Life lately has felt like riding the teacups. The turntable floor and cup slow to a near stop, the relief of getting off the intense ride setting in, but then the delta variant emerged and with it, the dizzying realization: The ride is not over.
Many health-care workers feel drained from living on the front line of the pandemic peak and the emotional fallout associated, and managing non-COVID-19 patients sicker due to delays in seeking needed health care alongside the substance use and mental health crises since. Seeing the COVID-19 uptick across the country is challenging on many levels.
During my initial patient evaluations in the ER, I go through a rapidly evolving mental list of potential diagnoses — some standing out as more concerning as medical history and presenting symptoms unfold. I consider what tests to order, what next steps might look like – and often whether the person has COVID-19.
During the recent visit of a patient with viral symptoms, I asked if they were vaccinated. That’s a game-changer: If yes, COVID-19 often moves further down my list of likely diagnoses.
“Not yet. And I’m not interested in that today,” they replied.
If we weren’t in the middle of a pandemic, with a more contagious and concerning variant spreading across the country, I might have accepted the reluctance. But recent months of engagement on COVID-19 vaccination have taught me that a meaningful dialogue about concerns can shift a person from a stance of “not yet” or even “no thanks” to being one less person in whom the virus may develop a more concerning mutation. One more person forming potentially life-saving antibodies. And one more person who reminds us that on vaccine hesitancy, we can’t give up.
At the end of my shift, I returned to the patient with an update on their tests and, as always, asked a final question. “Do you have any more questions or concerns for me?” This patient thanked me for my care and said they did not.
I paused before readdressing that “not yet” from earlier. The patient was open to discussing concerns, about side effects and the challenges associated with misinformation and politicization around vaccines running rampant on social media. I answered questions about vaccine development, different options available, and common side effects. While acknowledging reasons for distrust in medicine and media, I expressed my worries on waiting, particularly due to increased transmissibility of delta. They appreciated the dialogue and planned to make their vaccine appointment the following week once recovered from their current (non-COVID-19) illness.
While it may feel as if we are all on a pandemic roller coaster, just like this virus, we need to adapt. Spring vaccination was tracking to quell the COVID-19 embers as a powerful tool toward herd immunity by summer, but in May and June the vaccination pace dropped off significantly. Approximately 40% of eligible adults in Philadelphia are still not fully vaccinated. The delta variant we had hoped might remain smoke in the distance is a growing concern as Philadelphia has 11 zip codes at particularly high risk with current vaccination rates.
Still, global scientific collaboration quickly brought vaccines that continue to provide excellent protection against hospitalization and death. Thus, these vaccine conversations can have not just an individual but also a household and broader public health impact as we move through the pandemic’s next phase. In conversations in the hospital or community, I see patients reassured that I simply want to prevent meeting them in the ER with COVID-19 — and to protect the vulnerable, including the immune-compromised and children under 12, like my daughter, who are not yet eligible for our most potent form of immunity.
Some may balk at the latest CDC recommendations to maintain universal masking inside schools, and recent recommendations in Philadelphia and elsewhere for everyone to resume indoor masking in public places. But indoor activities with unmasked and potentially unvaccinated individuals, and delta coloring the picture, do create escalating risk. This variant accounts for 83% of sequenced COVID-19 cases in the United States and is expected to further impact our region soon.
Now is still the time to increase messaging within communities — focused on how COVID-19 vaccination and precautions can protect you, your children, and your neighborhood. The best vaccine messengers are often not doctors but friends, pastors, barbers, or other community figures. While health-care workers can offer access with community-based vaccination, we need the truth about the significant risks of COVID-19 compared with the tremendous benefit and effectiveness of vaccination to dominate mainstream understanding in parks, church parking lots, and summer barbecues.
Last week I was speaking with a young man in a park during a mobile vaccination clinic in the area. I found myself responding, again, to swirling misinformation and politicization around vaccination. He was hesitant — until his friend came by and joined our discussion. The vaccinated friend reinforced the things I had mentioned. The man’s hesitation dissolved enough for him to get his shot. Then he went back and told a group of friends across the park how easy it was, and two of them came over to talk. That day they all got vaccinated. None would have if not for their vaccine ambassador friend.
Go to vaccines.gov or text GETVAX to find the closest vaccination sites, or visit jeffersonhealth.org/mobilevaccine for scheduling and contact information for our team. And if you have already been vaccinated, take the time to reach out to those in your circle with lower vaccine confidence — that conversation may save a life.
Dr. Patricia Henwood is an associate professor of emergency medicine at Thomas Jefferson University’s Sidney Kimmel Medical College. She focuses on global health and infectious disease and is leading the Emergency Medicine COVID-19 Task Force and co-leading Jefferson Health’s Mobile Community Vaccination Program.