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- The state of vaccines and COVID spread in Shelby County, tonight on Behind The Headlines.

[intense orchestral music] I'm Eric Barnes with The Daily Memphian.

Thanks for joining us, as we continue to do the show remotely.

Tonight, I am pleased to be joined by Dr. Stephen Threlkeld, Medical Director for Infectious Diseases at Baptist Memorial Health Care.

Dr. Threlkeld, thanks for being here.

- Good Eric, nice to see you.

- Along with Bill Dries, reporter with The Daily Memphian.

So Dr. Threlkeld, we're we're at this point where vaccines are starting to get in people's arms, and that is a great thing and it creates a lot of hope for people and a lot of relief for people, but the rollout has been very uneven and very difficult in a way that has really increased a lot of people's anxiety, right?

I mean, there's just the anxiety of where do I go, when do I get it, am I in the right category, rumors on the internet, you know, just so much anxiety and frustration about it.

What can you say, if anything, to allay some or all of that anxiety?

- Well, it is one of these weird, kind of, dichotomy moments for us.

It is arguably one of the best medical advancements of a lifetime, to have these vaccines, these incredibly effective vaccines, and safe vaccines available to us so fast.

But the old saying in immunology is vaccines don't save lives, vaccinations save lives.

And so we have to have people have confidence in this vaccine.

It is an incredibly effective maneuver but we also need to have people have confidence in getting it out there.

We have to get it out to as many people as we can quickly and evenly through our population.

There are over 350,000 people who've died of this, people have lost their businesses, elderly folks have been shut in for months, healthcare workers are strained and working overtime for months.

So, you know, it's a hard process but none of those people are interested in that.

We need to get this done, we need to work smarter and harder to accomplish it.

And a big part of that is communication.

We have to know where the bottlenecks are so that we can attack them.

And I think one of the most frustrating things to people so far, is that we haven't even understood why it's not faster.

I think once you do that, once people are able to frame a situation so that folks can understand it, it's a little bit easier to accept the situation.

It's a great thing that Shelby County has really picked up speed and really gotten rid of all of their vaccines, put it into people's arms.

But it's also a terrible thing that we've run out of vaccine and don't really know when we're getting it again from the State.

This sort of thing really shouldn't be happening.

Somewhere along the line, there are some people that can arguably work smarter or harder, and at least let everybody know what's going on and hopefully fix it.

- You mentioned the State, I mean, do you hear this from other cities, from other hospital systems around the state?

Or is, you know, we often think that maybe we're getting mistreated over here in the corner of the state, is it something about Shelby County, or is it a statewide problem?

- I think it certainly is a statewide problem, it's a national problem.

So I'm not aware of any situation where people in other cities are flush with vaccine and we don't have enough.

But, you know, Tennessee is in the top three or four states so far in distribution of vaccine, which is a great thing.

I mean, that's something to be proud of but the problem is the number one state has only given about 50% of its vaccines.

and we're not grading on a curve here, I mean, we can all fail this test, and so we need to work very hard to get those numbers up for everybody, including the leaders, which thankfully, we are in right now in Tennessee - Before I go to Bill, on that question, there's so many things we'll try to get through, of course today, but that 50%, and The New York Times has a...

I mean, there are many of them out there, but actually, it's Bloomberg has a really nice tracker that you can go by state, how many doses have been delivered to that state, how many have been distributed, and how many have been, you know, shots have been taken.

They assimilate information from various state and local health departments.

We are at right around 50%, I think, I looked this morning.

So, that of our doses in Tennessee had been administered you know, given to people.

Is that 50%, and some states, about number five or six on that list, the highest are probably in the 60%.

When I looked at that 50%, I wondered is that the state holding back, give or take, 50% of the available vaccine for that second dose.

So when we look at those trackers, help us understand what a...

I mean, you said 50%, isn't good, would it be 100% is perfect, or is it always gonna be a little under 100% because you're holding back for that second dose?

- Yeah, it's a great question.

And I'm not sure that I actually have the answer and that's part of the communication that we need to have.

- Yeah.

- The fact that you and I neither know the answer to that question is in and of itself a significant problem.

So yes, there could be some held back.

And at first, Tennessee actually had sort of an emergency supply that we held back which I think is a very poor plan but we've, kind of, taken care of that and really released it all.

We hope more vaccine is coming.

I mean, I'm about to go get my second vaccine right after this program, but we need everybody to have that chance and to get it taken care of.

