As COVID-19 vaccine for Idaho kids comes closer to reality, doctors answer your questions
As we continue to cover the coronavirus pandemic, we know many of you have questions and concerns. We want to answer those questions with facts — and the best way to do that is to bring in Idaho's medical experts.
Idaho Matters is joined by Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force and Dr. Darin Lee, Vice President of Medical Affairs at Saint Alphonsus Health System.
"We need to get people vaccinated. [W]e don't vaccinate people just to save their lives. We vaccinate people so we can get this disease under control. That's why we have to vaccinate children."Dr. David Pate, former CEO of St. Luke's Health System and current member of the Idaho Coronavirus Task Force.
Read the full transcript here:
Gemma Gaudette: You are listening to Idaho Matters, I'm Gemma Gaudette. A smaller dose of the Pfizer COVID-19 vaccine cleared its first regulatory hurdle Tuesday for use in children ages five to 11 years old. This, after a Food and Drug Administration Advisory Committee voted to recommend it for emergency use authorization. The FDA is expected to make a final ruling in the coming days. So what will this mean for getting COVID under control and to a manageable level? Joining us today to talk more about this and to, of course, answer your questions, are Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force. And Dr. Darin Lee, vice president of medical affairs at St. Alphonsus Health System, as well as an emergency room doctor. Thank you both for being here today.
Dr. David Pate: Hi Gemma.
Dr. Darin Lee: Thanks, Gemma.
Gemma Gaudette: So I do want to start with yesterday's meeting regarding emergency use authorization for the COVID vaccine for five to 11 year olds. Dr. Pate, this has been a long time coming. So where are we now in this process?
Dr. David Pate: Well...you're right. It seems like it's been a long time coming, but in other respects, it's just really wonderful to see the FDA, the CDC coordinating their efforts to make sure that these things don't get bogged down in bureaucracy--and they haven't. So I'm really thrilled about that. This is great news. So yesterday was the first of essentially four big steps. This committee that met yesterday and unanimously approved the vaccine and determined that the benefits outweighed the risks has recommended that the FDA give it emergency use authorization. The next step is that it will go to the FDA. That recommendation will go to the FDA for their determination. They usually accept that recommendation, but not always. And then next week, in the middle of the week, we will have a meeting scheduled with ...the Advisory Committee for Immunization Practices, which advises the CDC. They will have their meeting and make that recommendation to the CDC. And it certainly would not be shocking if all four of these steps get completed and signed off by the end of next week. So I certainly think that week after next, we could be in the position where we start vaccinating children five and above.
Gemma Gaudette: Wow. There are new forecast models that are used by the Centers for Disease Control and Prevention and [are] predicting that weekly death totals will likely continue to fall in the coming weeks. Though we should note thousands of Americans are still expected to die from the virus within these forecast models. Dr. Lee, with that said, how...how are we doing in the Treasure Valley and in Idaho? Because, you know, there's this information coming out-- as I mentioned from the CDC saying, numbers are falling--yet Idaho is still in a bit of a different place than than other states in the nation.
Dr. Darin Lee: Yeah, I would say that it's interesting because if you look at the peak in Idaho for our two largest peaks, we have a much higher peak this time than we did the first time, whereas a lot of places experienced it the opposite way around. We're also behind everyone in the resolution of this peak. So a lot of places across the country have already flattened that curve and are seeing their positivity rate come down, their hospitalization rate come down. And we are starting to see that a little bit here, but it's very slow. It's much slower than we would have maybe anticipated, and it's still very high. You know, we still have 30% of these in Nampa... 30% of the hospitalizations are COVID patients. We still have deaths on a regular basis, and our positivity rate is still very high for this pandemic. We're talking about 15 to 20%. We should be below 5% and a lot of other places in the country are already getting down to that point. But we're still lagging behind in that regard.
