The ED is often the site of hospital workplace violence. Some nights, the atmosphere can be like a growth medium for trouble. Patients with nowhere else to go when they’re sick are joined by people suffering acute pain, asthmatics fighting for breath, hallucinating seniors who were given the wrong mix of meds, and people trying to combat mental health crises.
Add an out-of-control, emotionally disturbed teen to a space filled with fear, confusion, anger, tiredness, and pain, and you could have trouble. In some states, hospitals simply call the police to deal with the more disturbed individuals (with decidedly mixed results), but many EDs look for nurses like Nurse of the Week Heather Cartee, RN to work the heavy shifts. Because contact with a compassionate, well-trained, emotionally insightful nurse can quiet a disruptive patient as quickly as a bullet, and with a far more promising health outcome.
Luckily, Cartee was on duty the night Plattsburgh, NY cops brought a very disturbed, developmentally disabled teen to the University of Vermont Health Network Champlain Valley Physicians Hospital (UVHN serves northern New York as well as Vermont). The youth was angry, and according to staff his behavior was highly “aggressive” and “confrontational.” And since this was Vermont rather than Texas, the police did not draw their weapons or shoot the boy. Instead, they stood back and let RN Cartee work a little Nurse Magic.
Nurse Magic is usually behind the special traits that inspired you to become a nurse in the first place. It’s a certain perspective: where many see a disturbed, aggressive young man—and contemplate fight or retreat tactics—a nurse may see a stressed teen who acts out when he cannot express himself. So, instead of firing at his chest, Cartee took aim at the stress with a warm, friendly “smize” that would have won kudos from Tyra Banks herself. She was wearing a surgical mask, of course, but some smiles just cannot be confined. Her sympathetic, humorous comments, evident concern, and that smize relaxed the teen to a point where he began to focus on cooperating with ED staff.
However, when the boy’s stepfather left, the power of Cartee’s Smize waned. Bereft of any familiar faces, the youth again became increasingly agitated. Before the situation could snowball into an actual safety threat, the attending physician asked Cartee to make another appearance in her role of Disturbed Teen Boy Whisperer. Perhaps she could assay a Super Smize this time? By now, though, the boy was in such a disruptive state that even Tyra might have thrown in the towel. But the doughty RN, after surveying the scene, reached for one of the most powerful weapons in her arsenal. That’s right: Heather Cartee went in for a hug.
The doctor—who submitted the nomination that won Heather a Daisy Award—witnessed the entire scene. “It [the hug] was exactly what he needed. He actually smiled. The next thing I knew, the two of them were working out math problems using a dry erase marker on the window of the room.” Cartee cared for the boy that night, reassuring him and keeping him stable with minimal restraints. The doctor told the Plattsburgh Press Republican that she believes Cartee’s empathy and acceptance prevented the youth from incurring further psychological damage, and may have even “changed his life.”
Getting a Daisy Award is a terrific honor, but like most Nurse Magic Practitioners, Heather tries to provide everyone with Daisy-standard care: “This is why I got into the health care profession, to help patients and their family members during what can be the scariest times of their lives when they’re sick either mentally or physically. As nurses, we’re here to help our community feel safe and help them through the hardest times.”
After 4 decades in nursing—and first-hand experience with a global pandemic starting in year 39—our Nurse of the Week is done with handovers, aching feet, and N95s (possibly). On May 28, Long Island Jewish Forest Hills Hospital RN Sylvana Fontana Rega donned her scrubs one last time and hung up her stethoscope for good at the end of her shift. (Or did she??)
Her career has been bookended by two pandemics. Rega started as a nurse just as HIV/AIDS began to cast its shadow over the 1980s, and of course, the final chapters of her nursing story have been all about SARS-CoV-2. In the bleak, frightening April of 2020, as Long Island Jewish, like other New York hospitals, struggled to provide care for an ever-growing caseload of Covid patients, Rega herself was infected. She had symptoms, but luckily, her system shook it off quickly, and she was back on the unit caring for patients two weeks later.
