NEWS/EVENTS

The COVID-19 Vaccine

By Russ Herring, DNP, FNP-BC, CSCS

I have seen very few patients born in the 1920s-1930s who are scared of the COVID-19 vaccine. They have questions, as we all do, but they are the patients most likely to display eagerness, in my experience, to get this hurdle over and out of the way. This is a generation who takes infectious disease very seriously. These are people who have seen amazing, wonderful advancements in medicine during their lifetimes. This is a generation who remember what it was like to lock down during a plague, or at least remember the stories told by their parents, grandparents and other relatives. My patients born in the 20s and 30s have close family members who died in the 1918 Pandemic, “The Spanish Flu”. (Trivia – As a brief aside, it is generally agreed upon that the Spanish Flu did not, in fact, originate in Spain (Trilla, Trilla & Daer, 2008; Barry, 2004).)

The 80+ year old Americans know that Uncle Gordy or Grandma Dianne died from the Spanish Flu. I actually didn’t know people survived polio outside of an iron lung until I began seeing elderly patients when I worked as a cardiology nurse, who had mild paralysis in their legs, or would say they haven’t been able to breathe very well since they had polio when they were a child. The last person to die of smallpox was 3 year-old, Rahima Banu, of Bangladesh, in 1975 (cdc.gov, 2020).

Global health has made amazing strides with the proliferation of vaccines. Dr. Dave Engbrecht, my esteemed and knowledgeable colleague at Northwest Clinic, has always been quick to remind me that public health and sanitation also saved millions of lives, and in this, he is absolutely correct. Clean drinking water, and the separation of wastewater from potable water, the washing of hands and clean preparation of foodstuffs have doubtless saved millions, if not billions of lives in the past 150 years. However, you can’t be clean enough to eradicate smallpox without a vaccine. To do so would require perfect masking and separation from the balance of society, and we’re proving poor at this particular practice.

I cannot walk into a patient room right now without hearing questions about the COVID-19 vaccine. As of Friday, December 11, 2020, there is exactly one COVID-19 vaccine approved for human use in the United States. Technically, the Pfizer-BioNTech COVID-19 vaccine received Emergency Use Authorization (EUA) from the FDA, for the duration of the COVID-19 emergency, though it has not received formal approval at this time (Pfizer.com, 2020). The misinformation machine surrounding this vaccine is titanic, and frustrating. Both the Pfizer and Moderna vaccines are mRNA vaccines, a new type of vaccine, and these will be the first that are widely used in the United States.

Traditional vaccines, such as polio, smallpox, etc., expose the immune system to a pathogen in some form. Perhaps an inactivated piece of the viral coat is injected, and the immune system then works out the ability to recognize the proteins in the coat as foreign, and learns to attack it in the future. People who say the flu shot gives them the flu, misinterpret immune response and true infection. I’ve had this discussion hundreds, if not thousands of times – but getting influenza from the vaccine is exactly and specifically analogous to generating Russ from my jacket.

Literally.

This is not possible.

You may identify my poor taste, and, therefore, my identity, from my clothing, but you cannot manifest Russell in flesh and bone, from my coat. The production of these vaccines can be very time consuming, and can often result in failure. The reason the flu vaccine changes every year is that some parts of the virus change continually, and some don’t. We haven’t been able to generate a flu vaccine that works against the part of the influenza virus that are unchanging – the parts of the virus which identify it as flu. However, now that we have the ability to determine the entire genetic code of a virus, bacteria, human, cow…

There have been discussions about creating an mRNA vaccine for years, though there had been troubles with creating TOO strong of an immune response (Komaroff, 2020). The exact genetic code of a pathogen, in this case, the spike protein from SARS-CoV-2, can be used to directly induce the immune response to a pathogen (Komaroff, 2020). The Pfizer and Moderna vaccines are both mRNA vaccines. The genetic sequence of the SARS-CoV-2 virus, the virus that causes COVID-19, was quickly sequenced upon its discovery, which paved the way for development of an mRNA vaccine, which can be created in a much more direct, factory production line style, than traditional vaccines. As described by Komaroff (2020), for Harvard Medical School, the full genetic sequence of SARS-CoV-2 had been determined by Chinese scientists within weeks of its discovery, and published online. Then, thousands of miles away, work on an mRNA vaccine began, almost immediately. Within the span of a scant few weeks, enough vaccine had already been developed to begin animal trials, and then human trials, before enough vaccine had been created to begin rollout on multiple continents only 11 months later (Komaroff, 2020). The mRNA vaccine provides instructions to your body on how to build the response to the virus. If a traditional vaccine shows you a car, and you get to figure out how to build the car by seeing it, the mRNA vaccine is like providing the actual blueprints and factory to build it.

Necessity is the mother of invention.

