Major Milestone

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The initial doses of the COVID-19 vaccines provide promise for a healthier future, even as death tolls rise and frustrations mount about the sputtering rollout.


Sandra Lindsay, RN, made it clear to anyone who would listen that she wanted to be first in line to receive the coronavirus vaccine. She was emotionally exhausted from witnessing the pain and suffering of far too many dying patients, and the sweat and tears of her team of heroic providers who work tirelessly to save as many lives as they can. Last year, she lost an aunt and uncle to COVID-19.

"I just wanted the shot in my arm," says Ms. Lindsay, director of critical care at Northwell Health's Long Island Jewish (LIJ) Medical Center in Queens, N.Y. "That was the first step. Then I knew there was hope, and healing could begin."

She got her wish on December 14, when she became the first American to receive the vaccine outside of a clinical trial. Ms. Lindsay knew she would be among the first hospital employees to receive the vaccine, and understood the enormity of the moment. She knew there'd be a press conference and wasn't surprised when New York Governor Andrew Cuomo showed up.

What she didn't anticipate in the days that followed were the countless media requests, and the appearances on local news stations and national talk shows. She certainly didn't dream of being chosen to represent the nation's healthcare workers during the nationally televised gala celebrating President Joe Biden's inauguration. "I never expected to receive so much attention," she says, "but it's given me a platform to share my experiences and have productive conversations about the vaccine."

Ms. Lindsay received her second dose on January 4. Being fully vaccinated left her feeling energized and lighter, like a tremendous weight had been lifted from her shoulders. Still, she had mixed emotions about being one of the first Americans to reach the other side of the pandemic. She was now protected against the virus, but millions of Americans remain at risk of exposure. Ms. Lindsay says LIJ saw a recent spike in cases similar to what the hospital experienced a year ago during the pandemic's first wave.

"The virus is still out there," she says. "Although I'm hopeful for the healing the vaccines will bring, I'm fearful for the people who are still suffering. Word is spreading about the importance of being vaccinated. Hopefully, we'll start to feel safer and begin to reclaim our lives."

EASY CALL Stephanie Vasquez, RN, believes getting vaccinated was part of her ethical obligation as a healthcare provider.   |  Stephanie Vasquez

Operation Warp Speed, a public-private partnership launched last year to accelerate the manufacturing and distribution of Pfizer and Moderna coronavirus vaccines, intended to deliver 300 million doses by the end of 2020 and ensure 80% of the nation's population is vaccinated by June. The ambitious goals have so far gone unmet — 48 million doses were distributed as of last month and serious doubts remain if herd immunity can be achieved before the fall — due to the lack of a federally coordinated distribution plan, overwhelming demand and supply shortages. The rollout is in desperate need of a boost as nationwide deaths have steadily climbed past 400,000.

Erin Duffy, RN, an administrator at Ambulatory Surgery Center of Greater New York, located in the Bronx, received her first dose of the COVID-19 vaccine on January 10, only after researching for hours online to find available appointments for her and her staff. Ms. Duffy expected her team to have immediate access to the vaccines, but noticed doses were initially made available only to large hospitals, most of which are owned by huge corporations.

"We thought the vaccine would help pull us out of the financial issues and the mental stress the pandemic has caused," she says. "We administer flu vaccines to ourselves every year. Why couldn't we have done that with the vaccine?"

Ms. Duffy believes smaller hospitals and surgery centers should have been included in the initial roll out. "As an ophthalmology practice, we care for a lot of elderly patients," she says. "Is that not the perfect place to ask patients if they would like the vaccine? We could vaccinate so many people."

So far, close to 30% of her staff has received the first dose of the vaccine. Ms. Duffy received her second shot on January 31. "The rollout needed to be aggressive and strategic instead of distributing doses based on data in a spreadsheet," says Ms. Duffy. "New York is not a spreadsheet."

READER SURVEY
Have You Received Your Shots?
  |  Northwell Health

The majority of the 371 surgical professionals who responded to our survey last month about the COVID-19 vaccine have received a dose or are waiting for an opportunity to get vaccinated. Here's a closer look at their feedback.

\51;
LAUGHS LOST Janine Jones, RN, a beloved staff member at AUA Surgical Center, died in December from COVID-19.   |  AUA Surgical Center

Nicolette Williams, RN, CNOR, executive director of the Lakeland (Fla.) Surgical and Diagnostic Center, says her staff is currently not required to get vaccinated, but she would like at least half of them to receive the vaccine. "Our goal is to have all of our staff members vaccinated by 2022, and we will continue to communicate with individual employees to discuss their thoughts and concerns about vaccination." In the meantime, the facility is still conducting daily monitoring of temperatures, and requiring staff to wear N95s and practice social distancing.

Stephanie Vasquez, RN, a nurse at University of Texas Health ?Austin Ambulatory Surgery Center, was fully vaccinated on January 4. Ms. Vasquez received the shots out of a sense of responsibility she felt as a healthcare provider. "I believe it's my moral and ethical obligation to protect my community and to protect my patients," she says. "In order to do that, I had to protect myself."

Ms. Vasquez, who received the Pfizer vaccine, felt no ill effects after the first dose. She did develop flu-like symptoms the evening after receiving the second dose, but felt much better the next morning. "The side effects were short-lived," says Ms. Vasquez. "I'm happy to have experienced eight hours of discomfort to help prevent spreading the virus."

