S2:E11 - “COVID Q&A – with Dr. Russell Faust and Dr. Steve McGraw A discussion about the efficacy and safety of the forthcoming vaccines.” Recorded December 14, 2020

The COVID-19 vaccines are here!  Today, we welcome back Dr. Steve McGraw and Dr. Russell Faust.  Together, these guys have been major part of EMS’ understanding and response throughout the entire COVID-19 pandemic.  Even though we are located in Southeast Michigan and we mention our home state a lot, today’s content applies to EMS on the national and even the global scale. 

Dr. Steve McGraw is an ED physician at Ascension Providence Hospitals in both Southfield and Novi, Michigan.  Steve is also the current Oakland County Medical Control Authority EMS Medical Director which provides oversight to over 50 EMS agencies.  Dr. Russel Faust is the Medical Director of Oakland County Health.  Before medical school, Dr. Faust earned his PhD in cellular molecular biology.  After medical school he trained as a trauma surgeon and THEN, if that wasn’t enough, he did a fellowship in pediatric head and neck surgery.  Our man Russ has 30 years in academic medicine, and he ran NIH funded labs to do applied translational cellular molecular biology.  My boys are wicked smart!  What we're saying is that Russ and Steve know what they’re talking about.  They’re both considered experts in their respective fields and they’re here to explain what the vaccines are, how they work and the safety profile.  Since the announcement of the release of the COVID vaccines, the docs have been fielding a LOT of questions from their colleagues as well as their family and friends about the vaccines.  Are they safe?  What if I already had COVID, should I get it? What if I’m pregnant?  Do the vaccines alter your DNA?  What if I don’t want to get it right now, can I get it later?  As you can imagine, the list of questions goes on and on. 

In an effort to help, we’ve invited Steve and Russ to come on and lay out all the questions they’ve been receiving and deliver clear and concise answers.  Most importantly, all of their answers are based in the latest scientific data and literature that clearly demonstrates the safety of the current COVID vaccines that are currently available. 

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Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at QI@OCMCA.org.  

Transcript

Geoff Lassers: 0:08

Hello and welcome to the EMS on-air podcast. The mission of this podcast is to keep healthcare provider safe, informed and prepared. Today is December 15 2020. I'm Geoff Lassers, and I'll be your host. This episode was recorded yesterday, December 14 2020. In episode 8 of this season, which was launched on December 3, I sat down with Dr. Steve McGraw and Russell Faust to break down how our local system like many others across the world have been preparing for the availability of the COVID-19 vaccines. Well, they're here. As of this week, the first vaccines have landed in the US and right here in Oakland County, Michigan. Today we welcome back Dr. Steven McGraw and Dr. Russell Faust. Together these guys have been a major part of EMS's understanding in the response COVID pandemic, even though we are located in Southeast Michigan, and we mentioned our home state a lot. Today's content applies to EMS on the national and even the global scale. Dr. Steve McGraw is an EDI physician at Ascension Providence hospitals in both Southfield and of Novi, Michigan. Doc is also the current Oakland County Medical control authority EMS medical director, which provides oversight to over 50 EMS agencies. Dr. Russell Faust is the medical director of Oakland County Health before medical school, Dr. Faust earned his PhD in cellular molecular biology after medical school, he trained as a trauma surgeon and then if that wasn't enough, he did a fellowship in pediatric Head and Neck Surgery. My man Russ did 30 years in academic medicine. And he ran NIH funded labs to do apply to transitional cellular molecular biology. My boys wicked smart. What I'm saying is that Russ and Steve know what they're talking about. They're both considered experts in their respective fields. And they're here to explain what the vaccines are, how they work and the safety profile. Since the announcement of the release of the COVID vaccines, the Doc's have been fielding a lot of questions from their colleagues, as well as from their family and friends. Are they safe? What if I already had COVID? Should I get the vaccine? What if I'm pregnant? Well, I'm not pregnant. But if I was a woman, what if I'm pregnant? Do the vaccines alter your DNA? What if I don't want to get it right now? Can I get the vaccine later? As you can imagine, the list of questions goes on and on. In an effort to help. We've invited Steve and Russ to come on and lay out all of the questions they've been receiving and deliver clear and concise answers. Most importantly, all of their answers are based in the latest scientific data and literature that clearly demonstrates the safety of the current COVID vaccines that are currently available. Even though the fellows do a great job of answering every question they could think of. I'm sure there's more good ones out there. So please keep emailing your questions, comments, feedback and episode ideas to theEMS on-air podcast team by email at QA@ocmca.org. Also, check out our website, EMSonair.com. For the latest information, podcast episodes and other details, follow us on Instagram@ems_on_air and please whatever podcast platform you use, subscribe to our podcast and leave us a rating and a review. It really helps us grow this project. I really can't say this enough to everybody listening please leave us a rating and review to help us get noticed on a much larger scale. Remember the mission of the EMS on-air podcast is to keep healthcare providers safe, informed and prepared. So increasing our ratings and reviews gets us noticed by more listeners and more sponsors, and that will lead to increase in our reach resources, experts and abilities. Let's face it. Bottom line ratings and reviews are currency right now. And they're vital to our growth and your contribution will give us what we need to serve those that serve our communities. The only cost to us a few minutes giving us a rating and a review on whatever podcast platform that you're using right now. Thank you and enjoy the episode. How is everybody today?

