Dr. Anthony Fauci and medical experts answer YOUR questions about COVID-19 Variants/ Vaccines during this virtual Town Hall from South Florida PBS and the Health Channel.
Panel: Co-hosted by Dr. Michael Zinner M.D., Executive Medical Director, Miami Cancer Institute, and Health Channel host Olga Villaverde, the outstanding panel of health and medical experts include:
Dr. Anthony S. Fauci, Director, National Institute of Allergy and Infectious Diseases
Dr. Geeta Nayyar, Associate Professor of Medicine, University of Miami
Dr. Kavita Patel, Primary Care Physician, Brookings Institution
Dr. Carlos del Rio, Executive Associate Dean at Emory University School of Medicine
by baptist health. Through the john and Margaret Krupa Distinguished Chair fund mm It seemed like the crisis that dominated our world was almost gone, businesses, restaurants and stadiums opened, travelers hit the roads and the airports and the fully vaccinated took off their masks but then cases started rising in younger people, those who did not get the vaccine and even in some who did and now hospitals are once again at the breaking point and just as Children go back to school, many more of them are getting sick from Covid. We are here to answer your questions and dispel myths about the virus, about the variant and about the vaccines join us as we hear from the top experts on Covid vaccines clearing the air next. Mhm Yeah, thank you to the Unis Joyce Gardner charitable Foundation for its leadership support of the health channel. Yeah, welcome everyone to Covid vaccines clearing the air. I'm Olga Villaverde. There is so much misinformation out there and we are here to get you. The facts are moderator. Today is dr Michael Zinner. He is the Ceo and Chief medical Director of Miami Cancer Institute. He was the clinical director and surgeon in chief at Brigham and women's Hospital as well as Professor of surgery at Harvard Medical School for 22 years. Welcome Dr Zinner, thank you Olga. None of us in health care today have ever experienced the kind of challenges we faced for the past year and a half With over 600,000 American lives lost to this devastating disease. We all anxiously awaited a vaccine or treatments for a virus we had never seen before, the government and healthcare industries ability to rapidly develop solutions including a novel set of vaccines far exceeded any prior pandemic response in human history and in the spring and early summer of this year, as the infection numbers began to fall, we all breathe the tremendous sigh of relief. We relaxed our mask wearing, went back to social gatherings and thought we saw an end to this misery and the rate of infections dropped a lot but we were wrong. The virus changed and it is now not at all the same bad actor we fought last year. This new virus is worse than what we had before and now it's a new ballgame. No wonder people are confused and angry. We thought this covid nightmare was coming to an end. It has not. And with so much misinformation out there we felt it was necessary to clear the air and listen to clinicians and scientists answer your questions. So Olga, let me turn this back to you. Thank you Dr Zinner we have a wonderful panel of experts. Let me start first from the brookings institution is primary care physician. Dr Kavita Patel, Welcome from Emory University School of Medicine. Associate Dean Dr Carlos Del Rio is here as well. Welcome doctor and Dr Geeta Neher, she's a rheumatologist and an associate professor of medicine from the University of Miami. Welcome to all of you. We are delighted to have you this evening. Dr Zinner, thank you. Olga. We also have dr Anthony Fauci, the nature's the nation's top infectious disease expert and director of the National Institute of Allergy and infectious disease. I spoke with him earlier and asked him a number of questions regarding the delta variant and the fact that we are actually dealing with a new virus. Let's hear what he has to say. Delta variant has thrown us a curveball CDC recommendations are changing with respect of masking indoors and outdoors and now we've got breakthrough infections. Can you help us understand some of these delta changes? Well, yeah. Well delta is is really a very formidable virus in that it has the capability of transmitting much more efficiently than the original prototype virus that we had been confronted with early on in the outbreak. So you really dealing with you know obviously you're still dealing with SARS Kobe too but you're dealing with a much more formidable virus in the sense of transmissibility. Also it has the very interesting capability that when you get infected the amount of virus that's in your nasopharynx with the delta Varian compared to the amount of virus that would be in the nasopharynx uh of the other variants that we had faced previously is up to 1000 times more. Which really is the mechanistic explanation of why it's so readily transmits you bring up the point of breakthrough infections. A breakthrough infection Is something that is to be expected because no vaccine is 100% protective. And the vaccine trials that were originally done, the one that we're familiar with, for example, with the Mrna showing that there were 94 to 95 protected. That was protective against clinically apparent disease and not necessarily against infection, which for the most part, even if you had a subclinical infection that didn't make you symptomatic at all, there was very little chance previously with the other variants that you might transmit the infection if you were vaccinated and had a breakthrough infection because the level of virus would be so low in your nasal pharynx. But this virus is so efficient in transmitting that even if you are a vaccinated person and you get an infection even if you have no symptoms at all, a minimal symptoms, you still have the possibility that you may transmit it to someone else, even though you don't have very many symptoms. So that adds an extra important wrinkle in this. Which is the reason for the modification of the CDC guidelines about wearing of masks. Because the transmissibility in an indoor setting, particularly in a place like florida that has a high, high level a virus transmission, that the recommendation is to wear a mask if you are an indoor public setting, including in schools because the transmissibility is at such a high level of this virus. It sounds like things change with regard to recommendations. That's only because the virus itself is changing. You know, at this point I'd like to go around the panel and get everyone's thoughts. So Dr del Rio, let me start with