“…according to my ability and judgment…”

With all the hubbub brewing around the near-term potential of an available COVID-19 vaccine, politicians are getting excited/critical, and people are wondering if this new shot will be a license to return to normal.

Will it?  It’s a new vaccine technology, without the decades of safety data accrued by the boring vaccines against polio, hepatitis B, or measles.  Which could have been said about those previously scary diseases too, before people were vaccinated, so at some point you have to pull the trigger, having faith in the knowledge that we don’t sell nearly as many iron lungs as we used to.

Before going any further, let me assure the easily-triggered that I have been pro-vaccine from the start.  First, I never caught polio, for which I’m thankful.  Second, I went to an actual medical school where they taught the history and science behind vaccines, and allowed me to reason that vaccines are, in fact, a good thing.  Third, I just had my annual flu shot last week, even though I am not required to, but because I wanted it.  I have heretofore been sympathetic to schools refusing admittance to children unvaccinated against diseases with a high degree of significant morbidity/mortality (not the case with COVID-19).  Let me also firmly state, with a jaundiced (though not from hepatitis) eye toward the anti-vaxxers that I think they are nincompoops, and that anti-vax crusader Jenny McCarthy’s most valuable work was in the pages of Playboy.  Got it?

So now I shall invite your ire.  When this new miracle vaccine is made available, will I take it?  I’m not sure.  Will I recommend it?  I’m not sure.  This statement of uncertainty alone would be enough for some to howl that I should have my license revoked, the “cancel” equivalent in health care.  By history I’ve already had the damn virus, have been exposed to a ton of it in the subsequent eight months, and haven’t even gotten a runny nose.  Proof?  No, but I like my odds.  Honestly, I wouldn’t even wear a mask in the ER if I wasn’t required to.  Would I recommend the new vaccine to one of my immune-suppressed family members, or to patients at similar risk?  More likely I would, if they were otherwise stable and had not already had it.  I realize this logic could be broken if COVID-19 turns out to be seasonal, with recurrent mutant strains in the offing.

The advent of a brand new, never-been-tried-moonshot vaccine is not a black & white decision, but it will be presented, and then forced as exactly that.  The stumbling, mumbling Surgeon General who will be most famously remembered for flip-flopping on mandatory masking will push the pro-shot company line without hesitation (an aside, but why does the Surgeon General wear an admiral’s costume?  Couldn’t they just get him an army uniform to hold all his fancy ribbons, or better, a white coat and one of those iconic doctor’s forehead mirrors of yore, with a full-color Seal of the U.S. on it, that he always has to wear in public?  Just spit balling…).  The CDC will likely be as decisive as they’ve established recently, but in the end will issue guidelines that everyone not known to be immune to the elements in this brand-new vaccine should immediately take it.  And that’s where we’ll be in for trouble.

CDC guidelines have given cover to the hapless mayor of my little town to demand public masks, and plant nagging signs all over town, while local businesses knuckled under and demanded shoppers wear them.  Our state, using CDC guidelines as their rationale, closed all the bars – but allowed bars in restaurants to keep serving.  College football is now a virtual clown show, where masked referee’s huff-and-puff to keep up with unmasked players, who run to the sidelines on timeouts to get instruction from coaches frenetically pulling their masks down to speak, then pulling them up between sentences.  The flight attendants’ union will likely still be demanding mandatory masks when a clone of Elon Musk opens up commercial space travel for the current generation being told it will be too dangerous to go trick-or-treating this year.   Why go into all this rant?

The politicians and public health officials that first told us we simply had to “flatten the curve”, and then told us we had to stay locked down, and then told us we had to wait for a vaccine, are now back to flattening the curve – the PR curve.  They dare not back off of their entrenched positions, which means that in the face of so deadly a virus (for which we do not know the actual mortality rate, ahem), a vaccine that works must be so important as to be mandated.

We could just recommend the new vaccine to those at-risk, the way we should have had them self-quarantine without overreacting and punishing the productive majority, but no… Various state and local jurisdictions – following CDC guidelines! – will bar children from returning to school unless they have their COVID cards; will their parents be in for legal trouble if they refuse to vaccinate their kids?  Certain companies, made more powerful following a wrecked economy in a year of needless shutdowns, will demand their employees take the shot as a condition of employment.  Place your bets that state health departments will attempt to force all health care workers to take the vaccine if they have any direct patient contact.  The precedent has been set with hepatitis B, even though for most of us coronavirus will not present as nearly as great a threat.  Restaurants, or Costco may ask to see your COVID card before entry, or, demand that you mask up.  Fear of viral liability will be as bad as the real thing, with lawyers hiding behind every corner, intimidating public entities to play it too-safe.  Imagine having to show your COVID card to the helpful TSA screener prior to boarding your next miserable, masked flight.  If a bad side effect profile emerges, BLAMMO, the now-unmasked authoritarians will revert to screaming for masks and lockdowns, and …

