Like a miracle, COVID vaccines are being delivered to end both this pandemic and my incessant blogging and podcasting on the topic.
Nearly 60 million people as of today have been immunized. All of them are collectively asking, “When can someone sneeze into my face again?” Or, “All those folks in Florida and Texas have been so interested in eating out and going to the bar despite a pandemic, when can I get in on that action to see what they’re raving about?”
There are two post-vaccine topics to discuss: the immediate aftermath of your COVID vaccine(s) and the long-term implications.
I may have one or two more COVID blogs left in me, so let’s check this one off the list so we can move on for goodness sake!
The Immediate Aftermath of Your COVID Vaccine
First, a disclaimer. I’m a pharmacist, but I’m not YOUR pharmacist. You need to speak to your pharmacist and/or healthcare professional to get the post-vaccine management advice tailored to fit you best. That being said, let’s look at the controversy and the advice I’m giving to the aging hippies of Woodstock.
The COVID-NSAID Controversy
Normally after a vaccine, people will happily take some sort of anti-fever/anti-pain over-the-counter medication. Why the heck am I writing about it, then?
A few reasons. First, COVID is new and people are being rightfully cautious.
Second, remember all that confusion about NSAIDs and COVID from the early days? Basically, there were concerns that NSAIDs used at the wrong time would be like steroids at the wrong time and make the severity of COVID way worse than if you did nothing. It was proven to be not a concern VERY early on.
The third—and bigger reason—was that a government vaccine big-wig said the CORRECT thing, but not the responsible thing.
Basically, they stated something that many medical professionals have discussed in SCHOOL for a while: NSAIDs and acetaminophen could theoretically blunt our immune’s response to vaccines. Hang on, hang on…Hold your horses before you get upset and change your life around.
Let’s think about this logically: how many millions of vaccine doses have been given over the last 50 years? How many of those folks have used over-the-counter pain relievers to manage side effects?
While in theory NSAIDs and acetaminophen could diminish our response to a vaccine, in practice it really doesn’t. Or at least not to a degree that matters.
Here’s what you need to know: It is DEFINITELY OK to use NSAIDs or acetaminophen AFTER your COVID vaccine if you need to.
I, like many others, don’t recommend pre-dosing them; wait until you have symptoms, then address them.
COVID Vaccine Side Effects
First, we recommend that you check out the CDC’s app, vSafe. It allows recording and tracking of COVID vaccine side effects on a huge, easy-to-use scale. It adds adverse event transparency to the already transparent and scrutinized process of COVID vaccine development.
There are a number of side effects that are common with COVID vaccines.
Here are common side effects that can occur with any vaccine:
- Pain, redness, or slight swelling in the arm (or injection site)
- Fatigue and/or Weakness
These symptoms can start within 24 hours and usually last no longer than 72 hours.
With COVID vaccines, we have had the following adverse events reported, in particular after the second dose:
- Severe arm pain—this is what I had. Couldn’t use my arm for 2.5 days!
- Nausea & diarrhea
- Full body achiness
- Cold sweats
Most COVID vaccine side effects started 4-8 hours after a dose.
First dose side effects tended to be more moderate yet less frequent. If they occurred they lasted about 2 & ½ days.
Second dose side effects tended to be more severe and more frequent. If they occurred, most people felt better after 24 hours.
If I haven’t been clear yet, second doses tend to be a rough ride for a higher percentage of people.
Managing COVID Vaccine Side Effects
I recommend using the best, safest dose of the best, safest pain reliever/fever reducer. Again, this is up to your doctor or pharmacist.
I’ve told my patients that this is the STARTING PLACE of my recommendations, but then is tailored to your age and specifics:
- You can use Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen)
- I prefer Advil (ibuprofen) over Aleve (naproxen) because ibuprofen is shorter acting and you can make tweaks easier (if naproxen doesn’t work, you’re stuck for 8 hours)
- I do NOT recommend aspirin, as it’s a better blood thinner than it is vaccine-side-effect manager. If you use aspirin daily for heart issues, take it in the morning BEFORE you take any NSAID doses for the day.
From a dosing standpoint, here are the MAX doses of the things I recommend in my pharmacy that MOST people can take:
- Advil (ibuprofen): 800mg (4 of the 200mg tabs) up to four times daily
- Tylenol (acetaminophen): 1000mg (2 of the 500mg tabs) up to four times daily, but I really like 650mg up to 6 times a day.