But yeah, I think the very fact that we're not certain about that, certainly the CDC has recommended that we give out as much of the first vaccine as we can, but we also know that the data are behind two shots, not one shot.

And when we start going into delaying that second shot, we're just getting into a territory where we don't really know what the numbers are in that situation.

- Let me bring in Bill Dries.

- And it's easy to focus on the vaccine and maybe lose sight of for at least a little while.

The fact that we're in a holiday surge, as we speak, so has the vaccine, without any fault being attributed to it, but has the vaccine, kind of maybe, made that problem worse?

- I mean, that's a huge point.

And I think a very good one.

We've not done well, in anywhere in this country, at doing those things to prevent cases, infection.

I've said for a long time, we're in a game of chicken, the virus is coming at us faster, and faster, and faster.

More and more people are dying right now, just as we're hoping to swerve off into a lane of safety provided by these vaccines, we don't need to be messing around giving this vaccine as much to do.

We still need to be taking care of the social distancing, doing those things to prevent cases.

Because particularly the pace we're seeing now, by the time people get vaccinated to the point of herd immunity, we're gonna lose, you know, a lot of citizens to this virus.

We're seeing a lot of deaths, they're increasing around the country, and we cannot ignore the second major issue that we have to face just because help is indeed right beyond our outstretched hands on the near horizon but we can't lose sight of that second point.

If we do, we will lose a lot of people unnecessarily.

And it's getting increasingly frustrating for those of us in health care to watch people die when we're so close.

This is the beginning of the end of the process.

But between here and the end of the end, there are a lot of deaths if we don't do the things that we need to do individually and collectively.

- I'm probably not phrasing this technically correct, but it is the virus deadlier now than it was at the beginning of the pandemic.

- Well, it's a more interesting question than you might think.

It's deadly because more and more people are getting it, not per patient.

I mean, certainly, we do better at treating it, the virus with all the worry of mutations that are making it more infectious and spreading to people, there's no evidence that those mutations are making it any more intrinsically virulent, defined as being more able to make people sick.

But when you start having 3,000 cases a day, I mean, 3,000 deaths a day in the country, it's because there are so many people getting it.

So it being more infectious, will all by itself, have a lot more people die.

There's a difference in mortality rate and mortality.

If the mortality rate even goes down by half, but four times as many people are getting the virus, guess what, twice as many people die.

Despite that improved rate of death in individual patients that might be getting it.

When we did our first programs on this, nine or ten months ago, there was so much discussion about testing.

And there were even some scenarios that we talked about where, you know, testing is gonna be a regular part of life, a regular part of returning to work.

Is that off the table now?

- No, I mean, it's important to do, we just haven't done it.

I mean, nowhere, that I'm aware of, that people have been able to accomplish that.

And there are a lot of reasons, I mean, you know, but it's not in here because there's not enough testing available, we've been very blessed with available tests here.

But I think at some point we have to... We clearly have limited resources of attention to this, if not money and other resources.

We have to make a very big push to this vaccine because the vaccine is the endgame.

It's the finish and the fix to this problem.

Testing while very important, I've said for a long time now, when people look back at this 50 years later, we will be criticized because we didn't test enough.

We didn't test enough symptomatic people and we didn't test enough asymptomatic people.

But at some point, to just sort of try to rebuild a structure, to be more testing right now, I have likened it before to going out and trying to get raw materials, to build a storm shelter when the tornado is now tearing through your neighborhood.

We need to dive into the bathtub and put a mattress over our head.

And that's in the form of these vaccines which are highly effective.

But no, we don't need to forget testing, we need to continue to test people but the simple reality is the testing is down despite the cases and mortality being up.

We had been unable to generate systems to accomplish that, locally, regionally, nationally, everywhere.

- Because the testing, and we'll go back to Eric after this, because of the testing also at this point serves a critical function of allowing you to know who needs to isolate, who needs to be quarantined.

- I mean, the solution to this thing for months now has been testing, diagnosing, quarantine, contact tracing.

That's what we always should have done.

The simple reality is that we haven't done that well at all despite a lot of efforts from a lot of people.

But now we have, sprinkled into this, has been the vaccine, which of course is the ultimate cure for this situation.

So, yeah, but it's still very important to do the testing and we don't need people while we're waiting maybe months to vaccinate locally and nationally, we don't need people walking around and giving this vaccine to parents and grandparents who then might die of it.

That's a tragic mistake to make.

And we cannot forget the second job that we have, which really was the first job before distribution of vaccine.

- And I would rarely correct an expert who knows a whole lot more about this.