Gemma Gaudette: And I know, Dr. Pate, that there are many scientists who are now worried that this recent booster shot authorization might be giving folks a false impression that the existing vaccines are no longer offering protection. Can you talk a bit about that? Because I've definitely seen this kind of chatter on social media.
Dr. David Pate: Oh yeah, well, there's just so much misinformation out there. So the whole reason for boosters is that it's not that we lose our protection--all of the protection--for example, even the people that did have this waning immunity where the FDA and CDC did recommend boosters--it wasn't that they didn't have any protection. They still were very unlikely to end up severely ill, end up in the hospital and end up dying, even if they had what we call waning of these antibody levels. And that's because when we have these discussions about the immune response, we tend to talk about and focus on antibodies. But with viruses, antibodies are seldom the whole story. In fact, our cellular immunity is often plays a much more important role in our protection, and that's triggered by these vaccines as well. It helps our cellular immune system work. And what it appears, there's growing evidence that the antibody levels correlate with the likelihood of you being infected and being symptomatic. But the cellular immunity protects you from really severe disease--so there's a tremendous benefit from being vaccinated. And then what happens is we give these boosters so that we even reduce the chance that you're going to get symptomatically ill. Because like we talked about last week, it's not all about dying from COVID. It's...there's a lot of other bad things that can happen to you. So we don't want anybody to get COVID, and the boosters are not unusual. Probably every listener out there knows you've got to get a booster for your tetanus shot every 10 years. Sometimes a little sooner depends on the circumstance--but that's not a novel concept.
Gemma Gaudette: Dr. Lee, can you talk a little bit about some other misinformation that's been going around and this is in regards to crisis standards of care. In particular with the the shooting at the Boise Town Square mall on Monday. A lot of people made an assumption that...well,we're in a crisis standards of care,so these folks aren't going to get the care that they need at the hospital--and that is just false. Can can you talk about how...your hospital, all of the large hospitals...I mean, you prepare for these events and even if we are under the standards of care that we're under right now.
Dr. Darin Lee: Yeah, so thanks for bringing that up, because I think that's a really important point. You know, I noticed in working in the emergency department that we saw a drop off in patients as crisis standard of care...was announced. And we saw that during the first wave of COVID, a lot of people stayed away from the hospitals because they were worried about it. When the crisis standard of care was announced, also a lot of people stayed away to their detriment. We saw a lot of the COVID patients coming in extremely sick. You know, they would have probably come in earlier. So I would just like to state that crisis standards of care allows the hospitals to be more flexible in how they take care of patients. But we still see everybody who comes through the door in the emergency department. People who need surgery are getting surgery. Any trauma that comes through the door is going to get, you know, normal trauma care. You know, we have more resources now, which is helpful for us to manage these larger volumes of patients. We are keeping patients in alternative locations at times, but they're still getting excellent patient care. And so if you are...for any of the listeners, you should not be worried about going to the emergency department. We are not turning people away. We are not taking people off of ventilators at this point in time. We are doing what...you would probably not notice any change in the care that you would receive there. There are some changes from the operational side that we do and basically where we put people, and maybe it'll take longer to get admitted into the hospital. But we are still taking care of patients every day, 24/7, and no one should be worried about coming to the hospital during this time. You will still get treated well.
Gemma Gaudette: ...our first question comes from Barbara. She says that she... visiting a cardiologist with a friend. The physician assistant shared an experience of losing a patient who refused antibody treatment, and they ended up in a hospital. Unfortunately, they ended up passing away. There was nothing that she could do to change this patient's mind. So Barbara goes on to say, 'I seem to recall her mentioning this becoming a clinical term for these patients, this belief induced reality.' Do we know anything about any terminology like this? Dr. Pate I haven't heard anything like this.
