TORONTO -- As COVID-19 vaccines are being rolled out across the country, infectious disease specialist Dr. Abdu Sharkawy weighs in on some ‘dos and don’ts’ as well as other questions Canadians may have about getting the shot.
Here are some of the things you should do:
DO GET THE VACCINE WHEN IT’S YOUR TURN
Vaccine rollout varies from province to province, and as supply chains may become interrupted, it is important to continually check with your local and provincial health authorities when it is your turn to get the COVID-19 vaccine.
Provinces and territories have online guides outlining the phases of their vaccine rollouts.
The day of your shot, it is recommended by health organizations, including Ontario’s Ministry of Health, to follow your normal routine, wear loose-fitting clothing so the health care provider can easily access your arm and to eat meals as usual.
You should bring your health card and another government-issued photo ID card, your mask, and immunization records – as well as any supportive items or personnel you may need, like glasses, hearing aids or an interpreter, the ministry says.
Sharkawy said he would “definitely recommend pre-medicating” with something like acetaminophen, in a telephone interview with CTVNews.ca Friday.
“I think that people should anticipate that it will be more painful than a typical influenza vaccine and more so than most routine vaccines like tetanus… so prepare for some greater discomfort in your arm,” he said.
Sharkawy said to take Tylenol, for example, about half an hour before getting the vaccine and to take another dose about half an hour afterwards, and then again at night if needed.
“The other things that I found very useful is to actually ice the affected arm because there is actually a little bit of swelling that is around the inoculation site that will respond to some ice,” he said.
As the elderly and those with higher risk factors are among the first Canadians receiving vaccines, Sharkawy stressed that people should also make sure to take all their prescribed medication as usual.
“There should be absolutely no interaction between the vaccine and any prescribed medications,” he said.
Sharkawy added that, even though it is a “point of some controversy,” he would “caution against” Canadians turning to ibuprofen such as Advil and Motrin, or non-steroidal anti-inflammatory drugs.
“They may be very effective for pain control, [but] there is a theoretical risk that those medications may actually hinder or impair an optimal immune response to the vaccine,” he explained.
SHOULD I GET VACCINATED EVEN IF I’VE HAD COVID-19?
This question falls into something Sharkawy calls a “risk-stratified decision.”
“This is a decision that needs to be individualised, it should be discussed with your health care provider, and there should not be a blanket policy that says everyone who has had COVID-19 and survived it should still receive the vaccine,” he said, citing the ethical issues around vaccine supply and prioritising those who have had no exposure or immunity.
“What I mean by that is theoretically, if you have had COVID-19 and you have a relatively normal immune system and you've recovered from it, you should develop antibodies within about three months after you have been infected. So the concept is, if you are likely to be naturally immune, is it actually essential for you to get the vaccine? And that may not be necessarily true,” he said.
However, the way to prove natural antibodies and immunity lies with antibody testing, which is “not widely available,” Sharkawy said.
He also pointed out that there is a “small but not negligible” chance Canadians could become re-infected with the coronavirus, and therefore it is reasonable to consider getting vaccinated even if you have had COVID-19 – but stressed the choice is an individual one.
DO TELL STAFF ABOUT ANY ALLERGIES OR PAST ALLERGIC REACTIONS
While it may seem obvious answer to some, Sharkawy said it is “absolutely” essential to tell those administering the vaccines about any allergies or past allergic reactions.
“The reassuring point is that in the vast majority of cases, whether it’s prescription medication or environmental allergies, there’s actually very little relevance or change in the likelihood of an actual adverse reaction to the vaccine itself,” he said.
Sharkawy explained the components that are likely to be allergenic within the vaccine are, “in the majority of cases, entirely unrelated to individual allergies.”
“If somebody has a serious allergy history of any sort, it's important to alert the staff so that they can be monitored perhaps more carefully,” he said. “If they need an EpiPen for some reason or they've had anaphylactic reactions that are serious to do other exposures, it's worth taking note of this to monitor them more carefully.”
DO GET YOUR SECOND VACCINE DOSE WITHIN THE RECOMMENDED TIME FRAME
Again citing the ebb and flow of vaccine supply chains and possible interruptions, Sharkawy said that vaccine efficacy data is based on the schedule between doses.
The Pfizer vaccine has a schedule of 21 days between doses, and 28 for the Moderna vaccine. However, the panel of medical experts advising the federal government on vaccination said on March 3 that the second dose of COVID-19 vaccines can be given up to four months after the first, if Canada wants to maximize the number of people being immunized.
Canada's National Advisory Committee on Immunization (NACI) issued new guidance advising that the window between shots for all three of the currently approved vaccines—Pfizer-BioNTech, Moderna, and AstraZeneca—can now be considerably extended, while still being effective.
