#ThisIsOurShot to end the pandemic [PODCAST]

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“Vaccines have been around as early as 1776 when Edward Jenner first pioneered the smallpox vaccine and Louis Pasteur produced a rabies vaccine. As a microbiologist’s child, I grew up hearing these stories from my father and thinking of these men as heroes. Vaccines have been proven so effective and safe that we are guilty of taking them for granted. There may have been a few mishaps, but given current standards for testing efficacy and safety, there is very little to worry about.

In 1980, the World Health Organization declared that smallpox was eradicated from the face of the earth, and there was no need for further vaccination. I, for one, cannot wait to hear the same about COVID-19.”

Anupama Verma is a nephrologist and can be reached on Twitter @anuvmd.

She shares her story and discusses her KevinMD article, “#ThisIsOurShot to end the pandemic.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Anupama Verma. She is a nephrologist, and she wrote the KevinMD article “#ThisIsOurShot to end the pandemic.” Anupama, welcome to the show.

Anupama Verma: Thank you so much for having me, Kevin. I’m so excited to be here with you.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Anupama Verma: Yes. So I’m a board-certified nephrologist practicing in Green Bay, Wisconsin. I was born in India, and I did my medical training in Nigeria, and then I moved to England and then to Philadelphia. I did my internal medicine residency at the University of Pennsylvania, Penn Presbyterian, and then my fellowship at Lankenau, all in the Philadelphia area. I took up my first job in Green Bay in private practice and practiced for 18 years, and eventually, just this past year, we were acquired by a hospital. So I’ve seen both sides: private practice, and now almost one year of hospital-based practice. And I love nephrology.

I think the two interesting things about me that people like to hear about are that I have lived on four continents, Asia, Africa, Europe, and the Americas, and also that I am the editor-in-chief of the Women in White Coats blog. That is my passion, to get the stories of medicine out there, just like you, Kevin. I think you’re a pioneer, and we’re all following in your footsteps, kind of. But I enjoy telling stories from the medical perspective, because if we don’t tell our stories, who will?

Kevin Pho: Absolutely, and that’s what I say as well. We need to share the stories of clinicians behind the closed doors and let the public know what’s really going on. Now, from a nephrology standpoint, we’re speaking in the middle of January. What are you seeing about how the pandemic affects what you’re seeing in the clinic or in the hospital?

Anupama Verma: I practice out of three hospitals, so I work in three ICUs. I want to let people know, I mean, even people in medicine don’t know, that nephrologists are at the front lines of the pandemic. Many of the patients in the COVID ICU develop acute kidney injury or kidney failure and require dialysis. In fact, when we had the epicenter of the crisis in Green Bay, Wisconsin, one of the hardest-hit areas in the country, in October, we ran out of dialysis staff, and we ran out of dialysis machines to keep patients alive, you know, and filter out the toxins. We ran out of chronic renal replacement therapy machines. We had so many patients, it was overwhelming. So we saw that in the ICU setting.

And of course in the hospital, there were a few cases in the COVID wards of acute kidney injury as well. Most of those got better and went home, for the most part. And in the clinic, we are still seeing some follow-ups of aftereffects of kidney disease in COVID patients, and they are still struggling to get better from all the effects of the coronavirus. So yeah, we are at the front lines as nephrologists, and we are seeing the devastation that this pandemic has caused.

Kevin Pho: I’m a primary care physician, and let’s say we see a patient post-hospital discharge for COVID. Are there any kidney-related effects that we in primary care need to look out for?

Anupama Verma: Yes. Well, one is ATN, which recovers pretty quickly. The other is that some of them may not recover due to clots. As you know, COVID predisposes to clotting, and that happens in the kidneys. Usually by then they’re really sick and may not get better from their kidney disease, or even from the virus. But again, I would avoid at least nephrotoxins. You know, be wary of how you treat the patients with antibiotics or other drugs that can affect the kidney further, like NSAIDs. So really, it’s mostly acute kidney injury from ATN, and interstitial nephritis. If it’s from thromboembolic events, you know, they’re prone to clotting. That’s another thing to be watchful for. But I would refer to a nephrologist early, so that we can, you know, manage the side effects from kidney disease as well and prepare for the future.

Kevin Pho: So let’s transition now into your KevinMD article, “#ThisIsOurShot to end the pandemic.” Now, for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Anupama Verma: As soon as the vaccine came out, we have all been keeping a close eye, and the medical community and the world in general were so excited that the vaccine is here. And now, not only one, we have three potential vaccines. We have the Pfizer and the Moderna, and now the AstraZeneca is also coming out, all over the world. But then I was hearing, in my medical circle, some people who would not take the vaccine, even some patients and some doctors and some nurses, and that just shocked me. I was like, “This is what we’re waiting for.” How could people even think, in the medical community, that they would wait and see?

So that prompted me to write that this is our shot to end this pandemic, you know. And I didn’t even know there was a hashtag going around saying #ThisIsOurShot. A doctor started it somewhere in California, I think. And so that just became my article. I said, “I have to write something about this.” I had taken the first shot by then, and now I even have the second shot, and I just wanted to clear misinformation for everyone.

Kevin Pho: And when you talk to your medical colleagues or other health care workers, whether they’re nurses or other health care staff in the hospital, what are some of the concerns they express about the vaccine that you’re hearing?

Anupama Verma: Well, some of them say, “We’re too young. What if we get autoimmune diseases after?” And then some of them say, “I have allergies,” or mild, you know, seasonal allergies. Or some will say, “I want to wait and choose whether I should take the Pfizer or the Moderna.” And you know, the hospitals are only supplying one, and they’re both equally effective. They’re both safe, equally safe. And so I was like, whatever they bring on, I’m rolling up my sleeve and taking the shot. And so I have managed to convince some people.

