As of this week, every Idahoan over the age of 16 is eligible to get the COVID-19 vaccine. But the question remains: Will enough eligible people agree to get the optional vaccine in order for us to reach herd immunity? Idaho Matters talks with two Idaho physicians about vaccine hesitancy, and how to encourage more people to access the shots after a year of studying their effects.
- Dr. Meghan McInerney, ICU Medical Director at Saint Alphonsus Regional Medical Center
- Dr. David Pate, former CEO of St. Luke's Health System and a member of the governor's coronavirus task force
Gemma Gaudette: You are listening to Idaho Matters, I'm Gemma Gaudette as we continue to live with COVID-19, we should note that every Idahoan, 16 years and older is now eligible for a vaccine. Now, we know that many of you still have questions and concerns around the virus as well as the vaccine. And that is why we continue to bring in medical experts every week to answer your questions. So if you do have a question for our doctor, send us an email now, Idaho Matters at Boise state dot edu. And we will do our very best to get those questions answered this hour. So joining us today, Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, as well as Dr. Meghan McInerney, ICU medical director at St. Alphonsus Regional Medical Center. Good to have you both with us today.
Gaudette: So I want to start with some news regarding the AstraZeneca vaccine. British authorities today recommended that the AstraZeneca vaccine not be given to adults who are under 30 whenever possible, whenever possible, because of strengthening evidence that the shot may be linked to rare blood clots. So, Dr. Pate, can you talk a little bit about this? I know, you know, we have talked about the AstraZeneca vaccine before having some issues. But we should also say that, you know, medical experts still say getting the AstraZeneca vaccine is better than not getting a vaccine at all.
Dr. David Pate: Yeah, I think that's right. Let me also clarify a couple of points for listeners. First of all, the AstraZeneca vaccine is not offered in the United States. So please don't worry about the vaccines that are here and available to Americans. Second is that we have whatever may be going on with the AstraZeneca vaccine. We have administered millions of doses of the approved vaccines here in the United States and we have not seen this problem. So so now to the AstraZeneca vaccine. You know, the first thing is it is often very difficult when you are vaccinating very large populations of people to sort out what is actually being caused by the vaccine versus what happens anyway. And and so, you know, the problem is that people get blood clots all the time. And certainly Dr. McInerney and I have treated people with blood clots long before COVID or COVID vaccines. So the real question is, is the vaccine causing an increased risk for blood clots or for that is some blood clots of special concern. And I haven't seen the data. Obviously, these European regulators are looking at some data. I hope that they release the data.
Pate: Certainly, if the FDA ever considers approving AstraZeneca for use here in the United States, of course, we don't actually need it. We now in the United States have enough of the current vaccines that that's not a pressing need for us. But I know the FDA will take this into consideration. I would say that this the question is still not answered to most people's satisfaction, but it's because of that very fact that there is not an obvious connection that still, given there is great evidence that that vaccine prevents people from dying from COVID and from getting very sick. So obviously that is still the main benefit. And for those countries that have been offering AstraZeneca, we're certainly glad they're getting those people vaccinated. We don't want anybody to get a blood clot, but we do know how to treat that if they do. And so I think we just need to wait for more data. But it is not a concern in the United States and it's not a concern of any of the vaccines that are currently available in the United States.
Gaudette: Dr. McInerney, I want to talk a little bit about a recent NPR Marist poll that came out finding that one in four Americans say that they would refuse a coronavirus vaccine outright if offered, and then another five percent say they're undecided about whether they will get the vaccine or not. Some interesting things about this. Within this poll: the numbers were highest for Republican men and residents of rural areas. However, there were still a significant number of people across all ages and all demographic groups who claim they would say no to it. So what I'm curious about is how these numbers could potential could potentially impact herd immunity as we move forward. So first, could you once again explain what herd immunity is and then your thoughts on, you know, on this on this vaccine hesitancy that we're seeing?