…doctors will comply.  We will not want to be seen as anti-science, and we will not want to be fired into the ranks of the unemployed, or worse, cancelled by our state medical boards.  Medicine advanced reasonably, thoughtfully, building the science and implementation of vaccines that have helped billions, in a positive, compassionate manner.  Now, with the past eight months as preparation, bludgeoned by a hysterical, ignorant media and a panicked populace, we have established our profession as health commissars willing to advocate for any “temporary” restriction of individual choice in order to “save lives”, no matter how many others are harmed in the process.  Any of us not immediately sold on the unconditional goodness of the COVID vaccine if-and-when, will face ethical dilemmas that pit our medical judgement against our economic survival.  Many of us will look at large swaths of the population for whom masks and six-foot bubbles have taken on a religious significance that justify screaming at strangers, and rationalize that it’s simply not worth the effort to educate, or counsel anything other than the accepted, mandatory herd “recommendation.” 

No, I don’t think that the vaccine will contain Bill Gates’ nanobots, nor do I think it will be the Mark of the Beast.  I am not at all saying there should not be a vaccine, nor am I saying I wouldn’t take it.  I am predicting that we will not be given a choice, and will not be allowed to offer patients an actual choice.  I am saying that by abdicating our responsibility to provide calm, rational leadership during the pandemic, and through the rush of events, we have unwittingly placed ourselves in the forefront of a major fight over the right of the individual to decide for himself what care he shall receive.  If we roll over on this one, we set a terrifying precedent for the next health “crisis,” and our role in it.

Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption.

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6 Responses

  1. Rusty Shackleford says:

    Swanz-Ganz catheters for everyone seemed like a good idea at the time too.

    • Kurt Savegnago says:

      Oh gosh, I remember those days in 1984 as an ICU resident.
      Shoot the numbers every day. Thank God for the H-P thermo-dilution computers. Crude but worked and printed out PVR, TPR, SVR, CO, CI and a whole lotta other stuff I’ve forgotten about automatically. Did make it easier to regulate Dopamine, Dobutamine, Nitroprusside drips and the infamous “Leave ‘em dead Lethalphed” /Levophed drips. Levophed at that time was the drip of last resort that truly always left ‘em dead ‘cause they were already damned near there. Of course nowadays, found out it needed to be used as the first drip of choice in septic shock and it actually saved more people than the “other” stuff.
      Of course there was the rule that no matter what, the Swan had to be changed once every 6 days. People had every IJ, subclavian and femoral arteries poked both sides during a long stay. AND……… all this was done blindly at the ICU bedside just by waveform observation while floating the Swan. We weren’t wussies back then and didn’t need no stink’in fluoro to place a Swan. Of course, using fluoroscopy made it easier and safer on the patients as is done routinely now. Back in the day, I wouldn’t have been able to replace 5 Swans efficiently if fluoro had to be used. Subclavians had to follow the same 6 day rule too. Good gosh, I do not miss those bad old days one iota!! Oh as an aside. One of the attendings made us save every Swan we removed and drop them in a bucket of disinfectant. Rumor had it he sent them to his surgeon brother in an “unnamed” South American country to be re-sterilized and reused. Remember this was at the start of the AIDS epidemic. I assisted on a biopsy of a Kaposi’s node in 1982. In one year the guy had > 250 contacts! They rightly diagnosed the new disease HIV.
      Hope they got them Swans re-sterilized ok! 😉

      • Mamadoc says:

        Gosh, I remember that! And no flouro, you just did a CXR after placement.

        • Kurt Savegnago says:

          Yup, Just a chest xray to make sure one didn’t drop a lung. Hated when that happened as now had to do a chest tube. Fortunately didn’t happen very often.

  2. Rusty Shackleford says:

    Just read a Medscape article proposing we should withold medical care for “Anti-maskers”.

    The end can’t come soon enough.

  3. Jeremy says:

    100%.
    1. Novel mechanism as you mentioned.
    2. There are no long term studies. You can X Ray someone’s thyroid 100 times but you won’t see the cancer until later. No amount of data can cure this issue without time. If this vaccination ends up having long term effects, the public will lose all trust in future medical responses.

    It’s mind blowing we can blindly accept unknown risks on a virus that for many people is not deadly. I think it’s reasonable to really assess the individual’s risk (age, comorbidities) vs. Potential benefits. And I think it’s quite big brother to think we should be mandating healthcare workers to get it.

    The groupthink creeping into medicine and replacing critical thinking and skepticism is terrifying.

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