Confused about the Delta variant? Get the facts from host, Jonathan Fialkow, M.D., and his guest, Sergio Segarra, M.D., chief medical officer at Baptist Hospital. Their conversation covers frequently asked questions including:
Join our Baptist Health South Florida experts for an easy-to-understand discussion based on medical evidence.
Confused about the Delta variant? Get the facts from host, Jonathan Fialkow, M.D., and his guest, Sergio Segarra, M.D., chief medical officer at Baptist Hospital. Their conversation covers frequently asked questions including:
Join our Baptist Health South Florida experts for an easy-to-understand discussion based on medical evidence.
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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 quality of life.
Dr. Jonathan Fialkow:
Welcome back Baptist HealthTalk podcast listeners. I'm Dr. Jonathan Fialkow, Chief Population Health Officer at Baptist Health South Florida, and Chief of Cardiology at Baptist Hospital. This podcast topic is timely and of utmost seriousness, that of the present COVID-19 status and the impact of the Delta variant.
Dr. Jonathan Fialkow:
We're going to jump right into the conversation. Our guest is Dr. Sergio Segarra, a friend and colleague for many years. Sergio is Chief Medical Officer at Baptist Hospital of Miami, and an inspirational leader in our efforts to care for COVID-19 patients and stem the disease's progression. Welcome, Sergio.
Dr. Sergio Segarra:
Thank you, Jon. Greatly appreciate it.
Dr. Jonathan Fialkow:
So let's get right into this again. Time is of the essence, and this is such an important, as I said, topic exploding across the nation and in our Baptist community.
Dr. Jonathan Fialkow:
Sergio, let's start with this conversation. You know, I remember dialogue we've had and others have had very early in the COVID pandemic where we recognized the longer it would take us as a country as the world to control it, we were concerned about the long-term lack of control could lead to dangerous variants. What is a viral variant?
Dr. Sergio Segarra:
Yeah, very true. We had those discussions and while our worst nightmares haven't come true, we've gotten a variation that is very concerning. So what we have now, we've seen viruses need to change. They mutate in order to live. That's what viruses want to do, and they need hosts to go live in. So they will change in order to reproduce easier, in order to be able to continue their lifecycle.
Dr. Sergio Segarra:
So that's what we've seen. We've seen a variant. We've first saw the UK variant, which was a little bit easier spread amongst us and a little bit more virulent; by that I mean that it makes us sicker quicker. And then most recently in May, we saw the Delta variant.
Dr. Sergio Segarra:
So the Delta variant came from us from the Asian sub-continent, from India which had a terrible outbreak. And that variant initially was less than 1%. And we saw it in scattered areas throughout our country. Yet now, people that are doing the testing are seeing that it's as much as 90% of our COVID cases. [crosstalk 00:02:55].
Dr. Jonathan Fialkow:
Go go ahead, please. I'm sorry, go ahead.
Dr. Sergio Segarra:
Yeah. It went from May 1% to 90% and it's likely throughout the country, the dominant variant.
Dr. Jonathan Fialkow:
So viruses over time will change to maintain their survivability. The fact that it's the Delta variant and you mentioned Alpha, there have been other variants discovered. What makes the Delta variant so concerning?
Dr. Sergio Segarra:
Great question. Two things make it very concerning. So one of them is how easily spread. So when we first dealt with the Alpha variant, the original, we were saying that it was spread as easily as the common cold. It was contact precautions that we were taking. And that's why we were using terminology like the R t, the R-naught, how much the virus would spread to another person.
Dr. Sergio Segarra:
So initially it would spread to 1.1 or 0.8 when we had it on the decline. So all those things, we were able to track the virus. Now the virus has mutated to where it's spreads almost to the level of a chickenpox.
Dr. Sergio Segarra:
So when I asked the leadership here, "Who had the chicken pox," everybody raised their hand. It was very common and very widespread how the chicken pox was. That's what we're seeing. We're seeing a virus that spreads as easily as the chicken pox.
Dr. Jonathan Fialkow:
That goes back again, and that's a great analogy, towards the early stages when we talked about flattening the curve. It wasn't that people wouldn't get the virus. It's a matter of, we just don't want everyone to get the virus at one time, overwhelm our healthcare providers and our healthcare resources, of course; and even if it's a relatively, we'll say not a virulent virus, meaning most people will survive it because of the amount of people getting it, there will be deaths and there will be disabilities and will be hospitalizations.
Dr. Jonathan Fialkow:
So if you've expressed well that the Delta variant is more contagious, a person can give it to more people. The amount of exposure one has to someone with Delta is less that will make them sick.
Dr. Jonathan Fialkow:
Is it more virulent than the regular... Than the early COVID virus? In other words, are people sicker from it or is it just so many people have it, the percentages will wind up still with a lot of sick people.
Dr. Sergio Segarra:
It's a combination of both. It does spread a lot easier and because the viral counts, because the amount of virus that the person is exposed to receives as well as the person that gives off, we've seen a higher viral count. We have seen people that are sicker.