you. Well, mike, all I can say is is this virus has humbled all of us and I think what we've learned is that it's very hard to know what's going to happen next. And I almost feel sometimes like I'm I tell people, I feel like I'm going down a river with rapids in a canoe and you're you know, going from one place to another. And it's hard, it's just you're just trying to stay afloat. Uh We made a lot of progress. We know a lot of things, but Dr Fauci is absolutely right. Delta is formidable, is highly contagious. And I remind people if you're vaccinated, you're okay, you may get infected but you're not going to get sick, you're likely not going to die or end up in the hospital. But if you're not vaccinated, you're in trouble. Delta will find you. And believe me, if you get sick with Delta, you're going, you may end up being one of the thousands of people that we currently have in hospitals across the United States. Thank you Carlos. And and now dr Patel. Yeah, thanks doctor sooner. I'm gonna just I couldn't agree more with Dr del Rio. But I just want to add some points brought on by dr Fauci. So number one, this is a fluid situation and I think just the evidence we have is what's been happening over the last 7 to 10 days around third doses boosters. And number two, it's okay if you're confused and if you're troubled by headlines because I think all of us to Dr Del Rio's point, not only are we humbled, but we've never had kind of science on display. I've never seen so many people talk to me about pre print publications or trying to understand how to compare effectiveness or efficacy. So this is a world stage unlike no other one that I certainly didn't want. I don't think any of us want. The third point really has to kind of drive home to Floridians to my home state of texas and to several other states we are at a critical juncture right now because of this variant to Dr Fauci's point, it's we're not asking people to wear masks indoors because the vaccines don't work. But we're trying to create kind of, my way of thinking is a wall of immunity to protect those who cannot protect themselves those who are not eligible for vaccinations. And I'm sure we'll get into this more with you and Olga but it's really to do our part getting vaccinated and to wear masks, especially in kind of settings indoors just to create that layer of protection one that the whole world needs, but more than ever we need it now. Thank you and and dr mary your comments. Sure, Well, first of all dr senator, thanks so much for having me. Thank you the PBS team for continuing to do these town halls. I think we absolutely need to clear the air. Um I like to talk to my patients and really simple language because this is a really confusing time and I like to compare what we're seeing with the delta variance to a football game and it truly is us versus them, right? We're playing the variance and those of us that are vaccinated. You know, we've got the protective pads, we've got those big shoulder pads on, we've got our protective gear. And if you're smart, you're still wearing a mask, which is your helmet. For those folks who still haven't gotten vaccinated are not wearing those protective pads are in the game without a mask. Without a helmet. They're more likely to get hurt. Right? This is a contact sport. We're probably all going to get hurt at some point. But the thing folks need to understand if you're watching is that if you are not vaccinated and you are not wearing a mask, you're more likely to get severely injured. End up in the hospital or end up in the ICU and that doesn't have to be the case, right? We've got all this gear, you just got to put it on. We gotta work together when you get injured, You hurt the whole team. We can't get to the end zone without the whole team. So we gotta work together that that's really my my my kickoff here as we start to start the conversation. Thank you. Gotta you know, let's uh let's turn to some of the questions we get from the audience odor and as we speak we're getting lots of them. Doctors inner we've got a bunch on booster shots. Let me start with Andrea she wants to know when they will be available um for everyone and if she should get the booster from the same vaccine manufacturer that gave her the other shots as well. Great question Dr Zinner let me also add, we got a number of questions about boosters should a person on dialysis, three days per week, get a booster shot and one more I want to throw in here. Can antibody tests tell whether someone needs a booster shot. Dr Zinner Well let me answer the question about about antibody testing. So antibody testing is something we can do but it's not recommended by the CDC to make clinical decisions on. So we're not using that for clinical decision making yet. But as to the other issues. As for booster questions. Let me also turn to Dr Fauci, we had an earlier conversation with him as I indicated. Let's take a look at what he has to say the current vaccines right now. When you think in terms of protection from serious disease that might lead to hospitalization or deaths still do very well. But we are seeing data particularly from Israel which is about, you know, a few weeks to a month or so ahead of us in the dynamics of this outbreak and in the implementation of vaccines, they're starting to see even in vaccinated people with this delta variant, more and more people particularly the elderly and those who are in uh nursing homes and in extended care facilities or having an uptick in some of the hospitalizations. So for that reason, what has happened is that we are putting together a plan that will likely be implemented sometime in september to make booster shots available by booster. We mean a third shot if you've had a two shot regimen essentially for everyone, but particularly concentrating temporally in getting it rolled out with the people who originally got the shots earlier, the healthcare providers, the elderly, those in nursing homes. And the reason that plan is being implemented is because we want to stay ahead of the curve. You know, we use that analogy that Wayne Gretzky used to say, you want to escape where the puck is going to be, not where the puck is. So we want to anticipate that if in fact we do see a diminution and protection against hospitalization and or serious illness that could lead to death, that we want to be prepared to give the extra level of protection with a boost to people so that you can increase dramatically their immune response. In fact, in studies that have been done and are continuing to be conducted, We know that a third shot after several months