I think you said you wouldn't want people carrying around the vaccine to their family and friends- - Oh, sorry, yeah.

- And I say that only, and not to be a know it all, but because let's use that as a segue, what sort of resistance or wariness have you seen to the vaccine?

I mean, and that weariness is in some cases maybe expected, in some cases I find very surprising.

I mean, there are, some, maybe we walk through, there are some stories of a lot of healthcare workers, and there've been surveys of healthcare workers, The L.A. Times had a really great story, anecdotal, but big percentages of hospital staff, at various hospitals throughout California, not wanting to, I mean, 40 and 50% of people saying, no, I'm not gonna take the vaccine.

Where does that come from and have you seen that in Memphis?

- Yeah, and thank you very much for correcting that misstatement.

Yeah, it's very frustrating to those of us, you know, in healthcare and infectious disease, particularly because this is a statistical no-brainer, and there's several ways that you can explain this to people.

The biggest concerns are either that it's too fast and worried about long-term side effects.

So those are the two general large groups of concerns.

And the simple reality is that RNA vaccines have been in the works since the, you know, before the turn of the century here, 2010 ModeRNA was formed.

It's been doing nothing but trying to make an RNA vaccine for 10 years.

And so it's not that new, there are RNA vaccines to rabies, to flu, to other things, they've just not been successful enough because we've now got the white-hot intensity of every major pharmaceutical company in the world, working on it.

We're able to make it, get into people and be more effective.

So I think it's not a fair criticism, in that regard.

In terms of long-term side effects, vaccines don't really give long-term side effects that show up six months later.

Now sure, there's some side effects that come right away and might last.

But when you look at this vaccine, we've given it now, of course, into the millions of people once we're giving it.

But even in the trials, tens of thousands of people got the vaccine, no one died.

There were a few allergic reactions, they all did fine, but yet while we're sitting here making this program, between 50 and 100 people in the country are going to die of coronavirus.

I don't know that we need to say anything else after that.

But certainly when you look at the effectiveness and the safety, it is a statistical no-brainer.

- And have you seen any resistance among healthcare workers?

I'm not asking you to name names or institutions, but have you experienced that?

- Of course, no, there's no question.

We have an occasional healthcare worker that will, in fact, try to convince somebody else not to get it.

But I think most of the people, when you actually sit down one-on-one and talked about it, and I do it all day long, you know, most people can understand that numbers...

The decision is not whether or not to take a vaccine, the decision is whether to take a vaccine or to get coronavirus, which 70% of the people, kind of, by the definition of what we think herd immunity is, are gonna get the infection, if they don't get the vaccine.

And to suggest that those two are equal in risk, I think, is really very, very unsupported by the data.

But yes, we certainly see people say it, most people, if I talk to them for five minutes and point out these numbers, will actually say, "Wow, hadn't thought of it that way."

And we don't need to get our information from Facebook or from our brother-in-law.

that might be very articulate, charming, and nice but may not know anything about what we're talking about.

- One thing, I mean, we are what, 9, 10 months into this and some of this parts of this conversation are giving me, you know, flashbacks and PTSD due to conversations we had with you and other infectious disease experts about what we need to do.

And it is kind of mind boggling that we are still here in 2021.

But in that timeframe, a lot of people, and we'll just stay in Shelby County, many, many people in Shelby County have gotten the virus.

Some have gotten very sick, obviously some have died.

Some have not even known that they had it probably, right?

I mean, it's just such a strange virus that way.

If you've had it, and you know you've had it, do you still need to get a vaccine?

- Yeah, it's a great question.

That's the other main raft of questions that I get.

And the CDC has come out with a fairly nice position paper and update to their recommendations on their site.

And I recommend people look at them.

So yes, if you've had the infection, we don't know how long that immunity is going to last.

Now, we don't for in fairness, know how long the vaccine immunity is gonna last either, but that's baked into the vaccine trials.

We'll continue to watch these people who were vaccinated months ago now over two to three years to see if they start getting infected after a year or 18 months.

And that will clue us in to the fact that we might need to get it as well.

But absolutely, it's a very critical thing, I think.

- One more question, I'll go Bill about vaccines, you know, right now there's been a lot of focus on the drive-thru sites that at the Shelby County Health Department open, there's a lot of confusion who is allowed in there, who could come in, 75 and above.

It was a tremendous amount of confusion that they then tried to clarify, and clarify, and clarify.

And they are up against, as they will say, and as you've just said, upstream.

They don't know how much vaccine they're getting, they don't have clear guidance.

I mean, it is a very difficult situation to say the least.

