EMS on AIR

S2:E13 - "Another COVID-19 Vaccine Q&A with Dr. Russell Faust and Dr. Steve McGraw."

December 21, 2020 Season 2 Episode 13
EMS on AIR
S2:E13 - "Another COVID-19 Vaccine Q&A with Dr. Russell Faust and Dr. Steve McGraw."
Chapters
EMS on AIR
S2:E13 - "Another COVID-19 Vaccine Q&A with Dr. Russell Faust and Dr. Steve McGraw."
Dec 21, 2020 Season 2 Episode 13

In this episode, Dr. Steve McGraw and Dr. Russell Faust are back to answer more questions from the EMS and hospital communities.  In episode 11 (launched Dec 15, 2020) of this season, Dr. McGraw and Dr. Faust laid out all the questions they’ve been receiving about the COVID-19 vaccinations and delivered clear and concise answers.  Most importantly, all of their answers were based in the latest scientific data and literature that clearly demonstrates the safety of the COVID vaccines that are currently available.  We’ll keep the ball rolling and field more questions from the EMS and hospital communities. 

During this episode, the doctors answer the following questions:

  • Is the vaccine safe?  What about people that are immunosuppressed? 
  • What happens to the mRNA after it completes its mission? 
  • What are the known short and long-term side-effects of the current COVID vaccines?
  • If I already had COVID, do I have natural immunity?  If so, why get the vaccine?
  • How do the COVID vaccines impact flu vaccines or other similar vaccines I have had recently? 
  • When do I get my second dose?  When I went to get my vaccine, they scheduled my second dose for 18 days later.  I thought it was supposed to be 21 days later.  Which is correct?
  • Should women that breast feed, pregnant women, women trying to get pregnant or men trying to impregnate get the vaccine?
  • Do I need to wear a mask after being vaccinated for COVID?

Dr. Steve McGraw is an ED physician at Ascension Providence Hospitals in both Southfield and Novi, Michigan.  Doc 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.  My man Russ has 30 years in academic medicine, and he ran NIH funded labs to do applied translational cellular molecular biology.  Oh yeah, Russ’ first job in the medical field was as an EMT in the State of New York. 

Visit EMSonAIR.com for the latest information, podcast episodes and other details. 

Follow us on Instagram @EMSOnAIR.

Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at [email protected].  

Support the show (https://www.patreon.com/emsonair?fan_landing=true)

Show Notes Transcript

In this episode, Dr. Steve McGraw and Dr. Russell Faust are back to answer more questions from the EMS and hospital communities.  In episode 11 (launched Dec 15, 2020) of this season, Dr. McGraw and Dr. Faust laid out all the questions they’ve been receiving about the COVID-19 vaccinations and delivered clear and concise answers.  Most importantly, all of their answers were based in the latest scientific data and literature that clearly demonstrates the safety of the COVID vaccines that are currently available.  We’ll keep the ball rolling and field more questions from the EMS and hospital communities. 

During this episode, the doctors answer the following questions:

  • Is the vaccine safe?  What about people that are immunosuppressed? 
  • What happens to the mRNA after it completes its mission? 
  • What are the known short and long-term side-effects of the current COVID vaccines?
  • If I already had COVID, do I have natural immunity?  If so, why get the vaccine?
  • How do the COVID vaccines impact flu vaccines or other similar vaccines I have had recently? 
  • When do I get my second dose?  When I went to get my vaccine, they scheduled my second dose for 18 days later.  I thought it was supposed to be 21 days later.  Which is correct?
  • Should women that breast feed, pregnant women, women trying to get pregnant or men trying to impregnate get the vaccine?
  • Do I need to wear a mask after being vaccinated for COVID?

Dr. Steve McGraw is an ED physician at Ascension Providence Hospitals in both Southfield and Novi, Michigan.  Doc 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.  My man Russ has 30 years in academic medicine, and he ran NIH funded labs to do applied translational cellular molecular biology.  Oh yeah, Russ’ first job in the medical field was as an EMT in the State of New York. 

Visit EMSonAIR.com for the latest information, podcast episodes and other details. 

Follow us on Instagram @EMSOnAIR.

Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR Podcast team by email at [email protected].  

