“Can I get through the next 6 hours alive? If I can, maybe I can get through 6 hours after that.”
These were the thoughts running through the mind of Mike Policastro, MD, medical director for the Loveland-Symmes (OH) Fire Department, as he lay in the ICU, battling COVID-19. At this point, he says, the doctors told him there was nothing else they could do. Policastro, who also serves in the military, is 46 years old and healthy, with no underlying medical conditions. Yet 2 months later, he is still battling the effects of the virus.
Policastro shared his message on a webinar hosted by the International Association of Fire Chiefs designed to share information about the COVID-19 vaccine—or as webinar moderator Deputy Chief Billy Goldfeder put it, “Firefighters talking to firefighters, just trying to get out the facts so you can make an informed decision.”
In addition to underscoring the severity of the disease, the webinar presenters tackled many questions about the vaccine and what it means for firefighters and other first responders.
Mixed Reactions Among First Responders
A September 2020 poll by EMS1 found that only 24% of respondents would willingly get a COVID-19 vaccine, with another 12% saying they would do so if it was mandated by their employer. That compared with about 60% that said they would get a flu shot. Certainly, the timing of the poll could be a factor. As vaccine rollout has begun and additional information become available, we could expect the number of first responders willing to get the vaccine voluntarily to go up. A more recent poll from FireRescue1 showed a similar percentage of respondents intending to get vaccinated, but nearly a quarter had already received the vaccine.
“We are very sure this is going to be as safe as any vaccine we’ve ever had.”
Information will be key to helping first responders understand the importance of getting vaccinated, but it can only go so far. On the webinar, FDNY Captain Frank Leto explained that the department had conducted a proactive vaccine education campaign, including information disseminated by medical doctors, the chief of the department and the commissioner. “About 50% of our firefighters/EMTs are accepting the vaccine, and about 58% of our officers,” he says. While those numbers are a big increase from the EMS1 poll, Leto notes, “Even with the education, about half the members aren’t taking the vaccine.”
Reasons for not getting vaccinated vary, of course, but Leto points out one big factor could be that nearly half the department’s members have already tested positive for COVID-19. He says the vaccination rates are similar to the percentage of firefighters getting their annual flu shot.
COVID-19 Vaccine Safety
Naturally, a new vaccine brings safety concerns, and for many individuals, these are compounded by the lightning-fast pace of the vaccine development and rollout.
“This was a rushed vaccine—the development was very fast—but in a good way,” says Sara Jahnke , PhD, of the Center for Fire, Rescue & EMS Health Research and another webinar presenter. She relayed several factors that helped speed the development:
- An unprecedented $9 billion investment, which enabled manufacturers to prepare for mass production well before the vaccine was approved. Normally, manufacturers do not ramp up for production until approval is secured, but the investment took away the risk.
- Collaboration among scientists—“This was the shining example of what can be done in science,” Jahnke says. Medical journals fast-tracked research findings and removed firewalls that normally slow the spread of information.
- The slow evolution of the virus combined with a high rate of transmission, which makes it easier to develop test groups.
The COVID-19 vaccine is “very, very effective,” Jahnke says. “You don’t need to be a statistician” to understand the effectiveness.
Other webinar presenters, including Policastro and James Augustine, MD, National Director of Prehospital Strategy for US Acute Care Solutions and a member of the IAFC Coronavirus Task Force, stressed the safety of the vaccine and worked to clear up common misconceptions, including:
- The vaccine is made of mRNA, sugar and fat.
- No fetal tissue was used to produce the vaccine.
- The vaccine does not change or destroy ovarian tissue.
- mRNA does not engage with DNA or change any components of the cell. “It hijacks the cell to get it to make a spike protein,” Policastro says.
- Scientists believe the vaccine is safe for women who are pregnant and breast feeding, but no largescale testing has been conducted on these populations yet. “They are not requiring a negative pregnancy test to get the vaccine,” Augustine says.
Augustine acknowledged he had concerns about the vaccine when it was first being developed, too. But his research has left him convinced of its safety. “I’m part of a group of about 3,000 physicians and nurses [studying the vaccine],” he says. “We are very sure this is going to be as safe as any vaccine we’ve ever had. You cannot get the disease from the mRNA in the vaccine. That’s absolutely, 100% clear.”
The webinar presenters also tackled a few questions firefighters and first responders commonly voice about the COVID-19 vaccine.
Should first responders who have contracted COVID-19 get the vaccine? Augustine says yes, but advises waiting at least 90 days because the vaccine will likely be less effective if delivered in the 90 days following infection. This is especially important for firefighters and EMS professionals who have received monocloval antibody treatments (e.g., Regeneron). Policastro notes there is some evidence that people who have had moderate to severe COVID tend to have more vaccine side effects, such as a high fever and severe body aches. He experienced symptoms following his vaccination but felt the risk/benefit ratio was securely on the side of the getting vaccinated.
“For some reason we [act like] the virus doesn’t exist within the walls of the fire station—masks come off for meals, training, etc. Until everyone has the vaccine, we have to protect ourselves and our families.”
Will the vaccine work against the latest variants of the virus? “The vaccine is still 95% effective on all known mutations,” Policastro says. “In the future, if the spike proteins change, that could change. But it doesn’t seem to be the case.”
Does getting the vaccine mean first responders can’t spread COVID-19? “This vaccine is protecting the individual. There’s very little information about decline in spread. It may be reduced, but that’s not clear yet. So it’s preventing harm to the individual,” Policastro says. Leto stressed this is an area fire service leaders will need to continue education. “We’re doing a very good job of protecting ourselves on calls, masking up and keeping distance,” he says. “Where we’re getting sick is in the firehouse. For some reason we don’t think the virus exists within the walls of the fire station—masks come off for meals, training, etc. Until everyone has the vaccine, we have to protect ourselves and our families.”
Because the vaccine was rolled out so quickly, we can expect new developments to come quickly as well. Augustine predicts people will eventually be able to choose their preferred vaccine. He expects two more versions of the vaccine to be approved in the next month or so and notes there are 120 COVID-19 vaccine candidates in various stages of development across the globe.
Continuous data collection will help inform public health actions. Vaccine recipients have the option of downloading an app where they can report adverse reactions, future COVID-19 infections and other details. “The CDC is picking up this information and releasing it much quicker,” Augustine says. “That will help us suggest who gets which vaccine” and further tailor the rollout.
“We have never been in a pandemic where there are multiple vaccines available,” Augustine says. “Six months from now, there may be an oral or nasal spray. And it’s at that point where we can talk about mandating the COVID-19 vaccine for first responders—much like measles, tetanus and hepatitis. “
Until that happens, getting the COVID-19 vaccination will be a personal decision for first responders. Augustine encourages firefighters to consider the implications not only for themselves but their fellow crewmembers. “If you’re vaccinated, you may get the privilege to travel” for training or other department business. If there’s a COVID exposure, “you won’t have to quarantine—which at this point isn’t always paid. And if your entire company is vaccinated, you can all take your masks off in the station.”
Add to that, you won’t have to fear the possibility of lying in the ICU, wondering if you can get through the next 6 hours.