THE DOCTOR IS IN--Lots of tough questions remain as we enter the vaccination phase, with political and irrational nonsense blocking the way to our collective peace of mind, and with both "pandemic fatigue" and human nature that will test both our patience and understanding of our fellow Americans:
1) DO WE WANT TO GET PAST THIS PANDEMIC...OR NOT?
While this question might seem absurd on first blush, there are those who've entirely and inexcusably exploited the pandemic for their own personal economic or political gain. (Photo above. Waiting in line for vaccination.)
One of the best reasons to recall Governor Newsom is that he has overplayed the "shutdowns" at the expense of struggling middle-class Californians--particularly lower-middle-class Californians-- while the rich got amazingly richer.
Let's make something clear--not so much all Democratic politicians, but THESE Californian Democratic politicians running our state in Sacramento are anything BUT sympathetic to the little guy/gal. As the AP reports by the end of 2020 California lost a record 1.6 million jobs, nearly a half-million people stopped even trying to look for work, and business properties saw their value plummet more than 30%...
...all while California's bank account is overflowing by $10.5 million ahead of projections, with the result of requiring the government to send refunds to taxpayers.
2) Those demanding the shutdowns the most were getting PAID.
Pensioners, those working from home, and government workers, and in particular companies such as Amazon, got PAID. And those folks requiring face to face time with their clients (small businesses, waiters/restaurant owners, pharmacy workers, and grocery store workers, to name some of the big ones) had their lives placed at risk, or got sick with COVID-19, or at the least got financially destroyed.
In the past, I've advocated for a 25% tax on those who got incomes to have some of their income repurposed to those who got their incomes yanked...but arguably setting an income level higher than six-digit figures, or perhaps $150,000, should be considered. In general, I am anti-tax, and perhaps my proposed tax would be entirely misspent.
But I am sticking to my guns that those who got rich during the pandemic aren't necessarily bad people, but as a society we sent too many of our hard-working and desperate neighbors straight to Hades. The middle-class among us are NOT lower life-forms than those of us who got paid (including the writer of this piece...ME).
3) Minorities have been shoved to the end of the vaccination line, and wealthier and more politically connected individuals cut their way to the head of that vaccination line.
Now it's hardly a surprise to see the wealthy benefit, and Black/Latino minorities get shoved to the back of society's benefits, but it's particularly horrifying to see Black/Latino minorities have a program meant to improving COVID-19 vaccine distribution used to allow outsiders to grab vaccination appointments.
Furthermore, hotshot providers with insider access to vaccinations have unfairly and immorally allowed COVID-19 vaccination access to the wealthy That's "concierge care", all right!
Ditto for those desperate Californians made to wait for unspeakable amounts of time for unemployment aid in order to eat and have a roof over their heads.
And don't get me started about teachers' unions demanding all of their employees to be allowed to jump in front of the line, before seniors and grocery store workers, in order to open our schools back up.
Do some of the high-risk teachers merit that consideration? Yes!
In particular, the consideration of students being knowingly exposed or even infected when sent to school by parents too desperate or selfish to do the right thing should consider teachers' rights...but social distancing and remote learning while the children are able to interact with one another in either an outdoor or other facility safe for use were options entirely avoided by school districts with the WRONG priorities.
And there are enough safe and smart school districts who DID prioritize their students to prove the bigshot bullies of California's teachers' unions dead wrong in their assertions they were "following the science".
4) OK, let's get back to the good news, and not-so good news about our vaccination situation:
a) U.S. officials have approved the Pfizer vaccine storage at normal freezer temperatures That should allow for quicker and more efficient, and less limited, distribution of this vital vaccine.
b) The FDA has authorized Johnson & Johnson's single-dose COVID-19 vaccine.
Unfortunately, this vaccine has not been tested or cleared for children and adolescents, but these youngsters aren't in need of protection as much as adults and older folks. Furthermore, the single-shot vaccine doesn't need bigtime freezing/refrigeration, and has a different mechanism of action than the Moderna and Pfizer vaccines.
So, with the new vaccine blessed with a more standard, more time-tested mechanism of action, the reasons for Americans to avoid vaccines (because they're "not tested!") has gone down a big notch. The new vaccine uses a harmless adenovirus to carry the genetic code to create the spike proteins of the COVID-19 virus and provoke an immune response.
And this new vaccine compares similarly to the older Pfizer and Moderna vaccines with respect to safety and effectiveness.
The bad news? The government can purchase all it wants, but supplies of the Johnson & Johnson vaccine will be scarce until late April, and therefore distribution will be uneven and uneven..
c) Those with autoimmune diseases, such as lupus or rheumatoid arthritis, or either psoriasis or atopic dermatitis/eczema, will and should NOT discontinue medicationssuch as methotrexate. They should NOT discontinue their medication and should NOT be afraid of getting vaccinated with the non-living vaccines, because these vaccines are NOT live-but-attenuated, and that is why these three vaccines have been fast-tracked for approval by the FDA.
Only those on high-dose prednisone need to think twice about COVID-19 exposure and vaccination, while those on Methotrexate, Mycophenolate mofetil, Azathiprine, Humira, Cosentyx, Otezla, Taltz, and other such agents should NOT stop those medications.
One of the biggest problems I've seen is the horrifying number of patients who let their health go to Hades by discontinuing these vital medications, which--and remember this--may potentially STOP the "cytokine immune storm" that disables or even kills people infected with the virus.
This must end, and I am particularly sick of health care providers still giving their patients bad advice about their vital treatments. Stay treated!
d) Sadly, you can STILL get infected despite being vaccinated, but the likelihood and severity of such infections goes way, way down. Ditto for spreading it to others. Hospitalization is rather unlikely, but the need to do the lousy, miserable masking, social distancing, etc. will NOT go away until...
...we get enough of us vaccinated to establish "herd immunity" and minimize or even prevent the likelihood of the virus richocheting from person to person.
e) Read it and weep, folks--the need for regular COVID-19 booster shots keeps getting more and more likely(like the flu, this beastly virus mutates, and we've all heard of the horrible variants out there in the world just ready and willing to screw up a situation we thought could end with these new vaccines.
Moderna is focusing on this problem.
Ditto for Pfizer addressing the need for a third dose of its vaccine.
And the likelihood of future boosters that address the new variants that have yet to occur?
You make the call--it's a big world, and the consequence of our global economy and access to travel and commerce, will invariably create new and dangerous variants in the months and years to come.
So, the fear of getting vaccinated--already present with previous vaccines used for longstanding diseases--is entirely understandable...but will likely keep this virus in our world for a long, long, long time.
Because human beings are both the most rational and irrational animals on this planet, and the concept of free will and societal obligation will, I'm afraid, NOT end with the increasing availability of these blessed new vaccines.
(Kenneth S. Alpern, M.D, is a dermatologist who has served in clinics in Los Angeles, Orange, and Riverside Counties, and is a proud husband and father to two cherished children and a wonderful wife. He was termed out of the Mar Vista Community Council (MVCC) twice after two stints as a Board member for 8-9 years and is also a Board member of the Westside Village Homeowners Association. He previously co-chaired the MVCC Outreach, Planning, and Transportation/Infrastructure Committees. He was previously co-chair of the CD11 Transportation Advisory Committee, the grassroots Friends of the Green Line (which focused on a Green Line/LAX connection), and the nonprofit Transit Coalition, and can be reached at Ken.Alpern@MarVista.org. The views expressed in this article are solely those of Dr. Alpern.)