Dr. Meghan McInerney: Yes, so I have been dealing firsthand with a number of people both in my personal life and when I'm dealing with patients and other members of our community with some vaccine hesitancy. And it is quite concerning to me and still surprising, to be honest, because at this point we have almost two hundred million people who have received vaccines in the United States and we have one of the most robust vaccine safety monitoring that we've ever had. And the people who took part in the trials for the vaccines, in fact, were vaccinated at this point about a year ago. And so we now know that the risk of the vaccine are far, far lower than the risks of any infection with COVID, particularly for those patients at higher risk for severe disease. So with that said, I, the idea behind herd immunity is that a large enough percentage of a population has antibodies or immunity to an infectious disease, so that when there is an introduction of that infectious disease or an outbreak of that infectious disease, it will not spread enough in the population because there are enough people who have either been vaccinated or have some level of immunity because they had the natural infection. One of the things, though, that is really important for people to remember is that the natural immunity that comes with COVID infection, we now know is actually in many cases not as robust as the immunity that we are getting from the COVID vaccines. And I've heard Dr. Pate talk about this in the past. We cannot rely on natural immunity as the main source of herd immunity. We have vaccines available; that is the best way to get to herd immunity. So I'm concerned Gemma, I'm really concerned about the degree of vaccine hesitancy and the fact that that poll highlighted that, you know, Republican men were likely to not want to get the vaccine or have higher rates of vaccine hesitancy just highlights how much this pandemic has unfortunately been viewed through a political lens, and it should not be at all. This is a public health issue. It has nothing to do with politics.
Gaudette: And Dr. McInerney, what are what are some of the reasons that people are giving to you in regards to their hesitancy?
McInerney: Yeah, so the most common reason is that it is a first generation vaccine and people just want to wait. Right, for the hesitancy. They want to wait and see, “wait and see if there's going to be bad side effects down the road.” And then when I follow-up and say, well, how long would down the road be enough? Again, I try to highlight that it's been a year for a lot of people who were in the study. The Pfizer vaccine studies had 40 thousand people in it. And Moderna, I think had like thirty four thousand. So a lot of people have now been vaccinated over a year. Right. So how long would you need to wait? And so that's part of the concern is that people just have this misunderstanding that, you know, that because this is the first time we've had a COVID vaccine that therefore we need to wait and see how it's effective. And my counter to that is, well, this technology has existed actually a lot longer than I think the general public realizes this mRNA technology for vaccinations and that it's quite robust. And the data that we have is some of the best vaccination that we could get. I mean, the volumes of patients who've signed up for these studies is just amazing. And then other reasons, you know, there is some misinformation out there and I'm not going to speak to all of it because I feel like repeating some of the crazy ideas that are out there.
McInerney: Yeah, it just it just unfortunately perpetuates a lot of misinformation. So it's mostly people are just afraid because they don't understand the science and they don't trust the science, which…which is disappointing. I think, that we as a medical community are trying the best we can, this radio show is a good example of how we're trying to improve getting the right information out there.
Gaudette: You know, I believe it was one of the doctors on the program a couple of weeks ago was talking about the vaccine and said, you know, if there was a vaccine this good for cancer and preventing cancer, you know, she said she believed people would be lining up to get it. And I think that goes back to your point, Dr. McInerney of how politicized this public health issue has become.
McInerney: I totally agree. And the other analogy that I use is, you know, if we have somebody who comes to the hospital having a heart attack people do not hesitate to accept the medical treatments that we offer them. Even though sometimes the medical treatment doesn't have as robust of evidence as these vaccines do. And it just highlights to me that, you know, the lack of trust is driven by politics and not by true understanding of science.
Gaudette: Before we take a break, Dr. Pate, I just today, I believe the coronavirus variant first identified in the United Kingdom is now the most common strain of COVID-19 here in the United States. That's per the director of the Center for Disease Control and Prevention. I am sure you are not surprised by that, because I believe that you have been telling us this for at least I think, since about the beginning of of the year. January is.
