A Call to Action in the Rise of the Delta Variant
Emergency medical service workers have long been at the intersection of healthcare, public health and public safety, putting them in a critical position to advocate for the health of the communities and healthcare systems they serve. Responding directly to the homes and workplaces of patients experiencing medical emergencies, EMS providers are exposed to the unique socioeconomic circumstances, cultural climates and physical environmental factors that contribute to the composite health of their patients. As such, the delivery of community healthcare can be significantly improved with the integration of public health practice in emergency medical services.
EMS educators and experienced providers understand the limitations placed on the EMS clinical scope of practice. It is no mistake that early in EMS education, students are urged to “be a patient advocate above all else.” For the EMS provider, being a patient advocate can come in many forms, from recognizing and reporting abuse of vulnerable populations, to helping a patient experiencing frequent falls take preventative measures in their home. Communicating and serving the specific needs of patients beyond clinical practice, EMS providers demonstrate that patient advocacy is one of the most valuable assets of emergency medical services.
In the face of the SARS-CoV-2 (COVID-19) pandemic, EMS professionals have risen to the challenges presented on the frontlines of healthcare. These challenges ranged from EMS system understaffing, to nationwide PPE shortages and safe treatment and transport of patients infected with SARS-CoV-2. Not only are EMS providers familiar with the pathology of the virus as it affects individual patients, they have experienced firsthand the toll COVID-19 has taken on nursing homes, hospitals and other healthcare institutions. Many EMS workers have reported sentiments of feeling helpless while COVID-19 plundered their hometowns and EMS systems. As health departments across the country acquired the first doses of the COVID-19 vaccine, they began to run into problems staffing vaccination clinics with allied healthcare personnel, and many EMS professionals stepped up to serve in vaccination roles for the first time. It is apparent that EMS workers have been integral to the nation’s response to COVID-19, but is it possible that we can do more?
- EMS Needs to Assume the Role of Messaging for COVID-19
- Be Part of the Solution: Vax Up!
- How Student Providers Are Leaders in the COVID-19 Response On College Campuses
In December 2020, the COVID-19 Delta variant was identified in India and has since been on the rise in other countries, including the United States.1 The Delta variant, now accounting for 83% of all COVID-19 cases in the U.S. according to the CDC, is “more contagious and deadlier” than other COVID-19 variants.2,3 With the recent surge in COVID-19 cases and hospitalizations attributable to the Delta variant, healthcare professionals everywhere are beginning to lose sight of the end of the pandemic. As of July 29, 2021, only 57.2% of the U.S. population had received one dose of the COVID-19 vaccine, and less than 50% of Americans had been fully vaccinated.4 This is especially concerning considering “herd immunity” is only achieved when 70-90% of the population has been vaccinated.5 Without herd immunity, SARS-CoV-2 will continue to mutate into variants even more devastating than the Delta variant as the virus finds ways to evade existing antibodies.
A recent study published in the New England Journal of Medicine indicates existing vaccines confer a high degree of protection against the Delta variant of SARS-CoV-2.1 After two doses, the Pfizer-BioNTech vaccine provides 88% protection against the Delta variant, compared to 93.7% protection against the Alpha variant.1 The effectiveness of other existing COVID-19 vaccines against the Delta variant are still being explored, but it is evident that there is a means to ending the COVID-19 pandemic — vaccination. For some Americans, vaccination is the obvious and favorable solution to reducing cases of COVID-19, hospitalizations and death. For others grappling with skepticism and mistrust of the science community, the decision to be vaccinated is less clear.
Rather than being told what to do, many Americans who value independence and personal freedom must conclude on their own that the COVID-19 vaccines are safe, effective and necessary, before deciding to receive a vaccine. Much of the mistrust for the science surrounding COVID-19 vaccination comes from the high degree of variability in information presented to the public.6 The dynamic scientific process was on full display as the COVID-19 pandemic unfolded, and viewpoints often changed or even clashed, prompting public doubt toward the validity of science.6 It is understandable that not everyone would jump to receive a vaccine they don’t trust. This is where science communication comes into play. For science to be understood, it must be communicated properly, and it has to come from a trusted source. EMTs and paramedics, often members of the communities they serve, have an exclusive perspective on the ideologies and concerns of those choosing not to be vaccinated. As healthcare providers invited into the homes and lives of their patients during vulnerable medical emergencies, EMS providers are generally trusted to a high degree.
Since the beginning of the COVID-19 pandemic, EMS systems have found that the incidence of non-transport medical calls has risen to account for nearly 20% of all EMS calls.7 This leaves the EMT or paramedic as the sole healthcare provider a patient will encounter during their medical emergency, placing even more responsibility on the EMS provider to employ patient advocacy in their care of the patient. How can EMS providers engage in science communication during their interactions with patients to increase COVID-19 vaccination in their communities? Perhaps providers could include the COVID-19 vaccine in their line of questioning and patient assessment on medical calls, or maybe it is possible that integration of vaccination status in patient care reporting could spark necessary conversations between patients and EMS providers. When EMS professionals choose to have these conversations, it is crucial they are prepared to relay scientific ideas in a way that is received by the public.
