Experts have warned that vaccine hesitancy could stop the US from reaching herd immunity, which requires an estimated 70% of people to have immunity to COVID-19, Insider’s Dr. Catherine Schuster-Bruce reported. As vaccine supply swells in the US, some healthcare providers are running out of people interested in taking the shot, even prompting some mass-vaccination sites to close.
Republicans have especially shown hesitation toward getting vaccinated, despite some GOP leaders, including former president Donald Trump, getting vaccinated and talking up the shots. Senate Minority Leader Mitch McConnell urged Republican men to get vaccinated last month after polls showed the group was especially hesitant.
Recentpolls have shown nearly half of Americans who identify as Republicans do not plan to get vaccinated. One poll found white Republicans are more likely than any other group to turn down the shot, Insider’s Andrea Michelson reported.
In the new PSA, the lawmakers touted the safety and effectiveness of the vaccines and praised Trump’s Operation Warp Speed for their development in record time.
“The process was rigorous and transparent,” Rep. Brian Babin said, with Rep. Andy Harris adding, “the FDA did not skip any steps.”
The lawmakers also emphasized that taking the vaccine was a choice, but that they hope Americans will join them “in choosing to get the vaccine so we can throw away our mask and live life as free as we did before,” Sen. Roger Marshall said.
As vaccination rates have increased, many states and cities have begun to lift coronavirus restrictions. The Centers for Disease Control and Prevention also updated mask guidelines this week. The new guidelines do not recommend vaccinated people wear masks outdoors except for in crowded places, like a concert or sporting event. Everyone is still recommended to wear masks indoors in public places.
“I look forward to the freedom that I along with my loved ones will regain once the vast majority of Americans are vaccinated,” Sen. John Barrasso said in the video.
The group of politicians also included Sen. John Boozman, as well as Reps. Buddy Carter, John Joyce, and Michael Burgess.
Shawna Blackmun-Myers grasped her patient’s hand, called the woman’s family, and held up the phone. As everyone said their goodbyes on the other end, the patient couldn’t respond: A tube down her throat was feeding oxygen from a ventilator into her lungs.
Blackmun-Myers, an ICU nurse at the Jacobs Medical Center in San Diego, told Insider that the woman was in her 50s and had been bubbly when she came in weeks earlier. Normally in the ICU, Blackmun-Myers said, “people are so sick that that energy and that light is dimmed, but even her being in that situation, she was still just such a bright light.”
“We were dancing and listening to music, and we were watching some soap opera drama stuff on TV and, you know, talking tea about everybody,” she added.
But the woman’s condition worsened quickly. Hospital staff readied a ventilator.
“She’s crying and telling me, you know, ‘I just don’t want to be alone. And I just know that once this tube goes in, I don’t think it’s coming out. I think this is going to be it,'” Blackmun-Myers said.
“I did my best to let her know, you know, obviously she’s not alone. I was there with her. I had her back,” she added.
Then the virus brought heart and kidney problems. The woman went on dialysis. Eventually, there was nothing more the hospital could do to restore her quality of life, and her family knew she wouldn’t want to live this way.
In January, Blackmun-Myers oversaw the woman’s death as hospital staff disconnected the ventilator. The sound of crying family members echoed through the phone.
It was the middle of winter in Southern California. Coronavirus cases were at an all-time high, and ICUs were above 90% capacity. Blackmun-Myers’s unit was losing multiple patients every day.
“I ugly-cry, and then I get angry, and I accept the fact that I did everything I could,” she said. “And just move on so I can take care of the next person and their family.”
Blackmun-Myers didn’t know it at the time, but a new coronavirus variant had been overtaking the region.
The CAL.20C variant was first identified in Los Angeles in July, then disappeared from the record until October. But by January, it accounted for 44% of Southern California coronavirus samples in one study, and more than half of California samples in another.
Several other factors contributed to Southern California’s winter surge – holiday travel, crowded housing, pandemic fatigue – but many researchers think the variant played a role.
