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FAQ: The COVID-19 Vaccine and Migrant, Immigrant, and Food & Farm Worker Patients

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FAQ: The COVID-19 Vaccine and Migrant, Immigrant, and Food and Farm Worker Patients

Migrant Clinicians Network continues to receive questions from our clinical network on COVID-19 vaccines for their migrant, immigrant, and farmworker communities. While vaccines are available for all in the US, ages 12 and up, in reality, COVID-19 vaccines remain inaccessible for many people, for a variety of reasons, including fear over immigration status and misinformation. The dynamic situation does not belie the underlying mantra: everybody deserves a chance to get vaccinated against COVID-19. We encourage our constituents to continue to strongly and vocally advocate for the most underserved populations, who have frequently found themselves deemed “essential workers” in this pandemic while they remain among the most at risk of illness. 

This FAQ was last revised September 13, 2021. Information and data are changing rapidly. For more updated information, please visit our blog: www.migrantclinician.org/blog.

 



What should I tell patients about the Mu variant? What about the Lambda variant?

Information on newer variants of COVID-19 is just beginning to come in. As of September 13, Mu and Lambda are both circulating in the US, but the dominant variant continues to be Delta. Regardless of the variant, our tools to fight against COVID-19 remain the same: Vaccination is critical and efforts need to continue to make it fully accessible, with education and conversation available in the language of the patient to answer their questions and build trust. In the workplace, vaccination needs to be matched by ventilation, sanitation, personal protective equipment like respirators, and physical distancing efforts. 



 

A community member asked me about Ivermectin to treat COVID-19. What should I say in response? 

Unfortunately, a lot of misinformation/disinformation about Ivermectin is circulating on the internet, claiming that it is an effective cure for COVID-19. Here are some basic facts to share:

  • Ivermectin is primarily a deworming medicine for animals. It has limited use for humans, against a number of health concerns like worms, lice, and onchocerciasis. It is not approved for use in humans against COVID-19.

  • The reason it isn’t approved for use in humans against COVID-19 is because there is insufficient evidence that it works against COVID-19.

  • One of the largest clinical trials to assess whether Ivermectin is effective against COVID-19 was halted because it was showing no benefit over placebo, according to the New York Times.

  • One of the journal articles that purportedly demonstrated benefit was retracted.

  • The NIH reported on each of the completed studies, their findings, and their limitations, on their COVID-19 Treatment Guidelines page. The panel reviewing the findings determined that “There is insufficient evidence for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of COVID-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of COVID-19.”

  • Some people are getting sick from using Ivermectin. Calls to Poison Control for Ivermectin have increased significantly. Side effects include dizziness, pruritis, nausea, and diarrhea.

  • Remind patients how science works: that if well-conducted clinical trials show any indication that a drug works against COVID-19, that will be headline news. Such trials would be followed by additional studies to confirm its effectiveness and study side effects. In this way, scientists gather sufficient data to make sure a drug is both effective and safe for use. Unfortunately, at present, the clinical trials that have been completed have significant limitations, and most do not show positive benefits of Ivermectin. Consequently, we continue to lack sufficient data to show that Ivermectin works against COVID-19 and cannot recommend it. 


More resources:

FDA’s Why You Should Not Use Ivermectin to Treat or Prevent COVID-19

AMA, APhA, ASHP Call for Immediate End to Prescribing, Dispensing, and Use of Ivermectin to Prevent or Treat COVID-19 Outside Clinical Trials




Considering that the flu didn’t circulate much last year, should I still recommend a flu shot? 

Yes. All patients aged six months and older are encouraged to get the flu vaccine. It is very important that community members are given culturally competent information on how and why to get it. 

As hospitals and intensive care units continue to be filled with COVID-19 patients, it becomes urgently important that community members are protected as much as possible from the flu to reduce the likelihood of overwhelmed hospital systems.

This lifesaving vaccine can protect those like young children and the elderly who die every year from influenza. It is worth noting that, with children back to school and many people back at work, our day-to-day situation is quite different than during last year’s flu season. The pandemic is not a good reason to skip the flu shot.




What is different about the flu vaccine this year? What about COVID and the flu? 

The CDC’s new guidance for the flu shot highlights some changes. Clinicians are encouraged to review the CDC's guidance in its entirety. All patients aged 6 months and older are encouraged to get the flu vaccine.