Support the show (https://www.patreon.com/emsonair?fan_landing=true)

Geoff Lassers:

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 21 2020. I'm Geoff Lassers, and I'll be your host. This episode was recorded yesterday, December 28 2020. In Episode 11 of this season, which was released on December 15, I sat down with Dr. Steve McGraw and Dr. Russell Faust. They laid out all the questions that they've been receiving about the COVID-19 vaccinations and delivered clear and concise answers. Most importantly, all of their answers were based in the latest scientific data and literature that clearly demonstrates the safety of the COVID vaccinations that are currently available today, Steve and Russ are back to answer more questions from the EMS and hospital communities. together, Dr. Steve McGraw and Dr. Russel Faust have been a major part of EMS's understanding and response throughout the entire COVID-19 pandemic. Even though we're 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 ED physician at Ascension Providence hospitals in both Southfield and 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 because he had a little extra time on his hands, he did a fellowship in pediatric Head and Neck Surgery. My friend Russ has over 30 years in academic medicine. And he also ran NIH funded labs to do apply to translational cellular molecular biology. I don't know what that is, and oh, yeah, his first job in the medical field was as an EMT in the state of New York. So not only is my boy Russ, an intellectual Rockstar, but he is also fundamentally rooted in EMS. Russ and Steve are both considered experts in their respective fields. And they're here again to answer more frequently asked questions from the ems and hospital communities. Most importantly, all of their answers are based on the latest scientific data and literature that clearly demonstrates the safety of the current COVID vaccinations that are available. Today's list of questions is in the episode description so you can check them out there. One question that we received from a number of our vegan listeners was not covered in today's episode, so I'll answer it right now. The question was, are the COVID vaccines vegan? It turns out that the Pfizer vaccine technically is vegan because it contains no animal products. On the other hand, all vaccines are tested on animals before being tested on humans. So I'll leave it at that. Even though the fellas do a great job of answering every question they could think of and that we receive recently. I'm sure there are more good ones out there. So please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at [email protected] 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 and we can't stress this enough ratings, reviews, shares it's all currency these days, please leave us a rating and a review and 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 increasing our reach resources, experts and abilities. Bottom line ratings and reviews are vital to our growth. And your contribution will give us what we need to serve those that serve our communities. The only cost to you is a few minutes giving us a rating and a review on whatever podcast platform that you use. We're available on every platform that you can think of. So it's super quick and easy for you. Thank you and enjoy the podcast. Okay,you want to just roll?

Dr. Russel Faust:

Bring it.

Dr. Steve McGraw:

Yeah, lets go.

Geoff Lassers:

All right, boys. How are we doing this morning?

Dr. Russel Faust:

Great.

Geoff Lassers:

Good to see you guys. Again. We had quite the response from the EMS and hospital community. We're going to keep it rolling. We've received more frequently asked questions. I'll just kind of kick it over to you. Doc's. You know, a questions are being asked. Go ahead, sir.

Dr. Russel Faust:

Well, we have a few more days data than we did for that previous episode. And I think that the question, Is it safe? is a great question. There's a couple parts of that answer. The first is as an RNA vaccine. This is a safer vaccine than any we've had in history. That is there not a bunch of egg by products. There are not a bunch of additional viral proteins in there. It's not a live attenuated that might infect you and potentially kill you. If you are immunocompromised. In fact, this is a fine vaccine for those immunocompromised are immunosuppressed. So this is an extremely safe vaccine and that the vaccine is comprised essentially of one message RNA for one protein, it's wrapped in some lipids. Now, here's the qualifier, there were two people that had severe reactions in the UK on the first day of vaccination. And there was one person in Alaska that had a severe reaction here in the US on the first day of action nation, those cases are still under investigation, it's still not clear what the cause was. But all three had in common a history of severe allergies to either other medications or severe food allergies, severe reactions to various foods. So I guess what I can say is that anyone with a history of severe reaction to any injectable medication IV, or a vaccine should probably delay getting the vaccine. And anybody with a history of severe food allergic reactions, any kind of anaphylaxis reaction to anything, you know, strawberries, tomatoes, whatever it is that they've had a reaction to, they should probably put off getting this vaccine until further notice until we have more data, we've investigated these few cases more thoroughly.