of an interval after your second shot. And it's important because you give the immune system a chance to mature and make it more amenable to getting that extra kick from a boost that you could increase protection really much much better when you think in terms of antibody responses and other measurable immune responses. That's the rationale for planning and implementing ultimately the capability of giving booster shots to individuals. So at this point, do we know whether it will make a difference if you had the fighter shot and then get a modern a shot or vice versa or does it have to be the same one that you had earlier? We would like very much for it to be the same one you had earlier. But there are studies now called Mix and Match Studies which are trying to determine is the safety and the actual. Adequacy of the response the same. If you use the same or a different one, we'll get that information pretty soon. But to the extent possible, we would like people to stick with what the original vaccine was. Okay, um, a lot packaged in there. Uh let me again, go to the panel. Uh let's start with Carlos. Again, I know you've got experience here as being one of the investigators in the vaccine clinical trial. Any thoughts on what dr uh thought she was talking about. Well, again, you know, I think that that dr Fauci said what we all are concerned about, which is That you know, I'm really worried about our immuno compromised individuals and I think it's absolutely right. When we've seen hospitalized patients who have been vaccinated. We're seeing people who are transplant recipients were seeing people who have severe uh immunodeficiency because for example, they received a disease modifying agents like a city for you know antibody, something like that. But in general, you know, people like me are not in the hospital. However, I have seen the data showing a decrease in neutralizing antibody response over time. And people have been vaccinated after 6-8 months. But you know, and we can certainly boost that response. But I'm not sure we have seen data showing that that makes a clinical difference. So my concern is it might to be honest with you is while we're giving a third shot to people who already received two shots like me or you or most of us, I think Uh we're will be taken over resources that could be used to give people the first shot. And what I tell people is the most important booster that I need is for the 93 million Americans that haven't been vaccinated to be vaccinated because if we all vaccinated, we can stop transmission of this virus. This is not just about individual protection. This is about community protection. So I am worried that by giving boosters we maybe overcrowding those facilities and those those healthcare providers that are needed to provide shots to the people that that currently are not vaccinated and who are going to be vaccinated. Because vaccine mandates are going to make people take vaccine sooner or later as far as with vaccine to take. You know, I hear what Dr Fauci says, you want to get the one that you're likely received. But I have absolutely zero data to support that. And in fact the data suggest the opposite from europe. We have data that you get a astrazeneca vaccine followed by a Pfizer vaccine. You actually get a much better immune response. So quite frankly, why not? I mean why not give me a johnson and johnson vaccine? I may get an even better response. The reality is we are navigating right now and and data free zone. And I want to emphasize that to people. We have no data to say the things we're currently saying. Wow! Uh dr Patel committed to your comments. Yeah, I mean how do you follow that Carlos is he's both correct And I think also I don't want to say incorrect in his in his logic and reasoning but incorrect and kind of understanding what I think is happening in the psychology of the country. So he's I'll be brief. I think there's clear evidence to illustrate that immunity is decreasing over time. I think the critical question is well what level of immunity is enough to prevent what we really developed the vaccines for what Dr Del Rio was an investigator for which is to prevent severe hospitalization and death. I think we miscommunicated from the beginning that the vaccine would prevent you from getting an infection, it was just hard to communicate that. So when we started seeing breakthrough infections mostly mild I think to be candid the CDC made a misstep and not you know not requiring that to be reported because already you felt like there was a blind spot and then now we here and I've been trying I'm sure Dr Del Rio has. I've been trying to unpack Israeli data that was mentioned several times. There's also the mmwR reports and to just break it down for viewers what it tells us is exactly what both Carlos and and Tony Fauci have said that we are seeing an uptick and it is in long term care facilities and in nursing homes. Well you know what's hard to say about that mike. So look I'm going to come out on the side of I do want to see boosters especially in immunocompromised individuals. I also take care of nursing home patients especially in I would even go so far as to say certain age categories and high risk workers which include health care workers which include police firefighters E. M. S. Etcetera. I think that is a very different population than the average community population. But every time we've asked our every time we've asked our country to kind of do nuance or assess risk that way mike we failed. So what I want to avoid is kind of a failure of communication. Our vaccines work. They work incredibly well. In fact they work so well that we could argue that yes the Mrna vaccines and maybe two doses of johnson and johnson might be the most superior protection in the entire world. The question though with boosters now that we're going to start releasing them on September 20 and by the way, you know a lot has to happen for that to happen on that date. By the way, The question to ask is well what do we need to do until then? And I for one am desperate because we have 6-8 weeks of schools that are opened and are opening and we're watching children's cases because they're an exposed population increasing 2% hospitalization holding its own. But I think you know, we'll get to viewers questions. I think this is why you can see there are sometimes more questions than answers. Got it. Got it appreciated that computer data. So doctors enter, gosh we've we've got a lot of information here between dr Fauci dr del rio and Dr Patel I'm gonna actually zoom out for a second. I want our