Latest / The SHEA Podcast / COVID-19: Post-Vaccination: Adverse Events, COVID Exposure & Contraction, and More, 2/11/21

Transcript

COVID-19: Post-Vaccination: Adverse Events, COVID Exposure & Contraction, and More, 2/11/21 · The SHEA Podcast

• 0:08
  SPEAKER_03: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare-associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:24
  SPEAKER_03: I'm Dr.
• 0:25
  SPEAKER_03: Christina Woods, hospital epidemiologist at Mount Sinai West, and I will serve as your moderator.
• 0:30
  SPEAKER_03: Discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:40
  SPEAKER_03: Shay is excited to launch this episode of the podcast, COVID-19 updates, What We Know Now.
• 0:45
  SPEAKER_03: Today's discussion will focus on post-vaccination adverse events, COVID exposure, and contraction and more.
• 0:51
  SPEAKER_03: Our speakers today are Dr.
• 0:53
  SPEAKER_03: Anu Malani, Medical Director of Infection Prevention and Control and Antimicrobial Stewardship at St.
• 0:58
  SPEAKER_03: Joseph Mercy Health Systems, and Dr.
• 1:00
  SPEAKER_03: Lisa Maragakis, Senior Director of Healthcare Epidemiology and Infection Prevention at Johns Hopkins Medicine.
• 1:07
  SPEAKER_03: Thank you both today for joining us.
• 1:09
  SPEAKER_03: Before we start our discussion, I would like to turn it over to Dr.
• 1:12
  SPEAKER_03: Jennifer Hanrahan to get us started with brief news and guidance update for the week.
• 1:16
  SPEAKER_01: Thank you.
• 1:17
  SPEAKER_01: As of February 10, 2021, there have been 106,321,987 confirmed cases of COVID-19, including 2,325,282 deaths reported to the World Health Organization.
• 1:32
  SPEAKER_01: In the United States, a total of 43,206,190 doses of COVID-19 vaccine have been administered as of February 9th.
• 1:42
  SPEAKER_01: An article titled COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination in the United States, September, and December 2020 was published by Early Release in the Morbidity and Mortality Weekly report on February 9th.
• 1:58
  SPEAKER_01: The article states that national polls conducted before vaccine distribution began suggested that many persons were hesitant to receive COVID-19 vaccination.
• 2:06
  SPEAKER_01: From September to December 2020, intent to receive COVID-19 vaccination increased from 39.4% to 49.1% among adults and across all priority groups, and non-intent decreased from 38.1% to 32.1%.
• 2:23
  SPEAKER_01: Despite decreases in non-intent from September to December, younger adults, women, non-Hispanic Black adults, adults living in non-metropolitan areas, and adults with less education and income and without health insurance continue to have the highest estimates of non-intent to receive COVID-19 vaccination.
• 2:42
  SPEAKER_01: The authors conclude that ensuring high and equitable vaccination coverage among all populations, including by addressing reasons for not intending to receive vaccination, is critical to prevent the spread of COVID-19 and bring an end to the pandemic.
• 2:55
  SPEAKER_01: An article published online February 4th in infection control and hospital epidemiology examined air contamination of households versus hospital inpatient rooms occupied by SARS-CoV-2 positive patients.
• 3:08
  SPEAKER_01: The study included 25 air samples from 15 inpatient rooms and five households where SARS-CoV-2 positive patients were housed.
• 3:16
  SPEAKER_01: Overall, two out of 16 air samples from inpatient rooms were SARS-CoV-2 positive, while five out of nine household samples had virus detected.
• 3:25
  SPEAKER_01: All samples had cycle threshold levels above 30.
• 3:28
  SPEAKER_01: In this study, household samples were eight times more likely to test positive for the virus than inpatient samples.
• 3:34
  SPEAKER_01: Inpatient rooms only tested positive when the volume of air sampled was quadrupled and the distance between air samplers and patients was minimal.
• 3:42
  SPEAKER_01: Thus, these positive results may represent contaminated respirator droplets being expelled by patients rather than actual air contamination.
