(warm guitar music) - Hello, and welcome to "Prairie Pulse."

Coming up later in the show, we'll look at a photo exhibit about migrant farm workers in the Red River Valley.

But first, joining me now is our guest, Dr. Richard Vetter.

Dr. Vetter is the chief medical officer at Essentia Health in Fargo.

Dr. Vetter, thanks for joining us today.

- My pleasure, glad to be here.

- As we get started, course, we're gonna talk about COVID and vaccinations, but tell the folks a little bit about yourself and your background please.

- Sure, so I'm a North Dakota native.

I grew up in Linton, North Dakota, South Central North Dakota.

Did my undergraduate work here at NDSU and then medical school at UND.

I'm trained as a family physician, I've been practicing with Essentia for about 30 years, and about the past two and a half years have been working as their chief medical officer here in Fargo.

- Now, what does a chief medical officer do?

- So, chief medical officer really kinda oversees quality, patient safety, works with recruiting, medical staff development, those sorts of issues.

- Okay, well, we're here today, you know, how are the vaccinations going through Essentia right now?

- The vaccinations have been going very well.

You know, we've been rammed up, and we made a commitment to our patients and our community to really be able to staff up to whatever level we need to to provide vaccines, so as soon as we get the vaccine allocations from our state Health Department, we're getting those out to the patients as fast as possible, and I think if you follow the news, North Dakota has really led the nation in our ability to take the vaccines that have been allocated and getting 'em distributed in a very quick turnaround, and Essentia's been committed to continuing to do that.

We've been doing about 1,600 vaccinations a day over the past several months.

- Yeah, well, which vaccines do you have the most of, Johnson & Johnson, Pfizer?

- Yeah, so basically, the allocations from the state, Pfizer is probably the most common one that we get.

We also get a fair number of Moderna vaccine supply as well as the last two weeks, that we've been getting Johnson & Johnson as well, and those allocations are being ramped up as we speak.

- And you talk about that with supplies coming in.

Do you know when they're coming or how does all that work?

- Yeah, so the Health Department typically on the Thursday, Friday of the preceding week will say how many allocations we're gonna be receiving.

You know, one of the challenges with COVID vaccination has really been the two-dose series.

So you have to time and know when people are due for their first dose, but then also get 'em scheduled for their second dose and making sure that we have supply to do those second doses as well, and that's added a little layer of complexity, but we've been able to navigate that with the help of our electronic record and the state's help, but they will allocate the end of the week, and then we put the schedules out for the next week to get people vaccinated, and usually do it over a two- to three-day period.

- Have you been seeing any adverse reactions to any of the doses?

- Like most vaccines, there's always some minor reactions, you know, a little bit of arm soreness, low grade fever, feeling a little bit tired, maybe some muscle soreness, usually just a day or two.

Most of 'em are self-limiting and pass.

We've had a couple people that've had to miss work because of more significant reactions.

Serious side effects, though, have been extremely rare.

You know, when the vaccines first came out, there was a concern about some severe allergic reactions or anaphylaxis, and really that hasn't panned out to be a big issue.

We do still monitor individuals for 15 minutes or if they have a history of allergies for 30 minutes post-vaccination, but almost never do we have to intervene or provide any sort of assistance or transfer them to the emergency room, as an example.

If you look at the national data, you know, over 130 million doses have been administered now of the Pfizer and the Moderna vaccine, and the incidents of severe allergic reaction has been less than five per million.

So, I mean, it's exceedingly rare.

- Hmm, well, it is.

And you know, of course it was rolled out, and different people could go get vaccinations depending on their health and age, but now it seems like we're probably gonna open up and you can just get an appointment if you want to take the vaccine.

- Yeah, and I think that's been one of the other logistical challenges, has been trying to go through the prioritization groups that the Health Department laid out.

I think it was still the right approach, but it started with those at most highest risk, so healthcare workers, long-term care residents, people that work in long-term care, we know that that's where the biggest risk of COVID infection has been and the number of deaths have been from those facilities.

So I think getting the healthcare workers, long-term care residents, and then other high-risk individuals, and then now we're into the essential worker group, and then as of Monday, the state's gonna open it up and allow the general public to start be getting vaccinated.

- Mm.

You know, by what time do you think all essential patients, and for that matter, maybe everybody in our region, will at least have been offered a chance to come in and get a vaccine?

- It depends on the availability, but as I said earlier, the availability of vaccines has been ramping up every week, we see more and more allocations, and so we're gonna continue to do our best to get those out.

I would anticipate that really by mid to late May, end of the school year, we should have everybody vaccinated that wants to receive a vaccine.

- With that said, and you talked about it, why do you think the vaccines have been rolled out so quickly and what factors did contribute to this?

