thank you good evening and welcome to doctors on call this is our 41st anniversary session of doctors on call and welcome back it's been great over the years and we've certainly have enjoyed bringing this program to you I'm Dr Ray Christensen a faculty member from the Department of Family Medicine and biobehavioral health at the University of Minnesota Medical School Duluth campus and a family physician with Gateway Family Health Clinic in Moose Lake I'm your host tonight for our season premiere on covid-19 and monkeypox an update on coven 19. this season we will again be rotating our hosts from the medical school our hosts will include Dr Mary Owen Dr Peter Peter nalen and myself remember as always that this program is very dependent on you the viewer so please call in your questions and certainly you can email them also at ask ask at wdse.org our telephone numbers can be found at the bottom of your screen our panelists this evening are Dr Andrew Thompson an infectious disease specialist with Saint Luke's infectious disease of Duluth and Dr John Wood a family medicine physician with Essentia Health and director of Our Family Medicine Residency program here in Duluth our medical students answering the phones tonight are Barrett bukowic from Warroad Minnesota Shane Johansen from Austin Minnesota and Walker tordson from Fairmont Minnesota and now on to tonight's program covid-19 update and monkey pox and season 41 of doctors on call Dr Wood give us our kova 19 update a little background if you will please thank you Dr Christensen thanks Dr Thompson it's good to be here tonight and just to give you a little uh maybe a little update on kova 19 it's certainly something we've all probably heard of in our listening audience uh covid-19 first came a quick review for in December 2019 in a talent called in a town of China Wuhan China and rapidly developed to become a global global pandemic pandemic it's claimed over a million lives in the United States we've had about 96 million cases in the U.S and Minnesota about 13 000 deaths and about 96 million about um 96 000 cases I believe and then in in St Louis County where we're from about 550 570 deaths in our County Alone um so kova 19 is still very much with us we've learned a lot about covid-19 since it started we've learned how to treat it we've learned how to diagnose it and we've learned the power of vaccines in covet 19. we've now developed coveted covid-19 vaccines from patient populations from six months all the way to as old as you want to give it and we found that these vaccines are safe and effective and they save lives coupled with that there's treatment that can Target the vaccine and the disease in all stages of its development from viral replication initially we might talk about that later in the first five to five days or so when the disease is really the virus is really going to town and then as the disease sort of settles in you develop all these inflammatory cytokines and all these inflammatory things that get people pretty sick and then there's treatment for that too and then we've recognized that the folks who are the most risk of getting covered 19. so the point is that we know a lot about the disease and we know how to treat it and we know that the most important thing at least I would say if there's one take-home message you get get your vaccine and get that bivalent vaccine that's out there now they work and they save lives and that the older you are the higher your risk if you're under 30 you're not out of the woods but your risk of dying is less but if you're over 85 your chance of dying is 330 times higher than someone under 30. so if you're an older person your risk is really high so just remember that if you remember nothing else tonight so hope that helps Ray well that's great Dr Thompson anything you want to add on that before we jump to Monkey Fox that was a great quick summary you touched on all the important factors uh could you give us Dr Thompson could you give us a little background on monkey pox that's kind of jumped into the where we see or heard about in the what the last five six months somewhere yeah uh many people had not heard about monkey pox and may not still have heard about it until recently but this isn't a new disease this is a virus and Ortho pox virus which is similar to smallpox but it acts very differently and we have known about this virus for decades in fact there was a small outbreak in the United States about 15 years ago when this virus is imported with some exotic animals from West Africa this year though there has been a new outbreak that is global um there have been many thousands of cases worldwide and so far in Minnesota we've identified 206 cases of monkey pox it's a virus that's spread by very close contact so uh it has mostly impacted the men who have sex with men community though it can infect anyone um but but in those social networks is where it has initially spread um it causes some pretty bad skin ulcers and rashes which can be very painful and sometimes even very disfiguring we have a vaccine for it that's effective and we have an antiviral treatment it seemed initially in our region that this was really taking off and the speed at which new cases have developed has slowed down recently so I'm very happy about that and hopefully that's a sign of both vaccination and public health information working as we hope it would what's the mortality risk on monkey pox is this something that the body eventually beats off on its own or have we been losing people yeah so most people will get better on their own but it is weeks of a very painful rash there have been fatalities there have been a few fatalities in the United States typically in people who are otherwise immunosuppressed so the fatality rate is low but it is still a pretty high consequence disease