in Press Conference Earlier this month, Ashish Jha, the COVID czar in the White House, set some very high expectations for America’s immunity this fall. He said “millions” of Americans will flock to pharmacies to get the latest version of the COVID vaccine in September and October, the same time they will get their annual flu shot. “It’s actually a good idea,” he told the press. “I really think that’s why God gave us two arms.”
This is how I got vaccinated last week on my local resume: the COVID vaccine on the left, the flu shot on the right. I spent the next day or so, nursing not one of my arms, but two of my sore arms. Reaching the high shelves was difficult; Putting on deodorant was worse. And it made me wonder what would have happened if I ignored Jha’s teleological advice and got both hits in the same arm. Maybe say it annoys me. Or maybe shots from the same side would have made the pain in my left arm worse. When I posed this conundrum to immunologists, vaccinologists, and pharmacists, I took back a lot of hawthorn. For the millions of Americans who will be getting two-dates by the end of the fall, they tell me, the choice really comes down to personal preference in the absence of clear data: You just have to pick a side. Or, you know, two.
On the one hand (sorry), there are the developers of the dual vaccine. Sally Bermar, a pediatrician at Cornell University, and Stephanie Angell, an immunologist at Duke University, said they’re probably going to get two probes in the same shoulder; So is Rishi Joel, an immunologist at the University of Pennsylvania. “Personally, I’d rather have one arm that’s a little uncomfortable than both,” Joel told me.
On the other hand, we have a team that divide and conquer. Several experts said they would follow White House protocol for splitting shots left and right. Ali Al Yabidi, an immunologist at Washington University in St. Louis, tells me he’d rather have two slightly sore arms than one completely dead. Jacinda Abdul Mutakber, a pharmacist at Loma Linda University, says she generally recommends that her patients get their vaccinations on separate sides “for convenience.” Last year, she chose to get her flu shot and a COVID booster just a few inches from each other, and she told me “I wanted to cut my arm off.” “It will never happen again.”
Permar told me that the critical reasoning here should be very self-evident. Two shots to one side may be expected to double the extent of arm inflammation, although each vaccine recipient’s experience will depend on a combination of factors, including the ingredients in the injection and that person’s infection and immunization history, as well as the health of the immune system. Also, for people like my husband – who are prone to very severe side effects of the vaccine – the choice may not be important at all. He had been losing out with the fever and chills that came with the COVID-flu-flu vaccine kit, and he couldn’t have cared much about which arms got the injections.
I looked at studies examining the consequences of choosing one arm versus two and found only one: Canadian trial from 2003, which vaccinated a few hundred sixth graders in twenty middle schools against group C meningitis and hepatitis B at the same time. Nearly half of the children got both shots in the same arm; The others received one on each side. (Some of the children in the latter group requested that their syringes be given by a pair of nurses who could submerge both syringes at the same time.) Rated as ‘moderate or severe’. But these children fared better than children in the two-armed group, with 28% having moderate or severe pain in at least one arm, and 8% having both arms at the same time.
But these findings apply only to that group of children in that setting, with these two specific vaccines; There is no indication whether the same trends would appear with flu vaccines and COVID shots when given to children or adults. Michela Lucci, an immunologist at the University of Pennsylvania, tells me she suspects that combining flu and COVID vaccinations in the same arm could actually lead to additional side effects: “The overall inflammation may be higher,” she said.
Many pediatricians, who often have to give a child four or five doses at once, are a usual divider. “If there is more than one injection of vaccine to give the child, generally two feet will be used,” Bermar told me. (Children usually upgrade to an arm syringe at some point in childhood—it’s all about finding a muscle big enough for the needle to hit its mark.) Doctors also have a strange reason to split shots between arms or legs. “If there is a local reaction to a vaccine, you can tell which vaccine it was if you separate them by vacuum,” Bermar said. (For the record, I had a much more painful reaction in my left arm, getting my COVID injection. Others I’ve spoken to have reported the same discrepancy.)
The CDC advocates for Separation of vaccination shots at least one inch apart. According to the agency, if the COVID injection is given at the same time as the vaccine “which is likely to cause a localized reaction at the injection site,” then the doses should be given at “Different parties, if possible. There are two types of flu vaccines that are approved for use in people 65 years of age or older — the high-dose vaccine and the adjuvant — that fall into this category. But the advice from different parties does not seem to apply to other flu vaccines, including those removed for use in younger adults and children.
However, if someone ends up taking both flu and COVID vaccines at the same time, placement is unlikely to affect the amount of protection the vaccines provide. There may be an argument for allowing “each side to focus on their own thing,” says Gabriel Victora, an immunologist at Rockefeller University. “But it probably doesn’t make much difference.” Children routinely get mixed vaccines, such as DTaP and MMR, each of which combine several disease-fighting ingredients into one injection. Triple Threat formulas work just like injecting their individual parts. immune system Used for multitaskingJoel told me he spends all day bombarded with microbes, so there’s good reason to believe that with vaccines, too, our bodies will see simultaneous shots as “independent events.”
Which arm is taken for the shot, though, will affect where the contents of the shot end up. After the vaccine is injected, its immune-stimulating components travel to the nearest lymph node, such as the one in the armpit. there, Legions of immune cells fight over vaccine parts, the fittest and fiercest among them are chosen to leave the lymph node and fight. And here, again, doubling on one arm shouldn’t be a problem, Joel said: Immune cell training camps in these lymph nodes have “a great deal of real estate.”
It may be a good idea to stick the same tip – and thus, the same lymph node – each time you get another dose of a particular vaccine. After immune cells in the lymph node detect a certain portion of the pathogen, some of them take to battle, but others may hang around Like reservists, they think about what they’ve learned. a Husband From Recently Studies, one of which was in mice, suggest that repeated delivery of the same ingredients to those seasoned learners can give the body a slight advantage—although the extent of this advantage “may be marginal,” Victora tells me. However, Duke’s Langley told me that since she usually gets all her vaccinations in her “unscripted” arm, the lymph node underneath can now be particularly uncanny — a “wonderful bonus” to her overall defenses.
Having said that, no one should stress too much about getting an injection in the “wrong” arm. “It’s not like you’re immune to the left side and not the right side,” Joel told me. Immune cells travel throughout the body. There is no middle line DMZ. Permar also notes that having a newly designed COVID vaccine, which includes new ingredients designed to fight Omicron sub variants, on the other side from previous rounds could help its components reach a newer slate of cells. “I think you can convince yourself either way,” she told me. Which leaves me, frankly, at complete peace with my choice. Aside from the arm pain, I had no other side effects – and in a way, I preferred the consistency of the side-to-side injection.
With all that said, it is worth briefly recognizing a third option: dividing the influenza and coronavirus vaccine into separate visits. I was, before my last dose of COVID, about 10 months away from my previous dose. but she felt awfully early My flu shot, which may be better timed for maximum protection if taken later in the season. However, the allure of having it all was very baffling, especially since I was doing a lot of travel in the future. In the grand scheme of things, the biggest and most important choice was ever to choose shots.