COVID Vaccination Perspectives from an Integrative Doctor

Posted by Ingrid Bauer, MD, MS on Aug 9th 2021

As an herbalist, an integrative doctor, an organic farmer, and a social justice activist, I love to promote food- and plant-based strategies for maintaining wellness. It’s literally our business at Five Flavors Herbs. As a physician in the safety net, taking care of some of our most vulnerable community members, I am also trained in and accustomed to prescribing life-saving drugs and medical interventions. During the coronavirus pandemic, I have continued to work in a community clinic and in our local hospital, all the while constantly researching the virus so that I can provide the best, most up-to-date advice to my patients as well as to my friends, employees, and family members. While scientific research and my own experience as a physician and herbalist attest to the value of supporting overall health with natural remedies, the best defense for both individuals and society against a specific, contagious, and deadly contagion like COVID-19 is vaccination combined with masking, hand hygiene and physical distancing.

Witnessing a tsunami of misinformation about the pandemic and the vaccines from both ends of the political spectrum, including many voices in the natural health community, has prompted me to speak up. I don’t expect to change the minds of individuals who have already made up their minds about vaccines. But I do hope that some people who are on the fence, nervous about a new technology, or afraid of side effects—especially people who generally try to use natural methods to promote good health—might consider my experience and perspective when making their choice.

Why Did I Get Vaccinated for COVID-19?

I see vaccines as imperfect but overwhelmingly beneficial technologies that save lives all over the planet. I grew up using herbs and homeopathy on an organic farm (I’ll share some natural immune support recommendations below), but I also received childhood vaccines. Similarly, both of my children are fully vaccinated (given on a spread out schedule to monitor for any potential adverse effects along the way). I have received the flu shot annually for at least 10 years and on multiple occasions was the only person in my family to evade a really bad bout of influenza, which allowed me to care for them and continue working as a physician. This January, I was fortunate to receive both doses of the Pfizer coronavirus vaccine. I got “the shot” because I want to protect my family and my patients from a potentially deadly disease, and because I need to stay healthy to take care of them! The only side effect I experienced was a sore arm, and I recognize my luck given my co-workers’ and patients’ experiences with severe flu-like symptoms. I feel even more fortunate to have been protected when my husband contracted the virus towards the end of that same month and I did not, even though he was not able to self-isolate from me.

COVID VACCINE UPDATE: Safety Information & Recommendations, August 2021

As we have come to expect over the last year or so, new data is constantly emerging regarding COVID-19, vaccines, and public health. As a physician, apothecary owner, and spouse/parent, I’ve been monitoring these updates to be able to offer the best available information to my family, my patients, and our Five Flavors Herbs audience. Nearly three months have passed since this post’s last update, so I’d like to share some new information and thoughts about vaccines, variant spread, and current public health guidance. I’ll also offer my take on what herbs and supplements we can take to support our bodies during this prolonged pandemic period.

Should COVID Vaccinations Be Mandatory?

I strongly believe in personal autonomy and healthcare freedom. I am not a proponent of forced vaccines. I did not support California SB 277 (which removed the personal belief exemption for vaccines required for entry into public schools). I oppose the profit-driven model of healthcare that makes the coronavirus vaccines and many other life-saving treatments out of reach for so many people around the globe.

However, I believe that with freedom comes responsibility: to heed the guidance of experts such as scientists and physicians; to read scientific literature and to question what we read online; and to protect the most vulnerable in our communities. When it comes to infections and vaccines, this means taking in all the available information (even when it’s less than we would like), weighing the pros and cons and choosing the greater good. Many individuals who choose not to vaccinate their children enjoy the blessing of good health; are educated about healthy diet and natural remedies; can afford to homeschool their kids; or live in a society with clean drinking water and access to advanced medical care. Choosing not to vaccinate puts others at risk who may not share those privileges: babies, elders, immunosuppressed folks, or single parents who can’t afford to miss work to care for a sick child.

Because of our responsibility to our patients, co-workers, and our families, I do support the vaccine mandate for healthcare workers in California announced August 5, 2021. Those of us who work in healthcare already accept mandatory flu and hepatitis B vaccines. If we work in caring professions, we must protect ourselves and those around us by vaccinating and wearing our masks until we are through this pandemic.

