“I’m ecstatic,” she said. “In talking to infection preventionists (IPs) around the country who are being vaccinated — it is like hope. It is a positive step forward. It is a step towards the solution. Of course, we need to continue to mask and clean hands.”

Steed had only minimal side effects after the shots.

“If I compare it to the flu shot, my sore arm was pretty bad. With this vaccine, it was slight but insignificant,” she says. “The [overall] side effects — we’ve only had a couple of moderate ones. One person had hives and another one had some shortage of breath because of asthma. They used their inhaler and were fine.”

Pregnant Pause

Some young female healthcare providers are holding off on vaccination because of pregnancy or conception concerns, she said.

“They didn’t trial this vaccine in the pregnant,” Steed says. “One of our OB/GYN physicians has done some sessions to talk them through the pros and cons of taking the vaccine.”

Currently, the Centers for Disease Control and Prevention (CDC) is equivocal on the issue, saying pregnant healthcare workers “may choose to be vaccinated.”1 However, COVID-19 infection during pregnancy can have serious sequela.

“Observational data demonstrate that, while the chances for these severe health effects are low, pregnant people with COVID-19 have an increased risk of severe illness, including illness that results in ICU (intensive care unit) admission, mechanical ventilation, and death compared with nonpregnant women of reproductive age,” the CDC states. “Additionally, pregnant people with COVID-19 might be at increased risk of adverse pregnancy outcomes, such as preterm birth, compared with pregnant women without COVID-19.”

On the other hand, there are limited data about COVID-19 vaccination during pregnancy, although animal studies have revealed no safety concerns. The Food and Drug Administration (FDA) approved two “messenger RNA” vaccines for COVID-19, both having an efficacy of about 95%. One was developed by Pfizer Inc. (NYC) and BioNTech (Mainz, DEU), and the other by Moderna Inc. (Cambridge, MA).

“Limited data are currently available from animal developmental and reproductive toxicity studies,” the CDC said. “No safety concerns were demonstrated in rats that received the Moderna COVID-19 vaccine before or during pregnancy. Studies of the Pfizer-BioNTech vaccine are ongoing.”

Both vaccine manufacturers also are following participants in the clinical trials who became pregnant.

Arnold Monto, MD, acting chair of the FDA’s Vaccines and Related Biological Products Advisory Committee, recently weighed in on this topic in an interview.2

“I think a pregnant woman should look at her risk group and get vaccinated as she would if she were not pregnant,” he said. “By that I mean that if somebody has underlying conditions I would have no doubt that she should be vaccinated. There is always theoretical risk — especially during the first trimester. Looking at the flu story, we have come from most pregnant women not being vaccinated to pregnant women being the highest priority by the (World Health Organization) to be vaccinated.”

Beyond the issue of pregnancy, there is some hesitation among healthcare workers in general.

“Our chief medical officer said our staff vaccination rate of people who have been offered is about 70% right now,” says Tiffany Horsley, BSN, RN,CIC, an IP at the University of Kansas Hospital. “So that is kind of average. The data he had showed it ranges nationally from about 50% to 90%.”

Having received one dose of vaccine and awaiting her second, Horsley says they give healthcare workers all the information on COVID-19 immunization, but it is strictly voluntary.

“We share the accurate information, but some of those people may have valid reasons for not [being vaccinated],” she says. “Maybe they are pregnant, nursing, or had a previous allergic reaction or are under treatment by a physician for some other reason. Our healthcare teams are really educated, and they make the decision that is really best for them.”

CDC officials are emphasizing that healthcare workers should not decline the vaccine because of some of the circulating myths and misconceptions about the shots.

“I am definitely concerned that healthcare workers are electing to wait to get vaccinated,” Nancy Messonnier, MD, director of CDC’s national center for immunization and respiratory diseases said at a recent press conference. “It really makes it exceedingly important that we get correct information to healthcare workers and that we quickly dispense with myths and misinformation.”

For example, the CDC states that “none of the authorized and recommended COVID-19 vaccines or COVID-19 vaccines currently in development in the United States contain the live virus that causes COVID-19. This means that a COVID-19 vaccine cannot make you sick with COVID-19.”3

Addressing another myth, the CDC states that “COVID-19 mRNA vaccines do not change or interact with your DNA in any way.”

“We want [healthcare workers] not only to protect themselves, but we also want them to be educating their patients,” Messonnier said. “We are working in any way that we can to try to reach healthcare workers with this correct information. I think that if healthcare workers could really hear the data and see the information, it would help them make the decision to go ahead and get vaccinated.” 

‘No Rhyme or Reason’

Both vaccines were developed at record pace — less than one year. That raised suspicions that the production had been politicized during an election year, and some distrust set in about the safety and efficacy of a vaccine produced at “warp speed.”

“I’ll be honest with you, at the very beginning I was one of those that was absolutely not going to do it,” says Courtney Paschal, ADN, RN, an emergency nurse at a Veterans Administration hospital in Augusta, GA.

