Last Updated: January 24, 4:30 p.m.
Here’s the third installment of FlaglerLive’s “Ask the Doctor” column by Dr. Stephen Bickel, the medical director at the Flagler and Volusia Counties Health Departments. Below are his answers to some two dozen new questions submitted in the past week, including a dozen quite specific questions about the coronavirus vaccine and other issues.
Dr. Bickel answers those first 14 questions are answered individually in the first group segment. [The name of the person asking the question is included in brackets, if the person has granted permission to be named.]
Dr. Bickel, featured almost weekly on WNZF’s Free For All Friday program since last March to update the community on the coronavirus pandemic and answer questions, will be doing so on a rolling basis here. The questions don’t have to be limited to the pandemic.
You are invited to submit your questions using the form below, or by email, or in the comment section below. The entire list of questions will be archived, indexed and linked to their answers on a separate page, here.
As Dr. Bickel describes it, “the “Ask the Doctor” column will be a semi-regular feature of FlaglerLive, the frequency of which will depend on the volume of questions we receive. The updated timestamp in red at the top of the page, will indicate when new question s have been answered.
Please feel free to ask any medical question you want, and I will do my best to answer it. In preparing my answer to your question, I may consult with some of my medical specialist colleagues or review the medical literature in order to come up with the best possible answer.
“Please limit your questions to general medical advice—I can’t give you specific medical advice since I don’t know your individual medical history. The emphasis of this column will be to provide information based on current scientific evidence while keeping speculation and politics to a minimum. If I don’t know something or the medical literature really doesn’t have much to say on a particular topic, I will tell you that.
“The fields of medicine and science in general are always advancing and we don’t have all the answers, but I will try to come up with something helpful for every question I receive, even our knowledge in an area is limited. At first a lot of the questions may be about Covid-19, but they don’t have to be, and any area of medicine is fair game for this column.”
By Stephen R. Bickel, M.D.
It is not yet known if boosters will be needed in the future after the initial series. Recommendations for boosters will be made if it becomes clear they are needed.
More than 15 million doses of Covid vaccine have been given in the U.S. so far, and many more millions of doses have been given worldwide. When this many vaccine doses are administered and especially when they are given to the elderly, it is expected that some people will experience medical complications or even death following vaccination, but this does not mean that the vaccine was the cause of these events. In Norway an average of 400 people die each week in nursing homes and long-term care facilities, and these are the primary groups of people being vaccinated in Norway at this time. Norway is investigating these deaths to determine their most likely cause, but there is no convincing evidence at this time that these deaths are related to prior Covid vaccination.
The only contraindications (meaning you shouldn’t get vaccinated) to the Pfizer or Moderna Covid vaccines are severe or immediate allergic reactions to a first dose of mRNA Covid-19 vaccine or to the chemicals that are in the vaccine: polyethylene glycol or polysorbate (which are found in some skin care, cosmetic and cleaning products). A past reaction to another type of vaccine or to any antibiotics is NOT a contraindication to Covid vaccination. PLEASE NOTE, however, that a past history of anaphylaxis to any other vaccine or injectable therapy, while not a contraindication to these vaccines, is an indication for extra caution, and people with such a history should be observed for at least 30 minutes after they receive their first dose of vaccine so that if they do develop an allergic reaction, it can be treated.
My husband and I are both over 65 and had the virus in September. We wondered if we are unknowingly exposed to the virus again, we can transmit the virus to others? Any thoughts on having a child age 16 vaccinated who works at an assisted living facility?
While Covid infection generally confers immunity for at least 3 months, reinfections do occur, so you and your husband could now contract Covid and pass it on to others, and it is recommended that both of you get vaccinated. Regarding 16 year olds getting vaccinated, the Pfizer vaccine is approved for people 16 years of age and older, and because working at an assisted living facility increases the risk of acquiring or spreading Covid, I would advise the Pfizer vaccination when it becomes available for this age group, and in fact 16 year olds working in assisted living facilities may qualify as health care workers (depending on their duties), in which case they are eligible now for vaccination.
I am on Augmentin for an inflamed colon, diverticulitis. Presently I am not having any pain or symptoms. I have an appointment for the vaccine on Tuesday (will still be taking augmentin). Can I take the vaccine? [Bonnie Krell]
Antibiotics do not interfere with the Covid vaccine, although vaccination should be deferred if you are acutely ill, whether it’s an infectious illness or some other acute illness. However, people with chronic diseases whose condition is stable are eligible to receive the vaccine, and many people like this were included in the Covid vaccine trials. If you have any doubt about whether this is the right time for you to get vaccinated you should check with your healthcare provider.
