Latest / The SHEA Podcast / COVID-19 in the Midst of Flu Season, 10/29

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COVID-19 in the Midst of Flu Season, 10/29 · The SHEA Podcast

• 0:10
  SPEAKER_01: 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 fields of healthcare epidemiology and antibiotic stewardship.
• 0:25
  SPEAKER_01: I'm Dr.
• 0:25
  SPEAKER_01: David Bannock from the University of Connecticut, and I will serve as today's podcast moderator.
• 0:30
  SPEAKER_01: 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.
• 0:38
  SPEAKER_01: Shay is excited to launch this episode of the podcast, COVID-19 updates, What We Know Now.
• 0:43
  SPEAKER_01: Today's discussion will focus on being in the midst of the flu season while simultaneously addressing the COVID-19 pandemic.
• 0:50
  SPEAKER_01: Our speaker today is Dr.
• 0:52
  SPEAKER_01: Tom Talbot.
• 0:53
  SPEAKER_01: Dr.
• 0:54
  SPEAKER_01: Talbot is a professor of medicine and health policy at the Vanderbilt University School of Medicine and serves as the chief hospital epidemiologist for Vanderbilt University Medical Center in Nashville, Tennessee.
• 1:05
  SPEAKER_01: Thank you for joining us today.
• 1:07
  SPEAKER_01: Before we start our discussion, I would like to turn it over to Dr.
• 1:10
  SPEAKER_01: Hanrahan to get us started with a brief news and guidance update for the week.
• 1:15
  SPEAKER_00: Thank you, David.
• 1:16
  SPEAKER_00: As of October 28, 2020, there have been 43,540,739 confirmed cases of COVID-19, including 1,160,650 deaths reported to the World Health Organization.
• 1:33
  SPEAKER_00: There have been almost 500,000 cases in the United States alone in the last seven days.
• 1:38
  SPEAKER_00: One of the unanswered questions with regard to SARS-CoV-2 is how often reinfection occurs.
• 1:44
  SPEAKER_00: CDC has issued a common investigation protocol for investigating suspected SARS-CoV-2 reinfection.
• 1:51
  SPEAKER_00: This was updated on October 27, 2020.
• 1:55
  SPEAKER_00: The protocol is designed to support a common public health investigation into suspected SARS-CoV-2 reinfection cases across jurisdictions.
• 2:03
  SPEAKER_00: Confirming SARS-CoV-2 reinfection requires advanced laboratory diagnostic support built upon advanced planning to implement this protocol or a locally adaptive version with referral of specimens to supporting laboratory networks.
• 2:16
  SPEAKER_00: Data collected with this protocol will identify potential cases of reinfection, advance understanding of SARS-CoV-2 epidemiology, and inform public health response.
• 2:26
  SPEAKER_00: Currently, a gold standard confirmation of SARS-CoV-2 reinfection will require confirmation of initial infection and virus detection across two distinct time periods with genetic sequencing data needed to support a conclusion of high probability that reinfection has occurred.
• 2:42
  SPEAKER_00: Possible SARS-CoV-2 reinfection could be differentiated from persistent viral carriage through a variety of laboratory-based parameters, patient symptomology, and/or epidemiologic links.
• 2:52
  SPEAKER_00: However, reinfection cannot be confirmed if clinical specimens from the initial coronavirus disease 2019 illness are not available.
• 3:01
  SPEAKER_00: Reinfection is known to occur with other human coronaviruses.
• 3:04
  SPEAKER_00: CDC is aware of recent scientific and media reports of cases of suspected SARS-CoV-2 reinfection among persons who were previously diagnosed with COVID-19.
• 3:15
  SPEAKER_00: However, these reports use different diagnostic methods to ascertain reinfection.
• 3:20
  SPEAKER_00: Because of the need for a common understanding of what constitutes reinfection, CDC proposes this common investigation protocol for identifying cases with a high index of suspicion for reinfection and suggests paired specimen testing.
