December is typically busy in the ICU. Flu and respiratory viral pneumonia cases start trickling into the ICU, interspersed with cardiac arrests, strokes, pulmonary emboli, septic shock, and COPD exacerbations. The ICU census starts creeping up. December 2020 has been unique and challenging. There were seemingly endless days of patients coming to the ICU, only to die. People with COVID-19 and the usual ICU ailments seemed sicker than usual. Patients have delayed routine care and have been terrified of the ED. Many have tried to ‘ride it out’ at home, and when they finally come to the hospital, there is little anyone can do for them. Among this grim backdrop, my rainbow of 2020 was the COVID-19 vaccine. This vaccine is as novel as the virus it protects against. Though the first of its kind, an mRNA vaccine, the technology is three decades old, spearheaded by a little-known Hungarian born scientist named Katalin Karico in the 1990s. It took her another decade of trial and error to figure out how to stabilize the mRNA without alerting the body’s defenses. It was not until 2005 that this discovery came under Derrick Rossi’s radar, a Canadian post-doc fellow, who by 2009 used this technology to create stem cells, bypassing embryonic cell lines that had created ethical challenges. Rossi’s discovery finally led to the creation of Moderna by Rossi-Langer-Springer in 2010 to see its revolutionary potential beyond stem cells. In Germany, BioNTech was created by a married team of research entrepreneurs. Ugur Sahin and Ozlem Tureci, Turkish born scientists, had long been interested in immunotherapy, which harnesses the immune system to fight cancer. In 2013, BioNTech hired Kariko as senior vice president to help with its mRNA work and transform cancer care. Chinese scientists posted the new virus’s genetic code that emerged in Wuhan on January 10, 2020. Forty-two days later, Moderna created an experimental vaccine candidate. Over in Germany, Sahin, the head of BioNTech, realized the beginning of a pandemic, and a partnership with Pfizer was created to develop another vaccine candidate. Both Pfizer and Moderna began their late-stage vaccine trials in July 2020. Both the Moderna and Pfizer-BioNTech vaccines are made up of lipid nanoparticles that encapsulate the mRNA that codes for the Spike protein on the virus. The vaccine contains stabilizers but no preservatives, egg, or meat products, and is not produced in embryonic/fetal cell lines. Once administered into the muscle, it is taken up by the human cells. The lipid vehicle releases the mRNA into the cytosol of the cell. RNA is very labile and cannot enter the cell’s nucleus, hence it cannot change/integrate with human DNA. The code carried into the cell is then translated into the Spike protein, seen by the human immune system. The immune responses involve TH1, antibody, and T cell responses. This immune response is generated within 14 days. The mRNA is destroyed once it forms the spike protein. I was privileged and grateful to receive the Pfizer-BioNTech COVID-19 vaccine on December 23, 2020. I struggle to describe my emotions that day coherently. I posted the mandatory vaccine selfie on social media (VAXIE). I encouraged others in my network to do the same. I captioned the selfie with #ThisIsOurShot. I did not want to dilute the message with a soliloquy on why this was such a monumental day. But I will attempt to do so now. 2020 has been a hopeless year. Science and public health have been decimated by a dangerous and divisive politicization, which has left the nation deeply divided. The virus, unfortunately, has shown a predilection for communities of color and ageism. It has crippled an economy that was thriving. COVID-19 deaths are over 360,000 and expected to keep rising. I have borne witness to the lonely isolation and hopeless despair of COVID units. I have feared for my life. I have feared for my family. I have mourned loved ones and colleagues, some known, many unknown to me, that have fallen victim to COVID-19. I carry with me the stories of those I cared for. I remember their eyes glassy with fear and air hunger, the agony in their loved ones’ voices, the inevitable spiral to death, and maybe eternal peace. I recall photographs, cards, posters hung in patient rooms. I recall the emptiness of these same rooms after they are terminally cleaned. I am scheduled for my second dose on January 14, 2021. I am counting down to the day. I am hopeful, but it’s an almost hopeless hopefulness that emerges after almost a year of unspeakable agony and pain. Rizwana Khan is a pulmonary and critical care physician and can be reached at DrKhanMDOnCall. Source
