Latest / The SHEA Podcast / COVID-19: The Role of Emergency Departments in Vaccination & Vaccination Campaigns, 1/21/21

Transcript

COVID-19: The Role of Emergency Departments in Vaccination & Vaccination Campaigns, 1/21/21 · The SHEA Podcast

• 0:08
  SPEAKER_01: Welcome to the Rapid Response Podcast brought to you by the Society of Healthcare Epidemiology of America, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_01: I'm Dr.
• 0:25
  SPEAKER_01: Walee Javed.
• 0:26
  SPEAKER_01: I'm the hospital epidemiologist at Mount Sinai Downtown, and I will serve as your moderator.
• 0:32
  SPEAKER_01: Discussions on the podcast does not reflect Shay's perspective but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:43
  SPEAKER_01: Shay is excited to launch this episode of podcast COVID-19 updates, What We Know Now.
• 0:49
  SPEAKER_01: Today's discussion will focus on the role of emergency departments in vaccination and vaccination campaigns.
• 0:55
  SPEAKER_01: Our speaker today is Dr.
• 0:57
  SPEAKER_01: Alyssa Perkins, Emergency Medicine Physician at Boston Medical Center.
• 1:02
  SPEAKER_01: Thank you for joining us today.
• 1:04
  SPEAKER_01: Before we start our discussion, I would like to turn it over to Dr.
• 1:08
  SPEAKER_01: Jennifer Hanahan to get us started with a brief news and guidance update for this week.
• 1:14
  SPEAKER_00: Thank you, Dr.
• 1:14
  SPEAKER_00: Jamee.
• 1:15
  SPEAKER_00: Globally, as of January 19th, there have been 94,124,612 confirmed cases of COVID-19, including 2,034,527 deaths reported to the World Health Organization.
• 1:29
  SPEAKER_00: In the United States, 10,595,866 individuals have received one or more doses of vaccine against SARS-CoV-2, and 1.6 million have received two or more doses as of January 19.
• 1:43
  SPEAKER_00: A media statement from CDC was released on January 12, stating that the Centers for Disease Control and Prevention is expanding the requirement for a negative COVID-19 test to all air passengers entering the United States.
• 1:54
  SPEAKER_00: Testing before and after travel is a critical layer to slow the introduction and spread of COVID-19.
• 1:59
  SPEAKER_00: This measure is aimed at slowing transmission of emerging variants with increased transmissibility.
• 2:04
  SPEAKER_00: Before departure to the United States, a required test combined with the CDC recommendations to get tested again three to five days after arrival and stay home for seven days post-travel will help slow the spread of COVID-19 within U.S.
• 2:16
  SPEAKER_00: communities from travel-related infections.
• 2:18
  SPEAKER_00: Air passengers are required to get a test within three days before their flight to the U.S.
• 2:22
  SPEAKER_00: and provide written documentation of their laboratory test result via paper or electronic copy to the airline or provide documentation of having recovered from COVID-19.
• 2:31
  SPEAKER_00: Airlines must confirm the negative test result for all passengers or documentation of recovery before they board.
• 2:36
  SPEAKER_00: If a passenger does not provide documentation of a negative test or recovery or chooses not to take a test, the airline must deny boarding to the passenger.
• 2:44
  SPEAKER_00: This order was signed by the CDC director on January 12, 2021 and will become effective on January 26, 2021.
• 2:51
  SPEAKER_00: A report was published in the Morbidity Mortality Weekly report on January 15th about the emergence of SARS-CoV-2 B-117 lineage in the United States, December 29, 2020 to January 12, 2021.
• 3:04
  SPEAKER_00: On December 14, 2020, the United Kingdom reported a SARS-CoV-2 variant of concern.
• 3:09
  SPEAKER_00: This variant is estimated to have emerged in September 2020 and has quickly become the dominant circulating SARS-CoV-2 variant in England.
• 3:16
  SPEAKER_00: It has been detected in over 30 countries, including the United States.
• 3:20
  SPEAKER_00: As of January 13, 2021, approximately 76 cases of B117 have been detected in U.S.
• 3:26
  SPEAKER_00: states.
