‘This is a very, very personal topic’: Doctors combating vaccine hesitancy express frustration in caring for unvaccinated COVID patients

As unvaccinated individuals account for the overwhelming majority of COVID-19-related deaths in Ontario, physicians across the Greater Toronto Area are increasingly speaking out about treating unimmunized COVID-positive patients.

While emergency departments and intensive care units across the province are recording fewer cases of the virus, the highly transmissible Delta variant continues to pose a threat - especially to those who are not fully immunized. The variant represents about 74 per cent of new cases in the province, according to Ontario's COVID-19 science advisory table. Based on data by Public Health Ontario, unvaccinated people accounted for 93 per cent of COVID-19 fatalities between Dec. 14, 2020 and June 12, 2021.

Dr. Jennifer Tang, an emergency physician practising in Hamilton, said she asks every patient whether they've received COVID shots, even if they're in the emergency room for a sprained ankle.

Physicians and health-care workers, we're human. We have human feelings," she said. We've had colleagues who've been sick, some of us have gotten ill with COVID ourselves ... For [health-care workers], this is a very, very personal topic."

In recent months, most COVID-positive people Tang has cared for have been unvaccinated, she said.

It's so terribly difficult to see people suffering with symptoms and in some cases deaths that could have been prevented while balancing our own emotions. I feel extreme sadness for them and their families," she said.

Tang keeps discussions supportive and empowering," maintaining a curious attitude rather than making judgments. From speaking to people, she knows they are trying to make choices that are in the best interest of their health, but misinformation may have created some fears and anxiety. The falsehoods can make her feel frustrated, and sometimes angry, she said. But in opening conversations at bedside, she can help dispel vaccine myths.

Sometimes she finds patients are still facing access barriers, like the lack of a secure internet connection or the inability to take time off, and points them to resources. Others say they've delayed their jab, preferring to wait and see" as information - including new side-effects - around vaccines often changes.

If they're not open to the discussion, I respect that. Then I move on, and I continue to take care of them," Tang said. Even if they still decide they don't want to get vaccinated, or they say they don't believe in it, I tell them I hope they change their mind. And I encourage them to speak to their family physician."

The minority are people who generally don't believe in vaccines, Tang said.

Dr. David Carr, an emergency physician at the University Health Network and Mackenzie Health Hospital, echoed the sentiment.

You would assume that everyone who doesn't have the vaccine is a militant anti-vaxxer who's protesting. These are not the cases. For these people, there just hasn't been the knowledge translation," he said.

With the recent success of the vaccine rollout, Carr explained it's become more emotionally challenging to look after unvaccinated COVID patients.

We have tons of resources. We're a wealthy country. It's just hard when people make a conscious decision - on a matter of public health, and safety and altruism - that lets down our population," he said. I always want to treat people the way I would treat my family. I firmly believe in the vaccine; my children are vaccinated."

With the exception of people who are severely allergic to the vaccine, there are very few contraindications that should prevent someone from being immunized, he said. People who are immunocompromised - even if they have cancer or are an organ transplant recipient - should be rushed to the front of the line.

Regardless of a patient's complaint, Carr asks whether they've been vaccinated and teaches his residents to do the same. If the answer is no" and patients are comfortable with a conversation about their decision, Carr asks why. The response is often that they've heard the vaccine can kill you," or that they just don't want it," he said.

It's a wonderful opportunity to intervene, to provide education," Carr said. Almost certainly, by the end of the conversation, they've changed their mind and asked if they can get vaccinated the same day.

It's not like I'm a snake charmer. It's not like I'm selling things. It's that if we spend the time talking to people, they will take it."

A spokesperson for UHN said the health network doesn't have a protocol in place for addressing vaccine misconceptions, and conversations happen individually between doctors and their patients."

While consistent messaging around the advantages of vaccines is important, it's not necessary that the conversations are part of protocol, because they can happen in a variety of settings and nuanced situations, said Maxwell Smith, a bioethicist at Western University and member of Ontario's Vaccine Distribution Task Force.

It can be really frustrating for doctors, especially in Ontario's overwhelmed health system to see people becoming ill with COVID and learning they haven't been vaccinated, he added. But as professionals, managing their counter-transference - a physician's emotional reaction to their patient's past behaviour or circumstances - is not only an obligation, but something they have plenty of experience with, Smith said.

In medical ethics language," non-judgmental regard - caring for patients irrespective of their choices or past decisions - is part of a physician's duty, Smith explained. But that doesn't mean health-care workers shouldn't take opportunities, whether at bedside or in their offices, to promote an understanding of the benefits of being vaccinated, Smith said.

However, those conversations are likely to be more effective if had between a trusted health-care professional and a patient, than in an acute-care setting like an emergency department.

I speak to strangers every day. Imagine if I had a relationship with someone for 25 years of being their doctor, and I advocated for them to get a vaccine. They're much more likely to listen to that person," Carr said.

Dr. Camille Lemieux, chief of family medicine at UHN, said vaccine myths that exist in some communities are often bolstered by social media, eventually becoming entrenched beliefs. For example, some patients have expressed concerns the vaccine causes infertility, and the myth has contributed to their reluctance to get the vaccine, Lemieux said.

You're dealing with fear, entrenched ideas, and things that are very emotion-laden," she said. When we're so tired, it's easy to say ... How can you think like that?' But once you've listened and not judged, people are going to be much more open to trusting you and listening to your perspective."

While health-care workers can feel frustrated with those who haven't been vaccinated, they're skilled at not letting their personal feelings interfere with how they care for patients, Lemieux said.

It's not just the COVID vaccination. There's consistent situations where you just feel a personal frustration, at someone who will not take advantage of something that will only make their health and the health of others better, Lemiuex said, citing smoking and alcohol use as examples. We consistently as professionals have to set aside what we feel."

While emergency departments don't have the capacity to become vaccine clinics, Carr said he would love to see first doses administered to patients upon discharge, as an intervention. As an emergency room physician, he jabs people who have cut themselves with tetanus shots.

I've been a physician for 20 years and I've never seen tetanus. I've seen a ton of COVID, but I don't have that ability to give the COVID shot."

Tang agreed it would be wonderful" if emergency departments had a supply of COVID vaccines to administer to eligible patients, especially for patients who are still facing access barriers.

Smith said it would be unfortunate" if COVID vaccines aren't made available in hospital emergency departments for people who are convinced they want to receive a dose, especially as the province reaches a point in vaccine rollout where targeted strategies are needed to immunize stragglers."

UHN and Hamilton Health Sciences did not answer the Star's questions by deadline about why COVID vaccines are not administered in their emergency departments.

Maria Sarrouh is a Toronto-based staff reporter for the Star. Reach her via email: msarrouh@thestar.ca