COVID-19 is again dominating the headlines and challenging the health care system, with a sharp increase in new infections. Nearly 20% of these new cases are in the state of Florida. What are the factors behind the numbers and what can be done to reverse this trend?
Host, Jonathan Fialkow, M.D. posed those questions to a panel of experts from Baptist Health hospitals to get to the facts behind the latest COVID-19 wave.
The panelists were:
· Samer Fahmy, M.D., chief medical officer at Boca Raton Regional Hospital,
· Zulma Berrios, M.D., chief medical officer at West Kendall Baptist Hospital
· Yvonne Johnson, M.D., chief medical officer at South Miami Hospital.
COVID-19 is again dominating the headlines and challenging the health care system, with a sharp increase in new infections. Nearly 20% of these new cases are in the state of Florida. What are the factors behind the numbers and what can be done to reverse this trend?
Host, Jonathan Fialkow, M.D. posed those questions to a panel of experts from Baptist Health hospitals to get to the facts behind the latest COVID-19 wave.
The panelists were:
· Samer Fahmy, M.D., chief medical officer at Boca Raton Regional Hospital,
· Zulma Berrios, M.D., chief medical officer at West Kendall Baptist Hospital
· Yvonne Johnson, M.D., chief medical officer at South Miami Hospital.
Announcer: At Baptist Health South Florida, it’s our mission to care for you when you’re injured or sick, and help you stay healthy and fit. Welcome to the Baptist HealthTalk podcast, where our respected experts bring you timely, practical health and wellness information to improve your family’s way of life.
Dr. Fialkow: Welcome Baptist HealthTalk podcast listeners. I’m your host, Dr. Jonathan Fialkow, I am a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I am also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health.
COVID-19 is once again dominating the headlines and challenging the health care system, with a sharp increase in new infections. Nearly 20% of these new cases are right here in Florida, where positive COVID cases have increased 200% in the last two weeks, with no slow-down in sight. What’s happening here, and what can we do about it?
That was the central question of a recent episode of Baptist Health’s Resource Live program, which I had the pleasure to host. The conversation looked into reasons behind this new COVID spike, and our expert guests answered questions about vaccines, virus variants and how to keep ourselves and our loved ones safe.
My guests all work on the front lines at Baptist Health’s hospitals:
· Dr. Samer Fahmy, chief medical officer at Boca Raton Regional Hospital,
· Dr. Zulma Berrios, chief medical officer at West Kendall Baptist Hospital, and
· Dr. Yvonne Johnson, chief medical officer at South Miami Hospital.
Let’s hear what they had to say…
Dr. Fialkow: Folks let's dive into this important topic. Who would have thought we would have been here after all the various meetings and education vehicles we've had over the last year plus, but nonetheless, here we are. Yvonne, with the case increasing in the areas what are you actually seeing in the hospitals, and what can you report from your hospital. and the other hospitals?
Dr. Johnson: Jonathan, we are seeing a tremendous increase in the number of patients being hospitalized for COVID-19, and it's, you know, it's really very unfortunate. Three weeks ago, across the system, we probably had, you know, around 130, less than 130 patients across 10 hospitals. Today, I'm sorry to report that we have well over 530 patients in who are suffering from COVID infections, and many of them a significant rise in our ICUs. So we're seeing patients not only coming into the hospital, but also requiring very significant medical services and having very critical experiences.
Dr. Fialkow: What do you see as driving this increase? It's obviously multifactorial, but what are the main drivers that you see leading to these drastic increase in numbers of hospitalized patients with COVID-19?
Dr. Johnson: Well, I think one of the biggest things is the fact that we have not gotten a significant number of patients as we need to. So we've not reached that critical level, that what we call herd immunity, where we have protected all of those people who couldn't get vaccinated. And I think also driving that is that we have relaxed some of those mitigating strategies like masking, and while the CDC said it was okay for people who were vaccinated to unmask, I think if you look out in about, in our community, you'll find that there's a lot of people who are not wearing a mask. And if you consider the proportion of people who we know have been vaccinated, clearly there are people who are unvaccinated who are not protecting themselves with a mask.