Dr. Russel Faust: 4:15

Great

Dr. Steve McGraw: 4:15

Great. Good to see you Geoff. You to Dr. Faust

Geoff Lassers: 4:19

Dr. Faust. Dr. McGraw, can you please give our listeners who don't know you some background as to your expertise so that we feel a little bit more comfort taking information from you because there's a lot of voices right now on a lot of podcasts, a lot of news shows a lot of media outlets. Please give us and our listeners a little idea of who you are professionally so that we understand the context.

Dr. Steve McGraw: 4:43

Well, thank you, Geoff. I won't bore people with my CV but just to let people know before I went to medical school, I studied the University of Michigan and have a degree and microbiology with emphasis and cellular and molecular biology. And that was sort of the thing in an undergraduate that impressed me the most were that burgeoning scientific breakthroughs that were coming in the field of molecular biology. It was a different way of studying cellular science. And as I went through medical school, I never really lost my thirst for understanding more. Ironically, although I'm an emergency physician, and my relationship with EMS is really centered around clinical administration of EMS practices, protocols and oversight. I've always had a special kind of interest in response to community public health emergencies, pandemics. And it really relates to my previous career as a cellular biologist, my expertise now and my degree in EMS investment really played well into that in a previous experience with local community outbreak of measles, which kind of utilized some of both my interests and my hobbies and my skills and my access to EMS providers in a way that I thought allowed me to have an opportunity to help people. I would argue that like many, I only listen to the experts that I can get my hands on. And I'm really fortunate that a great partner of ours in Oakland County has been the Health Division led by Dr. Faust. Dr. Faust, maybe you should tell folks where you come from.

Dr. Russel Faust: 6:09

Well, thank you, Dr. McGraw. Again, it's our great privilege to work with the MCA and you as a co-director and Geoff for getting these messages out. So I've also had a rather circuitous route to get here to public health, I would not consider myself a public health expert by any means. Similar to Dr. McGraw, I am actually started out as a cell molecular biologist, I received my, I should say, earned my PhD in cell and molecular biology. Before going to medical school, I was trained as a trauma surgeon, and then did a fellowship in pediatric head and neck surgery. And I spent 30 years in academic medicine and ran NIH funded labs to do applied translational cell biology, molecular biology. So I think I have a pretty good handle on the molecular basis, the cell basis for these vaccines. And having been just over two years here at county health, I'm thinking I'm about maybe a 10th of the way into the learning curve for understanding public health. So what could I say?

Geoff Lassers: 7:15

Well, even if you don't have a full grasp on public health right now, I'm glad you got a full grasp of cellular biology, microbiology, because I don't. So I rely on people like you to know that information. At some point, you need to trust your experts. And I think you're demonstrating to everybody listening, that you two gentlemen certainly have a background that would make you legitimate experts on this case. Dr. McGraw, you got a hold of me yesterday, and you've been facing a lot of questions about the constant stream of information coming at people about these vaccines. So I'm just going to let you riff, can you just let us know, first of all, starting off with the vaccine update, what are we getting? When is it available? Those kind of things? And then what are the questions? So go ahead.

