Vaccination talk

My cousin asks me once, why do doctors say, “This will only hurt a little?’ when they give a shot.

I thought about it. “It’s a matter of scale. Picture this: in room one, I have a woman who thinks her lung cancer is back and it is. In room two I have a mother and daughter crying because the daughter is pregnant and frightened. In room three, I have a well adult who needs a vaccination. Scale their levels of pain.”

Room one is very high, room two is very high, room three barely registers on my pain scale.

I would give out a health department vaccination information booklet by 24 weeks to my pregnant patients, especially the first pregnancy. I previously had given it later, but then I had a woman who refused the child’s vaccines at visit after visit after visit, saying that they were still doing research. The child still had no vaccinations at 9 months.

Remember the woman who refused vaccinations for her children? She had more than four children. They all got whooping cough, pertussis. They whooped for months and were on quarantine. They were not allowed out of the household, any of them, until they were no longer infectious. The mother said she now was for vaccines and got them vaccinated.

I have seen adults with pertussis. Adults do not whoop but they cough. They can cough until they throw up or until they break a rib. For months. It is not fun at all. The adult Tdap stands for tetnus, diptheria, and acellular pertussis. I have never seen a case of diptheria and I don’t want to. It sounds horrible and can kill.

Have I seen a complication of a vaccination? One in 30 years of practice. And I know a person who had a complication, but they were not my patient.

The illnesses cause way more damage and disability than the vaccine. In residency I care for a young man in a group home. He can’t talk and has an odd skull shape. His mother got measles during the pregnancy. Measles is one of the infections that can cause severe birth defects. Get vaccinated before getting pregnant, though half the pregnancies in the US are “unintended”. That usually means “unbirthcontrolled”. I do not really understand that, since the risk of pregnancy in a fertile woman is one in four every time. Twenty five percent seems a pretty high risk to me.

I’ve written about my response to my last Covid-19 vaccination. It’s not a complication. It is an antibody response and it means that my immune system is WORKING, though admittedly it is weird and annoying. I don’t like the muscle dysfunction, but I will get the vaccinations anyhow.

I have a very alternative young woman in for prenatal care once. I give her the vaccination booklet. “Oh, my child is getting every vaccine there is,” she says.

“May I ask why? I was not expecting you to say that.”

“I was in the Peace Corps in Africa. I have seen kids die from every single one of the diseases we vaccinate for. My kid will get ALL the vaccinations.”

I said, “Please would you talk to my other moms?”

She smiled at that. “Maybe.”

I hope she did and does.

Vaccine refusal folly

Who should NOT get vaccinated for Covid-19?

This is supposed to be humor. You may not find it funny.

Clearly oppositional defiant people do NOT get vaccinated. Here are a list of the reasons that I have heard, most of them said to my face or on email:

Hyper Conservative:
1. God will take care of me.
2. It’s false news. All made up by the media. The media is liberal. Even Fox News. Even CNN. They don’t know the true meaning of conservatism. I honor the flag.
3. We do our own research. We have better and deeper sources even than QAnon. If you don’t know what I am talking about than you don’t know! Why are you so stupid?
4. Alien lizards made the vaccine and it has tiny nanobots and it is tracking us and will take over our brains. Some people have ALREADY HAD THEIR BRAINS TAKEN OVER BY LIBERAL MEDIA AND NOW QANON! It’s probably best to bunker down.
5. No I don’t vote. Where is my medicaid check? Those evil government people are trying to take away my mother’s social security. If I voted, I would be part of the problem.
6. Masks kill you. Because you breathe your own breath. It’s not the CO2. You didn’t realize that your breath was THAT foul, did you? EEEEEEE-YUK.
7. No one can tell me what to do. If they do, I won’t do it. I won’t die. So there.

Hyper Liberal:
1. Goddess will take care of me.
2. Antibiotics are evil. Vaccines are evil. If you live NATURALLY, you will live forever. But I ordered that book that tells you how to cook your own medicines on your stove!
3. There is this HERB. It fixes everything. What do you MEAN, my kidneys are failing? But I live NATURALLY.
4. Doctors are evil. Well, not naturopaths. The government is evil. Yeah, I’m on medicaid. My mother NEEDS her medicare check. WTF is WRONG with you people? Why would I VOTE on the evil government?
5. Scientists are evil. If they would use NATURAL remedies, we’d all be fine. No, I don’t get labs checked. I don’t need to. Yes, these are shoes. Whaddaya MEAN shoes aren’t natural? These are handmade with hemp processed in a massive factory and NO LEATHER because LEATHER IS EVIL. I have bamboo towels, too, bamboo is natural. What do you MEAN it takes a fungkload of chemicals to process bamboo into fabric? It’s NATURAL.
6. Humans are evil. We should live naturally. Yes, I live in a house. Houses are natural. If you use natural cleansers and only allow natural fabrics and toys and crystals and foods. I don’t approve of logging. Yes, my house is made of wood, what of it?
7. No one can tell me what to do. If they do, I won’t do it. I won’t die. So there.

Martians:
1. It makes their brains explode in their helmets.

Alien Lizards posing as humans:
1. Well, actually we need to get the vaccine. I got it.

Gorillas:
1. They get the vaccine too, even the oppositional defiant ones. Except for the wild ones that are really canny and who we can’t catch and dart gun with the vaccine.

