Updates about COVID-19

Posted by Nurse Linda in Life After Paralysis on April 15, 2021 # COVID-19

A few great things have happened in the COVID pandemic. First, many individuals have been able to receive their vaccine(s). You may still be waiting for yours, but it will not be long now until everyone who wants a vaccine will get one. If a vaccine is not available in your area, it will be soon. Remember when you register that you will qualify as immunocompromised if you have neurological disease or injury and may also be in the respiratory compromised groups.COVID-19 vaccine bottle

Vaccines are being safely provided in mass vaccination settings. I wondered about these arrangements in the initial discussions about safety. Measures have been taken to ensure your safety while waiting in your vehicle. You can be well assured that there will be a quick response in the rarest of cases if help should be needed. The vaccine risk of reaction is extremely low, so you can be comfortable that this is an acceptable method to obtain yours. Your county or state health department generally manages these, so the vaccine and administration are at no cost.

If you prefer a smaller setting, you can receive your vaccine at some pharmacies and medical centers. Vaccines are still not available in most healthcare provider's offices. You need to make an appointment just like anywhere else the vaccine is given. This is especially helpful in controlling crowds and waiting in lines. Vaccines provided in pharmacies and healthcare clinics may have an administration fee that you will be responsible for or billed to your payor. The vaccine is free, but these locations are allowed to charge for giving it to you.

Many individuals have wondered about home health providing the vaccine if it is difficult for you to travel to an administration location. This is a wonderful idea. I have heard of a few home health services providing this, but I don't have any validation of it. It might be done through your local health department, but this is a rare occurrence. Hopefully, in the future, we will see wider distribution opportunities like this.

Vaccine sign-up is made mostly through the internet, which requires a computer or smartphone. Many areas in our country do not have internet service. In some underserved areas, the public health department is going door to door to administer the vaccine. This is done on a county-to-county basis or mandated by individual states. You may have access to the vaccine through this method, but you will need to contact your individual county health department to find out.

Currently, there is not really a choice of vaccines. You should try to get one at the first opportunity that is available to you, as this is critical during the pandemic. The Pfizer vaccine is a two-step vaccination, with each vaccine given 21 days apart. The Moderna vaccine is the same two-step process with two vaccines given 28 days apart. It is important to note that the CDC's latest statement is that both the Pfizer and the Moderna second vaccination can be up to six weeks apart and still be effective. After a six-week interval from the first injection, the series needs to be restarted for effectiveness. The Johnson and Johnson vaccine is a one-time vaccine administration. Pfizer and Moderna are rMNA vaccines that teach your body to make a protein spike on your cells to keep the covid virus from entering your body. The Johnson and Johnson vaccine is a traditional vaccine that teaches your body to make antibodies once the virus has entered your body.

There have been some side effects from the vaccines. Soreness, pain, redness and swelling at the injection site are most common. The vaccines are fluid injected into a muscle where there is no pocket for the vaccine fluid. This can be uncomfortable. Keep moving your arm or have someone move it for you to reduce discomfort. The movement stimulates blood flow in the body which disperses the fluid more quickly. The Moderna vaccine might produce a red rash in the injection area. This has now been called the Moderna rash. Check with your healthcare provider to see if you can use medication or ointment for the rash. Mostly, it just resolves on its own.

Other side effects include tiredness, headache, muscle pain, chills, fever and nausea. These symptoms range from mild to severe. If you are uncomfortable or do not resolve in a day or two, you might want to notify your healthcare professional.

These side effects can trigger increased spasms or an episode of autonomic dysreflexia (AD), especially in individuals with higher-level injuries. If you are experiencing uncontrollable spasms or AD symptoms that your usual treatment plan or the new onset cannot be controlled, notify your healthcare professional.

Side effects may have more intensity after the second shot of the Pfizer or Moderna vaccinations. This is a sign that your immune system is working to incorporate the vaccine into your body. Do not worry if you do not have side effects; the vaccine is still working. Why some individuals have more intense side effects, and others have none is not yet understood.