Rega’s own bout with Covid certainly pales next to the daily grief and suffering she witnessed at work. “Every room on this floor had Covid,” she recalled to a CBS reporter. When she looks back, the stress and the workload seem to dim in importance, overshadowed by the constant, unending loss of life. “When you see people dying every day, it was… unimaginable,” she says, her voice tightening as she recalls the daily toll.
On the job, of course, there was no time for brooding, and Rega was admired for her dedication and commitment to her patients. Her former co-workers are going to miss her (or will they?) now that she has retired and is preparing to travel this summer for the first time since she was in college.
Having a nursing career spanning four decades has “been a ride,” Rega says with a smile. She has seen remarkable advances in the nursing profession, and sounds rightly proud when she says, “In the beginning we were [just about] following the doctors’ orders—and today, we are part of the team.”
On her final shift, as Rega walked out in her street clothes, the hallways were thronged with co-workers bidding her farewell. They gave her a hearty clap-out, cheered, waved, and adjusted their camera phone angles just so to record the moment for posterity.
To those considering a career in nursing, her advice is simple: “You just gotta do it with your heart!”
So, the farewells have all been made, but does this mean that Rega’s heart is no longer in nursing? Well, after her peregrinations, she expects to return to Long Island Jewish on a part-time basis this fall, so her stethoscope may scarcely have time to collect dust.
See the CBS New York video featuring Sylvana Rega here.
Lost on the Frontline is the most complete accounting of U.S. health care worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close today.
The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the covid-19 pandemic. One key finding: Two-thirds of deceased health care workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America’s health care workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.
The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of covid testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by health care workers. Studies show that health care workers were more than three times as likely to contract covid as the general public.
“We rightfully refer to these people without hyperbole — that they are true heroes and heroines,” said Dr. Anthony Fauci in an exclusive interview with The Guardian and KHN. The covid deaths of so many are “a reflection of what health care workers have done historically, by putting themselves in harm’s way, by living up to the oath they take when they become physicians and nurses,” he said.
Lost on the Frontline launched last April with the story of Frank Gabrin, the first known American emergency room doctor to die of covid-19. In the early days of the pandemic, Gabrin, 60, was on the front lines of the surge, treating covid patients in New York and New Jersey. Yet, like so many others, he was working without proper personal protective equipment, known as PPE. “Don’t have any PPE that has not been used,” he texted a friend. “No N95 masks — my own goggles — my own face shield.”
Gabrin’s untimely death was the first fatality entered into the Lost on the Frontline database. His story of working through a crisis to save lives shared similarities with the thousands that followed.
Maritza Beniquez, an emergency room nurse at Newark’s University Hospital in New Jersey, watched 11 colleagues die in the early months of the pandemic. Like the patients they had been treating, most were Black and Latino. “It literally decimated our staff,” she said.
Her hospital has placed 11 trees in the lobby, one for each employee who has died of covid; they have been adorned with remembrances and gifts from their colleagues.
More than 100 journalists contributed to the project in an effort to record every death and memorialize those who died. The project’s journalists filed public records requests, cross-connected governmental and private data sources, scoured obituaries and social media posts, and confirmed deaths through family members, workplaces and colleagues.
Among its key findings:
More than half of those who died were younger than 60. In the general population, the median age of death from covid is 78. Yet among health care workers in the database, it is only 59.
More than a third of the health care workers who died were born outside the United States. Those from the Philippines accounted for a disproportionate number of deaths.
Nurses and support staff members died in far higher numbers than physicians.
Twice as many workers died in nursing homes as in hospitals. Only 30% of deaths were among hospital workers, and relatively few were employed by well-funded academic medical centers. The rest worked in less prestigious residential facilities, outpatient clinics, hospices and prisons, among other places.
The death rate among health care workers has slowed dramatically since covid vaccines were made available to them in December. A study published in late March found that only four of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. But deaths lag behind infections, and KHN and The Guardian have tracked more than 400 health care worker deaths since the vaccine rollout began.
Many factors contributed to the high toll — but investigative reporting uncovered some consistent problems that heightened the risks faced by health workers.
The project found that Centers for Disease Control and Prevention guidance on masks — which encouraged hospitals to reserve high-performance N95 masks for intubation procedures and initially suggested surgical masks were adequate for everyday patient care — may have put thousands of health workers at risk.