viewers to understand the difference between the immune system in an immunocompromised patients such as the ones that I see in rheumatology and an immuno confident meaning a normal, healthy able bodied immune system. I'm gonna go back to football, right? So immuno confident, strong immune system. Your your your football team is made of a bunch of tom brady's right, immuno compromised. These are my patients, rheumatoid arthritis, lupus, psoriatic arthritis, right? These individuals have more Popeye, the sailor man football players, right, scrawny er shorter. Those players need a boost. Right? The concept here is that because your your football team is a little bit scrawny, er you're more predisposed not just a covid 19 but any infection, right? You're more likely to get sicker to be hospitalized. So the concept that Dr Fauci is talking about is look we think that these patients need to boost, they need that spinach, they need Popeye to build those muscles and go go go right and tom brady. He gets tired too, but he's got a little more time. Right? So, according to recommendations now, it's about eight months for the general population and much sooner for those that are immuno compromised. So that's really you know what we're debating here, just for the audience to understand. And look this continues to be our first pandemic doctor Patel. Doctor Del Rio have clearly shown us that there is debate in the medical community and they will continue to be because we continue to drive the car as we're building it. But going back to the fundamentals and the basics of science are gonna also be important as we way some of these decisions without the data to Dr Del Rio's point. Thank you all very helpful. Listen, let me go back to Olga as we get some questions from our audience. Thank you. Dr Zinner lots of questions coming in. I just got this one from Tony that I'd like to read and he writes, can I re infect someone who has already had covid with Delta if I have it, Dr Zinner? Well uh you know, I'm gonna ask Dr Del Rio Carlos, can you answer that question specifically? You know, it's very hard. Again, my answer, would there be it? Maybe it's possible. But the reality is if you're vaccinated and the other person is vaccinated, the possibility of you getting infected and the possibility of youth infecting other person is really, really small. The big concern. The reality is why I as a vaccinated person where mask indoors quite frankly is to protect the unvaccinated people is to protect all those that have not been vaccinated because they don't want to or because they can't for example young Children. But really the other vaccinated people are actually fairly well protected and we need to emphasize that, you know, I think we need to we're getting into a minutia that is, it's too too delicate. We're really concerned about the little bumps in the car when the reality is the big accident out there is that people who are unvaccinated. We need to get people unvaccinated vaccinated. We can. That is the key to our strategy to get out of this pandemic. Great response. I I totally agree with that. That the issue is vaccination to get out of this. Let me turn it back to Olga. We've got other questions coming in from the, from our audience. Thank you. Dr Zinner Maya wants to know what we're seeing from pediatric studies. Look at her question. Will vaccines be recommended for younger Children and toddlers and a few other viewers wrote in and let me read dr Zinner, they want to know the effect of the delta variant on Children. Doctors, you know? Let me toss it back to you. Okay, well first of all thanks Maya I asked Dr Fauci about Children and vaccines earlier and let's hear also what he has to say. And we'll get some reactions from our panelists also last year we heard Children had a very low chance of getting infected or getting sick. But now our Children's hospitals are beginning to fill up with cases. What's the difference and how do you think we should plan on protecting these Children? Well, it gets back to what I just mentioned to you about the delta variant, The delta variant is highly highly transmissible. We've seen that in adults. And we've seen that in Children and the more Children that get infected purely from a quantitative standpoint even though it is true that Children have a less of a chance of getting severe disease then does an adult or someone with an underlying condition. But you are absolutely correct. We are seeing more and more Children literally on a quantitative basis requiring hospitalization and getting serious illness. And for that reason we want to do the following first. When you think in terms of school we want to make sure we surround the Children by people who are vaccinated who are eligible to be vaccinated teachers personnel who were involved in the school system For those Children 12 years old and older who are eligible to be vaccinated. We want to encourage them very strongly to get vaccinated for those Children who not yet are eligible. And the studies are being done to determine if it is safe to do that and the kind of response and what dose they should get. That's the reason why we want to make sure we get people masked in the school system to protect the Children and to allow them to safely get back to an in person learning because we know of the deleterious effects of keeping Children physically out of school, mental health developmental issues and others. Mm. Kavita I know you're practicing primary care physician in the D. C. Area and this is such an important question as many Children are going back to school right now. Let me get your thoughts on it. Kavita Yeah, it's interesting. We were in, we are in kind of a relatively higher vaccination rate than other parts of the country. We're also kind of flipped into what would be considered by the CDC is high transmission based on our numbers of cases. So we are, most of our schools are opening have opened or we'll open in the next week. And already I think you're seeing a scrambling in a pretty mask, kind of friendly environment mike. You're already seeing a lot of concern from teachers, from parents, even from students who are pretty savvy. I think we kind of undermine how much kids actually understand and they're kind of scared when they see what's playing out on the media about, you know, kind of scary numbers and quarantine. So I do think that Children, by the way, if anything, it's back to Carlos point of anything Covid has taught me is that if I think I know something, I'm totally wrong. So I'm not going to kind of get arrogant enough to say we know everything