• Julie Swartz

An ED Physician's Perspective on the COVID Vaccine - Julie Swartz, MD

"Are you going to get the COVID vaccine?" "What are your thoughts on the vaccine?" My answer is, yes, I most definitely am getting the vaccine (which should hopefully be within the next 1-2 weeks), and I am willing to be the first in line for it. Here is why:


First, the history of vaccines is a story of profound success. Illnesses that once killed and disabled hundreds of thousands of people every year have become nearly eradicated (or in the case of smallpox, completely eradicated) since the development of vaccines. Illnesses that my older colleagues treated routinely are things I will ever only see in a textbook or hear about when they tell their horrific stories of kids not being able to breathe from epiglottitis or becoming paralyzed from polio. Have there been vaccines developed that were found to be unsafe or later found to have too high of a complication rate to be considered tolerable? Yes, but these have been few and far between in comparison to the number of life saving vaccinations that have been developed. Basically, I trust the brilliant scientists creating these vaccines more than I trust the disease to not cause serious complications in myself or one of my family members. And if scientists in the 1800s could figure out a way to mass produce vaccines without the knowledge and technology that we have today, surely we can safely do so now much more quickly than we could over 100 years ago.


A lot of people are concerned about the safety of the 2 leading vaccines, Pfizer and Moderna, in particular because they are using new mRNA technology. However, the biotechnology itself is not that new. It was being developed for many years before COVID existed to treat other viruses and even cancers and was only modified for COVID. This is partly why it was able to be created so quickly. The other reason it will be approved so quickly is because of the pandemic itself. Most clinical trials involving vaccines take so long to be approved because it takes a long time for sufficient numbers of trial participants to be exposed to the virus it is trying to prevent to verify its efficacy. However, with COVID being so prevalent, it did not take long for people in the clinical trials to be exposed to the virus and therefore get sufficient numbers much more quickly than typical for vaccine trials.

People also seem worried that this is genetic material that will then forever be a part of their body. However, that is not how it works. This IS how it works, in a quick and dirty simplified explanation. First, the mRNA is injected into the body. The mRNA then enters a cell and goes on to produce a specific protein that is on the COVID virus for the next 2-3 days. The body's immune system can then recognize the protein as being foreign and an invader and be ready to attack it if the person becomes infected with COVID. The mRNA itself is short-lived, never enters the nucleus of the cell where your DNA lives, and completely degrades within a few days. It does not become a permanent part of your DNA or genetic code.



I understand that there is a small risk that the COVID vaccine may be found to have some long-term detrimental effects on some people just as nearly every vaccination can cause serious problems in a very small proportion of the population. However, the number of people that are protected by vaccines are far greater than the number hurt by them. There are few people today who can name anyone who has been truly harmed by a vaccine, while in the early 20th century nearly everyone could name someone close to them who died from one of the diseases these vaccines now prevent. In my own risk assessment, I feel it is worth the miniscule risk of a possible long-term effect from receiving the vaccine in comparison to the following benefits the vaccine will hopefully provide.


First, the chance of me contracting COVID is very high right now as our positivity rate is sky rocketing. Like many Americans, I unfortunately have a BMI (but just barely ) that puts me in a higher risk category of developing complications from it. It is estimated that over 60% of Americans have at least one significant risk factor for developing complications from COVID. All it takes is a BMI over 30 or being on a single medicine for high blood pressure or diabetes. The vaccine will hopefully protect me from getting the virus and therefore any resulting complications from it as well as protect my close family members and colleagues who I am in frequent contact with from getting it from me. Also, just as we don't know the long-term effects of the vaccine, we also don't know the long-term effects of COVID. For example, shingles does not make its appearance in someone who was infected with chicken pox until decades later. Who knows what we will see in the decades ahead in people just now being infected with COVID who even just have an asymptomatic or mild course now? And, we already are seeing so-called "long-haulers" who have significant chronic problems like SOB and fatigue several months out from their diagnosis.


