Author: Kevin Homer, MD

As SARS-CoV-2 infections are increasing and some parts of the country are experiencing their highest rates of the pandemic, we face a medical shortage.  In Texas, the supply of staffed hospital beds is shrinking, and some communities are out of ICU beds.  Staffing shortages are becoming critical.  Is this the time to fire doctors, nurses, and other healthcare professionals for refusing a COVID vaccine?

Many people feel sick after a COVID vaccination, and some of those people won’t be able to come to work.  The Janssen vaccine isn’t fully effective for two weeks after the shot.  It takes five weeks for Pfizer and six for Moderna.   Meanwhile, hospitals are short on beds, and even shorter on staff.  Which will save more lives—fully vaccinated healthcare workers or staffed hospital beds?

The healthcare community has managed COVID surges without vaccine before, and we can do it again.  The universal vaccination of healthcare workers achieves no benefit that justifies the violation of individual liberty required to achieve this goal.  You may disagree with me.  We should have that debate.

But right now, those of us who work at hospitals have our hands full taking care of COVID patients.  Can we talk about this later?

If anything is sacred, the human body is sacred.

― Walt Whitman

How should we define victory in the war on the pandemic?  My vision may surprise you.  I think our objective should be not dying.  Death rates should be our success metric, and the preservation of our institutions and freedoms our goal.  We can accomplish this by making smart individual decisions, not sweeping collective ones.  We cannot allow our society to be fractured into camps of the vaccinated and unvaccinated.

The universal vaccination mandates sweeping across our nation now are more dangerous than the current wave of SARS-CoV-2 infections.  Don’t believe me?  Check out the CDC’s COVID Data Tracker.  Deaths from COVID-19 are at their lowest levels since the pandemic began.  Yet on pain of job loss, we are pushing vaccines into the arms of our young who have the most to lose and least to gain.

Don’t get me wrong.  Vaccination is an important tool in our effort to save people from dying of COVID-19.  Those at greatest risk—the old, the obese, the diabetics—should strongly consider vaccination for their own safety.  Vaccines also reduce the spread of COVID-19 within a community.  When vaccines became available in late December, community infection rates declined as vaccination rates went up.  But that doesn’t mean that vaccination is in the best interest of every individual.

Wait, I hear you say, we must vaccinate everybody to contain breakthrough and stop the spread of the virus.  Especially hospital workers—I want to know that people taking care of me are vaccinated so they won’t make me sick.  Nice theory, but where’s the data that supports the idea that vaccinated people can’t make you sick, that vaccines contain breakthrough and stop the spread of the disease?  I’ve looked; I can’t find it.  If you have it, please share it with me.

I see data that supports the opposite theory.  In last Friday’s Morbidity and Mortality Weekly Report (MMWR), the CDC reported a SARS-CoV-2 outbreak in a highly vaccinated community.  Some were shocked to learn that three-quarters of these cases occurred in fully vaccinated individuals, that the viral loads between vaccinated and unvaccinated individuals were identical, and that four out of five patients sick enough to be hospitalized were fully vaccinated.  This report supports one of the points made last week: vaccination doesn’t prevent COVID-19.  Breakthrough cases occur, and the vaccinated can spread the virus.  Universal vaccination will fail as a containment strategy.

But, you persist, we have to vaccinate everybody before new variants emerge that will be even more dangerous.  After all, you say, 90% of the virus in the reported outbreak were delta variant.  True, this outbreak was mostly delta variant, but delta variant is now the dominant variant in the U. S. because of its higher transmissibility, just like alpha variant replaced original SARS-CoV-2 earlier in the year.  Where is the evidence that universal vaccination prevents formation of more dangerous variants?  Again, I’ve looked, and I don’t find it.  If you have it, please share it with me.

Infectious disease orthodoxy says the opposite.  Indiscriminate use of anti-biologic agents pressure pathogens to mutate, increasing their virulence.  Doctors are reprimanded for treating viral illnesses with antibacterial agents (“antibiotics”) because they have potential for more harm than good.  The same is true for vaccines designed to prevent infections by viruses that easily mutate. That’s one reason we don’t have vaccines for the common cold—the target moves too quickly, and infection is not that dangerous to most people.  Universal vaccination will fail to prevent emergence of variants.

If universal vaccination becomes our objective in the war against the pandemic, deaths may increase, surges may continue, and more dangerous variants may emerge, but won’t we feel good about our vaccination rates?  The pandemic has an enemy; it’s not the unvaccinated.

There is another way.  Allow doctors to make individualized decisions for treatment and vaccination in the best interest of each patient.  If we do all we can to help those at risk, deaths will continue to go down.  The virus may never go away, but we can learn to live with it.  We can also preserve our institutions and freedoms, and we can stop dividing people.  We can stay alive.

