The Second COVID-19 Shot Is a Rude Reawakening for Immune Cells

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The Second COVID-19 Shot Is a Rude Reawakening for Immune Cells

Side effects are just a sign that protection is kicking in as it should. 

Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.

[Excerpts] At about 2 a.m. on Thursday morning, I woke to find my husband shivering beside me. For hours, he had been tossing in bed, exhausted but unable to sleep, nursing chills, a fever, and an agonizingly sore left arm. His teeth chattered. His forehead was freckled with sweat. And as I lay next to him, cinching blanket after blanket around his arms, I felt an immense sense of relief. All this misery was a sign that the immune cells in his body had been riled up by the second shot of a COVID-19 vaccine, and were well on their way to guarding him from future disease.

Side effects are a natural part of the vaccination process, as my colleague Sarah Zhang has written. Not everyone will experience them. But the two COVID-19 vaccines cleared for emergency use in the United States, made by Pfizer/BioNTech and Moderna, already have reputations for raising the hackles of the immune system: In both companies’ clinical trials, at least a third of the volunteers ended up with symptoms such as headaches and fatigue; fevers like my husband’s were less common.

Dose No. 2 is more likely to pack a punch—in large part because the effects of the second shot build iteratively on the first. 

When hit with the second injection, the immune system recognizes the onslaught, and starts to take it even more seriously. The body’s encore act, uncomfortable though it might be, is evidence that the immune system is solidifying its defenses against the virus.

When the immune system detects a virus, it will dispatch cells and molecules to memorize its features so it can be fought off more swiftly in the future. Vaccines impart these same lessons without involving the disease-causing pathogen itself—the immunological equivalent of training wheels or water wings.

The Pfizer and Moderna vaccines accomplish that pedagogy via a genetic molecule called mRNA that’s naturally found in human cells. Once delivered into the upper arm, the mRNA instructs the body’s own cells to produce a coronavirus protein called spike—a molecule that elicits powerful, infection-fighting antibody responses in people battling COVID-19.

To ensure safe passage of mRNA into cells, the vaccine makers swathed the molecules in greasy bubbles called lipid nanoparticles. These strange, fatty spheres don’t resemble anything naturally present in the body, and they trip the sensors of a cavalry of fast-acting immune cells, called innate immune cells, that patrol the body for foreign matter. Once they spot the nanoparticles, these cells dispatch molecular alarms called cytokines that recruit other immune cells to the site of injection. Marshaling these reinforcements is important, but the influx of cells and molecules makes the upper arm swollen and sore. The congregating cells spew out more cytokines still, flooding the rest of the body with signals that can seed system-wide symptoms such as fever and fatigue.

To access the full article, click on: The Second COVID-19 Shot Is a Rude Reawakening for Immune Cells

The Myth of Universal Health Care

Despite our illusions, Canada’s system is neither comprehensive nor equally accessible. What would it take to reform it?


Updated 9:46, Jan. 11, 2021 | Published 14:10, Dec. 8, 2020

[Excerpts] ERYN DIXON had enough to manage as it was. At the age of forty-five, with profound disabilities related to multiple sclerosis, Dixon was living in Almonte Country Haven, a long-term care facility on a grassy hill in eastern Ontario. Then, in March, she contracted COVID-19. As she lay unconscious and unresponsive, struggling on oxygen, her father, Rick, was told to say his final goodbyes. Against the odds, Dixon pulled through, but more than a third of her facility’s residents weren’t so lucky.

Hers is just one of so many stories that we have been reading and watching and hearing for months—a catalogue of media reports every day, documenting COVID-19’s progression through our communities and the various ways it takes its toll.

As COVID-19 took hold around the world in the spring, Canada prepared for one very specific kind of tragedy: the kind we saw unfold in Italy and in New York, one where hospitals were overwhelmed and ventilators in short supply. Thanks to good timing, hard work, and an economic shutdown that will have ripple effects for years, we have so far avoided that particular calamity. But, as Dixon’s, Punian’s, and Bernadel’s stories reveal, there are many kinds of tragedies: as a country, we were too slow to realize that there were—and are—other pandemic disasters happening all around us. The stories of COVID-19-affected Canadians are also stories about Canada and our health care systems—about which kinds of tragedies we go to great lengths to avoid and which we allow to persist.

