Q: I am 53 and have diabetes. I live in California and will soon be able to get the COVID-19 vaccination. What side effects can I expect? There are so many stories floating around and it’s hard to know what to believe.
A: It is true that there is a lot of confusion and, unfortunately, misinformation about the coronavirus vaccine. We’ve answered specific questions in recent columns, and we’re happy to share the bigger picture with you and the rest of our readers.
At this point, three vaccines have received an emergency permit from the United States Food and Drug Administration. They are manufactured by Pfizer, Moderna and, most recently, Johnson & Johnson. Clinical studies have shown that all three vaccines are effective in preventing symptomatic COVID-19. The Pfizer and Moderna vaccines require two doses, with the second dose given three or more weeks after the first. The exact interval depends on the vaccine you are receiving; You will be given directions on how and when to get your second dose when you get your first. Johnson & Johnson’s is a single dose vaccine.
Possible side effects of the coronavirus vaccine can range from mild to severe. Anaphylaxis, a life-threatening allergic reaction, has received a lot of attention. However, this reaction to the vaccine is extremely rare. According to the latest figures from the Centers for Disease Control and Prevention, which maintain a wide range of data related to the vaccine, we are currently seeing about 2.5 episodes of anaphylaxis for every million doses of COVID-19 vaccines administered.
The vaccine itself is administered through a very thin needle. Many people say they don’t even feel the injection. After you receive the vaccine, you will be directed to a designated area to wait for the 15-minute period prescribed by the CDC before leaving the site. People at risk of an allergic reaction, which is determined through a pre-vaccination questionnaire, are asked to wait at least 30 minutes. Each vaccination site should have the medication, equipment and trained medical personnel on hand to deal with any potential serious allergic reactions.
Some people respond more strongly to the second injection of the two-dose vaccines.
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The most common side effect of the vaccine is temporary pain and swelling at the injection site. This can start from a few minutes to a few hours after the injection. Additional reactions may include fever, chills, headache, muscle pain, nausea, and fatigue. These arise because the vaccine releases a fragment of the coronavirus genetic code to stimulate the immune system to recognize it as a foreign invader and build a response. You may be able to reduce discomfort at the injection site by exercising your arm before receiving the vaccine and applying a cool, wet cloth to the injection site.
Some people respond more strongly to the second injection of the two-dose vaccines. If so, over-the-counter medications such as aspirin, acetaminophen, or ibuprofen can help manage symptoms after vaccination. But do not take these medications in advance to avoid side effects, as it is not yet known whether they affect the vaccine’s effectiveness. If symptoms do not go away after a few days or if they get worse, see your doctor.
More COVID questions:
One reader said she uses an over-the-counter nasal antiseptic so she is less likely to spread the coronavirus if she becomes infected. “I read that killing germs in the nose can reduce the risk of bacterial infections such as MRSA and staph,” she wrote. “And some experts believe it can help fight COVID-19.”
It is true that some patients use an antiseptic nasal spray to “decolonize” the bacteria Methicillin-resistant Staphylococcus aureus, also known as MRSA. However, these nasal sprays target bacteria and not viruses. It’s a critical distinction because COVID-19 is caused by a virus and does not respond to antibacterial agents. We are not aware of any data to support this practice for COVID-19, and we would not recommend it to our patients.
• A reader who tested positive for COVID-19 in August asked about antibodies and immunity. “Should I be tested for antibody levels?” she wrote. Should I get the vaccine? When will my immunity run out? ‘ At present, antibodies are believed to persist for approximately 90 days after COVID-19 infection. The level of immunity they confer is not yet known, so the only reason to get the test is out of curiosity. And yes, we recommend that everyone get the vaccine. This includes those who have tested positive for the coronavirus in the past and currently have no COVID-19 symptoms.
• One reader wondered if the anti-inflammatory agent she is taking for a type of arthritis known as pseudogout is a problem with the vaccine. “Does it affect the effectiveness of the COVID-19 vaccine?” she asked. “Is one vaccine manufacturer better than another?” There are no known data on the reduced efficacy of the vaccine in persons taking NSAIDs (non-steroidal anti-inflammatory drugs) or steroids. As for the vaccines, they are equally effective. We strongly recommend that our patients have the former available to them.
• We heard from a number of readers that the vaccine is safe for people with conditions such as multiple sclerosis and Parkinson’s disease. Both the Parkinson’s Foundation and the National MS Foundation have convened panels of experts to investigate this question. Their conclusions are that, yes, people with these diseases should be vaccinated. It is important to note that these recommendations only apply to the mRNA vaccines Pfizer and Moderna.
• A reader with type O blood, which is associated with a lower risk of serious illness with COVID-19, wondered if she needed a vaccine. “Should I get the vaccine since I have a low risk of getting COVID-19? If so, which vaccine should I get?” Yes, we recommend that our patients with type O blood get vaccinated with the Moderna or Pfizer vaccine, depending on what is available.
• Many of you wonder whether prescription and over-the-counter blood thinners affect the effectiveness of the coronavirus vaccine and vice versa. It’s a question we get from our own patients. The guideline at this time is to continue taking blood thinners as prescribed, and to tell the person administering the vaccine that you are taking them.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to [email protected].