In my last post I covered a new line of research about possible post-vaccine harms, and how it has been sensationalized and misrepresented in the media. Today I want to step back and more broadly share some personal thoughts on COVID and on the vaccines.
Back in December of 2019 and January of 2020, I followed with alarm the growing reports of a new respiratory virus coming out of Wuhan, China. This was in part because a friend of mine happens to be a physician who originally hails from that very city, and who was able to tell me from his communications with friends and family back home that things there were much, much, worse than the Chinese authorities were letting on. So I was very concerned, but not at all surprised, when COVID started to emerge en masse here in the United States in March of 2020, and I understood (and to be honest was initially quite supportive of) the authorities reaction to “shut down” much of our society to try to slow the spread of the disease. Which brings me to the first point I wish to make in this post: namely that hindsight is 20/20. A lot of mistakes were made in how we handled the COVID pandemic, but I would urge people to be forgiving of those made in those earliest months when we truly were trying to figure out what was going on, and it appeared that the fatality rate for the virus might indeed be astronomically high.
As a primary care doctor, I was very much on the “front lines” of the pandemic in those early days, and I saw both sides of the virus. By which I mean that I saw patients – including sometimes middle aged people who ordinarily should not have their lives jeopardized by a common respiratory virus – get really sick, spend weeks in the hospital, and in a few cases die. But I simultaneously saw the vast majority of my patients with COVID do just fine, suffering no more than a few days of unpleasant “head cold” type of symptoms. In several cases I even saw completely asymptomatic disease in folks who just happened to go for a test due to social precautions. Which brings me to point number two: even in the worst days of the pandemic, it quickly became clear that COVID was not a life-threatening infection to the vast majority of people.
Moreover it was obvious that the folks who did suffer badly almost invariably were either older people, or people with significant chronic conditions, the most important of which was poor metabolic health (e.g. high blood pressure, pre-diabetes, diabetes, and obesity). This in turn leads me my third point, and my biggest critique of how the pandemic was handled: at no point did the authorities in this country make a concerted effort to emphasize to people that adopting healthy dietary and exercise habits would actually be the single best thing they could do to reduce their risk of a COVID hospitalization or death. This was perhaps the single worst failure of American medicine’s tendency to see solutions only when they come in pills, shots, and procedures that I have witnessed during my career.
When the first vaccines were announced in late 2020, I was – like most other physicians – ecstatic. The initial data on these vaccines was truly promising. They seemed to be safe and to completely eradicate COVID transmission. In the tradition of the Manhattan project of the 1940s or the Lunar landing of the 1960s, it looked like American science had solved an intractable problem in record time, and that we would finally have a full end to the COVID pandemic and a return to normal life. I was thus happy to receive my initial vaccine in January of 2021, and to be able to offer vaccines to my patients over the ensuing months, the vast majority of whom wanted nothing more than to get their first jab. But it’s around here that the story of the vaccines takes a turn for me.
Within several months, we began to see lots of cases of COVID infection in folks who had been vaccinated. Fortunately, almost without exception, these were very mild and posed no serious threat to health. Therefore I came to see the vaccines not as a public health measure that was a moral imperative for every citizen (“this shot will stop you from contracting and spreading COVID, so even if you aren’t worried about COVID for yourself, please do it for grandma”) to a personal form of protection that would make sense for many people to have (“you have risk factors for severe COVID, so it would be worth your while to get vaccinated so that when you get COVID, you will be far less likely to die from it.”)