Do all of the vaccines have aborted fetus tissue in them?
Neither the Pfizer/BioNTech Covid-19 vaccine nor the Moderna Covid-19 vaccine contains fetal cells, nor were any fetal cells used in their development. These new messenger RNA vaccines are synthetic vaccines that are sequenced on a computer in a lab, and no fetal cell lines were involved in any stage of their production.
A close friend is allergic to penicillin and said she was told she can’t have the vaccine for Covid. I’ve read several other opinions on this. Can you extend you thoughts on this please? [Amy Murphy-DeMeo]
A past reaction to another type of vaccine or to antibiotics is NOT a reason to avoid Covid vaccination. PLEASE NOTE, however, anyone with a history of a severe or immediate reaction to any medication should be observed for 30 minutes after Covid vaccination. If you develop a reaction, you will be treated for it.
I am over 65 with heart disease, type 2 Diabetes and severe Rheumatoid Arthritis for which I take a biologic injection monthly which lowers my immune system further. How effective will the vaccine be for me (90% effective for a healthy person?)
This is very hard to predict, but vaccination is still recommended for you. Also, check with your provider (the one who prescribes the biological injection) to see if he/she recommends an ideal time for your vaccination in relation to when you receive your biological injection.
This is an excellent, difficult question. Based on the studies, once you are all 2 weeks past your second dose you are more than 90% protected from catching symptomatic Covid disease, but we do not yet have sufficient data to know to what degree you’re protected from asymptomatic Covid infection, which one of you could then potentially transmit to someone else who has not been vaccinated. Until we have more data about the risk of transmitting Covid after vaccination we are recommending that everyone continue to wear masks and practice social distancing just like they were doing before. Hopefully for just another few months. We are not out of the woods yet.
What agency is tracking severe vaccine reactions – is there any tracking at the state or county level? Is information provided to vaccine recipients on who to contact concerning adverse reactions? Are physicians required to report adverse reactions that are reported to them by their patients? Where can the public view information related to continuing tracking of adverse vaccine reactions?
There are extensive monitoring systems in place to track all vaccines for side effects and adverse reactions, plus additional systems set up to monitor the Covid vaccines. Here is a link to a CDC webpage that describes all the measures being taken to ensure Covid vaccine safety.
I had a procedure on my back on January 18, 2021 with shots into my lower & mid back for arthritis in my spine. Will I have to delay (if I finally get an appointment) getting the covid -19 vaccine? I am 83, diabetic & have asthma which puts me at high risk. I am on a list for call back. [Sarah G Thompson-Lowe]
It depends on what was in those shots you received in your back. If they were local anesthetics, there is no need to delay vaccination. If they had corticosteroids in them, you may have to delay vaccination. You should check with your provider (the one who gave you those shots) about this.
If you’re having a colonoscopy on February 4 that means you would be doing your bowel prep for it on February 3, the day of your vaccination. Also, adverse reactions (headache, body aches, fatigue, maybe gastrointestinal upset–usually mild) lasting a day or two are more frequent after the second dose, and if these did occur it would be right at the time you were having your colonoscopy. I would advise postponing the colonoscopy for a week or so, just to make it easier on yourself.
Your question cut off, but if it was about whether taking Zoloft is a contraindication to getting vaccinated, the answer is no–you can take your usual Zoloft dose on the day of your vaccination.
Question added by Dr. Bickel (because I’ve been asked this several times)–Can persons with a history of Guillain-Barre syndrome (GBS) receive the Covid vaccine?
Persons who have previously had GBS may receive an mRNA COVID-19 vaccine. To date, no cases of Guillain-Barre syndrome (GBS) have been reported following vaccination among participants in the mRNA COVID-19 vaccine clinical trials. With few exceptions, the independent Advisory Committee on Immunization Practices (ACIP) general best practice guidelines for immunization do not include a history of GBS as a precaution to vaccination with other vaccines.
Second-shot questions on the Vaccine:
How important is it to get the second Covid 19 vaccine within the specific time period? Will the Department of Health make sure that people receive this vaccine within the parameters after they receive the first vaccine dose? [Ron Boyce]
The second dose of the Pfizer vaccine should be given three weeks after the first dose, and for the Moderna vaccine the recommended interval is four weeks. It is more important to not give the second dose too early than to delay it a little bit–certainly a week or two delay is not thought to be harmful. The Health Department is prioritizing the second dose so people will receive it without delay.
