HeartBeats Episode 17: COVID-19: Where We Are Now

Host

Welcome. I'm Cathy Murtagh-Schaffer, and I'm your host for this episode of HeartBeats. This podcast is brought to you by Shipley Cardiothoracic Center, an educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program, Lee Health and matters affecting your health. Today, we have Dr. Mary Beth Saunders, System Medical Director of Epidemiology with us today to talk about the latest news in COVID. Thank you so much, Dr. Saunders for taking time out of what I know is a really busy schedule. Can we start by having you talk a little bit about your role here at Lee Health, how long you've been at Lee and your involvement with the COVID epidemic,

Dr. Saunders:

Cathy, thank you so much for having HeartBeats and having all have the opportunity to get information out to our community. It's one of the most important things that we can do as healthcare providers is to get information out to the folks in the community. So, I've been with Lee Health for about 23 years, working in the health system at the hospitals as an infectious disease physician and for 15 years or so of that, I have actually worked with the infection prevention and epidemiology department, which is a large department within our health system that helps oversee just that very event, preventing infections in folks. Of course we've been very busy with the COVID pandemic.

Host:

I must say 2020 has been a real challenge for healthcare. I think it remains a challenge, although perhaps in different ways, we certainly have advanced our clinical knowledge base about what to expect and improved our treatment methods for COVID. What would you say is our biggest clinical challenge right now in the areas of viral variance, testing and treatment?

Dr.Saunders:

Well, it's been the same thing that it has all through. COVID it's a very big learning curve. So things that we didn't know about COVID a year ago that we now know, the same thing we're trying to learn about those variants, what they really mean, when they do start appearing, is the disease is going to spread faster? Are our vaccines still going to work? Are all the things that we've learned to do over the past year, still things that are going to help us as we develop variants. We know variants are going to develop, we see that with viral respiratory disease, we know it with flu, we know it's happening with COVID. Hopefully, we can flex as quickly as we need to with these variants presenting in our community,

Host:

According to CDC data, about 50.4% of American adults have been vaccinated or at least have received the initial injection, and about 32% have been fully vaccinated. However, these statistics apply to the older population, age 55 and up and part of the issue is the initial rules for receiving the vaccine did not include younger people. However, the vaccine is now available to anyone who wants it, but so far in talking to some of my younger friends, they're really not interested in getting it some say, they're not really going to get sick. Some are talking about the government secretly putting, tracking chips into the vaccine and younger folks for whatever reason, seem to have a more anti-vaccine attitude. Dr. Saunders, how would you respond to these folks who are resistant to getting the vaccine?

Dr.Saunders:

Well, I understand how they have vaccine hesitancy, but the most important thing that they can do is equip themselves with knowledge. There is a wealth of knowledge that the CDC produces and from other scientific advisory sites. So I know that often they're looking to things that they're used to, social media, for their scientific advice, but they need to go to a credible scientific site to get that information. And you know what I tell people every year about vaccination, when we get the flu vaccine, et cetera, and people say, you know, I don't want to get it- I never get sick. Well, yes, I don't want you to get sick, but I don't want you to cause other people to be sick. As we all know, you can have the virus, you can be asymptomatic but still shed the virus. So it's really important that you get the vaccine, not just for yourself, but for others, you want to protect those around you or people that you may come in contact with who may be more susceptible to COVID. I don't want to be that person that puts someone else at risk. So, you know, if you're not doing it for yourself, you know, do it for the people that you love. Really, just as we've proven with other vaccines, the COVID vaccine is safe. We do know that it can prevent you from getting sick yourself and you don't want to have the complications that can happen with COVID the people that get very little illness or, or resolve their illness and are fine. You know, they don't really think about it, but, in the healthcare field, we see those folks who have had just complications related to COVID and kind of long-term lung problems may have some cardiac events, late-term strokes. It's predictable in some ways, for people who may have co-morbidities, meaning they may have diabetes, high blood pressure, heart disease, but it's not always predictable. We can see it in a younger, healthy population. So you don't want to be that person that puts yourself at risk. It's just like if you're trying to cross the street on a busy highway, you know, take that time to walk five feet down to the crosswalk where you can cross more safely and decrease your risk for getting hit by a car. It's no different than with vaccination. Take that time to get to that, you know, safe spot where you can diminish your risks for complications.