• 3:33
  SPEAKER_00: Details of the protocol and case report forms are available on the CDC website.
• 3:38
  SPEAKER_00: A letter published in Annals of Internal Medicine on October 21st titled COVID-19 Mortality Risk and Down syndrome results from a cohort study of 8 million adults investigated Down syndrome as a risk factor for mortality from COVID-19.
• 3:52
  SPEAKER_00: The investigators point out that Down syndrome is not listed on the UK or CDC list of groups at increased risk.
• 3:59
  SPEAKER_00: However, it is associated with immune dysfunction, congenital heart disease, and pulmonary pathology, and given its prevalence, may be a relevant risk factor for severe COVID-19.
• 4:09
  SPEAKER_00: Authors evaluated Down syndrome as a risk factor for death from COVID-19 through a comprehensive analysis of individual-level data in a cohort study of 8.26 million adults.
• 4:20
  SPEAKER_00: Of these, 4,053 had Down syndrome, 68 persons with Down syndrome died, 27 of COVID-19, 17 of pneumonia or pneumonitis, and 24 of other causes.
• 4:31
  SPEAKER_00: Adjusted for age and sex, the hazard ratio for COVID-19 related death in adults with versus without Down syndrome was 24.94.
• 4:41
  SPEAKER_00: After adjustment for age, sex, ethnicity, BMI, dementia diagnosis, care home residency, congenital heart disease, and a range of other comorbid conditions and treatments, the hazard ratio for COVID-19 related death was 10.39, and for hospitalization it was 4.94.
• 4:58
  SPEAKER_00: Authors point out that Down syndrome is the most common genetic cause of intellectual disability with multi-organ manifestations.
• 5:05
  SPEAKER_00: Predisposition to pneumonias and acute respiratory distress syndrome in children, airway anomalies, pulmonary hypoplasia, and inhibited pulmonary angiogenesis have been reported.
• 5:15
  SPEAKER_00: Authors conclude that Down syndrome may confer elevated risk for COVID-19, and that this data should be used when developing policies to protect vulnerable individuals.
• 5:24
  SPEAKER_00: Also this week, the LANSA published an article titled, What Defines an Efficacious COVID-19 vaccine?
• 5:30
  SPEAKER_00: A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2.
• 5:36
  SPEAKER_00: The article points out that an efficacious vaccine is essential to prevent further morbidity and mortality.
• 5:41
  SPEAKER_00: And although some countries might deploy COVID-19 vaccines on the strength of safety and immunogenicity data alone, the goal of vaccine development is to gain direct evidence of vaccine efficacy in protecting humans against SARS-CoV-2 infection and COVID-19 so that manufacture of efficacious vaccines can be selectively upscaled.
• 6:01
  SPEAKER_00: A candidate vaccine against SARS-CoV-2 might act against infection, disease, or transmission, and a vaccine capable of reducing any of those elements could contribute to disease control.
• 6:12
  SPEAKER_00: However, the most important efficacy endpoint, protection against severe disease and death, is difficult to assess in phase three clinical trials.
• 6:20
  SPEAKER_00: In this review, authors described the challenges in assessing the efficacy of candidate SARS-CoV-2 vaccines, discussed the caveats needed to interpret reported efficacy endpoints, and provide insight into answering the seemingly simple question, does this COVID-19 vaccine work?
• 6:35
  SPEAKER_00: The development of SARS-CoV-2 vaccines is under great political and media scrutiny.
• 6:40
  SPEAKER_00: Authors state that in keeping with the development of any novel medical intervention, but particularly so in this context, it is imperative that efficacy outcomes for a SARS-CoV-2 vaccine are critically appraised with scientific rigor to understand their generalizability and clinical significance.
• 6:57
  SPEAKER_00: And that's the news for this week.
• 6:59
  SPEAKER_01: Thank you, Dr.
• 7:00
  SPEAKER_01: Hanrahan, for that great news update.