The policy on second shots has been evolving. There is no specific dose of vaccine earmarked for you but you will be given priority to get your second shot when you are due for it. Based on the distribution schedule that has been shared with us so far, we have every reason to believe that everyone due for a second dose of vaccine in the next month will receive it in a timely manner, and in fact we have already started scheduling second doses.
Additional Questions About Vaccine Logistics and the Politics of the Roll-Out
Numerous questions came in regarding the lack of vaccines and who gets priority. A reader asked why non-Flagler County residents are eligible to be vaccinated here. Priscilla Reid asked about “the lack of a reasonable distribution system other than the first come, first serve free for all we are in now,” and the possibility of making appointments alphabetically. Many are asking about the difficulties of getting on any kind of list. Marilyn Cichocki, who is 75, and whose husband is 86, cited the numerous health challenges they both face yet find themselves relegated to the same kind of lottery as everyone else. And Daniel Motta asked why health insurance companies that make billions in profits have been silent through all this. Dr. Bickel provided a detailed answer to the questions, below.
I understand everyone’s frustration with the vaccine rollout so far. We at the Flagler County Health Department are equally frustrated because we want to get as many vaccine doses into people’s arms as quickly as possible so we can end this pandemic and get back to living the lives we had before all this started. Having said that, please understand that all we (the Health Department, that is) are responsible for, and what we have been doing with efficiency, is getting all the vaccine doses we receive into eligible people (who meet the current vaccine prioritization determined by the state of Florida) within 7 days of receiving our shipments of vaccine. Of course, we also strive to make the actual vaccination process as convenient as possible. However, we are not in charge of manufacturing the vaccine, distributing the vaccine, determining the priority groups for receiving the vaccine, or scheduling the vaccinations. Other agencies on the federal, state, and local levels, as well as the private companies making and distributing the vaccines, are responsible for these other areas, including vaccinating nursing home residents. We have been told by the state that local organizations that consistently demonstrate their ability and capacity to give out their full allotments of vaccine within a 7-day window of receiving them will be eligible to receive greater allotments in the future. So that is what we are focusing on–vaccinating, vaccinating, vaccinating–and if we keep our focus on this goal, and vaccine distribution continues to ramp up nationally (hundreds of millions of doses are scheduled to be manufactured and distributed in the next six months), we hope to get the majority of Flagler County residents vaccinated in the next six months, starting with the highest risk groups.
You are eligible to be vaccinated now–you are in the first priority group.
How can we get signed up for the next receipt of vaccines? It seems like when we get the notice of available appointments, the appointments are all gone. Couldn’t the Flagler County Health Department go ahead and give a sequenced reservation so the appointments seem to be less of a lottery? How can the Flagler County Health Department be more proactive in scheduling appointments? I have heard that local senior living establishments have not gotten vaccines. Is that true? If so, why? Flagler County residents and health officials should not be penalized for working hard to limit transmission of Covid-19. Why are we getting so few vaccine doses?
The scheduling system is in a state of evolution and we acknowledge it has been far from perfect, but people have been working hard to fix it. Currently the Department of Emergency Management of Flagler County is in charge of scheduling, but the responsibility will soon be passed on to the state which is in the process of developing an integrated system to serve most or all counties in Florida. The Health Department is not involved in scheduling at all—we do not have the personnel to handle this, and we are currently taxed to the limit with Covid-related testing, contact tracing, case investigation, and vaccinating at this time. We have the capacity to vaccinate 1000 people a day 7 days a week, and could double that in a few weeks using our volunteers–we just need more vaccine.
Links to additional references (some of which Dr. Bickel referred to in preparing these answers):
Please be safe.
For a full, archived and indexed list of questions, go here.
Dr. Stephen Bickel, M.D.
Dr. Bickel, currently the medical director of the Flagler and Volusia County Health Departments, treats HIV and Hepatitis C patients at both departments, treats internal medicine patients at the Volusia Volunteers in Medicine free clinic, and is the medical consultant to the Community Care program at 9 Advent Health campuses in Florida.Dr. Bickel has a BA from Brown University, an MD from Rush Medical College, as well as MBA and MPH degrees from UCLA. He did residency training in internal medicine at Rush, public health/preventive medicine residency training at UCLA, as well as an endocrinology research fellowship at the University of Chicago. He is board certified in internal medicine and preventive medicine, as well as being a credentialed HIV specialist and a certified hypertension clinician.
He is very interested in how the social determinants of health impact our community and how we can address health disparities by improving our safety net. He has been on the Board of Directors of Flagler Cares since its inception.
Disclaimer: The content in FlaglerLive’s “Ask the Doctor” column is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. Reliance on any medical information provided by FlaglerLive.com or medical professionals presenting content for publication is solely at your own risk.