Time for an Update! 
Image from: Nature.com
First, I did get immunized, and I did so with the Johnson & Johnson/Janssen product. I did not die.
I did get nervous one night a few days later at 3 AM when I had a headache--"Oh no! I'm getting cavernous venous sinus thrombosis!" (What a mouthful of words to think in the wee hours!)
No, I wasn't. I probably had a headache because I wrenched my neck doing yard work earlier. But I'm human too. I can freak out. I just have so much more technical knowledge with which to both scare myself, and with which I can calm myself down. Back to sleep. Woke up at 7. No headache. I'm fine.
What's Changed for Me?
Not much. Even with the CDC's updated guidance, it'll be a few weeks before we see what happens with masking requirements, social distancing, and all the little things we didn't notice constituted "normal" until this episode. I do feel a bit privileged. As I reported in my previous blog, immunization against COVID seems like a badge of good citizenship, a shield, a fashion that's in-fashion, and I've begun to notice that people toss "It's ok. I'm vaccinated," or "I had my shots," into conversations. To reassure? To brag? I'm not certain. I've done it with my patients. It seems like a kindness, and says "There's safety here."
Unless you're someone who wasn't that worried in the first place, or if one has a political point of view about COVID safety that supersedes such precautions. Writing in the Philadelphia Inquirer, Allison McCook says that the change in CDC's masking guidelines don't provide any answers concerning those who might un-mask even though they are unvaccinated. She shares,
I’m not only afraid — I’m angry. Because I was really looking forward to not being afraid anymore. That, to me, is what “normality” and freedom feel like. That’s why I circled May 25 on my calendar [for her second shot]— it was the day I could stop feeling afraid that I would catch or spread COVID. And now I feel like that date is meaningless. Because even when it comes, I’ll still be afraid — not for myself, but for the future of this pandemic.
She then closes with this,
So I’m still going to wear a mask, even after May 25. Please don’t yell at me about it, or accuse me of fearmongering or some weird conspiracy plot. I’m just scared.
A month ago, Derek Thompson wrote in The Atlantic that deep cleaning of surfaces isn't a "victimless crime"--harmless "hygiene theater" that makes us all feel safer. It actually costs us money, time, and effort that could be better spent on measures that actually reduce risk. His main question is: Why did it take so long for the scientific establishment to get on this bus? My answer is: "theater."
Much of managing a public pestilence is about managing the public mind. The theater is still open for shows because that's the show so many people want to see. They're scared.
It will be interesting to see what happens. Will there be a surge? Was this change too soon? On the other hand, how much more can people take? The introverts in the world may have loved the enforced cocooning, but many of us see the risk as acceptable--and perhaps necessary. After all, how can we say the vaccine will change everything when it began to appear it had changed nothing?
This was the calculated risk of a risk-averse organization, the CDC. In a time of year when people feel expansive--springtime--their numbers still seemed to indicate a reduction in case rates and fatalities. It's reasonable to attribute this to two things: a lot of people had COVID and are immune, and a lot more people got artificial immunity from the vaccines. If this is indeed the case, you kind of have to give a little ground.
Vaccine Passports
Without these, it is argued, who knows who is and who isn't immunized? That's a fair argument, but also an impractical argument: The American social character isn't disposed to a "show me your papers" way of life. And if we have learned anything from this pandemic it is that you can only enforce limitations to the extent that there's a political path to do so. The culture and economics of an America, a South Korea, a China, a France, an India have had more impact on how things have evolved in these places than anything we have done with vaccination, medicines, or bleach.
Vaccine Avoidance
I heard from one of my patients about vaccine adverse events. It wasn't an alarming note, just meant to be interesting, and so, interested, I dug into the Vaccine Adverse Event Reporting System (VAERS) back on April 11th. The database reported on 117 million doses of all products administered as of April 5th, with 57,000 events of all kinds reported. This works out to an adverse event rate of about 0.049% or about 1 event for every 2000 doses given. I'm not talking sore arms here. These are reported events: people have to go to the trouble to submit a report, even though anyone can. So a lot of minor issues probably go unreported, but were probably already known from the original research.
"Serious" events, including hospitalizations, deaths, and other really bad stuff occurred at a rate of about 0.006% or about 1 event for every 15,000 doses administered. It was at that point that I closed the loop: As I said previously, I was waiting for enough accumulated data to determine if something really weird was going to emerge.
It didn't.
Yeah, I hear people talking about potential "long term" harms, but they generally are unable to be specific about these. As I note in an article on my website from March 2008, it's certainly possible that vaccines can cause subtle, complex harms. But as I have aged and become more experienced, I have learned that there are so many possible ways to these subtle, complex harms, including ongoing toxic stress, too much sitting, climate change, pesticides, air pollution, doom scrolling, racism, processed foods, medical marijuana, and bourbon! So many things that I have to ask: after 117 million doses, and with these risk ratios, does it really matter if I get this thing?
True, I could have been that one-in-a-million that gets the dreaded "brain clot", buuut...I wasn't.
Recently I lost a brother to a horrific, aggressive, Burkitt's lymphoma that likely resulted from 15 years' exposure to immune-suppressing drugs he had to take because he was a kidney-transplant patient. His experience made death from COVID seem trivial to me. I'm not trying to minimize anyone's pain if they lost a loved one to COVID. I'm simply contrasting a very public, common, and scary phenomenon (COVID), one that is beginning to fade, to a very private--and sadly ordinary--event that touched me personally and influenced how I feel about life in a time of pestilence. COVID meant we couldn't visit in groups at the end, but it was a side show compared to the main event: cancer.
While Chris' death was sudden--from start to finish it was only 6 weeks--and awful, if he hadn't gotten the transplant, he would have spent a good part of the last 15 years on dialysis...and it's very likely he would have died within 5 to 10 years--surviving longer is rare because of the risk of infection as well as just how hard it is on the body when you can only filter off the toxins a few days a week.
And so, while I'm aware of the possible weird, subtle harms that might emerge from the shot I got at Rite-Aid a couple of weeks ago, I'm inclined to ignore them. It's all about risks and benefits. I chose mine. It seemed a reasonable choice.
Choose well.
