COVID-19 vaccination update: Phase 2 Massachusetts

It is already being widely published that in the state of Massachusetts, the first group of individuals included in the “Phase 2” roll-out of COVID-19 vaccination are currently eligible to receive doses. This includes all individuals aged 75 and older who are well enough to travel out of their homes to a location where COVID-19 vaccines are being administered.

Please note this is in addition to ALL Phase 1 eligible individuals:
Listed in order of priority:
– Clinical and non-clinical health care workers doing direct and COVID-facing care
– Long term care facilities, rest homes and assisted living facilities
– First responders
– Congregate care settings
– Home-based health care workers
– Health care workers doing non-COVID-facing care

Other groups within Phase 2 are still pending eligibility. **If you are waiting, the most appropriate approach is to be patient.** Everyone’s turn is coming, and tremendous efforts are being made to ensure the steps are ordered so as to optimize the safety of the entire population, relative to the capacity of production, shipping and storage. We all have the same goal and want to see an end to this pandemic. As long as we remember that we are all in this together, WE WILL ACHIEVE THIS GOAL.

Attached to this message there is a document attached listing further details on the current phase of the vaccine roll-out in Massachusetts.

Unfortunately, due to supply limitations, we are still not able to obtain a supply of doses at the Thrive Adult Primary Care office at this time. Just as I requested above, we endeavor to remain patient and will simply continue submitting requests at reasonable intervals until the supply can meet the demand.

I am personally happy to report that I received my first dose of the Moderna vaccine last month at Gillette Stadium in Foxborough, am scheduled for my second dose in a couple weeks, and that it was all an impressively seamless experience, although I understand I was among the lucky ones who managed to schedule online without any issues.

Having explained principles of preventive vaccination to patients for many years, having regularly surveyed information updates on the current mass vaccination effort, having heard stories of others who also completed at least one dose, and now having had my own experience, please allow me to offer the following insights:

1) The objective of mass vaccination is a phenomenon called “herd immunity.” That is, in the interest of *public* health, we understand that amplifying antibody generation in as many members of the general population as possible helps to decrease the viral burden across the board, and thereby hinder (or ideally eliminate) spread of infection. While it is extremely difficult to completely wipe a micro-organism from existence because of the ability of viruses to mutate rapidly, by strengthening immune systems with vaccines, we achieve this to the best of our ability **as a population**. I have explained this principle in-depth year after year on my blog, here is a link to what I had posted on it most recently (yes, it has been a while since I regularly blogged):

2) There is little to no utility in getting up in arms about the lack of availability of the vaccine, nor on the flip side to get bent out of shape regarding associated risks. Let’s face facts, please: YES, the vaccine supply remains limited. YES, the vaccine is not 100% risk-free. Oh, and YES, there are studies to prove its efficacy and safety, and YES, these studies have limitations. But why do I recommend universal consideration of the vaccine? Because YES any and all risks associated with the vaccine have been widely demonstrated to be far fewer and less consequential than risks associated with actual infection and contagion with COVID-19, especially in certain populations. YOU ARE CERTAINLY FREE TO DECLINE VACCINATION, BUT IF YOU DO, PLEASE REMAIN MASKED AND SOCIALLY DISTANCED FOR THE SAFETY OF OUR VULNERABLE POPULATIONS.

3) While I am on the “yes” track, let me add that YES, most of us feel something after receiving the vaccine dose. For me, my arm hurt in the area where I received the shot for about 2 days afterwards. A lot. And the day after my vaccine dose, I was quite fatigued. Was it worth it? In my mind, a thousand times YES. Do I expect to feel sick after my second dose? Absolutely, YES. Will it hinder me? A thousand times, NO. I’m not personally afraid of the virus. If I were to catch COVID-19 I feel quite confident that with or without the vaccine I would feel bad for a few days then move on with life. But I would not be able to live with myself if I thought for a moment that I might be a vector passing the virus along to someone who winds up with a bad outcome. And there are many of those people whose health is my responsibility. So I personally see this as much my civic duty as voting. That’s my personal perspective.

4) Finally, because I have a number of patients who are chronically ill and homebound, there have been several queries as to whether they might be able to receive vaccine doses at home. If this situation applies to you, please be assured that as soon as I am aware of vaccine doses being available for any visiting health or medical service, I will prioritize efforts to get the vaccine into your arm at home. In the meantime, PLEASE STAY SAFE AT HOME, as you have been for the past several months. Your turn is coming, and I will continue to advocate for you until supply can meet the demand.

