I got my COVID-19 vaccine last month. Sitting in the waiting area for the required 15 minutes of medical observation, I took a vaccine selfie to send to my parents. I looked around, and everyone else was doing the same.
But those 15 minutes of mandatory monitoring can be a valuable opportunity to do far greater things than scrolling social media. Yo-Yo Ma may have thrilled a waiting room with an impromptu cello concert, but some health-care professionals are thinking bigger:
Detecting atrial fibrillation
Atrial fibrillation (AF) is the most common heart rhythm disturbance, affecting 200,000 Canadians. AF can lead to fatal AF-related strokes – often more devastating than other types of strokes. While we can easily treat AF with blood thinners, the problem is that many people living with AF have no symptoms at all. Blood thinners can’t help AF if it is undiagnosed. This has preoccupied Trudie Lobban, founder and CEO of Heart Arrhythmia Alliance, for decades. Her pursuit of mobile technology to detect AF on the go has led to the creation of an opportunistic AF detection program at vaccination sites in London, England.
“When you arrive at the clinic, you give your name, consent to the vaccine and then are asked if you consent to also having your heart checked for AF. Everyone says yes,” says Lobban. “While the nurse is taking 30 seconds to draw up the vaccine in the syringe, you take 30 seconds to place two fingers on a sanitized one-lead electrocardiogram (ECG), such as the AliveCor, to record your heart rhythm.”
The recorder confirms if the heart rhythm is normal or if AF is suspected. If suspected, ECG results are printed or sent directly to the person’s family doctor so that it can be properly diagnosed and treated. In some centres, a family doctor is on site and can prescribe blood thinners then and there.
One of Lobban’s volunteers has screened 817 people and detected unknown AF in 73 of them – that is 73 potential strokes, and possible deaths, avoided. The program has only been running for about a month and has since expanded to South Carolina and has received interest from Monaco. Discussions with Canadian collaborators have started.
Screening for chronic illness could extend to blood pressure checks for hypertension or blood glucose finger pricks for diabetes, among other things. These would be especially valuable during a time when many people have not had face-time with their clinician in over a year. However, Lobban has advice for anyone inserting screening into the vaccination system.
“The point is not to delay the vaccine and to keep a quick clinic flow. We can’t lose time. We can’t have a shopping list of things to screen for. While there are so many good things we could do in the vaccine clinic, there isn’t time. Pick something simple and efficient.”
Connecting on social needs
Andrew Boozary, a social medicine doctor in Toronto, tweets an idea of his own: “If we’re going to put people through long consent forms before the vaccine, let’s be sure there’s an opportunity to ask/provide connection to social supports (food insecurity, income, rent, etc.) and primary care access while together.”
Another support includes safety for those experiencing intimate partner violence. Especially with stay-at-home orders, domestic violence rates have increased significantly during the pandemic and continue to rise. Camilla Parpia, a second-year medical student at University of Toronto, has been in discussions with emergency medicine doctors in Toronto on implementing safety screenings.
“You may have heard about the posters on stall doors in women’s bathrooms at bars, since women are disproportionately affected, on ways to alert the bartender if they need help in seeking safety from the person they are with,” says Parpia. “We are now thinking that COVID-19 vaccine clinics could be a wonderful way to screen for violence and offer support for these women.”
Parpia says women could use a code word or signal to alert vaccine staff that they need support in escaping violence and could be connected to an on-site social worker or helped with resources, such as helplines to obtain a bed at a women’s shelter.
Selecting emergency contacts
“While registering my 70-plus-year-old dad at the COVID-19 vaccine clinic, I was struck when they asked me if I was his emergency contact,” says Ruby Shankar, a Toronto health-care ethicist working on complex and urgent health-care decisions with clinicians and families.
Many patients have an emergency contact who they trust to be available in an emergency, like a family member, friend or neighbour. “But what many patients do not know is that this person doesn’t automatically become their appointed SDM (substitute decision maker) to make difficult decisions on their behalf should they not be able to make decisions for themselves,” says Shankar.
Many patients do not know or understand the SDM hierarchy in the Substitute Decisions Act. This becomes even more relevant and important during a pandemic.
“As we continue to grapple with the pandemic, the distinctions between emergency contact and SDM become vital. The need for advance care planning heightens in times of a pandemic when the notion of an emergency takes on a whole new meaning.”
Shankar says the 15-minute waiting period post-vaccine is an opportunity to distribute information about the distinction between emergency contact and SDM and have people take time to think about who they may want advocating for them in the future.
Raising awareness on organ donations
Making decisions on life-saving situations is also on Allison Hunt’s mind. Hunt, the CEO of Hatch Research, donated her left kidney to a complete stranger.
Hunt had offered to donate her kidney to a sick male neighbour but he eventually declined. But Allison had all the paperwork done and, after some research, learned she could donate to a complete stranger. So she did.
Through the process, Hunt met health-care workers who, before her, had never encountered a living donation to a stranger in their time working in the hospital. “It made it seem like climbing Mount Everest was a common thing compared to living organ donation,” says Hunt. She realized that people simply did not know they could donate to a stranger.
“Living donors give to those they love. Deceased donors give to people they don’t know. How do we get living donors to give to people they don’t know?” asks Hunt. How about starting in a COVID-19 vaccine clinic?
The 15-minute waiting period could be used to ask people a simple question, she says: “Are you a blood donor?” If no, provide them with a pamphlet on blood and organ donation. If yes, initiate a conversation on donating to strangers, and if they know they can donate a kidney or piece of their liver.
“It’s a bit of a niche but it could be a really good thing for some people,” she says.
Second dose provides second chance
While Canada does not have any established programs like Lobban’s yet – and we may have missed our screening opportunity for the first vaccine dose – millions of people are coming back for their second dose in a few months. We could be ready for it.
“You have people who are already taking their health in their own hands by getting a vaccine,” says Parpia. “There are lots of ways that we can help people who are ready to be helped.”
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