The COVID Choice

We’ve received many questions about the various COVID-19 vaccines. Your undecided patients are asking questions and you were not sure what to say. Here is an article to help. We’ll cover key statistics and talking points to help you discuss these vaccines with your patients. You are also welcome to share it with them, as well.

The COVID Choice

Recent surveys have shed light on attitudes in the United States toward COVID-19 vaccines. American adults were asked by pollsters if they will take a vaccine as soon as possible.

The responses vary by age, ethnicity, and gender. However, roughly half said yes, 1/4 said no, and 1/4 are not sure. [1]

In this article we will lay out the risks and benefits to the various choices for those who are in the undecided camp. 

If your mind is already made up

If you have already decided against the COVID vaccine this paper is not meant to change your mind. 

You have every right to be skeptical. Our government institutions and leaders are as fallible as any of us. Even experts can get it wrong. Everyone is subject to human shortcomings and can be swayed by hidden agendas. You have likely lived long enough to have seen such problems first hand.

Is this virus part of an unimaginably complex political power-play? Is the vaccine a cover for a surveillance tool? Please take your educated skepticism and apply it evenly to everything you hear, not just what you disagree with.

None of us should blindly trust any sources. Yet we must see that few of us are trained to act as investigative journalists or reviewers of biomedical literature. The best strategy for most of us is to pay attention to the conclusions that show up consistently among high quality independent sources. 

If you are genuinely undecided, please read on.

The Scenario

People think that their choice is between receiving a vaccine with possible complications, or avoiding it and thereby removing any chance of a negative outcome from the vaccine. That could be true if we did not have a pandemic to contend with, but in reality the choice is not whether you want to take the vaccine or not, it’s between the infection or the vaccine. The following scenario can help give the choice more context. 

Imagine that you found yourself in a bizarre game show. You are being asked you to choose between:

Door #1

Door #2

Behind #1 is exposure to SARS-CoV-2, the virus which causes COVID-19. You don’t get to choose the time and place of your exposure, but as this pandemic continues the chance of being exposed eventually will be 100%. 

Behind #2 is the immunization which has been developed against SARS-Cov-2. 

While neither door hides a brand new car(!), there are benefits and/or dangers to each. Some benefits or dangers may be immediate, others may only show up down the road. 

You have to make a choice. Let’s look at the differences between them.

Comparing the Doors

Here’s a clear summary that more directly compares the choices behind each door. Below is a chart showing expected outcomes of 10,000 cases of COVID-19 and 10,000 immunizations with the Pfizer SARS-Cov-2 vaccine. Also included are the reported side effects from 10,000 doses of the saline placebo. The anticipated side effects from the vaccine such as sore arm, fatigue, and headache, last 1 – 2 days in most instances. Symptoms of COVID-19 last much longer, with nearly 70% of individuals having symptoms lasting longer than 60 days. [2]

When addressing vaccine side effects, it is worth remembering that many side effects seen in those who received the vaccine were also seen in those who received a saline placebo injection. The final column reports the side effects from the placebo group for comparison. The highest number in each row is in bold.

Table 1: Side Effects Compared: COVID-19 Virus vs COVID-19 Vaccine vs Saline Placebo [3] [4] [5] [6][7]

Side Effects per 10000Door #1 
COVID-19 Infection
Door #2
COVID-19 Vaccine [16] 
Saline Placebo [16]
COVID-19 Infections– – – 5-10**No protection
Fever7,100 [8]1,9602
Cough8,000 [8]00
Shortness of Breath4,300 [8]00
Fatigue6,200 [10]5,000650
Muscle Aches/Joint Pain6,100 [8]4,7401,080
Loss of Taste/Smell7,000 [9]00
Sore Throat3,500 [8]00
Sinus Symptoms690 [8]00
Nausea or Vomiting1,600 [8]200100
Diarrhea3,100 [8]1,000800
Headache5,800 [8]5,2002,400
ICU Admission200+ [12]1*0
Stroke250 – 500 [11]00
Long term symptoms***6,600 [2]00
Death180 [13]00
Additional COVID-19 infections from transmission to others.20,000 – 30,000 [14]?****Similar to COVID-19 group

*One person who received the vaccine and had an allergic reaction required a short stay in the ICU [15] for monitoring. See “Anaphylaxis” info below.
**Absolute vaccine efficacy and real-world effectiveness are not yet known. In Pfizer’s Phase 3 study, 19,000 people received the vaccine and there were a total of 9 cases of COVID in that group.
***Symptoms lasting longer than 60 days after infection.
****No new cases of COVID-19 would be from the vaccine itself (it is not a live virus vaccine and cannot cause COVID-19), but could occur from people who received the vaccine and still became ill. We also don’t know yet how well the vaccine prevents spread of the illness (it seems likely but we need more time to see how it works in a large population).
Statistics are as of December 19, 2020 or the date in the published reference.