Thanks kindly for your attention to this long message. Hang in there, and stay tuned for further updates.

Double Down on Protection

When it comes to defense, does it get better than this?

Only if you have properly vaccinated against Influenza!!
(Come on, this is a medical website — bad jokes are inevitable)

Visit our Open House 10/17/19 and get protected!

We are excited to partner with MBs Pharma Care
in hosting our First Annual Flu Clinic
at the Thrive Adult Primary Care office
on Thursday 10/17/2019 from 9am – 5pm

This event is OPEN TO THE PUBLIC, and ALL INSURANCES are accepted
for coverage of your annual flu vaccine!

Yes, in the medical field we recommend annual flu shots for everyone.  We do this for a phenomenon called herd immunity, meaning that we aim to reduce the exposure of individuals who are susceptible to severe disease by immunizing everyone.  Influenza is not your typical cold virus.  It has been known to cause fatal outcomes in certain populations, generally the very young, the very old, and the chronically ill — that is, people whose immune systems tend to be weaker than average.  Healthy individuals with strong immune systems can contract influenza and have it manifest as nothing more than a really bad cold.  However these people are still contagious and therefore may potentially spread the virus to others who are at risk for a worse outcome.  I am typically pushier about advising someone to get the vaccine if they have regular contact with these susceptible individuals, all the more for someone who is one of them.

I have heard the argument that, “every time I get the flu shot, I get the flu.”  Let’s make it clear that it is impossible for this to happen with the injected flu vaccine.  In this formulation of the immunization, it is as if the virus particle has been broken in half before being introduced to the patient.  A broken virus cannot replicate and therefore cannot generate infection.  However the whole purpose of the vaccine is to activate your immune system to generate antibodies so that if the real flu comes along, your body will be prepared.  The activation of your immune system feels a lot like how it would feel when your immune system is trying to fight off the flu in the case of an actual infection.  So some people will potentially develop low-grade fevers, body aches, weakness and fatigue.  This should last no more than a couple of days, and be assured that it is not an actual infection with influenza.  The nasal flu vaccine (“Flumist”) does in fact contain a live virus, enough to trigger an immune response but rarely enough to cause infection.  For several years in a row, Flumist showed no protective benefit against contraction of the flu virus, and was not recommended for the 2017-2018 season, but for the 2019-2019 season, protection against H1N1 virus has been added to the nasal flu vaccine and is felt to be beneficial for appropriate individuals.

I do advise patients who are actively ill to avoid the flu shot.  Again, this is not because the vaccine can cause an infection with the actual flu virus, because it cannot.  However, when a person is sick, their immune system is already busy trying to heal them from their current illness.  Giving a flu shot under these circumstances only adds strain to the immune system when it has a job to do; as a result, it may both prolong the active illness and reduce the likelihood of developing an effective immune response against Influenza.

Rare adverse effects are possible with the flu vaccine.  Probably the scariest of these is known as Guillain-Barre Syndrome which is a type of short-term paralysis that starts in the feet and legs and may ascend to the upper body.  This is exceedingly rare, but of course anyone who has had this type of reaction to the flu vaccine in the past should avoid it in the future.  Also, the majority of available flu shots are prepared using eggs, so folks with an egg allergy should ask whether an egg-free preparation is available where they are planning to receive the flu shot.  In general, anyone who has been able to tolerate the flu shot in the past should have no problem with the shot this year, either.

Finally, on rare occasion a savvy patient will bring up the presence of a mercury compound in the flu vaccine. This is thiomersal, or thimerosal, which is a widely used antiseptic preservative that suppresses the growth and reproduction of common bacteria. It does metabolize the the human body to a form of mercury that can be toxic in significant amounts. However the quantity of thimerosal in a dose of flu vaccine is less than 2.5% of what is considered safe daily intake. Meanwhile a flu shot is needed only once a year. If you want to reduce your body’s exposure to toxic chemicals you would be better off monitoring your daily intake of sugar, salt, or artificial sweeteners. But that is a blog entry for another day. 😉

All of that said, recommendations are merely that. In medicine, we base our advice on the science of statistics. What we recommend IN GENERAL will offer protection against bad outcomes in the population. But each person needs to make a well-informed decision for his- or herself about what advice they will follow or decline. It is my goal to ensure that the decision you make rests on a foundation of solid information.  In all cases, my wish for you as a reader is that you STAY WELL this cold-and-flu season!

Oh, and feel free to check out the latest post from the CDC on flu as well: