I Am A Doctor On The Internet, and I Am Covid-19 Vaccinated

Recently, it hit me.

I’m a doctor. And I’m “on the internet.”

But I don’t have a YouTube channel. Well, I technically do, but the only videos I have posted are of my cat, and of my daughter doing an excellent cover of Imagine Dragons’ “Thunder” when she was three years old.

But back to being a doctor who is “on the internet.” I have had a blog for years, and have even written a book! Perhaps I get a say in the whole Covid-19 vaccine debate too then?

Then again, maybe it isn’t my medical degree, my four years of residency training, my year of fellowship subspecialty training, my 11 years subsequent to that that I have spent as a practicing neurologist, my having been on faculty at Duke University, my having written a book, my having published my research in peer-reviewed journals, or even my having actually witnessed a patient with Covid-19 dying in front of me that gives me credibility. It seems that the greatest credibility a physician can have with the public these days is having a YouTube channel. But here goes anyway…

Recently, I heard the rumor that people who have been vaccinated against Covid-19 can shed virus and infect unvaccinated people. The physician in me said, “Huh?!” I thought – Covid-19 vaccines do not involve injections of live virus, and therefore viral shedding does not occur. It seems that when incorrect information is conveyed and then repeated amongst the public, when I ask for a source, I often hear, “I read about it from this doctor on the internet.” When I attempt to state my opinion, typically the response is, “Well, this guy is a doctor, and he says…” And then the opposing side is given to me. And then I think – the guy online is a doctor, and I am a doctor. So what gives? Thousands of doctors can advocate for vaccination, but if they don’t have an online platform, they are speaking into a void, it seems. It could be similar to why we become star-struck when we see a celebrity at a coffee shop, or worship professional athletes as opposed to the people who save our lives, or educate our children, or ensure that we have safe drinking water, or ensure that when we get on airplanes they won’t explode mid-flight. We idolize those who are on screens.

For anyone who has grown to trust me over the years through my blogging, I feel it is appropriate to speak out on Covid-19 vaccination, as a doctor who is also “on the internet.” I was here long before Covid-19 existed. And Covid-19 is a disease of clotting. And we have seen a lot of strokes in Covid-19 patients. The Stroke Blog is an appropriate place to discuss this topic. Additionally, I have spoken with patients who have recovered from strokes who then slide backwards in their stroke recoveries after becoming infected with Covid-19. My opinion is that everyone who can, and in particular patients with a history of stroke or who are at risk for stroke, should get vaccinated against Covid-19.

In 2016, I wandered through a cemetery in Pittsburgh, Pennsylvania with my family, looking for a section of final resting places of family ancestors. We located them, and I felt a metaphorical punch in the gut when I saw the number of miniature stones accompanying the larger, full-sized grave headstones, realizing that the smaller stones were what was left to declare that babies and small children resting in the ground beneath them had existed. And then I realized from the dates on the stones that all of these children had perished within several weeks of one another. A mother had buried four of her children within three weeks.

I have five children. The thought of four of them dying within three weeks is too awful to deeply consider. No more Gabriel, or Caroline, or Alexander, or Bethany. Ever again. Gone. The young people whose sweet voices fill my home would only be faint echoes of the past. How could I stand such a thing and continue on?

Quick research revealed to me that these children had died in the midst of a diphtheria outbreak over a century earlier. Diphtheria. A disease to which I had never given a second thought, other than having to learn about it during medical school. I have never seen a case of diphtheria. It effectively no longer exists in the United States due to two factors: vaccination and clean drinking water. What would the mother of those four children think of vaccination against diphtheria? Probably that it would be nothing short of miraculous.

When studying public health, there are two factors that have extended more human lives than the fanciest, high-tech surgeries or the most astonishing breakthrough medications. And guess what they are? Vaccination and clean drinking water. The truth is that children here no longer die of diphtheria, and that did not occur through accidental means.

To see so many people concerned about and resistant to vaccination against Covid-19 conveys to me that we are now a society (fortunately) that has not had to bury four of our children within three weeks because of a disease that destroys our families. We have not had to watch our children become quadriplegic because of polio. We take for granted that, if our children do not end up in accidents, they will most likely live to become adults with their own lives one day. That was not always the case. My great-great-grandparents had 13 children; five survived to adulthood. It was reality. But, thank goodness, it is not our reality today. And the reason it is not our reality is because of vaccination and clean drinking water. We are lacking the perspective of our ancestors, and we are now not learning from the past.

Covid-19 has killed over 609,000 Americans at this point, and more than 4,100,000 globally (likely an underestimate – the true toll will not be known for years, I suspect).

As the title of this post reflects, I am sharing here that I am vaccinated against Covid-19.

I have never smoked a cigarette in my life. I have never experimented with illicit substances. I was that kid in high school who didn’t go to parties and never tried pot. I realize this is abnormal (and please know I am being gently self-effacing here, not judging the very normal experiences of most people – I am the outlier). But my point is – I have consistently tried not to put things into my body that I believe are harmful or dangerous (with the exception of cookie dough – not advocating for that here though). I would not have allowed anyone to inject a substance into my body if I thought it was harmful. And the doctor in me read about and studied the Pfizer and Moderna vaccines (the two that were available when I was vaccinated). I felt comfortable with the data. What I did not feel comfortable with was the growing death counts and long-term disability from Covid-19 infections, and wanted to do what I could to protect myself, my family, and our society. As a physician, I had the opportunity to be vaccinated very early on, and I knew that, outside of the patients in the clinical trials, I would be taking a bit of a leap of faith too, because I was not going to watch millions before me and wait and see what happened to them before getting vaccinated. I was comfortable going early.

When I received notification on December 21st that the Moderna vaccine was available to all medical staff at one of the hospitals where I was credentialed, I jumped at the chance. And on December 22, 2020 I received Moderna shot #1. On January 20, 2021, I received Moderna shot #2. Did I have side effects? Yes. It would be dishonest to claim otherwise. I believe that those who are still hesitant about Covid-19 vaccination believe that pro-vaccination people are not being honest and transparent, and I want to be completely honest here.

After shot #1 my arm was sore for about two days, more so than with a flu shot, but I was fully functional and felt normal otherwise. After shot #2, I began running a fever about 12 hours later, and then had intense chills that night. The following day I felt very sore, and the arm soreness was much worse than it had been with shot #1. I took some ibuprofen early the next morning, and it was pretty amazing, because things got about 80% better quickly, within about two hours of taking it. By two days after shot #2 I felt completely normal, and have felt normal ever since. I have spoken with other physicians who got the vaccine early and had similar reactions to what I experienced. I have talked with others who had zero side effects, almost as though they had never gotten it. My husband had some arm soreness that was short-lived and that was all. Fever is an immune response, and I look at my reaction as my immune system awakening, reacting, and now being on the alert if I come into contact with the virus that causes Covid-19.

We need to reach “herd immunity” (getting a critical threshold of the population vaccinated) to defeat Covid-19. We aren’t there yet, and that won’t happen as long as the issue of vaccination remains a polarizing topic. Respectful conversations have to be had. Fears need to be allayed. Listening should occur. The labeling needs to stop.

As for the question of whether vaccinated people “shed virus” and can infect unvaccinated people – rather than assuming that’s completely crazy and labeling people, there is actually a basis for that fear, although it does not apply to the Covid-19 vaccines. According to the Centers for Disease Control recommendations, if a person is immunocompromised (has a weakened immune system), it is advised that the immunocompromised person not change a baby’s diaper after a baby has had the rotavirus vaccine because the baby can potentially shed virus for a brief period. Also, after a baby receives the chicken pox (varicella) “live virus” vaccine, no special precautions need to be taken, but if the baby develops a rash after vaccination, the rash should be covered and the immunocompromised should not come into direct contact with that rash because there is a small risk of transmission.

The Covid-19 vaccines do not contain live virus. There is no evidence of “shedding virus” after vaccination, because there is no virus to shed since no virus has been injected. The Covid-19 vaccines involve alerting the immune system such that our bodies will defend us if we come into contact with the actual virus down the road. Being able to explain the difference to someone who is hesitant about Covid-19 vaccination in a calm and sound way is, in my opinion, a better approach than labeling that person and assuming there is no basis to his or her concerns.

I sincerely believe that, over time, more people will get vaccinated. Vaccines save lives. The current deaths due to Covid-19 that are occurring are in unvaccinated individuals are tragic, in part because they are now preventable. Most of you who are reading this, I have never met and never will meet. But I care about you, and I want you to have a fulfilling, fruitful, and healthy life.

More evidence that Covid-19 is a disease of clotting

A paper appeared yesterday in The New England Journal of Medicine, adding to the growing body of evidence that clotting is a prominent feature in Covid-19, even if it isn’t always evident. People who develop difficulty breathing with influenza (“the flu”) or more run-of-the-mill pneumonias may look at first like they have similar shortness of breath to those with Covid-19, but this particular study details autopsy results of careful examination of the lungs in patients who have died from Covid-19 versus patients who have succumbed to influenza. The article can be accessed by clicking here.

For those without medical or scientific backgrounds, articles in The New England Journal can be difficult to decipher because of the medical terminology. However, it is worth translating for the public.

