Health care workers with temporary, unpleasant side effect from COVID-19 vaccines deserve appropriate time off without having to use up their regular sick leave or paid time off.
At a time when over 2,000 people in the United States are dying from COVID-19 each day and many more are harmed by it, we have started to roll out COVID-19 vaccines that may be the key to helping us out of the crisis. Two independent expert committees, one in the Centers for Disease Control and Prevention and one in the Food and Drug Administration, concluded that the two first vaccines to have data behind them are very safe and very effective. Safe, in this case, means that in large trials consisting of tens of thousands of people there was no signal to suggest that COVID-19 vaccines cause serious, long term or life-threatening harms.
We may still find out that the COVID-19 vaccines cause harm in one per a hundred thousand or one per a million cases, but we already know serious issues are likely to be rare, and certainly much rarer than with the virus.
However, we also know, from the trials and early experience with COVID-19 vaccine administration, that the vaccines have high rates of temporary and unpleasant—but not dangerous—side effects. The vaccines cause sore arms at high rates, and they can cause swelling, mild fevers, fatigue, and aches. That is not a bad sign; that means the recipient’s immune system is vigorously responding to the vaccine, building immunity that can protect the recipient, which is what we want. But these side effects can be debilitating. Vaccine recipients may need to take a couple of days to rest. This is what we are seeing now, among the health care workers, older Americans, and others that are the first recipients.
Unfortunately, not all hospitals or health care providers are making it easy for workers to take that needed leave. Some are: the Veterans’ Administration provided two days of paid sick leave. But some hospitals are making their employees use their paid time off or regular sick leave, which means fewer sick days or days off are available for the employee if something happens that requires leave.
Any new COVID relief legislation should allow employees to take paid time off for vaccine side effects. Although employers are no longer required to provide such leave under the Families First Act, they should. Such leave fits the Act’s purpose: COVID-19 vaccines would not be needed if it were not for COVID-19, and the few days of reactions are directly connected to the pandemic. Moreover, it is in our public health interest for people to get COVID-19 vaccines—it is our way out of the pandemic.
In addition, employers benefit from a highly vaccinated workforce, since other employees and patients are then less likely to get COVID-19, too. Hospitals and health care providers will face fewer worker shortages and fewer outbreaks among their staff if vaccination rates are high.
Practically, not allowing employees suffering vaccine side effects to leave work, or forcing them to use time off, can make staff hesitate to take the vaccine (undermining herd immunity) or push them to tailor it for a weekend. That latter option could lead to an imbalance in the burden on vaccine clinics, or strengthen vaccine hesitancy by workers who do not have open weekends, for example because of caregiving responsibilities. Alternatively, attending work while suffering from vaccine side effects can impair health care workers’ performance at a time when we need them to be at the top of their game more than ever. Ethically, it is unjust to make employees pay—through lost sick days of days off—for getting vaccinated, an act that protects them but is also in the public interest.
Employees deserve to have the few days they need to recover from temporary, but unpleasant, COVID-19 vaccine side effects. If hospitals do not provide that themselves, we call on state and federal policy makers to require it.
As the coronavirus vaccine rollout continues across the country, health experts say one thing is critical for people to understand before they roll up their sleeves: The vaccines may cause side effects.
The U.S. Centers for Disease Control and Prevention (CDC) says the most common side effects of the Moderna and the Pfizer-BioNTech vaccines are:
- Injection site pain and swelling
The following side effects have also been reported:
- Muscle and joint pain
- Delayed swelling, redness or a rash at the injection site
- Swollen lymph nodes (typically manifests as a lump in your armpit or above your collarbone)
Most of the reactions are temporary and resolve within a few days. Since you may feel under the weather, experts recommend not making any big plans for a few days after you get each dose of the vaccine.
“Where a mistake could be made is in people being surprised or not being prepared for side effects,” says William Moss, M.D., executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.
