I got my booster, should you?

It is not that I am a masochist, I’m just a bit impulsive. There I was again, in the same conference room I had been two times before back in December and January, lifting up my sleeve to get vaccinated against COVID-19. On one side of the room was a nurse with smiling eyes cheerfully administering my 3rd dose of the Pfizer vaccine just like the previous two times. This time, however, there was another nurse a few tables over willing to give me a flu shot. Why would I want to get both vaccines and a double shot of that crummy post-vaccine feeling? The answer is simple. I need to get them done at work otherwise I have to somehow prove to the HR department that I was vaccinated elsewhere. This involves emailing forms to nameless and faceless mailboxes, hoping there is someone checking at the other end. The pain of dealing with the bureaucracy of a multi-billion dollar healthcare corporation is far greater than the combined pain of both vaccinations. The real question is, was it the right thing for me to get the booster, and should you get yours as well. It turns out this is quite a difficult question to answer.

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Is vaccination better than prior infection?

In my job, ‘I told you so’ is a very unsatisfying experience. We’ve all experienced the spark of schadenfreude when, after a bitter disagreement with another, we are proven right in unassailable terms. It’s a wicked joy, no doubt fueled by some deep-seated insecurity, but it is a joy nonetheless. You would think the opportunities for the elation of ‘I told you so’ abound in medicine. After all, we tell people to do things all the time for their own good and they resist us more often than you would think. Unfortunately, this is not the case.

While suiting up to see my first critically ill COVID patient in several months I felt the schadenfreude brimming when the resident told me he was unvaccinated. I, along with just about every other doctor in the world, have been preaching the merits of vaccination to anyone who will listen. I wrote about it when I got my first dose back in December 2020. I think I made a strong case and that was long before we had several months of data and experience showing better than expected efficacy and safety. So when I went into room 504 there was a small part in the back of my head giddy with the prospects of the ‘I told you so’. Don’t get me wrong. I am not a monster. I wasn’t going to lay it on him right out of the gate. I had a plan for a more subtle drop of sarcasm to get the point across without being too harsh. Not as pleasurable as a pointed finger and playground sing-song but effective nonetheless. Well, that was my plan – until I saw him.

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90 is not 100 and the risk of COVID after vaccination

“Dr. Grove, I got COVID,”  was the first thing she said to me when I returned her call.  She has severe asthma and she was a bit worried.  Fortunately, she did not have severe a case so the first thing she said did not worry me.  It was the second thing she said that worried me.  “I got my vaccine, too”.  My next thought was that she must have contracted her infection between the first and second vaccine doses and, as if she read my mind and before I could ask, she concluded, “And I got my second dose in February.”  Ugh.  This means she got COVID even though she was fully vaccinated.  That wasn’t the only call like this I got last week.

The second call was from someone who wasn’t feeling well.  She called me to ask what she should do since she was exposed to someone who was known to have COVID.  The person she was exposed to was fully vaccinated but had more than one child at home with proven COVID.  She felt sick but assumed that it couldn’t be COVID because she was fully vaccinated.  She didn’t get tested or quarantine and went to the party even though she didn’t feel well.  Unfortunately she was wrong and tested positive a few days later after exposing multiple people. 

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Why the Johnson and Johnson vaccine side effect is so worrisome

She was a 51 year-old lady with asthma so severe that she required regular injections of a special medicine to keep her out of the hospital. She had prolonged damage to her lungs from her disease and daily symptoms of wheezing and shortness of breath. Any insult, whether it be a cold or cut grass, could put her out of commission. So when I asked her if she had her COVID vaccine she surprised me when she said was afraid of the side effects. So, a woman who has a very high likelihood of dying from this virus, was afraid of the vaccine. Her fear was driven by reports of scary side effects, most recently with the Johnson and Johnson vaccine.

Her decision was irrational but predictably so.

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Is the Johnson and Johnson vaccine any good?

How the Johnson & Johnson, Pfizer and Moderna COVID-19 vaccines compare |  ABC27

This post will attempt to answer the following questions:

  1. How do vaccines work?
  2. How does the Johnson & Johnson vaccine work compared to Pfizer and Moderna?
  3. Is it safe?
  4. Is it effective?
  5. Which vaccine should you get?

If a screech of joy could be expressed in text version, this was the sentiment that was given over by my wife’s text after she received her Johnson & Johnson vaccine. Just as everything else with this pandemic, her vaccine experience was annoying, uncertain, and unpredictable. She had heard that the Johnson & Johnson vaccine was available for her eligibility group from a friend and she went searching all over town for a place to get hers. Before embarking on her wild goose chase, she asked me if she should get this shot or wait until an opportunity to get the Pfizer or Moderna vaccines when they are available (and who knows when that will be!?). To be honest, I did not have a clear answer for her as a result of my own ignorance so I got to work doing the research. She decided to get it before I was able to render an opinion but it turns out she made the right choice. I thought I would give you a layman’s explanation of what I discovered and why I think she made the right decision.

