Be Part of the Solution: Vax Up!

JEMS Editor Emeritus A.J. Heightman is vaccinated by San Diego Fire Rescue Paramedic Program Clinical Coordinator Carolyn Gates.
JEMS Editor Emeritus A.J. Heightman is vaccinated by San Diego Fire Rescue Paramedic Program Clinical Coordinator Carolyn Gates.

JEMS proudly gives two thumbs up to the Ohio Department of Public Safety, Division of EMS, which, in partnership with the Mentor Fire Department, created an outstanding “Vax Up” edition of their “Be Part of the Solution” public service announcement (PSA) series.

The Division of EMS created, and is encouraging distribution, of this PSA as a resource to encourage EMS providers to receive the COVID-19 vaccine, to highlight the importance of vaccination to all public safety personnel and to the community, and to encourage the populations in the upcoming phases of the vaccination plan to be immunized against COVID-19.

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Carol Cunningham, MD, FAAEM, FAEMS, State Medical Director, and member of the JEMS Editorial Board, helped spearhead this effort. Her memo to EMS providers, announcing the PSA, notes the significant impact the COVID-19 pandemic has had on frontline healthcare workers, including EMS providers, and points out that it has been, overwhelming. 

She added: “The record-setting numbers of illness, hospitalization, and death due to COVID-19 substantially increased the demand for patient assessment, triage, transport, and treatment by all sectors of our healthcare system. Nationwide, including in Ohio, the availability of EMS providers continues to be strained by absenteeism due to COVID-related exposure or illness and, sadly in far too many cases, death.” 

No matter what your role is in the EMS system (dispatcher, first responder, EMT, paramedic, EMS student, supply officer, supervisor or clerical/administrative staff), you are a critically important part of the EMS system and at risk of exposure to the COVID-19 virus. All of you should get vaccinated when it is offered to you so you can protect yourself, your co-workers, your patients, your family members and the community you serve.

You Are Not Immune from Deadly Coronavirus Aftereffects

You may feel that because of your young age, good health and physical status and lack of co-morbidities that you can survive a bout of the COVID-19 virus, but you need to realize that the science has shown that, not only can you become a deadly spreader to other but may end up with thrombolytic aftereffects that are surfacing in those who have had, and survived, the virus.

EMS, fire responders and previously healthy patients that have survived the virus have reappeared in 911 systems and succumbed to acute respiratory distress, heart attack, cardiac arrest, and pulmonary emboli. So, you may survive COVID-19 initially but not survive its hidden, insidious aftereffects in the future. Please do not make that mistake!     

Most states, like Ohio, have prioritized their EMS providers in Phase 1A of their state vaccination plan and they should contact their local public health district for information on how to receive the COVID-19 vaccine. 

And, once vaccinated, all frontline providers are being encouraged to continue to prevent the spread of COVID-19 by engaging handwashing, social distancing, and wearing masks at all times while on duty because, until a majority of the population gets vaccinated and we have herd immunity present, you will still only be 95% shielded from this deadly disease.

The Facts Are Important to Know

A Bloomberg.com opinion article points out that, despite better treatments and better success at shielding the most vulnerable from the disease as a result of increased availability of tests and protective equipment, bringing fatality rates down, and lots of behavior changes aimed at slowing the spread of the disease, COVID-19 has killed at least 250,000 Americans so far, with deaths predicted to hit 400,000 for the 12 months since it first started impacting the U.S. in late March.1

Author Justin Fox points out that while a vaccine that is 95% effective at preventing the symptoms of COVID-19, mass vaccination will change the chance for people dying from COVID-19 from 1% to 0.05%, a 20-fold reduction. To take it out of percentages, he notes that deaths would drop from 1,000 for every 100,000 infections to 50.2

The 250,000 death toll experienced so far in the United States would be reduced to 12,500. The risk of death for those of ages 35 to 44 years would fall from 68 in 100,000 to just three in 100,000, and the risk for those of ages 75 to 84 years would fall from 8,500 in 100,000 to just 425.3

It has been estimated, based on the current contagiousness of COVID-19, that about 70% of the population would have to be immune for its spread to decline without any social distancing or other preventative measures.

And the latest “nowcasting” estimate from the covidestim model, as assembled by epidemiologists and biostatisticians at Harvard and Yale, is that close to 55 million Americans, nearly 17% of the population, have been infected with COVID-19 so far.4

These researchers note that, at the current rate of infections (not factoring in the new strain from Europe that is now infiltrating the USA and spreading the coronavirus at a rate of 70% greater that the initial strain) could be 30% or more by the time vaccines start to become widely available.5

It is predicted that if the vaccines do, in fact, turn out to be 95% effective at preventing COVID-19 infections, about 145 million previously uninfected Americans (44% of the population) would have to be vaccinated in order to reach the 70% threshold.6

The actual herd-immunity threshold might be higher or lower than that, and there are multiple other variables. But it’s an indication of what 95%-effective vaccination might accomplish.