By comparison with the death count unfolding south of our border, many Canadians have felt very proud of how our country and its health systems—thirteen provincial and territorial systems, with some areas of federal responsibility as well—rose to meet the initial crisis of the pandemic. Canadian medicare has always meant more than a set of public insurance programs: we are prouder of it than we are of ice hockey or the maple leaf. The notion that access to health care should be based on need, not ability to pay, is a defining Canadian value, surviving along the longest shared border in the world with the country that hosts the most expensive, inequitable, profit-driven alternative imaginable. That difference in values is often emphasized in our political rhetoric, as when Jean Chrétien would say, “Down there, they check your wallet before they check your pulse.”

We are two doctors working in very different environments and very different medical disciplines, and we have been seeing COVID-19 reinforce some basic lessons about Canada’s health care. First, our systems’ preexisting cracks become chasms when subjected to major shocks. Second, a conversation about health care that is divorced from the social factors that help determine how healthy you are is not really a meaningful conversation at all. And, third, perhaps the only lesson that should qualify as news: when they feel they have no alternative and the need is sufficiently great, governments, private-sector players, and individual people can make tremendous changes in very short order.

HEALTH CARE SYSTEMS exist to prevent and treat illness. What this means, as a matter of medical practice and health policy, is a matter of enormous ongoing debate. When Tommy Douglas implemented public health insurance in 1947, his Saskatchewan government focused first on covering hospitals and later on medical care—at that time mainly defined as physician services. This model spread across the country in the decades that followed, with the support of the federal government and its spending power.

Douglas dreamed of moving to a second stage of medicare, in which coverage would be much broader and the prevention of disease a bigger focus. That dream was never realized, and there are whole swaths of health care that are not included in our universal system at all. Instead, an ongoing emphasis on doctors and hospitals has led many observers to characterize Canada’s so-called universal health care coverage as “narrow and deep.” What we do provide (services like primary and specialty medical care, diagnostics, surgery) tends to be high quality; our health care system strives for equal access to care particularly by ensuring there are no financial charges for these services. If you are seen by a doctor or admitted to the hospital, if you need a CT scan or a blood test, if you require a biopsy or a specialist assessment, you will be well taken care of and never see a bill. But, if you are among the 20 percent of Canadians lacking adequate drug coverage and you walk out of your doctor’s office with a prescription for medication to treat your diabetes or high blood pressure or infection or depression, you may be on your own. If you require therapy with a psychologist for anxiety, or physiotherapy for your sports injury, or a root canal, your access will depend on your ability to pay.

Want to keep reading? Click on: The Myth of Universal Health Care


BC-wide transit and business incentives could fill rural transport gaps

Fran Yanor, The Goat Feb 25, 2021

“In an ideal world, we would have public transportation serving rural communities in such a way that people can access the services that they need outside of their communities,” said Ed Staples, president of BC Rural Health Network. (Nienke Klaver)

[Excerpts] Advocates behind a campaign for province-wide public transit say it would increase safety and access in underserved rural communities, while others recommend improving competitiveness so the private sector steps up.

“There have to be substantive investments made by government all across the province,” said Interim BC Liberal Leader Shirley Bond. “But there also needs to be a climate in British Columbia where we have the private sector looking at filling some of those gaps, as well.”

In 2018, Greyhound cancelled bus routes across the province citing low ridership and reduced profitability, the provincial government opened the routes up for bids, and all but two are now covered by private operators, according to a Ministry of Transportation and Infrastructure spokesperson.

One remaining gap is the former Greyhound route from Kamloops, through Valemount and Jasper, and into Edmonton.

“If it’s not a medical issue, you can’t go to Kamloops or Vancouver or anywhere points south for any sort of pleasure or business, unless you drive,” said Barb Shepherd, a winter bus rider and advocate for increased bus service through Valemount. “Even twice a week like the one going to Prince George would be fine.”

When Greyhound cancelled its B.C. routes, the provincial government formed BC Bus North to connect regional centres, including Valemount, Prince George, Smithers, Prince Rupert, Mackenzie, Dawson Creek, Fort St. John and Fort Nelson.

“A lot of the rest of the province was left with a kind of a piecemeal bunch of routes that don’t necessarily work together and don’t run very often,” said Maryann Abbs, one of the volunteers behind the Let’s Ride! campaign to make public transit B.C.-wide.

“It is far and away the number one thing we’re trying to improve on in the province,” said Ed Staples, president of the B.C. Rural Health Network, a collective of communities advocating for improved rural health care delivery.

In a survey of British Columbians last year by UBC’s Centre for Rural Health Research, rural residents spent an average of $777 in transportation costs to access healthcare services outside their home communities for their most recent health issue.