Dr. Fialkow: So a circumstance where good science and certainly good thought can enable bad behavior, and this is one of the results of that. Zulma from the hospital where you're a leader, as well as you connect with all the other CMOs around the hospitals, including those on this panel, what are the trends we're seeing in the hospital? Why is patient population, lots of vaccinated, lots of unvaccinated, or mixed? And can you also compare it to maybe previous waves, if there's any trends that you could see are different?
Dr. Berrios: Well, Jonathan, throughout the system and talking to my counterparts and colleagues in the other hospitals, we are all noticing that the vast majority of the hospitalized patients are those that are not vaccinated. Yes, it's true that there's a small fraction of patients that have been fully vaccinated that have been diagnosed with COVID, that they are hospitalized. They may be hospitalized for situations that are completely unrelated to COVID symptoms, or they may be having COVID symptoms, but generally are less intense and then less need for critical services like Dr. Johnson mentioned, at this point. So I have to reiterate, most of the admissions that we are experiencing are in patients that have not completed their vaccination.
Dr. Fialkow: So again, from, from your perspective, your leadership role, echoing what Dr. Johnson said, what Yvonne said, the unvaccinated component of our community is what is driving this surge of hospitalizations.
Dr. Berrios: And compared to, yeah, and compared to the previous, the second part of your question was compared to previous experiences, if we go back to the July of 2020 surge, what helped us at that moment, we still didn't have the vaccine, so what helped us at that moment were those mitigation strategies of physical distancing and wearing a mask. Come back, and then in December that we had another surge, then additional to the use of mass, then we had the vaccination. At this point is again, going back to those same strategies that helped us before the social distancing, masking, and now the potent tool of getting vaccinated.
Dr. Fialkow: And that's a great point that before we had vaccines, we were able to handle, well, handle surges and decrease those, the trajectory of increases by using those strategies. So the argument that they don't work is actually a specious argument, they have worked. We have an additional weapon with the vaccine, which is unfortunate, but we still have to use those strategies because not everyone's vaccinated. Sam, 800 pound gorilla, and I'm curious how you're going to tackle the question. What is the Delta variant and what differentiates it from the previous? Maybe delve a little bit about how viruses can mutate, especially when, you know, we're not able to control them in a short period of time.
Dr. Fahmy: Sure, and yeah, this is a, it's a question that's on everybody's mind. 'Cause we keep hearing about Delta variant on the news and in reports. Natural history of viruses is that if they replicate in a place that is a hotspot for that virus excessively or too much replication in any one hotspot, you can get copies of that virus that don't exactly match the parent. And those copies contain mutations, or changes to the genetic copies of that virus. So some of those changes, in fact, most of those changes with these excessive copies die out, they don't survive and the original virus stands. But occasionally when you have such a hotspot that there's, you know, that there's so many of these copies being made at the same time, so many mutations come about. One of those mutations may happen in an area that makes that virus a little bit more transmissible, or a little bit more deadly. And unfortunately, that's what we saw with the Delta variant. The Delta variant is one of multiple variants or mutations of that original COVID strain that we saw. Unfortunately, this one in particular had mutations that make it much more contagious. You know, in certain studies that they did around with people comparing the original variant with COVID versus the Delta variant. They're finding that the Delta variant is about a thousand times more viral load, or more amount of virus in the back of the throat at the time that somebody is diagnosed in the original. So that means it's able to make copies of itself so much faster, which translates into it being transmitted so much faster, 'cause if there's so many more copies in the back of your throat, and you're talking, or you're coughing, or you're sneezing, more particles fly out, and more people can get infected, those around you. So is it more contagious? I think that's without question, yes, it is more contagious. It's able to spread more easily because of that change or that mutation that happened. But isn't it more deadly, I think is a much more interesting question because I don't think we have enough information to answer it. Anecdotally at hospitals, you talk to doctors and yeah, they may be seeing sicker patients, but is there a real study demonstrating that there's the rate of hospitalizations that are increased in the Delta variant versus not? No, that's not clear out there. So what I can say for sure is yes, it's much more transmissible, but what I can't tell you, and what I don't think anybody in the world can tell you yet without information is, is it more deadly? We have to wait and see.
