Health Experts Pushing Flu and COVID Vaccinations
Avoiding a Twin Epidemic:
As COVID appears to be abating, health care experts are concerned that the general population may become a little too relaxed about getting vaccinations. It’s not just about COVID, it’s also about the flu season which traditionally revisits in the winter months. And this year, we may have a particularly nasty flu season.
Health experts fear a “twin epidemic” with some of the population falling victim to flu and COVID simultaneously. The threat can be attributed to 2020 not being a bad year for flu. Last year, due to social distancing, hand washing and masking efforts used to avoid COVID, there was almost a nonexistent flu season. Humans build a natural immunity every year as they fight off varying levels of the flu virus and last year they weren’t given a chance. Doctors and pharmacists are pushing Americans to get their flu shot now to help build back immunity and avoid possibly getting COVID and flu together. In an effort to spur public response to getting flu vaccinations, the Georgia Department of Health announced that flu vaccinations and COVID vaccinations are now available at all health departments across the state and can be given at the same time. (See accompanying article for more information.) Meanwhile, as COVID seems to be on the decline across the state, new information is being disseminated about the positive effects of the COVID vaccine for the state’s senior citizens. A new federal report shows that COVID-19 vaccination may have helped prevent roughly 5,100 new COVID infections and 700 deaths among seniors in Georgia during the first five months of the year.
The study, conducted by the U.S. Department of Health and Human Services (HHS), also found that vaccinations were linked to a reduction of about 265,000 COVID infections nationally, 107,000 hospitalizations, and 39,000 deaths among Medicare beneficiaries between January and May 2021. “This report reaffirms what we hear routinely from states: COVID-19 vaccines save lives, prevent hospitalizations, and reduce infection,” said HHS Secretary Xavier Becerra. More than 352,000 lives were lost during the first nine months of the COVID-19 pandemic. Prior to the availability of vaccines, nearly 80% of the deaths were among the age 65 and over Medicare- eligible group. Between January and May of 2021, when vaccination rates rose from 1% to 47% among adults 18 to 64 and from 1% to 80% among seniors, the study found an 11% to 12% decrease in weekly COVID-19 hospitalizations and deaths among Medicare beneficiaries for every 10% in county vaccination rates, according to Tim Darnell with Capitol Beat.
All racial and ethnic groups in 48 states saw reductions in COVID deaths, hospitalizations and infections linked to the vaccination rate increase, Darnell wrote. Texas and Hawaii were excluded from the analysis due to data reporting limitations. The study also showed that vaccines were tied to a reduction of about 5,600 deaths among nursing home Medicare beneficiaries, a group that was disproportionately impacted by the pandemic.
Bicera issued a directive last month authorizing all COVID vaccine providers to make available and administer Pfizer booster shots to seniors over 65. At the time, Pfizer was the only company that had received approval to administer the boosters, but recently, a federal panel voted to recommend the Moderna and Johnson and Johnson boosters. This means that well over 100 million fully vaccinated people will be eligible for the boosters once the Federal Drug Administration and Centers for Disease Control adopt the recommendations. It is expected that these boosters will be available locally in the next few weeks.
Dr. Karen McColl, Vice President for Medical Affairs and Chief Medical Officer at Memorial Health Meadows Hospital in Vidalia, said she totally agrees with the results of the HHS study and has seen the trend reported in the study to be reflected in Toombs County. “There has been a decrease in infections among the elderly because of vaccinations.” She expected that trend to occur because of the local statistics she and her staff is seeing, but expressed concern that younger populations are at higher risk, partially because they are not getting vaccinated. The second and third waves of COVID that struck the community beginning in the winter and early summer of 2021, respectively, have taken a significant toll on younger populations, as has been the scene across the nation.
Dr. McColl said in an interview on October 6 that as of that date Meadows had seen the lowest COVID patient volume since the second COVID surge in the summer, with 16 patients being treated. “Of the 16, unfortunately, half are on the vent. Of those, most have been here for two weeks or greater.” As of October 18, the number of patients being treated was down to 15 and those on vents were down to 5, however, several patients succumbed to COVID in the last few days. She noted that age distribution in the folks that are severely ill is a younger population than was seen in the first COVID wave in March 2020 when the hospital was primarily seeing patients over the age of 65, and in the second surge that began in December 2020 and continued through January and February of 2021.
“This current surge is very different, not only in intensity of the illness but the age group. We are seeing people in the mostly 30 to 54 age range affected. Our patient population consistently held true to that. That population is also the under-vaccinated population in Toombs County. Now, the vaccination rate for Toombs County is 40%, but that is still dramatically lower than what we want it to be.”
She added, “When you look at the group over 65, that group has heard the message and gotten vaccinated. That group is close to 75% to 80% vaccinated at this point.”
She said the over 65 age group in Toombs County has certainly “done its civic duty” in protecting themselves and others. “ We are hopeful we will see the same trend in the younger population.” She said health care officials are starting to see the 12 to 18 age group get vaccinated more. Because of a change in vaccination protocol, getting vaccinated not only offers protection against illness, it also offers incentive. “It’s to their advantage now. If they get exposed, they don’t have to quarantine and they can stay in school, can stay on the ball team, go to after school activities.”
