The first “rule” of medicine is DO NO HARM – don’t hurt the patient.
Another rule we learned in Medical School at the University of Kentucky was that many decisions in medicine are determined by the risk to the patient versus the benefits they may gain from that treatment or procedure.
Over 300,000 Americans and 2,207 Kentuckians have died as a result of the coronavirus. There are, as of Friday, 434 Kentuckians in ICU with the virus and 224 on ventilators. I personally have lost eight wonderful patients from COVID-19 with the oldest being 99 years old. All but one were nursing home residents.
Consider these statistics
•Over 58% of deaths are nursing home residents.
•If you get COVID-19 in the nursing home the chance of dying is 20%.
•If you are over 70 and get COVID-19 there is a 20% chance you will end up in the hospital.
•The elderly, those with diabetes or other chronic diseases are at highest risk.
•Half of those patients on ventilators will not survive, though there has been great progress in treatment of the virus. This week vaccinations will begin in our local long-term care facilities. Vaccines will be provided to the residents and staff, front line health care workers, then all health care workers and first responders, then the K-12 education community.
We are all familiar with wearing masks, using hand sanitizer, social distancing, washing hands and avoiding crowds. These will have to be continued after the vaccine as it takes one to two weeks after the second dose to be considered fully vaccinated.
There are two approved vaccines that have received Emergency Use Authorization by the FDA and CDC. The Pfizer vaccine may be given to those 16 and older with the second dose 21 days after the first one. The Moderna vaccine is approved for patients over the age of 18 followed by a second dose 28 days later. You should not have had any other vaccine such as the flu vaccine 14 days before or after the COVID-19 vaccine. The vaccines are NOT live viruses that are injected.
If you have COVID-19 at the time you should not get the vaccine as you might expose health care workers to the disease.
You may proceed with vaccine if you are pregnant, immunocompromised or breast feeding. You may get the COVID-19 vaccine if there is a history of allergies to food, pets, venom, insect or latex or a non-serious reaction to a vaccine. A 30 minute observation period is done if patients have a severe allergic reaction due to any cause or 15 minutes if allergic reaction but not anaphylaxis.
Precautions to the vaccine include patients with acute moderate or severe illness, then the vaccine may be deferred. If there is a history of severe allergic reaction to another vaccine or history of a severe allergic reaction (anaphylaxsis) to an injectable medicine, there should be a risk assessment, and potential deferral of the vaccine and a 30 minute observation period if vaccinated.
Contraindications to the vaccine: If there is a history of severe allergic reaction to any component of the vaccine, do not vaccinate. Polyethylene glycol is one component.
At the vaccine sites there should be epinephrine and Benadryl available to treat reactions. The chance of anaphylaxsis is one in 1.3 million vaccines.
Systemic signs such as chills, fever, sore muscles and achy joints, fatigue and headache if they occur are usually within the first three days after vaccination. Systemic adverse reactions are more common after the second dose and usually in the 18 to 55 age group. Tylenol and analgesics may be used. Some have considered these signs that the immune system is revving up.
Cough, loss of taste or smell, shortness of breath, rhinorhea and sore throat are NOT due to the vaccine.
The vaccine does not turn a COVID-test positive.
A program called V-Safe is available to check problems after the vaccine. This is done by text messaging daily the first week then weekly up to six weeks. You will be questioned: Did you miss work? Are you unable to do normal activities or have you received medical care?
If you have had COVID-19 infection and recovered you still should get the vaccine. Wait until the acute illness and quarantine has been done. Re-infection is uncommon in the first 90 days after illness and the vaccine could be deferred until after 90 days.
There was an imbalance of Bells Palsy but this was in an expected range.
If you miss the second dose of either vaccine you do not start the series over but get the second vaccine as soon as possible.
It is estimated that 40% of the general population will decline the vaccine. This is similar to the number that declines the flu vaccine. If you have any questions or concerns please discuss them with your physician. I have had many patients with COVID-19 infections, many very ill, besides the eight I have lost. I have had 26 COVID-19 tests myself – nasal, oral, and blood when I donated blood.
When my patients ask me about the vaccine I have two responses: I took it myself and I wouldn’t recommend anything to you without taking it myself.
Secondly, I wish that the patients I lost would have had an opportunity to take the vaccine, as well as the other 300,000 Americans who have passed with COVID-19.
Information on this article was from the CDC website on the vaccines.
Dr Drake is board-certified by the American Board of Family Medicine, is a past-president of the Kentucky Academy of Family Physicians and a member of the American Academy of Family Physicians. Dr Drake has practiced in Somerset since 1984.