After researching the vaccines and talking to experts, Pascal became convinced it was the best option when she saw two of her colleagues get infected with coronavirus.

“I’m 32 and I work with two other nurses my same age with no comorbidities,” she says. “They have both gone to the ICU. It doesn’t discriminate. There is no rhyme or reason of who gets it and why some get so sick. It’s very unpredictable.”

Although there has been some logistical chaos and delays as the vaccine rolls out, the sense of added security with immunization is appealing to some healthcare workers.

“I have two young children and grandparents that I take care of, so I am constantly worried about what I’m going to bring home,” Paschal says. “I think I’m going to find a little comfort in having some added protection for myself and others around me.”

Overall, healthcare workers — some of whom initially were hesitant to take one of the rapidly developed COVID-19 vaccines — are being immunized in an uneven national rollout marked by delays, chaos, and disruptions. “For me, at the end of the day, it came down to, ‘Somebody’s got to get it,’” she says. “That’s how we beat polio and measles — somebody had to get [immunized]. Is there a risk? Absolutely. But this is me standing up and getting this vaccine so we can somehow tackle this virus and save people that I care about in the future. That is a small price to pay for me.”

The vaccination program at her facility was just getting underway when HIC talked to Paschal, and she was on the list to be immunized.

“Our facility was only able to lock in [a limited number of] vaccines,” she says. “Ideally, you want to offer it to all healthcare workers, but the priority was to set it aside for any clinical worker in the emergency room or the ICU because we primarily handle the COVID patients." 

PPE Fatigue

An element of personal protective equipment (PPE) fatigue — particularly concerning the tight-fitting N95 respirators — has some healthcare workers hoping they can scale down a bit after receiving two doses of vaccine.

Hamad Husainy, DO, FACEP, an emergency physician at Helen Keller Hospital in Sheffield, AL, says at times during the pandemic he has worn an N95 respirator all the time for all patients.

He may revert to a surgical mask after being fully immunized, Husainy says.

“Some of my colleagues might debate or question that, but at some point we have to figure out how to revert, and of course the vaccine will help with that,” he says. “The temptation is going to be that I don’t need to be as protected [with PPE] because I have had the vaccination.”

In vaccinating healthcare personnel (HCP), clinicians should know the systemic signs and symptoms that may follow the first few days after immunization, the CDC advises.

“Systemic signs and symptoms, such as fever, fatigue, headache, chills, myalgia, and arthralgia, can occur following COVID-19 vaccination,” the CDC states.4 “Inform HCP about the potential for short-term systemic signs and symptoms post-vaccination and potential options for mitigating them if symptoms arise (e.g., nonsteroidal anti-inflammatory medications or acetaminophen).”

These symptoms can appear on the day of vaccination and the following two days, with most presenting on the day after immunization. The reactions are more frequent and severe following the second dose of vaccine, which is given 21 days later for the Pfizer vaccine and 28 days for Moderna.

In contrast to vaccine reactions, cough, shortness of breath, rhinorrhea, sore throat, or loss of taste or smell are more consistent with SARS-CoV-2 infection. “Strategies are needed for healthcare facilities to appropriately evaluate and manage post-vaccination signs and symptoms among healthcare personnel,” the CDC said.

The idea is to avoid unnecessarily excluding HCP with only post-vaccination signs and symptoms from work, while detecting those who may have SARS-CoV-2 or other infections. Ideally, workers could be immunized prior to having one or two days off using a system of staggered delivery so not everyone in a single department or unit is vaccinated at the same time, the CDC advised.

Husainy says this is the approach at his hospital and he also has scheduled days off after his vaccination — which at one point he questioned taking.

“I was very skeptical for a while,” he says. “I knew the science was going to have to come out about it [eventually]. I was able to do a little research and understand the [vaccine] mechanism. It would be prudent to have a little more data and proof, so to speak, that it will not cause adverse events. But being on the front lines, I recognize the need to make sure that we all stay safe. The other thing is I’m just sort of tired of [COVID-19]. I’m ready for it to be over. I think a lot people are. There is a subset of people who want to take [the vaccine] just to get this thing over with. Let’s move on.”

REFERENCES

  1. Centers for Disease Control and Prevention. Vaccination considerations for people who are pregnant or breastfeeding. Updated Jan. 7, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html
  2. AMA Ed Hub. Coronavirus vaccine update with Arnold S. Monto, MD. American Medical Association. Jan. 13, 2021. https://edhub.ama-assn.org/jn-learning/video-player/18575715?linkId=108990338
  3. Centers for Disease Control and Prevention. Facts about COVID-19 vaccines. Updated Jan. 4, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html
  4. Centers for Disease Control and Prevention. Post vaccine considerations for healthcare personnel. Updated Dec. 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/post-vaccine-considerations-healthcare-personnel.html