What Are the Risks of NOT Getting Vaccinated?

I urge my readers to consider the following statistics in the context of the effect of the pandemic on our families, communities, nations, and people across the globe. As of August 2021, we have seen over 600,000 deaths in the US, and over six million deaths worldwide, which is likely underreported. Depending on the country and on how data is reported, the case fatality rate is approximately 2%. By comparison, the 2019-2020 flu season saw 38 million cases, 400,000 hospitalizations, and 22,000 deaths from influenza in the US. There really is no comparison with any other recent global pandemic since the 1918 flu pandemic, which resulted in 50 million deaths worldwide, 675,000 of which occurred in this country. By now, almost all of us know folks who have gotten infected, been seriously ill, experienced lasting side effects, and/or died.

Choosing not to vaccinate (and/or adhere to strict social distancing measures) allows the virus to continue replicating, leading to mutations that cause transmissible and deadly variants. As illustrated in a recent Washington Post article, quickly vaccinating a majority of adults may be our only chance to stamp out a pandemic before it mutates beyond what the current vaccines and post-infection immunity can protect us from.

We all live in overlapping, expanded circles of humanity, and our decisions ripple far beyond what we can anticipate. It is time to shift from fear and self-centeredness to collective responsibility and care for each other, both by embracing vaccines and also by continuing to wear well-fitting masks, keeping physical distance, washing our hands, and using our diverse natural tools for staying healthy.

Are COVID-19 Vaccines Safe?

The mRNA vaccines currently available in the United States are very safe, though not without potential risks. The technology behind the vaccines has been under investigation for nearly 30 years and was able to advance so quickly due to earlier scientific discoveries, government funding, the removal of conventional roadblocks and delays in testing, and the prevalence of the disease itself. The ingredients are marvelously “clean” compared to other vaccines that contain adjuvants and preservatives such as aluminum and thimerosal, and the ingredients are published online.

The vaccines are also very effective; studies showed 92-95% protection against symptomatic infection after the second dose, which has been confirmed by data from Israel (where most adults over 60 are now vaccinated). Efficacy of the current vaccine may be lower against emerging mutant strains, and the duration of immunity is yet unknown; annual boosters may be required, not unlike for the influenza vaccine.

Now that millions have been vaccinated worldwide, initial safety data from the Pfizer-BNT and Moderna vaccine trials are being compared with real-life events. As in the trials, many recipients have experienced local mild effects such as a sore arm, while up to 70% have reported mild to moderate systemic effects (e.g., fatigue, headache, aches) after the second vaccine. These symptoms are believed to result from the robust immune response elicited by the vaccine and be effectively addressed with simple home remedies like acetaminophen, rest, and herbal teas.

Severe allergic reactions have occurred in a small number of individuals ( ranging between 2.5 to 5 cases per million recipients), and no cases of anaphylaxis have resulted in death. About one-third of these individuals had a history of anaphylaxis from other causes (a prior vaccine, food, bee stings, latex, etc.), which has made it easier for healthcare professionals to identify individuals at risk for an adverse COVID vaccine response and take precautions accordingly.

To date, 166 million people in the US have been fully vaccinated for COVID-19, about 50% of the population. From December until August 2021, over 345 million doses of COVID-19 vaccines were administered in the US. During that period, the Vaccine Adverse Events Reporting System (VAERS) received 6,490 reports of death (0.0019%), which may or may not be related to the vaccine.

If you’d also like sound advice on staying healthy during the pandemic (and beyond) from other herbalists with decades of experience, I recommend checking out Sevensong, Paul Bergner, Dr. Christopher Hobbs, Lily Mazarella, Rosemary Gladstar, and Nicole Telkes, among others!

IS IT SAFE TO GET VACCINATED WHILE PREGANT OR BREASTFEEDING?

