I recently cared for a man who loved Boston sports, whose wife had decided to have a quick meal with a friend. By the time she learned that her friend had symptoms of Covid-19, she had already passed the virus on to her husband. He died after weeks on a ventilator. There is a grandmother whose family took false comfort in a negative test. A father who welcomed a dozen people into his home for the holidays. Each casualty is made even more poignant by the celebratory vaccine selfies on my phone and the knowledge that had they waited, my patients might have lived.
And of course, our hospital is treating not just people with Covid-19. We also bear witness to the suffering of patients with cancer, with life-threatening infections, with complications from organ transplants. We see overdose and withdrawal cases in unusually high numbers, psychiatric illness pushed to its breaking point. A relatively young man was brought to our hospital after being found unresponsive in a hotel room, his heart barely beating. When we managed to extubate him and he started to wake up, he began screaming at his nurse and raging against his restraints. There are so many different kinds of pain for which we have no vaccine.
With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:
- If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
- When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
- If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
- Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
- Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
Early in the pandemic — watching people refuse to wear masks, assuming that youth or good health would keep them safe — I believed that fear was the only way to change behavior. If only you could see what it is to be intubated, if you could conceive of being suctioned through a tracheostomy tube while learning to walk again, you might make different choices. Surely, I thought, the fear that you might sicken your parent or spouse or child would be enough to motivate you to take precautions, no matter how lonely you were. But now, as people congregate because they are just so exhausted by the loneliness and the waiting, I wonder whether hope is actually a more powerful tool.
Maybe that is the real promise of the vaccine photos. It is not just a way to celebrate science or to encourage the public to get the vaccine when they are able. It’s also a tangible sign of hope, however fragile. For most of the country, the vaccine is still months away. And now, with headlines about the wealthy trying to pay to jump the line, and images of politicians getting vaccinated before many nursing home residents, it is so easy for some to fear that their time will never come. The vaccine selfies tell us to hold on.
When I work overnight, the hardest part is always the hour right before sunrise. In my exhaustion, my body’s ability to regulate temperature and my sense of time go haywire, and I often find myself reviewing lab reports while wrapped in a blanket from the blanket warmer, wondering why time feels as though it is moving backward.
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