20 Episode results for "Dr Greg Poland"

News briefing with Dr. Greg Poland

Mayo Clinic Q&A

17:51 min | 1 year ago

News briefing with Dr. Greg Poland

"Welcome to the Mayo Clinic. Dr Holy Magazine Guy. We're recording this episode on April the Twenty Second Twenty twenty and half with me again today Dr Greg Poland. Who's an infectious disease by polity expert from the Mayo Clinic? Thanks for being here Dr Poland. Whose ENJOY IT? I wonder if you'd start out today by just sharing as the latest numbers that you're hearing what's going on with the pander well worldwide word about point six million cases on Monday when we spoke just a couple of days ago it was about two point four so this is still a rapidly moving a pandemic in the US were it at just about eight hundred twenty thousand cases we were at seven hundred sixty five thousand on Monday. We have about a little over forty five thousand deaths on Monday. Were we were at about forty thousand deaths so while those numbers are still high one is beginning to sense that they're plateauing and as we talked about this lag period between when you get exposed than when you get sick enough to be counted can be fourteen to twenty eight days or so so we're just starting to see that plateau in the hard part will be the patience to continue this for perhaps another month or so. You talked a little bit about the numbers and it's the still were still seen infections. Does living in households convey any risk for transmission. What do we know about that since? We've all been social distancing concentrating infocomm that somebody there was a study just released from from China. That was a household transmission. Study they And I'll just look at the numbers here they had One hundred five people that were infected three hundred ninety two household members. All who were tested with. Are you look at the secondary attack? It's it was seventeen percent adult so in other words. If I'm sick what's the risks that my wife or another adult in the household would get infected? It was about seventeen percent about four percent for kids. If that index case quarantine themselves with all the measures we talked about household. Transmission was zero so it really works the court. The other side of that coin was well. What about the spouse where there'd be you the most intimate contact that attack rate was about twenty eight percent it? These measures are important. I know sometimes I get questions from people saying well. If somebody in my household has it is. Isn't it inevitable? As a matter of fact you can drive that two zero and that's a remarkable things speaking to the power of hand washing respiratory etiquette an appropriate isolation warranty. Well that is really amazing. Because if you think about all the surfaces that are shared in a household etc maybe it gives us hope for going back to work in doing other activities proper precautions. At some point there is such a dizzying array of Tessa for Cobra. Nineteen being discussed in the media and otherwise both tests for. I haven't now and serology tests for did I ever have it. There's talk about household kind of tests that can be done at home. Is this likely to become a reality and would help with the testing numbers that were seen? Were whether it's just not enough capability to test. Will you know you've you've put your finger on a an absolutely key issue in terms of how do we intelligently reopen and how would we intelligently reclosed this fall which many of us think is is like and a key to that is going to be testing? Otherwise we have no real idea of the amount of community transmission. That's occurring. The problem is in the rush to get these tests. Out The FDA has issued emergency use authorizations and what that means is that they haven't gone through the usual very careful clinical testing that we would normally put a test. That's going to be used in humans through so Some studies have suggested that the sensitivity and what that means is if I actually am in fact a new. Do this test army. What's the chance that it will be positive? Might only be about fifty percent five. Oh a flip of a coin and so I think before. We really have widespread testing. We're going to need assays that have been validated. And where we know Are they going to be appropriate and give us a good intelligence? The other tests that that was just released which is an interesting. One is the idea of allowing people to have it home. A Swab test so this is not have been infected. It's M. I. Infected now. I'm in what they're proposing lease. This company that's released it is to put. What looks like a q tip gist into the first half inch or inch of the of bananas and doing that on both sides. We have no idea how good dad ask say. Is We know that. In general you have to do a nasal torrential swab which goes up quite a bit into the nose in nasal passages It's uncomfortable. Somebody's unlikely to do that to themselves. On on their own and they're gonNA start with using it in healthcare workers first responders. So it's it's something that holds promise but I think we need to see the data a little while ago. We were hearing an awful lot about hydroxy Clark wine. And his sister Maya San in even president trump was talking about it on some of his Daily updates So much so that here mail. We had to put limits on how people prescribe those medications when a to preserve the supply. What do we know at this point about whether those are effective for treating who've nineteen but let me make a comment because I think it it pertains to so much surrounding this pandemic there is of course immense pressure and desire to get things out quickly whether it's a drug cast of vaccine and one understands that in has great empathy for People? Healthcare workers etc. Who who need to know. Want to know but there is no substitute for careful patients of scientific work. Let's just take this example of hydroxy chloroquine and reminds me a lot of pressure public and otherwise as you said to do something in us this. We now have to create good studies. That are showing one study done in in the Va that there was no benefit to this. Another study from France showing there was no benefit to either one or combination of those in fact evidence of harm in it as you and I know some of those drugs can do things to the heart rhythm like prolonged some of the electrical activity and actually cause harm. If they're not monitor Again I think this is really important because it says now when we actually done. The clinical trials is all this enthusiasm warranted and more and more data is accumulating to say no and in fact there might be Har- now other anti-viral drugs like rim. This aveer which we talked about it is a is a different story. We have some encouraging news. There look forward to hearing Morris Develops WE'VE HEARD ABOUT RISKS FOR PATIENTS? And what makes covert worse for? Some patients perhaps male different age groups that Cetera. Are there other risk factors that are becoming known that affect Either the development of Cova nineteen or how the the vitalize progresses illness for those patients that scenario where inside fourteen fifteen weeks. We've developed a lot of knowledge so I think everybody's familiar with the fact that older age heart disease lung disease diabetes things like that are risk. Factors We have not seen pregnancy. Be A risk factor for complicated disease. I have to say that's a surprise. Given how pregnancy is very much a risk factor for influenza. Smoking is turning out. Of course no surprise there to be a risk factor but a couple of things that are a little bit interesting here and that we don't have an answer for one is that males of any age seemed to have more severe disease than female so I mentioned of any age because it's not simply hormonally driven. There's something else happening there. In our our host genes. The other thing is that obesity. Now we did know that from from flu. So it's not that much of a surprise but obesity is turning out to be a risk factor that may increase your risk of severe disease by as much as two fold so we're beginning to get a more and more complete picture the other thing that has just recently has been reported is about five cases of Gaon Beret. This isn't a sending paralysis. This can happen with a variety of viral and parasitic infections. It can happen from influenza. And now we're starting to see some cases as a result of Kobe. Nineteen not very many but nonetheless case reports here and there there's a report that came out of South Korea about one hundred and forty patients. I believe who had been tested positive with Cova. Nineteen men seem to recover and now again tested positive. What did you make of that? You can imagine the the concern that this is raced in. It's a very complicated issue. I think probably one of two things is happening. One is maybe just very ability in testing. I do not believe that these people have recovered. And then that quickly been reinfected that would not be consistent with everything we know about the human immune system so it's either variability in testing or one part of that can be remembered that the RTP CRI say the diagnostic essay is just detecting pieces of the virus. It doesn't mean that there is virus in there that's so to speak live and capable of infecting somebody else it could be residual pieces of the virus that are there as part of your recovery on so what they're doing and it's an appropriate step though as you might imagine has some risk associated with a is there actually culturing that virus in human cells in a test tube to see are we actually seeing live virus or just these pieces. The same thing has happened in regard to checking stool specimens. Some people are shedding virus for as long as thirty days. Does that mean they're infectious? We don't know and in fact. Some countries some locales in the US. The country of France and others are actually going to waste water and sewage treatment plants and looking for evidence of the virus. And what I've noticed. Is that this is the other side of the disease is before people have actual symptoms. They can detect at the population level virus in the wastewater in the sewage. And they know that in five days they're gonNA start seeing cases so we're learning a tremendous amount here the the trick will be putting it into the proper context and understanding. You talked a little bit earlier about how it may be necessary to be reactive. So in other words that as we begin to open we may see changes in in the incidents Or even the second wave of infections that I've been hearing about what does that mean and when might have happened as somebody who studies these viruses in his EVAC sinologist. I have. I'll say grave concern when you think about this. Kobe outbreak in the US. It started in mid to late February so we were in fact past are influenza epidemic. It's unlikely that will happen. This fall rather we will have in a perfect overlapping fashion influenza epidemics and CO VID recurrence occurring. The problem is that the symptoms overlap nearly exactly particularly initially the second is the tremendous surge demand on the medical system and the third will be the anxiety around that and do we really close everything down again and do what we've just been through for the last Several months at this remains to be seen. I think what's going to be really key. We have difficulties with getting people to take flu vaccine. What's really going to be key to encourage everybody six months of age in older. Which is the recommendation to get a flu van scene and in this case to get it as early as it's available now wait until December January. Oh you have done. Count twists interviews since this. This is all begun and even in the last couple of months. I I'm sure you've lost count now but I'm wondering what is the most common question that you get asked in interviews? Probably the first one I did. His and people can hang their head and say. When is this going to all be over? And I don't know the answer to that question if I'm honest about my my guesstimate. And it's just that a guest in that no earlier than the winter of twenty twenty one and then people will tell me about symptoms. They've had and will ask me. Do you think I had Kobe? And you know the answer to that is evolving. Because what we're learning. Is that a lot of people have been infected in. Don't know it or had very minimal symptoms that they didn't attribute odd to Cogan. What's the evidence for me saying? That will just recently in. L. A. In California. They've done widerspread testing. I think that's about seven hundred thousand people something like that. Lo and behold about four plus percent of them are testing positive so by antibody tests meaning that they had been infected and as we talked about the numbers are probably even higher than that because the serology tests are not quite where they need to be and I think in in various locations in the US. We're GONNA find out that a lot of us probably were infected and really didn't know or attributed to you know a flu or something like that that would be very valuable to know it would be very reassuring and it would be he piece of how we in. A careful staged way as back into normal operations. Some sobering information actually. Is there anything else that you'd like to share with us before we go today? Greg you know I think the one thing we've touched on it. Sometimes that would courage all of our listeners. To as we all are learned from this and that is we are a bit cavalier in our culture about respiratory diseases. It's just the flu or well. Just have a little cough and people go to work. Go to school sick. They visit people in nursing homes in the hospitals. When they're ill. I think one of the things that I'm hoping will come out of this is that people will take respiratory diseases end of vaccines that we have available for them much more seriously and will be a more zealous in in guarding one another against the widespread transmission of these diseases. These masks might be here to stay for a while. Well thank you very much Dr Greg Poland virologist an infectious disease expert from Mayo Clinic. We've been visiting with today and thank you all for joining us on Mayoclinic Cuny Mayo Clinic. Cuna is production of the Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts visit news network DOT Mayoclinic Dot Org. Then Click on podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

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Dr. Greg Poland answers listeners COVID-19 questions

Mayo Clinic Q&A

23:30 min | 1 year ago

Dr. Greg Poland answers listeners COVID-19 questions

"Coming up on Mayoclinic. Qna Kovin nineteen researcher. Dr Greg Poland Answers Your Corona virus questions. I continue to believe 'cause we have not reached the peak of this yet. I think we are in for this over month not week. What should you disinfect? An how often should you do? You have a much easier job in your home with cleaning your hand after that. It is of course your telephone. Can you order? Take out food while you're sheltering in place takeout food and even ordering growth rates for Irish people is smart idea should we be reorganizing our summer schedules? Would I lie? Italy or China This summer no. What can we learn from? How other countries are combating the cove in nineteen outbreak? New Rochelle New York. They actually needed a containment area about one mile square and being a precipitous fall in case but it worked the answers to your corona virus questions my motto is. We really have to turn from a new culture to a leak culture next on Mayoclinic a welcome. Everyone I'm Dr. Tom. Shy and I'm Tracy. Mccray we are with Dr Greg Poland Infectious Disease Specialist Vaccine Expert at the Mayo Clinic for another update on the covert nineteen disease. Dr Poland good to talk to you again. Always happy to be here. Hopefully those. This won't last too long but we don't know how long do we know we built and You know as we've talked a bit Before there's this lag period between what we see and what happens two weeks from now so I continue to believe since we have not reached the peak of this yet nor have we seen the spread from the large EPI centers like New York and Washington happen with their full force to other area I think we're in for this month not week. We're recording this interview on March Twenty Fifth and the first question that we have is more a comment from a youtube viewer. Who said speaking of spread you in? Dr Sides are too close and so just so that you know Dr Poland. We are no longer close and he has tape measure. Why are you not practicing social distancing one recording and you know what that is a good question and we are we miss for not practicing what we preach even watched. You guys didn't enter my mind too that betting and Tracy sometimes forgets that. I'm at high risk for this. Covert nineteen. She stays over there. I stay over here good question. Thanks for alerting us to that. All Right Fifty. Five thousand cases so far twenty six thousand of those in New York eight hundred and nine deaths about what you expected yet. That's a case fatality rate of about one point three or so percent very different than the world which is four point five percent very different than Italy which is closer to eight percent so in that respect were doing well. The one thing that I do worry about is the idea that okay people have kind of been hunkered down or maybe a week or two and they're already starting to say well. Maybe this will just be another week. I cannot see I cannot be at that will be the case. We have not hit the peak yet. We have. We have longer to go with the and isn't the case that once we hit that peak then fourteen days. We have to wait or twelve days. We need to have some sort of timer in our head. You're thinking in the right direction but it it really works this way. It fourteen to twenty days after we see a sharp downturn or even elimination of cases. If you want to be really safe before you relax those restrictions all right another question from a listener. What items in my home or office should be disinfected? Yeah I think We'll we'll maybe start this way You have a much easier job in your home. Assuming nobody's infected with cleaning your hands when you come into your house so first thing you do is clear hand after that it is Of course your telephone. We touch our cell phones all day long. No matter where we are. We're probably contaminating the keyboard of your computer. Anything that you touch regularly the bathroom and spink Boston doorknobs in out of your home. Those are the those are the areas that are touched by everybody multiple times a day. Can you order take out food? While you're sheltering in place Dr Poland. Yeah And I actually think that takeout food and even ordering groceries for high risk. People is a smart idea. does it completely eliminate the risk. Nothing can or will but it diminishes the arrest and as we've talked about before what you're really trying to do is put layers of protection around you each one decreasing your risks that in Psalms. Your total risk is has low as you can easily drive it all right next question. Is it okay to eat in a restaurant? If you practice social distance thing I think the concern there is several. Fold Number One You have you have grabbed the door knob to enter the restaurant. You have touched the table. You don't know about the silverware. You have touched a menu. You have somebody else Preparing and touching your food carrying it to you. I've seen waiters carry a glass of fluid To waiting People in the restaurant with their finger their thumb inside the glass So you're just you're adding risk when you don't need to address and then some areas of course. The the governor's or the mayors have shut down Restaurant in in person edict. Next question comes from someone who's thinking about summertime and wants to know if they should cancel their summer time travel plans. I think depending on what they're thinking of. Would I lie to Italy this summer? No or China now If they're talking about what we're going to get in the car and drive eight hours be you know My healthy adult child and grandchild. I think it's too early. No but I wouldn't necessarily put those plan Cancel those plans. I just put them on. Hold and watch and wait just pencil them in for now. Yeah all right way to put it next question. How long can the virus live on different surfaces and also in the air? This is a really good question. And let me explain the Roughly Twenty three studies. That have been done. The latest one that came out in the New England Journal week or so ago and and people have to be careful to interpret this. They put together. I realized conditions for virus conditions which generally don't exist and they have the chamber and Aris the lives of Irish again that does not reflect reality. What do you mean what I'd say? Era Celeste because the difference between Arizona's -Ation and droplets. Okay good really key principle. Erris the live virus is Small amounts of virus without the large Mucus Dropped are often carrying it that can float and stay in the air for very long periods of time that generally happens with water called Aristotle ising producing procedures for example when you're intimidating somebody or they're having a bronchoscopy or something like that the the common nested that is Causing transmitted virus in the population is large respiratory droplet. This these are the costs of the nieces Where you have virus carried on mucus droplets. You can actually see the droplets. We may not be able to Stephen. Against the backdrop. You could see them okay But but they they do not float in the air and they drop quickly down to the ground. That's why the social distance thing. Ideally of six to ten feet work that now is that also why Measles is such so much more likely to be spread because it will stay in an aerosol in the in the air and not just on droplets at -olutely and in fact you know if the three of us were susceptible to measles and we walked into a room where somebody with measles had been eight hours ago. Likely all three of US would get that disease now this this idea of persistence on surfaces. So what the other twenty two studies have shown and the recent look at the Diamond Princess cruise ship is they found virus. Seventeen days after that cruise ship had been empty. We don't know if it was viable virus meaning virus that could still infect you but this is consistent with what a variety of studies have shown. Is that if you have somebody coughing? Sneezing symptomatic Kobe nineteen you. Can you can detect this on the surfaces of that room now. It's exquisitely sensitive to the proper disinfecting fluid that you would use to clean a room whether it's the dilute bleach sure Other approved disinfect. That so so it's a it's a key strategy in dealing with this because it is thought that this virus started in animals and then crossed over to humans. Our next question wants to know. Can Our pets get the virus and then transmit it to other people dogs In particular do have corona viruses but not the type that infect humans at least not commonly dogs actually have corona barbarous vaccine That that is made for that in terms of this corona virus stars. Kobe to that virus is not carried by our pets. We are not infecting our pets and our pets are not infecting up however out of an abundance of caution see did release a statement saying that if you have Symptomatic Co bid nineteen. You don't have to quarantine yourself from your pets but don't let the pet lick your face. Don't share your food. it's CETERA. Not because there's data suggesting risks but out of caution. Lassie sounds pretty safe all right next question. Can I get infected through a cut or open wound? There is no evidence of this being transmitted in that way. Nor are you going to in some way absorb the virus through your skin? This is why and washing and sanitizing works so well we're getting used to sheltering at home so this question Has To do with context. What is next? What'S THE MOST likely scenario? That is lies ahead of us. I think what we're going to see is More Institution of what we've seen around the world where countries and cities didn't take this history as they should had a major eruption in the number of cases and then just to use the term locked down and in two weeks started demolition cases. Good example in the American context is new. Rochelle New York where they actually made it. A containment area about one mile square is my understanding. And they've seen a precipitous fallen cases took guess. What two weeks for that to happen but it but it works. I think we're going to start to see that in other areas of the US as this moves away from the two coasts and more and more into the center of the US. So here's a listener. Who has obviously listening closely? She says two weeks ago you advised us to use contemptuously appropriate levels of protection explained again what that means and does it still apply it. It not only applies but it is a dynamic or moving target based on the context. I is simple analogy. And then we'll apply it If you live in safe area of the country where I do Rochester Minnesota When I go to bed at night I locked the front and back door later one. I closed my first floor. Windows layer to flip outside light on layers tree. That's all I need. If I lived in a in a more difficult area of the nation I might add layer for an alarm system layer. Five window bars. Maybe layer six the panic button. You get the idea. So what does that mean for us in the in the US again? Are you in a high risk or low risk situation and that can change over time? Low risk situation. Tell the work if you can social distance thing being sure in your hands or cling slayers two and three. Nobody comes in your home without him. Sanitizing layer or nobody comes into your home period. And unless it's absolutely necessary you just keep layering things on like that based on your particular context based on the transmission dynamics in your area recognizing they lag by two weeks or so. So you're sticking with that is your motto. You don't have a new one correct. Well the only knew it. I added more cultural and that is and we're beginning to see this. You Know Saint Paul Ramsey hospital up in the twin cities Among their greatest number of your visit not Kobe. Nineteen it's mental health issues and my motto. Is We really have to turn from a mean culture to way week culture and you see that in a grassroots through healthcare providers movement where you see them in the hospital with the same thing. I'm staying here. You stay home. If it's every man for himself we will do poorly as history shows in pandemics. I'm to take care of my neighbor. I'm to take care of my community to help at any level that I can and if we all do that and if we all take care of each other we will do better together all right. It's not me it's we all right. Yeah next question. Do Surgical Masks help or not only do surgical masks help but a mask of almost anything helps now the original reason that CDC and other organizations that don't wear masks is because they wanted to preserve those for frontline healthcare workers but you can have an effective mascot of a folded over Bandanna or handkerchief. The way it helps is in disregard. It decreases the risk that you'll breathe in these respiratory droplets that somebody else may have cost coughed or sneezed. And now you're breathing and it is a reminder not put your fingers in your eyes nose or mouth so from that perspective is protective now. It can't do anything against Aristotelian virus but that's probably not the primary mode of transmission air again. I think because they were. They didn't want people to go out and buy all the end ninety five and surgical masks because they were needed for healthcare workers think. That was the motivation behind that. Not Dia- Interesting Hell. Would you like to comment on the cure being worse than the disease thinking? Yeah I think this really get to cultural and personal values. What price a light? How much economic disruption for. How long can we take? What does it mean particularly for the most vulnerable members of our society who are often living paycheck to paycheck? This is where government comes in government is to do for the people what they cannot do for themselves. I'm fine I don't need anything but I know that there are neighbors of mine that do need help and we help them. How how far do you go with it? And how do you balance it? I think it is phased approach. You wait till the curve bent you. Wait till you start saying a great deal munition in case and then you wait two weeks more you begin to loosen restrictions. I with young people because there while they can still want occasion have severe disease. They are dying up there and we watch weight. We do it carefully the same way you might think of sort of the canary in the money's Mindset of you know you don't expose. Everybody wants to open up all the schools and colleges do it all right. Isn't it okay for people with no symptoms or who have tested negative to go back to work your difficult difficult question the no symptoms. You actually don't have any information It is apparent that ace symptomatic transmission. That is you have no symptoms but are still carrying the virus and can transmit it to somebody else does occur the more people you congregate in a building in a room in an area the greater the risk that you re spark that pandemic and start having cases. They get so. It's really important that we know that the other thing that's really important is that we. We begin to have very rapid tests to tell us whether somebody is immune even if it's in the short term so that they can go back to work in in particularly in essential job they can be frontline healthcare workers and responders. If I have a sick family member can I go to work or should I stay home? You should stay on you. Are you are risking. Other people by transmitting that disease I would say that if you're not in ential worker than than you need to be at all right next question the. Us and South Korea apparently had their first detected case of covert one thousand nine on the same day but it appears they have. They have flattened the curve and started the fourteen day timer. What can we learn from on how they have handled the outbreak? You know what the key thing that I know people bring up. Well you know SARS in in two thousand two wasn't like this. That was different. There was not a dramatic transmission. What drives this is that we do. Have people transmitting the disease? Who Don't know they have it. And so when if you really you have two choices in stopping this pandemic and there are only two absent antivirals and vaccines you either. Get everybody infected. In which case you will have millions in the hospital and Lou and and lose tens of thousands to hundreds of thousands of people to the disease or you shut things down now. Both are disrupted both have closed or Kahn. Both are value judgments about what to do but if the goal is stopped widespread transmission. You say everything isn't essential or that is not a part of national security Supply Chain Hospital Workers Federa telework. We are out of time basically but I have one last question. Because I've been getting this on nonstop for the last thirty six hours and it's about Ibuprofen What do we know about Ibuprofen Safety? So we know a lot about. Ib program safety though not in the context of this particular infection so I do pro fin regardless those a context is a drug. That can cause water and salt retention. It can elevate blood pressure and can cause bleeding as well as kidney dysfunction. Now you take a drug like that into somebody with a viral infection. As it help or harm I think despite the warnings of WHO and the government of France. I think most of US scientists recognized there really is not any solid scientific data saying that that represents a unique risk in code nineteen now having said that the only reason to take a drug like that is for fever. Reduction muscle aches and pain uses. See the benefits. Are stapler all right. Well Dr Greg Poland Infectious Disease Expert vaccine expert. Thanks so much again for answering all of our listeners questions on the covert nineteen outbreak We'll be talking to you again soon. We'll look forward to that. But hopefully we'll reach the apex of number of cases pretty soon and number of deaths and start to go on the other down on the other side of the curve. We all go. Yeah thank you moment Mayo Clinic. Qna is a production of Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts to see a list of all mayoclinic. Qna podcast visit news network. Got Mayoclinic Dot Org. Then Lick podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

