By Dr. Anthony Policastro

The musical Fiddler on the Roof begins with the song “Tradition.” It is about how the Jewish people carried on traditions for centuries. The song says that we are all like fiddlers on the roof. We keep our balance by tradition.

We all have seasonal traditions around Christmas. That is what allows us to keep our balance through the madcap holiday season. This holiday season will be like no other. It will challenge some of those traditions. It will challenge our ability to keep our balance.

Some individuals will press on like this Christmas is no different than any other. They will keep the same traditions. That is not a healthy approach from a physical standpoint. It is more likely to result in a family outbreak of COVID-19 infection.

Others will decide just the opposite. They will feel that since things are so different there is no need to keep any traditions. That is not healthy from a mental health standpoint.

With all the things that are bound to change this year, trying to keep some measure of sameness is psychologically healthy.

That being said, traditions are bound to change this year. That results in the need to be creative. There are several ways of doing this.

The first is to see if there is a way of carrying on the typical traditions. For some things this is easy. You can still send out Christmas cards. You can still decorate your tree.

For some things this is a little harder. Traveling by air to see relatives is more difficult. Spending time having Christmas parties is dangerous.

Even the usual handshakes and hugs can be an issue. Therefore, some of those traditions will need to be adjusted accordingly. That may be easier for some traditions than others.

Another option that is beneficial is to create new traditions. Every tradition had a starting point. Perhaps it is time for 2020 to be the starting point for something new.

There are many options for this. They could be new family traditions. They could be new individual traditions. In any case they will be something that will start with 2020. It is a year many of us would like to forget. However, that does not mean we can’t use it as a starting point going forward.

We might not be a fiddler on the roof. However, we do need to have balance in life. It is healthy both physically and mentally. That balance is better set with traditions. This year should be no exception.


We continue to see daily new cases in the 200,000 to 250,000 range. So those numbers appear to be holding steady.

On December 16th we once again doubled the total number of cases. Early on in the course of the pandemic it was occurring every 48 – 72 hours. Then it stretched out. It went to 45 days. Then it was 41 days. It then took 88 days from July 26th to October 22nd to double again.

The current surge has shortened that. December 16th represented 55 days since the last doubling. That is almost back down into the 45-48 day range.

If we continued at that rate without a vaccine, it would take 220 days (about 7 months) to have enough people infected to reach the 220 million that are needed for herd immunity.

That would take us into next July. The vaccine will cut that period shorter. So that means that between the vaccine and ongoing infection we should reach where we need to be sometime in the spring.

The initial distribution of the vaccine to Delaware is expected to be about 26,000 doses by the end of the year. Doses are three weeks apart. It is less than three weeks until the end of the year.

Therefore, 26,000 Delawareans will get the first dose of the vaccine by the end of the year.

There are 54,000 health care workers in the state. There are 9,000 nursing home residents. Thus we will not be able to even get the first dose into that entire group by the end of the year.

I encourage everyone who wants to know more to review the Delaware COVID-19 Vaccine Playbook.

Last week I reported that the UK had advised individuals with a history of anaphylaxis or use of an Epipen to not get the Pfizer vaccine. The CDC recommendation is different. They are going to treat it like people getting allergy shots.

Individuals receiving allergy shots have to remain in the office for 20-30 minutes to make sure there is no reaction. Anaphylactic reactions occur quickly so that makes sense.

This means that people with a food and/or drug allergy can still receive it. That is true even if they have a history of anaphylaxis. It would also suggest that those individuals should have the vaccine in a physician’s office rather than an outside pharmacy.

During the initial trials some patients (about 1 in 5,000) experienced some mild temporary inflammation of the 7th cranial nerve (Bell’s palsy). Temporary cranial nerve inflammation occurs with other vaccines as well. So this is nothing new. It cleared up in all instances.

I had a severe case of Bell’s palsy in 2001. I have also had food-related anaphylactic reactions in the past. These things are not true for the general population. It just points out that we all need to take our medical history into account when making these kinds of medical decisions.

Each individual is different. Most people need to head out to get the vaccine as soon as it is available for them. Failing to do so is another example of denial at work. It is purely a bad decision with no logical reason.

I do have one suggestion for vaccine recipients. About 16 percent of them will develop significant side effects. These include fever, pain at the site, headache, muscle aches, fatigue and chills.

When I used to give the old DPT vaccine, I gave advice to parents. We knew the old vaccine was going to cause a fever. Therefore, I would suggest that the parents give Tylenol when the shot was given and then four hours later. It was an attempt to minimize the symptoms.

The reactions to the COVID-19 vaccines suggests that this approach makes sense. Rather than waiting for symptoms to occur, it would be a good idea to take the Tylenol early. A dose at the time of the vaccine, a dose at bedtime and a dose upon waking the next morning should be sufficient.

Getting stuck with a needle has always been an issue in medicine. It happened to me multiple times. Sometimes the needles were clean. Sometimes they were not. Hepatitis B, Hepatitis C and HIV are transmitted by that method. So there was a need to address that.

We have been using needleless IV systems for almost 20 years. They use plastic connections instead of needles.

Retractable needles have been developed over the last few years. The principle is simple. There is a spring in the mechanism. When the plunger is pushed all the way in, the spring pulls the needle back into the syringe itself.

A video of this system has been totally misinterpreted by social media sites. They see the needle go back into the syringe after the injection.

However, they claim that it happens before the injection. They are still convinced that the COVID-19 pandemic is a scam and so is the vaccine.

Their denial remains strong. It also remains wrong. One thing is clear. Many things you hear about COVID-19 or vaccines on social media sites are very likely to be untrue.

Some stories never die.

Hydroxychloroquine was back in the news last week. We already know that it doesn’t work to treat COVID-19.

So some researchers looked to see if taking it prophylactically could prevent COVID-19 infections.

To no one’s surprise the answer to that question is also “No.”