In early January, Nali Gillespie watched her social media feeds fill with vaccine selfies: Photo after photo of her peers at other medical schools around the country posed proudly next to a syringe with their dose of either the Moderna or Pfizer Covid-19 vaccine.
But Ms. Gillespie — who is in her third year at Duke University School of Medicine and is focused on research rather than clinical training — knew she wouldn’t be able to join them yet.
Because she volunteers in an outpatient clinic just once a week, she has less direct exposure to Covid patients and is waiting in line behind classmates who are working in intensive care units and emergency rooms.
“You hear that at some schools, students are already getting their second dose, and then there’s some of us who haven’t even been scheduled for our first,” Ms. Gillespie said.
When she goes in for her weekly clinic shifts, she knows she is still vulnerable to exposure to the coronavirus. “You’re increasingly aware that an asymptomatic patient can come into the clinic and you’re seeing them in a small exam room,” she said. “The risk is very real.”
In December, the Centers for Disease Control and Prevention announced guidelines establishing priorities of who should get the vaccines first as the rollout began. Although the guidelines were broad, medical students learned that they could be included among the first wave of health care workers, especially those involved with care of Covid patients. But the rollout has varied widely across the country’s 155 medical schools, which have each set priorities based on the availability of vaccine doses in their state.
This has caused stress for some medical students continuing their clinical rotations. Although some schools bar students from treating Covid patients, that rule can be difficult to enforce, especially with asymptomatic cases.
While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.
The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.
No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
At some institutions, like Duke School of Medicine, students working in intensive care units and emergency departments were placed in the highest level priority group, 1A, while all others were told they would be vaccinated under group 1B. At Yale School of Medicine, all medical students, regardless of their level of patient exposure, were told they would be vaccinated in reverse alphabetical order (“by the first letter of their last name, starting at the end of the alphabet”).
“Those who were at the later stages of the alphabet were happy but a bit confused as to how arbitrary it was,” said Sumun Khetpal, a fourth-year student.
Students at Texas College of Osteopathic Medicine in Fort Worth said that for weeks they had received no communication from the school about when they would receive their vaccines, so some drove hours across the state looking for private pharmacists who would give them shots. And at the University of Pittsburgh School of Medicine, students said they also had to “take matters into their own hands,” and reach out to private pharmacies to inquire about getting vaccinated because until last weekend, they were not told how to receive vaccines from their school.
“The C.D.C. guidelines did not have the level of granularity needed for hospitals and schools to make decisions,” said Dr. Alison Whelan, chief academic officer of the Association of American Medical Colleges. “There’s been a fair amount of variability because of the lack of a national plan.”
Adding to the confusion, the vaccines were allocated to states according to their populations, which do not always reflect their populations of health care workers, added Dr. Janis Orlowski, chief health care officer of the association. There are 21,000 med students in the country.
For some of them, there’s a sense of guilty relief as they receive the vaccine knowing some of their peers still have not.
“One of my close friends is a dental student and is in people’s mouths on a regular basis, but she hasn’t received the Covid vaccine,” said Azan Virji, a second-year medical student at Harvard who got his first dose in late December. “It feels like there’s a disparity.”
Still, Mr. Virji said he has treated Covid-19 patients many times and felt a weight lifted knowing he is now inoculated.
“My parents in Tanzania may not have access to this vaccine until 2022, and now I’m one of the first people to have access to it,” he said. “It’s bittersweet, but essential for me to feel calmer in the hospital.”