I received my second COVID 19 shot (Pfizer) at noon last Tuesday at a flawless event powered by Cass Lake Indian Health Service and Leech Lake Tribal Health Division. I was one of almost a thousand people vaccinated over two days. No waiting. Comfortable social distancing. Friendly, professional, efficient, organized. I reconnected with some of my favorite Cass Lake elders. It was awesome and I felt great.
That is until about 9 PM. I was on the phone with my daughter when suddenly my teeth started chattering. I felt a wave of fatigue and weakness come over me followed by a pounding headache and muscle pain all over my body. All I could do was get to bed as fast as possible. Which is where I sweated and shivered for the next 16 hours. I was intensely nauseated, all my teeth ached, and my temperature peaked somewhere north of 102. With the help of acetaminophen, I was able to pull myself together and see a few patients by midafternoon on Wednesday. Thursday I was much better but still tired and feverish. By Friday I was back to normal, out skiing the trails.
So, what the heck happened? The first shot was so tame! Nothing but a sore arm. Why this, now? Well, remember those friendly immune cells (macrophages and neutrophils) that showed up to check out the first dose? They showed up again, took in the m-RNA, and made a little bit of corona spike protein. (See Why I Vaccinated Part 2). Only this time, the lymphocytes that were educated by the first dose were wised up and ready to fight. It took a few hours for the message to get to the lymph nodes and activate the highly trained special ops forces. But once the B cells and T cells (lymphocytes) got wind of the invading mischief they pulled out all their tricks, unleashing antibodies, cytotoxic killer cells, and CYTOKINES!
Cytokines are chemicals made by immune cells to communicate with each other and the rest of the body. Dozens of them are involved in any immune response and they do a complicated dance stimulating and inhibiting each other depending on the job to be done. They are responsible for the familiar “flu like symptoms” we get with infections. Some tell the brain to increase body temperature since immune cells work better when the thermostat is turned up. Shivering is a quick way to increase temperature. They trigger fatigue, headache, muscle and joint pain as strong messages to lay low and avoid extra stress so all the body’s energy is available to deal with the emergency. Similarly, nausea and lack of appetite discourage eating, freeing up energy that would be used in digestion. In short, they trigger what scientists call “sick behavior” which is basically curling up in a miserable little ball.
Now, if you’ve been keeping up with COVID you might be a little alarmed. Isn’t “cytokine storm” one of the really bad things the SARS CoV-2 virus can do to you? When something gets in the way of regulating the immune response there can be too many “on” and not enough “off” messages generated by the cytokines. When this happens blood pressure, heart, and lung function can be severely affected . This happens in a small number of the sickest people with COVID (and other infections). There is no danger of cytokine storm from the vaccine and no evidence that being vaccinated makes cytokine storm more likely from COVID or other infections.
So, what should YOU expect when you get your vaccine? The good news is my more severe reaction happens in only about 3-20% of people. Younger people are more likely to have severe symptoms since the immune system gets less reactive with age. Many people will have nothing but a sore arm from both doses. Most (40-60%) people will have some mild flu like symptoms and maybe a low-grade fever for a few hours to a few days, more likely with the second shot. Moderna and Pfizer vaccines have very similar side effect profiles.
The bottom line is even severe side effects of the vaccine are short lived and way less dangerous than getting COVID. Would I do it again knowing what I experienced? Absolutely and without hesitation. Vaccination is the only way out of this pandemic. I vaccinated for me and I vaccinated for you. Next post will be how to prepare for your vaccine and what we can expect from the new variants. Till then, wash your hands, wear your mask, and keep six feet apart. We will get through this together.