Can the Covid vaccine win the war against the pandemic?
Posted in September. For some reason I had to repost it.
Evaluating the Vaccines: Will they Win the War Against Covid?
It is hard to sort through information about the Covid vaccines. Even if you have made up your mind regarding the Covid vaccine, I would like to share some vaccine information from what I consider trusted sources, sources like Up To Date, which has been my most trusted source of medical information over the years.
As a physician I’m sure it comes as no surprise that I am generally in favor of the vaccine, however I believe that attempting to mandate the vaccine for the general public is like going for the consolation prize, born out of our inability to dispel myths and false information. We should be doing a better job of getting honest information about Covid-19 and the vaccines against Covid to the people of our communities.
My agenda is this. I believe that small towns like ours have to battle for survival. We have to make good decisions. I believe one preventable loss of life of a member of this community is one too many. I know it is our job, and we will continue to do it to the best of our ability, but taking care of Covid patients in the hospital is stressful. My agenda is to reduce the number of sick people coming into our hospital.
With the emergence of the delta variant, it does not appear the pandemic is ending soon. Cases of Covid infections are on the rise in every state in the country and in some states the new case rates are higher than they have ever been. In Yuma County, the average daily Covid cases for the seven days prior to 8/21/21 was 8.6/100K. During that same seven day period the average daily case in the state of Mississippi was 120.5/100K.
If Yuma County, population about 10,000, would have continued at the same case rate seen on August 21 over a 2 month period, which was the median length of time the Covid vaccines trials monitored people in their phase 3 trials, we would anticipate about 51 cases in the county and 7 Covid hospitalizations, and one death.
If, however, we should have a case rate of that of Mississippi of 120.5/100K/day, over 2 months we would anticipate about 723 cases in Yuma County over 2 months and about 101 Covid hospitalizations, 25 ICU admissions, and 18 deaths.These 723 cases would expect to see 45 people develop encephalopathy or delirium, 9 heart attacks, and 1.6 strokes, not to mention complications such as deep venous thrombosis and pulmonary emboli as well as persistent problems with fatigue, dyspnea, and impaired memory sometimes lasting for months after an infection.
I know that Covid is real. I know people who are suffering long term effects from Covid infection. I have seen patients with simple cold symptoms that had chest x-rays that should have looked normal, but instead looked so full of inflammation that it gave me such a feeling of dread that there is no mistaking, Covid for some people is very real.
The case rate in Mississippi would overwhelm us here in Yuma County. Fortunately our daily case rate is not near the 120.5/100K/day seen in Mississippi, however from 8/21 to 9/2 the case rate in Yuma County has increased from 8.6/100k/day to 20 cases/100k/day.
The percentage of people 18 and over fully vaccinated for Covid in Vermont is 77.9%, Colorado 68.1% and in Mississippi it is only 48.1%. What about Yuma County? 46.7%.
What about the vaccines? In the United States we have two mRNA vaccines, one made by Pfizer and one made by Moderna, and we also have a viral vector vaccine made by Johnson and Johnson.
In phase III studies, Pfizer and Moderna vaccines were 94-95% effective in preventing Covid infection. What does 95% effective mean? It means that instead of 723 cases in a hypothetical unvaccinated population, a vaccinated population would see only 36 cases. Compare this to the flu vaccine which each year is anywhere from 10 to 80% effective in preventing influenza. The Johnson and Johnson vaccine was 67% effective in preventing moderate to severe Covid infections, and in the United States it was 74% effective, still easily effective enough to be a valuable weapon against the Covid virus. One may have skepticism of results reported by companies that have financial incentives for favorable results, but with emergency use authorization and millions of vaccines administered, the protection rates seem to be holding true.
Systemic self limiting side effects are common especially after the second dose of the mRNA vaccines. Temporary symptoms such as headache, fatigue, muscle aches, fevers and chills occur about half the time after the Moderna vaccine and a little less than half the time with the Pfizer vaccine, usually starting the day after the vaccine. The Johnson and Johnson vaccine also showed these type of systemic side effects that were self limiting. These side effects are common and uncomfortable enough that I recommend scheduling your shot when you can take it easy the next day.
I think the majority of people are more anxious about some of the other more serious side effects that have been reported. The mRNA vaccine seemed to be associated with rare cases of anaphylaxis, Bell’s Palsy and myocarditis/pericarditis. The Johnson and Johnson vaccine seemed to cause rare cases of Guillain Barre syndrome and Vaccine induced Thrombosis/Thrombocytopenia. Investigations into these events concluded that these side effects were rare and the benefits outweighed the risk of continued vaccination. I think telling people that certain scary side effects are “rare” is too subjective, so I decided to use the population of Yuma County as an example.