Geoff Lassers:

Is that a recommendation that is any different than any other medication that would cause these types of things in these types of people? It sounds like these people would have a sensitivity to injectable types of medications anyway. So this essentially epic to this specific vaccination.

Dr. Russel Faust:

they should be aware of it. You know, these folks have a history, they're already aware they know who they are, they basically just need to sit tight, be patient, wait for more data to be collated and investigated. And at some point, there will be a vaccine that's appropriate for them. You know,

Dr. Steve McGraw:

just so you can get a gauge to about the relative risk of that. And you know this to that fast, if we gave 200,000 people antibiotic infusions, there would be one to a few that have had a history of anaphylaxis reactions to other medications who would have a severe immunologic or mast cell generated histamine generated immune response, it would happen with virtually any medicine you gave to this many people all at once statistically.

Dr. Russel Faust:

Yeah, absolutely.

Dr. Steve McGraw:

I wanted to point out one of the things about the safety too, and this goes to exactly what you were saying how we're not giving the people this whole viral, maybe heat killed or attenuated live virus like we do with other vaccines, we're giving them such a small piece of the code that only codes for the actual spike protein itself. And the magical thing, if you want to look at it, from my point of view, is that piece of mRNA that we get, once it's used by our cells to make a bunch of copies of these spike proteins, it is devoured and enzymes within our cell break it down. So it's not even traceable, there's, there's no part of the lingers to do damage a year, a decade later, it's gone.

Dr. Russel Faust:

Yeah, RNA is incredibly label, it gets chewed up, not only within ourselves, it gets chewed up in our bloodstream, it gets chewed up in the environment. Because so many viruses use RNA. Bacteria make a variety of enzymes to chew it up. So it doesn't get incorporated into our DNA, it doesn't, you know, make it even to the nucleus. Ribosomes plunked down on it reel off a bunch of copies of the spike protein. And then just like all other messages, it gets chewed up. And because of that, we won't test positive for COVID-19 using either the antigen test or even the molecular test the PCR because that message has been chewed up. We don't shed it like we would shed the virus if we become infected.

Dr. Steve McGraw:

That was one of the questions that I've had people ask, they said, Well, I've had other vaccines where they said, since my spouse is, you know, suppressed with chemotherapy, I can't have it. And I reminded them that that's in the case of an actual viral injection for a vaccine. This is a tiny little piece that only codes for a non-infectious part of the virus That won't do any harm. If anything, that's a better argument for getting vaccinated that you have a loved one who's immunocompromised so that you can maintain your health and then by virtue of their proximity to you keep them from getting anything from you. Or you wouldn't necessarily have symptoms but could be infectious.

Dr. Russel Faust:

That's such a great point, Stephen. I, I have to say, honestly, when it came down to it, that's why I was vaccinated. I'm touching people on a daily basis at county health. So I'm exposed on a regular basis, but the fact is, I have wonderful PPE and I've been doing this for nine or 10 months now. So I've not become infected. I feel like I have good sterile technique and good PPE hygiene. But there is that small risk that I would become infected and potentially transmit to household members if Im asymptomatic and we do have a multi generation house. Hold on, I just frankly, when it came down to it, and I was offered the vaccine, I did it for that reason to protect those around me.

Dr. Steve McGraw:

Me to, exact same reason.

Geoff Lassers:

remind everybody well around here, what are the short term side effects that are being predicted for those that are experiencing them? And then Are there any long term side effects that we currently know about?

Dr. Russel Faust:

I'm happy to chat about that. The symptoms of being vaccinated are fairly high with these well with this vaccine, and I'm reading and hearing that it's perhaps even higher and stronger symptoms for the the Moderna vaccine. So if folks get an annual flu shot, most people don't really have much of a severe symptom profile after getting the flu shot, they might have a sore arm, that's pretty common. They might feel a few aches and pains, they might have a very low grade fever. But that's usually the extent of it. It is anywhere from 60 to 80% of the people that are being vaccinated right now are complaining of headache, fever, fatigue, muscle aches and pains, myalgias, arthralgias, those sorts of things. My understanding is, those are in the 60 80%. After the second dose, I didn't have any symptoms. In our staff, I'm not seeing any symptoms, folks are complaining of anything. But this vaccine does seem to have a fairly high symptom profile after the vaccine. On the other hand, as we've already discussed, it's very safe. We have not many severe reactions. The fact that while you have any reaction at all, simply tells me that the spike protein ticks off your immune system pretty well, that it was a good selection of this protein, this mRNA that codes for this protein to incite a strong immune response. You know, the fact that people are getting red arm the fact that they're getting febrile and have headaches etc. Just suggests it's a strong immune response.

