Covid-19 vaccines can’t arrive soon enough for health workers

Now that the Pfizer-BioNTech coronavirus vaccine has been cleared for emergency use, frontline health care workers across the U.S. are days away from being offered the shots. They couldn’t be arriving at a more crucial moment, with Covid-19 cases at their highest level since the pandemic began a year ago and many hospitals overwhelmed.

With a second vaccine, Moderna’s, expected to be approved shortly, government officials have projected that 20 million people will be inoculated by the end of December, with health care workers and residents of long term care facilities first in line.

STAT spoke to health care workers — nurses, doctors, and a paramedic, in Covid hot spots around the nation — who will be among those first to be offered the new vaccines.

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While there is vaccine hesitancy among health care workers as well as the general public — in one study, 36% of nurses said they would not take the vaccine — many other frontline medical workers, exhausted by the pandemic and the many risks they’ve taken to provide care these long months, say the shots can’t come soon enough. Some are taking to Twitter to gleefully announce vaccination appointments.

Those interviewed by STAT spoke about the relief they hope the vaccines will bring, which health care workers should be vaccinated first, and, in one case, why health care workers should not be first in line.

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Juan Anchondo is ready for a vaccine — and more than ready for the pandemic to be over. A medical-surgical nurse at the Las Palmas Medical Center, a 337-bed acute care hospital in El Paso, Texas, Anchondo, 52, has been working grueling 12- and 13-hour shifts for months, as well as mandatory overtime. He’s seen Covid-19 patients fill unit after unit of his hospital since cases started surging in the state after Labor Day. “All of it was just Covid,” he said. “We fit them where we can.”

Anchondo said he’ll take the vaccine as soon as it’s offered. “I’m concerned about my health because I have asthma,” he said. “I see the reality of this virus in the hospital every day.”

While he’s happy vaccines are arriving so soon, Anchondo doesn’t see them as an instant solution. “I’m very encouraged, but it’s not a silver bullet,” he said. “They need to make vaccination part of an overall national program to fight Covid,” he said. “We still need PPE, good staffing levels, testing, and infection control.”

El Paso’s numbers are holding steady for the time being, but Anchondo remains worried. When he drives by a popular local mall on his way to the hospital, he sees parking lots full and large family groups entering the mall together to shop. “It’s not over. We have Christmas, and New Year’s Eve,” he said. “Here we go again.”

The work is exhausting. Anchondo does a shift in the Covid unit every two weeks, but even on regular surgical floors, he’s been exposed to patients who initially tested negative in the ER and were not placed in isolation, but later tested Covid-positive. He wears goggles he purchased himself, an N95 mask that must last his entire shift, and a surgical mask over that. He likes to spend time with patients, but is mindful of how close he gets or how long he stays in their rooms. He won’t take off his mask, except to eat. “I just keep it on the whole time,” he said. “It’s really tiring.”

“When I get home, that’s a whole other story — my new reality,” he said. He parks his car, puts his clothes in the washing machine that’s near the garage entry, and then takes a shower in an adjacent bathroom. “There’s no hugs and kisses for my family until I have my shower,” said Anchondo, who is married and has an 11-year-old son.

The El Paso native has stopped seeing his mother, who is 83. “If I have something and give it to her, oh my god, I just can’t let that happen,” he said. “She’s been doing everything right.”

Anchondo encourages everyone to continue to be careful about exposing themselves to the virus. He often thinks about a patient in his 50s, an avid racquetball player he cared for in the ICU who died after battling the virus for a month. “He was so active and vibrant,” Anchondo recalled. “People’s lives are being cut short by this disease.”

Chief Maria Beermann-Foat and her fellow paramedics in Johnson County, Kan., have what she calls “pandemic fatigue syndrome.” Many of her co-workers have been impacted, some infected, some forced to quarantine, and some have been unable to work because their day care providers are sick. “Other people are stepping up and working overtime, but they’re exhausted,” said Beermann-Foat, who serves as battalion chief of operations for her county’s busy 911-EMS service, just outside Kansas City, where cases are surging. “We’re all tired.”

In normal times, every ambulance call is an unknown. With coronavirus, that’s never been more true, and calls have never been more stressful. “When we enter a potential Covid patient home, we are literally walking into a biohazard environment,” she said. “Everything the patient has touched can be considered contaminated.”

Unlike hospital staff that often tend to patients in isolation or negative pressure rooms, or firefighters who often provide care at a scene and then depart for other calls, “we are with the patients from beginning to end of the call,” Beermann-Foat said. “When you talk about an ambulance, you’re talking about being in a confined box in the same airspace as an infected patient.”