• 3:27
  SPEAKER_00: Multiple lines of evidence indicate that it is more efficiently transmitted than other SARS-CoV-2 variants.
• 3:33
  SPEAKER_00: The modeled trajectory of this variant in the U.S.
• 3:35
  SPEAKER_00: exhibits rapid growth in early 2021, becoming the predominant variant in March.
• 3:40
  SPEAKER_00: Increasing SARS-CoV-2 transmission might threaten strained healthcare resources, require extended and more rigorous implementation of public health strategies, and increase the percentage of population immunity required for pandemic control.
• 3:52
  SPEAKER_00: Taking measures to reduce transmission now can lessen the potential impact and allow critical time to increase vaccination coverage.
• 3:59
  SPEAKER_00: Collectively enhanced genomic surveillance combined with continued compliance with effective public health measures, including vaccination, physical distancing, use of masks, hand hygiene, and isolation and quarantine will be essential to limiting the spread of SARS-CoV-2.
• 4:13
  SPEAKER_00: A study was published in Annals of Internal Medicine on the feasibility of separate rooms for home isolation quarantine for COVID-19 in the United States.
• 4:21
  SPEAKER_00: The study was done to determine the feasibility of separate rooms for isolation and quarantine for housing units in the United States.
• 4:27
  SPEAKER_00: Authors obtained data on residential dwelling units and occupants from the most recently available 2017 American Housing Survey.
• 4:35
  SPEAKER_00: They determined the number of bedrooms, bathrooms, and occupants per unit, as well as demographics of occupants.
• 4:40
  SPEAKER_00: The authors found that more than one in five U.S.
• 4:42
  SPEAKER_00: homes housing about one quarter of all Americans lack sufficient space and plumbing facilities to comply with the recommendations to isolate or quarantine to limit household spread of COVID-19.
• 4:52
  SPEAKER_00: The authors state that this proportion is particularly high among homes occupied by minority and poor individuals and among apartments, a pattern that mirrors both the high incidence of COVID-19 in those groups and racial discrimination in access to housing that was federal policy until the 1960s and unfortunately persists today.
• 5:11
  SPEAKER_00: An article published in The Lancet titled Insight into the Practical Performance of RTPCR testing for SARS-CoV-2 using serological data, a cohort study, was done.
• 5:21
  SPEAKER_00: The authors performed a cohort study in Shenzhen, China, and attempted to recruit by telephone all RTPCR negative close contacts, defined as those who lived in the same residence as or shared a meal, traveled or socially interacted with an index case within two days before symptom onset of all RTPCR confirmed cases of SARS-CoV-2 detected since January 2020 via contact tracing.
• 5:43
  SPEAKER_00: They measured anti-SARS-CoV-2 antibodies in serum samples from RTPCR negative close contacts two to 15 weeks after initial virological testing by RTPCR.
• 5:52
  SPEAKER_00: They also did a SIRA survey of volunteers from neighborhoods with no reported cases and from neighborhoods with reported cases.
• 5:58
  SPEAKER_00: Between April 12th and May 4th, 2020, serological samples from 2,345 of 4,422 RTPCR negative closed contacts of cases of confirmed SARS-2 cases were collected.
• 6:10
  SPEAKER_00: 1,175 of 2,345 were closed contacts of cases diagnosed in Shenzhen with contact tracing details.
• 6:18
  SPEAKER_00: And of these, 880 had serum samples collected more than two weeks after exposure to an index case and were included in the analysis.
• 6:25
  SPEAKER_00: 40 or 4.5% of 880 RTPCR negative closed contacts were positive on total antibody ELISA.
• 6:32
  SPEAKER_00: RTPCR did not detect 48 of 134 infected close contacts, and false negative rates appear to be associated with stage of infection.
• 6:42
  SPEAKER_00: And finally, an article published in Clinical Infectious Diseases titled Serologic Testing of U.S.
• 6:47
  SPEAKER_00: Blood Tonations to Identify SARS-CoV-2 reactive antibodies, December 2019 to January 2020, evaluated residual archived samples from 7,389 routine blood donations collected by the American Red Cross from December 13, 2019 to January 17, 2020 from donor residents in nine states.
• 7:06
  SPEAKER_00: These samples were tested at CDC for anti-SARS-CoV-2 antibodies.
