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COVID-19 in 2021

Added Jan 27, 2021 •

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first day of Cincinnati College of Medicine and Cincinnati Ohio and 9th and he has been with TriHealth since 1994 he is passionate about improving the health of patients cared for by Tri Health clinician do collaboration with multidisciplinary team and he also works in Uganda with an NGO also with hope for conveying cupping do and that is something that provides medical support Faribault village community and Uganda thank you all right, thanks Christy I appreciate that introduction solo you're going to drive the PowerPoint right I'm Steve infectious disease doctor medical director for TriHealth and I have a few slides set aside that I thought we would go through an issue just kind of has a review of I'm just so everybody can get up to speed and then we'll spend most of the time answering questions and talking about vaccines which I think is probably what everybody says interested in so go ahead to the next slide so this is just kind of a review of the agenda will talk a little bit about the epidemiology of Colvin and some testing issues we'll talk a little bit about treatment then we'll spend most of the time about vaccines so go ahead so this is kind of a timeline and it's hard to believe that it's only been a year cuz it feels like 10 years to me but the Health Organization first reported an outbreak of this unusual cluster of pneumonia cases in Wuhan China on the last day of December 31st 2019 and it was actually reported noticed all these people in his hospital or dying of pneumonia and turns out he ended up catching it and he also died from covid-19 it turns out the first case symptom onset was about December 1st 2019 and that person was admitted to the hospital December 8th so they've been going on there and Wuhan for at least a month and in retrospect they found people who probably had it in the months before that for whatever reason did not spread that quickly by January 3rd in 44 cases of pneumonia 11 patients Jill and seem to be clustered around the seafood market in the city of Wuhan by January 10th World Health Organization recognized that this was a huge problem and they publish to check list for countries to prepare for eggnog coronavirus outbreak by January 11th Chinese that actually already published the genetic sequence of the coronavirus which was incredibly rapid and by the 13th the first case was reported outside of China play January 30th just a month after the first case was identified the World Health Organization declared a public health emergency February 11th they named it's a name the disease covid-19 and the virus by March 7th there were over a hundred thousand cases reported worldwide that's barely two months after the first case was identified by March 11th the World Health Organization declared a pandemic to us it had a million cases by June 29th the global cases past 10 million so you can see the blue up spread incredible so where are we now so World rot worldwide there are over a hundred million cases in 2.1 million deaths and that's certainly a vast under estimate of the total number of cases because a lot of places around the country don't have good boarding in the area where we do some work in Uganda lots of the older adults that we know there have died kind of suddenly and the assumption is that they probably had Kobe and you're never going to be reported as killed in cases in the US we've had 25 million cases in 400,000 and if you look at the 1918-1919 flu pandemic which was previously the largest pandemic in history they're only 675,000 Destiny us will pass that number probably sometime in April with our current escalation of cases and those photographs what is from 1918 in the bottom one is from 2020 and things haven't changed too much so go ahead this is just a map of the US kind of showing the current hot spots this earlier this week and you can see the the darker states are the ones where the most cases are located so California Arizona Nevada Georgia and New York we're kind of in the middle between the Green states which have lower Chase rates go ahead and so this is just a graph showing in the state of Ohio deaths based on age group age group ranges to get the vaccine out there because as you can see that the mortality rate is dramatically higher in the older population so 25% of the cases are in patients over age 80 percent in the 77 Infiniti Kris is pretty dramatically as people get younger so so that's the population so this slide is just a demonstration of how the virus infects and and its incubation. So for sale incubation. On average between exposure and the first symptom onset is about five to six days so the vertical line in the middle is the onset of and people become infectious about two days before their symptom onset and that's really the problem with this virus is it's it's very infectious before you even have any symptoms so you don't know you have it and some people remained relatively automatic the whole time that are still infectious and they can spread the disease throughout that whole time frame if you look at the onset of symptoms to how long it is that you can still culture the virus it's only about 8 days which means people become non-infectious about 8 days after their symptoms start so that's actually good to know that people are not continuing to spread the virus after they had the infection but the problem is can you probably see mrs. PCR test of the