• 7:02
  SPEAKER_01: A lot of important things developing this past week and some discussion about the COVID-19 vaccine, which will be an interesting transition to our moderated discussion.
• 7:10
  SPEAKER_01: I do want to move to the moderated discussion with Dr.
• 7:12
  SPEAKER_01: Talbot.
• 7:13
  SPEAKER_01: So, Dr.
• 7:13
  SPEAKER_01: Talbot, thank you again for joining us on this Shay podcast.
• 7:17
  SPEAKER_02: Yeah, thanks for having me.
• 7:19
  SPEAKER_01: Within Shay, you've certainly been quite a leader, even in the healthcare epidemiology community in general.
• 7:25
  SPEAKER_01: And your specific area of focus seems to be pertinent to healthcare worker vaccinations, including influenza vaccine.
• 7:33
  SPEAKER_01: So, you know, I think there's some interest in hearing about your background and how you uh developed this area of expertise within the field of healthcare epidemiology.
• 7:40
  SPEAKER_01: Can you share with that for our podcast listeners?
• 7:42
  SPEAKER_02: Yeah, yeah.
• 7:43
  SPEAKER_02: So, like many career paths, it all sits on your mentors.
• 7:46
  SPEAKER_02: And back when I was in fellowship at Vayner Belt around the turn of the century, which seems makes me feel old when I say that, some of my mentors that I gravitated to were Bill Shaffner and Kathy Edwards, who both, as we all know, have a very strong vaccine interest.
• 7:59
  SPEAKER_02: And knew at the time I wanted to do infection prevention as well.
• 8:01
  SPEAKER_02: So it was a very nice kind of dovetail of occupational infection prevention and the importance of vaccination of healthcare workers to reduce harm in the healthcare workers, but also in our patients.
• 8:11
  SPEAKER_02: And so that really just kind of took light.
• 8:13
  SPEAKER_02: I worked on smallpox vaccine studies around transmissibility and just kind of took off from there and have enjoyed it ever since.
• 8:21
  SPEAKER_01: Excellent.
• 8:21
  SPEAKER_01: We all appreciate all the work that you've done in this area and the guidance and expertise you've lent to Shea and our membership.
• 8:28
  SPEAKER_01: So I do want to talk a little bit specifically about the flu and flu vaccine.
• 8:33
  SPEAKER_01: I know you were one of the uh early promoters of influenza vaccine mandates among healthcare workers, and uh that's that's seen a lot of traction and success.
• 8:42
  SPEAKER_01: So can you share sort of your experience at your institution with regard to influenza vaccination and the transition into mandatory vaccination, kind of where things stand today in 2020 at your institution?
• 8:55
  SPEAKER_02: Yeah, so we were an institution that even though we had folks like myself and Dr.
• 8:59
  SPEAKER_02: Shaffner were strong proponents that this really from a safety standpoint should be required, we had equal people that really kind of push back in a smart, thoughtful way.
• 9:07
  SPEAKER_02: And so we had our own kind of internal debate.
• 9:09
  SPEAKER_02: So Vanderbelt was a little later to the requirements um stage, but we've now acquired influenza immunization and actually the last, I think now four years, all ACIP recommended um immunizations for our healthcare personnel as a condition of employment, and have seen just the similar success in terms of immunization coverage rates in the high 90s.
• 9:30
  SPEAKER_02: And really, kind of now it's a quote unquote well-oiled machine as far as getting that out amongst thousands and thousands of healthcare workers each year.
• 9:38
  SPEAKER_01: That's excellent.
• 9:39
  SPEAKER_01: And over the last decade or so, been a much more widespread adoption of mandatory vaccination, at least for influenza vaccine.
• 9:46
  SPEAKER_01: And can you share any more details on your policy in terms of uh exceptions and how you approach those?
• 9:52
  SPEAKER_02: Yeah, we actually, and so it's interesting you say that because we literally just had our exemption description and our program papers accepted by Itchy.