about delta variant Children other than the heightened infectiousness. The ability for even toddlers to transmit or have enough of the virus in their nasal passages and respiratory tracts. And that's a warning sign that just means that we enter. We are at a stage where we had higher transmission then when we actually moved most schools to virtual learning. So this is our obligation. I'm gonna steal from Carlos, kind of what he said about vaccinating the world and trying to have that be our best line of defense. This is the best line of defense we can get for our Children. Anybody watching listening, if you know somebody who's not vaccinated, don't judge them spend time and try to appeal to the elderly, family members in their life, Children, grandchildren. And instead of running to think about when you need to get your booster, what date you need to get your booster. Think about how you can send a message to all the people that are unvaccinated around you. So I'm I'm very worried that coming out of this and mike I think you and I have talked about this, you know, hospitalizations and deaths kind of lag. We also know that we just aren't reporting data from the hospitals in the States the way we would like to. So we could very well see a darker picture with Children and I hope we don't get there. We can prevent it. You know, you're so right. Uh, you know, and I listened to some of the other media aspects that we listened to or some of the social media who complain about us in science, changing our opinions. The fact is we're learning as we're going, we've never seen anything like this before. So it's it's it's such an unfair criticism to say, well last week or six weeks ago you were recommended this and now six weeks later you're recommending something else. This is something we've never seen before. And it's going to change again. That's the bottom line. We all know that. All right, let me go back to Olga, she's got some more questions coming from the audience. Thank you Dr Zinner, I have a question here from Fatima that I hear a lot and this is what she asks. Why do we have to wear masks if we are fully vaccinated, dr Zinner? Okay, let's talk about masks data. I know there are different kinds of masks and can you share your thoughts on what those are and whether Children should be wearing mask and what kind of masks. Sure. So I'm happy to add some color. And I'm gonna tell you a little bit about what I tell my patients and also how I talked to my nine year old because very similar to Kavita. I'm a mom of a nine year old here in south florida where numbers are not looking very good. Right? So number one, trying to decide what mask to wear. Go to the CDC website. They have very clear guidelines. But the reality when it comes to, especially Children, the best mask is the mask that kids will wear and the best mask that you as an adult can tolerate. So that's number one, a mask is way better than no mask, don't get hung up on it. We don't want to see the mask around your chin. We don't want to see it around around, you know, dropping down from your nose, you've got to wear and you've got to wear it correctly. That is the most important thing. The second thing is really counseling your Children. So I'll tell you the discussion I had with Sonia before going back to school. Look the original virus. If we, if he was a superhero, he'd be clark Kent, right? The delta variant is superman, he's faster. He's more transmissible flying from nose to nose, right? That's the nasopharynx. And that's what you hear when we talk about this being more transmissible and more contagious. So really important to counsel your kids for any kids watching this is why it's important to wear your mask. And the danger zones when it comes to going back to school is when you're eating lunch or out in the playground. So council your kids on taking their mask off if they get sweaty, if they get acne, do it away from other Children, eat lunch outside, drink outside when you're taking a snack break to the best of the school's ability to the best of the child's ability. But we undermine we discount our Children's ability to understand as well as just counseling them on wearing the mask. The second thing that's really important to going back to that football analogy. So remember that protective gear. Children under 12. The only protective gear that comes in their side is comes in their size is a mask. They don't have this big shoulder pads, they don't come in two sizes under 12 years old. So everyone around them has to protect Children under 12. Like they're the quarterback, right? All of us that are vaccinated with all our gear on our helmets are protective shield. Our vaccines are mask, you're wearing it for them. You're wearing it to protect the Children and those that are vulnerable among us because it's the only way we win this game and end the game. So we've got to do our part. We've got to help everyone. The mask is one more protective gear on top of everything you're doing by being vaccinated. Great, thank you. Uh let's go back to questions from the audience. Thank you, Dr Zinner. This question comes from someone that did not put a name, but it's a great question. And let's show you what it is. My husband and I are trying to become pregnant and I'm concerned about whether the vaccine could harm my fertility. Please help me out here. And I really do believe this is an extremely common question. I even had some issues with my two teenage daughters to get vaccinated. They were very concerned about how that would affect their fertility down the road. So, I'm really glad this question came in. Dr Zinner, you know Olga, I I probably hear this question at work more often than almost any other question I get about fertility. Uh and it's not going to go away. And part of that is because many of us working environment where there are young women who are of childbearing age. So let's let's try to clear the air on this. I'd like each one of the panelists to give me your thoughts either, let me start with you and then we'll go to uh Kavita and then Carlos, geeta. Sure. So let's clear the air mike. So number one, as a mom, as a woman of childbearing age, hear it loud and clear The vaccine does not affect fertility period. End of story. And by not getting vaccinated, you are more likely to get COVID-19. More likely to end up sick in the ice. You getting hospitalized? Believe me that will impact your family planning way more than thinking about getting vaccinated. Talk to your O B G Y N. They're going to tell you the same thing. This is not an issue to be concerned with