[Music] good evening and welcome to our 40th anniversary season premiere of doctors on call i'm dr ray christensen faculty member at the department of family medicine and biobehavioral health at the university of minnesota medical school duluth campus i'm also a family physician at gateway in moose lake minnesota i'm your host for this season premiere tonight on covet 19 and the delta variant this season we will again be rotating hosts from the medical school the host will include dr mary owen and dr peter nalen and myself the success of this program is dependent on you the viewers so please call in your questions tonight or email them to ask wdse.org the telephone numbers can be found at the bottom of your screen our panelists this evening are dr christopher delp an emergency physician at st luke's hospital and dr a.j an emergency physician with essentia health our medical students answering the phones tonight are abby coyle from watertown minnesota holly olsen from cameron wisconsin and lindsey simonson from owatonna minnesota and now on to tonight's program kova 19 and the delta variant and season 40 of doctors on call gentlemen welcome it's interesting as i sat and thought about this show tonight we've looked at covid in many ways we've had several covet programs as you know but you both are in the area where you face covid head on in the primary care clinics basically we're screening and we're moving them to the ers and aj you work in an icu and both of you work in the emergency room so you get to see it from there so aj do you want to introduce yourself and tell us a little bit about your work sure uh hi i'm i'm aj hegg i'm a board-certified physician in emergency medicine internal medicine and critical care uh i work mostly in the intensive care unit although i still work in the er is once in a while as well so most of my patients when they come to me with covid are patients who are needing to go on the ventilator or very close to going on the ventilator and then we take care of patients until they are able to get off of the ventilator which you know sometimes can be quite a long time in the icu chris so hi i'm chris stelp i'm the medical director for our stroke program at st luke's hospital i'm also the associate medical director for lifelink 3 air medical transport system as well as an attending emergency physician and i've worked here in this community for about 26 years now so it's been quite some time so been most of my time is spent working in the emergency department seeing these patients kind of first hand and this has been a very unique part for all of our careers i think i don't think i've ever seen anything like this before this particular outbreak and it's impacted us in so many different ways i'm just happy to be able to help a little bit and i'm many years out beyond you and i haven't either it's been a long time it's my understanding in our discussions before we went on air tonight that the hospital hospital system is being pretty much overwhelmed in minnesota at the present time and that hospital beds are hard to come by what's it been like in your facilities so i'll i'll start because usually the emergency department is just a short stop where we can either fix the program problem or admit the patient for uh for further treatment and now it's become a place where we have to hold people for long periods of time because there's just no place to put them there they're all of our beds are full we try to make arrangements for transporting these people uh to other facilities but at the same time all over the state they're trying to transport patients as well so it's really a scramble to try to get beds to take care of these people and we're having to hold people for sometimes long periods of time which further log jams the emergency department yeah i i see very similar things when i'm working in the emergency department you know trying to get people in to be able to be cared for as an inpatient it's really challenging and um you know we we are taking care of patients for long periods of time there on the other side in the icu you know we we we have our our beds are full we're trying to take care of people as quickly as we can and trying to help people get better so we can get them out of the icu because we know we have patients waiting um and you know we get calls from all over with uh who who you know they're looking to transfer them to us and we do our best but it's hard to accommodate and the the entire state is trying to to share the load there's a system set up in the state to to help emergency departments and hospitals figure out who has capacity and that system is frequently overwhelmed or on the brink of over being overwhelmed you know at almost any given moment too as an older physician and being able to sit back in the private practice part of the world i'm very indebted to you and those of you that are on the front line and especially to the nursing staff and the people that are with these patients taking care of the covet patients all the time how are our staffs holding up nursing staff physician staff health provider staffs it's i i mean this has been a really challenging couple of years and my hat's off to all of the nursing staff all of the respiratory therapists all of the all of the staff in our hospitals they are just digging in and doing everything that they can to take care of patients but i mean it's i can't sit here and say that it has not been extremely straining on them it's been hard uh difficult conditions uh just physically when you're in the room with a covet patient and you're dressed in all of this ppe to keep you protected and masks and we have these large machines in the room that keep negative airflow to to protect them you can't hear anything it's loud it's hot and it's physically demanding and this goes you know day in and day out that the nursing staff