What to expect when you’re inoculating (i.e. what you can—and can’t—do after being vaccinated)

What to expect when you’re inoculating (i.e. what you can—and can’t—do after being vaccinated)

Congratulations! You have a fresh SpongeBob Band-Aid on your off arm; a dose of Pfizer, or Moderna, or Johnson & Johnson vaccine sunk deep into your muscle tissue; and the rabbit is … sorry, rabbits have nothing to do with this. However, if your first inclination is to climb onto a table in the middle of the nearest Applebee’s and belt out a chorus of “Climb Every Mountain,” there are several reasons why you really shouldn’t. And only one of them is that you really don’t have the range for that song.

The truth is that, in the immediate wake of getting jab No. 1—or jab one-and-only in the case of the Johnson & Johnson vaccine—the change in your behavior should be … nothing at all. Keep wearing your mask. Keep social distancing. Keep giving those hands the full 20-second scrub. That’s because none of these vaccines is instant. It takes a period of days or weeks before your immune system starts to kick in, and longer before the level of immune response is high enough to give you the kind of coronavirus protection you expect when you hear numbers like “95%.”

The past two days have been the highest yet when it comes to getting vaccine into human beings. At this point, 21% of American adults have received at least one dose of vaccine. That includes a majority of Americans over 65, and two-thirds of Americans over 75. If you’re not in those groups, you’ll soon get your chance. Not only has President Biden promised enough vaccine for every American adult by the end of May, there should be enough doses on hand for 75% of American adults to be vaccinated by the end of April. And with more than half of white Republicans saying they won’t get the shot … that’s more for everyone else. 

In the next few days, the CDC is expected to issue guidelines for those who are the proud new owners of immune responses to COVID-19. But just what is that advice to the inoculated expected to be?

As was made clear during each of the hearings before the FDA’s panel of outside experts, it takes time for each of the vaccines to really start to work. For the Pfizer and Moderna vaccines, there seemed to be a sharp distinction between the group of patients who received the vaccine during trial, and the placebo group, starting around 12-14 days after the first injection. Protection then was still far from perfect, but the departure from the people who didn’t get the vaccine is pretty distinct. 

Here’s what that looks like in Pfizer’s phase 3 trial data.

Pfizer / BioNTech vaccine vs, placebo in Phase 3 trial.

Two weeks after the first jab, new cases among the vaccine group are much more spread out. Yes, even three months in, some new cases of COVID-19 are appearing among the vaccine group—but they’re much, much less common than among the placebo group.

However, there’s one thing that’s really vital about this chart that’s easy to overlook. Get out a magnifying glass, and focus in on the first 10 days. What can be seen in both groups is that the rate of infections immediately after getting that first jab is quite high. In fact, if you hold a straight edge up to this section of the chart, you can see that the rate of infection for both patients getting a vaccine and those getting a placebo is higher in this first week than it is for the placebo group throughout the rest of the study. 

That’s not because getting a needle to the arm makes you more susceptible to COVID-19. It’s because getting a needle in the arm makes some people feel less susceptible to the virus, even when they’ve been told they’re not. And having just escorted my 86-year-old mom through her first shot with the Pfizer/ BioNTech vaccine, I can tell you that no one stepped up to give her any lecture about the vaccine not being an instant, 100% effective shield. Vaccine providers are getting vaccine into arms as fast as possible. They just expect you to know this stuff.

Here’s a similar chart for Johnson & Johnson’s vaccine.

Johnson & Johnson vaccine vs, placebo in Phase 3 trial.

