More people are getting vaccinated against COVID-19, but you or someone you know may still have questions and concerns about things like boosters, at home tests, and breakthrough infections. If so, you’re not alone. We sat down with OhioHealth’s system medical director of Infectious Diseases Joseph Gastaldo, MD, during a recent Facebook Live event to get some answers.
Note: If you want to hear Dr. Gastaldo’s answers to our questions, we’ve provided time stamps in our story, to help you find the answer in the video above.
As you read on, keep in mind that this information shouldn’t replace the advice of your doctor. If you have additional questions, visit the Centers for Disease Control and Prevention COVID-19 website.
Let’s start with the 12 And under vaccinations since the big news came out today Pfizer releasing they had a news release, I believe today that said that they’ve done their testing and we’ll be hearing more. So what is that telling us? (2:23)
Yeah, so hopefully we will have a vaccine available for five to 11 year old’s, my best guess sometime mid to late October – maybe the latest Thanksgiving based on the signals coming up on Pfizer. Pfizer today in a press release, released information saying that in their analysis of the data so far, the vaccine is safe, and it produces very respectable antibody levels to children.
Now the pediatric dose they announced is 1/3 the dose that adults get. It’s 10 micrograms separated by 21 days, the adult dose is 30 micrograms separated by 21 days. The results of their clinical trial have not yet been made public. They have not submitted the results of the clinical trial to the FDA yet. They’re kind of giving us a teaser a little bit in a press release. So that’s the first step, but I do think they’re on track to get theirs up and running first, as far as the pediatric indication. Again, it’s only from five to 11. Five to 11 year old’s are roughly 25 million of our population, so really, that age group needs to get access to vaccines.
Moving forward, beyond that, Moderna and J&J are also doing pediatric studies. Then after five to 11, the next category for a study are six months to five years old. And again, when it comes to children, we don’t want to rush the process. We don’t want to have any cuts at all, and the detailed review process is really emphasizing safety.
The next steps is then the Pfizer clinical trial results will be done. They’ll present it to the FDA, and just like the open transparent review that they did for the adult vaccines, they will do too. The FDA vaccine advisory committee will open and do a very detailed review. It’s not a love fest. They ask a lot of tough questions. It’s televised, anybody could watch it. They will make a recommendation for either emergency use authorization or not.
And then if it goes through, the FDA still has one more hoop to jump through, and that’s the CDC’s vaccine advisory committee. They do a very detailed review of the safety, the efficacy and make recommendations. So, again, those are the two hoops that the vaccine review process happens. Most of them are transparent, and the way we review vaccines in the United States is the gold standard of the world. No other country reviews vaccines the same way we do.
So timeline wise, could it be a couple weeks? A couple months? Next year? (5:18)
For children? I do. I mean, based on different signals coming out of DC, I think everybody has said, Halloween-ish, so mid to late October, no later than sometime in November. So again, in the scheme of what we’ve been in the pandemic, it’s not that much further away.
Third doses, booster shots, what’s going on there? (5:43)
Yeah, so a lot of hot topics with that. Two things I want to say. First of all, our biggest priority still is to get vaccines in the people who have not yet received them. We still have significant work to do in our country, in our state and our community. There are many countries in the world who haven’t even started vaccinating a big part of their population yet, so that is still the priority – to get vaccines in the people’s arms.
The second thing I want to say is, since we are talking about boosters, I don’t want people to think that the vaccines aren’t working. The vaccines that we are giving people are performing exceptionally well in what they’re supposed to be doing – preventing severe disease, keeping people out of the hospital and worst case scenario preventing death. So I just want to say that first.
So let’s talk about the third dose and what we know so far. Last Friday, the FDA’s vaccine committee reviewed data presented to them by Pfizer, and they also reviewed data from the country of Israel. And Israeli data suggested that those who are older would benefit from an additional dose – a third dose. The only thing Pfizer presented, however, was only safety information from only 300 people who received a third dose. They didn’t really do a clinical trial, like we did for their original submission, or what we talked about for a pediatric admission.
So what I wanted to know as an infectious disease Doctor, what is the safety profile of giving a third dose to people? And when you look at only 300 people, most of which are older, we really don’t have that. So the FDA vaccine committee had two votes – their first vote was a resounding no, and the first vote was, should everybody 16 and above who has six months out from their second dose receive a third dose? That got voted down really because the lack of safety data and really a lack of a clear signal that it’s needed. So there was a lot of scuttlebutt within that conversation.
They took a 10 minute break, Dr. Marks – a leader of the FDA – came on and of course, I was watching it all excited to say, Oh, my gosh, what’s going on? What’s going on? They took a 10 minute break. After the break, they came back and they said, “You know what, let’s figure out something we can authorize based on the information presented to us.”
