Pandemic Fatigue, Politics, and Positivity

As the COVID-19 pandemic stretches into its second year and cases continue to rise in Marion County and the state, some Ocala healthcare workers find themselves not only physically and emotionally fatigued but also caught in the politicization of the pandemic.

Through it all, they tirelessly work to help stem the virus’ impact and deal with the misinformation they encounter along the way.

Fighting a battle on two fronts “The hospitals are overcrowded,” said Dr. Anish Khanna, the facility medical director for the TeamHealth hospitalist group that contracts with Ocala Health System facilities in Ocala. 

He said there is a commonality among those who wind up in the hospital. “If you were to go around and take out all the unvaccinated people from the statistics of who’s hospitalized, our hospitals would be empty. Not only are they unvaccinated, but they’re also younger and sicker than previous patients,” he said.

Stacey Bates is an advanced practical registered nurse with Ocala Lung & Critical Care. She works in the ICU at West Marion Hospital, and she also sees similarities in who winds up as her patients in the ICU.
“What I have personally seen, and I work in the ICU five days a week, and I follow my patients
on my days off, I can only think of three patients at the most that were vaccinated,” said Bates.

As the pandemic has changed, so has her patient population.  “The first wave… at that time it was an older population that was getting sick, nobody was vaccinated… but that is what is so different with this third wave, it’s a younger population. We’re seeing young people dying, and there’s a certain level of frustration because you feel like this could be prevented if people would get vaccinated,” she said.

Dr. David Kuhn of Trinity Clinic understands that some may have questions about the vaccine or a
hesitancy to receive it, and he tries to take it one hesitant patient at a time. He attempts to answer all
the questions his patients have, but he finds it troubling when he encounters individuals who act in
bad faith, attempting to undermine Ocala’s healthcare providers who are working tirelessly and doing all
they can.

“It’s one thing to make a personal calculation to opt-out of the vaccine for personal reasons or
health reasons, that’s obviously OK. But to actively and even militantly try to interfere with what we’re trying to get accomplished during a pandemic, which is to try to vaccinate as many people as we can and to save as many lives as we can, is disrespectful,” said Kuhn.

Bates also sees two distinct groups when it comes to vaccines. She said there is a group of patients
who may not have access to up-to-date or accurate information. When she has conversations with them and provides them with information that answers their questions or addresses their hesitations, they usually change their minds and become more open to receiving the vaccine.

The other group actively operates to try to undermine the work they are doing. They are not interested despite whatever evidence she presents. “It feels like with the third wave of COVID there are two battles we’re fighting,” she said. “It’s not just fighting COVID itself, it’s fighting this battle of people refusing to believe in COVID or to believe in available treatments to help prevent it.”

For Bates, the encounters with her ICU patients are all eerily similar.

“Every time I see a patient for a consult and I ask them, ‘Have you been vaccinated?’ There is most certainly a level of regret,” she said. “Some are vocal about it, and then others you can just kind of see this wave come over them. You can see it on their face that if they had the opportunity to do it
again, they most certainly would get vaccinated.”

Dealing with Misinformation

One source of information often misrepresented is data found within the Vaccine Adverse Events Reporting System (VAERS). VAERS is a joint surveillance program designed and run by the FDA and CDC to monitor potential issues with vaccines. According to the FDA, “VAERS collects and analyzes information from reports of adverse events (possible side effects) that occur after the administration of US licensed vaccines.”

The program welcomes reports from multiple sources, including individuals, healthcare
providers, vaccine manufacturers and others.

While anyone can submit a report, simply submitting a report does not automatically mean there is a correlation or causation between a vaccine and the issue being reported.

Once an issue is reported, the FDA and CDC examine the data before determining if there is a causal link between a reported issue and a vaccine.

Kuhn said VAERS data is often taken out of context, and people use it to play on fears related to the vaccine.

“They like to use that (VAERS) death count, but basically, anybody can go on there and say that someone died from a vaccine,” he said. “But obviously, all the deaths are reviewed, and an extremely
small number, I think less than ten, are confirmed as death associated with the vaccine or as a result of the vaccine.”
Khanna also believes the individuals spreading misinformation are doing so by using technically true but misrepresented information.

“They’re playing on the fact that (the vaccine) was an emergency use and the fact that it’s not 100%
effective… but I think the numbers clearly state that it mitigates the severity of illness, and it mitigates the mortality,” he said.

Bates agreed.
“It goes beyond some of the statements… ‘Oh, it’s experimental,’ or ‘It doesn’t provide immunity,’ and it’s actually harmful disinformation at this point, and it’s malicious to the community,” she said.

“It (the vaccine) is proven effective and safe. It has been well studied, there are multiple research studies
that support this. It’s just frustrating at this point.”
She said it sometimes feels like those pushing misinformation or information taken out of context is
counteracting their goal of providing accurate information and to help gain acceptance of the
vaccine.

