Continuing the Fight Against COVID
We find ourselves in the midst of the fourth wave of COVID-19 battling primarily the Delta variant as summer comes to a close. As we reverse some masking policies and continue to see improved acceptance of the COVID-19 vaccine, we continue to encounter some pockets of resistance to immunization and some of these are entrenched in distrust of the pharmaceutical industry and the organizations that support them.
Most ACOI Presidents have not followed the path I traveled through internal medicine pediatrics training, which allowed me to view the world of vaccination somewhat differently. Although adult medicine employs vaccination strategies to improve the health of adult patients and for population health, childhood vaccination strategies have focused on protecting the most vulnerable patients, our children. Even in my relatively short career, I have been able to see many changes in disease management due to vaccinating against some of the most invasive diseases which provide significant protection to all children, and reassurances to parents that they can sleep a little better knowing their child will not suffer from debilitating illness.
During my internship year I recall a young child passing through the ER during my rotation who presented with stridor and difficulty breathing. The ER attending and I were cautious as examination of the upper airway had to be carried out carefully in suspected cases of epiglottitis and use of a tongue blade was to be avoided. Lateral neck x-rays were not perfect, and we needed to have this child examined under anesthesia to make the accurate diagnosis under direct laryngoscopy. Fortunately, this revealed a normal epiglottis, and the child was not intubated to protect the airway. During my residency the use of a vaccine against invasive Haemophilus influenzae increased, resulting in a greater than 90% reduction in this illness, and for me, the last case of epiglottitis occurred prior to that during my internship. Although this remains in the differential of all airway disease, it is a vaccine-preventable disease.
I had a recent conversation with a patient and thought about our current dilemma with COVID-19. She had just lost her husband of over 50 years to a natural, non-COVID cause. I again confirmed that they were both vaccinated against COVID and were discussing the vaccine concerns of many unvaccinated Americans. Her generation’s vaccination rates against COVID-19 are the highest in this country. She was surprised by the attitudes of the unvaccinated compared to her generation’s response to controlling polio, a disease parents feared for its debilitating effects and high mortality in those most severely affected. After the development of this early vaccine under much less stringent criteria, children lined up in massive vaccine sites for a chance to protect themselves from this illness.
In 1994, polio was considered eradicated from the Western Hemisphere.
Her generation relied on medical experts and followed those recommendations. There were very few media outlets that created controversy simply to create controversy. Politics were always politics, but we did not weaponize health and infection control measures to create fear and uncertainty in the process, and there was more trust in the medical community.
Most of us in healthcare see things through a different lens than those trying to make decisions for themselves regarding vaccine use. Having these conversations with patients is difficult today, as there is so much to consider and changing attitudes and perceptions are often met with more resistance and people digging into their positions. The battle is less about infection control and more about getting everyone to come along at their own pace. Vaccine mandates will give this a push, but the burden of understanding still rests with the doctor patient relationship and the understanding we can provide.
Michael A. Adornetto, DO, MBA, FACOI