nasal swab test may continue to stay positive for a lot longer than the patient is infectious so the patient may only be infectious for 8 days after symptom onset who are continuing to shed virus as long as 90 days after their initial infection and it's sometimes very difficult to tell wet when their onset of symptoms that's why the PCR test continue to be positive so go ahead to the next slide this is just a little bit about the virus so covid is a single stranded RNA virus and they're constantly evolving were mutating celebrities viruses that Sarah nature cause viral syndromes that we can identify any mutation that makes the virus more readily transmissible can result in an increase in a text so there are zika virus is like Cola. Cause severe illness and death of infectious disease said in this was in October 2019 which was just like two and a half months before covid-19 that new RNA viruses particularly influenza will continue to cause pandemics and we must be prepared to deal with so he was telling the future there we need to be ready and we're going to have to continue to be ready even after we get covid-19 control cuz these viruses are out there and they will constantly mutate and adapt to the human population so go ahead a little bit now about the coronavirus test so there's three kinds of tests out there there are molecular tasks and those are the nasal swabs that the detective genetic material of the virus in those are the ones that can stay positive for 90 days but they're also very sensitive so they're the first ones that will turn positive when a person is first infected and then in the last column or so the antigen test pick up the proteins on the surface of the virus are also maisel swab test but they're not as sensitive as the molecular test and then the third kind of test of the antibody test in the antibodies tell you if you had cobras on time in the past and if develops antibodies that fight the virus so initially we weren't sure if antibodies meant whether you were immune to the virus or not but more and more data is suggesting that if you have antibodies your relatively immune to the virus what's the current coronavirus versus are the current viruses that are out there this is just a comparison of the molecular rapid test lower left side in those are nice because they're half the cases with an antigen test the test is positive they're good that means that you do have coitus they come back positive but especially in people with few or no symptoms the antigen test are not very good the molecular test however much better they have sensitivities of a 95% and specificity is about 98% so if you have Kobe dunk pick it up and if the test is positive you almost certainly have so go ahead in this is just a information about the antibody test so this is a complicated slide but if you look at the top right under results what you'll see is that in the first 7 Days of the infection only about 30 percent of people will develop between 1/8 and 14 about 70% two weeks before you develop enough antibodies for most people for us to measure them and that's essentially the same as the vaccine takes about two weeks after the vaccine before we can get measurable antibodies in most stations in Texas dos2 really boost up the antibody levels too high levels that we know are protected so go ahead turn a move on now and just talked about some of the treatments for a Coban there's really only one antiviral medication that's available except the summary of the study that showed that it worked until they enrolled a thousand patients to me randomize the placebo or 10 days of this rum Desa beer and what it did is it shortens their time to discharged from the hospital by about four days so if you got only stayed in the hospital 11 days but if you Placebo you were in the hospital for about 15 days but overall there was no improvement in mortality or death rate there was no difference in those people who require oxygen there was no difference in keeping people off and laters so really it's it's a little bit but it is not these are just some graph showing that same data and if you look at grass see the key group that is benefited by REM death of beer are those people who are just starting to require oxygen and in what you see there in the two lines is there's that the two lines are separated by a space and that means there was a statistically significant Improvement in outcomes of the people got them disappear if you gave it to people who did not require oxygen yet which is panel B didn't help him and if you gave it to two people who were already requiring a ventilator and also didn't help himself just a really small slice of patients admitted to the hospital we need REM best severe so go ahead now this was the dexamethasone study and dexamethasone which is a steroid treatment is really the thing that's made a huge difference in outcomes for patients with so if you look at the panel a that's all all comers look like steroids reduce mortality rate versus usual care so that the line on the bottom is the Android group the line on the top of the usual care and you can see the usual Care Group had a higher mortality rate where it really made a big differences in those people that required mechanical ventilation it and you can see there that the deck dexamethasone group had about a 40% reduction in mortality so that has really been the major breakthrough is is learning steroids can stay with people who have severe infection later in panel see those are the people who only needed oxygen but