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GP When a super-spreadable virus meets a super-spreader event like Christmas we need to pause

Our GP details how the booster programme is set to work via GP practices and advises readers to step up and get the shots.

LAST UPDATE | 16 Dec 2021

PATIENTS WILL NOT be abandoned. General Practice is not closed. A national ‘Call to Arms’ to GPs and their staff was issued this week by the State. The target is to help booster vaccinate 1.5 million people by New Year. Patients who need to be seen during the Holiday season, will be. All those who want to, may not.

The General Practice system is temporarily refocusing from routine deferrable conditions towards the massive booster vaccine drive. It is inevitable that minor self-manageable illness, routine self-resolving coughs and colds and important but routine appointments will struggle to get seen in daytime services.

However, urgent cases will be looked after. Prescriptions will still get issued. Weight loss, blood loss, chest pains and mental health will still get prioritised. The annual New Year’s health check or the curiosity blood test will all get done by Paddy’s Day instead of Valentines Day. The sickest will continue to be treated.

Why is this happening?

This extraordinary reorientation of General Practice is being driven by the utter speed at which the Omicron variant replicates and spreads. The latest evidence shows that it replicates inside the windpipes 70 times faster than Delta, and was four times as good at infecting cells than other variants.

Whether it ends up causing as much disease in humans (which is different to infection) remains to be seen. Some evidence suggests it is 10 times less efficient at multiplying in lung tissue. The more the lung is damaged the worse the condition is, short and long term, for the patient.

Even if Omicron pans out to be a less severe illness for one, the fact it spreads like wildfire means more of the total population will end up badly affected by it. A smaller percentage of people getting seriously unwell is still a larger absolute number if applied to a vastly bigger grouping.

When a suped-up super-spreadable virus meets a suped-up super-spreader event like an Irish Christmas it is wise to pause, pre-empt and plan against the worst. Booster shots are a huge part of that strategy.

Irish Christmases are special for most of us. Be it Granny at the kitchen table, Grainne at the bar table or a gaggle load of mates at the races, we super mix at Christmas and New Years. It’s human nature. It is good for us. After the hard and harrowing last two years, it is probably necessary for our headspaces.

Therefore, taking sensible precautions, maximising our ventilation and boosting our immune systems made sense. This is what General Practice, alongside Mass Vaccine Centres, is reorganising to do over the Holiday Season. Its inevitable Omicron will wash over more of us

How are practices vaccinating?

As varied as each of our Christmas experiences are, so too are our local General Practices. There is no one way of getting your shot there. Rather there is your local way of getting it. Many practices, like mine, operate a self-service online booking system.

Here patient cohorts can book, cancel, rebook vaccine appointments at their convenience. We will do what most practices are planning: see patients as normal, but restrict afternoon appointments on days we vaccinate. GPs are experts at managing balances and competing demands.

The overriding clinical imperative to vaccinate as many as possible as soon as possible will be balanced with the need to keep seeing the sickest of patients. In areas where few of the population have had access to boosters, GP practices will need more time to catch up with their communities. In other communities, especially older ones, many have been done already.

Some practices will call their patients, or text them where they have a mobile contact. Others will Facebook the message or spread it by local WhatsApp groups. Some will run walk-in clinics. Each practice is set up differently, so will run the program differently.

What all Practices share in common is an inability to manage the complex balancing act of seeing enough patients while vaccinating rapidly, if people flood the phone lines with queries. The old way of ringing the surgery with your question doesn’t work if two thousand other people all do the same at the same time.

Who should get a vaccine?

Anyone who is three months or more from their 2nd dose of Pfizer or AstraZeneca should book in for a booster. If you got a Jansen single-dose vaccine you should immediately book in for a booster vaccine.

Pfizer is the main vaccine for boosters in Ireland and the only one being used in General Practices. While GPs will be working down the age groups and risk groups, everybody is encouraged to come forward for a booster shot over the next three weeks. Practices are mixed in their demographics and some will be vaccinating many groups on the same days, just at different times.

The national health imperative over the holiday season is for as many people as eligible to come forward and give their immune system the boost we need to minimise the risk Omicron poses to us all.

Will the Booster make me sick for Christmas?

Pfizer booster is very well tolerated. Many people who get Pfizer feel little or nothing. Some people get a very sore arm for 24 hours. Paracetamol or Nurofen help it settle. Overnight fatigue is uncommon but can happen. Many younger people who got AstraZeneca or Jansen experienced days of feeling pretty miserable but that shouldn’t be expected with this Booster.

Nobody should defer getting the Booster for fear of ruining Christmas Day. A false saving of the turkey dinner could lead to regrets on a cold January day.

What to do to get a vaccine

Check your practice’s website if they have one. Look in your practice windows if that’s how they share information. Ask your neighbours have they heard how their local doctor is doing things. Come forward if offered an appointment. Cancel your booking if you can’t come.

Covid vaccines are in vials of six doses. Unlike the flu vaccine which keeps if you can’t make your appointment, an uncancelled slot wastes a booster dose. It deprives somebody else of their chance. That somebody’s granny or cousin or at-risk mates might have avoided an illness if that cancellation had been made.

What we do most affects ourselves. However, it impacts on family and friends too. It ripples powerfully onto people unknown to us. Getting a booster as soon as it’s available to you is the right thing to do.

A cancer or transplant or appendicitis patient might find that a bed is available for them because somebody unknown to them stepped up, came forward and took the jab. It’s a quick thing to do. It costs nothing. It might be of more value than you could ever know.

Dr Maitiu Ó Faoláin is a GP with Deerpark Medical Centre in Ashbourne, Co. Meath. He is a GP Trainer with the Royal College of Surgeons in Ireland.

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Dr Maitiu Ó Faoláin
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