Answers to common questions about the COVID vaccines!

1truekhaleesi

I take care of covid ICU patients. I have been asked a lot what I think about the vaccines and if I will get them. I am waiting until the release of the full side effect profile as determined by the FDA to take an official stance. These are scheduled for 12/10 (Pfizer) and 12/17 (Moderna). They are hosting a live open forum. Anyone can send in questions and everyone can watch.

***Barring anything new or different than what the companies have already released? I plan to get a vaccine against COVID-19. I am high risk. I take care of covid ICU patients. ***

Answers to common questions about the COVID vaccines!

If you come to my unit, it's because things aren't looking good.

That said, my thoughts so far are as follows (I invite any questions and I will try to answer them to the best of my ability and/or tag those more knowledgeable than I am): If you are hostile or say this is a hoax, you will be blocked. I have seen adults of all ages get intubated and die over this shit. I have lost multiple coworkers who were also caring for covid patients over this.

Covid vaccine
Covid vaccine

Bits and pieces here have been borrowed and stolen over the months as I’ve read better explanations than mine- thank you to the many people who explained these concepts to me!

First, I will admit that when I first heard an mRNA vaccine, which has never been used before in humans, I was a bit worried. After evaluating the evidence and mechanism of action I have little to no worries about this particular type of vaccine (and think it may be the way of the future). Here are some of the questions I had and that have been posed to me (if you just want the summary scroll on):

Will COVID vaccines alter our DNA?

mRNA is translated only in the cytoplasm and doesn’t get into the nucleus. Therefore, it is impossible for this to incorporate into our DNA and it will then degrade quickly. Which is why both require significant cooling to be stable. Also, it has no reverse transcriptase, this is required to alter our dna- this is what HIV does.

Answers to common questions about the COVID vaccines!


mRNA (messenger RNA) is a molecule in our body that makes protein. It is just the messenger, so it sends its message (meaning it makes protein) and then it is recycled by the body. So the mRNA will not stick around. The mRNA in the vaccines will make the spike protein of the virus, which will display on some of your cells. This is enough to create an immune reaction. Then the mRNA will degrade and so will the proteins. It will not stay in your body. Basically, the mRNA is a dog alerting you to an intruder. But there isn’t an intruder. Your dog is barking at shadow. Then the shadow disappears and the dog goes to sleep (or also disappears) but your body is still in response mode.

Answers to common questions about the COVID vaccines!

The great things about RNA vaccines, is they are made on a platform. This means that once we find an RNA we want to use as a vaccine, we plug it into the platform and it is made. So, any new RNA can be plugged into this process and you have a new vaccine.

Answers to common questions about the COVID vaccines!


Pfizer and Moderna have been studying RNA vaccines for a long time. So they had a platform. Genome technology has advanced so much recently, that we already had the RNA sequence of the virus that causes COVID-19 in January. By May, Pfizer and Moderna were starting Phase I/II trials. These are purely safety trials. So there are people that have had this vaccine since May. And they are still being monitored. For the Pfizer vaccine alone, 40,000 people have received the vaccine and 30,000+ for the Moderna vaccine. That is a lot of people to already have the vaccine, allowing for a good evaluation of the safety.

Answers to common questions about the COVID vaccines!


What is the difference between the two mRNA vaccines?

Moderna is easier to store (less deep temps) and doesn’t require reconstitution- to me that equals less chance for error. In the future, I am sure they will test both mRNA vaccines at different storage and dosage.


What about the other ones?

The AstraZeneca vaccine is similar to the vaccines we’ve used before. This is a Spike protein vaccine like the flu shot but based off of an adenovirus with an inactive bit of SARS-CoV-2 subbed in. Initial trial showed 70% efficacy in one dosing group and closer to 90% in the other. They are a little ways away from approval and EUA as compared to the first 2. (J&J also has a vaccine I have not heard much about yet)

What if I am pregnant and what about my kids?

