Take the First Vaccine You’re Offered
My Twitter addiction is real.
I've never tried cocaine, but I imagine it produces a high that’s similar to the jubilation I experienced when, for example, Michael Mina, MD, MPH (the Brad Pitt of epidemiology/immunology) and Julia Marcus, PhD, MPH (the Lady Gaga of public health) started following me on Twitter this week.
It’s like high school all over again. Except this time the cool kids are nerds. It’s awesome.
Being part of a community of medical and public health experts committed to COVID-19 research, evidence, and messaging is exhilarating.
The good news for you is that I’m up to date on minute-to-minute vaccine news, information, and nuanced opinion.
The bad news is that I haven't slept quite enough in February (when my Twitter habit started). And when I’m tired, I’m irritable. Last night I snapped at my cat for meowing.
My plan? An enormous rest this weekend with a whole lot of nothing on the calendar.
In the meantime, I’ll answer the FAQs from my patients and readers this week. But instead of long prose, I’ll (try to) make it snappy.
Q: Which vaccine should I take?
A: The first one you can get your hands on! The data released yesterday on the single-dose, easy-to-store Johnson & Johnson vaccine is extraordinary. It is 100% protective against death and hospitalization 28 days after administration. This means that the J & J shot, like the Moderna and Pfizer vaccines, de-fangs and de-claws the coronavirus. It means that if you get this shot, you won’t die or need hospital care from COVID-19. It means that if you are in the small percentage of people who do get COVID-19 despite vaccination, you’d have a cold or mild flu—and even that risk is low. It’s another home run and one step closer to resuming normalcy.
Q: Shouldn't I wait to take a 95% effective shot and pass on an 86% effective shot?
A: No!! When the ship is sinking, we don’t pick which COLOR life jacket to take. In other words, ALL of these vaccines similarly (and marvelously) completely prevent the most important endpoint: death. All of the vaccines significantly reduce the risk of hospitalization. The different percentages you’re reading about are about RELATIVE risk. An 86% efficacy does not mean that in a single person, the risk for COVID is 86% less. Rather, it means that in a population, the risk of getting COVID-19 at ALL (from a sniffle to a cough) is reduced by 86% compared to a population of people who weren’t vaccinated. Bottom line: the vaccines are triumphs of modern medicine. Take what you are offered.
Q: But what about the variants? I heard that they are on the rise, particularly in California and New York!
A: The currently available mRNA vaccines and this new Johnson & Johnson vaccine prevent infection from the variants just as well as from the “regular old” coronavirus. But because the new variants are indeed more contagious, risk mitigation with (you guessed it!) our trusty MOSHPIT rules are more important than ever for — and among — unvaccinated people.
Q: So what do the variants mean, and why is the news so alarming? Even New York has one!!
A: The variants are the natural products of the virus’ evolution. Viruses mutate. SARS-CoV-2 is no exception. The good news is that the available vaccines still protect against the variants. At some point, the virus might evolve enough to evade the immune protection from either natural infection or immunization, but for now we are okay.
Q: Does that mean we’ll need booster shots at some point?
A: Perhaps. If and when the coronavirus mutates in such a way that it evades immune protection (either from natural infection or vaccination), then booster shots may be needed. It's possible that we may need regular—maybe even annual—COVID-19 shots. No need to panic! Researchers and vaccine manufacturers already are hard at work creating boosters in case we need them.
Q: How long does the immune protection from vaccinations last?
A: Remember that we are watching this data play out in real time. We know that the immune protection lasts at least three months, but it’s probably longer and of course depends on the emergence of variants that might outsmart immune protection. Bottom line: scientists, medical researchers, and vaccine manufacturers are hot on the case so that the general public needn't worry!
Q: Why am I hearing that I still need to wear a mask after I get vaccinated, when the vaccines are as good as you say?
A: Great question. I love this one, actually. Here are the reasons to keep wearing a mask after you have been vaccinated:
In public, no one knows that you’ve been vaccinated. So for now it’s our moral duty to stand in solidarity with people who’ve not yet vaccinated and therefore are vulnerable to COVID-19.
We still haven’t “blown the whistle” to say that vaccination prevents asymptomatic infection (and thereby transmission) EVEN THOUGH the scientific evidence is mounting—and in my humble opinion already is quite clear—that vaccinated people cannot infect and sicken other people. A recent article in Lancet showed that healthcare workers in the UK who were swabbed every two weeks after vaccination demonstrated an 86% reduction in asymptomatic infection compared to non-vaccinated individuals. This data is replicated in multiple other settings, including Singapore, Spain, and Israel. But until the CDC, Fauci, or other public health Gods say the word, vaccinated people should wear masks around all unvaccinated people on the odd-ball chance that we can infect others.
I can’t think of any other reason.
Q: Can I mix and match vaccines? For example, get the Pfizer first, then the Moderna the second time?
A: Don’t. Even though it probably would be fine, you should stick to the recipe — i.e. the way the vaccines were studied and proven to be so effective. Let’s not mess with amazing.
Q: If I’ve recovered from COVID, do I need the second shot?
A: Yes. For now. There is emerging data that after a person recovers from COVID, a single dose of a vaccine can generate robust immune protection such that the second dose isn’t needed. But until further study and until CDC guidelines change, let’s stick to the science.
Q: Do people with long COVID risk feeling worse when they get vaccinated?
A: Great question. It’s really interesting: we’re seeing the opposite! This is under active investigation, but right now we’re actually seeing that people with long COVID feel better with vaccination. Public health expert and COVID-19 guru Daniel Griffin, MD, MPH, estimates that 40% of his long COVID patients feel better after their first and second shots.
Q: Why is the messaging around the vaccines so variable? Different experts seem to have different advice about how to behave after vaccination, and it’s confusing and stressful!
A: Physicians and public health experts are people, too, with varying levels of anxiety and risk tolerance themselves. As an institution, the CDC faces political pressure and reputational risk with every guideline they issue. Facts and science aren’t up for interpretation, but the messaging around them clearly is.
And in my humble opinion, public messaging woefully underestimates the evidence-based benefits of vaccination—namely vastly improved safety, security, and SANITY.
Also in my opinion, it’s time to message optimistically and let people know exactly how safe they will be after vaccination. (For another optimistic opinion of my friend and public health expert Monica Gandhi, MD, MPH, at UCSF, click here.)
As I have said again and again, health is more than the absence of disease. In other words: not dying is important (and is essentially guaranteed with COVID vaccination); but what about living? When COVID vaccination drops our risk to a tolerable level—to be defined, of course, by the vaccine recipient—it only seems only fair to ponder the social and emotional benefits of calculated risk-taking.
Q: Why should I be happy for other people getting vaccinated when my turn to get the shot won’t be for months? All of this talk about life after vaccination is driving me nuts!
A: I hear you. And I get grouchy, too. (Ask my cat.) But remember, the more people around you who are vaccinated, immune, and unlikely to infect others, the safer YOUR world is, too.
Q: If I try Twitter, will I get addicted, too?
A: You might. So before you jump in, I suggest that you carefully consider the pros and cons of adding another social media platform. What is your capacity for even more stimulation? How much sleep are you already losing by checking your email, texting ridiculous memes to your friends, and watching cat videos in bed? If you’re anything like me, you don’t need more inputs. On the other hand, Twitter is fun, free, and fabulous. It’s also legal. (If you do join, come FIND ME!!!)
I will see you next week. Until then, be well.
This newsletter does not constitute or contain medical advice applicable to individual situations, nor does it necessarily reflect the views of Foxhall internists, P.C. Medical advice must be obtained from your personal physician.