Host:

What do you think is driving the whole anti-vaccine movement that seems to be so prevalent lately?

Dr.Saunders:

I think social media and people not taking the time to educate themselves, and once they do take the time to really look and look into, you know, the science that's available. They're going to change their mind, and we see it happen all the time, not just with scientific things, but with politics and other things in our world, taking the time to educate yourself and not relying on necessarily social media or even, you know, just newsreels that you have.

Host:

I know one of the things I'm really looking forward to is getting to some semblance of normal, again, whatever that might look like. I must say ever since I got vaccinated, I'm feeling so much more secure in my surroundings. I'm hopeful that traveling issues will resolve soon. I'm dismayed to see the airlines starting to sell middle seat tickets again, first of all, no one likes the middle seat to begin with. But for me, that puts people just a little too close for comfort with the state of COVID as it is right now. Am I being too paranoid about it after all I'm vaccinated? Do we still need to be careful about traveling even with a vaccination?

Dr.Saunders:

Yes. Because, traveling puts you at that greater risk, right? You're in closer contact with people in areas where you may not have as much opportunity to have free flow of air. And so in those events where you have close contact and it's not an outdoor venue, you really do need to wear your mask, wash your hands, all the things that we know, prevent spread of viral infections. So you may want to prevent COVID flu. We're seeing a lot of Corona virus that's not COVID in our community right now. So keeping yourself safe from any respiratory viral illness and heaven forbid those gastrointestinal viral illnesses, those are wicked, and you know, you can get those from touching a surface that's been contaminated and inadvertently touching your mouth in the airlines when you're eating your food and maybe if not, you know, washed your hands and you get sick. So it's just really a good idea to do all those safe practices when you're in that setting where you cannot distance yourself or have all the other opportunities needed to care for yourself.

Host:

Do you think about vaccine passports?

Dr.Saunders:

Well, you know, we have required vaccination for years to certain countries and for return, right? If you've traveled out of the country and in certain areas and you need a yellow fever vaccine, you had to show proof of your vaccination. I don't know what a vaccine passport will necessarily look like, but it's not new, we've required proof of vaccination to reenter the country after you've been in areas that may be endemic with certain types of diseases, such as yellow fever.

Host:

And I still remember going to school and needing to prove my vaccinations to get into school. So you're right. It's nothing new I've been around for a while. So I'm assuming that means they're kind of old.

Do you think we're going to need a booster vaccine in six months? Long-term do you think this is going to be like the flu shot required every year?

Dr.Saunders:

I don't know. You know, I do believe we probably will need some additional vaccination. It's probably not a one and done as it is with other vaccines, because it is a respiratory virus that does develop resistance or variants. So, yes, I think our vaccines are going to need to kind of keep up with what's happening with changes in the virus and will need, re-vaccination

Host:

As we advance in our knowledge, our questions are certainly changing. It seems our questions revolved around the vaccines, are they saved? Do I really need one? Do I still need a mask? Can I still catch COVID after the vaccination, et cetera. Actually, Dr.Saunders, perhaps you would comment about that. Could you explain exactly what the vaccine is supposed to prevent and the report of these so-called breakthrough cases?

Dr. Saunders:

Well, so the COVID vaccine is supposed to prevent SARS COVID2, the virus associated with our pandemic COVID and you know, just like any vaccine, it's not a hundred percent, but certainly, you know, the newest vaccines have been out the Pfizer, Moderna, they do offer very good help with preventing and getting the COVID virus. And so that's what they're intended for, and that's what we should kind of focus on as far as getting that vaccine. It's not going to help you from getting other types of coronavirus, not going to help you from getting the flu virus.

Host:

Right. It's kind of like when the new HIV drugs came out and, and they're talking about, you can take this for HIV, but it doesn't prevent you from getting other STDs.