Dr. Fialkow: So going back when we felt the original version of the virus, for lack of a better way to put it, you needed a certain amount of time to be exposed to it, to be able to become sick. With this variant shorter periods of time being exposed to it would then make someone more likely to develop the infection?
Dr. Fahmy: You know, it may happen that way because of the amount of replication, or how fast it's able to replicate or copy itself when it attacks a host or, you know, one of us. It's likely that it's able to replicate faster and transmit quicker than even the original strain. Again, I think Delta variant is a concern, and I think it's the predominant variant in our community now per the CDC data that's being reported. So the fact that we saw such a rapid rise in the number of cases, like Dr. Johnson was explaining earlier, I think that's a direct reflection of the amount of Delta variant that's transmitting today, and how much it's affecting the community.
Dr. Fialkow: More people exposed, more readily getting infected, and as a result, a higher amount of people being in hospitals, because a certain percentage of those people are gonna get really sick, I think is the take home point. And the other point of course is the longer, globally, it takes us to control this, the risk is more variance and some may be even even worse. Yvonne, going back to the vaccinations, or, I guess we never left the vaccinations, you know, great work being done on the public health standpoint to get millions of people vaccinated a day at the beginning. And the rates have really slowed over the last couple of weeks or months. Vaccination sites have doses sitting there and variably they're empty for people coming in asking me, asking to be vaccinated. What's going on? What is this hesitancy to get vaccinated? And then the followup question to that will be, how well does the vaccine really work? What is this hesitancy about getting vaccinated? What do you see?
Dr. Johnson: Well, I think it's multifactorial. I think that there are different people that have different hesitancies. I see among some people, just the whole idea that this is a genetic, they think, see this as a genetic type of vaccine, this platform, particularly the Pfizer and the Moderna, this mRNA platform, which is new. And, you know, that is something that we have to assure people that this is a virus that talks to your DNA, but it does not become part of your DNA. This talks to your cells, the messenger, it sends a message to your mitochondrial cells to produce the protein, but it does not in any way change your DNA. So that's one of the things. There's just a lot of misconception out there. One of the other things that has driven hesitancy is the mistrust of the medical system among certain groups, and I can speak about African Americans who a lot of times, point to the Tuskegee Experiment, where there were African Americans who were either not treated for, or even given Syphilis and denied the appropriate treatment. And what I try to tell people is, you know, when you deny yourself this vaccine, you're actually doing the exact same thing that was done speciously in that experiment. You know, that was a tragic experiment, A, experimenting on people without their consent or their knowledge. And B, to, you know, it was totally unethical to withhold appropriate treatment from people for a particular disease. So it really hurts my heart when I hear people using that rationale, that mistrust to the withhold from themselves or their family members, the appropriate treatment for this virus. And, you know, I think the other hesitancy is just that it's relatively new, and people say, well, you know, I don't know what the long-term side effects are. And what I try to remind people is you don't know what the long-term side effects are of having COVID either. And so, you know, as you weigh getting the vaccine versus getting the disease, you have to consider that. And I also think the fact that so, and when this first started, it really didn't affect young people that dramatically for the most part. And so they have gotten very comfortable like, "Hey, you know, I'll just take my chances with it." But I have to tell you, we have a significant number of people now who are under 30 in our hospitals suffering from COVID. And so, you know, as Dr. Fahmy described, this virus has been mutating and its effects have been mutating as well. So it really is affecting younger people in ways that it didn't before. It is effective. We know that it's been, you know, in the studies, it was 95% effective, if we're talking about the mRNA vaccines, and over 70% effective, we were talking about the Johnson and Johnson vaccine. And if you look at our numbers in the hospital, as Dr. Berrios mentioned, there are small breakthrough infections for people who were vaccinated. That's that 5%, you know, that's that number of people, but for 95% of the people who get the vaccine, they're gonna be protected from significant disease, and they're not gonna need to be hospitalized.