On April 27, Dr. Theresa Tam, Canada's chief public health officer, reiterated that a single dose of vaccine offers "very good protection" against serious illness and deaths from COVID-19, according to evidence taken from "real-life data." But it's still not as strong as a second dose for those immunized with a vaccine requiring a second dose. That second dose "will provide increased protection and also increased duration of the protection," said Tam.
NACI's guidelines are not set rules, however, so check the dosage timelines in your province or region.
DO CONTINUE WEARING MASKS AND PHYSICAL DISTANCING AFTER GETTING VACCINATED
Sharkawy said continuing public health guidance after getting vaccinated is important, as “you don’t constitute your immunity overnight,” he said. “Even after the first shot there's not full immunity constituted even in the healthiest of hosts.”
Sharkawy pointed out that it may take “several weeks” for immunity to become fully established, and within that period of time, there is “ample opportunity to not only become infected with COVID-19, but to transmit it to someone else thereafter unknowingly.”
Sharkawy reiterated that proving immunity through methods like antibody testing is not well established as “we don’t have an infrastructure for wide scale antibody testing that has been validated on any evidence-based measure.”
“Therefore, we can't say without a shadow of a doubt that even after becoming vaccinated, even… a month or two later, that you are free and clear,” he said.
Sharkawy said the best measure of success will be a low rate of community transmission of COVID-19.
“Until we're very close to that point in time or have achieved that, we're going to require everybody to maintain public health measures as a point of absolute safety and out of an abundance of caution to prevent any harm.”
Here are some things you should not do related to getting a COVID-19 vaccine:
DON'T LET MISINFORMATION CLOUD YOUR JUDGMENT ON GETTING VACCINATED
The World Health Organization said the rampant COVID-19-related misinformation was extreme enough to warrant being classified as an “infodemic,” and launched the United Nations Communications Response Initiative in April 2020 to combat it.
In Canada, a nationwide coalition of scientists has banded together to fight misinformation at its source on social media under the campaign “ScienceUpFirst.”
“Unfortunately, there is a myriad of sources based on a lot of different agendas that may be anti-science…or related to a lot of narratives that are sadly not very evidence based,” Sharkawy said.
Sharkawy said he would caution against people getting information from sources that have had “a history of campaigning against vaccines in general.”
“I would caution against any adopting of viewpoints related to those that have diminished the importance of COVID-19, or has trivialised it,” he said, adding that those are clearly sources with “an agenda in mind.”
“I think [those sources] diminish the true threat of this virus that has killed millions of people around the world…that’s irrefutable,” he said.
Sharkawy’s advice for Canadians is to rigorously vet their sources of information, and to make sure they have a “history of speaking from a point of informed opinion that is based on evidence… not through simple opinion.”
“Speak to someone in the medical establishment you trust,” he urged.
DON’T GET THE VACCINE IF YOU CURRENTLY HAVE COVID-19 OR HAVE BEEN EXPOSED
Going to get a vaccine while infected with COVID-19 could not only expose others waiting for their shot to the virus, but as Sharkawy pointed out, it could also affect you personally.
“If you currently have COVID-19 and are still within the acute phase… there is the possibility of potentially having a bad adverse reaction by triggering your immune system erroneously or adversely if you are in the throes of an acute infection,” he said.
Sharkawy added that if Canadians have “any acute infection,” they should not be receiving the vaccine or “almost any vaccine” because the likelihood of a benefit is “greatly diminished.”
IS IT OK TO GET OTHER VACCINES AFTER THE COVID-19 VACCINE?
The U.S. Center for Disease Control says to wait “at least 14 days before getting another vaccine, such as the flu or shingles shot, if you got your COVID-19 vaccine first,” and that if you get another vaccine before your COVID-19 shot, to wait at least 14 days before getting your COVID-19 vaccination.
However, the site notes that “when more data becomes available” they may update their recommendations.
Sharkawy said it may be best to avoid getting other vaccinations out of caution, but to “go ahead” for situations like a needle stick injury, which may require vaccinating against tetanus or Hepatitis B.
“The benefits certainly outweigh the risks,” he said, adding that getting a tetanus shot “should not” affect the efficacy of a COVID-19 vaccine.
DO NOT LEAVE THE VACCINATION SITE RIGHT AFTER YOUR SHOT
Similar to when donating blood, most vaccination sites will ask patients to wait after receiving their shot to monitor their reaction.
“Everybody reacts a little differently to vaccines and needles,” Sharkawy explained. “There is a small but distinct possibility you may become light-headed, and especially if you're driving, you want to ensure that you feel entirely safe and that you are cognitively intact and that there's no likelihood that you could do anything that would put yourself or anyone on the road in danger.”
Sharkawy urged Canadians to be patient.
“Take that time to escape mentally, take a few deep breaths, read something and enjoy your prospect of new found immunity without taking any liberties.”
With files from Rachel Aiello
