Readers and tweeters dispense timely advice for difficult times

Reviewed by Emily Henderson, B.Sc.Mar 2 2021

How to explain vaccines to people who resist them

Here is an attempt to write something that might convince people who resist getting vaccinations ("Vaccine Hesitancy vs. Vaccine Refusal: Nursing Home Staffers Say There's a Difference," Feb. 9).

Your body’s immune system has produced antibodies that will kill a few thousand kinds of germs and virus. Since you are alive, the chances are quite high you will survive its producing another. Here is how the system works. The vaccine contains cells that are a harmless model of the germ or virus that feels like the one it prepares your body to fight when it invades your body. And, except when we had a president running for election who pushed producing one to increase his chances of winning, we only go to the trouble of making vaccines if the infection it fights has a high chance of killing you. If you did not have these vaccine-produced antibodies, your body would wait until the germ or virus actually invades your body to start building antibodies. Then a race begins, the invaders are trying to eat as much of you as possible and your immune system starts building antibodies to fight it. Who wins? If you die, the invader did. If you live, your immune system did. If you got your shot, the invaders are confronted by an army of antibodies that start killing them immediately and your immune system's chances of winning are several thousand times better.

— James H. Gundlach, professor emeritus of sociology, Auburn University, Auburn, Alabama

— Amanda Bergson-Shilcock, Philadelphia

Communication is an essential medical skill

The recent article "Amid Covid Health Worker Shortage, Foreign-Trained Professionals Sit on Sidelines" (Jan. 25) lacked in-depth research. With 30 years of experience in the health care field, most of it as a hospital CEO, I can relate multiple stories of foreign-trained physicians who lacked the skills necessary to practice in this country. Why? In many cases, it was the inability to communicate with patients and staff, both verbally and in writing.

The author of this article gives slight attention to this issue, rather concentrating on years of training and education. While these are obviously critical, if the physician cannot communicate effectively to those he or she deals with, patients and staff alike, care given to patients suffers — regardless of whether it has to do with injections, surgeries or day-to-day patient care.

— Richard Butler, Grants Pass, Oregon

— Zoe Barber, Albany, New York

Lab workers are essential, too

I have never contacted a news outlet on an article before. But the article "With Demand Far Exceeding Supply, It Matters That People Are Jumping the Vaccine Line" (Feb. 2) was shared in a medical laboratory group on Facebook that I belong to. And, yes, I am a medical laboratory scientist and have been in the field since December 1999.

This whole covid pandemic has taken a toll on our field. First, it has increased our workload while fewer people are coming into the field. We still have blood to cross-match, hematology smears and blood counts to perform, coagulation checks to determine that the proper amount of blood thinners are given, urinalysis tests to do and microbiology specimens to examine to see what types of bacteria are growing in whatever body part has an infection, along with which antibiotic will treat it. Now we have covid samples to process — a lot of them.

When you handle covid samples and perform the test so that nurses/doctors can know if their patients have it then you are very essential. I have no idea why the author of this article threw my profession in with administrators, public relations staff and board members. It is highly offensive. Who does she think performs the oodles of tests that must be done?

Laboratory scientists' numbers are dwindling, and we work so hard and mostly short-staffed. Just this past month I worked 56-60 hours each week on my feet and every week in January. I work overtime at my full-time job during the week and then go to my second job, which is a busy hospital, where I work 13 hours every Saturday. I am burnt out and I know others are too. This article stung. Thanks for your time.

— Michelette D. Lewis Baldie, Fayetteville, North Carolina

— Jamie Townsend, San Diego

To quote KHN Editor-in-Chief Elisabeth Rosenthal’s article: “But many hospitals interpreted the recommendation broadly, inoculating their entire staff — public relations departments, administrators, programmers, laboratory scientists and, sometimes, their boards. They offered vaccines to psychiatrists who were seeing their patients on Zoom. They vaccinated radiologists who were reading films at home. Some of those immunized were at the upper end of the medical income totem pole, people who had sat out the pandemic at country homes.”

Inclusion of the laboratory scientists who are processing covid samples and reporting covid test results in the group that has little exposure to patients is incorrect. The laboratory performs phlebotomy directly on patients, accepts the biohazard samples and handles, processes and tests those samples — but you’re considering them as low-priority vaccinations. Every hospital I work with includes lab staff in its front-line worker vaccination program. And I assure you that the salary range for laboratory scientists doesn’t put them in the top tier of the totem pole or allow them to sit in their “country homes.” This line is insulting to those who work in the lab, which has been one of the most stressed areas of health care in the past year.

— Mark Tiemeyer, O'Fallon, Missouri

— Emmy Ganos, Philadelphia

Time to breathe easier?

With covid-19 cases surging and hospital capacity dwindling, you rightly point out that the nation's oxygen supply chain is being stretched to the limit ("In Los Angeles and Beyond, Oxygen Is the Latest Covid Bottleneck," Jan. 7). Given unprecedented demand and a global shortage of critical supplies including oxygen concentrators, the severe pressures in the market pose tremendous risks to some of the country's most vulnerable patients.