Pate: Yes, I'm not surprised at all, and I have been certainly expecting this to be the case. I've been warning about it, as you say, from from at least February or early February about this potential, because one only needs to look at the rest of the world. This is not an Idaho disease or a U.S. disease. This is a worldwide disease. And it really has been quite shocking the fact that more people, including some of the experts, haven't been more focused on looking around the world to see what's happening as the preview of what will happen here in the United States. Now, obviously, things can change, but when you're facing a serious problem, you want all the information you can. And Europe was giving us a lot of great information. And then, of course, the CDC came out, I think, right around that time and they said that they predicted their models showed that between one seven, the UK would be dominant sometime in March. And so, no, this is not surprising at all. If you want to know what it looks like when a state is having a surge due to be one one seven or the U.K. variant, go look at Michigan because they're in the throes of it right now. Also, New York, New Jersey, Pennsylvania, New Hampshire, Vermont, there's the number of states you can look at to see what this looks like.
Gaudette: Before we get to listener questions, can we talk a little bit about the CDC's new updated guidance on on travel in regards to fully vaccinated people on they? The CDC is now saying that if you are fully vaccinated, which means two weeks out from your second shot, you you can travel, even airplane travel. Still, you need to wear a mask, you know, to take all the proper guidelines and precautions that you that you have been taking. And so I'm curious about both of your thoughts on this, Dr. McInerney, in regards to to these new new guidelines.
McInerney: I'm in support of them, I really am, and the CDC still said that they don't recommend, you know, nonessential travel. Right. And I understand their reasons for doing that. But I think that we need to to highlight the the safety that's added when patients are vaccinated. Right. And so I think that I've also heard when we were talking about vaccine hesitancy, some people said, well, why should I get vaccinated, could change my behaviors. I still have to wear a mask all the time and I still can't do X, Y and Z. And my response is: since I've been vaccinated, my behavior has changed significantly in certain contexts. Right. I now do get to see my family who are going to travel on a plane because they've been fully vaccinated. They will still wear their masks on the flight. But I didn't feel comfortable having my parents fly until they were vaccinated and I didn't feel comfortable being in the house with them until we were fully vaccinated. So I support that. I think it's the right thing and hopefully that'll encourage even more people to get vaccinated.
Gaudette: And Dr. Pate, your your thoughts on that, because I do think Dr. McInerney brings up a good point in the sense of like there are things that you can do if you choose to get vaccinated.
Pate: Yes, I think that's exactly right. I think the only thing that I would add is let's also recall that the purpose of the vaccines are to particularly prevent people from getting very sick, being admitted to the hospital and dying. What we don't want is people ending up under Dr. McInerney care because that's not good if you're in that state. And and so I'd say three things. One, there still needs to be some individualized risk assessment. So, for example, while it's certainly true that you are going to be tremendously more protected with the vaccine, the vaccine is not perfect. So if you have a serious underlying condition, particularly something that causes you to be immunocompromised, you know, you really still probably shouldn't be flying right now unless you've got a darn compelling reason to be because those patients don't always mount as good a response to the vaccine. And we've seen some recent studies on that. The second thing is: if you're at high risk for some other reason, again, it's always a matter of what risk you're willing to take. There's much less risk if you're vaccinated, but it's not zero.
Pate: And we still have way too much transmission of this virus in the country. And we're seeing these variants and we don't have all the answers on the variants relative to the vaccine. So, for example, if you said, well, gee, David, I'd like to fly to the Northeast, I certainly wouldn't be recommending that now. They have a lot of the New York variant. And frankly, we just don't have the studies yet to know, does that protect you? So I agree with everything Dr. McInerney said. But I would just add on that if your particular circumstances are such that you may not have responded as well to the vaccine because of an underlying condition or that you're extremely high risk, I would still avoid traveling for right now. Let’s get those levels of disease down. I think in a few months it will be entirely different but right now it's still too high and there's just still too much unknown about some of the variants that we're not particularly dealing with here in Idaho. But depending on what other state you're going to, they may be struggling more with specific various.
