Issue link: https://beckershealthcare.uberflip.com/i/1414493
11 INFECTION CONTROL we have a trove of data on millions of patients now showing us that vaccinations are safe. So it involves a lot of reassurance, and patients do come back and get vaccinated. Inga Lennes, MD. Senior Vice President for Performance Improvement and Service Excellence at Massachusetts General Hospital Physicians Organization (Boston): Per the CDC guide- lines, vaccines are not indicated while patients are ill with symptoms of COVID-19. We recommend waiting until an infected patient has recovered. Aer recovery, patients who have been positive for COVID-19 should be vaccinated. If a patient was treated with mono- clonal antibody therapy or convalescent plasma, vaccination should wait for 90 days. Beyond the criteria for vaccination, we always try to handle these conversations with compassion. We know that unvaccinated patients are fearful and can have feelings of guilt when they have severe illness caused by COVID-19. We always offer compassion first and expert medical care. Oen, these situations offer the medi- cal team the opportunity to discuss and educate the patient's family and close contacts who may also be unvaccinated and are open to learning more about how the vaccine prevents serious illness and consider vaccination. Patients who recover from COVID-19 and are eligible as an inpa- tient can receive vaccination prior to discharge if ordered by the inpatient team. We also schedule unvaccinated patients into our vaccine clinics at the time of discharge to allow for the appropriate delay related to therapy. Faisal Masud, MD. Medical Director of Critical Care at Houston Methodist Hospital, Vice Chair for Quality and Patient Safety, and Medical Director of the Cardiovascular ICU at Houston Methodist DeBakey Heart & Vascular Center: Our initial focus is getting the patient better. Typically, when patients are quite sick, we say, "Let's get you better first, and then we'll discuss the vaccines." e last thing we want to do is have them feel like these things have to be done right now. More oen than not, patients and their family are already expressing regret, concern and sometimes shame that they did not or could not get vaccinated. Oentimes they are expressing shock and bewilderment. It's amazing how many people are still in disbelief that, one, they got COVID-19 and, two, that they got sick from it. So the first thing we try to do is just listen. We want to be able to un- derstand where they are coming from and their challenges. And then when the patient and/or the family is ready — meaning the patient is medically steady — then we start having conversations about why the vaccine is still important even if you recovered from COVID-19. And we share recommendations for families if they are not vacci- nated. We remind them that we have chosen to not only vaccinate ourselves, but also our own family members. We also tell them you don't have to experience the sickness from COVID-19 to realize that it is real. Why does everyone have to go through COVID-19 to say it's real? Don't do that — learn from others. Very early on last year, we established our COVID-19 recovery clinic because we knew a lot of these patients would need support. On top of that, we have a soware solution called CareSense that lets us connect with patients getting admitted to the hospital via technology. We prime them and get them lined up for not only follow-up care, but getting vaccinated. If any of their family members are open to it, we also get them set up with vaccination appointments. What we have seen is that's the moment they're very open to real and truthful medical knowledge. ey realize the importance of vaccination and that this is a real disease that causes harm. And if we line up that ap- pointment for them, they show up. e goal is to give them informa- tion and encourage them to share with their circle of friends, because I do believe — and we've seen it — that people telling each other is more powerful than other sources. Nida Qadir, MD. Associate Professor of Medicine at the David Geffen School of Medicine at UCLA and Associate Director of the Medical ICU at Ronald Reagan UCLA Medical Center (Los Angeles): For patients who are critically ill, these questions can be heartbreaking because you know their suffering could have been avoided had they been vaccinated previously. I usually tell patients in this situation that while the vaccine won't help them at this moment, we can plan for them to get the vaccine aer they recover to reduce the chances of them ever getting this sick again. I also tell them that they still have a chance to help their loved ones by encouraging any who remain unvaccinated and aren't currently infected to get the vaccine. We have the ability to give the vaccine while a patient is hospi- talized. However, most patients who are hospitalized with severe COVID-19 unfortunately cannot get the vaccine until aer they go home. is is because current guidance suggests that before giving the vaccine, we wait until there have been at least 20 days since their first positive test, symptoms have improved and fevers have resolved. Additionally, for patients who received certain therapies such as monoclonal antibodies, the CDC advises that we wait 90 days. A minority of patients will meet those criteria before they leave the hospital, but most will not. For those patients, we make sure that follow-up and home monitoring are set up before they go home, and when the timing is appropriate, they are able to obtain the vaccine from our outpatient pharmacy. Todd Rice, MD. Associate Professor of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine at Vander- bilt University Medical Center (Nashville, Tenn.): We now offer COVID-19 vaccines to inpatients who are being discharged. If they were hospitalized with COVID-19, we counsel them that the CDC recommends waiting 90 days from their infection to get vaccinated. is is a recommendation, and the patients are free to do what they want. Many of them ask to be vaccinated prior to discharge, even if they are not past the 90 days. If we vaccinate a patient, we almost always use one of the mRNA vaccines — and we write down the date that the patient is to get their second jab, informing them that they can come back to a Vanderbilt vaccination site to get the second shot, or they can go wherever their mRNA vaccine is available (oen CVS, Walgreens, a primary care clinic, etc.). n "They realize the importance of vaccination and that this is a real disease that causes harm. And if we line up that appointment for them, they show up." -Faisal Masud, MD, Medical Director of Critical Care, Houston Methodist Hospital