COVID workers need support but anti-vaxxers not so much

Maine Writer- Gratitude echoed during this daunting pandemic and any other time, when the goal of our community is to support one another during particularly challenging times. (Be sure to scroll and read the comment posted on this Central Maine Editorial Board opinion. I pasted it at the end of the article.) 

Gratitude and grace needed during the holidays (and any other time too!): The advice of the Maine CDC director strikes the right chord in a bewildering, frustrating time.

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Dr. Nirav Shah, director of the Maine Center for Disease Control (CDC) and Prevention, took a few moments at the start of his Wednesday briefing to make some observations about celebrating the holidays during a pandemic.

Before sharing what he knew about the fast-spreading omicron variant of the Sars-CoV-2 virus, the status of the state’s hospital capacity and efforts to vaccinate more people, Shah spoke about how our attitudes toward this disease could fit with the spirit of the season – a time of gratitude and grace.

Central Maine Editorial Board: We couldn’t agree more. Both qualities are in short supply this year, and the need is great.

Our gratitude, Shah said, is deserved by so many people, starting with health care workers, who have been fighting on the front lines of a crisis that keeps changing.

Nirav Shah Director of the Maine Center for Disease Control and Prevention

“They do this in a variety of settings,” Shah said. “Health care workers at hospitals, nursing homes, EMS stations, home care workers, hospice workers, every sector of the health care system has played a role in our response to COVID-19.”

Shah continued: “The work they do matters, perhaps more than ever before. And they do it over this holiday season because the disease doesn’t take a break.”

These workers deserve our thanks. “And if you know one – and you must – give them a high-five and thank them for what they have done throughout the pandemic.”

To the list of the deserving, Shah added public health workers – from community outreach workers to lab technicians – as well as volunteers who staff vaccination clinics and other community efforts, and members of the Maine National Guard who have been serving a role since the beginning of the pandemic, which has only expanded.

At the same time that he called attention to the people around us who should be thanked, he reminded us about those who need our generosity – the people in our lives, our friends, families, coworkers and neighbors who may be evaluating the risk of the pandemic in ways we don’t understand.

“These days it seems, when it comes to COVID, each of us feels like we are on an island,” Shah said. “Everyone who is taking COVID more seriously than you is an over-reactionary worrywart. And everyone who is taking COVID less seriously than you, it’s easy to cast them as someone who doesn’t get it, someone who is denying science.”

But, neither of those extremes is right.

“What is true is that everyone approaches COVID differently through their own lens, a lens that reflects and refracts their own health status, their family’s health, whether they’ve been vaccinated as well as a host of other factors,” Shah said. “No two people, right now, will think of COVID and their own risk in the same way. And that means that no two people will take the exact same set of steps, especially as we go into the holiday season.”

This can be frustrating and confusing and has already caused conflict within families, workplaces and communities. 

Yet, Dr. Shah’s prescription is to meet these differences with generosity instead of anger.

“Recognize that they are coming at this world, a messy, bewildering world, with a different set of thoughts and values than you may be,” he said. “It can be frustrating, but it’s also a time where grace will get us much further than will irritation.”

This is not exactly the kind of advice we expect to get from a doctor, but it struck the right tone at a time when so much of the news we have been hearing is bad.

After nearly two years of uncertainty and disappointment, we have learned not to see this pandemic as a transitory phenomenon that will be over sometime soon.

But, rather than settle into despair, we can offer our grace to the people in our lives who need it, and our thanks to those who have been giving so much to protect us from a disease that consistently and stubbornly surprises.

Among those to whom we offer our thanks are the people at the Maine CDC, whose work has never been more demanding or important, and their director, Dr. Nirav Shah.

Comment published on the editorial page:  

From Maine Stoic:  I admire Dr. Nirav Shah very much, make no mistake. I have followed his guidance since the beginning of the pandemic. Nevertheless, I have reached the point where I have to disagree with the notion of being gracious and accepting of those who refuse to be vaccinated. What if twenty percent of the Maine population decided from time to time to put on a blindfold and walk down a busy street firing a deadly weapon in random directions, leaving a trail of injury and death behind them? What would Dr.Shah, or most other rational people think of that scenario? 

How would Dr.Shah have the greater majority of us respond to these people? The unvaccinated are doing very much the same thing. The time is long past where we, individually and collectively, must respond to the vaccine refusers in some stronger and more effective manner.