not a ventilator there was some improvement until these people who didn't need any Oxygen if you look at that what you'll see is that steroids action hurt those people steroids are important but you have to use them at the right time to give them to early they actually work against you so that's why we don't recommend steroid because those are people who are not give those people steroids too early their outcomes are worse and that's probably because a normal immune response is helpful to help you get over cold but if it gets overly exuberant like in people who mechanical ventilation system hurts you and that's where steroids can help Sogo and this is just a summary of all the steroid studies and what the she loves you is that the boxes on the left side of that vertical are studies the favored steroids the boxes on the right of the ones that did not favor steroids and you can see basically every study shows what steroids were beneficial in in all those subjects Celeste in a major breakthrough all right so let's talk now about monoclonal antibodies the monoclonal antibodies are antibodies that are these are proteins that are able to bind to the virus so I can the pictographs on the left I see a human cell that the Stars Kobe to virus sticks to those cell surface receptors and get into the cell and cause they're damaged the virus so it can't stick to your cells your body clears those out before they have a chance to attack you or your cells in your lungs so there are two different products out there one by Lily Cole Family Leave You mad and regenerate which is two different monoclonal antibodies together and what those two products have been shown to do is there used in out patients who are at high risk of needing to be admitted to the hospital or having a soul like elderly people with lots of medical form of comorbidities and in those monoclonal antibodies have been shown to reduce the rate of admission in high-risk patients so you know if you take high-risk patients to come down with 10% of Amanda but if you use these monoclonal antibodies we can reduce that rate down to about 3% so at TriHealth we've been using a lot of these monoclonal antibodies for high-risk patients we've given a probably six or seven hundred patients a monoclonal antibody and irr admission rate in the group that got those antibodies is only 3% which is what we're hoping for so the golden key people out of the hospital it has to be given through an IV and so we have an infusion set where we bring the patients and give him a monoclonal antibody and send them home so go to the next slide so this is just a slide demonstrating treatment called, lesson plan so what will you do with this treatment is a patient who has recovered from Coben will donate blood and then we spin offer free soft their plasma which has their antibodies and you give it to a patient who has just come down with Colvin and try to improve their outcomes and so it turns out that a person has a high titer of this of these antibodies in there and you give it to a patient who is in the hospital oxygen we can reduce their mortality rate when we give the patients convalescent plasma before they get on a ventilator once again that's where steroids would come in so come bless and plasma has a role in people who are not get on ventilator so go ahead and this is a slide looking at a treatment call Total is directed against 6 and this is the treatment for that cytokine storm so impatient to get Colvin sometimes their immune system goes haywire and starts to damage their lungs to the point where they have to go on a ventilator and and when they get this cytokine storm in severe form very high mortality rate so what does monoclonal antibody does if you give this to people right when they need to go to the Intensive Care Unit before they go on a ventilator you can improve their outcome with the lower death rate so let's let's go on and talk about vaccines so so there's four kinds of vaccines that are being developed against Colvin the first are the RNA vaccines and so those are the two that are FDA-approved at the emergency already so the Pfizer vaccine and the Murder Nova and so what these back scenes do and I think I have a slide in the next one or two slides is its genetic material that will allow your body to produce the what's called Spike from when your cells produce the spike protein your immune system will recognize that is for him and develop antibodies against it and that's what allows you to become immune to The Cove in Cyrus so this is genetic material that doesn't get into your own genetic material it just stays out in the cytoplasm of the cell and it gets degraded fairly quickly within a few days both of those vaccines are highly effective we'll talk about that in a minute what let's go back to that first then we'll talk about yeah there you go so the second type of vaccine or called viral Vector vaccines so when this kind of vaccine what they do is they put the cold in genetic material inside of another virus and and and then inject that Cyrus the virus is being used is called an adenovirus and and that adenovirus then is able to get into cells and release the colon genetic material that will allow your body to make the protein which well then stimulate your immune system to make antibodies one of the advantages of the viral Vector vaccines if they don't require this really cold store instead of the RNA viruses require so they're more stable in the Third Kind of vaccine on the bottom left of a subunit vaccines are protein fragments