Lakeland Currents.

Your public affairs program for north central Minnesota.

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Hello again friends.

I'm Jason Edens.

Your host of Lakeland Currents.

Thanks for joining the conversation today and thanks for your ongoing support of Lakeland Public TV.

Covid continues to wreak havoc on communities throughout our viewing region, which is why I wanted to visit with our keystone healthcare partners to learn how they are responding and adapting to the ongoing pandemic and how it's evolving.

I'm honored to be joined today by Dr. Peter Henry who's the chief medical officer at Essentia Health.

Dr. Henry welcome to the program and thank you so much for making time.

Thank you Jason and we appreciate the opportunity to connect connect with the patients that we're so privileged to serve.

Absolutely.

Well first and foremost you and your colleagues have been heavily demanded upon at the front lines of the pandemic for the past 18 months.

How are you holding up?

How is morale at Essentia Health?

I would say overall morale is good but I will tell you that our staff is very tired.

I mean this has been a very draining 18 to 19 months not only on the front line staff, the people that do direct patient care but also all the support staff and ancillary staff that's behind the scenes to make this very large organization run effectively and meet the needs of the patients.

Well, I really appreciate you acknowledging the folks that we're not hearing about as often, some of the ancillary support staff.

You know, nationally it seems as if the Delta Wave is beginning to crest.

We've seen a reduction in the 14 day average of new cases and just now we're starting to see a reduction in deaths or a downward trend, however, that's not the case here in Minnesota and certainly not in our region.

I was wondering if you could give us an update on what you're seeing in our region at Essentia Health in terms of hospitalizations and active cases.

So Essentia Health, as you know it serves a fairly large geographic area.

All the way from northwestern Wisconsin across Minnesota, Duluth through the Brainerd lakes region and then to Fargo and even into eastern North Dakota.

And what we've seen is a little bit behind what the national picture, at least in the southern part of the country has seen.

So we're a little bit later in our surge, so our numbers continue to rise and currently at Essentia Health facilities, we have over 90 patients that are hospitalized specifically with Covid.

Along with that, we have obviously a huge demand of backlog of pent-up medical problems that they're presenting with increased severity and illness that need to be managed and taken care of as well.

And that's why it's just so important to get the message out about vaccination but also some key issues about testing and where to get testing so that you don't put additional burden on an already very stressed caregiver.

I was wondering, Dr. Henry if you could tell us a little bit more about how it is that you're wrestling with these simultaneous issues.

You have a part of the public that is wanting other services, other medical services and of course we're still grappling with Covid.

How do you triage that?

Well, I'll get to them, you know right here and specifically in the Beltrami, Cass, Crow Wing area, we still are seeing fairly high positivity rates that put us into what's called severe community transmission levels.

We're seeing levels anywhere from fourteen percent to seven percent.

We're fortunately starting to see a slight downward trend in the Beltrami and Crow Wing counties, but as we know hospitalizations and then eventually deaths kind of follow in sequence so our hope is that we see a decrease in the testing positive.

We'll see a decrease in hospitalizations and then we'll see obviously a decrease in deaths as well.

As far as how we're dealing with this, it's really been, I'll tell you it's been a struggle and the capacity of our health system and every health system in the state and in the country is being taxed at this point in time.

And there are multiple factors that go with that.

One of them is this pent-up demand of health care that was delayed when people were putting off what some people refer to as elective care.

What we prefer to call time sensitive care and then as a result of that they're presenting with more severe illness which requires more intense care and also prolonged care as well.

And so it is a definitely a balancing because we can't kick that can down the road any further.

We can't stop doing these time-sensitive surgeries or elective procedures because we'll have the same situation going forward.

We also are struggling with a shortage of health care workers in general.

We have seen a large exodus from health care.

People, just saying, you know this is very difficult work and some people have left the health care industry completely but also individuals in the baby boomer generation similar to myself, who were nearing the time of their retirement and felt that, you know, this is really difficult and have probably left the workforce earlier than we had anticipated and then on this in this and that just training programs to bring and train many different ancillary specialists and nursing staff that we need to do this.