So what they voted on – yes – was to authorize third doses for anybody 65 and above who was at least six months out from their second dose. They also voted to authorize a third dose for anybody any age six months and older who is at severe risk of COVID-19, and they also voted language to recommend a third dose for anybody who has a job that would put them at higher risk to be in contact with this virus. So that passed.
Now, that vote still has to be finalized by the leadership of the FDA. That vote from the FDA vaccine committee is non-binding, and theoretically, the leadership of the FDA could make up whatever they want legally. I don’t see that happening. I personally have problems with that, and I think that would cause a lot of a flurry for that to happen. So we still have to wait to see what the final authorization is by the leadership of the FDA, based on that FDA vaccine subcommittee. After that’s done. We still don’t have access to it.
On September 22, the CDC’s vaccine Advisory Committee – the Immunization Practices, is going to meet. They will go through all of the fine tooth detail of who should get vaccinated, who should not get vaccinated, but it boils down to this. Not everybody is going to need a third dose. We really want to follow the recommendations that come out by the CDC and again, those haven’t been written yet. They have not been made public, but that’s going to happen on Thursday. The CDC’s vaccine Advisory Committee, when they meet, it is open to the public, anybody can listen in. They actually even have a section on there for people to ask questions or to make comments. And once those final details come out for the final recommendations, then we could have people go get a third dose.
Now, this point in time, the only authorized third dose and recommended third dose, are for those who are moderately or severely immunocompromised. That’s only 2.7% of the population, roughly 7 million people. It’s not a 60 year old man with diabetes and hypertension, we’re really talking about transplant patients, people receiving chemotherapy, people receiving biological agents. It’s really not that many people but if anybody listening falls into that category, they qualify to get a third dose now and they should get a third dose because people with a weakened immune systems don’t respond well to vaccines.
How can we say the vaccine is effective when it does not stop you from getting or spreading COVID? (10:57)
Yeah, that’s a great question. So let’s dissect that a little bit. Okay. These vaccines were never studied or never intended to stop all infection. These vaccines whole point was to prevent people from having severe disease. So let’s talk about how the vaccine works. And I’m going to keep it very simple. And I’m going to talk about what immune response the vaccine gives you. And I’ll use myself as an example.
After somebody is fully vaccinated, there’s two parts of their immune system that are stimulated. One are your antibody levels, we call them titers. After you’re fully vaccinated, your antibody titers are very, very high, and over time your antibody titers naturally come down. The antibodies prevent infection. So with high antibody titers, you have antibodies right there and your mucous membranes, and as soon as the virus gets there, the antibodies bind the virus and prevent infection. So, the other part of your immune system that’s stimulated after you’re vaccinated are your memory cells, specifically B and T memory cells. Those go in your bone marrow. Those last for many years, maybe decades, or perhaps even the rest of your life. And if in the setting of an infection, your memory cells are stimulated, they get antibody levels up really quick, and they help clear the virus and they really prevent severe disease.
So for example, I was vaccinated in December of 2020. As a result of the Delta variant, and my lower antibody titers, I’m at higher risk for a breakthrough infection. But, my memory cells are ready to go, so if I get a breakthrough infection, my antibody titers are going to come up. My other parts of my immune system are going to stimulate, and I’m either going to have asymptomatic infection, or cold or flu symptoms. And I’m very, very unlikely to have severe disease, resulting in hospitalization.
So again, like I said earlier, in this pandemic, and what we’re talking about with COVID, there are no absolutes, and having these discussions now, especially when you talk about vaccines and immunology, they are full of caveats. But the vaccines, like I said earlier, what they’re intended to do is to prevent severe disease, and they’re performing very, very well against the Delta variant.
The flu shot very much is like the COVID vaccine. Getting a flu shot doesn’t stop people from getting infection with influenza virus. It’s really intended to prevent severe influenza resulting in hospitalizations or death. And again, it’s a very complicated discussion and immunology is complicated.
So can you explain the difference between infection and illness and how the vaccine plays a part in this? That was a viewer question. (14:20)
Yeah. So let’s – I think what they’re really asking is, what is the difference between infection and disease? Okay, so you can have infection without having disease. For example, cold sores are caused by a herpes simplex virus. So people who have cold sores have chronic infection with herpes simplex virus. They’re asymptomatic. It’s no problem at all, but when they get a sore, that’s disease.
You can have infection without having disease, and that’s the same thing with this specific Coronavirus. You can have infection without disease, and when you do have disease, that can either be mild, moderate or severe. It’s a spectrum. And these vaccines were never studied or intended to stop all disease.
Now, think about this. When these vaccines first came out, everybody had really high antibody titers, right. We have a big part of our population that were vaccinated earlier on beginning in December of 2020. So when these vaccines first came out, with everybody having high antibody titers, we had our levels actually go down a lot because of that. Everybody had a high level of protection against infection, but all antibody titers go down. When your antibody titers go down, you are higher risk for infection, but your memory cells are still there, they’re able to recognize the virus and nuclear quicker.