When you get your first vaccination, you will receive an official CDC wallet card that will indicate your vaccination's date along with the batch number and brand of the vaccine. It is very important that you keep this card safe and know where it is at all times. You will need to bring it to your second vaccination appointment if you have a two-step vaccination process. It will also be used if you have a booster vaccine in the future. It is not known how this information will be used later, but you might need the card for travel, sporting events, to enter large gatherings like concerts or movie theaters.

In the future, there is some discussion that you may even need the vaccine card to enter restaurants, but so far, that is not the case. This card is important to allow you access to events, so be sure you keep it handy and safe. We will have to see how the re-entry process works to know the full effect of using the vaccination card. Electronic versions may be used as well. Some electronic vaccination cards for air travel are available now but have a fee. Let's see how this all plays out before paying for more things that may or may not be necessary. All the new rules have yet to be written.

After socially isolating for over a year, it can be sort of scary to think about going back into the community. I know it is for me. When I go for a drive, I see people eating outside at restaurants and think, why can't that be me? But I know I am immunocompromised and taking even the chance can be disastrous for my health. Before the pandemic, it was not an issue but now, with COVID, being with others is a very serious decision.

After you are fully vaccinated against COVID-19, there is a two-week time period needed for your body to build immunity. This is two weeks from your second vaccination in a two-step series and two weeks after your one-step vaccination. There is some gathering evidence that you will have an even better response after a month.

It is very tempting to think once you are vaccinated to go out and about as we all did prior to the start of the pandemic. However, there is another issue to consider. Even though you have your vaccination, the COVID-19 virus AND all of its variants are still in the world. The vaccine protects you, but like all viruses, they can always be present once they are in the environment. Eventually, as long as people follow safety rules and get vaccinated, we will be safe. But just like other viruses, they are still in the world. People just don't get illnesses like polio or measles because of vaccines. Although, when people become lax or think that they no longer need the vaccines, those viral illnesses increase. There have been examples of outbreaks of polio around the world. There have been several outbreaks of measles in the US because people feel like vaccines are not necessary. This should be evidence that vaccines are necessary.

There is something else to consider, and that is the viral load of COVID-19 in the community. The CDC has charts so you can see how much COVID is present in your area. Keep following how your area is performing in control of the COVID-19 spread. Only return to the community when it is safe to do so in your area. That is not a guarantee that you will not be exposed, but it helps to know if you are going directly into it.

The CDC has guidelines for community entry once you have been fully vaccinated and your immunity has been built. You should only meet in small 'family' groups in your home while staying six feet apart from each other. Consider your healthcare needs and risk factors when making decisions about increasing your interactions with others.

At this time, we need to double down with caution. Follow all of the CDC guidelines. Wear a mask if over the age of two or any age without hand function issues, stay six feet or more apart, avoid crowds, wash your hands and get a vaccine. We have come too far through this to become complacent. We are doing this. Keep going. Nurse Linda

Pediatric Consideration: Vaccines for children under the age of 16 years are still being developed. Some are currently being tested. There is thought that a COVID vaccine for children could be available by the fall. Many factors could affect this timeline.

Children do have lower numbers of cases of COVID-19, but there are cases. There are children that have very mild cases and others with extreme cases. A chart showing the ages of people with COVID can be seen on the CDC website.

A disease called Acute Flaccid Myelitis has been reported in children with COVID-19. AFM is a polio-like disease that results in muscle weakness and paralysis. The numbers of cases are extremely low, but that is of no consequence when it affects your child. AFM can develop typically after a virus like the flu or COVID-19. Symptoms include sudden onset of arm or leg weakness and loss of muscle tone and reflexes. Also, the child may have facial droop/weakness, difficulty moving the eyes, drooping eyelids, or difficulty with swallowing or slurred speech. If you notice any of these symptoms, call your healthcare provider immediately or 911. This is rare, but knowledge can help you respond faster.

Helping children stay safe with neurological issues is possible. You will need to follow the same set of guidelines, wear a mask unless under the age of two or at any age if hand control is an issue, stay six feet or more apart, avoid crowds, wash your hands and as parents or caregivers, get a vaccine. Keeping your child safe is a parental imperative. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.