Pregnant people have a higher risk of severe disease and death from COVID-19 infection, which can also put the fetus at risk. Pregnant people were not intentionally included in the vaccine trials, but some participants did become pregnant and did not have adverse outcomes. To date tens of thousands of pregnant people have been vaccinated without reports of widespread problems. Furthermore, studies in pregnant lab animals were reassuring, and Pfizer BioNTech is planning on future studies of pregnant humans to gather more safety data. At this point, the WHO and health administrations in the US, Canada, and Europe, as well as physician’s groups such as the American College of Gynecologists and Obstetricians (ACOG), have all given the green light for pregnant and breastfeeding people who chose to get the vaccine. In cases involving high-risk jobs (including healthcare and front line workers) and/or high-risk pregnancies, the benefits of vaccination likely outweigh any potential risks.

I ALREADY HAD COVID, SHOULD I GET VACCINATED?

Yes, folks who have already contracted COVID should still get vaccinated. Once you have finished your quarantine period (10 to 14 days) and your symptoms have resolved, it is a good idea to get the vaccine when you become eligible. Unlike infections like measles, which provide nearly 100% lifelong immunity after recovery, natural immunity after a coronavirus infection is variable. Although 91% of infected people who actually develop antibodies won’t get infected again in the next six months, almost 10% of infected individuals do not develop detectable antibodies, and others lose their immune protection as quickly as one month after initial infection. In contrast, vaccine trials show that nearly 100% of participants not only had detectable antibodies, but had much higher levels of them than those who had experienced a natural infection. Scientists suspect this is because the vaccine induces a strong response against the most virulent part of the virus (the spike protein) whereas with a natural infection, factors like the severity of illness, the individual’s age, and their immune system function, make immune responses highly variable.

CAN A VACCINATED PERSON SPREADY COVID-19?

We don’t know yet if any of the vaccines provide “sterilizing immunity,” meaning that you can’t pass along the virus to others. The measles vaccine provides sterilizing immunity, while other effective vaccines do not (these include the hepatitis B vaccine and the seasonal influenza vaccine). Scientists are currently gathering data on individuals who have already been vaccinated, and these observations so far show much lower rates of transmission overall. If a vaccinated individual has an asymptomatic infection with COVID-19, they will likely have a lower viral load and transmit fewer viral particles in air droplets. Based on historical data on non-sterilizing vaccines, public health officials and scientists agree that COVID vaccines don’t need to entirely stop transmission target="_blank" to successfully end the pandemic.

How Do the Different COVID Vaccines Work?

As of this update, there are three COVID vaccines approved for emergency use in the US (with a fourth poised for US authorization), each developed by a different pharmaceutical company.

mRNA VACCINES

The first two vaccines to receive US authorization, created by Pfizer and Moderna, use a relatively new messenger RNA (mRNA) technology. These two vaccines deliver a small piece of modified coronavirus mRNA into the arm muscle, where it is taken up into our immune cells’ cytoplasm (the outer fluid-filled area of the cell, not the nucleus where our body’s personal DNA blueprint is stored). In the cytoplasm, ribosomes (the cell’s protein factories) read the assembly instructions in the mRNA and use it to build a COVID “spike”—a piece of protein shaped like a distinctive part of the coronavirus, but without any harmful properties. Once the spikes are built, our cells throw out the mRNA blueprint, and the spiny protein pieces are placed on the outside of the cell’s surface, where they are recognized as intruders and trigger an immune response. Afterwards, if real COVID-19 virus particles enter the body, the immune system recognizes those suspicious spikes and deploys the antibodies vaccination had trained it to make.

Both vaccines have been shown to be highly effective when administered in two doses, spaced 3 to 4 weeks apart. Large data sets from Israel (where nearly 50% of the population has been fully vaccinated) show that two doses of the mRNA vaccine reduced symptomatic cases by 94%, hospitalization by 87%, and severe COVID-19 symptoms by 92%.

VIRAL VECTOR VACCINES

The third vaccine to be authorized for emergency use in the US, made by Johnson & Johnson (along with the Oxford/AstraZeneca vaccine also being considered for use in the US), is a “viral vector” vaccine. Using a similar process to the mRNA versions, these vaccines deliver a modified, inactive adenovirus (cause of the common cold) into the body that introduces DNA instructions directing the body to make coronavirus spike proteins, which then trigger antibody production. Note that this is not a “live virus” vaccine. It contains no active adenovirus or coronavirus particles, so the vaccine will not cause a recipient to come down with either illness.