An interesting strategy is to alternate ibuprofen and acetaminophen. Start with ibuprofen, for example. Two hours later, use acetaminophen. Two hours from then (4 hours from original ibuprofen dose), you can take ibuprofen again. Play leap from for a max of 4 doses of either.
That addresses the pain, aches, and fever, but the concerning symptoms are the rare nausea and vomiting, especially in the elderly or frail folks. It is VERY important to maintain fluids and electrolytes to healthy levels after your vaccine. Though not ‘organic,’ it is VERY smart to rock some Gatorade, Jello, or freezy pops. I’d recommend going to coconut water if you’re not up for the other options.
“COVID arm” is a thing. Besides the severe pain, some folks get what resembles cellulitis: redness, warmth, and irritation over a large area of the injection site. Docs in my neck of the woods are recommending the pain managers as above, some Benadryl (diphenhydramine), and time. This seems to last more than the traditional 3 days.
I’ll go back to my statement I made on my Facebook and the podcast: “I’d sh*t Brillo pads for a week if it means no more COVID.”
These side effects are 100% worth it. They are RARE, it seems, especially in my elders. It seems us young folks are the wussies 😛
Socialization After Your First Dose
Based on preliminary data submitted by Moderna and official data from Pfizer, you will have some degree of protection about 10-14 days after your first dose.
This doesn’t mean anything officially. I think it is very wise to not socialize with anyone until you’ve completed your series, which means 2 weeks after your second dose of the two-dose vaccines.
At both steps, breathe easier, but don’t go nuts.
What I mean by that is to continue to be vigilant, but don’t be stressed you’ll be one of the unlucky ones to catch it despite doing the right thing.
I would still hold off on socializing with anyone, unless they are also 2 weeks out from their first dose.
Readjusting to Life Post COVID Vaccine
Socialization After Your Second Dose
Two weeks after your second or final dose, you are considered protected. That means you are officially wished “Happy New Year” by me, as 2020 is finally. f*cking. over.
At this stage, yes, you can AND SHOULD socialize with other friends or family that are also vaccinated fully.
In fact, get on that plane. Go on that vacation. Get out to a restaurant.
Do so, but be vigilant in public. Wear as many masks as Dr. Fauci tells you. Follow social distancing. Wash your hands. Brush your teeth. Wipe front to back. Do all the things you should be doing.
The rules won’t be changing for a while. It’s a good idea to continue to do the right thing, just in case. I want you to be confident that you now have a tremendous amount of protection.
“Can I still catch COVID?” Technically, yes. Someone with COVID could cough in your eyes and you could catch COVID. You could, theoretically, transmit it as well. In practice, it’s EXTREMELY rare, but we can responsibly say that it’s a possibility but not a real possibility.
Remember, we’re not giving you a force field. We’re teaching your body to identify and better fight an invader.
We’re giving you one more piece of swiss cheese:
Here’s an interesting scenario that’s popping up with us: our friends are vaccinated, we’re vaccinated, but none of our kids are. Our kids stay home, their kids go to school and do things (safely). What do we do?
We’ve decided that we will remain vigilant with the kids. Outdoor play with masks for now. Once cases fall dramatically to a point there is little community spread, then we will allow riskier interactions with the kids. I also will be a testing site soon, so we could always do rapid tests if need be.
Don’t Get Lazy
I see it already. Folks, once protected, are getting way too lax way too quickly with their decisions. You still have a real risk, and COVID is still very real and a big meanie.
KEEP YOUR GUARD UP. Don’t be like Texas. Do the right thing.
The Light at the End of the Tunnel
I not only see the light, but I feel the warmth. That light and warmth are NOT Darth Vader’s lightsaber; there is no other shoe that will drop if we stay this course of vaccination and vigilance.
My prediction: life is 100% different by April, with our future looking VERY bright by the end of May. My predictions have been pretty darn accurate, so I think we can all appreciate a brighter day is coming.
There has been no greater gift or achievement in my professional life than giving these doses to folks. Our extremely hard work is paying off and paying dividends for our region.
Side effects schmide effects. Who cares. Take Tylenol. Tough it out. Do it with a smile. COVID is ALMOST OVER!
I’m so excited for you all to get a dose, and I hope you get yours soon!
Just trying to keep it real…
Neal Smoller, PharmD
Owner, Pharmacist, Big Mouth