I estimate there are 7200 people 18 years of age or over in Yuma County. If none of these 7200 people got vaccinated, in one year there is about a 50% chance one person would have anaphylaxis probably to something like peanuts, medication or a bee sting. If all 7200 people 18 and over got vaccinated with the Pfizer or Moderna vaccine, the risk would increase from 50% to 53.6% chance that one person would have an anaphylactic reaction. The Johnson and Johnson vaccine is not known to increase the risk of anaphylaxis.
If none of the 7200 people got vaccinated, I might expect to see 2 cases of myocarditis/pericarditis among all the people 18 or over in Yuma County over the course of the year, probably from a viral illness. If all 7200 people 18 and over in Yuma County got vaccinated with the Pfizer or Moderna vaccine, the risk of myocarditis/pericarditis in this population would be 2.163 persons in the year. In other words there would be a 16% chance one additional person would have myocarditis/pericarditis from the vaccine in a year. The Johnson and Johnson vaccine did not show an increased risk of myocarditis/pericarditis.
If none of the 7200 people got vaccinated, I might expect 1.4 people to get Bell’s Palsy in one year. If all 7200 people were vaccinated with the Pfizer or Moderna vaccine, we would expect 1.6 extra people to get Bell’s Palsy for a total of about 3 people in the year. The Johnson and Johnson vaccine did not show an association with Bell’s palsy.
If nobody 18 and over received a Covid vaccine, there would be about 14% chance that one person in this age group would develop Guillain Barre syndrome, a disease marked by progressive muscle paralysis. If all 7200 people 18 and over received the Johnson and Johnson vaccine, the chance one person would contract Guillain Barre syndrome over the course of the year would increase from 14% to 20%. The Pfizer and Moderna vaccines did not show an increase risk of Guillain Barre syndrome.
Based on general incidence of thrombosis/thrombocytopenia syndromes, there would only be a 2% chance that one person would develop this problem if nobody in Yuma County got vaccinated. If 7200 people in the highest risk demographic, females between the age of 30 and 49, received the Johnson and Johnson vaccine, there would be an additional 6% chance that one person would develop vaccine induced thrombosis/thrombocytopenia. There was no reported increased risk of thrombosis/thrombocytopenia with the Pfizer or Moderna vaccines. Thus if given the choice, especially if you are a woman between the age of 30 and 49 I would choose the Pfizer or Moderna vaccine.
Throughout history, adverse effects to vaccines have generally showed up within 6 weeks of the vaccine. It is true that officials have not always been forthright with the public when problems were identified with a vaccine, and their intentions to avoid a panic is probably at least partly responsible for vaccine hesitancy that exists today, but after almost 9 months of vaccinating and after millions of doses, there does not seem to be new side effects showing up.
I believe, however, there may be another issue to consider. I believe that people are more likely to get sick, have a heart attack or have a stroke when they are under stress. This stress can be good stress or bad stress, such as getting fired, a job promotion, buying a new home, getting married, or getting divorced, but any stress, including the stress of the Covid vaccination can briefly upset a persons health balance, if you will, in predisposed individuals. I mention this despite any scientific evidence, because I want the reader to understand I am trying to present known as well as potential risks of the vaccines.
So now you get to decide, to take the jab or not. As Covid makes a surge again with the delta variant, I believe the risks of vaccinating are real but small. You get to decide if the risks are small enough. The older you are, the heavier you are and the more medical problems you have, the greater your risk with a Covid infection and the more favorable the risk benefit ratio is for the vaccine.
Many Americans may not really know how fighting wars in Vietnam or Afghanistan have had any affect on our freedom, but the fight against Covid is a war being fought on our home soil. No matter how you feel about our government’s attempt to limit the spread of this virus through mandates and restrictions, Americans have felt our freedom infringed upon. Americans have been kept from the classroom, from restaurants, and sporting events. We have missed Thanksgiving dinner with family, postponed weddings and cancelled graduation ceremonies. The number of Americans dead from this war are comparable to the American casualties in the Civil War, the last American war fought on domestic soil.
I believe it is time for the people of our communities to stop fighting each other and come together and formally declare war on this virus. Stop complaining about what the government did or did not do, and let’s win this battle. A few will suffer for taking a shot in the arm against this virus, but the vaccine is how we win this war. My family and I got the shots. I hope most of you will join us.