Healthy People who have lower antibody titers and get a breakthrough infection, most of those people fall into one of three categories: either asymptomatic infection, cold symptoms, or flu symptoms, and they stay home for that.
What protection does a previous infection in antibodies provide, and why is natural immunity not good enough, in terms of that? (16:24)
Yeah, that’s a great question. natural immunity comes up a lot. So one thing I will say is this, yes, when people get infection with this virus, there is a degree of immunity. They get both antibodies and memory cells. However, and this is the caveat, the degree of immunity people get is quite variable from person to person. It’s really dependent upon your age and your severity of illness. There are many studies out there looking at people and their antibody levels after being vaccinated, and some people don’t have measurable antibodies despite having symptoms and a positive test. So we really have to be careful with that.
We know that getting vaccinated after having COVID is safe. Nobody is at complete, a higher risk at all of getting vaccinated after having COVID, and when you look at the collection of scientific literature that’s published so far, the people who actually have bionic immunity, are those who have had COVID and then get vaccinated.
Finally, there is no test out there that measures anybody’s immunity. People talk about antibody levels, but all of the antibody levels perform differently. They’re all authorized under emergency use, and we don’t know what that marker of antibody that correlates to immunity.
Anecdotally, I can tell you, I’ve had a few patients have antibody levels done at different labs and they get different antibody results where they say detected, not detected, so we don’t really know what that means. There are many infections like HIV, like syphilis, like hepatitis C, that give you all kinds of antibodies and those antibodies don’t do anything. So, we don’t know what antibody levels mean with infection with this Coronavirus.
Could you explain the reasoning for dosage being based on age rather than weight or height? (18:37)
Yeah, so we don’t know the exact answer to that yet, because of the clinical trial and it’s fine details have not yet been submitted to the FDA.
Now, this is me thinking outside the box. You know, children are not little adults, their physiology is different. They have more active more robust immune systems. They respond very well, when it comes to stimulating your immune system. So physiologically, it makes sense that children need a smaller dose.
Plus, we want to make sure that the pediatric studies are done with the utmost resilient – with the utmost paying attention for safety, and we really need to have that process played out at the level of the FDA.
When boosters are available does a person have to get the same type as their initial vaccine? (If you got Moderna do you have to get Moderna?) (19:35)
The simple answer to that is initially, yes. So Pfizer’s clinical trial for their third dose is with their vaccine. Incidentally, it’s the exact same vaccine, and Moderna’s trial that they will eventually submit is going to be with their vaccine.
So initially, when third dose recommendations come out, just like they are with immunocompromised patients, it’s going to be with the same vaccine to stick with that.
So when it comes to third doses for Pfizer, likely to come out hopefully by the end of the month, it’s only going to be for Pfizer people, and I expect the Moderna third dose recommendations to come out sometime in October.
Johnson & Johnson is also doing a two dose clinical trial, and they will submit that to the FDA, so stay tuned for all of those. But to answer your original question, when third dose recommendations come out and authorizations come out, it’s going to be to stick with the same vaccine.
What is your guidance for gatherings during this surge for people who are vaccinated? (21:12)
Yeah, that’s a good question. So this is what I tell people you know, you want to follow the CDC guidelines and the health recommendations that we have.
It really has to do with how much level of community transmission there is. So right now, in Ohio, all 88 counties, there’s high level community transmission, and the guidance and the recommendations are – regardless of your vaccination status, in public, indoors, you should be wearing a mask.
A lot of that has to do with the protection a vaccine gives you and I’m going to use an analogy that I talk about a lot and it has to do with a raincoat. We wear raincoats to stay dry. So if it’s raining, a raincoat works well, a raincoat being vaccinated, works well, if it’s sprinkling. The rain coat will keep you dry, if it’s sprinkling. The amount of rain coming down is the level of community transmission of COVID. So if you have your raincoat on and outdoors, it’s down pouring rain, i.e. high levels of community transmission, you’re going to get wet from wearing a raincoat. Right? So as we get to lower levels of community transmission, the recommendations out by the CDC is if you’re fully vaccinated in public, you don’t need to be wearing a mask.
Now I’ll tell you what I do. In private, those guidances are not out there. Now, everything’s full of caveats. If you are in a private scenario, and you know with certainty that people are fully vaccinated, that is a safe scenario for people to be together if they are all fully vaccinated in the setting of not wearing your mask. Now, the caveats to that is you may live with somebody who has not been vaccinated, somebody with a weakened immune system where vaccines don’t work as well, maybe a four year old child, and you may decide that you don’t want to take any chances and that’s okay.
So, again, we want to follow the masking guidelines that are out there for us, especially in the setting of high or substantial community transmission. But in a private scenario, private setting, private home – if everybody’s fully vaccinated, no one’s feeling sick – it’s safe not to wear your mask. However, the caveat is, what else are you exposing people to, for example, someone who have weak immune system not vaccinated, etc.