When we get this right, a week, a month, let's call it a month from now, where will people, where were the bulk of people get their vaccines?

Will it still be through the Shelby County Health Department or at a drive-thru site?

Will it be at a pharmacy?

Will it be at their local doctor?

Will it be at one of the hospitals in town?

Or do we even know?

- Yeah, I think that's a game, unfortunately, of three or four dimensional chess right now that we're playing.

We don't know which other vaccines are going to come out and be approved in some of those months, which may make delivery to pharmacies and other places a lot easier.

It may make it easier for that to happen.

Right now, I think for the just immediate or foreseeable future, we're sort of stuck because of the logistics of this thing with hospitals and with health departments in larger centers to distribute this thing.

And I hope certainly that it becomes much easier and we're able to do those things because let's face it, in the same way that FedEx was able to distribute the vaccine very, very quickly to people, if we were able to get it safely and effectively out to private enterprises, and pharmacies, and the so forth.

And pharmaceuticals are already helping with distributing it to long-term care facilities and nursing homes.

So I think that'll be very important.

And let me just back up to the last question too, and say one thing as I didn't actually fully answer it.

Yes, people who've had the infection do need to get the vaccine.

And one other question that comes up almost daily to me now, it's a sidelight to your question, what happens if you get infected after you get the first vaccine?

And so the reality is that you can wait up to 90 days to get that second one because the infection itself it's felt to reliably give us immunity out to 90 days.

After that, they recommend that we go ahead with those vaccines.

And so it gets a bit complicated.

It's the kind of thing that you may have to check with your doctor about whether you've been infected and the exact time that you would get those vaccines.

- All right, let's go to Bill.

- And I believe what I've seen in the guidelines for the city sites that they're operating, is that for people who are concerned about any side effects, that they actually watch someone who gets the first shot for a period of what, 15, 20 minutes to make sure that there's not an allergic reaction?

- Exactly right.

The standard has sort of become 15 minutes, that's what we do in hospitals, that's what, and I've had some elderly relatives vaccinated, one at the drive-thru site, it went very well.

And they just have you sit there in the car while somebody is standing around in case you have a problem.

And certainly some people are gonna have allergic reactions, but again, let's point out the fact that no one has died of this vaccine.

It's 350,000 plus to zero, is the mortality comparison of the vaccine versus the infection.

So they have the epinephrine pens, for people who do have allergic reaction at all of these sites.

So far that really I think has gone very well.

- I think that sometimes in dealing with situations like this, where there have been things like flu season, we're used to the experts having a consistent degree of certainty.

And from the beginning in our discussions, just on this program, not to mention the many other discussions about it on the air, all over the place, you and other experts were very upfront with the fact that we're going to learn things during the process of this.

And some of it might contradict what we believed earlier and might change what we had believed earlier.

And that's kind of part of the method of what you and the other experts, how you approach these problems, which is kind of different from the public policy or I'll call it the political part of the equation, isn't it?

- Very much so.

Science and politics don't always mix very well.

Poor Dr. Anthony Fauci has been in charge of, sort of, being a scientist and helping to run the actual progress of fighting this infection.

And then also having to get messages out politically and one can only feel sorry for that situation.

Because in politics, the CDC has 330 million patients in their waiting room, and their office at one time, I have one.

And so it can be very different in how you kind of deal with those things.

But science works very differently.

Science makes projections, makes guesses, makes hypotheses.

then it gets tested.

We find out if they're right or wrong, other people have to replicate it, and I think it goes back to the very beginning of this pandemic, we thought we were just going to science it to death and this wasn't gonna be a problem in our country, we were gonna take care of it.

We found out very, very quickly, otherwise, New York got their nose bloody very quickly, and so did the rest of us.

And so then it became the sort of depression about it all.

And then science, wasn't gonna be able to do it.

And then sort of kicked in the incremental advancement of facts and studies and tests.

And that's really, what's gotten us out of this, is that created the vaccine, is real science.

But real science is wrong.

Real science is wrong by definition, and frequently.

And we have to be able to realize, we have to have the humility to say we were wrong about that and now we know this.

But that's not a conspiracy, that's not misinformation.

that's just what science is intrinsically.

- Right, and as you said, the mix between those two, public health policy and public policy via elected bodies, appointed bodies, those two instincts are very different in terms of dealing with the public.

I think sometimes when doctors are dealing with one another, because of your training, you know, that we don't always know that when we're listening to it.

- Yeah, I think that one of the most frustrating things to me is the accusations that doctors are part of a conspiracy theory.

