Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic

Update #14: Vaccination: Combating Hesitancy and Misinformation

In the current update, the ASRM Coronavirus/COVID-19 Task Force (the “Task Force”) continues to support both vaccination with currently available vaccines for all individuals, including women who are either pregnant or contemplating conception (see Update #11), and continued strict adherence to its earlier recommended mitigation strategies for disease prevention, including use of social distancing, and rigorous attention to hand washing, Personal Protective Equipment (PPE), especially masking, and quarantines when appropriate (see Update #3). In addition, the Task Force is issuing this update to assist reproductive care specialists in counseling their patients and their communities regarding vaccination, including vaccination in pregnancy, and to provide considerations for relaxing restrictions.

Since the last update published on February 22, 2021, the Task Force has observed the following:

• In the past month there has been a plateau in case numbers in the United States (U.S.) from the peak in January 2021. Daily new cases remain at 58,000 per day, similar to case numbers in late October 2020 and the July 2020 peak. Causes for the plateau are likely multifactorial and include the increased prevalence of more contagious variant strains, coupled with relaxation of mask requirements in some states and increased travel. Deaths have declined to 1,100 per day but remain at a high level.
  
  
• To date, the U.S. Food and Drug Administration (FDA) has issued Emergency Use Authorizations (EUAs) for three SARS-CoV-2 vaccines (Pfizer-BioNTech, Moderna, and Johnson & Johnson). Mass vaccination sites have opened, and vaccination continues at 2.5 million inoculations per day. As of mid-March 2021, in the U.S., 74 million individuals have received one dose (23% of the population) and 29 million are fully vaccinated.
  
  
• Emerging evidence suggests that COVID-19 vaccines are not only highly effective in preventing illness and hospitalization but are also effective for the prevention of viral transmission. If current trends continue, the U.S. is likely to reach herd immunity by late June 2021. Despite vaccinations, some countries have experienced taxing surges leading again to shutdowns.
  
  
• While a considerable percentage of older at-risk individuals have been vaccinated, a large portion of younger persons in the U.S. remain at risk for hospitalization and death because other risk factors affect many individuals, such as obesity or pre-existing conditions.
  
  
• In the past month, the U.S. Centers for Disease Control and Prevention (CDC) has issued additional guidance for fully vaccinated individuals, including being able to: a) visit with other fully-vaccinated people indoors without wearing masks or physically distance; b) visit with unvaccinated people from a single household without wearing masks or physically distance, provided they are at low risk for severe COVID-19 disease indoors; and c) refrain from quarantine and testing following a known exposure if asymptomatic. The Task Force emphasizes strict adherence to CDC guidelines and recommendations, including travel.
  
  
• The new SARS-CoV-2 variants identified so far (B.1.1.7, B.1.351, P.1, B.1.427, and B.1.429) are classified as “variants of concern” in the U.S. by the CDC. These are detected by most commonly used tests for the virus. The new variant strains appear more transmissible, but evidence suggests current vaccines remain reasonably effective against the variants. COVID-19 prevention should remain a top priority to reduce the likelihood of the emergence of additional, new SARS-CoV-2 variants. Reproductive care centers should continue to ensure double masking, hand washing, avoidance of crowds, and social distancing.
  
  
• Given the known risks and severity of COVID-19 disease during pregnancy, vaccination of pregnant women or women attempting pregnancy is recommended, including by the World Health Organization (WHO), the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM), and the ASRM, as first recommended by this Task Force.

This update will address issues related to available COVID-19 vaccine efficacy and effectiveness; COVID-19 vaccination and pregnancy; vaccination disparities; vaccination hesitancy and potential strategies to avoid vaccine hesitancy; vaccine misinformation; the critical role of health providers, including reproductive care specialists, in advocating for and educating patients and the public regarding COVID vaccination; clinic policies regarding partners or support persons; learning to live with COVID-19; and managing the continuing negative impact of the pandemic on mental health.

Read the Full Text Recommendations:

• Update #14 - published March, 23, 2021
• Update #13 - published February 22, 2021
• Update #12 - published January 19, 2021
• Update #11 - published December 16, 2020
• Update #10 - published November 17, 2020
• Update #9 - published October 12, 2020
• Update #8 - published September 8, 2020
• Update #7 - published August 10, 2020
• Update #6 - published July 10, 2020
• Update #5 - published June 8, 2020
• Update #4 - published May 11, 2020
• Update #3 - published April 24, 2020
• Update #2 - published April 13, 2020
• Update #1 - published March 30, 2020
• Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic - published March 17, 2020