I barely even feel the needle.

It is over so quickly that I begin to take it all in only afterward, as I claim a seat in the waiting area. There are a handful of us there, each of us newly vaccinated and waiting the designated 15 minutes before we can leave. I watch an environmental services worker flex his upper arm and shyly take a photo. A few internal medicine residents gaze out the window, bleary after a night shift. I feel a sudden urge to offer a congratulatory hug or handshake, but of course that is not possible. Our seats are too far apart for us even to talk.

I glance at my phone and open a message, an automated request to complete a mortality report for a patient who died of Covid-19 the week before. In our final conversation before he was intubated, I tried to comfort him, but he could barely hear me over the hiss of his high-flow oxygen. When he coughed, I flinched and hoped he did not notice. The survey asks if anything about this death was preventable, and I say no, because there is nothing we could have done differently — though clearly the real answer is yes. So many of these deaths could have been prevented.

My news feed is full of jubilant photos of doctors and nurses announcing their vaccinations. I consider taking my own photo, but then hesitate. Because just a few floors up, there are dozens of patients who cannot breathe, who are scared and alone, who might die simply because they shared a holiday dinner. I find myself, nine months into this pandemic, vaccinated and yet still on a pendulum swinging between hope and despair.

Outside, the snow falls. Already it feels like a long winter. Here in the hospital, the anxious adrenaline of the spring has given way to a heavy, lingering sadness. We are caring for patients who have sacrificed and taken precautions for months and now — bending under the pain of isolation, starved for human connection — might die simply because they decided to spend time indoors with people they love or to go out to dinner. I have been careful so long, they must have thought. Humans are inherently optimistic, notoriously bad at assessing risk. Surely this one small thing will be OK.

I recently cared for a man who loved Boston sports, whose wife had decided to have a quick meal with a friend. By the time she learned that her friend had symptoms of Covid-19, she had already passed the virus on to her husband. He died after weeks on a ventilator. There is a grandmother whose family took false comfort in a negative test. A father who welcomed a dozen people into his home for the holidays. Each casualty is made even more poignant by the celebratory vaccine selfies on my phone and the knowledge that had they waited, my patients might have lived.

And of course, our hospital is treating not just people with Covid-19. We also bear witness to the suffering of patients with cancer, with life-threatening infections, with complications from organ transplants. We see overdose and withdrawal cases in unusually high numbers, psychiatric illness pushed to its breaking point. A relatively young man was brought to our hospital after being found unresponsive in a hotel room, his heart barely beating. When we managed to extubate him and he started to wake up, he began screaming at his nurse and raging against his restraints. There are so many different kinds of pain for which we have no vaccine.

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:

• • If I live in the U.S., when can I get the vaccine? 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.
  • When can I return to normal life after being vaccinated? 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.
  • If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
  • Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
  • Will mRNA vaccines change my genes? 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.

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