Carson-Newman Trustee Addresses Covid Vaccine

^{By Dr. Hong I. Tjoa, MD, FACC}

As we continue to battle the Covid-19 pandemic, especially with the recent rise of the more infectious Delta variant, we all face the question of what is best to do in the interest of all individuals.

Diverse sources of conflicting information, various experts disagreeing with one another, and a polarized American society serve only adds to the confusion and further clouds the answer to this complex situation.

As a result, no one can claim that he/she has that answer. But God has given us all a mind and conscience to carefully weigh choices. Honestly, the options to control the virus and put this pandemic behind us are limited. Though the coronavirus may ultimately become an accepted part of human society (endemic), it needs to be bridled and not allowed to bring the entire world to its knees.

With the arrival of the more transmissible Delta variant and increasing Covid cases in our communities, “conditions on the ground” have changed for the worse since the spring of this year. As cases increase, so do hospitalizations and deaths consequently, and the healthcare system becomes overburdened again.

I wish to share some thoughts coming from one being an “on-the-ground” clinical observer and participant in this Covid battle, a physician wanting the best for his patients and community.

This is not about taking sides with either liberal or conservative politics or policies, but rather a hope for a collective will (not in any socialist or Marxist sense) in fellow Americans to seek the greater good for all and want to look out for one another. The end goal is to return to “normalcy” in life, a life that we all have been so blessed with in America.

Uncontrolled, the coronavirus will continue to infect, multiply and mutate. Unfortunately, this mostly occurs in defenseless individuals, the non-immune (unvaccinated and uninfected), who bear the highest risk of serious illness, hospitalization and death. This is particularly true in those with preexisting conditions like obesity, hypertension, diabetes, and chronic heart and lung disease.

This leads to an overrun healthcare system as new cases persist. The serious and potentially deadly consequences of this for the public can not be underestimated. Limited access to medical care because of shortage of hospital and ICU beds and staffing is real in the current Covid crisis. The faces of my fellow healthcare workers reveal the physical and emotional strain of their grueling work, but they don’t give up on their patients. The situation is unsustainable, however, and doesn’t bode well for a community that desires and deserves timely access to quality and safe healthcare.

God can reveal and provide through science, technology and medicine. This has been shown throughout history. Now, though not a perfect solution, He has gifted us with an option to move beyond the present state of this pandemic.

Greater “immunity in the community” is the best option to control the virus and cause the pandemic to recede. Natural immunity from a Covid infection is part of it. But the timing, course of disease, and level of immunity in all individuals is unpredictable. Along with unknown long-term effects of an infection and possible post-Covid syndrome (“long Covid”) with its debilitating symptoms that can affect daily living for weeks or months in up to 30% of cases, natural immunity is a riskier gamble.

On the other hand, vaccine immunity that prevents a Covid infection, while not risk-free, is an effective and safe alternative. Studies show vaccination reduces risk of infection by tenfold and hospitalization and death by twenty-five-fold. Getting a Covid infection from the currently available vaccines in the U.S. is not possible. Besides rare cases of myocarditis (self-limited heart muscle inflammation) in younger men (Pfizer vaccine) and venous clot in younger women (J & J vaccine), there have been no other known credible reports of serious side effects definitely related to the vaccines. This is even after over 2 billion injections globally and about 180 million inoculations in the U.S. since the vaccines became available. So far, vaccination also continues to effectively protect against the most serious effects of Covid-19, namely hospitalization and death. This is the most important reason to get vaccinated.

A number of other concerns have been voiced about the vaccine’s safety: speed of vaccine development, potential long-term effects, and effect on fertility. Operation Warp Speed was an historical accomplishment that combined the resources of the scientific community, private corporations, and the U.S. government to fight a single “enemy,” Covid-19. This allowed the coordination and acceleration of vaccine trials and production under the supervision of independent groups (Data Safety Monitoring Boards) to guard against shortcuts on safety. Moreover, usual bureaucratic “red tapes” in vaccine development and manufacturing were broken. This unprecedented action led to the rapid approval of the Emergency Use Authorization (EUA) of the vaccines without compromising safety. In fact, the criteria used for approval of the EUA for such a vital vaccine come close to those needed for full vaccine approval. So, the usual time (years) to test and make a vaccine had more to do with established time consuming protocols and burdensome regulations than looking at safety and long-term effects.

The long-term effects of the vaccine are not yet known. Yet, neither are those of a Covid infection. Researchers looked at occurrence of side effects at 2 months after the last vaccination to determine their true connection to the vaccine. Events occurring many months to years after vaccination will be much harder to relate to the vaccine.

Admittedly, there is currently no firm data on vaccination effects on fertility, but, on the other hand, fertility effects of a Covid infection also remains unknown. There is data showing vaccine safety during pregnancy, when women may be at higher risk of severe illness from a Covid infection and losing their child.

More recent developments in the Covid saga are breakthrough infections in those vaccinated and the need for a booster shot. This is worsened by the presence of the more infectious Delta variant that can also better (not completely) evade the vaccine. Data shows waning vaccine immunity over time as antibody levels in the blood fall. This is true of all vaccines.

However, this doesn’t mean that the vaccine is ineffective or useless because it can still protect against the most serious and deadly consequences by way of the body’s so-called adaptive immune response (memory B cells and T cells). It can even adapt to fight against the Delta and other variants. Fortunately, breakthrough infections are rare, less than 1%, but the elderly, immune compromised and those with high-risk diseases are more vulnerable. With waning vaccine immunity and fitness of the Delta variant, a booster shot to augment immune protection in the most vulnerable is justifiable. In the final analysis, best protection against Covid-19 for all is vaccination in those who remain defenseless, the non-immune (uninfected and unvaccinated).

Herd immunity is reached when 70% – 90% of the population becomes immune by way of natural immunity from infection or vaccination. Gaining immunity from a Covid infection is a riskier proposition. Until herd immunity happens, public health mitigation measures, i.e. masking, distancing, hand washing, and sanitizing, still do work and help. These same techniques were the only ones available during the 1918 flu pandemic before there were vaccines and treatments. That pandemic killed 675,000 Americans when the U.S. population was 1/3 of what is today and about 3% of the world population. Mortality was shown to be lower in cities that used mitigation measures consistently. Can you imagine the death toll without those measures? These are also the same protocols followed for years in hospital infection control and in operating rooms prior to the Covid-19 pandemic.

The purpose of this article is not to shame, force or suggest a mandate for anyone to mask or get vaccinated. Rather, it was to make an earnest plea to fellow Americans to wisely consider and weigh the options to fight and win this war against Covid-19 together – to do things not only for the benefit of self, but also that of others around us. These include vulnerable people as mentioned and nowadays children not yet eligible for vaccination. God knows we need this kind of mindset now more than ever! Our options are limited, and there are no perfect solutions. To do nothing and stay where we are is not an option. The situation is not improving and may be getting worse. This pandemic cannot be allowed to drag on and continue to divide us and dictate our lives. Vaccination is an effective and safe option to choose now in order to move us forward. Let us all pray for an end to this pandemic, do what we can to protect one another, and then leave all the consequences to God.

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Dr. Hong I. Tjoa serves on Carson-Newman University’s Board of Trustees. He specializes in the diagnosis and treatment of cardiovascular disease. He is experienced in a wide range of non-invasive imaging studies, including nuclear cardiology, echocardiography and cardiac magnetic resonance imaging.