Dr. David Pate: Yeah, that's a...new phrase for something we have known about for a long time, and that is when people are psychologically coping. So some kind of pressure, anxiety, tragedy is happening in your life. You have a number of potential coping mechanisms to help you psychologically get through what you do dealing with. Unfortunately, some of those coping mechanisms can be dangerous or not helpful. Other coping mechanisms are very helpful, and unfortunately, what we've seen is a lot of people adopting unhealthy coping mechanisms like this belief induced system that you were just mentioning. And that is when we are confronted with something that it's really hard for us to process. Why did this happen? How could this have happened? We can certainly choose to look at the evidence. So I mean, let's just take the example of the really tragic shooting on the set, the movie set that involved Alec Baldwin. One thing you can say...as you deal with that...I mean, that's so startling, so upsetting. You can say'wow, I don't understand that how that can happen.' But what I'm going to do is I'm going to try to wait for the facts. I'm going to look at the evidence. And then in the meantime, I'm going to think about my own handling of guns or my family members that have guns, and I'm going to try to encourage them to take extra precautions. That would be a healthy coping mechanism. Another coping mechanism is we could certainly deny it and just say, 'well, that's all fake news that didn't really happen.'
Dr. David Pate: Of course, that's not going to be productive, but we've seen that play out with COVID quite a bit. The other is you can begin to make up stories and fill in the gaps of what we don't know...'Oh, somebody must have purposely put in live ammunition in that gun and they wanted to frame Alec.' Or, you know, you could see this conspiracy theory growing. And that's also a very unhealthy coping mechanism. And we've seen that play out in spades with coronavirus. So I think that... And I hear what that PA was saying about--it's so bad that it has convinced people that they can't actually trust the true sources of information that would have recommended this patient get the monoclonal antibodies and it costs that patient their lives. And I think that's a good warning for everyone as we go on with our lives. So let's put COVID aside--I have always found it better, especially when I was in a leadership role, listen, don't sugarcoat things with me. Tell me the truth. Even if you know it's something I don't want to hear because I'd rather deal with the truth than being lulled into thinking, I don't really have a problem, and then something blows up. That's the same thing we have to do here. So we have to be very careful about our sources of information. And there are people that should be trusted and there are people who should not be trusted, and we have to get better about determining what is reliable information.
Gemma Gaudette: Dr. Lee wrote in asking, saying,' I'm hearing that it may be advantageous to mix the J&J vaccine with Pfizer or Moderna. Can you explain why it may be more beneficial to get an alternate booster as opposed to sticking with just the J&J?'
Dr. Darin Lee: Well, I think that, you know, I don't know that there's enough information to say that with a great deal of authority, but they do work a little bit in different ways. And so as you can imagine, if you have two ways of inducing antibody production and an immune response, theoretically, you could have a different response that might broaden that. But I don't know that there's enough information to say that would necessarily make me recommend one vaccine over the other. I think we have a lot of information that says boosters do help and that you can probably mix and match them and you will do fine. But whether or not that's advantageous, I don't think that there's probably enough information to say that we can say that with much certainty. So I would just say whatever you have access to would probably be the best if you're a person who needs a booster...in that case.
Gemma Gaudette: Dr. Pate, we just got a question in from Mike emailing us saying,'is it fair to say that the unvaccinated are putting the rest of the population at risk?'