Two studies that aren’t yet peer-reviewed suggest that the variant is more infectious than the original virus strain. The research also found it to be associated with a higher incidence of severe illness and partially resistant to antibodies developed in response to the original virus or vaccines.
Although California cases have dropped from a peak of about 40,700 per day in late December to about 4,000 now, experts warn that CAL.20C or other variants could still change the course of the pandemic.
“Now is not the time to relax the critical safeguards that we know can stop the spread of COVID-19 in our communities,” Dr. Rochelle Walensky, the CDC director, said at a White House briefing last week.
“Please hear me clearly,” she added. “At this level of cases, with variants spreading, we stand to completely lose the hard-earned ground we have gained.”
Blackmun-Myers and three other Southern California healthcare workers say what they saw this winter should serve as a strong warning.
Struggling to be heard
The ICU was loud. Given the influx of coronavirus patients, the Sharp hospital network in San Diego had to jerry-rig negative-pressure systems to prevent virus particles from wafting out of patients’ rooms. The makeshift tubing roared overhead, so nurse Kristine Chieh had to yell over it – and through several layers of PPE – for patients to hear her.
Chieh isn’t normally an ICU nurse, but in January, the COVID floors needed all the help they could get. Two days before her first ICU shift, Chieh’s friend, a man in his late 40s, died from COVID-19 after more than two weeks in the hospital.
“I walked through the ICU, looking at the windows, and I swear I see my friend over and over and over again in those beds,” she said.
Chieh recalled stopping to help a man video chat with his family. A mask covered his face, pumping oxygen from a BiPap machine. Chieh lifted the mask for short intervals so he could speak to his family. After a few seconds, he would run out of breath, and Chieh would put the mask back down. Family members would speak up to fill the silence.
“There’s all kinds of people on that iPad, like he must have a large family,” Chieh said. “They thought it was so awesome to be able to hear his voice, and I think he was really excited to use his voice.”
She spent about half an hour like that, lifting and lowering the mask.
“The other ICU nurse was in the process of intubating somebody at the same time that this is happening, so there’s no way she would have been able to do that for him,” Chieh said. “I clocked out for the day and I don’t know what ever happened to him, long term. Hopefully he made it out okay.”
‘It almost overtook my vocabulary and my mind’
Chieh works as a float nurse across three locations in the Sharp hospital network, going wherever she’s needed. Typically, she works in progressive care units – the level before intensive care. But during the winter, even the COVID-19 patients there were severely ill. Chieh would dash from room to room, changing in and out of protective gear to help patients who suddenly found themselves struggling to breathe.
“Throughout my shift, I’ll get patients who are off and on just being like, ‘I can’t breathe, I can’t breathe.’ And then I go in and I do breathing exercises with them. I adjust their oxygen. I have the respiratory therapist come in, do breathing treatments, whatever is needed,” Chieh said.
They would calm down and be fine for about an hour, she said, before it happened again.
Robert Bang, a floor nurse in Los Angeles, spent his winter days the same way. Alarms were constantly sounding through the computer system, he said, to alert him that a patient’s oxygen levels had dropped too low. He would rush to the patient’s room, sometimes to find that they didn’t even realize they were losing oxygen.
“If you’ve been short of breath for so long, you just start developing fatigue from breathing so hard. So it might be like your new normal,” Bang told Insider.
Even when he went home, Bang said, he would still hear the alarms in his head. Work followed Chieh home, too.
“My husband gave me this feedback: I talked about COVID too much at home. Talked about math too much, talked about every news article,” she said. “It almost overtook my vocabulary and my mind.”
That hasn’t fully subsided – Chieh said those winter days still haunt her.
“I feel like I can remember every single COVID patient,” she said. “I imagine what it must be like to have this astronaut person come into their room to work with them. They must be terrified.”
‘I’ve never seen something infect people so easily’
Many of Dr. Kenny Pettersen’s patients in Los Angeles live in crowded homes with a combination of parents, kids, grandparents, or cousins under one roof. That made it difficult to make quarantine plans for the COVID-19 patients who weren’t sick enough to stay at the hospital.
