Make me no promises

How do the lyrics go? “Make me no promises. Tell me no lies.”

Photo by Nataliya Vaitkevich on Pexels.com

There’s a problem with the messaging being published right now about vaccines. Every day I see a new headline with the title “I’m Vaccinated, Now What Can I Do?” or “Can You Hug Your Grandkids After Getting a COVID Vaccine?” “COVID-19 Vaccine Doesn’t Mean You Can Party Like Its 1999.”

They all carry the same message. Getting a vaccine doesn’t mean you can let you guard down. Nothing is 100%.

The problem is, it’s way underselling the effectiveness off the vaccine.

I saw a viral Facebook post yesterday that, basically, said that if vaccinated people still have to wear masks, still have to distance, can’t hug their grandparents, etc. then vaccines don’t work and they aren’t worth the risk.

THIS MESSAGE IS WRONG.

So how did we get here?

Well, to start, science knows its limitations. Research studies, especially medical research studies, publish a summary not just of the successes, but of the failures. Therefore, there is no 100%.

Then, there’s the problem of medical malpractice and informed consent. If you’ve spent any time in the medical world, you’ve probably observed that doctors tell you every risk, every worst case outcome. It’s part of their job that you know exactly what might go wrong. No one wants a devastating, unforeseen outcome. Especially since, when one happens, malpractice suits often follow.

Doctors are trained not to promise outcomes that cannot be guaranteed. This is why our introduction to Patrick was “life expectancy of 1-2 years.” Before his adoption, the GI who was treating him sat me down and spelled out in great detail how very difficult his life would be. For an hour. Most NICU parents can recount a similar experience where they were told about poor quality of life and low risk of survival and were left convinced there was no hope. This is why the term “defy the odds” is used so commonly in our circles.

The problem with this approach is that it often misrepresents the odds. Skews them towards the negative. Even when prognosis is good.

I’ll be honest, years of being told “the odds” related to Patrick’s transplant had me so terrified that I considered turning down the offer when it came. I cried the entire flight from Utah to Nebraska. Did he defy the odds? Or are the possible wonderful outcomes the exact reason why we take medical risks?

The truth is that, in most cases, the odds being emphasized about are the long odds. The long shots. The off chances.

So if you’ll humor me, I’d like to share some of the answers I wish were being emphasized in response to the questions in the headlines. I’ll follow by explaining what this information means for our family and vaccines.

The questions here come from the social media post my friend shared yesterday.

“If I get vaccinated can I stop wearing a mask(s)?”
At first, no. This partly because we do not know much about the risks of spreading the disease and because of variants. But I suspect there’s a behavioral motive, too. Early experience taught us that some health rules are better universally adopted. It’s easier to encourage everyone to wear masks than to try to split hairs about who should wear them and who shouldn’t. Mask mandates will lift when case counts decrease to safe levels.

A personal aside: Given that mask-wearing, distancing and quarantining when sick have essentially eliminated the influenza that has been a public health crisis for years, I hope we never fully abandon mask wearing.

If I get vaccinated will the restaurants, bars, schools, fitness clubs, hair salons, etc. reopen and will people be able to get back to work like normal?”
Accomplishing this goal will require many people to be vaccinated. In order to resume normal business, we’ll need to reach a certain level of herd immunity. That’s defined as somewhere between 60-90%1 of the population having immunity. We can accomplish this the slow destructive way, by just letting the virus run until 60-90% of the population has caught the virus, keeping precautions in place so our hospital system doesn’t collapse. Or we can do it the faster, safer way, with vaccines. Experts hope that herd immunity will be acheived by summer or at least fall, when most people have had the chance to receive the vaccine. A lot of that depends on our choices. Herd immunity is the point at which business will return to normal, or something like it.
1. https://www.nytimes.com/interactive/2021/02/20/us/us-herd-immunity-covid.html