• 3:50
  SPEAKER_01: Given that room ventilation was the main difference between these settings, the authors conclude that the findings may suggest that the degree of ventilation in a room is more important in determining the degree of air contamination than the acuity of illness that a SARS-CoV-2 patient may be experiencing.
• 4:06
  SPEAKER_01: An early release in emerging infectious disease presents genomic evidence of in-flight transmission of SARS-CoV-2 despite pre-departure testing.
• 4:15
  SPEAKER_01: The authors note that since the first wave of coronavirus disease in March 2020, citizens and permanent residents returning to New Zealand have been required to undergo managed isolation and quarantine for 14 days and mandatory testing for SARS-CoV-2.
• 4:30
  SPEAKER_01: As of October 20th, 2020, of 62,698 arrivals, testing of persons in managed isolation and quarantine had identified 215 cases of SARS-CoV-2 infection.
• 4:42
  SPEAKER_01: Among 86 passengers on a flight from Dubai, United Arab Emirates, that arrived in New Zealand on September 29th, test results were positive for seven persons in managed quarantine and isolation.
• 4:54
  SPEAKER_01: These passengers originated from five different countries before layover in Dubai.
• 4:58
  SPEAKER_01: Five had negative pre-departure SARS-CoV-2 test results.
• 5:02
  SPEAKER_01: To assess possible points of infection, authors analyzed information about their journeys, disease progression, and virus genomic data.
• 5:09
  SPEAKER_01: All seven SARS-CoV-2 genomes were genetically identical except for a single mutation in one sample.
• 5:15
  SPEAKER_01: Despite pre-departure testing, multiple instances of in-flight SARS-CoV-2 transmission are likely.
• 5:22
  SPEAKER_01: And that's the news for this week.
• 5:24
  SPEAKER_01: Thank you, Dr.
• 5:25
  SPEAKER_03: Henrihan.
• 5:26
  SPEAKER_03: I now want to move into the discussion with our speakers.
• 5:29
  SPEAKER_03: In previous episodes of this podcast, speakers have mentioned normal side effects of the vaccine, such as chills, fatigue, and arm soreness.
• 5:37
  SPEAKER_03: However, what have we seen in terms of adverse events?
• 5:40
  SPEAKER_03: Can you share what the data is telling us?
• 5:43
  SPEAKER_02: Thank you so much for having us today.
• 5:45
  SPEAKER_02: I can say that the side effects following the vaccine are actually quite common.
• 5:51
  SPEAKER_02: And you've mentioned some of the main ones, arm soreness being the most common adverse event reported after the COVID-19 vaccine.
• 5:59
  SPEAKER_02: In addition, it's very common to have systemic effects, including malaise, headache, even fever and chills, as a sign of the immune response to the vaccine.
• 6:13
  SPEAKER_02: And what the data are showing us is that this occurs in the vast majority of individuals following vaccine and is somewhat more common in younger individuals than in older individuals, and that these symptoms are very much more common after the second dose of vaccine.
• 6:32
  SPEAKER_02: I think one other thing we could discuss is that in individuals who have had a prior infection with SARS-CoV-2, we are seeing that the first dose of vaccine can elicit that stronger immune response, almost a booster effect, and more prominent side effects that can be quite intense, according to those who have reported.
• 6:54
  SPEAKER_03: And is that for both vaccines in your experience, or is that for one more so than the other?
• 7:01
  SPEAKER_02: I've heard that reported for both vaccines, both the Pfizer and the Moderna.
• 7:05
  SPEAKER_00: Yeah, I think it's an area we want to kind of watch very closely.
• 7:09
  SPEAKER_00: I think, you know, I've definitely had, you know, healthcare workers and other vaccine recipients that have described these, you know, more robust immune type responses.
• 7:19
  SPEAKER_00: But I've also, you know, had some that have had COVID previously where they didn't really have any response.
• 7:25
  SPEAKER_00: I think when you look at, you know, kind of the trials that were done with both the Pfizer and Moderna trials, the amount of patients that were enrolled that had COVID previously, I mean, the numbers were relatively low.