Unfortunately, the public health messaging did not change so quickly. For a long time afterward – and in some ways still – the message remained “You should get a shot not just to protect yourself, but to protect those around you,” which of course introduces a layer of morality to someone’s decision of whether or not to get vaccinated that is simply not supported by the evidence. If your decision to take a vaccine might affect my health, then I have some right to criticize you for not taking the vaccine. If it does not, then I really have no business telling you whether or not to get vaccinated. It was obvious by mid 2021 that the COVID vaccine fell into the later category; but the public health authorities in this country continued to treat it like the former. Whether they did so out of a stubborn refusal to change their minds, a desire to keep messaging simple in a way that they hoped would encourage more vaccination, or out of financial influence I will leave for others to speculate. But the refusal to tolerate debate over the vaccines eroded trust in the medical profession and created a lot of anger and suspicion between our citizens, and I believe we will continue to pay a price for this mistake for years to come.
Then too came the complete lack of nuance about who would most benefit from the vaccine. Consider the following:
By mid 2021, it was clear that we were dealing with a virus that was becoming less deadly over time and that really was almost never a threat to those who were not elderly or chronically ill. Despite this, the CDC continues – even to this day – to recommend regular boosters for people of all age groups, including healthy children whose risk of serious complications from COVID is virtually zero. By contrast, many other countries have opted for a more targeted approach, in which vaccines are emphasized only for those at the highest risk of severe disease.
By 2021, it was clear that people who had already had COVID could be reinfected again and again, and that subsequent infections very rarely led to serious illness. I myself have treated people on their fourth bout of COVID, and have yet to have anybody in this situation get seriously ill (by which I mean needing to go to the hospital, or worse). But to this day, the CDC still doesn’t account for “natural immunity” from prior infections when determining who needs a COVID booster, with the result that I have seen patients who have had COVID two, three, or even four times continuing to get boosted every few months despite the fact that this will not stop them from getting another bout of COVID and they are already at virtually zero risk for serious illness the next time they are infected.
Finally, the idea that the virus is mutating to new strains all of the time has been used as the justification for recommending that everybody get new boosters every 6-12 months. And it is true that the virus is constantly mutating, which is part of why the vaccines do such a lousy job of preventing COVID. But most of the evidence suggests that prior vaccines (or infection with prior strains) still protects against severe disease, because however much the virus mutates, it maintains enough similarity that your immune system can continue to recognize it.
Thus, I believe that a large number of the shots given in the past few years are of virtually no benefit.
Against all of this I want to stress that the best evidence to date continues to suggest that vaccination does reduce the risk for severe disease, hospitalization, and death in the most vulnerable, and I once treated a couple in their 90s who had refused to get vaccinated, contracted COVID, and subsequently both died. That right there is at least two deaths that might well have been prevented by the vaccine. So nothing I’m writing here should be taken as a blanket screed against the vaccines. Clearly, they do have benefits, and for the correct patient that benefit is worth obtaining, even at the possible expense of side effects.
And speaking of side effects, I will say that in my own practice I have seen very few of them. The vast majority of patients who have taken the jab have done just fine with it. But I have had a few patients who developed weird symptoms (headaches, dizziness, ringing in the ears, etc) for months after getting the vaccine, and there are certainly enough stories out there to think that possibly, at least sometimes, patients do suffer adverse consequences of the vaccine. Rather than taking such patients’ concerns seriously however, the medical establishment has been come off as arrogant and dismissive, asserting that the vaccines can’t possibly be the culprit for any of this, which has led to a further erosion of trust in our system.
Which brings me to my final point: the correct approach to these vaccines, as far as I am concerned, is the same as the correct approach to most medical treatments. Namely to acknowledge that the vaccines have both risks and benefits, and that the correct judgement about the balance between those risks and benefits will be different for each person depending on their baseline of health, their prior COVID exposure, their prior vaccine history, and yes, their personal preferences.
I see my job when discussing these vaccines with my patients as laying out the pros and cons, acknowledging that doctors are not infallible and we don’t know everything with certainty; offering a recommendation tailored to their unique health history; and then respecting my patient if they choose to follow a different course than the one I suggest.
Too often the conversation boils down to the folks on one side who think that everybody should be vaccinated over and over again without exceptions, versus those on the other who think the vaccines are toxic poison with no benefit to anybody whatsoever.
