the sausage making of DNA takes place). But what about all of these cells floating around with spike protein? How long will you be making this spike protein? Well, it turns out that eventually your very own cells that are making spike protein are also signing their own death warrants because that very spike protein will lead your body to come hunting for those cells as well when seeking out COVID-19 virus to destroy. In short, you wont be churning out weird spike protein cells or keeping spike protein instructions around forever (this is why we still dont know if the built in memory immunity your body gains will be enough to forgo future vaccine doses).
Let me also say this for the people in the back: The Covid Vaccine does NOT cause infertility!
I try not to engage too much in dispelling BS (because you just end up with more mounds of BS), but the nonsense that this vaccine can cause infertility must be shut down now before the rabbit hole continues to grow wider. This is an especially harmful form of disinformation because there are so many women of reproductive age on the frontlines who need this vaccine. The logic of the nonsense goes like this: A former Pfizer employee (who last worked there in 2011, but not on vaccines) notes that spike protein has some similar mRNA sequences with a broader group of proteins that support cell adherence (the process by which cells form contacts with each other). One of those similar proteins is found in humans and promotes placental growth.
Keep following me.
The logic behind the nonsense then says that since the mRNA sequences have similarities, the mRNA vaccine will cause infertility. Idaho is a state and New York is a state, so, they are basically the same, right? Wrong.
That nonsensical line of thinking falls apart pretty quickly and most easily by looking at reality. There have been millions of cases of COVID-19, but no corresponding infertility epidemic in the real world. Digging into the weeds a little more, the noted similarities are not in the area of the protein where our antibodies will attack.Myth busted!
What about side effects and the general safety of the mRNA vaccine?
As I sit here writing after my first dose, I am already developing some protectionand a little arm sorenessagainst COVID-19, and that protection will soar after I receive the second dose in 21 days (its 50% effective after dose one and 95% effective after the second dose administered 21 days later).
Seriously, am I going to grow a third eye?
What are the adverse effects, the bad things that happen? Two heads, extra arms, purple toes? The vaccine has not been around for long, and we should certainly monitor any development of downstream inflammatory mediated effects, no matter how unlikely.
OK, so tell me about side effects again.
Lets turn to the data we haveand some personal experience.
Side effects are mostly benign and seem more likely to occur after the second dose when the body is more primed to mount an inflammatory response. In fact, healthcare professionals may stagger second doses among our workforce in anticipation of some fatigue and, less commonly, low grade fevers after the injection.
On the day after I received my first dose, it felt like I got punched in the arm. In a completely unscientific poll conducted by a colleague of the other docs who received the vaccine with me, three of us had arm soreness, two docs felt completely fine and one, who had COVID-19 previously, developed some pain, skin sensitivity and a headache at the 24 hour mark48 hours later, all symptoms have resolved.
Thats it.
I had no redness, no fever, no nausea, nothing else. Like me, most people (84%, data says) will report some pain at the injection site while only about one in 20 will have any redness or swelling. One in six people may have a low-grade fever after the second dose while half feel a little tired. Symptoms like diarrhea and vomiting occurred about the same amount in the vaccine and placebo arm (about one in 50 people).
What about the more serious side effects?
A handful of medical problemsheart attacks, strokes, hospitalizationsthat occurred in the study are expected when you follow a lot of people that are older than 55 around for a few months. Its important to note that there were not any differences between the vaccine and placebo groups.
There have been a few (three as of this writing) severe allergic reactions (probably from polyethylene glycol). In at least two of those people from the U.K., each had a previous severe allergic reaction. One woman in Alaska who had an immediate reaction after receiving the vaccine had no prior allergic reactions, but remarked that very day she was still glad she got the vaccine and recommended it to others! With the whole world watching and documenting, most side effects are going to come to light and for a new vaccine moving to the arms of thousands and thousands of people, this small number of allergic reactions helps reaffirm the safety data. Per the FDA guidelines, after receiving the vaccine, all patients are monitored for 15 minutes (TGH hands out timers and lets people wait in a socially distanced space) and those with known prior allergic reactions are monitored even longer.
Does the COVID-19 vaccine cause Bellspalsy?
Bells palsy is a neurological condition that, oddly, paralyzes half of the face but usually resolves. Not surprisingly, internet myth makers have picked up on four cases of Bells palsy that occurred in the vaccine group of the Pfizer study, claiming that the COVID-19 vaccine causes Bells palsybut there is no evidence for this. There were 21,000 people in the phase three Pfizer study who got the vaccine. Bells Palsy occurs normallyon its own in about 25 out of 100,000 peoplemeaning we expected there to be five cases of Bells palsy in the vaccine group. Certainly we can ensure that this math stays true, but, for now, thats another myth debunked.
Minority enrollment, trust and transparency
Minority enrollment was an important part of the vaccine study10% of participants were African-American and 26% were Hispanic/Latino. In addition, the first person to receive the Pfizer vaccine after the FDAs emergency use authorization was a Black nurse in New York City, Sandra Lindsay. With the atrocities of Tuskegee and the horrible record of gynecological experimentation on enslaved Black bodies still in the rearview mirror, this representation of people of color is important. But will that be enough to gain trust in the vaccine?
Florida Shotsa free, statewide, centralized online immunization information systemwill help monitor who has been vaccinated. Monitoring vaccination information and linking names and personal information creates worries that undocumented people may be scared away because theyre willing to take the risks of COVID-19 and transmission to family over the fear of deportation.
There are no easy answers to the long history of exploitation against those with less power than governments and corporate conglomerates. Recognizing these issues and attempting transparency is a start. Disinformation and histories of structural violence are complicated.
Again, you should definitely get vaccinated if you have the chance
In sum, the message around COVID-19 vaccination can remain simple, persistent and consistent. The best available data demonstrates that mRNA COVID-19 vaccines from Pfizer (and Moderna) are safe and effective. Almost everyone should plan to take some version of the COVID-19 vaccine when the time comes for you to choose. If you are not in the first wave groupthose getting vaccinated before Jan. 1go get your flu shot right now and help prevent a twindemic. We dont need a flu surge on top of this ongoing COVID-19 surge.
Plan for two doses of the Pfizer-BioNtech vaccine (21 days apart) or the Moderna vaccine (28 days apart) and get the same brand of vaccine at dose one and dose two. Keep wearing your mask, keep maintaining social distance and avoid crowded indoor spaces. Help your healthcare workers help you and help this society get past a horrible pandemic.There will likely be no cost to anyone receiving the vaccine for the foreseeable future.
We will struggle with the disinformation if we do not start battling back with the set of facts that arise from reality. Disinformation drives fear and fear leads to the symbolic transformation and heated rhetoric we have witnessed among masks. Vaccines cannot become the new mask!
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Op-ed: This Tampa ER doctor just got his COVID-19 vaccine and, when able, you should, too - Creative Loafing Tampa