- Jonathan Howard is a neurologist who works at Bellevue Hospital in New York City. During the pandemic, he transitioned into leading a team of health professionals caring for COVID-19 patients.
- Howard says he took the opportunity to participate in the AstraZeneca vaccine trial because he has long been fascinated by vaccines and the anti-vaccine myths that surround them.
- Howard explains that while the COVID-19 vaccines were developed this year, the safety and efficacy of the same type of vaccine has been underway for years, so scientists didn’t start from scratch.
- While there is still more to learn about how the vaccines will work when distributed to millions of people, Howard says we may even find that the vaccines have unexpected benefits, just like others in the past.
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As a neurologist specializing in the treatment of multiple sclerosis, vaccines and vaccine-preventable diseases do not play an important role in my professional career. While I’ve seen polio and measles, the only vaccine-preventable disease I routinely saw before COVID-19 was shingles.
When the first wave hit New York City, I planned to man the neurology department at Bellevue Hospital. Although some patients had catastrophic strokes, it was generally relatively quiet from a neurological perspective and there was little for us to do. While others marveled, every other illness seemed to disappear for a month during the COVID-19 spike. When the cases arose, I transitioned to running a floor team caring for COVID-19 patients. All regular clinic patients were moved to video visits.
To be fair, there wasn’t much for most COVID-19 patients but to give them oxygen and hope for the best.
We would do our rounds, offer what we could to put them at ease, and encourage them to lie down in the prone position as there is some evidence that this can help with breathing. I also made sure that no patient on my team received experimental treatments (such as hydroxychloroquine). Doing “nothing” is often very difficult for physicians, but is preferable to unproven treatments unless patients are clearly dying or in a clinical trial. If patients got better, we would fire them. If they got worse, we would send them to the ICU. Not infrequently we returned in the morning to hear that a patient had died during the night.
I was honestly most stressed just before the pandemic hit, with frequent nightmares from patients dying in the hallways and streets. I first started taking medicines to help me sleep. Although scenes like this occurred in some hospitals, our emergency room was relatively quiet on most days and the vast majority of our patients were transferred from other hospitals, largely avoiding chaos. Still, the hospital’s intercom was the busiest I’ve ever heard, with calls to the ‘airway team’ blaring through the hospital every five minutes. I saw patients as young as 23 die alone, without anyone by their side.
I was also concerned about my own health and the health of my team.
It turns out that PPE works very well and most health workers who have contracted COVID-19 did so at home or with other health workers in work rooms or canteens. However, this was not clear during the early stages of the pandemic, and like all health professionals, I wondered if I was bringing a deadly virus to my family.
I’ve been fascinated with vaccines and people who oppose them since a former colleague of mine inexplicably turned against vaccines. This motivated me to learn more about vaccines and the myths that surround them. I even wrote a chapter on the anti-vaccine movement in a book on pseudoscience.
One of the most common myths about vaccines is that they are have not been properly tested for safety.
After years of arguing that vaccines are well tested, I took the opportunity to participate in a vaccine trial myself. I’ve always believed that people who participate in medical research are doing something noble. If no one volunteered for such research, medicine would never advance.
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I received my first injection of the vaccine or placebo at Bellevue Hospital in mid-November.
Although I work at Bellevue Hospital, I still had to register for the study by filling out a common online form for people interested in participating in vaccine studies. I was given information about the trial and what to expect on the first visit.
My experience so far has been pretty dull which is good news of course. My first visit on November 19 lasted a little over an hour. I had a full medical history and physical exam, which luckily for me was quite short. I got tested for COVID-19, got some snacks, then got the shot.
While of course I don’t know if I got the real vaccine or a placebo, I’m pretty sure I got the real one.
I woke up the next day with a pretty bad feeling: I had a sore arm, a mild fever, muscle aches and headache. This took about 24 hours, except for the sore arm, which lasted a few days. Considering the horrors I saw during the Gulf of New York, this was a miniscule price for the end goal of developing a COVID-19 vaccine.
On December 18, I will receive my second dose. In the meantime, I have to check in via an online questionnaire weekly to see if I have any symptoms. The staff is available 24/7 if I have any questions or problems.
While I am reasonably confident that I have some protection against COVID-19, I have not changed my behavior at all. I am not entirely sure if I got the real vaccine and I have yet to get the second dose. After that I will remain careful. No vaccine is perfectly effective, and the vaccines may prevent people from getting sick themselves, but not spread the disease to others.
The AstraZeneca trial I’m in is a Phase 3 trial, the largest of which will determine whether a vaccine is truly safe and effective.
But even before the vaccine got into my arm, the safety and efficacy of this type of vaccine had been worked on for years. The AstraZeneca vaccine is an adenovirus-based vaccine that uses a harmless, modified cold virus to trigger an immune response against SARS-CoV-2, the virus that causes COVID-19. Overall, the vaccine appears to be about 70% effective, although unexpectedly a lower dose of the vaccine appears more effective than a higher dose. It is unclear why this could be and needs to be confirmed in larger studies.
It is also a relatively inexpensive vaccine (less than $ 4 per dose) and does not need to be stored at extremely cold temperatures. General research into vaccines for coronaviruses has been ongoing for years, and a vaccine with the same technology has previously been approved for Ebola. Fortunately, scientists didn’t start from scratch when designing these vaccines – another reason why progress has been so rapid this year.
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Even when the phase 3 studies are complete, we will still have a lot to learn about it.
While they seem very effective in clinical trials so far, we’ll have to see if this holds up in the “real world”. While the vaccines are very effective in preventing disease, no one knows if people can remain asymptomatic carriers and spread the disease to others. No one knows yet if the vaccine will provide lifelong immunity or if boosters may be needed on a periodic basis.
In addition, rare side effects may not become apparent until a vaccine has been given to millions of people, although determining causality outside of a controlled trial is difficult. After all, if we gave 100 million people a cookie, some of them would likely experience unexpected negative side effects or reactions.
We can also learn that the COVID-19 vaccines have unexpected benefits. The measles vaccine, which has been around since the 1960s, has recently provided protection against other infectious diseases.
Given these unknowns, anyone who gets a COVID-19 vaccine will contribute to medical research in one way or another. And of course, we will certainly learn for many years to come about the long-term side effects of COVID-19 itself. Many survivors will have their lives permanently changed by this virus.
Overall, I am very optimistic about 2021 and that we should have a gradual return to normal by summer or fall.
Undoubtedly, the completion of multiple successful studies of a new virus in less than a year is one of the greatest scientific achievements in the history of medicine. Perhaps the hardest part is getting the vaccine to people around the world and convincing them to take it. Still, I am extremely proud that I played a small part in this project.
Jonathan Howard is an associate professor of neurology and psychiatry at NYU Langone School of Medicine and a neurologist at Bellevue Hospital. follow him Twitter.