What Getting the Covid Vaccine Really Means
At the end of one of my appointments, my patient turned to me before stepping out of my office and said “Thank you for what you do.” I had just evaluated her for what was likely a mild case of Covid-19 infection, collected a PCR swab, reassured her that everything suggested she would be fine, but also gave further guidance on red-flag symptoms and how to prevent spreading the infection to others. That was ten months ago.
Ten months ago, the pandemic was just starting to rear its ugly head in the United States. What we thought would be an isolated epidemic in China found its way over to us, and rocked our world. Anxiety, panic and confusion spread everywhere, making it very apparent that our government and healthcare system were lightyears away from being prepared to handle something of this magnitude. I was on vacation in Hawai’i when I received the news that my company was going to be to opening its doors to all patients, including those who were suspected or already diagnosed with having the Covid-19 infection. Patients who showed any signs of cold or flu-like symptoms would be redirected to receive care at designated “high-risk clinics” whereas all other patients would continue to be seen remotely, or in one of the other “low-risk clinics.” As stores and restaurants closed around me in Hawai’i, and the number of confirmed cases started to rise at an alarming rate, the only thing at the top of my mind was how to ensure the safety of my family as we prepared for the tsunami that was about to hit us. I didn’t know at the time that that was only one small aspect of what I had to worry about once I returned home. As I flew back home, I trusted my co-workers and my manager would understand that it would simply be too risky for me to work at the high-risk clinics. As one of the few team members with a young child, as well as an elderly parent living at home, I thought the obvious answer would be for me to work remotely or at the standard clinics. Others with less at stake would surely volunteer to work at the high-risk clinic. Right?
Wrong. On my first day back, I found out my office was selected to turn into the high-risk clinic. Only one other provider felt comfortable working in the the high risk clinic and seeing patients suspected or actually infected with Covid-19. On top of all of that, my manager announced that he was going to work exclusively from home because he was at high risk due to his age and he had a family members at home who were immunocompromised. It made sense, but I felt betrayed, and so alone. No one was looking out for anyone else. But then I realized that I was also letting people down when I assumed my team would make accommodations for me and my family. I was contributing to the problem that fear was creating, and I never wanted anyone on my team to feel the same sense of abandonment that I felt. Recently, I was watching a scene from Attack on Titan (yes, I am a nerd, in case that has not been made painfully obvious in my previous blogs), where a swarm of titans (giant naked monsters who ate humans for fun) was attacking a group of military troops who were defending an abandoned castle. The senior officers declared that they were going to launch an attack from the outside, but directed the rookies (who barely finished their training, and had no weapons or defensive gear with them at the time) to go into the castle that was already infiltrated with titans to form a barricade and prevent them from advancing any further into the castle. As scared as they all were, they all answered with a resounding “Yes” and did not hesitate for a second before jumping into action. And I thought “Why couldn’t everyone be like that? Why didn’t all of us respond in that manner when we found out we would be on the frontlines for this pandemic?” These rookies knew that their lives were on the line, and questioning orders would waste time and result in unnecessary deaths of their comrades. As healthcare workers, we found ourselves in a similar situation as these soldiers defending the castle (except instead of giant naked monsters, our enemies were microscopic crowned monsters) when the pandemic hit. So why didn’t we all spring into action when the threat of this virus knocked down our castle doors? Because we weren’t trained as soldiers, but we were asked to go to war. But if not us, then who? As fearful as we all were, we knew there was no one else so we learned how to don PPE like champions, transformed into social-distancing and masking tyrants and sanitized every exposed surface in our facilities until the paint chipped off. Basically, we became the badass Levi Ackermans of this pandemic.