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Hour 2: Dr. Greg Poland

The Dan Le Batard Show with Stugotz

34:42 min | 1 year ago

Hour 2: Dr. Greg Poland

"Stugatz here for advance auto parts now more than ever. It's important to think ahead advance auto parts remains open to help you keep your car up running at its best order online and then pick up in the stores you can get in and out as quickly as possible car. Batteries are stock soared. Just seventy nine nine thousand nine. They'll test your battery and install your new one for free. No appointment needed. Enter the Code Dan when you buy online and you'll save an extra twenty percent. Think ahead advance only at advance auto parts. Espn radio is presented by progressive insurance. Quoting home. Insurance just got easier with progressives homequote explorer quote and by all online at progressive DOT com. All guests any Damn Guitar Joe. Appear via the Shell Pennzoil performance line potential. Strap it on situation here. Dan I mean the guy is a really handed it to me today. Here's your sportscenter. Update Steve bomber and the newly formed caps. Llc has reached an agreement with James Dolan and the Madison Square Garden Company to purchase a forum for four hundred million dollars in cash. The forum will remain is a music venue as bomber potentially build a new arena for the clippers. The third fight between Tyson fury deontay wilder has been pushed back to the fall and finely Paolo Longo Parish Priest of the Church of San Pedro and San Benedetto Di Polio in Salerno province. Thanks for that. Mike livestream Mass on facebook to allow Para Shire's to attend the service. Virtually amid corona virus outbreak law goes video viral when he accidentally left the facebook air filters active during the livestream causing him to appear with animated accessories including a Sifi helmet lifting dumbbells and a hat and sunglasses. What happened if you love Nature Valley sweet and salty bars? You'll love the new sweet and salty. Minis it's all the indulgent savory. Goodness you know now in a smaller size end at one hundred calories snacking has never been so sweet for all the latest headlines and information tune the sportscenter on ESPN radio all throughout the day. A tweeter writes in helpfully. When are you guys going to handle? How bad the sound is from Billy Chris Greg Roy? It is unacceptable that you have not fixed this in two weeks. I don't want to become defensive about that criticism. I would just say to you that there are certain challenges that are making our show a little bit more difficult or a lot more difficult than it usually is and tensions are high stu gods just yelled at Roy for the First Time. I've seen in about fifteen years doing this Roy. Through his headsets a in in in a rage Stugotz has been trying to soothe Roy. Sense it has not worked. This is why divorce rates are already up all over the country. Everyone is sick of each other. We are tearing apart at the seams. And let me be defensive on your behalf year to that person who texted in shut the hell up. Okay seriously. Like we're doing the show very difficult conditions and I understand. Everyone is living under very difficult. Conditions Right now but we're actually trying to do a radio show that requires a lot of communication. You will never know from the way we do it but requires a lot of communication and we value the voices of Roy. Billy Chris and Mike and it is hard to get to them right now. So we're doing the best weekend but I'll be defensive and I will tell you shut up adult text us again. Thank you Guillermo at Lebatardshow is show. Tearing apart at the seams at Lebatardshow we've got an update all of these polls. We've had three days of Poles and we haven't gotten to reading any of them. We will do that before. The show is over but Earlier during last week I should say we were talking about just owners billionaires and I was talking about Micky. Arison the Miami Heat owner and many people because We've talked before about the idea. The Greatest Gulf between sports fans and the people who play sports. It's a bridge made of money because it is the place where a lot of judgment rains down and people don't have compassion generally for the millionaires and billionaires. There is something about having money in sports that makes people slightly less human so because I find fascinating and also stressful. What it is that some of these people with big money are enduring right now because no one really prepares for the apocalypse. And I don't know what Micky Arison monthly bills are. I have found fascinating that when I look at this situation. Not taking a side when. I looked at the situation of what's happening with the Miami Heat. And its owners as he ends up having a real crisis on his hands in the cruise industry a cruise industry that. I would make no arguments on behalf of bailing out. I don't believe that a cruise industry or a casino industry especially not cruise industry where the taxes aren't even paid in this country. I would not make any of the arguments on behalf of we should bail out a cruise company. But I do understand how it is that this would be a hugely stressful time. No matter how much money it is that you have the idea that you're basketball franchise has always been a toy. That doesn't even make money. It barely. It barely broke. Even during the Miami Heat's Lebron years now. There is money at the end of this. When you sell the franchise and like Steve Balmer. You end up paying two billion dollars because you WANNA franchise. While I wouldn't make the argument that it was an act of altruism either that Micky arison offered his cruise ships to Donald Trump as hospitals. Because I'm guessing he wants some of the money that would come or the government aid that would come. I'm guessing there. I don't know anything about this but I find the entire situation interesting. Like why wouldn't people imagine that if you're hemorrhaging money that is in the billions not the millions that that would be a stressful thing. No matter who the hell you are especially if you don't see any wearing the distance relief coming and only relief that you that you hope on is what will the country bail me out. We'll the government bail me out like what? What is it about people that they don't understand it? I'm not? I'm not trying to engender sympathy for anybody. I know that many of you and our audience for some reason have limits on your compassion and your empathy and your sympathy. But what is it about what? I'm saying that people can understand that that would be hugely stressful situation. No matter your wealth. Because they're comparison shopping their stress and their situation is way worse than Micky arison situation or more Cuban situation. Those guys the owners wealthy people they have resources that most of us do not have. They are staying nice houses. They're going to have a lot of money whether the Cruise Industry sinks or not Dan no pun intended Micky. Arison is going to be just fine. So they're comparison shopping and saying listen. I don't care about that guy stress and what he has to do and how much money he's GonNa lose. Because I am sitting at home and I'm not working in. My stress is for greater than a billionaire stress. That's what they're doing. If I may just out of curiosity how is it that you know exactly that? Micky Arison is going to be just fine. I'm just curious how it is that you would know that. I understand how you would arrive assumption. But given the given the general state of where we seem to be headed as an economy and given that you've got politicians right now arguing on behalf of we need to keep the economy alive more than we keep our old people alive like. I'm not sure that anybody is okay in this climate. And that's fair to answer your question. I don't know if he's going to be okay but people like myself people just assume that he's going to be okay like. Hey Mickey is GonNa be just fine. Even if his company goes because maybe they think he invested wisely. He's got a lot of money they just don't care they just assume that he's going to be five. Maybe that's totally fair response from you but most people just kind of feel like hey regards what happens here billionaire going to be fine after this is over. Yeah in this country. We just really don't allow billionaires to go broke especially if have those companies and even if you take carnival and the industry the cruise line industry as a whole doesn't get bailed out in the way that it's being reported in the news at it. Might he still has the asset at the Miami Heat. He no like. There's a lot of people that are losing their businesses right now and having to decide whether or not they go with a car micky arison is going to have to decide whether or not he wants to sell the Miami Heat. I would be curious if you guys what what's a number. I would have to put in front of you for it to reach you in terms of what the monthly bills are for someone like Micky Arison to have no income coming in and again. I'm not sitting here trying to make any argument. I would argue the other side. I would not bail out something like the cruise industry here but where would I have to put the number to get anyone's attention on what the monthly bills are? And I understand Steve. Balmer sits here and buys the forum in four hundred million dollars. Cash that that. There's no one listening audience right now. Who has any concept none of what that is to live in that world where you can buy something with four hundred million dollars cash and have it represent only ten percent of your well? Oh I wouldn't want Micky arison problems right now and that's horrible decision. I know it's like a situation that none of us can find a connection point to do. I have to decide whether or not to sell my professional basketball team for a billion dollars. He's got a I'm envious of his parachute but I'm not envious of the personal life decisions that he has to make week weakest problems right now a lot bigger than mine. Not Envious of the problems. I am envious of the parachute that he has but might people would love to trade their problems for Mickey's problems. That's where it comes from. I don't WanNA trade for his problems. I want to trade for his solutions. You want to right now like you want to give you right now and I give you this given what your life is right now. You wake up in the morning you go to a microphone and you've done by the by one o'clock and you're in then. I don't have problems. I'm not the one sitting home. At least not right now. I don't have a problem. We're working. I'm still learning paycheck. But if I wasn't working and our place to place a day to day then yes I would trade those problems for Mickey's problems if you missed any of our interviews. Check him out on demand and the Dan Lebatardshow podcast brought to you by the capital one quicksilver card earning unlimited one point five percents cash back on every purchase everywhere capital one. What's in your Wallet Dan? It's time for straight talk brought to you by straight talk. Wireless SCAPE THE CORONA VIRUS IF you're here to escape the corona virus You will not be able to do so in about fifteen minutes. We will have an expert on. We've got a bunch of questions to get some insight that we need and some answers to our questions One of the questions that still got have has is. Why can't we have Gulf at Lebatardshow on twitter? Put It on the poll Guillermo. Why can't we have Gulf? Yes or no I heard Mike and STU got to talking and STU gods want a movement some petitions. He wants golf. He doesn't understand and I'm yeah I mean I don't know what the limitations are. He doesn't understand why. We can't have goal. I mean we were were headed towards a place where we were just GonNa have golf. We played the first round of the players. Championship up in up in Orlando by that area and so Mike and I were talking yesterday because we miss sports so much that not only do. I think that we should have golf. A two thousand twenty that we should have golf and that there's a way to get golf. Done Two thousand twenty thousand individual sport. I'm not even certain that we shouldn't be playing tennis. I think we should probably be playing tennis and golf at this point like. Just give us the good stuff. Give us the majors at the very least you know. I can be talked into tennis golf. I'm having a really difficult time wrapping my brain around why we just don't have this sport it's a solo sport. Oh but you have the balls going into the pin into the cup and you have other people touching the lead the balls there make a deeper cup. I don't care I I read copper. We can have copper golf clubs. Well guess what you don't have caddies anymore. You can walk. Oh but what about? The TV broadcasts stationary cans. I just saw this. Why don't we have golf now? The let me explain to you with a copper comes in because they closed the golf course here now. I was playing golf like all weekend. Last week I was playing. I was playing by myself. I was not hitting the ball into the cup because I didn't want to reach my hand into the cup. Because that's the one place or touch the flag but why can't we have copper flags and copper cups and why can't the ball go into the cop and go through a little bit of a car wash like a hand sanitizer car wash and just show up on the next day that I'm with you? We have the science for it every time I watch a major. We're moving the holes every round. Why not put a washing machine underneath underneath the pin? There's guts I don't get it and look. I know that we have TV. Broadcast Rights in the masters are big deal fine. We won't play the Masters Under this but at least play the Valero Stugatz. That's it. I listen. We're not asking for the. Us Open. We're not asking for the open championship the PGA The masters. Just gimme the Valero. GimMe two of the top fifty players in the world. GimMe that tournament. I'll watch it. Golf will be the most popular sport in America. Tennis singles is five doubles completely out of the question. The question the question opening up a US Open just as a for a tournament in Connecticut. Somewhere I feel bad for the Bryan brothers. Great Americans loved the Bryan Brothers. But YOU'RE GONNA have to sit this one out just so low and look nobody's going to be fetching balls. Guess what unlimited balls unlimited balls yourself. A ball you don't touch the other person doesn't touch the ball. We can have tennis. This isn't the most difficult thing in the world. There is no reason we shouldn't have at least Gulf or just Valero just give us a Valero. Just the Valera. We'll take it and it's simple. I mean listen there. It's an individual sport both of them except for doubles tennis. Just test everyone. And if you test positive for corona virus you don't get the Valero your body. Temp is ninety nine degrees and that just makes me uncomfortable. You Sing you go ahead. You welcome to the Bolero Tennis Tournament Connecticut. That's all we're asking for man. I feel like you guys didn't have much there other than the desire to say the Valero against at lebatardshow on the twitter poll do you know anyone who fervently follows doubles tennis Bryan Bryan also not even the Bryan brothers followed double status and put it on the poll as well game or at Lebatardshow because festus zeal put on the poll you remember? Festus zeal the former NBA player. He says he misses hugs. What do you miss more Gulf or hugs at Lebatardshow Because I think you golf zealots golf sell. It's a little bit crazy. You were but I can't. I don't have a good argument for what it is. That's to God's and Mike or saying I mean they're right now because we're not totally quarantined as a country until we're totally quarantined as a country. Why can't you roam around big public spaces? I feel like golfers. Don't get near each other. You might have to carry your own bags. You might not be able to have a caddy or anything. But I think I'd like to see that too. Well thank you. I mean I can get a double espresso but I can't watch golf tournament. The Valero giving Alario we are going to have in a second here. A disease and infection expert. That can explain to us. We've got a lot of questions. We're going to ask him some of them next. Espn radio is presented by progressive insurance. Dr Greg Poland. GonNa join us at just a second here on the shell. Pennzoil performance live. We have a lot of questions for the doctor. Here's your sportscenter. Update Steve bomber and the newly formed caps. Llc has reached an agreement with James Dolan and the Madison Square Gordon Company to purchase the forum for four hundred million dollars in cash. The forum will remain as a music venue was bomber potentially build a new arena for the clippers. The third fight between Tyson fury deontay wilder has been pushed back to the fall and finally residence at the Bryn. Sealand Care Home in Wales which instituted a lockdown March twelve to protect residents and staff from the corona virus pandemic pass the time during lockdown by adapting the Board Game Hungry Hungry Hippos into a life sized competition with residents wheelchairs playing the hippos the residents worm wheelchairs being pushed back and forth while using plastic bins attached to Poles. Try to grab as many balls as possible from the middle of the Circle Creative Sport Center's brought to you by advanced apart figurehead think advance at any time one. Four batteries is about the fail. Get a free battery test at free installation with Eddie automotive battery. Purchase only at advance auto parts for all the latest headlines and information tune into sports center on. Espn radio all throughout the day. So He's Dr Greg Poland. He's a specialist in infectious disease at the Mayo Clinic. In Minnesota in two thousand sixteen he went on. Jimmy Kimmel live and taught Guillermo Jimmy how to wash their hands. If you remember that I feel for the state of your life regardless for years later Dr Greg. Poland joins us now on ESPN radio. Thank you for making the time doctor. We do in my pleasure a lot of questions. What would you say? Are Some of the biggest mistakes people are making right now? Because they're not properly informed. I think one is that they think they know how to wash their hands but they don't. I have never seen a layperson. Wash their hands properly. I think the second thing is people have a lot of misconceptions about social distancing and about how effective it is. I think the third thing is just how serious this really is. Even younger. People are taking them one at a time. Then what is the correct way as quickly as you can explain it to us? What is the correct later off your hands. What you want to do is walk is wet. Your hands in hand washing is better than hand. Sanitizer you get two soap on your hands and you're going to spend about twenty to thirty seconds washing your palms your thumbs in between your fingers. And here's what everybody forget the fingertips. That's the important part. Because that's what you touch your eyes nose and mouth with and then rents and then turn the handle off. Open the door of the bathroom wherever you are. If you're in a public washroom with the paper towel so water. I Water Warren. The hands hand. Wet Your hand wet then get to soak because you really want the lather. Reason handwashing is superior to hand sanitizers. Is that your physically washing bacteria viruses etc off. The soap has something that decreases surface tension and gets rid of hand. Oils dirt. Nukus whatever's on your hand hand sanitizers cannot penetrate or into dirt. So you know it's if that's all you have use it but hand washing better stugotz. What do you have for the doctor? So when should we use the sanitizer it sanitizer bit overrated doc? Is that what you're saying? No it's just it is not as good as handwashing now. It's better than nothing of course and I would call it second best. You WanNA use a ham sanitizer. That's at least sixty to seventy percent alcohol. You WANNA put a quarter to half dollar size. I see people scored a little. You know peanut size. That's not enough and you're GONNA YOU'RE GONNA wipe it over your hands the same way I demonstrate in the video to get all aspects all surfaces of your hands all right so we feel good about the handwashing here. I know I have a bunch of questions. I know. Our staff has a bunch of questions because no one is certain what to do here. Doc I'll start with the mail like am I supposed to go out and grab the mail from the mailbox because I have heard that I should let that mail or packages sit outside for a couple hours to a day before I go outside. And get it yeah. This is a complicated one because nobody has demonstrated transmission from the Mail on the other hand. We know that the virus can be recovered from paper and it then then it's a question of how long does it actually last on that paper? So you're talking about statistically improbable events and yet they probably occur. So what can you do? Well the safest thing would be exactly as you said if you can expose them to Higher outdoor temperatures to sunlight. That certainly helps. The other thing is open your mail and then go wash your hands. Billy what do you have for Dr Greg Poland specialists in infectious disease at the Mayo Clinic in Minnesota? Ostriches first off. I'm a crazy person. So you're wherever that I go to wash my hands. And here's some of the things that concern me. One eye open up the sink right my hands dirty when I opened up the sink so I try to do it with my elbow. But I've been opening doors and pushing buttons with elbow so I feel like I'm dirty it so then I washed my ange rate and then I have to close the which is now probably infected. Because I touched it before the that my dirty handwrite dirty Elmo and then if I want to get something driver hands. I've touched that with my dirty hands so if I go to touch paper towels regular towels to dry my hands with infected with the germs that I just watched off my hand previous so so it depends on whether you're in your own home or you're in a public washroom. Public washrooms are the worst they are danger zones for these viruses bacteria etc so you can go ahead and turn the water on with your bare hand. Wash your hands. But then turn the water faucet off with the paper towel. Exit the bathroom with the paper towel in your own home. You might have paper towels right next to your sink so that you can open and turn on and turn off the water using Napkins paper towel. Whatever so you're not doing exactly what you're talking about which is re- contaminated Gas Nozzles Supermarket. Debit machines. How dangerous those things you know again. No no way to quantitative but we do know this and I know what I'm about to say sounds really simple but but just bear with me a minute. There's nothing exotic about this virus. You cannot get infected if you don't breathe it in or don't introduce it to your body with your fingers. There's only two ways that we know of so think through what that means if I don't breathe it in okay I'm socially distance I'm not around sick people maybe even in public. I'm worrying self-made facemask. Cause and we can go back to it but that does help Those are those are really important. Things that that people can do and they tend to think. Well let's not very high tech. It's not gonNA help me but it really does help. And then the other thing that we talked about is washing your hands. You now prevented the only two ways in which you can get infected holding your breath around. People is helpful. Well he's interesting. My wife and I were talking about that when we were out running last night. And we said you know. What if we're if we're going to run by anybody and they're coughing or anything you know we're GONNA maintain a ten foot distance because these large respiratory droplets can't go that far. And Yeah you might hold your breath for a second or two until you pass that person billy. What do you have for Dr Greg Poland specialists in infectious disease at the Mayo Clinic in Minnesota? So if I every time I enter my house do I need to change my clothes or might just being crazy person by doing that because I go outside and on my clothes and I'm like well germs. Let me take this off. Let me put this in the hamper. But then when I leave again on my outside close on again so that doing anything or it might just be neurotic. Let me let me approach this way what I'm recommending to people is what I call can textually appropriate layers of protection so find a healthcare worker? You Bet you change your clothes in the garage and wash those clothes Ideally even before you get in your car onto public transportation or how however you're getting back and forth from work for you and I No particular reason to do that now. Nobody enters my house including me without washing my hand. Nobody comes into the house without sanitizing their hands. Nobody comes into my house. Who's ill I'm not I? I am not around other people. Nobody gets within six to ten feet of me. Those are the things that we can do now. The the surfaces that you're talking about you can hardly help touching if you're going grocery shopping or putting gas in your car. It's okay to touch those. It's not going to be absorbed through your skin. But here's the key thing you gotta sanitize your hands before you start touching things you're gonNA touch repeatedly or before you touch your face or eat. Chris. What do you have for Dr Craig Greg Poland again specialist in infectious disease at the Mayo Clinic in Minnesota a doctor? Can I burn my two year old to our house in a neighborhood that has a pool a community pool? Obviously we're not touching any of the lounge chairs or anything but can I bring my daughter to the pool safely. If we're not touching you know we don't. We don't have any evidence that you know. Unlike something like polio. Back in the fifties or other water borne diseases that corona virus would be would be spread that way. The issue is this How likely is your kids to be in the pool and inhale water where I see people sneezing and coughing and water getting into their nose or mouth and they spit out into the water. How likely are you to come in con- into contact with that right away depends on whether the pools coordinated or salt water so? I personally don't think that's a great idea. I don't think it's very likely that you can sort of in a bubble walk into that community pool. Dunked yourself awhile in the water get out not touch anything not come into contact with anybody. I I just think. That's an avoidable risk factor. What are some of the best questions? You're getting what are the questions? Were not asking that we should one of them is just how serious. This is You know when you when you look at it Just two days ago in the US we had about thirty thousand cases. We've got almost fifty five thousand cases. Two days later we had four hundred dead. That's doubled in two days and I think people don't have a full appreciation that and this is a bit of a difficult concept but it goes this way what you're seeing now reflects events. That happened two to four weeks ago so we are not even at the peak of this thing yet so to begin talking about well. We'RE GONNA I. I've done this for two weeks. I'M GONNA start to relax. A little bit would be mistake because there is this two to four week lag period between people getting exposed getting symptomatic getting sick enough to no longer be outside or or expose themselves to other people and then finally have having to be admitted to the hospital. I think the other thing is this false notion. Younger people are not at risk. It's true that they're not dying. At the level people my age and older are but fifty percents of the cases in the state of New York for example are between the ages of eighteen and forty nine forty percent of the first twenty five hundred patients admitted to hospitals in the US. Were between eighteen and fifty so this this misperception that. I'm young I'm invincible. I'm not gonNA have any any particular problems. Just not true. How bad do you project this getting? Well it's really hard to know and I get asked that a lot in it gives me new of sympathy for the weather man but you know let me just give you the outside scenario. These are the speedy fees numbers. Okay not mind the CDC estimate is that if we do not engage in the strict social distancing handwashing everything we've talked about by December. We could have a hundred and sixty two. Two hundred million Americans infected with twenty one million of them sick enough to be hospitalized in two hundred thousand to one point seven million debt. So let's let's not fool ourselves. This is not just the flu. This is more serious than that. It is affecting People and being transmitted in growing exponentially it has not mutated in any negative way but it nonetheless causes considerable morbidity and mortality especially in the older people or people who have chronic medical problems. The one the one other thing I would caution against is you hear a lot of really Leaning statements about drugs that are being tried that worked in such and such disease etc. Please be really careful about that. These have to go through clinical trials before we know that they help and not cause harm just because the drug helps in one disease doesn't mean that it won't harm in another disease it has to be carefully studied first. Stugotz one last question for Dr Greg Poland. Yeah dock with all that being said and understanding the serious nature of. What's going on here? Should we be playing the Valero Open? Golf Talk I mean I don't I don't know a lot about that. I've hardly had time to watch TV or or hear any media. But I think the principle is this. You do not want to bring groups of people together where you're going to magnify and amplify transmission that we had all the founder. It's called Valero. It's like two of the top fifty in the world. I mean it's golf. We're not near each other. Give us your comfort is if you can maintain you know six to ten foot distance. Go for it yes thank you Dr. We appreciate the time all right guys. Thanks Duck yes. This is from Tiger King. Right here. I am told that it's lips thank you. We will get some facts on his documentary. We've got an expert coming on in ten minutes. Who really embedded himself in the life of all of these crazy people who are being featured in tiger king. Apparently this is a lot of lip. Synching though Mike Ryan and a lot of other people have been fooled by this guy. Singing voice wait a second. Yeah that's singing. Voice isn't coming out of JOE EXOTIC coming out of Joe Exotic. I refuse to believe then. Voice of an angel his lyrics define us in the next hour. We will find out why it is STU gods. His father yelled at him. And yes we will get to that in a little bit. But as I said we've been talking about this tiger king documentary. Put IT on the poll. Guillermo please at Lebatardshow did this thing. Not Get real for you until three hundred sixty five waffle house waffle house restaurant closed. But what are some of the things got you want to know because we've been talking about this Netflix documentary? It's about exotic animal. Owners big cat owners primarily and they're just crazy people crazy people we've never had. I think what's happening here is a lot of us are being enlighten to what this world is. And it's just basically the private zoo world and it doesn't seem like you can exist in and be any kind of sane. So what kind of questions do you want to know? Fr from this gentleman who has been immersed in all of these worlds for a while now and his super informed. Because we're GONNA talk to him in about ten minutes. Well I have to episodes to go so this could be tricky for me but I am interested. I want more information on this angel investor. And what happens with him? He apparently comes in to save the day to save. Joe EXOTICA I want to know if the EXOTICA EXOTICA an exotic erotica just did their Hashtag looking at him. Just looking at him. I understand why it is. You would arrive at that conclusion because he is as erotic as he is exotic right. I want to know if the animal reserve that wife. If she actually did kill her husband like Joe Joe Proclaim. She did many many times. They made a video about it. So I'm interested in that as well. Okay so again. It's it's part comedy and it's also about a murder attempt and possibly a disappearance as well that's next.

golf Micky arison Lebatardshow Mike Ryan Dr Greg Poland Dan Lebatardshow Guillermo Jimmy Espn Miami tennis Cruise Industry Valero Minnesota Mayo Clinic clippers Gulf Billy Chris Greg Roy basketball Steve bomber Steve Balmer
Strict adherence to public health measures effective in combating COVID-19

Mayo Clinic Q&A

23:19 min | 9 months ago

Strict adherence to public health measures effective in combating COVID-19

"Welcome. Everyone to Mayo Clinic. and Dr Halina Gonzaga. We are recording this podcast on August having deep twenty twenty while public health efforts continue in an effort to control and slow the spread of covid nineteen. And the last couple of weeks we've discussed the development of vaccines in an effort to treat covid nineteen and prevent it. We've discussed ramifications of returning to school and today we're here again with more updates I'm pleased to say that I have with me again today, Dr Greg Poland Biologist, and infectious disease expert at Mayo Clinic thanks for being here Greg. Fun To be with you again. I am looking forward to hearing what you have to say to us today lose keeps coming out we are in the US now at about five and a half million cases with over one hundred, seventy, thousand deaths. We still have prominent outbreaks particularly in Florida, Texas along the southern in southwest rim schools are starting back and we've heard of outbreaks at the college level, the the school level most recently La County, which is the I think the second largest school district in the US decided to cancel any kind of in-person classes as they try to get a hold on. This, but there's something interesting to note New, York in New York City in particular have kept cases suppressed below one percent. Now, this is really remarkable but observers or noticing that because of what New York City went through, they don't deny the seriousness this in people take it very seriously. They're wearing masks they're maintaining distance they closed you know bars and things like that where there are known places where the virus easily transmits and it works as you know, I was on Mayo campus last week and it was a remarkable thing to see you know twenty thousand. Staff and doctors and patients in our in our facility. But everybody distance everybody wearing a mask properly above their nose screening questions, hand sanitation stations, and it works those are together simple measures that have been terribly effective. And Somehow, it's been difficult to convince our culture society that strict adherence to those things in toto that is doing all of them together is a very, very powerful antidote to this virus. What you said about some people are in and some people are out there. I saw multiple articles actually in the national news this morning about why do some people take this? So seriously in wire other people having difficulty or denying it. On and we certainly are having some large outbreaks in in certain areas. You know you and I talked about vaccines last week Greg and today I wanted to ask you about the concept of heard immunity. We've touched on this briefly in the past. But now we've had some really big outbreaks. I'm thinking of the outbreak in the San Quentin prison for instance, what do we learn? What can we learn about community from Situations like that, and from other countries who are a little further ahead of us in. New Now. That's a great question to San Quentin. Affidavit pandemic is is really instructive. I was just looking up the numbers they've got just under thirty three, hundred residents in that facility and twenty two, hundred of them have been documented to be infected. They've at twenty five deaths. So what that means is that two thirds okay a number about where people have been talking herd immunity would happen two thirds of those inmates were infected and yet in the last two weeks, they've had more than sixty cases. So this tells us that in close quarters now that that wouldn't be reflective for example of a of a medical clinic or you know some other experience, but it would perhaps be more reflective of a dormitory of crowded school hallway things like. and. It's apparent that heard immunity isn't occurring that way that in fact that number is likely to be even higher if that concept exists with this novel, a Corona virus infect know if you think about it if you took those numbers and it's kind of inappropriate to do so because the US isn't a prison in that regard. But if you took those numbers and you translated at to the US population that would be about two and a half million Americans debt. So this this concept of just opened things up, forget about it. Let's let's approach. Her immunity is is definitely a false one Bhakta we've heard this with Sweden. And I went in and did the homework looked up the numbers as diligently and carefully as as their reported in Sweden his head A. A death rate almost five and a half old higher than Denmark nine and a half old higher than Finland and almost twelve times higher than Norway and yet they're population Ciro. Positively is only about seven to ten percent. So the the cost of saying we're just, GONNA, let everybody get infected would be enormous in the toll of deaths and still not get us there. So I think our job yours and minus as physicians as. is to one be knowledgeable about the data ourselves. But to be those reason voices that are telling people look, this is what the science is showing us. We can protect ourselves. We can decrease the length of time that we're going to be under these conditions will get a vaccine hopefully within the next six months to a year, and then we'll be better off if we just cooperate together and the responsibility of our viewers and listeners as well to Damascus to wash hands to socially distance neck. That's a good reminder. Saying yesterday Greg Ice stopped in a local restaurant here to have lunch and I was asking for a table outside and they have their tables nicely distance and they asked me for my phone number when I checked in and I said, Oh is the wait that long I don't know if I really went wait quite so long for a table and they said, no, we're collecting phone numbers in case there's an outbreak. Of any of our workers and our restaurant or we hear guest for context tracing data and I'm wondering, what can you tell us about what kind of work is going on in that arena and what we're learning from first of all, that's that's very sophisticated thinking in planning on the part of that of that restaurant. When you look around the nation. What we're hearing from state public health departments is to difficulties. One is getting a hold of people phone numbers outdated or not available. Until they can't actually contact trace because they can't contact people and the second one on his even when they do their affair fair number of people who don't want to divulge who their contacts are making contact racing a null and void of its power. On the other hand, there are some states that have managed to do this well, and when you do it well, you're able particularly in the early stages of an outbreak before it's just you know running rampant. You're really able to contact these people talk to them about the importance of quarantine and dramatically suppress the case load in that community or in that that state. So contact tracing is really helpful that way it also tells you something else. ooh and. What age individual? Where are they getting infected? Is it schools? Is it community? Is it bars or restaurants? All of that is very, very helpful and formulating public health policy. So it's something that I think in the US we were slow. To do now state health departments at various levels are doing it I think the next stage is to get those data on public health sites so that the public can see what is the risk in my community and what are the appropriate measures to take, and then see that it actually works Greg you and I have talked previously on another podcast about how Mayo Clinic uses context tracing for. Our employees to help prevent the spread of covid within our our employees group and I also was thinking about how important that has been educationally. So looking in public affairs in a lot of education of our patients of our employees as well and to be able to share with employers, how their behaviors might have had an impact on others is really very interesting in essential I think he no longer. You make a good point helene. It's really kind of a feedback loop business not only does it decrease cases, but you can tell by your collective behaviors that it's having an effect and you can see the numbers and I think it's a it's a fabulous thing to do. We know it works in epidemics and pandemics it just needs to be done. Months ago I had actually heard that when Amazon boxes come to the house, you should be careful because the virus can live on surfaces for a period of time, and then there's been concern within some food packaging plants about on the spread of the virus perhaps not just. Food but via the packaging and I'm wondering what can you tell us about how to handle food packaging is that something we should be concerned about should be wearing gloves to the grocery store should be wiping off our groceries. Tell us about that. Great good good practical questions I maybe just a little bit of a primer here. So the fact that you can find virus by PCR doesn't mean. So to speak that it's live virus, it just means elements of the genetic material. Are there the second thing is it doesn't mean that it's infectious virus. Infects. US is the inoculate the amount of virus. So for example, it's highly doubtful whether one particle of virus actually cause infection. No one knows what at innocuous size is. All right. So what what has been done is a number of studies showing that you can find the genetic material. For days sometimes even weeks on various kinds of hard surfaces or external surfaces. The ones that are at risk are where there's high inoculations size I go. And then I grabbed a door not and you're right behind me and grab it. We think that's logically a risky thing because we know with other respiratory viruses like influenza that you can get into infect other people in get infected that way no one has proven that with food or with external packaging that's different than the hard surface in a hospital room for example, where that inoculate size might be very high if it housed covid patient. So so first of all I think we can say there's not been a single demonstration that. Viruses on Food Ben Infect somebody or on a package than infect somebody you think about the route of let's let's even take something like. An expedited shipping where it's twenty four hours nobody has shown that somebody become infected that way now people then asked me well, is there any harm in wiping my packages off or putting them out in the sun none none at all and I think It's a, it's a margin of safety even though we don't have any proof that that is a direct risk but I I don't discourage people from doing it at where I get more concerned when people say, well, maybe my food isn't safe and there just isn't any evidence for that. There isn't evidence of that for other respiratory pathogens e either. And I think that's particularly true where food is cooked. That that's a logical route of infection, you've been giving us updates all along on the vaccines that are being developed and how many have enrolled at Cetera. Can you tell us how the vaccine trials that are in phase three are going right now? Yeah. So the the face trials that are occurring in the US had enrolled slower than than thought at least last week. Remember they have to enroll thirty thousand. They had enrolled about forty five hundred now only roughly about fifty nine I think it was of the eighty four clinical trial sites had. As of a week or two ago. So I expected that will accelerate on a little more. But when you think about it, those first participants that enrolled, let's say early August you have to wait thirty days. Then they get another dose two weeks after that, they get a blood draw then all of those hundreds of thousands of. Laboratory assays have to be done. The data has to be analyzed, etc. You're talking well into twenty twenty one before those data would be available could be looked at by the FDA and by expert advisers. So I think realistically and which said it all along and less another mechanism is used. If we go through full licensor I don't think we should be looking for a vaccine for another six months and for some people because of the time it takes to manufacture doses a year even. So. We're in this for the long haul again as we've said. from the very beginning that. Somebody was joking with me were they said twenty twenty Oh that's right. Year one of quarantine. And you know it's kind of gallows humor, but it makes the point. If we can suppress cases, draw this out slowly because we don't have any other preventive measures until we get a vaccine and hopefully we get a safe and effective vaccine get administered to people as quickly as possible will be able to begin truly relaxing these but not until a vaccine. Even when you suppress cases if you start relaxing that prior to vaccine, we have seen that outbreaks will start again. I had shared with you that I had seen an interesting study done which I thought was actually rather well done where they compared masks in how effective they are. While we're waiting for that Beck seen that unfortunately is taking longer than we wish. We're protecting ourselves in protecting others and I had read about four different types of masks and their their efficacy, and I was hoping that you and I could just talk a little bit about them. Today I have examples on my desk here to show and I have a gainer on myself right now So if you can start by telling us about gators. So you know the latest data and actually this was just last week. In a study published in science advances from a group, I think it was a duke. US Some pretty simple equipment and remember that the goal of their study was to say if I had a mask on of various types, how many particles escaped that that would be potentially infectious. So they didn't prove infection. They're just saying with normal people talking I. Think they were saying healthy people stay healthy or something like that. So with just that they weren't yelling singing anything like that just speaking and how many viral particles escape. So they they all escape if you don't wear anything over your mouth, right? So not wearing any kind of mask. Is, foolish. You are exposing other people to virus if you're infected and most of the time you won't know you're infected, which is why it's so important next they looked at the various navigators I. I have one too and these are very lightweight. They have their kind of stretchy cotton. If you held him up to the light, you can see through it and what they found is that really did not decrease the number of large viral particles by very much and in fact, if found something worrisome and that is by expelling the particle through the material, it actually served to take the big particles and fracture them into more dangerous smaller particles. So these mass don't prevent you from expelling virus, and in fact, make it really skier for other people. So this is not an appropriate to wear next they tried bandannas a double layer of a Bandanna that decrease the number of particles I think by about twenty thirty percent something like that, and if we go to some of your other props there I brought one, my wife made this mascots, three layers of cotton. Now, all the Duke Study Group studied were two layers of cotton, but almost all the other materials that they use decrease the. Release of particles by anywhere from sixty percent to ninety plus percent. When you get to some of the mass you have their. Yes I also had a cloth masks to show you. It sounds like these net gators. We should probably just say for warming next in the wintertime and not count on them for mass, and then this is the most common type of mass. You showed us out with this on last week that you and I would wear seeing patients. Surgical mask, it's taper mass. So. That's a that's a three layer paper mask or so called medical or surgical masks. Those are surprisingly good worn properly, they're not perfect. There is no even the end ninety five is not perfect. handwashing isn't perfect. Physical distancing isn't perfect but together, they're about as perfect as you can get as it turns out. So you're probably reducing the expulsion of viral material by about ninety five plus percent with that just three ply surgical masks. Masks worn properly. What about ninety? Five Massey's are the masks that are used. In Hospital when we know that we have a patient. With covert or when there is a high risk of potential transmission does everyone need to wear one of these so those masks are very, very effective. They filter it's called an end ninety five because it filters out ninety five percent of viral particles added least efficient point. So it's actually better than that. But when it's least efficient, it's still ninety five percent effective in that the problem is this has to be fitted properly. Now I have a short beard other people have longer beards you really can't fit it well with with a lot of facial hair and it takes some experience experienced person to fit. The other thing is you know inside a medical facility or indoors where there's air conditioning Eric's changes they're reasonably comfortable to wear outside they. I, personally, don't see how I could wear one more than. An hour maybe two hours because they are tight. They, they are kind of constrictive if you wear them too long the ex- ex- elation begins to get the mask wet and a wet mask is not an effective mass. So probably not something that the general public is going to be wearing. Usefully Greg I don't have an example of the last one that I wanted to ask you about in high don't think they mentioned it and the article that we were discussing, but I have seen people wearing masks with the valves on them I think to allow that's to allow barrel carbon dioxide to escape. So the valve and ninety five are not as effective as the N. ninety five mask It's it's certainly better than nothing certainly better than some of the cheap one or even two layer cotton. Maso at knows no harm in wearing it in there is benefit in it but that the presupposition behind the mask is a faulty one that somehow co two levels are GonNa build up in me. There is no evidence for that. As you know as healthcare workers, we wear them for hours at a time in healthcare workers are not keeling over with with carbon dioxide. Poisoning. But. I think some people maybe find him a little more comfortable in terms of letting out some of the the moisture but whatever can go out can come in. And that's why that you never see a healthcare worker wearing a bow and ninety five mask. So I looked on the CDC website to see what they said about very mass in they said, you should not wear a mask with a valve because essentially all you're doing is pushing out. Your virus to others and not providing the protection of the mass typically would this has been fun. Thank you. We compared our gators today we'll save on for fall for a fashion accessory. Thanks so much for being with. US Today Greg. With us today has been again infectious disease and viral AJI expert Dr Greg Poland from the Mayo Clinic. We appreciate him being here to share updates with us and we appreciate you listening to have a nice day. MAYOCLINIC QNA is a production of the Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts to see a list of all male clinic podcasts visit. News Network. Dot Mayoclinic Dot Org. Then Click on podcast. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

US Greg Ice Mayo Clinic Mayo Clinic. Mayo Sweden Dr Greg Poland Biologist Mayo Clinic News Network New York City York San Quentin La County Dr Halina Gonzaga CDC infectious Dr Greg Poland FDA Texas
Real world effectiveness of COVID-19 vaccines

