Letter by pediatric physician, Dr Helge Hartung, on current state of COVID.
As school starts again and COVID case numbers rise -again-, September 2021 feels a lot like September 2020. Wasn’t it supposed to be over by now? Weren’t we supposed to be back to normal, whatever that new normal might be? Weren’t our children supposed to start a normal school year, after 18 long months of Zoom school and all the limitations required to keep our children and teachers safe?
Yes, yes and yes. And yet it is déjà vu all over again, to paraphrase Yogi Berra.
All that said, September 2021 is fundamentally different from September 2020. A year ago, we were all sitting ducks, at the mercy of the R0 of a virus none of us understood all that well. We masked and we hand sanitized and we socially distanced, and we argued about best ways to balance competing risks: We were in the midst of a global pandemic. We desperately hoped for a vaccine.
Fast forward 12 months, and our most optimistic projections came true: We got not just one but multiple highly effective and safe vaccines. More than 5 billion vaccine doses have been administered worldwide as of September 10th, almost 380 million doses in the United States alone (Covid World Vaccination Tracker - The New York Times (nytimes.com) Yet despite this remarkable triumph of science and public health policies, we are not back to normal. Far from it. We see rising case numbers all over the country, rising death tolls…every 48 hours we are losing as many Americans to COVID as we lost on 9/11/2001. Every 48 hours.
September 2021 is fundamentally different from 2020 in another crucial metric: It now is a pandemic of the unvaccinated. The overwhelming number of those hospitalized and dying from COVID this summer are unvaccinated. As a pediatrician working at the major children’s hospital in our area, I saw it during my week on service which ended just a few hours ago: The teenagers and young adults admitted with COVID – some intubated, some dying from the disease- come from all walks of life. They are white, black and brown. Caucasian, Asian, African-American; Latino and others. Male or female. Skinny or obese, of all religious faiths or no faith. Widely diverse and yet they all share one characteristic: They are unvaccinated.
As a physician, I -along with many other physicians and nurses and hospital workers- jumped on the opportunity to get vaccinated in early 2021, as soon as the vaccines became available.
Many of us hoped the vaccine would keep us safe and would keep our families safe. Crucially, as we take care of thousands of children and their families who cannot be immunized due to their underlying diseases, we felt it was our duty -a sacred obligation- to do all we can to make sure we would not spread the disease. Our own COVID vaccination would protect the patients we care for. If you had a loved one who is a vulnerable patient, high risk to do poorly if he/she contracted COVID, wouldn’t you want to be assured that your nurse and your doctor are vaccinated? Wouldn’t you want to be assured that your hospital is doing all it can to keep you safe?
My wife and I pushed hard for a vaccine mandate for ALL health care workers and staff for this very reason, and we were delighted when our hospital issued such a mandate this summer. I agree with those who argue that we should have the freedom to choose most things in life – a free society values this foundational principle. But COVID vaccinations are different, as I, as a physician, can attest to: My personal freedom ends where the freedom of my patients begins – and I do not have the right to put my patients’ health in danger, whatever my personal beliefs. Health care workers should be mandated to get COVID vaccinated or leave the job where they endanger others – there simply isn’t any tenable argument against this.
I argue that the same logic applies to many other professions: Teachers and school staff have no right to endanger students who are entrusted to them. Especially those under age 12 years who, in perfect analogy to my immunocompromised patients, are not able to protect themselves via vaccination and therefore rely on those around them to keep them safe. But it goes well beyond teachers: Of course, all nursing home staff should be required to be vaccinated. Ditto for the military, all employees in close contact with others, and much beyond…we are our neighbor’s keepers. As far as COVID goes, literally so.
I started this letter stating that a year ago we were at the mercy of the R0 of a virus none of us understood well. Today we understand this virus far better, thanks to our scientists. But the delta variant has changed almost everything, due to its sky high R0. Our only weapon against this variant is far-reaching vaccinations: All majors vaccines are highly effective against the delta variant. As a physician who got a 2-shot series in January and February 2021, I walked into the room of a coughing COVID pneumonia patient yesterday knowing that my vaccines protect me, along with my N95 mask and all the other protective measures we employ. At the most, some of us vaccinated may get a breakthrough infection – almost always a much milder COVID infection than what we would otherwise have to suffer through. Some of us may need a booster dose 6-9 months after completion of our vaccination series – especially those with other risk factors in whom even mild COVID could trigger serious heath problems. The CDC is looking at all the data right now and will let all of us know – stay tuned, as I do.
Our only powerful weapon is widespread vaccination…and yet sadly, as a society, we have failed to get to the 90+% vaccination rate we need to beat back the delta variant and reclaim our lives. Get back to normal. Get our kids back to school, in person, full time, so that they can become the citizens we want them to become. This is why I was thrilled to hear President Biden’s remarks last week in which he outlined the six areas of actions his administration has chosen to take to fight back COVID. Remarks by President Biden on Fighting the COVID-19 Pandemic |
The White House The immediate controversy on social media reminded me of the internal discussions we had at our hospital months ago: It would be great if we could get to 95+% vaccination rates with voluntary measures alone, we all agreed. Mandates are hard on everyone – not the least those tasked to enforce them. But our overarching goal was clear and unshakable: We need to get to near 100% vaccination rates in order to keep our patients safe.
Nothing was and nothing is more important – in the end, we realized that we needed a mandate to get there. President Biden’s team realized the same exact thing last week – and I am glad that his directive will force all 17 million healthcare workers across the country to get vaccinated. Not just those hospitals and providers who had done the right thing already – now all vulnerable patients and their families will be protected, regardless of the preferences of hospital administrations across the country. Thank you, Mr. President! Leadership in action. President Biden's COVID-19 Plan | The White House
The president said last week that” We’ve been patient, but our patience is wearing thin.” I could not agree more. As a physician, I see the enormous stress all around me – on nurses, on physicians, on caregivers of all strides. The burnout rate is astronomically high right now – threatening health care far beyond this pandemic. Teachers and other educators are in a similar situation – we all want to be back to normal. Back to living up to our fullest potential – and help our kids living up to theirs.
Let’s hope these new vaccination requirements succeed in beating back the delta variant and allowing us to overcome this pandemic. September 2021 marks a self-inflicted wound, an own goal. It did not have to be this way – we could have beaten this already. In the spirit of 9/11’s Shine a Light, let’s dedicate 2021 to COVID vaccinations. Be your neighbor’s keeper: Get vaccinated. Talk to your loved ones about finally getting their shots. And help your employer and any other organization you are involved in implement the White House vaccine requirements. Let’s beat this pandemic of the unvaccinated.
Background: Dr. Hartung’s clinical efforts focus on pediatric non-malignant blood disorders, with a specific emphasis on the diagnosis and management of children with inherited and acquired bone marrow failure syndromes. As a member of the Division of Hematology and the Bone Marrow Failure Center, his goal is to ensure state-of-the-art diagnostics for patients with suspected bone marrow failure syndromes and to assist in the development of optimal treatment plans.
He was one of four scholars chosen for the newly created Entrepreneurial Science Track within the University of Pennsylvania’s Masters for Translational Research program offered by Institute for Translational Medicine and Therapeutics (ITMAT). In this capacity, Dr. Hartung has developed expertise in medical device development and its regulatory infrastructure. Dr. Hartung has built industry collaborations for CHOP and is currently working on the development of an automated device for bone marrow aspirates and biopsies.