COVID-19 Q&A with local health experts | #elderly | #seniors | #execrise
DAVENPORT, Iowa (KWQC) – On Thursday, TV6′s Montse Ricossa moderated a live Q&A with local health experts surrounding your questions about COVID-19, the vaccine, and what we can expect. You can watch the full panel and read through some of your questions below.
Will my personal information be shared if I get the vaccine?
No. “Any healthcare provider, including public health, takes your health information very seriously and your privacy very seriously. We will not be sharing any of that information with anyone, including ICE or any immigration official, there is no worry about that. We do keep that information so we can keep track of what vaccine that you received in case you had forgotten. And to make sure that we ask for the ethnic or racial backgrounds to make sure that we are distributing the vaccine fairly and equitably. We know that people of color are not getting vaccinated as quickly as white people. And this is one of the reasons why we’re doing this forum. We want to set everyone’s mind at ease.” – Janet Hill, COO of the Rock Island County Health Department.
Is there a cost to receive the vaccine?
“There is no charge for the vaccine. Some private health care providers could charge an administrative fee to your insurance, but there is no out-of-pocket cost to you. This is a federal asset the federal government has.” – Janet Hill
Why should someone get the vaccine even if they aren’t considered high-risk?
“Because younger people are at a lower risk for showing signs of having the illness. That doesn’t mean that they might not be transmitting it without having those symptoms. So that would be asymptomatic carriers and transmitting it to people who that they have contact with. Such as anybody that they run into and spend a little bit of time with especially if they’re unmasked can spread that virus very quickly.” – Dr. Colette Hostetler with UnityPoint Health Trinity Hospital in Muscatine.
What is in the vaccine? Isn’t it too new to be effective?
“One of my biggest concerns from patients is that these vaccines are new and untested. The truth is that this vaccine is not as new as you think. They’ve been working on these for around 20 years now. A quick lesson in cell biology: a human cell is made up of a cell membrane (the wall of the cell), cytoplasm (the inside of the cell), and the nucleus (the core of the cell). Inside the nucleus you have DNA. DNA makes small copies of a part of itself call messenger RNA. This messenger RNA comes out of the nucleus into the cytoplasm like a ribbon and acts as a blueprint. Once it is in the cytoplasm, these small “3D printers” called ribosomes read this blueprint and make proteins. Proteins have many useful functions and act as building blocks for our bodies. So somewhere in the 1990s, we started thinking “why not inject this messenger RNA” into our cells to make proteins that we actually want (like to treat different diseases). The problem with this is that we found that messenger RNA is extremely unstable and falls apart really easily. Also, when we inject it, our immune system sees it as foreign and immediately destroys it. So it didn’t work! So in the late 90s and early 2000s, some really smart people came up with something called “vectors.” These vectors act like protective bubbles to prevent the messenger RNA from falling apart and allow them to drop off the messenger RNA blueprints into the cell to now make the proteins that we want to be made without getting eaten by our immune system right away. The Pfizer and Moderna vaccines use a lipid vector which is just a fat bubble that looks like a cell membrane and the Johnson & Johnson and AstraZeneca uses an inactivated Adenovirus shell (not an actual Adenovirus) as this “vector” to drop of the messenger RNA (or DNA in Johnson & Johnson/AstraZeneca). These companies actually started making this method of delivery to make vaccines for other viruses like Ebola, Zika, SARS and had done all the early testing, but the endemics calmed down before they could be used. So when COVID-19 showed up, they already knew how to make it. All they needed was the blueprint to deliver. What’s unique about COVID-19 is that it has a “spike protein” that sticks out of it that the virus needs to be able to get into the cell. In order to make the messenger RNA for it, all they had to do was unfold the protein and read it in reverse. So when you get the vaccine, the messenger RNA is transported by the vector into your arm muscle cells where your body makes ONLY the spike protein and then falls apart like its supposed to. Your immune system notices this “foreign” spike protein and immediately destroys it. It then sends a message to “the cloud” (like you have on your phones) to remember this spike protein and attack it when it sees it again. This method is with antibodies. They literally look like “Y”s with the tips of the “Y” detecting the spike protein and sticking to it. The bottom part of the “Y” then acts like a beacon telling your immune system saying “come over here and kill this thing”. I give the example of a soldier pointing a laser at the specific building it wants to bomb in a city so it is a focused attack on this enemy. For Pfizer and Moderna, the second shot (booster) is your immune system saying, “Hey, this spike protein is back so we better really make sure to remember it”. That’s how you end up with 95% protection. The CDC has a very good picture of this if you would a better visual of what I have just talked about. An important thing to know is that messenger RNA that is dropped cannot go backwards and turn into DNA so it cannot become a part of your DNA. The DNA dropped off by the Johnson & Johnson and AstraZeneca enters the nucleus but does not fuse with your own DNA (it can’t). Both the foreign messenger RNA and DNA naturally degrade within a day so it does not stay active in your body.” – Dr. Jared Terronez with UnityPoint Health Trinity Hospitals.
