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COVID Vaccination Perspectives from an Integrative Doctor

COVID Vaccination Perspectives from an Integrative Doctor

Posted by Ingrid Bauer, MD, MS on Apr 2nd 2021

As an herbalist, an integrative physician, 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.

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.

NOTE: This post was updated with new information added on April 2, 2021. The information from my original post is still relevant, but if you are a return reader looking for the latest additions, see my  COVID vaccine updates below

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, 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.

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 am not an apologist for “Big Pharma,” and I resoundingly criticize the profit-driven model that makes the coronavirus vaccines and many other life-saving treatments out of reach for poor people around the world, including those in our wealthy nation.

However, I believe that with freedom comes responsibilities: 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.

Are COVID-19 Vaccines Safe?

The mRNA vaccines currently available in the United States are very safe, though not without potential risk. 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 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 experience local mild effects such as a sore arm, while up to 70% have mild to moderate systemic effects after the second vaccine. These symptoms are believed to result from the robust immune response elicited by the vaccine, and respond well to simple home remedies like acetaminophen, rest, and herbal teas. Severe allergic reactions occur 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.), making it easier to identify individuals at risk for an adverse COVID vaccine response and take precautions accordingly . Another emerging complication may be thrombocytopenia, a condition where the immune system attacks platelets (an important component of clotting) that can result in internal bleeding. Thirty-six cases, including one death, have been reported to date in the US, and causality with the vaccine has not yet been established. Generally, the reports of death after vaccination have not been linked definitively to the vaccine and are very infrequent (0.003% of recipients). Resources for tracking side effects after the vaccine include signing up for VSafe with your first shot, or using the Vaccine Adverse Event Reporting System.

If you have a history of a severe allergic reaction, a platelet disorder, an autoimmune condition or are immunosuppressed for any reason, or if you are pregnant or breastfeeding, please consult your healthcare practitioner before signing up for a shot. Also, if you have more questions than I can answer in this post, great places for solid information include:

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 Gladstarr, and Nicole Telkes, among others!

What Are the Risks of NOT Getting Vaccinated?

I urge my readers to put these statistics in the context of the effect of the pandemic on our families, communities, nation, and people across the globe. By mid-February 2021, we have seen nearly half a million deaths in the US out of 27 million cases, and nearly 2.5 million deaths worldwide (where the 100 million cases are sorely underreported due to lack of testing capacity, especially in developing countries). 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.

If you are fortunate enough to have a chance to get vaccinated, consider accepting the opportunity to help halt the spread of a potentially deadly (and definitely mutating) virus. 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.

COVID VACCINE UPDATE: New Safety Information & Recommendations, April 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 two months have passed since this post’s original publication, so I’d like to share some updates on vaccines, variants, 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.

COVID-19 Vaccine Safety, by the Numbers

To date, 51 million people in the US have been fully vaccinated for COVID-19, about 17% of the population. In the first month of coronavirus vaccination in the US, during which 13 million people received a first dose of the vaccine, the CDC received about 7,000 reports of adverse reactions. Of these reactions, 90.8% were non-serious, and 9.2% (644 cases) were serious. Approximately 4.5 cases of anaphylaxis were reported per one million shot recipients. There were 113 deaths reported, 65% of which occurred in long term care facilities, and none were shown to be a direct result of the vaccine.

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 datasets 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 adneovirus 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..

COVID Variants: Should We Worry?

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 is likely driving 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.

Is It Safe to Get the Vaccine While Pregnant or Breastfeeding?

Many folks have asked me if I recommend getting the vaccine while pregnant and/or nursing. As an internal medicine physician, I’m not an expert on maternal or fetal health—but as a parent who was formerly pregnant with and breastfed two kids, this matters to me! Like all of my answers to vaccine safety questions, this decision comes down to a risk-benefit analysis, without 100% certainty.

Here’s what we do know. P 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 to14 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 Spread 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 to successfully end the pandemic.

What Activities Are Considered Safe After I Have Been Fully Vaccinated?

In general, the only thing that we currently know really changes after you are fully vaccinated is that you now have a dramatically lower risk of contracting or getting seriously ill from COVID-19. According to the  CDC, if you’ve been fully vaccinated:

  • You can gather indoors with fully vaccinated people without wearing a mask.
  • You can gather indoors with unvaccinated people from one other household (for example, visiting with relatives who all live together) without masks, unless any of those people or anyone they live with has an increased risk for severe illness from COVID-19.
  • If you’ve been around someone who has COVID-19, you do not need to stay away from others or get tested unless you have symptoms.
  • However, if you live in a group setting (like a correctional or detention facility or group home) and are around someone who has COVID-19, you should still stay away from others for 14 days and get tested, even if you don’t have symptoms.

Should I Take Herbs & Supplements Before and/or After Getting 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 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 something simple like ginger, cinnamon, chamomile, or lemon balm tea could be soothing and gentle if you feel beat up after the vaccine.

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:

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Written by Ingrid Bauer, MD, MS: With experience that bridges Western and Eastern medicine, Ingrid brings rigorous scientific knowledge to Five Flavors Herbs. A graduate of the UC Berkeley/UCSF Joint Medical Program and the American School of Herbalism in Santa Cruz, CA, Ingrid integrates plant-based medicine into mainstream healthcare. She is passionate about bringing holistic care to people from all walks of life. Her master’s research focused on Latino health beliefs and traditional medicine at a bilingual clinic in Oakland, CA, and she teaches workshops about herbal medicine at conferences and schools.