Dr. David Pate: Oh, it's absolutely fair to say-- it's a fact. So we're dealing with an infectious disease. This virus is transmitted person to person--and we've talked about this many times going back to last year Gemma--that if we allow this virus to transmit unfettered. In other words, we're not willing to get vaccinated. We're not willing to avoid getting to large groups. We're not willing to distance ourselves. We're not willing to wear masks. And if we just allow this virus to have its way with us, it will. It is highly contagious. It will spread among all those who are vulnerable. And then what we've talked about is the bad thing about when it spreads like that --one, it overloads our hospitals, like what we're seeing for the last month and a half at. Number two--it mutates. The more opportunities we give this virus to transmit it is developing mutations. Many of those mutations are going to be of no consequence. Unfortunately, it's kind of like doing the the slot machines. Every once in a while, you're going to hit the triple 7s. And what's going to happen is we're going to have a new variant of that virus and it will now be one that has gained some advantage over the previous variants. And that's what we've been seeing. We saw that with Alpha at the end of last year-- sorry in the early part of this year--and then we saw it with Delta with this latest surge. And if it keeps on spreading across people across the world, then it's going to...we're going to have more variants. So the key to blocking the transmission of this virus and getting those levels down really low so that we can get on with our lives in a much more normal way and we don't have to worry about schools closing, we don't have to worry about our hospitals being overloaded. It's for as many people as possible to get vaccinated. We have a fantastic study that just came out looking at even protecting family members. If you if it's just you and your husband, Gemma, if one of you is vaccinated, the other person's chance of getting COVID is going to be reduced. If you have a family of five and you can get four of them vaccinated, your chances of that fifth family member getting infected are reduced like 97%. So vaccines work. Vaccines are a way out of this. We need to get people vaccinated. [W]e don't vaccinate people just to save their lives. We vaccinate people so we can get this disease under control. That's why we have to vaccinate children.
Gemma Gaudette: Dr. Lee, Beverly wrote in. She's 57 years old, fully vaccinated. She has underlying conditions that make her very cautious about her health. She's scheduled for a dental cleaning and a checkup next week, she wrote in saying when she called her dentist office to find out what their COVID protocols are, all they would tell her is that they encourage everyone to wear a mask. She did ask if they require their employees to be vaccinated or undergo COVID testing. She was told that they could not provide that information because of HIPAA. So her question is, 'how safe is it in our current environment to have a dental technician hovering over my mouth for 30 minutes without knowing whether he or she is vaccinated or has tested negative for COVID?' And I think Dr. Lee, this kind of goes back to your original point of people holding off on on health procedures or going to the emergency room. I think a lot of people have also held off on going to the dentist.
Dr. Darin Lee: Yeah, that's unfortunate that that information is not available because it helps you make a better decision as to whether or not... It's a safe environment. If you have somebody who is that close to you--I mean, most dental hygienist, even before the pandemic wear a mask, which is great. But you're unmasked. You're very close. And yes, she's vaccinated, which is good. I mean, her likelihood of getting very sick is very low, but that is a pretty close encounter with somebody without knowing that information. I think it is hard. You do have to respect people's personal privacy when it comes to the medical field. This has been a controversial issue about whether or not people who are caring for other people should be vaccinated or should be tested should be masked. We've lived through this as people respond to the vaccine requirements. But I believe most dentist office, very similar to most hospitals, probably have vaccine requirements for taking care of patients within them--whether those be hepatitis B or annual flu or what they might be. So I would tell this person that I think that without knowing that information, it's difficult to say that I would feel comfortable with, say, routine cleaning. If it's something that is potentially a dangerous situation, someone has an infection or something like that, you have to weigh those risks. But it's unfortunate that that information can't be released to at least give the patient some idea as to what their risk is.
Gemma Gaudette: Dr. Pate, Catherine wrote in, and this is in regards to something that we talked about last week. She goes,'I lost my sense of smell during a bout of COVID last year. Luckily, only for a week or so. But I want to chime in on what Dr. Pate stressed about COVID not being only about death. Losing my smell was absolutely devastating. This may sound overly dramatic, but I really don't know how I would have carried on in my life without it. Hard to explain, but it was extremely depressing and disorienting. I'm fortunate it came back. Not 100%, but good enough.' And I wanted to read this email Dr. Pate because I think again, we get so fixated on, you know, the death rate, which frankly shouldn't be what it is already. But people talk about, well, you can survive it. Well, I think Catherine brings up a good point.