So clinical assistants, nurses, x-ray techs, laboratory techs, so we're working to really try to partner with these educational facilities to bring and help with tuition and to increase the workforce but that's not going to be a quick answer.

We know that health care worker shortage is going to be with us not just for the next few months but probably for years to come.

And if you just look at the aging of physicians in this country, a large number of them are in the category of being older than 55 and so trying to do what we can to improve the work, help them stay resilient and keep them in the workforce is going to be very very important for us to meet the needs of the patients that we serve.

Well, needless to say, you've described a perfect storm.

I'm curious this exodus of which you speak, has that happened during the pandemic?

Some of it has been happening part of the pandemic.

We knew that baby boomers were leaving the workforce and as we know that was a very large portion of the workforce.

Fewer people and the younger generations are coming in to help the healthcare industry.

So, what we would need to do is really figure out how do we work more efficiently, innovate the care and the care model that we provide, utilizing technology, especially.

You think about all the different methodologies of letting people know that we're they're here for our care.

So you have the electronic medical record that can let these care team know that you're sitting in the parking lot ready to come in and reduce some of the steps and registration but also just the technology about delivering of health care, especially virtual health care.

Now that's been a huge revolution that was moved very quickly when the pandemic struck just out of necessity and the great great majority of telehealth is actually provided by health care companies like Essentia Health and not by these technology companies.

It's really done by us and we've really moved that platform very very quickly to help meet the needs and also help with reduction in the workforce that we have.

Interesting.

Well, also on the note of staffing I'm curious, if the vaccine mandates have had any impact on your staffing.

Have you actually lost any staff as a result of that?

We, unfortunately have lost a few individuals because of the making when we say a mandate, that's a condition of employment.

It's similar to what we have done in Essentia Health for Influenza for the last three years and we don't want to lose any of our staff.

We want them to, hopefully, understand that the decision to make this a condition of employment is rooted in our mission and in our values at Essentia Health and that decision was not made lightly.

We have an obligation as healthcare providers to protect every patient that comes into our facility.

They come there not by choice always.

They come there in the most risk part of their life, in the most vulnerable part of life.

They're oftentimes immunocompromised and we have an obligation as healthcare providers to protect them.

We also have an obligation to protect the sanctity of life and that's what the decision making was around this.

The key thing that I think at an employee cafe today and what i'm trying to impress throughout this is, that these are not new vaccine technologies the MRNA vaccine technology has actually first started to be looked at in 2001 with the first SARS epidemic and then with the MURS in 2010 or 11.

It was further advanced.

So that technology was already being developed and having so many people willing to get into clinical trials allowed this to accelerate the vaccine and bring it to market very quickly.

There's been an over-exaggeration of the adverse effects from the vaccine.

By the fact that these we have to report to these vaccine adverse event reporting systems.

Just because the report doesn't mean that it's a cause and effect.

So we know that, unfortunately, many people who are in their 80s and 90s die naturally and we have to report that if a person dies within two months of getting a vaccine, that they died.

But that doesn't mean that the cause of their death was related to this.

We know that natural instances of disease is the great great great majority.

Statistically, these are some of the safest vaccines ever brought to market and we have the advantage of literally 350 million doses in this country but billions of doses around the world to look at what is the risk of getting the vaccine versus what is the risk of getting Covid.

We know that the risks of Covid are far far greater.

We also know that the long-term adverse effects of getting Covid from some individuals has a significantly significant impact on their life and their livelihood.

Well, I appreciate you reminding us that correlation doesn't necessarily equal causation.

So, Dr. Henry is it safe to assume then that as chief medical officer, you support this condition of employment?

I think it's an important, I do support it and I support it primarily because, I as a health care provider in our organization because of our mission values, need to protect the patient.

Every single patient that comes into our facility.

It was the key decision around why we implemented Influenza and making that a condition of employment because we knew that there were times when people had come into our institution and actually contracted these diseases and had adverse outcomes because of that and that's that's a difficult thing to recognize.