Dr. Steve McGraw: 7:56

Well, thank you, Jeff. And thank you, Dr. Faust, I think, first of all, it's it's an enormously hopeful sign, after 10 months, a lot of discomfort and fear and heartache and misery to know that the things that we've been waiting for the real solution, the final ability to get this pandemic under control, and ultimately behind us is actually at hand. And I have been very fortunate to learn that among the first people that will be vaccinated and offered the vaccine are our EMS colleagues and our frontline medical care providers. And so I have been not surprisingly asked by several of my friends and colleagues in those worlds exactly how the vaccine works, why it's different, and some real questions that have become interested in having answered due to things they've read online or things they've heard from friends and colleagues. And so I couldn't think of a more reliable and tuned in expert to lean on than our friend Dr. Faust, from the Public Health Division over at the county, not only a physician and a friend, but someone who understands our EMS world and our frontline medical world completely, because as a colleague and a public health executive, he really understands both worlds. So a couple of questions, Dr. Faust, that I think are really weighed on people's minds more than anything are, what vaccines are being made available, and in what relative supply to the need. And then what is different about these vaccines that we've always learned in vaccine development takes, you know, years or decades, and this was really under 12 months. Why are they different? And how do we know they're safe?

Dr. Russel Faust: 9:28

Great questions. It is a huge step forward in vaccine development. You know, historically, the last record held for the fastest vaccine developed was the mumps vaccine. And that took four years before that it was routinely 10 or 12 years, sometimes longer to develop a vaccine. So that this is a huge step forward in vaccine development. There were really as I see it, three factors that contributed to the speed with which these vaccines that is the Pfizer and Modurna I'll talk about those in just a moment, the speed with which they were developed. And the first is the support the financial support that was just poured into these companies that were developing these. The second is that these are mRNA vaccines. These are the first mRNA vaccines developed. And the third reason is that those mRNA vaccines were actually started on with these, say three or four or five companies that were developing them. They were working on them already. They were previously working on them for SARS, and MERS. So the previous Coronavirus is that we had epidemics or even pandemics with say, I think starting in 2014, we had a couple of epidemics, and also Ebola, but I want to really focus on the SARS and MERS because essentially, the technology, the methodology have been developed for those these companies that as Pfizer, Moderna, and AstraZeneca, were far ahead toward developing those vaccine based on those mrnas. And essentially, all that was required to get it done for COVID-19 or SARS COV-2 was to take that message that they were using for SARS and MERS, and swap it out for the mRNA for COVID-19 spike protein. And that put them years ahead, in developing they'd already been working on those prior vaccines for several years, they developed a methodology. And all they did was basically change out that cassette of the message, which takes me to the question of how these vaccines work. Both the Pfizer and the Moderna vaccines are, as I say, mRNA vaccines, they're based on taking the message that encodes for the COVID-19, or SARS COV-2 spike protein on the surface. Now that spike protein is immunogenic, it elicits an immune response if it's in you. And that's how you develop an immune response when you become infected. That is when the virus multiplies in you, and it's in your system, your immune system sees that spike protein on the surface of the virus, and develops a response. All they needed to do was take the message that codes for that single protein, and somehow get it into you to develop an immune response. And the way they did this is quite ingenious. They took and synthesized up a lot of that message ribonucleic acid that encodes for that protein made a vat of that, and they homogenized it along with some lipid to make little nanoparticles of lipid or fat surrounding the message. And if you then take that into a syringe and inject it into like any other vaccine, you have immune cells that take that up. And actually, our protein synthesis machinery uses that message and produce a spike protein, it doesn't need to get into your nucleus. It never does. It doesn't get integrated into our DNA. It never does, it doesn't change our DNA. So that's beautiful. And it doesn't infect us. So most vaccines historically have relied on three methods. And they're all very, very time consuming and difficult, in all have many, many potential side effects associated with them. And most of them virtually all of them rely on growing up lots and lots of virus in chicken eggs. You've seen vaccine production factories with racks and racks of eggs that they've inoculated with virus that's not done for these new vaccines. But what they had done traditionally, historically, is then take that and purify up lots of the virus and give it to you in one of several ways, either live attenuated virus where they basically mutate the virus or change the virus such that it's not as infectious and doesn't transmit, but it still infects you. And that's why people who are immunocompromised can't get those viruses because it will potentially kill them. The second kind of virus is that they just take vats of virus and they kill a virus usually irradiated, something like that, and inject the virus into you. And your immune system responds to that. But potentially lots of different side effects. Many products are in that niche. And then the third way is to take vats of virus and purify out parts of it, like try to purify out, for example, the spike protein, and it's not absolutely pure as lots of other viral stuff, particles in it and potential side effects. None of that happens with these new RNA vaccines, through the safest vaccines in history. They only have mRNA and a little bit of lipid that surrounds it. So in the first phase three clinical trial Phase One, two and three. We have nearly 100,000 People in the history of all those, and they've had no severe adverse reactions. There are two reported on the first day of inoculation in the UK with this Pfizer vaccine. Those are still under investigation that's not at all clear what they were.

