Getting the COVID vaccine
My experience with the COVID vaccine and more thoughts on our roll out
I got my second dose of the Moderna COVID vaccine this week.
Like basically everyone who has been vaccinated, I’m incredibly privileged here. Not just to have access to the vaccine, but also to be able to interpret the efficacy and safety data myself, to navigate the system to get into the vaccination line, and that I’ve had the luck to avoid COVID thus far.
I wanted to discuss the vaccination process now that I’ve had some personal insight, which I think is applicable to vaccine distribution at large.
The process of signing up for vaccination was abysmal
Everyone seems to be screwing this up.
To start, the sign up was ridiculous. I had to register one account on a new employee portal, which led to my ability to sign up for a second online portal. After I had signed up for both portals, I then had to complete a series of checklists and questionnaires in the first one, which had nothing relevant to do with the COVID vaccine. It was only after I finished my checklists that I was able to schedule a vaccine appointment on the second portal.
Who came up with this idea? I’m still surprised that creating these portals and new accounts gets through any kind of coherent administrative decision making process.
I ultimately ended up getting my vaccine through a different hospital system because it was more straightforward.
It’s no coincidence that the sign up process was simple where I ended up getting the vaccine. You could just show up during open hours and get in line. So that’s what many of us did.
I had an intense immune response from the vaccine
The first dose made me feel mildly crummy for about a day. I get my temperature checked every morning at work. I’m usually 97 degrees. The day after my first dose I was 99 degrees. But in a day I felt back to normal and didn’t have major symptoms.
The second dose was different.
I felt like I was hit by a truck. I had night sweats, muscle aches, and weird hallucinatory dreams. Wearing an N95 made the day at work feel like one of the worst I’ve ever had. I suspect I had a fever for about 24 hours.
Oh, and my arm was about 10x more sore than it gets from a flu shot.
It’s good news on one hand - an immune response probably means the vaccine is working. And this is fairly common with both the Moderna and Pfizer vaccines - about 10-15% of patients in the clinical trials had symptoms like mine.
But it was no fun.
Vaccine distribution is still too complicated
I get questions from patients everyday about how to sign up. People are asking how to get appointments, where to find whether they’re eligible, and whether it’s safe for them to get the vaccine.
If you read any of the state websites, you’ll see a huge amount of information regarding distribution details, different phases of planning, and criteria for safety.
Every state convened experts to develop eligibility criteria. Many have incorporated occupation, age and place of residence.
Some are trying to prioritize populations that have been hit particularly hard by COVID, so as to try to correct for the racial and ethnic inequality in disease burden.
All of these criteria are wonderful in theory - if you were designing a system to be most equitable, these are all things that would be great to consider.
But seeing this play out just creates more inequality and slows down our push for herd immunity.
Just like my hospital systems confusing communication undermine my trust in leadership, navigating multiple phases and subphases of eligibility doesn’t make things feel equitable, it just makes them feel confusing.
Trying to prioritize the most vulnerable often means that they remain unprotected
Setting up prioritization criteria means that you need a way of verifying a person’s eligibility.
That means creating portals, checklists, and applications.
I had a ton of trouble navigating a system like this, and I work in an electronic health record everyday for hours. In other words, I spend a large portion of my life navigating terribly designed electronic portals.
And this was still really hard for me!
So how is a person with low health literacy, a few chronic medical conditions, and limited internet access supposed to do it?
A complicated system with tiers prioritizes those who can navigate a bureaucracy, not necessarily those who would benefit most from vaccination.
We should be making this as easy as possible, and my fear is that by trying to make this fair and equitable that we’re ultimately screwing it up.
Remember, the vaccine is really safe and really effective
From my read of the clinical trials here, there is almost no reason not to get vaccinated.
The one group that I would be cautious about is in pregnancy or in people trying to become pregnant. We don’t have enough information about safety here to make me feel comfortable recommending this without equivocation.
Now, you need to balance risks and benefits, of course. Pregnant women are more likely to have severe COVID infections that non-pregnant women, so it certainly makes sense to take extra precautions if you’re in that group.
But for everyone else, there is almost no reason not to get vaccinated.
I have been recommending this unequivocally to my patients because the data are really strong across ages, races, and genders.
I would love for you to reply to me and share your vaccination stories, concerns, and issues.
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