Dr. Fialkow: And again, I appreciate that articulate and well thought through response. Multifactorial, we have to be sensitive to one's personal preferences, cultural imperatives, and whatnot. It's always fascinating to me how people assess risks and benefits poorly, afraid of things that are unlikely, and will make decisions about their life and what they do to avoid something that's very unlikely and ignore things that are much more likely. But I guess, so we wouldn't be human beings, if we if we had solutions to all those types of questions. Sam, to follow up on what Yvonne brought up, the goal of the vaccine, or let me phrase that, the promise of the vaccine is not to guarantee that a vaccinated individual won't get COVID. So if in fact one can still get COVID after the vaccine, why should people still get vaccinated? What is the benefit of the vaccine for public health and to the individual?
Dr. Fahmy: So when you're looking at vaccinations, and not just COVID vaccine, but any vaccine, it's typically not a 100% protective against the virus that you're going to get. I mean, we've been accustomed to getting yearly flu shots and giving yearly flu shots, when we know that it has a certain failure rate, but even if you do get that infection, whether it's the flu, or COVID in this case, you don't get it as bad, and it's not as severe. And the chances of you ending up in an ICU or in a hospital is much, much less, if you get vaccinated and still get that infection, that if you're unvaccinated. So there is no doubt the benefits go well beyond just protecting you against catching that infection. Even if you catch that infection, if you're in that unfortunate 5% or higher, and some other vaccines, you're still protected against hospitalization and death. That's different than the protection it would give you initially from getting the infection to start. So multiple layers of protection. There is no doubt that what we're seeing on the ground, in our hospitals is that the unvaccinated folks that are getting COVID are suffering, they are suffering much, much more than the vaccinated people who get COVID and breakthrough that vaccine. So, you know, and it's just in addition to what Dr. Johnson said about the, you know, why some people are hesitant about this vaccine? A lot of what I get is, "This is experimental. "It's an experimental vaccine. "And I don't wanna put "an experimental treatment in my body." But I'll tell you from what I'm seeing at the hospital, the minute somebody gets COVID, and I offer them some of the experimental treatments that are under Emergency Use Authorization now, like Remdesivir, or Regeneron that President Trump took when he got ill. Nobody's objecting to that. You know, it seems like there's this change, as soon as you feel the symptoms, as soon as you feel the danger of I can't breathe, that you no longer care about that as much anymore, and you just wanna be treated. What I'm telling people out there now is don't wait until you get to that point. It's much safer to get the vaccine upfront and to avoid having to get COVID and end up in the hospital, and end up with an experimental treatment at that point. After hundreds of millions of doses given now, we can fairly say that this is a safe and effective vaccine, not just based on the studies, but based on experience, based on the people that we've vaccinated, the tens of thousands that have been through our own facilities that we've vaccinated, and have done great with the vaccine, and I have gotten that protection. Don't wait, and get sick with COVID, before you're willing to try a new treatment. There is a treatment that's very safe and effective now that you can take to prevent it from happening. Get vaccinated, that's really the message, get vaccinated and keep yourself out of the hospitals.
Dr. Fialkow: Zulma, let's switch gears again, a little bit to a different population, which that of children. And we can talk about 12 and above adolescents, And maybe even in younger, in terms of separating them out. People are hesitant to have their children vaccinated. What are the recommendations? What's the age cutoffs? What do we know about the safety? And then maybe we could touch on, which again is still something that's in flux, do you think the kids will go back to school wearing masks, even if they're vaccinated?