• 7:37
  SPEAKER_00: And it didn't look like there was a significant signal effect in terms of you know having more robust reactogenicity and immune response.
• 7:44
  SPEAKER_00: But I think definitely, you know, anecdotally have definitely heard about some having these, you know, more significant responses.
• 7:51
  SPEAKER_00: And I think it's an area that we really kind of want to watch closely and try to see kind of what data looks like at a population level.
• 7:59
  SPEAKER_03: I know at my own institution, there's sort of been a thought that people who who get this reactogenicity are almost a little bit excited by it because they feel like it means that the vaccine is actually working for them.
• 8:09
  SPEAKER_03: And conversely, those who happen to be in the minority who haven't really had many reactions are getting a little bit concerned that they maybe don't have the same level of protectiveness from the vaccine.
• 8:21
  SPEAKER_03: Have you found similar conversations happening at your institutions?
• 8:24
  SPEAKER_03: And what are your thoughts on that?
• 8:26
  SPEAKER_00: Yeah, it's actually very true.
• 8:29
  SPEAKER_00: And it's actually something commonly that's reported.
• 8:31
  SPEAKER_00: And frankly, even in my own household with my wife receiving her vaccine, she actually really had minimal symptoms.
• 8:38
  SPEAKER_00: And the same thing was true with my parents, where my, you know, my my dad had a pretty significant reaction where my mom did not.
• 8:44
  SPEAKER_00: So we definitely have people asking about that and what does that mean.
• 8:47
  SPEAKER_00: And then the follow-up question often is do we need to check, you know, my serological response, do we need to check antibodies and see what this looks like?
• 8:56
  SPEAKER_00: And I think, you know, what we've really kind of answered has been is is one, we don't need to check serology.
• 9:01
  SPEAKER_00: We don't really know what would be defined as being protective from an immunological response.
• 9:06
  SPEAKER_00: And then secondly, even when you look at the trials, not everyone had, you know, these re-ecogenic of findings and this immune response.
• 9:14
  SPEAKER_00: So I think it's just an area that I think is great if you if you have the response, but I don't think that, you know, aside from getting both vaccines, that you need to do anything differently at this time.
• 9:25
  SPEAKER_03: So, you know, we now have a lot of people who are being vaccinated and clearly a lot of different effects depending on the individuals.
• 9:32
  SPEAKER_03: So, what are some suggested approaches to evaluating and managing individuals who show these side effects, especially if they're those that might be from either the vaccine or from infection with COVID-19?
• 9:44
  SPEAKER_02: It's such an important question because we all have screening programs in place, asking individuals before they come to work whether they have any symptoms and instructing them to, of course, not work with symptoms, call occupational health services.
• 10:00
  SPEAKER_02: And this presents a dilemma when you're vaccinating large numbers of people who are then going to have some symptoms post-vaccination and determining whether that is due to the vaccine or whether it may be an early sign or symptom of infection.
• 10:16
  SPEAKER_02: And so it is tricky.
• 10:18
  SPEAKER_02: The approach that we have taken is number one, to make everyone aware of this so that they're considering the possibility that their symptoms may be a sign of infection and to not just write it off as being related to the vaccine.
• 10:32
  SPEAKER_02: But we do allow our healthcare personnel to come to work because we, you know, staffing is a is an ongoing challenge.
• 10:39
  SPEAKER_02: So we do allow them to come to work with signs and symptoms as long as they are not febrile and their symptoms that can reasonably be attributed to the vaccine in the first two days after vaccination.
• 10:52
  SPEAKER_02: But we do instruct them that anything that lasts day three or beyond needs to go through occupational health services just out of an abundance of caution.
• 11:01
  SPEAKER_02: And of course, we have seen quite a few individuals test positive in the week or weeks following their vaccine.
• 11:09
  SPEAKER_02: So it is extremely important to do testing promptly for anyone who develops signs and symptoms that last more than a couple of days.
• 11:17
  SPEAKER_00: I'd agree.
• 11:18
  SPEAKER_00: And that approach is very similar to our approach as well.