The investigation exposed how the Labor Department, run by Donald Trump appointee Eugene Scalia in the early part of the pandemic, took a hands-off approach to workplace safety. It identified 4,100 safety complaints filed by health care workers to the Occupational Safety and Health Administration, the Labor Department’s workplace safety agency. Most were about PPE shortages, yet even after some complaints were investigated and closed by regulators, workers continued to die at the facilities in question.
The reporting also found that health care employers were failing to report worker deaths to OSHA. The data analysis found that more than a third of workplace covid deaths were not reported to regulators.
Among the most visceral findings of Lost on the Frontline was the devastating impact of PPE shortages.
Adeline Fagan, a 28-year-old OB-GYN resident in Texas, suffered from asthma and had a long history of respiratory ailments. Months into the pandemic, her family said, she was using the same N95 mask over and over, even during a high-risk rotation in the emergency room.
Her parents blame both the hospital administration and government missteps for the PPE shortages that may have contributed to Adeline’s death in September. Her mother, Mary Jane Abt-Fagan, said Adeline’s N95 had been reused so many times the fibers were beginning to disintegrate.
Not long before she fell ill — and after she’d been assigned to a high-risk ER rotation — Adeline talked to her parents about whether she should spend her own money on an expensive N95 with a filter that could be changed daily. The $79 mask was a significant expense on her $52,000 resident’s salary.
“We said, you buy this mask, you buy the filters, your father and I will pay for it. We didn’t care what it cost,” said Abt-Fagan.
She never had the opportunity to use it. By the time the mask arrived, Adeline was already on a ventilator in the hospital.
Adeline’s family feels let down by the U.S. government’s response to the pandemic.
“Nobody chooses to go to work and die,” said Abt-Fagan. “We need to be more prepared, and the government needs to be more responsible in terms of keeping health care workers safe.”
Adeline’s father, Brant Fagan, wants the government to begin tracking health care worker deaths and examining the data to understand what went wrong. “That’s how we’re going to prevent this in the future,” he said. “Know the data, follow where the science leads.”
Adeline’s parents said her death has been particularly painful because of her youth — and all the life milestones she never had the chance to experience. “Falling in love, buying a home, sharing your family and your life with your siblings,” said Mary Jane Abt-Fagan. “It’s all those things she missed that break a parent’s heart.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
With millions of Americans now receiving COVID vaccines, the country may soon start to control the pandemic that has so greatly challenged the healthcare system and nursing. Still, the threat remains, with the potential that new variants of the coronavirus will cause more suffering and death.
As these variants menace public health, nurse practitioners (NPs) work to control those new strains. NPs have been on the frontlines of the pandemic since it started. Some 61% of NPs are treating patients who have been diagnosed with COVID-19, according to a recent survey from the American Association of Nurse Practitioners (AANP). Almost as many (58%) are offering COVID-19 testing at their practices.
In this article, we’ll take a look at the variants, testing, vaccination, and how NPs are dealing with patients who are hesitant to get the inoculation. First, let’s look at some of the numbers.
Tracking the variants
To understand the spread of the COVID variants, healthcare providers can consult a map from the Centers for Disease Control and Prevention (CDC) that tracks three “variants of concern.”
B.1.1.7 (United Kingdom): This variant was first detected in the U.S. at the end of December 2020.
B.1.351 (South Africa): Cases from the variant were first reported in the U.S. at the end of January 2021.
P.1. (Brazil): This variant was first detected in the U.S. at the end of January 2021.
These variants, says the CDC, seem to spread more easily and quickly than other variants. As of mid-March, the U.K. variant was found in 49 states. According to the CDC, the U.K. variant is on track to be the dominant strain in the U.S. by April, says Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, Pediatric Nurse Practitioner House Calls, Inc., Amityville, NY.
In general, most healthcare providers are unlikely to know if a COVID patient has the variant. A lab result will simply say if the patient does or doesn’t have COVID, notes Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of AANP in an interview with DailyNurse. She practices at a community health center in New Orleans that serves a diverse patient population.