In spring and summer, he told Insider, “when someone in the household would have COVID, usually like half or less of the rest of the household would get COVID.”
But this winter, Pettersen, said “it was almost universally 100%.”
Pettersen is a primary-care physician at Olive View-UCLA Medical Center. The change in LA’s outbreak was so noticeable to him during the winter that he assumed the virus itself must have changed.
“I’ve never seen something infect people so easily,” he said. “I felt like I was almost wasting my time talking to patients about the prevention of household transmission.”
More research on CAL.20C is still needed to confirm his suspicions, though, since the initial studies of the variant haven’t been peer reviewed, and the spike-protein mutation that characterizes it has not been thoroughly investigated.
Relief and grief after the surge
Pettersen’s grandmother died of coronavirus in August. Many of his patients died, too, and some left behind young children. One family is losing their home after the coronavirus-related deaths of two family members.
“Practically every one of my patients, either they’ve been infected, or many of their family members have been infected, they know somebody very well who has died or gotten severely sick,” Pettersen said. “I think the cumulative toll that takes on my patients is just really profound.”
Still, he said, the mood among his coworkers is more upbeat now. There are even days at the hospital when nobody dies of COVID-19.
“I think that we can start to breathe with a little bit more confidence,” Pettersen said. He and his wife have both been vaccinated.
Bang and Chieh say they feel safer these days, too. The volume of COVID-19 patients is much lower. They’ve been vaccinated, and more people are getting shots each day. But the winter memories persist. Some healthcare workers are now nervous about other variants. And there’s a strong possibility they or their colleagues will develop PTSD.
But Pettersen, at least, said he was finally able to go to an outdoor restaurant for sushi with his wife recently.
“We can, you know, be optimistic for the first time in about a year,” he said.
Doctors are calling to investigate one of the country’s most prestigious medical journals.
The Institute for Antiracism in Medicine, an antiracism group founded by three Black women physicians, launched a petition against The Journal of American Medical Association after the publication tweeted “No physician is racist, so how can there be structural racism in health care?”
JAMA, a peer-reviewed medical journal that dates back to 1883, is the most widely circulated journal in the world, per its website. JAMA’s now deleted tweet promoted a podcast episode where two editors discussed how to talk about racism in medicine.
“Structural racism is an unfortunate term,” JAMA deputy editor Ed Livingston said in the podcast, which has also been deleted, according to The Root. “Personally, I think taking racism out of the conversation will help. Many of us are offended by the concept that we are racist.”
JAMA removed the podcast after Black doctors and other medical experts brought attention to offensive remarks about race in the episode. Editor-in-chief Howard Bauchner released a statement apologizing for the harm caused by the tweet and parts of the podcast.
The petition calls the investigate whether Bauchner failed to diversify editorial staff or discriminated against them. The group is also calling on JAMA to hire a deputy editor dedicated to antiracism and health equity publications, and schedule town halls with Black, Indigenous, and other community members of color.
The petition had more than 1,600 signatures as of Tuesday morning.
Research suggests racial bias in medicine leads to worse patient care for Black people. A 2016 report found half of white medical students and residents in the study endorsed false beliefs about biological differences among Black and white people, which led to making less accurate treatment recommendations for Black patients.
The result of decades of racial bias in medicine has led to Black people having less trust in the life-saving COVID-19 vaccine.
Medical institutions in the US have taken some responsibility for the industry’s racial bias, prompted by the COVID-19 pandemic’s outsized impact on Black people and the calls for accountability during the 2020 George Floyd protests.
The American Medical Association recently defined racism as a public health threat. In 2018, AMA had apologized for actively discriminating against Black doctors and barring them from joining medical societies between the 1800s to the 1960s.
JAMA has been revising its editorial style for reporting on race and ethnicity over the last eight months.
JAMA and the Institute for Antiracism in Medicine were not immediately available for additional comment.