from the virus that cause your immune system to react directly to them and develop antibodies to the proteins and then the Third Kind are some of the Chinese vaccines which are weakened are inactivated viruses so they take the Cove advisors us and they weakened it and then they use that to inject will hopefully stimulate an immune response so go ahead so this is just kind of a comparison of the various kinds of vaccines so the two that are currently emergency use authorized are moderna and Pfizer the two in the middle both of those require two doses of Adderall both 95% effective which is tremendous but they have this really cold storage require has to be stored at 70 degrees Centigrade with nobody nobody has those freezers are Tri Health System had to buy three of them and they're really hard to come by right now and so sad is that vaccine flaws out for more than 6 hours you can't use it so it's really tricky trying to the right number you need for your patience and then but not lose any moderna vaccine has to be stored at -20 degrees Centigrade cold but still require special storage Nova AstraZeneca vaccine which of the one developed in the UK is a viral Vector vaccine so one of those that has the adenovirus with covid genetic material inside of it is somewhere between 60 and 90% effective so not as effective as the RNA vaccines but the beauty of it is you can just keep it in a regular refrigerator so it doesn't have to be frozen and then love the bottom one is the Russian vaccine is also a viral Vector vaccine they claim it's 92% effective but can't we don't have much good data on that but it can be kept in a regular refrigerator so go ahead so this was a little bit about side effects which is always something people are interested in so ugly to the two vaccines that are currently FDA-approved they basic have almost identical side effect profile so you get a little bit of a sore arm you may get some swelling at the injection site about 10 to 20% of people may get a low-grade fever fever and chills fatigue and may have a head most of those symptoms go away within 48 Hours we've also seen some other kind of weird rashes that come and go over a. Of a week or two after the vaccine so I personally have had both of my doses of the vaccine a little bit of a sore arm maybe felt a little feverish after the second dose of vaccine but it didn't last long and so I think the side effect profile given me the excellent effectiveness of the vaccine is certainly worth it there is an app called V say that you'll get information about downloading if you want you can send your symptoms to the CDC they're collecting all of those be safe app so this is just some graph showing the moderna vaccine data and and what should what this shows is in the placebo versus the vaccine group how many people got killed in the placebo group it was just a steady increase in the number of new cases from the beginning of the trial till the end of the three months at a hundred twenty days versus the Group which is where almost nobody 95% Effectiveness has absolutely dramatic and it's just amazing that we got this so go ahead this is just some side effect information and reviews of kind of complicated slides but basically it just shows the side effects fever headache fatigue sore muscle aches and the relative percent of people the red is people who had severe symptoms the blue is mild and medium great grey bars are mild symptoms so go ahead I just want to get on this is the reason why people may not want to get back this is just from some surveys done from Germany so people are worried that the vaccine might not be safe there worried about side effects it don't feel like covid as a risk for their help the people just don't take vaccines at all and other people feel like they're letting nature take its course has the best action but you know my my response to that is least these vaccines are incredibly effective and Incredibly stay and if we want to get out of this the only way is to our relation to herd immunity 70 to 80% immune range stop this thing from being transmitted I think all of us can probably agree we'll be happy when it's over so go ahead so this is just some information about vaccine efforts in Ohio so we just which phase 1A which was the healthcare workers and nursing home patients on Monday we started phase 1B which is 80 year olds and above so there a 750 locations throughout the state where you can get a bag they're only a hundred thousand doses only a hundred thousand doses for the whole state but there are at least 425,000 people who are over age 80 really up to blow local Health departments to develop their own vaccine distribution plans there is a website here you can go to to look at the Ohio vaccine dashboard which can tell you who in your area is giving the vaccine within TriHealth we have about thirty thousand patients over age 80 and we are only getting about a thousand doses of vaccine a week over 80 population would be 30 weeks so clearly there is not nearly enough vaccine available for the people who want it or need it so I think that's our big challenge right now I think pharmaceutical companies over-promise and under-deliver on getting enough doses of vaccine out there so when you call to get signed up for vaccine or you will get on website probably what's going to happen is they'll say you no call back next week or will put you on the list and and get you a vaccine when we get back to me but right now the problem is we just don't have enough vaccine so I think that may