Those early days of the pandemic were the hardest for me mentally and emotionally (and physically – wearing an N95 mask for 8 hours straight is no small feat). Not only was I in constant fear of contracting Covid-19 and then spreading it to my son-who might end up developing that terrifying systemic inflammatory disease that was only seen in young children-I also had the added pressure of protecting my team members who were on the ground with me, as well as the patients who were coming in to seek care for a disease that no one knew anything about. Many nights, I would lie awake wondering if I had done the right thing by not sending that patient to the Emergency Room. And then there was the added stress of being constantly reminded by the media that over half the country didn’t believe coronavirus was a real thing. Driving home from work, I would see people dining inside restaurants without a care in the world, completely oblivious to the risk that others were taking to fight this war and end the pandemic. It was depressing. I felt like a hamster running on a wheel, and many days I wondered whether this would be my life forever. I found some refuge by reaching out to my former co-residents, who were scattered across the United States for various jobs and fellowships. Some of them were working in the hospitals, and caring for patients who were sick in the ICU. Others were living in New York City, where the situation was so dire that pathologists were being summoned to provide medical care for hospitalized patients. If you are wondering why that particular scenario captures just how serious the situation is, most pathologists, despite having a medical degree, have not interacted with a single living patient since completing their residency. #yikes. Reconnecting with them made me feel less alone, and reminded me that the only way we were going to make it out of this cluster was by leaning on each other and supporting each other. And it also helped that we were being called heroes. Restaurants would send food over to hospitals as a gesture of appreciation for all the frontline workers. At 7 PM every evening, people would stop what they were doing to cheer and bang on pots to show their gratitude. My patients would stop on their way out of my office, and thank me for “my service.”
And then the holidays hit. The holidays are usually a hard time for healthcare workers. We usually don’t get those days off, and it’s usually the busiest time of the year because winter time also means flu season. So instead of spending time with family and loved ones, we are caring for patients. You can imagine that this past holiday season was particularly difficult because of the surge in Covid cases. And despite the CDC’s recommendations for people to stay at home, airports were packed with people who wanted to visit their family over the holidays. I saw all kinds of things at work during that time.
“I just need a Covid test because my family is flying in for Thanksgiving. What do you mean the results won’t be ready by the time they arrive? Can you expedite it? I’ll pay extra money.”
“My mom said she had the sniffles when she joined us for Christmas dinner, and now my husband isn’t feeling well. We have plans to share a cabin by the lake with another family next week for New Year’s and really don’t want to cancel it, so I need to get a Covid test”
“Do you have any holiday plans? Oh, why not?”
And this was also the same time that the free meals stopped coming and the pots stopped clanging. What we were doing was old news now and the number of deaths due to Covid became an ominous dark cloud over everyone’s heads. Everyone was tired. Everyone, except the virus. The virus decided that at our lowest point, it was going to mutate, just to keep things interesting. And by doing so, it reignited the same fear that many people had at the start of the pandemic. Except now that fear was cast on people who had very little reserve left. Things seemed hopeless.
Enter Covid vaccine.
When I first got the call that our team was up next to get vaccinated, I cried. When my team members sent me photos of their vaccination cards, I cried again. When I got my own shot, I felt like I could conquer the world. Finally, after months of fighting this war, we got the armor we needed. It was a huge victory after a time of many losses, and I felt a burden lift from my shoulders that I was no longer putting my family at risk every time I came home from work. It was surreal.
