There are two reasons to get any vaccine. One is to protect you from the disease, and the other is to help protect others by limiting the disease's ability to spread.

‍

Make no mistake about it, the virus that causes COVID-19 is highly infectious, and the disease is potentially very dangerous. The vaccine can prevent you from getting the infection, which will prevent the potentially serious complications and side effects associated with the disease. At the time of writing this, April 2, 2021, there have been over 30 million cases in the US and over 550,000 deaths [1]. The vaccine is the best way to help stop the pandemic. But it only works if enough people get it.

‍

Vaccination Types

Both the Pfizer-BioNTech and Moderna vaccines are mRNA vaccines. mRNA stands for messenger ribonucleic acid. Typically, our cells carry out a variety of functions depending on what their role is. The DNA in the nucleus will send out mRNA to the other tiny organelles in the cell to give instructions like “make this protein” or “cleave this fatty acid.” These two COVID-19 vaccines use mRNA to tell our cells to make a protein that mimics the look of the virus. Our body sees the protein as a foreign substance and activates the immune system against it.

‍

‍

The Johnson & Johnson vaccine is a viral vector. Viral vectors work by using a modified version of a harmless virus (not COVID-19) to tell our cells to make the protein that mimics the look of the COVID-19 virus.

‍

You cannot get the disease from any of these vaccines because it does not contain the disease virus [2], [3], [4]. However, you can have temporary reactions to the vaccine, and these are normal. Pain, redness, swelling, fever, fatigue, body aches, chills, and headache are all potential reactions as part of your immune system kicking into overdrive. The reason you have similar symptoms with an illness is the same – your immune system is kicking in to fight.

‍

‍

Because there is a significant risk of fatigue with these vaccines, the FAA has declared a 48-hour grounding after receiving the vaccine [5]. If your symptoms last longer than 48 hours, you should remain off flight duties until the symptoms subside.

‍

The mRNA vaccines are two-shot series, 21 days apart for Pfizer-BioNTech and 28 for Moderna [3], [4]. The first shot primes your immune system like starting your APU. The second is like the main engine start. For those of you with kids, you probably know that many vaccines require multiple doses, so this isn’t abnormal. The Johnson & Johnson is only one shot. It makes scheduling more manageable, but at the cost of lower effectiveness.

‍

There are no preservatives and no animal protein [3], [4], [6] in these vaccines, so they are fairly allergen free. Allergic reactions are rare but can occur. Because of the potential for an allergic reaction, it is recommended that you wait 15 minutes after receiving any vaccine, not just the COVID-19 ones, before you leave the place that gave you the vaccine.

‍

But I already had COVID?

If you have previously had the disease, it is still recommended to get the vaccine. We don’t know how long a natural immunity to COVID-19 will last. We aren’t even sure exactly how long the immunity from the vaccine will last. Several vaccines we get need to be refreshed from time to time; Tetanus being the one you may be most familiar with.

‍

All three vaccines are currently being used with an Emergency Use Authorization. Because of this “Emergency Use Authorization,” some people are concerned that they have not undergone proper scientific testing.

‍

Phases of Vaccine Testing & Approval

‍

There are five phases to testing and approval of vaccines:

‍‍

1 - Preclinical

2 - Safety and dosage trials

3 - Large Scale Effectiveness

4 - Regulatory approval

5 - Long term observation

‍

All three vaccines have passed phase 3 trials, with the Pfizer-BioNTech having enrolled over 43,000 participants [3], the Moderna having enrolled approximately 30,000 participants [4], and the Johnson & Johnson over 44,000 [2].

‍

The emergency use authorization allows for the use of the vaccines while the normally time-consuming regulatory aspects of phase 4 are being conducted. The actual scientific testing and validity have been completed, and all vaccines have been shown to be safe and effective.

‍

Some people are still concerned with just how fast these vaccines were made. On May 25, 1961, US President John F. Kennedy set the goal of putting a man on the moon and returning them safely to Earth. It took over eight years to do it. But it only took 123 days to do it a second time. We have been making vaccines for over 200 years. Give those people a perfect storm of a global pandemic, prioritization, and funding, and the result is a safe vaccine in under a year.

‍

Health Impact

Suppose you do the math on 550,000 deaths out of 30 million cases; that is about a 1.8% case fatality rate. That may not seem all that dangerous, especially if you are an otherwise healthy person with limited risk factors. Still, even if you don’t die, you could potentially have long-term complications from the disease. I have several patients who had their bout with COVID-19 in the summer of 2020 and still can’t walk up a flight of stairs without running out of air. These are very healthy and fit Marines; they are not people of advancing age with pre-existing conditions. I have physician friends who are Pulmonologists and Infectious Disease doctors who see the same thing at other locations among very healthy and active young people.

‍

‍

As an aviator, your ability to breathe during periods of high task loading and stress, as well as at cabin altitudes with a lower partial pressure of oxygen than sea level, is vital. Not just for your job, but also for your way of life.

‍

I did not want to get the disease myself because of this potential issue. If I developed this complication, my career as a military pilot and physician would be over. My personal life would have taken a dramatic change as well. Gone would be my hiking, backpacking, and bicycling with my kids.

‍

A stall on takeoff is recoverable if recognized quickly and recovered properly. You are a professionally trained pilot with recurrent training; you should be able to recover from it without incident. But do you want to get even close to that stall? Or would you rather know your takeoff data, perform all your checklists, pay attention to your V speeds, monitor for your expected takeoff distance and execute an uneventful takeoff and climb out?