• 9:59
  SPEAKER_02: So coming to you soon, but describing both the program and specifically the exemption facet.
• 10:04
  SPEAKER_02: We've had a multidisciplinary group with HR, legal, infectious diseases, infection prevention, quality, and for the last three years, an allergist who review all of our medical, religious, and personal belief exemption requests to assess whether we'll approve those.
• 10:20
  SPEAKER_02: We have an appeal process.
• 10:21
  SPEAKER_02: So folks, if they feel like they weren't heard, they're allowed to appeal.
• 10:25
  SPEAKER_02: They can also appeal to our executive sponsorship.
• 10:27
  SPEAKER_02: And so that's been a very successful way to balance the need for our employees and healthcare workers to be heard and their concerns, but also really being kind of looking at the reasons for the program and safety.
• 10:37
  SPEAKER_02: So, for example, if you if your reason for exemption is I don't want to be mandated to give a vaccine, it's my body, I can control that.
• 10:44
  SPEAKER_02: We have said that's not a held belief against the vaccine, that's being held a belief about employee policies.
• 10:50
  SPEAKER_02: And so we've rejected those, whereas others we've considered.
• 10:54
  SPEAKER_02: And so it's been a really good balance, and it's a difficult line to walk, but we've non-gon would have been uh mainly successful with that.
• 11:02
  SPEAKER_01: Yeah, that's great.
• 11:02
  SPEAKER_01: I agree.
• 11:03
  SPEAKER_01: Sticky subject, and uh having that multidisciplinary approach is is really important because the exemptions that are requested can be from so variable um for all different reasons, and having expertise at the table who can address all the different facets of those is really critical.
• 11:17
  SPEAKER_01: And I think making people feel like they're heard too.
• 11:20
  SPEAKER_01: I think that's another point.
• 11:21
  SPEAKER_01: Absolutely.
• 11:22
  SPEAKER_01: No, that that's a really great point, too.
• 11:23
  SPEAKER_01: And and I think uh we're all excited to see your publication in Itchy coming up.
• 11:26
  SPEAKER_01: I think that'll serve as a good model for institutions that are looking to develop this type of process.
• 11:30
  SPEAKER_01: So let's talk a little bit about COVID and the flu.
• 11:33
  SPEAKER_01: I mean, there's a lot of anxiety about what the next few months may look like as we see both viruses circulating in the community and try to prepare ourselves in order to address that.
• 11:43
  SPEAKER_01: I'm interested in hearing kind of your your overall thoughts, and I won't hold you any to any predictions, but what you're thinking, you know, moving into the next few months and how you're sort of preparing at large as an institution.
• 11:54
  SPEAKER_01: And then we can talk a little bit more specifically about flu vaccines and maybe even the flu testing.
• 11:58
  SPEAKER_01: But sort of big picture-wise, what are your thoughts and what are your main concerns moving into the what's typically the flu season over the next few months?
• 12:05
  SPEAKER_02: Well, it seems like that, you know, we've been living through the pandemic, and now I guess with flu season starting, we have maybe the bad sequel, but I don't know.
• 12:12
  SPEAKER_02: I think we don't know.
• 12:13
  SPEAKER_02: I think there's some lessons from the Southern Hemisphere where when they were in lockdown and using masking and other precautions to prevent the spread of COVID, like other respiratory viruses would also be impacted with those.
• 12:24
  SPEAKER_02: So they had a really very low influenza season.
• 12:27
  SPEAKER_02: I've also heard from some of our pediatric colleagues about some of the summer viruses that they didn't see those circulate as much because kids weren't going to camps and congregating.
• 12:35
  SPEAKER_02: That's a little different now that we go back to school.
• 12:37
  SPEAKER_02: So, on one hand, I think, gosh, maybe we'll mitigate other respiratory spread with COVID.