It is easy to see at a glance that the risk of complications between the virus and the vaccine are clearly distinct.

It is possible that more side effects will emerge with the vaccine. It is also possible that the virus will become milder over time. Yet even if both of these events occurred – the gap is far too wide to close. You could imagine a race between a sports car driver and a skateboarder. Even if the skateboarder gets faster, or the driver lets up on the gas, the outcome won’t appreciably change. 

The next section will give more detail to help bring these numbers into focus. 

COVID-19 Vaccine Side Effects

How do you feel after the vaccine?

A personal note from one of the authors, Alan Christianson NMD. This is my personal experience as an early recipient of the COVID-19 vaccine. 

I do believe in the net benefit of the COVID-19 vaccines. I was willing to contribute to the data by participating in one of the clinical trials. However, I was rejected from the study as not having enough day-to-day exposure to the virus to meet trial requirements. Nonetheless, as an Arizona health care worker, I did receive my first dose of the Pfizer-Biontech vaccine on December 17th. 

I received the shot in the morning. The first day, my only symptom was tenderness at the injection site. It was pretty mild. I didn’t even notice it unless I rubbed on the spot. 

I did have side effects the morning of the following day. They were all as described – headache, body aches, chills. They were significant enough for me to skip my workout that day but not significant enough to change my other activities. By the third day, I was back to normal. Had a nice morning workout and had no unusual symptoms. 

From reading the studies, it seems that my experience was quite typical. 

At the time of this writing, the Pfizer and BioNTech vaccine has submitted full briefing documents to the FDA and these documents have been made public.[16] Since this is the most comprehensive data available, it will be the main source of data on side effects unless otherwise specified. 

In this study, 43,548  participants ages 16 to 85 years of age were given two doses of the COVID-19 vaccine or two doses of an inert placebo. The placebo given was an injection of 0.5 mL normal saline in a volume equal to that of the vaccine. [16]

Normal saline is used in IV solutions because it is an inactive carrier solution. Other than the discomfort of the injection itself, saline injections of this quantity (0.5mL) cause no known physiologic effects. 

At the time of the data cutoff for publication, participants had been followed for a median of two months, and up to 14 weeks of follow up data were included in the report. Monitoring is ongoing and will continue for two years. [16]

The vast majority of participants did experience initial side effects. These typically started within 24 to 48 hours after the vaccination and lasted one to two days. The most common ones noticed included pain at the site of injection, fatigue, headache, fever,  chills, vomiting, diarrhea, muscle pain, and joint pain. [16]

Let’s discuss some of the effects from the above table in greater detail, as well as some other concerns that have been raised about the immunization.

Fever

Fever is a common symptom of COVID-19, and was also experienced by some of the vaccine recipients. This is a good sign the immune system is working. In the vaccine trial, just under 20% had fevers after the vaccine, but the vast majority were mild (less than 102 degrees). Two individuals in the vaccine group had a fever > 102 degrees, and interestingly, so did 2 of the placebo group. [16]

Anaphylaxis 

Anaphylaxis is a severe allergic reaction that can cause airway compromise if not controlled. There have been a small handful (4 as of this writing) of instances of vaccine recipients having an anaphylaxis-like reaction after receiving the vaccine. [17] This side effect did not occur in the vaccine trial, but people with severe allergies were excluded from the trial. [16]

It is not clear yet what component in the vaccine may be responsible for this reaction, but all incidences of anaphylaxis have been successfully treated, with full recoveries. This is definitely something to watch out for in the post-licensure data, and a good reason that the vaccine should be administered in a facility with the capability to manage allergic reactions, with epinephrine and airway support.

Also important to note; these outcomes were immediately and widely reported, and recommendations on how to administer the vaccine safely were put into place. They were not hidden, which gives me confidence that if other negative effects are noted, they will be transparently reported to the public.

Bell’s Palsy

There have been a number of questions about Bell’s Palsy. This is a relatively common condition where one side of the 7th cranial nerve (the one which controls facial motion) suddenly is paralyzed. We expect to see approximately 15 – 30 cases per 100,000 people per year. [18] It is not known why this happens, but viral infections do seem to play some kind of role. It usually resolves on its own. There were 4 people in the vaccine group who had Bell’s Palsy, and 0 in the placebo group. [16]

Based on the natural prevalence of this condition, we’d fully expect some people in the study to have a case of Bell’s Palsy, so this is not surprising. In a group of 38,000 (the number of people in the vaccine trial) we’d expect to see 4-10 cases happen just by random chance alone. So if you want to argue that the vaccine caused these cases of Bell’s Palsy, it is just as fair to say that the placebo prevented it.

