Carvings                February 1, 2021

In the news

            Does it seem logical to wear a mask after you have received the COVID-19 vaccine?

            “I honestly don’t think I’ll ever go without a mask at work again,” says Dr. Eugenia South, emergency physician. At first glance this doesn’t seem to make sense but we need to look at her statement in context, especially the words “at work”. Healthcare workers are at extremely high risk for several reasons. They spend many hours a week in the presence of the sickest COVID-19 patients, those that are shedding large amounts of virus as they cough and breathe rapidly. Physicians have known for decades that a large dose (called an inoculum) may cause more rapid and more grave illness. E.g., a small amount of a poison will make you sick but a large dose will do you in. The protective gear that caregivers wear for many hours at a time is uncomfortable and unless it is donned properly and adjusted frequently it causes exposure to infection. That especially applies to medical-grade face masks. Caregivers have been under the kind of stress that few of us can appreciate and they have been doing this for nearly a year. Chronic stress can lower the immune system; in a high-risk setting it can be fatal, as the large number of healthcare workers who have died has shown. Dr. South has undoubtedly received a vaccine but there are other considerations that she is surely aware of.

             First, very few vaccines are 100 % effective. Persons who are immune-compromised have a poor response to vaccines and so do persons who are obese – currently 42 percent of U.S. adults. That’s a lot of poor-responders. Sometimes the specific sample of the vaccine is ineffective because of improper storage. This occurred a couple of decades ago when the measles vaccine was kept in refrigerators whose door shelves were not cold enough to preserve the vaccine. The first two coronavirus vaccines released so far have extremely low temperature requirements for storage. Some facilities and some personnel may not be as competent as they should be. The risk of vaccine failure for this reason is probably small but it is real.

            There is considerable fear among healthcare workers and the general public that these are unproven – some use the word “experimental” — vaccines. We have enough evidence that the vaccines now being distributed provide a strong protective response and serious side effects have been uncommon and treatable but there’s more to the story. Will we see serious side effects in the months or years to come? We don’t know. If vaccine recipients are exposed to the natural virus next year will they be protected or will they have even worse disease? We don’t know. How long will protection last? We don’t know.

            Dr. Tom Friedman, former director of the CDC, is concerned that vaccine recipients might be free of disease after later exposure but if they are reinfected they might still be able to transmit the virus to others. Again, we don’t know, but my personal feeling is that the risk of that is very low.

            All viruses mutate but so far it seems that the current mutations do not negate the protective effects of today’s vaccines. Could that change? Of course, but vaccine developers are watching that closely and may have to modify their product. We do that every year with the influenza vaccine.

            Let’s assume the best-case scenario: the vaccine that you received caused nothing more than a sore arm and feeling punk for about a day. The vaccine will prevent you from becoming ill with this virus for at least a year. Studies later will show that you cannot transmit the virus to others. The virus is stable and you don’t need another variant of the vaccine.

            You won’t get complete protection even in this best-case scenario for at least a month after your second dose and you could be infected – and infectious – until then. It is this fact that has prompted the warning that we need to keep wearing a mask after vaccination. Less worrisome reasons are those that I mentioned above: faulty vaccine and mutations.

            If you are in a vulnerable group, i.e., over 60 years and/or with a comorbidity such as obesity (I include overweight), diabetes, heart disease, hypertension or kidney disease, get the vaccine as soon as you are able. If you are young and healthy I suggest waiting until those who are not have been protected, which will probably take until about April 2021. By then we should have answers to most of the questions that are of concern to those who have been refusing the vaccine until now.

            That is, of course, unless this rascal of a virus unleashes another surprise!

Lifestyle

            Snacks can make or break a diet. The kind that you find while you’re standing in line at the checkout counter are probably the worst, even the trail mix or beef jerky. Some trail mixes have well over 100 calories per ounce and a piece of beef jerky that weighs a little more than a half-ounce can contain as much as 440 milligrams of sodium – about 20 percent of what you should allow yourself in a whole day.

            The ideal snack should contain enough fiber or protein to satisfy your appetite. A piece of fruit averages only 50 to 75 calories but the fiber leaves you feeling full. A single handful of nuts, especially almonds or walnuts (for the engineers and accountants in the audience that’s about 12 pieces or about ½ ounce) will provide about 80 or 90 calories. That will also give you some protein and some omega-3 fats, both of which will give you a feeling of fullness – especially if you eat them slowly!

            Diet gurus sometimes recommend a tablespoon of peanut butter on a stalk of celery. Nice theory but who has the time to make it – and not find something else that’s more appealing and convenient in the refrigerator to nibble on, like ice cream?

            Dried fruit? Not such a good choice because it’s high in sugar. After all, 6 apricot halves are the equivalent of 3 whole apricots, and four prunes are the equivalent of four plums. Do you usually eat that many pieces of fresh fruit at one time?

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