The majority of her 12 colleagues at the surgery center have been vaccinated. She understands vaccination is an individual choice, but is personally grateful to have had the opportunity to be among the first wave of recipients. She's also felt a tinge of guilt. "If I did contract the virus, based on my medical history, I think I'd recover fully," she explains. "I typically put others' needs before my own, so it was hard for me to take the vaccination away from someone who might need it more."

Jeffrey Blank, DPM, a podiatrist in the Chicagoland area who works at Dundee Foot and Ankle Center in Wheeling, Ill., had access to the vaccine in early January. Dr. Blank, a cancer survivor, hesitated due to the concerns he had about the long-term health effects. "Vaccines need to be safe and effective," he says. "Effectiveness is easy to determine. Safety takes time."

He's not worried about immediate allergic reactions or feeling sick for several hours. He's worried how the vaccine will impact his body five years from now, which is essentially an unknown risk factor. He made an appointment with his oncologist to discuss his concerns, and received advice that changed his mind. "He told me the virus was more likely to kill me than the vaccine," says Dr. Blank.

VACCINE DISTRIBUTION
Rollout Raises Questions About Inequitable Care

As America's eagerly awaited but excruciatingly slow and disorganized COVID-19 vaccine rollout machine began wheezing in fits and starts, numerous politicians received vaccines on television. For healthcare professionals who have had a front-row seat to the rollout, the distribution of doses is spotlighting healthcare inequities. While the great majority of the general public continues to go without, they have witnessed hospital board members and spouses of physicians somehow move to the front of the line.

That's why Marty Makary, MD, MPH, a professor of surgery and health policy at the Johns Hopkins University School of Medicine in Baltimore, is refusing to get the vaccine himself — at least for now. He blames the ruling class making rules that benefit themselves, particularly those "low-risk Americans with access and power." The implicit message these people are sending, he says, is that their lives somehow matter more than those of tens of millions of their fellow citizens, particularly those who are most vulnerable to the virus.

"High-risk Americans have been devastated by COVID-19," he says. "Why aren't we vaccinating vulnerable populations before younger, low-risk individuals?"

Because vaccine supplies remain low, ethical questions are playing out in healthcare facilities throughout the country. ICU and ER personnel should be getting the vaccine before office workers, for example, but that's not always the case, says Dr. Makary. He says people who have already had COVID-19 are being vaccinated, a circumstance he attributes to poor CDC guidance. As long as the vaccine supply remains constrained, he believes those who have been infected already should step back from receiving their vaccinations until the availability situation changes.

Dr. Makary says allocating vaccines by profession results in many low-risk individuals getting vaccinated before high-risk people, who are disproportionately comprised of Black, Hispanic and Asian-Americans. Instead, he believes the U.S. should follow Europe's example of using age and risk of mortality as the leading criteria. This, he says, would maximize lives saved, and he's encouraged to see some U.S. states such as Florida pivoting to the European model. Of course, this points to deeper, more fundamental questions about the lack of a coherent virus allocation response at the federal level. The CDC's guidance is only advisory and leaves crucial decisions to individual states, explains Dr. Makary.

He's currently heavily involved in academic work, far from the frontlines of COVID-19 care, and part of a growing number of healthcare workers who refuse to be vaccinated before every high-risk American gets both doses. "Just because you can get the vaccine doesn't mean you should," says Dr. Makary.

— Joe Paone

The staff at AUA Surgical Center in Amarillo, Texas, are still reeling from that reality. Janine Jones, a 58-year-old registered nurse, died December 4 from COVID-19. She was considered an informal founder of the center, which opened in 2015. Her friends and colleagues knew she scared easy, and laughed hard. She was also a patient and staff favorite.

"Even before the facility was built, the owners asked her to apply because they knew and loved her spunk, charm and can-do attitude," wrote an AUA staff member on a Facebook remembrance page after her death. "Around the center, Janine was the first to laugh at a silly joke, a dry comeback or absurd story. Her laugh was often heard throughout our halls during the day. She was joyful in her manner, and generous with her laughs."

The post says Ms. Jones wore her RN badge with great pride, which showed in her level of patient care. She looked after her patients as though they were members of her family, and patients called her by her first name by the time they left. She always ended her pre-op assessment by asking if the patient would like her to pray for them. "It was at this moment that Janine would keep even the most cantankerous surgeon waiting," says the post. "She would not be rushed through her spiritual care, and her patients loved her for it."

PROOF POSI\TIVE
PROOF POSITIVE Providers at Ambulatory Surgery Center of Greater New York show off their vaccination cards. Close to 30% of the staff has received the first dose of the vaccine.  |  Erin Duffy

AUA Administrator Adam Johnson says nearly every member of his staff wants to be vaccinated, and Ms. Jones's passing played a role in that attitude. "Not everyone is educated on the vaccine, and Janine's death absolutely had an effect on them," he says. "It definitely pushed the staff to get vaccinated."

Ms. Lindsay always wanted to be a nurse, ever since she took care of her grandmother as a young girl growing up in Jamaica. "I loved caring for her, and she cared deeply for me," she says. "I am who I am today because of her."

Ms. Lindsay's grandmother maintained a small classroom in her house where she taught neighborhood kids.

"After they were gone, I would love to write on the chalkboard, pretending I was teaching just like her," says Ms. Lindsay. "I saw nursing as a profession that incorporates my passions for patient care and education. During this moment in time, I've come full circle. I'm grateful for the tremendous opportunity to share my story."

When asked what she'll do when the pandemic mercifully ends, Ms. Lindsay sighs and pauses to collect her thoughts. "I'll go back to my grand-mother's house," she says. "And I'll sit quietly to reflect on all we've been through." OSM

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