Dr. Steve McGraw:

You know, Dr. Faust that goes right into exactly what I experienced, I had a mildly sore arm, it felt a little bit like I had been punched by within 24 hours bad and some mild myalgias were gone. But I think that's in its own way, reassuring that my immune system encountered the spike protein, and said, Let's work to make sure we remember what this looks like. That's exactly how the vaccine is designed to work. I think that's also part of the answer. I get people who tell me, well, really, why do I have to get it? I tested positive back in May. And frankly, I've got natural immunity. And I'm good enough with that. What do you think?

Dr. Russel Faust:

You know, so all the calls I've been on with the CDC. And these were some months ago, when they were looking at natural immunity, looking at the antibody titers, that sort of thing. All of those calls with CDC suggested that the natural immunity wanes fairly precipitously after a few months. And I don't think they're seeing that from the clinical trials with these vaccines. So I think the natural immunity, basically, your immune response against the native virus may not be as strong as that from something designed something selected and use for the vaccine. So I think we have to wait and see what things will look like in a year after the vaccine. But I think right now, the data suggests that the immune profile after the vaccine is stronger and longer lasting than the native infection profile. What do you think?

Dr. Steve McGraw:

I completely agree, I heard a immunologist that I think he was from Hopkins was suggesting that in vivo, studies show that the immune response for the vaccine is two to eight times more robust and long lasting than the ones they see in the native infection. And that's especially true because not all natural infections are the same. We've seen people with very minimal if any symptoms, and we think that their immune response is likely, while they might have tested positive, to not be long lasting at all, and others who had maybe more serious illness, arguably, they could have had a more robust immune response at the beginning. But that as well might not last as long. As you suggest maybe the one that's designed by the vaccine manufacturers for this very ideal target, the spike protein may, in fact be the best way going forward. Another argument I gave the person who suggested that was, you would feel really regretful I think if you would adored the illness to whatever extent you had, were ultimately offered a vaccine and said, No, I'm good. And then what's to say if you got infected again, your immune response wasn't long lasting, you could stick Gosh, I wish I'd taken the opportunity to be vaccinated and worried about it just happen. So it's sort of a way of you have an opportunity, it would make the most sense to probably not pass it up. When you know what the outcome is with that versus what we don't know your outcome would be with the natural infection.

Dr. Russel Faust:

Agreed. And that's been our routine recommendation to our staff and everybody else's, even if you've tested positive previously is long as you've recovered, you should be vaccinated.

Dr. Steve McGraw:

I get that question too. I have people say, Well, I recovered, but it was real recent. I've only been asymptomatic for about a week and a half now. Do you think I should get the vaccine? And what I tell them is you should get it just not yet.

Dr. Russel Faust:

Yeah, you know, we're using kind of a 10 day to two week rule. As long as folks have met the standard 10 day time based return to work kind of profile. That is it's been 10 days since they tested positive, their symptom profile is waning. They've been a febrile for at least 24 hours. We give them a couple days beyond that, and then vaccinate we haven't run into that yet, but we've had the question like you.

Geoff Lassers:

This quick commercial break is brought to you by American CME. American CME is an online continuing education learning platform designed for EMS providers by EMS providers. The mission is simple create and host high quality video based EMS CE content, with the aim of improving the quality of EMS care while drastically reducing or eliminating the cost associated with EMS training. American CME courses focus on the most current topics and signs related to the EMS industry and they're available in a format that makes them convenient to access and complete the EMS on air podcast will continue to release more episodes on Americancme.com. This means that EMS providers can earn ems continuing education credits by completing an entire podcast episode a brief post course quiz and survey. To do this visit AmericanCME. com, click on the courses link. Then click on free courses. Scroll through the course list and look for the courses with a EMS on AIR podcast logo. The first five episodes of season two are now available on American CME and they are approved for EMS providers in Michigan, don't worry in the next 30,40, maybe even 50 days, we'll have them all approved for the rest of the nation as well. We're also trying to get CAPSE accreditation for these. So standby, if your license is coming up, get on over to American cme.com and get you some credits. Think about it cruise into work kicking back and engaged in an EMS on AIR podcast episode and earning CE's Come on. Does it get better than that for EMS CE's? Did I mentioned you can access all of American CME's content for free? Yeah, free. And now back to the show.