From the CDC website:


Second, I am hopeful that the vaccine will allow me to see my most vulnerable family members again like my 101yo grandmother living in a long term care facility or other family members currently fighting different medical issues making them more susceptible to the dangers of COVID. I want to be able to spend time with them again without worrying that my interaction with them may be the cause of their death or disability.

Third, I believe vaccinating a large proportion of the population is what is really going to allow our economy to recover. The economy is not hurting because of shutdowns but because of the virus. Even without shutdowns, many people are not going out to restaurants and stores etc because of a rational fear of contracting the virus and then having to face all the consequences that having COVID causes, from the illness itself, to spreading it to others, to needing to take off work for nearly 2 weeks and their children from school for even longer. I believe a vaccine will give many people more confidence that they can safely partake in more public activities again. That being said, I do believe masking and social distancing will still be a thing for another year or so even with a successful, widely distributed vaccine. It will take time to distribute the vaccine to the general population and also some time to determine just how long immunity lasts with the vaccine and if you get the vaccine, if you are in fact unable to pass COVID onto others. Until then, we will need to continue to be careful.



Fourth, I want myself and my family members to be able to get back to the activities we enjoy doing without having to do a risk assessment beforehand everytime. I don't want to have to ask myself if it is safe for my kids to play soccer, to eat inside a restaurant, or spend the day at Cedar Point. And whatever your opinion is on the possibility of a vaccine mandate at some point in the future, the reality is there will probably be requirements of being vaccinated in order to participate in certain activities or to travel to certain places.


Fifth, part of my decision to be agreeable to being one of the first to receive the vaccine (I even volunteered to be part of a phase 3 trial but was never contacted about it) is an ethical one. I recently read the book Medical Apartheid (which I recommend to anyone in healthcare or clinical research) which went into great depth about how vaccines and other medical innovations have often been tested on minority (especially Black) and underprivileged populations without them giving consent or fully understanding the risks vs benefits before agreeing to it. This occurred from the very beginning of science and research in our country's colonization 100s of years ago to the most recent example in the book occurring in the early 2000s. The book was published in 2006. The rest of us have benefited from this unethical research on our most vulnerable populations and, what is even more sad, is that once these vaccines and innovations have been approved for the general population, it is oftentimes the case that these same vulnerable groups can no longer receive the treatment because of cost or poor access to care. Therefore, if I will be encouraging my patients, many of whom are minorites and/or underprivileged and especially hard hit by this pandemic, I believe it is important that I can say that I received the shot and took the risk myself.



These are my thoughts. I'm not an expert in immunology nor virology nor public health. However, I feel I've educated myself on the topic using as reliable and unbiased sources as possible and, as a physician, I am educated on how to interpret scientific data. I also understand that each person has their own unique life experiences and situations that they need to consider and discuss with their personal physician when making their own decision on the vaccine. But truly take the time to think about it, and when doing your research, please read from reputable sources and true experts on the subject. I honestly believe a vaccine is our safest and fastest way out of this pandemic, but for it to work, people have to be willing to get it.


https://www.fda.gov/media/144245/download

https://www.fda.gov/media/144246/download

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906799/#!po=0.328947

https://www.phgfoundation.org/briefing/rna-vaccines

https://pfe-pfizercom-d8-prod.s3.amazonaws.com/PFIZER-MRNA_Vaccine-COVID_Infographic_final_square.png

https://www.nature.com/articles/d41586-020-03248-7

https://www.nature.com/articles/nrd.2017.243

https://www.sciencemag.org/news/2020/11/covid-19-vaccine-trial-complete-pfizer-and-biontech-update-their-promising-result

https://mobile.twitter.com/nowthisnews/status/1329802429395738626

https://www.americamagazine.org/politics-society/2020/11/23/misinformation-us-bishops-catholics-covid-vaccine-abortion



What are your thoughts on the vaccine? Comment down below!

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