Do we know how long we’re immune after getting our vaccine?
“These are new vaccines. Those studies are ongoing. We’ll see how long they are. One thing that we’re pretty sure about is that the immunity that we get from actually having the infection is shorter than what we have seen with the vaccine. And that’s one of the reasons even though people that have had the COVID-19 infection should go ahead and get vaccinated. Some people are recommending that they wait 90 days and some of that is so that other people that are available can get it. Because people who have COVID-19 infection might still be protected for that period of time. But you don’t have to wait for that 90 days. Take that vaccine when it’s available to you.”- Dr. Hostetler.
“COVID has only been around a year. Honestly, it’s only been around for a year. We don’t know how long immunity is going to be when the vaccine has only been around six months or studied and distributed for six months. We don’t know, we’re still learning that as we go, it’s looking really good so far when it comes to the antibody response and the effect on a population. Like in Israel, they did a study where it’s showing that is actually driving it down dramatically. Even in our hospital at UnityPoint. They show an inverse relationship where the numbers are going down as the vaccines pan up dramatically, that’s just in our population in our hospital so it’s limited. So we’re seeing it already. So time will tell.” – Dr. Terronez.
What is the difference in efficacy between the vaccines?
“When we talk about prevention and the morbidity and mortality aspect of it, there are two separate things. So prevention is when we talk about 95% preventable prevention, that’s really good and like Pfizer and Moderna, you’re right around there as soon as you get your second vaccine two weeks after. That’s really really good. That prevention part of it is saying that if I had COVID and you’re vaccinated and Coronavirus comes to you, you’re not likely to feel any symptoms at all… So that’s what that prevention part of that is. The second phase of this is what if we do get Coronavirus? What is the likelihood that you get it so severe that you end up getting hospitalized like our family members have where you get hospitalized, you have to stay in there get on oxygen, and then intubated and all that stuff, or actually dying. So with Johnson and Johnson, even though it doesn’t have as good of numbers for the prevention part of it, it dramatically decreases the hospitalizations and death rates. So that is phenomenal. In that aspect that even though you can et it, you’re not as likely to get the severe forms.” – Dr. Terronez
What are some of the side effects we could expect from the vaccine?
“Some of the side effects, of course, are just those localized kinds of effects that we get with every vaccine: some soreness, some redness, maybe some swelling of the arm, and some people get a little bit more severe. But that still isn’t the kind of reaction that we really worry about being an anaphylactic reaction. Other kinds of system-wide effects can be a fever, fatigue, some people might get some nausea, headache, a fever is a pretty common one as well. We suggest not medicating people get your shot because you couldn’t get your body the chance to react to that vaccine. To do what it’s supposed to do. Some of those side effects will we meet that your body is doing what it’s supposed to… I just had like 20 minutes of chills after about 10 hours. So don’t be afraid of those side effects. After you get the vaccine if you really feel like you need to take some acetaminophen or ibuprofen, talk with your provider about that and know that might be okay if you’re feeling bad. A cold wet clean cloth on your vaccination site could be helpful to help you not need to take one of those pain relievers. Make sure you’re hydrated. Make sure that you’re hydrated. Exercise your arm! I know it sounds kind of counterproductive to move a sore arm, but we know that it is helpful for it not to get as stiff after you get your shot.” – Dr. Hostetter
“I want to add that before you get your vaccination, we found that our clinics that it’s really important, as the doctor said to stay hydrated and to eat a little something. We’ve had some though some people feel faint, while they’re sitting there in that 15 minute waiting period. We’ve had no serious reactions. But we’ve had had a couple of people faint just from improper nutrition that day.” – Janet Hill
For two-dose vaccines, how long should you wait between doses?
“For Pfizer and Moderna you can go a couple of days early. The optimal window is for Pfizer is 21 to 42 days, and for Moderna it is 28 to 42 days. But the CDC and the FDA say if it’s not available to you within that 42-day window, just get it as soon as you can. That vaccine availability is becoming much stronger, so we do not anticipate having to go past that 42 days. we have much more vaccine moving into our community and we believe we’ll be able to get people vaccinated here in the summertime.” – Janet Hill
Once we’re fully vaccinated, do we have to wear masks around others that are also fully vaccinated?