When do you anticipate Ohio peaking during this current surge? (23:52)
Right now in Ohio, we are in hopefully the peak of our delta surge. So the Delta surge began in places like Missouri, Arkansas. They began really in areas with lower vaccine uptake. What happened in Missouri was their Delta surge began probably about four weeks before ours. Theirs went up, it peaked, it plateaued a little bit and is slowly coming down.
In Ohio, we are still going on an upward trajectory. If you look at our seven day moving average, if you squint and look really close, you’ll see the numbers of a seven day moving average have come down a little bit the last three or four days. So it could be that that’s the beginning of our delta peak, but also it could be a teaser too.
Again, the positivity numbers in the community are the leading indicator. The lagging indicator are hospitalizations, and the ultimate lagging indicator are deaths, so we’re still on the upward trajectory of those things.
How soon after someone has had COVID can they receive their vaccine? (24:59)
That’s changed a lot. A lot of people confused with that. The CDC official guidance on that now is for anybody who has had COVID, as long as they are out of isolation, meaning that they are no longer contagious and they are feeling better, they can be vaccinated.
Initially, the CDC guidance was if you’ve had COVID, you can wait 90 days because we had a shortage of vaccines for many, many people who wanted it. And again, you don’t have to get it right away. When someone has had COVID, they do have a degree of immunity for a period of time.
You don’t have to get it right away, but people who have had COVID should still get vaccinated.
Are there risks for those with medicine allergies, like penicillin to get the vaccine? (25:50)
The short answer to that is no. When you go to get vaccinated, if you’ve not been vaccinated yet, they ask you a lot of questions, and if somebody has had a severe allergic reaction to penicillin, peanuts, puppies, or really anything, they can go and get vaccinated.
The only true contra indication do not receive this vaccine is if you know that you are severely allergic to an ingredient in the vaccine. Now there aren’t that many ingredients in the J&J and mRNA vaccines. The vaccines have no preservatives in them. They’re really unlike any other vaccines that we have. The mRNA vaccines, what do they have in them? They have a little bit of sugar. They have some salts or buffers. They have messenger RNA, which we all have, and then some cholesterol or fat.
Why does the Delta variant affect children more? (26:50)
The big reason is because they’ve not been vaccinated. That’s the bigger reason. When you look at the only children now who have access to vaccines are those 12 and older with the Pfizer vaccine, and I strongly endorse 12 year old’s and older to receive the Pfizer vaccine.
The Delta variant is a super spreader variant. It spreads easier and children have not been vaccinated, especially below the age of 12, and that’s one of the reasons why we are seeing more COVID in kids.
How are symptoms with the delta variant different from those with the original, alpha variant? (27:31)
The symptom complex, with Delta, and even more so with people who have had a post vaccination infection is a little bit different. It’s really any type of upper respiratory tract infection, whether you have what you think is a sinus infection, an earache or a sore throat.
Out of the UK, they did a symptom survey from people who have had infection with Delta, and their top three symptoms from the survey were headache, sore throat, and a runny nose. Previously, a runny nose was not a symptom at all associated with the COVID-19.
Because of these symptoms being so similar to colds and upper respiratory infections, would you suggest just having some at home tests? (28:37)
Yeah, if you can find them. When we say at home test, we’re talking about antigen tests. Many companies make them, and in the setting of somebody having symptoms with widespread community transmission, it’s a good test. It lets you know when somebody is contagious.
PCR testing, and I agree with this, many people say it’s too sensitive, but antigen testing lets you know what’s important – when you are contagious. So antigen testing is out there. Home testing is out there.
One of the mitigation recommendations that we really need to emphasize is to test. If somebody has COVID symptoms, they need to stop what they’re doing and get tested, regardless of their vaccination status. Before, in this pandemic, one of the challenges was not having access to testing. That’s gotten better. I think more places have testing available. I was recently at Sam’s Club, and they had some antigen test there and I bought two kits. I have them in my house, in the setting that I may use them, and knock on wood, I haven’t had to use them.
So at home antigen tests tell if you’re contagious? (29:55)
So PCR testing, you can be PCR positive or detectable without being transmissible or contagious. Antigen testing when it’s positive, you are contagious.
How do I help my anti vaccination family members understand the safety of the vaccine? (30:18)
First of all, thank you for that question. Second of all, don’t give up on them. You know, we want to be respectful with anybody. We’re not this tribe or that tribe, we are all part of the same community. We really want to not build up these artificial walls, so we really want to not give up on anybody.
For people who have not been vaccinated yet, it boils down to two things. One: people have concerns or questions that matter to them, and they cannot get their concern or question answered from a reliable source. There are many people who don’t have access to a physician. They don’t have access to a reliable source, so they go online, and online you can go down a rabbit hole of misinformation. It’s very easy to go online and come across misinformation that looks pretty good. I see that all the time, and it’s really challenging for people.