Host:

Johnson and Johnson recently had their vaccine suspended due to issues with blood clots and not just any type of blood clot, but cavernous sinus clots for our listeners, the cavernous sinus as a cavity at the base of the brain, which drains deoxygenated blood from the brain back to the heart. Can you talk to us a little bit about this phenomenon? Do you think it's related to the vaccine?

Dr.Saunders:

Well, I know that the CDC and the FDA are still closely watching this, but they did pull back those recommendations. They still have a recommendation for women who are 50 years and younger who may have had problems with clotting to have an alternative vaccine such as the Moderna or Pfizer vaccine. But, the usefulness of the J&J vaccine is for individuals who may have a difficult time getting vaccinated and it's a single-dose vaccine and, you know, hospitalized patients who may not have access to getting out and getting vaccines very easily. It is one of those populations that we think about. So it does have its place. I know they're going to continue to monitor, but you know, thousands and thousands of J&J vaccines have been given, there's going to be a certain number of things that just happen naturally. And so taking a look at that data to say, is this natural occurrences, is there an increased occurrence with this particular vaccine? Right now, there are plenty of alternative vaccines out there, Moderna and Pfizer and the J&J out there for, for those who may need a single dose. Don't forget, we now have the opportunity to start vaccinating, children 16 and above with Pfizer. So that is great and hopefully, recommendations for children 12 and above will come soon.

Host:

I recently read something about some new at-home testing for COVID that should be available soon. Do you think this could prove helpful?

Dr.Saunders:

Well, I think it'll prove helpful. I don't know necessarily what people are going to do with that information.

Host:

Right, that's kind of what I'm thinking too.

Dr.Saunders:

People can remain positive for a long time, carrying particles of the virus, but not necessarily be infectious. It may cause them not to seek medical advice, or may they may continue to work when they probably should be staying home. I'm not sure how that is going to work for us in the future. If people are kind of following the rules that they need to follow when they're ill and actually isolate when they think they have COVID, then it'll be great. But otherwise, it could cause a lot of confusion.

Host:

Yeah. I see it as a double-edged sword. I really do.

We have a lot of have listeners who are parents of school-aged children. Mine are all grown up now. So I have not been keeping up with the latest reports of how school is being managed this year and what to look forward to the next school year. Can you fill us in, on what's happening with the Lee school?

Dr.Saunders:

Well, all I can tell you is the Lee County school district has done a phenomenal job. They've been great. They have, you know, they meet regularly. They make changes as needed as recommendations that come from our state and local government or County health departments. They have just done an awesome job. I still have school-aged children and I feel very safe with those children going to school in our area because of their just really proactive role. So I don't know necessarily what their plans are for this coming summer. I think even over the summer, things will change and they will have to change and flex with those plans. Again, you know, urging the teachers to get their vaccines, when children can have vaccine available to them, for them to be vaccinated. And those will all be important things to kind of diminish the amount of illness that goes on during the school year, during our traditional seasonal respiratory season.

Host:

I have to admit, I've been very impressed with the Lee school district and the things that I've heard and seen how flexible and attentive they've been to this.

Dr.Saunders:

They're an amazing group of people. And I'm just so proud of their community effort.

Host:

I wanted to broach a subject with you. That was a difficult one for our staff last year. And I'm currently doing talks to various healthcare staff discussing stress, burnout, and PTSD during COVID. One of the things I talk about leading to stress is this concept of dismantling everything we thought we knew about infection control, the steadfast rules of infection control all the habits and behaviors. We, as healthcare providers worked so hard to establish through relentless training and skill-building were turned upside down and we were asked to work with limited supplies of PPE, decontaminate our N 95, and reuse isolation gowns. The steadfast rules that govern our lives for years morphed into guidelines. I'm curious, as someone dedicated to practicing good infection control techniques, how did you personally come to terms with this change in protocol? Did you find it stressful to come to those terms with this change in paradigm?