Dr. Russel Faust:

What else do we have here?

Dr. Steve McGraw:

I forgot a flu vaccine. I finally got myself and went down to Rite Aid got my flu vaccine. But it's only been a few days since I got my flu vaccine. Now I'm being offered the COVID-19 vaccine. When can I take it?

Dr. Russel Faust:

First off, let me emphasize that it's important to get a flu vaccine this season. In frankly, it's not too late. If you have not been vaccinated for influenza, do it now. Do it now do it. Now. If you are infected by influenza, and COVID is a co infection, it least doubles your mortality risk. And I can't emphasize this enough, so back to that question. The fact is, we just don't know what the immune response to other vaccines does to the immune response to these vaccines. So the manufacturers are recommending a 14 day cooling off period before being vaccinated with either the Pfizer or the Moderna vaccine following some previous vaccine.

Dr. Steve McGraw:

I think that's reasonable. And I will tell you that when I tell people that that's a pretty good window to sort of let things reset. Its conservative, but it's not so long that they're absorbing all this additional risk waiting long, long periods between vaccines. I think the 14 day rule is a really safe conservative one to go with.

Dr. Russel Faust:

I was just gonna say that the crazy thing is the flu vaccine appears to decrease your risk of contracting COVID-19.

Dr. Steve McGraw:

Isn't that a nice little silver lining?

Dr. Russel Faust:

I know it's kind of neat. Just basically a generic rile up of your immune system, get it all revved up from other vaccines a few weeks prior really reduces your risk.

Dr. Steve McGraw:

one of the questions I did get as well. And this was from someone that's had sort of moderate to discomfort type reactions to the flu vaccine. And they seem to believe that there are times that when they've gotten the flu vaccine, it's somehow predispose them to getting the flu. I always point out it's just the time of year. You know, you get the flu vaccine and you can unfortunately leave CVS and get exposed to someone with a flu sneezing all over you picking up their own cold remedies at the store. But you didn't get the flu from your flu vaccine. It's just they both happen in the fall and winter. But having said that, I've had people suggest that if they get this COVID-19 vaccine, won't that for at least a short time predispose them to other illnesses, including covid I said just the opposite. That it's no science suggests that so far, is that the same that you've heard?

Dr. Russel Faust:

Absolutely, No, you're right on it. Just the opposite. And let us stress at this point, we've said it before, but there's no way for you to become infected with COVID-19. From the vaccine. This is not a killed virus. This is not a live attenuated virus. This is not a groundup virus that's been grown up in batches and eggs. This is a single short sequence of message RNA that codes for protein, I want to emphasize that it will not infect you.

Unknown:

Right. And I will say also that I try to reassure people that whatever their immune response sore are, maybe my allergies is low grade fever, get a headache. And, you know, you could address those with ibuprofen, or naproxen sodium and Tylenol. And really right through it, people didn't get hospitalized from some of the immuno response. Now, the couple that you pointed out had an anaphalactic response, which has been very rare. But it does indeed exist, those that have got these sort of history of exaggerated reactions to medications and food. Nonetheless, none of them have died. None of them have been permanently disabled. And the people that had gotten a sore arm or the mild aches or pains or low grade fever, these have really been very limited. And within, you know, a day or two, they're feeling well again, and taking the Tylenol and ibuprofen do not prevent you from having a healthy immune response. They just give you some comfort while your body's processing the vaccine.

Dr. Russel Faust:

frankly, I would rather have the entire list of adverse side effects from the vaccine than have COVID-19 infection and potentially have all those well, potentially fatality, but potentially all those long lasting kind of chronic residual symptoms that we hear so much about.