“This is really good news to a lot of the grandparents who have been waiting to hug their grandkids. So if you have two fully vaccinated people, they can meet indoors without having masks. If you have one vaccinated person and one unvaccinated person from just one other household, you also could meet indoors without having a mask. When you’re talking about being in the general public, you still must wear your mask. And that will be with this for many, many more months. We don’t yet know what herd immunity is. But we know that it’s many months away. So just because you get your vaccine does not mean you can ditch your mask anytime soon.” – Janet Hill
What are the differences in guidelines between Illinois and Iowa?
“In Illinois, we are still under a master mandate. So that means anytime you are in public, you are required to wear a mask in most stores and restaurants and businesses are forcing that. We do have indoor dining at this point. In Iowa, there is no mask mandate. However, the Scott County Health Department and all of our healthcare partners are strongly strongly suggesting you still wear your mask. We know that they work, and we have strong metrics to prove that. We had very, very little flu this year. And flu and COVID are similar respiratory illnesses, they are not the same, but they are transmitted the same way. And by people wearing their masks and watching the distance and washing their hands, we had virtually no flu in the Quad Cities and all across the country.” – Janet Hill
How will vaccinating the general population affect the Quad Cities?
“If Illinois meets its metric of vaccinating enough of the senior citizen population, we will be able to vaccinate every adult on April 12. Now, it’s important to remember that only people who are 16 and 17 can receive Pfizer, and that’s per the emergency use authorization from the FDA. Moderna is only approved for 18 and older. So it’s really important if you have a 16 or 17-year-old to get the Pfizer. Right now we can do 16 or 17-year-olds who are frontline essential workers and next week we’re going to be able to do restaurant employees. We currently also can do people with chronic medical conditions. So I think that heading toward April 12, there’s going to be a little bit of a bottleneck at the beginning because everyone is going to be eligible in Illinois. But in Rock Island County, we’ve already been seeing most of our population be eligible. We have a lot of frontline workers. We have a lot of people with underlying health conditions and we have a lot of elderly people in our county. So we have been treating it as if everyone is available at this point. We know that that’s not 100% true as far as every single individual patient. But, you know, at the population level, many of our residents already were eligible.” – Janet Hill
There is a high survival rate with COVID-19. Why get the vaccine?
“I have this discussion with my patients all the time, that the mortality rate for Coronavirus is really low. Okay, somewhere between 0.5 and 2%. I admit that yes, you are absolutely 100 correct. But you’re forgetting about the morbidity factor. A lot of things in medicine that we care about in medicine is about mortality and morbidity. What is that? That’s the long-term effects or how bad you feel when you’re sick. When a person has a stroke they don’t always die but they have significant morbidity, that they can’t swallow. That’s very very damaging and that’s something that we as physicians care about sometimes even more than mortality. So what about the morbidity aspect of Coronavirus? We almost have seen it in we have family members who have been in there. I’ve had tías and tíos (aunts and uncles) that have been in for seven days, two weeks at a time intubated at a time. And now even coming out, even as a physician I’ve seen my patients have prolonged symptoms about how they can taste, they can’t drink coffee anymore because it tastes like dirt. I had somebody tell me that today. Just really prolonged symptoms when they’re feeling fatigued for periods of times. My wife’s grandfather was a professional cyclist, he’s barely able to walk right now. He’s still working out, so that’s the severe morbidity and that happens more like 20% of the time. 80% of the time you’re gonna be fine, especially more prevalent in the younger generations, it’s going to be better at that point. But the thing is, you still have that higher risk 20% is a lot. That’s a lot of morbidities. The other thing is it strains our system. Hospital systems are only designed for the person in a hospital for maybe three days-ish. When you’re hospitalized for Coronavirus it’s usually around seven. So, it adds up. There’s supposed to be people leaving but they’re not. So when they’re not leaving, the beds fill up and now somebody over here has a heart attack or a stroke and needs to get into an ICU bed, they can’t get in. We had this happen. This isn’t something that could theoretically happen, it happened in November. My patients were being shipped to Rockford, to Chicago, to any place that had an ICU bed so to say this is possible is not true. It happened and it can happen again we don’t stay ahead of it.” -Dr. Terronez
Is there a case where I shouldn’t get the vaccine?