We want to keep every single patient safe and that's why we're so adamant about the appropriate use of the PPE mask, the hand washing, appropriate gowns and making sure our staff is vaccinated.

Vaccines aren't a panacea.

They're not the only answer but they're probably the most important answer to getting us through this pandemic and bringing our lives back to normal.

Reducing the burden of health care that is currently on these health systems that is being very challenged to be able to meet at this point in time.

And we know that the great majority of those 90 some patients that are in our facilities right now are unvaccinated.

Those that do have breakthrough infections typically don't end up in the hospital.

As a physician you need to understand of course not only Physiology and Anatomy and Organic Chemistry, but you also need to have a good understanding of Sociology.

I have a question about historical vaccine hesitancy.

Of course during the 1950s, Polio was a threat.

A clear and present danger in the United States and when the vaccine first became available in the was in 1956 there wasn't a great deal of resistance to that.

What's changed?

Well, I think a couple of things have changed.

One is the devastating effects of Polio were very evident.

Almost everyone at some point in time in their family knew someone who was impacted by the effects of Polio.

I think the other thing that's happened is that through the advancement of social media the ability for people to hear misinformation and disinformation that sways them to against a specific vaccine has markedly changed that whole scenario.

And back in 1956 I was a one-year-old in 1956 and received that vaccine as a child but we know at that point in time we had, I lost my train of thought, but we know that vaccine technology has advanced dramatically and at this point in time these vaccines are safe.

We have decades of use of these vaccines and understand how they work and how their effectiveness can be impacted.

Sure.

The World Health Organization has identified both Moo and Lambda are we in our region and nationally for future variants of concern?

Well, I think that is the key thing that most people get worried about.

I think it's the key that all the experts in Virology or Epidemiology or healthcare providers worry about is the effectiveness of vaccines against these new variants.

Now, vaccines of variance of interest have shown potential changes that would impact the either the transmissibility of the disease, the ability to test for it, the ability to treat it with some of the treatments that we have and the severity of the disease.

The fortunate thing is is that right now the great great majority in Minnesota it's over 99 percent of the cases are the Delta variant.

We know that the the treatments, the monoclonal antibiotic therapies are very effective in preventing severe disease.

About 80 percent the likelihood of reducing your risk of developing severe disease if you have high risk factors and so that's the key thing now.

We need to monitor these but most importantly we need to get people vaccinated because we know viruses naturally mutate and they mutate when they get into the cells and they replicate or make copies of themselves.

The fewer people that are infected, the less replication, the less chances of variants and then we won't deal with any potential problems.

Where the worst case scenario, the vaccines that we currently have developed would not be effective at all and we know that they're still very effective.

Although there's breakthrough infections, those infections are mild in the great majority of cases and they keep you out of the hospital and they keep you from dying.

So, you just mentioned that Minnesota the the dominant strain is in fact the Delta in excess of 99 percent, but it's my understanding that the United States doesn't actually do genetic sequencing as often as other nations.

Why is that?

I'm not exactly sure because I think it's personally been one of my frustrations that we have an opportunity to do more surveillance of these vaccines, the viruses and the genomic sequencing that's required of that.

European countries have been doing this at a far greater level and with that you as soon as you identify a potential variant especially if it's a variant of concern as much has been proven to have either increased severity, evade testing, etc.

You can then do the contact tracing and hopefully control that spread of that of that virus.

The other thing that's a little frustrating is that we haven't been more proactive in testing of to the effects and the ability for natural immunity and how long it lasts and how to how to really better monitor it.

Because that's a big concern for individuals who under our condition of employment, we still require for those people who have had Covid because we still don't have the final answers.

How long does natural immunity last?

We know that the common cold there are four SARS viruses that cause the common cold.

We know that that immunity from getting that virus lasts about six to nine months.

We know that with SARS kov2 probably going to be about the same but we don't know if it's longer and we don't know for sure if it's shorter and if we'd been doing more studies, there are some in in process right now knowing more about natural immunity will help us with focusing our vaccination efforts where they really need to be as well.