Last week, the FDA added a new statement to the Janssen vaccine Factsheet for Healthcare Providers, warning of an increased incidence of Guillain-Barré Syndrome among vaccine recipients. This warning was issued after cases in India and the United Kingdom were published in the Annals of Neurology.  Although the warning only applies to the Janssen vaccine, at least one case has also been reported following Pfizer vaccination.

Guillain-Barré Syndrome is a condition in which the immune system attacks peripheral nerves, the nerves responsible for sending signals for motion and sensation between the body and the brain, resulting in pain and weakness, and in severe cases, paralysis and death.  Although most people recover, symptoms may linger for a long time.  Guillain-Barré Syndrome is triggered by various conditions that cause inflammation, including infection, surgery, trauma, and cancer.  Rarely influenza and childhood vaccines have been associated with Guillain-Barré Syndrome.

Guillain-Barré Syndrome was identified as a complication of COVID-19 early in the pandemic.  Subsequent studies demonstrate that these cases are “not due to a direct attack of the virus, but rather to an immunological reaction to the virus.”  Now we learn this long-recognized complication of COVID-19 can also be an adverse effect of a COVID vaccine.

The warning for Guillain-Barré Syndrome is the third FDA statement of an immune mediated vaccine complication, adding to the precautions previously issued for myocarditis and clotting disorders.  Interestingly, myocarditis and clotting disorders have also been recognized as complications of COVID-19. 

It’s becoming increasingly clear that COVID-19 has two separate disease pathways.  The first is the direct effect of the virus.  The second is the response of our immune system to the virus.  Vaccines intentionally stimulate this immune response.  Is it surprising that adverse vaccine effects overlap with COVID-19?  Expect more examples of autoimmune complications of COVID vaccines.

Some individuals infected by SARS-CoV-2 experience brain damage.  Although it sounds like science fiction, “COVID brain fog” describes a very real condition in which infected patients experience memory loss, strokes, and other nervous system lesions.  How can this happen?

In an article published last week in Nature, Michael Marshall, a free-lance science journalist from the U.K., describes the current areas of research into the causes of this condition.  One possible mechanism is autoimmune disease.

The immune system’s job is to protect the body from agents of disease (“pathogens”) without damaging the body’s own cells.  Like the military guarding the border of a sovereign nation, the constituents of the immune system carry lethal weapons meant to destroy an invading enemy.  But what if the military can’t tell the difference between friend and foe?  Those lethal weapons might be unleashed on its own people, and the citizens of that nation would be at risk of harm from their own government.  Let’s say for example that the U.S. learned all its enemies wear red hats.  If the army was ordered to seek and destroy anyone wearing a red hat, many innocent Americans unwittingly wearing red hats could be killed in an effect to stamp out a threat to our nation.  

The immune system works by learning something about the pathogens that threaten the body—not the color hats they wear, but the shape and composition of molecules on the invaders.  When the shape and composition of those molecules are similar enough to the shape and composition of molecules on the cells in our own body, the immune system can’t tell the difference, and it attacks us.  That’s autoimmune disease.

Autoimmune disease is highly individualized.  Although we lump these diseases into categories ranging from lupus to rheumatoid arthritis, each person with an autoimmune disease has a disease that’s uniquely his or her own.  There’s a lot of overlap, but no two individuals have exactly the same disease manifestations.  

There are many examples of autoimmune disease targeting specific organs.  Hashimoto’s thyroiditis is a disease in which the immune system targets the thyroid gland.  In Crohn’s disease the immune system targets the cells of the gastrointestinal tract.  Multiple sclerosis is an autoimmune disease of the central nervous system.   COVID brain fog may also be, at least in part, an autoimmune disease of the central nervous system in which an immune system primed to destroy SARS-CoV-2 causes collateral damage to the brain.

If that’s the case, we have yet another reason to avoid COVID-19.  But we may also want to avoid stimulating the immune system to fight SARS-CoV-2, which is precisely the goal of a COVID vaccination.  We know that everyone who has had COVID-19 develops antibodies to the viral spike protein.  We also know that everyone who has received a COVID vaccine develops antibodies to the same viral spike protein.  What if these are the autoantibodies associated with COVID brain fog?

Although there is no proof this is the case, there is evidence suggesting that the idea is plausible.  Last week, we learned that vaccines may cause myocarditis and pericarditis, essentially an autoimmune disease affecting the heart.  VITT, a condition in which vaccination causes blood clots, is also immune mediated.  We must consider the possibility that stimulation of immunity against viral spike proteins causes autoimmune disease in some vaccine recipients.

As we connect more dots, an image emerges from the haze of the pandemic.  As the picture becomes clearer, will we have the courage to believe what we see?