[Music] good evening and welcome to doctors on call i'm dr mary owen a faculty member from the department of family medicine and biobehavioral health at the university of minnesota medical school duluth campus and director of the center of american indian and minority health at the university of minnesota i'm also a family physician for the fond du lac band of lake superior chippewa and i'm your host for this evening's program tonight this evening's program coveted 19 update the success of this program is very dependent on you the viewer so please call in your questions or email them and to ask us at wdse.org ask wdse.org the telephone numbers can be found at the bottom of your screen our panelists this evening inc include dr j dave bupal an internal medicine and critical care specialist at essentia health and dr andrew thompson he's an infectious disease specialist with saint luke's infectious disease associates our medical students answering the phones tonight are barrett buckovec of warroad minnesota abby rader of glencoe minnesota and megan sarator from bemidji minnesota and now on to tonight's program on covet 19 update welcome both of you i think this evening before i jump into a couple of questions that we got ahead of time i'd like to ask if you have any i mean this is such an important topic that's been on our minds for two years now so would you like to share any thoughts on it and your work dr bupal first yeah i think i'd like to start by saying it's been a very long two years for everyone i think the the icus in our community are at capacity we are at a place where we are waitlisting patients even from outlying hospitals that don't normally keep that level of care so i think it's important this is not just about our covert numbers it's about our ability ability to care for patients in our community that may have a heart attack or may have a car accident so i think it's important that we reiterate that this is about being able to keep our communities safe and being able to uh ensure we care for our our fellow uh citizens thank you for that so just to clarify what you're saying is that patients are in critical care and outline our outlying rural communities and they should be transferred here normally but they can't be because our icus are so full yes yes okay thank you for that dr thompson would you like to add anything yeah i think one thing somewhat related to what dr bupal said was uh regarding vaccination and i keep getting the question of well if vaccines work so well why is this still here and what we're seeing at st luke's and i'm sure you're seeing the same thing at essentia is the majority of people hospitalized and people in icus are those who are not fully vaccinated and i think expecting vaccines to be perfect and prevent all infection is unrealistic what we expect them to do is prevent severe disease and prevent hospitalization we would love to turn this from a critical illness into a cold or a relatively mild illness and that's what vaccines do so even though people may get sick after vaccination they're not as sick as they otherwise would have been thank you for that when you say make it into a cold or flu with the vaccines if we get to a place where the vaccines work well enough do you imagine that there will be less of the long-term effects of covid and i know that this is just a you know we don't know this yet with the science but right that's one concern with covet is once you recover do you have lingering symptoms and we know there's a syndrome called long covet and it appears that and it would make sense if you have a less severe infection due to vaccination or due to some underlying immunity that you would have less risk of having long covid it's a little early to for me to speculate but uh it looks like there is less of that when people have been vaccinated thank you i can speak to that i in our icus without getting into exact numbers the vast majority of our patients are unvaccinated and this is not something that is only affecting old people we are unfortunately seeing patients in their 30s and 40s that are incubated which is to say on life support on full mechanical support and it has been very very sad to see the amount of loss that we've seen so i second dr thompson that vaccination reduces your chance of being critically ill from this illness is there a possibility of breakthrough yes but i think that it it is your best chance i think uh in preventing critical illness and it's not the the hard part is it's not even getting through just the critical illness there are several things that happen to your body when you are on mechanical support and life support and usually one day on a on a ventilator equates one week of rehab and unfortunately if you do get critically ill because of the nature of the virus we are seeing people on the ventilator for at least two to three weeks so it's several months of rehabilitation being out of work and being away from your family so it's something that i absolutely second i think prevention at this point is far superior to core to cure that's such a good point about the impact of having having been on the event and how long the recovery is and i don't think people think about that and we think about before so thank you for that thank you both so dr thompson do you anticipate that the flu season will be worse or better with covid circulating it's a it's hard to speculate uh on without covid how flu might act in any given year and we never know uh sometimes we look to the southern hemisphere to give us a prediction of what things might look like but so far this year especially in the past few weeks we've seen a big uptick in flu activity people are coming into our hospital with influenza the people in the community are getting influenza and so in addition to covid i have additional concern this this puts us an additional strain in hospitals in the winter time on top of an already overburdened hospital so uh do