Gaudette: And Dr. McInerney: Sue wrote in and she writes, I read on Idaho education news that the number of COVID-19 cases in schools has gone up since spring break by 56 percent. I know those numbers are incomplete, but 111 cases in a week in schools seems like a lot to me. Is that a lot? And then she goes on to say, what do you think about bringing kids back into the classroom before they can be vaccinated? But can we start with this increase that we've seen in schools and spring break? We should note, though, that most schools didn't go back full time until after spring break.
McInerney: Right. So I think I wasn't surprised at all to see that because people were traveling for spring break and I imagine that the a lot of the people who are traveling, you know, the parents of school age kids had not yet been vaccinated. We know that, you know, there's a large percentage of people greater than seventy five, I think about seventy five percent of people greater than sixty five or seventy five. I can't remember the exact number, but the the population that's older, they are much more vaccinated than the younger population. So I'm not surprised that the people who were likely going on spring break with parents in their 40s and 50s and their kids traveling were at high, higher risk of contracting the virus and then bringing it back and going back into schools. And then, as Dr. Pate has highlighted, I think that we need to also recognize that there is a risk that some of this transmission that's happening could be the be one one seven variant. And we do know that that be one one seven variant is more likely to be transmissible between kids. Four for the law. For a long period of time, we saw that school age kids were getting the virus from adults, the adults in their lives and then bringing them they went to school. But I think that we do have to be cautious about the fact that it's possible that if this be one one seven variant is increasing in prevalence in our community and in the schools, and there is a risk for the kid to kid transmission. But I think currently my personal thought is that it's just from people having traveled during the spring break, mingling with multiple families and bringing the virus back.
Gaudette: And Dr. McInerney, I know that you wanted to know about your thoughts regarding, you know, kids going back in the classroom before they can be vaccinated. You know, we've talked about this before, and I realize that my kids go to a smaller school. It is a they are privileged enough to go to a private school. They have had very little COVID in their school, but they have followed every CDC recommendation. You know, there are there is not one person that is not wearing a mask at that school. You know, kindergartners, they have a hard time social distancing, but they do wear their masks. So I realize that, you know, yes, in a perfect world, kids would be vaccinated. But that's not going to happen for a while.
McInerney: Right, and I think that this is is such a difficult question to answer as a black and white, I also have young kids and virtual school just it doesn't work for my kids. It did not go well. And so I am a big proponent of having my kids in school in a safe way. And likewise, my children have been in school and it has been safe and they have been safe and their teachers have been safe now that all of their teachers are vaccinated. But those schools are very, very strict and very good about masking, wiping off the desks, hand sanitizing frequently, hand washing frequently. So I think that schools can do it safely. I think that there is guidance available to help schools do it safely. And and I also support parents who feel like they're not yet ready, that they don't feel that that that it's worth the risk to send their kids to school and that they want to keep their kids doing virtual platforms for schooling.
Gaudette: Dr. Pate Marian in Boise wrote us this question: “Have any vaccines before COVID-19 failed? I ask because of the naysayers, I am old enough to have gone to school with the victims of polio. I am 65. The kids in school who spent their lives with braces and difficulty moving broke my heart so I can I cannot understand the fear of vaccines.” So she's she's curious as to once again the original question of any vaccines before COVID-19 failed.
Pate: So, yes, many vaccines have have failed, but those have been in clinical trials where they just didn't work. So, for example, there's certain diseases that we have tried our darndest to come up with a vaccine and tried some things that we thought would work, but they just didn't work. There's no vaccines that are out there being administered today that have failed is, as I assume, what she means by failing, because to get approved, to be able to be administered to Americans, you have to show the data from clinical trials just like these COVID vaccines that you have to show the FDA that it works before they will allow you to administer it to people outside outside of trials. So, yes, we've had a lot of failures in the laboratory, but we don't have failures of vaccines that are currently available to the public. Now, with that said, what I'm assuming she means by failures, they just don't work there. Certainly with every vaccine, there are people that don't respond. There's no vaccine is 100% effective in everyone under all circumstances, but there's no failures of vaccines that are currently available.