Meadows closely follows the Centers for Disease Control and state DPH sites which monitors vaccination rates and updates this information twice a week. “I was very excited to see about a month ago that the vaccination rate was increasing pretty steadily.” But, since then, the rate of vaccinations seems to be falling off. “We are not seeing quite as many feel the urge to be vaccinated.”
Since March 2020, when COVID first broke out, Meadows admitted over 250 COVID patients from the area the hospital serves. These patients were predominantly in the 50 plus age range. In the third surge, from July 1 until now, there were 55 deaths at Meadows. Most of the victims were between the ages of 30 and 59. Of those who died, two were fully vaccinated but were older patients who were immuno-compromised.
“More people have died in this current surge than in the winter 2021 surge when deaths were in the teens,” McColl said.
“I would tell everyone who has successfully completed their vaccinations that I feel you are protected and should still have immunity,” McColl said. That does not mean that those who received vaccines earlier this year will not potentially need a booster. Currently, Pfizer boosters are available locally to those who fit certain protocol including that: the patient must have had the Pfizer vaccine initially; that they are 65 years of age: are immuno-compromised or have another health risk; or that they are health care or essential services personnel. Meadows is getting a lot of questions from residents who want to be antibody tested to determine whether their vaccinations are still effective. “Right now, it’s a hot topic,” Dr. McColl said.
Getting tested would determine whether a patient has had the infection and still has the antibody, but this testing simply isn’t reliable enough to sort out whether those who were vaccinated are still safe, Dr. McColl explained, “The reason is that with an antibody test, you don’t get all of the antibodies to all the different proteins on the COVID capsule. You get the most prominent, which is the S protein. The test may artificially show the patient is not immune, yet they may still have the ability to fight off the COVID infection even if the antibody is negative or low.” This test is not recommended if the patient has not had COVID symptoms and has never been diagnosed with COVID. When people who are considering the booster ask Dr. McColl whether to get antibody tested, she said she tells them that if they have no indication that they had COVID they should not waste their money on an antibody test. “Maybe this testing will be better in the future; it is not reliable now. It is only good to see if you have had the COVID infection.”
Dr. McColl said, “If you have had been diagnosed with the COVID infection and are 14 days or greater out and asymptomatic, you are eligible for the vaccine. We think vaccine immunity lasts longer than the natural immunity from having had COVID. If you get vaccinated, the long-term active immunity will be more extensive.”
Residents also want to know if observing COVID protocols is still necessary. “In a public place, the concentration of the COVID variant is still high in the community. We were advised to start wearing masks again in June. That is when the Delta Variant increased in volume and people started having break through infections, even if fully vaccinated,” Dr. McColl pointed out.
Dr. McColl said, “People could be asymptomatic and still be a COVID carrier. There is still a lot of Delta concentration in this part of country and in Toombs County. To be safe, the best thing people can do is to wear a mask. You protect yourself and others.” She said she hopes to see the volume of Delta variant cases go down consistently and in the next month or two lapse into a low lull.
“The virus is persistent and it will be with us as a disease process from now on. Hospital and health care workers are going to be wearing masks for a long time, at least another year or so, until we see what is the steady state. As any other communicable disease, we will have to take precautions.”
Right now, there are discussions about mandating the vaccine for hospital and health care workers. “It’s something on the horizon. When you look at the data in states that are doing this, the effect on staffing COVID free is pretty significant.” There are ongoing discussions about vaccination mandates for health care workers being part of the Medicare and Medicaid coverage conditions and OSHA is raising vaccinating health care workers as a safe workplace issue, Dr. McColl said, adding, “I am doubtful we will deal with this issue this year, but it is on the horizon.”
Commenting on the vitamins and Ivermectin combinations that have surfaced in the public domain as treatment for COVID, Dr. McColl noted, “I think when you look at prevention of COVID, everything you read shows that Ivermectin has nothing more than a placebo effect. The studies I have seen show no advantage in using Ivertmectin in prevention or reduction of illness from COVID or reduction in death from COVID.” She emphasized, “What I am hopeful about is the antiviral pill being produced by Merck. The drug looked so promising that the stage three trials were stopped prematurely. With 775 people in the trial, there were eight deaths with people on a placebo but none with the Merck pill. The pill is going to FDA for approval and may be on the market by the end of the year.
The drug is administered in the initial 48 hours of the onset of COVID and works much the way Tamiflu does in lessening the effects of the common flu virus. The pill’s effects are very similar to what is achieved with monoclonal antibody infusions, in terms of preventing critical, life-threatening developments with COVID. “The problem is that a lot of folks will think (with the Merck pill) we have a preventative treatment and they don’t need the vaccine. We want folks to realize vaccination provides long-term protection and yes, if you have a breakthrough and contract COVID, you have an alternative treatment to antibody infusions. The pill will be oral and accessible and I think it will eventually replace monoclonal antibody infusions if the data remains good.”