Becker's Clinical Quality & Infection Control

10 INFECTION CONTROL Heal first, then vaccinate: How 9 systems are connecting COVID-19 survivors with the vaccine By Mackenzie Bean, Erica Carbajal and Gabrielle Masson A necdotal reports from physicians on the front lines of the COVID-19 surge that started this summer suggest disbelief, shame and fear are common emotions among many unvac- cinated patients who contract the virus and need to be hospitalized. Here, nine physician leaders share how they approach conversations with hospitalized COVID-19 patients who ask for the vaccine, along with how they connect recovered patients and their family members to vaccination opportunities. Leaders shared their insights with Becker's via email and phone from July 28-30. Responses were edited lightly for clarity and length. ey are presented alphabetically. Neera Ahuja, MD. Clinical Professor of Medicine at Stanford (Calif.) Health Care: We are very supportive of promoting vaccina- tions for all individuals who are interested and encouraging vaccina- tion and individuals who are uncertain if they wish to receive it. For hospitalized COVID-19 patients who are interested in the vac- cine, our recommendation is to wait 60 to 90 days until the infection has cleared the body, and the patient's antibody response has been mounted and stabilized before receiving the vaccine. is can be set up as an outpatient. Additionally, for patients presenting to the hospital who have not been vaccinated and do not have COVID-19 as their admitting diagnosis, we are offering the Johnson & Johnson vaccine upon dis- charge, which is a "one and done" [single dose] vaccine. George Anesi, MD. Attending Physician in Pulmonary and Crit- ical Care Medicine at the Hospital of the University of Pennsyl- vania (Philadelphia): Most COVID-19 hospitalizations today, and especially those with severe disease in the intensive care unit, are unvaccinated and therefore are largely preventable tragedies. Unvac- cinated patients with severe COVID-19 who request a vaccine break our hearts because their disease could likely have been prevented and because the vaccines do not treat acute COVID-19 pneumonia. But on the other hand, we embrace any and all opportunities to get anyone vaccinated who has not previously been, including those who recover from COVID-19, as the vaccines offer superior protection compared to natural infection. We can vaccinate hospitalized pa- tients before discharge, regardless of their reason for hospital admis- sion, or set up vaccination in an outpatient follow-up appointment. e only patients who require any sort of a substantial waiting period aer recovering from COVID-19 are those treated with monoclonal antibodies or convalescent plasma, which is a small minority. G.R. Scott Budinger, MD. Chief of Pulmonary and Critical Care at Northwestern Memorial Hospital (Chicago): Vaccine-induced immunity to SARS-CoV-2, the virus responsible for COVID-19, is more effective and longer lasting than immunity induced by natural infection. erefore, we encourage all survivors of COVID-19 in the system to undergo vaccination with any of the approved vaccines aer recovery. Patients who receive convalescent plasma or monoclonal antibodies against SARS-CoV-2 as part of their treatment should wait 90 days aer those therapies were administered to receive a vaccine. We discuss the importance of vaccination with all of our patients sus- pected of post-acute COVID-19 syndrome seen in the Northwestern Medicine Comprehensive COVID-19 Center. Panagis Galiatsatos, MD. Director of the Johns Hopkins Tobacco Treatment and a Pulmonary and Critical Care Medicine Physician at Johns Hopkins Bayview Medical Center (Baltimore): First, we must recognize we're in a tough situation in regards to the pandemic. We can't be so arrogant as to say "the science is enough" to have all Americans vaccinated. is always happens — if science was enough, everyone would've stopped smoking. We have to engage with people without judgement and stigma. If you want to get people to listen, you have to know what motivates them — their culture, their values. Community engagement is now the best thing we can invest in moving forward. We can't sit back anymore in our ivory towers and wonder why people aren't following science. Instead we have to focus on engagement and education. When patients ask for the vaccine, I tell them, "Yes, once you get through this we will sign you up when you're eligible." is is an edu- cational moment for anyone and everyone. When you have the entire family there, I say, "Let's talk about the vaccine. What's your status? You're not my patient but I want to talk about it with you." We connect COVID-19 patients with those resources. We have a tech system that follows up, but every patient I care for gets my personal email and a phone call. We're in a pandemic — patients need to see me as a human being, from one person to another. e people who are refracting from this vaccine, there just isn't a trust there. ey don't see me as a person who they trust. Roopa Kohli-Seth, MD. Director of the Critical Care Institute at e Mount Sinai Hospital (New York City): Our inpatients can be offered COVID-19 vaccination 14 days or so aer they are asymptomatic or recovered from a severe illness. Certain patients are immunocompromised, so obviously we cannot vaccinate them aer 14 days. So our clinicians educate the patients and families when it is appropriate to receive the vaccination based on their unique clinical status. Some patients shed the virus for a much longer time, so we do offer them vaccination at discharge aer consulting with infectious disease and infection prevention colleagues. It is a joint decision to offer them the vaccine. We can also offer it to them as inpatients, and we have multiple venues where patients can think about vaccination, can come back, ask any questions and talk through their thought process. We have a critical care recovery clinic, so we educate the patient about the re- covery clinic and ask them to come back to us with any health issues. We provide tele-ICU consult services where we have more conver- sations. And we set them up with clinics where they can come as an outpatient and get their vaccination. Mount Sinai Health System also has a center for post-COVID care where patients are tracked and offered vaccinations. And there is a pulmonary clinic where they do the same. Now, Mount Sinai is offering vaccinations at home, too. Some of our patient population is still skeptical. e top three things they ask us about are whether the vaccine will affect their fertility (no), if they need to get vaccinated if they just had COVID-19 (yes) and about vaccine side effects they are worried about. We tell them

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