Note: Dr. Orient is executive director of the Association of American Physicians and Surgeons, AAPS.
The trucks are rolling, bringing pallets of COVID-19 vaccine to distribution centers. If you are in the 1A allocation group, you'll be among the first to get the vaccine. Should you take some precautions?
A nurse apparently fainted on live television while touting the vaccine she had just received. Fortunately, people close by eased her to the floor, so she did not fall and injure herself. People commonly faint after getting injections, so this may not be a cause for specific concern about the COVID-19 vaccine. Just be aware of the possibility and take precautions for at least 15 minutes.
There have been six cases of anaphylactic shock post-vaccine in the U.S., not all in patients with a history of severe allergic reactions. A nurse in Alaska spent at least one night in the hospital, as symptoms recurred when the initial treatment wore off. Symptoms include a rash, wheezing, swollen lips and tongue, and difficulty breathing. If the airway completely closes off, the untreated patient will die of asphyxiation.
Fortunately, there is effective treatment. You should get the vaccine only in a place that is staffed and equipped to treat you. Shots are being given in drive-through "pods." You are advised to wait for a time in the parking lot before driving away. Medical personnel will be on the scene. Consider taking someone with you to be sure that you can summon help in time, in case this rare complication happens to you.
After the second injection, most people get mild or moderate systemic symptoms such as fever, fatigue, headache, or achyness. If you are a workplace supervisor, you might want to stagger the injection schedule so that your staff members are not all absent at once.
Bell's palsy (paralysis of half the face) has occurred in four trial subjects out of about 22,000 who received the Pfizer vaccine; three of about 15,000 who received the Moderna vaccine; and one who received the Moderna "placebo" (a meningococcal vaccine known to cause frequent reactions). Although Pfizer claims this is about the same as the background rate (1/10,000 per year), this is 2/10,000 within a two to three month period, and is thus 8 to 12 times the annual background – and much higher if the paralysis occurred within a two-week period following the shot.
In most people, Bell's palsy is temporary, beginning to improve within a few weeks, with complete recovery in six months. Sufferers need to protect the eye that can't close properly.
The COVID vaccines are not recommended for women who are pregnant or might become pregnant. How long might a deleterious effect on pregnancy or ability to become pregnant last? We may know in a few years. There simply has not been enough time for long-term effects to emerge.
Antibody-dependent enhancement (ADE) could occur in persons who get infected after vaccination. This has been reported with dengue, respiratory syncytial virus (RSV) and related coronaviruses such as SARS-CoV-1. Getting vaccinated may keep you from getting mild or severe symptoms if you get infected with SARS-CoV-2 (the cause of COVID-19), but may not prevent transmissions to others. And rare individuals might get sicker due to ADE. Hence, you need to continue infection-control measures.
Be sure to read and keep the Fact Sheets that come with your vaccine. You will also have the opportunity to sign up for the smartphone app v-safe, which you can use to tell CDC about any side effects and which will remind you to get your second dose.
For more information on protecting yourself, see "A Home-Based Guide to COVID Treatment." For a variety of treatment protocols and physician resources, see c19protocols.com.
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