be the last slow others one more so this is obviously Tony falchi he was kind of the guru of covid-19 now and so he's just tell you let's be careful out there we all still need are masks and social distance until we get to herd immunity and you probably saw that he was originally saying we get the herd immunity when we got to maybe 60 to 65% of the population being immune now he's up there. the 80 to 90% rain it's a very hard thing to predict with any particular virus all right so that way really the only for the prepared slide show and we can answer questions Liz if you want to read questions or how do you want to do that what does everybody have a reaction does anybody have a question do you see how you can raise your hand at the I can look and see or if you want to type anything in the chat do you have a couple email or just unmute yourself a hold on jojo are you got it still had you are muted okay I went to ask the doctor if you've had virus as my son who's 50 has win or should he get the Vive the vaccine yeah so you can get the vaccine anytime that your symptoms from the infection have resolved you're probably immune for at least 90 days after after natural infection but the current recommendation is as soon as you're cute symptoms resolved go ahead and get the vaccine if you can okay thank you we think the vaccine leads to longer-lasting immunity than the natural disease based on some studies about how long the antibodies last in people who haven't had natural infection any idea how long the vaccine protection last still have very high antibody levels which is good so they'll be monitoring most people in the vaccine trials with monthly blood levels that there antibodies to see how long those antibodies last question right now so we're going to have to have it a booster every year are those antibodies going to last you know years we we just don't know you dr. Blatt hi there my name is Mary Sue neighbor and I'm the parish nurse at Immaculate Heart of Mary I'm writing an article for the next edition of the Heart Beat magazine that goes to all parishioners I would like to quote two pieces of advice from you to our Parish okay you want to send those to me or I can email you but I just thought you could speak them in this is being recorded so I'll go back and listen but what would be two things that you say to the prisoners the first thing is that the vaccine is incredibly safe and effective so if you have the opportunity to get this vaccine I really think you should do it both for yourself and for people that you're around for the community in general for the community to get yourself a till we get enough people have heard immunity thank you I was wondering if it would be convalescent plasma eye is someone who has received the vaccines two or more weeks earlier then able to donate convalescent plasma to help immunity or kind of license with someone right now they're only taking people that have the natural does but I'm on a call with the guy who runs Hoxworth once a week I can ask him if they're going to start taking people who can fully vaccinated but right now it's only who recovered from the disease itself Dr blanner I don't know who's next Bob yeah I have a question is it possible to carry and spread the virus after you've been vaccinated meaning that if if and I'm thinking it when my wife and I get fully vaccinated can we interact with our grandson and our daughter who may not be vaccinated for another month or two down the road so the answer to that is we don't know for sure but if this is like every other vaccine that gives you protective immunity it should be fine and that you will not be infectious been adequately immunized the CDC has been reluctant to say that it's all okay until we get a little bit more data and so the vaccine is 95% effective that means 5% of the people might still not be protected but 95% is really good so so I think once you get to leave me nice with two doses almost everybody should be safe to be around people who are unvaccinated quick follow up with that if you're fully vaccinated should you continue to wear masks in public or since you're vaccinated are you you know do you need to do that right now the recommendation is continue to wear your mask to both protect other people in case there is a chance you could be infectious and two to protect you from acquiring it even know your 95% small chance you could pick it up okay thank you card for glad on do you have any new information on the new variants coming up from South Africa yeah spell that little variance are very troubling so the one from UK doesn't look to be mad it's like the vaccines will inactivate that variant the one that's concerning is the one from South Ave there was just a a report published yesterday that the in the South Africa is not in activated as readily as the original phobic vaccine it's partially inactivated but not I'm not at a high level and so we're not sure what that means yet so that's all the more reason we got to get vaccine out there and get the world for this thing mutation resistance to our current vaccine that would be a complete disaster Jericho questions over in the chat you have to stay within your county you don't have to stay within your county but you do have to stay within your state so if you live say an in you're supposed to get Indiana vaccine vice versa if you live in Ohio you're not supposed to go to Indiana vaccines we just had our first little shot how does this affect our covid-19 Nations any other vaccine in your immune system to