"When people decline vaccination ... there is a sensation of helplessness that I have rarely felt in 17 years of practice." Dr Elspeth Frascatore. Photo / Getty Images
Elspeth Frascatore, an emergency medicine physician and founder of Doctors Stand Up For Vaccination, describes the experience of the Covid pandemic from a doctor's eyes, and the complex emotions that it has provoked.
I'm not sure medical school prepared me to be a doctor in a global pandemic. Medical school taught me what a virus is, how to form a diagnosis, and how to treat pneumonia. I'm not even sure being a doctor prepared me to be a doctor in a global pandemic. On the job, you learn how to resuscitate a critically ill or injured patient, how to treat a septic patient, or how to talk to the whānau of a recently deceased patient.
But for Covid, with 17 years of medical experience, I wasn't prepared. The last global pandemic had been a century ago: not even in my grandparents' lifetime. Looking around the world at the shell-shocked medical community, I wasn't alone. The medical community wasn't prepared. The world wasn't prepared.
It wasn't prepared for the devastating impact of a tsunami of life-threatening illness that swept across the planet over a few months. Not because a viral pneumonia and its many complications are new to us, but for so many other reasons that were unfathomable to us at the start of 2019. Even in 2021 things change by the month, week, or day in the shapeshifting global Covid crisis.
Within weeks of the World Health Organisation declaring Covid a "Public Health Emergency of International Concern" in January 2020, hospitals across the globe were overwhelmed. I will never forget the face of Dr Li Wenliang, the "Wuhan Whistleblower" who warned the world of a mysterious respiratory illness spreading through patients, before himself fatally contracting Covid in February 2020. Nor will I ever forget the videos of Italian doctors and nurses who had exhausted their country's supply of PPE, continuing valiant attempts to save their patients, at real risk, all too often realised, to themselves. The title "heroes" has been used for healthcare workers across the globe, often to mixed emotions from the recipients of the accolade, but in these instances the title was rightly offered.
In Aotearoa New Zealand we watched in horror as countries toppled like dominoes to the seemingly irrepressible force of Covid. On February 28, with the inevitable first case landing on our shores, for Aotearoa Covid finally became a reality.
As a doctor, I remember that day. The news swept across the medical community with a sense of dread. What does this mean for us? At the time, a vaccine was a distant dream, a faraway "solve-all" that, on its eventual arrival, would be greeted with fanfare and celebration in the streets.
As suspected Covid patients started to come through our doors, we were confronted with a reality entirely new to us: due to potential exposure, we became a risk to our whānau. Healthcare workers with pregnant wives or vulnerable close contacts either self-isolated in rooms in their houses, or at times even moved out. Doctors and nurses returning to their whānau from work entered surreal rituals at the end of each shift: remove phone from plastic bag, alcohol wipe all surfaces, drive home, leave work clothes in the garage or laundry, shower, don fresh clothes and greet your whānau with a nagging doubt that you were accompanied by an unwelcome visitor. Should I sleep in a separate bed from my husband? Can I kiss my child? Am I the risk?
At work, patients with "respiratory symptoms" were placed in single rooms. A single room is usually a positive thing – privacy, an en suite, extra space. It became quickly apparent to medical staff that being a "suspected Covid patient" was no such luxury. Staff would enter a room only when fully prepared in PPE: a lengthy and careful process that involved donning a gown, gloves, N95 mask, and visor. For a patient, the person that enters the room does so in multiple protective layers – all necessary and all of which create a barrier between the doctor desperately trying to display empathy and the patient desperately wishing to be seen. After the consultation is complete, the doctor prepares to leave the room. Again, a complex ritual ensues of safely removing PPE in the correct order as the patient watches on.
I had the unfortunate experience of being a "suspected Covid patient". My toddler was suspected for Covid, admitted to hospital, but didn't have it.
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I know the emotions of a patient as that person leaves the room. There is an isolation that is equally necessary and unnatural. The emotional toll was palpable, even as a healthy patient who returned home with a diagnosis of "Covid negative". Tears were shed that day, and even now I'm not entirely sure why.
But, as humans have done for millennia, we adapted. The mask-wearing, alcohol gelling, PPE donning and doffing, sanitisation rituals on leaving work – they all became routine. It was the "new normal".
And finally, the vaccine arrived. On December 1, 2020 the first vaccine was approved for use in the UK. On February 19, 2021 the first dose was administered in New Zealand. As a doctor, I stepped forward to be vaccinated with a sincere feeling of privilege. I knew that as a healthcare worker I was at greatest risk of exposure to Covid, but I also knew I was so lucky to be vaccinated against a disease that, to date, had killed 2.4 million people.
However, this sense of elation was followed by the final confronting problem that nearly two decades of medical experience hadn't prepared me for: the equally devastating epidemic of Covid and vaccine misinformation. Doctors are professional carers who follow science. For centuries, doctors have taken medical advancements, ensured their safety, and utilised them in practice for the wellbeing of their patients.
Covid was no different, right?
As I write, social media is alight with selfies of people thrilled to be "doubled-vaxxed" echoing across Facebook while the "Shot Bro" vaccination bus drives through Auckland and the Twitter universe. But equally, a different echo is heard in other "chambers" of the same social media forums, speaking of myriad perceived horrors regarding the vaccine, most based upon misinterpretation of information: misinformation.
Those echoes even spill into our own social media feeds, dinner table conversations or drinks with mates. As a doctor, the emotions that come with that are hard to explain. We know that misinformation is shared online daily and permeates our news feeds, our community groups and our social circles. We know where the science has led the global medical profession in the fight against Covid. We know that vaccination protects ourselves, our patients, our whānau, our communities, our healthcare system, and our country. When people decline vaccination, for reasoning based upon misinformation that we know is categorically untrue, there is a sensation of helplessness that I have rarely felt in 17 years of practice. The knowledge that, no matter how competent I am as a doctor, there may be some people that I cannot help.
It is likely we will never be completely rid of Covid. As pressure mounts to "open our borders" and "live with it", the Government desperately pushes for high vaccination rates. We need only look abroad for their reasoning: in the US only 55 per cent are fully vaccinated, the death rate is on average 2000 covid deaths per day in September and almost all of those deaths are people who aren't vaccinated. It is clear that the vaccine provides high levels of protection against death from Covid.
To "live with Covid" we must find a way to reach those yet to come forward for their vaccination.
So, as a doctor, what can I do? I can continue to do my best. I can use my medical knowledge to counsel my patients, share decision-making, to explore fears and answer questions. I will do everything I can to ensure that the harm of Covid one day becomes a distant memory so that my son's future - and Aotearoa's future - can be as bright and as beautiful as I have always imagined.
Kia kaha Aotearoa.
Doctors Stand Up For Vaccination is a grassroots initiative of 5000 New Zealand doctors who wrote an open letter and FAQ document to Aotearoa NZ in support of vaccination for Covid-19. The group can be found at doctors-stand-up-for-vaccination.com and on Twitter @NZDRSUV
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