Invasion of the New Highly Transmissible Coronavirus Variant

If this information is not enough to convince you and your loved ones to get the COVID-19 vaccine as soon as it’s offered to you, you must be educated, and educate others, that the new highly transmissible coronavirus variant (strain) now invading the USA makes up the majority of new cases in the United Kingdom.

In fact, a random testing sample of people in the southeast region of England found that the new, more transmissible variant accounted for 71 per cent of new cases, rising to 72 per cent in London.7

Data from the Office for National Statistics also found the new strain was responsible for 67 percent of the cases in the eastern region of England and 53 per cent across the whole of England.8

These figures from Great Britain indicate that the new variant is dominating the latest cases “as it sweeps like wildfire through communities despite the continuing tiered restriction system.”8

Professor Peter Horby, chairman of the New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), points out that the new variant started from one person in Kent, England and could have been caused by ‘random errors’ when the virus copies.

He says that the variant likely originated in this patient who may have had a weakened immune system which was struggling to beat the virus. Therefore, instead of destroying the virus, this person may have become a breeding ground for the virus to mutate.9

Professor Lawrence Young, virologist and professor of molecular oncology at the University of Warwick, England, said: “While levels of the variant virus were low in mid-December in many parts of England, rapid rises were beginning to appear in certain regions consistent with the conclusion that this new virus variant which is fueling infections in the UK is more transmissible (infectious).”10

The new UK variant of coronavirus was identified shortly before Christmas and is thought to be behind the huge surge in UK cases, particularly in London and the southeast of England.11

Cases in the UK have increased by 70 per cent and, even more frightening, is the fact that his report also highlights that this variant is responsible for the increased levels of infection observed in individuals under 20 years old.12 

The alarming spread of the new variant is one of the reasons that the UK imposed a third national lockdown in January as daily cases rose to more than 58,000, an increase of nearly 50 percent in just a week. Deaths and admissions to UK hospitals have also risen by 20 percent since Christmas week and are likely to continue to rise in the coming weeks.13

The Tricky (and ‘Sticky’) Spike Protein on the New Virus Variant

The new coronavirus variant (called VUI – 202012/01) carries a mutation to the gene which forms spike proteins, little grippy rods on the outside of the virus cell which attach to human cells.

Vaccines do their job by instructing the body’s cells to produce their own spike proteins, which the immune system then uses to spot foreign objects and stimulate the production of antibodies that attach to the virus to clear it from the body. Once that has happened, the body has a memory of the coronavirus and those antibodies are ready to attack it if it sees the virus again.14

However, a change in the shape of the new spike protein (aka the “new strain”) makes it more difficult for the immune system to spot because its response has been trained on a different model. It also makes it harder for antibodies to bind to the virus so that it can be eradicated from the body.

There’s currently no evidence to suggest the new variant (“new strain”) is more likely to lead to more serious illness than the current deadly strain of the COVID-19 virus. However, since it binds more easily to human cells and is being shown to spread quicker, more people will become infected. As a result, more people will be calling EMS and more people will need hospital treatment potentially causing the depletion of available ICU beds.

Professor Young, from Warwick Medical School, has said several important things that EMS responders must realize about this new strain of the coronavirus. One is that it’s getting into the body more efficiently and the mutation which has occurred in the spike protein increases the strength of the interaction of the virus with cells in our bodies, increasing what he calls its “stickiness.”15

Another is that data recently reported from NERVTAG says that where you do see this new virus strain, “there are higher virus loads in the throat.”16  That seems to signal why it is easier to spread though aerosolization.

Of most concern to me is that scientists have said the new mutated coronavirus strain could more easily infect children. Professor Young said that preliminary research suggests this is also due to its “stickiness.” He notes that children have less of the receptors which attach to the older coronavirus variant, meaning they were less likely to catch the virus. However, the new variant “might compensate for lower levels of that receptor or that door to the virus in children by being stickier.”17

In short, he is warning us that the younger population, that we previously felt was not as likely to get COVID-19, may be more susceptible to this new strain of the virus that is creeping throughout the United States.

So, it is even more important for as many people as possible to get vaccinated because it is the safest and most effective method to prevent COVID-19 disease. 

I recommend you disseminate the information I present to you here, as well as the Ohio PSA, to get these important messages out and encourage our colleagues and their families to get vaccinated. Or, as the Ohio PSA boldly states, “VAX UP!” 

References

1-6. What a 95% Effective Vaccine Could Do Is Pretty Exciting; https://www.bloomberg.com/opinion/articles/2020-11-19/what-a-95-effective-covid-vaccine-means. By Justin Fox at justinfox@bloomberg.net.

7-17. New Covid strain: how dangerous is it, and could it hamper a vaccine? https://www.telegraph.co.uk/news/2021/01/13/new-covid-strain-what-coronavirus-variant-symptoms-where-uk-dangerous/; Sarah Knapton, Science Editor; January 13, 2021.

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