The second group of people who have not yet been vaccinated, are those who – I’m still not giving up on, I’m not giving up on anybody – are those who really believe something that’s scientifically impossible, like being magnetized; like interfering with your cell phone reception; like the vaccine causes infertility, which it does not. Or they hear something that Nicki Minaj says, or they hear something on a podcast.
There are people who don’t follow this every day. I’m an infectious disease doctor. I follow all of this stuff every day. For people who are working nine to five, it’s really hard to stay current on what’s new for the day and to sort out what’s something that’s important to know and something that’s background noise.
I get that, but we really need to wrap our arms around people who have not been vaccinated and really talk to them from a vantage point of caring and understanding. And we talk with them, not at them, and really try to connect them to a reputable source of information.
Are there any legit studies showing that women who may want to become pregnant should not get the vaccine? (32:40)
There’s great information on that. If a woman is pregnant, if she’s thinking of getting pregnant, if she is nursing, the recommendation from the American College of Obstetricians and Gynecologists and the Society of Maternal Fetal Medicine is to get vaccinated. They would not make that recommendation without a strong scientific consensus on that.
We know that being pregnant is a riskier proposition in this setting of somebody getting COVID. I have personally seen pregnant women have bad outcomes with COVID-19, and it is a tragic situation when you worry about the health of the mother and her baby.
In addition, when you choose to get vaccinated when pregnant, you’re also giving your baby a wonderful layer of protection. Some of your immunity, your antibodies, will go to the baby, and then after the baby is born, for a while you’re going to be producing antibodies that get in the breast milk, if the mother chooses to breastfeed.
If a majority of the population is vaccinated, will we ever get back to normal? (33:56)
Well, depends on what you mean by normal, to be honest. We are never going to have a COVID zero world. We need to learn to live safely with this virus, and the way to ending this pandemic is through immunity.
Now, if you’ve not been vaccinated yet, you’re at higher risk of getting COVID and you’ll get immunity that way, but the safer way to begin the process of getting immunity is through a vaccine.
Once we get to a level of really herd immunity, community immunity – really the whole herd for COVID is planet Earth, and we’re nowhere near herd immunity for planet Earth. Our country’s very, very blessed, but we really need to get vaccines into people’s arms because what’s driving the potential for more variants are high infection rates in areas who have not been vaccinated. We will get there and we need to learn to live safely with this virus.
Now, my crystal ball, eventually we’ll have more immunity in our Ohio community. As immunity is built up more, we will have lower rates of community transmission. As we get lower rates of community transmission, it’s safer for people to go out not wearing their mask.
Also moving forward, I do see us having a Tamiflu type pill, an antiviral medication for COVID-19 by the end of the year. Both Merck and Pfizer are working on antiviral pills. So moving forward, when we talk about SARS Coronavirus-2, it’s eventually going to be a cold virus, just like the other coronaviruses that we’ve known about now for decades.
The one treatment we have right now is the monoclonal antibodies. How does that work? (35:52)
Yes, so monoclonal antibodies are made in a lab, and these are antibodies that neutralize the virus. They bind us by protein. We give monoclonal antibodies to people who have a diagnosis of COVID, and they have an at risk condition, whether they be morbidly obese, diabetic or above a certain age.
Earlier on in the disease process, somebody has a very high viral load, and when we give those people monoclonal antibodies earlier on in the disease process, it neutralizes the virus and prevents them from going to a higher severity disease.
Since we’ve been using monoclonal antibodies now for many, many months, the science has shown that they really do a good job, up to 70 percent, of keeping people out of the hospital.
Now, monoclonal antibodies are – they’re FDA authorized under emergency use. But still, we want to talk about them, people need to know about them. However, the best layer of protection still is to get vaccinated, not monoclonal antibodies.
Who qualifies for monoclonal antibodies? (37:15)
It’s pretty inclusive. Recently, the FDA liberalized the inclusion criteria for monoclonal antibodies. Diabetes, obesity, heart disease, lung disease, pregnancy, people who have any other type of immunocompromised condition, cancer patient, or anybody in a biological agent.
We have several graphics. The first one is the vaccine side effects that are compared. Do you want to walk us through this graphic? (37:46)
What we’re looking at here in this graphic is the side effect profile. Let’s go from left to right. The very first thing we have there is the shingles vaccine, Shingrix, and you can look at the bottom line. The overall side effects of the shingles vaccine is 46%. Half the people who get the shingles vaccine have a vaccine side effect, the biggest one is being myalgia or pain at the muscle site.
Pfizer dose number one is the Pfizer mRNA vaccine dose number one. Dose number one is pretty well tolerated – 27 percent of people will have a side effect of the vaccine, the big ones being fatigue, headache, and myalgia or muscle pain followed by pain at the injection site. Pfizer vaccine dose number two you can see there the biggest one is being pain at the injection site, followed by muscle pain, followed by fatigue, followed by headache.
