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With health care systems stretched thin, physicians reframe the debate over vaccines

The stress on medical providers from the COVID-19 delta variant is prompting doctors to refocus the debate over vaccinations on protecting and supporting health care workers.

Nasal swabs are tested for COVID-19 at Central Maine Medical Center in Lewiston. Andree Kehn/Sun Journal

The day after an unprecedented joint news conference with leaders of Maine’s largest health care networks, state health officials Friday reported 143 people were hospitalized with coronavirus, a number that beats out counts reported during the spring surge of cases.

“We’ve reached a critical moment in the pandemic, where what Mainers do moving forward will determine what happens next,” Dr. James Jarvis said at the news conference Thursday.

The chief medical directors from MaineHealth, MaineGeneral Health and Central Maine Healthcare joined Jarvis, Northern Light Health’s COVID-19 incident commander, to express their concerns publicly.

The number of people being treated for COVID-19 in intensive care units in Maine on Friday was 71, which tied the all-time record on Jan. 20, when there were 71 people in ICUs.

Friday’s critical care count was an increase of 12 from Thursday, and there were 31 people on ventilators.

The major difference between now and late January are the vaccines. The vaccine rollout was still in its early stages and only a fraction of Maine’s population was eligible to receive shots.

Eight months later, 71% of eligible Mainers are fully vaccinated and 80% have received at least one shot.

The delta variant accounts for nearly 100% of all new cases, according to a report on genome sequencing from the Maine Center for Disease Control & Prevention.

The delta variant poses a particularly acute threat to unvaccinated people, who make up the overwhelming majority of new cases and current hospitalizations.

And 18 months into the pandemic, health care systems and providers are being pushed to a tipping point.

Though there are warranted concerns that the Oct. 1 deadline for health care workers to be fully vaccinated looms over the health care networks, MaineHealth’s Dr. Joan Boomsma said they’re not losing providers over the mandate.

“With the very high rates of community transmission right now in Maine, part of our shortages are that we are losing staff because they’re infected with COVID,” Boomsma said. “Right now we’re losing them to the virus, not to the vaccine.”

State health officials reported 267 new cases of COVID-19 statewide Friday, including 15 in Androscoggin County, eight in Franklin County and 12 in Oxford County.

The seven-day rolling average of new daily cases was 1.02 per 10,000 residents of Androscoggin County, 1.82 in Franklin County, 1.36 in Oxford County and 1.61 statewide.

Dr. Joe Anderson, a pediatric hospitalist at Central Maine Medical Center in Lewiston, said he doesn’t necessarily have a strong opinion on the mandate, but does worry how the health care system would fare without the layer of protection that vaccines provide.

“I think my perspective is really from doing the best thing for our patients, and for that I think, is number one, by getting vaccinated,” Anderson said.

“I know that if I come into contact with COVID I would be less likely to get it and pass it on to somebody else. And the other piece of that, it’s a little bit (of) kind of maintaining the strength of our health care system,” he said.

Anderson said he’s concerned about what’s happening in the South, where there are low vaccination rates and high rates of infection.

“Hospitals are completely overrun and unable to provide good medical care because there’s been so many patients admitted with COVID that they can’t deal with patients coming in with traumas or heart attacks or anything else that would bring them in to the hospital,” he said.

That concern was at the crux of the network leaders’ pleas to Mainers to get vaccinated.

Even when hospitals have the capacity to add beds, “you’re going to rob from Peter to pay Paul,” said Dr. Steven Diaz from MaineGeneral Health, because there isn’t the staffing to support that.

“The solution has to be a public health measure of making everything safer so that we can get the numbers down and provide the health care in an appropriate way,” Diaz said.

The Maine Department of Health and Human Services has the authority to require the COVID-19 vaccine under a rule that dates back 20 years. It says staff at all designated health care facilities must be vaccinated against certain infectious diseases, such as measles, rubella and chickenpox.

Although this rule has been around for a while, David Salko, a family medicine specialist in Topsham and a regional director of primary care for Central Maine Healthcare, said he can understand why some providers have reacted negatively to the addition of the COVID-19 vaccine.

“I think we take on a choice to be in health care and we dedicate our lives and our abilities in some way to take care of others,” Salko said. And there are risks that predate the pandemic that come with being in this field.

“Because those things have been quelled by vaccination and have been in place for a period of time, they’re more commonly accepted,” he said. “This is new information.”

With the deadline, Salko said he could see why some individuals feel as if this is an ultimatum.

“But we make choices without 100% of the information,” all of the time, he said. And in this case, although the vaccines themselves are new and there are not yet studies that span years yet, “the thing about progress is what we do now does happen a lot faster.”

Add to that the fact that as a global pandemic, “this is a real human effort of every country and every scientific community to try to work and develop a solution.”

Salko said it’s important to put this conversation into the context of everyday medicine. Providers ask their patients to take actions that are “invasive and potentially harmful,” from having an X-ray to surgery.

“This is something we’re asking everyone to do to help out in prevention of further illness in our community members, our families, our friends, our loved ones, even people we don’t know.”

No vaccine is 100% effective nor risk-free, but complications from the COVID vaccine are rare, Salko said.

Getting COVID, on the other hand, presents a much higher risk to an individual and those around them, as is evidenced by the current surge and stress to the health care system, public health officials have said.

When faced with this decision to get vaccinated, Anderson, from CMMC, said one of the best sources out there is a person’s primary care physician.

Those physicians are familiar with their patient’s medical history and can talk to them about their concerns.

“Plus, they have a relationship with them so they can help kind of allay those fears in a more personalized manner than just reading about it or watching somebody on TV telling you (that) you should get vaccinated,” Anderson said.

“You should be able to have that personal conversation and talk about it with your physician,” he said.


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