Some patients tell me, “I get the flu shot, but I’m not going to take this one because it’s new.” And then I have to convince them that the mRNA technology has been researched for 20 years now. In fact, I talk about that in the article too. The technology is not new. Yes, it has been applied to this vaccine urgently, expedited with the significant, generous funding, but the technology behind it has been researched at the University of Michigan, everywhere, you know, Cornell, everywhere. There have been researchers in L.A., at the San Diego Institute of Vaccines, researching this for 20 years. So the technology is not new. It may seem like it’s new, but it’s not.

And even for reactions, most have been safe, and very few people had severe allergic reactions. But my takeaway for those people is that, you know, I have been a nephrologist for 18 years, I have practiced in three different ICUs and hospitals since I became an attending, and I have never seen anyone die from a vaccine yet. But in the nine months that this pandemic has raged, I have seen hundreds of people wheeled out from coronavirus. So I mean, you have to weigh the implications of that.

Kevin Pho: So you mentioned some potential health care resistance that you’ve encountered. What are you seeing in social media, whether it’s on your blog or on your Facebook channels or Twitter channels? What are you seeing about the response to the vaccine in your social media circles?

Anupama Verma: Yes, well, most people are very excited, and some are actually waiting: “When can we get ours? When can we get this shot? Why is it not available yet?” You know, and of course the distribution has been a problem, you know, as we all know, and that’s one problem. Many of my friends are waiting, their elderly parents are waiting, and my patients are calling in the clinic and saying, “Why are we not getting it?” Many of my patients are octogenarians and have chronic kidney disease, which predisposes them to coronavirus in the first place, and many are transplant patients who are at very high risk of death from COVID-19. So these people are waiting and waiting, and that is one urgency.

The other side is the vaccine people who say they will not get it. They’re going to wait and see over time. And even some nurses in the offices, my friends tell me, my other doctor friends tell me, “I’m not going to take it.” They want to wait and see. So yeah, it’s a mixture of both.

Kevin Pho: We’re talking to Anupama Verma. She is a nephrologist, and she wrote the KevinMD article “#ThisIsOurShot to end the pandemic.” Now, you mentioned that you had convinced some previously skeptical vaccine recipients to get the shot. Now tell me, what’s some advice that you could give fellow clinicians whenever they encounter resistance to the COVID vaccines? What are some of the tips and techniques that you use to convince some people who were previously skeptical?

Anupama Verma: Yes. One of them is that we are not going to be injecting live vaccine and live virus in you, because that’s another concern. So you cannot get coronavirus infection from the vaccine. The mRNA particle is used to encode the spike protein, which protects you and causes your body to produce antibodies, and it is later discarded by the body. So it doesn’t even stick around to invade your DNA or cause problems down the road. It’s very unlikely to stick around and cause problems down the road.

And vaccines are safe. They are so safe that we don’t even think of them until you get the disease. I mean, we have all been vaccinated, most of us in childhood, and we are all alive to tell the tale. And you know, vaccines are so safe that we take them for granted. I come from, you know, a country where I have seen cases of polio where they were not vaccinated. I have seen, you know, the devastation caused by being crippled from polio, and other diseases like diphtheria and tetanus. People die from those, from rabies. I have practiced in Africa, I’ve lived in India. I mean, I have seen the devastation that not being vaccinated can cause. And I feel, unfortunately, you don’t want to see that. You don’t want to see that. Learn and listen to the experts.

I mean, I did a little bit of research. Yes, I do have knowledge and a scientific background, being a physician and my father being a microbiologist, that’s all we talked about in the house. But I did my research still, and I just rolled up my sleeve, because I trust the experts. Trust the doctors who have done the work for me, for us, you know. I go to an electrician when I need some electrical work in my house. I go to a painter or a plumber, and I don’t try to do those things myself, for the most part. I mean, they’re small projects. So I just trust the experts.

Kevin Pho: I’ve had the Pfizer vaccine myself, and I know that there are some side effects associated with the vaccines that are likely a result of an immunogenic response. Describe some of the effects that people are feeling which are considered to be totally normal.

Anupama Verma: Yes, and I also had those effects with my second dose. My first dose was almost completely painless, and I basically had a little soreness for three hours, and that was it. And my second dose, luckily, was on a weekend that I was not working, because I was completely myalgic. I felt chills, and I felt feverish. I didn’t really have a fever, but I felt very feverish, and I couldn’t get out of bed. And then I did take some Tylenol, and honestly, after 10 hours it was gone, and I was fine the next day.

And that’s just your body’s immunogenic response, as you said. In fact, I was happy I had it, because I felt, “OK, my body is working to produce antibodies.” I felt happy that I was doing that, actually, even though it wasn’t fun to be feeling like I had the flu, almost.

Kevin Pho: Yes, and that’s the approach I take as well. I had, I’d say, myalgias, and had a little bit of low-grade fever, which completely resolved after 24 hours. And really, this is your body telling you that it is generating the proper immune response. So my final question, Anupama: What is your take-home message that you want to leave with the KevinMD audience?

Anupama Verma: Yes. My take-home message, again, is trust in science and the experts. Take the shot. It’s our chance to go back to normal life, to have a semblance of visiting our elderly parents and grandparents without fear, and living our lives. It’s a chance to open up the economies and rebuild, you know, businesses, and go back to what we had before. Take the shot, trust the experts, and everything will be OK. I want everyone to be positive.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Anupama Verma: Thank you so much for having me, Kevin. It was a pleasure.

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