From P. Turlo: “These days it seems, when it comes to COVID, each of us feels like we are on an island.” The island analogy is misleading. There are certainly shades of gray. Yes, we should take into account the fact that many "may be evaluating the risk of the pandemic in ways we don’t understand." But there's another group who will simply deny science and who will put others at risk for 'political' reasons. Those 'reasons' involve a deep, unfounded distrust of 'science.' Dr. Shah has been extremely helpful and comforting for months on end. His attempt to promote 'grace' is commendable, but in some cases it will fall on deaf ears. When it comes to the deniers, "grace," in many cases, won't get us further. I agree with the thanks we should give to all the healthcare workers and the long list of support staff who tend to those with COVID. 

They have many, many long days ahead. God keep them safe.

Vaccine compliance must be supported with regulatory enforcement

Australia recently instituted rebates for general practitioners who provide counseling about Covid-19 vaccines.  

Patients' medical appointments reimbursement from insurers, including Medicare and Medicaid, must include a question about how the provider counseled the patient about vaccines!

Echo opinion essay published in The New York Times: Doctors and Nurses Are the Key to the Final Vaccine Push by By Saad B. Omer, the director of the Yale Institute for Global Health.

Maine Center for Disease Control (Maine CDC) Director Dr. Nirav Shah, M.D.

America was in the midst of a summer of celebration, with cases and deaths from the coronavirus on the decline. Although the collective relief was well deserved, parts of America remained vulnerable to outbreaks because of spotty vaccination rates, between states and even counties.

Any risk of future surges and loss of life is almost entirely preventable, given the availability of vaccines. 

And yet there’s reason to believe that the plateauing vaccinations will cause the nation to fall short of President Biden’s target of 70 percent coverage before July 4 among eligible Americans. 

That’s despite the fact that an overwhelming majority of COVID-19 deaths are among the unvaccinated.

So, what happens now? There’s no reason the United States should settle for patchwork vaccination rates and easily preventable death. There are ways to overcome low vaccine demand. It starts with doctors and nurses.

Twenty years of research on how to persuade people to get vaccinated shows that health care providers are the most trusted source of vaccine information, even among vaccine refusers. 

In fact, the nation’s doctors and nurses must talk to patients about Covid-19 vaccines at every opportunity.

This may seem obvious, and yet very few providers have been trained in the most effective approaches for talking to people about vaccines.

For example, doctors and nurses may assume they need to offer patients more information about the vaccines in order to persuade them. But, research shows that often a lack of knowledge is not the main problem. Many people refuse vaccines because of their worldview, values or mistrust of the health system. 

While people on the fence about vaccinations may need more information to help make up their mind, at this stage, there’s actually information overload.

Strategies like framing vaccination as the default choice — “It’s time for you to get vaccinated,” versus, “Maybe you should think about receiving the Covid vaccine” — can be effective. It doesn’t take away someone’s autonomy, but still serves as a verbal nudge toward vaccination.

But how can the nation ensure that its doctors use these approaches? There needs to be a continuing medical education program — a tool used by physicians to keep their skills and knowledge of medicine up-to-date and to maintain their license — to train them in effective vaccine communication techniques. Yale started such a program.

Another way to ensure that health care providers spend sufficient time on sometimes challenging conversations about vaccines is to make vaccine counseling reimbursable.

Right now, providers are compensated if they vaccinate their patient; they don’t get reimbursed if the patient ends up refusing the vaccine.

But doctors don’t always know if their conversations with patients persuaded them to be vaccinated or not. They should be compensated for having the conversation in the first place. Many other countries do so. For example, Australia recently instituted rebates for general practitioners who provide counseling on Covid-19 vaccines.

Persuading people to get vaccinated often requires multiple discussions. Ideally, as part of any appointment, physicians will urge unvaccinated patients to get the Covid-19 vaccine, and talk through any concerns. If the physician does so for more than a few minutes (e.g., more than three minutes, similar to the threshold for reimbursing physicians for smoking cessation counseling), the doctor can seek reimbursement. Physicians should be able to bill for multiple counseling sessions with the same patient up to a reasonable limit of three times per year.

Other continuing efforts, such as increasing vaccine access and making the vaccination process simple, remain important. To this day, there are many people who are concerned about the cost of the vaccines even though they are free. Vaccination sites should stop asking for insurance information.

The most effective vaccine message is one that comes from a trusted source and not only leads the listeners to get vaccinated but also motivates them to encourage others around them to do so as well. This is what we need, as people become complacent with the benefits of others getting vaccinated. 

Health care providers hold this sway, and all health workers need to push toward higher vaccination rates together.

Saad B. Omer (@SaadOmer3) is the director of the Yale Institute for Global Health and a professor of internal medicine and epidemiology at the Yale School of Medicine and the Yale School of Public Health.