Side effects are a sign the vaccine is working
Side effects from vaccines are not uncommon. The seasonal flu shot, for example, can cause fever and fatigue, among other reactions. And the vaccine to prevent shingles can induce shivering, muscle pain and an upset stomach, to name a few.
In some ways, these mild to moderate reactions are “a good thing,” Moss says, because “it’s a sign that the immune system is responding to the vaccine.”
The key, experts say, is to weigh the temporary discomfort against the long-term benefits: a potentially high level of protection from a disease that has uprooted everyday life for many of us and has killed more than 2.2 million people globally.
“We are willing to tolerate discomfort in other aspects of our life — many people exercise and have muscle aches afterward, and don’t say, ‘I’m never going to exercise again,’ ” Moss points out. “There are just many aspects of our lives where we need to be willing to make the trade-off of some degree of discomfort for a longer-term gain.”
Older adults could experience fewer side effects
While the coronavirus vaccines have been shown to be just as effective in older adults, people age 65 and older experience fewer side effects than younger recipients.
Researchers are still studying why this is the case, but they say it’s likely related to the declining immune response that comes with age.
Studies also show that most people experience more severe side effects after their second dose.
How to treat side effects
Although side effects may affect your ability to do daily activities, most should go away on their own after a few days, the CDC says. Plan for plenty of time to rest in the days immediately after you get each dose of the vaccine.
If you have pain or discomfort, an over-the-counter pain reliever such as a nonsteroidal anti-inflammatory drug (Advil, Motrin) or acetaminophen (Tylenol) can help you feel better, doctors say.
“If your fever is making you uncomfortable, taking acetaminophen or a nonsteroidal anti-inflammatory should bring it right down,” says Dean Blumberg, M.D., an infectious disease specialist at UC Davis Health in Sacramento, Calif.
The CDC advises against the use of pain relievers before vaccination “for the purpose of preventing post-vaccination symptoms,” so wait until after you are experiencing side effects to take any medication.
If you have a delayed reaction at the injection site – typically described as a rash, itchiness or redness that appears 5 to 10 days after vaccination – it’s likely a mild allergic reaction, Blumberg says. He recommends treating it with an over-the-counter antihistamine like Benadryl or a topical steroid like hydrocortisone.
Another side effect that may last more than a few days is a swollen lymph node, which may feel like a lump under your armpit or over your collarbone. The swelling is not harmful, but it can last a few weeks, Blumberg says. Eventually, it should go away on its own.
Few reports of adverse events
Federal analyses of the vaccine clinical trials and the vaccine rollout so far show that few adverse events — which the CDC defines as any serious health problem that happens after a shot — were reported.
Of 1.9 million people who received their first dose of the COVID-19 vaccine, only 21 developed anaphylaxis, a severe allergic reaction, the CDC said. Seventeen of the 21 who experienced anaphylaxis had a history of similar reactions to other vaccines or medications, the CDC said, and all 21 recovered.
The reaction is “exceedingly rare,” the CDC said, and should not discourage people from getting vaccinated.
Because of this, the CDC recommends that anyone who has ever had a severe allergic reaction to any ingredient in a COVID-19 vaccine abstain from receiving it. (You can find the ingredients of authorized vaccines on the FDA’s website)
The CDC recommends people with a history of anaphylaxis be observed for 30 minutes after getting the shot; other recipients should be observed for 15 minutes.
Safety monitoring doesn’t stop
Just because the vaccines have expanded from trial participants to the public doesn’t mean monitoring for them will stop. Individuals who receive the vaccines will continue to be watched for long-term side effects and adverse events or disease.
One way health officials are tracking side effects is with an app called v-safe you download to your smartphone. When you get your first dose of the vaccine, your health care provider will give you information about how to get started.
Infectious disease experts urge vaccine recipients to participate because it gives them important safety information about the vaccine. The daily survey takes only about 30 seconds, and the app protects your privacy by erasing your phone number after you take the survey.