A time to be ill, a time to heal -- a time of vaccination
Before I get started on this week's topic, I need to put to rest a rumor that I've now heard twice. Since I am the central figure in the rumor, I should be the one to debunk (and hopefully quash) this rumor.
The rumor is that several weeks ago I obtained 30 Covid tests, and sent them to the lab without swabbing anyone, and they all returned positive, proving, I assume, that you can't rely on the Covid test.
There is nothing about this rumor that is true. My practice only recently received our 30th Covid test. We have, so far, sent in about 2 dozen tests. None of them has been positive.
Even the premise of the rumor does not make sense. I cannot just “send in” 30 tests. Each test must have a person's name attached to it, or it won't be run. If I “made up” some names, the lab would want to have more information (so they can send a bill to the person or the insurance company). If I used names of people in my practice, they would be pretty upset when they get a bill for a test that they didn't participate in!
Bottom line, none of this happened. The tests are very reliable. Some people with Covid have only mild symptoms. Some have no symptoms. It doesn't mean they don't have Covid — and they still can spread it.
On o my column. My column for this week is about a topic that seems to be on everyone's mind — Covid vaccination.
By the time you read this, the vaccine will have reached New York, and may already have been given to some high-risk individuals. I've held off writing this column on the vaccine until now because it wasn't clear what the vaccine would entail. It is now known, at least in part.
You've been hearing a lot about the Pfizer vaccine, the Moderna vaccine, and maybe some others as well (Astra Zeneca, Johnson & Johnson, etc) The first two vaccines are fairly similar to each other, though the Pfizer will be available first and must be kept at an extremely low temperature (-94 degrees F), which will make shipping and storing it problematic. Moderna's vaccine can be stored in a regular freezer.
How do they work? You may have heard that the technology is new and that it involves something called “messenger RNA” (or mRNA). mRNA is what transmits the information from DNA (your “genes”) to the protein-making factories (ribosomes) in the cells. It's the “blueprint” that tells the ribosomes how to string together peptides (building blocks) to make proteins that your body needs. So, in a way, your body is a chemical factory. The technology has been used to fight cancer, but never to prevent an illness.
Using this technology, instead of injecting a piece of dead virus into you as is done with the flu shot, you are vaccinated with a piece of mRNA from the virus that codes for one small part of the virus (in this case, the “spike”). The immune system recognizes this as an invader and makes antibodies and other cells to fight this portion of the virus. If you get exposed to Covid once these antibodies and cells are made (it takes about 2 weeks), your body knows how to fight the virus and can prevent you from getting sick. The mRNA itself breaks down quickly in the body and does not interact with your own DNA.
This technique speeds up the vaccine process considerably, allowing us to come up with this vaccine much quicker than ever before. It also appears to be a highly effective vaccine (95% vs. 40-60% for the typical flu vaccine).
Being a new technology, of course, also means there are questions: Does it work? Are there side effects? Is it safe? How long does it work? Does it just prevent you from getting sick, or does it prevent you from spreading the virus as well?
As noted above, it definitely works! BUT — and this is very important — you need to get two shots, three weeks apart for it to work. It definitely prevents sickness, but the data on prevention of spread is not available yet (meaning you still may need to mask and socially distance until enough people, maybe 75-80%, are vaccinated). The exact percent of people needing vaccination to achieve herd immunity is not known. This is a best guess estimate.
Safety looks good so far. There have been very few serious immediate reactions (two in the UK in people who had problems with shots previously). There are some people who felt sick and had a fever after the shot. This is not unexpected, and really shows a robust immune reaction, which is a good thing. It is not possible for the shot to give you Covid, since only the spike protein is made. There is no active virus. No long term (30-45 day) issues have been found. Thirty to 45 days is typically when long-term problems with vaccines show up.
The vaccine has been scrutinized by the FDA, CDC, a group of doctors who are independent and do NOT work for the government, and finally, an independent task force put together by Gov. Cuomo. All have felt the vaccine is safe and should be given.
In talking to my patients about the vaccine, there seems to be two distinct groups. One group wants to roll up their sleeves right now and get the vaccine. The other seems to want to hide in their basements so that no one will find them and give them the shot!
As a family doctor, and an “older person,” I'm pretty high up on the list of people to be vaccinated. And I definitely will be receiving the vaccine. My personal evaluation is that the benefits far outweigh any risks. Right now, each day, we are losing as many Americans as we lost on 9/11. All told, we have lost nearly as many Americans as live in Pittsburgh, Pennsylvania. This has to stop. And now we really have a way to stop it.
If we can immunize our way to herd immunity, we will wrest control from Covid. We can come out of our homes, gather with friends, eat out (or rather eat IN) at a restaurant, go to the movies, and to sports activities. Kids will only be out of school in the summer, and everyone can return to work, even go to the office. Less screen time, more enjoy-life time. And grandparents can hug their grandkids again!
But we need your help. For the sake of your family, yourself, and our community, please get vaccinated when your turn comes up.
I'll make a deal with you. I'll be the guinea pig. I'll be in line ahead of you because of what I do for a living. If I get the shot, and I'm still standing, you'll know it's OK. Then you can get your shot when the time comes.
Dr. Wayne S. Strouse, M.D., is a family doctor in Penn Yan.