Starting in March of 2020, I started working part-time with my county health department on the COVID-19 response team. At first, this was as a volunteer through the Medical Reserve Corps, and later I became an employee once it became clear that this crisis was worse than anyone predicted.
The biggest part of my job from March through January was managing nursing home outbreaks. When positive tests showed up in a nursing home, we’d put on the hazmat suits, test everyone, and give guidance to try to prevent the infection from spreading throughout the population. Sometimes, we found it early and were able to stop the jump from employees to the residents. Other times, however, we were not nearly as
lucky. I worked a number of nursing home outbreaks where more than 10 people died. This was a really hard experience, and I’ll never forget it.
But that time is over. We are simply not seeing many positive tests in the nursing homes in my area. We’ve gone nationally from a maximum of 6600 COVID deaths per week in congregate care (the week of Christmas) to about 400 currently. You can see the data at CDC COVID Data Tracker.
In early January 2021, nursing homes and other long-term care settings started administering vaccines to their residents. By the end of February, pretty much every willing resident had been fully vaccinated. Currently, pretty much the only positive tests we see in these facilities are in staff or residents that refused vaccination. The difference has been miraculous.
Unfortunately, we’ve seen community vaccine opt-out rates in my area that are close to 40% of adults. Because of this, we continue to have outbreaks in businesses, schools, churches, travelers, etc. And, even as we’ve reduced deaths among our most vulnerable populations, we’ve seen death rates increase substantially in younger people due to the spread of highly contagious variant viruses. In fact, national rates of COVID-19 in unvaccinated adults are nearly as high as they were prior to vaccines becoming available.1
Most shockingly, it is becoming increasingly obvious that the unvaccinated are pretty much the only ones who are going to the hospital and dying.2 Yet, it looks like we are going to stall out at less than 70% of adults vaccinated.
Nationally, we have administered just shy of 332,000,000 doses of the three Emergency Use Authorization vaccines.3 We have seen 2 to 5 severe allergic reactions per million as a result.4 There have been some other rare reported side effects, which are being investigated. We have seen around 36 cases of blood clots related to one of the vaccines, which may be causally related.3 5 More recently the CDC has been evaluating some reported incidents of myocarditis in adolescents and young adults receiving two of the mRNA vaccines;3 the vast majority of these cases have recovered quickly. The number of these rare cases are outweighed by the number of hospitalizations, ICU admissions and deaths among adolescents and young adults who catch COVID-19. This is really the worst of it. It pales in comparison to the morbidity and mortality these vaccines have already prevented.
In the past several decades, participation in vaccine programs has dropped substantially. Vocal anti-vaccine activists have worked to erode trust by spreading misinformation and innuendo. Just in the past week, we saw an anti-vaccine activist assault a vaccine station – one much like the pop-up clinics I work in several days per week – with her car.6 There is really no sign that this movement is going away.
We have all just watched a profound and shocking lesson in how a pandemic can affect our daily lives. Many of us have lost loved ones, had our livelihoods fall on hard times, and made huge sacrifices to protect those around us. Some of us have cared for gravely ill patients in situations that were simply terrifying.
An important lesson we are all learning in 2021 is that vaccinations work to prevent disease, but they will only let us get back to normal if enough people participate to achieve population immunity, where the nation as a whole is protected. The core of most soft anti-vaccine arguments I’ve heard over the past decade is something like “I get to choose whether or not to vaccinate, and I’ll trust my immune system to protect me.” While this belief may have some truth at an individual level, it reflects a deep misunderstanding of how vaccines protect communities.
Reminder to the clinical folks out there: the biggest predictor of whether your patient will get vaccinated is a strong recommendation from a trusted provider. Try to find a few minutes in every visit this year to ask about vaccination status, and to decisively advocate for it every chance you get. If we all do our part, maybe we can have parties and concerts by the fall.
- https://covid.cdc.gov/covid-data-tracker/#vaccinations Data current as of July 6, 2021 8:00 PM ET. Accessed July 6, 2021
- https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html accessed June 28, 2021.