Geoff Lassers: 15:18

Dr. Faust, when you say they're not severe reactions, can you give us a scale of something they might be able to expect? You know, when I get a flu shot, My arm hurts for a little bit.

Dr. Russel Faust: 15:27

The most common symptoms that people can expect are headache, fever, fatigue?

Geoff Lassers: 15:33

to what degree?

Dr. Russel Faust: 15:36

I have no idea.

Dr. Steve McGraw: 15:40

You know, I think it's instructive, though, to learn that nobody got hospitalized. Now one of the people in phase three, some of them did have the body aches and the headache and the fever typically lasting, you know, 12 to 24 hours. But it really is remarkable.

Dr. Russel Faust: 15:53

It's in stark contrast to any previous vaccine trials. Every other previous vaccine trial has all sorts of adverse reactions. These are historically the safest vaccines. Now, the flip side of that coin is we don't have long term follow up. We don't know how long the immunogenicity last, we have just no idea, right? We know it last for the three months of the trial. But we don't know if it's going to be around five years from now. We just don't know yet.

Dr. Steve McGraw: 16:22

You know, they've (the manufacturers) been really careful to not over promise. But like you I find the safety profile extraordinary, the best I've ever seen. And even maybe, to be on the more optimistic side, it does appear as though we're generating memory cells with the vaccine to a greater extent than even those that have had the actual disease. And if that's

Dr. Russel Faust: 16:44

true, so the natural so called natural immunity from becoming infected.

Dr. Steve McGraw: 16:49

Yeah, right. And because of that, I think we have reason to hope that this will not be something we have to do every six months, but more likely, these could wind up having an immune tail that provides us with immunity for years or even more. I don't think anyone's ready to guarantee that yet. But I think from some of the initial studies, it's exceedingly hopeful that that's likely to be the outcome.

Dr. Russel Faust: 17:12

Agreed.

Geoff Lassers: 17:15

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Dr. Steve McGraw: 18:53

Another question that I did hear, you know a lot of well meaning people ask is they were told that the FDA approval included those that are pregnant that they didn't specifically discourage those or eliminate those, even though there were people at the beginning, who offered to be in the trial that were pregnant, and they were not accepted. Interestingly, in the phase three trial, some of those 20,000 or 30,000, if you add up both companies that were included, became pregnant during the time after which they had been vaccinated. And it was through no fault of anybody, but they followed those that have been pregnant, and they've had no discernible effects on the pregnancy. And what I find hopeful is they are going to begin those trials next year with actually pregnant women and younger people to be vaccinated. We just haven't done them yet. But because of that the FDA did not specifically exclude them and I have a female patients and partners and EMS providers that said if I'm pregnant, would you recommend it? And what I told them was I wouldn't specifically recommend against it. I would always do like we do in everything in medicine weigh the risks and benefits when you work like we do. in an area where we are considered by my OSHA and every other Occupational Safety Administration group to be in a high risk category with exposures on a daily basis, being pregnant is an independent risk factor with COVID-19. The pregnancy itself is a risk factor and the risk to the pregnancy from the natural infection. So while I don't think that the answer has been entirely provided with the experience of some of the people in phase three trials that have gotten pregnant, and the fact that the FDA does not exclude them from being able to receive the vaccine, my ask of them is to compare the relative minimal risk, if any exists being pregnant and being vaccinated versus the known risk of being pregnant working in an environment where they could become infected quite easily, and having that impact their both their pregnancy and their overall health. Would you agree?