be focused on developing immunity to which vaccine you just got so if you get two vaccines at once it might be a little more tricky for you to develop immunity to both vaccine the viruses at the same time so two weeks between vaccines is recommended if you get the Pfizer vaccine by should be sure to get the Pfizer of the second time also has recommended yes so whichever one you got the first time you should also get the second time and all the systems in Cincinnati are very careful about making sure you get the same vaccine twice I have a question can you hear me I'm on the phone I've been working non-stop since March I had someone who actually got the virus car right on me he thought he had a cold and a couple days later he got destiny has a virus I never ever had symptoms and I've been working 9 stopped since March and I was sent home from work you know when that happened and I never had any symptoms you know there's a possibility I'm over 50 years old I am and you know my health is good I'm not compromised or whatever but my question is I'd like to what's the easiest way for me to test to see if I have the antibodies so I could give it do I have to have a whole vial of blood drawn and you can I go to TriHealth to do so I could donate if I thought I just can't imagine that I haven't had it but I certainly have not had symptoms ever in these nine months that would be the way to know if you if you had acquired covid in a few still probably be immune for the time being which maybe is why I still haven't gotten it I don't know but is that do they take a whole vial of blood for that do they draw blood to take all by I struggle to be able to go like I can't donate but it just doesn't come out I have very low blood pressure thank you considering the supply chain of the virus that we are experiencing Ohio how important is it the timing this is so stay between someone that's got the first injection versus how long I have to wait to get the second one don't get you in ya so that's a really good question to originally the plan was that they would send out enough supply for the first and hold back your second toe so that it would be is there somewhere for you but governor and actually the Bible Administration has decided that they're going to just release all the vaccine they've got and hope that the manufacturers can keep up and deliver enough vaccine for you to get your second system 3 or 4 weeks when you're do I'm not sure if that's the right answer it's probably not critical that you get it exactly at 8:21 or exactly at day 28 I think you don't want to wait like 3 months but which is what some of the European countries are doing there's just no data and and they're clearly have been cases of cold at the first and second doses so it looks like you really need that second dose to be well protected from virus doctor a question from two of your try to help patients when will try him be able to publish or let us know when were able to get online and register for were aged in the age 65 269 Brak there's no information out there available before then how will we know that it's time to get online to register so if if you have a MyChart account they're going to send you a MyChart message when the age range comes up that you're in and we're found the governor's mandated in order starting with the 80 year old on next Monday at 75 and above the following Monday 70 above Monday after that 65 so if you have MyChart account that's how it'll come to you you can also go to the website and and it should say on there that anybody 80 or above can sign up now website what we do have the website will check it out thank you okay dr. Blatt I have a question a very specific one I have a 42 year old daughter he's actively being treated for recurrence of breast cancer according to the CDC website I interpreted she should be A1C but how can she get herself to get the immunization in the state of Ohio because she's too young by the age ranges that were giving it yeah so basically the federal government sends all the vaccine to the states and every state Governor can decide how they want to distribute it you know in Kentucky they're doing teachers before old people every States doing it differently in in the state of Ohio the governor just decided to do it by age ranges and not with respect to depression I know other high-risk conditions so he had them pick some method and that's the method he decided is to just go at the age range is so unfortunately right now there's is really no way in Ohio to get the vaccine earlier if you're young person suppressing condition okay thank you I have a question can you hear me I had heard that people with type O blood actually have less risk in getting the disease do you have you heard that or is that true or somebody make that up some studies showing the type O blood people or at lower risk of having severe covid-19 people with state ID and that probably is there something genetic about bad blood type that is relatively protective against having severe outcomes we don't understand exactly what it is is true whatever my 20 year old granddaughter who has type O blood got yeah well it's not a hundred percent it doesn't necessarily protect you from getting it but it helps protect you from having a bad outcome maybe we'll put when she was pretty sick but she wasn't in the hospital can you get the first shot and you can't get but you can't get back online and they're still getting all the people that haven't had how are you going to be able to get in line to get your