Mayo Clinic Q&A

29:33 min | 6 d ago

Real world effectiveness of COVID-19 vaccines

"Coming up on mayoclinic. Qa after fifteen months of this this is the first week we have not had an increase in cova cases in any u s state and in thirty three of those states. There was a decrease last week. This has not happened on any consistent basis for every us state since the start of this pandemic even though there has been a decrease in adult cases more children and teens are getting cova due to variant strains so it's crucial that parents get their children immunized when the vaccine is available for their age groups. My advice to parents would be get your kids immunized as soon as you can't let them go to summer camp let them get together with friends that socialization is so important and let them get back to person school as safety as possible. Welcome everyone to mayo clinic q. And a. i'm dr halina gazelle recording. This podcast on monday may the tenth. Twenty twenty one. There was big news on the covid. Nineteen vaccination front last week. pfizer requested. Emergency use authorization of their vaccine to be extended to include twelve to fifteen year. Olds will here to discuss this and other covert news with us. Today is our favorite expert. Dr greg poland. Who's an infectious disease vaccine. Expert and virology expert at the mayo clinic. Thanks for being here greg. Thank you lena. Glit- glad to have you back. You had a few days off. But now i hope that you missed me. Last week. i missed our conversation. Yes we have a lot to get to right. I want to ask you about vaccines. And i have several listener questions for you but i. I heard that you have some really good news for us today. So let's go with the good news. News gets out good news especially gets out the fast well. The good news is this. After fifteen months of this. This is the first week we have not had an increase in cova cases in any us state and in thirty three of those states. There was a decrease last week. This has not happened on any consistent basis for every us state since the start of this pandemic. well. I know who. America good covid news. We can use good covert news. That's great greg. now tell us about vaccines. Where are we with teenagers. And with vaccines overall yeah. You know the flip side of the good news is where we are. Seeing infections is in people who are not yet vaccinated net includes younger adults kids. That's that's a concern A good quarter of the cases that are occurring are in kids. Something we did not. That's a lot. Yeah earlier in this pandemic when you look at the us now. It's hard to even imagine these numbers. Two hundred and sixty two million doses. Wow we're given by the end of this weekend. Which means forty six percent of the population has gotten at least one dose and thirty five. So let's just call it. A third of the nation is fully vaccinated. Wow that means the big push now. Is we gotta get you know. I think none of us want to go back. None of us want wanna go back. I think what's going to happen. Is that through. The spring and summer will continue. I hope i hope to see a decrease in cases the concern will be as summer travel. Starts and travel is a risk factor. Where you have people who are not vaccinated and then with kids going back to school in the fall are we gonna see surges again. Part of that will be determined by what variants circulate but the good news. Follow on to the good news is that visor is coming forward to extend their e you way down to twelve years. Ol- wonder that means is that we will be able to start immunising every american aged twelve and older and they're working their way down. Madonna will do the same thing. Johnson and johnson will probably do the same thing. So if we do this well america if we do this well and all do our part in get a vaccine we are going to have a normal life again and not constantly be thinking about kobe. That deserves another woo. So a lot of the obstacles to receiving vaccine's are being removed. Greg here in minnesota The dissenters even here at mayo clinic and many of the state Vaccine centers are opening up for watkins. Lockable events great convenience. Yeah yeah so in a lot of things. I think that's true. I hope people take advantage of that. I hope we very quickly get this by the way followed on the pfizer and dern will do the same thing and two other companies are filing or what's called a b. La so a full approval license and what that mean is that anybody can walk in and get a vaccine. There will be no excuse. No reason to not protect yourself your family and your community and regular. You remind us again. What an e you a is sure. So emergency use authorization and what that says is that the unknown and potential benefits and risks are outweigh in other words more benefits than risks. That are no now what happens with a b. l. layer biologics license application full. Licenser is now you don't. You're not looking at potential risks. You're not you're looking at no so we're looking at known benefits known risks. We have more data for these vaccines than any vaccines we've ever had at this stage. I mean america needs to hear that this is a stunning amount of data with stunning efficacy and safety associated with it. So when you move to a be. La now you know the risks you know the benefits you know what's called the real world effectiveness and the last part of it is that the fda does all of the lot to lot consistency testing. They examined they've already done it but they normally under normal conditions. They wouldn't normally do the facilities inspection and till this stage. They've already done that. So it's gonna be what's called a rolling be. La they'll put the part that fda wants empty will have more questions they'll put that nex card forward and that should accelerate full licensor. Oh wonderful that's great. Oh and greg. You mentioned more and more people getting the vaccine and here in minnesota. And i've seen in many states as well but governor walls started sort of a rollback of the the mandates Distancing how many can gather in a group on Hours that restaurants etc can be open and it's sort of in a staged process as more minnesotans get vaccinated. I think the hope is for seventy percent by july first to be able to open up even more. You know what a great thing to july for a day of freedom right. Yeah that ben and it really it really centers on people getting vaccine. I cannot stress this enough. This virus will continue to mutate. We've seen excellent efficacy against these mutant but once they get a hole in a community where you have a high number of unvaccinated people as we just saw in michigan. Then we start all over again. And i just dearly hope that doesn't happen And that people have the confidence that they are warranted to have in these vaccines. I wanted to go over that one more time with you. Because i was going to be my next question. Greg is about the variant. So you're saying that each of these vaccine seems to be efficacious about against the very ans- no we. We have some really excellent what. What's called real world effectiveness so not in a special kind of study but what actually happens out in the world and we They published studies now actually last week. So your questions. A very timely one in qatar and israel looking at pfizer vaccine other studies have looked at dern vaccine. They are just shy. I presented to of one hundred percent. Efficacy against del severe illness critical illness about eighty five percent effective against a symptomatic infection. And that's the key that's why we all get the vaccine so that we're all protected and protecting those that can't get the vaccine so this is really important and it's. It's really good news. If we do this well and greg yet. There are still those who are concerned about receiving a vaccine that it was just rushed that it was brought that vaccines were brought forward to early. Can you just again for our listeners. And for me silent to learn something everyday go through a little bit of the history and why we've been able to do this within the fifteen months and why we know they're safe. No really good question and everybody deserves an answer to that question. So the amarnath vaccine's started being developed in the nineteen sixties by nineteen ninety. They figured out. How do you stabilize that. M r name molecule and decrease the reacted in this city so that started in nineteen ninety ninety one they worked and worked and worked on those vaccines along comes. Sars covy one in two thousand three. They started doing the studies for the for the development of that. Mr a vaccine thankfully sars. Kobe won through containment procedures. Much more lethal disease went away. We were able to control that in a disappears. It put the vaccine on the shell. Twenty twelve comes along murders another parana virus. They take it back off. The shelves start developing it. Merged did not thankfully become a pandemic back on shell and then of course in twenty nineteen twenty twenty. We learn about this so corona virus vaccines using. Mri technology where already developed. They had already had depending on how you want to count it. Fifty to thirty years of development so all operation warp speed does was figure out. How do you cut out the administrative bureaucracy. How did we get contracts out how we incentivize manufacturers to make hundreds of millions to billions of those. How do we get countries around the world to cooperate. It can be a multi year process to cooperate in getting all the ethical approvals for the face. Three clinical trials and the drug companies pitched in. And they did it. You play. I will say i can sometimes be very critical of them. They did this beautifully and we ended up with really large phase. Three clinical trials into this point when somebody says well. I'm not sure that they've used it enough for that. We know enough hundreds of millions of doses have been given at this point and no safety signal with the mr mia vaccines other than nfl. Axes and with the adenovirus vector maxine. No safety signal at all other than this very rare coagulation syndrome that can occur so to say that these are vaccines were developed in the past year would be eroneous spring. It's frankly wrong. And i don't expect that lay. People would know that right to them. They just heard about this to us in the field. This has been being developed my entire career. This is just the first application in a widespread manner. Well greg gets time to turn to the mailbag our brilliant listeners. Have some great questions for you today. I always wonder what am i going to get. We like to test you on your toes. Our first question is from an individual with a penicillin allergy who is questioning whether the colored vaccines are indeed safe for someone with penicillin allergy and is there a preference for one vaccine over another nets a fortunately a very easy one. They do not contain preservatives. Antibiotics nothing that would cause any other sort of allergic reaction that the one we've seen in about two to four out of million doses about the same as other things so the advantage of these vaccines. No antibiotics in them. No preservatives in them perfect. I'm gonna read the next question to you dr poland. I'm wondering if you could comment on whether or not the post vaccination symptoms of bells pollen palsy after an initial dose of sufficient concern to delay the second dose as general recommendation. So maybe start with. What is bell's paul's the newest listener talking about now so bills. Palsy is a condition when the the Cranial nerve that causes us to move our face. Allow us to smile or frown or blink is whatever it would be when those nerves in this case. The seventh nerve actually is damaged in some way either from an inflammatory process shingles is one of the more common causes of it and in the clinical trials. There was a very slight imbalanced. So remember we give. Some people a placebo. Some people the vaccine. That's been hundreds of thousands of people now and we look for any differences in the initial. Study that was a slight imbalance toward the vaccine so in other words a little red flag. Here's something we have to look for so now after mill. Hundreds of millions of doses. Tens of millions of doses. They looked again no imbalance. They have not seen anything that they can say is vaccine associated. So you're really looking to say in a group of people that get the vaccine. Do we find that side effect any more frequently than two years ago before there was any cova cope with beck seen or among people who never got the vaccine. And there's no imbalance so so while there was a hint of a concern that particular concern has not shown up to be true. All right Another concern our next listener has a teenage daughter in his wondering whether it is safe for their daughter to receive the johnson and johnson vaccine out of concern for potential blood clots and if not blood clots possible that the researchers will later find their other complications and that we should have waited to receive vaccines so the latter question is a really good question. Right i mean people want to know and deserve to know is what i'm about to take say what are the risks and what are the benefits. Now wisdom resides in knowing the risks and benefits of getting vaccine and the risks of not getting a vaccine view if any benefits to not getting a vaccine unless you're allergic component in that and that's this idea of of trying to balance risk. So let's just say that. With the johnson and johnson back seen. We're looking at a risk of about two people out of a million developing this very new very rare syndrome called t t s what it basically means is blood clots associated strangely enough with a decrease in the cells that circulate in our blood. Cause clotting called platelets almost all those cases have occurred in women and almost all in women under the age of fifty so the concern as teeny as it is is a concern limited almost entirely to younger women so you have a choice in the. Us you go ahead and get james j big advantage single dose or you can get the marinade vaccines and later this month. They'll be four new vaccine available for people. So what would i do. I would get the vaccine. That's available to me and you know it depends on circumstances if you're a young woman's living at home and she's got good access. She could pick any of them. If it's college. And i've got one choice. And i get it done in one dose. I would have no problem with that either. The main thing is that we would just monitor somebody. These are not hard to pick up. This is the worst headache. I've ever had in my life. A swollen blue limb or severe abdominal pain. The these are not subtle things. Okay as and one of the reasons for the john. Jay pause was to educate the public about that but also for you is physicians to be educated. Because you treat that blood clot very differently than we treat all other blood lots. So even within that minor safety issue there's enhanced safety in knowing what to do okay. I'm not aware of who is in the household of our next listener but this individual is wondering. Is it enough just to vaccinate adults within the household even as vaccines become available for the younger individuals in the household. The answer to that is also pretty clear. No and you were talking a little bit before the show that where we are seeing cases is in younger people in teenagers who are in school. Who are in congregate settings in colorado or thir. More of the cases are were occurring in the in the younger kids. So the sooner we get them immunized the better right now with pfizer vaccine. We can start at age. Sixteen may twelfth. So this later this week. The a c i p will be meeting in almost certainly will extend this down to age. Twelve after seeing the safety data in the studies and my advice appearance would be. Get your kids immunized as soon as you can let them go to summer camp let them get together with friends that socialization is so important and let them get back to person school as safety as possible. You know this is so important. It's really th- really interesting to me to see who's picking up on this colleges and universities by the droves are making it mandatory so that they can safely have in person classes all the state universities in new york. this fall will be mandatory. So it's interesting. i've seen that in some health systems. that are considering making it mandatory. Hope i hope they all do. Our job is Be safe ourselves but to keep our patients safe. So i always say you do your kids favour. They want to live a normal life. Get them immunized as soon as you can. And that reminds me to say Get them caught up on any vaccines. They missed over this past year because of yeah that was a real issue. Initially i remember That little chiltern weren't necessarily getting into have their normal vaccine schedule. That's a good reminder. The next question is kind of interesting. Greg and i went to thought of it but this individual is wondering because their adolescent is a smaller sized individual than abandon adult do they need two doses of the two dose vaccines Or does it have anything to do with the size of the individual with the responses. All i can say is wow. That is a research question that my group is stunning. Whoever that listener is that. I'm we make them an honorary member of the mayo clinic. Vaccine research group We we had that same concern In fact we have that concern in males versus females because women produce better antibody responses by men now know smiling who but they all have many things but they also have tend to have more in the way of vaccine side effects fever not feeling well red swollen arms etc so in the studies that they did down to age twelve. They saw no safety issues. Any different than adults when you get down below age twelve Pfizer studying and earner studying half doses. And sometimes a third the dose for exactly that reason so our listeners is very sharp too thin. They as they all have been. I gotta stay on my toes with our listener questions but our listeners. Very sharp and we'll know the question to that kerr people below the age of twelve as we do those studies while all of our listener questions and they were great questions. I saw the most fascinating article in the new york. Times that i wanted to ask you about is that people are showering less during ovid. Y trooper metoo confessions. I as i said. I believe in radical transparency when we're talking to patients and it's not true after i've gone running or biking or anything like that. Thanks clarifying the reason for. It is the complex. But the idea behind it is import- what dermatologists will tell you is that daily bathing and showering with the harsh chemicals and soaps and shampoos that we use are actually not healthy for your skin so you know unless you got a manual jobber. You've been outside or working out. There really is no reason for that every day. Now you know we would say. Wash the parts that need to be washington under your arms but you know the rest. Your skin is actually healthier without doing that every day. So maybe you're doing it every other every third day. I know some people have moved to a routine especially in the colder states of one or twice a week and there is no ill effect from that and interestingly we have to remember that humankind never did this before this is a modern day invention basically of the marketers who are selling deodorants and scented shampoos and stopes. And things. Like the for me for one thing. I mean the volume shampoo didn't work done with no more selling that to you. It's interesting this sort of a luxury to be able to turn on your shower and have a shower every day. Indoor plumbing with clean water. And that's the only reason ever worked and i do think about the skin living in minnesota. You know get so cold. You notice in the winter. That's that your hands get much drier because we're constantly washing them obviously in healthcare and then during covert everybody's constantly watching any of our patients that we have sent the dermatology always here. This moisturised moisturised monster is and there actually is a company that kind of spun off a mayo invention. I think it's called danny crane that they actually use and the dermatologist. Think is a great Skin cream for exactly that reason. They see rashes. They see cracks in the skin with infections and cellulitis so we can probably cool it a little bit on may be something to this idea. Well any last thoughts for our listeners. Today greg i think kind of what we often do I'm a at the point as dangerous as this is gonna be is if you really have information based needs in hesitancy on the vaccine contact us. I will personally do everything. I can to try to give you an answer or direct you to an answer. I'll probably be overwhelmed. But truly i mean i have spent forty. Years is a vaccine apologised. I would not put my reputation on the line or at stake here if i did had not. Seen the data myself in did not believe these data. These are out of the ballpark superior. Vaccines they are safe and effective vaccines and we have come through in the united states is. We've often talked about it. Breaks my heart one out of every five hundred fifty. An american died of kobe. Or its complications in it need not have been so. Please get your vaccines lease. Get your kids immunized. If i can help you or mayo clinic can help you with any information needs. We will do that. it's that important. We want to see that positive trend. You talked about in the beginning. Continue doing right. We're know wouldn't it be when it be great if we are on summer vacations with our families and kids are in summer can sin doing all the things kids should do as parents us not worrying it all. We have had somewhere around six hundred. Children die in the us of kobe. I don't wanna see even one more. It is heartbreaking. I i'll tell you transparently. I didn't go into pediatrics. because i can't emotionally divorce myself from that with kids. I don't want to see anybody. Die needlessly but kids and young adults when we know we can prevent it keep doing the work and space space and back sonate perfect. Thanks for being here greg. I look forward to seeing you next week. Thank you are. Thanks to dr greg poll and for being here today to give us our covid nineteen updates and to answer some of your questions. I hope that you'll learn something. I know that i did. We wish each of you a wonderful day mayo clinic. Qna use a production of the mayo clinic news network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to mayo clinic news network at mayo dot edu.

greg mayo clinic Pfizer cova penicillin allergy dr halina gazelle Dr greg poland us johnson state Vaccine centers La symptomatic infection Greg minnesota fda mr mia coagulation syndrome
Ramping up COVID-19 vaccination rate in race against virus

Mayo Clinic Q&A

18:48 min | Last week

Ramping up COVID-19 vaccination rate in race against virus

"Coming up on mayo clinic. Qna this is the worst. The pandemic has been worldwide. Since its start and we've got some just tragic hot spots that we're seeing for example in indian brazil are probably the best known with much of the world still suffering from the effects of covid nineteen. Why is the us in a better position and we've had over. One hundred million americans vaccinated forty percent of adults are now fully vaccinated and eighty three percent of americans who are sixty five and older have now gotten vaccinated. The reason that cases are falling here in the us is that immunization ary welcome to mayo clinic. I'm deedee steepen. Sitting in for dr halina kazataka. We are recording. This podcast on monday may third twenty twenty one here for our weekly covid. Nineteen update is. Dr greg poland a mayo clinic corologis and infectious disease specialist. Dr thanks so much for being here. You good to see you to work with you to see you too so give us a status update. What is the latest on covid. Nineteen here in the us and worldwide. So you know this is an interesting and it's kind of a study. In contrast this is the worst. The pandemic has been worldwide since it start. And we've got some just tragic hot spots that we're seeing for example in indian brazil are probably the best known at the same time and again related to vaccination rates. We're starting to see a fall now in the number of cases hospitalizations and deaths in the us which which has trended upwards after all the spring break travel that we know that we talked about in warn people about so. we're starting to see that decrease. Why is that happened. We've had over. A hundred million. Americans backs and aided forty percent of adults are now fully vaccinated and eighty three percent of americans who are sixty five and older have now got back snake. We're at about forty percent of all adults age eighteen in Older so that's a. That's a very very good statistic and and the reason that cases are falling here in the us is that immunization rate two hundred forty five million doses of of covid vaccine have been given in the us nonetheless. We have to be vigilant. Tsa has extended the mask mandate until mid september I think we might talk about if you're interested we could talk about the new. Cdc mask guidelines later but all of this is good news and at the same time there are still people that need more information and need to be persuaded about the safety and the value of getting kobe. Vaccine right. And you know you mentioned the forty percents Vaccination rate is there still a chance that we're going to reach her to immunity worldwide. It seems unlikely. That will get there in the us but can covid be controlled even if we don't reach herd immunity. No i don't think so. I think the nature of the transmissibility of this virus as we have seen is that you probably have to have immunity levels in the eighty five. Maybe even ninety percent range now you could get there by a combination of infection end end so people have gotten infected. People who've gotten back seen the problem is to get to that high. A level on the infections side means a tragic number of deaths hospitalizations and long term health. Consequences that no one wants to see by contrast the safety of these vaccines and the efficacy has been beyond what any of us is back. Sinologist thought would be possible in a first generation vaccine. So might we reach that in the. Us were were hopeful. Might guess because we're such an interconnected global community until everybody say none of us are safe and we're gonna likely no one knows for sure but likely seek continued circulation of the virus and that mirus will seek out whoever is not immune. So let's go back to talking. You mentioned some basking guidelines last week. The cdc changed outdoor masking recommendations. A tell us what the current guidance is. And what's the science behind it. So what they're really looking at is saying you know once you reach a certain level of immunity and unless that changes which could right we still have a large number of people who have not been immunized but if that trend continues the transmission outdoors is such a small part of overall case burden that particularly for those who have been immunized. They can be out in public without a mask. The one exception being you know if they're in a crowded outdoor venue like you know i. I don't know a concert or something like that for indoors. The recommendation continues to be even for those of us that have been fully vaccinated to wear mass in crowds. When we're at a movie theater when we're around of our family who have been unvaccinated now. A small group like your neighbor could come over for example even unvaccinated and have dinner with you. They should probably wear a mask but not us. The other thing is that they just cdc just released over the weekend their initial guidance or summer camps for kids so by default initiation almost all those kids are below the age of sixteen there are some exceptions and so they've not been able to be immunized and the recommendation is not only distancing but mask wearing at all times could to know. Let's get to some listener questions that we have here. First listener says asks. Have there been any issues with ringing in the ear Or had problems for people after they get the vaccine. I had ringing in my ears after the vaccine. And i wondered if that's a side effect so this is a very interesting question that you asked me about an hour. After my second dose. I developed severe ringing in my ears about ten weeks later. It's starting to decrease this is called tinnitus. it's a very common phenomena. I've queried the cdc about it. Some one thousand reports have been received in regards to this so like any side effects. If you feel you've had a side effect from a vaccine we ask people please report it. You can go online and just type in. B a e r s. There's and it's an online reporting system that you can report. It's the only way that we can find out about rare safety signals so so far. The number of people who have developed ringing in their ears has not exceeded the expected baseline if there were no kobe. Vaccines being given so what you want to know is by giving vaccine. Are you seeing a higher rate than among people who have not gotten the vaccine and it has thus far not reached that That that state but something to be aware of by way of encouragement. And i've talked to a number of emt's about this. They believed that if that's real. It's on a transient or temporary inflammatory basis. And that most all of those will resolve in the six to twelve month time period. We'll see if that's true but that seems to be the trend very interesting definitely something to continue to follow The next question. What will be the deciding factor for the time of year when boosters will be most effective since as we know people have gone covid nineteen and its variants year round. It won't be based on time moved year. I don't believe dede more likely on evidence of immune evasion another words by having the large group of people who have not been immunized and who still get infected you give the virus marin more room to mutate eventually. That virus could mutate such that for those of us who have backseat. The virus may be able to evade or escape that vaccine immunity just as it is learning how to escape prior infection. And so now we're seeing people who never got an accident but got infected get reinfected and that's a that's a real issue and problem so we start to see cases rise and we start to see that happen even in people who were immunized then you would think about giving a booster now having said that there is likely to be some seasonality just like we see with influenza for example and there are companies working on a combination single shot of influenza and sars koby to so we'll see how that plays out that is interesting. Our next listener question. What is the latest on treatments for people who do contract covid nineteen. I understand the vaccine may be less effective for some people like immuno-compromised or transplant patients. So we need to know if there will be an easy access to treatment if we need it now through the great question deedee and it's a really important practical one as you pointed out for people who may not respond with full protective immunity. Now they tend to be developing much less severe disease it even if they have so-called breakthrough infection but nonetheless. What's important to know. is that if that happens. The physicians in your area know that they have access to convalescent plasma. This plasma contains proteins. Antibodies from people who recovered from infection and we infuse those antibodies. There are anti viral drugs. Like remdesivir there. Monoclonal antibody drugs that are being developed right now. The ones that are available are by in fusion june. in fact there's a couple of companies merck is probably the closest to developing an oral pill. That could be taken. That's still in. Clinical trials not yet A routinely available. That's actually Somewhat the higher me is that these are under way so you have people who don't want to get the vaccine because it's under e you get infected who are then treated with something that's under e you way so i. I find that you know kind of paradoxical in a in a in a way so there are treatments. And i think that's a key point is that people shouldn't just assume well i've gotten infected. There's nothing i can do. If you are high risk another words you have medical problems that make you high risk or because of age are high risks than definitely. Go get tested if you have co bid. The treatment is better early in the course not waiting until it becomes obvious that you're really getting sick and are going to have to be admitted to the hospital or be on a ventilator. You wanna treat wade. Before that and our last listener question comes from expecting mom. She says ivan fully vaccinated and so has my husband. I wonder what recommendations you dr. Poland have for when baby arrives in terms of visitors especially those who chooses not to get vaccinated. She asks should. We allow visitors who are unvaccinated to visit. If so is having them wash their hands and be masked safe enough for baby agree question. We're going to be having our first grandchild so this is something that means a lot to me too. And so first of all congratulations to our listener. Who in expecting a blessing. The second thing is we're in the realm now of what's the safest safest and what is safe. The safest thing is that that baby is not within six feet of anybody who is unbalanced to naked and unmasked that represents to me and unnecessary risk. One doesn't need to undertake so when you have vaccinated people who are healthy and responded to the vaccine. I think when you're talking about numbers of the family. That's not an issue. They can go ahead and hug in love on that baby. That baby needs that actually for proper growth in development. That's a really important thing. But for people outside of the family particularly who were unvaccinated. I would say that represents an unnecessary risk and let about visitors who are vaccinated. Can they is okay for them to be with baby without a mask. I would probably still with a baby asks them to wear a mask. That may be a belt and suspenders approach. But this is a little baby and fortunately we have not had a lot of severe disease in babies. There has been some. I would point out that there has been a lot of hospitalization and death among babies in brazil for example. So you don't know which potential burien somebody could be carrying and expose that baby too. So i personally would be very reticent to have somebody you know hold an in the kind of proximity were talking about with holding a baby. Who was unboxing david wearing a mask helps but it's not the same thing as a mask end vaccinated if you're from outside the family. Great information dr politics or anything else that you'd like to add this week you know again just to encourage people. I know that some people have misperceptions about the vaccine. Let me just mention that. Ninety eight ninety nine plus percent of physicians win offered the vaccine. Get the vaccine. You're not being forced to. They're doing it because they are convinced of the safety and efficacy. So you would have to ask yourself. Do i know more. Do i have more data than what's published in the scientific literature. I'm not talking about anecdote. Well i heard something like this The only real safety signal that has been seen as the nfl axis which occurs at about the same rate with all beck scenes. It's true that people after the second dose frequently have low grade fever headache a variety of symptoms that are very temporary very transient. And believe me. That's nothing like the consequences of not getting the vaccine and getting infected with kobe. When you look right now in the us one out of every nine point eight americans have gotten infected so if you haven't been vaccinated what makes you think you're special and not going to get infected as a physician i wanna i wanna preserve your health and your well big. I would not be saying to you. Get vaccine if i didn't get it myself. And if i had not thoroughly looked at the safety and efficacy data in america one out of every five hundred fifty. Five americans is now dead of kobe. That is just a tragic number one just to make round numbers one out of every five hundred fifty. That's a. that's a stunning number. How many people have died from getting a covid vaccine. It's an easy decision and it's a decision. I would caution you not just for your own health but for the health of your family the health of the people that you work with or worship with or go to school with very quickly we're going to have vaccines available for twelve years old and up and we're studying it all the way down to birth ages just like we do other vaccine so just by way of encouragement. It's a safe vaccine. And it's a highly effective vaccine while said while our thanks to mayo clinic infectious disease and variety expert. Dr greg thanks as always for the great information dr poland closure. You will mayo clinic. Cuna is a production of the mayo clinic news network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to mayo clinic news network at mayo dot edu.

indian brazil america mayo clinic deedee steepen dr halina kazataka Dr greg poland cdc infectious disease influenza Tsa dede koby deedee merck ivan
COVID-19 variants and the evolving science