Dr.Saunders::

Well, it was out of the norm of what we would know for infection prevention, but certainly when we looked at the option of having no protective equipment available, versus how could we reuse it safely or extend the use of it? You know, we found that these alternatives did work and much to our surprise. You know, we had very little, healthcare providers who actually got COVID in the workplace. We know that most of the exposures were outside of work. Through this, even though we were not doing things, it's what we consider in the optimal world. There was still, you know, safety for the health care providers. So, yes, it was hard. It was really hard with those decisions. I still worked and saw patients in the hospital and people with COVID and just to see the staff working day in and day out with those conditions. Sometimes you felt so bad, your heart just ached for them to know what they were going through, but, you know, there's other folks that we didn't even like, I feel like we didn't give enough recognition to. Like our folks that worked at our local grocery stores like Publix , and all of those. They were there every day, you know, supplying, you know, there for us. So healthcare workers could get their supplies, having the same fears, having the same close contact. I just felt like we probably haven't done enough to acknowledge all the support that they did for all of us, so we can continue doing our jobs. So, you know, I just wanna acknowledge, everyone who was out there playing their role. And even though you may not have been a frontline person, you were a frontline person for me. I still needed to take care of my family and you know, my parents and, and do all those things. So I appreciate all those folks so much and really, you know, thank you from the bottom of my heart for all that you did.

Host:

That's, it's a great acknowledgment. I think we sometimes forget about those folks, but you're absolutely right. I can't imagine how we would have gotten along without them.

Host:

If you had the opportunity to do this year over, what would you do differently and why?

Dr.Saunders:

Well, one of the things that I would do differently, and I know we are going to do differently as a health system is probably that early adoption of mask and people masking and, you know, I didn't think children would be able to adopt and wear a mask like they do, and they actually do a great job.

Host:

They did better than we did. I think.

Dr.Saunders:

They do. I see them out on their little playgrounds with their mask on. I thought they would be wearing like, you know, pirate hats, and things like that. And they did not, they did great, but, you know, we would be remiss as a healthcare entity, not to think that we shouldn't wear masks during the height of the respiratory season. And we can never go through a respiratory season again, even long after, you know, COVID is kind of smolder down without having masking during that time of the year, we saw so little usual cold symptoms influenza.

Host:

I was amazed at how little flu we saw.

Dr.Saunders:

So, you know, we have mandatory vaccination, but we are going to have to have massing for a certain part of the year because that's what keeps our employees safe from getting sick and keeps us from spreading it to patients and patients spreading it to us. So, you know, if we lose that valuable lesson, I'm going to be very sad, but that is, you know, as a healthcare system we know from here on out that during the height of our respiratory season, which is usually November to, to end of March, we're going to need to wear a mask.

Host:

Yeah, I have to admit, I was truly impressed with how little flu we saw this past year and, and I attributed it to masking as well. And that's just a neophyte observation from this side of the world.

Dr.Saunders:

A very good observation on your part,

Host:

Dr. Sanders, I really appreciate you being here today. COVID is still very much on the minds of our listeners. Is there anything you'd like to add before we go?

Dr.Saunders:

People need to continue to have faith that we are gonna get through this and that there are certain things that are kind of tenants of basic infection prevention that we need to do to keep ourselves safe from any infection. And so that is hand washing, making sure you're using soap and water and washing your hands for 20 seconds or, you know, alcohol hand gels and, and doing those and frequent hand-washing. Avoid touching your mouth and your nose and your eyes so you don't inoculate yourself. And when you're sick for goodness sakes, stay home, don't spread it to other people. And, you know, know that wearing a mask is not a government conspiracy. It's not a healthcare conspiracy. It is a way to protect yourself from getting viral particles in your nose and your mouth, or you spreading it to other people, I mean, it is a barrier. So, you know, we have to think that it's just not about ourselves. It is about those that we are around. And we want to protect the people that we love and we want to, the people that we care for as a health system. So that's just the reminder I have.

Host:

Thank you, Dr. Mary Beth Saunders, until next time. I'm Cathy Murtagh-Schaffer, and this has been HeartBeats, Shipley Cardiothoracic Centers podcast, dedicated to bringing research innovation and education to our patients and the community.