second shot so when you show up for your first shot they will give you an appointment to get your second dose okay thank you that last week that's how it should be today I got it at Kroger and asked about the second dose and they said they weren't scheduling it right now just to keep an eye out and call them when it gets close to the time that I should be getting the second so I'm not very hopeful about that. can I ask a question I miss the beginning I apologize I was at work did you talk about vitamin D and if and how much do you feel that that helps tremendously if your vitamin D level is above 30 had did you talk about that in the beginning I miss the beginning of demonstrating a big differences vitamin D levels there's some small studies that suggest if your vitamin D deficient that you don't do as well as hard to say what the right level is and whether or not it makes a big difference so okay Margaret Tietz trying to get on but she doesn't realize she's muted so she can't get on her hello sorry my son had covid-19 and very mild case but then you said three months he should be pretty much safe from getting it possibly again is that correct yeah it looks like that you know antibody levels stay high for at least three months so you should be protected if he came he let's say in three or four months would we be susceptible to that if we haven't gotten the vaccine yet well it depends on whether he still has the antibodies so I guess he could get an antibody test before he comes to visit to make sure he's still got got antibodies and that was okay thank you is the vaccine safe for pregnant women and their babies yeah so they have not done a study where they've enrolled pregnant women in a bat in this vaccine a trial but there were a number pregnant while they were in the trial and and there were no adverse outcomes so far the American College of Ob-Gyn has stated that they feel like the vaccine is safe for pregnant women and they recommended that all pregnant women get the vaccine and the reason is you know pregnant women who get cold but don't do as well there's much higher incidence of early delivery and add outcomes and pregnant women so certainly safer than getting the disease so my question would be if the pregnant women get it to they get it through the OBGYN because obviously they're younger than these age groups that are thousand AirHeads order set up well right now there's no way for pregnant women to get it cuz they were actually going by those days I think this one more apply after we get enough vaccine out there where there aren't waiting list so we were probably talking you know 4 to 6 months before the vaccine Supply is adequate where you can do Chris Paul said for 6 months thanks should spouses of Frontline healthcare workers get the vaccine as well as the workers themselves well that would be ideal but then again you know we we thought we would be able to get vaccines for the in a family members especially high risk family members of healthcare workers because they'll care workers ivy bring the virus under their families but right now there's not enough vaccine so they're they're not able to get it with the fact that so many people that stay under age whatever it is right now 80 in Ohio can't get the vaccine right now I mean before we swim now we're down to h65 whatever it is right what what is your recommendation for of course we need hair mask of course we need to socially distance of course we need to wash our hands especially before we eat is there anything else in general that you would say like I'm taking a thousand milligrams of Vitamin C morning and night because I'm going to everyday in an office setting with hundreds of people I'm I'm almost 60 years old again I don't feel compromised I don't have asthma I don't have high blood pressure so I'm taking a thousand milligrams vitamin C morning and night cuz I've heard you should spread it out my vitamin D level is above 30 so I'm not taking D3 although many women above 50 years old are taking D3 and calcium because it's something a gynecologist recommends is there anything do you agree with those two vitamin D and C and do you want to add anything else to that or what's your thought on what we can do because we can't get the vaccine yet yeah I mean it from a scientific standpoint there's just not a lot of data jesting that those vitamins prevent you from coming down with cold it won't hurt you that's for sure okay if you want to take those those are you know I think maintaining a healthy diet keeping yourself in shape those are all good things we know that you know people who are in better physical condition have stronger immune system so whatever you normally do to keep yourself healthy I keep doing it unfortunately we don't have a lot of good day what really makes a difference in okay I've also heard that alcohol you know I never really knew this but alcohol I get brings down your immune system of course it's different levels of how much alcohol someone drinking but you know that alcohol is reducing alcohol as much as possible you know or at all could help her immune system is that correct color gray hopefully in a moderate to heavy alcohol use is depressing so I think moderation in all things is good idea thank you I think there were a couple of other things on the Chad here that there's a question about you anticipate employers demanding employees get the vaccine so what will the virus while the vaccines are under emergency use authorization in Knoxville FDA approval it's going to be legal to