Paramedics have faced among the highest risk of infection and death during the pandemic but they haven’t gotten as much attention as frontline doctors and nurses. Beermann-Foat is glad to see the risk and service of paramedics being recognized at the federal level now that they are among health care workers chosen to be among the first vaccinated.

She said her department’s logistics manager has been amazing at procuring N100 masks and respirators to protect her crews, and those crews have become adept at quickly slipping into their powered air-purifying respirators (PAPRs), devices they might have used once in a career before the pandemic. But she said paramedics need protection beyond PPE.

They often deal with combative patients who may physically fight them. They have to strain to lift and move patients, which can lead to PPE gapping or tearing or goggles going ajar. If they let their guard down for an instant in a chaotic emergency environment, they could accidentally contaminate their PPE. “We’re not machines, and we work in a world full of unknowns,” Beermann-Foat said. “The vaccine is biological protection against human error. It’s peace of mind.”

Keenly aware of staffing shortages, however, she suggested large numbers of health care workers in a location should not all receive the vaccine at the same time. “If the virus makes you feel crappy for one to three days, you don’t want those people at work helping people in crisis, and you won’t know if they’re sick from the vaccine or from Covid,” she said. She suggests vaccinating people at the start of multiday rest periods, when schedules allow.

A recent survey showed 34% of EMS workers would not take the vaccine, possibly due to worries about unknown long-term effects. Beermann-Foat is planning to roll up her sleeve. “In my eyes, getting a vaccine that can protect me is the responsibility I have to my patients and to my staff,” she said. “We transport sick people all the time. If I contracted the virus and transmitted it to someone who couldn’t protect themself, like a cancer patient, I would feel terrible.”

Maria Elena Holguin, a senior critical care nurse who has cared for the sickest of Covid patients for months, can’t wait to get the vaccine. “I’m for it,” she said. “Isn’t this what we’ve been asking for since the very beginning?”

Holguin, who works in the ICUs of St. Peter’s University Hospital in New Brunswick, N.J., has spent countless 12-hour shifts answering code blue and rapid response calls when patients suddenly decline, intubating patients, and helping disoriented patients keep from pulling out their oxygen tubes. Last spring, her hospital rapidly went from having a single Covid patient to running out of space for them.

She’s had long, anxious nights tending to medication bags, adjusting ventilators, and helping patients stay prone while family members wait on hold, desperate to be connected to their relatives via the hospital’s iPads. She balances everything while trying to keep herself from getting the virus, shielded by an N95 mask her hospital autoclaves so it can be reused for her next shift. “My face is dented. My hair’s a mess,” she said. “I don’t take that mask off.”

She can’t help but feel dread when she hears a call that a patient needs to be intubated. “That’s really putting you at risk. You’re freeing all that virus,” Holguin said. “When they call a code blue, I think, ‘Please not me, I hope it’s not my turn.’”

It’s why she said she hopes the vaccine is prioritized for nurses, nurse’s aides, and respiratory therapists who spend lengthy periods in close proximity to Covid patients. “Doctors only go in for a few minutes. We’re the one that are inside these rooms with the patients,” she said.

Holguin, 53, has been a nurse for 30 years, and said she has never experienced anything like the coronavirus. “It’s a lot. We’ve seen enough people suffering. And it doesn’t seem like we’ve seen the end,” Holguin told STAT after coming off a shift where she tended to three Covid patients in her ICU.

The vaccine, she said, will definitely make things easier for her and her ICU. “I would like to get the vaccine. I would like to have some sort of protection rather than nothing,” she said. It will also help units that are short of nurses.

One reason for staff shortages, Holguin said, is that many nurses, especially those with underlying health conditions, retired early once the pandemic hit. “They said, it’s just not worth it. I want to enjoy what’s left of my life.” Filipino American nurses, like Holguin, have been hit especially hard during the pandemic.

Holguin said she’s not sure when she’ll be offered the vaccine, but said her hospital had been making plans for distribution, surveying staff to see who would be willing to be vaccinated. Some younger nurses, she said, told her they were unsure if they would take the vaccine because they worried about effects it could have on future pregnancies.

“Some people say it’s too soon, they’re rushing, why would I put myself at risk?” said Holguin, who is a faculty member in the nursing department at William Paterson University and is working toward a doctorate of nursing practice. “But as a researcher and someone who is into science, you look at the data, and the FDA assessment looks very promising.”

And for those who think the vaccine isn’t necessary because they believe the virus is a hoax, Holguin has some sharp words: “Anyone who thinks this isn’t real,” she said, “should come see the patients we’re taking care of.”

For Jennifer Hsu, an infectious disease physician at Sanford USD Medical Center, South Dakota’s largest hospital, the vaccine her hospital is likely to start doling out this week is “the shining light at the end of a very dark tunnel.”

