Bitter pill, but still, good jab!

By: Rafael R. Castillo MD - 4 years ago

It started slow, with many health-care workers hesitant to get vaccinated. But seeing their top consultants proudly posting their vaccination selfies, droves of doctors, nurses and other health-care workers joined the queue to get their jabs.

From less than a thousand per day in the first few days, there are now more than 10,000 daily availing of the free vaccination.

Good jab! But we should aim to get more people vaccinated. If we want to vaccinate all suitable candidates and achieve herd immunity in 12 months from the initiation of the vaccination program, I estimate that we should be inoculating at least 215,000 per day by next month. So, we really need to pick up more speed in our vaccination rollout.

It’s quite a big jump, from the number we currently have, but it’s highly doable, provided we get our act together.

There must be a good communication plan that will correct all misinformation about vaccination, and inspire the far bigger majority to do their altruistic act of protecting not only themselves but the people around them. Getting our young people vaccinated will protect the vulnerable people in their household, like the elderly and those who have concomitant illnesses like high blood pressure, diabetes, asthma, chronic lung disease and others.

Unknowing exposure

Theoretically, healthy young people in their 20s or 30s may not need the vaccine that much since their risk of dying from COVID-19 is extremely small. At most, they’ll just be sidelined by the flu-like symptoms the viral infection causes. But they need to be vaccinated because they’re the potential superspreaders of the virus. They’re the ones going to work, and are more exposed to the virus.

Most of them may even have an asymptomatic infection and unknowingly infect their parents and other vulnerable members of the household.

I have an elderly patient who never left their house since the pandemic broke out, but got ill with flu-like symptoms recently. When I suggested that she get a swab to rule out COVID-19, she was incredulous. She insisted it was impossible because she remained within the confines of their house, and the farthest she had gone were the rest areas in their vast garden.

I explained to her that she might not have been exposed outside, but her children and grandchildren were most likely exposed. Even if none of them showed any symptom of COVID-19, they might have been infected but because of their strong immune system, they did not show any symptoms because their immune cells easily overcame the virus. But they may have been infectious for several days that the virus was still replicating in their nose and throat tissues.

True enough, the swab turned out positive, and by God’s grace, she recovered without any serious complication.

So, again to our young people—please have yourselves vaccinated for the sake of your parents, lolos and lolas and other people whom you may unwittingly infect with the virus.

For the young and relatively low-risk, the Sinovac vaccine should be good enough, so we can reserve the other vaccines for the higher-risk people. But either Sinovac or AstraZeneca, or the other vaccines (Pfizer and Moderna)—should they become available later on—should all be good enough for everyone.

Palpitations, elevated BP

Several doctors and nurses have texted me to inquire about the side effects they were experiencing after vaccination. I assured them they’re in good company.

The majority—up to eight out of 10 people vaccinated—will experience mild side effects. These may range from pain or mild swelling in the inoculation site to fever and chills, headache and muscle pains, or even elevation of the blood pressure (BP). But usually the side effects are mild and readily dissipate in two days. I even tell some of those who are very worried about their side effects that they should be thankful they have these mild reactions. At least, they’re more assured that the vaccine is working, and activating their immune system to produce antibodies.

If the symptoms persist for more than three days, especially if they get progressively worse, then one needs to consult a physician to rule out other possible causes.

I got at least a dozen phone calls the past several days for palpitations and elevation of the BP with the AstraZeneca vaccine. Surprisingly, I didn’t get any call for side effects after the Sinovac vaccination. All those who developed palpitations and increased BP only had it for a few hours, at most for 24 hours.

I assured them they were probably just excited about it, and that revved up their nervous system, forming more cortisol which increased their BP and heart rate, causing palpitations.

If the palpitations and high BP persist for more than 48 hours, it may be due to the enigmatic mechanism which we occasionally observe in the COVID-19 long-haulers—those with persistent symptoms long after they’re supposed to have recovered from the infection. It’s due to a dysfunction of the nervous system causing tachycardia or rapid heart rate felt as palpitations, and labile BP, either high or low. But none of those who developed palpitations and high BP after the AstraZeneca vaccination had these persistent symptoms.

This should not be a cause for worry, but previously hypertensive patients who get the AstraZeneca vaccine should make sure their BPs are adequately controlled with medications before they get the AZ jab.

Immune system at optimum state

I also advise our young resident physicians and nurses not to get their vaccine shots after a duty day. It’s best to have at least two nights of good sleep prior to vaccination. The immune system may not be at its optimum state when sleep-deprived and may react erratically during vaccination.

That’s why some global experts like my good friends—professors Russell Reiter and Dun-Xian Tan from the University of Texas, and Gregory Brown from the University of Toronto—recommend taking melatonin for several nights prior to vaccination and for a week after.

They published in their papers that melatonin does not only improve the quality of sleep; its immune-system modulating effect can also reduce vaccination side effects, and prolong the immunity generated from the vaccination. I’m privileged to be part of their global alliance advocating high-dose melatonin in COVID-19.

Last week, several European countries were reported to have suspended the use of the AstraZeneca vaccine due to several reports of serious blood clots in various parts of the body. One person was reported to have died from it.

The number is still small, and may just be a chance occurrence. However, there appears to be a temporal relationship between the AstraZeneca vaccination and the development of the blood-clotting complication. The exact figures have not been released, but looking at the sketchy reports, it looks like one in 100,000 people vaccinated.

So, it’s not alarming yet, and definitely the risk from COVID-19 is higher, but if there are additional reports of the blood-clot complications with the AstraZeneca vaccination, we should temporarily suspend also the use of the AstraZeneca vaccines until all doubts about its potential side effects are cleared.

It is also to be noted that side effects are usually worse with the second dose of the vaccine. So, if we’re already experiencing frequent, though mild side effects with the first dose, vaccine recipients may need to be informed to expect slightly worse side effects with their second doses.

But all pros and cons factored in, the medical and nonmedical benefits with vaccination still outweigh the potential harmful effects. It’s a bitter pill we have to swallow. If we want things to get better, we don’t have much choice.