A new villain has arrived in the world sponsored by the COVID-19 pandemic. The Omicron variant appeared in South Africa and contains up to 30 different variations, which may give it the ability to spread more efficiently and threaten the effectiveness of protection from our current vaccines. Vaccine scientists and others are working furiously to figure out more about it, and may have to start reconfiguring vaccines to combat it. Meanwhile, COVID surges are occurring in this country in which 60 million vaccine-eligible Americans remain unvaccinated. Worse than this, most of the world continues to experience low vaccine penetration, which prolongs the pandemic and the development of more resistant forms of COVID-19. Please continue to urge friends, family and patients to become vaccinated, and even boosted, as vaccine protection has been found to wane after about 6 months.

While practicing emergency medicine for 32 years, I heard talk from smart doctors and nurses suggesting that the ER was a good place to conduct vaccine clinics and start medical treatment for drug addiction based on the premise that many patients visit the ER on a regular basis because they are disenfranchised from the medical establishment. They are victims of social ills like unemployment, chaos, and transient lifestyles, which prevent them from accessing the conventional outpatient and primary care medical system in this country. I remember thinking at the time that emergency medicine was hard enough to practice for its own sake, and trying to provide primary care and preventive medicine services correctly in the ED would be a daunting Herculean task. A great deal of organization and resources would be necessary to pull this off. Extra consumable supplies, personnel possibly dedicated to this task, geographic space in generally crowded ER’s, and extra medical records keeping power are just a few of the components necessary to conduct these “extra curricular activities” efficiently in the ED.

Yet after reading several articles on these subjects, I found some thoughts expressed by Drs. Anita Sudbury and Gigi Kwik Gronvall in the publication Think Public Health. They point out that 25% of Americans lack primary care physician coverage and 33% of Americans live in pharmacy deserts. There are between 139 and 150 million ER visits annually, with 90% of the patients discharged after their ER visit, and 89 million more patients visiting urgent care centers. They point out that vaccines offered and administered in the ER provide a rapid way to get vaccinated, and that administering vaccines in the ER is not a new concept. Flu vaccines, rabies shots, and tetanus shots have been given in most ER’s for quite a while. The authors believe that offering vaccinations such as COVID would accelerate the pace and expand vaccine access to many medically underserved populations. This process would be welcoming to undocumented people in this country.

The authors point out that ED’s will have to carefully develop plans and systems to track vaccine administration. Accepting unused doses from vaccine clinics will enable ER’s to try and minimize wastage of thawed, but unused vaccine doses. Furthermore, the CDC is urging ED’s and urgent care centers to offer vaccinations before discharge from their respective facilities.

My wife and I have recently returned from a week of adventure and relaxation aboard the 3rd largest cruise ship in the world sailing to the Bahamas and Mexico. The cruise industry is bouncing back from a devastating shut down thanks to the pandemic. Thousands of ships’ officers and crews were stuck on ships, more or less in self-quarantine, feverishly developing safe operating practices strictly in line with CDC guidelines and recommendations while floating aimlessly around Caribbean islands and other world venues, unable to dock safely.

As a result, we felt quite safe even though we cruised with two unvaccinated children. All adult cruisers are required to be vaccinated and show proof of vaccination. All passengers, including unvaccinated children, must show a negative COVID PCR test result two days prior to sailing. In the case of Royal Caribbean, they will accept the results of a Binex quick turn around antigen test performed in front of telehealth witnesses. Crews are tested twice weekly. Unvaccinated children are repeatedly tested by ship personnel. Every crew member wore a mask at all times, and their name badges included their headshots. Guests were required to wear masks in all indoor public areas. Some venues had separate areas set aside for unvaccinated guests, such as the dining room and theater. You could see abundantly smiling faces and genuine gratitude displayed by each crew member. A great time was had by all.

In closing, I find it strangely ironic if not distressing that our state is so against vaccine and mask mandates when the result of such measures is to make everyone safer. Just look at the cruise industry: thousands of passengers on our ship joined us in having great and safe fun while being vaccinated and wearing masks. ■