One thing that’s immediately apparent about Johnson & Johnson’s single-dose vaccine is that the “peel away” point is less dramatic. The placebo group and vaccine groups diverge at around the same point, just after two weeks, but they trend much more similarly over the next two weeks. When Johnson & Johnson sets the efficacy of their vaccine at 72%, that number comes from looking at a point about 28 days after the single vaccination—or at about the same point folks getting the Moderna vaccine are getting their second shot. But as the chart makes clear, things get better after that. In fact, the uptick at the end of the line is actually due to modeling. In terms of the real data, there are no more moderate/severe cases of COVID-19 among people receiving the Johnson & Johnson vaccine after that last lonely dot around day 48. And that’s despite the fact that parts of this trial happened in South Africa, where one of the more contagious and evasive variants made up over half the cases.

What does all this tell you? When a vaccine becomes available to you, get it. They’re all good. There are arguments that might be made for one to be better than the others in some specific fashion, but if you’re not the person in charge of maintaining the freezer, and you don’t mind making a trip for a second shot, it doesn’t matter. Take a vaccine when it’s offered.

And then hunker down for the next month. Because you’re not done cooking.

For those who are fully vaccinated

At the end of that month, everyone will have had their second shot, or had long enough for the single shot vaccine to do most of what it’s going to do. Immune response should be high, antibodies should be raging, and look out coronavirus! What then?

Indications are that the CDC guidelines, which were stalled under the … what was that guy’s name again? … administration, have now been drafted and sent to the White House for approval. What’s in them isn’t clear, but it surely contains some of these points:

  • Keep wearing your mask. There are several reasons to do this. One of them is that even 95% is not 100%, and you really don’t want to find out you were one of those who failed to cook up a sufficient response. An even better reason is that, even if you’re not sick yourself, you may still transmit the disease. Moderna did the grunt work during its trial to be pretty sure that it protects against transmitting the virus as well as preventing infection. The not-available-here AstraZeneca vaccine also did the necessary checks. Additional data makes it likely that Pfizer is also likely to ward off transmission. However, notice how all the stuff about Johnson & Johnson really just looks at “moderate to severe” cases? A trial that doesn’t count people with mild cases is certainly not protecting against asymptomatic cases. Finally, failing to wear your mask is a bad signal to people who have not been vaccinated. One day soon, we’ll all get the signal that masks are optional. Don’t go there yet.
  • Don’t engage in risky behavior. Meaning it’s not yet time to get together with 50 of your closest friends, or to take in a five-course indoor meal, or to do anything that involves taking Jell-O shots off a body part (unless this is among a small number of consenting adults in your own home, in which case, go for it). Basically, if you wouldn’t do it before getting a vaccine, don’t do it after getting a vaccine. Not as long as the virus remains uncontrolled and the case counts remain unreasonably high.
  • Except … some of those things that you’ve been putting off doing, you should really give yourself permission to do. If you’ve spent a year dealing with mushy fruit delivered by someone at Instacart who always just grabs the first damn apple off the top, even if that apple is missing a bottom, indulge yourself. Go to the grocery and buy your own produce. Wear a mask. Wash your hands. But get a decent Gala, by God. Maybe even indulge in a SweetTango. 
  • Stop putting off those necessary medical tasks you’ve been putting off for a year. This is especially true if you are, for example, in the same category as a certain Daily Kos writer who is realizing that he is way overdue for all kinds of unpleasant, but necessary tests that come with being an Old Person. Wear your mask. Wash your hands. But stop postponing that appointment.
  • Mostly stop doing more than the CDC had in their guidelines to begin with. Reach into your paranoidometer and crank it down a notch. Maybe two. Visit the farmer’s market. Don’t be afraid to dart into the local bodega (or Dollar General Store, depending on your level of ruralosity) and grab that quart of milk when you’re short. Stroll in the park. You might, and this is a maybe, even think about getting that haircut. Though the length suits you. It really does. And remember: Wear a mask. Wash your hands. Keep social distancing.

When the CDC gets some official guidelines out, expect an update. Because they’ll likely have many more suggestions and give a lot more specifics on what’s in and out for the immunologically empowered set. And somewhere around the time we’re shooting fireworks in July, all of these rules may get wadded up and tossed away. We’ll see.

Anyway … keep wearing that mask.

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