“If I get vaccinated will I be resistant to Covid?”
Yes. Don’t dwell on the odd outliers. No medical treatment comes with a 100% guarantee. But with the current vaccines, we get pretty darn close to it. In studies, the Moderna and Pfizer vaccines showed 90% effectiveness in preventing moderate to severe illness for those who received both shots. However, the 10% who still experienced mild disease were.. well, mild. In other words, these two vaccines have nearly 100% efficacy in preventing or reducing your risk of severe illness, hospitalization and death.2 Data in the general population is following the same pattern. Johnson and Johnson’s vaccine shows 72% efficacy in studies. (66% overall). However, it was 85% effective in preventing hospitalization and death.3,4
2.https://www.sciencemag.org/news/2020/11/absolutely-remarkable-no-one-who-got-modernas-vaccine-trial-developed-severe-covid-19?campaign_id=9&emc=edit_nn_20210118&instance_id=26125&nl=the-morning&regi_id=94133618&segment_id=49584&te=1&user_id=b1e0880472a5057b2471cc3672dea780&fbclid=IwAR2yregj5DNSXDv9XbidrmP7lhCVlnIqpj6dti58ar2S9E3cvY4T3u3WYHI
3. https://www.nytimes.com/2021/01/29/health/Covid-vaccine-explainer.html?campaign_id=9&emc=edit_nn_20210201&instance_id=26625&nl=the-morning&regi_id=94133618&segment_id=50744&te=1&user_id=b1e0880472a5057b2471cc3672dea780&fbclid=IwAR2dLw3v_WpX2Cr9XuLd-nBI4scgcoD8ldGe1ZMR6EPiO85Q7Iwqz-Y-D6U
4. https://www.jnj.com/johnson-johnson-announces-single-shot-janssen-covid-19-vaccine-candidate-met-primary-endpoints-in-interim-analysis-of-its-phase-3-ensemble-trial

“If I get vaccinated, at least I won’t be contagious to others – right?”
We hope so. However, there are some vaccines, such as the one for polio, that still allow carrier transmission of the virus. And no studies have been done to see if the vaccine provides mucosal (as in in the mucus of your nose) immunity. That would require swabbing a whole bunch of vaccinated people and no one has done that yet. We are still early enough in this disease to be working in hypotheticals. And it’s better to err on the side of caution. So, they recommend that you assume you may still be able to be a silent carrier of the disease.

That said, studies have shown the AstraZeneca vaccine does reduce contagion.5 The Pfizer vaccine showed significant protection from spread in animal trials.6 In general, vaccinated people, even when infected, carry less of a virus than an unvaccinated ill person.6 Reducing the number of infected people is likely to reduce spread. So while we don’t know and caution is still warranted, there are early signs that vaccines reduce spread.

And if there is still a chance of spread by vaccinated carriers? That’s an even stronger argument for more people to be vaccinated.
5.https://www.nytimes.com/live/2021/02/03/world/covid-19-coronavirus?fbclid=IwAR1tjCFBfNX5ykwhaKaBCx2crCjOPmeorZM2GElbVvPJqhwZR71zci1NHOE#astrazeneca-coronavirus-vaccine
6. https://www.bbc.com/future/article/20210203-why-vaccinated-people-may-still-be-able-to-spread-covid-19

“If I get vaccinated, how long will the vaccine last?”
This question is tricky, because we don’t have data yet. The vaccines themselves are less than a year old. Experts predict at least month and possibly years.7 This comes from an understanding that contracting the actual illness provides at least 3 months’ protection, but a recognition that there are cases of reinfection. Different people will have different immune responses. Also, Covid like other viruses can mutate. It’s possible that an annual shot, like a flu shot, might be necessary to keep up with mutations. Only time will tell. However, don’t mistake a lack of information with a lack of effectiveness. The vaccines do protect you from the virus and continue to do so in study participants.
7. https://www.kgw.com/article/news/health/coronavirus/vaccine/verify-how-long-will-immunity-from-the-covid-19-vaccine-last-no-one-knows-for-sure/531-86718292-cef8-4e81-9c54-4333aafbae65

“If I get vaccinated, can I stop social distancing?
It’s hard to make recommendations with less than a year’s data. So the safest recommendation is to continue distancing. As a society, we need to keep social distancing until 1) We establish a certain level of herd immunity, 2) We know more about the effectiveness of the vaccine on current mutations. Remember the behavioral element of this recommendation. It’s easier to tell everyone to distance than to try to distinguish who can safely do so and who can’t.

However, because the vaccines greatly reduce risk, it may be relatively safe for vaccinated people to gather in small groups. Remember that vaccines are only effective 2 weeks after the second dose. And for contact tracing purposes, it’s still best to keep these gathering small and make sure there is no contact with unvaccinated people.8
8. https://www.radio.com/kcbsradio/news/can-vaccinated-people-socialize-safely-with-each-other

“If my parents, grandparents and myself all get vaccinated can we hug each other again?”
People with weakened immune systems may have a weaker immune response to a vaccine than a younger, healthier patient. So there is a possibility that you could pose a risk to an immunized grandparent, especially if you haven’t yet been vaccinated.. If you want to 100% safe, experts say you shouldn’t hug. But they also recommend common sense.

Lucy McBride, a primary care doctor, gave this advice,”If we want to 100% avoid COVID risk, the answer is no. If we want to consider emotional and physical risk and reward in tandem, for our family, the answer is yes because the emotional benefits of hugging an immunized grandparent greatly outweigh the very small risk of sickening or endangering anyone involved.”9 Hugging is safest if everyone is fully vaccinated and at least 2 weeks after their second shot.