• 7:10
  SPEAKER_00: Specimens reactive by pan-immunoglobulin enzyme-linked immunosorbent assay were further evaluated.
• 7:16
  SPEAKER_00: Of the 7,389 samples, 106 were reactive by PAN-IG.
• 7:21
  SPEAKER_00: Of these 106 specimens, 90 were available for further testing.
• 7:24
  SPEAKER_00: 84 of 90 had neutralizing activity, one had S1 binding activity, and one had receptor binding domain ACE2 blocking activity greater than 50%, suggesting the presence of anti-SARS-CoV-2 reactive antibodies.
• 7:37
  SPEAKER_00: Donations with reactivity occurred in all nine states.
• 7:40
  SPEAKER_00: These findings suggest that SARS-CoV-2 may have been introduced into the United States prior to January 19, 2020.
• 7:48
  SPEAKER_00: And that's the news for this week.
• 7:50
  SPEAKER_01: Thank you, Dr.
• 7:51
  SPEAKER_01: Anahan.
• 7:52
  SPEAKER_01: I will now move into discussion with Dr.
• 7:55
  SPEAKER_01: Perkins.
• 7:55
  SPEAKER_01: So, Dr.
• 7:56
  SPEAKER_01: Perkins, as an emergency medicine physician at Boston Medical Center and the co-chair of Society of Academic Emergency Medicine Transmissible Infectious Disease and Epidemics Interest Group.
• 8:07
  SPEAKER_01: Can you tell us why this group began a national dialogue on using EDs for COVID-19 vaccines?
• 8:14
  SPEAKER_02: Absolutely.
• 8:15
  SPEAKER_02: And thank you very much, Dr.
• 8:17
  SPEAKER_02: Javed, for having me here today.
• 8:19
  SPEAKER_02: Emergency departments are at a unique position in our healthcare system.
• 8:23
  SPEAKER_02: We're really at the interface of the inpatient setting, the outpatient setting, and the community around us.
• 8:28
  SPEAKER_02: And the patients that we care for are often those that don't interact with the healthcare system otherwise.
• 8:34
  SPEAKER_02: We see patients that just don't access routine medical care.
• 8:37
  SPEAKER_02: This has become especially true since the pandemic hit.
• 8:40
  SPEAKER_02: And as medical centers throughout the country canceled visits throughout the spring and shifted ambulatory visits to telemedicine, emergency departments actually remained open and we continued to provide 24-7 care.
• 8:53
  SPEAKER_02: Now, as coronavirus continues to surge across the nation, we see that emergency departments are going to continue to care for patients that might not otherwise have in-person contact with the healthcare system.
• 9:03
  SPEAKER_02: On top of that, even in non-COVID times, in the emergency department, we take care of some of the most vulnerable patients in our nation.
• 9:10
  SPEAKER_02: We take care of patients without regard for their ability to pay.
• 9:13
  SPEAKER_02: And we see more patients that are minorities than other venues.
• 9:17
  SPEAKER_02: We also see a disproportionate number of patients that are housing insecure, that are job insecure, and that have mental health problems or substance use disorders.
• 9:25
  SPEAKER_02: So essentially in the emergency department, we have access to patients that are particularly vulnerable to suffering from the effects of COVID-19, and also those that might not have other opportunities to talk with healthcare providers about getting vaccinated.
• 9:38
  SPEAKER_02: They might not be inclined to get vaccinated on their own.
• 9:41
  SPEAKER_02: They may not have other opportunities to actually get vaccinated.
• 9:45
  SPEAKER_02: And that's the reason that we started having these conversations.
• 9:48
  SPEAKER_01: This is fascinating.
• 9:49
  SPEAKER_01: So, what experience do you have in your own emergency department and others nationwide that led you to believe that EDs can be an effective venue to provide public health initiatives such as COVID-19 vaccinations?
• 10:03
  SPEAKER_02: Yeah, that's a great question.
• 10:04
  SPEAKER_02: There has really been an increasing recognition over probably the last decade or so that in order for emergency departments to be really effective in improving health outcomes for our patients, we need to do more than just care for the isolated issue that brought the patient into our ED.