• 11:21
  SPEAKER_00: I think, you know, when people receive their vaccine, so first, you know, there's been a lot of communication about what to expect.
• 11:29
  SPEAKER_00: And when people receive their vaccine, they get a handout saying, hey, you know, this is what you know the studies have shown, this is what people experience, these are the rates of pain and fatigue and headache, et cetera.
• 11:40
  SPEAKER_00: And then when you think about these symptoms, there are some that are very classically related to the vaccine, such as, you know, I have pain at the site of injection.
• 11:49
  SPEAKER_00: And there are some that some symptoms that are very clearly not related to the vaccine, such as sore throat, shortness of breath, loss of taste or loss of smell.
• 11:59
  SPEAKER_00: And I think it's very clear that you'd want to do testing if you experience any of those symptoms.
• 12:03
  SPEAKER_00: There are some symptoms that Dr.
• 12:04
  SPEAKER_00: Marikakakis mentioned that are in between, such as fever.
• 12:08
  SPEAKER_00: And in those cases, we too, you know, offer testing and really have encouraged people to kind of be, you know, reporting their symptoms, accountable for their symptoms, and not working while they're federalized.
• 12:19
  SPEAKER_00: Now we do allow people to work if they experience, you know, fatigue, chills, headache.
• 12:24
  SPEAKER_00: And I think the key, as already mentioned, is that those symptoms really should resolve in a couple days.
• 12:29
  SPEAKER_00: And if they're not resolving, then there is a concern.
• 12:31
  SPEAKER_00: I think when thinking about testing, I think you really don't want to have a lot of barriers.
• 12:36
  SPEAKER_00: And important to point out and recognize that the vaccines are not going to impact testing results.
• 12:42
  SPEAKER_00: They're not going to cause tests to become positive.
• 12:44
  SPEAKER_00: And as already mentioned, also, we did have a handful of healthcare workers that developed COVID soon after their first vaccine, somewhere a little bit later.
• 12:54
  SPEAKER_00: And even after the second vaccine, you know, we've had a couple cases in healthcare workers that had a positive test after the second vaccine.
• 13:02
  SPEAKER_00: You know, whether they were brewing really at the time of when they had their vaccine and it just took a little bit to exhibit symptoms.
• 13:09
  SPEAKER_00: I think that's probably the more likely case, but it's another area that you know we continue to watch.
• 13:14
  SPEAKER_00: And as the studies have shown, you know, the vaccines are not a hundred percent effective in reducing the risk of you know symptomatic COVID infection.
• 13:23
  SPEAKER_03: So I think you both have highlighted some of the challenges that we're having with you know with staffing in the hospitals.
• 13:28
  SPEAKER_03: And I know a lot of individuals are concerned about making sure that you know they can continue to come into work and you know take care of their patients and not put any extra burden on their coworkers.
• 13:38
  SPEAKER_03: So with that in mind, are there any best practices or considerations to minimize the impact of post-vaccination signs and symptoms in these individuals?
• 13:47
  SPEAKER_00: I think you know, one is making sure that it's very clear that developing you know these adverse effects are are to be expected.
• 13:54
  SPEAKER_00: I mean, the large majority, you know, 80 to 90 percent of recipients will have some type of symptom.
• 13:59
  SPEAKER_00: And so that's to be expected.
• 14:01
  SPEAKER_00: I think also recognizing you know the symptoms that may not be associated and that would be of more concern.
• 14:07
  SPEAKER_00: And I think that one thing that sort of naturally happened, and we tried to do our best in terms of scheduling is especially around the second dose, is to prevent people from you know missing work or not feeling well while they were working, is to try to schedule those doses at a time where maybe they don't have to work or before a weekend or where they may have a day or two off, and thinking sort of proactively about that.
• 14:33
  SPEAKER_00: You know, our approach for that was really working with managers and directors from different departments to help with scheduling, you know, of their staff, recognizing that they, you know, would know schedules.
• 14:44
  SPEAKER_00: And I think one thing that kind of naturally happened as you know, there was different waves of healthcare workers receiving their vaccines and you know, word was getting out in terms of how people felt.
