Support for Arkansas Week provided by the Arkansas Democrat Gazette.

The Arkansas Times and KUER FM 89.

Hello again everyone.

Thanks very much for joining us with Corona virus cases breaking records in Arkansas as elsewhere.

Can our states hospitals coordinate to ease any patient overloads, alleviate shortages in beds, intensive care units, more on that a bit later first.

The vaccines that could bring the pandemic under control if not ended entirely.

When will the vaccines reach Arkansas?

Who's first in line to receive it?

Joining us up.

Top.

Doctor Jennifer Dillehay is the states epidemiologist Jennifer Doctor Dillehay.

Thanks again so much for giving us your time.

Which vaccine we have?

What three different versions?

Now?

There's a lot of confusion this Reporter is experienced across the state which vaccines are on their way to Arkansas.

How many doses and when will they arrive?

So there are two vaccines that have completed their trials of study to see if they are safe and effective they have.

Presented their data to the Food and Drug Administration, the first one, the Pfizer vaccine.

the FDA will meet on December 10th and make a determination about whether they will allow the vaccine to be used under an emergency use authorization.

If they do approve it for an EU as we call it, then we could have Pfizer vaccine in Arkansas within a few days after the FDA approves it, the Moderna vaccine.

Also, being under is under consideration and the FDA will consider the safety and the efficacy data from those studies for the Moderna vaccine on December 17th.

So after they make a determination if they allow it to be used under EUA then we'll have Moderna vaccine also in Arkansas by the end of the month.

Who should be?

What's the protocol that will be involved in determining who is immunized first?

Well, of course the number of doses that will receive in the beginning is very small.

It won't be enough to vaccinate everyone, of course, so we are working to prioritize those people who should receive the vaccine 1st and we're taking the national recommendations into consideration.

In Arkansas, the Advisory Committee for Immunization Practices has recommended that healthcare workers and.

People who live in long term care facilities should receive the vaccine 1st, and that's how we're doing our planning in Arkansas.

For those groups, will the dosages doctor that we receive are likely to receive are in terms of the number?

Is that likely to cover our medical personnel?

A frontline medical personnel and the elderly?

Or will that have to be done in stages?

Our first allocations will not be enough to cover all the people in those two categories, so we will also need to prioritize within those groups and but then as more vaccine shipments arrive, then we'll continue to vaccinate people in those groups until those groups are taken care of.

You spent a working lifetime an entire career doctor working with vaccines and epidemics, infectious diseases.

In your best judgment, how soon, how much time will it take until the manufacturers are able to come out or to dispatch quantities?

Large quantities of vaccine?

It may take several weeks before we're able to get the numbers that we need to vaccinate.

Large numbers of people, and it may even be months before we're able to provide vaccine to the general population.

It's really hard to predict right now because it depends on the numbers of doses they're able to produce rapidly.

They have already produced millions of doses.

And they have done that at great risk because normally vaccine doses would not be produced until after the FDA has ruled on whether they could be used.

So this is a risk the US government has taken to provide funding to the pharmaceutical companies to ramp up their production now so we don't have to wait for them to ramp up later and produce those millions of vaccines.

That will be needed to address the needs of the US population so they will get some now an as they continued to produce an even further ramp up.

Will have more, but it will take some time before there's enough for all the people in the US who wish to receive the vaccine.

Right now it's just for adults, right?

It's being done, of course under the rubric or under the banner.

The model of Operation warp speed.

The idea of warp speed.

Alarms, some people and of course we're going to the notion of the safety, the efficacy of the vaccine itself.

Do you want to address that?

Yes, that is because warp speed too fast.

Yes, so that really has raised a number of concerns for people because of the speed at which the vaccines have been developed.

It leads some people to believe that the safety and efficacy studies.

They they've cut corners on them, which is not really the case.

We were very fortunate with this illness because there had already been a lot of good work done on coronavirus vaccines related to the earlier outbreak we had of SARS in the early 2000s, as well as MERS, which is also a coronavirus disease, so it was not hard to come up with a good vaccine candidate.