Perhaps the two sentences in the abstract (the brief summary of the study presented at the beginning of the paper to gain an overview) that stand out the most to me are: “Histologic analysis of pulmonary vessels in patients with Covid-19 showed widespread thrombosis with microangiopathy. Alveolar capillary microthrombi were 9 times as prevalent in patients with Covid-19 as in patients with influenza.”

Translation: The lungs of the patients who died secondary to Covid-19 had wide-spread clotting, nine times more blood clots and blockages in the thousands of small capillaries and blood vessels in their lungs, compared with the lungs of patients who died from influenza.

This could be why patients with Covid-19 go from talking to their healthcare providers in emergency departments to abruptly dying, and why so many who are on mechanical ventilators still don’t do well. It’s difficult to ventilate lungs that are full of blood clots. How can oxygen and carbon dioxide pass across the walls of blood vessels if these blood vessels are solidly, unabashedly blocked and blood is not flowing?

We have heard reports about young people with Covid-19 showing up with strokes. Reports of blood clots in arms/legs/fingers/toes are becoming more prevalent. This recent study confirms evidence at the cellular level that clotting is a feature of Covid-19.

Stroke emerging as complication of Covid-19

On April 28, 2020, a letter published in the New England Journal of Medicine describing blood clots in large arteries supplying the brain (known as “large-vessel strokes”) in young patients testing positive for Covid-19 brought media attention to this particular facet of a disease physicians, healthcare providers, and researchers are endeavoring to understand. (Click here to read the brief NEJM letter.) The letter’s authors have been treating patients with Covid-19 in the Mount Sinai Health System in New York City. They note that, on average, every two weeks their hospitals typically encounter 0.73 patients with large-vessel strokes who are under the age of 50, but within a two week period, they encountered five, and all were Covid-19 positive. It’s a small sample size, but the trend is concerning.

As time passes and more information is published about what this disease looks like in its various presentations, it seems to start in many patients as a respiratory illness, but when patients become ill with it, it is because it has transitioned into a disease involving blood clots and/or severe inflammation within the arteries. Report after report has emerged of patients who are awake and talking with emergency medicine physicians and healthcare providers, who then quite suddenly go into cardiac arrest and die. Stories of patients losing limbs and fingers/toes due to blood clots are emerging. Lungs are full of blood clots (pulmonary emboli) in many patients. Stroke is yet another complication of blood that easily and readily clots when the brain is the organ on the receiving end of that impact.

And now children, who were initially thought to be safe from Covid-19, with “mild” or no symptoms initially, are being reported as developing inflammation within their arteries and going into heart failure, in what is similar to a syndrome known as Kawasaki disease.

(Click here for a good mainstream media article summarizing various effects of Covid-19 in layman’s language.)

As for my own patients – what I am personally hearing from people who have experienced strokes in the past who have been infected more recently with Covid-19 is that they seem to be losing the progress they made previously through rehabilitation and time. Old stroke symptoms from their prior brain injuries are rearing their ugly heads again, and deficits that they thought were in their rearview mirrors have now arisen again. This can happen after a stroke with any bodily infection, whether it is a urinary tract infection or pneumonia, and is called recrudescence.

As businesses begin the reopening process, we are still seeing tens of thousands of new cases emerging daily in the United States, and the death count in this nation now exceeds 78,000. Mind you, this is the death count. We’re not talking about patients who survive Covid-19 with long-term scarring in their lungs, or those who have suffered limb amputations or disability associated with strokes. We also still do not know what the long-term toll of this disease is. It was only about seven months ago that this virus began infecting human beings, and we really don’t know what the long-term effects will look like a year, five years, or ten years down the road.

I’m not trying to be unnecessarily alarmist or cause panic. I care about our economy. I deeply care about jobs, livelihoods, and businesses. But as a physician, I am being real.

I also know that people who need to get back to work will not be successful in the work place long-term if they are trying to recover from the aftermath of strokes, or if they have long-term breathing problems because of the lung damage they have sustained. I am looking at the Covid-19 pandemic as a long-term battle, and do not want all of the sacrifices that have been made to fight it to be in vain if/when it just keeps returning.

I mentioned in my previous blog post that Dr. Anthony Fauci announced to the press in March that models were projecting deaths of 100,000 to 240,000 people in the US, and reporters argued with him in disbelief. They didn’t like it. They didn’t accept it. He basically said he hoped for a better outcome, but the numbers were what they were. We are getting closer to this estimated range each day.

We can feel emotionally impassioned, bored, scared, or beyond ready to resume life as we knew it only a few months ago.

But unfortunately, viruses don’t play by our rules.