Dr. Russel Faust: 20:49

Yeah. On the call yesterday, with MDHHS, they specifically addressed this question. The fact is, we just don't have good data available, the COVID 19 vaccine may pose a risk. But as you point out, certainly a COVID-19 infection clearly poses a risk. And they advise anyone in frontline health care provider, for example, who's regularly being exposed to discuss the risks of their pregnancy with their provider with their obstetrician and weigh that risk benefit. They also addressed lactating women, there is clearly no risk to the breastfeeding infant. So again, I think overall positive good news.

Dr. Steve McGraw: 21:32

I agree. And I've also had well meaning people say now, once I get vaccinated, I can just stop worrying masks and forget about social distancing right? I mean, it'll just take care of everything. And I really wanted to approach you because I know you would like me, don't think that's at all recommended. And maybe some of the reasons as to why,

Dr. Russel Faust: 21:50

you know, the clinical trials that have been done to date really only had the endpoint of safety and efficacy, that is efficacy with regard to reducing the risk of infection, none of them actually looked at the next step and assessed as an endpoint the risk of transmission to others if they do become infected. Certainly, if it reduces your risk of becoming infected, it reduces the risk of you transmitting, but it's not clear that for those few who get vaccinated, and to do become infected, actively infected, although with significantly reduced symptomatology, it's not clear what it does to their infectivity or infectious risk to others, I will back up to several studies that have clearly demonstrated transmission risk, parallels symptom severity, and certainly, if being vaccinated reduces the severity of your symptoms, and it clearly does if you do become infected. My prediction is that it would reduce the transmission, but we just didn't have that as a measured endpoint.

Dr. Steve McGraw: 22:55

Once we see mass vaccinations, and we are becoming closer to that hoped for herd immunity, I think sometime in the summer or early fall, maybe then we can talk about augmenting our behavior and what we wear. But I think the rest of the scientific world is going to encourage us to still protect one another as best we can, until such time is we reached that point,

Dr. Russel Faust: 23:18

greed, I can't emphasize that enough masks distance, avoid crowds,

Dr. Steve McGraw: 23:24

you know that your house, you know, you and I have the perspective that science is going to and technology and our ability to innovate is going to get us out of this horrible pandemic worldwide. Like it has so many other times in history. But history is also unfortunately splattered with really terrible things that have occurred in the name of science, and not the least of which has affected those in our community are African Americans and Latina and folks that are indigenous members of our community. When it comes to some of the medical experiments that took place in the early and middle of last century. This is a stain on the history of medicine that has been brought up once again. And I think it's important to acknowledge to the members of our community that shares some unfortunate history of that legacy. And to be very open about it, to say that medicine did some things that were really reprehensible and horrible and unethical. The Tuskegee experiments with syphilis, for instance, and they were unfortunately targeted at minorities and people of color. Maybe one of the things that has been voiced to me by some of my partners really needs to be said that these vaccine trials were conducted under the most scrutinized and ethical standards, probably in the history of vaccine development. And among those in the phase one, phase two and phase three trials were people of every ethnicity, and race and background and a wide spectrum of ages and socio-economic backgrounds. And I think it's also really important to recognize that this disease has unfortunately impacted our minority communities even more than in a disproportionate way than the community at large for that matter. reason many others, this benefit of vaccine is actually going to impact those communities even more, because they've been so disproportionately impacted by the negative effects of the virus. And I just want to make sure that we all recognize that despite what you may have read on the internet, despite some of the crazy things, you can really get the facts by turning to the FDA and the CDC, who recognize our history, who recognize the mistakes and unethical things that have happened in medicine in the past, we've learned from it and have not repeated it in the development of this vaccine in any way. I was reminded, one of the nurses that I work with reminded me that this is still a suspicion, it's held by many people, in many walks of life and in many different cultures. I think it's helpful just to say it out loud, that we acknowledge that those things happened. Fortunate we've learned from them, and medicine, the house of medicine and science, I hope we'll never succumb to something as horrible as that again. But we have to admit that they occurred, allow people to ask those questions. And then most importantly, point to the data and the testing that we've done, these trials were done in a most transparent way that could possibly have been performed. We're all beneficiaries of that, by the way. And I hope that going forward, this will become a landmark in the way we develop vaccines, and other medical interventions to help all of us live better and healthier. And maybe that's the legacy that this pandemic will provide to us that we really learned to do things the right way for the greater good and make certain that we didn't miss anybody or leave anybody behind. Another question I've heard Dr. Faust is I know other companies are, Moderna is likely to get approved and coming online. But if I decline the vaccine now, even though it's being offered to me as a frontline health worker, but then I decide, you know what, these trials were safe, and I see all my colleagues becoming vaccinated and say in early January, I said change my mind, I want that shot right now. Is it likely that we're going to have just unlimited vaccine early next year, and I can just wait and obtain my shot then?