In other diseases it's taken years to do that.

We also have new vaccine technology that's been developed over the last, say ten 1520 years, so we know now how to make effective vaccines and what we really need is simply the genetic code for the virus that will give us the protein that we want the immune system to target and insert the genetic.

Code for that protein into these vaccine platforms.

These ways of making vaccine so it's a new game an it can happen really quickly because of the changes in the vaccine technology.

This has been very fortuitous for us.

We could begin clinical trials very soon after the coronavirus that causes COVID-19 was identified in the genetic sequence was obtained and published on the Internet.

I would assume Doctor that you and other members of the clinical community would be the first to roll up your sleeves with the cameras rolling to demonstrate your confidence in it.

But what measures are we prepared to take?

Or do you think they're going to be necessary to to win widespread or broad public acceptance in Arkansas vaccine?

Well, we do want people to make an informed decision when they get these vaccines, so we'll be providing written information.

But also, we're trying to help people know about how the vaccines were developed, so that can have confidence that these safety and efficacy studies were not.

Short changed that they were completed in a rigorous, transparent manner, and that the data, when they are available after the FDA has reviewed them, that they will be published and people can assess for themselves.

But of course we do battle with some misinformation related to vaccinations, not just the covid vaccines that are coming on board.

But also vaccines in general, and so this is a issue that we as a state in our communities will need to address so that people can have factual, accurate information in order to be able to make an informed decision.

We were warned by experts here and across the country that we were likely to see a post Thanksgiving surge in cases it apparently we are now.

Could you address that?

Well, we saw a significant surge after Halloween and it appears that we're having another surge appana surge.

We should have a better feel for.

How great the impact will be because it takes maybe 5.

6 seven days after someone's exposed to developed illness, it could be sooner, but on average it's that period of time.

So Thanksgiving was a little over a week ago, so people who develop illness will start getting tested.

So I sadly expect the numbers to begin to greatly increase.

And that's a real concern.

I cannot tell you how happy I am that we're getting a vaccine.

Well, in the meantime though, we've got the Christmas season approaching and a lot of people who were fairly sceptical of the of not have shut down, but of the calls for social distancing and limiting gatherings.

Presumably are those who aren't infected anyway, or presumably getting ready to.

To celebrate the Christmas holiday or Hanukkah, whatever you would have some admonitions for them, I gather.

Yes, we are encouraging people to have a. Small intimate Christmas, Hanukkah, other holiday seasons gatherings.

This year we're encouraging people to not travel if at all possible, and to limit their mixing of households.

It's better to celebrate with your own household and then connect with others, either electronically or the old fashioned way by phone or letters.

But we are strongly encouraging people to do whatever they can to limit the spread to prevent themselves from being exposed, and from exposing other people.

We are really concerned about the number of people who are going into the hospital.

With COVID-19 we usually have high number of hospitalizations in the winter time anyway and so this added to it is really causing.

Big strain on our hospital systems.

We absolutely must do whatever we can to keep people out of the hospital well before we let you go, doctor, the CDC has some new regulate, not regulations necessarily, but recommendations regarding quarantine after exposure, could you go over those with us?

Sure, so we know that the virus has an incubation period that can last up to 14 days.

Most of the people who get COVID-19 will develop illness before then, so it's thought that if we can end incubation period at 10 days, then we would miss very few people who would develop illness after 10 days.

So that's a possibility for us to take in Arkansas knowing that.

There will be a small percentage of people who will be missed, so people who have been exposed they could quarantine for 10 days without testing.

If people need to go about their business or their work before then, they could quarantine through day 7.

An be released from quarantine.

If they have had testing and the testing needs to be collected no sooner than day five after exposure.

So with a negative test either PCR test or an antigen test then they could come out of corn teen at day seven, but this is all for people who don't have any symptoms.

If people do develop symptoms, even if they've had a previous negative test.

Then they need to go get tested again.

If they have been tested already to make sure they haven't developed Cova 19 in the meantime.

