We Get by With a “Lot of” Help from our Friends

Good morning.

Over the last couple weeks, we have seen the results of the best and worst in human behavior.

On one hand, we have witnessed an unmatched wave of unvaccinated and seriously ill individuals flood hospitals across Mississippi, setting our state hospital system on the precipice of collapse. We have thousands of people testing positive for COVID-19 daily and heartbreaking deaths of young, otherwise healthy, people.

It didn’t have to be this way and it saddens me greatly that we have not fully utilized the tools available to us. (If you want to hear me say this and not just read it, watch the press conference where we talked about the opening of the Samaritan’s Purse field hospital in Garage C.)

On the other hand, we have state partners like the Mississippi State Department of Health, Mississippi Emergency Management Agency and the Office of the Governor that have collaborated with us to provide much needed assistance to our state’s hospitals. The U.S. Department of Health and Human Services and Samaritan’s Purse have provided field hospitals and health care professionals to staff them. The additional health care staff to care for COVID-19 patients is as important as the beds for the waiting patients because they offer some relief to our clinical staff and overloaded hospital system.

There is strength in numbers, and it is wonderful that we have so many willing public and private organizations uniting for the benefit of patients and the hospitals that serve them. I thank them all for their assistance and lifting the spirits of our health care heroes who know they have their support.

With all the frustrations and fatigue that come with this swell of COVID-19 patients, it’s easy to lose sight of the good, like partnerships that produce additional resources. Today, let’s focus on the good.

In addition, some of you have submitted questions, comments and concerns to me through the VC Notes email about UMMC’s COVID-19 policy and related topics. We announced earlier today that the Medical Center is making the COVID-19 vaccination mandatory as a condition for employment (except for approved accommodations), rather than providing a masking option for those who are vaccinated and those who are not.

I fully support this change because as I have stated many times, increased vaccination rates in Mississippi is our path out of this crisis. To protect our workforce and our patients we serve, we need to be vaccinated because even though the virus can still be transmitted - the outcomes are markedly different between vaccinated and unvaccinated individuals

We have seen numerous reports about the safety and efficacy of the COVID-19 vaccine from various organizations, including the World Health Organization, the Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious Diseases, and the Mississippi State Department of Health, but I asked our UMMC infectious disease experts to assist me in answering the following emails I received. Your clinical colleagues, who have been at the center of the COVID-19 care at the Medical Center, are: Dr. Bhagyashri Navalkele, medical director of infection prevention and control, and Dr. Jason Parham, director of the Division of Infectious Diseases.

Questions:

“I would like to ask a question in regards to the new vaccine policy. In light of the CDC changing its recommendations for everyone to mask indoors regardless of vaccination status, and we know that those vaccinated can still spread the virus, why is this vaccine being mandated as a condition of employment when fully approved? What actual difference does it make if the staff are vaccinated or not since it can still be transmitted, and if the masks work, why would employees need to be forced to take the vaccine? This does not follow the science. Also, since visitors will be allowed in regardless of vaccination status and they can't be forced to take the vaccine, what is actually being accomplished? Visitors coming in can spread this virus inside. We are essentially being used to drive up the vaccination numbers and encourage other employers to do the same, and some of us have very real concerns about it. We, like our patients, should still have the freedom of choice in this matter since the data is still evolving and nothing known of any longterm effects.  My natural immunity is superior to immunity from a vaccine, and I still have antibodies. Please forward this to the correct person, if needed, to answer, but I would like a response to these questions, as I do not understand the policy in light of the above and can't sign a form saying that I do.”

