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Vaccine, Florida, Coronavirus The Weekly: Central Florida doctor talks COVID-19, vaccine distribution

This is the weekly on clickorlando.com, with justin warmuth good morning, i’m justin mormouth, while the vaccine has given us hope, the coronavirus continues to surge across the u.s. Dr kenneth alexander with nemours hospital is here this morning to discuss getting vaccinated the new variant of the virus and when we can finally put the pandemic behind us just trying to find a way to kind of start this, and i think we should just start with The current state of the pandemic and uh the current surge uh in cases hospitalizations and, unfortunately deaths um. How long do you think this surge will last? So this is a very important question and there’s good news and there’s bad news. Of course, we’re all looking at the the numbers reported from the cdc and from the state, and we are certainly in a surge, the numbers are exceeding what we saw earlier in the pandemic. The good news is is that if you look at a lot of the predictive models, things in terms of new infections are as bad as they are going to be for the foreseeable future. The downside is that the number of deaths usually follows the the surge in infection by about two weeks. So in florida we will continue to see a climb in the number of daily deaths over the next two weeks, and then the predictive models are suggesting that, after that, it will gradually and underlying gradually begin to tail off.

Is it shocking that we are seeing uh this surge in cases and everything like that after the holidays, when people were getting together, i think it was predictable in many ways, there’s been a change in the way uh the disease is transmitted early in the pandemic. We saw people getting infected at work. We saw people getting infected in public places. Now what we’re seeing is people are getting infected from family members and in places like restaurants, so as we’re coming off the holidays? In fact, what we’re seeing here was, unfortunately predictable? Um, you know we’ve heard the the term herd immunity um being tossed around. Is that something that will likely happen this year? Do you think the herd? Immunity is a fascinating term? Of course, what it means is you get enough people who are immune that the virus or an infection in the community sort of peters out, because there aren’t enough susceptible people around. Will we see herd immunity this year? As we move our vaccination numbers up, we will see a gradual increase in herd immunity. But if you look at the mathematics behind this infection, it looks like we’ve got to have about 60 percent of people immune so right now, we’re, probably in the united states somewhere around 12 to 15. So, if we’re looking to achieve herd immunity purely on the basis of infection, we’ve got to go through what we’ve been through three more times. This is why the vaccine is so important.

My prediction is that we won’t get over the 60 percent mark until sometime in 2022, but it’ll all depend on how eagerly people accept vaccination. You know so many people have have heard that hurt immunity and trying to achieve this, but there are also issues that come with herd immunity and obviously one of those issues is death. Can you talk about some of the issues that you have with trying to achieve herd immunity? So if we achieve herd immunity, it can be achieved in two ways, of course, just people getting wild type disease and then becoming immune or people becoming vaccinated and becoming immune. That way, the trouble with getting wild type disease is, of course, it carries its cost. People end up in the hospital people, end up dying and so that’s a tough, tough way to get hurt immunity. The other problem is, we don’t know how durable immunity to natural infection is. Does it last for months? Does it last for years we don’t know yet the flip side is the vaccine, where the vaccine gives you a bit of a sore arm. No, no doubt about it. I’Ve had my two doses and my right arm is a little sore today, but true beats the heck out of having covid, and we know that my antibody response, everybody’s antibody response to the vaccine is very, very good. I suppose the other challenge here is it’s a question of timing. We all want to get back to our lives, pre pandemic.

I want to eat in restaurants. I want to go see families it’s taken us a year to get 15 percent of people infected. So if our goal is to get to 60 that’s going to be several years where, if we can vaccinate it’s all dependent on how quickly we vaccinate right, the vax, the vaccination rollout has had its challenges. No doubt is this: how you expected it to go as we as we kind of go back to december and now we’re a month into it, give or take. Is this how you expected it to go rolling out? Vaccines is always tricky business and it’s a it’s. A complicated process that begins with the manufacturing process, the delivery process and, of course, a lot of it’s a marketing issue as well so i’m, not surprised that there have been sort of bumps along the way. This is a learning process. We have to remember that we haven’t done this kind of immunization in the community almost since polio days. So this is a new thing for us. I think we’re learning we’re going to get better 65 and up uh, plus healthcare workers plus first responders, and also people living in assisted living facilities and long term care facilities. Those are who can get vaccinated right now, um doctors as well – and is that too large? Because i, i think that a lot of people have an issue with alf and long term care facilities are not fully vaccinated, yet 85 plus are obviously based on the research and the data the most susceptible to this virus and and the effects it has, and so The rollout has focused on a lot of people, in other words, should the 85 plus community and people living in long term.