• 12:43
  SPEAKER_02: But on the same coin, if we're not attentive to things like masking other things, then we're at risk to have a double surge and what that means to the capacity of the healthcare system, what that means to just the overall emotional mental health of our healthcare workers who've been dealing with this for 10 months, what that means for diagnostics when someone comes into a clinic with, you know, a cough and flu-like illness, how we handle them now will be very different than I think we handled them last year.
• 13:08
  SPEAKER_02: And we're still trying to figure out how to do that.
• 13:10
  SPEAKER_02: What does it mean for testing?
• 13:11
  SPEAKER_02: Will we have the supplies, uh, isolation and quarantine until you know it's not COVID, et cetera.
• 13:16
  SPEAKER_02: So I think it'll be really, it's going to be more of the unknown, unfortunately.
• 13:22
  SPEAKER_01: Yeah, I agree.
• 13:23
  SPEAKER_01: I think those thoughts are kind of circulating amongst us.
• 13:26
  SPEAKER_01: And uh, you know, we're trying to prepare with some optimism, but still uh it's it's certainly a cautious optimism about flu specifically.
• 13:33
  SPEAKER_01: I think one of the areas that we're struggling with, it pertains to exactly what you just mentioned.
• 13:38
  SPEAKER_01: You know, how are we going to evaluate patients with flu-like illness and test them?
• 13:42
  SPEAKER_01: Um, you know, we're looking at different ways of standing up different flu testing platforms in parallel with our COVID testing platforms and looking at different types of settings where we can collect specimens.
• 13:53
  SPEAKER_01: And you know, we like many other um facilities have drive-thru specimen collection.
• 13:57
  SPEAKER_01: And I'd imagine that Vanderbilt probably has some version of that.
• 14:00
  SPEAKER_01: Um, although that's that's actually a concern here in the Northeast.
• 14:03
  SPEAKER_01: Uh the winter comes and the letter gets told, or you know, how to how to best adapt that.
• 14:07
  SPEAKER_01: So, in terms of specifics, are you able to share any more concrete ideas for hospitals that are planning on evaluating patients with respective flu and COVID concurrently, and ways that we should be thinking about them in terms of environment of care, specimen collection, testing.
• 14:25
  SPEAKER_01: Any advice for us as we're moving into this this season?
• 14:28
  SPEAKER_02: We we actually just I just have been reviewing our draft, kind of sort of beginning to put in our testing algorithms and a couple things I think to be aware of and some thoughts.
• 14:36
  SPEAKER_02: And I don't know that that what we're deciding is going to be the best option.
• 14:40
  SPEAKER_02: But one is remember that often our lab personnel that are running the COVID tests are often the same personnel that are running like our restroom panel testing.
• 14:49
  SPEAKER_02: So personnel resources may be an issue or the actual equipment.
• 14:53
  SPEAKER_02: One thing we're looking at is for patients coming in hospitalized, so sick enough to be hospitalized with a constellation of symptoms that could be flu or COVID, they're gonna get tested for both because that has implications for isolation, for PPE, for other things as well.
• 15:06
  SPEAKER_02: In the clinic, it's gonna be a little different, and it may be a model where you come in, you get COVID assessed first.
• 15:13
  SPEAKER_02: You could have it where you save the specimen and run flu if the COVID is negative.
• 15:17
  SPEAKER_02: You could do a dual test where you have both.
• 15:19
  SPEAKER_02: There's some platforms now we're looking at where you can do run both flu and COVID.
• 15:23
  SPEAKER_02: You may also recall back in flu season in a lot of our clinics, when flu season picked up, if someone came in with an influenza-like illness, they wouldn't even test.
• 15:30
  SPEAKER_02: They would just give them osultamavir and have them stay home until they're ill.
• 15:33
  SPEAKER_02: So that could also be a model where you rule out COVID and then manage them for flu.
• 15:39
  SPEAKER_02: The one other thing I'll throw out there that we were toying with is the one symptom that does seem to be a little bit unique is that loss of taste and smell aspect of COVID that we really have not traditionally seen with flu.