Kavita. Yeah, I'll just add to that that the CDC recently released some updated guidance and it was based on data kind of what I call real world evidence from over 100 and 103,000 women who kind of went forward and just submitted data on their vaccination fertility pregnancy says, first of all with, with fertility we also think about miscarriages, there were no differences in terms of vaccinated people having more miscarriages. And in fact we now know that with covid infections there can be a higher risk for preterm labor and some bad outcomes for the mom and baby with respect of fertility. There have also been across the world several studies that have been looking at now. If you think about it mike we've had billions of people receiving vaccines. So we really do have not just the trial data but growing evidence, no differences and no effect on fertility. There's a lot of bad rumors that my patients have found on facebook WhatsApp about changing their ovarian cells. There is no proof of that. These are not vaccines that interfere with your DNA. That's another reason people think it affects fertility. And then I'll just say for men, we do know again that covid can potentially have outcomes on your sperm count and other factors for fertility. So, I know many young men have been worried about this as well. They should ask these questions so far, I would say. And I like to get reminded of by some of the vaccine experts. We've got one next If you were going to see some of these outcomes. You would also generally see them in the weeks following vaccination, which is why it was really important for the CDC to conduct their registry and also for other countries to share their data. So hopefully we can dispel a very valid concern amongst men and women Carlos. Well, I would just say that I totally agree with what has been said so far. But I would say that this idea that the vaccines affect fertility is fake news is totally misinformation that has been disseminated by people. This is absolutely wrong. And I'll give you two pieces of information besides everything that has been said. Number one, there's a paper published in Jama showing very nicely in men who were vaccinated. There's absolutely no decrease in this sperm count. You'll see the same level of sperm motility and numbers of sperm. And number two. I'll just give you an anecdote as an investigator in the modern a study. While we did not enroll women who are pregnant. Some of the participants that we enroll where women of reproductive age who got pregnant during the study and I can tell you that more women got pregnant on the vaccine arm than the placebo arm. So maybe the vaccine actually increases your fertility. I don't think it decreases it. Well, I'm gonna take that as a re emphasis point. Let me make that .1 more time. There is no evidence that the vaccines interfere with fertility or even pregnancy. And that unfortunately that myth is out there. And it's wrong. Anyway, let's let's move on. Uh hold on, let me go back to you. Thank you. Dr Zinner statistics continue to show that people from underserved communities, especially black and brown communities are not getting vaccinated. So we asked a local community pediatrician to talk about why they are so reluctant. Let's take a listen. So there's two problems. There's number one reading the wrong information misinformation which we're all familiar with today in this day and age misinformation that's spreading like wildfire and then to not really having a reliable source that you trust or reliable person or or person in your community that you can trust and that you can get advice from. I have found personally That I would speak to my patients and their families about the vaccine, literally the parents would tell me I do not want to get vaccinated and in the 10 minutes that were together in the room, I've been able to change their mind and they've gone and got vaccinated right after our conversation. And that makes me feel great because that means that they trust me and they value what I'm saying. I never tell them that it's my opinion. I never tell them what I think they should do. I just give them the facts. Well, thanks. So go. I also spoke to dr Fauci about this very topic and let's take a look at his comments. Underserved populations, continue to have a lower vaccination rate. And what are we doing to help these communities? Well, we are doing a lot where we're getting uh search teams out to help with the logistics of getting vaccines to people, but we also are intensifying our work with the community core namely getting trusted messengers that people of color trust and know they could be clergy people. They could be family physicians and health care providers. They can be peers. They can be sports figures, People who at the really in the trenches level can be in the community and be the trusted messenger to get people of color to be vaccinated for so many reasons, particularly because they are suffering unfortunately disproportionately when they do get infected of getting more severe disease for a variety of reasons, including many of the social determinants of health that provide them unfortunately with getting the the environment to get more severe types of underlying conditions, hypertension, diabetes, obesity, chronic lung disease, kidney disease and things like that. One of the other lessons we've learned from the underserved community is access and that some of them don't have transportation and are either homebound or housebound and we've begun to move those kind of vaccination opportunities to them. I've learned from that lesson. And in fact in my institution, we've got 1700 employees and some of them didn't get vaccinated. And what we discovered is if we have a mobile cart, a vaccine cart that would go florida floor or department to department, we actually increase the vaccination rate. It's the kind of thing we need to be and doing in our communities even outside of my hospital environment. All right, look older. Let's let's go to the next question. All right. Dr Zinner, thank you. Our next question comes from Helen and this is what she writes, I've had three separate cancer incidents and I'm not currently under any treatment right now. She wants to know am I considered a person with a weakened immune system and therefore a candidate for an extra dose of the vaccine? There's her question right there, Dr Zinner. Okay, thanks. Okay. I'm gonna take I'm gonna take this question. We've made some decisions at the Miami Cancer Institute to follow the guidelines and give boosters to cancer patients under active treatment. And those