“For people living rural, to be able to access the care that they need, many have to rely on transportation that they can’t provide for themselves,” said Staples. “Even if they can provide transportation, sometimes it’s a huge inconvenience.”

To read the full article, click on: BC-wide transit and business incentives could fill rural transport gaps


What Matters To You?

“What Matters to You?”
Virtual Care Appointments
A Resource for Patients from the BC Patient Safety & Quality Council

As virtual care is new to most of us, this checklist has been developed with patients to enable you to prepare for and make the most of your virtual care appointments. Prior to booking a virtual care appointment, your health care providers office will instruct you on whether your symptoms can be addressed virtually. If you do not have a family physician or need to access services after hours, there may be other secure virtual services available (e.g., First Nations Virtual Doctor of the Day, or provincial/national telehealth services).

Prior to the appointment

I have…

□  tested my equipment, permissions, audio/video settings and
downloaded necessary software/ applications (your care provider’s
office may be able to provide support with technology related to your

□  checked my computer, smartphone or tablet to ensure it is fully
charged or plugged into a power source and connected to the
internet (preferably high speed)

□  earphones or headphones available (for better audio quality and

□  a comfortable chair in a well-lit area without distractions and noise

□  asked a family member, caregiver or translator to be present, if

□ my health card or health insurance details available

□ my list of medications ready

□ my medical history available

□ a list of symptoms (when they started and severity) and any
associated health data e.g., temperature, blood pressure, blood
sugar etc. readily available. There may be apps or other technology
that can send health information straight to your health care provider

□ a list of other health care providers available (i.e. pharmacists and
other medical professionals)

□ prepared to answer the question: “What Matters To You?”

□ a list of any other questions or concerns

During the appointment

I will…

□  be prepared to wait online while my care provider is joining

□  take my time to listen and be respectful

□  introduce my caregiver, family member or translator, if present

□  let my care provider know whether they can share con dential
patient information with the people around me

□ highlight the purpose of the visit and what matters to me

□ ask about follow-up tests and appointments

□ ask what to do if my condition becomes worse

□ ask for clarification if I am not sure about anything

□ be an active participant in my care planning process

□ make notes, or have my family member, caregiver or
translator make notes

What to expect from my care providers

They will…

□  introduce themselves and share their location

□  be respectful and free of discrimination

□  ensure my care will be the same quality as an in-person appointment

□  order tests or prescriptions, if necessary

□ refer me to another professional, if necessary

□ give me follow-up information and an appointment, if

□ confirm a way that I can connect with them if I have any additional

Some components of this resource are adapted from the Virtual Care Resource for Members of the Public.–Watch-Health-Talks-Live–Celebrating-a-Great-Year-of-Work

Rural Health Councils – Policy Brief

Invermere – Hospice Society of the Columbia Valley

Daneve McAffer – President, Chair of Events Committee
Dodie Marcil – Secretary
Barb Gagatek – Treasurer and Board Member
Linda Herbert – Board Member
Laura Cuthbertson – Vice President and Board Member

Michèle Neider – Executive Director

Tel. (778) 526-5143

Unit #103 Frater Landing – 926 7 Ave
Invermere, B.C.
V0A 1K0
(Box 925)


Work began on the Hospice Society of the Columbia Valley in September of 2012 by Maria Kliavkoff with financial support by Susan Kliavkoff.  By November of 2012 the first board was assembled.  The Board consisted of Karen Arif (VP/Treasurer), Catrien Dainard (Secretary), Dr. Chris Gooch, Maxine Jones, and Donna Power who became the first President of the Board of Directors.

Vision Statement
Hospice is an oasis where no one dies or grieves alone

Mission Statement
To provide emotional care, understanding, comfort and a sense of well being – through compassionate end-of-life and bereavement support – and to be an advocate for change in the way our communities care for the dying and bereaved.

Hospice is not a place, it is a concept. The focus is on caring, not curing – on life, not death.  Quality of life, family wellness, community involvement and personal dignity are all part of our compassionate and progressive vision.

Our mandate is to make the last months of life comfortable and peaceful for clients and their families by:

  • improving quality of life,
  • facilitating important conversations,
  • developing creative ways of coping,
  • supporting healthy grieving and,
  • fostering growth and emotional healing.

To provide programs and services that support those struggling with the intense emotions associated with grief, loss, and bereavement.

HSCV is community based. Trained volunteers provide one-on-one support in the form of in home and/or hospital/care home visitations for anticipatory grief, end-of-life and bereaved clients.