New COVID-19 Cases

For every case of COVID-19, we expect to see 2 to 3 new cases due to transmission from one person to another. Obviously, masks/distancing/handwashing are all ways to reduce this number, but on average we’d expect to see somewhere in that range, so for this comparison we’re using that baseline. [19] We don’t yet know how well the vaccine prevents spread of the illness within a population, but because this vaccine is not a live attenuated virus, it is impossible to get COVID-19 from the vaccine. The preliminary data from the Moderna vaccine trial suggests it reduces transmission [20], but until more information is available, we do not know for sure.

Ongoing Vaccine Symptoms?

None of the vaccine recipients in the trial had any chronic symptoms or chronic side effects from the vaccine itself.

Although uncommon, the vast majority of serious adverse reactions from a vaccine occur within the first week or two after the immunization, and are extremely rare. [21] The further away in time from the vaccine being administered, the less likely an event will be related to the vaccine itself. 

People will have health issues after vaccination that are totally unrelated to the vaccine: for example, in the Moderna vaccine trial, one person was struck by lightning a month after receiving the vaccine [20], and subsequently suffered from an irregular heartbeat. This is, of course, not related to the vaccine, but was reported in the trial as an outcome because they collect all the data to analyze. 

By that same type of random chance, some people will have negative health outcomes around the time they receive the vaccine that have nothing to do with the vaccine itself. Heart attacks, strokes, blood clots, and other conditions all have a background rate at which they occur, and just because they happened after a vaccination, we shouldn’t necessarily blame them on the vaccine.

The frequency of these events are monitored closely, just like the anaphylaxis example above. If safety monitoring shows that there is a sudden uptick in a negative health outcome, for example: heart attacks, after the immunization above the baseline rate we’d expect in the population, investigators would immediately begin assessing if the vaccine was responsible.

The last point to make here is this: Because the mRNA vaccine produces SARS-CoV-2 spike protein, if the vaccine is found to cause a negative outcome, it is highly likely that this outcome could also occur with a case of COVID. If someone is presenting an argument that the vaccine caused a certain event, they also need to explain why it wouldn’t be just as likely to occur due to a wild type SAR-CoV-2 infection.

COVID-19 Virus Complications

For COVID-19, the most easily documented complications are hospitalization and death. There are many more who seek out medical care in outpatient settings and countless more who manage their symptoms at home. 

How many people are currently hospitalized from COVID-19? The numbers have changed throughout the course of the pandemic and vary by country. For the United States, as of December 5, 2020 there were 101,192 people in the hospital, with 19,947 in the ICU and 7,006 on a ventilator. [22] As of December 5, 2020 the overall hospitalization rate for the US was 11.4 per 100,000 people. [23]

The death rate from COVID-19 is fortunately lower than it was at the start of the pandemic, but is still much higher than the death from the seasonal influenza, which is approximately 0.1%. [24] Overall in the US, 1.8% of those diagnosed with COVID-19 have died from it. This corresponds to a crude mortality rate of 93.7 people per 100,000 people. The current case fatality rate is 1.5%.[25] 

Your Decision

As you plan your decision, please consider the following mindset. The choice you make is about others as much as it is about you.

The mindset of helping the community was an essential part of past pandemics that were brought under control. Think about it like filling sandbags: Imagine your town is at risk from a river which is rapidly rising due to torrential, once-in-a-century rains. If the river crests its banks, it will ruin most of the homes in town. People will be displaced, livelihoods will be lost. 

Filling sandbags is not fun. It is hard work, done under pressure in gruelling conditions. No one would do it if they did not need to, and not everyone is physically capable of the work. It can’t be done alone – it won’t even make a difference unless everyone who can help does so.

Pandemics are the same. Are you immunocompromised? Maybe you’re too young to receive the vaccine? Have you had anaphylactic reactions in the past? If so, you won’t be able to help out right now. You will need to rely on others. 

If you can, please consider enduring a tiny risk and a few days of discomfort to help others. If not just to protect yourself from illness but to protect someone else. The more we can do to help our community, the safer we will all be as individuals. The more we work together, the faster we can get back to living our lives free of the spectre of an encroaching global pandemic.


