Nebraska Doctors Despondent as Preventable COVID Wave Slams State

By Matthew Hansen, Flatwater Free Press

Mark Rupp has grown numb to people telling him he’s wrong, yelling that he doesn’t know what he’s talking about, when he encourages them to get the COVID-19 vaccine. “I have certainly experienced plenty of that,” he says dryly. This is Dr. Mark Rupp, Chief of the Division of Infectious Diseases at the University of Nebraska Medical Center and the medical director for infection control at Nebraska Medicine. Dr. Mark Rupp, author or co-author of 137 scientific papers on infectious diseases, including recent papers titled, “Effect of SARS-CoV-2 mRNA Vaccination in Healthcare Workers” and “The Case of Novel Coronavirus Disease.”

- Dr. Mark Rupp, Chief of the Division of Infectious Diseases at UNMC

“In those situations, I have to just respectfully tell them that the information they have is false and they are making an ill-informed decision,” not to get vaccinated, he says. “I tell them that I’m sorry I’m not going to be able to give them an alternative viewpoint.” Image credit: UNMC

People are coming into Rupp's office and telling him — a nationally-renowned expert on infectious diseases — that he’s dead wrong on the treatment for an infectious disease. These people are his own patients. “In those situations, I have to just respectfully tell them that the information they have is false and they are making an ill-informed decision,” not to get vaccinated, he says. “I tell them that I’m sorry I’m not going to be able to give them an alternative viewpoint.”

It’s a little like a beer-league softball player trying to school Mike Trout on how to hit a 93-mph slider. Or an audience member walking onstage at Carnegie Hall and yanking the cello out of Yo-Yo Ma’s hands to show him how it’s really done. It seems funny, almost, until you hear the hard edge in Rupp’s voice.

“It’s going to cause, it’s already causing, an awful lot of suffering that simply isn’t necessary,” he says. “It’s not necessary. That is the most frustrating, awful part.”

— Dr. Mark Rupp, Chief of the Division of Infectious Diseases at the University of Nebraska Medical Center

Eighteen months into a pandemic and more than nine months after the Pfizer and Moderna vaccines started going into American arms, Nebraska doctors and medical experts cannot quite believe that more of the Nebraska public will not heed their calls to get jabbed. It will keep you from getting severely ill with COVID-19, say doctors who since March 2020 have watched terrified patients gasp for air. It will keep you from dying, say doctors who have notified family members that their father, wife or sister has passed from COVID-19.

“I’m way past burnt out,”

Dr. Andrea Jones, a Nebraska Medicine family medicine physician who has spent much of the past 18 months caring for desperately ill COVID-19 patients. Image credit: UNMC

They note that many people are grasping the severity of the Delta variant, leading to a recent uptick in vaccination. They admit that preexisting problems, like lack of access to and lack of trust in American health care, have hampered vaccination efforts. Still, some days they feel like they are screaming into a black hole. Why can’t the 30 percent of Nebraska adults who remain unvaccinated hear them?

“I tell people I’m crisped. I’m way past burnt out,” says Dr. Andrea Jones, a Nebraska Medicine family medicine physician who has spent much of the past 18 months caring for desperately ill COVID-19 patients. “It’s hard for me to understand why people won’t do the right thing. What’s it going to take for people to do the right thing? “I’m going to be honest. It’s really made me question my faith in humanity.”

Jones says she has been screamed at by hospitalized COVID-19 patients who refuse to believe they have the virus. On other occasions, she has told family members that a patient’s heart is damaged, or their liver is failing, and the patient’s family members have laughed in her face. That’s ridiculous, they say. That can’t be from COVID-19. It can’t make anyone this sick.

“These people are in complete denial,” Jones says. “All I can do is care for them the best I can and move on.”

Moving on seemed easier last year, when no hospitalized Nebraskan had access to a vaccine. Now, it’s hard for Jones and the doctors and nurses around her to ignore that the vast majority of the patients they are intubating and feverishly trying to keep alive are Nebraskans who made the decision not to get vaccinated.

How stark is this vaccinated-unvaccinated divide in hospitals? Bryan Medical Center in Lincoln recently released numbers to illustrate the difference. On Aug. 19, 60 of the 67 Bryan patients hospitalized for COVID-19 were unvaccinated. Sixteen of the 17 patients in intensive care were unvaccinated. Thirteen of the 14 patients on ventilators were unvaccinated. As Jones makes her Nebraska Medicine rounds caring for unvaccinated patients, she catches herself thinking things like “it’s completely your fault that you are here with me right now.”