would be those that we think are immuno compromised, but not to give to those who simply have a history of cancer, particularly if we think that they are in remission and they're doing well. They may fall under the category that dr del rio and Dr Fauci talked about that's coming up in september that may be age related and or other disease related. But right now we're focusing on patients that have that are under active cancer treatment. Hold the next question. All right, doctor let me take this question from raj. And this is what he's asking is herd immunity a possibility with covid 19 doctors dinner. You know, Carlos, I want to turn this one to you. This seems to be a moving target because the numbers we heard earlier in the year and the numbers we're hearing now may be different. Can you enlighten us on this police. Well, mike, I think what problem, you know, what was said before is that we are now sort of, you know teaching science through television, right? We're teaching science to the community. And herd immunity is a very complicated concept. I like the term instead of herd immunity. I like the term community immunity and the community immunity. The level of Of disease people who either have suffered a disease have been infected or have been vaccinated is determined by what we call the are not the transmission rate of the virus. So the original Wuhan Strain had an or not about 2.5, which means 2.5 individuals Everyone individual infected infects 2.5 individuals, 2.5 individuals in fact 2.5. So in a naive population at the end of 10 cycles of transmission, you had about 9000 people infected are not. The herd immunity is determined by the are not so we are not of 2.6, you herd immunity threshold is about 60% With the delta variant. We think they are not is somewhere around six When you get an are not of six then one individual in fact 66 and in fact each 16 etcetera etcetera. At the end of 10 cycles of transmission, you have 30 million people infected. That's the difference with delta. But that what that does to the or not is that you're not now it's over 85% is close to 87%. And what that means essentially in my mind is that you're not going to be able to get to herd immunity Because unless you really cover 100% of the population with vaccines. And that is the challenge. Is that at this point in time, eradication of this disease is going to be virtually impossible. The best we can hope for is mitigation and decreasing the transmission to a level that is manageable in your hospital, in my hospital. And the mortality are or so are available are in a manageable range. So, the reality is at this point in time with Delta. I think herd immunity is really a far reaching concept. Wow! Carlos. That's a that's a lot to unpack also. Um thank you. Let me turn this back to Olga Dr Zinner. Great question here from mary and this is what she writes is the Moderna vaccine better than Pfizer vaccine when it comes to the delta variant dr Zinner uh you know that that's an interesting topic that's come up in part because of what's in the press. And uh Kavita, let me turn that one over to you. What are your thoughts on that? What does the data look like on that one? Yeah. So I'll just say this that the data hasn't been peer reviewed. So there's there's a study and there are several but uh since we've got a modern a clinical trial investigator with us, I'll just say that one of the studies that was released without peer review publication but was mentioned by Dr Fauci doctor Wolinski and did make its way through the press illustrated that when they followed people who got received Madonna as well as people had received Pfizer kind of in cohorts, meaning they tried to find people who got it in january and see how their effectiveness changed over time. They found that Moderna seemed to decrease its efficacy at a lower rate than Pfizer. Or simply put the headline that was taken away. Was that Madonna was somehow better than Pfizer? There are many issues to take with that, including the fact that they really they did not actually see that both vaccines worked incredibly well in preventing death and hospitalization kind of a theme. You're going to hear us say over and over which leads to the conversation of even if there is decreasing efficacy, there is no data to support that one. MRNA vaccine is somehow superior to the other. There are also a lot of speculations that maybe Madonna because it was administered four weeks apart versus fighter which was three weeks apart for its two doses might have been a better combination. But again, I think this is where we're kind of getting uh I am gonna just it feels easier if I just steal Carlos phrases. But if we can just avoid the menu sha And you go back to the question, there is no reason to think that anyone of our current three vaccines can't protect us against what we really want it to do. I think that's where. So I would have I received Moderna very proudly and and I have colleagues who work right by my side who received fighter and I don't lose any sleep over whether one of us had something better than the other. They're both the same technologies, They both approach the immune system the same way. Different different doses but not a change that I would dwell on. And I will say the same thing. The best vaccine kind of like the best mask is the one that you'll actually get. So don't just get dose one of anything, make sure you get both. And if that means johnson and johnson is a better fit for you, then that's a great option too. And if I recall from uh that pre print also that one of the not headlines but takeaways was that even though there may be some difference in terms of effectiveness over time, there was no difference in hospitalization rates in either one of those two vaccines that was somehow missed. That was somehow missed in the press. Sure. And I'll say it again. I've never seen so many pre we go through a process and science of having our peers review what we do because first of all these types of studies aren't considered as good as the kind of study Dr Del Rio had to do for his trial. But I understand why people want to know that answer. But hopefully that offers hopefully that offers the question or some comfort that there have been so many of us vaccinated with both and we have not seen any differences in some of the real world data from around the world. Okay, good. Uh let me go back to older. She's got another question from the audience. I do. Doctors enter and this one comes from Bill and he writes, please discuss the known variants such as lambda. Are they going to get traction in