HSCV is part of a comprehensive care team; we work closely with clients, families, medical representatives, social workers, and caregivers.

All programs, services, resources, and education to residents in need of support are free.

HSCV’s actions are governed by the knowledge that there is a duty to manage resources wisely and cost effectively.

Core Values
Hospice is CommittedCompassionateHonest and operate from Integrity in all we do. As a non-profit society we are ApproachableAccountable, and Fiscally Responsible.We operate in an atmosphere of CooperationFlexibility and Respect.

Constitution of the Society
The purpose of the Hospice Society of the Columbia Valley is to

  • Promote health by relieving conditions associated with end of life in the 14 communities of the Columbia Valley by providing Hospice Services in the form of in home and/or hospital visitation to those diagnosed with a terminal illness.
  • Promote health by relieving conditions associated with bereavement and the grief process through programs designed to support those struggling with the intense emotions associated with grief, loss and bereavement.

How Cities, Travel, and Families Will Change

(Image credit: Emmanuel Lafont)

How will the way we live look different in the wake of the pandemic?
We don’t yet know the answer – and, in some respects, we don’t even know the right questions to ask. That’s why we’ve been surveying dozens of global thought leaders, doers and thinkers for our special Unknown Questions series, in which we’re unearthing the biggest questions we should be asking as we move toward a post-pandemic society. 
In this edition, we look at how the virus will continue to change the way we live – from the way we build and live in cities to how we move between countries and continents.

[EXCERPTS] Tony Wheeler: Co-Founder, Lonely Planet
Will only the wealthy be able to travel?

When it comes to the coronavirus pandemic, I keep repeating baseball player and philosopher Yogi Berra’s wise advice that “It’s tough to make predictions, especially about the future.”
In the travel game, it’s tough even to understand what’s going on in the present. Some countries (Australia) won’t let people out, other countries (America) won’t let people in, even when they’re coming from a place with a better virus story. Or you can leave (the UK) and go somewhere else (the list changes daily) only to find (typically at 4 a.m.) all sorts of restrictions on your return.

Audrey Azoulay: Director-General, Unesco
How will AI shape our lives post-Covid?

Covid-19 is a test like no other. Never before have the lives of so many people around the world been affected at this scale or speed.
Over the past six months, thousands of AI innovations have sprung up in response to the challenges of life under lockdown. Governments are mobilising machine-learning in many ways, from contact-tracing apps to telemedicine and remote learning.
However, as the digital transformation accelerates exponentially, it is highlighting the challenges of AI. Ethical dilemmas are already a reality – including privacy risks and discriminatory bias.
It is up to us to decide what we want AI to look like: there is a legislative vacuum that needs to be filled now. Principles such as proportionality, inclusivity, human oversight and transparency can create a framework allowing us to anticipate these issues.

Ezekiel Emanuel: Member, Biden-Harris Covid-19 Advisory Board and Chair of the Department of Medical Ethics and Health Policy, University of Pennsylvania
What will we be craving in a post-pandemic world?

There are three clear legacies from the Covid-19 pandemic. They all derive from the unnatural and unpleasant circumstances imposed by the pandemic and the necessary public health responses.
First, we all want security. The pandemic has filled us with uncertainty and insecurity. The natural response is to want security. This means security in having an income, child care, family leave and other things necessary to care for your family during a pandemic. Every country will have to critically evaluate its social safety net and shore it up.

Michael Banissy: Professor of Psychology, Goldsmiths, University of London
How will we socialise? 

Social interaction affects many areas of our lives impacting on the workplace, home life and many day-to-day activities. In many cases, one of the biggest predictors of mental and physical health is the quality of social relationships.
For me, the big questions linked to the pandemic therefore relate to how we can support social interaction as we move forward.

Click on


When Will COVID-19 Be Over

[Excerpt] 2020 has brought previously unseen challenges upon humankind. A virus that, due to globalisation, spread at an unprecedented speed, stormed the entire planet and there is only one thing that can stop it as it is now: a vaccine. And as I wrote in The Medical Futurist vaccine pledge, if you worry about the long-term consequences (which no data indicate for now after having tested the vaccine on tens of thousands of people and vaccinating already millions), you might want to wait out. But then we’ll be in lockdown for years.

Over the past year several lockdowns have taken place. We adopted new habits, learned and worked through videoconferences, made social distancing an everyday habit and masks a fashion item. But we all hate these, don’t we? So once we have a chance to end the pandemic, I’d say we should go for it; and with several trustworthy and reviewed vaccines available worldwide, the race for vaccination has begun. 