Since cases started surfacing in South Dakota in large numbers in July, Hsu has been consulting on some of the most complicated cases of Covid, patients whose Covid-weakened lungs have left them vulnerable to fungal and bacterial pneumonias. Her state has been hit hard — 1 in 3 residents are now estimated to have been infected with the virus.

Hsu, 42, has become increasingly worried about burnout among a frontline staff that’s been stretched thin. “I worry about my colleagues, especially the nursing staff, who are witnessing a huge amount of death,” she said. “That takes a toll.”

“The vaccine is our beacon of hope right now,” she said. “That’s keeping us going, knowing that it’s near. All of us have been anxiously watching what the FDA is doing.”

Hsu, who is also the assistant dean for medical school education at the University of South Dakota, said she has been told her region could have vaccine on the ground as early as Tuesday. South Dakota officials plan to follow federal recommendations to vaccinate frontline health workers first, which means Hsu won’t likely be first in line. “While I 100% would be willing to be the first one to roll up my sleeve, I think my colleagues who are working every day, all day, with Covid patients should be getting it first,” she said.

She said it will be up to the medical community to educate people that the vaccine is safe — and far less dangerous than being infected by the coronavirus — so people are willing to be vaccinated. She said she’s had questions, even from physician colleagues, about whether mRNA vaccines like the Pfizer and Moderna ones could alter the genes of a vaccine recipient, which they cannot. “The term mRNA sounds scary, but it degrades right away after its job is done,” she said. “This is not an unknown technology, and the safety profile in the vaccine trials is very good.”

Like other infectious disease experts, she thinks people who are vaccinated will need to keep wearing masks, at least initially, until it is shown that vaccines prevent transmission as well as disease. “I think people need to think of masking and social distancing as an act of kindness, a way people can actively take care of their neighbors, their loved ones, and their communities,” she said. “I hope people don’t let up on that once the first group of people start getting vaccinated.”

Though he’s an ICU doctor, Joel Zivot doesn’t think health care workers should be vaccinated first.

It’s not that Zivot isn’t deeply concerned about the coronavirus. A veteran of the 2009 H1N1 flu pandemic, he started worrying about ICU capacity as early as last February. As a critical care specialist, he’s since treated a steady stream of Covid-19 patients at Emory University Hospital in Atlanta. He’s lost patients in their 20s, 30s, and 40s. And he was infected with Covid in August, spending a frightening two weeks at home dealing with fever, chills, and coughing.

“When my fever went up, I worried. I thought, ‘Am I going to be OK? Am I going to need ECMO?’ I just didn’t know. My colleagues didn’t know,” said Zivot, 58, an associate professor of anesthesiology and surgery.

He assumes he was infected at work because several colleagues he worked closely with were also infected, but he can’t be sure. He has since recovered and returned to work. He still wears a mask at all times. But he doesn’t think he personally — or anyone who has been verified to have been infected with coronavirus — should be at the front of the line for one of the new vaccines because those who have recovered are very likely to have natural immunity. “It would be a waste in these early days when vaccine supplies are limited,” he said.

Zivot, who has a master’s degree in medical ethics and is also studying for a law degree to further future work in health policy, goes further. He doesn’t think any health care workers should be first in line for coronavirus vaccines. “I recognize this is going to be an unpopular thing to say, but it’s just the cold mathematics,” he said. “Vaccinating health care workers won’t materially lower the overall mortality rate.”

“The hospital is clogged with patients and you have to unclog it. The only way to do that is to target the vaccine to people who are getting admitted to hospitals and having lengthy stays,” said Zivot. “If we vaccinate all the health care workers, great, but the hospital will be just as full. And a full hospital is not a safe hospital.”

Instead, Zivot thinks the first vaccinations should go to those patients who are taking up ICU beds at the highest rates: older adults, people with obesity, and those with serious underlying medical conditions. “It’s well-described that these are the populations at highest risk. It’s not a secret,” Zivot said. “While it is true that some health care workers have become sick enough to become patients in intensive care, and a small subset of those have even died, I have cared for very few health care workers in the ICU.”

While some argue that vaccinating health care workers is important to keep them healthy and maintain staffing levels, Zivot disagrees. “Vaccinating health care workers might be trading off staffing issues with death,” he said.

Just minutes after the FDA’s vaccine advisory committee approved the use of the vaccine Thursday, he received a notification from the Georgia commissioner of public health telling him he was eligible to be vaccinated and giving instructions on how to locate vaccination sites. He expects his hospital will encourage him to get the new vaccine. And he’ll be happy to do so. He just doesn’t think he should be one of the first: “The health care workers should wait until the vaccine is much more widely available.”