By Dr. Katie E. Golden, MD

The recent approval and early distribution of the COVID vaccine certainly feel like some of the most uplifting news we have had all year and outshines even the most impressively decorated Charlotte homes this holiday season. (And I’m sure you have noticed the Griswold-esque light displays in our neighborhoods this year.) The collective feeling of hope for the end of this pandemic is met by the understandable questions that some people have about the safety and efficacy of a quickly developed vaccine. As ER doctors, our community’s health and safety is our highest priority, so let’s close out the year by addressing those concerns so that we can all have a happier and healthier 2021.

Is the vaccine safe?

This is perhaps the most important question to address about the vaccine, and the short answer is yes. The long answer involves understanding how this particular vaccine was engineered.

The COVID vaccine is an mRNA vaccine, which works differently (and is safer) than traditional vaccines. (Say it with me, mmmmm RNA). Historically, vaccines have used an inactivated form of the virus that, when introduced to the body, teaches the immune system how to kill the virus while being too weak to actually cause the infection. Developing these types of vaccines is not only time and labor-intensive, but also makes them higher risk for adverse safety concerns. The COVID vaccine, however, consists of a protein made by the virus, not the virus itself. Think of it like using a simulator to train a soldier, rather than dropping them into a warzone and hoping for the best. Instead of exposing the immune system to the real virus, the COVID vaccine shows it the protein it needs to know in order to kill the enemy if the real deal arrives.

It is also important to point out that the technology for mRNA vaccines has been 30 years in the making. Prior to the pandemic, brainiac scientists had already designed and tested the platforms to both rapidly identify key viral proteins and subsequently engineer a vaccine. So while it may seem as if the vaccine was developed over the short course of only one year, in actuality many scientists have spent their life’s work developing the technology that was put to good use in this year’s pandemic.

Other important points to understand about the safety of the vaccine:
● The mRNA protein used in the vaccine degrades quickly in the body. It shows up, teaches the immune system a lesson, and then disappears faster than the angel in It’s a Wonderful Life. (Has anyone else inadvertently watched that movie twice already this season because they didn’t have the energy to change the channel? Just me?) This means that the likelihood of long term side effects is low.
● The vaccine DOES NOT interact with human DNA or alter genetic content in any way. That mRNA has about as much chance of getting into a cell nucleus as I have of buying ‘just one thing’ on a Target run (try it, it’s impossible).
● No shortcuts were taken in the review and approval of the vaccine. In fact, vaccine trials adhere to higher standards than drug trials given vaccines are administered to healthy individuals.
● I know it’s hard to believe in anything that resembles ‘good luck’ this year, but both the vaccine’s efficacy (94-95%) and favorable side effect profile has far exceeded our expectations. Those brainiac scientists really nailed it.

How is it administered?

The shot is administered into the muscle of the upper arm. Both the Pfizer and Moderna vaccine will require two doses – the second dose of the Pfizer vaccine is administered in 21 days, and the second dose of the Moderna vaccine is administered in 28 days after the first dose.

What are the expected side effects?

The commonly reported side effects include pain and swelling at the injection site, generalized fatigue, body aches, headaches, and less commonly, fever. These symptoms tend to resolve within 48 hours and were more common after the second dose. It was more likely, furthermore, for younger patients (under 55 years old) to develop these symptoms. So if you experience this expected immune response, rest assured that it is those proteins doing exactly what we want them to do. Never has feeling bad felt so good . . .

Can the vaccine lead to COVID infection?

No. As mentioned, the vaccine does not contain the actual virus and thus cannot cause infection. So if you develop a cough, shortness of breath, a runny nose, or loss of taste or smell shortly after receiving the vaccine, don’t blame the vaccine. Blame the COVID. And really unfortunate timing.

Will vaccination affect test results?

No. Just as the vaccine cannot lead to infection, testing results are also not impacted by vaccination status.

Can I get the vaccine if I had COVID?

If you have had COVID, it is still recommended that you get vaccinated, especially given it may confer more lasting immunity to the virus than the infection itself. People who are actively infected should wait until full recovery to receive the vaccine. Additionally, if you received antibody therapy for COVID infection, experts suggest you wait 90 days until after therapy to receive the vaccine.

If I get the vaccine, when will I be immune to the virus?

The CDC advises that COVID infection is still possible immediately after vaccination, as immunity does not kick-in until 1-2 weeks after the SECOND dose. It is also important to note that vaccinated individuals still need to follow all the current safety measures to avoid transmission (masks, social distancing, and frequent hand washing).

Is the vaccine safe for everyone?

There are two groups who should not receive the vaccine, until we can further research its safety in these specific populations:
● Children under the age of 16
● Patients who have a history of severe allergic reactions to a prior vaccine (note that no egg products, latex, or preservatives are used in the vaccine, so these allergies don’t count)

While the vaccine has not yet been fully studied in immunocompromised patients, it is still advised they undergo vaccination, especially given they are at increased risk of COVID infection.

What if I am pregnant?

We do not yet have safety data for the vaccination in pregnant patients. Given the favorable safety profile of mRNA vaccines, however, the American College of Obstetrics and Gynecology (think: a group of smart people who are the authority on how to keep pregnant mothers safe) have released a formal statement that the vaccination should NOT be withheld from pregnant women who elect to receive it. This should be an individual decision that weighs the risk of vaccination with the risk of a pregnancy complication from COVID infection, and we recommend pregnant individuals discuss this decision with their healthcare professional.

When can I get the vaccine? How much will it cost?

Healthcare professionals and high-risk individuals will be the first populations to receive the vaccine, followed by front-line workers. We currently project that the majority of our community will have access to the vaccine by the spring and early summer. Distribution processes are still being developed, but there is one thing we can guarantee: the vaccine will be FREE for everyone. Like extra Chick-Fil-A sauce. Both free, both worth their weight in gold.

When will we reach herd immunity?

You may have HERD this term used a lot lately (c’mon, you know I can’t help myself). It refers to immunity on a population level – community immunity, if you will (I can’t stop). This is achieved when the majority of a population is immune, making person-to-person transmission unlikely, and typically requires that over 85% of the population be immune to the infection. So if you are relying on herd immunity to protect you, you will be waiting a long time. Game theory is best saved for board games and gambling tables, not deadly infectious diseases.

I hope this article answers your biggest questions about the vaccine, so that you can roll up your sleeve with confidence and relief on the day of your vaccination.