- I know that there's been a lot of concern, safety concern around that rapid release, and I think if you know the details behind it, might help some allay some of those fears.

We know that the technology, particularly for the Moderna and Pfizer, that messenger RNA technology has been developed, well, started to be developed even with the Ebola outbreak several years ago, so the technology, the platform was already there.

The other thing that the government did is took a risk, they said to the manufacturers, "We'll buy the vaccine upfront, just make it," with the bet that the vaccine would turn out to be efficacious and safe.

If it wouldn't have been, they would have just discarded those and the manufacturers wouldn't have been on the hook for that outlie of financial input.

So the government taking on that risk, really, they started making the vaccines as soon as they had 'em in the pipeline.

The other piece is that the RNA structure of the virus was identified early on back in January, so even before we had our first case in the US, we knew the genetic sequence of that virus.

So we knew the genetic sequence, we could make the vaccines using that technology.

Really, by time we saw our first case, the vaccine was already developed and then just had to go through the trials.

- Mm-hmm.

Have you ever heard of a vaccine, you know, being clinically trialed and put to the public this quickly?

- No, partly because I think, again, manufacturers would typically do their test studies and then they would, once they could prove efficacy, then they would start to ramp up manufacturing, so that whole process really extended by an extra year or more.

I think having the emergency use authorization that the FDA did also moved it up many months as well.

So I think there were some steps in there that kind of, not shortchanging the process, but just shortening the process, that really helped get the vaccine available in a quicker timeframe.

- You know, there are some people out there that are still concerned even though we're now weeks and even months into the vaccine being distributed.

What can you say, speak to that?

- I think a couple things, first of all, as I mentioned, 130 million doses have already been given of the Pfizer and Moderna products.

We've seen very few adverse side effects of any significant degree.

We know that the efficacy studies show that those two are 94 to 95% effective in preventing COVID infection, so we know they're efficacious, we know that they're safe at least in the short term.

If you look at how the technology is developed, knowing the vaccine biology, really, the risk to the individual should be exceedingly low because that messenger RNA that's put in there that produces the protein, those spike proteins people might've heard about, the messenger RNA's inserted, goes into your cell, your cellular process produces protein based off that little template, and that messenger RNA is degraded relatively quickly just like it is with your natural messenger RNA, it doesn't last very long, and those proteins then get distributed to this outside of the cell, your body recognizes those as foreign and develops an immune response.

So the technology is very unique, but knowing that biology, the risk should be exceedingly low.

I know there's a lot of myths out there about vaccine, will it cause infertility is a common one I've heard.

Again, knowing the vaccine biology, there's really no reason why that should be so.

In fact, the American College of OBGYN is actually recommending that pregnancy, we know that those people are at increased risk of COVID morbidity and mortality, so they're actually recommending their pregnant patients talk to their doctors and providers about getting vaccinated, and there's ongoing studies looking at that pregnant population.

The other thing that postmarketing that the government does and the CDC does is they monitor safety, and so they have a vaccine reporting system for adverse events.

Those of us that've been vaccinated actually got an app on our phone that we could report back on, they would send a text message, you report how you're feeling.

And so they're developing other new ways of developing that safety data that hopefully should give people some peace of mind.

- Okay, so is this vaccine gonna end up being like a flu shot that we have to get every year or how much do we know about that?

- Yeah, at this point, I would say we really don't know.

You know, we don't know how long the natural infection will actually provide natural immunity, we don't really know how long the vaccine will produce, whether it'll produce lifelong immunity or not.

It may or may not, we don't know what the booster series may or may not look like, so there's a lot we're gonna learn over the next year or two, but I have no doubt that our researchers will give us that data when it's available, and we'll be able to adjust or modify how we treat our patients.

- You know, in the news, we're hearing a lot about the variants now, and I guess mutations or whatever, you know, and how they're gonna react to the various vaccines.

What's the data showing on that?

- Yeah, so we knew, and we know that viral viruses in general try to get around our mitigation strategies, so whether it's hand hygiene or using different medications, they continue to mutate and try to, they try to outsmart us and try to work a way around that.

And we know that's gonna happen with vaccines as well, and so far, the initial studies show that the current vaccines actually do provide some protection against the variants, but I think that's one of the other reasons why we wanna try to vaccinate as quickly as possible to not allow that virus to continue to mutate and change and figure out a way around our vaccines.

And then the vaccine manufacturers are gonna continue then, again, to use that technology, that new RNA inserted in and develop new vaccines in a really rapid turnaround to be able to adapt to that changing virus.

- You talked about North Dakota being very good at rolling out the vaccine, and it seems, I bet you're right on that.

But so, let's back up to, you know, we were also number one in cases at one point.

