Getting the vaccine was no big deal

The two doses are not going to change my daily routine

This is another in a series of conversations between Dr. Jarone Lee, a frontline critical care and emergency physician at Massachusetts General Hospital and associate professor at Harvard Medical School, and Dr. Paul Hattis, a retired associate professor at the Tufts University Medical School who participates in CommonWealth’s Health or Consequences Codcast. Find links for past conversations at the end of the story.

 

PAUL HATTIS: What was it like getting the Pfizer COVID-19 vaccine last week?

JARONE LEE: It felt like any other vaccine. It was a single injection in my arm and then they monitored me for 15 minutes to ensure I did not have serious side effects. We also scheduled my second dose during this waiting period. It was very straight forward and not a big deal.  I did experience around 18 hours of discomfort at the injection site, which felt more intense than other vaccines I’ve received. I had no other side effects.  Some of my colleagues experienced mild fatigue, muscle aches, and low-grade fevers.  All these symptoms were transient and typically went away within a few days.

HATTIS: When you receive the second dose in a few weeks—do you expect that to change how you feel about your COVID infection risks? Will it change your behavior at work, at home, or out in the community?

LEE: Knowing that the vaccine will give me some protection against COVID is a relief.  At 10 days after receiving the vaccine, the efficacy of the vaccine is around 50 percent to prevent COVID-19 symptoms and goes up to 95 percent after the second dose.  Tthe vaccine was studied under ideal, research conditions and real-world use will likely be much lower.  Regardless of the level of protection, the added safety I will feel as I enter a COVID patient’s room will be reassuring.

But even after getting my second dose, my daily routine will not change.  Whether at work, home, or outside in the community, I will continue the same level of vigilance as I do now. I will wear masks, socially distance, stay away from crowds, and wear my N95 and full PPE when I see patients with COVID.  Even if I am protected by the vaccine, I could still get COVID and spread it to others.  The vaccine was studied to measure symptoms, not infection.  In many ways, the vaccine could mask the symptoms of COVID and I could easily become an asymptomatic spreader.

HATTIS: There was a lot of news coverage of the initial rocky rollout of vaccines to staff at Massachusetts General who were prioritized to get it first.  What happened?

LEE: The hospital system’s scheduling system for making vaccine appointments crashed soon after it went live.  For many of us taking care of COVID patients at MGH, the snafu was heart-breaking, not just because of the difficulties with the vaccine rollout, but because the vaccine rollout became the focal point of everyone’s pent-up COVID frustrations. An entire workforce that buckled down, moved forward, and stayed on mission was looking for a way to vent, and it was the botched vaccine rollout that provided the focus for expressing a range of emotions.  Despite understanding the bigger picture, I felt it, too – a feeling of unfairness—that this is just simply one more complication in a string of many that the pandemic has brought us.

Personally, I knew that this vaccine scheduling challenge was temporary. The difficulties were primarily technical and process-related–unlike at other hospitals across the nation where it appears that some people jumped the vaccine queue.  Since the initial hiccups of vaccine rollout, Massachusetts General Brigham has received an additional large shipment of vaccines, with many more to come.

HATTIS: Do you know health care colleagues who are eligible, but refusing to take the vaccine so far?

LEE: Yes. Some of my colleagues who are pregnant, currently breastfeeding, dealing with auto-immune disease, or who have severe food or drug allergies have worries and appropriate concerns. The concerns focus on the impact the vaccines will have on these special populations. Getting the vaccine is a very personal choice and the risks and benefits must be weighed.  Overall, because COVID could cause severe and deadly illness, the benefit of the vaccine seems to outweigh the risks, even in pregnancy and severe allergies.  Only those with a known severe allergy to the COVID vaccine or its ingredients are told to avoid vaccination.

HATTIS: Recent news stories indicate that monoclonal antibodies—a treatment President Trump received—are not in demand.  Why?

LEE: I am not surprised. These two new monoclonal antibody treatments were approved under an emergency use authorization by the Food and Drug Administration. The antibodies are not an approved drug like a blood pressure medication. Instead, the FDA found the benefits of these drugs outweigh the risks during our current COVID crisis even as research data remains somewhat incomplete.  Specifically, these two new drugs were shown to work only for patients with early COVID symptoms and not requiring hospitalization.  Essentially, you have to be well enough to be at home to get these drugs.  Also, the patients most likely to benefit are the people with high-risk of bad outcomes from COVID, such as people over the age of 65 or with certain chronic conditions.

This new therapy is not in high demand for two reasons.   First, patients have to travel to an infusion center to receive the treatment.  Second, there is a small window of time when a patient can get this treatment.  Unfortunately, my guess is that patients in this window feel okay enough to not want treatment, especially an unproven, experimental drug.