Mayo Clinic Q&A

26:15 min | 2 months ago

COVID-19 variants and the evolving science

"Coming up on mayo clinic. Qna the good news. Is that deaths in the us over the past week. Dudek kovin have dropped another thirty percent. The number of cases have dropped by another fifteen percent but as cova cases dropped the uk. Variant of the virus is spreading rapidly. What does this mean for the us population. What the data show on that. Thus far is nine encouraging. Many people feel that we're going to hit another surge in march with this very peak because it so much more transmissible. Welcome everyone to mayo clinic. Qna i'm dr helena's elka we're recording this podcast on february the twenty second. Twenty twenty one. It's time for our weekly update all things newsworthy about covid and while we know that vaccines have been rolled out under emergency use authorization left to do today. We're gonna talk a little bit about the clinical trials that are underway in groups that have not been studied before such as pregnant women and children with us again. Today dr greg poland infectious disease expert at mayo clinic. Welcome greg morning. Wonderful to see you again on monday morning. You i can report that. We're warming up here in minnesota. Greg sewer excited. We're going to be above thirty degrees today. Tastic a heatwave. Before we get started. Greg i just have to ask you. What is on your tight today. Well clo- listeners. Who those who view our podcasts have asked about this sometimes. This is influenza and i wore it because One of the really interesting things that has happened by mask. Wearing an distancing is we have had essentially no influenza this year influenza less transmissible than than copay but masking in distancing have worked beautifully for that disease as it does for corona virus in memory of that. Well i'm glad that you brought us some good news about influenza today and i just i was so stuck on where does one find all these virus ties like who makes virus ties. It's really interesting. I guess there's something for everyone. There is know we'd nerd out in science. That's that's right greg. Tell us a little bit about the numbers. A surrounding covid nineteen right now. Yeah well you know like everything here. There's there's good news and bad news. The bad news is We're almost at twenty nine million cases and we have crossed five hundred thousand deaths so that means about one out of almost every eleven americans has gotten Infected in one out of about six hundred forty americans has died. That's that's the bad news. The good news. Is i think that amount and i don't know a word for it. Other than devastation gotten through to the american public because they are wearing masks they are distancing you still see exceptions which are really unfortunate but because so many americans are doing that. The good news is that deaths in the us over the past week. Duda cogan have dropped another thirty percent. The number of cases have dropped by another fifteen percent even compared to last week so this is very very good news. We worry a little bit about. Is this lol between a fourth wave with these variant viruses. But that's another topic. Well that is some good news greg. It sounds like people might be listening to your hands face in space jam. And you know we've gotten about forty million americans now have gotten at least one dose of that scene. that's wonderful. another thing that will help is if we can get more groups vaccinated at the top. I had stated that we're going to talk a little bit about other groups being studied such as pregnant women and children. Can you give us an update. Ya Both moderna and pfizer have committed to doing studies in pregnant women. They're going to enroll between two thousand and three thousand women primarily in their second and third trimesters and then follow post delivery. Follow those children and mothers for six months after delivery. So that'll be. It'll be nice to have a a richer data set. That can really make all of us feel very comfortable with what we've observed so far which is no risk associated with that in fact great benefit when you realize that Pregnant women have about a three to five fold increase risk of hospitalization about a three to five percent. Increase risk of death in icu. Admission due to do to kobe pregnant. Women i talked about so the benefits are clear and large. The risks have been unidentifiable so far but the more you collect data the better and better you feel about that. Yeah that is good. I'm glad you gave us that update because it has been a concern of multiple of our listeners. Who are either pregnant or anticipating pregnancy. And so it's good to hear those in the same thing is true halina for children. A pfizer is now doing. The study downed age twelve. So they'll do twelve to sixteen. See what kind of dough stay need. And what kind of protection they get. It won't require the same numbers that it took an adult's because now what we're looking for is safety and immunogenetics city That will bridge to efficacy. And then they'll march it down to lower and lower age groups so those data will probably be available this late spring summer so by fall time. I think we're going to. We have a good chance of being able to immunize school kids. Oh that would be wonderful. Thank you ve given us a little update about where we are with vaccinating americans which no doubt in this. Last week has been hampered by the incredible weather that has been experienced over much of the united states. But can you tell us what's going on with vaccination rates in the rest of the world. You know it's really quite variable. You look at some countries like bahrain. Israel the ua e the uk. They've done better and delivering vaccines. However we are very rapidly catching up the goal was a million doses a day. We are far beyond that we heard about one and a half million plus doses per day heading toward two million so that repeatedly is starting to strain the supply but this friday in fact Johnson and johnson their partner company johnson will be presenting to the fda there one dose coded vaccine and they've got several million doses in storage. So that will roll out. I think very quickly next week a greg. You just mentioned the one dose johnson and johnson vaccine but there is some indication that one dose of the other vaccines that are intended to be two doses. Might also be efficacious. Should our listeners continue pursuing and getting their second dose of vaccine until we learn more and you know Helene and one of the things that that you and i committed to. And i think we've been very faithful to is that we're going to go exactly by the data and be transparent in every way with the data as we understand it so what the data says is that you are best protected with two doses. A minimum of three or four weeks apart depending on whether you get pfizer dern. Now what's happening is people are looking at antibody levels and and Protection after one dose. This has been primarily in israel and what they found. Is that after one dose. There's a reduction in symptomatic kobe. After twenty eight days of about seventy five percent if you look at all symptomatic so not just all kobe but just symptomatic disease. That's about eighty five percent protection. So that's good data suggesting that we could at least start to think about Increasing the intervals between doses which in effect expands the relatives supply. Questions come up. Might one dose alone be sufficient. Might one dose in people who previously had coverted be sufficient and the early data are suggestive of that but the data are not yet completed. So i would certainly not recommend to somebody. Get your first dosen. Don't worry about the second dose. We do not have that level of confidence in the data yet. To say that. Greg could you tell us also a little bit about the cdc guidance regarding quarantine for those who have been vaccinated so what they said. Is that for people who have been vaccinated. So they've completed now. They've completed their backs donation series. Once they are seven to ten days past that ten days actually passed that if they happen to be exposed. They don't need to go into quarantine if they have no symptoms and for that three months after the ten days after their second dose. I know that's a little complicated. Functionally says is that ten days after your second dose if you get exposed in have no symptoms. You don't have to quarantine in the next ten weeks okay. So it's twelve weeks total but you got ten fourteen days after your second dose before that kick sent it takes that long to be certain that you have full immunity right and that's based on data. That doesn't say there's no chance you can't transmit it. It's based on data saying the practical reality. Is that the chance you would transmit it with no symptoms and two is very very low and therefore acceptable. Do you think that that ninety days will be extended at some point. Or what do we know about how long this vaccine lasts. I do and and actually thank you for bringing that up because I get calls in emails saying well. You know the data change does that mean that scientists don't know what they're talking about and let me just encourage listeners that that's not what it needs as we gain more experience than collect data. We've got really good data in the first three months. Were headed toward having really good data after vaccination for four to six months and that will march out and as we learn new science. We use that science to modify our recommendations and so it's not that scientists are flip flopping. It's that new. Data allows you to begin to expand those recommendations. Greg said one. Other thing that i wanted to ask you to clarify. You're talking just a moment ago about those have been vaccinated and transmission. Can you tell me what the current thinking or understanding is now regarding whether the vaccines help decrease transmission Or severity of illness or both. What the data show and these are really pretty good data after you have gotten your vaccines theories. The reduction in risk of you. Ace symptomatically transmitting to somebody. Else is on the order of sixty to seventy plus percent while it's really pretty good at that given that these vaccines are not vaccines that produce. What's called sterilizing immunity in other words. That for sure. Now greg that. I think we are. I think we're clear on the data with that but even with a symptomatic transmission that is suppressed by about sixty to seventy percent which is really good. It's also an argument. I can see your mind jumping to it. It's also the argument for why we have to widely vaccinate because sixty to seventy percent reduction as symptomatic. Transmission is not a hundred percent. So how do you so to speak make up for that and decrease number of cases by all of us getting immunized and reaching herd immunity. Greg i know that there had been Talk about the johnson and johnson vaccine in particular decreasing the severity of the disease. If it's a contracted but we understand that all of the vaccines have a similar effect. Does that we believe that will be true. So it hasn't been strictly studied in all of them. It's been studied pretty well in the astra zeneca vaccine and it's been studied well in the amarnath vaccines. We don't know yet. About the johnson and johnson down until those are published while no discussion about at cova. Nineteen would be complete without a discussion about what we know about variants this week. This has been the big We're something new is always popping up and this is definitely out there. Can you share with us. What we know right now. Well you know in the us so for the vast majority of our listeners. The concern is the so-called uk variant the be one one seven and what the data show on that thus. Far is not encouraging. It's in the numbers vary because it depends on where you're looking but let's take you data where this were. They were devastated by this burian and collected a lot of data. It was between a. Thirty and seventy percent more deadly if somebody this variant it was about a sixty percent increase risk of hospitalization and about a forty percent. Increase risk of icu. Admission if they gotta so. This is a bad actor and the best evidence suggests that sometime while already in the us this variant and the number of cases is doubling about every ten days. Wow so i'm gonna use this as a moment to encourage people despite all of us me too. I'm fatigued of co bid precautions in requirements. I wanna be able to hug my son and daughter-in-law but until they're immunized even though i've been immunized i don't wanna take that risk so it's doubling every ten days and many people feel that we're going to hit another surge in march with this variant peak 'cause so much more transmissible and yet to hear various states loosening precautions we've seen large sporting events Those are all things that make control of this virus. More difficult particularly in the face of these highly transmissible variants. Now the good news. Is that people who get their vaccines. Even though there's a reduction in what's called neutralizing activity in other words we unites you. Take your blood and put it in a test tube with the virus it neutralizes it at is. Kills it if you will. But the the there's a reduction in that neutralizing ability none the less these aunt. These vaccines raise such high levels of antibody that it appears immunized people will be protected against the uk variant pregnant. When you're trying to test this to see whether the Variants are susceptible to the vaccines. Do it actually in a lab in test tubes or is it more observational and people who've had vaccines both are done. So so the in the first. Study like i say. We take blood from immunized people and we mix it with the virus and say okay normally this. This will neutralize one hundred percent of that now with this variants. We say there's about a sixfold reduction in the neutralizing ability but then we do the observational. Study that you just mentioned in otherwise healthy. People who were immunized protected now. The johnson johnson and novak's vaccine's when they tested those against the south african variant an actual clinical study. They only protected about forty sixty percent of the time. Though those cases were more mild than people who were not vaccinated for that reason many of the manufacturers as a precaution are getting ready to study a booster dose against those new variants. So that's news to come so from what we understand greg all of the vaccines have efficacy against covid. Nineteen that we are aware of and so individuals should embrace getting the vaccine that they're offered absolutely. I mean those data and let me say it is clearly as i. Can those data show safety in fact I think we talked some last week about. Cdc releasing data on the first month of the rollout identifying no safety concerns other than the known risks cavanna full axis in a very small number of people and high very high efficacy with these two. Am our neighbor axiom so you know this is better than as a vaccine knowledge est. We could have hoped for to have a vaccine. First generation vaccine be this effective and have so little risk associated with it is almost nothing short of a miracle. That is good news. No i i have a one question from my own practice for you before we close today when i'm not here with you. I'm often seeing patients in our pain clinic here in rochester or i am doing interventional procedures for patients. Often those involve injections that have corticosteroid in them so joint injections or epidurals steroid injections etc Is currently known about whether individuals should avoid. Having epidurals steroid injections or steroid based joint injections et cetera related to their covert vaccine. Very good and very practical question fact. I worked with our orthopedics department. Because that's such a common question. So i'm going to give the strict data and then the practical implication of it. The strict data are win. You exceed a dose the equivalent of forty milligrams of oral prednisone so if an injectable doses more than that. You can see a slight decrease in antibody response. So what do we do with that. In terms of practicality the ideal thing would be to not get that injection in the thirty two fifteen days before or after your injection so that there's no chance of any suppression. That's not practical for some of our patients. As you. And i know and for those patients i would say you know what we're giving two doses as long as you're not getting that with both doses. I would proceed ahead because you're also talking about a quality of life issue here. There are some patients that simply cannot wait a month. And i think they should go ahead and be injected recognizing that we're going to give a second dose of vaccine where they will not have been injected so i think it's overall a safe thing to do in general were giving injectable doses of steroids that are within the boundaries. Where we say it's acceptable to receive vaccines and as a point of clarity. Greg there is quite a difference between taking steroids orally and having an injected into a localized area. My colleagues and i number of years ago actually did some studies with epidurals steroid injections to see how much Steroid absorbed into the bloodstream. Overtime after those injections were performed it was relatively minor And so is there a difference for people who have to take oral steroids regarding the covid vaccines will. I know. i just learned something today. Thank you for that but yes you're exactly right. You know you think about what we're in general doing we're injecting a knee holder hand those are generally low doses as you say they tend to be confined to that joint space. There action is at that joint space. So you're not getting anywhere near that amount of steroid in the bloodstream where it could affect the immune response and that's why say you know. There's the strict data. And then there's the practicality and the practicality would tell me that i just wouldn't overly worry about that particularly in the setting where we're giving two doses of vaccine any comments about those who have to take their Steroids orally well can't be avoided if they're on them and if we're if you're taking twenty milligrams of oral prednisone zone for fourteen days or more or taking a dose of forty milligrams of prednisone. That's when we begin to worry. Non talking about orally that you have enough systemic suppression of the immune response that that might be important again. We have patients where it's not practical to reduce below that dose. And if we think that's not going to change in the near future. I would go ahead and immunize them because maybe instead of ninety five percent protection you're talking about ninety or eighty five well in the face of this pandemic so what gets your vaccine. Well just let me say greg that it is music to my ears when you say that you learn something from you today you know a famous broadcaster told me that one anything else you'd like to share before we close today you know a again. Just take every opportunity. I can to encourage our listeners. They're doing the right things. You and i have gotten really really encouraging email and notes from our listeners. Thank you for that. S thank river molina and i. This has been a long haul of working more hours than we would have ever expected to do. What we always do it mayo. It's your needs your the patients your needs. Come first and so. We're willing to work as hard as it takes to be able to deliver this information. So thank you for the encouragement and Just encourage you to continue to send in questions. We want to help you understand. What can be confusing data out there. I spent my full time on this. And i'm more than willing to help people. It's a wonderful thank you. I echo what greg said. Thank you all for listening and for sending your comments and questions. Thanks to you too greg until next week you. This is all of us together. Our thanks to the vaccine and infectious disease expert. Dr greg poland for being here with us today to talk all things cove in nineteen. Thank you to you to for listening in today. I hope that you learned something. I know that i did. We wish all you a wonderful day mayo clinic. Qna is a production of the male clinic news network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to mayo clinic news network at mayo dot edu.

greg influenza johnson mayo clinic Greg Dudek kovin dr helena dr greg poland Greg sewer Duda cogan united states halina pfizer uk pfizer dern
Tackling the latest COVID-19 topics

Mayo Clinic Q&A

36:11 min | 3 months ago

Tackling the latest COVID-19 topics

"Coming up on mayoclinic. Qna the advocacy. The protection against disease is extraordinarily high. It's ninety five percent against symptomatic. Cova we can see the light at the end of the tunnel. It really does work. But as more americans received the copen nineteen vaccine will it still be effective against the new variants entering the us even in the face of these variants the vaccines have been extraordinarily effective against the more severe spectrum of disease. Welcome everyone to mayoclinic q. And a. i'm dr helene gazelle. It is monday february. Fifteenth twenty twenty one and while the logistics are still a significant challenge. The vaccine roll out in the united states is really picking up speed. The cdc estimated yesterday that thirty eight million americans have had at least one dose of vaccine and over. Fourteen million americans are fully vaccinated so that some progress here to talk about this. Today is one of our favorite experts. Dr greg poland from the mayo clinic. Hi greg morning helene. I'm pretty sure you wearing red. Because i forgot to send my co host of valentine's day greeting great on might be wearing my read because you forgot to me a valentine this year. I hope you remember to give your wife. Valentine however but i noticed today that you have a great tie on that really applies to your field of science. It's which you leave it to another physician to have sharp is like that. This is the tie of all different kinds of resources. And i sort of wore it in in celebration of the fact that we are actually getting a handle on this virus in the united states. So i think that officially classifies us nerds greg virus tie and recognizing. That's awesome good to see you today. Greg new are you. Are you staying warm well. It is really frigid in minnesota. It's almost twenty below zero and so and no hope in sight for the next couple of days after that in that weather is important because that's affecting so many of us across a broad path of the us and when we're in cold weather and enclosed that's a risk mission of kovin so we really have to be a redouble our efforts which are working. I mean we've got good news to share while. Tell us some good news greg. I mean we are down son. As of sunday we had sixty four thousand new cases. Now i mean that's still a lot but remember. We were peaking at three hundred thousand new cases a day getting up to three thousand deaths. Today we're right at about a thousand deaths so people are getting it. And i think in the in the face of what we've seen. They are masking. They are distancing and it's working as well as getting so many vaccines out there. Let's just be careful to maintain that during the cold time when we're indoors that's a great reminder but it is good to hear some good news today greg. We're talking about vaccine roll out at the beginning. So let me just ask you. Do you think greg All americans are going to have a chance to get vaccinated by spring or summer. I think that is definitely true for adults above the age of sixteen to eighteen years old. So i do think that is a A reality not just hope. I think that is a reality. What i'm hoping is that before school starts in the fall will have data so that older kids at least will also have an opportunity to get the vaccine so that one still depends on studies that have been actually enrolled now and data has to be analyzed. And i think that will happen to. That's great last week greg. We shared our email address here at abc male clinic. Cnn the news network. And we've had some questions one of the most common questions that we're receiving is questions about. What is a normal reaction to the vaccine. How do i know if my reaction is normal. And how do i know what to do about it. you know. this is a really good question. I get lots of these questions from my patients so let me just say this. The vaccines are reacted. Genyk what that means is that they are inducing. A high level of antibody response. And that's a good thing but if you will sort of the price to pay for such a good immune response is that we get local and systemic side effects. those can be small rashes. The arm they can be fevers fatigue. Headache muscle and joint aches by the second dose. You're talking about sixty to eighty percent of adults experienced some level of that. I had pretty moderate symptoms after my second dose of vaccine but there are self limited they last usually under twenty four to thirty six hours. I took one dose of tylenol to control low grade fever and the next day it was back to normal so I don't want people to think that fever. Having any of the sort of symptoms that i mentioned means that anything's going wrong. It doesn't it means. Your body is developing a very vigorous response to that spike protein. That you're being given and intern. That will protect you. And that's why we see such extraordinarily high efficacy of these vaccines greg. I had absolutely no response to either. No reaction except maybe a little bit of a sore arm with the second one Does that mean anything. In terms of my immune response and have you noticed a trend toward higher reactivity or side effects in younger individuals. Or is that just kind of myth. That's out oh you're you're right halina that that is true that was seen in the in the face. Three clinical trials Adults over the age of sixty sixty five ten to have less in the way of those side effects compared to younger people while day. Five yet guy. No you're not. They're definitely not. Let me just say that publicly. I'm in regards to the question of whether the severity of side effects In any way predict your measured antibody amount. We don't have any data to say that so in other words the fact that you had minimal symptoms than i had. Moderate symptoms doesn't mean that you didn't respond with equally as protective antibody levels. How do you know the difference between what is an immune response which is what we want. And what is an allergic response. That's really key and anybody going to get a vaccine. Anybody giving vaccine should at least have a basic knowledge of that. An allergic response. Almost always has skin manifestations and associated symptoms like swelling of a lip swelling of your throat. So that there's difficulty breathing a drop in blood pressure. Those would be the sorts of things that we would be. Concerned are indicating an allergic reaction. Now there's dangerous allergic reactions non-dangerous a rash at the site a little bit of itching. That's not a contra indication to getting a second dose difficulty breathing on the other hand. True anifa lactic. Reaction is an absolute contra indication to getting another dose of the vaccine so we do want to distinguish those and those are distinguished intern from the things. I've mentioned a sore arm a swollen arm a minor rash at the injection site headache. Fever shaking chills. I had i had a few hours of shaking chills. That is not evidence of anything going wrong and for reasons. We don't quite understand. Those side effects can be different in different people. My body just reacts differently than than yours did. But it doesn't mean that one is more or less protected than the other. So greg speaking of reactions if you will just clarify for us. It has been noted. And you've commented on this yourself that the second dose of vaccine often promotes more of a reaction or side effect afterward. Are we getting something different in the second dose. Or why do we react differently. You're getting the exact same vaccine in fact right now. The recommendation is to not interchange vaccines. I tried to think of an analogy for when you give the first dose of vaccine as it's as if you've started that cold car the car's now idling you give that second dose. The cars warmed up. And you can put the pedal to the metal and go you know sixty miles per hour in in just a few seconds which you wouldn't have been able to do without. That car started in an idol. So again it is not an indication of anything going wrong. It's an indication that your body nap out. Recognizes is revved up prepared to do battle against what it thinks is a foreign invader this spike protein. When it sees that protein your body is now trained to think. Oh it's the whole virus it's dangerous and it starts releasing chemicals that tell other immune cells. Come over here to this arm do battle here and those are what the side effects are that we experience. They're not dangerous. They're not something that persists they go away generally with minimal or no treatment. Greg how do you explain. Those of us like myself. Who didn't have a response like that so you did have a response. What you didn't have is the same level of Immune response and i'm getting down into the weeds a little bit but each of our bodies releases different amounts of chemicals. What my body did is released more than what it needed. What your body did halina match what you needed to the vaccine. So you're justice protected. The data showed that you just didn't suffer those those side effects so you know some of us. The car gets revved up higher than it needs to be Dangerous and others of us it gets revved up to just the right amount what we have actually called the goldilocks phenomena. Not too much not too little. Just right right. that's great greg. I just needed that. Reassurance that i was ok refine greg leave a listener. Who would like to know if they did have a mild reaction in their arms such as maybe a little rash or soreness or something like that. Does it matter if you have the second vaccine in the same armor. Should you switch arms really. Shouldn't matter which arm you get it now. Many people do switch arms because they're depending on which vaccine you get three to four weeks apart and they don't want to have a sore arm in the arm. That was just sore two or three weeks ago. So there's no problem with doing that. But nor is there any data that would tell us. One is better than the other i would say. That may be something to think about. Is that with your second dose. Maybe you want to get it in your non dominant arm because you're likely to have more soreness or local reactivity with the second dose so you'd like to have your dominant armed free to do your activities of daily living greg. We've had many many questions about this. About having antibody tests after having a vaccine are antibody tests needed after a vaccine When would you need to do them. What are the current recommendations. What are your thoughts about that young. Good good practical question Halina there really is no Regular or standard indication to to do antibody testing that represents an additional demand on the healthcare system. At a time when we're deploying people to try to give vaccines and try to do just regular contact testing it's cetera. So there's no need to do any sort of antibody testing there might be rare exceptions to that for example you can think of a situation may be were. Somebody had gotten an organ transplant and Could not avoid going into. Perhaps some sort of risky situation may be something unusual like that but under normal circumstances there is no need. Now why would i say that. Because when you look at the clinical trials and they enrolled a wide diversity of age race gender co morbidity etc the efficacy. The protection against disease is extraordinarily high. It's ninety five percent against symptomatic cova essentially one hundred percent against hospitalization death so the cost and the effort is just not justified at the current time. There's no recommendation to do that. So i have a follow up question on that. I think i mentioned at least a month ago. That i was involved in this Vitamin study here at mayo clinic zinc specifically and whether that would the people who took zinc would have less opportunity. You're or converter. Have antibodies to covid or developed. A the illness now. I had been told originally that once. I got both vaccines. I would need to be de enrolled from the study. Because i would have formed. Antibodies but must be different types of antibodies. That you can test for. Because i've been told that no it would be a different antibody that you would have after having a vaccine then what they test for. So how would anyone know what antibodies to ask for anyway. Yeah you're very right in. That can be a little bit confusing. So the to 'em are a vaccine her under eu way. The third one. Johnson and johnson which will probably come toward the end of the month. All three of those vaccines are only giving one portion of the virus called the s or spike protein when you're infected with the actual wild virus yes you would have s antibody but also antibodies against the other parts of the virus for example the nuclear caps at the end protein. And that's what standardly tested so n protein antibody indicates you've been infected s antibody alone means either. You were infected in the past or got maxine. Okay so if you if someone had wanted to antibody to show that they were That they had received vaccine. They wouldn't want the same antibody drawn necessarily than you would to test exactly right. We will do s antibody whereas if we were concerned that you've gotten infected we would measure in antibody interesting. We always learn so much greg greg. I'm wondering if you can talk a little bit about the variant source strains their specific questions about the south african Variant and what we know about that in particularly as it relates to the vaccines that are being used now. This is an area of ongoing research and investigation. What we have now are vaccines from astra zeneca johnson and johnson. Novak's were there were trials in countries where we could look at the brazilian so-called brazilian variant the so-called uk The so called south african variant. And what we can say is that they are less effective not by very much but a little bit less effective in preventing mild in even up to moderate infection. They remain very effective in preventing severe infection and again close to a hundred percent in preventing hospitalization and death even do those variants now. We need to gather more and more information. And as you've pointed out before halina this is a moving target right. There are going to continue to mutate. Even the variants that we have may well have additional variations on that theme. So it's something we're going to have to continue to watch in preparation for that. We don't know if it will be needed but in preparation for that. A number of manufacturers are making a booster vaccine against particularly the south african variant or in the case of johnson johnson looking at what would two doses do as opposed to just one dose. But again you know. The the variants are a reason to be as strict as we can. About proper masking in distancing. But i really want to reassure our listeners in viewers even in the face of these variants the vaccines have been extraordinarily effective against the more severe spectrum of disease. That doesn't mean you couldn't have moderate or even mild or even transmit to somebody else if you've got infected but you're not going to end up in the hospital and you're not gonna die this weekend Greg we're visiting with my husband son and his wife and she had a question and multiple of our listeners have had if a woman becomes pregnant okay for her to receive a vaccine which vaccine and how about breastfeeding mothers as well so the latter one is easy no contra indication whatsoever in breastfeeding the the only likelihood that could happen is that antibody would get into the breast milk and protect the baby so not worried at all zero concern about breastfeeding now pregnancy. So some of the manufacturers are now doing a clinical trial in they're enrolling about two thousand pregnant women. We don't have those results yet. What we do have is in the phase three clinical trials. There were a number of women who were pregnant and didn't know it at the time that they were immunized. We have not seen any increased risk of spontaneous miscarriage or premature delivery. Or anything like that. what we don't know because the numbers are small is are there any other side effects. Well you have to balance that so the answer is no. We have not yet seen anything adverse happening in a pregnant woman with vaccines. You have to balance that against not getting a vaccine so some data just came out If you look at women of the same age and you look at non pregnant women versus pregnant women. Those women had a risk of about two point. Eight percent of getting hospitalized from cova in the pregnant women it was about ten percent so about three and a half old higher. In addition the risk of death in a pregnant woman was about thirteen point. Five fold higher in pregnant women. That got cova. So you know. We're balancing that against some data indicating safety with the vaccine in pregnant women but not as much as we would to have so what to do. I really think that this is one of those places where the tilt toward getting the vaccine given the data that i just shared with you but my personal practice and what. I'm doing a lot of because as you might imagine. I get a lot of calls and emails about it is to talk to the woman in find out what they're doing if it's an er nurse. Did the vaccine right. You're at high risk. You're a schoolteacher. Whatever whatever that might be if you're somebody that says you know what my husband. And i are working from home. We don't go out in public. We mask were really strict about it. I would say you know. I'd probably than think about getting the vaccine. The iot in my second trimester because that risk goes up the higher the trimester that you are at in terms of getting covert in having complicated disease so again my my own Impression of the vaccine is that it is safe during pregnancy. We have not seen a single indicator of anything that would indicate alarm or risk. There's more to learn right. I'd like to have data on twenty thousand pregnant women. But i don't have that so i am in the situation of some data about the risk of vaccine and a lot more data about the risk of disease and so we have to operate together me and my patient discussing it and figuring out what is best for her and her family and greg. I'm not sure how much this weighs into the consideration of the complexity severity of the disease in women. But i had read somewhere that the risk of long hauler syndrome or having long term fatigue and other complications of covid might be higher in women. You know that does seem to be true. That is the impression we don't yet have good data for that. But i share that impression. We have seen that with other kind of long-haul symptoms chronic fatigue syndrome. A post lime and other infections. I think that's real. I think it has to do with the difference by gender in immune systems. We've talked a little bit about this in the past women generally have much better immune responses to vaccines than men. Do but the other side of that coin is that they have a much higher incidence of autoimmune diseases not due to the vaccine but just auto immune diseases in general and so there. There appears to be something that might put them at slightly greater risk for those long so-called long-haul symptoms but a lot to be learned there yet. I think the main thing is that it is incumbent on us as medical professionals to not only take those symptoms seriously but to begin to do the research in understand. What are the best treatments to help. People recover from those symptoms. That's a great answer greg. One of the little challenges that we had that we ask you to help us interpret at times as all of the changing cdc guidelines obviously the guidance has to change as we learn more about the virus and its complexities There is now a recommendation that fully vaccinated people wouldn't need to quarantine. Can you tell me in what situation that would be applied. And i wanna say this clearly because there's an important nuance here. That the media kind of mrs when they say vaccinated people don't have to be warranting. Here's the recommendation two weeks after your second dose if you're exposed you don't need to be quarantined in less. You developed symptoms for the next ten weeks after twelve weeks twelve weeks after your second dose you'd have to quarantine if you get exposed so it's a brief kind of hen week time period two weeks after the second dose up to twelve weeks after the second dose. Leaving ten weeks in there that you wouldn't have to quarantine if you got exposed and had no symptoms. And why is that. Greg is that because we don't know how long the protection less resign slee. So it's it's a. It's a careful measure designed to kind of open the door for a little bit of flexibility but to go slow and phased in will march that time period out longer and longer as we have more and more data particularly in the face of these variants. These variants are changing. What we knew when we were dealing with these variants so it's a very fluid situation remains that way doesn't it sure does challenge. Here's another one for you. There's been such debate about what should be done with children and schools and i think every state is facing this has now been a year. That's some kids have not been able to be in classrooms and i know it's concerning to educators and parents alike. What are the current recommendations from the cdc and practically a regarding a school. This is a really tough one. Boy do i. My heart goes out to those parents with young kids. Where where they don't know what to do. I think the data are pretty clear that particularly the younger children do in a classroom setting. Or i should say a structured looking environment kids who are at risk do better when they're in school older kids high school. Maybe even junior high. You have a little more flexibility there so what. Cdc is trying to do is sort of thread that needle in in an appropriate way. I think to say that there are phases and mitigation measures. That can be taken. And what they're saying is that if there's low levels of community transmission and if there is strict adherence to proper mass worn properly and distancing and appropriate context surface cleaning and the availability of testing and contact tracing. So that's a lot of hip salata If you do all of those you might then consider particularly getting the elementary school. Kids back in school because they do seem to have less in the way of disease. Less risk of transmitting. Then as you get up into the high school years Kind marching it out that way now having said all that the one remaining boogeyman in all of this is those are data done in the face of the original strain that circulated when not if unfortunately but when we have widespread circulation of the south african and other strains in there are a number of them are rising in the us. Those data could change based on the higher transmissibility of those variance and also increased balaji of those variants. But at least we've got some science to help guide us and begin to do this in communities that can meet those provisos in. It is awfully hard to teach math over over zoom camera. I saw my heart goes out to those parents and educators as well. It's funny you say that math and me as a young boy would not. We're not a good combination. And i would not have learned as well as i did in a classroom setting. I just remember my struggles with algebra with my younger daughter and high. I don't envy the parents who are who are trying to do that right now. So greg we've talked so much about preventative vaccines etc and i'm wondering about therapeutics. Now we haven't talked in a while about what we are treating covert with When people contract it so what. What's out there now. What's the new cocktail new cocktail of the leviathan mab and at a seven map. These are two monoclonal antibodies. So these are. Antibodies designed to attack that receptor binding domain of that s protein preventing it the the virus from docking with or joining with the receptor. That's on ourselves. The net effect of that is virus can enter ourselves can't cause infection. These are very encouraging data. It was very effective in preventing progression from mild disease or even moderate disease to severe disease. The problem is it requires. Iv infusion and there are some other provisos around age twelve and older least forty kilograms. But it's really meant. And i. And i like the strategy here. It's if you will of a rescue kind of therapy. What i mean by that is after exposure with mild to moderate disease if you are not yet hospitalized not on oxygen but at high risk of progressing to that we now have an option and a good option in terms of doing that. Now i mentioned that because monoclonal have not been well used in the us in many of us. Think that the use of monoclonal the use of high tighter convalescent. Plasma are therapeutic options. That are underused in should be used. So gregory you said for high risk but not necessarily so ill. Oxygen is this an outpatient therapy primarily. It's designed to be infused As an outpatient these are these are did monoclonal. Antibodies are something that we would be very careful about in in a hospitalized patient or somebody already on oxygen and the reason for that is. We don't have any data of their benefit once the horses so to out of the bar. It's really in that early stage that we want that. They're found to be the most effective fed to try to keep people from progressing or from needing hospitalized. Jackley exactly that's great anything else you'd like to share with us today greg Let's see when. I was just thinking when you were saying that about Vaccines that's that's a little over. Eleven percent of the american population is already gotten vaccine. And i guess you know. I'm just i'm really encouraged. To tell you the truth. I now see when i have to go out. I see everybody in a mask now. Sometimes they're not using it appropriately and we should mention that. Cdc has come out with a recommendation that you either wear a surgical mask tightly. Or you put a cloth mask on top of that in essence what is called double masking. That was found to be over ninety six percent effective in preventing transmission. That's slightly better than vaccines. So this is highly effective and encouraged about. Is you know we can see the light at the end of the tunnel unless this virus It comes up with something. we're not expecting. it really does work. We have solid data. If you wear a proper mask properly if you maintain distancing if you get vaccines we're going to get back to normal. That's wonderful. And i have to say greg that when i go out and see people in masks i am continuously amazed by noses covered gaps. It's like they're wearing a mask but not really wearing a mask. I know at mayo that we have determined that. We are all wearing masks because we're wearing surgical masks tightly fitted to our faces long so it truly makes a difference. I think how you wear the mask for. I see the same thing. The other thing i see in you know. I'm always very humble. When i approached somebody about it but i'll see the blue surgical mask one inside out with the whiteside out in the blue side. It's not meant to be worn. The blue site or the yellow side should be out. And it should be as you're pointing out tight fitting. There should not be gaps alongside the nose along cheek or under the chin and if you're particular mass doesn't fit you that way you may be able to nod it so that it fits tighter. Put a second mask over that to protect yourself and we've really seen the value you know i was thinking When we were talking about long haulers the best defense is to prevent getting infected in the first place. Now that's not always under our control right. Healthcare workers know when we walk into that room even with our protective gear. There's still some small chance but we take that risk on behalf of the public that we serve right. I mean our motto at mayo remains the needs of the patient. Come first and so we take those risks and what we're asking is that all of us take the same precautions all of us together and I just really encouraged. It's working or get into this across and it's working and lives are being saved. Well gregory love to hear you encouraged. Man's family space and that sonate right next to the nation. We should then goes next. Scenes are coming mean. We were doing well over a million doses a day in. Wow that's just wonderful. Thank you greg for some encouraging news today where we appreciate it. Our thanks to our weekly guests. Dr greg pool to save infectious disease expert. Biologists and vaccine expert at mayo clinic. I hope that you learned something today. I know that i did. We wish everyone a wonderful day and be encouraged mayoclinic. Cuna is a production of the mayo clinic news network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to mayo clinic news network at mayo dot edu.

greg halina dr helene gazelle Dr greg poland Greg Genyk fevers fatigue Headache muscle us Fever shaking chills cdc fever Halina cova mayo clinic zinc Cova greg greg
Special Mayo Clinic Q&A Episode: The latest on COVID-19