Just reassure us if you will, that the cavalry is coming I think is 1 hell throw us had not too long ago.

I am so thrilled that we're getting a vaccine.

I cannot tell you what good news that is, is just.

Just awesome alright Doctor Jennifer Dillehay, thank you.

Thank you for your time and for for your information.

Will see you again soon amid the optimism about a covid vaccine.

The consensus among clinical personnel in our state is clear the situation in Arkansas will get worse, perhaps much worse before it gets better.

And that includes hospital capacity, especially intensive care capacity, it could be exhausted in days, if not hours.

Hutchinson administration is asking assistance from federal entities, including the Veterans Administration, but there's a plan from the nonprofit sector as well.

Troy Wells, as CEO of the Baptist Health System and a member of the Governors Winter Covid Task Force, Troy Wells.

Thank you very much for being with us.

Like you're having mistake, you and some associates are putting together a kind of consortium, or it's put it in your words that will will allow an easier administration of care.

To patients, particularly in the covid era.

Yes Dave, we talked about trauma, comma last week and the governor's press conference during his briefing and trauma comma is a system that's existed in Arkansas for several years now and it's been used to identify the right place to send a particular trauma patient across the state of Arkansas.

So if you think about trauma, it's very specific and well defined and we only have a few hospitals in Arkansas that can handle certain types of trauma.

So it's really important from a timing perspective to get patients to the right place in a timely manner.

And it's also important that they go to a place that has the resources available to treat those specific issues.

So we've talked for some time about the potential for using the trauma com model to move COVID-19 patients during the pandemic, particularly when scarce resources like ICU beds become an issue, and so we've been working over the past two weeks to see how we can retrofit if you will.

The trauma.

COM model and use that to match up covid patients with the appropriate hospital to send them to.

Here in Arkansas, recognizing that the normal referral patterns or transfer patterns that EDS may have around the state may not work when a particular hospital is full, so the point would be to try and speed up the process of identifying a hospital that you know can receive a patient and provide the right level of care, and then the other important thing about this is to not have patients that are maybe low acuity ending up in a high acuity setting.

Just because there's availability.

Recognizing there's such a shortage.

So it's really like.

Demand matching is the way I think about it.

You match the demand for a certain service with the specific patient and the specific bed around the state O at its most basic than Mr Wells.

Let us say, if suddenly Jonesboro was without a covid bed or an ICU bed, but Fort Smith might have one.

That patient could presumably be moved from.

Crack head to Sebastian.

Yes, and that's what's really different and unique about this situation.

Is patients may have to move into a geography that they're not quite used to going to.

Typically in that example, Saint Bernards or NEA Baptist is a referral Center for Northeast Arkansas, and it may be that they have an ICU bed available, but a patient from Piggott may not need ICU, but they needed covid bed and so they may end up in Searcy.

Or they may end up in Pine Bluff or even in Sebastian County, to your point, the implications almost wells for.

Say insurance coverage.

An and the protocols of the financial.

The financial side of medical care are accommodation is going to be made for that in system out of system.

Yeah, I would anticipate there would be many issues here in Arkansas with pay Or's most of the hospitals in the state or in the same insurance networks.

There may be a few odd exceptions if you're in a certain Medicare Advantage plan, for example, but I would expect during the pandemic a lot of those.

Those challenges can be worked around.

How concerned are you as an administrator?

Yours is the largest I believe the largest system in the state as an administrator.

How concerned are you that a shortage?

Of ICU and or covid beds could be imminent.

Well, I get asked that question quite a bit and you know ICU beds become very short in Arkansas.

On a normal, you know, in a normal year an we've had situations back in the summer when we had very few covid patients relatively speaking.

And yet our ICU's were full an any day.

You know, I can walk into the office and check my numbers and see that we don't have a ICU bed available at that moment.

Now what happens is during the course of the day, we move patients through the system out of a Med surg bed and then that allows an ICU patient to move out.

From time to time we may be holding a patient that needs an ICU bed in one of our emergency departments until that bed becomes available.

But this is pretty normal for us.