• 14:55
  SPEAKER_00: I think natural sort of selection is that you know, people were trying to accommodate for that and really, you know, scheduling their second vaccine, you know, right around that three or four week mark, taking their schedule into account.
• 15:07
  SPEAKER_02: It's such an important point because as we've said throughout the podcast, we are all struggling with staffing issues.
• 15:14
  SPEAKER_02: Everyone is tired, everyone's stretched very thin.
• 15:17
  SPEAKER_02: And, you know, to the extent possible, I think there's a best practice around scheduling, as Dr.
• 15:22
  SPEAKER_02: Malani outlined, so that, you know, any given unit or area doesn't have too many personnel out at the same time with vaccine-related side effects.
• 15:32
  SPEAKER_02: But that operationally is very challenging to do.
• 15:35
  SPEAKER_03: Absolutely.
• 15:37
  SPEAKER_03: While it's known that it takes approximately seven to 14 days for the first dose of the vaccine to become effective, does this increase the need for individuals to get tested before or during the vaccination process?
• 15:49
  SPEAKER_02: You know, I think ideally a testing program and a vaccination program are are working hand in hand and are abundantly available for individuals who have indications for testing.
• 16:00
  SPEAKER_02: I don't think that we need to test people specifically, you know, before vaccination or after vaccination, unless they have, you know, signs or symptoms or reasons to believe that they may have become infected around the time of or after vaccination.
• 16:17
  SPEAKER_02: You know, we've talked a little bit already about the overlap in some post-vaccine signs and symptoms and those of infection.
• 16:25
  SPEAKER_02: And so certainly it's helpful to have testing widely available and to encourage or require through occupational health for employees to get tested for symptoms that persist.
• 16:37
  SPEAKER_00: I agree with all those comments.
• 16:39
  SPEAKER_00: I think as we sort of move from healthcare workers and we think about vaccinating those that are residing in the community, whether they're, you know, seniors above 65 or whether it's you know essential workers, I think the important point again is to make sure that we're asking those that are going to be getting their vaccine about their symptoms and making sure that they're not presenting for their vaccine when they may be experiencing any symptoms that may be consistent or with concern for COVID.
• 17:06
  SPEAKER_00: And you know, the hospitals would readily do that as we all probably have some sort of screening process in place, you know, for our healthcare workers.
• 17:13
  SPEAKER_00: But that's also an important uh consideration as we start, you know, moving in into other areas of vaccination.
• 17:19
  SPEAKER_02: It will also be very important, I think, you know, going forward to keep an eye out for variants of the virus.
• 17:26
  SPEAKER_02: And we know that this is a huge issue right now, and there's an effort to increase surveillance for the variants by doing whole genome sequencing.
• 17:36
  SPEAKER_02: And some states have made it reportable for individuals who have infection after vaccination, either the first dose or the second dose to be reported so that that can be investigated further by looking at those viral samples to make sure that you know we're aware if it is a variant or maybe not, and then perhaps to even to do more investigation about the antibody response.
• 17:59
  SPEAKER_02: And so we have a fuller picture of what's going on for that individual, but also at a population level.
• 18:06
  SPEAKER_03: Absolutely.
• 18:07
  SPEAKER_03: So when somebody gets their first dose and then they find subsequently that they are COVID positive, whether or not they're symptomatic, obviously it's going to delay their second dose.
• 18:17
  SPEAKER_03: How are you approaching those situations at your institution where somebody becomes infected between their first dose and their scheduled second dose?
• 18:25
  SPEAKER_00: You know, we would go by their level of illness.
• 18:28
  SPEAKER_00: And so, you know, the large majority of patients and healthcare workers that develop COVID that are that are not hospitalized, you know, would likely be mild to moderate in nature.
• 18:38
  SPEAKER_00: And typically, you know, after 10 days after symptom onset, as long as they're if abrile and their symptoms are improving and they're recovering, then they would be okay to get their vaccine.
• 18:49
  SPEAKER_00: So that is really kind of the you know the algorithm that that we've used.
