Everyone except me should get the coronavirus vaccine.

December 7, 2020

A Nursing Researcher’s Experience in a COVID-19 Vaccine Trial

Kristen R. Choi, PhD, RN1,2
Author Affiliations Article Information
JAMA Intern Med. Published online December 7, 2020. doi:10.1001/jamainternmed.2020.7087

I was scrolling through Instagram in early August 2020 when I saw an advertisement that caught my attention. Usually, I swipe past these without a second glance, but this was for the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine trial. It was recruiting participants for the highly publicized phase 3 trial of a new vaccine, BNT162b2, that had shown promising results earlier in the year. As a nurse and researcher who has encountered social media recruitment in my own work—and has closely followed the COVID-19 vaccine trials—I was curious to see how Pfizer planned to convince 30 000 people in the US to volunteer. I clicked on the advertisement.

The recruitment website (https://www.covidvaccinestudy.com/) was nicely designed with bright photos and thoughtful messaging about the trial. I intended to look at the recruitment approach, but found myself instead thinking about how important it is for people to participate. In the US, as of September 2020 COVID-19 had been diagnosed in nearly 7 million people and had killed more than 200 000.1 A vaccine could save lives and stop the spread of the virus. Volunteering for the trial felt like an honorable thing to do—and the 50% chance to be randomized to the vaccine early seemed equally compelling to me as a practicing nurse. Before I left the website, I entered my contact information to be considered for participation.

A few days later, I was in a parking lot loading groceries into my car when I received a phone call from the study coordinator.

“Hi, is this Kristen? I’m calling from the COVID-19 vaccine study. I’d like to go through a screening and schedule you for the first visit, assuming you still want to participate, that is.” He went on to ask me questions about my health and lifestyle. When I passed the screening, he continued, “Let’s check the schedule for your first visit... It looks like I have an opening today. Can you come in today?”

I responded, “Um, sure. Yes. Send me the time and place and I’ll be there.”

As a researcher myself, I had an idea of what to expect when I arrived. I read through an informed consent, signed paperwork, and answered questions about myself and my health. I chatted with the medical assistants and research nurses about what it was like to be a nurse during the pandemic. I gritted my teeth through the dreaded nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2.

Nearing the end of the visit, I found myself alone. Waiting for the actual injection, I thought about how strange it felt to be a research participant. Randomization is considered the gold standard in clinical research, necessary for omitting all possible bias and determining causality. I had studied the ethics of randomization and why it can be unappealing or even unacceptable to people. But the disconcerting feeling of randomization surprised me. I thought about why getting the experimental vaccine rather than the placebo mattered for me as a health care worker—and then, even those stakes seemed low when I thought about what randomization must feel like for patients.

I sent up a final prayer for the active vaccine as the research nurse finally administered the blind-to-me injection. A visit for the second injection was scheduled for 1 month later. My arm was sore, but I did not notice anything out of the ordinary. I could not begin to guess whether I had received the vaccine or the placebo.

I returned to the research clinic the next month. It was easier and faster this time, although I was dismayed to find that there was another nasopharyngeal swab test. I received the injection and returned home.

The experience after the second injection was different. My arm quickly became painful at the injection site, much more than the first time. By the end of the day, I felt light-headed, chilled, nauseous, and had a splitting headache. I went to bed early and fell asleep immediately. Around midnight, I woke up feeling worse—feverish and chilled, nauseated, dizzy, and hardly able to lift my arm from muscle pain at the injection site. My temperature was 99.4 °F (37.4 °C). I tossed and turned, sleeping little during the rest of the night.

When I woke up again at 5:30 am, I felt hot. Burning. I took my temperature and looked at the reading: 104.9 °F (40.5 °C). This was the highest fever I can ever remember having, and it scared me. I took acetaminophen and drank a glass of water. When the research office opened at 9 am, I called to report my reaction to the injection. Thankfully, my fever had come down to 102.0 °F (38.9 °C) by then. The research nurse said, “A lot of people have reactions after the second injection. Keep monitoring your symptoms and call us if anything changes.” My fever hovered around 99.5 °F (37.5 °C) for the rest of the day. By the next morning, all my symptoms were gone except a sore, swollen bump at the injection site.

I cannot be certain, but based on my reaction, I have a strong suspicion that I received the experimental vaccine, not the placebo. While waiting for the research office to open that morning, I had read the research report2 on the earlier Pfizer-BioNTech trial. To my surprise, the nurse was right about how common my symptoms were. In the phase 1 trial of BNT162b2, the following adverse effects were observed in the intervention arm of adults aged 18 to 55 years after receiving the second dose of BNT162b2: fatigue (75%), headache (67%), chills (33%), muscle pain (25%), fever (17%), and joint pain (17%).2 If this vaccine is approved, it is possible that most people receiving the vaccine could have 1 or more reactions to the vaccine like I did. Fortunately, my experience of having all symptoms together seems to be rare.

The adverse effects of the vaccine—even if, at worst, they all happen at once—are transient and a normal sign of reactogenicity signaling an effective immune response. But I worry that they could be a major barrier to vaccine uptake. Clinicians will need to be prepared to discuss with patients why they should trust the vaccine and that its adverse effects could look a lot like COVID-19. They will need to explain that fatigue, headache, chills, muscle pain, and fever are normal, reactogenic immune responses and a sign that the vaccine is working, despite the unfortunate similarities with the disease’s symptoms.