Here in Arkansas, we just don't have the numbers of ICU beds at some other places have and so we're used to manage in that throughput.

But there are some things that can be done in are being done that are helping us.

One of the items that Governor mentioned the other day was the prior authorization issues.

So if you think about a patient that is in a medical surgical bed that needs post acute care, maybe rehab or a. Skilled nursing beds somewhere.

Sometimes we wait multiple days, sometimes weeks.

For an insurance company to authorize moving that patient at the.

So for us to be able to have the insurance companies waive those prior authorization process processes right now really does give the hospitals a lot of flexibility to move patients quicker.

Every Med surg bed you free up that allows somebody moved out of ICU, so you have to just keep the flow going and those are really important things for us right now.

Well, we are in the midst of what ordinarily would be plain old flu season.

You have yet to.

Or have you yet begun to experience the influx of ICU demand in addition to the obvious?

Year round coronary cases, stroke etc.

Well, we haven't seen a whole lot of flu as of yet, but I will tell you that many people back in the spring and summer when the pandemic started began to delay certain types of health care.

And we think that today we're seeing the result of that where the patients that do come in, and I'm talking about non covid patients.

The strokes are more severe.

The heart heart attacks or worse things.

People are just really sick and so we want to encourage people to continue to see their doctor.

Don't delay going to the emergency room if you're having symptoms.

We can safely care for our Kansas, in our hospitals, and we hate to see people coming in because they delayed care earlier and now being admitted to an ICU bed when we desperately need those beds.

Well, one and two, the impact on elective surgery.

That individuals may not necessarily be putting it off, although their physicians may be suggesting as much.

That's a possibility.

I've not heard of that being widespread where physicians are recommending people don't come in.

Our experience has been quite the opposite.

The physicians want to keep things moving and continue to see their patients and continue to do procedures and the diagnostics and the screenings that are so important for people's health.

So we've not experienced that first hand where I've heard physicians trying to talk patients out of being cared for.

Well, yeah, and I phrased that question very poorly, and I apologize for.

But I, for example, a knee replacement.

Or some sort of orthopedic procedure that might be on the margins there in terms of of morbidity or mortality.

I think that's a great example of the types of things that you know.

Putting off a neighbor placement that you've been wanting to have done for the last year or two certainly doesn't cause much long-term damage, and unless there's some underlying morbidity in the joint, but those are examples of things that could safely be delayed, and you know the thing about elective cases that people ask about quite frequently or.

You know if we stop or delay elective procedures, does that free up a lot of capacity and the reality is, it really doesn't.

Most of those cases don't end up in an ICU bed there in there out very quickly, so we do have to manage our our schedule an be mindful of that each and every day so that we understand that the patients coming out of surgery that do require an ICU bed are going to have a bed and that we can also accommodate those patients who are going to be coming through the Ed needing intensive care.

Yeah, and finally Mr.

Wells the staffing situation.

It's reported as stressed in every practically every clinic and hospital across the state.

Your assessment.

Yeah, I think it's definitely stressed on the staffing levels and also the stress levels on staff.

Where we're very mindful of the stress on the existing staff.

They're carrying a big burden right now for all of us here in Arkansas, and so we've got to pay particular attention to their stress levels to their mental health and to make sure that we can take care of those that were taking care of others.

And so we really emphasized that Baptist Health, and I think all hospitals are very mindful of that right now.

COVID-19, from my perspective has not created a nurse staffing problem.

It's just highlighted and exacerbated an already existing staffing problem in Arkansas.

We compete regionally and nationally for clinicians including nurses.

An Arkansas has had a tough time competing from a wage perspective with other states, so now it's being highlighted that we have a need to make sure we're investing in people in clinical resources here in Arkansas.

And we got into there because we're out of time.

Troy Wells, CEO of the Baptist system in Arkansas.

Thank you very much for being with us and come back soon.

And thank you for joining us.

Will see you next week.

Support for Arkansas Week provided by the Arkansas Democrat Gazette.

The Arkansas Times and KUER FM 89.