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Dr. Rai on vaccinating seniors and the immunocompromised

Published: Dec. 22, 2020 at 7:37 AM CST
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GREEN BAY, Wis. (WBAY) - Seniors who do not live in assisted living have been asking why they are not in the first phase for the COVID-19 vaccine. Prevea Health President and CEO Dr. Ashok Rai explained how the phases work and the overlap.

“There’s supposed to be an overlap between [phase] 1A, 1B, and 1C. So they’ll kind of all be happening around the same time, and hopefully very quickly as the government continues to roll out more vaccine. 1B, we found out this weekend, was those who are 74 and older and a smaller list of what’s defined as essential,” says Dr. Rai.

Dr. Rai joined us Tuesday on Action 2 News This Morning where he talked about the new strain in the United Kingdom and answered questions about Bell’s palsy, diabetes and those who are immunocompromised.

Dr. Rai joins us Tuesdays and Thursdays. Have a question? Email news@wbay.com.

Watch previous Dr. Rai segments: https://www.wbay.com/health/drrai/

NEW STRAIN IN UK

A new variant of the COVID-19 virus has appeared in the United Kingdom. Has it reached the United States?

“There’s probably, statistically, the chances are it’s gotten here. We have no proof of it yet. The CDC’S obviously doing surveillance and all of the labs that test for COVID to see if they find that variant. It’s important to know that we’ve been looking for variants since the first strain, which we don’t even know if it’s an original strain, came to the United States, and we’ve seen variants throughout these 10 months here.

“It’s important to remember the virus is a small piece of genetic material and it lives by replicating in humans. It grows and grows and replicates, it basically is reproducing very rapidly, creating opportunities for basically a genetic mistake, which is a mutation, a lot more than other cells would. A lot of these genetic mutations are nothing. Some actually cause the virus to be less infective or to die out. We haven’t seen that yet. In this case, it’s presumed, and it’s still being researched, that it lets the virus spread more quickly to other people. It doesn’t make it more deadly or more infectious, but it may spread a little bit more. Right now, it’s presumed, based on the research, that the vaccine should still be effective against it. Both companies [Pfizer and Moderna] are testing and the UK is doing a lot of testing right now.

“It’s hard to even know when you look at some the UK data, and I think people are diving into that a little bit more, because they were loosening up their restrictions. So was the virus spreading more because people were loosing up restrictions? Or because of the mutation? Probably a combination of both. We’ve said this since the vaccine came out that our biggest concern is people would let up. They’d get to the goal line, they would slow down and they would put the ball down waiting for someone to knock it out. We cannot slow down right now. That’s the biggest issue, and I think we saw some of that in Europe and the UK. Now they’re getting more serious about it. We can’t stop being serious about this until we have a broader acceptance of the vaccine and more people have been vaccinated. That’s not going to happen until mid-summer or even beyond that. We need to be very vigilant during that time period.”

VACCINES AND LOCAL HEALTH CARE WORKERS

The goal is to get local health care workers vaccinated by Jan. 24.

“We know what our allocation is. We know how many people we submitted that work for us that we want to vaccinate. We started Wednesday with 20 people, and then we ramped up a half a day on Thursday, full day Friday, half day Saturday, full day yesterday, so we’re a little over 800 people vaccinated so far, so we’re pretty happy with that in that timeline. Now it’s just continuing to ramp that up. What we’ve said time and time again to our people and to the community is that this our dress rehearsal for vaccinating everybody else. We literally are learning something new every day on how we can do it better.”

WISCONSIN TRENDS

There’s been a decrease in the number of positive cases and tests in Wisconsin. What should we read into this?

“It’s important to know that it’s Tuesday, so the Monday-Tuesday numbers are coming out of the weekend where testing volume is lower, and because people are not getting tested as much as they should. They are ignoring simple symptoms that likely are COVID, and we’re starting to see more spread. That’s why that percent positivity is not coming down, our total numbers are staying up there. We need more people to get tested and stop ignoring the symptoms.”

KIDS AND COVID

“I think it’s really important to remember not to ignore the symptoms in your kid. That runny nose should get tested, and I think a lot of people have been under testing children, thinking they’re going to do fine. And generally they will do fine. But they spread it. They spread it just as much as adults. And it’s really important to get them tested, to be vigilant. They need to mask, they need to distance, too.”

SANTA GETS VACCINE

“This is at HSHS St. Vincent Hospital. We made sure Santa would be safe for this week and get his first dose of vaccine in and be good to go.”

BELL’S PALSY

Does the COVID-19 vaccine cause Bell’s palsy in some people?

