My COVID Journey

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.

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.

He had smoked a pack a day for over 50 years and had no thoughts of quitting. He was a confident and defiant gentleman who did not take anyone else’s word for it and he knew his body better than any doctor. He didn’t want to get his flu vaccine but his wife talked him into it. Prior to the shot he had been losing weight but he had been eating less and didn’t think much of it. His primary care doctor was concerned, however, and at the same visit where he got his flu vaccine, he was sent for a CT scan of his chest. The scan was done a week later and showed a large mass which turned out to be lung cancer. He was furious, convinced that flu shot had given him cancer. This is a true story.

This post will attempt to answer the following questions:

1. Should you get vaccinated?
2. Why?
3. How do you evaluate the risk of the vaccine?

The pandemic roller coaster of emotion can be jarring at times. The past week was more illustrative of this than any thus far. It was a whiplash of the best and worst moments of the pandemic. I should have known it would be a difficult week when a grieving family member was carried out of the ICU shouting expletives at our team for failing to save her mother. She was just one of the eight COVID deaths (plus two non COVID deaths) we had over the course of the week. I had never lost that many patients in one week before and, while none of the deaths were a surprise, the sheer number was more than unsettling. There was a pall over the entire unit.

This post will attempt to answer the following questions:

1. What is an emergency use authorization (EUA)?
2. What are the official efficacy results for the Pfizer vaccine?
3. What’s the difference between efficacy and effectiveness? Does it matter?
4. Were there any safety issues?
5. What were the major side effects of the vaccine and how should we treat them?

I typically try to make these posts more personal for people by describing my own experience with COVID-19. I know many people feel distant from the pandemic and many have told me it really helps them to get a frontline point of view. Today I was just too excited.  The reason for my elation is that I read the briefing document from the EUA analysis of the Pfizer vaccine put out by the FDA. I figured I’d summarize the report in laymen’s terms.  It is a 58 page document (and that’s just the summary) and may be too much for people on the go.

There was a sense of foreboding outside room 527 that night at shift change. The unfortunate soul in that room had been in the hospital over a week with COVID-19 and had followed the pattern we had seen countless times. She had a severe case and was on a lot of oxygen but was holding her own without a lot of symptoms as long as she kept her oxygen on. Then, without warning, her blood work showed signs of rapidly increasing markers of inflammation and she started to look worse. She had escalating requirements for oxygen and was put on CPAP. The thing that was so scary to me as I started the shift that night was how she looked. She just looked so tired. She could not open her eyes or say even a few words. Her breathing was rapid and shallow and it didn’t appear she could last much longer. I adjusted her CPAP but over the next couple of hours, her oxygen levels started to drop. I had no choice but to put her on a ventilator.

The unspoken foreboding was palpable in the room. We all knew that when patients go on the ventilator things usually don’t turn out well. Most will not survive, many will have prolonged hospital courses with severe disabilities, few walk out of the hospital, and nobody is ever the same.

Up until two weeks ago we had just a few COVID patients in total in my hospital and none in the ICU. For a few months we had quietly slipped back to our usual routine. We were caring for those sick with heart attacks, severe infections, drug overdoses, and other sundry calamities that can befall the human body and land someone in the ICU.

Then everything changed in just a few days.

He was a lonely older man without any living family. He came into the hospital with severe COVID but, after several days, stabilized. He wasn’t getting better and he wasn’t getting worse. We had given him all the standard treatments and were hopeful that he would improve. Then, as is often the case with COVID-19, he rapidly deteriorated over the course of a day and ended up on life support.

What would you say is strongest single predictor of behavior and attitudes towards COVID-19? What factor makes it most likely that someone will follow masking and social distancing guideline?

You would be considered reasonable if you answered that those with the greatest risk of dying would be the most cautious. You would be wrong. You would be considered a rational thinker if you answered that healthcare workers that are confronted with the sick and dying from COVID-19 would have the strongest emotional response motivating them to extra caution. You’d be wrong. You would not be thought crazy if you answered that those with more education would be more careful because they have more of an understanding of the complicated factors at play. Again, you’d be wrong.

Race? Wrong. Gender? Wrong. Employment status? Wrong.

The single strongest predictor of behaviors and attitudes towards COVID-19 is political affiliation.