For those who have COVID-19: At present, there are no data to inform optimal timing of influenza vaccination for vaccine effectiveness in persons with COVID-19 or who are recovering from COVID-19, according to the CDC. Patients without contraindications or allergies are encouraged to get both the COVID-19 and flu vaccines as soon as possible to protect themselves, their families, and their communities.

For those who wish to get the COVID-19 vaccine and the flu vaccine: It is safe to administer a COVID-19 vaccine and a flu shot on the same day. However, patients may wish to space the two vaccines apart by two weeks, to better manage common side effects.

 


 

Who should get a third dose/booster shot? 

As of August 24th, the CDC recommends that people who are moderately to severely immunocompromised should receive an additional dose of an mRNA COVID-19 vaccine after the initial two doses, because they are at a higher risk of serious prolonged illness, and may not build the same level of immunity as the general population with just two doses. The CDC outlines who they consider moderately or severely immunocompromised.

The CDC has also indicated that others who received two doses of Moderna or Pfizer should get a third dose, administered eight months after their second dose. Roll-out for third doses is expected to begin at the end of September. As of August 24th, there is insufficient data to determine whether a booster dose will be recommended for recipients of the J&J vaccine.

It is critical to continue to voice that initial vaccinations with two doses of mRNA remain very highly effective against severe disease, hospitalizations, and death. More than 99% of COVID-19 deaths as of late August 2021 are among those who are unvaccinated. The recommendation for a single booster shot follows data that indicate that a booster may lessen the risk of breakthrough infection. Getting initially vaccinated remains critically important to prevent severe disease, hospitalizations, and deaths.

Some vulnerable populations like migrants, immigrants, and refugees continue to want to get a vaccine but cannot, because of fear of exposing documentation status, lack of transportation, lack of educational materials in the language of their choice, etc. It is critical that clinics, health departments, and other vaccine provision locations continue to connect with the most vulnerable in their communities to facilitate initial vaccine access.

Worldwide vaccine access is highly inequitable. Outside of the US, many frontline providers lack access to a first dose, leaving them at high risk for infection. Additionally, oxygen supplies are hard to secure and/or transport throughout the Global South, leaving those with severe disease without access to a lifesaving intervention. Efforts like www.peoplesvaccine.org are working to address this ongoing health injustice by pushing for better worldwide access to first doses while we in the US begin the path to third doses. 

Remember that our understanding of the effectiveness of the vaccines over time continues to develop as we receive more data, and, consequently, recommendations may change. Please continue to check back here for updates and from other trusted news sources like the CDC.

 


 

What does the approval of the Pfizer vaccine mean for migrants, immigrants, and refugees?

 

In late August, the Pfizer vaccine received full approval from the FDA for patients ages 16 and up. Emergency Use Authorizations remain in effect for the Moderna and J&J vaccines, as well as for Pfizer for patients ages 12 to 15.  These vaccine manufacturers, however, are in process to receive full approval from the FDA.

Many people expressed hesitancy to get the vaccine because of its lack of full FDA approval. This may prompt new conversations with patients. The FDA’s approval further establishes the Pfizer vaccine’s efficacy and safety.

Full approval paves the way for vaccine mandates, which may be issued for vaccines that are not under emergency use authorization. MCN supports vaccine mandates as long as they are accompanied by efforts to implement them in an equitable way and are preceded by strategies to mitigate the spread in the workplace and keep workers safe. It is worth noting that many workers in the US, including many food and farmworkers, still lack access to COVID-19 vaccines because of numerous barriers, including lack of culturally relevant and low-literacy information and education in the language of their choice. 



 

Is it safe for a person to get vaccinated during pregnancy, while breastfeeding, or when planning to get pregnant?

As of late August, more than 139,000 pregnant people have been vaccinated against COVID-19. Of that cohort, no unexpected pregnancy or fetal problems have occurred. There have been no reports of any increased risk of pregnancy loss, growth problems, or birth defects. As a reminder, the COVID-19 vaccines are not live vaccines, and pregnant women and their babies cannot get COVID-19 from the vaccine. It is also believed that some immunity is conferred by the vaccinated mother to the newborn.

With this data, the CDC has recommended vaccination for pregnant women as of August 2021. 

