So You Got Your Vaccine, Now What?

Weeks ago I was honored to interview Dr. David Agus and discuss questions that the community were asking about the vaccines. If you have not yet had the chance to read his answers, they each still hold up beautifully, and can be read right here. Since then, there have been new questions sent to me by numerous readers and friends. Although I have not had the chance to speak with him a second time, let me attempt to address some of these popular queries. I will acknowledge that this is based on my own informed understanding of the material, and as more information is learned, these answers could of course be adjusted:

• Do I wait for one vaccine over another?

No! Each one that passes will overwhelmingly prevent hospitalizations and save lives. You don’t pass on the chance to do that with one, because maybe another will be slightly better. Whatever you can get that day, get. And make sure you follow-up with the second dose (except for Johnson & Johnson which has no second dose).

• What’s the deal with Tylenol and Ibuprofen after getting my vaccine? What about alcohol?

Officially there seems to be no hard data to suggest a change, but there are very logical reasons why many have advised you to avoid Ibuprofen or alcohol for about 3 to 5 days after each shot. Think about the desired response from your body. You have just taken a vaccine that is designed to create an inflammatory response. That’s what you want to happen. Ibuprofen is one of many medications that are called NSAIDs – this stands for Non-Steroidal Anti-Inflammatory. So it is an anti-inflammatory. Taking an anti-inflammatory when you are trying to achieve an inflammatory response is counterproductive. The reality is that it may hardly at all have an effect on the vaccine, and if you are on regularly prescribed NSAID medication please keep taking it or discuss with your doctor. But if you have a choice between popping a Tylenol in your mouth or an NSAID, why not opt for the Tylenol which has no effect on the desired inflammation. Alcohol has been known with many medications to inhibit their desired responses in your body. So again, I would consider it prudent to just skip alcohol for 3 to 5 days, giving that inflammatory response a nice window to do its magic without anything getting in its way.

• Some people seem fine after their vaccine, others seem to have bad side-effects, should I worry?

I find it very helpful to look at these “side-effects” as positives, not negatives. The idea of the vaccine is to create the aforementioned inflammatory response, priming your body to be on-guard and ready to fight off the virus if ever encountered. The first dose introduces you to the antibodies. The reaction to this is usually quite mild. But the second dose is where it is truly ready to react and create a full body armor, thanks to the inflammatory response. But in doing so, that inflammation will feel different to each of us. Some of us for whatever reason are lucky and barely even notice it, but for many (myself included) your body will react to the inflammation and feel crummy for 1 to 3 days (1 day being most common). Fever, chills, headaches, body aches, fatigue, nausea – all of these are normal, expected ways that our bodies react. And it’s not a bad sign at all, it shows our body responding positively to the vaccine, and then as soon as all of that happens, it disappears. Your body was not sick, it was just inflamed temporarily. In my case I had a crummy next day, I took some Tylenol (NOT Ibuprofen) and the next morning I woke up feeling 100%, and thrilled that I am now protected from the disease. Should this scare you from taking the vaccine? Absolutely not! Should you set aside the next day to rest at home? That would be prudent.

As an important side note, this normal reaction after the second dose is why people with active infections and fevers, or inflamed flares of their chronic medical conditions would be wise to wait and get their vaccine after their flares/infection/fevers have passed. If your body is already inflamed for other reasons, and fighting off other acute conditions, you don’t need to exacerbate it. Plus getting it while inflamed for other reasons could in theory lower the efficacy of the vaccine.

• Does it matter if I can’t get my second dose exactly 3 weeks later with Pfizer or 4 weeks later with Moderna?

Yes and no. It is certainly safe if you end up getting it a little early or late. The CDC has approved a wider range of margin that is certainly all harmless, and I’m confident you will still achieve sufficient immunity. But, was it tested to be specifically 3 weeks later for Pfizer and 4 weeks later for Moderna as ideal targets? Yes. So the moral of the story is, don’t stress if you can’t get your second appointment exactly when it is recommended, but obviously if you can, get it on time.

• I’m reading the first dose alone could get you to a very high percentage of immunity, should I get just one dose?

No, and here’s why: The first shot starts to create an immune response, creating your antibodies to COVID-19. And that’s wonderful. But the beauty of the second shot is that your body has exponential more antibody growth thanks to being primed from the first. Whereas the first shot creates antibodies, the second gives you something that may end up proving even more helpful – your memory cells. This second shot causes your T-cells to stimulate your memory B-cells, which then in turn produce massive amounts of antibodies. And the ideal 21/28 day timing was tested to stimulate those memory cells at exactly the ideal timing. So the end result is, get your vaccine, try to get your second one on time, but definitely get that second one!