Mayo Clinic Radio

21:35 min | 1 year ago

Special Mayo Clinic Q&A Episode: The latest on COVID-19

"Coming up on Mayoclinic. Qna The cases that we're seeing now reflect what happened fourteen to thirty days ago news from the front lines of the Kovic nineteen outbreak. You're getting results back in about forty five to sixty minutes. Infectious disease expert. Dr Greg Poland shares his insight on social distancing. So we literally don't know but I think the safest answers to talk in terms of months not weeks new revelations about the virus. Once we don't see any cases we wait fourteen to thirty days question. What is Dr? Poland's best advice for you and your family at this point in the pandemic you need to be able to take care of you and your family in your home for a minimum of thirty days. Do the logical things take science into account as you look at your context and take seriously those things and do them. And you'll do well the answer next on Mayoclinic Qa. I'm Dr Tom Scheib. And I'm Tracy mccray joining us by phone for another covert nineteen pandemic. Update is Mayo Clinic Infectious Disease and vaccine expert. Dr Greg Poland actor Bolin. Good to talk to you again. You good to talk with you. We are recording this on Monday. March twenty third. Tell us what has changed over the weekend. A number of interesting developments. That have occurred one. Is that accompanied called Sefton? Had A emergency use authorization approval from the FDA for what can essentially be closer to a point of care asa it's still a molecular RTP. Cr SAY but you're getting results back in about forty five to sixty minutes. What's helpful about it is that this particular company has about five thousand of these machines deployed around the US. Now they can only do a small number per hour. But it's one more thing we can use to meet the demand for testing and those should be available mid week. I understand that's my understanding to the other things that are of interest Our number one a report out of China showing that as many as fifty five oh fifty percent of patients may present with diarrhea as opposed to classical respiratory symptoms. Now the key here is that this was only two hundred patients but importantly if they presented with gastrointestinal symptoms diarrhea. Abdominal pain vomiting. They had a worse prognosis. Another words presenting with Gi symptoms was a marker for increased severity of disease. And we thought for quite a while that diarrhea wasn't part of this wasn't a usual symptom. You're right not unusual symptom. Although in the initial reports coming out of China about three to as many as ten percent of patients were said to have diarrhea this is a little different cohort. They're looking at needs to be confirmed. Tatra Pollen this morning. I read something about folks having trouble smelling or tasting. What do you know about that? Well what we're hearing are anecdotal reports from particularly in Britain from their ent doctors. They're saying that they're seeing patients who've recovered from Cova nineteen being left with loss of the ability to smell or taste or at least diminish again. These are very early reports. They are a handful of pixels on an unfinished canvas. And we need to know more but it's probably true that we need to add three things to our symptom list diarrhea and loss of taste and smell correct correct although I think the latter two are probably late in the course of the disease not presenting symptoms the other. The other thing that has come up over the weekend and and we've talked a bit about it but Mit did a study looking at where we seeing the burden of cases. And they're noticing that it's in a band of countries where the temperature currently varies between thirty seven degrees and sixty three degrees and they're seeing slower spread in warmer climates. Now as they admit that difference between colder countries in warmer countries is at best modest. But could it be a hint toward the idea that as we get to summertime? Maybe this will dampen down. We have to stay tuned. We were hoping so we also heard over the weekend that hydroxy chloroquine or chloroquine and a ZIP through. Mizen what we know as her Max. Or Z pack that the use of these medications in treating patients with Kobe. Covert nineteen could be a game changer degree. I probably don't agree with that. And in this regard what what. Those statements are born on our son patients from France that appear to have gotten better concomitant with using that medication. And as we all know until you do clinical trials to you look in a more fashioned way. Are you really seeing natural history of disease in some people or are you actually seeing benefit from the medication having said that there are several large clinical trials now in progress to examine that question and the question of various currently licensed antivirals? Is there a rationale for using chloride one zinc and vitamin C to treat this disease? I don't I don't know of any mechanism for zinc and vitamin C. But with Plaque Miller hydroxy chloroquine the idea. There is that in the end zone of the cell. You're actually creating a more acidic environment. Which is adverse to the ability of the virus to propagate itself as of today in the United States about thirty five thousand cases and approximately are close to five hundred deaths. Is that about what you expected? Is that surprising? Is that less than you expected. I think it's about what we're expecting. Based on what we've learned in other countries you know when you look at it just on the seventeenth of March. We had forty five hundred cases. Today WE ARE OVER THIRTY THOUSAND CASES. This is doubling every couple of three days. And that's what we've seen in other countries too. That's why the plead from public health authorities. Shut things down now or we're going to see this continuing exponential increase in cases. So in your opinion. Are we doing enough? I don't think so I think As I've talked with colleagues around the US and my own observations are there appear to be some people who haven't gotten the memo yet Literally you're having to have Mayors and state governors make laws in order to get people to do the social distancing and to do the right thing so many people ask me because I get to talk to you. They WANNA know. How long is this going to go on? And will we know as lay people when we can see the number of active cases versus recovered cases? Start to change is that we haven't hit a baseline yet correct correct. And here's the thing that's really hard for people to to to to understand because they want to take what they see right now as predictive of the future and that is not true with this virus another words the cases that we're seeing now reflect what happened fourteen to thirty days ago. What we don't want to do is make the mistake that I believe. Japan is doing where they see a decrease in cases and say okay all clear kids back to school. That's not what we WANNA do. Once we don't see any cases we wait fourteen to thirty days to know that there are no more cases because you can tell at the same time but once we don't see any cases that is tied in with our testing and because we are so far behind in our testing. It's going to be hard to know when that is correct. Well that's right and so Casey Tracy what you had higher talking about is cases. So you're you're putting your finger on exactly the right thing. Cases are people sick enough to come to medical attention or be tested. What we don't know is that big base of the Pyramid of people who have little or no symptoms yet are in infected and can be infectious to others. You said you didn't think we were doing enough. What more should we be doing? I think that we need to shut down. All non essential activities. I understand that will be terribly disruptive economically personally mentally socially but we have no other tool with which to battle this virus. We do not have licensed antivirals we do not have vaccines and the issue as every major city and country is discovering is that the mortality rate skyrockets when there is a surge demand that the medical system cannot meet so by flattening that curve and spreading out infections. We can do what we do. Best which is give superb twenty-first-century medical care but you can't do it when the system is literally overrun. So I do WANNA be able to say to people that are asking me and I know if they're asking me they're asking you tenfold. How long will this go on? Can we say today? Our best guess is fill in the blank or is there no way to even say that that that is a prediction harder than predicting the weather and the reason for it is. We have exactly eleven weeks experience with this virus so we literally don't know but I think the safest answer is to talk in terms of months not weeks. This virus seems to be particularly stressful for people. I know there are multiple reasons for that Because we've never seen it before mostly and we don't know how long it's going to last Do you have some tips for controlling anxiety and stress because of the social distancing and this isolation? Yeah I think a couple of things first to frame it We are really the first generation that has not faced War Famine Pandemics. The way they they have in previous generations so this is new to us but I think the first thing is. Let's look to history. People have been through these things before they have pulled together. And that's a key switching from me to we and they have done well when they've done that. The other thing I think worth remembering is technology. We have technology connections well beyond imagination from previous generations. I actually think the youngest among us will whether this better than the rest of us they are and I'm simplifying of course but they're used to coming home from school for example and playing video games and doing so remotely with their friends. There's no disruption in that so I think those are our key things I think getting outside is really important. Interesting observation here. The streets are dark at night. There's no cars at ten. Ten thirty and people were out riding on the busiest roads in the middle of the road on their bicycles. Maintaining six to ten feet apart from each other. I thought that was glorious. Good for you I think getting outside into nature and creation turns out to be something really helpful in terms of your mindset and what I have noticed is that people are much more civil to each other. They say hello they nod their head. They stay a respectful distance away but want to talk and I think those are a really really good things to do. I'd like to talk about testing for a moment as of Monday. The twenty third. We have enough test kits or where we add in that quest. I think we are rapidly ramping up to have enough test kit. Some organizations that are really large producers of these are saying now going to be able to get out Ilyas a week. The question will be the personnel and the machinery to run these. What we really need. Tracy is what's called a point of care ask say that's rapid the same way we do with influenza. Now that helps us to understand the denominator but if people are otherwise well or have minimal symptoms whether they test positive or not in terms of their individual health doesn't matter because they're going to go home recover just fine from their infection where it helps is knowing something about community transmission and protecting those around you from the infection and that's why it's important so that's why the mass testing is so important. That's why having the tests available so important exactly and that should be this coming week. Yes that's what the indicators are all right we can never talk enough about prevention so remind us again who is at particular risk for this disease and the most important things we can do to prevent it. Yeah you know. I think to the list of things like smokers. People who are very obese who have cardiovascular lung disease and older people we need to add healthcare workers when you look at Italy for example Ten to twenty percent of their cases are healthcare workers. So these are very brave. People who in the face of a pandemic like this and without adequate personal protective equipment are still there in the battle trying to do their very best for patients so so one plea is healthcare of brothers and sisters in medicine and nursing. Take good care of yourself. How do you do that? One is using your personal protective equipment appropriately. I think when to the extent manpower allows when you dawn and off your protective equipment. You do it with a colleague watching you so you don't make a mistake. You go into the room with somebody so you don't make a mistake. I want to emphasize again. What is obvious and simple but has profound implications? There's nothing particularly exotic about this virus. You can not be infected if you don't breathe virus in touch contaminated surface and then touch your eyes nose or mouth so knowing that what do you have to do in your particular context to avoid breathing the virus in and to regularly sanitize your hands? So you don't infect yourself all right let's talk about some common misperceptions about this virus and the first one. I want to ask you about is the generation. That's the kids between eighteen and twenty five years old and the millennials aren't at risk. Yeah I I heard a terrible joke about this About you know kids coming home and living in the basement wondering how do they get to live on the upper floors and they're calling them boomer removers terrible but but I would caution them a couple of things? The first twenty five hundred cases that were hospitalized here in the United States forty percent of those patients were between the ages of twenty and fifty four intercom. You may have heard the case of Thirty four thirty two year old retired gold medal Olympic swimmer. Who says he has never experienced anything like this. It has whacked him so hard and I think people need to realize that they have the misperception that oh it'll be like a little cold for some of them. Yes they're right but they can also spread it to the people. They love to their neighbors to their friends. And so they need to take the same kind of precautions in terms of respiratory etiquette social distancing in hand washing as all of us need to are males and females equally affected. Well what we can say is that they are differentially affected in terms of severity. It has indeed been the case that in virtually every country. I'm aware of then have had more severe disease and have had mortality rates. Hyder than women. Some of that may relate to what we know is a positive genetic predisposition for women to survive infections. The other thing is men. Tend to engage in riskier behaviors behaviors including for example smoking which is a major risk factor for complicated disease. Here you know thanks for all the great information every time we talk to you and we always like to ask as we finish up. What is your best advice for people and their families at this point in time in the epidemic pay? I really think that what people have to do is seriously. Assess their context. If you have a immuno-compromised child or other family member you have to take precautions. That are much more restrictive. If you will then say in in my family so I think you cannot be strict enough about social distancing hand washing and respiratory advocate and. I think the other thing is ever since nine eleven the CDC has told America because of natural disasters pandemics. Whatever it would be you need to be able to take care of you and your family in your home for a minimum of thirty days. Now that's not to be panicked. It's to say be prepared. Do the logical things take take science into account as you look at your context and take seriously those things and do them. And you'll do. Well do we know if we Have been infected and recover. Are you immune immunity level there? Have we found out that information? That's a really good question you guys. And here's what we can say with the seasonal corona viruses that regularly circulate that immunity less in terms of months to a year or two. Will that be true with this again? We only have eleven weeks experience but the concern is based on what we know about Corona viruses so these are human Beta corona viruses. Immunity seems to not be long lipped. Will that turn out to be true with this virus? Could you get infected again? If it's say circulates again next year just don't know yet. We'll have a vaccine by Dan. Won't we doctor? I'm I'm hoping but you know Think of another health emergency bull that took six years Dr Greg Poland Infectious Disease Specialist vaccine expert from the Mayo Clinic. Thanks so much again for being with us on pleasure. Mayo Clinic Q. And A. is a production of Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts to see list of all. Mayoclinic. Qna podcasts visit News Network Dot Mayoclinic Dot Org then glick podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

United States diarrhea Dr Greg Poland Mayo Clinic chloroquine Casey Tracy Mayo Clinic News Network Mayoclinic Tracy mccray Dr Tom Scheib China Poland FDA Mayo Clinic gold medal Abdominal pain Cova Britain
The latest on COVID-19

Mayo Clinic Q&A

21:35 min | 1 year ago

The latest on COVID-19

"Coming up on Mayoclinic. Qna The cases that we're seeing now reflect what happened fourteen to thirty days ago news from the front lines of the Kovic nineteen outbreak. You're getting results back in about forty five to sixty minutes. Infectious disease expert. Dr Greg Poland shares his insight on social distancing. So we literally don't know but I think the safest answers to talk in terms of months not weeks new revelations about the virus. Once we don't see any cases we wait fourteen to thirty days question. What is Dr? Poland's best advice for you and your family at this point in the pandemic you need to be able to take care of you and your family in your home for a minimum of thirty days. Do the logical things take science into account as you look at your context and take seriously those things and do them. And you'll do well the answer next on Mayoclinic Qa. I'm Dr Tom Scheib. And I'm Tracy mccray joining us by phone for another covert nineteen pandemic. Update is Mayo Clinic Infectious Disease and vaccine expert. Dr Greg Poland actor Bolin. Good to talk to you again. You good to talk with you. We are recording this on Monday. March twenty third. Tell us what has changed over the weekend. A number of interesting developments. That have occurred one. Is that accompanied called Sefton? Had A emergency use authorization approval from the FDA for what can essentially be closer to a point of care asa it's still a molecular RTP CR essay. But you're getting results back in about forty five to sixty minutes. What's helpful about it? Is that this particular company has about five thousand of these machines deployed around the US. Now they can only do a small number per hour. But it's one more thing we can use to meet the demand for testing and those should be available mid week. I understand that's my understanding to the other things that are of interest Our number one a report out of China showing that as many as fifty five oh fifty percent of patients may present with diarrhea as opposed to classical respiratory symptoms. Now the key here is that this was only two hundred patients but importantly if they presented with gastrointestinal symptoms diarrhea. Abdominal pain vomiting. They had a worse prognosis. Another words presenting with Gi symptoms was a marker for increased severity of disease. And we thought for quite a while that diarrhea wasn't part of this wasn't a usual symptom. You're right not unusual symptom. Although in the initial reports coming out of China about three to as many as ten percent of patients were said to have diarrhea this is a little different cohort. They're looking at needs to be confirmed. Tatra Pollen this morning. I read something about folks having trouble smelling or tasting. What do you know about that? Well what we're hearing are anecdotal reports from particularly in Britain from their ent doctors. They're saying that they're seeing patients who've recovered from Cova nineteen being left with loss of the ability to smell or taste or at least diminish again. These are very early reports. They are a handful of pixels on an unfinished canvas. And we need to know more but it's probably true that we need to add three things to our symptom list diarrhea and loss of taste and smell correct correct although I think the latter two are probably late in the course of the disease not presenting symptoms the other. The other thing that has come up over the weekend and and we've talked a bit about it but Mit did a study looking at where we seeing the burden of cases. And they're noticing that it's in a band of countries where the temperature currently varies between thirty seven degrees and sixty three degrees and they're seeing slower spread in warmer climates. Now as they admit that difference between colder countries in warmer countries is at best modest. But could it be a hint toward the idea that as we get to summertime? Maybe this will dampen down. We have to stay tuned. We were hoping so we also heard over the weekend that hydroxy chloroquine or chloroquine and a ZIP through. Mizen what we know as her Max. Or Z pack that the use of these medications in treating patients with Kobe. Covert nineteen could be a game changer degree. I probably don't agree with that. And in this regard what what. Those statements are born on our son patients from France that appear to have gotten better concomitant with using that medication. And as we all know until you do clinical trials to you look in a more fashioned way. Are you really seeing natural history of disease in some people or are you actually seeing benefit from the medication having said that there are several large clinical trials now in progress to examine that question and the question of various currently licensed antivirals? Is there a rationale for using chloride one zinc and vitamin C to treat this disease? I don't I don't know of any mechanism for zinc and vitamin C. But with Plaque Miller hydroxy chloroquine the idea. There is that in the end zone of the cell. You're actually creating a more acidic environment. Which is adverse to the ability of the virus to propagate itself as of today in the United States about thirty five thousand cases and approximately are close to five hundred deaths. Is that about what you expected? Is that surprising? Is that less than you expected. I think it's about what we're expecting. Based on what we've learned in other countries you know when you look at it just on the seventeenth of March. We had forty five hundred cases. Today WE ARE OVER THIRTY THOUSAND CASES. This is doubling every couple of three days. And that's what we've seen in other countries too. That's why the plead from public health authorities. Shut things down now or we're going to see this continuing exponential increase in cases. So in your opinion. Are we doing enough? I don't think so I think As I've talked with colleagues around the US and my own observations are there appear to be some people who haven't gotten the memo yet Literally you're having to have Mayors and state governors make laws in order to get people to do the social distancing and to do the right thing so many people ask me because I get to talk to you. They WANNA know. How long is this going to go on? And will we know as lay people when we can see the number of active cases versus recovered cases? Start to change is that we haven't hit a baseline yet correct correct. And here's the thing that's really hard for people to to to to understand because they want to take what they see right now as predictive of the future and that is not true with this virus another words the cases that we're seeing now reflect what happened fourteen to thirty days ago. What we don't want to do is make the mistake that I believe. Japan is doing where they see a decrease in cases and say okay all clear kids back to school. That's not what we WANNA do. Once we don't see any cases we wait fourteen to thirty days to know that there are no more cases because you can tell at the same time but once we don't see any cases that is tied in with our testing and because we are so far behind in our testing. It's going to be hard to know when that is correct. Well that's right and so Casey Tracy what you had higher talking about is cases. So you're you're putting your finger on exactly the right thing. Cases are people sick enough to come to medical attention or be tested. What we don't know is that big base of the Pyramid of people who have little or no symptoms yet are in infected and can be infectious to others. You said you didn't think we were doing enough. What more should we be doing? I think that we need to shut down. All non essential activities. I understand that will be terribly disruptive economically personally mentally socially but we have no other tool with which to battle this virus. We do not have licensed antivirals we do not have vaccines and the issue as every major city and country is discovering is that the mortality rate skyrockets when there is a surge demand that the medical system cannot meet so by flattening that curve and spreading out infections. We can do what we do. Best which is give superb twenty-first-century medical care but you can't do it when the system is literally overrun. So I do WANNA be able to say to people that are asking me and I know if they're asking me they're asking you tenfold. How long will this go on? Can we say today? Our best guess is fill in the blank or is there no way to even say that that that is a prediction harder than predicting the weather and the reason for it is. We have exactly eleven weeks experience with this virus so we literally don't know but I think the safest answer is to talk in terms of months not weeks. This virus seems to be particularly stressful for people. I know there are multiple reasons for that Because we've never seen it before mostly and we don't know how long it's going to last Do you have some tips for controlling anxiety and stress because of the social distancing and this isolation? Yeah I think a couple of things first to frame it We are really the first generation that has not faced War Famine Pandemics. The way they they have in previous generations so this is new to us but I think the first thing is. Let's look to history. People have been through these things before they have pulled together. And that's a key switching from me to we and they have done well when they've done that. The other thing I think worth remembering is technology. We have technology connections well beyond imagination from previous generations. I actually think the youngest among us will whether this better than the rest of us they are and I'm simplifying of course but they're used to coming home from school for example and playing video games and doing so remotely with their friends. There's no disruption in that so I think those are our key things I think getting outside is really important. Interesting observation here. The streets are dark at night. There's no cars at ten. Ten thirty and people were out riding on the busiest roads in the middle of the road on their bicycles. Maintaining six to ten feet apart from each other. I thought that was glorious. Good for you I think getting outside into nature and creation turns out to be something really helpful in terms of your mindset and what I have noticed is that people are much more civil to each other. They say hello they nod their head. They stay a respectful distance away but want to talk and I think those are a really really good things to do. I'd like to talk about testing for a moment as of Monday. The twenty third. We have enough test kits or where we add in that quest. I think we are rapidly ramping up to have enough test kit. Some organizations that are really large producers of these are saying now going to be able to get out Ilyas a week. The question will be the personnel and the machinery to run these. What we really need. Tracy is what's called a point of care ask say that's rapid the same way we do with influenza. Now that helps us to understand the denominator but if people are otherwise well or have minimal symptoms whether they test positive or not in terms of their individual health doesn't matter because they're going to go home recover just fine from their infection where it helps is knowing something about community transmission and protecting those around you from the infection and that's why it's important so that's why the mass testing is so important. That's why having the tests available so important exactly and that should be this coming week. Yes that's what the indicators are all right we can never talk enough about prevention so remind us again who is at particular risk for this disease and the most important things we can do to prevent it. Yeah you know. I think to the list of things like smokers. People who are very obese who have cardiovascular lung disease and older people we need to add healthcare workers when you look at Italy for example Ten to twenty percent of their cases are healthcare workers. So these are very brave. People who in the face of a pandemic like this and without adequate personal protective equipment are still there in the battle trying to do their very best for patients so so one plea is healthcare of brothers and sisters in medicine and nursing. Take good care of yourself. How do you do that? One is using your personal protective equipment appropriately. I think when to the extent manpower allows when you dawn and off your protective equipment. You do it with a colleague watching you so you don't make a mistake. You go into the room with somebody so you don't make a mistake. I want to emphasize again. What is obvious and simple but has profound implications? There's nothing particularly exotic about this virus. You can not be infected if you don't breathe virus in touch contaminated surface and then touch your eyes nose or mouth so knowing that what do you have to do in your particular context to avoid breathing the virus in and to regularly sanitize your hands? So you don't infect yourself all right let's talk about some common misperceptions about this virus and the first one. I want to ask you about is the generation. That's the kids between eighteen and twenty five years old and the millennials aren't at risk. Yeah I I heard a terrible joke about this About you know kids coming home and living in the basement wondering how do they get to live on the upper floors and they're calling them boomer removers terrible but but I would caution them a couple of things? The first twenty five hundred cases that were hospitalized here in the United States forty percent of those patients were between the ages of twenty and fifty four intercom. You may have heard the case of Thirty four thirty two year old retired gold medal Olympic swimmer. Who says he has never experienced anything like this. It has whacked him so hard and I think people need to realize that they have the misperception that oh it'll be like a little cold for some of them. Yes they're right but they can also spread it to the people. They love to their neighbors to their friends. And so they need to take the same kind of precautions in terms of respiratory etiquette social distancing in hand washing as all of us need to are males and females equally affected. Well what we can say is that they are differentially affected in terms of severity. It has indeed been the case that in virtually every country. I'm aware of then have had more severe disease and have had mortality rates. Hyder than women. Some of that may relate to what we know is a positive genetic predisposition for women to survive infections. The other thing is men. Tend to engage in riskier behaviors behaviors including for example smoking which is a major risk factor for complicated disease. Here you know thanks for all the great information every time we talk to you and we always like to ask as we finish up. What is your best advice for people and their families at this point in time in the epidemic pay? I I really think that what people have to do is seriously. Assess their context. If you have a immuno-compromised child or other family member you have to take precautions. That are much more restrictive. If you will then say in in my family so I think you cannot be strict enough about social distancing hand washing and respiratory advocate and. I think the other thing is ever since nine eleven the CDC has told America because of natural disasters pandemics. Whatever it would be you need to be able to take care of you and your family in your home for a minimum of thirty days. Now that's not to be panicked. It's to say be prepared. Do the logical things take take science into account as you look at your context and take seriously those things and do them. And you'll do. Well do we know if we Have been infected and recover. Are you immune immunity level there? Have we found out that information? That's a really good question you guys. And here's what we can say with the seasonal corona viruses that regularly circulate that immunity less in terms of months to a year or two. Will that be true with this again? We only have eleven weeks experience but the concern is based on what we know about Corona viruses so these are human Beta corona viruses. Immunity seems to not be long lipped. Will that turn out to be true with this virus? Could you get infected again? If it's say circulates again next year just don't know yet. We'll have a vaccine by Dan. Won't we doctor? I'm I'm hoping but you know Think of another health emergency bull that took six years Dr Greg Poland Infectious Disease Specialist vaccine expert from the Mayo Clinic. Thanks so much again for being with us on pleasure. Mayo Clinic Q. And A. is a production of Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts to see list of all. Mayoclinic. Qna podcasts visit News Network Dot Mayoclinic Dot Org then glick podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

United States diarrhea Dr Greg Poland Mayo Clinic chloroquine Casey Tracy Mayo Clinic News Network Mayoclinic Tracy mccray Dr Tom Scheib China Poland FDA Mayo Clinic gold medal Abdominal pain Cova Britain
Mayo Clinic Q&A: Shifting from Me to We

Mayo Clinic Talks

23:30 min | 1 year ago

Mayo Clinic Q&A: Shifting from Me to We

"Coming up on Mayoclinic. Qna Kovin nineteen researcher. Dr Greg Poland Answers Your Corona virus questions. I continue to believe 'cause we have not reached the peak of this yet. I think we are in for this over month not week. What should you disinfect? An how often should you do? You have a much easier job in your home with cleaning your hand after that. It is of course your telephone. Can you order? Take out food while you're sheltering in place takeout food and even ordering growth rates for Irish people is smart idea should we be reorganizing our summer schedules? Would I lie? Italy or China This summer no. What can we learn from? How other countries are combating the cove in nineteen outbreak? New Rochelle New York. They actually needed a containment area about one mile square and being a precipitous fall in case but it worked the answers to your corona virus questions my motto is. We really have to turn from a new culture to a leak culture next on Mayoclinic a welcome. Everyone I'm Dr. Tom. Shy and I'm Tracy. Mccray we are with Dr Greg Poland Infectious Disease Specialist Vaccine Expert at the Mayo Clinic for another update on the covert nineteen disease. Dr Poland good to talk to you again. Always happy to be here. Hopefully those. This won't last too long but we don't know how long do we know we built and You know as we've talked a bit Before there's this lag period between what we see and what happens two weeks from now so I continue to believe since we have not reached the peak of this yet nor have we seen the spread from the large EPI centers like New York and Washington happen with their full force to other area I think we're in for this month not week. We're recording this interview on March Twenty Fifth and the first question that we have is more a comment from a youtube viewer. Who said speaking of spread you in? Dr Sides are too close and so just so that you know Dr Poland. We are no longer close and he has tape measure. Why are you not practicing social distancing one recording and you know what that is a good question and we are we miss for not practicing what we preach even watched. You guys didn't enter my mind too that betting and Tracy sometimes forgets that. I'm at high risk for this. Covert nineteen. She stays over there. I stay over here good question. Thanks for alerting us to that. All Right Fifty. Five thousand cases so far twenty six thousand of those in New York eight hundred and nine deaths about what you expected yet. That's a case fatality rate of about one point three or so percent very different than the world which is four point five percent very different than Italy which is closer to eight percent so in that respect were doing well. The one thing that I do worry about is the idea that okay people have kind of been hunkered down or maybe a week or two and they're already starting to say well. Maybe this will just be another week. I cannot see I cannot be at that will be the case. We have not hit the peak yet. We have. We have longer to go with the and isn't the case that once we hit that peak then fourteen days. We have to wait or twelve days. We need to have some sort of timer in our head. You're thinking in the right direction but it it really works this way. It fourteen to twenty days after we see a sharp downturn or even elimination of cases. If you want to be really safe before you relax those restrictions all right another question from a listener. What items in my home or office should be disinfected? Yeah I think We'll we'll maybe start this way You have a much easier job in your home. Assuming nobody's infected with cleaning your hands when you come into your house so first thing you do is clear hand after that it is Of course your telephone. We touch our cell phones all day long. No matter where we are. We're probably contaminating the keyboard of your computer. Anything that you touch regularly the bathroom and spink Boston doorknobs in out of your home. Those are the those are the areas that are touched by everybody multiple times a day. Can you order take out food? While you're sheltering in place Dr Poland. Yeah And I actually think that takeout food and even ordering groceries for high risk. People is a smart idea. does it completely eliminate the risk. Nothing can or will but it diminishes the arrest and as we've talked about before what you're really trying to do is put layers of protection around you each one decreasing your risks that in Psalms. Your total risk is has low as you can easily drive it all right next question. Is it okay to eat in a restaurant? If you practice social distancing I think the concern there is several fold number one You have you have grabbed the door knob to enter the restaurant. You have touched the table. You don't know about the silverware. You have touched a menu. You have somebody else Preparing and touching your food carrying it to you. I've seen waiters carry a glass of fluid To waiting People in the restaurant with their finger their thumb inside the glass So you're just you're adding risk when you don't need to address and then some areas of course. The the governor's or the mayors have shut down Restaurant in in person edict. Next question comes from someone who's thinking about summertime and wants to know if they should cancel their summer time travel plans. I think depending on what they're thinking of. Would I lie to Italy this summer? No or China now If they're talking about what we're going to get in the car and drive eight hours be you know My healthy adult child and grandchild. I think it's too early. No but I wouldn't necessarily put those plan Cancel those plans. I just put them on. Hold and watch and wait just pencil them in for now. Yeah all right way to put it next question. How long can the virus live on different surfaces and also in the air? This is a really good question. And let me explain the Roughly Twenty three studies. That have been done. The latest one that came out in the New England Journal week or so ago and and people have to be careful to interpret this. They put together. I realized conditions for virus conditions which generally don't exist and they have the chamber and Aris the lives of Irish again that does not reflect reality. What do you mean what I'd say? Era Celeste because the difference between Arizona's -Ation and droplets. Okay good really key principle. Erris the live virus is Small amounts of virus without the large Mucus Dropped are often carrying it that can float and stay in the air for very long periods of time that generally happens with water called Aristotle leising producing procedures for example when you're intimidating somebody or they're having a bronchoscopy or something like that the the common nested that is Causing transmitted virus in the population is large respiratory droplet. This these are the coughs sneezes Where you have virus carried on mucus droplets. You can actually see the droplets. We may not be able to Stephen. Against the backdrop. You could see them okay But but they they do not float in the air and they drop quickly down to the ground. That's why the social distance thing. Ideally of six to ten feet work that now is that also why Measles is such so much more likely to be spread because it will stay in an aerosol in the in the air and not just on droplets at -olutely and in fact you know if the three of us were susceptible to measles and we walked into a room where somebody with measles had been eight hours ago. Likely all three of US would get that disease now this this idea of persistence on surfaces. So what the other twenty two studies have shown and the recent look at the Diamond Princess cruise ship is they found virus. Seventeen days after that cruise ship had been empty. We don't know if it was viable virus meaning virus that could still infect you but this is consistent with what a variety of studies have shown. Is that if you have somebody coughing? Sneezing symptomatic Kobe nineteen you. Can you can detect this on the surfaces of that room now. It's exquisitely sensitive to the proper disinfecting fluid that you would use to clean a room whether it's the dilute bleach sure Other approved disinfect. That so so it's a it's a key strategy in dealing with this because it is thought that this virus started in animals and then crossed over to humans. Our next question wants to know. Can Our pets get the virus and then transmit it to other people dogs In particular do have corona viruses but not the type that infect humans at least not commonly dogs actually have corona virus vaccine That that is made for that in terms of this corona virus stars. Kobe to that virus is not carried by our pets. We are not infecting our pets and our pets are not infecting up however out of an abundance of caution see did release a statement saying that if you have Symptomatic Co bid nineteen. You don't have to quarantine yourself from your pets but don't let the pet lick your face. Don't share your food. it's CETERA. Not because there's data suggesting risks but out of caution. Lassie sounds pretty safe all right next question. Can I get infected through a cut or open wound? There is no evidence of this being transmitted in that way. Nor are you going to in some way absorb the virus through your skin? This is why and washing and sanitizing works so well we're getting used to sheltering at home so this question Has To do with context. What is next? What'S THE MOST likely scenario? That is lies ahead of us. I think what we're going to see is More Institution of what we've seen around the world where countries and cities didn't take this history as they should had a major eruption in the number of cases and then just to use the term locked down and in two weeks started munition cases. Good example in the American context is new Rochelle New York where they actually made it. A containment area about one mile square is my understanding and they've seen a precipitous. Fallen CASES TOOK GUESS. What two weeks for that to happen but it but it works. I think we're going to start to see that in other areas of the US as this moves away from the two coasts and more and more into the center of the US. So here's a listener. Who has obviously listening closely? She says two weeks ago you advised us to use contemptuously appropriate levels of protection explained again what that means and does it still apply it. It not only applies but it is a dynamic or moving target based on the context. I is simple analogy. And then we'll apply it If you live in safe area of the country where I do Rochester Minnesota When I go to bed at night I locked the front and back door later one. I closed my first floor. Windows layer to flip outside light on layers tree. That's all I need. If I lived in a in a more difficult area of the nation I might add layer for an alarm system layer. Five window bars. Maybe layer six the panic button. You get the idea. So what does that mean for us in the in the US again? Are you in a high risk or low risk situation and that can change over time? Low risk situation. Tell the work if you can social distance thing being sure in your hands or cling slayers two and three. Nobody comes in your home without him. Sanitizing layer or nobody comes into your home period. And unless it's absolutely necessary you just keep layering things on like that based on your particular context based on the transmission dynamics in your area recognizing they lag by two weeks or so. So you're sticking with that is your motto. You don't have a new one correct. Well the only knew it. I added more cultural and that is and we're beginning to see this. You Know Saint Paul Ramsey hospital up in the twin cities Among their greatest number of VR. Visit not Kobe. Nineteen it's mental health issues and my motto is. We really have to turn from a mean culture to way week culture and you see that in a grassroots through healthcare providers movement where you see them in the hospital with the same thing. I'm staying here. You stay home. If it's every man for himself we will do poorly as history shows in pandemics. I'm to take care of my neighbor. I'm to take care of my community to help at any level that I can and if we all do that and if we all take care of each other we will do better together all right. It's not me it's we all right. Yeah next question. Do Surgical Masks help or not only do surgical masks help but a mask of almost anything helps now the original reason that CDC and other organizations that don't wear masks is because they wanted to preserve those for frontline healthcare workers but you can have an effective mascot of a folded over Bandanna or handkerchief. The way it helps is in disregard. It decreases the risk that you'll breathe in these respiratory droplets that somebody else may have cost coughed or sneezed. And now you're breathing and it is a reminder not put your fingers in your eyes nose or mouth so from that perspective is protective now. It can't do anything against Aristotelian virus but that's probably not the primary mode of transmission air again. I think because they were. They didn't want people to go out and buy all the end ninety five and surgical masks because they were needed for healthcare workers think. That was the motivation behind that. Not Dia- Interesting Hell. Would you like to comment on the cure being worse than the disease thinking? Yeah I think this really get to cultural and personal values. What price a light? How much economic disruption for. How long can we take? What does it mean particularly for the most vulnerable members of our society who are often living paycheck to paycheck? This is where government comes in government is to do for the people what they cannot do for themselves. I'm fine I don't need anything but I know that there are neighbors of mine that do need help and we help them. How how far do you go with it? And how do you balance it? I think it is phased approach. You wait till the curve bent you. Wait till you start saying a great deal munition in case and then you wait two weeks more you begin to loosen restrictions. I with young people because there while they can still want occasion have severe disease. They are dying up there and we watch weight. We do it carefully the same way you might think of sort of the canary in the money's Mindset of you know you don't expose. Everybody wants to open up all the schools and colleges do it all right. Isn't it okay for people with no symptoms or who have tested negative to go back to work your difficult difficult question the no symptoms. You actually don't have any information It is apparent that ace symptomatic transmission. That is you have no symptoms but are still carrying the virus and can transmit it to somebody else does occur the more people you congregate in a building in a room in an area the greater the risk that you re spark that pandemic and start having cases. They get so. It's really important that we know that the other thing that's really important is that we. We begin to have very rapid tests to tell us whether somebody is immune even if it's in the short term so that they can go back to work in in particularly in essential job they can be frontline healthcare workers and responders. If I have a sick family member can I go to work or should I stay home? You should stay on you. Are you are risking. Other people by transmitting that disease I would say that if you're not in ential worker than than you need to be at all right next question the. Us and South Korea apparently had their first detected case of covert one thousand nine on the same day but it appears they have. They have flattened the curve and started the fourteen day timer. What can we learn from on how they have handled the outbreak? You know what the key thing that I know people bring up. Well you know SARS in in two thousand two wasn't like this. That was different. There was not a dramatic transmission. What drives this is that we do. Have people transmitting the disease? Who Don't know they have it. And so when if you really you have two choices in stopping this pandemic and there are only two absent antivirals and vaccines you either. Get everybody infected. In which case you will have millions in the hospital and Lou and and lose tens of thousands to hundreds of thousands of people to the disease or you shut things down now. Both are disrupted both have closed or Kahn. Both are value judgments about what to do but if the goal is stopped widespread transmission. You say everything isn't essential or that is not a part of national security Supply Chain Hospital Workers Federa telework. We are out of time basically but I have one last question. Because I've been getting this on nonstop for the last thirty six hours and it's about Ibuprofen What do we know about Ibuprofen Safety? So we know a lot about. Ib program safety though not in the context of this particular infection so I do pro fin regardless those a context is a drug. That can cause water and salt retention. It can elevate blood pressure and can cause bleeding as well as kidney dysfunction. Now you take a drug like that into somebody with a viral infection. As it help or harm I think despite the warnings of WHO and the government of France. I think most of US scientists recognized there really is not any solid scientific data saying that that represents a unique risk in code nineteen now having said that the only reason to take a drug like that is for fever. Reduction muscle aches and pain uses. See the benefits. Are stapler all right. Well Dr Greg Poland Infectious Disease Expert vaccine expert. Thanks so much again for answering all of our listeners questions on the covert nineteen outbreak We'll be talking to you again soon. We'll look forward to that. But hopefully we'll reach the apex of number of cases pretty soon and number of deaths and start to go on the other down on the other side of the curve. We all go. Yeah thank you moment Mayo Clinic. Qna is a production of Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts to see a list of all mayoclinic. Qna podcast visit news network. Got Mayoclinic Dot Org. Then Lick podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