• 15:49
  SPEAKER_02: And whether that could also be a triage symptom that says if you've got that, COVID, if you don't, you know, whether you would then maybe then don't even worry about flu in that patient, but then others you do.
• 16:00
  SPEAKER_02: I think it's still to be determined.
• 16:02
  SPEAKER_02: So I don't want to, we don't even have ours completely finalized.
• 16:04
  SPEAKER_02: But I think those are things we're thinking of, is and probably will be a different approach to how sick you are versus clinic, the available resources, whether you can get some point of care in some of these locations.
• 16:15
  SPEAKER_02: I still think for many, you're gonna have to test for both and use the precautions we're using for COVID collection until you know for certain someone doesn't have COVID.
• 16:24
  SPEAKER_01: We're in a similar boat looking at testing inpatients, you know, with a different approach compared to outpatients, and then thinking about treatment for outpatients when appropriate without testing.
• 16:34
  SPEAKER_01: You know, I think there's so many different facets to consider.
• 16:37
  SPEAKER_01: Now we're also encountering concerns about testing supplies for flu testing with some of the platforms that we commonly use and whether those will all be readily available in a timely way, or we're gonna come across shortages, much like we have with COVID testing in the past.
• 16:52
  SPEAKER_01: There's a lot of complexities here that I think we'll have to constantly adapt to these changes that are happening, you know, epidemiologically, but also practically with all the factors that we mentioned earlier.
• 17:03
  SPEAKER_01: I'm interested in transitioning to vaccines a little bit over the last few minutes of the podcast.
• 17:08
  SPEAKER_01: One area that uh we've been pretty active with right now is flu vaccines and thinking about vaccination in the setting of COVID and what are the best ways to provide our healthcare workers flu vaccines in this environment.
• 17:21
  SPEAKER_01: And I was hoping you could share some of your experience with your flu vaccine campaign and how you've been able to provide your healthcare workers vaccination in a sort of COVID-safe environment.
• 17:32
  SPEAKER_02: Yeah, so it's interesting.
• 17:33
  SPEAKER_02: So our occupational health team has been incredible.
• 17:35
  SPEAKER_02: And about, I want to say eight years ago, their program, they actually set the Guinness Book of World Records for most vaccines given an eight-hour period with this event called Flu Lapalooza.
• 17:44
  SPEAKER_02: So that's been an annual event at Vanderbilt where you basically in about two and a half minutes go through this massive tent.
• 17:51
  SPEAKER_02: We get thousands of people that come through in a single day and vaccinate them for flu, and people love it.
• 17:55
  SPEAKER_02: Obviously, as we planned for this year, that was completely scrapped.
• 17:59
  SPEAKER_02: And so actually, our OckHealth folks created the Fluula to use it.
• 18:03
  SPEAKER_02: And what we basically did was take their existing model where they had trained the trainers of people on units and clinics that could give the vaccine and mobile carts and basically put that on steroids because we could no longer congregate.
• 18:15
  SPEAKER_02: So you had to get more people to go out to places and get people where they are.
• 18:19
  SPEAKER_02: So far, that's been successful.
• 18:21
  SPEAKER_02: We're actually last numbers I heard for this flu season, I think we're up in the high 70% compliance now.
• 18:26
  SPEAKER_02: We have about 25,000 employees.
• 18:29
  SPEAKER_02: So that's actually two weeks ahead of where we were last year.
• 18:32
  SPEAKER_02: We are also for the first time doing a drive-thru vaccination option for our employees, which is something we had not attempted.
• 18:39
  SPEAKER_02: I know other places like Virginia Mation have done that for years.
• 18:42
  SPEAKER_02: So that's something we're doing.
• 18:43
  SPEAKER_02: And the other thing, we've used our flu program also thinking ahead to COVID and thinking about some models and seeing how that would work as we start to anticipate having to vaccinate our healthcare workers and eventually our patients with the COVID vaccine.
