Vaccination: What If I Already Had COVID?

Current recommendations are that people who had COVID should still get vaccinated. Does it do any good? In looking into this, I found two recently published papers (there may, of course, be others) that address this question with interesting results [1].

First, yes, the first dose of the mRNA vaccines significantly boosted the level of antibodies of people who previously had COVID. But interestingly, the second dose didn't seem to add much additional benefit.

At the same time, systemic reactions (fever, chills, fatigue, et.) to the first dose were more common in people who previously had COVID than in people with no prior exposure. Reactions to the second dose were similar irrespective of exposure history.

Does this mean that if you've already had COVID you can skip the second mRNA dose? Well, on average the data seem to point that way, although there will always be variability in the population. We don't know what the longer-term effects would be, like how long the antibody levels stay elevated. But if you previously had COVID and were miserable from the first mRNA dose, you might talk with your doctor and/or health department to see what they think.

I don't know whether or not recommendations will change based on these data. One problem is that people are often not reliable in recounting their health history. I know people who think they had COVID very early in 2020--so early that it is unlikely to be true. One person was convinced they had it in the fall of 2019! So if health officials said, "If you had COVID you only need one dose," there is a legitimate fear that we would end up with a bunch of half-vaccinated people because they self-diagnosed themselves as having had COVID. So I can't blame health officials if they just stick to two doses to help ensure everyone is fully vaccinated. But if you are really sure that you had COVID, then it might be a conversation worth having with your doctor and/or health department.

Notes:
1. Pre-print versions of these papers came out in February. However, official publication was within the last two weeks, and both can be viewed for free: here and here.

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Vaccine #2 Achieved

This week I received my second dose of the Pfizer COVID vaccine. Hooray! The next day was no big deal for me. I had some minor aching in my back and legs, and of course a sore shoulder, but if I had woken up with amnesia I wouldn't have had any reason to think that day was out of the ordinary (except for the shoulder, which was fine by the second day). Soon I will be considered fully vaccinated (i.e. second dose plus 10-14 days).

I'll be honest that things weren't as smooth for my wife. She started feeling increasingly ill the next day and developed a fever that got as high as 100.8 degrees F, along with a lot of aching (she said even her toes hurt) and chills. It hit hardest about 24 hrs after the vaccine, but after another 7 hrs the fever broke. On the second day she was feeling better, but still recovering from the soreness. By the third day she was pretty much fine [1].

It's impossible to know, but I can't help but wonder whether our respective responses to the second dose would have any correlation to severity of disease. If so, my wife would have been in pretty bad shape. Or, if it were an inverse correlation, I would have been in bad shape. Fortunately, we'll never know.

Some may think, "Well if I have a chance of getting sick with or without the vaccine, then why get the vaccine?" That's the wrong way to look at it. First of all there is the simple matter of duration. My wife was miserable for 1 day, and then it was over. People who get COVID are miserable for many days. Second, although my wife felt ill as a result of her immune system kicking into gear, there was no underlying disease. There was no virus causing damage to various organs, no loss of smell, no coughing, no extreme fatigue, and no breathlessness from simply going up the stairs. There was also no wondering when (or whether) recovery would come, worrying about whether a trip to the hospital would be needed, worrying about whether anyone else in the family would be next, or worrying about long-term effects. Other than some special cases, there is no rational risk assessment that would suggest that it's better (or neutral) to not get vaccinated.

We can't completely throw caution to the wind yet, since our 13-year-old is still vulnerable. But Pfizer has reported 100% efficacy in his age range, so I think it's probably only a matter of days before it is approved for him. At any rate, our family is close to being immune (our daughter was previously vaccinated due to some lucky circumstances--with no side effects), and I can soon go out to lunch with coworkers without worrying about getting sick myself or bringing the virus home to my family.

So my advice is to get vaccinated, but if you get the Moderna or Pfizer vaccines [2], just assume that you may need a sick day after the second dose. If your experience is more like mine, then great! But if your experience is more like my wife's, then at least you will be prepared.

Notes:
1. My wife had/has a bulging disk in her neck, so if she's not careful with her posture there is a domino cascade of muscle cramping in her upper back and a resulting headache. We think that the hunching and shivering set off that cascade, so technically on the third day she was still recovering from that.
2. I'm not as familiar with the Johnson & Johnson side effects. My wife's social media intelligence is that they are less severe, but last longer.

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