You can read more about pregnancy outcomes on this August 2021 study: Characteristics and Outcomes of Women With COVID-19 Giving Birth at US Academic Centers During the COVID-19 Pandemic.

 


 

How do I talk to women who are pregnant or breastfeeding about getting vaccinated? 

Women who are pregnant or breastfeeding will have many questions and hesitancies because of their concern over the health of their babies. It is very important to share with pregnant women why it is so critical for them to get vaccinated.

Women who get COVID-19 during pregnancy:

  • Are three times more likely to need ICU care;
  • Are two to three times more likely to need advanced life support and a breathing tube;
  • Have a small increased risk of dying from COVID-19;
  • May be at an increased risk of stillbirth and preterm birth;
  • May pass antibodies to their babies.

 

It is worth pointing out that COVID causes hypoxia (lack of sufficient oxygen) and hypoxia so severe that it requires ICU care or advanced life support for a pregnant mother is dangerous for a developing fetus. The COVID-19 vaccine is the best way to protect the fetus and the mother from serious disease, hospitalization, and death.

When encountering resistance from pregnant women:

  • Build trust with women over time.
  • Listen with respect. Show empathy and support: “I understand your concerns and it’s good that you’re being careful regarding the health of your baby. It is important to protect your baby.”
  • Then provide the facts: “These studies provide evidence that this vaccine is a way to protect your baby.”
  • Tell stories, about other patients, about your own COVID-19 vaccination, or about colleagues or friends, that may be relevant. 
  • If the patient remains concerned, ask them to talk with another trusted source like a doctor or midwife.
  • It may take more than one conversation to help a mother through hesitancy.

 


 

What special concerns should I be looking for among migrants, immigrants, and refugees? 

Frontline clinicians are reporting that some patients, particularly otherwise young and healthy patients, who are very or severely ill with COVID-19 have been found to have uncontrolled and undiagnosed diabetes. Diabetes remains a serious health concern among migrant, immigrant, and refugee communities, who lack access to health care and oftentimes struggle to implement and maintain strategies for healthy living. Clinicians who serve these populations are encouraged to increase outreach to these communities and screen patients for diabetes. Read more about diabetes and access resources on MCN’s Diabetes page.   



 

What if a patient who has received both COVID-19 vaccine shots has been exposed to COVID-19? Is quarantine required?

 

In July 2021, the CDC revised its recommendations for a vaccinated patient who has been exposed to COVID-19.The CDC now recommends that such a patient get tested for COVID-19 three to five days after exposure, but does not have to quarantine. This is a change from their previous recommendation and is in response to breakthrough infections from the Delta variant. As with other questions in this FAQ, conditions are changing rapidly so please continue to check back for changes.   



 

What is considered a breakthrough case?

A breakthrough case is a positive COVID-19 case that occurs two weeks or more after the last dose of the COVID-19 vaccine is administered. This case may be symptomatic or asymptomatic. The CDC states: “Vaccine breakthrough cases are expected. COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control. However no vaccines are 100% effective at preventing illness. There will be a small percentage of people who are fully vaccinated who still get sick, are hospitalized, or die from COVID-19.” As of August 2021, in most cases of breakthrough infection, symptoms have been mild and have not required hospitalization or ended in death. It is important to note that as more people are fully vaccinated, it is natural to expect a rise in the number of fully vaccinated people who are hospitalized – especially those who were already immunocompromised. 




Should vaccinated patients get a COVID-19 test if experiencing symptoms?

Yes. Vaccinated patients who are experiencing symptoms in line with COVID-19 infection, including but not limited to fever, chills, cough, shortness of breath, fatigue, headache, and loss of smell or taste, should seek a COVID-19 test.  

If a vaccinated patient has a known exposure, the patient does not have to quarantine, but should get tested three to five days after exposure. Read more on the CDC’s Quarantine page.  



 

Why is the Delta variant concerning? Does the variant change the efficacy of the vaccines?

The science around the vaccine and COVID-19 variants is moving quickly. The Delta variant, which is causing spikes in cases around the world and the United States, is dangerous because it is highly transmissible. The Delta variant is about 50% more contagious than the Alpha variant, which was first identified in the UK. The Alpha variant was already 50% more contagious than the original COVID-19 strain, first identified in China in 2019.