Dr. Berrios: So the hesitancy in parents making decisions for their children is pretty similar to what Dr. Johnson mentioned about the adults, making decisions for themselves. There's approvals for use in pediatric population for the vaccine. This vaccine has been very well studied, and there's a lot of rigorous research that was done before the FDA gave the Emergency Use Authorization for the pediatric population. So the recommendation is the same as for the adults, it's safe and effective to those patients. And we do have patients in the pediatric population that are at high risk for having adverse outcomes related to the disease. You know, obesity, asthma, those children that are undergoing cancer treatment, are immunosuppressed, and you name it. There is a lot of pediatric population that are vulnerable, and then the best way for protection, besides the mitigation strategies that we've mentioned before, is to get vaccinated. Also for an young, normal, healthy, pediatric patient that gets infected, there is a risk of having what's called multi-system inflammatory syndrome. It's a serious disease that may have some sequela for children that we still don't know what is gonna be the long-term sequela for those childrens, because the story is still being written day by day. Every day, we're getting more evidence. We are accumulating more knowledge to be able to augment our knowledge and use it for what we are telling the parents in the vaccination.
In regards to the return to school and the use of masks, if there is so many children that are still not eligible because of the age cut-off for the vaccines that are approved, they are unvaccinated. And the CDC still say that for them, they should be using a mask. We will still, we are, you know, all of us in the call, we are, are anxiously waiting for a communique that is gonna come out later today from the CDC related to what are going, there are new and updated recommendations to the use of masks for vaccinated and unvaccinated patients. So it's gonna be their unvaccinated, if they're older than two, and they're going to be indoors with other kids, the best thing to do to protect those children that cannot get the vaccine is to be using a mask.
Dr. Fialkow: Let's take a few questions if you guys are good with that, I'll send this to Sam, are masks effective against the Delta variant?
Dr. Fahmy: So the Delta variant has the same mode of transmission or how you give it to somebody else, same mode of transmission as the original strain of COVID. You transmitted through respiratory droplets, and yes, masks, while not perfect, provide a protective barrier so that these respiratory droplets don't get from one person to another. So there's no doubt masks have some level of effectiveness. I think when people think about masks, they expect it to block a 100% of infection transmission. It doesn't work that way. Nothing is a 100% protective, but is it better than not wearing a mask? Absolutely, absolutely, it 100% is.
Dr. Fialkow: And that goes back to the original premise, we're not confident we're gonna eradicate COVID, we just don't want everyone getting it at the same time. And obviously decreasing those that will get it. A follow up question, Sam, you mentioned it before, but again, we'll just mention it again. Are the symptoms of the Delta variant the same as the original COVID-19 virus? You mentioned it's not necessarily is more dangerous or more virulent. So are you seeing any differences in people presenting with the present Delta variant than before?
Dr. Fahmy: You know it's pretty similar. There's not much change, although there are some surveys out in the UK that they did that showed maybe there's a less loss of taste and smell than with the original strain infection. But again, in general, yes, you're gonna the same, you know, upper respiratory infection symptoms, including, you know, sore throat, runny nose, cough, and maybe shortness of breath, that develops into pneumonia. So yes, those are very similar to the original strain.
Dr. Fialkow: So multiple times more transmissible is the differentiator in Delta virus. Zulma women are hesitant to get the vaccine 'cause of unknown reasons. Speak to women and men, we've heard myths out there, or I should say, we've heard concerns out there regarding fertility. Can you speak a little bit about what's known and what we're doing to address those concerns regarding fertility, women and men with the vaccine.
Dr. Berrios: Absolutely, so the mechanism of action, how the vaccines are approved in the United States work. The mRNA, they do not get into the nucleus. There's not alterations. They don't get absorbed into the nucleus. They don't interact with the nucleus. So they are not gonna change the DNA of the person or the person that's going to try to get pregnant, or they're trying to get pregnant. And even if you're not getting pregnant, you know, when we talk to young female patients and men, they're concerned that this vaccine in the future, when say they still decide to get pregnant, they may have problems. There's no scientific evidence that supports that statement. As a matter of fact, here recently in the University of Miami, they did a study with healthy men doing infertility studies before getting vaccinated after being fully vaccinated. And there was no change or impact in the number of the volume of the semen sample, the number of sperms, and motility rate. It was absolutely the same. There's another recent study in females that are undergoing fertility treatment, and they were going to receive their embryo transfers. And they compare control patients, patients that have been infected with COVID and recovered, patients that received the vaccination. There is no difference between any of the groups in the rate of getting pregnant and their rate of progression of those pregnancies. We still don't know live birth because this is very recent. So those babies have not been born yet, but they have, there's no proven difference between the groups. So this two studies are just example of all the evidence that we're seeking to support and myth bust the notion that this vaccines can cause infertility, they don't.