the the everyone there is just working hard and it's it's taxing and i think it's taken its toll on a lot of people what's it like being a patient in that situation uh the patients so you know my patients in the icu most of them are sedated on ventilators um and so a lot of times they probably aren't as aware about it if they are not sedated on ventilators it's and they're trying to talk to us then it's challenging because you have all this noise all these machines you know they can't hear you're trying to talk through masks and and patients are in a situation that's incredibly scary for them you know and incredibly stressful and the physical environment um around it is making it even harder for them to communicate and be heard it also impacts people that uh that don't um that don't have covid because in the emergency department we're experiencing very long wait times these are people that uh that are sitting in there waiting to be seen for sometimes hours and hours uh waiting uh uh just to have their their lacerations repaired because we're just so jam-packed with covet patients so that makes it uh it makes it challenging for everyone and being a patient in this in this time one of the other things that we had talked about earlier before we came on was the air transport system and you're a co-director do you want to talk about how that's working so the big problem with aeromedical transport in the in this covid era is that we to transport patients in a closed area they had to be put on a ventilator in order to contain the virus and we all know that putting people on a ventilator sometimes impacts their outcome negatively because we we can't really clean the cockpit with the with uv light that or some of the detergents needed to to clean that so instead here in minnesota we the life link system used the sealong helmet which is a special helmet to contain the virus so we were able to transport the patient and help support their ventilation and still contain the virus and provide a safe environment for for both the patient and the crew how is it working in the ambulances um the ambulances are are strained they can they're a little bit more able to clean their rigs using the normal kind of varicidal agents the aeromedical transport is much more tightly regulated in terms of those kind of transport issues and that first responder ems system is another front line that faces faces it right up front and yes and the fire departments too all of them yeah from from the police uh all all the way through these are all people that uh they're they're used to putting their their lives on the line but for the first part of this pandemic there was so many unknowns they they were they were putting themselves at a risk that they didn't even really know and that none of us understood vaccination so thank you for this background i think it's a good background for all of us to know have a call from a person who had both moderna vaccinations early in 2021 and then a breakthrough case in august does she need to wear a mask still and i don't know if this is going to fall in your your skills or not so you can dump the question too if you want to i mean i i think it's it's hard and it's hard to know what the right answer is but i think you know having two modern vaccinations having co-ed certainly that sets you up to have antibodies and decreases your risk of future infections but at the same time if you do get coveted again it may be less symptomatic or asymptomatic and so masks still help prevent the spread of covet and so whether you've been vaccinated whether you've had coveted or not i think the moment that we are in with continuously rising cases in the state of minnesota you know cases the whole region you know we are having increased covet i think the smart thing is to wear a mask there's so many unknowns and the bottom line is you're you're you're helping out other people and so why why would you not wear a mask and help out other people and help protect them agreed and it's also interesting that this is a pandemic with a new illness that we don't know anything about and we are learning as we go it's in the past all of us when we wanted to know something about disease you go to the books and you look it up or go online or whatever you can't do it with this one it's just not because it's not there and we don't know the long-term effects either of kovid and i would say another reason to wear a mask is you don't want to get it because we don't know what 10 years from now is going to be like with covid or 20. we just don't know those pieces yet can i get can i get a covert vaccination if i'm pregnant and if i do what are the risks yes they've approved it for pregnancy and as a matter of fact the risks are much greater by not getting it much greater for both the patient as well as the baby and this is something that we look at very very hard with multiple studies with a lot of people because these are complex issues and and the last thing we want to do is add additional risk and an already risk-prone disease and so these studies have been looked at done by multiple centers to to firmly establish that safety yeah and i completely agree i mean everything that we've looked at it is safe it is safe in pregnancy the patients who are getting hospitalized with problems and the pregnant patients that are getting hospitalized with problems they're the ones who get covered not the ones who are getting the vaccine that's everything i read agrees with what you're saying the other question is does it transmit some protection to the baby when you at least for a while and i don't know the answer to that one we certainly know that the maternal antibodies do uh uh with breastfeeding um those are passed on to the to the babies so there should be an element of protection for for the child as well so let's talk about delta delta is kind of new