“We really haven’t drilled down to testing every patient to see if they have a variant or not,” Thomas says. “That’s to come in the future. Right now, we’re doing so much testing it would be virtually impossible to test every patient to see what variant they have. From a patient’s perspective, they just want to know if they have COVID.”
“We don’t know who has the variant or not,” agrees Doreen Cassarino, DNP, APRN, FNP-BC, BC-ADM, FAANP, who practices at an internal medicine practice in Naples, FL. “All that we will get when we do testing is positive or negative. We don’t actually know if one of our patients has the variant or not.”
The treatment for COVID doesn’t differ with a patient infected with a variant. The symptoms are no different, notes Koslap-Petraco.
NPs can ask to have their patients typed to identify if the patient has a variant, Koslap-Petraco says. This can assist with public health, she notes. She worked as an NP/public health nurse for the Suffolk County Department of Health Services for 30 years.
“The problem with the strains is they’re more communicable,” Koslap-Petraco says. “When you have something that’s more communicable, you’re going to have more people being affected, and ultimately you’re going to wind up with more deaths, more long COVID and all of the other issues that are related to these viruses. But in order to contribute to public health efforts, nurse practitioners can ask to have these strains typed so that they know exactly what is circulating in their community.”
Koslap-Petraco hopes for more surveillance. “If the variants take hold and the vaccines don’t work, we’re in a lot of trouble. So that’s why we have to track these variants,” she says.
Vaccination to prevent mutation
Getting vaccine shots into arms as fast as possible holds the key to combating variants. “The big issue here to prevent the variants from taking hold further is to get as many people vaccinated as quickly as possible so we keep the virus out of the community, and then the virus doesn’t have the opportunity to mutate,” Koslap-Petraco says.
The Pfizer, Moderna, and AstraZeneca vaccines offer effective protection against the U.K. variant, notes Koslap-Petraco. NPs want to make sure, she says, that their patients get vaccinated before any other strain of the virus starts to take over, as the U.K. variant has done.
Cassarino agrees. In her Florida practice, since the week of February 22 she has tracked an increase in the number of patients age 65 and over getting the vaccine. “More and more people are getting vaccinated, which is really the main thing to preventing these variants–to encourage vaccination as soon as possible.”
With getting jabs into arms the major method to limit the spread of variants, vaccine hesitancy presents an obstacle NPs have to help overcome. “Overall, we are seeing some vaccine hesitancy,” says Thomas.
“Quite honestly, we saw a lot more vaccine hesitancy at the beginning of the pandemic because people didn’t know what to expect with the vaccine,” says Koslap-Petraco. “I am definitely seeing much less vaccine hesitancy now, especially in the African American population, but it’s all about building trust.”
“For the most part, what I’ve seen is when patients hear that their friends, family, loved ones, or even me as their healthcare provider has gotten the vaccine, they’re much more likely to take it,” says Thomas.
It helps, says Cassarino, to be able to tell a patient that Cassarino herself has received the vaccine, as have members of Cassarino’s family who are eligible. “It helps to be able to be a good role model for your patients,” she says.
Therapeutic communication plays a part, says Thomas. That involves acknowledging a patient’s concerns, showing empathy, and sharing the evidence and science about the vaccine, as well as sharing that the NP herself has gotten the vaccine. “The most important thing is communication with our patients, and when we do it effectively, it really makes a difference,” Thomas says.
“Nurse practitioners provide a huge potential service as far as educating our patients and the general public as well on the importance of vaccination, preventing the spread of this terrible virus,” says Cassarino.
Serving the community
As inoculations continue, the theme of NPs serving the community comes into play. “We have to treat this like we’re at war, and every single person in the United States is important,” says Koslap-Petraco. “That’s so important about what nurse practitioners do. We’re out there to make sure that everyone stays healthy.”
“We have a lot of NPs that are volunteering their personal time to go work at vaccine clinics on their off time. Service to the community is so important,” says Thomas. “The health of the community impacts the health of our nation, and so I think our dedication to community health just rings true as we see these NPs volunteering their time to go help others.”