So the answer about natural immunity is kind of, it's a common question I get, but my answer to that is more time, more study needs to be done.

I mean this is a very new virus and we need to learn a lot more about it.

Throughout the pandemic, the medical community hasn't always presented a unified front in terms of responses and treatments and things of that nature.

In fact, just recently there was a very public divergence within the CDC regarding boosters.

How does that affect public confidence in the medical community's response to Covid?Well, I obviously I think it probably has a negative impact but what I think we need to understand is and give grace because when you have a completely, essentially new virus that is creating has caused a pandemic and it has far greater lethality than for example Influenza.

We have to learn as we go and then very early in this pandemic we had very poor knowledge about the transmissibility.

Was it just by droplets or was it aerosolized?

How risky was it to be transmitted by what's called formide transmission, by touching surfaces?

We've learned so much more about that.

We've also learned more about the structure.

It's risk of mutating.

How best to treat it and so we've seen the mortality from Covid go from three to five percent initially very early in the pandemic, to now into that one to two percent.

Now, there's still, that's a very very high rate of mortality if you compare that with Influenza for example, you have about one in one thousand and one in two thousand all come or risk of dying from Influenza.

For Covid its one in 200 or one in 100 or two in a hundred.

That's a tenfold risk greater.

So I think we need to give ourselves a little bit of grace.

We will learn more about this this virus but we do we have to focus on things.

What do we know?We know that this virus is deadly.

We know that it impacts the elderly and the immunocompromised the greatest.

We know that the vaccine is very effective very safe and it keeps people from dying and it keeps them out of the hospital.

I think that's what we need to focus on is not so much what we don't know but what we do know and how do we apply that and encourage people to do to be more informed about the safety and efficacy of this vaccine.

I think it's all about perceived risk.

If you don't know someone personally or you don't have a family member who's been impacted by this, that risk doesn't seem to be as real.

When it's in your own family, you watch individuals die from this or you have friends who have been impacted by this, it becomes much greater reality and we see you know 30 year olds, 40 year olds, 50 year olds on ventilators and intubated for weeks at a time.

The reality is there and I will tell you our staff sees this every single day.

That divergence of opinion is within the CDC was specifically about boosters.

Will boosters be a part of the rest of our lives?

I don't think anybody has the final answer to that.

I think it goes down to how long does natural immunity last?

You know, certain viral diseases, we know have years or essentially a lifetime immunity.

You have Measles as a child, you're not going to get Measles as an adult in general.

And, so the more we learn but I do anticipate that there may be the risk or potential of requiring boosters for Covid just like we have annual Influenza vaccines going forward.

At this point in time because there really wasn't good consensus by the CDC, the Advisory Council and immunization practices, FDA, we don't make the booster a condition of employment.

We want people to have the primary series of full vaccination but we haven't made the booster at this point in time.

As more data comes out and they're able to look at the efficacy of these vaccines and whether the booster isn't required and has benefit in all age groups, then we would change that guidance going forward.

Since there has been some confusion about the guidance about boosters.

In your opinion based on what you know now, should say, for example, a 50 year old classroom teacher get a booster?

Well, part of the criteria is that 50 to 64 year olds is our unit occupation occupational profession that's put you at increased exposure or risk or do you have underlying health conditions?

You know, for me as a 65 year old 66 year old, I personally chose to get the booster.

I got the booster.

I look at the risk benefit.

The risk of the vaccine other than the short-term minor adverse effects.

The fatigue I got, the generalized muscle aching and the mild headache for a day or two are far outweighed by the risk of me getting and contracting Covid and having a protracted illness, being in the hospital and so forth.

So, I think it's an individual situation at this time.

They have, as you see, in this new guidance the wording is should and may and I think that's where it becomes more of a personal decision in those individuals that are in that criteria of 50 to 64.

You have underlying significant risk factors or you work in professions where you are exposed just because of the higher risk of what you do, healthcare workers, for example.