• 10:20
  SPEAKER_02: Because that one issue is often the culmination of a number of life events and societal structures.
• 10:25
  SPEAKER_02: And if we don't work on those outside factors, we won't truly be able to improve our patient's health.
• 10:30
  SPEAKER_02: So, with that recognition, we've seen more and more efforts nationwide to have emergency physicians think broader and apply a public health lens to our work.
• 10:39
  SPEAKER_02: Many emergency departments, for example, now have programs in place in which we diagnose patients with hepatitis C virus or HIV and we link them to care.
• 10:48
  SPEAKER_02: Many EDs nationwide offer access to medication assistant treatment programs for substance use disorders.
• 10:54
  SPEAKER_02: These are just two examples of the way that public health thinking has started to really permeate emergency medicine.
• 10:59
  SPEAKER_02: And at our national conferences, we now make time and we make space to have these conversations because we see the value of utilizing a public health framework in our approach to emergency.
• 11:10
  SPEAKER_01: Thank you.
• 11:10
  SPEAKER_01: So do EDs have experience implementing vaccination programs in general?
• 11:15
  SPEAKER_02: We do.
• 11:16
  SPEAKER_02: Tetanus vaccination is probably the easiest example to give.
• 11:19
  SPEAKER_02: Most emergency departments give out tetanus vaccinations like candy for any injured or wounded patients, even though we know that the likelihood of contracting tetanus from a wound suffered in much of the United States is incredibly low.
• 11:31
  SPEAKER_02: We are doing so in part to protect against pertussis, and in part, you know, because of the problem with tetanus.
• 11:38
  SPEAKER_02: But that's a public health vaccination program, though admittedly probably one that is a little bit less relevant for this conversation.
• 11:45
  SPEAKER_02: Influenza vaccine programs probably have a little bit more in common, and they have sprung up in various emergency departments across the country over the last few decades.
• 11:54
  SPEAKER_02: In fact, there are actually policy statements that support utilizing the ED as a setting for influenza vaccination programs.
• 12:00
  SPEAKER_02: And those policy statements come from national organizations such as the CDC, the Advisory Committee on Immunization Practices, and even the American College of Emergency Physicians itself.
• 12:10
  SPEAKER_02: However, most of these flu vaccination programs have been small and fairly limited in scope, though there are plenty of examples in our literature of the successes of these programs, both in getting patients vaccinated as well as having an impact on ED admissions and pneumonia morbidity.
• 12:26
  SPEAKER_02: This year, as COVID-19 has really further threatened hospital andpatient capacity, many hospitals have begun rolling out larger influenza vaccination programs.
• 12:35
  SPEAKER_02: Every year, hospitalizations, ambulance diversion, and just overall demands on ED resources increases during the winter months, partially driven by the influenza season.
• 12:45
  SPEAKER_02: So this year, especially, it makes sense to increase our flu vaccine programs.
• 12:50
  SPEAKER_02: And our hospital and many others have started expanding our flu vaccine programs in part to preserve hospital capacity, but it's also been really intentional with the goal of informing future possible COVID-19 vaccine programs.
• 13:03
  SPEAKER_02: These flu vaccine programs give us a real window into what we can expect from future COVID-19 vaccination programs and the challenges that we can anticipate.
• 13:11
  SPEAKER_01: This is very, very interesting as ED is in general in most conversations not considered to be the one place to deliver COVID-19 vaccines.
• 13:20
  SPEAKER_01: So is there an appetite among your own hospitals for using ED for COVID-19 vaccine delivery?
• 13:27
  SPEAKER_02: There is.
• 13:27
  SPEAKER_02: And we're just starting to have these conversations at our own hospital as well as hospitals nationwide.
• 13:33
  SPEAKER_02: In Massachusetts, where I work, we really haven't started vaccinating non-healthcare and non-frontline workers, but we've started talking about the processes that we're going to use to make sure that our patients get vaccinated.
• 13:45
  SPEAKER_02: It's going to some extent to be on federal resources, to some extent on state resources, and then in large part on hospital resources.
• 13:53
  SPEAKER_02: And our hospital is really excited to consider how we can use the emergency department to supplement outpatient vaccination processes.