Care facilities have already been vaccinated by this point, this is a discussion. That’S actually happening at the national level. How should we prioritize – and of course, there are many voices at play here? There are people that say well. We should immunize healthcare providers, because this is what it’s going to take to keep the hospitals open. Should we immunize people over 65 first, because those are the people that end up in the hospital – and this is part of the science and art of of public health and different states are, are doing it different ways. The cdc has some recommendations. Florida has an executive order on how we’re going to prioritize so it’s going to be interesting to watch all this roll out and see how it goes. So you know someone sees how the the vaccine affects one person this one off case of someone, maybe going to into anaphylactic shock or their body reacts in a certain way, and thus they are now worried about getting the vaccine themselves. It it’s such a small percentage of of of cases where someone reacts in a certain way. Can you can you put that into perspective uh, possibly certainly happy to so you’re, absolutely right, the adverse events, the serious adverse events are very rare uh. I mean the very fact that these severe allergic episodes make it into the newspaper tells you how rare they are but there’s another way. I want people to think about this.

There is it’s it’s like risk benefit right for you to get in your car and drive to the grocery store. There is the definite tangible benefit that you’re going to get groceries for the week. There is a small but real risk that you will die in a flaming collision on the way to the grocery store or back, and when we look at vaccination here, what we’re doing is comparing the proven real benefit of you not getting covet 19 with the very Rare and often theoretical risk of something bad happening coming up. Dr alexander will explain what we know about the new strain of the virus and what it means going forward in the fight against covet 19. stay with us. This is the weekly on clickorlando.com, with justin warmuth. Welcome back as more and more people get the pfizer or moderna vaccine, other companies like johnson and johnson are hoping. Their versions will get fda authorization soon and while we’ve seen the demand high. So far, health officials are still concerned not enough people will get vaccinated once they have the opportunity. I talked about that hesitancy with nemours hospital, dr kenneth alexander, as more vaccine becomes available and and some other companies hopefully get that fda approval and a wider audience. A wider population will be able to get the vaccine. There are still going to be those folks who are hesitant to do so, and so, as someone who has received both doses, what would your message be to those folks who might be hesitant so two parts to that answer? A certain amount of hesitancy is normal.

You know accepting vaccination is, is not unlike buying a new car or or perhaps that new uh that new iphone some people want it. The minute it comes out. Some people want to wait for a little while to see that there are no problems with the new model gear and some people aren’t going to buy it until the third or fourth model year. So this is this is part of of human nature. I think the important thing is that we remind people to keep considering vaccination, to turn it around and say. Well, why did i choose to accept vaccination? A number of reasons to protect myself, to protect my family, to protect my patients, but equally important. I want to get back to the lifestyle that i had in 2019. I want to be able to go to restaurants. I want to be able to go to the movie theater. I want to be able to go to concerts and then, as i look around at our economy, especially here in central florida, i have a lot of friends that work in the different theme, parks or or drive for uber, or this kind of thing and they’re all Out of work – and so i think, it’s also important – that we realize that accepting vaccination is patriotic. This is what we do to get our country back up and running the way we want it to be on the topic of vaccines, pfizer moderna, both approved and they use mrna.