Dr. Sergio Segarra:
So these are folks that we're seeing now that have gone... You know, we have some that are repeat cases, but the majority are novel cases. This is the first time they've had COVID.
Dr. Sergio Segarra:
We're not seeing it in that elderly, debilitated population. We're seeing it in a very vibrant, younger, healthier population that's out in our workforce, that's out in our community. That's not only the people that we're seeing that are coming in, but also unfortunately, people that are dying from COVID.
Dr. Sergio Segarra:
The last week alone, we've had three deaths. Of the three deaths, one was in the eighties with multiple comorbidities, someone that was more frail; however, the other two were in their fifties and one of them had no comorbidities.
Dr. Sergio Segarra:
So that's very concerning when you have a 52-year-old otherwise healthy person that comes down with COVID, gets into the ICU and dies of COVID, that's very concerning.
Dr. Jonathan Fialkow:
You know, I use the analogy certainly in my practice, and when you work heavily in preventive areas, how do you get someone who feels well to do something, to prevent something that may or may not happen? It's hard. I mean, people don't perceive of themselves at risk.
Dr. Jonathan Fialkow:
So through what you've just explained very eloquently about the Delta variant and why it has become a source in terms of its transmissibility, you've said that you're seeing at Baptist Hospital as chief medical officer, an increased volume of COVID patients again, younger patients.
Dr. Jonathan Fialkow:
Let's talk about that preventive strategy and the vaccine. So first, are you seeing a differential in the hospitalized patients between those vaccinated and not vaccinated?
Dr. Sergio Segarra:
Yeah, we're seeing a significant... Early on, it was a greater difference. Greater on it was 95% of the patients were unvaccinated. So 95% of the patients that were presenting to the emergency department that were sick were unvaccinated, and that continues through the course of care. As a matter of fact, the vaccine protects you with the progression of the disease.
Dr. Sergio Segarra:
So we're not seeing those ICU cases as much or the critical care in the vaccinated population; but we are seeing breakthrough cases. I think as time evolves, we're going to end up seeing more breakthrough cases because there's just more of that constant, repetitive insult on vaccinated patients.
Dr. Sergio Segarra:
So vaccine offers a lot of protection. However, we also have to go through the mitigation strategies. We also have to wear our masks, wash our hands, socially distance. All of those things are also of utmost importance.
Dr. Jonathan Fialkow:
When we say 95% of the acutely ill are not vaccinated, and we do know vaccinated people can get ill, although I think the hospitalization and death rates will remain significantly lower. We're also working against time that we know that boosters may be necessary. So there might be some waning of the vaccine benefit.
Dr. Jonathan Fialkow:
But it's very clear what you're saying, that it still benefits an individual to get vaccinated, but also it benefits the people around them if they get vaccinated, if you're vaccinated as well.
Dr. Jonathan Fialkow:
So let's switch gears for a second. I do want to get back a little bit to the virus and vaccines.
Dr. Sergio Segarra:
Sure.
Dr. Jonathan Fialkow:
How do you find in your experience that you're able to discuss with people that not only should they get vaccinated, but how should people engage others around them who might be vaccine hesitant to convince them that it's better for themselves and the community get vaccinated? These are tough conversations. We all have them. How do you approach that?
Dr. Sergio Segarra:
Yes, yes. A critical conversation indeed and it's very sensitive. A lot of people have that predisposition and frankly are angry when we bring up even asking the vaccination status.
Dr. Sergio Segarra:
So part of it is as healthcare professionals is how we ask it. So if we ask it in a nonjudgmental manner, if we say, "Hey, we need to know to see the amount of cases whether you're vaccinated or not," as opposed to saying, "Hey, why didn't you get vaccinated? You have COVID now."
Dr. Sergio Segarra:
So how we approach our patients is important that we aren't judgmental. A lot of people didn't get vaccinated because they had misconceptions. There's still a lot of myths and misinformation out there. So the first thing we need to do is clear up those misperceptions and say, "Hey, why are you hesitant? Let me know why you haven't gotten vaccinated. What are your concerns?"
Dr. Sergio Segarra:
So when we've approached it like that as healthcare professionals, people will open up and tell us. I'm happy to say that there have been people that I've been able to change their mind that have said, "Oh, gee, it really won't affect my daughter's DNA? It really won't change her DNA?" I'm like, "No."
Dr. Sergio Segarra:
Same thing with long-term effects. Sure, we don't know what the vaccine is five years from now, but we haven't seen any other vaccine that has caused problems in the long-term. And we have a short-term crisis. We have an immediate crisis.
Dr. Sergio Segarra:
So those people that are hesitant, I approach as not only as if they're on the fence for themselves, I ask them to look at those around them. Do they have susceptible people that can't make the decision, whether their children, where they're debilitated adults that have difficulty getting it. And most people are open to that discussion.
Dr. Jonathan Fialkow:
Again, tough discussions for all of us, but that's a great approach and context.
Dr. Jonathan Fialkow:
Are the vaccines safe? How do you answer that again going through [crosstalk 00:12:28].