Gaudette: Dr. McInerney, we're getting a lot of questions in regarding people's reactions to the vaccine. In fact, one listener asks, everyone is talking about their reaction to their first or their second COVID vaccine shot. How many people feel side effects and which ones am I most likely to get? And then another listener chimed in, Are your reactions worse with the second shot compared to the first?
McInerney: OK, good questions. So. You know, in general, it's important to recognize that that you cannot predict who will get reactions and who won't, what the studies have shown or the data, I should say. And for those who don't know, once you get the vaccine, you have the option to sign up for a safe app. And what happens is they send you and I just got another check in last week. So for the first couple of days after the vaccine, they ask you questions about what your symptoms are. And then a week later and then a week after that and then a month later. And so the reason why I am prepping the response to this question with that information is that the CDC has been keeping track of a ton of vaccine data and scientific data. So not just what was studied in the original studies, but now that we're four months into the vaccines, they're able to keep track of what people are actually experiencing. So the most common side effects is pain at the site, some redness and swelling, and the majority of people will have that. And then other side effects like tiredness, headache, muscle pains, chills, nausea, fevers, that's much more variable. And I would say it's about a 50 50. And some have said Pfizer, if you're over the age of fifty five, you're much less likely to have those reactions. Same with Moderna. But it's but it's like 50 percent of the people less than age. Fifty five will have those side effects and then 40 percent greater than age 55.
McInerney: So I would say about half of the people have more severe reactions than just soreness in your arm. And women are somewhat more likely to have reactions, and those people who are younger, and that makes sense because the immune system is more robust and I try really hard to talk to people about this. Is that a site like an adverse event or a reaction? It's actually a natural response of your immune system. It is your immune system doing its job, showing you that it is developing that response to be able to recognize the virus if you do actually get infected with the virus. As far as the question about first versus second dose, so what what we have been finding is that the majority of people have a more robust response, immune response to the vaccine after the second dose. And that makes sense from an immunological and biological perspective. The immune system is primed with that first dose. So you get the first dose and that kind of introduces your immune system to what the virus looks like and says, hey, this is what the virus looks like so that if you see it, you'll know what to do with it. And then when the second dose comes, because your immune system is already primed, it it kind of responds more robustly and causes some of those some of those immune responses. Right. Because all of those symptoms, fevers, headaches, swelling, nausea, that's just the immune system causing inflammation and response. So most people have a more robust response after the second dose.
Gaudette: And I and I will say anecdotally. So I got my second dose of Pfizer last week. And it first off, the only symptom that I had was I was so dizzy, which is not. And I do. And I did sign it for the safe. And that was not something that I expected. And I hadn't and I had never read about that. And I'm talking like, lie down and get the spins. Like I went on a bender or like almost falling over in the shower, dizzy. But I didn't drive for a couple of days. But that was honestly the only the only reaction that I had. And then, of course, being me, I start, you know, seeing if if this is a common if it's a common side effect. And I think from that very safe information, Dr. McInerney, the CDC is is keeping track of they are finding that as a possible side effects of. So you never know. Right?
McInerney: You don't. And everybody is going to to respond differently. But I do want listeners to recognize that this is short lived. Right. So I had yeah, I felt I felt pretty bad. It was about 12 hours after my my second dose and then that next day I was rounding in the ICU and I'm like, wow, I'm feeling it, you know, fever, sweats. And I was like, all right, I shouldn't keep but I got to sit down for a minute. But then the next morning I woke up and felt fine. So it's really about twenty four to 48 hours that people usually have symptoms and then they feel fine. It is important for people to also recognize that we are seeing that if someone had COVID already because their immune system was already primed from the actual infection, that they are more likely to have a response after the first vaccine. So that's important to recognize.