HATTIS: Looks like total COVID hospitalizations and ICU admissions are each up about 35 percent since Thanksgiving. What do the numbers look like at MGH and across your system right now?

Steadily increasing. We’re seeing more and more COVID patients in the emergency department and in the ICU. We continue to be successful in evening out our COVID hospitalizations between MGH and Brigham and Women’s, as well as across our entire system.  Since we last spoke, COVID hospitalizations increased by just over 30 percent across the entire hospital system, with about a 25 percent  increase in the ICUs.  Right now, we have about 60 COVID patients requiring ICU level of care, split about evenly between Brigham and Women’s and Mass General. Without sharing the very sick COVID patients between the two academic centers, we would likely already be pressed to open additional surge ICU space at MGH.

Demographically, the critically-ill continue to be older males with co-morbidities.  But there is an abundance of younger patients dying from COVID. Nationally, the younger patients tend to be black and Latinx people between the ages of 25 and 44.  Here at Mass General, the trend is similar in that we have many non-English speaking, primarily Hispanic patients from high-risk neighborhoods such as Chelsea, Revere, and East Boston.

HATTIS: Do you anticipate that you can get through the surge we are in now without having to open up a lot more COVID beds?

LEE: If the current surge stays at the current levels, I believe we could get through this with minimal need of surge ICU spaces. Here at Mass General we have the ability to open up surge ICU spaces quickly.  This could be turned on in 12-24 hours, and possibly quicker if needed. Local hospitals that are part of our network may face more challenges if cases begin to surge higher. We recently moved a few hemodialysis machines to help Newton-Wellesley Hospital deal with COVID patients with kidney failure.

The current uptick in cases most likely is from the Thanksgiving holidays.  With the Christmas holidays past us and with New Year’s on the horizon, I personally worry that these new gatherings will lead to a large surge on top of our current surge.  With hospital and ICU capacity already stretched across the state, a new surge on top of our current status could be truly challenging to our local health care system.

I appreciate that the governor has continued to be worried about this possibility, and has just put new restrictions on indoor and outdoor gatherings.  Additionally, the new requirement to reduce elective surgeries requiring inpatient bed use should help add inpatient capacity to help with COVID patients.

HATTIS: Sitting here today, what are you most worried about right now as we move into the next few weeks?

LEE: As we continue to surge here in Massachusetts, the rest of the country worries me more. We have a robust healthcare infrastructure, especially in the Boston area.  We will weather this storm much easier than many rural areas across our nation which often have an insufficient number of ICU beds and ICU clinicians.  Working as part of a Department of Defense initiative, some of my colleagues and I here have started helping by providing remote critical care consults for some rural, critical access hospitals in the Midwest.

There also also secondary impacts of COVID. Rates  of complications for alcoholism and substance use continue to rise. Prior to COVID, our mental health capacity was already strained and difficult to access.  I predict this will continue to worsen as we move past COVID and into recovery.

 HATTIS: On the personal side, anything new in these past few weeks related to the pandemic and its effects on you or family?

LEE: I know during this crisis many people lost their jobs and need to go on unemployment, which also led to increased unemployment fraud.  I am sad to report that last week I found out that someone or some group filed for unemployment benefits with the Massachusetts Division of Unemployment with my personal information.  I only found this out when I received a new unemployment debit card in the mail.  I quickly called the bank to cancel the debit card. I reported what happened to the state, my employer, and the FBI, and I froze all my credit reports.  Hopefully, this will stop or deter further use of my information.  Many of my colleagues also have had fake unemployment claims made with their information.  I wonder if frontline healthcare workers were targeted because we are working constantly these days and have less time to focus on other responsibilities.

While this situation cost me a few hours of time, my heart goes out to all the people who are scrambling to make ends meet. Thank goodness the president signed the stimulus relief package, which hopefully will give some people a bit more breathing room.

 

Earlier interviews with Dr. Lee:

The Codcast: A report from the frontlines at MGH

Q &A with MGH doc Jarone Lee: We’re seeing patients of all ages

Dr. Lee: Preparing for the surge

Dr. Lee: ICU units won’t beat this disease

Dr. Lee: At MGH patients don’t die alone

Surge still manageable for Dr. Lee

Dr. Lee: We’re busy but in good shape

Dr. Lee says COVID-19 patient counts down

I’m seeing promising ventilator death data

At MGH, they worry about a second surge

Fewer but sicker patients in the MGH ICUs

The black swan of our time

Meet the Author

Paul A. Hattis

Associate professor, Tufts University Medical School
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