Using traditional vaccine methods, there is no way we’d have come this far, this fast. We’re losing over a thousand Americans each day, with the body count closing in on 300k. Hospitals are operating above 100% capacity, nationwide. I’ve spoken to friends across Montana. Billings is operating above capacity. Great Falls has had to create places to treat COVID patients. The trauma and mental anguish this is causing patients and healthcare providers alike, is profound.

Are there unknowns regarding the vaccines? Yes. I cannot deny this truth. What I do know, with certainty, is that we’ll see 500k Americans dead from COVID-19. Of this, I am absolutely certain. A number of Americans numerically proximate to the population of Wyoming is going to die from COVID-19 before this is over.

The first public vaccine given outside clinical trials in the United Kingdom, was given to Margaret Keenan, who described it as the “best early birthday present” after receiving it a week shy of her 91st birthday (bbc.com, 2020). Margaret undoubtedly remembers the days before vaccines. Margaret may have made it to her 91st birthday because of vaccines.

I’m younger than Margaret, and based solely on age, I’m guessing that I’m probably healthier. Healthcare workers are slated to be vaccinated first, before the infirm and elderly follow us in close succession. We are privileged to be at the front of the line, simply to improve our odds of being healthy and remaining available to care for everyone else. It is an HONOR to be up first. I’ve been telling my patients that I’m relatively young, relatively healthy and it is my duty to be part of what could justifiably be referred to as a really enormous clinical trial. I expect to feel like trash after the second shot. Accounts thus far have described the first shot as relatively benign, creating a sore arm, but nothing much more exciting than that, while the second shot, 3 weeks later, generates an extremely robust immune response. I’m expecting sore muscles, mild fever and a headache. I accept that this is an immune response, as expected, and that it will pass. I know that it is impossible to create SARS-CoV-2 from the mRNA vaccine, only possible to generate an immune reaction, which is the goal.

You cannot create Russell from his socks.

I hear people say that they’re concerned about the ingredients of the vaccine. Do me a favor, and reach for the food item closest to you. Now, read the ingredients. Tell me what all of those chemicals are, and what they do? I can say, with absolute certainty, that I’ve put far worse into my body, willingly, than could ever be legally included in a vaccine meant for injection into a human body. What about you? Have you ever smoked? Drank alcohol? Eaten manufactured food?

What the heck is in that energy drink, anyway?

I’m going to be one of the first people in the local community to receive the COVID-19 vaccine. Currently, it’s looking realistic to expect it before Christmas.

I don’t expect to grow a tail, start clucking like a chicken (worse than I do, currently) or glow in the dark.

If I do, you’ll be the first to know, and I’ll gladly share my experience.

Get the shot. You’ve put worse in yourself, willingly. Get the shot. We can’t continue watching this many people die. Get the shot. I want to be able to see my patients’ faces again.

Be like Margaret. Be like her generation. Learn from those who remember a pre-vaccination world. We’re all sick of hiding, and we’re all sick of masks, but they aren’t going anywhere until the vaccine has been widely distributed and used.

Get the shot.

Russell HerringAbout Russell Herring, DNP, FNP-BC, CSCS

Russell R. Herring, DNP, joined the Great Falls Clinic in 2018 and is among the newer healthcare providers in the State of Montana. He works alongside Drs. David Engbrecht and Dr. Carey Welsh in Family Medicine at the Great Falls Clinic Northwest location. Russell specializes in diagnostic, preventive, and therapeutic healthcare and treatment plans for acute and chronic illness, and in education and guidance of patients regarding disease prevention and health promotion. He is currently accepting new patients at the Northwest Clinic, 1600 Division Road, Great Falls. For more information or to schedule an appointment, please call 406-268-1600.

References:

Baicus, A. History of polio vaccination. World Journal of Virology. 2012 Aug 12; 1(4): 108–114. doi: 10.5501/wjv.v1.i4.108. Retrieved December 13, 2020 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782271/.

Barry, J. M. (2004). The great influenza: The epic story of the deadliest plague in history. New York: Viking

bbc.com. Covid-19 vaccine: First person received Pfizer jab in UK. Retrieved December 13, 2020 from: https://www.bbc.com/news/uk-55227325.

cdc.gov. History of smallpox. Retrieved December 13, 2020 from: https://www.cdc.gov/smallpox/history/history.html

cdc.gov. Understanding and explaining mRNA COVID-19 vaccines. Retrieved December 13, 2020 from: https://www.cdc.gov/vaccines/covid-19/hcp/mrna-vaccine-basics.html#.

Komaroff, A. Why are mRNA vaccines so exciting? Retrieved December 13, 2020 from: https://www.health.harvard.edu/blog/why-are-mrna-vaccines-so-exciting-2020121021599.

Trilla, A. Trilla, G. Daer, C. The 1918 “Spanish flu” in Spain. Clinical Infectious Disease. Volume 47, Issue 5, 1 September 2008, Pages 668–673. doi.org/10.1086/590567. Retrieved December 13, 2020 from: https://academic.oup.com/cid/article/47/5/668/296225