When I was in elementary school, all of my grade cards came back with great scores and really positive comments. However, there always was the one little comment “She’s too bossy and overly talkative.”
I had a big personality and used that to my advantage from a young age. Interestingly enough, as I transitioned into high school, my grade cards began to read “She’s a great leader and has great class participation.”
I wondered if my “bossiness” and excessive talking had become more direct and efficient, or if I was just perceived differently by elementary school teachers versus high school teachers. I’ll never know, but one thing I do know is the detrimental effects that the word “bossy” can have on a young girl.
It’s discouraging to young ladies and makes them feel as if they cannot be assertive. How can girls aspire to be politicians, lawyers, and judges if we shoot down their leadership traits from the very beginning? Several women leaders in medicine spoke with me about their “bossy” experiences, and how they’ve learned to use this trait successfully throughout their careers.
1. Assertive women may have to make adjustments to earn respect
“I had to learn how to lower the tone of my voice and smile more to not come off as controlling,” said Dr. Sharon Gustowski.
Gustowski is an osteopathic doctor based in Houston, Texas who is certified in neuromusculoskeletal and osteopathic manipulative medicine.
As a young child, she was independent and assertive, which helped her to gain the respect and trust of her elders who felt comfortable leaning on her for more responsibilities. As doctor however, she felt this trait and the way she carried herself alienated her peers, because it seemed she came off as snobby and unfriendly.
To offset these perceptions, she made adjustments to her tone and mannerisms so she was more inviting. Constantly being aware of your delivery can be exhausting, but she said it felt like she had to do it to earn respect and not be ostracized.
As a current medical student, Gustowski’s account helped me understand that assertive women may have to adjust facial expressions, hand movements, volume, and tone to be heard in male certain dominated atmospheres. Without these adjustments, their colleagues may get caught up in the delivery and not the message which hinders progress, which could create strain and frustration.
2. Becoming a leader comes with growing pains
The road to becoming a good leader isn’t straight and easy. In fact, becoming a leader will probably include quite a few setbacks before successes. Dr. Candace Walkley, an internal medicine physician based in Conroe, Texas, has experienced being “bossier than her boss.”
Her assertive personality is either perceived as go getter or too assertive. Being a go-getter creates great work relationships, but being “too assertive” can create tension which can interfere with communication and expectations.
Walkley refers to her assertiveness as “the sword with two sides.” These experiences have helped her shape her leadership skills to better assess and control herself in interactions, but not without a few bumps in the road with coworkers and colleagues.
A leader is nothing without a team behind them. The best way to gain a team’s trust and get them to work hard is to listen more than one speaks. This is especially important when working in the medical field because of all the different teams and personnel that could be working one case. Without hearing what they have to say, a leader won’t be very successful.
Dr. Peggy Taylor is an OBGYN who ran her own practice for years before eventually selling it to retire. She now teaches and picks up shifts when needed.
Although considered bossy by some when opening her own practice, she said she “never wanted to be seen as really my way or the highway. I took more of a teamwork approach: I know I’m the leader and I make the final decision, but I want their input.”
Taylor says she put in the extra effort to make her employees feel respected and heard, and she listened to their suggestions and implemented them when they were appropriate.
4. Assertiveness is necessary in serious situations
As physicians, these women are not just responsible for day to day operations. They are responsible for human lives, which means, occasionally, that assertiveness is absolutely necessary.
“I try to only bring this trait out in its full glory when I’m supervising people or when a situation is clearly dangerously chaotic – where a leader must emerge for safety,” said Walkley.
Taylor also put patients at the front of the helm when it came time to be the boss. She made decisions that her staff did not always like, but at the end of the day, they benefited the patients.
There are times to be laid back, but when serious decisions have to be made about someone’s health, these bosses in medicine know how to get the job done. Gustowski learned to fully accept this duality of silliness and seriousness in the job, and when to switch back and forth. The ability to turn it on and off is powerful in a job where things can go from good to bad in the blink of an eye.