I love these other words from Dr. McBride. “We can and should allow ourselves the pleasure of looking forward to the days when we and our loved ones are vaccinated, because our risks of being together will be so very low and the benefit to our mental health high.”9
9. https://www.webmd.com/vaccines/covid-19-vaccine/news/20210203/covid-faq-i-got-the-vaccine-is-life-normal-again?fbclid=IwAR3x4XjLQfPe0t82WdKvXKhNytQQwEdocDACshhLmi43xOaDX_dVIarcO5o
10. https://www.theatlantic.com/ideas/archive/2021/01/giving-people-more-freedom-whole-point-vaccines/617829/

“So what’s the benefit of getting vaccinated?”
If there’s so much we don’t know and the vaccine isn’t the golden ticket, is it really worth the risk? After all, a fast developed, limited study vaccine sounds risky, right?

One thing is abundantly clear from all the data. All of the currently approved and soon to be approved vaccines will reduce your chances of contracting COVID, reduce the severity of your illness if you do, and make you less contagious. Also, it is the fastest way to quickly and safely reach herd immunity.

“Are you sure the vaccine won’t injure or kill me?”
Doctors never say they are sure. However, clinical trials show the vaccines to be remarkably safe. And the rapid vaccination effort in the country provides extra assurance as we have data from 22 million currently vaccinated people. There is a risk of anaphylaxis in those with a history of allergy. That risk is treatable. A few incidents of reported death do not seem to be directly linked to the vaccine, but are being studied. Only 1,000 adverse event reports would be considered serious. Compared to 22 million, that number is very low. Meanwhile, these vaccines themselves are being highly and very publicly scrutinized. As for Bell’s Palsy, which has received some viral internet attention, in studies, there were actually many more cases in the control group than in the vaccinated group. Incidents of other events such as heart attack, stroke and embolism in the vaccinated group were the same as would be expected in the normal population. Some of these events will happen in any group of people.11

Overall, the risk of severe illness and death from COVID-19 is much, much higher than the risk of death or injury from the vaccine.
11. https://www.usatoday.com/story/news/health/2021/01/28/covid-19-vaccines-cdc-safety-data-pfizer-moderna-coronavirus/4281434001/?fbclid=IwAR0yVbrFJgmh0JCA5QXcq17qyD-8Y6YAdCqpJER_zKowouGDq9CIdquaDl0
12. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html?fbclid=IwAR3zADlbswgiETfRL6uN_yZJE9UY2jc_erVQZWEvFe3ZKs22Sn74e1D3qVM

“If statistically the virus won’t kill me, why should I get vaccinated?”
Vaccination protects you, your family, and society at large. True, COVID has a 99% survival rate. But in a country with a population of 328 million, that’s still 3.2 million people who could die. 10-15% of COVID cases progress to “severe disease.” 13 For every person who dies of covid, at least 4 others were hospitalized. The financial impact alone of that many hospitalizations, many lasting months, is significant on businesses, healthcare systems, and especially individuals. 76% of hospitalized have long-term symptoms of the disease.14 20% of reportedly healthy 18-34 year old patients report long-term effects of the disease. 13 And when hospital ICUs are above 80% capacity, the risk of death from other factors such as car crashes, heart attacks and strokes increase as well.15
13. https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update-36-long-term-symptoms.pdf?sfvrsn=5d3789a6_2&fbclid=IwAR0tZTv8uWRfP3QAXwE56sPCNiYMWQiV1_bH3SfBkRsCCc3ObKpGCNGureQ#:~:text=Approximately%2010%2D15%25%20of%20cases,about%205%25%20become%20critically%20ill.&text=For%20some%20people%2C%20some%20symptoms,to%20others%20during%20this%20time
14. https://www.healthline.com/health-news/over-75-percent-of-people-hospitalized-with-covid-19-have-symptoms-months-later?fbclid=IwAR0GfQp_Q1pUgPT7d6vd1sfEnMOMgjaucJHXmgJs0AedCAf0lWyD6PcJRUA#Long-term-symptoms-are-common
15. https://www.deseret.com/utah/2020/11/12/21562579/coronavirus-covid-19-pandemic-real-stories-impacts-hospitalization-long-term-effect-salt-lake-county

“If I experience a severe adverse reaction, long term effects (still unknown) or die from the vaccine will I (or my family) be compensated from the vaccine manufacture or the Government?”
True. They are shielded from litigation. Vaccine manufacturers take a considerable risk, especially in rapid production of a virus. The probability of adverse reaction is small, though never none. As of February 14, the rate of death among vaccine recipients was 0.0018%.16 Rate of anaphylaxis (which is the most severe effect reported thus far) is 2-5 people per million.16 Compare this to a 1% chance of death and approximately 20% chance of lasting adverse effects from the disease itself. You will not be compensated for this risk, either.
16. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html?fbclid=IwAR3zADlbswgiETfRL6uN_yZJE9UY2jc_erVQZWEvFe3ZKs22Sn74e1D3qVM

I was worried that the trials had been rushed, too. However, I’ve seen multiple statements, including from doctors whom I trust and who have reviewed the research, that assert the trials were complete and safe. A pandemic creates a unique circumstance where 1)there are many eager trial participants, 2) there is ample opportunity to expose those participants to the disease and 3)the government was willing to remove the red tape that usually slows studies. When they say they expedited trials, what it really means is that they didn’t let them sit on someone’s desk for months between steps.