With Delta, the difference is that the infected person will make many more copies of the virus, at a faster rate, which makes it easier to spread. A study in China found that people infected with the Delta variant carry 1,000 times more virus in their noses compared with the original version. In the United States, which has experienced more COVID-19 cases and deaths than any other country, the Delta variant represents about 83% of new infections, as of late July. So far, unvaccinated people represent nearly 97% of severe cases.

New research points to continued high effectivity of vaccines against the Delta variant – around 79 percent protection among people vaccinated with two doses of Pfizer, according to recent research in the Lancet. Researchers from Public Health England found protection against the Delta variant with two doses of Pfizer was around 88 percent. While these figures are lower than the protection the vaccine provided against other variants, the protection is still remarkably high. As mentioned above, almost 97% of people with severe cases from the Delta variant are unvaccinated. The vaccines are still highly effective against severe disease, hospitalization, and death.  That means that patients’ best protection from the Delta variant is vaccination.

 


 

What do I do if a patient is partially vaccinated with a non-FDA approved vaccine, like AstraZeneca or Synovax?

Some migrant patients are arriving in the US with partial vaccination. AstraZeneca and Synovax are two vaccines that are not available in the US, but are widely used in other countries. Both require two vaccinations. If a patient arrives with documentation indicating only one vaccination of the two has been administered, MCN recommends the following.

For migrant women between the ages of 18 and 60, and if Pfizer or Moderna are available, MCN recommends that the patient begin the Pfizer or Moderna two-shot series. (Learn more about why MCN recommends this here.)

For migrant women over the age of 60 and migrant men of any age, MCN recommends the administration of one dose of J&J if available. 

Read the CDC’s recommendations here.


 


 

What do I tell a patient about post-vaccination mask wearing and distance?

It's very important that vaccinated people continue to wear masks and maintain physical distance in public. As of July 27, 2021, the CDC again recommends that vaccinated individuals in areas with high COVID-19 transmission wear masks when in indoor public spaces. Vaccinated individuals may contract the virus in some rare cases (see the question about “breakthrough cases,” below.) Most COVID-19 cases among vaccinated individuals are mild and do not require hospitalization. However, these individuals can still spread the virus to unvaccinated people, who now make up about 97% of severe cases, hospitalizations, and deaths. Additionally, the continued spreading of the virus is dangerous for everyone – vaccinated and unvaccinated alike – as it may result in new and more dangerous variants.




How do I talk to my migrant patients about the Johnson & Johnson/Janssen (J&J) vaccine?

Migrant Clinicians Network recommends the J&J vaccine to male migrant patients as well as female migrant patients over the age of 60. (Please see the next question for more.) If a patient was already feeling hesitant toward vaccinations, the pause on this vaccine that occurred in April 2021 and the July 2021 FDA addition of a warning around Guillain-Barre syndrome may worry patients and further their hesitation.

  • Validate patients’ concerns. Reassure them that it is normal to have such concerns.

  • Update patients if needed on the CDC and FDA’s decision to make the pause and to resume the distribution and use of the J&J.

  • Make sure all their questions are answered to the best of your ability.

  • Be honest about the unknowns.

  • Point out the benefits of the pause and the warning. 

    • Efficacy of public health and vaccine safety systems.
      • On the pause: “The public health authorities were able to track six people out of 6.8 million as of April 2021 who had an adverse outcome, one to three weeks after the J&J vaccination. This is a very rare reaction, affecting much less than one percent of those who received the vaccine.”

      • On the warning: “Public health authorities reviewed reports of about 100 out of 13 million people as of July 2021 who have received the J&J vaccination. Most were reported in older men, about two weeks after vaccination. This, too, is a very rare reaction, also affecting far less than one percent of those who received the vaccine. The increase in Guillain-Barré after vaccination is similar to the increase seen after the seasonal flu shot. The shingles vaccine may also increase the risk of the syndrome.”

      • On the system’s effectivity: “It is remarkable that the systems could pick up such a small percentage of adverse reactions.”

  • Migrant women require specific considerations. See the following question.

 



Should migrant women take the J&J vaccine?