Let explain that to the viewer in the best way possible and how these vaccines might differ from other vaccines that that they’re used to or or accustomed to seeing. This is very exciting technology, these mrna vaccines, so the first kind of vaccine and the most common vaccine. As we have are, are essentially protein vaccines they’ll either take a whole virus and kill it or they’ll. Take a subunit from a virus and purify a specific protein. Give that to somebody we mount an immune response and we are protected. The trouble with that technology is that it takes years to develop and we didn’t have years here. So what the moderna and pfizer people have done is used an already existing technology, it’s already well studied, where they take a little piece of messenger, rna and you’ll. Remember that messenger rna is what your body normally uses as a blueprint for proteins. So, instead of this piece of messenger rna coming out of our nucleus and into the ribosome to make a protein here, what we’re doing is we’re giving that mrna blueprint to the ribosome and it’s making a small amount of viral protein. In this case the spike protein and then we are making antibodies to the spike protein. So in many ways this is probably the most natural form of immunization you can think of, because we’re using the body’s own machinery to make the protein are the other ones down. The pike that are still waiting on approval using that same messenger rna are those.

Are they messenger rna vaccines? There are a variety of other mechanisms in the pipeline. There are some companies that are doing the more traditional protein vaccine, where they’re, making a purified form of the spike protein and we’ll make antibodies. To that there are other companies that have made attenuated forms of the virus, essentially crippled the virus so that it doesn’t replicate. Well and shouldn’t make you sick and then there are other people. Other country companies, rather who have have made virus carriers, essentially non pathogenic viruses that will express the spike protein so that, in the end, they’re all going to the same point. They’Re making or helping your immune system make antibodies to the spike protein. And we know that spike protein antibodies are what protect you. So, as i put a button on on the moderna and the pfizer vaccine, just what is improved right now, the bottom line is, you can still become infected with cobit 19, but it will not have the same effects on you correct. So we’re still learning about this, but you’re right, there’s, a truism in the world of vaccines that vaccines, don’t always prevent infection, but they attenuate disease. In other words, they don’t 100 percent, keep you from getting infected, but they 100 percent keep you out of the hospital, and this is what we’re, seeing with pfizers and modernist vaccines. Now data are now coming out that, in fact, these vaccines also prevent asymptomatic infection. So watch this space there’s going to be some exciting news in the weeks to come.

Looking forward to that uh, this new strain and people see mutated and it freaks them out right. I we’ve dealt with one strain and that’s seen that’s enough, but the second strain of covet as we’ve seen some countries really dealing it with it worse than we are currently right now. Why is this second strain concerning to you? They have seen these new or or maybe the word better than mutated – is evolved. Strains of kovat, both in uh first identified in in the united kingdom, and also identified in south africa, and these are strains where their real difference is that they are more infectious. They transmit more effectively, they don’t cause more severe disease, but they transmit from person to person more effectively and, if you think about it in terms of a viruses goal to copy itself, that makes sense right that’s. What a virus should try and do is transmit more effectively, so this doesn’t come as any great surprise, but there’s two bits of good news. One. These viruses don’t appear to cause more severe disease and number two. They still appear to be amenable to prevention by the vaccines that are under development and that we have available. I want to. I want to ask you about children and obviously that’s your specialty and cases among children and we’ve. We have seen cases we’ve reported on cases of kids needing to be hospitalized because of cobenite. What are you seeing? What can you tell us about this virus and how it affects children? Here we have some very good news.

In florida there have now been over 150 000 children diagnosed with covet 19 infection and, given that huge number it’s very impressive, that there have only been nine fatalities, so children are at the exact opposite end of the spectrum of the people over 85.. Kids, do really well, and so what i tell parents, when they’re thinking about getting vaccinated, focus on the adults same way for schools when kids go to school, the kids are going to be fine focus on the teachers and the adults in the school environment. Kids. Do great now what we’ve seen in the hospital are a few kids with acute covet, essentially like an ammonia? What we’re, seeing more commonly are children with this mysterious post infectious inflammatory syndrome, multi system, inflammatory syndrome in children or misc, and at nemours we’ve seen about 20 of these kids so far, and the good news is that while many of them come in very, very sick, Many of them ending up in our icu, all of them have gone home and have done well. My thanks to dr alexander for his time this week for the latest information on covid19 and vaccine distribution just head to clickorlando.

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