Ask An NP: Prof. Apple on COVID Vaccines, Virginia's New 'Standing Orders,' & What It Means for VA
Assistant professor Ashley Apple, the Virginia Nurses Association’s commissioner on government relations and a family nurse practitioner who works in pediatric urgent care, on what we need to know about COVID vaccines, the virus, and why now might be the best time for Virginians to get our shots for fall.
The pandemic’s over, but COVID is still circulating. What do we need to know?
“The pandemic is over in a technical sense, meaning we’re no longer in the midst of a crisis, but COVID is endemic now, which means it’s here, and it’s staying.
“You might remember that when COVID first emerged, it was a lower respiratory illness. As the virus evolved, it’s become more of an upper respiratory illness, which is a little less dangerous in large part because we have good vaccines and people in the general public got them. But people absolutely still die from COVID. Some people experience Long COVID, which comes with prolonged symptoms and complications, so it’s still important to prevent.
“Just like other respiratory illnesses, you’re more likely to get it when in close proximity to others. While we see rates of respiratory illnesses decline in the summer, given that we’re spending more time outside, with the fall, kids are back in the classroom and people are moving indoors. We know we’ll see spikes of COVID infections this fall and winter. And while we’re no longer in a pandemic, COVID is still here, and it makes some people quite sick.”
Is there anything new about this fall’s COVID vaccines?
“The new shots are same kind of COVID vaccines most folks remember. The MRNA vaccine is one, and there’s another vaccine that’s protein-based, more traditional, but which tends to be less effective. It’s updated and creates an immune response to the variants currently circulating.
“With the COVID shot, there really aren’t a lot of true medical contraindications. For the majority of us, it’s safe and effective, and the benefits outweigh the risks.”
What’s the best timing to get the COVID shot?
“Now! I plan to get my shot now for two reasons: One, we’re in the fall season, we’re moving inside, and the holidays are approaching, and that’s really when we see spikes in infection – and two, I have an underlying medical condition that puts me at higher risk. We also see flu spikes in January and February, so it’s good to consider pairing the COVID vaccine with the flu vaccine, too."
“On Sept. 10, the Virginia Department of Health commissioner issued a standing order, so Virginians 65 or older, and adults ages 18 to 64 with an underlying condition or risk factor, no longer need a prescription to get a COVID vaccine. With the stroke of a pen, they solved what was a real problem for adults."
Assistant professor Ashley Apple, Virginia Nurses Association commissioner on government relations
Will private insurance, Medicare, or Medicaid pay for a COVID shot?
"While the FDA has approved the vaccine for those age 65 and older, as well as adults 18 to 64 with an underlying medical condition, there's a possible regulatory barrier that's forthcoming that could impact whether patients are reimbursed for the COVID vaccine.
"The American Council on Immunization Practices (ACIP) will soon meet to make a list of who should get the vaccines, which influences whether insurance companies pay for them. Should the ACIP not recommend the COVID vaccine, insurers might opt not to cover them because they're not on the approved list . . . which means that those who want to get the vaccine might have to pay out of pocket.
“That’s a big problem for most people. Right now, the price of the COVID vaccine is high, with an out-of-pocket cost of more than $220 at some Virginia pharmacies."
What does Virginia’s new standing order do specific to COVID vaccines?
“Vaccines started to arrive in pharmacies around the country in September of this year, but you needed a prescription to get one, which, in most cases, created a lot of confusion. State laws determine whether or not pharmacists can administer vaccines, and under what circumstances. Virginia law only allows pharmacists to administer a vaccine without a prescription when that vaccine has been approved by the ACIP. That meant that all patients needed a prescription to receive the vaccine in Virginia.
“On Sept. 10, the Virginia Department of Health commissioner issued a standing order, so Virginians 65 or older, and adults ages 18 to 64 with an underlying condition or risk factor, no longer need a prescription to get a COVID vaccine. With the stroke of a pen, they solved what was a real problem for adults.
"Right now, both children and adults without an underlying prescription still require a prescription to receive the vaccine."
How do you talk to patients and families about vaccination as a nurse practitioner?
“I encourage people to get vaccinated against COVID and, frankly, share that I’m a supporter of people getting all vaccines because they help you and they help others. Even though I don’t administer a lot of vaccines because I work in pediatric urgent care, I see patients on the other end, when they come in sick with COVID or the flu, so I often ask about vaccine status, because it’s important to know.
“Over the last four or so years, I’ve seen growing numbers of unvaccinated children in our practice. That’s a problem, because we’re also seeing growing numbers of vaccine-preventable illnesses, like measles and pertussis. It used to be exceedingly rare to see kids who haven’t been vaccinated at all, but now, it’s common to see kids who are either fully or partially unvaccinated. It’s a direct result of the politics of science surrounding vaccines. And it has real, tangible consequences.
“Anytime I have a patient that comes in who’s unvaccinated, I feel the situation out, see how receptive I think they might be talking about it, and then I try to have that talk. I know people often feel uncertain, but I share what I know, and what I do, and hope that that helps.
“‘This is what I do for my children,’ I tell people. ‘They get the COVID and flu vaccines each year.’ I understand the science behind vaccines and feel completely comfortable and confident in what they have to offer. I don’t confront people but try to provide good guidance and not jeopardize the patient-provider relationship. My hope is that they ultimately will feel the same as I do.”
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Ask an NP is a regular feature from UVA School of Nursing that features faculty experts on a range of clinical topics. The series supports the School of Nursing's 10-year Strategic Plan, Our Extraordinary Future, and goals 2 ("Co-Create and enhance partnership to improve health and healthcare") and 4 ("Cultivate trust and equity in all that we do.")