Dr. Russel Faust: 27:03

you know, The vaccine has already been ordered. We have our -80 freezers in place at three sites right now. We're ready to accept vaccine and we expect to accept vaccine either today or tomorrow. So this being Monday the 14th. We will start accepting registration from EMS frontline starting tomorrow, the 15th in the afternoon through the nurse on call, and we will begin vaccinating at the end of this week. I want to make two points for those who elect not to first that's a darn shame. But if you change your mind, we will be getting more vaccine. Unfortunately, we're not getting an enormous truckload of vaccine, it's going to be trickling out as Pfizer ships it out to the nation and the planet, we will be getting more at this time we're being promised weekly shipments. So I don't see that becoming a real hardship for EMS frontline. They're at the very top of the list for who gets vaccine first, when I did want to point out is that for those EMS teams that elect, say, let's say you had 100% of your team elect to become vaccinated here in this first wave of vaccinations, I strongly urge you to split your crew into at least two cohorts, and not all vaccinate on the same day. And the reason is this, we talked about symptoms a little bit those symptoms being fevers, fatigue, headaches. If you become severely symptomatic, chances are you'd still be able to work except that if you're screening for symptoms, you may be screened out as likely infected with COVID-19. In you certainly don't want the entire squad un-available. So I urge you to split your cohort into two and stagger your vaccine days.

Geoff Lassers: 29:01

Even after you receive the vaccine. If you experience any symptoms, even there, if they're expected if they're on the list of potential COVID you should not be going to work.

Dr. Russel Faust: 29:10

That is correct. And understanding that many of the people listening here are considered essential frontline and they're going to work even if they are symptomatic as long as they're in full PPE.

Dr. Steve McGraw: 29:24

I think that's a really important point Dr. Faust for the record to the hospital is going to divvy up, say our emergency department, they're not going to vaccinate the entire emergency department staff on one day, we're gonna probably do 15 to 20% of our nursing and medical staff, and then wait a day and then do another 15 or 20%. Wait maybe a day or two and then do another 15 or 20%. With the notion being exactly as you said, we have to have departmental readiness and adequate staffing. But I think it's also important to point out that while many people had some symptoms, the numbers of those symptoms in comparison to placebo, we're really indicative of a profoundly safe vaccine. Again, nobody in the trials had to be hospitalized for their subtle side effects. Their headache was not debilitating, their chills, body aches, fever and soreness at the site didn't require hospitalization. And when you're talking about trials that included 10s of 1000s of people in a broad range of ages and health statuses, I think that's just remarkable.

