I have recently endured a rough week where several of my home hospice teammates came down with COVID. Astonishingly, most were unvaccinated individuals. The teammates consist of a case manager RN, a chaplain, a patient care secretary in the office, and a home health aid. Several hospice patients who were cared for by this team came down with COVID, and one patient died of COVID-related illness.

Failing to achieve herd immunity against COVID-19 has resulted in the appearance of mutant variants, including the most recent and infectious one, the Delta variant, which is infecting large numbers of people across the world and in the U.S., including fully vaccinated individuals in “breakthrough” infections. The victims are generally younger and less vulnerable, due in large part because the U.S. was successful in vaccinating a large proportion of older and more vulnerable members of the population. Fortunately, breakthrough infection victims rarely get very sick and end up in hospitals on the verge of death. Yet hospitals are being overrun, and ER and ICU beds are running dangerously short. Blog posts and news contain numerous reports of exhaustion and compassion fatigue among EM and ICU docs. Make no mistake: the current resurgence of COVID-19 Delta is a disease of the unvaccinated.

So how do those of us in healthcare manage compassion fatigue for the unvaccinated? First of all, we can pray that more unvaccinated people get vaccinated. Vaccination numbers are increasing in large part due to the terror of rising COVID infections in younger, healthier people.

Let’s look again at the groups of people who are generally vaccine hesitant. The first and most astonishing group of vaccine hesitant people are healthcare workers. While 96% of physicians are vaccinated, up to 50% of other healthcare workers, including nurses, CNA’s respiratory techs, pharmacists, medical assistants and hospital administrators, are not. There have already been some landmark court decisions upholding the right for hospitals to require that their employees be vaccinated in order to work in their facility. The courts have held that this principle is a safety issue with respect to the patients for whom they provide care. EMT’s and paramedic personnel are another reservoir of first responders with a relatively high degree of COVID vaccine hesitancy. Atlantic reporter Derek Thompson recently broke down vaccine hesitancy into four categories:

#1) Vaccine dissenters are concerned about taking vaccines in general, no matter what disease they are designed to protect. These people may be unaware or refuse to believe that vaccines have saved more millions of lives during the past century than all other modern medical technology advances combined.

#2) The deliberation crowd wants to wait and see if the vaccines are really safe and are awaiting final approval by the FDA, which in the case of the Pfizer vaccine, has already happened.

#3) Distrust is found among individuals who are skeptical of medical advice coming from the government because of past cultural or community experience with less than honest programs, such as the Tuskegee syphilis treatment experiments.

#4) The indifferent cohort is just not seriously concerned about COVID in their area.

While all healthcare workers join civilian non-healthcare workers in belonging to these above described groups, EMT’s and paramedics have an additional cultural barrier of being risk-takers, which enables them to run into burning buildings and pick up injured and sick victims in safety-compromised settings. Dr. Edwin Leap and others advise that compassionate and sensitive discussions based on friendship and trust among our colleagues is the best way to sway medical healthcare workers who are COVID-vaccine hesitant.

A relatively large proportion of vaccine hesitaters are convinced that their personal freedoms and bodily autonomy are being violated. These people need to be educated and reminded that the health and safety of others trumps enforcing personal freedoms in times of a pandemic when huge numbers of lives and personal health conditions are at stake. Again, these people need to be talked to by their friends, neighbors and colleagues in whom they trust, because the national dialogue has been perverted by misinformation in the public and social media.

Yet we who come down on the right side of these issues must resist frustration, which leads to anger and then depression about those whom we know and love who do not yet believe in the efficacy and safety of mitigating tactics. We must continue to do our jobs without being judgmental towards our non-vaccinated patients, and exercise the opportunity to conduct compassionate and informative discussions with those who trust us who may not yet feel comfortable with COVID vaccination or see the merit in mask wearing or social distancing. ■