• 18:53
  SPEAKER_00: We haven't been delaying second doses.
• 18:55
  SPEAKER_00: So you would get it scheduled as long as you know met the recovery criteria for you know passing that isolation period.
• 19:02
  SPEAKER_00: If you know one were to develop COVID closer to that second dose, say for the Pfizer biotech vaccine, say it was you know at day 17 or day 18, then of course that second dose would be delayed and the same approach would be taken for the Moderna vaccine.
• 19:18
  unknown: Dr.
• 19:18
  SPEAKER_03: Marigakis, are you doing the same at your institution?
• 19:21
  SPEAKER_02: We have a very similar approach.
• 19:23
  SPEAKER_02: We are recommending that both doses be given, irrespective of an individual's you know, prior history of COVID-19, and similar to what Dr.
• 19:33
  SPEAKER_02: Milani outlined, that they can proceed with their second dose after they recover if they are infected in between dose one and dose two.
• 19:41
  SPEAKER_02: You know, I do think there's ongoing investigation about whether that second dose is actually needed.
• 19:48
  SPEAKER_02: But at this time, we're sticking with the recommended two-dose schedule, irrespective of people's history of infection.
• 19:55
  SPEAKER_00: And just to add to what Dr.
• 19:56
  SPEAKER_00: Merigakis was saying earlier, I think, you know, this is an important point to know when someone does develop COVID and if they've had the vaccine, because I think, you know, these clearly with an increase in the amount of variants that we're seeing across the country, whether it's reportable or not, something that we actively need to be thinking about and working with our public health and state laboratories to make sure that there are potential isolates available for sequencing.
• 20:22
  SPEAKER_00: So if you know healthcare workers are calling occupational or employee health, then I think it's an area that one would want to know whether they've had vaccine or not.
• 20:31
  SPEAKER_00: And I think this can get a bit tricky in some places depending on whether you're acting as an employer or acting as a provider when you're giving vaccine and you know, privacy issues around that.
• 20:43
  SPEAKER_03: So there was recently news that a member of Congress tested positive for COVID-19 after receiving both doses of the vaccine.
• 20:51
  SPEAKER_03: What are your thoughts on how the vaccine is going to impact initially the mitigation that we're taking for COVID-19 in terms of all the different masking and hand washing protocols and distancing protocols?
• 21:03
  SPEAKER_03: And I guess a little longer term, where do you think that's all going to land?
• 21:07
  SPEAKER_02: So, right now, based on what we know to date, the recommendation is to continue all of the infection prevention measures despite being vaccinated, even if you've had both doses.
• 21:20
  SPEAKER_02: And there's several reasons for this.
• 21:22
  SPEAKER_02: We know that although both of the currently utilized vaccines are very efficacious at preventing serious complications from COVID-19, we don't yet know if either of the vaccines prevent an individual from picking up the virus, carrying it, and transmitting it to others.
• 21:41
  SPEAKER_02: And what we do know is that vaccine penetration in the larger population is very low right now.
• 21:47
  SPEAKER_02: And so it's extremely important with all of those susceptible people out there that the infection prevention measures be followed even after vaccination.
• 21:56
  SPEAKER_02: I know this is hard for people.
• 21:58
  SPEAKER_02: There's such a desire.
• 22:00
  SPEAKER_02: Really, for vaccination to be the ticket to getting back to normal.
• 22:05
  SPEAKER_02: And that's completely understandable.
• 22:07
  SPEAKER_02: But we really need to get many more people vaccinated and also to learn more about this issue of viral carriage and transmission and how that is or is not affected by these vaccines.
• 22:19
  SPEAKER_00: Yeah, I agree with all the points just discussed.
• 22:22
  SPEAKER_00: I think just to underscore again that the vaccines are 95% efficacious in terms of prevention of symptomatic COVID infection.
• 22:31
  SPEAKER_00: And if you look at not just the Pfizer and Moderna vaccines, really the prevention of severe disease, hospitalization, and mortality, I mean, the data is really fantastic, as good as it gets around those outcomes.