Despite the extensive information I had on the research process and vaccine, on a personal level I did not get the message that I should anticipate a reactogenic response. I was scared when I saw that I had a fever, and my gut reaction after months of scrutinizing myself for all the possible COVID-19 symptoms was: Do I have COVID-19?

I texted a few friends about my experience, and their response was the same: “Wait, does this mean you have COVID-19? Are you contagious?” I assured them I did not and was not, but every physician and nurse in the US needs to be prepared to have a conversation about adverse effects with patients. I can already see the wrong message about the COVID-19 vaccine going viral.

There are some things that are extremely important so they must be on this blog. This is one of them.

Instagram

The Washington Post

Climate and Environment

The world’s most beloved 94-year-old naturalist says his Instagram record brings ‘great hope’

By Jennifer Hassan

September 28, 2020

It took less than five hours for David Attenborough to break Instagram’s record for the fastest accumulation of 1 million followers.

Britain’s revered 94-year-old naturalist beat Jennifer Aniston’s record by 32 minutes — an achievement he said has given him “important hope” for the future amid growing concerns over “the destruction of nature” and the looming threat of an irreversible climate emergency.

Attenborough told the BBC that young people are in the best position to drive change in a world that faces an increasingly precarious future. In seeking to reach a wider — and younger — audience, Instagram seemed like a good place to start: According to the statistics database Statista, about 70 percent of Instagram’s worldwide users are younger than 35 and more than a third are younger than 25.

“It’s their world, and it’s their tomorrow,” Attenborough said. “I won’t be there. They will be.” He added that he felt “privileged” that the platform’s users were interested in “what an old bloke like me is talking about.”

Dangerous new hot zones are spreading around the world

It was Thursday when Attenborough — star of the upcoming Netflix documentary “A Life on Our Planet” — used an Instagram video to venture beyond his familiar radio and television mediums in a bid to reach a significantly younger demographic.

“Hello,” he says softly in a voice that is characteristically soothing, before going on to warn Instagram users that the world remains in grave danger unless people begin working together to tackle climate change and biodiversity loss.

“I’m making this move and exploring this new way of communication to me because, as we all know, the world is in trouble,” he warns. “Continents are on fire. Glaciers are melting. Coral reefs are dying,” he continues, before inviting users to join him on his mission to help solve some of earth’s most pressing problems.

The video has been viewed nearly 17 million times.

Attenborough told the BBC that he was willing to use “any medium” available to connect with people around the world to educate them on looming threats and advise them on how they could help protect the planet from myriad disasters.

He is fast approaching 5 million followers.

“We have a responsibility,” he said as he urged people not to waste food or electricity and to respect the natural world.

While Attenborough is not publishing updates to the platform himself — “Social media isn’t David’s usual habitat,” wrote his “Life on Our Planet” collaborators, who are managing the account — he promised to record a series of Instagram videos about the future of the planet in the coming weeks. “Stay tuned,” he says, smiling at the end of his first recording.

Attenborough’s Instagram debut was widely celebrated. “Not all heroes wear capes” wrote one user. Another requested that the broadcasting legend begin posting videos on TikTok, too.

How long until it’s too late to save Earth from climate disaster? This clock is counting down.

Last week, Attenborough headed to Kensington Palace for a socially distanced meeting with the Duke and Duchess of Cambridge — Prince William and Catherine — and three of his biggest fans: their children, Prince George, Princess Charlotte and Prince Louis.

William joined the broadcaster for a private screening of his new Netflix documentary, which explores the changes that world has experienced at the hands of humans.

“This film is my witness statement and my vision for the future,” Attenborough says in the trailer, which promises to tell the story of his life’s work in the wild and what the world needs to do to reverse decades of devastating damage.

Following the outdoor viewing of his latest project, Attenborough was photographed laughing with the family and gave 7-year-old Prince George — who is third in line to the British throne — a fossilized shark’s tooth that he found while on vacation in Malta during the 1960s.

The prince showed much interest in the ancient tooth, which once belonged to the extinct megatooth shark species known as Carcharocles megalodon — reportedly the largest shark that ever lived. Attenborough collected fossils as a young child before carving out a career as one of Britain’s most successful scientific storytellers.

But Prince George is not the only person to be wowed by the 23 million-year-old fossil.

Maltese Culture Minister Jose Herrera told the Times of Malta on Monday that the country would like the prehistoric treasure returned to its original home, promising that he would “get the ball rolling” on its safe return.

“There are some artefacts that are important to Maltese natural heritage and which ended up abroad and deserve to be retrieved,” Herrera said.

Attenborough later told the Times of London that the three children were “charming.” Photos showed an apparently star-struck Princess Charlotte clutching her face in bewilderment as she gazed up at the Attenborough, who beamed back at her.

Discussing Britain’s nationwide shutdown, imposed in March amid the global health crisis, Attenborough said he passed weeks of stay-at-home measures “listening to birds” as he sat in his garden.

“A lot of people have suddenly realized what deep, profound joy can come from witnessing the rest of the world — the natural world,” he said as he reflected on how the pandemic has changed human behavior and united people in the face of tragedy.

David Attenborough gave the natural world a voice. Now he’s talking about climate change like never before.

The world has just over a decade to get climate change under control, U.N. scientists say

Britain’s David Attenborough enjoys a moment as his ‘Blue Planet II’ takes a hard look at ocean pollution