I will note that Dr. David Agus (who as mentioned, I recently interviewed here) sent out a message on 2/19/21 answering this very question, saying, “Beware of the headlines. One shot of Pfizer will reduce symptomology at 4 weeks, but immune response is still inferior to the 2 shots. We need the full immune response to give durable immunity & to protect against the new Covid variants.”

• When has the vaccine made me safe?

A complicated question. For other people to be around? We don’t know, because we don’t yet know if you can easily still pass this on to others. But when are you safe after getting the vaccine? 2 weeks after your second dose.

• What can I do differently after my second dose?

This answer is a huge work-in-progress. You’ll see many different responses to this right now, because they are all speculating what has not yet been determined. We need a bit more time to watch as the tens of millions of people who have gotten it become hundreds of millions, and the weeks of people getting both shots become months of people getting both shots. We will know a lot more soon. Right now, we have a responsibility to ourselves and others to be safe and change almost nothing after the vaccine. Why? Because of two things:
1. The mutations – We know how fantastic the vaccines each are with the main strain, but we simply haven’t had enough time yet to observe the new strains and determine if people who are vaccinated will get sick from it. We’ll know soon. (More on this below.)

2. Transmission of the virus to others – We also need time to see how likely and possible it is for someone who’s vaccinated to still give it to someone else. Here’s what’s realistic: It will almost certainly be a lot less likely to give it to others. Because we know that getting it is affected by the size of the viral load; and we know that when you are vaccinated, even if you can carry the virus without knowing it, you almost certainly will have a smaller viral load. So it is very likely that it will be significantly harder to give it to others, and I assume we will never find any so-called “super-spreaders” among the vaccinated population. But we do need time to calculate how likely that is, and if it’s still a significant versus negligent risk. Until then we need to be responsible and protect others.

• I’m seeing scary numbers showing that the mutations/variants have a low percentage of protection/efficacy with different vaccines. So what’s the point?

I need to remind you that when it says something has 94% efficacy, that means 94% won’t get any symptoms. None. If you have it it’s asymptomatic. Amazing. If it says this one only has 70% efficacy, then again it means 70% won’t ever have any symptoms. But again, that’s not the most important thing. Most crucial is what percentage are still able to get sick enough to be hospitalized or die. Those are the metrics that matter most. As you might know, the main reason our economy was largely shut down was not only to protect its citizens from death, but because of the ability of this virus to spread so severely in quantity and quality, that we have no ability to safely run our hospitals for any patients. This is something we have seen in places ranging from Italy to New York to here in LA. So I have never been as concerned about the numbers of positive Covid-19 cases; I have always paid the most attention to our hospital and ICU capacity as a way of knowing if our society is adequately able to handle this plague. Many have died of this virus, but countless others have suffered by paramedic and hospital resources being unable to help them in the way we are used to being helped. One hour wait times to get a hospital bed becoming 24 hours can certainly become the difference between life and death for many health conditions. This is why, as depressing as the economic devastation has certainly been to so many, most of us who work in hospitals have been in favor of the majority of measures to slow this virus down.

The beautiful thing is that so far all of the vaccines are almost perfect at preventing death and hospitalizations; and what seems very likely is that although the efficacy of prevention plummets with the mutations, they seem to still highly prevent hospitalizations and death. For example, you might read that _____ vaccine only has 20% efficacy for the South African variant, but if only 1 in a 100,000 of those cases get serious enough to be hospitalized, that may not be perfect but it’s still pretty incredible. So the bottom line is the variants suck, and they might create boosters that target them, but the vaccine will still usually help prevent the most serious complications. And give it a little time and my conjecture will hopefully be backed up by hard data.

Until we know more, please do not change your behavior after you’re vaccinated, because you might still be able to give it to others, and you might still get sick from the variants; and in a few short months we should know those answers.

• And until then?

As I’ve been recommending for months: Mask up when outdoors. Keep 6 feet of distance from others. And if you have to be indoors with others, wear a surgical (not cloth) mask and add a face shield on top.

Boaz Hepner grew up in LA in Pico/Robertson and now lives here with his wife and daughter. Thus, the neighborhood is very important to him. He helped clean up the area by adding the dozens of trash cans that can still be seen from Roxbury to La Cienega. When he is not working as a Registered Nurse in Santa Monica, he can be found with his family enjoying his passions: his multitude of friends, movies, poker and traveling.