Studied since the 1970s, this same technology has been used to manufacture a vaccine against Ebola. Unlike the mRNA vaccines, viral vector vaccines are much more durable and can be transported and stored at normal refrigerator temperatures. They also only require a single dose. The J&J trials included 44,000 people in the US, Central and South America, and South Africa, while Oxford/AstraZeneca enrolled 32,000 people in the UK, South America, and South Africa. Furthermore, the O/AZ vaccine was shown to be 79% effective in preventing symptomatic infections, and 100% effective in preventing severe infection and/or hospitalization. The latter vaccine was temporarily halted in the UK last month due to concern over a possible link with blood clots, and while the EU health commission determined lack of causality, some countries have not resumed using the Oxford/AstraZeneca vaccine, and it has not been approved by the FDA for use in the United States.

Delta Variant: Why Vaccination & Masking Are Both Still Needed

The more times a virus has the opportunity to replicate, the more chances it has to mutate. In the absence of widespread herd immunity, COVID’s RNA has mutated to form variants with enhanced transmission and virulence that is threatening natural and vaccine-induced immunity. Even though vaccines may be slightly less effective against variants, their emergence—and evidence that natural immunity may not protect against them—is another reason why vaccination continues to be such an important public health goal.

Like most Americans in June 2021, I was enthusiastic to start socializing, traveling, eating in restaurants, and otherwise getting back to some semblance of normal. But I was also nervous. While we were busy taking off our masks, millions of people were dying in India of COVID-19, and word was spreading about a highly infectious new variant: Delta.

After a brief honeymoon period from the pandemic this summer, the Delta variant of COVID-19 is now running amok not only among the unvaccinated, but now among vaccinated individuals as well. In my county of 100,000 people, we’ve had 207 new cases reported in the past week, which is more cases than the prior five weeks combined (since California lifted the mask mandate on June 15th). This is twice as high as the weekly case rate in our county at the peak of the pandemic in January 2021. Recent outdoor gatherings in our community have turned into super-spreader events. Many of these individuals were vaccinated and are experiencing mild symptoms while isolating at home. Many unvaccinated people are very sick, and our hospital is full.

It didn’t have to be this way. The vaccines could have worked to prevent this recent wave, in the wealthiest nation in the world where we have more than enough vaccine doses to cover every eligible human. Months ago, infectious disease experts suggested that we needed at least 70% of the adult population to be fully vaccinated to reach anything close to herd immunity. This is not an arbitrary number—it’s based on data from many other infectious diseases such as measles, polio, and smallpox which have been nearly or completely eradicated thanks to global vaccination campaigns.

Unfortunately, with only 50% of eligible Americans vaccinated, we didn’t reach anywhere close to a safe threshold before this latest surge of a more virulent strain. Match this with nearly universal unmasking and a new variant that is four times more infectious than the original strains of COVID-19, and the stage was set. As early as May, public health experts worried that low vaccination rates, even in small areas of the country, could spill over into neighboring communities and lead to a resurgence of infections even among those vaccinated. And this is what we’re seeing today.

Breakthrough cases are real, and I am seeing them in my community. In an outbreak in Provincetown, MA, out of 900 individuals who tested positive, 75% were vaccinated; there have been no deaths and only 7 hospitalizations. However, we now know that if you actually contract the Delta variant, whether you’re vaccinated or not, you can still transmit the virus to others: to children under 12 who don’t yet have the chance to get the vaccine, folks with weaker immune systems, and of course to those who aren’t vaccinated.

It’s certainly disheartening to think that even if you get vaccinated, you could still get COVID-19 or pass it to others. That’s why the CDC reversed course and re-issue recommendations for all individuals, regardless of vaccination status, to wear a mask indoors “in areas of high transmission.” With or without a vaccine, masking and physical distancing are still critical to slowing the spread of the virus and saving lives!