  1. AP-NORC poll: Only half in US want shots as vaccine nears. (n.d.). Retrieved December 13, 2020, from https://apnews.com/article/ap-norc-poll-us-half-want-vaccine-shots-4d98dbfc0a64d60d52ac84c3065dac55
  2. Carvalho-Schneider C, Laurent E, Lemaignen A, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset [published online ahead of print, 2020 Oct 5]. Clin Microbiol Infect. 2020;S1198-743X(20)30606-6. doi:10.1016/j.cmi.2020.09.052
  3.  Hilton J, Keeling MJ. Estimation of country-level basic reproductive ratios for novel Coronavirus (SARS-CoV-2/COVID-19) using synthetic contact matrices. Flegg JA, ed. PLOS Comput Biol. 2020;16(7):e1008031. doi:10.1371/journal.pcbi.1008031
  4.  Wang Z, Yang Y, Liang X, et al. COVID-19 Associated Ischemic Stroke and Hemorrhagic Stroke: Incidence, Potential Pathological Mechanism, and Management. Front Neurol. 2020;11:571996. doi:10.3389/fneur.2020.571996
  5. Burke RM, Killerby ME, Newton S, et al. Symptom Profiles of a Convenience Sample of Patients with COVID-19 — United States, January–April 2020. MMWR Morb Mortal Wkly Rep. 2020;69(28):904-908. doi:10.15585/mmwr.mm6928a2
  6. Hettiarachchi NM, Manilgama SR, Jayasinghe IK. Clinical Characteristics of COVID-19. J Ceylon Coll Physicians. 2020;51(1):14. doi:10.4038/jccp.v51i1.7881
  7. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-426. doi:10.15585/mmwr.mm6914e4
  8. https://www.acep.org/corona/covid-19-field-guide/patient-presentation/signs-and-symptoms/
  9.  https://www.ecdc.europa.eu/en/covid-19/latest-evidence/clinical
  10. Fatigue reference: https://www.cdc.gov/mmwr/volumes/69/wr/mm6928a2.htm
  11. Stroke reference: https://www.frontiersin.org/articles/10.3389/fneur.2020.571996/full
  12.  ICU admits 2%: https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm
  13.  https://covidtracking.com/data
  14. Hilton J, Keeling MJ. Estimation of country-level basic reproductive ratios for novel Coronavirus (SARS-CoV-2/COVID-19) using synthetic contact matrices. Flegg JA, ed. PLOS Comput Biol. 2020;16(7):e1008031. doi:10.1371/journal.pcbi.1008031
  15. https://www.washingtonpost.com/health/allergic-reaction-covid-vaccine-alaska/2020/12/16/cf8f5c56-3fcb-11eb-8db8-395dedaaa036_story.html
  16. FDA. Vaccines and Related Biological Products Advisory Committee December 10, 2020 Meeting Announcement. Published 2020. Accessed December 11, 2020.
  17. https://www.washingtonpost.com/health/covid-vaccine-allergic-reactions/2020/12/17/a8490340-409d-11eb-8bc0-ae155bee4aff_story.html
  18. Ranges vary; see https://emedicine.medscape.com/article/1146903-overview#a7
  19. Hilton J, Keeling MJ. Estimation of country-level basic reproductive ratios for novel Coronavirus (SARS-CoV-2/COVID-19) using synthetic contact matrices. Flegg JA, ed. PLOS Comput Biol. 2020;16(7):e1008031. doi:10.1371/journal.pcbi.1008031
  20. Vaccines and Related Biological Products Advisory Committee December 17, 2020 Meeting Briefing Document Accessed December 18, 2020
  21.  Spencer JP, Trondsen Pawlowski RH, Thomas S. Vaccine Adverse Events: Separating Myth from Reality. Am Fam Physician. 2017;95(12):786-794. www.aafp.org/afp. Accessed December 18, 2020
  22. https://covidtracking.com/data Accessed December 17, 2020
  23. COVID-19 Hospitalizations Accessed December 17, 2020
  24. Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study Accessed December 18, 2020
  25. America Is on Track to Hit a COVID-19 Death Record Accessed December 17, 2020

picture of Alan Christianson, NMD
Alan Christianson NMD
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Alan Christianson, NMD is a naturopathic doctor in private practice with a focus on thyroid disease in Phoenix, Arizona. He has been actively practicing in Scottsdale Arizona since 1996 and is the founding physician behind Integrative Health. He is a New York Times bestselling author whose titles include The Metabolism Reset Diet, The Adrenal Reset Diet, and the forthcoming Thyroid Reset Diet. Dr. Christianson is the founding president of the Endocrine Association of Naturopathic Physicians.
Maxwell Cohen, ND
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Max Cohen, ND is a naturopathic physician in Portland, Oregon. He currently works for a Federally Qualified Health Center (FQHC) providing primary care for a wide variety of patients. He is a member of the Board of Directors of the Naturopathic Academy of Primary Care Providers (NAPCP), as well as the Scientific Advisory Board for Boost Oregon.He completed his medical training and residency at the National University of Natural Medicine. Prior to medical school he worked as a microbiologist in a tuberculosis vaccine development lab. Twitter @MaxwellCohenND

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