This is supposed to be humor. You may not find it funny. Don’t use it as proof that you shouldn’t get the vaccine, though people with really crazy ideas shouldn’t get it. Did you hear that they are about to send all the remaining vaccine supply to Africa because people here are refusing it? Is that a rumor or is it true?
The CDC has other ideas. But we don’t trust them, right?

For the Ragtag Daily Prompt: folly.

send the remaining vaccine to another country

I know that it sucks for US nurses and doctors and hospitals to say this. You are having to intubate and take care of and watch people die, who have refused vaccination. You are really really tired and discouraged and sick of death and sick of working way too many hours without a break.

However, I think it’s time to give up on the oppositional defiant section of the United States, say “ok, boomer” or twenty two year old or seventy old and send the rest of the vaccines to people who want it and who would be happy and grateful and glad. If we don’t help vaccinate the rest of the world, we’ll see more strains. They might morph to something milder than Delta. They might turn into something worse and more lethal.

Send the vaccine to people who want it.

Covid-19 Delta Variant

This article: The CDC warns that the delta variant is as contagious as chicken pox and can make people sicker than the original Covid-19

Chicken pox has up to 21 days before you break out after exposure. It is really really contagious. And it is infectious until every pustule has scabbed over. And it can kill people, especially adults. It can also cause some pretty awful birth defects, which is why we ask every patient who is pregnant if they have had chicken pox or the vaccine. If not, we check antibodies. If they have no antibodies and are exposed, they are to get VZIG within 48-72 hours, an antibody to the virus to try to stop the birth defect. In my small town, it’s flown in by the health department.

So as contagious as chickepox is really bad. Chickenpox is worse than influenza. Tuberculosis is a very small bacteria and can be airborne as well.

The delta variant kills people who are unvaccinated at a higher rate than the original Covid-19. The 30-50 year olds are dying.

The delta variant can infect vaccinated people though rarely. The vaccinated people are way less likely to be hospitalized and die. However, someone walking around with delta (vaccinated or unvaccinated) apparently sheds 1000 times more virus than the original Covid-19. This means that we all need to put our masks back on unless we are in our homes with the very small groups we should stick with. If we do not do that, we may have more deaths this winter than last winter.

I double masked on the plane, one flight from Chicago to Seattle, two days ago. I kept the mask on in the taxi and waiting for the ferry. I felt most exposed waiting for the ferry because fully half the people were ignoring all of the mask signs. Ah well. I was going to travel in late August again but the prediction is for a big Covid-19 wave starting to peak in 4-6 weeks. Seems like a bad time to go anywhere, much less on oxygen.

Gather up whatever you need to get through the winter and get ready. Enjoy the August sun, but store up things for this winter. I think it is still going to be a hard one.


There is lots of detail on the CDC website.
will the unvaccinated change their minds in time?

Top ten causes of death: US 2020

Top ten causes of death US 2020, according to JAMA, here.

Total deaths: 3,358.814
Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.

1. Coronary artery disease: 690,882
Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.

2. Cancer deaths: 598,932
This is cancer deaths, not all of the cancers.

3. Covid-19: 345,342
I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.

4. Unintentional injuries: 192,176
Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.

5. Stroke: 159,050
This rose too.

6. Chronic lower respiratory diseases: 151,637
This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?

7. Alzheimer’s: 133,182
This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.

8. Diabetes: 101,106
This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.

9. Influenza and pneumonia: 53,495
So this went up too in spite of a lot less influenza. Other pneumonias, presumably.

10. Kidney disease: 52,260
This went up.

And what fell out of the top ten, to be replaced by covid-19?

11. Suicide: 44,834
This actually went down a little. What will it do in 2021?

So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.

Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.

Take care.

Vaccine Adverse Event Reporting System (VAERS)

Anyone can report to the VAERS system.

Doctors may be a bit nervous about reporting covid-19 reactions. Doesn’t matter. You can report on your own.

That being said, I don’t recommend reporting if you feel like crap for a couple of days after the second shot. If it is severe, you need an ambulance or it goes on for more than say, five days, report.

The first shot is about 80% effective. So, 4 out of 5 people are protected, and 1 in 5 doesn’t take. After the second shot, about 95% are protected. That means 1:20 is not.

So if you responded to the first shot, you will have an antibody response to the second shot. I ran a fever of 102 for an hours and cancelled my day of work and the next day. You could have fever, chills, muscle aches, joint aches, whatever. Take a hot bath or sauna or hot tube, because you can sweat the antibodies out.

I would report reactions that last more than two days or are severe. You can fill the form out yourself online and send it to the CDC.

For the folks refusing the vaccine: Hello. Are you going to have covid-19 parties to infect each other? If you do and you get covid-19, I can tell you that I am glad I am not your doctor. Also I don’t want you in my house. I don’t want to be around you at the Farmer’s Market either. And I think that once everyone has had the opportunity to get the vaccine, if you refuse and get covid, you might have to pay your own doctor and hospital bill. Yeah, that is what I think. And if it bankrupts you: well, you had the opportunity to get the vaccine. Why should insurance have to pay? Or you might die. Death rate for world is holding at 2 out of 100. In the US it’s “only” 1.78 out of 100. That is a fungkload. It’s a lot of people. Choose not to get your vaccine and you could be one of them. I just found out this week that a friend from medical school died in November: age 59. Do not tell me it’s all 80 year old “who would have died anyway”. Each of us will die anyway and I don’t want to die of covid-19.

I took the photograph in medical school: it’s my fellow doctor who was found to have covid-19 after he died suddenly, age 59.