What was the peak time for your COVID units at Essentia?

Was it last fall or winter?

- Yeah, it was kinda mid-November, you know, started to ramp up beginning of November, mid-November was kind of our peak and then started to decline after that.

And over the past really post-holiday season, that number has remained relatively steady, up and down a little bit, but pretty steady.

We were all worried around the holidays whether or not we would see a second spike, and fortunately, that didn't occur.

That was the same time, though, that I think some of those other mitigation strategies came into play, which probably helped us as well.

- Well, there you go, 'cause you know, why do you think COVID numbers are remaining low now in North Dakota?

Is it the mask-wearing or the distancing, of course, or are we reaching herd immunity as some people suggest, or is it all the above or just, you know, what?

- Yeah, I think it's a combination of all of those things.

You know, we know the mitigation strategies, masking, hand hygiene have some impact at least.

We know that when people have been naturally infected, they're gonna be protected for a period of time.

We know that vaccines are protecting a certain number of people, and then finally we know that there's some seasonality to viral illnesses as well, and the virus naturally kind of peaks and abates over time.

And so I think all those things put together, so it's probably a complex answer, but there's all those factors, I think, play a role.

- Well, you know, a year ago at this time, we were saying we just need a few weeks to get back to normal, and here we are a year later.

But looking back, what things might've been done differently to help the onset of COVID outbreak?

- Yeah, I think, you know, we knew, and our hope was always that the vaccine would come and that other pharmaceuticals or medications to treat COVID would have to be developed.

And so really what the ask early on, as you remember, was really to kind of draw out that phase prior to the peak, to develop the infrastructure to care for an increased number of patients.

And so that timeframe did allow us to develop some new medications that we learned better how to treat COVID patients, we developed monoclonal antibodies, which we can give a infusion for those people, that keep 'em from becoming less sick, and then of course, it allowed the vaccine to get rolled out.

So I think in retrospect, I'm not sure any of that could have changed much knowing all the uncertainty.

I think communication, we just need to continue to communicate and do a better job maybe communicating so that we keep maybe kind of the politics out and the science maybe more at the forefront.

- Yeah, I remember that flattening the curve is what we kept talking about.

So, can you talk about how your staff responded at Essentia during those peak times of COVID?

It had to be stressful.

- Yeah, it was extremely stressful, I think for all, people of all walks of life, but particularly in healthcare where they were having to see patients, many times without their loved one because of the visitor restrictions.

And so to be there and to watch those people pass away without their loved ones, sometimes necessarily being able to be at their side, I think that was particularly hard for some of our staff.

We've tried to do a good job about reaching out and providing resources, behavioral health, mental health support for our staff to help them cope with some of these challenges, and I think we've done a reasonably good job at that, but our work's not done.

We're gonna continue to see, I think, some mental health challenges going forward, again, not just with our staff, but the public at large.

And so we're gonna continue to put resources there.

I can't be more proud, though, of how our staff stepped up.

I think the other thing that helped them a lot, to be honest, is our community support.

Seeing the parades that came by the hospital, the stickers on the window, the monetary support, the food support, all those things that the community really did to support our healthcare workers was just outstanding and helped them get through those challenging times.

- Hmm, yeah well, can you tell me a bit about Essentia Health and what areas of our region it covers?

- Yeah, so Essentia Health is actually a three-state, all the way from Wisconsin, Northern Minnesota, into North Dakota.

The Fargo market of Essentia Health goes all the way from Walker, Minnesota, up to Park Rapids, Fosston, down to Graceville, Ada, our hub hospital here in Fargo, and then we have clinics out to Jamestown, Valley City, Lisbon, Wahpeton on the North Dakota side.

- Mm-hmm.

You know, you've talked a little bit about this, but what do you think some of the big lessons that we learned from the pandemic?

- I think one of the main learnings for me is how fast we can adapt when we need to.

I think all of us, you know, making significant changes in the way we do our work takes a lot of effort sometimes, and we found that we can actually do this a lot quicker when we needed to do that.

I think virtual care was another real learning, that you can actually take good care of people using a virtual platform like telehealth and other, going into their home with a video camera and being able to interact and provide healthcare in a way that was different than what we've done before.

So I think that the other piece is really taking a step back and showing empathy when people are stressed.

All of us respond to stress different, and so having that ability to really support one another and the community support, like I said, it just was heartwarming to see how when we put our mind to something, the community will help rally around and help support the effort.

- You know, some people ask what's the best vaccine to take.

Do you have an answer for that?

- I would say whatever vaccine is available is the best vaccine to take.

We know that all three vaccines are highly effective in reducing hospitalization and death, and that's really what we're trying to avoid.