Dr. Steve McGraw:

Yeah, I'm really glad you said that the natural infection isn't just life threatening, which is bad enough. But there are many people that do require and have had a very difficult time these long haulers are people with respiratory vascular inflammatory responses. And I think those are underappreciated how debilitating that condition can be. And besides just the terrible load of fatality that's been caused by this horrible disease, I think when you consider the risks of the vaccine versus the risk of natural infection, this is truly a essentially a no brainer decision making process.

Dr. Russel Faust:

Let's talk just briefly about the timing of the second shot a second dose of the vaccine for the Pfizer vaccine. So there's quite a bit of confusion about this. And I think I can clear that up. Like all clinical trials, the Pfizer team was extremely vigilant, they are absolutely literal with regard to the vaccination schedule, a plan that was submitted to the FDA, they don't monkey around because they don't want people thrown out of the trial. That is everybody that enters the trial, they want to stay to the very end. So everybody, this is so crazy. Everybody that entered the trial, whose data is reported on that is included in all the final data received their second dose of the Pfizer vaccine on day 21. Now, it's not clear why but Pfizer realize that not everyone would be able to make it on exactly day 21. Some folks will be maybe a little earlier, some folks a little later. So Pfizer recommended a four day window within which to get your second dose. According to Pfizer's documentation, they say your second dose should be anywhere from day 19 to day 23. Now, for reasons not at all clear to the universe, the CDC decided on a different four day window and all of their documentation and all of their presentations or webinars for information for practitioners, etc. cites the four day window of date 17 through day 21. All of mdhhs information is taken from CDC. They basically do everything based on CDC guidelines. But the fact is, both groups are just guessing they don't know because everybody in the clinical trial was vaccinated for the second dose day. 21 So the fact is, the window is reasonable anywhere from day 17 to day 23. We've been scheduling on day 18 because it falls on a Tuesday. And it ends up being logistically easier for us to move around the various fire stations that were vaccinating in.

Dr. Steve McGraw:

really glad you said that because I've heard that question quite a few times. What if day 21 falls on my next day to work and I didn't want to get it when I might have a slightly more uncomfortable experience with the second vaccine and I'll be at work when that happens. And my advice to them has been either get someone to change with you or reschedule your day. Unfortunately, our health systems have been Like the CDC recommendations, allowing people to utilize that window a little short of 21 days or a little past 21 days. And I think that it's important to recognize we may be talking about something that in the end matters not much. Maybe instead of 95%, you're 94 or 93%. efficacy is experienced. But that's still an insanely great vaccine. I mean, this is so much better than the vaccines we have used for things like influenza, it really comes out in a category of success, kind of a net strata with measles, and demopolis, influenza B, and its ability to really make a lasting and effective response to the recipient. We should be proud of that.

Dr. Russel Faust:

It's awesome. It truly is. I mean, a good year, we're happy to get for influenza, what do you think? 30 or 40%? efficacy? Yeah, yeah, that's a good. That's just, you know, this is just crazy to see 95%. And we don't have the data for the first efficacy after the first dose for the Pfizer. But we do have data for after the first dose of the Moderma. And they're kind of playing it close to the chest. But it looks like it's really high. It looks like it's at least 90%.

Dr. Steve McGraw:

Yeah, I saw that too. And I realized this when I was reading, it was kind of tucked in a footnote of a description of the Moderna vaccine, I think their real intent is to be very glad that that's true. But to not allow people to say, Well, if I'm 80, or 90%, effectively, meal, well then why finished the dose, we know the best practice and the practice that was really utilized in phase three was when people got both vaccines. So even though it looks really great, and really promising to commit yourself to if you've gotten the Pfizer vaccine, getting your next dose in and around 21 days for its for its best effect. And similarly, if you receive the Moderna vaccine, follow their guidelines to

Dr. Russel Faust:

agreed. they're not advertising that effect, because they really don't want to risk anything that would risk the FDA approval.