“So far when you look at the studies, and there was actually Bell’s palsy observed in people who actually were in the placebo group. The placebo group are the ones who actually didn’t get the vaccine. When you look at the actual numbers of Bell’s palsy cases in the vaccinated group and compare it to the normal incidents of what you’d expect Bell’s palsy in the population, it’s about the same. So there hasn’t been a direct tie to Bell’s palsy and the vaccine. There’s been an association because they saw a couple cases. But we generally would have seen that number of cases in the general population. It’s something to watch for. Most people with Bell’s palsy do recover. It’s an important thing to talk about, too. But right now we don’t think there’s a direct correlation that we know of.”

SENIORS AND VACCINE PRIORITY

Some seniors in the 65-74 age group are wondering why they have to wait for the vaccine.

“I think it’s important to understand how these phases work. Phase 1A was health care workers and those who are in long-term care and those who work in long-term care. There’s supposed to be an overlap between 1A, 1B, and 1C. So they’ll kind of all be happening around the same time, and hopefully very quickly as the government continues to roll out more vaccine. 1B, we found out this weekend, was those who are 74 and older and a smaller list of what’s defined as essential. The state of Wisconsin will finalize that essential list for us. That could include teachers, that could include others that the CDC has recommended.

“Then there’s also a phase 1C, which would be those 65-74, those with other chronic health conditions that may be younger but at more risk, say somebody who has cystic fibrosis or other lung diseases. Those may be falling in 1C. That has yet to be determined. That will be determined here in the coming weeks by the CDC. Once again, our state committee will sit there and try to refine that.

“Then you get into Phase 2, which would be everybody else. If you’re 65-74, definitely not forgotten. I think that what we know of so far, we don’t have any proof of this, it’s going to fall under 1C, which will overlap with 1A and 1B.”

STATE VACCINE PLANS

“They don’t really vary too much. I think what they do is take the CDC broad language and they help fine tune it to make it practical.”

HOW DO YOU KNOW WHEN IT’S YOUR TURN?

An 83-year-old viewer who lives alone wants to know how she’ll be informed when it’s her turn to get the vaccine.

“It’s a great question and I’d love to say I knew the answer to that. We don’t yet. Hopefully in the next days to coming weeks we’ll refine that. What we need to understand from the state of Wisconsin is who’s going to be allocated the vaccine for that population, and once that allocation is there how that provider or that person, whether it’s a public health entity, whether it’s a health care provider like us at Prevea, how they’re going to interact with those patients, how we can manage scheduling. All that’s yet to be determined. As a health care provider, we’re ready. But we also need direction from the state of Wisconsin.”

VACCINE AND DIABETES

Is the vaccine safe for people with diabetes?

“I would say that’s somebody who would fall even higher on the list. Diabetes, whether it’s type 1 or type 2, has a component of being immunocompromised. In other words, if you were infected, you would do worse. So having the COVID vaccine is very important in that disease population, and one that we’ll highly recommend.”

IS THERE ENOUGH PROOF THE VACCINE WILL WORK?

A viewer wants to know if we know for sure that the vaccine will work against the virus.

“Efficacy is the proof we have. That’s the point of efficacy. We studied tens of thousands of people, we saw how it protected people versus those who got placebo who were unprotected. Ninety-five percent efficacy on these vaccines is amazing. We’ll continue to see that as it rolls out more around the country and then fine-tune that number.”

LOSS OF TASTE AND SMELL

A viewer had COVID in October, but her senses of taste and smell have not returned. Will they be lost forever?

“We’re still early in this. We know about 10 months, so I would never say ever or never coming back. As we start to manage these patients, I think we’ve called them long haulers or different names for them, two weeks is the general time period that most people their smell and taste have returned. But some have gone months. So be patient. Continue to follow up with your primary care physician. They may want to look at other causes at some point. We’ve actually, because of so many long haulers, have now opened up our post-COVID clinic to help manage these people.”

VACCINES, THE IMMUNOCOMPROMISED, AND REACTIONS

“Immunocompromised people normally are worried about people getting a vaccine because they’re worried about the vaccine actually giving them the virus. It’s a dead virus or a attenuated virus. That’s not the case in an mRNA vaccine. You’re not getting COVID-19 injected into you. So if your body’s able to mount an immune response to the vaccine, you should get it. That’s a determination, depending on what type of immune compromised you are, that you should be talking through with your physician.

“If you’ve had an adverse reaction to an injectable, like was mentioned, that’s definitely a conversation you need to have with your physician before you get any type of vaccine, whether it’s COVID or any other shot.”

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