The new thing there that has the gray box surrounded by blue is the Pfizer third dose vaccine side effect profile that Pfizer submitted from only 300 people, and when you look at that it’s very similar to the second dose. The biggest side effects reported from volunteers who received it is pain at the injection site, followed by muscle pain, followed by fatigue, followed by headache. So if you see 33 percent of people who got the third dose compared to 34 percent, the second dose had a side effect from the vaccine. Finally there in the far right is the flu shot.
So generally speaking, the Pfizer vaccine third dose is pretty well tolerated, as tolerated as the second dose. I received the Pfizer vaccine first dose no problem with at all. The second dose I had man flu for a day. I had a fever, I had muscle pain. I had to go home and lay down and take care of myself. But guess what? A day later I felt fine went back to work.
How accurate is the rapid at home COVID test? (39:58)
The at home test is very good. In the setting of somebody being symptomatic, and with high level of community transmission, it is a great test. It’s very sensitive, and it’s very specific in that manner.
Now, in the setting of lower transmission, that’s the issue you have to worry about. For what we’re using it now today, and somebody who is symptomatic with high levels of community transmission, it’s a good test.
Are there any other variants we are concerned about in the foreseeable future? (40:38)
Oh God, I hope not. The biggest thing right now is delta. In the news, they’ve had identification of the lambda variant in the mu variant. We don’t know a lot about them. They are here in this country, but the one that is the most powerful, the one that’s most transmissible, out crowds everything else. Right now that’s Delta. The one that’s most transmissible out crowds everything.
Now, moving forward, we’re going to have other variants. There’s going to be infections in other parts of the world. We will probably get through the whole Greek alphabet, and then we’ll have to come up with a new naming system. When we get to all these variants, we need to study the variants. We need to respect the variants, but don’t fear the variants. Don’t fear the variants.
If there is a bionic variant that comes up someday, where the vaccines don’t work, where it evades all immunity, we will be prepared for that. And these vaccines can be changed very quickly to come up with a variant specific vaccine.
Earlier in the broadcast, we were talking about how vaccines do not prevent getting COVID, but they prevent keeping you out of the hospital or having severe cases. That is what these graphics are intended to share with our community. Dr. Gastaldo can you kind of just break down what these numbers are? (41:49)
Let’s look at this in detail. So this is September 20 2021, from OhioHealth, all of our care sites, and we had a total of 282 people in the hospital with COVID: unvaccinated 232, vaccinated 50. In the intensive care unit, a total of 65 people – 59 unvaccinated, six vaccinated. On ventilators, a total of 36 – 31 unvaccinated and five vaccinated.
What I want to do is really explain the people who were vaccinated, and I look at this every day. When you look at the people in the hospital who have COVID, who have been vaccinated, there is a underlying theme that you could see. Many people are on this spectrum of ages 85 and above. Vaccines don’t work as well in them. And the other thing that you’ll see in the pattern is many of those people have weakened immune systems – cancer patients, transplant patients, dialysis patients.
So collectively, if you look at that, like I said earlier before, the vaccines are performing very, very well with what we want them to do to prevent severe disease and severe disease is being hospitalized with COVID.
Unvaccinated can be completely unvaccinated, can be one dose, and can be two doses before that two week timeline. So we wanted to make sure we made that clear, but why does it make a difference – why do we just consider if you haven’t completed all of your doses you’re unvaccinated? (44:00)
After you get vaccinated, you have a rise in your antibody titers, and you have stimulation of your B and T memory cells along with other parts of your immunity. To have that full immunity of the vaccine, it’s two weeks after the second dose or two weeks after J&J.
If you only receive one dose of Pfizer and it’s three or four days later, you’re still on the charging component of getting your immune system up to speed of the full benefit of being vaccinated. There’s a lag behind getting vaccinated before you get the best immune response, the best level of human protection.
What kind of strain, if any, is COVID having on our hospitals right now? (45:03)
At OhioHealth, and all the hospitals in Central Ohio, we’re really trying to walk and chew gum at the same time. There’s a lot going on in the hospital. We are still catching up on people who have been delinquent in their COVID care. We still have a lot of people catching up on colonoscopies, hip replacements, and things like that.
We have more COVID patients in the hospital. We typically have more traumas this time of the year from being in the summer with car accidents. We have all of that going on. In addition, in the hospital, we – like everybody else in the community – have COVID fatigue. People are emotionally tired, people are physically tired. It really takes a lot out of your spirit to take care of COVID patients. They’re very sad case, visitation policy is hard for families and patients, and it’s not the way most doctors and nurses have really been trained to take care of patients. It’s not how we are used to providing compassionate care.
It’s a different way of doing things, and everybody has a yearning to get back to what that prior COVID healthcare delivery was.