The next step after getting vaccinated was to start vaccinating everyone else. We were pumped. We were ready. We saw the light of the end of the tunnel. Let’s do this and nuke coronavirus out of our lives. But as all things with Covid, it wasn’t that simple. The vaccine actually comes in vials of multiple doses (10 for Moderna; 6 for Pfizer) meaning that in order to ensure you don’t waste any doses, you need to make sure that you vaccinate people in some multiple number of 10. And once you open a vial, you have 6 hours to use it all up before it expires. That means you need to make sure everyone shows up to their appointment, and on time. Otherwise, you will need to find someone else to receive the dose. With such a limited supply, you never know if you’re going to get more doses to administer the second dose for patients. So you are faced with decision of whether to save half of your stock, or keep administering first doses to patients and pray that you get more 4 weeks later. We need to get to herd immunity as fast as possible, don’t we? And that’s not where the complexity ends. The CDC has created a tiering system to identify which persons in our communities should get the vaccine first. The priority tiers include healthcare workers, and those 75+ years old. They’ve given the responsibility of distributing vaccine allocations to state and local health departments, (cue sarcasm) who are so well known for their organization, efficiency, and wealth of resources. The local health departments, in turn, chose to make an already complicated tiering system even more complicated by adding tiers within each tier – each county’s different from the other, and many restricting tiers even though the state had opened them up. The result was endless hours of creating a unique and nuanced scheduling system followed by even more hours of calling individual patients who met eligibility criteria to invite them for their vaccine. After the first day of administering vaccines, word spread quickly, and our lives became even busier when other patients, many of them not eligible but too confused by the government’s tiering system to understand why not, began showing up at our doors and blowing up our phones. It became too much, there simply were not enough hours in the day to vaccinate patients AND provide patient care AND continue Covid testing AND field the myriad of questions regarding the tiering system and eligibility criteria. So our team made a decision, instead of calling individual patients, we were going to allow patients to self-book vaccine appointments, but require a self-attestation that they met eligibility criteria specific to their local department of health, and ask them to show proof of employment or age at the time of their appointment. We put our trust in people to be honest, and hoped that it would make our jobs easier. In our county, we were still only vaccinating patients in phase 1a (healthcare workers) and those 65+ years. That should be relatively straightforward, shouldn’t it? Wrong again. We had a ton of people who showed up claiming to be in the correct tier with proof of employments that came in all shapes and sizes. We had a woman who wrote her own letter saying she was the caretaker for her elderly mother. Per county guidelines, “formal caregivers” qualified under phase 1a, but offered no definition for what “formal” meant. As a side note, they later updated it to include “formal and informal caregivers,” as if that cleared things up. We had a mother who brought in a letter from her child’s pediatrician saying that she was the caregiver for her child. But aren’t all parents caregivers of their children? We had a man who brought an online certification saying that he had passed a class to become an official caregiver (completion date was 1 day prior to his appointment). We had a man bring in a W2 form for a medical device company. Did he interact with patients who had Covid? “Yes” he said “all the time.” His wife brought in a W2 from the same medical device company. Did they work together? “Yes” they said. We had a lawyer of a hospital who didn’t interface with patients, we had a CEO of a vaccine development company, we had more lawyers from that vaccine development company, we had lawyers with absolutely no ties to the medical field who became upset when we turned them away and demanded that we vaccinate them and 6 of their family members as a way to apologize for how we treated them. We turned away 64-year-olds who were turning 65-years-old later this year. We turned away younger patients who were fighting cancer. We turned away teachers who were working with kids with mental disabilities who would scream and bite and kick them when they were upset. And if someone did not show up for their appointment, or we were fortunate enough to draw up an 11th or 12th dose from the vials, we had to find someone who was 1) eligible and 2) able to drop everything they were doing and drive over to our office before the dose expired.
Needless to say, I am exhausted. And my team is exhausted. What was suppose to be a glorious and meaningful first step in beating back this coronavirus has been crapped on by a combination of government bureaucracy and the ugliness of human fear and desperation. And to make matters worse, we’re facing constant criticism from the public that we’re not moving fast enough, or we’re vaccinating the wrong people, or our system is too confusing and difficult to schedule an appointment. Once hailed as heroes of this pandemic, we were now the villains. It feels like a slap in the face. The betrayal makes it difficult to want to keep going. But we know that we have to, because our comrades on the frontlines are still battling this virus – and we can’t stop until all of us can stop. So if you still want to show your appreciation for the healthcare frontline workers who have been working their asses off over the last year, be responsible and check whether you are eligible to receive the vaccine in your local county. If you are eligible, go get your vaccine. If you are not eligible, go find someone who is eligible and help them get scheduled for the vaccine – then wait your turn. We can move much quicker towards achieving herd immunity if everyone in the community (and by everyone, I mean everyone – healthcare workers, patients, the government, the media, the pharmaceutical companies) look out for one another. Practice patience instead of criticism, generosity instead of selfishness, and compassion instead of judgment.
This post is dedicated to all of my colleagues who are still working on the frontlines in the hospital ERs and ICUs. I see you. I know of your tenacity, your dedication and your sacrifice. We will continue pushing forward with the frustrating intricacies of administering Covid vaccines until you are all safe and get the rest that you deserve.