• 14:01
  SPEAKER_01: Yeah, I would imagine it will require some degree of background work to kind of implement this successfully.
• 14:07
  SPEAKER_01: So, what resources do you imagine would be needed to start a vaccination program like this?
• 14:12
  SPEAKER_02: Yeah, it's not an easy question to answer because I'm not aware of any ED that has started a COVID vaccination program, but it is something that I and my colleagues have been thinking and talking a lot about.
• 14:23
  SPEAKER_02: I think it's really important right up front to understand that this can't be accomplished using only native emergency department resources.
• 14:31
  SPEAKER_02: As I alluded to earlier, hospital systems are strained under the additional burden that COVID-19 has placed on us.
• 14:38
  SPEAKER_02: And that's particularly true of emergency departments.
• 14:40
  SPEAKER_02: And many emergency departments have really been operating in semi-disaster mode at baseline for years with daily overcrowding and daily challenges just related to space and resources.
• 14:51
  SPEAKER_02: When you add to that the difficulties imposed on us by COVID, you can see that many of us are operating really close to the breaking point.
• 14:58
  SPEAKER_02: So it is hard to think about what it will take to take on this additional burden.
• 15:03
  SPEAKER_02: Additionally, it's really crucial to realize that as with all public health measures implemented in emergency departments, the ED itself is not going to realize the benefit of the program.
• 15:12
  SPEAKER_02: That benefit will be realized by the patient, by the hospital system, by the population at large.
• 15:17
  SPEAKER_02: And we want to get involved because we see the benefits that it will have, but we can't do so without outside additional support.
• 15:23
  SPEAKER_02: And that support may come from multiple places, right?
• 15:25
  SPEAKER_02: We can see it coming from outside the ED, but other hospital resources.
• 15:29
  SPEAKER_02: We could see it coming from state resources.
• 15:31
  SPEAKER_02: We could see it coming from federal resources, but we know that we're going to need outside support outside of just our ED resources.
• 15:38
  SPEAKER_02: And what does that support look like?
• 15:39
  SPEAKER_02: For starters, I would say it looks like additional personnel, right?
• 15:43
  SPEAKER_02: We can't rely on our native ED pharmacists and nurses to vaccinate.
• 15:48
  SPEAKER_02: They're working at capacity already.
• 15:49
  SPEAKER_02: So even though we have this captive patient population, there needs to be parallel staff brought in to do the work of the vaccination.
• 15:56
  SPEAKER_02: Additionally, we're going to need infrastructure support like help documenting, for example.
• 16:01
  SPEAKER_02: So just with our own influenza vaccination program, we've seen that documentations of which patients have already been vaccinated is often inaccurate.
• 16:09
  SPEAKER_02: And we spend a lot of time approaching patients to offer them vaccines, and then we discover that they've already received their influenza shot.
• 16:16
  SPEAKER_02: So EMR modifications and EMR support for a vaccination program will be essential.
• 16:20
  SPEAKER_02: Another thing that we will need is scheduling support.
• 16:23
  SPEAKER_02: Most EDs are just not equipped to arrange timely follow-up.
• 16:26
  SPEAKER_02: And that's going to be really important for a COVID vaccination program because we know that dose two ideally would be given at a predetermined date with only a few days of buffer on either side of that date.
• 16:37
  SPEAKER_02: And that's not going to be an easy lift for this largely disenfranchised ED population.
• 16:42
  SPEAKER_02: I think that one other thing that we will need is the opportunity to have conversations about what we're going to do.
• 16:48
  SPEAKER_02: What happens for patients that we suspect won't return for a second immunization?
• 16:52
  SPEAKER_02: Is it worth it to still get that first dose into them?
• 16:55
  SPEAKER_02: And then what processes do we put in place for capturing these patients in any subsequent ED visits?
• 17:00
  SPEAKER_02: Should we be giving them a second dose at that time, even if it's delayed compared to what the EUA for the vaccines is for?
• 17:07
  SPEAKER_02: These are questions that will need to be answered by hospital systems.
• 17:11
  SPEAKER_02: And there needs to be the opportunity to have these conversations to figure out what we will actually need.