And not many people say that, but enough, where you sort of look at and say, are you kidding me?

Doctors are not very organized or politically savvy.

Arguably the most intelligent, in terms of just IQ, presidents we ever had was Richard Milhous Nixon.

And he came down in flames because he couldn't bring off a two-bit a burglary at a hotel across town.

This can't be done at the scale we're talking about.

Doctors and other healthcare people, nurses, they're just trying to get it right.

And, and we will be wrong, on occasions, make mistakes, but hopefully, you know, we'll do the best we can to correct those errors and and get out the message that we were wrong and now we know better and we're trying to do the right thing.

- All right, a final point, before we go back to Eric.

And talking about distribution of the vaccine and it becoming easier, would some of that be a function if we had vaccines that were single dose and didn't require the elaborate refrigeration that we've seen with the two most familiar vaccines out there now?

- Absolutely.

A very key point and one that we hope we will...

It's a problem we hope to have, is to decide which vaccine to give.

Johnson & Johnson, for example, is a one-shot vaccine.

That would be something of a game changer because it's easy to store, it's easy to give, you don't have to have the bureaucracy of keeping up with who's had the vaccine, have them come back the next time.

It removes entire layers of barriers to getting this done in that sense.

And some of the ones that don't require such ultra cold storage, allow us to get it out to more rural areas, places that really can't get the Pfizer vaccine, just because of the logistics and the practicalities.

So, yes, if we get vaccines that are approved, that are one dose, it's going to be a very, very extra weapon we have in this fight, to be sure.

- One thing you...

Going back to something you said earlier about holding back vaccine, Shelby County is out of vaccine, and as you said, that's a good thing in the sense, you know, that they're pushing it out and they're trying to distribute as quickly as possible.

There was part of that confusion and anxiety, that I talked about at the beginning was, this lack of clarity and what groups had been greenlighted and and guidance from the State, that look, if someone's in line go ahead and give it to them.

Although messy, is that the right policy?

I mean, because again, you're pushing the vaccine out, it will expire, more will come.

I mean, should they be erring on the side of giving people shots versus no, this is the hard and fast category, you're not in that category, we can't help you.

- Well, there are about eight layers to that question- - Yeah, you have a minute and a half to sway them.

- So yeah, I think the CDC and I would agree, you know it has said, try to give all of the vaccine that you can.

That presupposes that there's going to be more vaccine coming, right?

And so the more that is a problem, the more people lose confidence in that sort of thing.

And so, I think, that at first the State was actually holding back an emergency supply and I was critical with that I said, "Look, you know, we're in the biggest rainstorm in 102 years and we're standing in the wettest spot on earth.

We do not need to be holding back umbrellas or any other such tools to fix this."

But at the same time, you have to have that supplier from upstairs.

or we end up with the one-shot and no second one coming.

I think it's gonna come.

I think that we'll have the production, but you're right, I think we should err on the side of giving it to people when we can although the British idea of putting it off three months, we don't know what we're doing there, I think the data are just not very strong to do that in a plan since, that's a different matter.

- One more question.

One of the huge stresses that we've talked about for 9, 10 months now, is not just the deaths, not just the illnesses, not all that, it is also the stress on the healthcare system.

What are you seeing right now in terms of the the maxing out of rooms and availability but those data are on our site and they're in places and with just 30 seconds left, what are you seeing in terms of the stress level, the emotional and physical, and sort of toll on healthcare workers like yourself and the people around you, that has been a huge concern that they are burning out.

- Yeah, I think, it's something that people can't really understand unless you're doing it 17 hours a day to accomplish this.

There are family members dropping off elderly relatives, not knowing if they will ever see them again.

We have nurses spending hours in rooms, connecting patients with cell phones and FaceTime, knowing that they will never see their family member again in person, they can't come visit and they're going to die.

And if you think that doesn't take a piece out of those nurses, every time that happens, you're wrong.

It is a very big problem, and they're having to do it for months on end.

And, you know, I feel for them.

The doctors, we walk in and do the interviews and stay there for 15 minutes and talk, the nurses really don't take the brunt of that and it's very difficult to watch, even, let alone for them to do.

- All right, well on that difficult note, thank you, Dr. Threlkeld for what you're doing.

Thanks for being here.

But that is all the time we have this week.

Remember you can get past episodes of the show on the WKNO website at wkno.org or you can download the full podcast of the show from The Daily Memphian site, iTunes, Spotify or wherever you get your podcasts.

Thanks and we'll see you next week.

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