“I worry about the younger people feel like they’re invincible. Sometimes I feel like that myself even though I’m way past that point. Why should I get it when I’m being as careful? We all want to get back to doing things that we have done in the past and that’s when they have a lot of contact with each other as well and you know there’s really no real contraindication to getting this vaccine other than an anaphylactic reaction to a vaccine which means you had to go to the hospital that you had swelling or hard time breathing and certainly you should talk to your provider if you’ve had that kind of a reaction to a vaccine, or see if there was something specific you’re allergic to in the vaccine or whether it was a mixture of things. If you really don’t know, you might not be a candidate for the vaccine. There really aren’t that many medical conditions (to stop you from getting the vaccine}. There maybe are medications that people should check with their healthcare provider on, again those people who take medications for immuno-compromising conditions like rheumatoid arthritis or lupus, some of those medications should be put off for a little while so your body has the chance to do what it should before you take those other medications that affect your immune system. There are really very few cases where you shouldn’t get the vaccine.” – Dr. Hostetler
Can pregnant individuals get the vaccine?
“It really is up to each pregnant individual. Pregnant women or persons were not included in the study. However, some of the people who received the shot did get pregnant. Those pregnancies are being followed closely and I believe that I heard not too long ago that some of those people had delivered and that they actually saw antibodies in the placenta but not causing a problem with the infant, which is a good thing. It shows there was a production and maybe some protection in those systems. So we’ll have much more information as more people are getting pregnant… There there are some studies that are being set up and initiated to look at the breastfeeding population. But it is a population that is recommended to get the vaccine.” – Dr. Hostetler
Is healthy living be enough to battle COVID-19?
“We are pushing healthy living. That’s one of the hardest things in my practice to get my patients to try to live a healthier lifestyle. But viruses really don’t care about healthy living, I mean the way that they’re spread is they take advantage of our systems and you may do a little better if you’re healthier. But I have some pretty healthy patients who were hit hard by the infection. On the other hand, I had some very sick patients who didn’t to who did better than what I thought they might. I don’t think that there’s any rhyme or reason. Yes, you should try to stay as healthy as you can. But I don’t think that that’s the complete answer to this epidemic.” – Dr. Hostetler
“Number one you should be doing nutrition and healthy living, anyway. Number one, first and foremost, I taught by patients we all need that. But the thing that I noticed is that really this is all odds. The whole thing is, what is the likelihood of you having a bad hospitalization or death from having Coronavirus. Yes, it’s higher when you’re obese, which is why we preach all the time to get your exercise in addition to healthy living, stuff like that, to decrease that obesity factor and kind of keep those bad things from happening. We should be doing that anyway. That’s how you keep a good immune system in general. So obviously we want you to do that and yes we’re preaching that on a regular, consistent basis. But that weight isn’t going to go away in a month to three months. In order to get to that level where you need to be out of that obesity level takes years. Usually, I’d have that discussion with my patients all the time, ‘don’t expect to lose all your weight in a one to a three-month time frame and expect it to stay off.’ In order for it to be actually medically beneficial, you need to have it off and be consistent. That’s how you know you’re going to actually be healthy to fight off the serious infections but, like Dr. Hostetler said, the virus is going to fight whoever wants it and it’s going to find somebody who has the weakened immune system at just the right time.” – Dr. Terronez
Are there worse side effects with Moderna than there are with Pfizer?
“Not really. When you look at the numbers as a whole is pretty much the same. I tell my patients, ‘you’re going to get a sore arm, 70% of the time you’re going to get a sore arm, so just expect that.’ You’re should expect to feel typical flu-like [symptoms] but some people don’t get any symptoms. Like for me, for example, I was knocked out hard after my second dose of Pfizer. But there hasn’t been actually a true difference with the kinds of side effects that you get: fatigue, headaches, muscle aches, some cramping, tiredness, all that stuff is still pretty similar on both sides. I haven’t found one being more likely to do it than the other. Even the Johnson & Johnson, people are getting the side effects from the few people that I’ve seen that I’ve actually got it for John Deere etc. I haven’t seen much of a difference when it comes to one less likely to give you the side effects than the others.” – Dr. Terronez
There have been reports of blood clotting with the AstraZeneca vaccine in Europe. Should we be concerned in the US?
“I think it’s like some of those other things that we heard about adverse effects. Every event, everything is recorded. Those clotting events are not greater than what we see in the general population. So it’s not clear, it doesn’t look like those were actually related to the vaccine. They may have just been not caused by the vaccine and would have happened anyway. But of course, all of the vaccine producers take those very seriously. They’re looking very hard at whether the vaccine is causing some problems or not.” – Dr. Hostetler
What if I just wait for Johnson & Johnson vaccine since it’s just one dose?