• 22:45
  SPEAKER_00: The other issue about, you know, how do we approach, you know, whether it's masking or distancing, and this issue has come up in the hospital setting and especially around a visitor's coming in and you know, we've been vaccinated.
• 22:59
  SPEAKER_00: I want to see my you know loved one who unfortunately has COVID.
• 23:03
  SPEAKER_00: I think for all the issues just raised about, you know, can you still become infected and can you still be infectious, those are really important.
• 23:11
  SPEAKER_00: And then once you get you know into the community and even in the hospital, you know, we really don't know who has had the vaccine.
• 23:19
  SPEAKER_00: And so without knowing that at a larger level, it's going to be very difficult, at least at this time, until you really have an effective curb immunity to really lift those prevention measures that we have right now.
• 23:31
  SPEAKER_03: Yes, there's definitely still so much to learn to help us really inform a lot of these policies, both for the general public and in the hospital setting as well.
• 23:39
  SPEAKER_03: There's obviously now also new data that seems to suggest that individuals who've had COVID-19 may not necessarily need both doses of vaccine.
• 23:47
  SPEAKER_03: Do you have any thoughts on that topic?
• 23:49
  SPEAKER_00: Well, I think where we are right now is that this is also evolving.
• 23:53
  SPEAKER_00: And, you know, I think much like many things related to COVID, I think we're, you know, finding new information really on a daily basis and trying to, you know, understand kind of what the data looks like.
• 24:04
  SPEAKER_00: I think where we are right now, today, second week in February, you know, we are continuing to give patients and healthcare workers that have had COVID-19, you know, there's consideration for delaying the dose for 90 days just based on immune response and scarcity of the vaccine, but it's not a requirement, it's not a recommendation.
• 24:24
  SPEAKER_00: It's really just a consideration.
• 24:26
  SPEAKER_00: And those that have had COVID-19, we continue to give them second doses as currently scheduled, as long as they're not in any sort of isolation related to active COVID.
• 24:36
  SPEAKER_00: But I think that this data is evolving and we're watching it very closely.
• 24:41
  SPEAKER_02: I agree.
• 24:41
  SPEAKER_02: We're watching the science unfold as rapidly as it has throughout this pandemic.
• 24:46
  SPEAKER_02: We're learning more every day.
• 24:48
  SPEAKER_02: You know, I certainly know that people are looking at this issue and whether after infection, maybe one dose is sufficient to serve as a booster essentially to achieve the same results that someone would get from two doses if they did not have that prior infection.
• 25:05
  SPEAKER_02: But right now we're erring on the side of caution, administering both of the doses as recommended, irrespective of prior history of infection.
• 25:14
  SPEAKER_03: And I know some of that conversation also seems to circulate around whether or not the vaccine may provide some additional protection against variants where natural infection may not.
• 25:23
  SPEAKER_03: So I think that's going to be another issue that's going to make that whole conversation a lot more complex.
• 25:28
  SPEAKER_03: Do either of you have any final words or final thoughts for the listeners about COVID-19 after receiving vaccinations?
• 25:34
  SPEAKER_02: I just really appreciate you hosting this conversation.
• 25:37
  SPEAKER_02: It's important that we all share information and continue in this really what is a race against the virus that we know now that these variants are out there and mutations are arising.
• 25:49
  SPEAKER_02: The more uncontrolled spread is allowed to continue, the more danger we're going to have of that, and the more rapidly we need to vaccinate everyone.
• 25:57
  SPEAKER_02: Vaccine supply remains a huge challenge.
• 26:00
  SPEAKER_02: And I hope that that is one that we can solve in the near term so that we can, you know, continue to vaccinate people.
• 26:08
  SPEAKER_02: I feel very fortunate as a healthcare provider to be vaccinated.
• 26:11
  SPEAKER_02: And I'm heartened really by the desire that I see out among our patients and in the public, the desire to be vaccinated.
• 26:19
  SPEAKER_02: I think many of us felt that vaccine hesitancy was going to be the major hurdle.