Dr. Fialkow: Sam, if someone has had COVID and vaccinated, do they still stand a chance of getting COVID again? So the question, I guess is what protections are we seeing by having had COVID? And is it still conceivable that someone could still wind up getting the Delta variant?
Dr. Fahmy: So let me take that in parts. If you've had COVID before that means you have natural immunity against the virus. That does offer you some level of protection from getting the virus again. Now, because COVID is so different in everybody, some people get it and don't have symptoms at all, and some people get it and are definitely ill. We think that the immune response, if you were sicker with COVID should be greater, and it should be more protective than if you had a very mild or asymptomatic case. So could there be natural immunity? Yes, but the short answer is we can't trust it because we don't know how much immunity you really have from that natural infection. It's important that if you've had an infection before that you still get vaccinated, 'cause we are, we know for sure what the immune system response is like for vaccines, much more than we do then for a natural infection. So yes, if you've had COVID before still recommended to get vaccinated, there's no doubt about that. Now, if you've had a natural infection plus a vaccine before, it seems like that would offer you even better protection, and you would be more protected against the Delta variant, and other variants of COVID. But is it a 100% protective? No, I don't think anything in terms of immunity is a 100%. So there's still a risk of getting infection, but that risk is just significantly lower.
Dr. Fialkow: And how long should someone wait if they have COVID before they get vaccinated.
Dr. Fahmy: According to the CDC, you can get it as soon as you're out of your isolation period.
Dr. Fialkow: All right, Yvonne, perfect question for you, given previous answers and information you provided, what do you feel is the biggest misconception about the COVID 19 vaccine?
Dr. Johnson: Yeah, I think we've talked a lot about some of those misconceptions, you know, the idea of fertility, the idea that it changes your DNA, that, you know, I've even heard people talk about the fact that it allows the government to track you. And I had to laugh about that because, you know, if you carry one of these phones around, Folks you're tracked.
Dr. Fialkow: You're being tracked.
Dr. Johnson: You know, that my phone told me where my car was parked the other day. It's like ooh, okay.
Dr. Fialkow: Yeah.
Dr. Johnson: So, you know, I think a lot of misconception is out there. I will grant people the idea that we can't possibly know long-term effects because there has not been a long term, but really if you look at what most vaccine side effects when they happen, it's in the first few months after you've gotten the vaccine where you see the side effects. And I would dare to say, there's not been any vaccine that has been as broadly administered in such a short period of time as this one. So we have a tremendous amount of data for, you know, at least the last six months that were not study participants. But now for more than a year, that people have been involved in studies, and pretty large scale studies. And we still don't have any evidence of significant long-term effects. And again, I just wanna remind people who are hesitant because of their concern about potential long-term side effects is, we don't know what the long-term side effects of getting a COVID infection are, but I can tell you every one of the people on this panel can tell you that they've seen what the immediate effects of getting a COVID infection can be. And, you know, it can range to the point where people can not breathe, where they have to be put on machines. To breathe for them, or where they don't ever make it out of the hospital.
Dr. Fialkow: Yeah.
Dr. Johnson: And that is just so tragic. It was tragic a year ago, but now for us, it is a real tragedy because every one of those deaths we know is preventable because they're the unvaccinated who are dying from this disease.
Dr. Fialkow:To our listeners, remember that you can send us your comments and suggestions for future topics at Baptist Health Talk at baptisthealth.net. That's Baptist Health Talk at baptisthealth.net.
On behalf of everyone at Baptist Health, I encourage you all to say yes to the COVID-19 vaccine. Thanks for listening and stay safe!
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