In April 2020, we collected what will be the most specific changes we would need to bear even after the pandemic has gone. Almost a year on and the virus still upon us, we are revisiting those statements and having a look at all those things we expected and forecast: what will surely change, what has the chance to change and what shouldchange in the future. Our 2021 updates are clearly marked within the topics.

What will surely change

We’ve seen it all during this global public health crisis; overwhelmed hospitals forcing patients to sleep on the floor; mounting fear of being in proximity to others; but also the importance of a robust healthcare system. As a consequence of our collective and individual experiences throughout the pandemic, things will change in the healthcare landscape. Below we discuss three of the most significant changes we’ll experience.

COVID-19 Takes a Toll on People in the Frontline

1. An unprecedented toll on healthcare workers

What we wrote: 

During this global tragedy, it’s not only the economy or the population that’s being affected but also the healthcare professionals on the frontlines. The latter are enduring extreme work conditions and sacrifices in order to help the infected. Despite a shortage of personal protective equipment (PPE), they show up to work using DIY-solutions like ski goggles and bin bags with a high risk of being infected. Many are working overtime and witnessed patient after patient succumb to the disease.

The anxiety of knowing you might be at risk when you’re doing your job can be very challenging for health care workers,” says Terri Rebmann, a nurse researcher and director of the Institute for Biosecurity at Saint Louis University. “It’s physically and mentally draining.” This will lead to an inevitable spike in burnouts among the healthcare staff. Before the novel coronavirus, some estimated nearly half of the world’s 10 million physicians had symptoms of burnout. Now imagine after COVID-19…

More than burnouts, we will see frontliners with symptoms of post-traumatic stress disorder (PTSD). After this pandemic subsides, we will have to brace ourselves for the aftermath on medical professionals on the frontlines.

2021 UPDATE 

This is one of the saddest and most depriving moments in the history of medicine. All of the above are still underway: medical professionals being emotionally drained, leaving the field, having mental health issues and burnoutInstitutions, governments and even the direct management of medical facilities realised this way too late and are now rushing to provide support to staff with direct counselling, online support or via applications – with mixed results. And once the vaccination brings down case numbers, patients with chronic illnesses will return to the system and meet a totally burned out, exhausted personnel.

2. Diminishing trust in the globalized world

What we wrote:

In the pre-pandemic globalized world, we enjoyed a certain level of trust we mostly took for granted. We could travel almost without limitations, meet people without restrictions and order products worldwide. This will simply change after billions of people had to stay indoors for weeks.

We will not be able to travel that freely or enjoy the supply chains of the world so easily. We will think twice before going somewhere or meeting someone. The pandemic is already exacerbating signs of social anxiety and agoraphobiaRegaining trust takes time and these trends will take place for months after lockdowns are lifted.


By now we would all happily choose to stay at home “for weeks” as written above; in reality, we have been as good as closed down for months. Working from the office, meeting our besties, planning a vacation and travelling freely, grabbing a coffee or going to the gym still seem quite far. And although we have positive takeaways from online meetings (we can be much more effective), home or office is still not a choice but a situation.

Moreover, with so much time spent online, we now have multiple generations glued to the screens and sometimes unknowingly spreading misinformation limitlessly. The next task in this regard will be how to combat fake news, fight anti-vaxxers and gain our lives back again.

3. Focus on the healthcare system

What we wrote:

It’s tragic how the pandemic highlighted the shortcomings of healthcare systems worldwide. The overburdened hospitals need an upgrade on every level from their infrastructures to their processes. These will be needed to ensure a safe environment for the personnel and patients, as well to better cope with any emergency situations.

For example, one of the reasons speculated for Germany’s comparatively low death rate is its good intensive care situation. Digital health showed its aptitude to deal with such a crisis. We can expect to see many governments put more focus on healthcare. They can adopt similar strategies employed by other countries that better managed the crisis. As people in the frontlines of the fight witnessed, with inefficient healthcare systems, we will not be able to handle the next outbreak.


We have seen enormous growth on the technological side of healthcare, experts say the pandemic has advanced the sector by years. We dedicated multiple articles to the topic but you can just start with How COVID-19 Catalysed Digital Health Trends.

However, the cultural transformation was not as fast as the technological one. And in order to benefit from the technological growth we experienced, healthcare participants must leapfrog cultural transformation. With all our channels, outputs and keynotes, The Medical Futurist is on this mission – ask us about it.

To read more, click on:


Life after COVID

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