5. Good leaders care and create lasting relationships
The fun part about being a good leader is being able to create long-lasting relationships with employees. However, this only happens when employees feel like they matter and physicians care about them as people.
Women leaders in medicine may have an advantage because many are natural nurturers at home and in society, and bring that attribute to work.
Dr. Mary Manis, a family medicine doctor in Conroe, Texas, made sure to keep up with her employees by asking them about their families and personal details they shared with her. This helped her develop relationships that lasted far beyond any work situation.
Taylor kept the same staff for over 20 years because she created such a family friendly environment.
As a mom, she understood the stressors of having children and allowed employees to bring their children to work when they were not able to go to school. Small acts like these help create fulfilling, long-lasting bonds between boss and employee.
“I would’ve loved to have found a woman boss or mentor, but that never happened,” said Manis.
While she did have a great relationship with a former male mentor and boss, Manis says it was disappointing to not find a woman boss to support her during her medical career.
As a medical student myself, I’m fortunate enough to have
Manis, among many other women, as my mentors. I hope that as more women enter medicine and learn the same lessons as the women in this article, they too can find and be a mentor to other women leaders in medicine.
7. Leadership skills can emerge at any point in life
Dr. Ouida Collins, a family medicine physician in Conroe, Texas, has been an introvert her entire life. Still, she says there were times early in her medical education journey when she had to be vocal and assertive.
“What made me stand up a little more is in a couple of classes, if you were a woman or didn’t fit the characteristics of those in leadership positions, they kind of pushed you to the side,” Collins said. “I was working on a project with another guy in the group and he told me ‘you need to do this’ and that and I said, ‘no, I don’t.’ That’s not how this works. That was the beginning of the pushback.”
Women in medicine often deal with being silenced or pushed aside in such a male-dominated arena. Patients may think they are the nurse and some male counterparts don’t respect them the same way as male physicians. But, no matter how old you are or your personality type, when it’s time to speak up for what’s right, you have to.
At the end of the day, Collins always had her paperwork in order and did her job, which gave her the confidence to assert herself regardless how others reacted to her firmness. She too has learned to tailor her leadership skills and always falls back on doing what’s right for her and her patients.
Disclaimer: These views and opinions are of the individual physicians and the writer and in no way representative of their employers.
Dr. James Phillips, the emergency room physician who called out President Donald Trump for his decision to greet supporters while he was being treated for the coronavirus in October, has been removed from the schedule at Walter Reed National Military Medical Center beginning in January, according to CBS News.
On October 4, Trump rode in a motorcade with attending Secret Service agents while still being infected with COVID-19. Phillips, the chief of disaster and operational medicine at George Washington University and an attending physician at Walter Reed, harshly criticized the president’s actions at the time.
In a tweet that has since been deleted, Phillips wrote: “Every single person in the vehicle during that completely unnecessary Presidential ‘drive-by’ just now has to be quarantined for 14 days. They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity.”
He added in another tweet that has also been deleted: “That Presidential SUV is not only bulletproof, but hermetically sealed against chemical attack. The risk of COVID-19 transmission inside is as high as it gets outside of medical procedures. The irresponsibility is astounding. My thoughts are with the Secret Service forced to play.”
Officials at Walter Reed told CBS News that the hospital “provides requirements for contract positions,” and stated that “schedules are determined by the contractor.”
They added: “There was no decision made by anyone at WRNMMC to remove Dr. Phillips from the schedule.”
This decision comes more than two months after Phillips’ initial criticism and a month after President-elect Joe Biden defeated Trump in the November general election.
“Colleagues of Dr. Phillips were surprised that a disaster medicine specialist would be eliminated from the schedule at a busy military hospital at a time when Maryland is nearing a record high for COVID-19 hospitalizations,” according to CBS News.
Trump, who revealed his COVID-19 diagnosis on October 2, stayed at the Walter Reed facility in Bethesda, Maryland for four days before being released. The first lady, Melania Trump, and their son, Barron, were also infected with the virus but recuperated at the White House.