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Special Mayo Clinic Q&A episode: How public health measures can help reopen the country

Mayo Clinic Radio

14:39 min | 1 year ago

Special Mayo Clinic Q&A episode: How public health measures can help reopen the country

"Welcome Clinic Cuna. I'm Dr Sanjay ca-car and we are recording this podcast on the twentieth twenty twenty while the covert nineteen pandemic continues. Efforts are beginning to reopen the country. A move to a new normal that is guided by important public health principles with us to discuss the latest information as Mayor Clinic Infectious Disease and vaccine expert. Dr Greg Poland not to Poland. Thanks again for joining us. Pleasure all the news. This weekend is being about reopening the country and really starting the economy since we last spoke on Friday. What have you been seeing regarding trends Regarding numbers for covert nineteen when you look at it just since Friday. Today's Monday we've got about a hundred thousand more documented infections in the US and about five thousand more debts while they're starting to be some slowdown. We're not there yet. I I understand that. People are sort of tired of the social distancing. But we're just starting to see the fruit of those efforts from fourteen days ago. Let's not jump the gun prematurely. That's sobering statistics to here. She said obviously was trying to think about getting back to life as normal we can but as an infectious disease expert. What sort of principles do you think we should be adhering to us? We slowly start trying to reopen things. Sanjay that's actually a very good and an excellent question is it really puts the finger on all right if we're GONNA do this. Under what conditions do we do it? And they're really sort of of those one is that we need to see case load really bend down low. Which is an indication of decreased community transmission? Secondly we need the ability to do testing. And we're not quite area once we have that testing the ability to do contact tracing so that we can quarantine isolate remaining cases in the last one and this is a big issue Particularly for some of our major cities. You don't want to do that and less you have hospital in medical care capacity another words. You don't want to trigger. Something happening and again have surged a demand on the on the medical system. So when you say another surgery you talking about the second wave that we were hearing about it could it could either be that this fall or by opening prematurely increasing community transmission an increasing number of cases. That's what happened. For example. In Japan they sent their kids back to school. I think prematurely. That experiment has been done. And what did we see? Fourteen days later. Major uptick in cases again. You mentioned about testing and this. There's some confusion about testing. You know people think well if I don't have the symptoms. Why do I need to be tested? Can you just explain From the infectious disease aspect. Why is testing so important? It's important for two reasons the molecular diagnostic test. We have you here called. Rtp CR those are test designed to tell us. Are you currently infected or have the virus? So that's important because we we're gonNA want to isolate. Those recording team knows individuals. Not let them work for example in transmit to others. The other test is serology tests. These are tests done after the fact act to say were you infected in the recent past and might that mean immunity. Obviously the advantage of knowing that is you're you're not concerned about your own risk anymore and you're able to go back to work. Let's say you're a healthcare worker. For example you're able to go back to work and not have to use the same level of P P potentially so when we've talked about testing the pasta show. We we've talked about. She said the other serology testing. We've also talked about putting the nasal swab down But you know when we're hearing about. We don't have enough tests. What are we talking about it talking about those that we are talking about the finger prick test? What are we talking about? We're really talking about all of them. I neglected to say another important part about doing the serology testing is to know what percent of a community has been infected. 'cause that's really a key thing if we were to find out for example that seventy percent. That's not going to be the case but seventy percent of the community had been infected. Well you're getting up toward herd immunity and it's likely safe to do so but if it's more like five percents or ten percent you still have ninety percent of your population at risk. So if that's the case indeed and then we have an an uptick in cases if we go back to quickly. What do you see happening that you see us? Dan Rea instigating all these. Stay at home mortars distancing exactly and I and I think that would put us in a very tough position I would people really be willing to flip the switch that rapidly in basically start all over because of the lack egg period. Between when you get infected and when you start developing symptoms and then when you actually end up needing medical care so going premature in opening means we might start all over again rather than sustain this for another two three weeks. See that that case load really is flattened down and then in a phased way begin to reopen last week. We also talked about some of the promising news regarding treatment. An in particular rim disappear since we last spoke has been anything new. That's come onto the horizon regarding treatments. Yes Sanjin thank you for the question because I think this is a real bright spot About thirty minutes ago a paper was released on this is an NIH group. Excellent study where they took two groups of monkeys expose them both to SARS Kobe to at an appropriate dose and then twelve hours later started infusing rim disappear in the so one group got run disappear. One group Got Placebo in the group that got run disappear. Viral Tigers were dramatically suppressed. They didn't develop pulmonary infiltrates. They didn't die and in the placebo treated monkeys. None of that was the case. So I think we're learning to things at least in this. Small Animal Study reminisce. Aveer was very helpful. No no doubt about that. But the second point in it. And it's a significant point for US AS CLINICIANS TREATING. Humid's is that it's very likely as many of us thought that you're going to have to initiate that antiviral treatment as early as possible in the course of disease now. This is not unknown to us. This is exactly the case for influenza. We tried to get it in a antiviral drugs into influenza Patients within forty eight hours at most seventy two hours after they develop symptoms. So I think the way it's GonNa turn out is that REMM disappear will be useful but we're going to really have to push it toward the left. That is a very early in the course of infection particularly for people who have risk factors for complicated disease. That's very promising Indeed and last week we also explained that perhaps the most infectious with this disease before you actually develop any symptoms so it just shows how a how important getting early testing as applicable with possible treatment. Early may may be where we need to go with this absolutely in an also why this lag period between when you are infectious and then you're talking another fourteen days before you start seeing the consequences of that transmission to other people and that's why this is. This is a slow process in terms of reopening obsolete. We also talked about the other infections. That can happen. We'd cove in nineteen and the other pathologies we just mentioned about pulmonary disease What else are we? Learning regarding how this is affecting other areas of the body. It is very apparent that having one infection does not in some magical way protect you against another infection so you think about during the winter season in the United States for example depending on where you live. You're exposed to SARS Kobe to influenza A. Influenza B. R. S. The measles mumps pertussis human met ENUMA virus rhinovirus. Well that's about eight or nine right there and in this study what was shown is that about twenty percent of people who were coveted nineteen positive were also infected with another respiratory pathogen. That's important for a couple of reasons number one. A CO infection may may mean worse disease the other thing is that some of those other viruses and respiratory. Bacteria are treatable so we wouldn't want to just do a Kobe test in say positive or negative. And entreat a therapeutically based on that they have influenza and that's treatable they might have pertussis and that's treatable so we would want to know that and it's an important clinical facts bear in mind. Yes absolutely. It's it's interesting how you mentioned all of those viruses so as we obviously get through the summer and we go into the winter the flu epidemic will start again and so to prevent this. We talk about vaccinations. What is your message to the to the PA regarding the flu vaccine and whether they should be having that or not because that will be the most prominent respiratory virus that circulates we really do want people to get influenza immunized. As soon as the vaccine becomes available now we do not have a culture of that in the US in our highest risk patients which are the elderly. Maybe we get sixty percent of them to take the flu vaccine. An important part of that is that Kobe nineteen influenza symptoms. Overlap essentially identically. So it's going to cause the individual a lot of concern it again causes this surge capacity that the medical system can't easily meet so by getting influenza vaccine you're taking a good deal of that respiratory disease off the table so that we can concentrate on Kobe. Nineteen and you're decreasing the chance of co-infection meaning if you did get infected with Kobe. Nineteen you're likely to not have as severe course as if you also had influenza action. Instead of Poland. A lot of people will get the flu vaccine. But they'll push it off. They'll say well. I'll get it in February or March. What's your message to those people again? Because as we very likely as we move into our fall out we're going to start seeing cases of Kobe. Nineteen because of the burden of disease that will occur in the Southern Hemisphere. It'll re circulate backup. Here is almost certainly the case so I think perhaps uniquely in this regard will want people to get their influenza vaccine early and not delay as we're looking to try and get back to normality. We're entering the summer season. Schools are out families are thinking vacations at Cetera. As we've talked about how this disease process is the new norm now. What is your thoughts as as people try and think about these plans when I think is likely to happen in this is GonNa be a very is going to be a choreographed dance could is the way I would put it. Is I think as we get into our actual summer. We'll see cases decrease in some phase in normalacy. My fear and my concern is then as we move into the fall in wintertime in the US in the Northern Hemisphere. We're going to start seeing increasing numbers of cases and and the reason for that is. We won't have heard immunity. I guess is it'll be depending on the geographic five ten percent. Maybe something like that will have been infected but the vast majority of us will not have been and then very likely. We'll have another outbreak like what we've seen. So it'll be this slowly coming out of the distancing were doing now more more normalcy. Than if I'm right about the fall than phasing right back into the social distancing mask wearing maybe teleworking etc until we get through or develop a vaccine that can be used. You know while. We're all getting tired of this. I think we're we're getting a handle on this. We're learning a fantastic amount of scientific and medical knowledge has been generated. There's there's more to go but we're seeing really encouraging signs in terms of the patience and forbearance of changing our lives to bend this curb. Down is starting to work so let. Let's not not give up in addition we're seeing some real medical breakthroughs. I think in terms of these early studies with the Rim disappearance particular and I think this is going to give us a lot of motivation to start doing. Clinical trials very early in the course of disease with reminisce. Always a pleasure and an honor to speak to Dr Greg. Poland a Mayo Clinic Cove nineteen expert. Thanks for joining us today again. Greg Pleasure. You're doing a lot of good by educating appreciate it. Mayo Clinic Q. And A. is a production of the Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts visit News Network Dot Mayo Clinic Dot Org then. Click on podcast. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

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How messenger RNA vaccines work

Mayo Clinic Q&A

17:52 min | 5 months ago

How messenger RNA vaccines work

"Welcome everyone to mayo clinic in. I'm dr helena's alka. And we are reporting this podcast on november the thirtieth twenty twenty each week. We do our best. Keep you up to date on. What's going on with corona virus and answer your questions about how to stay safe in the midst of this pandemic while here today for our situation updates because it is monday. Is dr greg poland. He's a viral vaccine expert in an infectious disease specialist at the mayo clinic and is here with us weekly to answer our questions. High grad. welcome back after thanksgiving yes. Wonderful. we've now had a lovely thanksgiving and we're back together today. We're going to catch up. And then i have some listener questions for you as well. What will the good news is that we had thanksgiving. The bad news is the likely impact of Just in the last five days we've added a million known cases. We have gone up to about ninety. Three thousand americans in the hospital With with kobe in november alone we added four million cases which is about one hundred thirty seven case. Thirty seven thousand cases a day. We added over twenty five thousand deaths which is eight hundred fifty new deaths a day due to covid nineteen. So you know. As as a culture we're going to have to take responsibility for what is almost certainly going to be a major search surge in cases and then the lag period we've talked about with hospitalizations and deaths all the way through the two to three weeks after christmas while greg you really know how to kick off a conversation that was going to be my first question for you was what we're numbers looking like now and we've heard so much about all the travel that was going on over thanksgiving in spite of warnings. By the cdc and yourself. Can you tell us when. Would we expect to see a surge related to thanksgiving travel if that's going to occur. No that's a. that's a really good question. There were More than a million travelers in the several days each day the several days before giving and then of course after thanksgiving so what will typically happen. Is that people will not begin to develop symptoms for seven or fourteen days in that time period generally speaking and they're infectious. They're very infectious. The couple of days before developing symptoms and the five days or so after developing symptoms. That means that you have a week or two lag before symptoms develop a week or two leg before people get into the hospital and a week or two lag after that before people start dying. So it's a it's an unfortunate thing that people will grasp onto while the number of cases. Went down over thanksgiving. No it didn't. It's that testing centers and healthcare workers. And all the normal processes were diminished during that time period. Now will now. We'll see this surge happening our numbers at mayo clinic. We keep statistics obviously and the numbers of positive tests that we have over the weekend are always less during the week. Probably due to the number of people being tested now in one of the interesting or telling Parts of that is. Cdc is saying if if you traveled. Assume you're infected in. Go get tested greg. I want to get to vaccines but before we do that. I wanted to ask you quickly about monoclonal antibody. So we've begun to distribute monoclonal antibody at mayo and then other facilities as well obviously. There's been some reluctance by patients. Who would qualify for that treatment to receive treatment. And it's not just here at mayo for that from other some other major medical centers as well. Do you know why that would be the what. What the concerns are i. You know frankly. I think it's probably the unknown and ignorance about it. These are generally safe drugs to take they have to be infused. Iv and that may be one issue the other thing is you have to catch him. Just the right time and so it's logistically difficult not really gonna treat a symptomatic individuals and we can't see a large value in treating people who are already in the hospital in sick so so that presents as i say logistical difficulties of who you treat. I think the the other thing is as i said just the unknown these expensive people just like with the worry that they've been quote rushed that we don't have enough safety data. But i'll tell you if i was a high risk patient and i had developed Evidence of infection monoclonal. Antibodies are our major therapeutic advance in treating disease. We don't have all of the data yet clearly But these are these are something. I would strongly consider for myself if i were in if i were high risk on now. Let's get onto vaccines one of your favorite topics. And i'm hoping you could give us an update on the vaccine where we stand with those and what the outlook For getting maxine on december ten the pfizer application will come up before the fda advisory committee on december seventeen. The modern application will come up. So we're waiting to see what will fda do about that. I think what we're going to find is a very good safety. Excellent efficacy and so the question. I think that. Fda is really going to wrestle with his. Do they issue an emergency use authorization or an expanded access type of recommendation and the reason for the difference between the two is the fact that issuing an e you way might have on the completion of the current phase. Three trials in other words. If a vaccine were to become widely available. It might well be the case. That people would drop out of those trials particularly if they thought they had gotten placebo in order to get one of the one of the two. Mr rene vaccine's madonna just released another Preliminary reanalysis of their data showing ninety four percent. Efficacy it had a hundred percent efficacy against severe disease. There were five people that had apparently a symptomatic or mile disease and a very acceptable safety profile adverse event profile. So this is going to be very important. Information on the adenoviruses vectored side. We've had these odd results from astra zeneca and it turns out that where we initially thought. The half dose as a i dose was deliberate. It appears that that was a formulation. Error it has now of thrown a wrench into the clinical trial. I would say for astra zeneca. They're probably going to have to redo at least parts of that trial now. It's showed excellent efficacy but it was in a small group of people and primarily limited to younger people and then of course the bax a protein recombination. Recombinant vaccine that phase. Three trial is steaming ahead in the uk and is expected to start very shortly here in the us so a lot of positive things happening greg. You've talked to us before. About how madeira vaccine in the pfizer vaccine are little bit different than the other vaccines being developed in that they are am are in a battle scenes just to clarify for myself and for our listeners to two different drug companies essentially inventor developed the exact same thing or do they. Are they different from one. Another in spite of the fact that they worked through a similar process. We'll they both use the same genetic code but they'll both be you know formulated in slightly different ways which appears to be a relevant because their efficacy estimates are identical and their side effect profiles Pretty much identical so the way these vaccines work is that you actually come up with the genetic code once you know the genetic sequence of the virus so they took the genetic code for the spike protein and then inject that usually encapsulated in some kind of a particle like a nanoparticle stabilize that protein and win that when that m. r. a. then gets into our cells it then produces over and over copies of that spike protein shrinking your body into thinking that it has been infected with the virus and so you develop an immune response against the s protein. The reason net so important is the s protein is what 'attaches the virus to the receptors in our cell. So if you can block that from happening by producing antibody that will go on to that virus. You don't get infection you're protected. It's really interesting. And i it as a little bit akin to an i tell patients that medications are sort of cousin drugs of one another. They have similar modes of action But aren't exactly the same. Well greg this is one of my favorite parts of the program when we get to answer some listener questions. So let's dive right in the listener ass. If i use a bar of soap to wash my hands with it. I virus on my hands with soap. Back in someone else will come along and use the so far later are they at risk of contracting the virus and contracting it from that bar of so it's a very good question in here is where we are. If i could use the word fortunate in regards to this novel virus it has a lipid membrane and viruses like this that have a lipid. Membrane are very easy to inactivate to to kill an essence. Any kind of soap or detergent will inactivate the virus very quickly Isopropyl alcohol inactivates the virus. So when you wash your hands. And i save fortunate because wearing masks keeping distance in washing your hands are extremely effective in preventing infection with the virus. So you wash your hands and then you rinse your hands. You have inactivated. The virus any virus sitting on that bar of soap is inactivated. So you really are not going to contract it from touching soap as you say that somebody else is used. Can we extrapolate that to other surfaces as well. What about doorknobs countertops keyboards that we share at work. That gets more complicated. Nobody has demonstrated an infection. Due to that logically could occur. We know it occurs with influenza. And other you know wintertime and cold viruses for example. I think the difference here is that these viruses while they can persist on particularly hard serve surfaces. You need to have a certain burden or amount of the virus in which to be exposed in actually develop any kind of infection much less symptoms and that apparently is not happening could conceivably happen particularly where let's say somebody coughs or sneezes into their hand and there's nukus on their hand that's that has virus in it then you touch doorknob. Somebody comes right behind you. Touches that nukus and then rubs there or puts their finger in their mouth or something like that one could conceivably be infected. But as i say we have no proof of bad at this time. This is The way way way a majority of cases are caused by the respiratory route. And that's why. I'm asking in distances so important. Our next question from a listener is about testing. You know this is pretty much gives us a headache trying to straight the tests that are out there but others listener asked if they've had covid nineteen have recovered from having cova nineteen and had subsequent negative test. Comme still spread the virus to others no That really isn't can happen. Once you have a negative test in particular you are. You are no longer infected with the virus. You're not spreading where the question comes up is what happens when you've recovered but can still isolate virus by pcr in secretions whether that be stool mucus. Whatever are you infectious. Then and the answer is probably not once you've recovered in enough time elapsed the chance that you're infectious. Somebody else really goes down to almost not quite zero but almost zero and we had talked about this before that there's an immunity conveyed for some period of time. That is not quite determined at this point and is that Keep individuals from being able to pass virus if they came in contact with it to others because they have the have an immunity. That's active right. And that and that active immunity has actually killed the virus. That's that's in their body now. There are exceptions people who are highly immuno-compromised. There's a case report out of a woman who they believe was infectious for some seventy days. But she was Immuno quite immuno compromise. That would not be the norm You're the other part of your question is well. How long are we protected for after we have either gotten the vaccine or been infected and recovered from the virus is not entirely known in part because it depends on the individual and their immune system. What we can say in. General is that people appear in general to be protected for six eight months possibly longer and yet we see occasional case reports of people after six to eight months who have had a second infection but that does not appear to be highly common. So that's going to have to wait for a definitive answer into. We study a lot of people overtime. The next listener is someone. Who's christmas list i would like to be on. They are asking They like to bake holiday cookies to give out his gifts. Is that still a safe thing to do this year. Or should it be avoided. What can of reassurance is. can you give people who might give or receive Let's maybe what we should do is offer to receive those in you and i will test them and be sure they're saying no to be serious. Anything baked like that is is not an issue. I would not hesitate to to share baked goods things that are properly handled properly. That's just not going to be the issue where you get into issue is when those cookies are sitting on a table and everybody is gathered around it or touching all the cookies that kind of thing then you could have a potential Risk i suppose but just you know cook- cooking Baked goods in sending them to a loved. One is not in their shoe. While i'm relieved to hear you say that because i do love to receive baked goods dude men. Thanks so much greg. Do you have any last words for us this week. You know. I feel a bit like a broken record saying yet but I guess mark my words. We're gonna see a surge as a result of the travel that we saw for thanksgiving. I hope and pray that when people see that they will think in their mind twice about listening to the experts and staying at home for christmas. We are on the verge of these vaccines who wants to be the last one hospitalized with the last one to die before these vaccines are available. We're asking people to hang on for a few more weeks to months before these vaccines are available. And it's in your interest in your family's interest to do so and i hope people will get reminder greg. We've come this far at spent nine months. Now i think making progress though nelson dude. Thanks so much for being with us today. Greg are thanks to dr greg pulling for giving us our weekly kovac nineteen of date as well as answering some listener questions. I hope that you learned something today. I know that i have. We wish you a wonderful day mayo. Clinic cuna is a production of the mayo clinic. News network is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well.

mayo clinic astra zeneca greg dr helena dr greg poland five days Mr rene ninety four percent severe disease pfizer fda infectious disease fourteen days kobe cdc three weeks Cdc maxine mayo hundred percent
COVID-19 vaccine update

Mayo Clinic Q&A

19:01 min | 5 months ago

COVID-19 vaccine update

"Welcome everyone to mayo clinic. Qna dr helene kozelsk. Were recording this podcast. On december the seven twenty twenty in the past week we have heard lots of vaccines preparing for vaccines and the new surrounding them. And the fact that the first vaccine has been approved for use in the united kingdom here in the us plans are underway for vaccine distribution as covid nineteen vaccines nearing approval. Here as well while today. Our favorite expert on vaccines here to visit with us. Dr greg poland returns he has a mayoclinic clinic infectious disease expert vaccine expert and virologist. Welcome back right. Thank you good to be back. Well wonderful to have you here on talking about vaccines. i know. This is practically your favorite topics. So thanks for being here of course so tell us a little about the vaccine that was approved in the united kingdom. A for us is that under the emergency use authorization irs completely approved by their fda equivalent. No you're exactly right halina. This was the equivalent of an emergency use authorization and so they're going to start with healthcare workers and long-term care residents as well as elderly much like we will In fact in the us. Greg last tiny told us a little bit about the a cip. And if you could tell us again what that is. And i think they make recommendations on who gets the vaccines i in the united states. Tell us how that process is going to work. Just very briefly and i have served on all of these Committee so i have a pretty detailed knowledge of them. The fda has a committee. They call ver- pack. They're the ones that will review the data and make a recommendation to fda once. Fda says this is a go and we anticipate the ver- pack meeting to be this thursday. Then it will go over to cdc. Cdc has an advisory committee called the advisory committee on immunization practices a c. I as you mentioned. They're responsible for the implementation phase of it so in this sense that they will make recommendations about who should get the vaccine what precautions you know. The the operational details of immunization they make that recommendation to cdc cdc take that under advisement and then issues a recommendation. Then what will happen in a third stage. Is that each state will decide within that priority. Who will get immunized so for example a stage one eight is healthcare providers as as one example but which healthcare providers so each state and each institution will have some latitude within which to make those decisions. I saw a fascinating picture last week of some freezers that Mayo clinic obtained to store vaccine. And if i'm not incorrect they said that each of them can store about forty five thousand doses of vaccine and they were them to minus seventy four degrees celsius and there were five of them. It was really fascinating to me. So what about distributing whichever of these vaccines were going to be using. Are we ready to do that. And what an incredible process. That must be yeah. I mean. I think we're very fortunate mayo. Clinic would already. There have been lot of people putting a tremendous amount of time into thinking about this. So so we're ready. That may not be true for other particularly more rural or smaller areas where the logistics and economics of. It are difficult. But you're exactly right. Those freezer store many thousands of doses of vaccine. They have to be kept to add minus seventy seventy which is about minus one hundred four fahrenheit colder than an arctic a lot colder and then they can be put in the refrigerator in thaad for use in actual immunizations so whole process at mayo. Clinic has been designed from start to finish. And how we're gonna do this. What waves of immunization are going to occur and the actual when you think about it. It's sort of a choreographed dance as to how this happens because you don't want a single dose of vaccine to get wasted. That was gonna be my question to you. Greg it you defrosted before administering obviously not aso must warm up somewhat for a period of time right right so that's exactly true. You can hold it in at refrigerator. Temperatures for a few hours each vaccine is different and then at room temperature for a very short period of time in order to able logistically actual immunization to occur. So when you think about we're going to start with the pfizer so you can hold the pfizer at refrigerator temperature for five days and at room temperature for about two hours when you get to the dern vaccine. You're talking about thirty days in a refrigerator in about twelve hours at room temperature so there is a little leeway but not a lot like other vaccines. And that's peculiar to these. M rene vaccine's gregoire obviously working on our communication plan at mayo clinic. And our distribution plan and one of the things that i noted in some of the information that we're distributing is that they mentioned that people can feel ill after receiving the vaccine. And can you explain to us why that would be in. How long is it anticipated to last year. You're very right about this and this is something we have to be careful to educate people about if you don't warn them about the normal expected sensations and feelings that they'll experience they'll think it's something wrong and it's not when you give vaccines like this what you expect what you hope is that you're in munich. Chelsea this react to it they elaborate or secrete a number of chemicals called cytokines and chemokines which attract other immune cells so that you build a high antibody titre which in turn protects you that process makes you feel similar to what you feel when you're like quote starting to get the flu so we've all experienced a sore arm. Maybe redness swelling something like that but A moderate amount of people can expect to have a low grade fever headache fatigue. Maybe not feeling well for a few hours all of this resolves without any treatment it can tend to be a little more worse with the second dose but when you look at severe side effects. You're talking less than single digit percents. So these are indications that the vaccine is in fact working so i wouldn't be afraid of it I'd be more concerned if you felt nothing absolutely at all. Well that em gave me a follow up question for you. That i'm sure some of our listeners mites out wonder as well if you have the site types of symptoms with shout sound a little bit like cova did symptoms. How do you know if you should go to work or if you should get tested for covid yeah. This is a really practical question because particularly for the workplace. You don't want to give everybody vaccine all at once. Have confusion light that. Remember some people just by chance alone will be developing code bit right so it depends on if you're if you're developing a cough shortness of breath fever loss of smell or taste that would put it into a high index of suspicion about kobe. We send those people to go and get tested but the sore arm low grade fever without a cough without a sore throat without loss of smell or taste. That's a vaccine expected side effect and not to worry about that now. There are some people for example in professions. Where maybe a sore arm would be detrimental. Let's say a surgeon for example that may be somebody who wants to take a vaccine on a day when they're not operating the following day because these side effects are very transitory. They don't require treatment. They last a couple hours to at longest about twenty four to thirty six hours. That's good information to have going into getting a vaccine greg. While people who have had documented cases of covid need to get back separated. My sense is yes now. We don't have a lot of data on this. Frankly and part of the problem is we don't have large scale numbers of people of different age of different With different medical problems to know win will their antibody titre start to wane such that they become infected. We certainly know of cases of people who had documented cove. Ed and then some months later were reinfected so we know it can occur for that reason alone. The recommendation is going to be immunized everybody nonetheless in in a time of shortage for example perhaps in some communities. They might say something like well if you had documented kobe and it's been Within eight to twelve weeks maybe will hold you until the next shipment of vaccine but right now. That is not the recommendation okay. I'm greg i noted the cdc has given some updates about the information that they share with the public about covid in one of them was regarding quarantine time. Could you explain that to me. I want to be very clear about what. Cdc is doing here what they noticed. Is that the best practice which is fourteen days of quarantine after exposure was not being adhered to so as a second best compromise. In order to increase compliance. What they're saying is if you had exposure and you had no symptoms but no test you can be in quarantine for ten days and then come out if you have a test than its negative seven days of quarantine now. Here's the key part. You cannot exclude with either of those levels of quarantine a risk as low as one percent to its highest twelve percent of still being still having kobe and being able to transmit it. So it's not perfect but it's up population levels strategy to try to get some level of quarantine people who are unwilling to quarantine for fourteen days. I feel like it just gets more and more complicated. Greg talked before about who who are your close contacts. And how long have to be around them for to be close contacts and same thing with the quarantine. It's it's getting a little complex you know and you're very right about that and and and that makes it here in difficult doesn't it. I think the the rule of thumb is this the more time you're around somebody outside of your family the more people you're around the greater your risk acquiring cova and people should not underestimate this. We are looking at over a hundred thousand americans currently in the hospital. We are right now. Approaching about one out of thirteen hundred americans have died of covid. This is common. It's extensive and it continues to surge so we need to take these things very seriously and dampen this curve down while so that brings us again it. We're still in the holiday season. And before thanksgiving you and i did a program where you strongly recommended along with the cdc that individuals not travel during the holidays or have large gatherings in their home of friends and family members. I imagine this still holds true for christmas. Which is rapidly upon us But the cdc now recommends that if you're going to travel that you are tested. I is this contradictory or And when you get tested before he travel you know it's it's a difficult public health and communication problem because the best recommendation to keep the most people the safest is do not travel do not gather even in small groups with people outside your family and your work. People are not adhering to that exactly. What we said would happen after thanksgiving is happening. We are experiencing a major surge in the number of cases hospitalizations and deaths that are occurring recognizing that. Cdc saying well. If you're not gonna listen to the best advice available the second best doesn't preclude you from getting infected but the second best is to say get tested one to three days before travel. Soon you can get your test result back in enough time get tested again. Three to five days later and then finally home quarantine for seven days when you get back now. Would you think the chances are that. People are going to adhere to a three stage process like that and yet we have been unable to convince the american public in the numbers needed. Certainly some people have taken it seriously but we have been unable to relate. Just how serious this is and what Having millions of people transit through airports does in the context of a pandemic greg. We have talked before about testing in that. Originally testing was for people who really felt that they were sick with covid or Significant concern it. Sounds like you're in. The cdc is advising that people who are symptomatic be tested are dramatic individuals able to get tests. You know it is different by locale so that. Cdc recommendation in a sense pretends that testing is widely available and that you could get it act in a period of time to actually be actionable. I just had a close friend who was exposed and it took almost seven days. This was another state almost seven days for him to get his result back. So obviously this isn't gonna work in a lot of locales that makes sense. This has been great information very practical. That you've shared with us today greg. Do you have any last words of wisdom. For us i am. I am beside myself in many ways. Who wants to be the last casualty of this pandemic and yet there's going to be many thousands who will be people who are parents are friends. God forbid our children but if we do not take this seriously the best estimate right now is that by this april one. In seven hundred americans will have died of covert and. This is unnecessary lease. Wear a mask. Please maintain distance. Just hang on a few more months. These vaccines are coming. We are very likely to start the first wave of immunizations before the end of this year with many millions of doses. Coming after that it's not worth it to not treat yourself and your health with the importance that it deserves so please take precautions. Please be are. We are at a stage that we are in many locations around the. Us we are now doing crisis care which is not state of the art best care. We have truman ill. People and too few healthcare providers one in seven hundred is a sobering number. But you've brought us hope today as well. We know that the vaccine is very very close. probably faster even than many believed it would be available yes and and these vaccines looked to be not only stunningly effective but safe. And if we can get these distributed out in when we have vaccines of this quality if we can get people to take them. We are going to see a resumption of normal activities. So it's actually counterproductive. To not wear masks and distance. It will prolong the pandemic rather than quickly. Get to what all of us want which is to be with our family and our loved ones in our friends and we will get there but with how much pain what is it. You always tell us greg. Hands face in space and space space. Think positive test negative wonderful. Thanks for being here. Greg closure our thanks to mayo clinic. Virologists and vaccine expert dr greg poland for being with us again today to give us some particularly on vaccines. I hope you'll learn something. I know that i did. And we wish you a wonderful day mayo. Clinic is a production of the male clinic news network and is available. Wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org then. Click on podcasts. Thanks for listening and be well.