When we’re looking at our graphics, does it make a difference for OhioHealth’s numbers that we’re sharing, if a person is hospitalized for COVID or if they are hospitalized for something else, and we learn that they have COVID? (46:26)
When people get admitted to the hospital, the bedrock of what we do is patient and associates safety. All the healthcare systems in Columbus are doing testing on everybody admitted to the hospital. We do PCR testing, and if there’s any suggestion that anybody has infection, we have to put them in isolation to provide protection for all associates and patients. That’s what everybody’s doing.
It kind of goes back to that difference between infection and disease. The test does have some pitfalls to it, but we have to air on the side of caution. If somebody has a positive PCR test, do they have infection or not? It’s sometimes difficult to say, and we put them in isolation.
If you don’t get the third booster, will you no longer be considered fully vaccinated? (47:29)
No, absolutely not. That’s not the case at all. Fully vaccinated right now is defined as two weeks out from Pfizer or Moderna, or two weeks out from J&J.
That definition of being fully vaccinated has not been changed by the CDC, and I don’t see that changing at all because not everybody is going to need a booster.
What are the treatments when someone is hospitalized with COVID-19? (48:11)
Nothing’s changed that much over the last six months. First of all, when people come in the hospital and have COVID, a lot of what we do is provide supportive care. We give them fluids. We make sure they eat. We check their oxygen level. We make sure they are supported as well as they can be. We watch them for any type of kidney or heart problems. We watch them closely to see if they happen to get a bacterial infection, which by the way, most people don’t.
Depending on where they are in their disease process, earlier on, they may get an IV antiviral agent called Remdesivir. The one thing that we really give them that has the biggest impact on mortality or actually surviving is giving a medicine called Dexamethasone, which is an anti-inflammatory corticosteroid, and that ship has sailed. Clearly that medicine does decrease mortality and keeps people from dying with COVID-19 if they are admitted to the hospital and they have an oxygen requirement.
The steroid that I just mentioned, Dexamethasone, is not meant to be used with people who have COVID and are on room air. If you’re in the hospital for oxygen requirement, you should be on the steroid dexamethasone.
One more graphic to look at. It’s basically the same information presented in a different way – it’s just the percentages as opposed to the numbers that we looked at last. So do you want to just kind of explain with this one is? (49:27)
Yes, the same thing. So this is OhioHealth hospitalizations as of September 20 2021. 82 percent of our hospitalized patients are unvaccinated. 91 percent of our ICU admissions are unvaccinated, and 86 percent of those on ventilators are unvaccinated.
Like I said before, not to sound like a broken record, our vaccines are performing very well with what matters the most. Those people in the hospital, most of the people in the hospital with COVID are not vaccinated. There’s no surprises there. The very old, 85 and above – I recently saw a 90 year old person in the hospital who’s fully vaccinated who came in with COVID – and those with a weakened immune systems, vaccines don’t work as well in those individuals.
There’s one small little sentence along the bottom that we have that says 96% of patients hospitalized with COVID-19, under the age of 50, are unvaccinated. (50:28)
That’s a powerful statement. That is a very powerful statement, and a lot of that has to do with the reflection of the fact that in the state of Ohio, over 80% of those 65 and above are fully vaccinated.
In the state of Ohio, as you go lower in people’s age, there’s less vaccine uptake. So really, you know, we want people to get vaccinated. I don’t want to see anybody in the hospital with COVID. It is not a fun experience to come in the hospital with COVID. It is very challenging from a patient perspective and their family members.
There’s a difference in where people go and the kind of care they receive. Can you explain that a little? (51:11)
OhioHealth is a big system and the hospitals all support each other, and patients do get moved around according to the level of care that they need.
COVID patients, when they are here, they are here for a long time, and they’re very labor intensive from a nursing and physician perspective because they’re all in isolation. You have to put a mask on, take the mask off, your PPE. So they really are more labor intensive to provide appropriate care for.
Will health care workers beginning a booster? (52:07)
At OhioHealth we do have a vaccine requirement, but that’s for only the first primary series. The decision to get a third dose needs to be taken one on one with somebody.
When can I expect my three year old to be eligible for a vaccine? (52:34)
Hopefully by the end of this calendar year or early 2022.
Which scenario would you rather be in: vaccinated and get COVID or be unvaccinated and treated with monoclonal antibodies? (52:44)
Vaccinated, then get COVID. I want my first level of immunity to be from a vaccine not monoclonal antibodies.
There’s a lot of unsafe information out there about “treatments.” The one big one was ivermectin, but people are also talking about betadine and hydrogen peroxide. Where do you think this is coming from, and what advice would you give to somebody seeing it? (53:01)
Everybody wants a quick fix. They want to cure. They want this to go away, and they want to provide help to people. If someone’s sick, it’s human nature to want to help them.
When you look at the ivermectin studies throughout the world, if you look at them all individually, they’re all different and there’s a lot of confounding variables in them. They’re not good studies, and one of the studies that was referenced quite highly was done in Egypt and was retracted because of falsified information.