• 17:16
  SPEAKER_01: So as you can imagine, this will probably strain the system a little bit, as you have already alluded to.
• 17:23
  SPEAKER_01: So what barriers do you anticipate in rolling out COVID-19 vaccinations program in an emergency department?
• 17:30
  SPEAKER_02: Yeah, I think we're likely to face barriers on multiple fronts.
• 17:34
  SPEAKER_02: On the part of the emergency department staff, it will be a tough sell because we are already at or over capacity and is going to be challenging to get buy-in for.
• 17:44
  SPEAKER_02: Even if it's easy to recognize that it's for the greater good of our patients and the greater good of the healthcare system in the long run.
• 17:50
  SPEAKER_02: So we're going to need to have conversations in order to get our colleagues and our teammates on board.
• 17:56
  SPEAKER_02: Additionally, depending on how a vaccine program is structured, you could imagine that we may be asking native ED staff to take on more responsibilities at a time when they are already close to drowning in their work.
• 18:06
  SPEAKER_02: So that staff side, I think, is going to be a really big barrier.
• 18:10
  SPEAKER_02: Additionally, on the patient side and on the reception side, I think we can see some barriers because vaccine hesitancy among patients is a real phenomenon that we're going to need to grapple with.
• 18:20
  SPEAKER_02: And we've already seen it present in healthcare workers leading to high levels of vaccine refusal.
• 18:25
  SPEAKER_02: We anticipate that it will be higher than that in patients.
• 18:28
  SPEAKER_02: And in the emergency department, where there's not already a pre-existing relationship between the patient and the physician, it may be even harder to overcome.
• 18:36
  SPEAKER_02: And if we can't convince patients to accept the vaccine if we're offering them, all of these great intentions and all of this logistical support will essentially be for nothing.
• 18:45
  SPEAKER_02: So we have to figure out how to overcome these barriers in order to have a successful COVID-19 vaccination program.
• 18:51
  SPEAKER_01: Yeah, that's a really great point about vaccine hesitancy and addressing the barriers.
• 18:57
  SPEAKER_01: One comment I would probably make here is there are people who are hesitant, and then they are people who are very interested in getting the vaccine and addressing some of it during our vaccine rollout, and then seeing for people above 75, there were a lot of people who were interested in getting the vaccine.
• 19:14
  SPEAKER_01: So my imagination about using emergency department in that scenario would be something like people who are interested probably can't come to one location.
• 19:22
  SPEAKER_01: Okay, this ED is available to give you vaccines.
• 19:25
  SPEAKER_01: They can, among other areas, they can come to this ED department.
• 19:28
  SPEAKER_01: Another issue, really, for ED department is people who are coming there for any other illness and convincing them to get vaccine.
• 19:35
  SPEAKER_01: That's probably there will be more reluctance.
• 19:38
  SPEAKER_01: So, how do you anticipate addressing the vaccine hesitancy in the patient population you have?
• 19:44
  SPEAKER_02: Yeah, I think you're right.
• 19:45
  SPEAKER_02: I think it makes a lot of sense to start with those who are willing and eager.
• 19:49
  SPEAKER_02: Unfortunately, we know that if we don't hit broader aspects of the population, we are not really ever going to be able to achieve anything even close to herd immunity.
• 19:58
  SPEAKER_02: So we will have to address vaccine hesitancy in all parts of the patient population.
• 20:03
  SPEAKER_02: I wish I had a good answer.
• 20:04
  SPEAKER_02: I can tell you, I know it's going to require a multi-pronged strategy.
• 20:08
  SPEAKER_02: I hope it starts from the very top down with our government and our societal leaders making more of an effort to promote the safety and efficacy of the vaccine.
• 20:15
  SPEAKER_02: And I'm optimistic that going forward, these efforts will permeate our society so that there's really consistent messaging at all levels.
• 20:23
  SPEAKER_02: Then at a more local level, I do think that there are things that we can do for our community even before the patients hit the emergency department.
• 20:30
  SPEAKER_02: I think hospital systems will need to partner with community thought leaders, with voices that are already trusted and respected in the populations that we serve.
• 20:38
  SPEAKER_02: This can predispose our patients to accepting the vaccine.