cdc fda dr helene kozelsk Dr greg poland halina mayo clinic seventy four degrees celsius Greg Cdc united kingdom M rene vaccine pfizer kobe headache fatigue advisory committee on immuniza Us greg thirty six hours infectious disease cough
How flu vaccines can help in COVID-19 fight

Mayo Clinic Q&A

14:06 min | 8 months ago

How flu vaccines can help in COVID-19 fight

"Welcome everyone to Mayo Clinic Q&A. I'm dr. Halina gazelka and we were recording this podcast on September 21st, 2020 with follow-up ROM scene and winter just around the corner many are wondering how the covid-19 pandemic will affect flu season. In fact, some experts are even warning of a twin demek with the overlapping the ongoing pandemic and the onset of influenza in the northern hemisphere. Well here to discuss this with us today as one of our favorite experts. Dr. Greg Poland biologists and infectious disease expert at the Mayo Clinic. Welcome Dr. Poland tell me about this twin demek How concerned are you about a twin demek and why is it important to have a flu vaccination this year? Yeah. Oh twin demek is a is a termite coin some months ago and it got kind of picked up and it's it's really the Confluence as you very well said of layering in the context wage. It's covid-19 demek and influenza epidemic, you know, we have to realize that both viruses are spread essentially the same way. So we're we have them spreading. We will very likely have influenza spreading because they're spread in the same way and and generally speaking through the same Avenues. Now the concern about this is is several full one is diagnostic confusion the symptoms of covid-19 flew enza overlap almost exactly in their initial thoughts of the stations with the exception of the loss of smell loss of taste that would be very unusual and influenza. So clinicians are going to have to remember they may they're going to have to test out for both during our influenza season. And the reason for that relates to now the treatment side of things there are a growing set of treatments for covid-19. Licensed very effective antiviral treatments for influenza. So if we knew somebody had influenza, we would of course treat them. The third thing will be sort of the The Surge Demand on the medical system. We've seen that in some of our big cities haven't we just with covet in in the March and April May timeframe imagine adding an epidemic on top of that and finally from the pathology point of view, you know, you have a you have a respiratory virus that's essentially infecting the same organ the lung and causing complications. So for all of those reasons, we are pushing very hard pleading with people to follow what has been a CDC recommendation since February of 2010. And that is that every American age 6 months and older get a phone number. Vaccine for people that are age sixty-five and older just to reminder that there are two highly effective flu vaccines meant specifically for older persons. So this is a this is a really important message to to get out and I can see why this would be so confusing. I mean just with the onset of even upper respiratory infections or what we call a classic cold. Yes. I am these three things may be very difficult to distinguish. Absolutely Greg. When do you recommend that people in the United States get their flu vaccines? I'm very much an adherent in this case of the sympathy recommendations, which says that all influenza immunization programs should ideally conclude by the end of October. So the question has really been is there a time frame in which it's too early to get the flu vaccine. We don't have great data, but particularly an older people where antibodies log Will's don't start out as high I would say that in general from mid September. So, you know, basically the time frame we're in now ideally through the end of October. However, since most of our influenza outbreaks don't Peak until the February March time frame we get flu vaccine all the way through winter and log into early spring because you never know when you'll come across the case just in your daily life. Now, you've made me a little bit curious cuz I have always assumed that we get the flu vaccine whenever it's ready here. However, are there differences when you should get it in the US different parts of North America or even other parts of the world not so much in North America that recommendation would would be seen but your point about the southern hemisphere is is a very good one. Of course. Our winter seasons are just the opposite. So they're coming out of their coming into spring and home. Their summer as we go into our fall and winter now there's been a very interesting observation. First time. It's been observed in modern human history in those local channels and countries that had high compliance to mask-wearing physical distancing hand sanitizing they saw virtually no influenza. I mean this is remarkable and has never been seen before. So an opportunity we have in the context of this twin demek is not only to get our flu vaccines. But to remember these non-pharmaceutical interventions the mass squaring hand-washing physical distancing while they prevent covid-19. Reminder that we really can make a difference with just very simple tactics that will allow us to avoid use of medical care and and to be Elvis winter. Nobody. Enjoys break. How long does the flu vaccine last once we receive it? There's a lot of research still happening in that area. It's kind of an issue of what do we mean by last another words by summertime influential? It has pretty much faded away. So people aren't exposed to it. The only thing we could do would be measure antibody levels not whether they actually got the disease, but what we can say is that in your when you're older as you get over age 65, if you have a variety of medical conditions that decrease your immunity, your antibody doesn't start off his high after the flu vaccine. So it very likely Wings down faster. And that's why this recommendation of you know, get these done in the September October dead. Even into November plus time frame and that will carry you through when the peaks of influenza are in the u.s. I had a discussion this weekend with my husband who is also a physician about whether we should be wearing masks are Goggles or face shields in addition to wearing a mask. I had we had all she understood that you the droplets are what we're trying to prevent giving and receiving by wearing a mask, but there's evidence about I transmission as well as that true. And what would your recommendations be in that regard? You know, you're always right on top of it. As a matter of fact just Friday or this weekend CDC released some information agreeing with what many of us have been saying from the beginning that this virus can be transmitted not only by large droplets, but by the aerosol and smaller place Route. So in fact last week there was an article now it's an association but showing that people who regularly wore eyeglasses actually had a decrease risk in association with a mask of acquiring covet. Well, we know this on the medical side now we're we're in higher risk situations, but we wear a mask off face shield or eye goggles for that. Very reason. Well, the most important thing is a mask no question about it and sanitization masks and physical distancing is absolutely the best thing to do. Now. What if you're going to go into an airplane a store or a crowded area, I think wearing the face shield is another layer of protection and we notice that people are getting that message and starting to do that. I think that's even a little more foreign or odd for people to do so, they're not dead. Used to it. But if you said to me, what's the best protection I would say a mask and a face shield. So I hear you primarily saying that we'd be wearing the face shield and they or the Palm Coast to alleviate some of our risk of receiving covid-19 or behind infected with it. What about is it possible for a covid-19 patient to touch their life and then to transmit it from there I to someone else similar to coughing into your hand and then you know shaking somebody's hand you can you can certainly spread virus that long. So what we're trying to do with with eye glasses or goggles or a face shield is prevent those droplets from hitting RI our nose or mouth and not getting infected. So what is the latest that we know about reinfection with covid-19 are people getting it a second time is up and proven yet. What we have are a home. Fuller to of documented cases and I think we have to take that as sort of the tip of the iceberg. Let me explain what I mean and in the very first and I thought very well documented case of this young man in in Hong Kong. He had symptoms got tested by PCR proven to have Maddick what we don't know is well what happens not a few months but a year from now, will they be equally susceptible and this is an area of great research. We know off with SARS Covey one. We know with seasonal coronavirus is in particular that immunity can last as short as Eighty Days and as long as as multiple years so one important ramification of that is might that be true with vaccines. We don't know another important ramification is when people let's say get tested and their antibody positive or they had the PCR swab and they knew that they were positive. They should not presume that I'm home free. I can do anything that I want to they absolutely are at risk of getting reinfected and even if they don't have symptoms of potentially birth And submitting that to somebody else even though they're not sick. So this is this is an active area of inquiry it has as I say huge ramifications wage for how we think about this pandemic how we treat it how we evaluate our vaccines and how we get across to people this message. There is no such thing as an immunity passport. Is it possible that the vaccine that we will be looking at 4 covid-19 will be one that will need to be repeated sort of like we do with the flu vaccine. My guess is the answer to that will turn out to be yes or one very good reason and one potential reason the good reason is we already know even with symptomatic infection where you see the whole virus and produce an immune response to it that people are getting reinfected. The other potential reason is that this is an RNA virus and yep. A virus has inherently changed they mutate they have subtle changes. We've seen that with some of these persons who have gotten reinfected. I suspect that will be true of the vaccine and that will have to give periodic booster doses. How often no one knows because not enough time has elapsed, but that's an area of research for a future our thanks to Mayo Clinic virologist and infectious disease expert. Dr. Greg Poland. I hope you learn something today. I know I did and we wish you a wonderful day Mayo Clinic Q&A is off option of the Mayo Clinic News Network and is available wherever you get And subscribe to your favorite podcasts to see a list of all male clinic podcasts visit News Network. Mayoclinic.org, then click on podcasts. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at my home. Thanks for listening and be well.

flu vaccine influenza Dr. Greg Poland United States Mayo Clinic CDC Mayo Clinic Mayo Clinic News Network dr. Halina gazelka North America Hong Kong Palm Coast Fuller Eighty Days 6 months
How public health measures can help reopen the country

Mayo Clinic Q&A

14:39 min | 1 year ago

How public health measures can help reopen the country

"Welcome to Mayo Clinic. Cuna I'm Dr Sanjay ca-car and we're recording this podcast on the twentieth twenty twenty while the covert nineteen pandemic continues. Efforts are beginning to reopen the country. A move to a new normal that is guided by important public health principles with us to discuss the latest information as Mayor Clinic Infectious Disease and vaccine expert. Dr Greg Poland not to Poland. Thanks again for joining us. Pleasure all the news. This weekend is being about reopening the country and really starting the economy since we last spoke on Friday. What have you been seeing regarding trends Regarding numbers for covert nineteen when you look at it just since Friday. Today's Monday we've got about a hundred thousand more documented infections in the US and about five thousand more debts while they're starting to be some slowdown. We're not there yet. I I understand that. People are sort of tired of the social distancing. But we're just starting to see the fruit of those efforts from fourteen days ago. Let's not jump the gun prematurely. That's sobering statistics to here. She said obviously was trying to think about getting back to life as normal we can but as an infectious disease expert. What sort of principles do you think we should be adhering to us? We slowly start trying to reopen things. Sanjay that's actually a very good and an excellent question is it really puts the finger on all right if we're GONNA do this. Under what conditions do we do it? And they're really sort of of those one is that we need to see case load really bend down low. Which is an indication of decreased community transmission? Secondly we need the ability to do testing. And we're not quite area once we have that testing the ability to do contact tracing so that we can quarantine isolate remaining cases in the last one and this is a big issue Particularly for some of our major cities. You don't want to do that and less you have hospital in medical care capacity another words. You don't want to trigger. Something happening and again have surged a demand on the on the medical system. So when you say another surgery you talking about the second wave that we were hearing about it could it could either be that this fall or by opening prematurely increasing community transmission an increasing number of cases. That's what happened. For example. In Japan they sent their kids back to school. I think prematurely. That experiment has been done. And what did we see? Fourteen days later. Major uptick in cases again. You mentioned about testing and this. There's some confusion about testing. You know people think well if I don't have the symptoms. Why do I need to be tested? Can you just explain From the infectious disease aspect. Why is testing so important? It's important for two reasons the molecular diagnostic test. We have you here called. Rtp CR those are test designed to tell us. Are you currently infected or have the virus? So that's important because we we're gonNA want to isolate. Those recording team knows individuals. Not let them work for example in transmit to others. The other test is serology tests. These are tests done after the fact act to say were you infected in the recent past and might that mean immunity. Obviously the advantage of knowing that is you're you're not concerned about your own risk anymore and you're able to go back to work. Let's say you're a healthcare worker. For example you're able to go back to work and not have to use the same level of P P potentially so when we've talked about testing the pasta show. We we've talked about. She said the other serology testing. We've also talked about putting the nasal swab down But you know when we're hearing about. We don't have enough tests. What are we talking about it talking about those that we are talking about the finger prick test? What are we talking about? We're really talking about all of them. I neglected to say another important part about doing the serology testing is to know what percent of a community has been infected. 'cause that's really a key thing if we were to find out for example that seventy percent. That's not going to be the case but seventy percent of the community had been infected. Well you're getting up toward herd immunity and it's likely safe to do so but if it's more like five percents or ten percent you still have ninety percent of your population at risk. So if that's the case indeed and then we have an an uptick in cases if we go back to quickly. What do you see happening that you see us? Dan Rea instigating all these. Stay at home mortars distancing exactly and I and I think that would put us in a very tough position I would people really be willing to flip the switch that rapidly in basically start all over because of the lack egg period. Between when you get infected and when you start developing symptoms and then when you actually end up needing medical care so going premature in opening means we might start all over again rather than sustain this for another two three weeks. See that that case load really is flattened down and then in a phased way begin to reopen last week. We also talked about some of the promising news regarding treatment. An in particular rim disappear since we last spoke has been anything new. That's come onto the horizon regarding treatments. Yes Sanjin thank you for the question because I think this is a real bright spot About thirty minutes ago a paper was released on this is an NIH group. Excellent study where they took two groups of monkeys expose them both to SARS Kobe to at an appropriate dose and then twelve hours later started infusing rim disappear in the so one group got run disappear. One group Got Placebo in the group that got run disappear. Viral Tigers were dramatically suppressed. They didn't develop pulmonary infiltrates. They didn't die and in the placebo treated monkeys. None of that was the case. So I think we're learning to things at least in this. Small Animal Study reminisce. Aveer was very helpful. No no doubt about that. But the second point in it. And it's a significant point for US AS CLINICIANS TREATING. Humid's is that it's very likely as many of us thought that you're going to have to initiate that antiviral treatment as early as possible in the course of disease now. This is not unknown to us. This is exactly the case for influenza. We tried to get it in a antiviral drugs into influenza Patients within forty eight hours at most seventy two hours after they develop symptoms. So I think the way it's GonNa turn out is that REMM disappear will be useful but we're going to really have to push it toward the left. That is a very early in the course of infection particularly for people who have risk factors for complicated disease. That's very promising Indeed and last week we also explained that perhaps the most infectious with this disease before you actually develop any symptoms so it just shows how a how important getting early testing as applicable with possible treatment. Early may may be where we need to go with this absolutely in an also why this lag period between when you are infectious and then you're talking another fourteen days before you start seeing the consequences of that transmission to other people and that's why this is. This is a slow process in terms of reopening obsolete. We also talked about the other infections. That can happen. We'd cove in nineteen and the other pathologies we just mentioned about pulmonary disease What else are we? Learning regarding how this is affecting other areas of the body. It is very apparent that having one infection does not in some magical way protect you against another infection so you think about during the winter season in the United States for example depending on where you live. You're exposed to SARS Kobe to influenza A. Influenza B. R. S. The measles mumps pertussis human met ENUMA virus rhinovirus. Well that's about eight or nine right there and in this study what was shown is that about twenty percent of people who were coveted nineteen positive were also infected with another respiratory pathogen. That's important for a couple of reasons number one. A CO infection may may mean worse disease the other thing is that some of those other viruses and respiratory. Bacteria are treatable so we wouldn't want to just do a Kobe test in say positive or negative. And entreat a therapeutically based on that they have influenza and that's treatable they might have pertussis and that's treatable so we would want to know that and it's an important clinical facts bear in mind. Yes absolutely. It's it's interesting how you mentioned all of those viruses so as we obviously get through the summer and we go into the winter the flu epidemic will start again and so to prevent this. We talk about vaccinations. What is your message to the to the PA regarding the flu vaccine and whether they should be having that or not because that will be the most prominent respiratory virus that circulates we really do want people to get influenza immunized. As soon as the vaccine becomes available now we do not have a culture of that in the US in our highest risk patients which are the elderly. Maybe we get sixty percent of them to take the flu vaccine. An important part of that is that Kobe nineteen influenza symptoms. Overlap essentially identically. So it's going to cause the individual a lot of concern it again causes this surge capacity that the medical system can't easily meet so by getting influenza vaccine you're taking a good deal of that respiratory disease off the table so that we can concentrate on Kobe. Nineteen and you're decreasing the chance of co-infection meaning if you did get infected with Kobe. Nineteen you're likely to not have as severe course as if you also had influenza action. Instead of Poland. A lot of people will get the flu vaccine. But they'll push it off. They'll say well. I'll get it in February or March. What's your message to those people again? Because as we very likely as we move into our fall out we're going to start seeing cases of Kobe. Nineteen because of the burden of disease that will occur in the Southern Hemisphere. It'll re circulate backup. Here is almost certainly the case so I think perhaps uniquely in this regard will want people to get their influenza vaccine early and not delay as we're looking to try and get back to normality. We're entering the summer season. Schools are out families are thinking vacations at Cetera. As we've talked about how this disease process is the new norm now. What is your thoughts as as people try and think about these plans when I think is likely to happen in this is GonNa be a very is going to be a choreographed dance could is the way I would put it. Is I think as we get into our actual summer. We'll see cases decrease in some phase in normalacy. My fear and my concern is then as we move into the fall in wintertime in the US in the Northern Hemisphere. We're going to start seeing increasing numbers of cases and and the reason for that is. We won't have heard immunity. I guess is it'll be depending on the geographic five ten percent. Maybe something like that will have been infected but the vast majority of us will not have been and then very likely. We'll have another outbreak like what we've seen. So it'll be this slowly coming out of the distancing were doing now more more normalcy. Than if I'm right about the fall than phasing right back into the social distancing mask wearing maybe teleworking etc until we get through or develop a vaccine that can be used. You know while. We're all getting tired of this. I think we're we're getting a handle on this. We're learning a fantastic amount of scientific and medical knowledge has been generated. There's there's more to go but we're seeing really encouraging signs in terms of the patience and forbearance of changing our lives to bend this curb. Down is starting to work so let. Let's not not give up in addition we're seeing some real medical breakthroughs. I think in terms of these early studies with the Rim disappearance particular and I think this is going to give us a lot of motivation to start doing. Clinical trials very early in the course of disease with reminisce. Always a pleasure and an honor to speak to Dr Greg. Poland a Mayo Clinic Cove nineteen expert. Thanks for joining us today again. Greg Pleasure. You're doing a lot of good by educating appreciate it. Mayo Clinic Q. And A. is a production of the Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts visit News Network Dot Mayo Clinic Dot Org then. Click on podcast. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

influenza United States Poland flu vaccine Dr Sanjay ca-car Kobe Mayor Clinic Infectious Diseas Kobe Mayo Clinic Mayo Clinic News Network Mayo Clinic Mayo Clinic Dot Org Dr Greg Poland Mayo Clinic Cove pertussis Dan Rea Tigers Greg Pleasure
US tops 10 million cases of COVID-19

Mayo Clinic Q&A

15:03 min | 6 months ago

US tops 10 million cases of COVID-19

"Welcome everyone to mayo clinic. Qna dr helena gazelle. We're recording this. Podcast on november. The knights twenty twenty. Thanks for joining us today. The us set the wrong kind of records last week with exponential growth and grown virus cases. Hundred thousand in one day. This incredible surge infections is leading to increased hospitalizations in putting strains on the healthcare system here to discuss this with us today and to give us our weekly covid. Nineteen updates is dr greg poland virologist vaccine expert in infectious disease physician from the mayo clinic. Hi greg thanks for you bet you. You're exactly right talking about these records. I mean we are now over ten million cases with what almost two hundred forty five thousand deaths. That's one out of every fourteen hundred. Americans europe s surge there over ten million cases with slightly more death. So this is. This is not only a national problem. But a transnational problem that needs national transnet trans-national policies around us. You talked a little bit about current covid numbers. And there's also been some news in the world of vaccines pfizer announced. Today ninety percent efficacy for their vaccine. What's the latest on vaccine development. What does this mean and where do we go from here. What they're reporting is the very first sliver of their study goals. Which was what is the efficacy. Seven days. After the second dose. They're reporting by press release. We don't have any peer reviewed data yet. They're reporting greater than ninety percent efficacy. So we really need the details on that. But there's much more to come. Nobody cares if you will attack seen that protects you for seven days. They're gonna want to and they do have planned. What is it looked like it. Fourteen days one month six months twelve months and four months those will be the important and compelling data because it will tell us something about durability of that protection. The other issue is safety which we've talked about. We only have a modicum of early safety results. So we're gonna wanna see those as time goes on then a point that i don't think any other scientists frankly his thought of beside myself and that is this. These are efficacy. Studies being carried out in a world that for the most part is masking in distancing. Begging the question of what is the efficacy of this vaccine with mass off without distancing. I think that's going to be very important. Remember too that this is. A vaccine requires two doses. I am fairly reacted genetic. Twenty one days apart and requires an ultra cold chain minus eighty centigrade. So that's gonna be logistically difficult in the us. Probably a non starter outside of the west grad wine. Will we have answers to some of those questions. Like is it really gonna work and well at working real world conditions. The other thing to sort of think about here is that this is efficacy against mild symptomatic disease. We don't know anything about severe disease. Death transmission a symptomatic disease efficacy in children pregnant women highly immuno-compromised people the oldest of the old specific subgroups for example. The native american population has been very hard hit. I don't have the data yet. But my guess is if they don't have a large number of native americans enrolled into the trial. They do talk about fairly impressive diversity of thirty to forty percent so that will be important. We won't really know what happens until time goes on with these forty four thousand that had been enroll or until an or expanded access mechanism gets used and hundreds of thousands and millions. Get the vaccine and our follow. What would it mean for example. I don't know this but let's just do the mind experiment. What would it mean to have a vaccine that protects you for three months or six months against mild disease but not severe disease and a requirement at six months or twelve months or twenty four months to have a booster dose of the vaccine. Those are all things left to figure out about this very curious virus. Obviously we have a significant problem in the united states with this. And i'm wondering. Does this require an a national approach or strategy and what do you see as our path forward and the likely steps that president-elect biden will take with his task force we are now exponential in the number of cases exponential reality cannot be controlled absent one of three things either the virus changes in some way. So that it's less transmissible. We lacked down. The nation as europe and other countries are now recognizing they have to do or reinforce the way some states utah for example announced mandatory masking in an attempt to control this otherwise system will be overwhelmed and many more people than we ever want to think about are going to get seriously ill or die as a consequence. This is a national problem. That requires a cohesive national policy around it it also trans-national and we need coherent trans-national policies. The most immediate thing we can do is is what the science shows us distancing closing down environments where high rates of transmission occur wearing proper mask properly and probably restricting travel and other activities that we know lead to issue such as what we're seeing with burying viruses showing up in europe and then of course the last thing would be a winning if we have a highly efficacious safe vaccine that the majority of the population actually a super majority of the population would be willing to take in order to control this. One of the things that i was thinking of that has seemed different from I think even city to city in some cases and certainly state to state are mandated. masking policies. a believe some states still don't have mandated masking policies in public buildings. Some states are leaving it to local jurisdictions. What do you think about that. This is an absolute tragedy. this is not about politics. this is not about religious ideologies. This is about science. A mask is a simple thing to wear an a simple thing to ask people my opinion. We need a mandatory masking enforceable. The way it is for example in the uk a a great policy that was released just recently is the state of utah which had no policy in effect and they have recognized. What is an will will be happening to them. And they put into place variety of wealth off out measures. And we need to do that. Every state every locale as i say otherwise people are going to get hurt and you know halina because of your work is an anesthesiologist. You certainly have seen this. When you get into mass casualty type situations where the system is over. Well were talented. Goes up even with the same team. Same equipment same therapeutics because you can't give state of the art care to ten thousand people at once in a medical center you can only do what you have personnel and beds available for and much of this can be prevented by masking. It reduces the chance that you would get infected by over seventy ol- i mean that's a medication. We'd be celebrating the efficacy of this so we really do need a policy like that. We are now. We are now past contact tracing. There's too many cases to disperse throughout the entire nation. We need to take action. We need to take action now. In order to protect lives sobering reminder to wear masks social distance and clean our hands. And you know the the other thing we've talked about and it's hard. It's hard for me as a certain kind of what's been called covid fatigue and i'm very very concerned that that is going to be a major issue that will take us to the absolute unimaginable heights of this as we have kids returning from school as we have thanksgiving and christmas holidays and people are tired of cove it. So the sooner we get this thing Dampen down an inch the better. But another thing that i've been reading about in the news greg and i think you might have touched on it just a little bit earlier about mutations of the covid nineteen alad krahn virus and rather intriguing article that caught. My attention was a story out of denmark that some of the mink were being infected with covid and were were trying. And i'm wondering is that because of mutation what should we expect. Gen tweets expect to see more of that in animals a again. A very good question. There's there's some very large studies looking at a variety of different animal species to understand what species can indeed get infected and transmit it turns out that mink at least minkin the kind of conditions where they're crowded in unfortunately is An animal species. That is easy to get infected and transmitted mink mink and this is the important part. Mink to human. So what we're seeing not unexpected. All with aren a viruses is that you -tations genetic recombination occurs. This is not good. This is not good news or the field of controlling corona virus. Because all that needs to happen. Is he mutations which would either make it more transmissible. More severe or escape our current therapies or vaccines. I've written i wrote about this published about this Four or five months ago concerned that this very thing could happen. So we're going to need to keep our eyes closely on this yet raises this issue about transnational policies. You know when you look at spain. France ireland switzerland latvia. A number of those countries not only are cases surging but they are surging with two new variant viruses. Now that it causes any difference in the immune response or in the likelihood that a vaccine would protect. But we don't know that and all that needs to happen is multiple mutations in the wrong spot and one of these you. -tations is right next to the receptor binding domain in fact it seems to increase The receptor binding affinity with the two receptor many full. And if that's true that bears out that is not good news so we really need a policy that not only controls the pandemic in humans but also remembering this zoo and no cicis and it travels animal to human and human to animal now. I don't want our listeners. To be alarm does not appear to be the case in domestic animals like cats or dogs but in Out bread animal species that are being grown and are close together like like mink farming in unfortunately in denmark. You and i have talked before. About how amazing it is how much we have learned about the toronto virus it just in this brief period of time since january of this year. But how much more there is to learn because things keep changing and we keep finding out new information. And i think you know you and i are aware of this as scientists and physicians. But we're always thinking about what what is it. We don't know that we don't know what is it that's going to surprise us. Time goes on and we learn more and we don't want to be arrogant as physicians or scientists. We want to have an open mind. We want to be appropriately. Skeptical of essays of treatments of vaccines and see here reviewed data in order to understand these issues. That is the hallmark of good scientific method. Well greg do you have any last words of wisdom for us before we go today. You know. I never wanna miss the opportunity to say. Get your flu vaccine. If you are eligible for get your pneumococcal vaccine where your mask. Clean your hands and keep your distance. Its hands face and space. It's that easy hands face in space. No i can that straight. Thanks for being here greg. My pleasure think positive but test negative. I love that went bumper stickers. Aren't thanks to mayo clinic. Infectious disease expert corologis vaccine expert. Dr greg poland for being with us again today to give us covid. Nineteen updates mayoclinic. Cuna is a production of the mayo clinic news network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well.

mayo clinic Qna helena gazelle ninety percent dr greg poland one month six months Twenty one days symptomatic disease twelve months forty percent twenty four months europe greg Infectious disease Fourteen days us halina pfizer utah
Special Mayo Clinic Q&A episode: Dr. Poland answers listeners' COVID-19 questions

Mayo Clinic Radio

23:30 min | 1 year ago

Special Mayo Clinic Q&A episode: Dr. Poland answers listeners' COVID-19 questions

