The Surgeon Says: Covid-19 Update

By Post 3036 Surgeon Robert Lehman, MD

It is clear that for many people the current status of Covid-19 and vaccinations is frustrating and confusing.  But if you can sift through the noise, the overall message has not really changed.  In short, I think the frustration is that the status is not what the public HOPED it would be at this time, but it is pretty-well following what the experts predicted it would be.

To my utter amazements, we still only have the two approved vaccines: Pfizer and Moderna.  These are essentially the same, but do not mix them.  If you get Pfizer for your first shot, then get Pfizer for your second.  Pfizer has just petitioned the FDA/CDC to change the requirement of keeping the vaccine at negative 70 degrees.  It apparently isn’t necessary, and requiring that has kept it away from pharmacies and physician offices.  The Astra-Zeneca/Oxford vaccine seems to be stuck in the regulatory process.  It will be easier to use as it doesn’t have the refrigeration requirements, and it “probably” will only be one shot.  It doesn’t appear to be as effective as the other two vaccines, and seems to be much less effective against the South African variant.  However, although some vaccinated persons with the Astra-Zeneca vaccine are becoming ill with the variant, they are not getting serious ill or dying, so it obviously has some protection.

A recent Israeli study suggests significant protection with just the first shot of the Pfizer vaccine.  The second shot will still be recommended, but there is logic to delaying the second shot so that more people can receive the first shot.  Britain is doing that already.  The official US recommendation is to continue what we are doing, but if the recommendation changes, then this is the reason.

Getting the vaccine is very frustrating.  They are a lot more people wanting the vaccine than appointments available to get the vaccine.  But the biggest problem is supply.  A vaccine clinic might make you an appointment for 2 weeks from now based on their anticipation of receiving the vaccine 10 days from now.  But if the vaccine does not arrive, due to either weather, political or simple supply problems, then your shot will be canceled and hopefully rescheduled.  That said, the number of vaccinations given is roughly what the experts had predicted by this time, although certainly still less than the politicians had promised.  My wife and I did manage to get both shots, but I was trolling all of the sites listed on the State website every day to find openings.

Most people are not having major side effects from the vaccinations, but they can occur.  My wife and I both had sore arms at the injection site for about 2 days.  This wasn’t enough to stop lifting weights, but it was very noticeable.  My wife had the sore arm again overnight for the second shot.  I didn’t get the sore arm, but I mentally felt ‘off’ the whole next day.  I went jogging — I can’t tell you if that is a good idea or not, but that is what I did.  I held off on a project I was building because I didn’t trust my ability to measure and cut things accurately.  Again, I suspect I was mentally fine, but since I felt a little fuzzy, I just didn’t.

I have read lots of reasons some people are anti-vaccination.  So far, I have not seen a single reason that was not scientific nonsense.   We are not talking about a vaccine to try to prevent the common 3-day cold with annoying symptoms.  This virus is killing people as well as causing some permanent sequela.  All theoretical reasons not to have the vaccination do not really compare to the potentially real consequences of having this disease.  Three people in my own family have had the disease, and even though none of them required hospitalization, all three continue to have symptoms several months later.  This is NOT a benign disease.

The last question I am asked is that hardest to give a simple answer:  if vaccinated, do I still need to wear a mask?  Again, you primarily wear a mask to prevent GIVING the virus to someone else even though you might have no symptoms.  Yes, you can still carry the virus even after being vaccinated, but the most recent data is suggesting that most people after vaccination do not get asymptomatically infected, and thus are a low risk to spread to others.  But the vaccination is not 100% effective, and so you still do not know if you might be a spreader.  You most definitely need to wear a mask when out in public, particularly if around unvaccinated people with risk factors (smokers, lung/heart disease, diabetes, obesity, high blood pressure, pregnant, etc).  

Wearing a mask can reduce your risk somewhat of picking up an infection.  Thus, you need to wear a mask if you are around anyone that could potentially be infectious, particularly if you have any of the high-risk factors.  Right now, the most important reason for a vaccinated person to wear a mask is that we need to continue to emphasize to the public that everyone needs to wear a mask — at least until we have a significant percentage of the public vaccinated — the famous herd immunity you have heard of.  I cannot tell you what that percentage is; there is no universal agreement.  But we are not anywhere close to that yet.  I suspect we will hear more about that as we get to the summer as it will take at least that long to get a large percentage vaccinated. And since children will not be vaccinated for at least another year (or longer), source of continuing the infection will exist for unvaccinated adults.

I add the following example only because I know someone will ask.  I cannot tell you that this is the correct answer; only that this is what I am doing based on the science available to me at this time.  Our no-mask bubble is ourselves, our daughter and her family.  She and her husband are both doctors and both vaccinated.  And they have two children.  We are at low risk of becoming infected after being vaccinated; the grandchildren being the most likely vectors.  However, we have no high-risk factors, and have concluded that if we indeed become infected, our risk of serious disease or death should be very small.  At all other times in public – including jogging — we are wearing masks.