The rise of the highly contagious Delta variant has led to an alarming number of severe COVID-19 infections and deaths, overwhelmingly in unvaccinated people. Daily U.S. cases could rise to 200,000 by early September under the current trajectory, according to Thomas Frieden, MD, MPH, former director of the Centers for Disease Control and Prevention.
“It's heartrending to see the news stories about people who are deathly ill in the intensive care unit saying, ‘I wish I’d had a vaccine’,” said Dr. Frieden, CEO of Resolve to Save Lives, a New York City-based preventive health initiative.
Physicians and other health professionals should be encouraging every patient they see to get vaccinated, he stressed in an episode of the “AMA COVID-19 Update.”
“Delta is doubly infectious, so we have to double down on our levels of protection. That's why it makes sense where the virus is spreading to add a double layer of protection with masks in addition to vaccination,” said Dr. Frieden.
Approaching the vaccine-wary
Ideally, Dr. Frieden said, he would like to see vaccines offered in every doctor’s office and medical facility in the United States. The difficulty is convincing the reluctant to get their shot. While there’s no silver bullet for addressing vaccine hesitancy, the physician’s office is a good place to start.
“People trust their doctors, their pharmacists and others, and this is really where we can make the biggest difference increasing vaccination levels,” added Dr. Frieden. Physicians can bring this up as part of the routine office visit, he suggested.
Rather than directly asking a patient if they want a vaccine, Dr. Frieden advised a different approach. The physician, he advised, can say something like, “Mrs. Smith, I provide COVID vaccines to all my unvaccinated patients, especially those like yourself who are over the age of 50. I'd like to provide the vaccine today. Would that be OK with you?”
It’s also important to listen to patient concerns about the vaccines and not brush them aside, he said.
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Mandates as a motive
Mandates are another important tool to boost vaccine uptake in health care facilities and schools.
Unvaccinated health care workers can spread infection to patients and co-workers who can die from it, stressed Dr. Frieden.
“That's just not acceptable. We really need to ensure that anyone who can get vaccinated does get vaccinated and that in, at least health care facilities, that's a requirement, given how serious COVID can be.”
The AMA and nearly 60 other medical organizations recently signed a joint letter calling for all health care and long-term care employers to require their employees to be vaccinated against COVID-19.
Dr. Frieden anticipates that more schools will mandate vaccination once the Food and Drug Administration fully approves the Pfizer-BioNTech and Moderna vaccines. The New York Times has reported that the FDA is aiming to hand out final approval to the Pfizer vaccine by September.
“I'm encouraged with the data that suggests that more than 80–85% of teachers have already been vaccinated. Also, all kids 12 and up who can be vaccinated should be vaccinated,” he said. Masks, increasing ventilation, and rapid identification of cases offer other layers of protection in schools.
Workplaces may also decide that the legal, reputational and ethical risk may be too great to allow COVID-19 outbreaks and start mandating the shots.
More breakthrough infections, fewer deaths
The COVID vaccines have been astonishingly effective, but like every other vaccine, they're not perfect, said Dr. Frieden. Breakthrough infections are inevitable, and they will rise as infections rise.
“If we see the kind of big wave that I'm afraid we may see in the coming month or so, we will see lots of breakthrough infections. The vast majority will be mild, some will be severe, and tragically, some will result in death but that risk of death is something like 100 times less than if those people hadn't been vaccinated,” he said.
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