Gaudette: Absolutely. Dr. Pate: Susan, sent us this email. And I and I know we've answered this before, but we keep getting questions about this. So she wants to know, can you take pain relievers before or after getting the COVID-19 vaccine?
Pate: So the first thing I would say, let me divide this up a little bit, I would not recommend people take anti-inflammatory before they have any symptoms, before they've gotten the vaccine. We should note, this is a theoretical concern. We haven't proved this in studies. But when you heard Dr. McInerney talking about that localized reaction with the first shot that you get that just kind of like for the first couple of days, what what she's describing is something called our innate immune system. In other words, we just that is part of our immune system that just sets off alarms and says, hey, we've got an invader making antibodies. So the theoretical concern is we don't want to blunt that before it occurs because that's actually helpful to developing antibodies. So that's why I don't want people to take medicine before the vaccine or before they have symptoms. Now, if you have the vaccine and you're having really bad symptoms, then we got no problem because that is your innate immune system, just as Dr. McInerney was telling you. And so we don't have to worry about suppressing it. It's already going. So, yes, if you're miserable, uncomfortable, I was then take medication to help of the available ones. Acetaminophen or Tylenol would be the best choice because it has the least anti-inflammatory effect. But again, do whatever it takes. And if the symptoms are severe and you want to take some ibuprofen, do that, just stay real well hydrated.
Gaudette: And then Dr. McInerney Shonna wants to know is an allergy or a previous anaphylactic reaction to sulfa. And I don't know how to say that. Sulfonamide, contraindication for the. Oh, I said it right. OK, good. Is it is it a contraindication for the Pfizer vaccine? How about the Johnson and Johnson vaccine?
McInerney: Yeah. So those are different types of antibiotics. And and the short answer is no. The anaphylaxis to antibiotics is not a reason to not get vaccinated. It is. All the more reason, though, to highlight the importance of part of getting the COVID vaccines is the observation period afterwards. So after you get the vaccination, there are health care workers on site available and watching as you sit for the 15 minutes afterwards to make sure that people don't have an anaphylactic or other severe reaction. If people are going to have anaphylaxis, it will happen within the first 15 or so minutes. So it's just important to be to be monitored. It's important to be forthcoming with your medical history and share that with a person who's vaccinating you and to and to take that that post vaccination monitor and seriously.
Gaudette: Dr. McInerney: McKenzie just wrote us and she says this. I have a four year old and an almost three year old. Our family has been socially isolating for the past year. Now, my husband, myself and our extended family in our bubble are fully vaccinated. Is it safe to enroll my kids in enrichment classes such as gymnastics?
McInerney: First of all, congratulations on your bubble being vaccinated. That's my first response whenever I hear someone's been vaccinated. So again, this is this is a personal call. I think you have to weigh the the benefits of your kid being in your kids being in enrichment classes. I personally would make sure that those classes still require masking and if possible, that they're outside. And then you could also even add to find out whether or not the the the people running the enrichment courses have been vaccinated.
Gaudette: Good information. Dr. Pate: Erica has been listening to the show today, and she wrote in, she says, I've heard twice on the program now that if we had a cancer vaccine as effective as the COVID vaccine, people would be lining up to get it. She goes on to say, this is unfortunately not true. We do have a vaccine that is very effective at preventing many different types of cancer, including over 99 percent of cervical cancer. The HPV vaccine was poorly advertised and rejected by many people. Vaccine skepticism has always been a problem. Now, Dr. Pate, I would note that when the HPV vaccine came out, many people felt like it was promoting promiscuity in children and it was being given to children. And that was the issue. Correct me if I am wrong on that.