“I am a nurse here at UMC. I am fascinated by the history of medicine and how it has evolved over the centuries. However, I am very confused why we continue to push the vaccine to end the pandemic when vaccinated individuals are still transmitting the virus. Even if you don’t get hospitalized, you can still give Grandma the virus. We lost several family members during this pandemic so my family is no longer avoiding each other to protect them. Most of us have had the infection and did well with no treatment aside from our healthy lifestyles. No one was offered treatment but told to go the ER when you can’t breathe. I see news blasting how people with COVID end up on the vent and die because they don’t wear a mask or take the vaccine. What I haven’t seen is a focus on teaching Mississippians about healthier lifestyles including activity and nutrition. I also haven’t seen anyone offer treatment options or preventive regimens.  There are experts around the world sharing their case stories and providing evidence of treatment in patients who avoided hospitalization and long hauler syndrome. I understand we have some of the brightest minds in the world but I haven’t seen them share the risk/benefit analysis of the popular censored treatment protocols out there. Would it be possible in a future VC note to share what treatment algorithms or protocols are in place at UMC and the evidence supporting them? And also an explanation why the FLCCC protocol is not being used. They are very convincing with their supporting data. I love taking care of patients and prefer to work with patients I can educate to empower them in their own healing. I am constantly seeking new knowledge and sharing what I learn with everyone. Is there a way the administration can help the staff understand why our protocols are what they are? What I’m hearing is the vaccine is the right thing to do, the ethical thing to do, to save lives and the only option we have but my scientific mind needs more justification than that. Can you help me understand so I can help others understand?”

Why vaccination?

COVID-19 infection is known to cause severe illness resulting in hospitalization and deaths. As of August 18, 2021, Mississippi has reported 396,394 cases of COVID-19 and 7,916 deaths. Worldwide multiple research studies have been conducted to evaluate effective and safe options for treatment of COVID-19 disease.

We have a limited number of medications, such as monoclonal antibody therapy, remdesivir, certain immunomodulating agents such as steroids and tocilizumab, which have proven to help with clinical recovery and reduce the risk of death associated with COVID-19; these are the only treatments with enough evidence to support their use. However, these treatment options are nowhere near 100% curative, and deaths still occur in patients despite aggressive treatment.

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To keep Mississippians safe, keep businesses and schools open, avoid health care systems from collapsing with high COVID-19 patient burden, and most importantly, to prevent any further deaths from COVID-19, it is important for all of us to put our trust into safer and much more effective preventive measures - vaccines and masks.  

The main reason for getting COVID-19 vaccination is to prevent development of severe disease requiring hospitalization and death. Currently, in UMMC and across the state, more than 90% of hospitalizations and deaths have occurred in the unvaccinated population. Fully vaccinated individuals are still at risk for acquiring and transmitting COVID-19 infection; however, they are infectious for a shorter time compared to unvaccinated people and are far less likely to become seriously ill, get hospitalized or die from this disease.

The majority of viral transmission in the community is still occurring from unvaccinated individuals to others. If the majority of the population becomes vaccinated (achieving herd immunity), the number of people getting infection and transmitting the virus will eventually slow down, and we can finally get back to a normal life.

Is the vaccine safe? What about natural immunity?

As of August 18, 2021, 358 million doses of COVID vaccine in the U.S. have been given and we now have almost 8 months of real-world vaccination experience with no major safety concerns reported. Although natural immunity against COVID-19 lasts for 6-8 months, longer-term data is not available yet. Studies have shown that vaccinated individuals have a more robust immune response against the more transmissible variants and longer duration of immunity than those who develop natural immunity from contracting COVID-19 infection.

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Natural immunity to COVID-19 infection is less robust and shorter in duration than vaccination with 2x higher risk for reinfection and produces higher risks of serious illness, hospitalization, and death.

Currently, we are faced with a new challenge in the form of the Delta variant which is two times more contagious than previous variants. Nearly 51% of the population in the U.S. is fully vaccinated which leaves 49% of the population vulnerable to develop severe disease and transmit virus to others. While we are waiting for the other half of the population to receive their COVID-19 vaccination, it is in everyone’s best interest for all of us to continue wearing masks when around others to help prevent spread of the virus.  

Finally, I hear a lot about personal choice when it comes to the COVID-19 vaccination. Wearing seat belts when in a vehicle or wearing a helmet when riding a motorcycle are also examples of choice, but you do that to protect yourself if, unfortunately, there’s an accident.

Not taking safe and proven precautions to limit serious disease and death isn’t a personal choice because that decision affects others around you. That’s the essence of public health.