all the things uh that we're doing for coved you know wash your hands and wear your mask and and take care around others and um do those people with the flu does does the flu seem stronger this year at all have you no no it's hard to say it appears that there's right now there's an influenza a um that's predominant people are getting sick we um we have had multiple people hospitalized with it so did you notice more or less last year with more people wearing masks more regularly last year there was virtually no influenza last year thank you there was so much uh care given to distancing isolating masking there was almost no flu it was incredible what it would be like if we just did that for our flu season huh it's hard to live that way it is yeah dr bupal what are the best things to do to keep me and my family safe from kofi 19. i think like we touched upon earlier from a critical illness perspective your best chance is getting the vaccine we are seeing some waning immunity beyond six months so get your booster i think in addition just general we're seeing obviously uh people that are in not in not people that are generally not in good health are higher risk for critical illness obesity is a risk factor diabetes is a risk factor so getting your chronic health conditions taken care of um and taking care of yourself from that perspective is important but from a coveted perspective i think the most important thing is vaccination and if you're high risk take additional precautions wear a mask avoid large crowds and if you do get sick and you are high risk reach out early because there are therapies that are offered to high-risk individuals uh that include monoclonal antibodies that include the neural medicine uh paxluvid which is are both now coming into availability in our region the monoclonal antibody has been around where he's switching to a different one with the omicron variant and the pax liquid is coming in so if you are high risk and when a high risk i mean if you are obese if you have diabetes if you are immunocompromised or an immunosuppressive medications reach out to your primary care physician early so that you can we can determine if you're eligible for these these therapies that can potentially reduce your chance of becoming critically ill now just hearing that list i can imagine a lot of people are thinking am i obese do i have these things do i have that so can they should they call their providers and and ask the questions specifically there can they get that information there yes i think but by body mass index i believe it's greater than 30 definitely greater than 35 but that that is something that we can they can ask their primary care provider exactly exactly what is the requirements okay thank you um dr thompson what's the recommended time frame between uh getting booster shots and i notice in addition to that i noticed that the time frame has changed a little bit with time according to the cdc why is that um i think the the why is we're we're learning more about um how how your antibody levels wane over time um and i would say that based on the interval you should pay attention to it's currently five months uh it just changed after completing your your first series you can get a booster uh five months later but stay tuned because we're learning more and more about this and uh that's it's possible the interval may change um and it's possible by next year there'll be a different program any thoughts that the interval might get shorter or longer any what i mean you're reading the literature as it comes out um and again it also depends on how whether there are new variants um are there new variants that um perhaps our current vaccine doesn't work against or do we come up with a new vaccine that works better against certain variants um i would i would not expect the interval to get shorter um perhaps there will be a better vaccine and the interval can be longer um so this is an area of active uh research and change i think thank you dr bhupal does the covet booster protect against the omicron variant i think at this point uh yes vaccination is protecting against critical illness in in patients that are being seen in our hospitals is uh dr thompson is there a specific study or research that supports this is a good question i think because a lot of people are asking it a specific study or research that supports that vaccination lessens covert severity or is this speculation it definitely reduces severity and there are many studies which show that vaccination reduces severity of illness it reduces the chance that you will spread your infection to another person if you do get sick so i think that is one of the most well established findings from our vaccine studies and every vaccine study that has been approved shows this it's overwhelmingly effective against uh illness and especially severe illness thank you so not just one study but many studies many studies and well-done studies excellent thank you dr bupal if you get sick with one covert variant can you get sick with the same variant again i think that we are not seeing that we are not seeing that people i have not seen patients get reinfected so i think that when there is a fair amount of evidence that natural immunity will protect you from subsequent um infections for some length of time um so we are not seeing i have not seen patients get critically ill and get subsequently critically ill from the same illness thank you and dr thompson how long do you need to wait to get your kova 19 booster shot after getting breakthrough covid yeah you there's no reason you can't get a booster shot um but after having a breakthrough infection uh your immune system has has seen that that variant that that covid and so uh you probably have some protection for a matter of a month to three months but i would recommend getting that booster sometime in that time frame maybe a month or so later okay thank you and someone asked if i got