HJNO Sep/Oct 2021

HEALTHCARE JOURNAL OF NEW ORLEANS  I  SEP / OCT 2021 17 continue to go up. We are learning a lot right now about how Delta spreads, about the transmission dynamics of Delta, and, quite frankly, the CDC and the country are learn- ing a lot about how Delta spreads because of our data. That data will help inform the foundation’s understanding of Delta, unfortunately to the benefit of other states, because it takes time to analyze this data. At this point, we have let ourselves be vul- nerable. Only 43% of Louisiana’s population has chosen to initiate their vaccine series, and that’s too low. We can’t blame it on any- thing but ourselves right now, because for the past four or five months, we’ve had more vaccine supply than we can use. So, I am cognizant that this is largely preventable at this point, and I think states that have done a better job getting their neighbors and com- munity members vaccinated will avoid a surge of this degree. Editor Breakthrough cases are happening with this Delta variant, and a lot of vacci- nated folks who are getting Delta are blam- ing the unvaccinated. Does this mean that if all of us were vaccinated that SARS-CoV-2 would have died out? And how do we know that? Kanter If all of us were vaccinated, we would not be having the surge that we would have now. We might have a small increase in cases that would not be overwhelming our hospitals and would not be leading to dra- matic increases in our fatalities the way it is right now. We do have breakthrough cases, there’s absolutely no doubt about that, and of the over 2000 patients who are hospital- ized with COVID right now, about 90% of them are unvaccinated, which means one in 10 are hospitalized with COVID despite being vaccinated. Those individuals trend old, and they trend sick. They usually have either underlying health conditions or advanced age. In fact, the median age of that group is 74 years old. Breakthrough infections do happen. They are rare by the numbers, but they do happen. When they do happen, they’re usually of mild symptoms. You are 25 times more likely to be hospi- talized with COVID if you are unvaccinated, you are 25 times less likely to die of COVID if you are vaccinated, and you are eight times less likely to be infected with COVID, with any symptoms, if you are vaccinated. Those numbers are with regards to the currently circulating Delta variant. So, we might have case increases anyway, but we would not be overwhelming our hospitals. We would not be having so many people get sick and die if more of us had chosen to get vaccinated. Editor On the LDH website “for providers” section on vaccinating, it says, “The medi- cal system has a long history of mistreating black and disabled Americans. This earned mistrust means that it is essential to foster confidence as we try to vaccinate as many Louisianians as possible.” Can you give those of us who may be unfamiliar with it the background for this statement and how we can understand the earned mistrust, so we can get through it? Kanter Institutional racism is a reality across society and particularly of our healthcare system. We have to acknowledge that, par- ticularly in theAmerican south. Many physi- cians will tell you their personal anecdotes, and I’ll tell you mine. I used to help run a homeless clinic in New Orleans, and I will never forget a patient of mine — a woman who was homeless and who suffered from congenital syphilis, because her father was a subject in the Tuskegee experiment. Those types of experiences are difficult to erase, and we have to acknowledge that not every person interacts with the “system,” in the same way. There is a lot of mistrust out there, and oftentimes it’s for very under- standable and legitimate reasons. Even if it’s not, you have to acknowledge that the mistrust is there, and if you want to do the right thing for your patient, you need to work to understand why that mis- trust is there. What are their concerns?Why do they hear the message differently than somebody else does?And more importantly, how can you meet them where they are to improve their health? At the end of the day, that’s what physicians and other care pro- viders must do. Editor Why was the offer of immunity given to drug companies for side effects if there are no worries of any kind? “… if somebody still would feel more comfortable receiving the more traditional type of vaccine, the J&J vaccine is a more traditional vaccine platform that’s based on the adenovirus, a very common type of vaccine platform that does not employ messenger RNA technology.”