• 18:58
  SPEAKER_02: So trying to look at models of these kind of roaming, you know, the COVID vaccine, as you guys are well aware, um, we'll probably need two doses.
• 19:06
  SPEAKER_02: We'll need some pretty strict cold chain requirements that make you're gonna have to do some centralization while distancing.
• 19:12
  SPEAKER_02: So things like these events where you can filter people through without gathering whether it's drive-thru.
• 19:17
  SPEAKER_02: We're trying to use this flu campaign to help um troubleshoot some of those aspects as we anticipate um COVID vaccination, hopefully crossing fingers in the next few months.
• 19:29
  SPEAKER_01: That sounds great.
• 19:30
  SPEAKER_01: Thanks for sharing that.
• 19:30
  SPEAKER_01: I think uh, you know, we're all we're all thinking about COVID vaccines, and there's a lot of uncertainty about when these will become available and how we'll be able to effectively provide them, and even um, you know, who'll be providing them to.
• 19:42
  SPEAKER_01: So I I think to close the podcast, I'm interested in your bigger picture thoughts about the COVID vaccine.
• 19:47
  SPEAKER_01: I'm sure you've been very attuned to uh some of the discussions that's happening and some of the early data that's come out.
• 19:52
  SPEAKER_01: You know, I'm interested in in your your general thoughts on how you you think this might unfold and uh you know what what the pulse is like at your institution about things like uptake and hesitancy.
• 20:02
  SPEAKER_01: Do you foresee some challenges pertaining to healthcare workers?
• 20:06
  SPEAKER_01: I won't hold you to any predictions again, but definitely want to hear your thoughts and how we as podcast listeners can uh use that information as we start thinking about it as well.
• 20:14
  SPEAKER_02: Yeah, so I think it's gonna be really interesting.
• 20:16
  SPEAKER_02: So a couple of things that we're thinking of, and I know everyone else is thinking of as this begins to emerge, is we it's we're getting clear guidance that healthcare worker population will be in that first wave, whether under the emergency declaration or use authorization.
• 20:29
  SPEAKER_02: But even within that bucket of healthcare workers, kind of what Shay had to deal with with our very first flu position paper, the second half of that paper talked about prioritization because it was after the contamination event and shortage of flu vaccine.
• 20:41
  SPEAKER_02: And having to think about well, in that bucket of healthcare workers, we're not going to have enough to give everybody all at once.
• 20:46
  SPEAKER_02: So who are the priority groups?
• 20:48
  SPEAKER_02: Who goes first?
• 20:50
  SPEAKER_02: How do you even think about that and start to walk through with that um rationale?
• 20:53
  SPEAKER_02: And I know Shay's working on some white paper guidance on that piece, but who are those folks that get in that group first?
• 20:59
  SPEAKER_02: So that'll be a key piece.
• 21:01
  SPEAKER_02: I think that unlike you know, I'm a big vaccine mandate, but this is not a vaccine that I would recommend, and I don't think we're recommending that you mandate it first because we still don't know a lot.
• 21:10
  SPEAKER_02: Some of these platforms are new vaccine platforms.
• 21:13
  SPEAKER_02: So it's gonna be, you know, the healthcare workers are gonna opt for it.
• 21:16
  SPEAKER_02: And I think what we're hearing both in our healthcare workers and the general population is a mix of anticipation for the vaccine because that gets us closer to quote unquote returning to normal, but also some concern with the thoughts of, you know, warp speed, does that mean safety is sacrificed, some more hesitancy?
• 21:33
  SPEAKER_02: And so one of the things that we've talked about, our institution, both for our workers and our patient population, is really being very transparent in discussion about the oversight of the vaccine product, how the FDA is going to look at these vaccines for safety, what does it mean and entail in a very much direct way?
• 21:49
  SPEAKER_02: We also have gathered a group, so we have an operational group looking at COVID vaccination and all the logistics.
