Episode 109: The COVID-19 Vaccine is Here. What Does it Mean? A Discussion with Dr. Tim Hindmarsh

Well, it finally happened, the COVID-19 vaccines have started to arrive and get administered to health care workers in the United States. The first out of the gate is the Pfizer vaccine which will almost certainly be followed soon by the Moderna vaccine. Both vaccines use a revolutionary new technology for inducing an immune response, messenger RNA (mRNA).

As millions of doses start rolling out throughout our hospitals and nursing home care workers we need to reflect on whether the vaccine is effective, safe, and how it should be distributed. My discussion today is with Dr. Tim Hindmarsh who is the co-host of a fellow Doctor Podcast Network show called BS Free MD. Dr. Hindmarsh has extensively studied the vaccine and faces questions every day from his patients about whether or not they should get the vaccine.

Is the Vaccine Safe?

The preeminent question that everyone asks me in the OR or on social media is whether or not the vaccine is safe. The simple answer is yes. A more nuanced and accurate answer is almost certainly but perhaps time and millions of doses will lead to a more robust feel as to how safe the vaccines really are. Obviously, there is no long term data because there hasn't been enough time passed to gather data. What we know of short term results is that the vaccines seem very safe. The usual vaccine related complications that people really worry about (Guillan Barre, transverse myelitis, etc.) occur within the first six weeks or so of vaccination. Those haven't been seen in the trials so far with tens of thousands of volunteers.

But that doesn't answer the broader question of what the potential long term complications of the vaccine might be. I believe by the time the vaccine gets to the public distribution phase we will have a very good idea if there are any side effects that just aren't being picked up right now. Since that is months away we will have more than enough time and doses given to evaluate its long term safety.

Does the Vaccine Work?

Again, we can answer this questions two different ways. Short answer: yes. Long answer: yes and maybe. The studies clearly show that the vaccines minimize the likelihood of developing severe COVID-19 disease. And functionally, that is all that really matters. Yes, the chance of you getting a severe infection to COVID isn't 50% but it is also much greater than zero if you are older. And even quoting survival numbers is not that helpful if you end up sick and unable to work for months or some complication to the virus which happens even to those who survive.

The other question that we don't know is if you can still get infected if you've been vaccinated and transmit the virus to others. The studies weren't designed to find that answer so it will be months before we know the answer. It is possible that the immune response triggered by the vaccine prevents the presentation of symptoms but that you still get infected and spread the virus. A good example of this would be the oral polio vaccine which allows for infection but it prevents the devastating paralysis effects (the US no longer uses the oral vaccine but an inactivated injection now).

Should I Get the Vaccine?

Here the answer is it depends. If you're elderly or have any of the now well known co-morbidities (heart disease, diabetes, pulmonary disease) then getting the vaccine should be a no-brainer. Contracting COVID-19 will almost assuredly be a worse chance of survival than any theoretical risk from the vaccine. Also, those working in that population or coming in contact with patients should probably get it too. Having that much exposure just puts you at a risk that probably makes the chance of severe COVID too high when compared to theoretical risks.

The tricky answer lies in what to do with a healthy 25 year old. I suspect that by the time that individual has the opportunity to get the vaccine we will have more knowledge of any complications and make a better assessment at that time. For now, just remember that even if you get COVID-19 and survive or have mild symptoms of fatigue and fever it's not any fun. Just as I don't believe the flu will kill me I still don't want to get it because I won't be able to work and I will feel miserable.