Day #1 – 14th August 2020

I received my first Coronavirus vaccine today. I feel fine without fever, chills, headaches, muscle aches, weakness or injection site redness or pain. Hopefully, I received the actual vaccine and not the placebo. The chances are 50/50 in the randomised double-blind controlled trial. We are living in a historic time with humanity faced with a common enemy.

Never before in recent world history, we were forced to look beyond our conflicts and deploy armies to not subdue but uplift and support each other this way. I am an existentialist, a physician mom, a teacher, a researcher and a writer. COVID-19 pandemic has affected every part of my life. I am worried for my family, loved ones, patients and friends.

Everything that we do is just harder. My day to day practice has changed. We are seeing some patients using hospital provided telemedicine interface, some via facetime, and some through phone calls. My interaction with patients has changed a lot. Everyone in the office is wearing masks that limits the human communication through faces. No hand shakes any longer and physical exams are limited to absolute necessary to gather needed information.

It’s hard to believe that we have had no contact with the virus yet when it’s all around us and there are so many getting infected everyday. Wearing masks around everyone and washing hands all day long obsessively has become a second nature by now. Some days, I still wish this was just a bad dream but it is not so.

COVID-19 is a virus identified as the cause of an outbreak of respiratory illness that was first detected in Wuhun, China in late 2019 that has since spread globally into a pandemic. Symptoms of COVID-19 include fever, cough, and shortness of breath. While majority of cases report mild symptoms, some progress into severe pneumonia and multi-organ failure and can lead to death. On January 21, 2020, the patient tested positive for COVID-19 in the United States. The virus has since spread across all 50 states and the number of individuals testing positive for COVID-19 continues to rapidly grow each day.

Fridays are our half clinic days. After seeing all of my patients, I ran over to the physician’s lounge to pick up lunch and then drove down to the Lynn institute of Norman to get my first coronavirus vaccine injection. The front door was locked. As I was looking for my phone, Karen opened the door for me. Due to the virus outbreak, the doors are kept locked and only one person is allowed to enter at a time. Our workloads have just gotten heavier everywhere.

She handed me an iPad to go over the consent paper work. I reviewed and signed it. The consent forms explained the entire study process over next two years. I understood that I will be either receiving the active agent or the placebo. Aja drew three vials of blood from my left forearm. I looked at my blood in the test tubes and thought to myself, it looked dark and I should have drank some water before coming over. I also thought about being more regular with taking iron supplements. She took my medical history.

I was examined by a nurse practitioner. It felt nice to have my heart and lungs listened to. It felt nice when she asked me how I was feeling. I should go see my own doctor more often. After drawing blood, Aja handed me a Kleenex. What is this for? I asked. She showed me the nasal swab! Oh, ok! She stuck it up in my nose in one nostril and my head jerked back involuntarily. My eyes started to water and I reached for the Kleenex. She said, we now need to do it in the other one! Oh boy, did I feel relief when that was over.

They asked me to have it in the non-dominant arm which is left for me. I pulled my sleeve up for the vaccine injection for her assistant. I asked this young man if he had ever seen the scars for the small pox or the BCG vaccine for tuberculosis. No! He said, not outside of books. This is what they look like, I showed him over my left arm. A teaching moment! I love teaching. Small pox had been eradicated in several countries and had people stopped vaccinating when I received it in Pakistan.

Vaccination is key to preventing disease and has been a major advance in public health to eradicate epidemics like smallpox or polio. Vaccines work by mimicking an infectious agent, and by doing so, train our bodies to respond more rapidly and effectively against them. The vaccine I received today is an “RNA vaccine”. RNA vaccines rely on a different way to mimic infection. Compared to previous vaccines, this method is more robust, more versatile, and yet, equally efficient. Have you heard about RNA vaccines?

Scientists made the observation that when children get chicken pox, they develop immunity against it. This idea led to the development of vaccinations. Vaccination is the process in which substances called antigens are introduced artificially into the body to stimulate the immune system. Those antigens are generally infectious agents – pathogens – that have been inactivated by heat or chemical treatment so that they will not cause disease, or they can also be purified proteins from the pathogens.

Exposing the body to antigens leads to the production of molecules specifically directed against them, called antibodies. Antibodies create a memory of a specific pathogen and enable a more rapid and efficient response to a real infection with an active pathogen. The RNA vaccine that I received today is expected to stimulate production of antibodies against COVID-19. Once I have developed antibodies against the corona virus, if I am exposed to the actual virus, my body will be ready to fight it.

Vaccination has been central in diminishing or eradicating multiple infectious diseases, such as smallpox or polio. However, producing vaccines is a long and complex process. Thanks to evolving and advancing scientific advances, RNA vaccines have been invented.

According to one article by Alexis Hebaud, as an analogy, one can see the DNA as a cook book in a library: the recipe is stored here but cannot be used. The commis, or chef’s assistant, first makes a copy (the RNA) of a specific recipe and brings it to the kitchen. The information is now ready-to-use by the chef, who can add the ingredients in the order specified by the recipe and create a cake. By cake they mean the antibodies we need to fight the pathogen or disease causing agent.

For a classical vaccine, the antigen is introduced in the body to produce an immune response. However, in the case of DNA- or RNA-based vaccines, no antigen is introduced, only the RNA or DNA containing the genetic information to produce the antigen. This is a much simpler process than the culture of virus in eggs.

Another advantage is that the production of RNA-based vaccines is more rapid compared to production of traditional vaccines. This rapid production could be a major advantage in face of sudden pandemics. Moreover, RNA-based vaccines may be effective against pandemics because they also provide more flexibility to prevent or treat pathogens that are rapidly evolving. The World Health Organization estimates it takes approximately five to six months to produce an influenza vaccine, whereas the companies claim that RNA-based vaccines could be manufactured in less than two months at a lower production cost, making it possible to respond to epidemics even as they develop. Therefore, RNA-based vaccines offer a comparatively simple and rapid solution to unpredictable, rapidly evolving pathogens.

The injection itself was not painful at all. Nothing in comparison to the anthrax vaccine I received last year. Those three injections were really painful. Aja, the clinical trials coordinator told me, some people never returned for another shot after the first one. I want to laugh about this but I will stop myself because no two people experience the pain the same way. I remember that sting of the anthrax vaccine injection all over my arm, how it makes you feel.

For few moments, I realized how patients in pain feel. It changes the state of your mind making you feel vulnerable and out of control. I felt a little dizzy for a couple of minutes which I think was a combination of getting blood drawn, being hot and dehydrated and looking up and down trying to download the Coronavirus diary that I need to fill out everyday for few days while trying to talk to everyone at the same time.

Aja brought me a glass of cold water. I felt better after drinking it and left for home with a blue bag with a COVID-19 testing kit in case I felt ill, a thermometer, a scale to measure any induration at the injection site and a couple of charge cards with money on them. I received $120 for participating in the clinical trial today. I spent all the money I got last year for the anthrax vaccine on eating at Red Lobster.

When I got home, Tom had brought sushi. We ate and I fell asleep missing the American against the next war meeting at 4:30pm where my wise friends from around the world meet every Friday to discuss how to save humanity from itself. When I woke up, I received a reminder to answer the questions about any side effects with the vaccine in the corona diary provided by Pfizer in an app. The information technology has completely changed the way, data is received and calculated in clinical trials.
Thanks to the power nap, I am able to write this paper this evening.

Dr Lubna Mirza
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