The problem isn't confined to hospitals; more than 1 million Americans who need respiratory care at home are also potentially compromised because of these supply shortages in some markets. For those with serious illnesses like COPD or ALS, home respiratory care is vital for improving quality of life, maintaining independence and preventing hospitalizations.

Unfortunately, historical federal reimbursement policies unwittingly have led to this crisis. Previous rounds of Medicare's competitive bidding program utilized an extremely complex methodology that forced suppliers to accept reimbursement rates far below the cost of providing service. As a result, many suppliers left the Medicare program, while many manufacturers of oxygen equipment stopped production and halted efforts to innovate treatment options. While Medicare has rightly paused Round 2021 of the competitive bidding program, which would have required suppliers who did not win the bidding process to stop supplying patients in competitive bidding areas, the lingering damage from previous policies is exacerbating the crisis. Further reducing capacity of oxygen equipment during the pandemic would have been devastating.

The Biden administration has the opportunity to address the shortage by finalizing the CY 2021 proposed rule, which will expand the blended rate for respiratory care products into noncompetitive bidding areas, and appropriately eliminate outdated budget neutrality requirements — a major step forward to ensuring patient access in rural America. Medicare could also help by maintaining the streamlined documentation requirements to minimize paperwork that have helped hospitals, physicians and other practitioners maximize resources for patient care.

Oxygen remains an essential tool in the treatment arsenal for combating the pandemic. We need to ensure a steady supply of oxygen for patients in the home, which, in turn, helps to reduce the tremendous surge in hospitals' capacity. The respiratory care sector is eager to collaborate with the Biden team to implement policies that will ensure Americans' continued access to home oxygen.

— Crispin Teufel, chairman of the Council for Quality Respiratory Care, Washington, D.C.

— Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, New York City

— Erin Miller, Denver

Accentuating the miraculous

I am a retired physician. I was appalled by this article ("College Tuition Sparked a Mental Health Crisis. Then the Hefty Hospital Bill Arrived," Feb. 26). To me, a fundamental issue was not addressed. Was the care appropriate? We do not know what the subject told the therapist, but if the therapist thought this person was at significant risk of suicide, referral to a hospital was probably appropriate. The patient’s impression that the care in the hospital was not helpful was presented as the last word without comment. Maybe the care was helpful.

Can you imagine what a health care provider would experience if a patient mentioning suicidal thoughts was sent home and then took their own life? Health care providers must deal with “diagnostic uncertainty” every day. The press should not minimize the challenge of lack of certainty in the delivery of health care, particularly a question of whether a person is truly suicidal. Because of confidentiality issues, any such accounts of the medical care are one-sided (the patient's view). The reporter should make an effort to get an independent observer to address the generic medical situation before publicly presenting the account.

The real issue of this situation was the impersonal automatic billing procedures, and the financial difficulty individuals encounter in our health delivery system. The “miracles” of this case — no terrible outcome (no suicide), insurance reducing a $50,000 charge to a $3,413 bill for a weeklong hospital stay, and handling that bill by getting the right person on the phone — should have been highlighted rather than handled as afterthoughts.

— Dr. Robert Alter, Chicago

— Rebecca Gourevitch, Cambridge, Massachusetts

The art of sacrifice

Another reason to compare death tolls from World War II to covid-19 ("Comparing Death Tolls From Covid to Past Wars Is Fraught," Feb. 5) is to emphasize the idea of shared sacrifice — provide a basis for comparison of what they are being asked to sacrifice with what those before them have been asked to sacrifice. To generations with no sense of shared sacrifice, wearing a piece of cloth for a year is a vast sacrifice. Many in the boomer generation have never sacrificed anything that’s not part of their careers. I spent 10 years working with WWII vets in the VA but was never was in the military. To many non-military medical patients, the idea of a mask as a sacrifice is LOL. Consider the hoary old conservative, with a sense of shared history (I am a Democrat) and the image of society as a three-stranded cord: past, present and future.

— Robert Murphree, Norman, Oklahoma

— Fifi Larouche, Van Nuys, California

Maintaining journalistic distance

One of the topics discussed during the podcast episode "KHN's 'What the Health?': Open Enrollment, One More Time" (Feb. 18) was Gov. Andrew Cuomo’s decision to send covid patients to nursing homes. KHN's Julie Rovner seemingly defended the governor, saying it’s hard to make decisions in times when we don’t know much (e.g., we didn’t know the impact on seniors at the time of this directive). Three counterpoints to that: Everyone knew that elderly people were susceptible to this virus based on what was happening in Italy and Asia; Florida’s governor allowed nursing homes to reject referrals of patients who had the virus; and the Navy’s hospital ship docked at New York’s Pier 90 five days after Cuomo’s directive that hospitals refer covid patients to nursing homes. I’m fairly confident that Cuomo knew that this ship was coming and chose not to use it to manage hospital capacity issues.

This defense of Gov. Cuomo is unfounded and can only suggest political bias in KHN’s reporting. Very, very disappointing.

— Laureen Boll, Denver

— Rita Numerof, St. Louis