my booster a few weeks ago i got my booster shot we'll have to wait another boost for another booster well i have to get another booster in six months kind of getting to what you were saying earlier that we don't know don't know right now yeah um and dr bupal are there any supplements someone can take to boost their immune immune system and decrease their chances of getting coveted no you get coveted if you're not vaccinated you get covert if you're not vaccinated we have seen a lot of people that are deciding to take things that there's no evidence for unfortunately in the information age there's a lot of information out there with regards to a lot of therapies that simply don't work and i think it's the effort and time that they've taken to research those therapies that don't work and they've ended up critically ill despite those therapies i think the vaccination is going to give you much more protection at least from a critical care perspective absolutely i can see unequivocally at essentia where a large group of physicians that specialize in icu medicine we have at any given time i'd say on ventilators several patients and like i've said before all of us unequal unequivocally think that and know that you are well protected if you are vaccinated it's not to say you can't get critically ill but i think that there was a recent release from the american medical association that says your chance of critical illness is 10 to 14 times higher if you are unvaccinated and that is what we are seeing on the ground and that is absolutely what we are seeing in our hospitals and regarding that supplement question a lot of repurposed medicines and drugs and supplements have been studied and there's been no benefit found to taking a lot of them you know we were desperate initially we tried all kinds of repurposed medications um and other antivirals uh for from other disease you know to use to treat other diseases and they haven't been shown to help and so it's not as if this hasn't been studied if we had an answer if we had a great prevention apart from vaccination we'd be happy to have it thank you for that i think that both of you have emphasized how important it is that in this time and particularly in this time to be listening to the doc our doctors who are following the science you know it's we don't have time for otherwise so thank you both for that um from another question is what has it been like and dr bupal i'll turn this to you what has it been like for physicians and nurses knowing that the majority of the patients they are caring for in the icu are vaccine unvaccinated what's that what's that doing to morale how's that take looking like i think something that's been talked about nationally is compassion fatigue where we feel like people are dying from something that could how well have been prevented so it's been heartbreaking it's been very sad to see the loss at the same time we're physicians we're we're nurses we're respiratory therapists and we are called to to do what we do so i don't think it affects the way we deliver care to our patients i think we care for everyone the same whether they're vaccinated or unvaccinated but i think that when we see wave after wave after wave and the numbers go up and up and up you ask yourself why is there such a mistrust with the medical community and i think one of the things that has been hard to answer that question about the aspect of delivery of care is prior to this i don't believe that i was questioned or my my group's expertise was questioned as much as it is now we get a lot of questions about about fringe treatments that there's no evidence for and my answer is often if we believe that it would help we would do it but we have to follow the science we have to follow evidence-based medicine we can't just prescribe something because we because someone said so on the internet um and i think that's been the toughest aspect of our care because in that time that we spend explaining that to families sometimes these conversations can take 30 to 45 minutes a day it's the time taken away from me caring from other critically ill patients so i think that that's been the thing that's most challenging that's exactly what i've heard from my colleagues over and over over again dr thompson anything to add i would agree with what dr pupal said so someone asks it seems that all we talk about now is omicron variant what happened to delta uh dr thompson you take it delta is still with us uh um a number of the people we have hospitalized right now um have been there for weeks and and got sick late in 2021 when delta was predominant but really it has been overtaken by the omicron variant which is much more contagious probably milder overall than delta but because because it's so contagious and so widespread it is reaching corners of our community that that weren't infected before and so with more people infected uh right now our hospitalization numbers in minnesota which had been kind of declining at the end of the year are starting to increase again how long do you think we're in for this increase based on how contagious this is and how quickly this is going to move through our community and our state i would i would expect in the next few weeks for this current surge to to peak and then probably decline beyond that i don't like to try and predict the future given that given that we have a few weeks of omicron dr bupal should people be masking in public spaces absolutely i think we need to mask we need to we understand that people are tired of this people want to get back to living their lives they want to uh in the you know in the manner that they always have we want to be behind this as well but absolutely i think masking protects i think if nothing else even like dr thompson said last year we had virtually no flu and an overburdened health system i think any prevention of respiratory illness that in addition to what we already have will go a long way