mandate employee please get the vaccines so at this point I don't think they're allowed to mandate it now what what I think Could Happen though is that you won't be able to fly on a plane you won't be able to go to the movies won't be able to into a restaurant unless you've been vaccinated and so you may have to have your vaccine card to do a lot of things that you might want to do that maybe one way that will be a lot of pressure for people to get back summated since this is set up like on a weekly basis as far as when the next group start do you have any idea if they're taking those people are the next group are they waiting until all of the 80 year olds get their is that wanted before they start doing the 75 at least you're try  so people 75 and over will start being eligible next week the problem is we we don't have enough for the over 80 year old then you add in all the 75 to 80 year olds that's another you know 30,000 people who we won't have vaccines for it's just going to get harder and harder to get into schedule anywhere because of the vaccine shortage the governor has told us that he doesn't think we're going to catch up until we get a third vaccine approved by the FDA she's probably going to be in March when they're Johnson & Johnson vaccine gets approved most likely will be the next one I think we're going to see in all these vaccine shortages going on for another one to two months at least even if you get a vet if you magically get a vaccine say the Johnson & Johnson one which is not as effective and then later on all these vaccines become available can you decide hey maybe I want to get the Pfizer the moderna would that be advisable or that's a good question I mean one thing you could do is if you got one of the less effective once you can get an antibody test if your if you have antibodies if for some reason it looks like you didn't respond to the vaccine then there might be a reason to I repeat the dose with one of the more effective vaccines I just recently got was on a steroid now how does that affect for a vaccinate the vaccine receiving the vaccine is not a real high dose we consider high doses of 30 mg of Prednisone or higher is probably fine shouldn't affect your ability to respond to the vaccine so people who are chronically surprised let's say you know people with rheumatoid arthritis you were taking immune-suppressing drugs or people who had a kidney transplant they're going to probably have a low response rates and then other people to the vaccines like they would with any vaccine that's just something we'll have to live with a lot of my friends have had it have been getting zpacks Zathura myosin and then they send out maybe a steroid inhaler you know like if you're at home and you're just coughing your head off and you know you have mild to moderate covid-19 yeah that's a really good question cuz we don't have a lot of proven studies of what works in outpatient so the monoclonal antibodies are very helpful in people who are high risk of having adverse outcome so people over age 65 or people who may be having me in suppressing condition those people would benefit from the monoclonal antibody preparation other words if you think you have covered call your doctor anybody else have any questions there was one more in the chat what percentage of healthcare workers chose not to choose not to get the vaccine yeah so that's a really interesting question so it within TriHealth in the first 3 weeks or 4 weeks of the vaccine being available for healthcare workers about 90% of Art actors got it but among nurses and other healthcare workers was only running about 50 to 60% so then the governor just like 3 days ago Monday said okay if your health care worker sweet you're not going to be able to get it you're going to have to wait till your age range comes up you can imagine how we're going to be up for everybody in the $0.78 range Federal lot of people sitting on the fence then you go first and then I'll see what happens but I think people are getting more comfortable with it now I was involved with a nursing home and the nurse came in where was covid-19 no she'd had it or what the situation was but I was quite nervous about that I'm sorry she came in without a masker she had a mask on but that's all she was in street clothes password fully gal booties and everything and I just and they said they had a special quarantine area will that what I went out to the Hall of the whole nurses area that whole area was wide open so I was kind amazed it you know the insecurities of nursing homes in Ohio have been strictly lockdown with very rigid guidelines on what do you have to wear and where you're allowed to be and obviously the nursing home since I have had the highest risk patients the mortality rate is terrible and when Kobe gets into a nursing home so sounds like something wasn't right there when they were just start going to have their their first this was on a Friday and they're going to have their first dose on Monday so I don't know if she'd had it or got it someplace else or maybe I don't know I was not very secure about that for sure right last call anybody else have any questions alright so it lives of people have other questions feel free to email them in and we can address those as time goes on to happy to do that these thanks a lot for doing what everybody else or get the vaccine so we can get out of there when did we can get an appointment how many Ross now thank you everyone tonight thank you

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