• 26:24
  SPEAKER_02: I know it's real and it is there, but there are also very many people who are, you know, desperately waiting to get a vaccine.
• 26:31
  SPEAKER_02: And right now, supply is our major focus and stumbling block.
• 26:35
  SPEAKER_00: You know, the vaccine distribution allocation process, you know, has not been perfect.
• 26:40
  SPEAKER_00: I think, you know, the fact that we're here and talking about the remarkable achievements in science is just, you know, if we can just take a step back and think about that, it's really incredible.
• 26:49
  SPEAKER_00: And again, you know, here we are second week in February, and we're still, you know, there's a lot of challenges around allocation and distribution.
• 26:57
  SPEAKER_00: But I think that every day we're probably a step closer.
• 27:01
  SPEAKER_00: You know, we're vaccinating a million plus residents of the United States on a daily basis.
• 27:06
  SPEAKER_00: And so that's a step in the right direction.
• 27:07
  SPEAKER_00: And you know, we're seeing that while you know the effect may be very early, we're just clearly seeing, you know, encouraging trends in cases and hospitalizations.
• 27:15
  SPEAKER_00: I think the other thing to really highlight is how remarkably safe these vaccines have been.
• 27:20
  SPEAKER_00: We're talking about mRNA vaccines, you know, a new type of technology in regards to vaccines, but the intense and really comprehensive vaccine safety monitoring program is really robust.
• 27:32
  SPEAKER_00: And the data that we're seeing about safety profile is really reassuring.
• 27:37
  SPEAKER_00: There has not at this time been a signal with respect to any serious safety concerns.
• 27:43
  SPEAKER_00: There have been some cases of anaphylaxis, but these are pretty rare.
• 27:47
  SPEAKER_00: It's about five per million in the Pfizer Five Tech vaccine and about two to three per million in the Moderna vaccines.
• 27:54
  SPEAKER_00: And the other good news is that there's going to be, you know, other vaccine manufacturers.
• 27:59
  SPEAKER_00: And I think this is all encouraging.
• 28:01
  SPEAKER_00: And I hope a month from now or soon thereafter, you know, the allocation and distribution process won't be so much a challenge and that we'll get to a time where, you know, that there's actually more vaccines than demand.
• 28:13
  SPEAKER_00: I think the other point to sort of highlight is, you know, we're talking about, you know, our effort domestically and you know, nationally, but uh to really kind of achieve where we want to be with respect to this global pandemic is, you know, once we are, you know, in a better point in terms of vaccine allocation, distribution, et cetera, you know, we need to be thinking about how the world really gets access to vaccine.
• 28:36
  SPEAKER_00: And I think that will really be the way we move forward with respect to the pandemic.
• 28:40
  SPEAKER_02: It's such an important point, and it really highlights, you know, another thing with which we're struggling so much in the United States and worldwide right now, and that is health disparities.
• 28:50
  SPEAKER_02: It's a true challenge right now with limited vaccine supply.
• 28:54
  SPEAKER_02: You see the conflicts arising over allocation of that scarce resource, both in our country and around the world.
• 29:02
  SPEAKER_02: And I think, like so many things in this pandemic, it has highlighted pre-existing disparities and inequities and problems that we are really going to have to solve going forward in rapid fashion during vaccine allocation and the administration of the COVID-19 vaccine, but also on a much broader scale.
• 29:22
  unknown: Dr.
• 29:23
  SPEAKER_03: Maragakis and Dr.
• 29:24
  SPEAKER_03: Milani, thank you very much for sharing your perspectives and experiences, especially during this very unprecedented and historic time.
• 29:32
  SPEAKER_03: This podcast can be accessed on SHA's online education center, Learning CE, under the Rapid Response Program.
• 29:38
  SPEAKER_03: You will also find resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHA COVID-19 town hall.
• 29:47
  SPEAKER_03: New members can now receive 50% off 2021 SHA membership using the coupon code WELCOME 2021 during checkout through March 31st.
• 29:57
  SPEAKER_03: This concludes this episode of the Rapid Response Podcast.
• 30:00
  SPEAKER_03: Thank you all for tuning in.