• 21:55
  SPEAKER_02: We've just started up, and our we met for the first time last week, an oversight advisory committee of folks like Bill Shaffner or Kathy Edwards, and my wife Kip is on the um ACIP COVID advisory group to basically look at whatever vaccines come out and are offered, how we're gonna evaluate that, whether we're gonna offer that for our workers.
• 22:13
  SPEAKER_02: What do we you make sure is a level of confidence to the workforce that we've we've got a group that have looked at this as well, as well as looking at what workers will go first.
• 22:23
  SPEAKER_02: I think the other side aspect of vaccines that we have to think about kind of dovetailing with our earlier discussion about people that have symptoms is the data that we're looking at from the vaccines that have been released so far is a fair number of folks after that second vaccination dose have pretty substantial symptoms, often fever, flu-like illness for the 24, 48 hours after vaccination.
• 22:41
  SPEAKER_02: What is that gonna mean for us in infection prevention and operations if we vaccinate a huge wave of folks and in 48 hours we've got a wave of people with fevers?
• 22:50
  SPEAKER_02: Is that COVID?
• 22:51
  SPEAKER_02: Is that the vaccine?
• 22:52
  SPEAKER_02: Can we write it off as the vaccine?
• 22:54
  SPEAKER_02: Do you have to test them?
• 22:55
  SPEAKER_02: I think it's a whole other different layer of complexity to think about as well.
• 22:58
  SPEAKER_02: And that we're just starting to penetrate and think how we're gonna manage that in a safe manner.
• 23:03
  SPEAKER_02: But I think one message, and we have some good advisors from us from some of our diversity and equity groups, is really make sure we reach out to those who are less included groups to make sure that they understand, have outreach about their concerns about vaccination and those barriers that are that are typically there for any vaccine, but I think are more there for COVID, and make sure that we have outreach to both our healthcare worker and patient populations and just message, message transparent, answer questions if we don't know the answer, be up front and say we're not sure yet, and really advise that.
• 23:34
  SPEAKER_02: And I think that will reassure our our folks, hopefully, of the vaccine.
• 23:40
  SPEAKER_01: Thanks, Dr.
• 23:40
  SPEAKER_01: Talbot.
• 23:41
  SPEAKER_01: That's all a lot to think about, but some really terrific insight into what may lie ahead with COVID vaccine.
• 23:46
  SPEAKER_01: I 100% agree that frequent communication is really critical.
• 23:50
  SPEAKER_01: We found that throughout the entire pandemic response.
• 23:52
  SPEAKER_01: So uh, you know, I do want to thank you again for coming on to the podcast.
• 23:56
  SPEAKER_01: This has been really great, and I really appreciate all the work you're doing for Shay and for you know advancing the importance of healthcare worker vaccination.
• 24:04
  SPEAKER_01: And uh thanks again for joining us on the podcast.
• 24:06
  SPEAKER_02: Yeah, thank you guys, and thanks to Shay and everybody who's out there on the front line.
• 24:10
  SPEAKER_02: This has been a long year and we're not done yet.
• 24:12
  SPEAKER_02: So just and stay healthy and keep looking towards the science.
• 24:18
  SPEAKER_01: Thanks again.
• 24:18
  SPEAKER_01: So thank you, Dr.
• 24:19
  SPEAKER_01: Talbot, for sharing your perspective and experiences and a sincere thank you from Shay to all healthcare personnel for all that you're doing to respond to COVID-19.
• 24:28
  SPEAKER_01: This podcast can be accessed on Shay's Online Education Center, Learning CE, under the Rapid Response Program.
• 24:34
  SPEAKER_01: You'll also find resources such as the recorded webinars, healthcare facility outbreak preparedness, and the SHA COVID-19 town halls.
• 24:41
  SPEAKER_01: You can now receive 75% off SHA membership for the remainder of 2020 using the coupon code podcast during checkout.
• 24:48
  SPEAKER_01: That concludes this episode of the Rapid Response Podcast.
• 24:51
  SPEAKER_01: Thank you for tuning in.