Dr. David Pate: Yeah... I think she brings up an excellent point, and of course, anybody who agrees with me is bringing up excellent points, so that's great...but I think her point is very important and it really personalizes what I was trying to say last week. And it's exactly what you said, Gemma. If we just focus on deaths, we're going to miss the the bigger picture here. Of course it's tragic any time anybody dies from a preventable disease. But we cannot dismiss the many more people that have gotten this infection, and they're dealing with terrible consequences. Like in her case, with the loss of smell. People don't know what it's like not to have your smell until you lose it, and it's a big change to your life. It can cause you to stop eating, lose weight, get into dangerous situations--so it's not good. But there's many other things that can happen. And this is part of the frustration when we talked about earlier about some of the misinformation. And so there are people out there who are are saying, well, but 'this side effect from the vaccine or, you know, you've got to be scared about that.' What they don't tell you is that that very same side effect is 200 times more likely if you get COVID. So we have to be careful about this. We need to give this virus the respect it deserves. And I would just add on Dr. Lee's excellent advice about the dentist. Let me just say two things--first of all, there's plenty of dentists out there that are taking this disease seriously and protecting their patients. I would consider finding one of those dentists because that answer tells me that one...they either don't understand how this virus is transmitted or they're not willing to make the difficult decision to protect their patients. And also, I can tell you, as a health care attorney, they don't understand what HIPAA is because there's nothing about HIPAA that would prevent them from disclosing whether their employees are all vaccinated or whether they're wearing masks. So just wanted to add that.
Gemma Gaudette: I appreciate that. Dr. Lee, Aaron literally wrote in while we've been talking on on the program. She and her husband are both vaccinated. They're traveling with their unvaccinated 11 year old to Disney World this weekend. The numbers in Florida are significantly lower than in Idaho. Much of their activities will be outdoors. They're going to wear N95 masks on the plane and in the airports, and they want to wear cloth masks in the parks when they're indoors or in crowded areas. Erin's question is this--and Dr. Lee, I'm asking you because you and I are both parents, we have kids around the same age. She wants to know what other precautions that they should be taking because they want the trip to be fun, but they want to be safe.
Dr. Darin Lee: Yeah, that's a good question, and as a father of an 11 year old who won't be 12 for another six months anxiously awaiting the vaccine, I can understand that the want to get out and try to do a few things. So I think that they've done the things that-- so far--sounds like they've done some of the things they can. They're both vaccinated. They're going to be traveling. They're going to be wearing masks. It would be best to have surgical mask rather than cloth masks is just a little bit better protection. Try to limit their indoor time. It's the same things we've kind of talked about and over the last year and a half to try to to to be safe, you know, on the plane as a fairly safe place, you know, everybody has a mask on. For the most part, it's pretty well enforced. And when you're in, say, a park, you are mostly outside. And so those are good things. There are probably indoor things that if they are having to sit close together that maybe they should avoid if they have an unvaccinated child, but...they can still enjoy the travel and go outside and just take those precautions. And it is good that they're in a low vaccinated rate state or sorry...A state with low numbers. However, you have to remember that Disney World brings in people from all over the country, including places from Idaho, where our positivity rate is much higher than others. So it is a little bit more risky because you're not dealing with the general population, you're dealing with people coming from all over. So you really don't know what their vaccination rate is or...their disease rates. So just wear a mask, keep your distance, try to limit your indoor activities, and I think you will be as safe as you can be. Unfortunately, another couple of weeks and you might be able to get them vaccinated, but I know that doesn't always work out, sometimes at timing.
Gemma Gaudette: Isn't that true. Well, Dr. Lee I appreciate that advice because as as you and I both know, when you're anxiously awaiting for those vaccines, for the kiddos. Man, it is... it is stressful. I want to thank both of you for coming on the program today. Dr. David Pate, former CEO of St. Luke's Health System and a current member of the Idaho Coronavirus Task Force, and Dr. Darin Lee, Vice President of Medical Affairs at St. Alphonsus Health System. Thank you both so much.
Dr. David Pate: Thanks, Gemma.