December 15, 2020 / Charles W. Lapp, MD / Ask The Doctor
Q: Should I take the COVID-19 vaccine when it becomes available?
A: Many PWCs (Persons with CFS or FM) have developed a flare or relapse after vaccination with live viruses, so we have always recommended avoiding immunization with influenza vaccine, the MMR, and Hepatitis B, if feasible. The question is: how safe are the COVID-19 vaccines?
Currently there are at least 52 COVID vaccines in clinical trials according to the WHO, two of which will be imminently available in the USA. These are produced by Pfizer and Moderna here in America. Products by Astra-Zeneca and Johnson & Johnson are not far behind.
The Pfizer and Moderna products are not made from live virus, so they are not likely to cause flares or relapses in our PWCs. They both require two doses 21 to 28 days apart. It takes about 2-3 weeks to develop a 50% level of immunity after the first dose, and that level persists for just a few weeks so the second immunization is necessary. The vaccines are about 90-95% effective, but there is no data yet on how long such immunity will last. Side effects of the vaccination include injection site soreness and fever in most cases, increased fatigue (up to 60%), headache (up to 50%), muscle aches (37%), and chills (32%), especially after the second jab. These symptoms resolve in 24 to 48 hours, and a minority of individuals has to take Tylenol or other remedies for them.
Our concern is not the short term effects, but long term. The Pfizer and Moderna vaccines have been administered safely to thousands of individuals already, but new issues are likely to arise after millions of individuals have been immunized. Time will tell. This is currently a moot point since the vaccines will be provided first to medical providers, health care workers, nursing home residents, prison inmates, and first responders. It will probably be many months before they will be available to the public, so we will probably have a much better idea about long term effects by then.
Because COVID-19 is such a severe disease we currently recommend that high risk individuals strongly consider vaccination. These include individuals with high blood pressure, diabetes, obesity, asthma or pulmonary disease, cardiovascular disease, and immune deficiency. The vaccines have not been adequately tested in pregnant or lactating women, or in children under 16 years.
Since PWCs frequently suffer immune dysregulation, many wonder if they should be considered “immune deficient.” Our opinion is that many patients have an UP-regulated immune system and fend off viruses readily, so they rarely fall ill. If you are the type of individual who “catches every virus that comes along,” then you are probably in the minority of DOWN-regulated patients and should highly consider the vaccination when it is available.
Despite immunization there is still a small but significant chance one could contract COVID-19; therefore, prevention is KEY. Dr. Lapp has just reviewed dozens of past epidemics and one point is clear: frequent washing, hand sanitizing, face masks, and isolation are crucial for avoiding infection.
Dr. Bateman, from the Bateman Horne Center recommends the following:
"We [the world] certainly need COVID-19 vaccines desperately and everyone who is healthy enough for the vaccine should get vaccinated, starting with those at highest risk of COVID exposure. This includes healthy family members of vulnerable people. For the ME/CFS/FM population, my advice is to stay safely quarantined and wait a couple of months while the vaccine is distributed and broadly administered. Because of the large numbers and close monitoring, we should know fairly quickly how people do with the vaccines. This advice will apply as each new branded vaccine is approved and rolled out. In general, the people who should be most cautious are those who have previously had allergic reactions to vaccines or are prone to severe allergic reactions in general. If you decide to get the vaccine, be rested and stable prior to the vaccine, and plan on resting/relaxing for at least 72 hours afterward. Supportive care will include anything you usually do for flu symptoms, PEM, allergy flares, worsened orthostatic intolerance, etc. If anything, including a vaccine, makes you sick enough that you are unable to maintain adequate fluids and nutrition, or results in fluid and electrolyte losses (sweating, diarrhea, etc), it is always appropriate to seek IV fluids as a primary intervention."