Also, these vaccines use technology that was already in use. For example, Moderna and Pfizer use mRNA technology that was being used for cancer research. (Remember how we fundraise to support cancer research?) Johnson & Johnson and AstraZeneca use technology developed when working on vaccines for Ebola and Zika. They customized existing technology to this specific virus.

And in case you’re wondering, even using nanotechnology, they couldn’t hide microchips in the vaccines without them being detected. Vaccines are reconstituted from powder to make a clear liquid. Even the best microchip using current nanotechnology would appear as a small floating contaminant in the vial. Feel free to ask to inspect your dose. Also, multi-dose vials would make it impossible to hide and equally distribute multiple doses of microchips in a reconstituted solution. (I know you probably don’t believe this, but if you know someone who does.. well, this may not change their mind. But knowledge is power.)

In summary
In my opinion, doctors and journalists need to trust the public a little bit more. We ARE capable of balancing hope and caution. However, when the message of caution is over-emphasized, there is a tendency to give up hope.

As a society, we have prayed, fasted, sacrificed, researched, hoped and waited for an end to this pandemic. Those prayers were answered with the rapid production of not just one but several highly effective vaccines.

This. Is. A. Miracle.

We need to be careful that we don’t let skepticism, caution, politics, or worry lead us to reject this gift. This answer to our prayers. Turning down the vaccines because you may have to wear masks and distance a little while longer is like turning down a new sports car because you’ll still have to follow the speed limit.

The road back to normal is through these vaccines.

So, what about us?
Utah will open up vaccines to the high risk medical group on March 1st. And there are a few questions I am asked regularly.

Will Patrick qualify for the vaccine?
Patrick meets 4 of the criteria on Utah’s high-risk list. Solid organ transplant, asplenia, immunosuppression and cerebral palsy. However, vaccines are not yet approved for pediatric patients. Trials are underway in this patient population. They are taking longer than adults because children are less at risk, parents are more hesitant, and teens are less compliant with study regimens. Still, we hope by late summer or early fall that a vaccine will be available to him. And we have been instructed to get him vaccinated as soon as possible.

What about you and Brian?
I am also in the high risk group because of my immunosuppression for Rheumatoid Arthritis and because of my weight. We have been strictly quarantining for my sake as well as Patrick’s. I’m the only one who has his entire medical picture in my head and he needs me to be here and healthy.

I plan to stalk the health county website on March 1 until I have an appointment. I’ll go off my R.A. meds to improve my immune response. It should be miserable. And totally worth it.

Brian will probably have to wait until the end of the line, unless we can get someone with decision making power to include caregivers of high-risk children in the higher priority groups.

When can we hang out with you again?
Did you notice above that the safest groups were those where everyone was vaccinated? We hope that you, with us, will choose to be vaccinated so that we can get back to spending time together as soon as possible.

Patrick and I both are in that group who may not have as “robust” of an immune response to the virus. So we don’t know how much protection we’ll have. But if we are vaccinated and you are vaccinated, we have much better chances of being safe.

Our initial interactions will be limited to small groups of vaccinated family and close friends. We’ll slowly come back into society like we did after transplant. Large group activities will wait till all of us are vaccinated. But time (and better data) will tell.

If you want to see us before the U.S. reaches herd immunity, get your shot.

Will Patrick be back in school in the fall?
Honestly, I don’t know. I have every intention of sending him back to school when his team says it’s safe. Patrick needs people.

Since we expect it to take longest for children to be vaccinated, it will for sure need to wait until he at least has the protection of immunization.

This could happen in fall. It might be later. And honestly, given how much better math has been with me teaching, the schedule may be part-time. At least to start.

Here’s a header so you know we’re at the end
There’s a lot we still don’t know. There is a lot that can’t be promised. But despite uncertainties, the future is very, very promising.

Hebrews 11 is one of my favorite books of scripture. Verse 1 read:

“Now faith is the substance of things hoped for, the evidence of things not seen.”

And verse 11 tells us that Sarah conceived when she was past age “because she judged him faithful who had promised.”

God hears our prayers and keeps his promises. He still sends angels. He still works miracles. And we are watching one unfold in this moment.

Let’s not be too afraid to accept that gift.

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