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There’s one more surge coming

This post will attempt to answer the following questions:

  1. When is herd immunity expected to be reached?
  2. What impact will the UK variant B.1.1.7 have on us?
  3. Will there be another big surge of cases before the summer?

It was the beginning of December,1944 and, six months after the D-day invasion of Europe. Allied forces had steadily marched East towards Berlin much faster than anyone had expected. The steady flow of newsreels showing allied victories lifted morale back home for those desperate for this long and brutal war to end. Many felt it was pretty much already won. The nation began to relax.

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The best possible news

This post will attempt to answer the following questions:

  1. What is the data that has recently come out of Israel on the effectiveness of the Pfizer vaccine?
  2. How effective is the vaccine in real life?
  3. How effective is it at preventing asymptomatic spread?
  4. What does this mean for COVID restrictions?

It has been a snowy, dreary several weeks here in Baltimore. The days are short, gray, and cold. It has been dark when I go to work and dark when I come home, but it has been even darker in between. The long COVID winter has left a dusky haze over every thought and feeling. This was where my head was when on February 24th, without warning, the sun shone overhead and the temperatures suddenly rose. The bright sunshine reflected on the melting snow and ice. It was as if the world suddenly woke up out of a coma.

The sun warmed me on the outside, but it was the New England Journal of Medicine that warmed me on the inside.

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Will the vaccines work against the new COVID strains?

This post will attempt to answer the following questions:

  1. What are viral variants and what do they do?
  2. What are the SARS CoV2 variants of concern?
  3. What is the difference between the UK and South African variants?
  4. Are the vaccines effective against the new strains?
  5. How do we know?

I was late. It was an early class and it was the furthest distance across campus and I was late for the first day of organic chemistry. The class was notorious for its brutality and I didn’t want to start behind, but behind I was. The auditorium had a few hundred seats and the decor made me feel as if I had traveled back in time 100 years with its wood paneling and musty aroma. The professor was a small woman dwarfed by the 10 oversized chalkboards that spread 30 feet a across and slid up and down like a dust covered guillotine. She had already started scribbling illegible hieroglyphics that I should have been paying attention to but I was more focused on where I was going to sit. There was not an empty seat in the room which was teeming with eager pre-meds with clean, unused notebooks and sharp cornered overpriced textbooks. I ended up sitting on the steps at the top of the aisle.

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Do I need to wear a mask if I’m vaccinated?

This post will attempt to answer the following question:

  1. What is known about the Moderna and Pfizer vaccines?
  2. Can you still get COVID-19 and be contagious after you are vaccinated?
  3. How can we find out if the vaccine prevents viral transmission?

It’s a normal part of human nature to adapt to whatever situation we find ourselves in. We get used to both the good and the bad if given enough time. It’s just how we’re designed and is essential for our well being. During this pandemic, however, it has become a sign of how bad things have become. In the United States, where case numbers are astronomically higher than just about anywhere else in the world (USA! USA!), we’ve been hovering near 200,000 new cases with a few thousand deaths every day for a couple of months now. We have become so numb to these numbers that we don’t flinch when we hear them. When the case rates drop to 150,000 we feel as if things are going really. Remember when 30,000 was a lot? Neither does anyone else.The adaptation and subsequent lack of shock at the numbers combined with pandemic fatigue, anger, and even denial fuels the desperation for an end. For better or worse, that end only comes when enough of us are protected through vaccination. Until that happens, there will be a transition period. It will be a period where a lot of people are vaccinated but not quite enough to prevent devastating surges like many parts of the country have seen over the past 2 months. How long this period will last and what it will look like remain to be seen. There is no negotiating with this virus.

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Is the monoclonal antibody bamlanivimab a miracle drug?

The feeling I get is usually a mix of despair, anger, and foreboding. It typically starts with a conversation, email, or social media post by someone that is to the far extreme of asinine. These statements, at any other time in history, would make much chuckle and shake my head but this is not any other time in history. This is a time where misunderstanding and misinformation leads to ever more annoyance, suffering, and death as it fuels the fire of the pandemic. This is a time where such statements make me feel ill physically and emotionally. That was my headspace when I recently learned that some families with a child sick with COVID were intentionally getting the entire household infected to decrease their quarantine times. If that was not enough I was blamed for this behavior because I have advocated that schools follow expert guidelines on safe practices.

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