It is now the autumn of 2021, and it seems the Groundhog year of 2020 just won’t let go. There are regions of North America with widespread COVID disease and more firefighter deaths than at any time in the pandemic.
While this COVID wave spread through America and Canada, the impact on the fire service continues at a high level as we mourn the deaths of our co-workers, family, and friends.
A Quick Lesson About Variants
What has happened with the COVID-19 virus that has resulted in the tremendous uptick in cases on the planet?
Like many small viruses, as it passes through humans, a virus mutates. That happens because viruses can only exist by entering human cells and borrowing the cell’s ability to try to make copies of itself. But that also causes many errors in making copies, so a lot of them are defective. After enough copies in humans, the viral copies are different enough that there are recognized as variants. One that started in India is called the COVID Delta variant, and one that started in South America is called the COVID Mu variant. Both have spread across the planet. At this point, these variants are still covered by the existing vaccines.
In North America, the surge in COVID deaths caused by the highly contagious Delta variant is hitting working-aged persons (which is the common age of fire and EMS personnel) and significantly increasing the risks for people who remain unvaccinated. All the data sources show that hospitalizations and deaths have been concentrated among the unvaccinated. The CDC released studies in early September showing that unvaccinated Americans were 4.6 times more likely to be infected, ten times more likely to be hospitalized, and 11 times more likely to die. The Delta variant has acted like a heat-seeking missile in finding populations that are not vaccinated.
Just a few data points regarding the current risks:
COVID infection is expensive. COVID hospitalizations of unvaccinated patients in June and July cost the U.S. health system $2.3 billion, according to an analysis by the Kaiser Family Foundation. Delta Air Lines announced that it would apply an additional charge on unvaccinated employees enrolled in the company’s health care plan because each unvaccinated employee hospitalized with COVID cost the company a minimum of $50,000.
COVID is hospitalizing a younger patient population than a year ago. Hospitals have found that 85-98% of patients are unvaccinated, and many more are in the age group of 40 to 60, rather than the age 80+ population hospitalized a year ago. From one state where I serve: Fully vaccinated people have accounted for just 2.5% of the 21,584 Ohioans hospitalized for the virus this year. A total of 80 fully vaccinated Ohioans have died of COVID-19 this year compared to 7,167 who were not immunized.
Breakthrough infections in those who have been vaccinated still occur. Generally, those breakthrough infections are patients who do not get very sick and do not get hospitalized. If breakthrough infections occur in older patients and have serious underlying medical problems, those patients may end up in the hospital or rarely die. Vaccines are clearly providing protection from the worst dangers of the virus.
Many firefighter deaths are occurring now that a Safety Stand-Down is likely to be conducted to convey current risks and management strategies to reduce deaths and long-term COVID risks.
What Preventive Measures Will be Useful This Fall?
The combination of prevention measures to reduce respiratory infections may be called into action again. This consists of 5 disease prevention methods:
- Monitoring for signs and symptoms and staying home when sick.
- Washing hands frequently.
- Maintaining a social distance of 6 feet.
- Wearing masks in the congregate areas of the station.
- Not letting diseases enter the fire station and living quarters by disinfecting the ambulances and all personnel before they enter.
There will be more COVID testing in the fall to identify those that might be spreading the disease. The use of accurate tests for COVID will be much more timely and much more routine to trace the disease and prevent spread in the workgroup, schools, athletic teams, and families that are at risk. That will be matched with quarantine programs that will again cause some interruption of services and events.
The hospitals and healthcare systems are currently overloaded in many areas of the country. Hospital treatment of very sick patients is tying up beds and staff.
There is a new effort to keep patients off of ventilators and using high-flow oxygen treatments to reduce deaths. But this results in prolonged hospital stays. And in some cases, the enormous flow of oxygen at hospitals has resulted in fire departments having to thaw the oxygen lines on tanks running such high volumes. So far, no other treatments have proven effective, unfortunately. That includes the use of the de-worming drug ivermectin, which has somehow been advocated as an effective treatment drug, with no current scientific support, and a lot of risks.
What is Ahead in the Vaccination Arena?
Three types of COVID vaccinations are widely available and still at no cost. They have proven to be tremendously safe and effective over now hundreds of millions of doses. Those considering vaccines should be reassured that the vaccines have been very safe and effective.
There are more groups to get vaccinated. This spring, Pfizer began a study of its COVID vaccine in progressively younger groups of children. In October, the FDA will likely authorize the use of vaccines in those children aged 5 to 11 years. Work will continue to look at the safety in younger children. This development process is “just like” polio eradication from 70 years ago. By the winter, it may be possible to vaccinate many school-aged children.
Those who want to provide immediate protection for their children can make sure that those in the household and any close contacts are vaccinated and that the children know how to wear a mask.
How Will the Country Implement COVID Booster Vaccinations?
The FDA and the CDC are studying results across the planet to make a good recommendation on the need for vaccines in people who are both immunocompromised and those who have intact immune systems. At this point, it is not clear, and there must be benefits in both effectiveness and safety before a nationwide program will be implemented. It would fit the pattern of other vaccines if eventually there is a booster, given from 6 to 12 months after the original immunization.
The public health message is clear. Vaccination is the key to ending the COVID pandemic for individuals and ultimately for society. Five vaccine types will likely be available in high quantities across North America in the near future. For the fall, the CDC has already suggested that a patient can get both the seasonal flu vaccine and the COVID vaccine in one visit. So high-volume vaccination programs will be used again.
The Phoenix is Rising
The coming months will be the opportunity to increase the numbers of vaccinated individuals in North America and bring the current wave of cases under control.
And then 2021 can finally come to an end.
Checklist for the Wind-Down of the Pandemic
The coming months will also provide us the opportunity wind-down, reflect, prepare, and adjust.
- Take a vacation.
- Vaccinate all eligible adults, including all eligible Fire-EMS providers.
- Vaccinate the eligible children as vaccines are approved for this purpose, with Fire-EMS assistance.
- Open the schools.
- Develop an accurate testing process for the disease, especially for symptomatic patients.
- Establish an effective contact tracing program at local level.
- Write an excellent After Action Report that can guide our Fire-EMS leaders (and others) for the next pandemic, whether it is 5 or 100 years from now.
- Figure out the level of effective antibodies with an accurate test that will guide the need for future booster vaccinations.
- Prepare for fall outbreaks of seasonal respiratory diseases and influenza.
- Apply want has been learned of the politics of a public health emergency and the accurate and skillful application of social media.
Be well and stay safe.
James J Augustine, M.D., FACEP, currently serves Medical Director roles with fire services near Atlanta, Georgia; Naples, Florida; and Dayton, Ohio. He is a Clinical Professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio, and serves as the Chair of the Georgia EMS Medical Directors Advisory Council. Dr. Augustine is a member of NAEMSP, and is a key member of the “Eagles” group of Fire EMS Medical Directors.