Nurse of the Week Ellen Mulkerrins, BSN. RN, OCN has always stood out for her empathy, compassion, and standards of care. The Daisy Award winner cares for cancer patients at Memorial Sloan-Kettering—with emphasis on the word “care”–and as Michelle Sottile, BSN, RN, OCN said in a moving tribute, “I personally saw Ellen’s true gift when she cared for my own family member. Nothing was too much for her to make sure my family member was comfortable, monitored closely and, especially, could laugh, making his hospital stay easier. Her compassion, kindness and dedication will never be forgotten.”
“All her patients are left smiling, asking for pillows to brace their fresh surgical incisions as they try not to laugh.”
Virginia Pfeifer, B.S.N., RN, OCN, CWOCN, Memorial Sloane Kettering
Life as a New Yorker certainly hasn’t diminished Mulkerrins’ capacity for empathy. She is known for her ability to “sense unspoken needs” of her patients, as well as for her sensitive treatment and support of those who are in pain or are dying. And, as Sottile makes clear, Ellen Mulkerrins will gladly go the extra mile (or two) to lift patients’ spirits and brighten the last days of those who are not going to recover.
One of Mulkerrins’ patients needed all the brightness his nurse could muster. He checked in with a security… action figure—a Hulk doll he carried as he wrestled with his disease and his fears. Mulkerrins quickly became another source of security and comfort as she gained his trust. As he pondered his deteriorating condition and the growing unlikelihood that he would survive, he spoke to her of his partner, saying that he deeply regretted not having formalized their relationship by getting married. So the OCN took on a side-gig, as a wedding planner.
Mulkerrins orchestrated a ceremony that allowed her patient to tie the knot in the hospital. (He entrusted his Hulk doll to her for the duration). There was music; two nurses walked the wife-to-be down the make-shift “aisle,” and some witnesses were so moved that they followed the tradition of crying at a wedding.
One of Mulkerrins’ colleagues vividly described her effect on the unit. A fellow Sloan-Kettering nurse, Virginia Pfeifer, B.S.N., RN, OCN, CWOCN, said, “To Ellen, caring for patients is not just a job but a passion. She treats each patient as if they were her own family. There is no request from a patient that is too big for Ellen. If there is anything she has taught our staff over the years, it’s that the small things count. All her patients are left smiling, asking for pillows to brace their fresh surgical incisions as they try not to laugh. No matter how difficult the day, Ellen’s passion and joy for the patients and their families is evident.”
Though African Americans are being hospitalized for COVID-19 at more than triple the rate of white Americans, wariness of the new vaccine is higher in the Black population than in most communities. The U.S. Centers for Disease Control and Prevention highlighted communities of color as a “critical population” to vaccinate. But ProPublica found little in the way of concrete action to make sure that happens.
And it could be hard to track which populations are getting the vaccine. While the CDC has asked states to report the race and ethnicity of every recipient, along with other demographic information like age and sex, the agency doesn’t appear ready to apply any downward pressure to ensure that such information will be collected.
In state vaccination registries, race and ethnicity fields are simply considered “nice to have,” explained Mitchel Rothholz, chief of governance and state affiliates for the American Pharmacists Association. While other fields are mandatory, such as the patient’s contact information and date of birth, leaving race and ethnicity blank “won’t keep a provider from submitting the data if they don’t have it.”
In the initial stages, vaccines will go to people who are easy to find, like health care workers and nursing home residents. But barriers will increase when distribution moves to the next tier — which includes essential workers, a far larger and more amorphous group. Instead of bringing the vaccine to them, it’s more likely that workers will have to seek out the vaccine, so hesitancy and lack of access will become important factors in who gets the shots and who misses out.
“There are individuals who are required to be on the front line to serve in their jobs but perhaps don’t have equitable access to health care services or have insurance but it’s a challenge to access care,” said Dr. Grace Lee, a professor of pediatrics at Stanford University School of Medicine and member of the CDC’s Advisory Committee on Immunization Practices, which is tasked with issuing guidance on the prioritization of COVID-19 vaccine distribution. “We can build equity into our recommendations, but implementation is where the rubber meets the road.”