Luckily, if you’re vaccinated, you’re unlikely to get seriously ill or die from COVID-19. For example, the Pfizer vaccine is at least 90% effective against hospitalization or death in breakthrough infections with the Delta Variant. An analysis of breakthrough cases of Delta variant among UCSF employees demonstrated that unvaccinated people were five times more likely to become infected, and 25 times more likely to be hospitalized. Per the CDC, out of 164 million fully vaccinated individuals, just over 7,000 hospitalizations or deaths have been reported since January. In states with low vaccination rates, the vast majority of hospitalizations and deaths are among the unvaccinated, according data collected by the Kaiser Family Foundation.

For those of you who are still vaccine hesitant, or who are waiting for more data on vaccine safety, or for a better vaccine to hit the market…the time to get vaccinated is NOW. You are much more likely to die, get hospitalized, or suffer “long COVID” if you don’t get vaccinated. If data on vaccine safety and efficacy doesn’t convince you, let me share my personal experience. I do not have any patients on my panel or in my clinic or any co-workers, friends or acquaintances that have had a major side effect from the vaccine. The worst I’ve seen is one person who had an allergic reaction requiring epinephrine and steroids. Many have spent a day or two feeling exhausted and feverish (including my husband and 12-year-old daughter), but many more have had nothing more than a sore arm (like me). All together, this comes to thousands of people that I am directly or indirectly aware of in my immediate community—and in a context in which I would absolutely know if there were a severe consequence or death from a COVID vaccine. Compare this to the chance of severe COVID requiring hospitalization, death, or long-term symptoms. The choice, to me, is clear: get the shot(s), and put your mask back on!

COVID VARIANTS TIMELINE:

The more times a virus has the opportunity to replicate, the more chances it has to mutate. In the absence of widespread herd immunity, COVID’s RNA has mutated to form variants with enhanced transmission and virulence that may threaten natural and vaccine-induced immunity. Even though vaccines may be slightly less effective against variants, their emergence—and evidence that natural immunity may not protect against them—is another reason why vaccination continues to be such an important public health goal.

Here is a timeline of notable COVID variant emergences:

UK Variant (B.1.1.7): First discovered in September 2020 in the UK, this variant has been detected in over 50 countries and at least 14 US states. Because it is the most widespread variant, more transmissible, and up to 30 to 70% more lethal than other mutations, public health officials are very worried about the potential of the UK variant becoming mainstream in the US. Fortunately, so far, all available vaccines still seem to be effective against the UK variant.
South Africa Variant (B.1.351): First identified in early October 2020, this variant has been identified in nearly 50 countries and 24 US states. Like the UK variant, it is more transmissible than earlier COVID strains, but it does not appear to be more lethal. However, it may also be more resistant to antibody therapy and pose a risk of reinfection, and vaccines may be less effective against this variant. Pfizer and Moderna both declare their vaccines effective against the variant, but the Johnson & Johnson, Novavax, and Oxford-AstraZeneca vaccines appear to provide inadequate protection.
New York Variant (B.1.526): Identified in November 2020in New York City’s Washington Heights neighborhood, this COVID strain now makes up nearly 50% of the city’s new infections and has spread to at least 14 other states.
Brazil Variant (P.1): With more mutations than other variants (some of which actually change the spike protein region of the viral RNA), this variant drove a massive and deadly surge of COVID-19 infections in Manaus, Brazil, a large Amazonian city that already had an estimated 76% herd immunity after the initial surge in May 2020. The case of the Brazil variant and the outbreak in Manaus exemplify the many things that can go wrong with a public health approach that promotes the broad natural exposure of a population to a new and deadly pathogen for the purpose of driving herd immunity, regardless of the human toll racked up in the process.
California Variant/West Coast Strain (B.1.427 and B.1.429): These variants are now found in many states and are increasing, with a 20% high transmission rate. As of March 24, according to the California Department of Public Health, of 427,461 positive COVID patients sampled, 8,600 were due to one of these variants.
Delta Variant (B1.617): First detected in India in 2020, it ravaged India in early 2021 and has now become the dominant strain both in the UK and the US. It is about 4 times more transmissible than the original variant that emerged in China in late 2019, and is now causing “breakthrough” infections in individuals fully vaccinated against COVID-19. Read on below for more about the delta variant.
B.1.621 is a new variant of major concern in the US and Europe, having entered south Florida from Colombia in July 2021. It already accounts for about 10% of cases in Florida after just a few weeks.