MCN recommends that migrant women between 18 and 60 avoid the J&J if an alternative (Pfizer or Moderna) is available. This eliminates the risk of TTS, as both Pfizer and Moderna, as mRNA vaccines, do not share the same vaccine mechanisms as the J&J or AstraZeneca that have the TTS risk. Migrant women in particular have serious barriers to access health care, including transportation, language barriers, work limitations, rural and isolated locations, and limited integration into their new communities to understand health care options. These barriers may make access to emergency care needed for TTS even more difficult.

Most cases of TTS have been seen in women between 18 and 49, with a small number in women between ages 50 and 58. In an abundance of caution, MCN is recommending the avoidance of J&J for migrant women up to age 60.

If a migrant woman prefers the J&J or if the J&J is the only vaccine available, make sure the patient knows the signs and symptoms of TTS and typical window of onset of symptoms.

For women 58 and over and for men of any age, MCN recommends to get vaccinated with the vaccine that is available in their area, whenever they first have the opportunity to do so. Do not delay vaccination.

Read more about these recommendations on Johnson & Johnson COVID-19 Vaccine: Care for Migrant Women Requires Adjusted Approach.

 



How do I respond to my patients’ basic questions about the safety of vaccines?

This critical basic question is very important to answer fully, with respect and patience, and in a culturally competent manner. 

It is important to remember that some vulnerable populations who would best benefit from the COVID-19 vaccine are also the populations that have been grossly mistreated historically during vaccine trials or forced into state-sponsored medical procedures without consent.  The racist underpinnings of our public health systems continue to traumatize our patients today.

Some basic points to consider:

  • Since its release, almost 50 percent of the US population, including millions of health care workers, leading scientists, politicians, and community leaders, have received the shot themselves. Many of your doctors, nurses, and health care staff, those who work tirelessly to care for you, have taken the shots to protect themselves and in turn their communities, showing another vote of confidence in the safety of the vaccines.

  • Like all vaccinations, there is a risk of minor side effects, most commonly pain at the site of injection, fatigue, muscle or joint pain, and headaches, all of which clear up in a matter of days.

  • The J&J vaccine may cause a very rare but serious effect of cerebral venous sinus thrombosis combined with thrombocytopenia. (See the first question in this FAQ.) 

  • Side effects remain very low, while the risk of developing severe disease and death without the protection of the vaccine continues to be high. 
Practical Resources from MCN

 Other Resources



My patient has concerns about having their teenager get vaccinated. What resources do you recommend?

Hesitancy around vaccination for children can be approached in a similar way to hesitation for the self. Spend time listening to the parent’s concerns; reflect back and validate those concerns without judgment; ask questions to get specific about their concerns; provide the information we have and be up front about the information we don’t have; provide an open and safe space for discussion.

For many parents – including many who have been vaccinated themselves – the vaccine still seems too new. Some have heard misinformation about the vaccines potentially affecting fertility (of which there is no evidence); others are concerned that the vaccine may result in myocarditis in adolescent boys. Hearing out their specific concerns, affirming their concerns, and providing the evidence we have that point to the safety of available vaccines is a start. Then, reaffirming why vaccination is important in the family and community – to protect the abuelos from hospitalization, to prevent more deaths in the community, to ensure that school, prom, and hangouts with friends aren’t interrupted again – can help reframe the conversation in a positive light. 

  



Many places are requiring parents to be present when children receive their vaccinations. This is posing a barrier to many of my immigrant and migrant patients who need to work. What suggestions do you have to address this?

Rules vary greatly according to state, and some states are changing their laws because of the COVID-19 vaccines. Presently, medical consent laws in 40 states require parental approval for children under 18 to receive a vaccine. Some states are moving to reduce barriers for teens to receive COVID-19 shots; others are pushing for greater stringency to block teens from acting without parental consent. Additionally, some counties have their own consent laws that override state laws. The website vaxteen.org provides guidance on minor consent laws by state and by county if applicable. The website also offers materials to help teens discuss vaccination with their parents.  We recommend that clinicians check their states’ laws to determine whether parent presence is required.

In areas where parents are required to be present, some parents encounter a barrier to vaccination. Many health centers and health departments are offering after-hours and weekend clinics to increase access to COVID-19 vaccines. If your patient is unable to attend available vaccination clinics, it is likely that that patient is not the only one in the community with limited access. It is highly recommended to coordinate vaccination clinics that cater to the needs of the migrant and immigrant community, taking into account work schedules, mobility, language and cultural barriers, and fear of immigration status. Mobile vaccination clinics that go to farmworker housing, and pop-up clinics in popular locations like grocery stores, flea markets, and churches, are critical avenues to increase access. Culturally relevant vaccination materials are also important. (See “Practical Resources from MCN” below for materials.) 