the us? How dangerous are they dr Zinner you know, uh I'm going to turn back to you Carlos, that's that's sort of right up your alley having been in that in the vaccine field and watched that trial over time. So, Carlos your thoughts. Well, you know, again, I think it was said at the beginning of our talk today that as long as virus are transmitting, they're mutating and they're producing new variants and the lambda variant has emerged in peru And could it be here. Absolutely. But you know, I'm not going to worry about the future because the reality is I'm concerned about right now we need to control the delta variant and again, if we stop transmission of the virus, we're going to stop mutations and very mutations variants happened when the virus is control is transmitting an uncontrolled way if we can stop that transmission, we're going to be in good shape. Now, I'm going to tell you also that many of the pharmaceutical companies moderna fights or the producing vaccines are also working right now on what we call pan coronavirus vaccines. And I think the future is going to be a pan corner virus vaccine. In other words, it's going to be a vaccine that no matter which vary and you have no matter which strain of coronavirus you have is not only SARS COv, but it's going to be immersed is going to be the original source. You're going to be protected. So again, this is evolving very rapidly. But at the end of the day, the investments that we as americans have made in science are actually paying off. We will be out of this in great part because science is helping us. Great comment. I want to turn this back to uh to Olga were coming near the end of our our we are doctors dinner And I'm going to actually end with this question from mary jane. It is a question that I think everyone has asked up to this point and she wants to know when will this nightmare end dr Zinner? This is one I need comments from all three of our panelists. Let's start with Dr del Rio and then Doctor Patel and then Dr Nair. Well, I will start by saying that this will end pandemics and but they end not when we decide it's going to end. I would say that President biden made a mistake quite frankly by saying july 4th is our independence from covid day. You don't make that decision. The virus makes that decision, The immune system make that decision. So at what we need to do is do the right thing. I know we're all anxious. We're all tired of this. I'm tired of this. But we also need to just you know how long do the best thing we can and you know, I would implore people to have compassion to have kindness. But more importantly to think about yourself, to think about your loved ones and to think about everybody else because that was as good a said before. If we all do the right thing, if we all wear our army of protection, if we all take our vaccines, if we all wear a mask, we will control this infection. It is upward, it is not up to anybody else. It is up to us to control this disease and we will be able to do it. I am confident that this will be over and this will be over when we all decide that it's time to have it over. Kavita november 20th 2020. That's when this ended for me and I may have gotten the exact date wrong. That's one Pfizer filed for emergency use authorization and we saw some of the top line data that had that dramatic uh 96% efficacy. I truly cried that morning. It's amazing to think that science. I mean we knew these trials were happening. We had no idea what the outcome would be. And so that really was like to me an incredible inflection point and one that people really have optimism. If you had said to me in january and december 2019 when we saw these reports coming out of Wuhan that in under a year we would have not one, not two but almost three highly effective vaccines and an abundant supply to our country. I wouldn't have believed you truly would have thought that was fake news. So I'll be honest mike for me that moment of clarity was november 2020 which just shows you how much we have because that's from then to now that's precious time. We could have preserved lives that we lost. So think about your loved ones, think about doing it for them and Judah, we only have a few minutes. Sure. So mary jane, great question. I think we're all asking ourselves the same. My nine year old certainly asked me that on her way to school this morning. So the important thing to recognize is that the delta variant has changed the game. It's no longer about if you will get exposed to the variant or the virus. But it's really a question of when So putting on that protective gear, putting on those shoulder pads, putting on that vaccine is key. Second keeping a helmet on wearing that mask is critical. It's also really important to ask the experts such as the ones on this panel, attend things like this town hall, right? Getting the right information is really important. You don't go to your mechanic for a haircut, right? So for health care you need to talk to your doctor. No one else. For those that don't have a doctor look for one. For folks who have issues around access, please remember there are free clinics such as the one at the University of Miami where I practice, there are federally qualified health centers, there's telemedicine, there's an opportunity to find a position 24/7 online and there's your pharmacist. Your pharmacist is a terrific person to ask questions to. And lastly remember that your physician doesn't make any money if you get vaccinated or not. We are not running for re election. This is not about freedom, this is about survival and for those who feel like there's no hope there is a lot of hope. We've made tremendous progress. As dr Patel mentioned this pandemic ends with you and me. You are the M. V. P. You are the most valuable player here. So let's make it happen. I have to ask you. I I apologize but we are absolutely running running out of time. I want to thank our panelists. This has been an incredible evening and if we thank all, please say thank you to them. and remember this is about your health and your care. And if you take anything away, ask the experts about the opinions raised tonight. Thank you all older. Thank you dr Zinner. And of course we thank you for joining us right here on the Health channel. Please stay safe and have a good evening. Okay. Yeah. Mhm. Mhm. Mhm. Yeah. Yeah. Mhm. Thank you to the Unis Joyce Gardner charitable Foundation for its leadership support of the Health Channel. Yeah. Mm. Mhm. Yeah. Mhm. Support for this program is provided by baptist health through the johN and Margaret Krupa Distinguished Chair Fund.