Natural Immune Support & COVID

I still favor using herbs for optimizing health. I use them for anxious nights, sore throats, aching muscles, period cramps, cranky kids, post-viral coughs, poorly healing wounds, and so much more. I have been sharing herbal remedies with individuals experiencing mild COVID-10 symptoms for months. However, I do not expect herbs alone to end a global pandemic, nor to prevent death from hypoxic respiratory failure in the context of overwhelming sepsis due to COVID-19.

SHOULD I TAKE HERBS & SUPPLEMENTS BEFORE OR AFTER BEING VACCINATED?

I honestly don’t know. Because these vaccines are new, and haven’t been studied in combination with herbs and supplements, I don’t feel comfortable making strong recommendations on this topic. I don’t think it’s a great idea to consume products geared at boosting or modulating the immune system right before and after, just in case there is some impact on the vaccine’s efficacy or side effects. Most doctors recommend rest, fluids, and acetaminophen for fever or body aches. I think simple home remedies like a tea of ginger, cinnamon, chamomile, or lemon balm could be soothing if you feel beat up after the vaccine. Most important is to rest, hydrate, and let your immune system do its job in response to the jab: to make antibodies.

NATURAL HEALTH TIPS FOR SELF CARE IN COVID TIMES

Now is a really important time to use food, movement, herbs and supplements for whole person support. Grief, fear, uncertainty, and disconnection have taken a toll on our bodies and spirits. Many of us have gained weight and/or increased our dependence on sugar, alcohol, and other substances to cope with the stress of this uncertain time. Some of us have been cooped up at home and not getting enough sunlight or exercise. Others have been working overtime as essential workers in agriculture, food service, healthcare, childcare, and other sectors that haven’t gotten a break at all! Whichever combination of factors has impacted you, your family, and your community, here are some of my favorite tips for promoting resilience:

Move: Now that it’s officially spring, take advantage of warmer temperatures and longer days to spend some more time moving, especially outside! Yoga is one of my favorite ways to move in the early morning or after work, and as the weather warms it’s a great time to try practicing outdoors.

Connect: Many of us have become accustomed to keeping to ourselves during quarantine. Even though many of us need to continue physically distancing due to the persistence of the virus, there are so many ways to connect virtually or outdoors at a distance! Pick up your contact list and reach out to three people you haven’t talked with or hung out with in the past year. Make a phone call, set up an online chat, or go for a walk in the park together—and reconnect.

Nourish: Spring is an amazing time to clean out the pantry of heavy winter foods and commit to lighter, greener cuisine. Cut the sugar, carbs, and alcohol, focus on lean proteins and fresh greens, and start to feel better! Check out our spring liver detox guide and broth recipe blogs (vegan and bone) for more tips

Support Immune Health:

Vitamin D is critical to normal immune function, and more and more science backs this! Plus, it benefits bone health and mood. If you are able, get your levels checked to make sure you’re not over- or under-doing it (aim for a serum level of 50 to75 mg/dL).
Medicinal mushrooms are superfoods that support a healthy immune system year-round, and have long-term benefits beyond warding off bugs. Try to make medicinal mushrooms like reishi, maitake, shiitake, and cordyceps a regular part of your wellness routine.
Decongest your lymphatic system with traditional remedies such as figwort, cleavers, nettle, burdock root and dandelion greens as tea, tincture, or even homemade nettle pesto.

Support the Nervous System:

Adaptogenic herbs like ashwagandha can help soothe your way through stressful times and help you get a great night’s sleep.)
Bupleurum root formulas inspired by Chinese medicine can help smooth emotional turbulence that may come with seasonal changes and other times of stress.
Sleep better with rest-promoting habits, herbs and essential oils.

Now is the time to take an integrative approach to health: get vaccinated, wear a mask, physically distance yourself, eat well, move your body, avoid toxic exposures, and use herbs and supplements to fortify your body and mitigate symptoms if you have a mild infection. And, if you get really sick, seek emergency medical attention immediately. And let’s give a huge shout out to the scientists, nurses administering vaccines and COVID tests, first responders, emergency room staff, and critical care teams everywhere!