"Coming up on Mayoclinic. Qna Kovin nineteen researcher. Dr Greg Poland Answers Your Corona virus questions. I continue to believe 'cause we have not reached the peak of this yet. I think we are in for this over month not week. What should you disinfect? An how often should you do? You have a much easier job in your home with cleaning your hand after that. It is of course your telephone. Can you order? Take out food while you're sheltering in place takeout food and even ordering growth rates for Irish people is smart idea should we be reorganizing our summer schedules? Would I lie? Italy or China This summer no. What can we learn from? How other countries are combating the cove in nineteen outbreak? New Rochelle New York. They actually needed a containment area about one mile square and being a precipitous fall in case but it worked the answers to your corona virus questions my motto is. We really have to turn from a new culture to a leak culture next on Mayoclinic a welcome. Everyone I'm Dr. Tom. Shy and I'm Tracy. Mccray we are with Dr Greg Poland Infectious Disease Specialist Vaccine Expert at the Mayo Clinic for another update on the covert nineteen disease. Dr Poland good to talk to you again. Always happy to be here. Hopefully those. This won't last too long but we don't know how long do we know we built and You know as we've talked a bit Before there's this lag period between what we see and what happens two weeks from now so I continue to believe since we have not reached the peak of this yet nor have we seen the spread from the large EPI centers like New York and Washington happen with their full force to other area I think we're in for this month not week. We're recording this interview on March Twenty Fifth and the first question that we have is more a comment from a youtube viewer. Who said speaking of spread you and Dr Sides are too close and so just so that you know Dr Poland. We are no longer close and he has tape measure. Why are you not practicing social distancing one recording and you know what that is a good question and we are we miss for not practicing what we preach even watched. You guys didn't enter my mind too that betting and Tracy sometimes forgets that. I'm at high risk for this. Covert nineteen. She stays over there. I stay over here good question. Thanks for alerting us to that. All Right Fifty. Five thousand cases so far twenty six thousand of those in New York eight hundred and nine deaths about what you expected yet. That's a case fatality rate of about one point three or so percent very different than the world which is four point five percent very different than Italy which is closer to eight percent so in that respect were doing well. The one thing that I do worry about is the idea that okay people have kind of been hunkered down or maybe a week or two and they're already starting to say well. Maybe this will just be another week. I cannot see I cannot be that that will be the case. We have not hit the peak yet. We have. We have longer to go with the and isn't the case that once we hit that peak then fourteen days. We have to wait or twelve days. We need to have some sort of timer in our head. You're thinking in the right direction but it it really works this way. It fourteen to twenty days after we see a sharp downturn or even elimination of cases. If you want to be really safe before you relax those restrictions all right another question from a listener. What items in my home or office should be disinfected? Yeah I think We'll we'll maybe start this way You have a much easier job in your home. Assuming nobody's infected with cleaning your hands when you come into your house so first thing you do is clear hand after that it is Of course your telephone. We touch our cell phones all day long. No matter where we are. We're probably contaminating the keyboard of your computer. Anything that you touch regularly the bathroom and spink Boston doorknobs in out of your home. Those are the those are the areas that are touched by everybody multiple times a day. Can you order take out food? While you're sheltering in place Dr Poland. Yeah And I actually think that takeout food and even ordering groceries for high risk. People is a smart idea. does it completely eliminate the risk. Nothing can or will but it diminishes the arrest and as we've talked about before what you're really trying to do is put layers of protection around you each one decreasing your risks that in Psalms. Your total risk is has low as you can easily drive it all right next question. Is it okay to eat in a restaurant? If you practice social distance thing I think the concern there is several. Fold Number One You have you have grabbed the door knobs to enter the restaurant. You have touched the table. You don't know about the silverware. You have touched a menu. You have somebody else Preparing and touching your food carrying it to you. I've seen waiters carry a glass of fluid To waiting People in the restaurant with their finger their thumb inside the glass So you're just you're adding risk when you don't need to address and then some areas of course. The the governor's or the mayors have shut down Restaurant in in person edict. Next question comes from someone who's thinking about summertime and wants to know if they should cancel their summer time travel plans. I think depending on what they're thinking of. Would I lie to Italy this summer? No or China now If they're talking about what we're going to get in the car and drive eight hours be you know My healthy adult child and grandchild. I think it's too early. No but I wouldn't necessarily put those plan Cancel those plans. I just put them on. Hold and watch and wait just pencil them in for now. Yeah all right way to put it next question. How long can the virus live on different surfaces and also in the air? This is a really good question. And let me explain the Roughly Twenty three studies. That have been done. The latest one that came out in the New England Journal week or so ago and and people have to be careful to interpret this. They put together. I realized conditions for virus conditions which generally don't exist and they have the chamber and Aris the lives of Irish again that does not reflect reality. What do you mean what I'd say? Era Celeste because the difference between Arizona's -Ation and droplets. Okay good really key principle. Erris the live virus is Small amounts of virus without the large Mucus Dropped are often carrying it that can float and stay in the air for very long periods of time that generally happens with water called Aristotle ising producing procedures for example when you're intimidating somebody or they're having a bronchoscopy or something like that the the common nested that is Causing transmitted virus in the population is large respiratory droplet. This these are the costs of the nieces Where you have virus carried on mucus droplets. You can actually see the droplets. We may not be able to Stephen. Against the backdrop. You could see them okay But but they do not float in the air and they drop quickly down to the ground. That's why the social distance thing. Ideally of six to ten feet work that now is that also why Measles is such so much more likely to be spread because it will stay in an aerosol in the in the air and not just on droplets at -olutely and in fact you know if the three of us were susceptible to measles and we walked into a room where somebody with measles had been eight hours ago. Likely all three of US would get that disease now this this idea of persistence on surfaces. So what the other twenty two studies have shown and the recent look at the Diamond Princess cruise ship is they found virus. Seventeen days after that cruise ship had been empty. We don't know if it was viable virus meaning virus that could still infect you but this is consistent with what a variety of studies have shown. Is that if you have somebody coughing? Sneezing symptomatic Kobe nineteen you. Can you can detect this on the surfaces of that room now. It's exquisitely sensitive to the proper disinfecting fluid that you would use to clean a room whether it's the dilute bleach sure Other approved disinfect. That so so it's a it's a key strategy in dealing with this because it is thought that this virus started in animals and then crossed over to humans. Our next question wants to know. Can Our pets get the virus and then transmit it to other people dogs In particular do have corona viruses but not the type that infect humans at least not commonly dogs actually have corona virus vaccine That that is made for that in terms of this corona virus stars. Kobe to that virus is not carried by our pets. We are not infecting our pets and our pets are not infecting up however out of an abundance of caution see did release a statement saying that if you have Symptomatic Co bid nineteen. You don't have to quarantine yourself from your pets but don't let the pet lick your face. Don't share your food. it's CETERA. Not because there's data suggesting risk but out of caution. Lassie sounds pretty safe all right next question. Can I get infected through a cut or open wound? There is no evidence of this being transmitted in that way. Nor are you going to in some way absorb the virus through your skin? This is why and washing and sanitizing works so well we're getting used to sheltering at home so this question Has To do with context. What is next? What'S THE MOST likely scenario? That is lies ahead of us. I think what we're going to see is More Institution of what we've seen around the world where countries and cities didn't take this history as they should had a major eruption in the number of cases and then just to use the term locked down and in two weeks started munition cases. Good example in the American context is new Rochelle New York where they actually made it. A containment area about one mile square is my understanding and they've seen a precipitous. Fallen CASES TOOK GUESS. What two weeks for that to happen but it but it works. I think we're going to start to see that in other areas of the US as this moves away from the two coasts and more and more into the center of the US. So here's a listener. Who has obviously listening closely? She says two weeks ago you advised us to use contemptuously appropriate levels of protection explained again what that means and does it still apply it. It not only applies but it is a dynamic or moving target based on the context. I is simple analogy. And then we'll apply it If you live in safe area of the country where I do Rochester Minnesota When I go to bed at night I locked the front and back door later one. I closed my first floor. Windows layer two and flip outside light on layers tree. That's all I need. If I lived in a in a more difficult area of the nation I might add layer for an alarm system layer. Five window bars. Maybe layer six the panic button. You get the idea. So what does that mean for us in the in the US again? Are you in a high risk or low risk situation and that can change over time? Low risk situation. Tell the work if you can social distance thing being sure in your hands or cling slayers two and three. Nobody comes in your home without him. Sanitizing layer or nobody comes into your home period. And unless it's absolutely necessary you just keep layering things on like that based on your particular context based on the transmission dynamics in your area recognizing they lag by two weeks or so. So you're sticking with that is your motto. You don't have a new one correct. Well the only knew it. I added more cultural and that is and we're beginning to see this. You Know Saint Paul Ramsey hospital up in the twin cities Among their greatest number of Er visit not Kobe. Nineteen it's mental health issues and my motto. Is We really have to turn from a mean culture to way week culture and you see that in a grassroots through healthcare providers movement where you see them in the hospital with the same thing. I'm staying here. You stay home. If it's every man for himself we will do poorly as history shows in pandemics. I'm to take care of my neighbor. I'm to take care of my community to help at any level that I can and if we all do that and if we all take care of each other we will do better together all right. It's not me it's we all right. Yeah next question. Do Surgical Masks help or not only do surgical masks help but a mask of almost anything helps now the the original reason that CDC and other organizations that don't wear masks is because they wanted to preserve those for frontline healthcare workers? But you can have an effective mask out of a folded over. Bandanna or handkerchief. The way it helps is in disregard it decreases the risk that you'll breathe in these respiratory droplets. That somebody else may have cost coughed or sneezed. And now you're breathing and it is a reminder not put your fingers in your eyes nose or mouth so from that perspective is protective now. It can't do anything against Aristotelian virus but that's probably not the primary mode of transmission air again. I think because they were. They didn't want people to go out and buy all the end ninety five and surgical masks because they were needed for healthcare workers think. That was the motivation behind that. Not Dia- Interesting Hell. Would you like to comment on the cure being worse than the disease thinking? Yeah I think this really get to cultural and personal values. What price a light? How much economic disruption for. How long can we take? What does it mean particularly for the most vulnerable members of our society who are often living paycheck to paycheck? This is where government comes in government is to do for the people what they cannot do for themselves. I'm fine I don't need anything but I know that there are neighbors of mine that do need help and we help them. How how far do you go with it? And how do you balance it? I think it is phased approach. You wait till the curve bent you. Wait till you start saying a great deal munition in case and then you wait two weeks more you begin to loosen restrictions. I with young people because there while they can still want occasion have severe disease. They are not dying up there and we watch weight we do it carefully the same way you might think of sort of the canary in the money's Mindset of you know you don't expose. Everybody wants to open up all the schools and colleges do it all right. Isn't it okay for people with no symptoms or who have tested negative to go back to work your difficult difficult question the no symptoms. You actually don't have any information It is apparent that ace symptomatic transmission. That is you have no symptoms but are still carrying the virus and can transmit it to somebody else does occur the more people you congregate in a building in a room in an area the greater the risk that you re spark that pandemic and start having cases. They get so. It's really important that we know that the other thing that's really important is that we. We begin to have very rapid tests to tell us whether somebody is immune even if it's in the short term so that they can go back to work in in particularly in essential job they can be frontline healthcare workers and responders. If I have a sick family member can I go to work or should I stay home? You should stay on you. Are you are risking. Other people by transmitting that disease I would say that if you're not in ential worker than than you need to be at all right next question the. Us and South Korea apparently had their first detected case of covert one thousand nine on the same day but it appears they have. They have flattened the curve and started the fourteen day timer. What can we learn from on how they have handled the outbreak? You know what the key thing that I know people bring up. Well you know SARS in in two thousand two wasn't like this. That was different. There was not a dramatic transmission. What drives this is that we do. Have people transmitting the disease? Who Don't know they have it and so win. If you really you have two choices in stopping this pandemic and there are only two absent antivirals and vaccines you either get everybody infected. In which case you will have millions in the hospital and Lou and and lose tens of thousands to hundreds of thousands of people to disease or you shut things down now. Both are disrupted both have closed or Kahn. Both are value judgments about what to do but if the goal is stopped widespread transmission. You say everything isn't essential or that is not a part of national security Supply Chain Hospital Workers Federa telework. We are out of time basically but I have one last question. Because I've been getting this on nonstop for the last thirty six hours and it's about Ibuprofen What do we know about Ibuprofen Safety? So we know a lot about. Ib program safety though not in the context of this particular infection so I do pro fin regardless those a context is a drug. That can cause water and salt retention. It can elevate blood pressure and can cause bleeding as well as kidney dysfunction. Now you take a drug like that into somebody with a viral infection. As it help or harm I think despite the warnings of WHO and the government of France. I think most of US scientists recognized there really is not any solid scientific data saying that that represents a unique risk in code nineteen now having said that the only reason to take a drug like that is for fever reduction. Muscle aches and pain uses. Peterman offen- are stapler all right. Well Dr Greg Poland Infectious Disease Expert vaccine expert. Thanks so much again for answering all of our listeners questions on the covert nineteen outbreak We'll be talking to you again soon. We'll look forward to that. But hopefully we'll reach the apex of number of cases pretty soon and number of deaths and start to go on the other down on the other side of the curve. We all go. Yeah thank you moment Mayo Clinic. Qna is a production of Mayo Clinic News Network and is available wherever you get and subscribe to your favorite podcasts to see a list of all mayoclinic. Qna podcast visit news network. Got Mayoclinic Dot Org. Then Lick podcasts. Thanks for listening and be well. We hope you'll offer a review of this and other episodes when the option is available comments and questions can also be sent to Mayo Clinic News Network at Mayo Dot Edu.

US Dr Greg Poland Italy Mayoclinic New York Qna Kovin Kobe Tracy Mayo Clinic China measles Mayo Clinic News Network Disease Specialist Vaccine Exp Ibuprofen youtube Dr. Tom Dr Poland Boston researcher
Why Is a Universal Flu Vaccine So Difficult to Develop?

BrainStuff

09:30 min | 9 months ago

Why Is a Universal Flu Vaccine So Difficult to Develop?

"Today's episode is brought to you by Mazda back in the before times before covid. Nineteen. Mazda invited a few of US IHEART podcasters out to drive there do see X. Thirty from Palm Springs to San Diego and trip encapsulates what I miss about traveling and being on an unfamiliar road feeling the grip of the curves enjoying the world is you only can from a car with the windows down in the music up their whole lineup of. Is made to be agile in sippy on city streets or winding mountain roads but roomy enough to bring long whatever you need for either or both their sleek outside and in designed to reduce distraction and give you the control and confidence to really enjoy the drive for more information on Mazda C UV lineup including the first ever see X. Thirty. GO TO MAZDA USA DOT COM SLASH IHEART and don't forget to explore their strongest options. Welcome to brainstorm a production of iheartradio. Hey grainstuff Lauren Vogel bomb here. Your annual flu shot protects you from some types of influenza usually the ones that got people sick the year before. But if a new strain of flu shows up, the shot may not work for it. That's why a holy grail of medicine is to create a universal flu vaccine. And a universal flu vaccine can't come soon enough especially for particularly vulnerable populations such as children, the elderly and the immune compromised. More than six hundred and fifty thousand people around the world die of seasonal influenza every year according to the World Health. Organization. Seasonal flu also costs the US healthcare system and society in general a lot about eleven point two billion dollars in two, thousand, eighteen alone. Of course, this is to say nothing about covid nineteen, which is caused by corona, which is an entirely different virus than multiple strains of influenza the 'cause the flu although some symptoms of both covid nineteen and the flu can be similar. Researchers are racing to develop the first corona virus vaccine though none have been successful yet these things take time. But we've had vaccines for the flu for years. So why haven't we developed a universal flu vaccine that could stop all future iterations of the flu the threat and impact are so great that it would surely be worth researchers time. It has to do with the fact that influenza is incredibly cunning. We talked with Dr Greg Poland spokesperson for the infectious. Diseases Society of America and professor of Medicine and Infectious Diseases at the Mayo Clinic in Rochester Minnesota. He noted the trillions of new strains of the flu can develop in mere minutes. Quote. You can hardly imagine a more promiscuous virus fortunately, ninety, nine, point nine, nine, nine percent of new strains don't have genetic fitness, they can't survive. However those that remain compact a pretty serious punch. Those survivors can either experience antigen shift or energetic draft. Let's break that down in aunt genyk shift unknown strain of the flu morphs into a novel strain that can cause a pandemic level flu event such as h one, n one and and influenza. This hardly ever happens there have been just four influenza pandemics in the last hundred years but what it does, it can be dire. The shift resulted in the H One n one influenza pandemic of nineteen eighteen sometimes called the Spanish flu infected five, hundred, million people and killed fifty million around the world. This was of course before antibiotics were available to treat secondary bacterial infections associated with the flu. Also vaccines were not around to prevent infection and lessons severity. But back? To shift and. Drift. In comparison to rare but dangerous shifts and genetic drift happens all the time with influenza resulting in many small changes to the virus, which makes it tricky for vaccine developers to mail even the annual flu virus squarely on the head. Holon said. So what happens is about a quarter of a million viruses are isolated every year and genetically sequenced to give us an idea of what's circulating it takes six months or so to develop and distribute the flu vaccine by that time, many of the strains have drifted to the point where they have next to no protection. meaning that one of the reasons you can still get the flu after receiving a flu vaccine is that the strain you get may have developed after the vaccine was created again, these things take time, but it's worth noting here that even mismatched vaccine is known to reduce the severity of flu symptoms and the length of the overall illness. So it's important to get the vaccine annually if you can. After all, it's better to be bedridden for three days than seven where worst tip and in the hospital. There are multiple roadblocks to developing a universal flu vaccine, but a number of biotech companies and academics are currently working to overcome them. A Poland explained that one idea is to develop broadly neutralizing antibodies to influence viruses that would ideally protect against every influenza strain. Let's talk a bit about how the influenza virus works. Simply, put the influenza virus is made up of a couple of types of proteins called H. Proteins and end proteins plus a stock occuren- vaccine's attempt to teach your immune system, how to hit the H. and N. proteins which are what the virus uses to attach to and infect human cells. The problem is that the exact makeup of those proteins drifts all the time By comparison, Poland explained the stock portion is relatively in variant. So the variant has been why don't we shift how we technologically make flu vaccines to the portion of the virus that doesn't shift and drift. Another complexity is that flu viruses only infect the most cells lining the respiratory tract apart of what's called the respiratory. Flu Viruses do not replicate throughout the body which is known as systemic replication. We also spoke with Dr Jeffrey Taliban, Burger Virologist with the National Institute of Allergy and infectious. Diseases. He said if you look at vaccines provide good lifelong immunity like measles one of the differences there is the kind of recall you get from a systemic infection is different and much better. There's something we're not understanding about how immunity at the Mucosal. Level, sets. Up. long-term immunity. This kind of protective immunity is hard to establish. We have to come up with ways to bolster the mucosal immune responses to give us better protection with these kinds of vaccines. So. In other words, a universal vaccine would again ideally help your immune system at the local level where the infection actually occurs, but we just don't understand enough about how that works in order to help. Once. This gets worked out. It could prove in the development of universal vaccines for other respiratory ailments like crazy virus. With any luck one or more of the numerous universal flu vaccine development efforts currently going on will pan out. Aversion developed by the pharmaceutical company seek is about to enter phase three clinical trials and DR in Burgers. Own Team is hoping to start human clinical trials on their vaccine in twenty twenty. Don't expect a universal flu vaccine to be ready to soon though as it's an arduous undertaking that requires a lot of trials to get FDA. Approval? It's a multi step process that ensures the drugs are safe and effective. Poland, explained typically takes ten or more years and costs about a billion dollars. We should note that in case of emergency do drugs cannon have been brought through the process sooner, but it takes again work and money. Today's episode was written by Elliott Hoyt and produced by Tyler Clang or more on this lots of other topics is that how stuff works dot com prince stuff is production of iheartradio. For more PODCASTS, my heart radio, visit the iheartradio APP, apple podcasts or wherever you listen to your favorite shows. Today's episode is brought to you by Mazda back in the before times before covid Nineteen Mazda invited a few of US Iheart podcasters out to drive there do see X. Thirty from Palm Springs to San Diego, and that trip encapsulates what I miss about traveling and being on an unfamiliar road feeling the grip of the curves enjoying the world is you only can from a car with the windows down in the music up their whole lineup. Of you is made to be agile in sippy on city streets or winding mountain roads but room enough to bring long whatever you need for either or both their sleek outside an in designed to reduce distraction and give you the control and confidence to really enjoy the drive for more information on Mazda C UV lineup including the first see X. Thirty go to Mazda USA dot com slash Iheart, and don't forget to explore their strongest finance options.

flu vaccine influenza Mazda Poland seasonal influenza US San Diego Palm Springs Lauren Vogel professor of Medicine and Infe Dr Greg Poland Holon respiratory tract Diseases Society of America systemic infection Minnesota FDA
Listener mailbag on COVID-19

Mayo Clinic Q&A

21:48 min | 6 months ago

Listener mailbag on COVID-19

"Welcome everyone to mayo clinic q. We're recording this podcast on november the second twenty twenty. Can you believe that it's november already. We've been receiving a lot of good questions and today we're going to open our listener mailbag once again and try to answer. Some of those with us is our favorite experts. On covid. Nineteen dr greg poland a virologist seen expert in infectious disease specialist at the mayo clinic. Welcome from greg your morning halina. Thanks for being back with us today. Well let's just jump right in greg with a question from a listener who is exercising has been very important to them during covid and has been exercising outside but now has begun to wonder. Is it safe to even be outside exercising. Do we need to be wearing masks. And how far apart would we need to be from other individuals while exercising if we were not wearing masks. No this is a really good question. And when i take very personally because i'm an outdoor exerciser First of all let me go kind of from the mental health side through the physiology in the epidemiology. The first thing is when you're outside and you're seeing nature and sunlight is hitting your. Is your brain actually releases some chemicals. That are very important to a sense of wellbeing. The second thing is you'll sleep better if you're outdoors and exercising the third thing. It's a bit of a problem right now in minnesota. But when you're outside you're getting vitamin d conversion in your skin. Vitamin d is to be an important factor in lessening the severity of covid nineteen cases. Two studies one in showing that a satisfactory levels of vitamin d decreased. Severity another study showing that people who were deficient in vitamin d had more severe cases. That's not a recommendation. To blanket take vitamin d. But to be aware of that now to the epidemiology part of it what the data suggests and it's this is really hard so i'm gonna have to by nature of this generalized. If you will are engaged in an activity where a map. A mask would not hamper your breathing. So walking for example. And you're around other people. A mask is a good idea. If you're out running in your near no one. There's no need to wear a mess. The question is how far are you in danger. Walking on city streets you could be exposed out in the countryside running or cross country skiing. You're not gonna be exposed. There are models showing that when somebody who would be a symptomatic but infected is john mccain ahead of you that his slipstream could contain infectious virus for as large an area as thirty feet. And that's i think probably stretching it a bit when you're outside and you have air currents but nonetheless that's what at least a couple of the models show so precautions are warrant warranted. I had wondered that too about the aircraft. I had heard that inside. Exercising is certainly would need to maintain a significantly absolutely at the beginning of covid nineteen or very close to the beginning of mayoclinic had distributed for monitors to employs and asked us all to begin taking our temperature before we came to work in the morning and certainly taking temperatures on patients from. What do we know about that. Currently is taking one's temperature still or is it considered a good way to screen for covert night. We thought that it might be helpful in the beginning. But that's because the cases that were identified were older people who had symptoms. We now know that forty plus percent of the cases are occurring in younger people. The vast majority of whom will be asymptomatic or minimally symptomatic. Now it's never a good idea to go to work or school with fever. That part is true but in terms of using temperature monitoring to identify those who might be sick with kobe. it's a losing proposition. there's benefit. Emily wedding in our family very recently. And my husband and i didn't have the opportunity to attend but The entire bridal party and many guests developed covid nineteen or tested positive thereafter. and so. i'm wondering. Would you say now about indoor gatherings particularly this thanksgiving coming close to. We need to avoid them. Do we need to mask Go for mass. What what do you think will if i answer this. I'm gonna end up being labeled the grinch that stole christmas. But you know what even covid can't steal the real christmas okay but let me say halina that your family's experience is in fact very very calm if you look at the major surge of cases around the mid west. It is being driven by a small family gatherings small friend gatherings and primarily the twelve to thirty plus year olds who mostly are symptomatic and then transmitted to older people who do develop symptoms. This is one of the reasons for the lags that maybe we'll talk about in a bit. So what do you do on the holidays while the safest thing to do and i know this sounds grinchey but the safest thing to do is to not have family. That's outside your immediate bubble or friends in any sort of indoor environment. What's the next best thing you can do well. Everybody wears mass adheres to all the public health protocols that we've talked about in when masser off they eat in different rooms or outside if that would be potentially Feasible this is gonna come up and likely drive a major increased surge in the us. with kids. coming home from college over thanksgiving and christmas. So greg what do you think about this idea of taking your mask off once you get inside i. I had a friend who went to a funeral in another state for very small. They kept the group very small But once she was inside the building they stated well. We're not going to require people to wear masks. She said i'm going to wear a mask. But what do you think about that. That after you're seated you can take your mask off such as in church her in another it. Just frankly doesn't make sense when you do that. And there's no black and white answer here but when you do that you are increasing the probability that if somebody is a symptomatically infected but spreading the virus that you will get infected and it's sort of a game of probability you don't know who's going to develop symptoms in who's gonna have severe disease or even die you can't you can you can make estimates but you can't with reliability pinpoint who's going to have problems so the safest thing to do is when you're around people outside your family when you're indoors with other people you are in a proper mask worn properly. The question about holiday travel is a natural extension of that. Is it safe to travel in an airplane or certainly car is safer if you're taking proper precautions particularly when you stop for food gas Lodging so you have to take that into account. An airplane is an interesting thing. And i would say. We have inadequate data right now. surprising that airplanes air travel has not seemed to be as much of a risk factor as i would have guessed it to be there. Several studies now showing even on prolonged international flights. That if somebody is on the flight who is transmitting the virus. But everybody's wearing a mask and the ventilation system is working properly. Relatively few people get infected. It's not that nobody does but less than you would have expected. So i think there are ways to do it safely. There's an entire protocol involve the safest thing to do is where a proper mask end of face. Shield which a lot of people are not willing to do but that is the safest way to travel if you must travel. I can definitely empathize with The question from our next listener my mother spent several years and assisted living facility. And i think all our hearts have gone out to those individuals who are elderly and haven't been able to have many visitors due to covid. I'm wondering and so is this listener. Should we go visit our elderly parents who live alone or grandma who lives alone or into those facilities If able that is really hard one. Isn't it my heart. Goes out to them to Particularly because index sort of an environment. You don't know what that person's longevity is going to be and you want to you know. Say your goodbyes etc. I would say the vast majority of assisted care and nursing. Home facilities are not allowing visitors. And the reason for that is. The amply demonstrated large outbreaks. That have occurred over and over across the country in these facilities. I suppose there would be a way to do it wearing a mask. A face shield getting properly tested in advance An coming from if you yourself are pretty much staying in isolation but my guess is the facility wouldn't allow it. We are moving into two holidays. That are very focused on food We often share meals of people on thanksgiving and christmas and our next listener is wondering. How do we eat safely with others. And a second part of that question. How does one safely prepare food or know that it has been prepared safely. Let me take the last part of your question. I this has come up a lot. I get a lot of email questions about the. We have no evidence it despite it being able to culture virus off some foods like frozen chicken etc. We have no evidence that that has actually been responsible for a case or any sort of an outbreak. So what i would say is what i would have said. Two years ago asked me that question. Follow the standard precautions for good kitchen hygiene in terms of not using the same plates and and utensils for handling wrong meat and then taking it off grill with that same fork or anything like that being sure. Things are well caught so i. I really don't think that's the risk factor. The risk factor is each other so the ideal thing would be. And i know i know it's not ideal emotionally but it would be to either outdoors or in separate rooms if that's not possible you simply have to accept that you are accepting risk for everybody in that room and there. There's just no way around that. There is no mass you can leave on and still eat so it's really really hard to to give advice. That says you're gonna be safe if you do this The fact of the matter is any indoor activity with masol off from outside your immediate. Hubble is a risk factor for infection. And so i know i've sort of said that people particularly when it comes to people you have to think through. How much of a sacrifice is it really to forego this one year. We hope in order to keep everybody safe. My daughter had a nice way of saying it might be the best gift you can give do. We need to be certain that the people preparing food or wearing masks while they prepare it or is that not necessary you know. I don't think. I don't think that's an i mean. Clearly if they're sick they shouldn't be preparing food. But otherwise. I do not know of any data that suggests that food itself could be the career of a high enough viral load to actually infect somebody i it must be your radically possible but there's not been any documentation of that. I actually heard of a very creative idea. Greg that Bad i share with you on our listeners. You know so often. At this time of year we have worked parties so we may host in a department A dinner or something along those lines and in this particular department at male individuals had been able to order food from delivery service that just one of the delivery services that are available and they could get from any restaurants that they that they selected and then the entire department sat on a zoo meeting and enjoy their meal together. I thought that was a really neat idea. I just had my. It's hard to believe my fortieth medical school reunion and we did it. Virtually anyways delightful. I mean it's not the same as being in person but we probably had more people because one had to travel everyone was safe And it was very enjoyable and a good option for families to particularly if they're states away or they're trying to lessen the impact of being what my is doing for thanksgiving and christmas. This leads into something. That's a little less pleasant. But i'm gonna. I don't think i'm going out on much of a limb here. But i'm going to say one way we are now exponential and that's just the fact we have now exceeded almost two hundred thousand cases in one day this this past weekend as we face these all holidays. My concern is that this will spiral out of control and outside the ability of most healthcare systems to manage it. Healthcare providers are exhausted. This has been a long nine plus months and to now have an overwhelming surge with these kinds of numbers is greatly greatly concerning. I wake up at night concerned and worried about what this is gonna mean so you and i have talked many many times really the way i would put. It is pleading with people. This is science. This isn't politics or religious ideologies or personal preferences. This is science. Wear a mask maintain your distance and get a flu vaccine in. We now have again. We've talked about it. We have the first case of co infection with kobe. And this year's current flu strain in san francisco and that not a good sign. That's all very sobering in the future. We'll probably touch on what it looks like when someone gets the flu and covid when we know more about it you know it. Wasn't that long ago. Greg that our listeners were wondering what to do with their kids going back to college and now we're sort of looking at the reverse and listeners are asking what do i do. My kids usually come home for thanksgiving. They want to come home for thanksgiving. How how do we manage that. We feel the same thing. We've decided not to do that. But if your family decides to do it the there are things you can do. One is we could make a protocol available but the basics of it are that about eight to ten days prior to coming home and this entails personal sacrifice for everybody to be safe he to ten days before that young adult is gonna come home. They agree to quarantine their classes are online. Even though they're physically president college they're not seeing friends. They're not going out two to three days depending on. How long local testing takes they get tested. They fly or drive home under the proper protocols they get home they wear a mask for the first at least several days if they develop any symptoms they get quarantined isolated and tested. And you. You just do things like that. In order to decrease the opportunity and the probability that somebody is a symptomatically infected and spreads it to the family. I've just the nature of what i do. Is i get called by many of our colleagues and listeners and others and the stories are sometimes heart-wrenching over what happens they would do anything to unwind that story. But you can't once it happened so you know at an ounce of prevention truly is a better than days in a hospital well. Our next listener has a question about how to keep her family going with the appropriate measures. Um we hear so much about this covid fatigue that we're all getting sick of wearing masks and doing those public health measures that are important. What will be the signal to us. At some point that we can let our guard down and that we can begin to less than some of those restrictions. What are we looking for. That's a really good question and it depends a lot on context so for example. We have ample demonstration now of locations or countries that have shut down because they reopened too early. They have shut down melbourne australia. For a hundred and eleven days until they had zero cases new zealand has done the same thing. Thailand thailand taiwan. Europe is about to have a major shutdown. It works it works because it is people mixing that continues these infections. So if we did that that would be one signal if we got everybody to wear a proper mask properly that would work because we would see infections. Just spiral down to next to nothing. The third way would be a vaccine so if we really did get a highly efficacious vaccine that high numbers of the population would be willing to take. That would be another way out of this. And the last way out is sort of really second or third best and that would be the development of antivirals that we knew were highly efficacious so that we could treat people right away as soon as they had infection. That's more distant hope but the first three. I think our way out of it likely. That won't happen until the fall of twenty one or even into twenty twenty two okay good admonition to keep pushing on with What we know we should be doing great. Our last question is kind of a fun. One of our listeners. Read that mouthwash may help prevent the spread or less than the spread of covid nineteen. I assume they mean alcohol based mouthwash. Is there any science behind this. You know interestingly enough there is the turns out mercifully that this particular strain of corona virus as all of them are is a has a lipid envelope and for that reason detergents alcohol anything like that readily disrupts that membrane n inactivates the virus. So what's been done are not studies of transmission but studies showing that viral load in the throat can be dramatically decreased by over ninety nine percent with at least thirty seconds of contact with an alcohol based mouth Washer gargle whether that would transmit into decrease illnesses complications in transmission remains to be seen. But the way i think about it it can't hurt the next logical question which is coming from me and not a listener wine or a mixed drink offer the same benefit. Nobody has studied that. So i don't know we do know that. There are health benefits from a one glass of red wine. Maybe to more than that But hard alcohol. I know of no benefits Are thanks to infectious disease. Expert and biologists. Dr greg poland for being with us again today to answer listener questions and thanks to youtube for joining us on a busy monday to get our week started off right. Mayoclinic is production of the mayo clinic news network and is available wherever you get and subscribe to your favorite podcasts. To see a list of all male clinic podcasts. Visit news network dot mayoclinic dot org. Then click on podcasts. Thanks for listening and be well.

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