COVID Redux in the Wound Center

In my suburban hospital, there are 75 COVID-19 patients hospitalized right now, 72 of whom are unvaccinated. While I know you can do the math, that means 96% of patients hospitalized with COVID at my institution are unvaccinated. The 3 vaccinated patients in the hospital are doing great and will be discharged.

The unvaccinated patients are not doing great. Three of the unvaccinated patients are on extracorporeal membrane oxygenation (ECMO), meaning their lungs are so bad that a machine is oxygenating their blood outside their body. The husband of a friend of mine just died from the Delta variant. Last year he contracted COVID pneumonia and recovered. He chose not to get vaccinated and this year died of COVID. I have heard a lot of talk about the fact a few vaccinated people have still gotten COVID—and not as much talk about the many people who have suffered from COVID infections more than once.

In other words, the “natural immunity” after infection doesn’t protect a person from getting COVID-19 again. You have a better shot at immunity with the vaccine.
 
Once again, COVID-19 is dominating my life as a wound care doctor. There are some positive changes in my clinic, such as having family members or caregivers attend patient visits via the FaceTime app, doing more phone follow-ups, and wearing face shields. I am also checking every patient’s vitamin D level. It’s not only vital for wound healing—the majority of COVID-19 deaths are linked to low vitamin D. And hospital discharge planning is finally remembering to send the ICU survivors with pressure ulcers to the wound clinic.
 
The downside is that patient volumes still have to be kept down (to reduce the risk of transmission), and that affects the livelihood of the staff—including me. I need another doctor to work in the clinic, but with revenue down, how can we recruit anyone?

My one unvaccinated staff member is out with COVID. I’m tired of trying to communicate with elderly, hard-of-hearing patients through a mask. We can’t get supplies in a timely way, and I never know from day to day what we will be out of. Elective surgeries have been cancelled again and a lot of wound center patients need elective procedures. The hospital administration is stretched to the max, as are hospital beds. The hospital is struggling financially so there’s no possibility we will get the new equipment we need. Prior authorization processes for insurance are slow.
 
Some of my friends have decided not to get vaccinated, in part because they are afraid of vaccine side effects and in part because they don’t want to be told what to do. I hear a few hospital staff members who say they will quit if COVID-19 vaccination becomes mandatory. I, too, have an independent spirit—but I still wear my seatbelt, have car insurance, and pay my taxes. I don’t rebel against things just because I have to do them. Like taxes, death is also inevitable—but I’d rather not die of COVID. The risks of the vaccine are minor compared to the risks of a COVID infection—and given how contagious the Delta variant is—I am pretty sure my unvaccinated friends are going to get COVID, and spin the wheel of fortune on their lives. In a world of evil, all we can do is pick the lesser of the evils.
 
There are battles on so many fronts. I just want to take care of patients with wounds, but it’s getting harder and harder to do that.

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Caroline E. Fife is Chief Medical Officer at Intellicure Inc., The Woodlands, TX; executive director of the U.S. Wound Registry; medical director of St. Luke’s Wound Clinic, The Woodlands; and co-chair of the Alliance of Wound Care Stakeholders.