If you are an EMS provider, whether an EMT or paramedic, here is how you can address your patient’s concerns with the COVID-19 vaccine:
- Understand how the vaccine works
- The mRNA vaccine is injected into the deltoid muscle.
- Inside muscle cells and lymph nodes, the mRNA code is read by the ribosomes and spike proteins are built.
- Muscle cells and lymph nodes present the spike proteins to the immune system, generating an immune response.
- Antibodies are created which bind to SARS-CoV-2 via recognition of viral spike proteins. This prevents the virus from entering and infecting cells of the body.
- Be able to address common misconceptions about the vaccine
- The vaccine can alter your DNA. The mRNA in the vaccine cannot alter your DNA for several reasons. mRNA has a different molecular composition than DNA, so it cannot bind to DNA or integrate into your genome. mRNA functions in the cytoplasm of your cells where it is read by the ribosomes and destroyed while your DNA is protected in the cell’s nucleus.
- The spike proteins are dangerous. The spike proteins produced by the body in response to the mRNA vaccine are not harmful. They are produced only to illicit an immune response so the body will be better prepared when it encounters the spike proteins on the SARS-CoV-2 virus.
- The vaccine will make you sick because it will give you COVID. The symptoms you may experience from the vaccine are only due to the immune response generated against the spike proteins. Your immune system is working hard to produce antibodies, and this may make you feel sick, but you cannot get Covid from the vaccine. There is no virus in the vaccine.
- mRNA vaccines are new, so they’re probably not safe. Researchers have been studying mRNA vaccines for nearly 30 years, and the COVID-19 mRNA vaccines are held to the same FDA standards as other vaccines in terms of safety and effectiveness.
- The vaccine can cause infertility. There is no research suggesting that the vaccine can cause infertility, this is a myth.
- Know the ingredients in the vaccine and their purpose
- The vaccine does not contain any metals, egg, latex, gelatin or preservatives.
- The vaccine does contain polyethylene glycol, which can have cross-reactivity with polysorbate. Allergies to either of these ingredients is a contraindication for the COVID-19 vaccine.
- Continue to educate yourself on scientific literature and best practices in healthcare so you can provide relevant, up-to-date information to your patients
The role of EMS professionals in healthcare, public health and public safety is essential to the country’s COVID-19 response. With the rise of the COVID-19 Delta variant, EMS providers have extraordinary potential to be powerful patient advocates, bridging the gap between unvaccinated populations and the science community, and leading the efforts to end the pandemic through meaningful science communication. Where EMS protocols and scope of practice explicitly outline what EMS professionals can do for their patients, patient advocacy bestows limitless powers unto the EMS provider.
- Lopez Bernal, J., Andrews, N., Gower, C., Gallagher, E., Simmons, R., Thelwall, S., Stowe, J., Tessier, E., Groves, N., Dabrera, G., Myers, R., Campbell, C. N. J., Amirthalingam, G., Edmunds, M., Zambon, M., Brown, K. E., Hopkins, S., Chand, M., & Ramsay, M. (2021). Effectiveness of COVID-19 vaccines against the B.1.617.2 (delta) Variant. New England Journal of Medicine. https://doi.org/10.1056/nejmoa2108891
- Spencer, S. E. W., & Willey, S. (2021, July 22). Delta variant spurring uptick IN COVID-19 cases largely in unvaccinated. University of Massachusetts Medical School. https://www.umassmed.edu/news/news-archives/2021/07/delta-variant-spurring-uptick-in-COVID-19-cases-largely-in-unvaccinated/.
- Leatherby, L. (2021, July 31). As Covid CASES rise all over U.S., Lower vaccination Rates point to worse outcomes. The New York Times. https://www.nytimes.com/interactive/2021/07/31/us/covid-delta-cases-deaths.html.
- Centers for Disease Control and Prevention. (2021, July 30). COVID data Tracker Weekly review. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html.
- Rogers, L. S., & JH Bloomberg School of Public Health. (2021, April 7). What is herd immunity and how can we achieve it With COVID-19? Johns Hopkins Bloomberg School of Public Health. https://www.jhsph.edu/COVID-19/articles/achieving-herd-immunity-with-covid19.html
- Boyd, K. (2021). Beyond politics: Additional factors UNDERLYING skepticism of A COVID-19 vaccine. History and Philosophy of the Life Sciences, 43(1). https://doi.org/10.1007/s40656-021-00369-8
- Satty, T., Ramgopal, S., Elmer, J., Mosesso, V. N., & Martin-Gill, C. (2020, December). EMS responses and non-transports during the COVID-19 pandemic. American Jounral of Emergency Medicine. https://www.ajemjournal.com/article/S0735-6757(20)31206-7/fulltext.
- CDC. (2021, July 16). Interim clinical considerations for use of COVID-19 vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/COVID-19/clinical-considerations/COVID-19-vaccines-us.html#Appendix-C.