Dr. Sergio Segarra:
I tell them the first thing, as soon as I was eligible, I lined up. There was enough information... We have to remember vaccines are tested typically under 30, 40, 50,000 people before they're released. We've had hundreds of millions of people that have gotten vaccinated. So the population has been secondary to none as far as the amount of people.
Dr. Sergio Segarra:
When you look at the disease, when you do a risk/benefit analysis with any other vaccine or medication, the risk/benefit clearly say that the benefit of the vaccine versus the risk is to be vaccinated. And that's what we do in all aspects of medicine. Nothing that we do is without potential harm. That's why we do the risk/benefit.
Dr. Jonathan Fialkow:
Great. Great. Does the vaccine work with Delta?
Dr. Sergio Segarra:
Yes. The vaccine has been shown to work with Delta. The unfortunate issue, as you mentioned earlier... We've been vaccinated now for some of us seven, eight months. So we don't know... Is there a waning immunity? So now we're dealing with potentially a waning immunity of our bodies, of our system with a virus that has a much high viral count. So those things make it a bit worrisome.
Dr. Sergio Segarra:
So that's why we need to bring in our other strategies. That's why we need to bring our mask wearing and social distancing to protect us from that.
Dr. Sergio Segarra:
I can tell you personally, I am behaving as if I was unvaccinated. So when I go into a store, I wear my mask. When I go inside to a room where I don't know a lot of people, I wear my mask. And as you know, here at the hospital, we wear our masks everywhere outside of our offices.
Dr. Jonathan Fialkow:
And we do in our clinical offices as well. So to that end, if enough people were vaccinated of all ages, and again, this is speculative, would that be the means of removing the masking and social distancing recommendations? Is that the end goal, if we're going to resume normal lifestyle, as we say, and not have these extra precautions? Maybe we'll always have precautions, which is certainly worthwhile. Is getting more people vaccinated the means to achieve that?
Dr. Sergio Segarra:
I believe so. I believe so. I think we've come close a couple of times. It's very frustrating as close as we have come various times and we just can't get over that hump. You know, we just can't get... We get there and then we either lax the guidelines, or we end up thinking, "Oh, well. Enough people have gotten vaccinated. I don't have to get vaccinated." I've heard that. I've heard, "Oh, I'll wait for the other people to get vaccinated. Oh, we're close enough."
Dr. Sergio Segarra:
No, we all have to do our part. We all have to do our part, because I make the analogy to driving the speed limit. If you see somebody going 120 miles out there per hour, not only are they endangering themselves, but they're endangering other people.
Dr. Sergio Segarra:
Those are things that we do because we're part of a society, because we're around other people. If you want to go 120 miles an hour and end up wrecking, okay. That's sad but if you do it down the Palmetto at rush hour, not only are you going to kill yourself, you're going to kill somebody else.
Dr. Jonathan Fialkow:
It always amazes me how we don't draw those analogies. I mean, people can smoke in their home, but they can't smoke next to me and I don't want them smoking next to our kids and in restaurants. And we accept that because the secondhand smoke is dangerous.
Dr. Jonathan Fialkow:
You can drink in your house, but you're not going to get in a car and drive because you can hurt someone else. I even have those conversations with patients. Would you want to be in an accident and harm or kill another person or a baby in the backseat? We don't do it.
Dr. Jonathan Fialkow:
So you don't want be vaccinated? Okay. Stay at home and don't expose others. But that's the same kind of analogy in terms of behaviors. Weird how we just don't connect those.
Dr. Sergio Segarra:
Yeah. Yeah. No. Things we do every day.
Dr. Jonathan Fialkow:
Yeah. Well, anyway, Sergio, I mean, this is great. I'm sure our listeners can appreciate your knowledge and your passion to help lead the efforts and support those in need, from a medical standpoint, with COVID-19 and the families, as well as help mitigate this pandemic.
Dr. Jonathan Fialkow:
Any final thoughts, I'll ask you? You may have mentioned them already. What keeps you up at night about COVID-19 and the variants?
Dr. Sergio Segarra:
Great question. Thank you. The same thing, maybe a little bit worse that keeps me up now is what kept me up a year ago. You know, that's when I thought we were getting a vaccine.
Dr. Sergio Segarra:
Then we get a vaccine and my biggest concern is that we're going to look back five years from now and say, "Boy, those people in 2021 really had an opportunity and they blew it. They had a vaccine that was effective with the virus and they chose not to use it. And look at us now. We're in spacesuits. We can't socialize because the virus has mutated to something that is resistant to vaccines."
Dr. Sergio Segarra:
That's what keeps me up at night, that missed opportunity. So that's why I'm so passionate.
Dr. Jonathan Fialkow:
Avoidable. Preventable. Just have to get the right messaging and responses to achieve that.
Dr. Jonathan Fialkow:
Well, thanks again, as always. And to our listeners as usual, if you have any thoughts, opinions, requests for future podcast topics, please email us at BaptistHealthTalk@BaptistHealth.net. That's BaptistHealthTalk@BaptistHealth.net. Otherwise stay safe, and please get vaccinated.
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