  



When will farmworkers or other essential workers get access to a vaccine?

Thousands of farmworkers around the country have already received their vaccine where they have been prioritized. In other areas, vaccines remain inaccessible to workers who encounter barriers (including technological, linguistic, transportation, and work-related) to schedule an appointment and/or to attend a vaccine appointment.     

  • Farmworkers need your continued advocacy. Clinicians need to loudly and regularly speak up on behalf of their patients. Make connections, stay informed of when vaccinations are arriving, insert yourself into the discussions on distribution, communicate regularly with the larger farmworker community.

  • Encourage essential workers to keep checking in with your local community health center and/or health department, as localized distribution is rapidly changing.

  • Develop a health center team to coordinate vaccination for farmworkers and other essential workers. Create a detailed workplan and workflow to clearly prepare for all aspects of vaccinations, from paperwork burdens to appointment confirmations to the vaccination provision itself. Include community advocates. Be prepared for poor distribution communication and interruptions in deliveries by preparing and executing a transparent communication plan with essential workers, that anticipates the many bumps and hiccups in vaccine provision and distribution. Build in flexibility and contingency plans when possible, recognizing the changes in farmworker populations as the seasons progress.




The Moderna and Pfizer-BioNTech vaccines require two shots. What if a patient is moving? Should the patient wait to get the one-shot vaccine when/if it is again available, or to get a two-shot vaccine in the next location?

Due to ongoing limited supply, we recommend that farmworkers get vaccinated when they have the opportunity to do so.  Encourage your patient to take a photo of the vaccination card and to send that photo to a family member or trusted person, so that if the card is lost (or even the phone), there is evidence of the first dose of vaccination.
If a patient isn’t sure if they can make a second appointment, sign them up with Health Network.  Migrant Clinicians Network operates Health Network, a virtual case management system that assists migrants with ongoing health needs in finding health care at their next destination. Clinicians are strongly encouraged to enroll patients who may need to migrate before they can receive the second vaccination. After enrollment, a Health Network Associate will follow up with the patient and assist in finding a health facility in the migrant’s next location so the patient can access the correct second dose. Health Network’s services are without cost to the health facilities or patients.

We recommend that farmworkers get vaccinated when they have the opportunity to do so. Encourage your patient to take a photo of the vaccination card and to send that photo to a family member or trusted person, so that if the card is lost (or even the phone), there is evidence of the first dose of vaccination.

If a patient isn’t sure if they can make a second appointment, sign them up with Health Network.  Migrant Clinicians Network operates Health Network, a virtual case management system that assists migrants with ongoing health needs in finding health care at their next destination. Clinicians are strongly encouraged to enroll patients who may need to migrate before they can receive the second vaccination. After enrollment, a Health Network Associate will follow up with the patient and assist in finding a health facility in the migrant’s next location so the patient can access the correct second dose. Health Network’s services are without cost to the health facilities or patients.

Learn more about Health Network here:
https://www.migrantclinician.org/services/network.html

Learn more about Health Network enrollment here:
https://www.migrantclinician.org/services/network/enrollment-in-health-network.html 

Contact Theressa Lyons-Clampitt for more information: tylons@migrantclinician.org.




What patients should I be particularly concerned about?

Migrant patients encounter numerous and overlapping barriers to accessing health care. This results in some migrants experiencing ongoing health concerns that go unaddressed. Some of these health concerns, including asthma and diabetes, increase the patients’ risk of severe COVID-19 disease, if they become infected with the virus. Indeed, clinicians in our network have encountered the results of unaddressed diabetes in the hospital. “If I have a seemingly healthy young person in the ICU with COVID-19, more often than not, they have an underlying but unaddressed concern like uncontrolled diabetes. One patient’s A1c was 13 – and I had to tell him, ‘you’re not just struggling with COVID-19. You have diabetes,’” said Laszlo Madaras, MD, MPH, MCN’s Chief Medical Officer.

More than ever, outreach workers, community health workers, and other clinicians working closely within migrant and immigrant communities need to reach out to community members who may be overlooked and make sure their underlying health needs are being met.

