How to get 25 million more Covid-19 vaccines into the arms of Americans

On the morning of December 31, I received the Moderna Covid-19 vaccine. But now, I am not sure I should have gotten it. Here’s why:

As a doctor, in March I had gotten Covid-19, likely from a patient. At the time I had moderate symptoms of fatigue, fever and loss of smell and taste. Covid tests were unavailable to me at the time — but several weeks later I took several antibody tests which confirmed the presence of Covid-19 antibodies. At the very beginning of the pandemic, I wrote about my early experience and advocated the garlic smell test, masks, opening windows and staying outdoors as much as possible to combat the spread of Covid-19.

On New Year’s Eve day, I got the vaccine at the hospital where I perform surgery. The injection was uneventful. But as the day wore on, I felt exhausted and had chills, recurrent fevers, muscle cramps, and joint pains such that I couldn’t get out of bed for the next 48 hours. I inquired at the hospital whether others had similar severe reactions and was told they had a few just like mine. I asked if they could check with those with bad reactions on whether they had previously had Covid. The injection team checked, and several said they had previously had Covid. I am on doctor message boards and learned of similar situations nationwide.

“…we may be wasting vaccine on millions who don’t need it.”

I contacted the CDC (I registered with the V-Safe app) with no response to my concerns and experience. After the long weekend, I finally spoke to a representative and was told to fill out the Vaccine Adverse Event Reporting System (VAERS) form, which didn’t even ask if there had been previous Covid-19 infection. It made no sense to me that neither the vaccine approval research, nor the subsequent monitoring, asked the important question of whether previous Covid patients should get the vaccine, and if so, did they really need two doses? I believed this was so important, that I contacted the New York Times on January 6, 2021 with my experience, and those of others, and stated that “…we may be wasting vaccine on millions who don’t need it.” On February 1, 2021, the New York Times ran a story on this phenomenon and quoted me and others who had Covid-19 and a serious reaction to the first dose of the vaccine. They also reported on research which confirmed this correlation. The scientists found that antibody levels in previously infected vaccine recipients were 10–20 times higher than those who were never infected, even after only one dose. These findings suggest that a single dose of mRNA vaccines elicit strong immune reactions in previous Covid patients, even higher than in non-Covid infected patients after 2 doses. Basically, the infection serves as the “first dose” and a single dose of the vaccine is the “booster.” The authors suggested that we should be testing for antibodies and strategically deploying vaccinations.

Based on this research, the NYT journalist correctly questioned whether people who have had Covid-19 should even get the second vaccine. Indeed the headline declares : “Had Covid? You May Need Only One Dose of Vaccine, Study Suggests.” This is a great suggestion, as it goes directly to the health of the at least 25 million Americans who have already had Covid. This could save 25 million doses and have them go to Americans now waiting for the vaccine, and I am happy to pave the way. Having had Covid-19 and experienced such a strong reaction, I am not going to get the second dose — or at least not until more research shows that I should.

For me, there is an even bigger question and perhaps a similar opportunity. Given the shortages of the vaccine and unresolved questions like this — should those who have had Covid-19 even get the first dose? I clearly have Covid-19 antibodies. This is clear from several (OneMilo) Covid-19 rapid (15 minute) antibody tests I took. Each test found positive antibodies from a single drop of my blood. It is also clear from research studies that confirmed ny antibody titers. It is also clear from my reaction to the vaccine.

If you have antibodies/immunity to a virus you are unlikely to get the viral infection as the job of antibodies is to fight the virus. Your cells have the memory to fight infection even as antibody levels drop. To believe that you don’t have some degree of lasting immunity after an infection is to discard all we know about germ theory. And if Covid infection disproves germ theory, then we have bigger issues, like permanent social isolation.

Fortunately for us, Covid has not disproved germ theory. For one, very few people have gotten Covid-19 twice. Antibodies fight infection, that is why viruses die and we survive. It is still an open question of how long the Covid-19 antibodies last and their duration certainly varies from person to person, but if a test can determine they are there, then I am not sure it makes sense to give the vaccine to that person.

Moderna, when it tested its vaccine, appears to have excluded people known to have had Covid. Yet somehow it reported that roughly two percent of its test subjects had had Covid and did not report any adverse or different reactions. It is a confusing situation and the FDA filing simply isn’t clear. More, the initial study was intended for those without previous infection, so this 2% rate in the Moderna study does not mean the vaccine is needed or indicated for those that have had Covid.

Today, the protocol is not to even ask vaccine recipients if they have had Covid. The CDC app for self-reporting symptoms after vaccination does not ask this crucial question. This needs to change immediately so the data can be collected. It may even make sense to test at least some of those getting a vaccine for the presence of the Covid-19 antibody first, and give those with positive tests the chance to opt out of receiving the vaccine. This should especially, and immediately, be done with at-risk patients like the frail and pregnant where the side effects of the vaccine may be far more serious than the small risk of getting Covid a second time.

The quick creation of the Covid-19 vaccines is a wonderful testimony to scientist ingenuity combined with smart federal government policy. But the distribution and manufacturing of the drugs have been spotty and the roll out so inconsistent that we will be in a shortage situation for several months. Indeed, this past week, Kaiser Permanente cancelled 5,200 injections due to a shortage of vaccine.

This needed change in policy is also a global opportunity. Many countries of the world have no prospect of getting adequate shipments of vaccines and thus will not receive herd immunity until 2022, 2023 or later. In short — we are still in a crisis! What good is it if we can vaccinate Americans but the rest of the world remains unvaccinated?? We need to be wise in how we prioritize who gets a limited supply of vaccine.

So let’s be smart and speed the process up. We should eliminate the second dose for those that have had Covid and reconsider whether those who have had Covid really even need the first dose at all. This should bring down deaths and serious illness from Covid-19 as those who clearly need the vaccine will get it before those that probably don’t.

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Vitreoretinal Surgeon, American Board of Ophthalmology Examination Developer, Patent Holder, Researcher, Entrepreneur

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Susan M Malinowski, MD

Susan M Malinowski, MD

Vitreoretinal Surgeon, American Board of Ophthalmology Examination Developer, Patent Holder, Researcher, Entrepreneur

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