Pate: No, I think that's right. I think you and the listener are both correct. The HPV vaccine is extremely effective at blocking certain types of cancers that we know are caused by a virus that is transmitted. And then you're right that then a lot of people went ahead and stigmatized that. And and so, you know, I think what the doctor meant that we had talked about that was on a previous show is if there was some vaccine that we said, look, you take this vaccine and you won't get any kind of cancer, I think her point was people would line up for that. And, you know, because I think for most people, cancer is very real to them. They either have had cancer or they know somebody in their family. This had it or they've lost somebody in their family. You know, part of the problem with COVID until more recently was there were a lot of people that didn't hadn't had COVID and didn't know someone that's less and less common now. And so I think the point is still a good one that, you know, that there is just like with the HPV vaccine, where there's stigma around that with this vaccine, people have politicized it. You know, we had Republicans getting the vaccine, but Republican leaders, elected officials getting the vaccine, trying to hide that fact, not letting people know they were getting it because they thought they would pay politically for it. So that's kind of the problem. And that's the point, I think,
Gaudette: Dr. McInerney: Christian wants to know, do we know how long protection from the vaccine will last? And then an emailed wanting to know, do we know if we will need to be revaccinated?
McInerney: So we do not know exactly how long the protection will last. The news is good, though, for those in the study and the trials that it's been a year out and they still have protection. As far as vaccination is concerned, I suspect that we might end up having something very similar to the yearly influenza vaccine where every year we need to get COVID vaccine or it might not even be an every year interval, but at some interval we might need to get vaccinated so that we are sure to have protection against whatever is a dominant variant circulating at the time because viruses will continue to mutate and variants will continue to be circulating. So so, yeah, I think I think we still don't yet know how long immunity lasts. But good news is that we know that based on the studies so far, that they last about a year at least and probably longer. And then I do suspect that we have to get boosters for for whatever variant might be might be circulating on a seasonal or yearly or every other year basis, whatever it might be.
Gaudette: Dr. Pate: Susan wrote in and she says there does not seem to be any drive through vaccination stations in the Treasure Valley. She says, you know, we see them on the evening news and other cities and other states. Why do we not do we know why we don't have them here? And I thought the reason Dr. Pate was what Dr. McInerney said about this 15 minutes of needing to be monitored after you get vaccinated.
Pate: Yeah, as usual, Dr. McInerney just gives wonderful answers and she has set this up completely where she was answering the question about somebody that had had anaphylaxis before it was going to get the vaccine. You know, we do need to monitor everybody for that. Really, the people that are really at the most risk are people that have had anaphylaxis before, but it can occur. And so we need to monitor. And as she said, almost all of those reactions occur in the first 15, 20 minutes. So the you could do a drive through vaccination. I think the reason why people aren't doing it is we don't want people to actually drive on through and leave and then have an anaphylactic reaction while they're driving. And the other thing is it's just simply with everybody having tinted windows and those kind of things, it's hard to really even if they got it and stayed in their cars, it's just really hard to observe people to to make sure you're seeing it if somebody is having a problem. So I think we're not likely to have too many drive through situations, but there certainly are going to be other mass vaccination opportunities where people do stick around, are going to be sitting in a place where it's visible, where we can observe them.
Gaudette: And I do want to note, as an after I asked you that question, Dr. Pate that Crush the Curve is going to have a mass vaccination clinic tomorrow. So that's April 8th. It will be at the economy parking lot at the Boise Airport. Now, you do have to get on to the curve and make an appointment, but this will be a drive through vaccination process. Now, according to the spokesperson for the Curve, you people will drive and do a tent. You will get your shot, and then you will pull into an observation stall for that 15 minutes. So that will happen tomorrow. You can make your appointment. It's the Pfizer vaccine. Anyone 16 and older can get that. You do have to have a guardian present if you are between the ages of 16 and 18. But but but that's tomorrow. They will then do a second clinic for that second shot on April 29th. So no reason to not get your vaccine if you have the ability to to make the appointment and get to that clinic tomorrow.
Pate: Absolutely. And a big shout out of thanks to Crush the Curve. That's that's fantastic.