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CDC Approves Moderna Adult COVID-19 Vaccine

Moderna’s adult COVID-19 vaccine has now earned full approval following recommendation’s from both the Food and Drug Administration and the Centers for Disease Control and Prevention’s (CDC’s) immunization panel.

On Feb. 4, after CDC’s Advisory Committee on Immunization Practices unanimously voted to recommend Moderna’s two-shot series, CDC Director Rochelle Walensky, MD, quickly endorsed that recommendation.

“If you have been waiting for approval before getting vaccinated, now is the time to join the nearly 212 million Americans who have already completed their primary series,” Dr. Walensky said in an agency statement. “CDC continues to recommend that people remain up to date on their COVID-19 vaccines, including getting a booster shot when eligible.”

The adult version of the Moderna vaccine is for people aged 18 and older. Pfizer’s two-shot vaccine, which was granted full approval in August 2021, is for use in people 16 and older.

SELF-CARE FOR HEALTH CARE WORKERS DURING A PANDEMIC

Public Health Notes

by Catherine Colquitt, MD – Tarrant County Public Health Medical Director

This piece was originally published in the January/February 2022 issue of the Tarrant County Physician. You can read find the full magazine here.


Almost two years into the COVID-19 pandemic, healthcare workers (HCWs) and those who study them are cataloging HCW burnout and compassion fatigue at epic levels. But experts who study HCWs have been describing and attempting to address these phenomena long before anyone could have imagined the impact of COVID-19 on our world and the healthcare systems we inhabit.

Very early in the course of the world’s experience with COVID-19, investigators began to sound alarms about the secondary trauma HCWs may sustain by caring for those infected with the virus. There was concern about HCWs being forced to make decisions about allocation of scarce resources, placing themselves and those they love at risk for infection through their work-related COVID-19 exposure, and having to deliver bad news to patients in person and to their families remotely.  There was also concern about the moral injury caused by the deaths of so many in their care from a disease for which treatments remain somewhat limited. 

Lai et al in JAMA Network was one of the first authors to publish on mental health outcomes of pandemic HCWs in China.1 The paper evaluated 1,257 HCWs in Chinese hospitals with Fever Clinics or COVID-19 wards and found that a large proportion of survey respondents expressed symptoms of depression, anxiety, insomnia, and emotional distress. Their findings supported the need for a range of responses including various psychological support services. 

Later in 2020, researchers in Italy examined “professional quality of life” in the context of the COVID-19 pandemic and sorted 627 subjects into two groups: those caring for COVID-19 patients and those not working with COVID-19 infected patients.2 They found statistically significant differences between HCWs caring for those with COVID-19 and those who were not, and those differences centered around perception of stress, anxiety, and depression as assessed by various scales akin to the PHQ9, a questionnaire designed to identify subjects at high risk for depression. These investigators found higher levels of “stress, burnout, secondary trauma, anxiety, and depression” among HCWs caring for COVID-19 patients, but they found no difference in their survey aimed at assessing “compassion satisfaction” between the two groups.  Compassion satisfaction for these researchers “encompasses positive aspects of working in healthcare” and the embodiment of “empathy and a strong desire to care for those who are suffering.” 

Perhaps most encouraging in the Italian study was the finding that compassion satisfaction among HCWs treating COVID-19 patients allowed these HCWs to use their capacity for empathy and the emotional support they received from coworkers, family, and friends to function effectively during the pandemic without losing hope or a sense of purpose. The Italian study concluded that “the mental health of frontline workers demands more study” to devise preventive and intervention strategies. 

What can such prevention and intervention strategies look like? Mental Health America (MHA) surveyed HCWs with a web-based tool from June to September 2020, and the majority of respondents reported stress, anxiety, and feeling overwhelmed.  They also reported concern about exposing loved ones to COVID-19, as well as emotional and physical exhaustion, inadequate emotional support, and inadequate time and energy to parent effectively.3 The MHA survey respondents included 52 percent with potential COVID-19 exposure at work, 20 percent with no COVID-19 exposure at work, and 28 percent with definite COVID-19 exposure at work.  The majority of MHA survey respondents reported compassion fatigue and only 31 percent reported feelings of gratitude, 28 percent of hope, and 20 percent of pride. In addition, 38 percent of those surveyed reported increased tendencies to smoke, drink alcohol, and/or use drugs. 

MHA has a 24-hour Crisis Line for frontline COVID-19 workers, who can call 1-800-273-TALK (8255) or text “MHA” to 741741 to speak to a trained crisis counselor. 

Now psychologists and other researchers are analyzing the results of these studies and similar data to develop strategies for protecting the mental health and well-being of HCWs and other frontline workers during this pandemic and in future disaster scenarios.  Greenberg et al, writing for BMJ in March of 2020, suggested several strategies, such as adequate staffing and resources.4 This would include providing personal protective equipment and access to mental health services on demand, establishing forums in which staff members at all levels can discuss “the emotional and social challenges” of caring for COVID-19 patients, establishing other channels for peer support, and actively monitoring of the mental health and well-being of all staff.

We have all experienced COVID-19 through individual lenses as HCWs in different settings, but few of us have ever lived through a pandemic of this magnitude. We must work to remain resilient, hopeful, and grateful with help from our peers and friends. 

References

1. Lai, Jianbo et al. “Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 19.” JAMA Network. March 2020. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2763229

2. Trumello, Carmen et al. “Psychological Adjustment of Healthcare Workers in Italy during the COVID-19 Pandemic: Differences in Stress, Anxiety, Depression, Burnout, Secondary Trauma, and Compassion Satisfaction between Frontline and Non-Frontline Professionals.” International Journal of Environmental Research and Public Health. November 12, 2020. Doi: 10.3390/ijerph17228358

3. https://mhanational.org/mental-health-healthcare-workers-covid-19

4. Greenberg, Neil at el. “Managing Mental Health Challenges Faced by Healthcare Workers During COVID-10.” The BMJ. 2020. doi: https://doi.org/10.1136/bmj.m1211

Behavioral Health Resources at JPS

By Allison Howard

JPS has numerous behavioral health clinics that can serve as a valuable tool for physicians struggling to provide patients with access to mental health resources. Through their Outpatient Behavioral Health program, patients can be established with a physician who will be able to address their mental health needs.

To access care, a physician or patient can use the below Outpatient Behavioral Health number to begin the process of enrollment. The Behavioral Health call center is open Monday through Friday 6:30am to 5:00pm; physician callers should press option 3. 

Outpatient Behavioral Health: 817-702-3100

Inpatient Behavioral Health: 817-702-3636

Psychiatric Emergency Center: 817-702-1088

Email: psychinfo@jpshealth.org

The Psychiatric Emergency Center, located at JPS Main Campus at Tower 10, is open 24/7.  Walk-ins are welcome for anyone in need of an immediate psychiatric evaluation. 

Anyone can be referred to JPS. Health insurance is accepted, including many commercial plans, Medicare, Medicaid, and CHIP. If JPS does not accept a patient’s insurance, they can still be seen on a self-pay basis.