it's very painful when you say immunosuppressed you want to just elaborate oh so so folks who might have underlying immune weakness so HIV or maybe a malignancy like a cancer or take medications to suppress their immune system like for an organ transplant those folks are at higher risk of developing worse disease from Monkey pox thank you it's an interesting new disease and the other thing I just noticed that people leaving Uganda are getting screen Free Ebola so Ebola has re-emerged as a as a concern also on the national level on the immunizations for covid John apparently this is changing so the new one that's coming how is the new one I got the last one and now this new one is bivalent what's the difference here well the bivalent one targets the Omicron variants and the subsets of those Omicron variants which are more I would say correct me if I'm wrong Andrew but more highly contagious and potentially more lethal and so the and you if you've gotten the initial series with in the old days so to speak with the initial Pfizer moderna or even the novovax vaccine or the jnj vaccine any of those you can still get the bivalent on top of that at the end of that you know series to start off if you started with a different series you can still get the the bivalent vaccine and that's that's been available I think since Labor Day so it's been out and we it's certainly available in Duluth and we certainly have it at all the clinics in town so you can mix the brand types yeah so let's talk a little bit about now that we have the bivalent we're also facing a flu season yeah cold season and all the rest so can you get how do you do this can you get both your flu shot and the bivalent together yep yep same day maybe different arms but the same day so can you what about two weeks apart or does it have to be the same day or something well you could do it two weeks apart life's busy and if you're in the doctor's office or in your your provider's office why not just get them both the same day but that's that's just my own I know this is just me if I say I'm going to do something and I do it one day and then sometimes life gets in the way and I can't get back there so it's okay to get them both at the same time you may get like a little achy fever you know feel a little down but that's going to pass and trust me that's that that protection is worth any any short Downstream effects I've always been kind of taught when you have an immunization do them all the same day or otherwise two months apart yeah so and so that's my background and I would say but I'm old old but smart race so I would get them all the same day if you could so it's it's okay so we talked a little bit ahead of time at least Andy and I did I don't know if you were with us John at that point but there's a lot of testing going on at home do we have any idea about the home tests and uh how many there are and what that might be doing to our numbers and then another question that comes up from this person is uh if you have a home kova test and you take it you do a repeat in five days are you still infectious at that time or if the test is negative are you no longer infectious it's confusing I might have you go with that first if you're good with it yeah uh testing um we've really come a long way in testing um if you remember when this first started tests were really hard to come by uh at least in healthcare we were desperate to get tests and so now we're a wash and test and not all of those you're correct are being tracked home coveted tests are not reported to the state and so those numbers aren't reflected in totals so our actual number of cases is more than is reported by our Public Health agencies because of Home testing the benefit of Home testing though is uh better access for people who can get those home test kits and some of them are free or at least they recently were they have access to testing home antigen tests typically reflect infectiousness so if you test positive and you test yourself five days later and you're still positive it's likely you're still contagious to answer that question so the and the confusion I always get as a PCR versus the home test PCR if that's positive you've had or you have it how do yeah so PCR looks for um kind of nuclear material from the virus and that can stay positive for a long time um that can stay positive for months after you've had an infection that has to be done in a laboratory so you can't do a PCR test at home what people are doing at home is an antigen test and that will stay positive for a shorter amount of time and likely the amount of time you're contagious thank you that's very helpful and I think they're pretty accurate you know I think the false positive rate is pretty low on those and home management tests so if it's positive it's positive you get what I'm saying so if you're really saying that even though I Stumble and mumble my way through it it's probably okay huh yep so the accuracy is there for all of us to do it um this gentleman had covet on 9-5 and got paxilovid when can he get a booster I've heard three months but um you can get a booster at any time it's probably best to wait two or three months to get the best effect from the booster your immune system is is really going to learn better when you give it a little more time from from when you had an active infection taking the antiviral shouldn't matter that doesn't affect your immune system's ability to learn from that booster so it's interesting with the antiviral the pack the the bidens had they started out they got better than they got worse after they took it and others too is is that something that happens frequently or yeah the that's an area we know how to answer that even yeah no no paxilovid rebound is what it's or people are calling it is a a well-known entity um it's being