Ivermectin is an anti-parasitic agent. As an infectious disease doctor, I prescribe it for various uncommonly encountered parasitic infections that we see here in the United States. It’s been around for a long time. It’s been used for years for parasitic infections. It came when in a lab, they did a petri dish or test tube study showing that this medication kills the virus, but at the levels for that to happen, it’s really too high of a toxic level that would make sense physiologically.
Nonetheless, we need to have a well done, randomized controlled trial without any confounding events to cloud the results of it. This is being done. It’s been done in Oxford at the recovery trial. We are going to have that answer hopefully sometime soon, but at this point in time, there is no compelling data to support the use of ivermectin for treatment or prevention of COVID-19, and I would highly not recommend anybody to take the veterinary form of ivermectin.
In addition, the new thing that there’s becoming more chatter on is the use of betadine gargles for COVID-19. Betadine is something that we put on wounds to keep them clean and also comes in a very dilute gargle, but the stuff that you put on wounds potentially can make you quite sick if you gargle and swallow it. It goes back to the human nature, people want to provide a quick fix, they want to relieve pain and suffering.
We have an FDA approved vaccine. We have a total of three vaccines, and today in our country alone, over 380 million doses have been given. We have a robust mechanism in place to look for any type of safety signals. Because of that mechanism, we know of three very rare, but potentially serious safety signals that when you look at those all individually, the benefit of getting a vaccine far outweighs any risk of getting a vaccine.
It’s a riskier proposition to get COVID and potentially gamble on what that may look like for you. There’s long COVID. People who have COVID can have persistent symptoms that go on for months, and some of those symptoms are very debilitating for people, and we really don’t know a lot about how to treat long COVID yet.
In addition, if somebody does get COVID, they could transmit it to somebody who has not been vaccinated because they’re too young, or somebody who’s having a weakened immune system. Everybody in their family, has somebody who has not been vaccinated because they don’t have access to a vaccine. Or everybody in their family, highly likely, has somebody with a weakened immune system, and we really have to go out of our way to protect those people.
Are there medicines or vitamins that will help to prevent getting COVID? (56:55)
When it comes to medicines or vitamins, you should stay home, hydrate, take the cough medicines and take Tylenol as needed.
Talk to your doctor about vitamin D supplementation. It’s not a cure or prevention for COVID. There is an association of low vitamin D levels with high severity of illness, with COVID. There is an association of low vitamin D levels and other respiratory viruses, like rhinovirus.
Vitamin D is a fat soluble vitamin. You can take too much of it and get sick from it, so, the best advice is to go to your doctor get a level done. That’s actually a good question to ask because in the winter months, we are all a little bit deficient in vitamin D, and that’s a good conversation to have with your doctor about taking a supplement and getting your level checked.
You need to take care of yourself. If you get COVID, the healthier you are, the less likely you are to have a severe disease. But there’s nothing that you could do to out healthy, not getting infection with this virus.
The way I think of it is like being in a car accident. If a young healthy person is in a car accident, their body is in a better position to survive and recover from the car accident versus somebody who is weak and frail in the same car accident.
There’s nothing that you can take to prevent you from getting infection with this virus. There’s things that you could do to not have yourself get as sick.
How are healthcare workers coping with all of the strain of COVID? (58:52)
It’s a lot. Health care workers – there’s a lot going on. It’s not just physical strain, but it’s an emotional strain. You know, people come to work surrounded by COVID. They’re nervous about working. They’re nervous about their family. They’re nervous about their community, and I wouldn’t be a bit surprised if people are going to have some post-traumatic stress disorder from COVID.
It’s something that we all have in common and we all have to look out for, our resiliency. We all have to look out for our well-being and it’s okay to feel anxious. It’s okay to be fearful of the unknown. I am confident that we will get through this. What’s different now than a year ago was immunity. We have more people with immunity. We have vaccines. We are talking about medicines. We’re in a much better scenario than we were a year ago, and I feel confident we will get through this.
Any final thoughts? (59:54)
I do mean this, we will get through this, but we really need everybody to think in a community mindset. What happens to you affects me because if you get COVID, you may give it to your neighbor who may give it to someone else who may have a connection to me.
So we really are all connected by COVID in our community, and we really need everybody to – number one, get vaccinated if you’re not yet been vaccinated. Find answers from a reliable source, so you can get all the information you need to hopefully choose to get vaccinated.
Follow the masking recommendations that are out there by the CDC. If you are in an area of high or substantial community transmission of COVID-19, regardless of your vaccination status, you should be wearing a mask indoors in public. Outdoors is very, very safe, and I would only tell people to wear masks outdoors in public if people are on top of each other where you cannot physically distance.
This article is a transcript of of a live interview conducted on Facebook on September 20, 2021. Due to the changing nature of COVID-19, some information might be dated. Always check with the CDC for the latest changing information concerning COVID-19.