It's generally accepted that Covid is a zoonotic disease.

In other words, one that was transmitted from animals from non-human animals to humans.

What are examples of other zoonotic diseases in our in our lives?

Rabies...very very infrequent but you hear a lot about because essentially if you don't get treated for Rabies it's uniformly fatal but that's that's one of the common ones.

But probably the most common thing that we would see here in this area is Lyme Disease or Anaplasmosis.

Some of the tick vector disease.

Obviously, West Nile virus from mosquitoes is a psumatic illness and so there are these have been around for a very long time but the ones like most people here would be familiar with would be Rabies, Lyme disease, Anaplasmosis, what used to be called Ehrlichiosis, West Nile virus, etc.

I've been curious throughout the pandemic as the vaccines have become available, why there are such different approaches to immunization.

As you mentioned the MRNA approach or methodology or technology has been available or at least been investigated since the early 2000s.

Why is it that there are these two different approaches to treating Covid, both the J & J more conventional vaccine as opposed to the MRNA vaccine?

Well, I think it has a lot to do with the specific pharmaceutical company or the company that was developing these vaccines.

So they all have different things that are in development at any one given time and recognizing that Pfizer and Moderna were working on Messenger RNA technology not just because Covid came around but they were looking at for other potential opportunities for immunization.

The other companies probably were working on a different.

So, Johnson & Johnson uses what's called the viral vector technology and then there's a new one that we hope will come available that has antigen technology and that's called the Novovax.

I don't see that being available anytime in the near future in this country but I think, I don't know 100 percent about this, but I believe the most likely reason is what you're working on, what you're familiar with, what you've already done some development on, that's what you're going to pursue to bring and hasten it, to get bring it to market as quickly as possible to save people's lives.

Do you anticipate that children younger than 12 years of age will be approved for receiving the vaccine in the near future?

I do anticipate that but I think they just need to get the appropriate data.

You know we have what has to happen is you have to go through trials and you have to have numbers in order to be able to evaluate the effectiveness and safety of a vaccine and so just getting the numbers there available to do that.

But, I anticipate that similar to what we saw with Influenza vaccine.

There used to be an age limit that was greater than it is now down to six months.

I think you'll probably see a similar rollout with the Covid vaccine going forward.

I'd like to ask you a two-part question that requires us to look into the rear view mirror.

What do you think the United States did well and what do you think we could have improved on?

If you were to have to endure this again both at the local level and the national level, what would you like to see done differently?

I think what we did well is we brought the vaccines to market very quickly.

You know, we were actually probably world leaders in some of this area, the large quantities of it and and I think that's important.

What we probably didn't do well is the communication of the safety and effectiveness of these vaccines early on.

I think because it was rolled out so quickly, we had an opportunity to educate people better as to how effective they are.

The other thing is being prepared.

So most of us have never dealt with a pandemic in our lifetime but if you think back to some of the flu epidemics that occurred earlier in this century, in the previous century, you know millions, 58 million people died who died worldwide from this and I think we need to take the lessons that we learn and apply them to the future and specifically around personal protective equipment, medications that are effective and the necessities.

Simple things like the saline solutions that we used and the shortages that we experienced.

We are in a much better place now with our ability to have personal protective equipment, masks, gowns, eyewear protection, gloves, etc.

We don't want to have that mistake again because that's an important part of preventing transmission, especially for healthcare workers.

I think that's one of the opportunities we had to do better and we should have been more prepared as a country to deal with that.

Well, Dr. Henry, I want to thank you and all of your colleagues at Essentia Health for all the work that you have done to keep our community as safe as possible.

We all really appreciate it.

Thank you.

And, of course, I also want to thank you for making time for our conversation today.

We appreciate the opportunity to speak with the public and our patients and it's wonderful we can partner with you.

Thank you for that.

And I want to thank all of you for joining me once again.

I'm Jason Eden's, your host of Lakeland Currents.

Be kind and be well.

We'll see you next week.