Viewpoint: Health Care Professionals—Get Vaccinated or Get Out

In the last 2 months COVID-19 cases have not fallen. They are hovering above 60,000 per day (7 day moving average). Some have wondered why doubling the number of vaccinated Americans has not budged the numbers. There are two reasons: variants and vaccine hesitancy.

Vaccine hesitancy is a very large issue. Some patients are even needle adverse and do not wish to have any injections, especially one for a virus whose dangers have been downplayed by large segments of the media over the last year. The pausing of the Johnson & Johnson vaccine for investigation of severe complications, reporting to occur in less than 1 in a million, has compounded the problem by reducing vaccine access and fueled the hesitancy for obtaining vaccines.

Kevin Kavanagh, MD

The segment of our society who are not taking the vaccine largely resides in rural America where they tend to clump together and gather in churches and large box stores such as Walmart. This is the same population which does not appreciate the dangers posed by this virus including the long-term sequalae which are being reported in 10% to 30% of those who are even mildly infected. This segment of the population is also mask adverse, questioning their efficacy. All of this makes large regions of American a petri dish for viral spread and devastation.

And now we are hit with the first wave of variants, brought on by the UK or B.1.1.7. mutation. This variant is up to 70% more transmissible and approximately 64% more lethal. Reinfection data is scant, but a recent Israeli study found that if one only receives a single dose of the Pfizer/BioNTech Vaccine that you have a 26-fold higher risk of being infected with the UK variant. (Two doses of Pfizer/BioNTech has up to 97% efficacy in preventing “symptomatic COVID-19 cases, hospitalizations, severe and critical hospitalizations, and deaths” from the B.1.1.7. variant.

The UK strain is fast becoming the dominate strain in the United States. It is more transmissible and lethal than the wild type of virus, and it requires full dosage of a two-dose vaccine to afford substantial protection from infection. In other words, the vaccines are working, but the virus has adapted and is now working twice as hard to maintain the same effect.

Unfortunately, there are other more concerning variants which are looming. On March 17, Infection Control Today® reported a coronavirus outbreak in a highly vaccinated nursing home in Eastern Kentucky. On April 21, the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health released a report which describes what I believe was the same outbreak (the report is confidential, but let us pray this has not happened twice in Eastern Kentucky.) The predator was identified as a SARS-CoV-2 variant having the E484K mutation. The same immunity escape mutation found in the South African, Brazilian and New York variants.

The CDC reported that the nursing home had 83 residents and 116 health care personnel (HCP). “During the outbreak, 46 COVID-19 cases were identified, including cases in 26 residents (18 fully vaccinated) and 20 HCP (4 vaccinated).”

It is clear that vaccines were not fully protective, but that unvaccinated residents and health care personnel had 3 to 4 times the risk of acquiring an infection. Natural immunity was also not completely protective with 4 individuals experiencing possible reinfections with symptomatic COVID-19.

Vaccine effectiveness in preventing infection was estimated to be 66% in residents and 79% in health care workers. Vaccine effectiveness in preventing symptomatic COVID-19 was 87% in both groups. Viral infections (attack rates) were 3 times higher in unvaccinated residents and 4 times higher in unvaccinated HCPs. And the vaccine was 94% effective in preventing resident hospitalizations (no HCP was hospitalized). Three residents died, one of whom was vaccinated.

Of utmost concern is that the index case was an unvaccinated symptomatic health care worker. Many in our society feel it is their right not to be vaccinated, and even not wear masks. But to exercise this right and place the most defenseless segment of our society, who has entrusted their lives to health care workers, at risk, I feel is simply reprehensible. If you work in a health care facility, you need to be vaccinated against SARS-CoV-2. If you choose not to become vaccinated, then you should choose not to be working in a health care setting.

Thus, even with the E484K variants, vaccination appears to provide substantial protection against severe COVID-19. However, for the most part, severe is defined as dying or being hospitalized. This is a very low bar to set for community health. I personally know too many of my friends who have had “mild” COVID and are now suffering from chronic dyspnea and heart disease, such as arrhythmias.

The take-home message is very simple, get vaccinated and even if you are vaccinated, you can become infected with immune escaping variants and transmit the virus. You should also avoid poorly ventilated indoor settings, wear a well-fitted well-constructed mask and if possible, purchase several N-95 masks (they are currently available on Amazon).