- Obviously, you think vaccines should be taken, but, you know, unfortunately, for whatever reasons, people are scared of the vaccine for various reasons, maybe that it came too quickly or it's political now or they're hearing bad things, but you know, what's your advice to somebody who is scared to take a shot?

- I would say, talk to your healthcare provider about your concerns, why you might be concerned.

I think do some research, learn about how the vaccine was developed, read about the number of healthcare workers that are accepting of it.

I saw a study the other day, about 90% of doctors have accepted or received the shot, so that should give you some reassurance hopefully.

I think recognizing that over 130 million people have received the vaccine, and it's shown to be very safe and very efficacious, and it's really our way out of this pandemic.

And it's not, I think, to also think about the broader context, that it's not just about your own personal health or personal protection, but it's really about your family, your community, those at higher risk, how can we best protect them?

And the best way we can protect them is by getting vaccinated so that we're not sharing that illness with someone else.

- Mm-hmm.

Do you foresee mask-wearing going away once the population's all been vaccinated, or is this something that we might see continue to some degree?

- I think it'll be a gradual reduction probably, I think there'll be some businesses or some organizations that may choose to have that in place, which particularly, if you can't maintain appropriate distancing and those sorts of things, but I don't think it'll be just all of a sudden, we'll wake up one day and masks are gone, I think it'll be a gradual decline in the use, and again, certainly those people at higher risk or those who haven't been vaccinated should continue to consider that as a mitigation strategy.

- Well, we look forward to the day that we have some sense of the old normalcy though.

It'll be a new normal, I guess.

But now, if people want more information, where can they go?

- Yeah, I think a great resource that we have is essentiahealth.org.

There's links there to other organizations that provide vaccine information.

You can sign up for a shot there as of Monday, as I said, it'll be open to the public.

We have other links, like I said, connected to that, so essentiahealth.org would be a great place to start.

- Okay, well, thank you for all the information, and thank you for joining us today.

- You're welcome, my pleasure.

- Stay tuned for more.

(warm guitar music) In the 20th century, the planning and harvesting of sugar beets in the Red River Valley couldn't have been completed without the tireless work of Hispanic migrant field workers from Texas and Mexico.

Ken Mendez with the University of Minnesota Crookston stumbled onto historic photos of the time by photographer Russell Lee, and he curated them into an exhibit.

(lighthearted guitar music) (camera clicks) - I never knew what working in the fields were like.

The best example that I have of what I know is from these pictures from 1938 through Russell Lee that I was able to just haphazardly stumble upon.

But then it was like, oh my goodness, it was a goldmine.

- Ken is one of those individuals who gives back to the community all the time.

He came to me and said, "I have come across Library of Congress photographs that were taken during the sugar beet harvest back in the '30s and '40s."

He said, "I think we can get them from the Library of Congress, I've already been in contact with them."

And I said, "Okay, let's check and see."

- [Ken] The chancellor bought into it.

- [Mary] He worked with another one of our students, and they came up with an amazing idea to have a gallery to have people come and see the story of the sugar beet harvest, and the importance of the migration of people who came to help out our local farmers.

(lighthearted guitar music) Ken obviously had an interest in this because that also is a reflection of his own heritage.

So fast-forward, Ken had figured out how to get access to the prints, had them all blown up, and he came one day and he said, "Can I bring a few over?

I wanna show them to you."

He put them down, and I was like, oh my gosh.

These really tell through the stories of faces.

The one of them has a backdrop of a family sitting around a table.

They really communicated the migrant story.

(lighthearted guitar music) - These pictures are amazing, the clarity is astounding.

And so we brought them to life.

- The part that always hits me when I looked at the photos is just the hard work.

We have come to the situation now where things are done mechanical, the bending over, the cutting of the sugar beets, the tremendous impact that that had on bodies.

And that was true throughout all of agriculture during the '30s and '40s.

It wasn't just a job, people brought their lives with them, their children.

The migration story is one of the Latino population.

When we look at the demographics of our K through sixth grade right now in the Crookston public schools, approximately 40% of our students have a Latino origin, so not only did people come to help and begin in the harvest, but they've stayed, and they've created wonderful families and contributed so much to the community.

Helping people understand what it was like and sharing the family story is a very important outcome that came from this.

(warm guitar music) - These pictures are, like the chancellor said, the toils on these bodies is amazing.

The physicality, I have not seen repeated.

Somehow they survived and somehow they did this.

- [Announcer] "Moving Lives Minnesota: Stories of Origin & Immigration" is made possible by the state's Arts & Cultural Heritage Fund.

- Well, that's all we have on "Prairie Pulse" for this week.

And as always, thanks for watching.

(warm guitar music) - [Announcer] Funded by the members of Prairie Public.