Even though the vaccine will be moved from emergency approval to full authorization relatively soon, Kuhn believes there will still be those who will find issues with the process.

“The FDA approval is right around the corner, maybe a month away or so, but I feel like a lot of
them (who won’t get the vaccine) are just going to use another excuse after the FDA approval comes,” he said. “They’re still going to say, ‘Well, it was rushed. We don’t believe the FDA now,’
and that kind of thing.”

Another source of information lacking context comes in the form of published studies. Opensource
studies that have not been peer-reviewed for accuracy or errors are presented as irrefutable
facts.

“Those of us that are speaking out, doing this on a daily basis… we understand this,” said Khanna. “We
look at all the studies that are out there, we know what’s a good study, we know what’s a bad study, we
know what’s an in-between study… the numbers speak for themselves. You can go on Google and find whatever you want to find… but the percentage of people hospitalized [who have had the vaccine] across the country, state by state is easily under 10%. And I can tell you, anecdotally, from our experience in our facilities and the numbers that are out there that patients who are vaccinated
are less likely to get hospitalized, less likely to have a severe illness, and less likely to succumb to the
disease.”

One factor that is key in accepting and believing the information found on COVID-19 is trust.
“There’s so much mistrust about anything that anybody reads or hears or sees anywhere online unless it comes from that they’ve already pre-determined is a trustworthy source,” Kuhn said.

And if they choose to believe less than credible information, it leads them to
overestimate their ability to beat the virus.

“The ones who have no fear of the virus, it’s extremely difficult to get them to get vaccinated,” he
said.

Separating medicine and politics
Kuhn has been proactive about getting the new cases, hospitalizations, and other statistics relating to COVID in Ocala through his weekly Facebook posts. And while he realizes some see the pandemic through a political lens, he actively works to keep his posts apolitical.

“I try very hard to keep the politics out of our posts. I don’t mention it,” he said.

While people tend to take politics and their political views seriously, Bates said there’s no room for partisanship in treating patients.

“(Using) care and compassion is what we do for everybody, whatever political side you fall on,
whatever your beliefs are. None of that matters. We care for each patient the best we can. Nothing else
matters… nursing is truly there for everyone, no matter what,” she said.

Khanna believes the two should be detached as well. 

“To me, medicine and politics need to be separated… to me, this (pandemic) is not political…because at the end of the day, if you’re not alive to have political views, then it’s a moot point. Your healthcare is much more important. Your health is much more important than your political views,” he said. “We’re not doing (anything in regards to medicine) to be a part of a political party… we’re doing it because the science is dictating that that’s the right way to go. So it is upsetting that it’s been politicized.”

Finding a Bright Spot in
the Storm

Some shifts feel like déjà vu to Bates.

“It’s the same scenario, you walk into a patient’s room, they were diagnosed with COVID and pneumonia and they have severe difficulty breathing, and they’re requiring a higher level of oxygen. Maybe a BiPAP machine, and they are struggling even with that. And you have to, as a provider, approach them with, ‘OK, what is the next step from here if you cannot sustain on this machine?’
And these people are awake, they’re very much orientated, they know what’s going on. And as soon as you say, ‘I would recommend putting you on a life support machine,’ you can just see this wave of anxiety and fear come over them.”

She said that anxiety often transfers to the providers as well, and the experiences they deal with daily require a strong bond with their coworkers.

“When we see young children, 19, 20 years old falling to their knees in the ICU crying, pleading with God as we’re terminally extubating their father on a ventilator, there is that
support group to fall back on,” Bates said.

Kuhn also realizes the toll it’s taken on him and his peers. “Obviously, it’s affected all of us in healthcare.
Doctors, nurses, everybody in healthcare,” he said. 

While working during the pandemic has been taxing, Khanna described one positive that has emerged.
“What keeps all of us going as a healthcare community is each other. An unexpected side effect of this
pandemic has been a global respect for each other, and a level of kindness and respect for each other’s role,” he said.

That level of gratitude he said, is one big factor in keeping their spirits up.

“We appreciate each other, and I think that’s what gets us up every morning and gets us to work every day is that we’re working in a community that’s coming together, and being a part of that community as a whole.”

Bates feels that community bond as well.

“We certainly stand together, stand strong…we couldn’t do it without each other,” she said.
Khanna realizes times may be tough, but the healthcare providers in Ocala fighting to make their patients’ lives better won’t give up.

“We’re obviously being stretched to our limits, and what we think are our limits change day to day because as healthcare workers, we adapt,” he said.

Despite all their efforts, Kuhn said it’s difficult to gauge their success.

“There’s no way to ever know if we moved the needle or not,” Kuhn said. “But hopefully we did over the
last 18 months or so. If we were able to convince one person to get vaccinated or
save one life, it will all be worth it.”