September 8, 2021

Back to School 2021 – “New Normal” or the “Delta Blues?”

 We were all hoping that Back to School 2021 would be a smooth return to a “new normal.” We have highly effective vaccines. We know how to protect our children with vaccines, masking, spacing and testing. COVID cases were trending down early in the summer. However, the Delta variant had other plans.

 Here is where we stand in September 2021. The Delta variant is more infectious, especially in children. Over 251,781 children were diagnosed with COVID-19 8/26/21-9/2/21, representing 26.8% of the weekly reported cases, according the the American Academy of Pediatrics. This is the most pediatric cases reported in a single week, since the pandemic began. Thousands of children and school staff are getting infected, isolating and quarantining. The situation is much worse in communities with low vaccination rate. Nearly all the deaths from COVID-19 are among unvaccinated people. The children in communities with low vaccination rates are suffering disproportionately from illness, deaths of teachers and family members and education loss. There have already been disruptions due to isolation, quarantine and even due to severe weather.

The moral of the story is that all eligible people need to get vaccinated. Employers can play a role in requiring or incentivizing vaccines. We all need to wear masks, especially in schools. Families and employers need to continue to be careful and flexible to get us out of the Delta blues and keep the children safe and in school.

 April 21, 2021

How Do We Protect Grandma and her Helpers?

The elderly and residents of nursing homes are at extremely high risk for death from COVID-19. Nursing home staff have witnessed the suffering and death caused by the COVID-19 first-hand. So, why are only about half of the staff of long-term-care facilities fully vaccinated?

 Unvaccinated staff puts staff and residents of risk of COVID-19 as well as increasing the risks associated with understaffing the facilities. Through March 7, nursing home residents made up over 35% of the deaths from COVID-19 in the United States, even though they represent a small fraction of the population, according to the COVID Tracking Project. A federal program worked with CVS and Walgreens to vaccinate residents and staff of long-term-care facilities early on in the vaccine rollout. This program is starting to wind down, but too many staff members are still not vaccinated. Why are so many staff unvaccinated? How do we help them get vaccinated to protect themselves, their patients, their colleagues and their families?

 The CDC is starting a collaboration with a nursing home trade association to study this question. The demographics of long-term-care workers could be a factor. Many long-term-care workers are people of color or immigrants. They may have distrust of the medical establishment or the federal government. However, I suspect these “vaccine reluctance” theories blame the employee too much. I have spent my career in health care working with communities of color and immigrant communities. The families I worked with were very pro-childhood vaccination.  

I resist the oversimplified “vaccine reluctance” theory in the community of long-term-care, nursing home and home healthcare workers. This inadequate vaccination rate needs to be taken on a system-wide and a case-by-case basis. Workers in long-term-care facilities are often overworked, underpaid and exploited. If management doubles the number of patients a staff member has to care for or withholds overtime pay, how will they react to the next email reminding them to get vaccinated? If an employee needs their full paycheck to feed their family, but does not have paid sick leave to get vaccinated or to recover from the common flu-like side effects of the vaccine, what are they supposed to do? Furthermore, nursing home staff and residents were offered the vaccine very early on in the vaccination effort, with good reason. But they may have been reluctant to be among the first few million people vaccinated and risk being “guinea pigs.” Now that over 200 million people have been vaccinated safely in the United States, staff may be more comfortable being vaccinated. They need to be encouraged to do so.

 Nursing homes, long-term-care facilities and home health care providers should make it as safe and easy as possible for their staff to get vaccinated. Staff need paid time off to get the vaccine and to recover from possible side effects. Staff need improved pay and working conditions overall. Nursing homes, long-term-care facilities, and home health providers should be required to report their vaccination rates for residents and staff. This could motivate the employers to do everything they can to get their staff vaccinated.

Nursing home staff and residents need to be vaccinated. This presents yet another opportunity to learn from the pandemic. We need to take better care of the people who take care of Grandma.

 https://www.nytimes.com/2021/04/21/health/vaccine-nursing-homes-infections.html?smid=url-share

https://www.npr.org/sections/health-shots/2021/03/31/982772372/federal-program-to-bring-vaccine-to-nursing-homes-missed-around-half-of-staff

April 15, 2021

 Don’t Throw away your Shot – A COVID-19 Vaccine Update  

We will start with the good news. The vaccines approved for use in the United States are safe and effective. The Moderna, Pfizer and Johnson & Johnson vaccines are all nearly 100% effective at preventing hospitalization and death from COVID-19. The vaccines are so effective that vaccinated people do not even have to quarantine after travel or COVID-19 exposure.

Moderna has been shown to be effective against the B.1.1.7 UK variant. People are getting vaccinated in the United States. As of today, 125,822,868 people in the United States have received at least one dose of COVID-19 vaccine. 80% of people 65 years old and older have received at least one dose of the vaccine. Many states have made everyone over 16 years old eligible for vaccination. Aside from sore arms and brief flu-like symptoms, there are few side effects.

Now for some more sobering news. Yesterday, April 14, 2021, The Centers for Disease Control and The Food and Drug Administration recommended a pause on the administration of the Johnson & Johnson vaccine after 6 cases of a rare, but serious type of blood clot, Cerebral Venous Sinus Thrombosis with Thrombocytopenia. This is a rare form of blood clot that occurred in 6 women out of nearly 7 million J&J vaccines administered. This pause will allow further investigation into what may have caused these incidents as well as education of the public and clinicians to know what symptoms to look out for and the appropriate treatment of this type of blood clot. This pause is important to achieve these goals, but hopefully it will be brief and eventually allow for the vaccines to get back into the fight against COVID-19. The Johnson and Johnson vaccine represented a very small percentage of the vaccines administered in the US, but was convenient, as it only requires one dose and does not require ultra-cold refrigeration.

If you already got the Johnson & Johnson vaccine, do not panic. These incidents were extremely rare. However, if you have any symptoms of blood clots or stroke, such as severe headache, neurological symptoms, shortness of breath, swelling or tiny bruises, contact your health care provider immediately.

Back to the good news, The CDC and FDA were paying such close attention that they were able to identify 6 blood clots out of millions of vaccines administered. This gives me great confidence in the safety of all the COVID-19 vaccines. The Moderna and Pfizer vaccines use an entirely different mechanism, as they are mRNA vaccines and continue to be used safely across the country. So, get your COVID-19 vaccine when it is your turn. If you are already fully vaccinated, enjoy! Tell people about your experience. Volunteer to help others get vaccinated. Hug a loved one.