“Compassion fatigue is real,” the doctor says. Unvaccinated people filling hospital beds “is not fair to other patients, and it’s not fair to us.”

As she grows more frustrated with this reality, Jones has started to urge her patients — the ones who can still speak — to pick up their cell phones. Why don’t you call five of your loved ones and urge them to get vaccinated so they can avoid this fate? A few have taken her up on this suggestion. Most have said no. Jones daydreams about asking her patients to appear in an ad campaign similar to the anti-smoking commercials that showed longtime smokers speaking through voice boxes.

Maybe people need to see video proof of what a COVID-19 patient looks like in intensive care. “It has to be someone who isn’t a doctor in a white coat lecturing you,” Jones says. That, she thinks, is simply not working. The five Nebraska medical professionals interviewed for this story said they have worked hard to infuse empathy into conversations with their unvaccinated regular patients. They have tried to do more listening, less lecturing.

The five Nebraska medical professionals interviewed for this story said they have worked hard to infuse empathy into conversations with their unvaccinated regular patients.

For Dr. Jasmine Marcelin (above with mask), a Nebraska Medicine infectious disease specialist who has planned and participated in vaccine outreach in Omaha, these conversations start with a question. “What do you think about COVID-19 vaccines?” If the patient expresses doubts or says they haven’t been vaccinated, Marcelin asks simple follow ups. “Tell me more,” she says. “Why is that?” The goal is to get her patient to open up about his fears, and then politely offer information that may combat the misinformation that helped form those fears, she says.

It works far better than a speech. But it also takes time, time not always built into the frantic pace of clinic visits. So Marcelin has learned to cut the conversation short when it becomes apparent that her patient doesn’t want to talk. When they would rather argue “it’s simply not worth it,” she says. Rupp and Jones also try to keep the door to vaccination at least cracked, in the hope that a patient might walk through it later.

“Early on, we should have decided that the enemy was the virus, and we could have united with a common goal as citizens, as Americans. Instead, as it rolled out, we decided that the enemy is a mask, or the enemy is a vaccine, and we turned on each other.”

— Panhandle Health Department Director, Kim Engel

In the Nebraska Panhandle, health department director Kim Engel, her staff and hospital partners across the region also hold out hope. The group starts each week with a renewed sense that this week will be better, that the local politician who just came out in support of vaccination will move a few people, and news about the Delta variant will move a few more. Most weeks end in disappointment. Recently, a vaccination clinic in Ogallala, a town just east of the Panhandle Public Health District, had to be canceled after the clinic’s staff received threats.

“It’s almost embarrassing when you step back and realize how many people haven’t been vaccinated. We have so much here. It just makes me so sad.” Eighteen months in, doctors and public health experts are hanging onto any hopeful signs they can find.

For Marcelin, it’s a recent North Omaha pop-up vaccine clinic organized by a group of Benson High School students. The students handed out information at a Lake Street apartment complex where many South Asian immigrants live. In July, the teenagers partnered with Nebraska Medicine and the Douglas County Health Department and showed up with the vaccine. They made it a community day, had games for children and food for adults. Eighty people got their first jabs that day, Marcelin says.

Rupp’s hope is that people will continue to come off the fence, joining the upswing in vaccination that lasted through August and will, he hopes, continue past Labor Day. But the doctor’s hope is hanging by a thread. Because Rupp cannot believe that roughly 1,000 Americans are still dying of COVID-19 each day in the late summer of 2021. They are dying, he knows, because nearly all of them are unvaccinated. “Listen. We have given hundreds of millions of doses now,” he says. “We really understand how effective they are. The only message going out to everyone should be, ‘the data is there, the safety is there, the efficacy is there. Go get your vaccine!’”

“Instead, these continued negative messages circulate so widely, and the truth is I really don’t know how to combat that. It’s like people say, ‘Here’s another positive message, how boring, the vaccine is 95% effective, nah, I’m going to spend my time looking into this conspiracy that Bill Gates is microchipping that vaccine!’”

He pauses to collect himself.

“We’re having an argument where we shouldn’t be arguing,” says Dr. Mark Rupp, nationally known expert on infectious diseases. “Because there simply isn’t any argument.”