this past several months that it's been around what are you seeing are you seeing mostly just covet or are you seeing delta also so what we do is we randomly send samples to get a sampling of which people have delta and which don't and at least for me i never get those results to know if that particular person has delta or not but more of a surveillance word more during doing surveillance and then extrapolating that data yeah and and if you look at that surveillance data i mean i don't get it on a particular patient either but you know overwhelmingly we are seeing a lot of delta and i can say that there's a big difference in uh the cases that we are seeing now versus what we saw in the icu in november december of last year at the height of our large surge we have a lot of patients who are a lot younger who don't have as many co-morbidities patients as young as in their 20s you know patients in their 30s 40s 50s and the first time around we didn't see that as much if you were healthy and young um you tend to stay out of the icu but that is not what we're seeing now we are we are seeing a lot more aggressive virus so you bring up a year ago and you've been through this both of you been through it uh what what things are we doing now that might be helpful in treating covid um there's a lot of talk about what's the worming pill that goes to the animals and the nectar yeah that's the one help me out here so like a lot of things there is some grain of truth in how these things got started because early on we were all looking for anything to try to help these patients um and there was some some studies that were done and we looked at ivermectin to see that might be helpful there was some theoretical evidence that might be helpful and there was actually some published data the american journal of therapeutics is one that you commonly see quoted uh in which they did a meta analysis of all of these studies that showed that ivermectin was beneficial the problem with that is you that it took a lot of very badly done studies and if you combine a bunch of very badly done studies you don't get a great study so the subsequent studies that were done on these showed that ivermectin wasn't nearly as beneficial and maybe harmful as well and we and there's still ongoing studies so we have we're not done with that yet um this this data has is being looked at time and again and these studies are being redone to see if there is some benefit that may be gotten from that but right now the best done studies show that that just doesn't uh it's not helpful yeah and i i mean i couldn't agree more ivor mechtin we we've been trying to follow the evidence and we've all looked for whatever we thought could help you know early on in this pandemic we were prescribing hydroxychloroquine um you know when ivermectin studies came out we all said let's look at them we've been interested to see if there's any signal there but the data has not shown that ivan recton is helpful and what we do have is we have a lot of data on things that are really helpful number one vaccines vaccines are the most important and most helpful thing that you can do if you get covered and you're early on in your symptoms and you don't have to be hospitalized the monoclonal antibodies will help you from getting hospitalized if you get into the hospital and you need oxygen then we put patients on steroids dexamethasone is the mainstay of what we use and we have a couple of other medications that are immune suppressants one of them is called tosalusimab one of them is called barocytinib we use those pretty frequently too we were looking at a medication called remdesseviere a lot of people used it for quite a while the literature isn't really bearing out that it has a lot of mortality benefit and so that's a little bit more of a gray area if it's helpful or not i think a lot of people are starting to think it's not helpful anymore but vaccination is the number one and then it's you know do those monoclonal antibodies if you can and if you're in the hospital we we have medications that are definitely helping and improving mortality so we've seen these medications have been helpful in decreasing improving more decreasing the death rate and making it so that people can live longer and come out of this in a better shape the other thing that kind of hangs out there is the long-hauler syndrome and people just don't get over these these illnesses how's that how's that going especially as you of course you don't get to see them follow up do you they you send them home and i i don't i don't see them in follow-up um i do hear about them from some of my colleagues in clinics you know as they go to pulmonary clinic as they go to cardiology clinic um and but i mean it's it's interesting i mean we've had patients who have been in the icu for 90 days you know in the hospital for for even longer and so these long-haul symptoms i mean patients who get to the level of the icu you are going to have symptoms for a long time what is that gonna look like in two three four five years i don't think we know but this takes a toll on you it is it's a long and chronic disease after you get better even and it appears that at least the first round us older guys overweight all the other things that were against us made it a lot more of a risk to get okay to get coveted now with the delta that's changed a little bit and more of the young people i don't think it's more the young people i think that the that uh we are seeing more young people than the first than the first wave and i think that your your comments bear that out um but the first wave so many uh affected uh disproportionately the uh older people but then they the ones that got over it uh um then that virus moved on so we are seeing just a disproportionate amount but it still hits the elderly the delta variant still hits the elderly uh and those