Hesitancy is Rooted in Medical Exploitation and Mistreatment
About a quarter of the public feels hesitant about a COVID-19 vaccine, meaning they probably or definitely would not get it, according to a December poll by the Kaiser Family Foundation. Hesitancy was higher than average among Black adults in the survey, with 35% saying that they definitely or probably would not get vaccinated.
Mistrust of the medical community among people of color is well-founded, stemming from a history of unscrupulous medical experimentation. The infamous Tuskegee study, conducted from 1932 to 1972 by the U.S. Public Health Service, still looms large in the memories of many Black Americans, who remember how researchers knowingly withheld treatment from African American sharecroppers with syphilis in order to study the disease’s progression.
But the injustices aren’t confined to the past. The National Academies’ Institute of Medicine has found that minorities tend to receive lower-quality health care than white counterparts, even when adjusting for age, income, insurance and severity of condition. Black Americans are also more likely to be uninsured and utilize primary care services less often than white Americans.
“It’s not just about history. It’s about the here and now,” said Dr. Bisola Ojikutu, an infectious disease physician at Massachusetts General Hospital. “People point to racial injustice across the system. It’s not just hospitals; people don’t trust the government, or they ask about the pharmaceutical industry’s profit motive. From the very beginning, Black and brown people are marginalized from the enterprise of research. They think: ‘So few people look like us in research, industry and academia, why should we trust that someone at that table is thinking of our interest?’”
When it comes to vaccinations, the consequences can be grave. Black and Hispanic people are less likely to get the flu shot than white people, according to the CDC. At the same time, Black Americans have the highest rate of flu-associated hospitalizations, at 68 people per 100,000 population, compared to 38 people per 100,000 in the non-Hispanic white population.
Health officials have tried to assuage vaccine concerns in the traditional way, by publicizing specific individuals receiving the shot. The U.S. began its mass immunization effort by injecting a dose of the Pfizer-BioNTech vaccine into the left upper-arm of Sandra Lindsay, a Black woman and critical care nurse in New York.
Meanwhile, an onslaught of memes and conspiracy theories characterizing the vaccine as harmful are making the rounds on social media. One reads, “Just had the covid-19 vaccine. Feeling great,” along with the picture of the character from the 1980 movie “The Elephant Man.” Another image circulating on Twitter features the photos of three Black people and claims they are suffering from Bell’s palsy due to the vaccine. The Twitter user who shared the image asked followers, “still want those Tuskegee 2.0 genocide vaccines?”
It may only take one or two negative headlines to further sow fear, said Komal Patel, who has 16 years of experience as a pharmacist in California. After two health care workers in the United Kingdom experienced allergic reactions to Pfizer’s vaccine, Patel said she saw anxiety spike on social media, even though regulators have said that only people with a history of anaphylaxis — a severe or life threatening immune reaction — to ingredients in the vaccine need to avoid taking the shot. “Just two patients, and here we go, there’s all this chatter.”
Key States Lack Concrete Plans to Promote Vaccines in Black Communities
It falls to states to make sure their residents of color are vaccinated. But the speed at which the vaccine needs to be disseminated means that states haven’t had much time to plan communications efforts, said Lee, from CDC’s advisory group. “How do we make sure messaging is appropriate? You may want to emphasize different messages for different communities. We don’t have the time for that.”
ProPublica found that few states can articulate specifically what they are doing to address vaccine skepticism in the Black community.
Texas, Georgia and Illinois’ state plans make no mention of how they plan to reach and reassure their Black residents. Black communities make up between 13% and 33% of the population in the three states, according to data from the U.S. Census Bureau. None of the three states’ health departments responded to requests for comment.
California’s state plan includes “a public information campaign … to support vaccine confidence,” but does not provide details apart from the state’s intention to use social media, broadcast outlets and word of mouth. In an email, the California Department of Public Health did not provide additional information about outreach to Black residents, only saying, “this is an important issue we continue to work on.”
A spokesman for New York’s Department of Public Health said the state has been working since September to overcome hesitancy with expert panels and events like Gov. Andrew Cuomo’s November meeting with community leaders in Harlem to discuss concerns with the Trump administration’s vaccine plan, specifically for communities of color.