The vaccines haven’t been tested in pregnant/breastfeeding women or children, yet. Until it has? I don’t think it is safe for these populations. If I were pregnant I would not get it. We have found that this disease is hard on pregnant women (Source). Stay careful and vigilant and I hope those around you get vaccinated.

Why did it get through so fast?

Billions of dollars and thousands of man hours have been invested. All of the brilliant scientists who have been working on a Zika vaccine, a universal flu vaccine, an Ebola vaccine, an HIV vaccine, and every other vaccine were told to focus on THIS disease. They have gone through the expected phases. They just did them simultaneously.

Answers to common questions about the COVID vaccines!

As I said, genome technology allowed us to sequence the virus super-fast, so we knew the vaccine target very quickly. The Phase I/II trials have been going on since May (so 6+ months). The Phase III trials, which is efficacy, have been going on since July. For Phase III, you have to have so many people come down with the disease before you can unveil the results. Well, with a highly contagious disease circulating through the population, it didn’t take long for the needed number of diseased participants.

When that happened, Pfizer and Moderna put a tremendous effort into crunching the data. For example, if 5 people would normally be assigned from the company to work for 3 months to crunch the data, the company assigned 30 people to do it in 2 weeks. The same number of person-hours, just less time to finish. The FDA approval process is the same thing. Instead of 5 people assessing the data, they assign 30. So the assessment can be done quicker. But no short cuts are being done. They just are putting more resources into the project than typical.

What about the side effects?

I have heard anecdotal stories (again, waiting until the full report comes out from the FDA) of people who were convinced that they got the placebo and after the unblinding- they actually got the vaccine. I think that this, like many other vaccine, will effect people in different ways. After getting the flu shot my arm is sore. I don’t get any other symptoms. There are some people who experience flu like symptoms because their immune system goes into overdrive! We can assume these vaccines will be similar (and we will know more with the FDA reports).

If you made it this far? Here’s my bottom line:

The long term effects of COVID scare me way more than potential side effects of a vaccine: pulmonary fibrosis, heart failure or myocarditis, fatigue, and thromboembolic events (Stroke and heart attack), the list goes on. I have actually seen young healthy people die or become “covid long haulers.” I work in a covid ICU.
Almost all side effects from a vaccine would be apparent early on. When we see big ones like guillain barre and flacid myelitis? It’s immediate.

Answers to common questions about the COVID vaccines!

The COVID vaccines are a technological miracle and we are in the right place in our scientific knowledge to make it happen. This is the shit of Nobel prizes. This was a disease that shut down the world- and the response was monumental. No short cuts were taken in the safety assessment. Pfizer and Moderna are staking their reputation on these vaccines. They do not want to destroy their company’s reputation by putting out an unsafe vaccine. But this proves that with the right resources, we can scientifically do anything. In the past, we just never devoted the resources necessary to combat a common enemy.

Is it absolutely zero risk?

No. No health treatment comes without risk. It's much lower risk than my risk of dying from COVID or having serious morbidity from it. And I’m sick of not seeing my grandparents and aunties and uncles. I’m sick of every fever requiring a painful swab. I’m sick of being scared I will bring disease to my parents and my roommate. I’m sick of being scared of the large gathering I used to live for: concerts, traveling, breweries, sports, family gatherings.... we all begged for reprieve, this is it.

References and resources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906799/...
https://www.nature.com/articles/s41586-020-2798-3#Fig1
https://www.nature.com/articles/s41586-020-2639-4
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2022483
https://www.nejm.org/doi/full/10.1056/NEJMoa2027906
https://www.sciencemag.org/.../absolutely-remarkable-no...

To end this on a positive note, heres a favorite piece of poetry of mine. By Rupi Kaur
To end this on a positive note, here's a favorite piece of poetry of mine. By Rupi Kaur

A great podcast if you want to be informed with the freshest data:

https://www.microbe.tv/twiv/

Answers to common questions about the COVID vaccines!
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