Dr. Russel Faust: 30:27

And a really good point. Let me talk a little bit about we are expecting to receive Pfizer this week. I know the shipments are going out from Kalamazoo, and again 9:30 in the morning, I expect us to receive ours today or tomorrow. As you pointed out, this is a Pfizer vaccine requires logistically it's a little bit of a challenge for most folks, because it requires -80 freezers for storage. But frankly, if it goes out in shipments, or I should say aliquam, it's at 975 doses. So if you require at least 975 doses, most folks can handle it because it comes in a dry ice packed shipping container. And that's perfectly adequate to maintain it for several days. Gosh, I think for quite a while. It's like a week. So if you receive it, and you're going to vaccinate in three or four days, that's not a problem. The Medina should be under review, I believe the end of this week, and moving forward. If anyone receives the Pfizer vaccine, and then the maternal vaccine for some mix up, they shouldn't receive a follow up dose vaccination of either one of those until that is studied further. That's as of yesterday. Both of these are our two dose vaccines for the Pfizer, the second dose should be given 17 to 21 days following the first dose. So essentially three weeks later, a little bit shorter three weeks, but if you miss that second dose, the second dose should come as soon as possible. Following that 21 days. If you've had a prior COVID-19 infection, as long as you don't have any other contra-indications, it's okay to be vaccinated, you should fully recover before becoming vaccinated. There's no minimum interval between full recovery and becoming vaccinated. If you're in quarantine, complete your quarantine period before we get vaccinated. If you've been one of the lucky few have received monoclonal antibody treatment, or convalescent plasma defer vaccination until this is studied further That is until further notice. For those with underlying medical conditions, it's okay to be vaccinated unless otherwise contraindicated those with immunocompromised or immunosuppression. It's okay to vaccinate unless otherwise contraindicated. If you have post vaccination symptoms, do complete the series. Even if you have headache, fatigue, fever, complete the series, get your second vaccination, immunity should develop within one to two weeks following your second dose. But after vaccination is Dr. McGraw points out, continue to follow precautions. mask distance, avoid crowds. If you've had a severe reaction to any previous vaccination, or IV medication, you can still be vaccinated, you should be monitored for 30 minutes following vaccination. The last question I routinely get will I test positive after these mRNA vaccines following vaccination, you will not test positive for COVID-19 by either rapid antigen, or PCR. That is by the viral tests, you may test positive for IGN, or idg antibody test for the COVID spike protein. And the the antibody test to test for immune response immunity to the spike protein may test positive.

Dr. Steve McGraw: 34:02

I'm really glad you said that that you're fast because I was asked that question too. And the way I reminded them was of the entire genome of this virus, you're getting the tiny little sequence of messenger RNA, the codes for the spike protein. And yet when we swap people's nose, the molecular essays are looking for a big chunk of RNA. And it wouldn't necessarily be anywhere near enough of the sequence for you to have tested positive on a molecular essay, either the rapid ID test or the PCR. And I was really anxious to be able to tell that to people because I think that some were significantly concerned about inadvertently testing positive and then being able to be excluded from work or not being able to visit their families and things like that. And I like you reassured them that that wasn't the case.

Dr. Russel Faust: 34:48

And the follow up is can the vaccine Give me the COVID-19 infection? And just because of what you just said it's just a little message for a single protein. No, it's not the virus. You will not do COVID-19 infection from this vaccination.

Dr. Steve McGraw: 35:05

Well, thank you very much, Jeff. I especially appreciate the speed with which we were able to gather everybody together, I know there's going to be more information as more product gets approved and FDA approval, and I would encourage people to tune in to the podcasts as we update but also to get their information from trusted sources. I would especially recommend the CDC website and information distributed by their EMS leadership, their agencies and public health in conjunction with the CDC. We are very fortunate that we have those reliable sites and sources at our fingertips. And people should not hesitate to make themselves aware of new announcements as they come online. But more than anything, continue to protect themselves, protect the people they care for, be accountable to each other, and stay safe.

Geoff Lassers: 35:54

That is all for the show today, everyone. Thank you for listening. Thank you to Russ and Steve for coming on and spreading your knowledge, your time and participation is always appreciated and never wasted. Again. Even though the fellas did a great job of answering every question they could think of. I'm sure there are more great questions out there. So please keep emailing your questions, comments, feedback and episode ideas to the EMS on-air podcast team by email at QA@ocmca.org. Also, check out the updated website emsonair.com. For the latest information, podcast episodes and other details. Follow us on Instagram @EMS_on_air and please whatever podcast platform you use, subscribe to our podcast and leave us a rating and review because it really, really, really does help us grow this podcast. Thank you for listening to the EMS on-air podcast. Stay safe and have a great day.