researched and you know some of it might have happened anyway some people will get coveted feel a little better and then feel a little worse if they didn't take paxilvid it also occurs when people do take packs of it what we do know though is that paxilavid helps keep people out of the hospital and out of the ER and so it works for that purpose yep and the immunizations are very helpful in that same area too so that's true how long does the covid vaccine provide coverage for do we know I don't think we know because we're constantly that's why we're you've probably noticed that the recommendations have changed meaning that we started with one and then two and now three you know what I mean so I think that we're finding it's it's a wonderful time to probably be in immunology and to be in research because we're able to figure this stuff out whereas before that wouldn't have been the case and and the fact that you could develop this new bivalent vaccine in a relatively short period of time and prove that it's effective meanings that it you know I've heard talk that maybe there's a force booster and maybe down the road every year you'll get a new booster based on kind of what's happened with the flu where you know we learned from what the flu is doing the Flora the flu or the change the immunogenicity of the flu so they changed the vaccine every year that may happen with covet I I think and so I I can't really answer that question specifically have we seen Andy have you seen any cases of monkey you or have we all have we seen cases of monkey pox in St Louis County when you were going through the numbers I thought you said there were so we know it's here yeah there have been cases in uh St Louis County how do you treat it um so sometimes we can treat it with uh this antiviral called ticoviramat it's called tpox the trade name um and it's a fairly effective antiviral people get a response to it pretty quickly um it doesn't you know depending on the severity of illness it doesn't always require treatment and there's also an antibody treatment which can be given in in severe disease so as long as you're on the hot spot is there a risk of reinfection with monkey pox or do we know we really don't know it's the kind of thing you probably have some protection for a while but uh we don't know I don't know it makes me think back to smallpox and I can't remember how you know that's kind of what us old people went to school on a little bit correct and that's how I'm thinking about it as well and actually people who have been uh immunized against smallpox probably have some protection against monkey pox as well that might be why we're seeing a Resurgence right now or new cases of monkey pox is younger people are not immunized against smallpox thank you um John go through the list the question comes in is how many shots there's been four shots and now we're looking at a fifth for covid right well three so we had the initial two yep and then the by and the booster which is kind of where we're at right now okay so and some have had four shots yep I've had four I think I've had four yeah and what about the fifth one though what should we when it's available go get it is that yeah because the shots I've had have not protected me against this new bivalent right variant and so yeah but I haven't had that vaccine yet and that's just what we're learning about the the virus and the you know the treatment so back of monkey pox you're going to be the monkey pox dude tonight I guess the question is I think it's available you can get it off fomites and things like that it's not just the men having sex with men but there's also transmission can you get monkey pox from hotel rooms that aren't cleaned properly so we're back to the sanitation question yeah that would be very very unlikely um so it is possible that you know bed clothes or sheets from someone who has an active infection close contact with those is a potential means of transmission but it would be really rare so really it is close contact like skin skin to skin contact with with an infected lesion which which gives you monkey pox back on the immunizations for covet again the question is are there any clinical trials with covid-19 for vaccine injured people so apparently there are some people that have had some difficulties with the vaccine what data is out there and is it is it approved by a CDC or FDA so yes the immunizations are approved by the CDC and FDA but are there I assume there are trials going on for vaccine reactions of sorts that's most I know about it you track the vaccine registering if you're allergic to say some of the components of the vaccine obviously you shouldn't get that vaccine you know and but I'm not aware of any specific studies other than longitudinal studies you'd be doing on people who are getting vaccinated because you report to the vaccine registry if you have a reaction that's all I'd be aware of right nothing specific for that population I'm sorry tonight because we're jumping around a little bit but that's okay I think it's kind of fun because there's a lot here do you anticipate a worse influenza influenza season since influenza statistics weren't tracked during covid that's not quite right I think the influence influenza statistics have been tracked all the time do you want to address influenza either one of you during covet South America southern hemisphere those kind of things well I can just speak briefly about what I know about this down in the southern hemisphere it was Australia it was fairly of difficult flu season it was pretty bad from what I heard and that's typically been a predictor of what's going to happen here and the flu season is October to May or really starts really ramping up November December but we're sort of kind of entering That season gets a little darker we're inside