“Governor Cuomo has been leading the national effort to ensure…black, brown and underserved communities have equal access to, and confidence in, the vaccine,” a Saturday statement said.
Dr. Georges Benjamin, executive director of the American Public Health Association, said: “Media outreach is not enough. TV ads are one thing, but usually public service announcements are at midnight when nobody is listening, because that’s when they’re free.” Normally, public health officials go to barber shops, beauty salons, bowling alleys and other popular locales to hand out flyers and answer questions, but due to the pandemic and limits on congregating, that’s not an option, Benjamin said, so officials need to plan a serious social media strategy. That could involve partnering with “influencers” like sports figures and music stars by having them interview public health figures, Benjamin suggested.
Dr. Mark Kittleson, chair of the Department of Public Health at New York Medical College, said he’s not surprised to hear how vague some of the state health plans are, because states often focus on providing high-level guidance while county or regional level health departments are left to execute the plan. But he said specific efforts need to be undertaken to reach residents of color. “Spokespeople for the vaccination need to be a diverse group,” Kittleson said. “Dr. Tony Fauci is fantastic, but every state needs to find the leading health care experts that represent the diversity in their own state, whether it’s Native American, African American or Latino.” Kittleson also suggested partnering with churches.“Especially in the African American community, when the minister stands up and says, ‘Folks, you need to take your blood pressure medication and take care of yourself,’ people listen to that,” he said. “The church needs to be brought into the fold.”
Maryland’s state plan acknowledges the distrust among Black and Latino communities as well as rural residents, and says it will aim to tailor communication to each group by working with trusted community partners and representatives of vulnerable groups. A Department of Health spokesperson said in an email that “as vaccination distribution continues to ramp up, we urge all individuals to get the vaccine.”
Florida’s written plan includes a messaging strategy for everyone in the state, but does not specifically address the Black community. A “thorough vaccination communication plan continues to be developed in order to combat vaccine hesitancy,” a spokesperson for the Florida Department of Health said in response to ProPublica’s queries.
In North Carolina and Virginia, however, health officials started preparing months ago to reassure residents about potential vaccines. North Carolina formed a committee in May with leaders from marginalized communities to guide the state’s overall response to the pandemic. Vaccine concerns were a priority, said Benjamin Money, deputy secretary of health services for North Carolina’s Department of Health and Human Services.
The politicization of the pandemic has mobilized the Black and brown medical scientific community to dig into the research and how the vaccines work, Money said, “so that they can feel assured that the vaccine’s safe and it’s effective and they can convey the message to their patients and to their community constituents.”
The committee is advising North Carolina officials on their vaccine messaging and hosting a webinar for Black religious leaders. Similarly, the Virginia Department of Health has staff devoted to health equity across racial and ethnic groups and is putting on a series of town hall-style meetings speaking to specific communities of color.
Black residents in Virginia have expressed concerns about how rapidly the early vaccines were developed, said Dr. Norman Oliver, Virginia’s state health commissioner.
“It all boils down to telling people the truth,” Oliver said. “The first thing to let folks know is that one of the reasons why these vaccines were developed so quickly is because of the advances in technology since the last time we did vaccines; we’re not trying to grow live virus and keep it under control or do attenuated virus and develop a vaccine this way.”
In addition to promoting reliable information, Virginia health officials hired a company to monitor the spread of vaccine misinformation in the state and to locate where falsehoods appear to be taking hold, Oliver said. The state hopes to target its communications in places where distrust is most intense.
The CDC has set aside $6.5 million to support 10 national organizations, according to spokesperson Kristen Nordlund. The funds are “to be disbursed by each organization to their affiliates and chapters across the country so they may do immunization-focused community engagement in the local communities they serve,” Nordlund said in an email. She didn’t respond to questions on whether the funds had already been disbursed and to which organizations.
Data Collection on the Race of Vaccine Recipients is Likely to be Incomplete
Every state has a vaccination registry, where data on administered shots is routinely reported, from childhood vaccinations to the flu shot. What’s new in this pandemic is that the CDC has requested all the data be funneled up to the federal level, so it can track vaccination progress across the nation.
