Vaccines in the time of Corona

Covid Vaccines:

If you are able, I would recommend exploring vaccine availability at My Turn(external link)

Unfortunately, Full Circle has not been allowed to sign up to administer vaccine, But we are absolutely in support of people being vaccinated.


The Pfizer and Moderna vaccines are not contraindicated for those with allergies, even anaphylaxis to foods(though they should be monitored for 30 minutes afterward instead of the usual 15 minutes), but it is recommended that anyone with a history of anaphylaxis to any other vaccine consult with a physician, perhaps an allergist, prior to receiving it. There is speculation that polyethylene glycol may be causing some of the reactions - that is in miralax and some bowel prep regimens.

We do not know enough details about possible deaths after the vaccine for me to give advice, but I can say that the risk of SERIOUS adverse reactions like anaphylaxis is about 5 cases per million doses administered(0.0005%) for the Pfizer vaccine, whereas the mortality from Covid-19 looks like about 2% overall (4000 times as high), and as high as 13-20% for people over 80 years old. I always think the risk of a vaccine needs to be weighed against the risk of the disease it protects against, so I am urging people to get this vaccine.

Also, although the Moderna vaccine has had some bad press, the risk of anaphylaxis looks lower with it than the Pfizer, maybe 2.8/million.


The Janssen vaccine is in a more traditional adenovirus vector, not relying on mRNA. The most allergenic ingredient that we are aware of is polysorbate-80. I think it makes the most sense for those who are at moderate or lower risk of severe disease, and for my patients with needle phobia, since only one dose is required, but as it turns out it may cause more Guillain-Barré and other autoimmune responses than the mRNA vaccines.

Regarding boosters:
Right now, the only people who are actually recommended to receive boosters by the CDC are those who are immunosuppressed(external link)
There have been a number of confusing and contradictory announcements, but right now, I am not recommending booster shots for my general patients, only for those of you who have CLL, are on strong medications for rheumatoid arthritis and similar conditions, are undergoing chemotherapy, etc.

Although immunity is falling in those who have been vaccinated (see for example this article(external link)) We still have good protection against serious illness from our original vaccine series, and all of us should be masking at this point. For those who are vaccinated, if you are infected through a mask ( i.e. lower viral inoculum) and you are eating lots of veggies and not an inflammatory diet, you are still very unlikely to require hospitalization, etc. Particularly since we now have access to the monoclonal antibody therapy in Humboldt County ( see my treatment page), I do not think my vaccinated patients need to be frightened at this point, and I will update this when it becomes clear that boosters should be given to everyone, and at what interval.

updated 9/15/2021

Preparing for your vaccine

A number of patients have contacted me asking about what they should be taking or doing prior to receiving the vaccine. Fortunately, these are all highly effective vaccines, so I do not think that any sort of special immune support is required to ensure a response, but I would recommend being well rested, and approaching the vaccine with gratitude, not fear.

There was an interesting study by Pennebaker at al looking at disclosure of personal trauma and vaccine response:(external link) Journal writing about personal trauma actually led to an improved response to hepatitis B vaccine in medical students. So maybe pull out your journal and get something off your chest before you go in.

I definitely recommend not aggressively treating fever in people who are actually infected with influenza or Covid 19, however it is not clear if pre-medicating for the vaccine will mute the response. Just in case, I recommend not taking anything until 6 hours after your dose of vaccine, at which point controlling fever and discomfort in the arm is fine(with acetaminophen or ibuprofen unless you have stomach problems or some other reason not to take those.) I also recommend a cognitive reframe: if you have flulike symptoms from the vaccine, think of that as your immune system doing its job of responding to the vaccine and protecting you from a severe and much more miserable illness, and be grateful that your immune system is letting you know it is working.

Flu shots in the time of Corona:

MARCH 2021 update: I think that time is past for flu shots this year, but I will leave in place the advice I was giving last fall:

I was recommending:
  • Please DO get your flu vaccine this year, particularly if you are over 65 or have underlying medical conditions would make you high risk for influenza.
  • The flu season in our area is often late, February or March, so I recommend delaying the vaccination until the first or 2nd week of October, so that immunity will last.
  • Whatever you are currently doing to protect yourself against exposure to Covid 19, please step up those precautions during the couple weeks before and after receiving the flu shot, because it may increase risk of severe disease if you are incubating Covid 19 or are exposed to it around the time of receiving the flu shot.
  • Contact your pharmacy and ask if they are willing to give flu shots outdoors or are planning any sort of drive through flu shot clinic. (I am hoping that this suggestion coming from enough clients will inspire someone to do so.)

My reasoning:
As I have discussed with many of you, I have some ambivalence about flu shots this year, because although I do believe that the flu shot can be lifesaving for patients over 65 or with underlying risk factors, they may actually increase the risk of acquiring other respiratory infections for children and possibly some others. (See articles below regarding this possibility.)

That said, it appears that the greatest risk may be in the first few weeks after vaccination, which is also part of why we recommend giving vaccines either on the same day or 6 weeks apart, because the 2nd vaccine will not have a robust response while your body is in the middle of reacting to the first vaccine. My suspicion is that your body may also not respond normally to a new infection within the first week or 2 after vaccination. This has been seen with the Hib vaccine for meningitis in children, where there is an increase in meningitis in the first week after successful vaccination, but then lifelong protection thereafter. A similar phenomenon was apparently seen with typhoid vaccine more than a century ago.

At the same time:
1. influenza may be difficult to distinguish from coronavirus clinically
2. We sadly cannot rely on our neighbors to universally use precautions to decrease the transmission of flu this year, since they do not seem to be doing that even with Covid-19, and
3. Anyone getting seriously ill from influenza is likely to need to seek care in a setting where patients with Covid-19 also will be seeking care, increasing the risk of acquiring the 2nd infection, and also further overwhelming healthcare resources.

Thus, I am asking patients to get their flu shots but take extra precautions to make this safe.
If you are due for a Pneumovax, please get it at the same time as your flu shot.
If you need a tetanus booster because of a high risk injury, get the tetanus shot. (Tetanus has a 50% mortality!)
On the other hand, shingles rarely kills - I would recommend waiting on the Shingrix series until you are immune to Covid-19. . .

Association between the 2008–09 Seasonal Influenza Vaccine and Pandemic H1N1 Illness(external link) - multiple observational studies suggested that seasonal flu shots increased risk of pandemic H1N1 illness
Assessment of temporally-related acute respiratory illness following influenza vaccination(external link) - the risk of respiratory infections other than influenza was higher in the 2 weeks after the flu shot in children
Epidemiology of respiratory viral infections in children enrolled in a study of influenza vaccine effectiveness(external link) - kids who got the flu shot got more non-influenza respiratory infections
Haemophilus influenzae Type b Meningitis in the Short Period after Vaccination(external link), Disease Caused by Haemophilus influenzae Type b in the Immediate Period After Homologous Immunization(external link) - children may be at increased risk of meningitis in the first week or so after receiving the Hib vaccine