more now we're not masking so I think the maybe the predictions from my infectious these colleagues are that it's going to be a serious flu season this year as a because it certainly was last year wasn't so bad mild season mask you know we got through it pretty well but this year I think the predictions are a little more dire so yeah there was a lot of surveillance going on in the past two years so we were still looking for influenza it's just that in the first year of the pandemic there was virtually none because there was so much masking and isolation going on there was some influenza last year not a lot but you're right John in Australia they had a really high peak early on of influenza that wasn't seen throughout the southern hemisphere so it's really hard to know but um based on people's behavior their reduction in masking and you know we're all kind of back to doing a lot of our usual things I'm I'm concerned about flu season this year uh in part because we haven't ever taken a two-year break from influenza like we did the past two years so we don't know what could happen you know what what kind of immune immunity we still have from flu as a population so the flu strains have an ability to be similar or they can make a big jump also is that peace that we can be facing question for you John this one's perfect for you does a healthy diet and exercise do a good job in prevent it preventing covet infection any evidence beside yourself I don't know if I'm the best walking evidence for that but I haven't had covet so maybe but not that I know but I would say you know I don't know if there's any specific they just look at specific you know who gets coveted and people who are without chronic medical diseases you know say asthma COPD you know it has solid organ transplant immunosuppression had a stroke diabetes hypertension they tend to do better and if they get coveted they tend to be healthier because they don't have those comorbidities going into it so my way of answering that question is to say if you if you're if you have a healthy diet a healthy lifestyle the odds are you're not going to have some of those things I just talked about and so you're not going to be automatically in a high-risk group for covet except based on your age does that make sense so I'd say that's probably the the best answer for that question I think I just recently read something too about the benefits of exercise and helping prevent disease stimulating the immune system and all of that on a basis Andrew any comments on that one uh yes I mean exercise is good for your immune system I don't think it will necessarily help you prevent from getting coveted but you may do better if you do get infected like Dr Wood was saying after uh this person had a immunization and of covid for covet after the first one developed a headache after the second one hallucinations is this common um side effects are common after the coveted vaccine and and many people will have you know 12 to 24 hours of pretty significant side effects I personally did I felt really horrible and had shaking chills for for a day after each of my boosters um uh hallucinations could be part of that and if they go away within a day that wouldn't be too unusual um a lot of questions about the boosters again if you've had one should you get another booster and I know there's is there going to be a timeline in between the boosters now the the new one is coming out it's been about every two to four months haven't they what do you mean the timing between boosters so you get a shot you have the initial two and so is there a there's a lot of questions coming in on that timing piece well yeah two months two to four months but yes the booster is here and you should a lot of people haven't had that bivalent booster and it's here and available so I'd encourage people to get that after that initial waiting period from those first two shows and the other question is where can you get it and by now we should all know that do you want to reinforce that I would say at any clinic in in wherever you're watching this program or listening to this program you could call your clinic your provider and they would be able to get you in right away to get that coveted vaccine and throughout the Northland throughout this listening area and in Wisconsin you can also call pharmacies Walgreens or CVS and I believe the deck is still offering vaccine likes a couple days a week maybe Sunday and Monday the question we kind of talked about Andy a little bit ahead of time how long does it take to develop long haulers from covid how long does it take to develop what are the signs symptoms can you do anything about it and that's one of those things that we're watching and I don't know if I have answers no this is your baby yeah there are a lot of unknowns about long covet and that's really still one of the reasons we need to avoid becoming infected we don't know who gets long covet and why and typically it's symptoms that last a month to three months beyond their initial infection and symptoms can be profound fatigue shortness of breath difficulty concentrating or also known as brain fog these can be very debilitating gentlemen this has been a great discussion thank you so much for both of you coming in and doing this we've covered an awful lot tonight and we've bounced around a bit I want to thank our panelists Dr Andrew Thompson and Dr John Wood and our medical student volunteers Barrett bukowic Shane Johansen and Walker Walker thornson please join Dr Mary Owen in two weeks for a program on women's health and female cancers her panelists will be Dr Michael cassing and Dr Addie Vittorio wdse will also broadcast a forum with the candidates in Minnesota State Senate District number seven next Thursday night thank you for watching have a great night and a great week