in supporting a very tired healthcare community that's sort of been at at our at our maximum giving our maximum for the last over 20 months now and not just our health community but our education community everybody who's feeling the impact of this right now yes absolutely a lot of different industries dr thompson following the cold vaccine if you get symptoms are you contagious uh so symptoms right after vaccination are probably side effects we know that the covert vaccine has pretty significant side effects from personal experience i can tell you the the side effects the day after are significant um but if you become infected after being vaccinated yes you're contagious the the duration of contagiousness and probably the amount of contagiousness is reduced from what it otherwise would have been but you still have to consider yourself contagious and isolate until you're better so if you get symptoms several weeks after you've been vaccinated then you should be tested before getting around a lot of other people again and potentially infecting them yep you should get tested and you should isolate until you know the results of those tests okay thanks and the general isolation by the cdc is at least five days now at least five days right thanks a little confusing but to say the least dr bhupal is it safe to use steroid-containing inhalers like advair in the midst of the covet pandemic will the inhaler lower my immune system i think they're thinking that steroid yeah no i think that whatever chronic therapy that you are on uh should be continued um i don't know that we have any evidence that it increases the risk of covett infection thank you dr thompson what's your opinion on the reliability of at home covet tests yeah so the at-home antigen tests are pretty good um but sometimes people will have onset of infection um they haven't yet reached their kind of peak of a virus load in in their in their nose and so if they take an early antigen test they might get a negative but with that increasing virus in their nose the next day or the day after that might be when their test would turn positive and so sometimes the best use of those tests is to take more than one if you have ongoing symptoms to take one a day apart now with the cost of them that isn't always easy for everyone but they're pretty good they're not perfect no test is perfect okay for critical care can a cpap take the place of a ventilator to treat covet initially in the early phases yes it is a form of non-invasive ventilation and but eventually people when they are sick enough some people may get by with a cpap if they're not terribly hypoxemic if their lung injury has not progressed so the cpap is what we do use initially to see if we can avoid invasive mechanical ventilation because with invasive mechanical ventilation comes sedation and comes other complications from being critically ill but i would like to look of it look at it as a step up the cpap is where we start initially or high flow nasal cannula which is a oxygen through the nose but at a higher rate 40 to 60 liters so it gives you more support and some people will get by on a cpap or high flow and not end up on an invasive ventilator but some people will not so that's a great question but i think that's where we start and as the lung injury progresses you may progress to the point where the cpap cannot give you enough support or the high flow will not give you enough support and then you would be placed on a ventilator okay thank you for that dr thompson you and i talked about this a little bit before the show where can i find the exact ingredients that are in the covid vaccine uh you can look that up on the internet the the cdc and the drug the vaccine manufacturers list all the ingredients and they have some kind of long names because they're being very specific about it but really what it is is a piece of rna that is just a small part of the the virus gives instructions for how to make part of the virus and the rest of it is some salt and some sugar and some lipid and we're talking about this is a tiny tiny amount a micro drop people have been concerned about it because it's new and you know i hear questions about what's in it how do we really know what's in it the ingredients are very simple most medications that we take have far more complicated structures and strange molecules compared to this so you can look it up you can read what's in it thank you for that we only have about a minute left but i do want to leave with this question dr rupaul because i think people are asking this or something similar i have repairs that need to be done in my home and my contractor is not vaccinated should i cancel i think i think that's uh i think you have to look at the risks and benefits of you know how high risk you are um [Music] and again like we've said over and over and this that i encourage everyone to to get vaccinated because it prevents critical illness but i think you have to look at the risks and benefits of the situation you know i can't tell someone you should not associate with someone that's not or otherwise but i think it's in the best interest of um it's the best interest of protecting yourself and your community good anything to add and do other things to reduce your risk you know improve the ventilation it's hard to crack a window especially today but uh you know if you're in a situation where someone isn't vaccinated there are other things masking improving improving the ventilation to make your environment safer if you don't have a choice there thank you so i want to thank good thank you for being here tonight for doctors on call with dr thompson and dr bupal thank you both for this information next week join us again for doctors on call where i believe we will be talking about lower lower extremity injuries or lower extremity diseases and that's just off the top of my head if i'm wrong check on tv thank you very much and good evening [Music] you