“Our recommendation is still to get the first vaccine available to you. Honestly, don’t wait. Because you don’t know… even my 65’s when we were more focused in the 1A kind of scenarios, you don’t know how many people are going to be rushing in the 18 to 25-year-olds, what about when the 16-year-olds jump in? Now you end up waiting in line, waiting another week when you could have had it three weeks ago! It’s like that now. It’s still circulating in the population that now when you talk about these mutations of the current Coronavirus. The reason why it’s mutating is because it’s more around. The more it’s in the bodies of more people and the more it overproduces and expands, the more likely you are to have a genetic variation. Where you have that genetic variation, you’re going to get stronger viruses. Just like us, they get stronger when they kind of figure out how to work around our systems and how to learn our ways of blocking. So it’s the same concept. The longer that is floating around, the more likely you’re going to have bad new strains that our current vaccine doesn’t quite touch, it won’t get to it as effectively. Get what’s available to you right away. None of us want that, to feel cruddy with the side effects twice, and have to wait three weeks to go into it again. But honestly, as long as we’re getting it, the sooner we are to getting back to some kind of normalcy.” – Dr. Terronez
“Most sites have been really good about scheduling the second vaccine when you get the first vaccine and so we’re really trying hard to make it easier for people to get those vaccines.” – Dr. Hostetler
Will there be Johnson & Johnson vaccines available at the Rock Island County clinics?
“We have a few hundred [vaccines] coming into the county every week. We have been prioritizing them for our partnership with the Alternatives for the Older Adult. There are some extremely medically fragile people who need immunity as quickly as possible and have transportation and mobility issues. So we want them to have the one dose as be done as quickly as possible. So for the foreseeable future, until we get more vaccines from Johnson & Johnson, it most likely will be Pfizer or Moderna at our clinics.” – Janet Hill
Is there help available to those not fluent in English at the Rock Island County clinics?
“There are many people on our staff who speak Spanish. At the clinic there are National Guard soldiers who speak Spanish, and there’s one person who speaks French and one person who speaks Korean. If it becomes a serious translation issue, the health department has access to translators in many languages. That is the same thing for the Community Health Care, Trinity, Genesis, and the Scott County Health Department: there are translation services available. Language should not be a barrier here.” – Janet Hill
Will there be a clinic in East Moline?
“We are working with a church in East Moline. We will have some details to announce that very soon. We are working with Pastor Harris and his church in East Moline and we hope to get several hundred people vaccinated in the coming days, that our mass vaccination site at the Camden Center in Milan is open six days a week. And the ways to register for that are on our Facebook page, the Rock Island County health department’s Facebook page, and our website, which is richd.org So it’s important to look at those links to look at those sites often because sometimes we have a little bit of problem with the vendor getting links as quickly as we want. And we know that’s a little frustrating to people, they want to be able to plan three weeks in advance. We just don’t have those links available yet.” – Janet Hill
What would you say to those that don’t want to receive the vaccine? Especially the Latinos?
“Like a lot of you out there, I’m sick of the Coronavirus. I’m sick of it, okay? I’ve had enough of my patients coming in. And what I’m really sick of is seeing so many people depressed and anxious, financially strained. And that’s really really bothering me. The biggest concern that I also have is, when I decided to come on in this panel because I’m sick of seeing and hearing about my other tío and tía have died or are currently hospitalized in Peoria. I’m tired of hearing about it honestly. I’m just overwhelmed by it and I’m sick of it. So I decided to come on this panel today, really to reach out to you about how we want to get back to normalcy. We’ve got to do something about it. Because it’s been a year and we haven’t figured out how to treat this thing. We really have not figured out how to treat the Coronavirus effectively to keep you out of the hospital. The only thing that’s worked so far has been the vaccine. And I know I’m not going to get everybody to change their mind, that’s fine. But I do want to at least make sure that you’re not scared of it. I don’t want you to be afraid of this vaccine or the fear of it being something new inhibit you from doing something that could be right. We have disproportionately- Latinos being disproportionately more sick, more likely to get hospitalized, and more likely to die from the Coronavirus is unacceptable. And the fact that we are now less likely to get vaccinated to prevent that goes against logic. And that is something that we have to work hard in our communities, talking to our family members; I can only do so much. You have to be the one to talk them into it. We’ve all got that stubborn tío who’s not going to get it. You know, they all say that they don’t want to do it. We need you. I need your voice, I can only do so much. And I really hope I touch more people today. And I really hope that you can spread the word. Honestly, and if you have questions, if you see me on the street I don’t know who you are, I don’t care. Ask me at this point. Because I really want to get, I want to get back to normalcy too. I want to hug my family. I want to have be there for those birthday parties, everybody there for the pachangas (parties) and stuff and I want that. But I need everybody to get on board too.” – Dr. Terronez
Watch Part 2 of the panel:
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