Transatlantic public health

Ontario wrote to me in October to say I should schedule a covid booster vaccination, as it had been nearly six months since my last one. Conveniently, I had a brief trip to Toronto planned, so I booked an appointment. In fact, I made two appointments, the first with a small pharmacy near our house, my preferred purveyor of vaccines and other drugs. "You can have Wednesday at 3:45," said the woman on the phone, "but we won't know whether we have any supplies until Monday." So I also scheduled one with a large chain store, slightly further away, as a back-up, for 5:00 the same day. I expected to cancel it.  

"How long after having covid should I wait before getting my booster?" I asked a doctor friend who works for the NHS, a week before I flew from England to Canada.

"Twenty-eight days," she responded promptly. I counted. I may have used my fingers. 

"Good. I'm scheduled for thirty-six days after." I counted again and it was thirty-seven. In any case, there was margin. 

All of the five days I spent in Toronto were busy with appointments, meetings, and errands. On Wednesday morning I went to the dentist. From there I locked my bike outside my office and went in for the first time in 2.5 years. It was pretty exciting to walk through the corridors after working remotely for over two years (bar occasional outdoor meetings). My door-key worked, the lights turned on, and the kettle was still there.  There was a touch of the Miss Havisham about the place: the wall calendar tacked open to March 2020, a pile of papers and folders from my previous, long-completed project threatening to topple out of the in-tray, a thin forgotten cardigan draping itself over my desk chair. Exactly as I had left it. Thank goodness I had crept in late at night on March 12, 2020, to retrieve the potted plants. At that point we were anticipating an absence of several weeks. It's hard to remember how we thought then, how much we did not know, how much wiser we are now. Sort of. 

Frozen in time: March, 2020

I felt like a country bumpkin as I navigated my formerly familiar desktop computer with its two monitors. I noted the loss of the water cooler in the shared kitchen area and felt grateful for the colleague who keeps a bowl of candy handy (thank you, Sharon!). Only four or five people appeared, masked and wraith-like, in the corridors. My supervisor and I had a lovely face to face chat. 

I sat at my desk and did some work and made a vague attempt to tidy up the papers.  Then I headed for the local pharmacy. They had supplies of the bivalent booster. I had completed the screening questions online. No one else was in the shop when I arrived. "Left or right?" asked the pharmacist.  I bared my non-dominant arm. We commented on the sunny weather. I mentioned that I had recently had covid. 

"Oh," he said, pausing with thumb on syringe. "When?"

"It's fine," I reassured him. "More than 28 days ago."

He lowered the needle. "It's supposed to be six months, I think," he said. "Or is it three? Let me check." He pulled out his phone and used his plunging thumb to scroll instead of inject. "Three months," he reported, and showed me.

"In the UK, where I'm living at the moment, they say 28 days," I told him. "And this is the bivalent vaccine, so it ought to protect me against whatever variant I didn't have."

"I'm sorry," he shook his head. "That's probably right, but it's several levels above my pay grade to take the decision. I can't vaccinate you."

We looked at one another. "I shouldn't have said anything, I guess."

"Probably not," he agreed. 

"It's not one of your screening questions," I pointed out.

"I'll mention that to my boss." 

"So if I went somewhere else and didn't say anything..."

"That's certainly something that you might do," he said. "I mean I'm not advising you. I'm just talking to myself and you can hear me."

I checked the CDC website (US). "You may wish to delay your booster for three months after covid infection," it says, airily, not committing. 

A dilemma. There's value to having all my vaccinations in one jurisdiction (Ontario). There's value to getting boosted here and now, where I'm eligible. There's value to allowing the natural immunity conferred by infection to protect me for some amount of time that might be three months rather than five weeks. It reminded me of trying to follow pregnancy and baby-care rules, which differed between the US and the UK. "No peanut butter while pregnant," said the US. "And don't give the baby solid food until six months."

"No soft cheese while gestating," said the UK. "Start feeding the baby solid foods at four months." And so on. Since my babies were half-English and half-American, we started them on solids at five months. Halfway.

But I could not get half a vaccination.

Husband said just do it, and that sounded right to me. So off I cycled to the big chain drugstore, where I completed their paper form, which also had no screening question about past covid infection. I kept conversation to a minimum with the nice pharmacist. She put the needle in. Thus I am boosted. I hope the vaccine knows that it should work on me since I'm currently based in the UK and not in Canada. After all it has been thirty-six days. Or perhaps thirty-seven.