‍

Risk Mitigation

Right now, there are no good numbers on how many people end up with long-term complications like I described. But is it a risk you are willing to take? If you are vaccinated, you stand a 95% chance of avoiding symptomatic disease with the Pfizer-BioNTech [3] vaccine, 94% chance with the Moderna [4], and 66% chance with the Jonson & Johnson [6], which is lower primarily because it is a one-shot vs. two-shot series. Frank Borman, former astronaut, said that “a superior pilot uses his superior judgment to avoid situations which require the use of his superior skill.”

‍

That only covers half the reasons to get a vaccine. With a population of about 330 million in the US, a 1.8% case fatality rate could potentially be close to 6 million dead. That is the equivalent of the populations of Los Angeles and Phoenix combined. Most likely, that number would be lower because we don’t know of every single case a person was infected, but we do know that this is the rate for detected cases.

‍

We need to protect each other, particularly those at higher risk and those who cannot get the vaccine. Anyone with a compromised immune system -- whether they were born with it, have some illness that has caused it, or have cancer and are on chemotherapy -- needs help being protected. And we do that by the concept of herd immunity. If enough people are vaccinated, those who can’t be are shielded from disease; the virus has a hard time getting to them. Different diseases have different population immunization requirements to reach herd immunity [7]. Unfortunately, we do not yet know what percentage of the population needs to be immunized to reach herd immunity for COVID-19, but the more people who are, the closer we will get.

‍

Top COVID-19 Vaccination Myths

‍

There are several myths regarding the COVID-19 vaccines that should be discussed:

‍

• Cold storage – The concern here is that the cold temperatures are needed because of the preservatives used in the vaccine composition. The reality is that messenger RNA is very fragile and easily damaged. The cold temperatures help keep the vaccine frozen and stable during transport and storage [8]. As mentioned previously, there are no preservatives used in these vaccines.

‍

• Microchips – As much as I love science fiction, we are not yet in the age of nanotechnology that can inject microchips or robots into our cells via a liquid. Anyone who has a dog that has been microchipped has likely seen the size of the needle used for that, and it is plainly evident that an object is being embedded in their skin and not a small amount of liquid as is the case for these vaccines.

‍

• The vaccine will “reprogram my DNA” – Reprogramming your DNA is pretty much how an infective virus works to spread in our body, but not how the mRNA vaccines work. As mentioned above, the mRNA vaccines capitalize on our internal cell signaling structure to mount the defense but does not actually reprogram the DNA in our cells. The Johnson & Johnson viral vector does operate as a virus, but not to replicate itself, only to create the protein. In effect, it is very similar to the mRNA vaccines.

‍

• Sterilization – An organized campaign by anti-vaccination people has spread this myth to further their own agendas. It purports that the antibodies created as the result of the vaccines will result in infertility by attacking the placenta. There is absolutely no scientific evidence to support this claim. The vaccine causes our immune system to make the same antibodies as if we had the actual disease. No dedicated studies of the vaccine have been performed in pregnant women, but since the antibodies are the same, we can look at women who had COVID-19 while pregnant. The current data suggests that women who contract COVID-19 during pregnancy have a higher hospitalization rate but do not have a higher rate of pregnancy loss [8]. If the antibodies were going to cause infertility by attacking the placenta, then there would have been a noticeable increase in pregnancy loss for pregnant women with COVID-19.

‍

Protect yourself, protect your crew, protect your department, protect your community – consider getting a COVID-19 vaccine when you are able to do so.

‍

Keith Roxo, MD, MPH

Keith is a TOPGUN trained adversary pilot turned Aerospace Medicine physician. He holds an ATP certificate, is a CFII, and is an FAA designated Aviation Medical Examiner (AME). Keith is currently the Flight Surgeon and medical director for Marine Aviation Weapons and Tactics Squadron One and Marine Fighter Training Squadron 401, the “Snipers,” in Yuma, Arizona. In addition to writing for AvBrite, Keith offers aviation medical consulting services. Click here for more information.

‍

Legal Stuff

The health information provided in this blog is for educational purposes, does not constitute a doctor-patient relationship, and shall not be construed as individual medical advice. The information and other content provided in this blog, website, or in any linked materials are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment.

Any personal health decisions, changes to regimens, or any other personal medical or health actions should be made with your personal physician's direct consultation. Always seek a physician or other qualified health provider's advice with any questions you may have about individual health matters. AvBrite is not liable or responsible for any advice, treatment, diagnosis, or any other information you obtain through this site. Please see our privacy policy and terms of service for more legal information.

‍

References

1. ‍CDC. (2020, March 28). COVID Data Tracker. Centers for Disease Control and Prevention.
2. Janssen Investigational COVID-19 Vaccine: Interim Analysis of Phase 3 Clinical Data Released. (2021, January 29). National Institutes of Health (NIH).
3. Oliver, S. E. (2020). The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine—United States, December 2020. MMWR. Morbidity and Mortality Weekly Report, 69.
4. Oliver, S. E. (2021). The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Moderna COVID-19 Vaccine—United States, December 2020. MMWR. Morbidity and Mortality Weekly Report, 69.
5. FAQs on Use of COVID-19 Vaccines by Pilots and Air Traffic Controllers. (n.d.). [Template]. Retrieved April 2, 2021.
6. ‍CDC. (2021, March 31). Information about the J&J/Janssen COVID-19 Vaccine. Centers for Disease Control and Prevention.‍
7. Coronavirus disease (COVID-19): Herd immunity, lockdowns and COVID-19. (n.d.). Retrieved February 12, 2021.‍
8. COVID-19 vaccine myths debunked. (n.d.). Https://Newsnetwork.Mayoclinic.Org/. Retrieved February 12, 2021.‍