“Race and ethnicity data should be recorded in states’ immunization data, but we do not know how reliably it is collected,” said Mary Beth Kurilo, senior director of health informatics at the American Immunization Registry Association. “We really don’t have good data on how well it’s captured out there across the country.”
Many immunization records are fed into the state’s registry directly from a doctor’s electronic health record system, Kurilo said, which can present technological stumbling blocks: “Is [the data] routinely captured as part of the registration process? Can they capture multiple races, which I think is something that’s become increasingly important going forward?”
When asked about historic rates of compliance and how they planned to gather information on race and ethnicity of vaccine recipients this time, health departments from Georgia, Texas, Illinois, Florida and California didn’t respond.
Maryland’s state plans indicate it intends to use information gathered through its vaccine appointment scheduling system, including demographic data gathered from recipients, to direct its communication outreach efforts. The Maryland Department of Health, which didn’t provide more detailed information, said it is “currently exploring all options as far as vaccine data reporting.”
North Carolina’s immunization records system routinely collects race and ethnicity information, and a spokesperson told ProPublica it has that type of demographic data for 71% of people in the system. Stephanie Wheawill, director of pharmacy services at the Virginia Department of Health, said that providers will be “asked to record that information” but didn’t elaborate on how the department planned to encourage or enforce compliance.
Data fields for vaccine recipients’ race and ethnicity are standard in New York, a spokesman said. But the state didn’t provide any details about rates of compliance in supplying that data.
“You’ve got to have the data to compare,” said Martha Dawson, president of the National Black Nurses Association and an associate professor at the University of Alabama at Birmingham’s nursing school. “Because if you don’t have the data, then we’re just guessing. There’s no way to know who received it if you don’t take the data.”
There is tension between gathering enough data to understand the extent of the rollout and the possibility that asking for too much information will scare away people who are already leery of the vaccine.
“The biggest concern people have is how will this information be used?” said Lee, from the CDC’s advisory group. “People need to trust that the data will be used with a good intent. “
Rothholz, with the American Pharmacists Association, said there could be ways apart from state registries to estimate vaccine uptake among minorities. “If I’m a community pharmacy in a predominantly African American community, if I’m giving away 900 or 1000 vaccines, you can track penetration that way,” he said. Geographic-based analysis, however, would depend on the shots being distributed via community pharmacies rather than by mass vaccination sites — a less likely scenario for the Pfizer vaccine, the first to be administered, which requires ultracold storage that will be difficult for many small pharmacies to manage.
It Will Be Up to Doctors and Community Leaders to Encourage Trust
The best way to help a worried individual, whether scared about data collection or the vaccine itself, is a conversation with a trusted caregiver, according to Dr. Susan Bailey, president of the American Medical Association.
“Time and again it’s been shown that one of the most valuable things to encourage a patient to undertake a change, whether it’s stopping smoking or losing weight, is a one-on-one conversation with a trusted caregiver — having your physician saying, ‘I took it and I really want you to take it too,” she said. “But patients have to have the opportunity to ask questions, and not to be blown off or belittled or feel troublesome for asking all their questions.”
“If someone says that they’re afraid of being a guinea pig, maybe drill a bit deeper,” Bailey suggested. “Ask, ‘What are you concerned about? Are you concerned about side effects? Are you concerned that not enough people have taken it?’”
The American Academy of Family Physicians uses the mnemonic “ACT” to guide their members in conversations with patients of color, president Dr. Ada Stewart said in an email: “Be Accountable and Acknowledge both historical and contemporary transgressions against Black, brown and Indigenous communities. … Communicate safety, efficacy and harms such that individuals can weigh their own personal risk to potential benefits, and exercise Transparency with regard to the development of vaccines and the distribution process.”
David Hodge, associate director of education at Tuskegee University’s National Center for Bioethics in Research and Health Care, urges Black and brown leaders such as pastors and community organizers to take control of the messaging right now and not wait for their local governments to tackle the issue.
“We’re not in a position right now to be patient. We’re not in a position to sit on the sidelines, we have to make it happen.”
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