Dr. Steve McGraw:

Exactly. And hats off to them for finishing the race, you started down this very real challenging road. And you did it in times that really allow us to recognize people work seven days a week at these labs and these companies, and they worked crazy long hours. And they worked so hard to get people entered into initially phase one and phase two. And then ultimately, in phase three. And with our uptick in the prevalence in our communities across the United States, phase three actually completed faster than it might otherwise you know, we had more people in the placebo group get sick, and people in the treated group not get sick. And it became very apparent that this was worthy of FDA consideration. But if we are going to finish the race like they did, that means getting both of our doses in is a responsible and effective way as we can, on the schedule that they recommend. They didn't do it for nothing. They did it because they know this is the best recommendations they have at this time. One of the thing that I have heard, and this really came down to the American College of Obstetricians, gynecologists, it's probably no surprise to you. Many of the men and women in the fire service and in my hospital are attempting to start a family or you know, might be getting pregnant. And this is both men and women. Although, admittedly, it's it's more of the females that have asked me, but even men have said, Look, my wife and I are in the process. I reassure the men that this is not entering their DNA. So there's really nothing that should prevent them from getting the vaccine when they're trying to start a family. But for the young women who may be pregnant, or maybe considering being pregnant, I thought it was really great that the American College of obstetrician gynecologist did indicate that especially for those in fields or jobs, where they have a greater risk profile than someone that can stay home, say for a job where they don't have to interact with the public, for instance, a female paramedic or a nurse or nurse practitioner or someone like that, or a physician, the people that are encountering significant risk on their job, whatever risk there might be to those getting pregnant or are pregnant or lactating. It's outweighed by the likely protection this vaccine would provide to them so that they don't become naturally sick from the infection while pregnant, which we know is an independent risk factor for both them and their pregnancy. I was really glad that they stated that overtly.

Dr. Russel Faust:

agreed. The CDC has advised that women who are pregnant under those conditions at risk for becoming infected should have a chat they should avoid or reconsider having the vaccine and it was great to see the a con come out with very strong support for the vaccine and saying these women really should get the vaccine we shouldn't put obstacles in their way. So yeah, that that was that was great to see.

Dr. Steve McGraw:

One of the other points of that too, and I thought this was kind of insightful for them to say it was that we hadn't had the actual tests constructed yet. The phase three trials did not intentionally include pregnant lactating or hoping to become pregnant female However, there were some participants at age three that became pregnant, and some of them have been delivered babies in phase three. And what's I think reassuring is there has been now it's a limited number, but there have been no to date, abnormalities noted. And those studies will probably begin on intentionally vaccines, vaccinating women in that condition in 2021, they just haven't done they haven't constructed those very specific tests. Similarly, they haven't really looked at children and these vaccines under age 16, yet, but those things will get done. I just thought it was great that even without that just knowing what happened in phase three, a cog, you know, sort of took the bold initiative to say talk to your doctor, but also consider the risks of your job or your lifestyle in whether or not it would be better for you to get the vaccine, even though we haven't done this specific test yet, a very bold thing.

Dr. Russel Faust:

For our county policy I have fully accepted embraced their recommendation. Let's talk about the question that we are getting frequently about the need to continue wearing a mask after being vaccinated. What do you have to say about that, you know,

Dr. Steve McGraw:

I had this one from several people, it's enough I if I have to wear a mask anyway, I don't think the shot is worth it. And I said, remember why you wear the mask in the first place, you don't really wear the mask, primarily because it will protect you from becoming infected, it will do that to some extent. And the real reason all of us should be wearing masks is to protect those of us who encounter others from getting an infection from us that we might not even know we have. And when you wear the mask, you keep all of the things in your airway in your airway or near you not in their airway of where they could inadvertently become sick. Now the truth is, when you get this vaccine, we just don't know yet. If you could subsequently even while you're immune to the actual native infection, still obtain, harbor, and then transmit asymptomatically viral particles from your airway, we just don't know. And those studies haven't been done yet. So here's an example, as an emergency physician, I'm going to be immune, and I'm going to have my mask on even though I've been vaccinated. But let's say I take care of a really sick person. And despite the mask I wear in my equipment, I inadvertently become a symptomatically a carrier of these viral particles. True thanks to the vaccine, it's profoundly unlikely that I'll become sick. But we don't know if I could still take that home to my family. My loved ones are the people I see at Starbucks, and not wearing a mask, just give it to them anyway, I wouldn't necessarily have ever gotten sick. But I could have inadvertently become a carrier asymptomatic as it was, and not wearing a mask just unnecessarily exposed all the people that I've come in contact with one day, the masks if everyone gets vaccinated, we'll go away. But I'll need all the people I'm going to have encountered at Starbucks in my family to have been similarly vaccinated, so that I don't put them at risk without intending to. That's how I've tried to answer that to other people. We're going to get there. And you know, I think that's what we all want to be able to hug our family members and our friends, again, I want to go to a concert and a baseball game, I want to do all the things that sort of make our lives interesting and enjoyable. And, and we all have become very aware that it's been denied to us, we just can't do it yet. And I know these companies are manufacturing vaccine to the greatest extent possible. And in doing so, of course, not deviate one bit from their quality control, doing it safely and ramping up their manufacturing capacity as much as they can. We just have to be a little more patient and say, Yes, I'm going to get my vaccine, I'm going to make certain that I still protect those around me because when everybody's had the vaccine, and the virus really doesn't have a way to go from person to person now, but it does. Now, once we get to that level, I think our social distancing, and masks will become much less important that then I'll be the first one that wants to sign up and meet you at a concert to go out for a beer. But we do so without a mask and it's getting old. And don't we all feel it too. Maybe even more acutely over the holidays. I've had a lot of people say you know I was okay when it was Labor Day and that was October but boy I just really miss being with the people that are closest to me over Thanksgiving and and now the you know Hanukkah and Christmas and New Year's and I tell them I feel it. I feel everything you're feeling and I understand how much we all want that what I've tried to get people to recognize as if you've gotten six or seven innings into those long ballgame, don't give up a three run bomb now just bear down, hang in there continue to do what we do. But by us getting vaccinated to those lucky enough that it's being offered to us were the first part of what is going to become the most ambitious vaccination program in the history of our country, the most ambitious vaccination program in the history of the world. If we just play our part and do our part first. We're going to all get there, and it will have been worth the effort and the way I both I fully believe that.

Dr. Russel Faust:

Yeah, it's so difficult because we are a social species. We always have been. And the reason we've had these additional surges of COVID cases is because we are a social species and we struggled so much with isolation. But you're absolutely right, we can see the light at the end of the tunnel. And we just need to hang in there and continue the mitigation practices, wear the mask, maintain the distance and get vaccinated when you're offered it.

Dr. Steve McGraw:

It is really important to do that. Because while I've been vaccinated, and you've gotten your shot, and we're going to get our second shot, that leaves about 200 million other people that need to be vaccinated before we start to really begin to see herd immunity in the United States. So and that's not going to happen overnight. I know that President elect Biden, is talked about 100 million vaccinated people in 100 days. And that's extraordinary logistical effort, I'm hopeful that he can pull that off. But however many days it takes, we're going to get there. We just have to hang in there to that point, I'll say another thing too. And for those that wonder a little bit, the overwhelming response I saw when my colleagues and I at the hospital, we're getting vaccinated. It wasn't euphoria. But I saw a lot of people very happy, and a lot of people even move to tears. I couldn't exactly figure out why I felt that way. But I got it, I had the same sense of this is really wonderful. And one of my partners said to me, and she's a physician who's been practicing medicine on time, she said, I know exactly why I feel this way. Because for the last nine months, we've just taken it, our community, our profession, our way of life has just been getting kicked in the pills by COVID-19. And while we wear masks, and we've been successful in many of the things to mitigate it, this feels like it's the first time we're taking it to the virus like technology is helping us fight back more effectively than we've done at all in the last 10 months. And I realized that's exactly what I felt. I felt like now we were on the offense. And how wonderful is that technology is going to get us out of that horrible pandemic that's hurt and injured and killed so many people in our country. It'll feel so good to be on the offense. Again,

Dr. Russel Faust:

prior to this vaccine being available. We were just kind of biding time, and now we're actually making a difference.

Geoff Lassers:

That's 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 are always appreciated and never wasted. Again. Even though the fellas did a great job of answering all the questions that we could think of and that we have received in the last week. I'm sure you got more so please keep emailing them to [email protected] org. Also, check out our websit , emsonair.com. For the latest nformation, podcast episode and other details. Follow s on Instagram @ems_on_air and p ease whatever podcast platform ou use, subscribe to our podca t and leave us a rating an review because it really do s help. Thank you. Thank you for listening to the EMS on AI podcast. Stay safe and have a g eat day.