people at risk very hard as well but the other thing is that the that was the group that got most vaccinated and therefore has the most protection and so part of us not seeing younger patients are it is the group with less vaccines right now are kids at a lower risk of contacting cova 19 compared to adults yeah go ahead i i mean it seemed like in the first round there was a lot less children but it seems like with delta kids are getting covered more often you know kids are still young and healthy and they tend to do really well but there are certainly some kids that are getting very sick from this there are kids that are being hospitalized and so you know i think that we should be doing everything we can to protect our kids the biggest thing goes back to everyone who can get a vaccine should do it and that just decreases the virus in the population and that's how we'll protect our kids best and wear a mask and wear a mask absolutely is there a difference in accuracy in getting tested at the deck versus a physician clinic or your hospitals each test has its own individual accuracy amounts they're all i think very accurate but each we we study and look at a variety of different tests and their accuracies i think you in general you can depend on the results trying to compare one uh with the other i think it's very difficult i think the one thing uh caveat i'd say is if you get these at home rapid tests and you can buy them at cvs now you know those are pretty good but they're not as sensitive as the tests that we send in for for pcr testing and so they will give you some false negatives sometimes and i think you should be cautious that that is not a perfect test the pcr is the gold standard right now yeah yeah when is it recommended to get a booster of the vaccine if tested positive about a week ago i don't know the answer to that one i don't know if there is one so the question is somebody who has coveted and now they're wondering when they should get the booster when is it recommended to get a booster of the vaccine if you tested positive about a week ago i think as soon as you have recovered it from your covid and i would you know if it is a mild case of covid two or three weeks if you are recovered then do it if i'm vaccinated and my friend is too also do i need to wear a mask when i visit them indoors so the cdc has gotten guidelines for that and some of that depends on if you're symptomatic we certainly look at families that have been vaccinated husbands and wives and friends in small gatherings if you're not symptomatic and the people are vaccinated i think the the cdc um says that if it's small gatherings um and among vaccinated individuals that that's that that's still okay unless you're symptomatic because again we have all these breakthrough infections that are occurring uh in vaccinated people and the tough part is is that you shed for two or three days before we know that you have have any symptoms aj anything to add to that one i mean just i mean i agree but you know we live in a world where nothing with this is 100 safe we can't we can't say what this is what you're going to do and this is where you're going to be safe but we can say um what you can do to be safer but i think you know if you're with your family and a small group of friends i think it is reasonable and people are vaccinated to not have masks if you go out in public or in larger settings then put it on mass or viruses are very small how can a mask with little holes in it keep from letting the virus through to you how does the mask work so the virus is transmitted both in large droplets and small droplets the mask is going to decrease those and i i would encourage you you know if people really want to see this uh new england journal had an amazing video where they they show somebody and they put a mask on and they show particles coming out they use a laser to do this and and show it with and without and it's really obvious it decreases what you are are putting out in the air and the flow is 20 feet not six six is too close and then there's different types of masks also if we don't know the behavior of the delta variant how will we make a vaccine so uh i'm not sure the premise of their question but the the so the vaccines are the vaccines that we currently have will protect against the delta variant and and i think that it's very clear that it is protective against the delta variant um and they're currently doing surveillance or uh the viruses that may or may not evade the vaccine um and they're they're very they do that kind of surveillance just in case there is any that emerged that will evade the vaccine and then the companies will will be able to now that they've ramped up to alter the vaccine to cover those in a much more rapid fashion the third pfizer shot how long to wait before getting the flu shot i wanted to ask that one we've got about a minute left um i got my flu shot one week after my third pfizer shot so i would have done it on the same day but they didn't have it and i got mine both on the same day yeah i think that's probably better and i what i read was at least two weeks so there's there's some various discussion on that any final things that you gentlemen want to say go ahead yeah i just the the vaccine there's worries about side effects those side effects are so rare and when you can compare that to the mortality of the virus itself that the vaccine i just want to encourage people who are hesitant to just ask questions he speaks for all three of us i want to thank our panelists dr christopher delp dr erin higg and our medical student volunteers abby coyle holly olsen and lindsey simonson please join me next week for a program on women's health and female cancers when my panelists will be dr michael cassing and dr verna thornton thank you so much for watching tonight have a great night [Music] [Music] [Music] you