Read more about the link between diabetes and severe COVID-19 on this FAQ from the American Diabetes Association.

Utilize MCN’s low literacy Spanish language comic book, available to print and download: Mi salud es mi tesoro.  

 




What if a patient who has received one shot of the Pfizer or Moderna (and therefore is only partially vaccinated) has contracted COVID-19?

Patients who fall ill after their first vaccination must follow all precautions as those without any vaccination: get tested and isolate while waiting for results. After recovering from COVID, patients should discuss the timing of the introduction of the second dose with their physician. A second vaccination sooner than 90 days after infection may give increased side effects, compared to severity of side effects in those who did not contract COVID-19 after the first vaccination.




If a patient had COVID-19, do they still need to be vaccinated?

The CDC notes that patients who have had COVID-19 (and therefore have antibodies) should wait 90 days from the end of their infection before receiving a COVID-19 vaccine. Read more about why in this Health article.

The CDC recommends that after those 90 days, a patient who has recovered from COVID-19 should receive the full vaccine amount, meaning two shots of the Moderna or Pfizer, or one shot of the J&J.




What do I do if my patient has lost the vaccination card?

Patients who say they have already received a vaccine but do not have evidence may need assistance in contacting the location of their vaccination to verify their vaccination status – social workers and outreach workers may be helpful here. If the patient has migrated since they got vaccinated, determine any details the patient remembers – location, time and date, type of vaccination – and contact the vaccination site. Each location has a different process in terms of recording and providing vaccine records to the local health department. Each state has a vaccination registry that contains records of all vaccinations provided in the state. Depending on the location, the patient’s information may already be registered with the state. The CDC’s Immunization Information Systems gives contact information for each state here.




Should a patient get a mammogram after getting the COVID-19 vaccine?

It is recommended to wait at least two weeks after the provision of a COVID-19 vaccine before receiving a mammogram or other diagnostic imaging exam. This is because the COVID-19 vaccines may cause swollen lymph nodes, which may be interpreted as cancer in such imaging exams. Read more here. As a precaution, if the patient is not migrating and can delay the imaging exam, clinicians may recommend that the patient wait six to ten weeks after the second COVID-19 dose. If a patient needs to move before that six to ten week period is over, clinicians can enroll the patient in Health Network, and we can assist in guiding the patient in the new health system in their next location to schedule a mammogram or other diagnostic imaging exam. 




What do I do if my patient or my patient’s community is encountering misinformation about the vaccine?

Patients are concerned about the safety of the vaccine and much misinformation is circulating around. Help the patient understand the safety of the vaccine and how to deconstruct conflicting or confusing health messages that may be misinformation through our interactive guide, “Deconstructing Health Misinformation”.




How can I help my fellow clinicians be informed?

It is clear that some clinicians continue to be concerned about the safety of the COVID-19 vaccines – not just the larger community. Considering the speed of their development and the limited communication efforts, this hesitancy is expected. Thousands of clinicians – many within our network – have shared their COVID-19 vaccination selfies on social media, many with notes on their elation of having the opportunity to be vaccinated. This message is important for both clinical colleagues and the larger community to see. Sharing clinician-centered resources to better inform colleagues may also help ameliorate concerns:

Resources

Q&A: What PCPs Need to Know about COVID-19 Vaccines, article co-written by MCN’s Chief Medical Officer, Laszlo Madaras, MD, MPH

CHA Healthcare’s video, COVID Primer for Primary Care

The New Vaccines, Attitudes Toward Vaccination, and the Biden COVID-19 Task Force, Grand Rounds from UCSF

CDC’s Clinical Resources for Each COVID-19 Vaccine

 



How can I keep track of vaccination in my region?

Vaccination dashboards are developing. Resources vary in each community. Here are some early national resources:

Resources

Johns Hopkins provides a vaccine dashboard: https://coronavirus.jhu.edu/vaccines

MCN is part of a new initiative, Resilient American Communities, which is just getting off the ground and will be a resource to watch: https://resilientamericancommunities.org/




Other Resources

MCN has upcoming online seminars specifically on COVID-19 vaccinations. Watch our Upcoming Webinars page for registration when new seminars are announced: https://www.migrantclinician.org/trainings.html

 

 

 

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