Pharmacist Marjorie Morgan draws a dose of vaccine Jan. 8 , 2021, or Ascension St. Vincent frontline workers getting the second dose of the Pfizer-BioNTech COVID-19 vaccine.

Tim Bath | Kokomo Tribune
Pharmacist Marjorie Morgan draws a dose of vaccine Jan. 8 , 2021, or Ascension St. Vincent frontline workers getting the second dose of the Pfizer-BioNTech COVID-19 vaccine. Tim Bath | Kokomo Tribune
Dr. Gabriel Bosslet, associate professor of clinical medicine at Indiana University School of Medicine, recently saw one of his patients who had not been vaccinated, but was at a high risk for becoming seriously ill from COVID-19.

Bosslet explained the risks of not getting a vaccine. Still, the patient declined. So Bosslet took it one step further. He penned a handwritten note and mailed it to the patient.

“It would break my heart to have to care for you in the ICU with COVID-19,” he said. “I urge you to get the vaccine.”

A LOOMING SURGE

Bosslet is one of thousands of doctors and physicians across the state pulling out all the stops to get people vaccinated as the more contagious and deadlier delta variant begins to spread across Indiana.

According to the Indiana State Department of Health, the delta variant accounts for over 81% of all new cases. That’s double from just a month ago.

Now, with only 50% of Hoosiers vaccinated, health experts are preparing for a huge surge in new cases this fall that could once again put a heavy burden on hospitals and health networks, many of which are already running at maximum capacity.

Dr. James Bien, chief medical officer for the IU Health hospitals in Frankfort, Lafayette and Monticello, said that concern is becoming more real every day due the alarming uptick in new COVID patients. He said that a month ago, IU Health Arnett had around three people hospitalized with the virus. Today, there are 14.

“Every hospital system is under pressure right now, and not just because of COVID,” Bien said. “It’s because of other disease rates. Adding another COVID surge and a flu season on top of that will be extremely challenging for health care systems.”

Emily Sego, Community Health Network’s vice president and chief nurse executive of ambulatory care services, said it’s the same story at their hospitals and medical centers as new COVID cases have started to creep back up in the last few weeks.

“It’s very concerning,” she said. “We are kind of bracing ourselves at this point. We’re digging out our COVID staffing plans and operational plans that we had developed during the last surges and dusting those off again. We’re starting to talk through what we need to do and where we are today.”

Bien said that most hospitals are bracing for the fall, when students return to classrooms at schools and colleges, many of which are not requiring masks.

With only 20% of 12- to-15-year-old kids and 33% of 16- to 19-year-old teens vaccinated, experts are projecting large surges at schools that will then quickly spread to the unvaccinated population.

Dr. Sean Sharma, the county health officer in Fountain and Warren counties, which saw recent upticks in delta variant cases, said he fully expects that to happen in his part of the state.

“The overall vaccination rate is quite disappointing,” he said. “I think it’s concerning as we go into the back-to-school season, where many schools are choosing to make masking optional, regardless of the public health guidance.”

However, if another wave hits, most hospitals will be better prepared to deal with it after having lived through last year’s surges.

Sego said that at Community Health Network, officials have weekly calls to discuss how many are being admitted for the virus and how best to prepare for a surge. And even though only half of Hoosiers have gotten a vaccine, that should keep the hospitalization numbers down compared to last year, she said.

“I’ll say overall, we all feel much more prepared this time around,” Sego said. “We’ve got some experience under our belt and we’re ready to go if anything should happen if we get a spike.”

UNVACCINATED PANDEMIC

Even with the threat of another COVID surge looming, the vaccination rate across the state has remained mostly stagnant for around a month. Many officials say that number likely won’t grow much, as many people have made up their mind not to get one.

IU professor Bosslet said that even if the vaccination rate does increase, it won’t be enough to reach herd immunity or fully eradicate the virus.

“I think that we’re in for this virus living among us for the coming years,” he said. “Those of us who are vaccinated, it will be a nuisance. The true, severe pandemic that we all worry about will continue almost exclusively with those who decided not to get the vaccine.”

According to a study by the Kaiser Family Foundation, the number of adults who are more reluctant to get the COVID-19 has remained relatively unchanged since January. The study found about 6% of unvaccinated adults say they will get a vaccine “only if required” for work or other activities. Another 14% said they will “definitely not” get vaccinated.

Bosslet said he understands people’s concerns about the vaccine, considering it was developed and distributed so quickly. But with billions around the world already vaccinated with nearly zero side effects, the evidence is there to show it’s safe.

“It’s proving to be one of the most effective and safest therapeutics in the history of mankind,” he said. “If people had been praying for a miracle, that miracle is here, and it is the vaccine.”

Community Health’s Sego said that although the uptake of the vaccine is currently slow, she anticipates a large increase in the number of people getting one once the vaccines are fully approved by the U.S. Food and Drug Administration.

“I think that’s really the key, to be honest,” Sego said. “That’s what we’re hearing from patients. We expect to see a huge increase in our vaccine volumes once the FDA approval occurs.”

A DOCTOR’S SHOT

Even with a stagnant vaccine rate, doctors and physicians aren’t giving up on getting more people vaccinated, and many see themselves as one of the few people left who can convince them to get a shot.

Bosslet said patients trust their doctors and primary care physicians, and are more likely to listen to them when it comes to getting past any hesitancy about receiving a vaccine.

“Those types of relationships and those types of words from trusted people who have cared for you can’t be underestimated,” he said.

According to the Centers for Disease Control and Prevention, more than 80% of adults have a medical office where they receive health care, and many people prefer to be vaccinated in their regular doctor’s office. Studies have also found that a doctor’s strong recommendation “is closely correlated with vaccination,” the CDC said.

That’s why hospital networks across the state are pushing to get vaccine doses into the hands of doctors and physicians, who could administer vaccines on site to their patients.

Warren County Health Officer Sharma said they’ve been working closely with their county’s health care providers to get vaccines into doctor’s offices, since the health department is currently the only place to get a vaccine.

He said private pharmacies do offer the vaccine in neighboring counties, but that can mean a 30-minute drive for some residents.

“We want to have them accessible in the same place where you get your high blood pressure medicine or your diabetes treated,” Sharma said. “I think that’s going to make a big difference. We’re working to partner with our local health care providers to make that a reality.”

Sego said that they tried having doses inside their emergency rooms and other facilities to offer to discharged patients, but discovered many of those people had already received a vaccine.

She said they discussed putting vaccines in individual offices, but decided not to since many doses would go to waste. Vaccines come in five- or six-dose packages that, once opened, have to be used within around six hours. If a doctor opens a pack for one patient, there’s no guarantee the other doses would get used it time.

Instead, the health network has set up on-site vaccination clinics at its busiest facilities on certain days. Doctors and physicians know when the clinic is open, and can send patients to those immediately following an appointment or checkup.

“We’re very cautious of wasting, so we’re targeting the practices that have the most needs, and that’s how we’ve been handling it,” Sego said.

The State Department of Health stated in an email it has made vaccines available to physicians and other providers to offer in their offices, and have distributed provider toolkits containing fact sheets, posters and other information to help them talk with their patients about the vaccine.

To help remove any concerns that the vaccine would expire, the state department also offered smaller batches of the vaccine to providers to keep in their offices.

Bosslet said doctors are applauding the state’s support, and that now it’s up to health networks and physicians to start bringing the vaccine in-house to make it as easy as possible for patients who are skeptical or scared to get a shot.

“We need to do everything we can to get the vaccine into physicians’ offices,” he said. “I do think that’s the way we reach people who have concerns about the virus.”
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