Concerns about COVID-19 Vaccines

Hello, friends and families…

I am very excited that the first vaccines for COVID-19 are being distributed, and I’m grateful to the Mt. Sinai Health System and the department of Otolaryngology for getting me the Pfizer vaccine. I frequently work in the ICU and I have recently seen a number of COVID positive patients in my practice (I test anyone who might have an infection outside for the safety of my staff and the other families in my office). Getting the vaccine doesn’t mean that I don’t need to continue observing all of the precautionary measures and mitigation practices that we have developed over the year (masks, hand hygiene and social distancing). But it is a step towards the end of this pandemic, and towards easing the burden on our health care resources.

Unfortunately, I have seen a LOT of misinformation being passed around on social media, so I thought I would address two common concerns. Some people are genuinely confused and post misleading stuff because of a lack of better information. But there are also bad actors out there - one pharmacist in Wisconsin deliberately spoiled hundreds of doses, possibly with the intent of vaccinating people and then using any subsequent infections as “proof” that the vaccine doesn’t work.

There are a lot of concerns out there, and I don’t need to duplicate the many excellent official sources about COVID vaccines. Here is a good summary from the Mayo Clinic, here is a long list of questions and answers from the Children’s Hospital of Philadelphia, and here is something from the CDC. I just wanted to do a quick message to my patients and their families to help address these two issues. Just like a virus, bad information spreads quickly between people and can cause a lot of damage.

1) Is the vaccine safe? It was developed SO fast, and I read about someone who had a problem after getting it.

Even though the vaccines have been developed very quickly, they went through all of the standard testing for safety and efficacy. There is almost no medical intervention that isn’t going to have SOME complications, but the risk of that with these vaccines is extremely low. Even with common medications like antibiotics, decongestants or pain relievers, you will find isolated reports of life threatening adverse effects if you give them to enough people. The risk of dying from COVID-19 - while in general very low - is FAR higher than the risk of a fatal reaction to a vaccine, and that’s not even considering all of the potential long term risks of getting the infection. Some viruses have risks that you don’t know about for decades (like cancer after HPV infection), so you should do everything you can to avoid getting COVID-19, even if you would probably survive it.

Some vaccine “complications” aren’t even that - they are just the statistical certainty that if you give ANYTHING to enough people, you will be able to find the occasional report of someone who died within a short time after getting it. If you read past the headlines in those stories, you will find that it makes as much sense to blame the vaccine as it does to blame the coffee that the person had that morning. This is going to be even more common as elderly patients in nursing homes get vaccinated - death from natural causes is frequent in that population, and certainly some of those will happen after the shot. Correlation and causation are two different things, and every scientist knows that good research HAS to take that into account.

There are common, minor side effects of any vaccine, and this one is no exception. I had a brief headache the next morning, and a slightly sore arm on the day of the injection (a lot less pain than my annual flu shot). Fever, fatigue, chills, and muscle or joint pain are all reported, and are brief.

Maybe some numbers will be reassuring. Take one example of a serious allergic reaction - anaphylaxis. Out of over 2 million people who have currently been vaccinated against COVID-19 in the US, there have been 11 cases of this potentially life threatening condition (with no reported deaths). Anaphylaxis to penicillin occurs in about 1 in 5000 patients - that’s over thirty times more often than with the vaccine. And these drugs are one of the most common medications given. Patients generally aren’t concerned about this much greater risk at all, if anything doctors are pressured to overprescribe antibiotics.

Here is an excellent summary of the problems of communicating with the public about the safety of vaccines, and some good numbers for context.

2) Is the vaccine effective? I read about someone getting the vaccine and then getting COVID.

Again, both of the approved vaccines (and the ones in the pipeline) have gone through extensive testing on this question. As you may remember from my last article, the primary question was whether the vaccine prevented people from getting the disease and getting sick, as opposed to how well it blocks the chain of transmission. Because of the need for rapid development, the research focused on the first question. While it makes sense that the more antibodies you have and the less sick you are if you get infected, the less virus particles you will shed, experts are very careful about stating that as fact until more research is done. One concern is that while the vaccine induced immune response is good at killing virus that makes it into your body, it may be less effective in killing virus that hangs out in the mucus of the nose and throat, which is a big source of spread.

Almost no one outside of the test subjects has had the required two doses of the vaccine at this point, and it usually takes a few weeks for immunity to develop after that. So making a big deal about stories like this one of someone getting COVID within a few days of their first shot is misleading and unhelpful.

We are heading into a bad winter. But spring is coming and the vaccines are coming. Stay safe, mask up, wash your hands, watch your contacts, and #stopthespread!


Mike Rothschild, MD

@snotdoctor on Instagram

(212) 996-2995