• 20:41
  SPEAKER_02: Then when we have the patients in the emergency department, we need to work on building trust with them, the way we always do when we establish our doctor-patient relationship.
• 20:48
  SPEAKER_02: We'll need to make time to answer the questions that our patients have, even when time is really the most precious resource that any ED doc has.
• 20:57
  SPEAKER_02: I think it'll be really important that we approach these conversations honestly, because there's often a very good reason that an individual patient doesn't trust the medical system.
• 21:05
  SPEAKER_02: And honesty about what the vaccine can and can't do and the anticipated side effects will hopefully go a long way toward building that trust.
• 21:13
  SPEAKER_02: I do think, though, we really will need to hear the concerns and understand that an individual patient just might not accept a vaccine on that day, but recognize that even just having that conversation and opening that door has power and might pave the way for a future provider to have a more open and productive conversation.
• 21:31
  SPEAKER_02: And it might make a future provider more successful that second or third or fourth time that vaccination is discussed.
• 21:38
  SPEAKER_01: I think that's a really, really, really great point you are bringing up here.
• 21:42
  SPEAKER_01: That at the minimum, what we probably could do with even the current resources is in our conversations with patients coming into the ED, we can include some conversation about the vaccine itself.
• 21:53
  SPEAKER_01: And that might actually start that thinking process that people need to have in a conversation with their providers, but at least they can start thinking about getting vaccinated at some point.
• 22:03
  SPEAKER_01: That's a great point.
• 22:04
  SPEAKER_01: So, lastly, what can you say to those individuals who are hesitant about receiving the vaccine?
• 22:10
  SPEAKER_01: And how can emergency medicine physicians like yourself and emergency departments around the country address these concerns?
• 22:17
  SPEAKER_02: Yeah, I have spent a lot of time thinking about this and talking with my family and my friends about this topic.
• 22:23
  SPEAKER_02: For me personally, what I have been doing is I share with them the reality that I have been seeing over the last 10 months and the devastation that I am seeing in my emergency department with every shift that I work.
• 22:37
  SPEAKER_02: The fear and the sadness that accompanies a COVID-posit diagnosis and the sickness and the death that I've actually seen.
• 22:45
  SPEAKER_02: And trying to bring home that reality to people, I think goes a long way.
• 22:49
  SPEAKER_02: And I'm very open about the side effects that I personally have had, which were not terribly severe, but you know, I did suffer from shaking chills and some exhaustion.
• 22:59
  SPEAKER_02: And I try to be really honest and open about that.
• 23:02
  SPEAKER_02: And I share with everybody that I do have a conversation with that my conclusion is that my own side effects and the side effects that have been reported in the literature and the side effects that I have heard from my colleagues are all ultimately better than having COVID itself.
• 23:17
  SPEAKER_02: And that is the take-home point that I try to leave everybody with is that these concerns are real.
• 23:23
  SPEAKER_02: The side effects may be real, but in the end, they're better than COVID.
• 23:27
  SPEAKER_01: That's really very well said.
• 23:28
  SPEAKER_01: The goal of vaccination is to protect ourselves from the severe illness from COVID.
• 23:34
  SPEAKER_01: And absolutely, COVID can kill us.
• 23:37
  SPEAKER_01: So what you said is 100% that any side effects from the vaccine are likely much better than the illness itself.
• 23:45
  SPEAKER_01: So thank you, Dr.
• 23:46
  SPEAKER_01: Perkins, for joining us today and sharing your perspective and experiences.
• 23:50
  SPEAKER_02: Yeah, thank you again for giving me the opportunity to talk about what has been on the minds of so many emergency physicians over the last month or two.
• 24:01
  SPEAKER_01: Thank you.
• 24:01
  SPEAKER_01: And this podcast can be accessed on Shay's Online Education Center, Learning CE, under the Rapid Response Program.
• 24:10
  SPEAKER_01: You will also find resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHAED COVID-19 town halls.
• 24:19
  SPEAKER_01: New members can now receive a 50% off discount on 2021 SHA membership by using the coupon code WELCOME2021 until March 31st.
• 24:30
  SPEAKER_01: That concludes this episode of Rapid Response Podcast.
• 24:34
  SPEAKER_01: Thank you for tuning in.