Ep. 9: Infectious disease specialist talks COVID-19

Amid another COVID-19 surge, Dr. Avish Nagpal urges vaccinations

Episode Transcript

Host (Simon Floss):

Hello, thanks for listening, and welcome to this special podcast brought to you by the experts at Sanford Health. I’m your host Simon Floss with Sanford Health News. Today, we’re giving you an update on all things COVID-19. We’re talking about the delta variant, addressing confusion on the vaccine types, what you need to know on booster shots, and squaring away confusion on flu and COVID shots. The expert to answer all our questions is Dr. Avish Nagpal, a Sanford Health infectious disease specialist out of Fargo, North Dakota. Dr. Nagpal, thanks for taking the time to join me today.

Avish Nagpal, M.D.: Thank you, Simon. How are you?

Host: Doing good, doing good, thank you.

First thing on the docket, I know we’ve got a lot of things to get to. Cases have been, and still are rising with the delta variant. Sanford health has hosted press conferences across our communities, urging folks to get vaccinated. Where do we currently sit with both cases and vaccinations and what do people need to know when it comes to the Delta variant?

Avish Nagpal, MD: The delta variant has kind of changed the dynamics of the pandemic here. We had a good summer. We were thinking that our vaccinations were going well. But unfortunately they stalled over the summer and then we have this more transmissible delta variant, which has been going through our communities. It started off with a surge in Southern states first and now we are seeing the surge here.

We are just starting to see the surge. I believe that it will get worse in the next few weeks to months here. Our hospitals, they have quite a bit of COVID patients in the hospital. At the time of the recording of this podcast, we have about 32 patients in Fargo hospital here admitted with COVID-19 as their primary diagnosis.

We have around 25 or so patients who remain in the hospital, they are not in the COVID unit anymore because they have completed their period of isolation, but they continue to remain critically ill. That’s why they need to remain in the hospital for one reason or another. Our hospital census is about 550 running right now, which is already above capacity. But out of those 550 patients, a little over 50 patients are directly admitted because of COVID-19. So, even during the early part of our surge this fall we are already seeing 10% of hospital capacity occupied by COVID-19 patients.

This is unfortunate because we have an effective vaccine. Unfortunately, uptake has not been as robust as we were expecting. And most of the patients who end up in the hospital are unvaccinated. There’s still time. We are encouraging everybody to get the vaccine so we can manage. We don’t have any community mitigation strategies right now; everything is open. So despite the availability of a very effective vaccine, we are still seeing high case numbers just because we don’t have any community mitigation strategy strategies right now, and a significant chunk of our population is still unvaccinated.

Host: Why is this variant so much more contagious than the previous strain of COVID-19?

Avish Nagpal, MD: That’s normal for a virus, especially a respiratory virus. We can’t see viruses, but they also react like living organisms to the environmental pressure which is for them medicines and vaccines. And what happens is when virus is dividing in a host and it produces millions of new virus particles, when they come under pressure there’s always a chance of mutation. Even without pressure, sometimes viruses can mutate on their own because they divide very rapidly and their genetic material when it divides because they have very basic genetic material, there’s not much editing that it can do.

So, viruses can pick up mutations randomly and every now and then you’ll see a mutation in the virus, which makes it either more transmissible or more virulent or a combination of both. And if there is one vital strain, which is more transmissible, then of course, it will become the predominant strain in the community given enough time. So this is not unexpected. This is a normal virus behavior.

Host: There are still, as you mentioned, still many people out there hesitant to get the vaccine saying that they question its safety. Can you explain why this vaccine is safe, and should there be any concerns associated with the vaccine?

Avish Nagpal, MD: Vaccines are the most highly regulated products on the planet across any industry. They have gone through phase one, two and three randomized clinical trials, and also post-marketing surveillance which means that we continue to monitor in real time, any side effects that we see from the vaccine which we may not have seen in randomized clinical trials.

And when I say clinical trials, these are clinical trials involving thousands and thousands of patients between the three vaccines that are currently approved by the FDA. There were almost one hundred thousand participants in those trials. We have subsequently immunized millions and millions, hundreds of millions of people with this vaccine. We continue to monitor data in real time. And there is no specific safety signal that has emerged from the mRNA vaccine.

There are a couple of minor safety signals. By minor, I mean, there’s some serious side effects, but very, very rare, like to the tune of one in a million associated with the J & J vaccine. But, if you look at the overall benefits as compared to the risk of getting COVID-19, it’s not even close. COVID-19 causes far more complications and far more severe complications as compared to any complications that might emerge from receiving a vaccine. A vaccine is safe. It is very effective. It has been thoroughly tested according to the highest scientific standards. It is actually safer than many of the over-the-counter medications or vitamins that you take.

Host: You and I have talked about this before, saying how a lot of people question the fact that the vaccine, the mRNA, was developed in under a year. (Saying) that people were worried about, if it was rushed. What would you say to that? We know it’s not rushed, we know it’s been duly tested and, the science is so far advanced in previous years, and you can’t compare this vaccine to any previous vaccines because it is so new, but we’re not starting from scratch, if that makes sense. Things like this are being worked on. How would you respond to that?

Avish Nagpal, MD: Absolutely. This is not the first SARS epidemic. We have had a couple before in 2002, 2003, we had the SARS epidemic. Fortunately it was contained relatively rapidly and did not become a global phenomenon as much as COVID-19 did. And then in 2012, 2013, we had the MERS epidemic, which is the Middle Eastern Respiratory Syndrome. Both of these epidemics were related to the same family of viruses, the coronaviruses, very similar in structure and pathology. So, the vaccine work has been going on in the background for the last couple of decades now.

The only reason we could not test the vaccine earlier was because these epidemics kind of abated even before vaccine could enter a clinical trial. And with this COVID-19 pandemic, unfortunately it has persisted long enough that we have had plenty of time to do a very designed randomized control trial accounting for all the different populations across the world. The results have been amazing.

Yes, we do get worried about new technology. There are early adopters, there are late adopters, there are people who are skeptical of the new technology, but medicine is no different from any other industry. We are already seeing rapid advances in medicine, just like we are seeing rapid advances in diagnostics or computer technology or internet technology. So, I think this is an achievement developing a vaccine in one year that we should really be proud of. This is not something that that happened overnight.

These are well-designed clinical trials. This is the highest evidence of medicine that we desire for most of the drugs that we use. Many times we don’t have evidence based on randomized clinical trials. But, for this vaccination we do, and we could not have asked for a better evidence and a better conducted trial.

They are supported very well and a lot of work has gone into this and we should actually be proud of this achievement. I know sometimes you can question government or administrations with which you don’t agree with. You can question their intentions or their competence, but this vaccine was developed by the scientific community as a collaboration between government agencies, as well as pharmaceutical industry, as well as academic scientists. It was overseen by both the previous administration and this administration.

So, I think we should be very proud of our medical achievement here. But unfortunately, it has been complicated by a little bit of distrust among people and misinformation which is kind of a sad part. So, I think we are missing an opportunity for unity here and being very proud of our work that we have done over the last couple of years as it relates to the vaccine.

Host: Switching gears now, and moving to booster shots, who is currently eligible for the booster shots? And could we see the general public eventually falling into that category?

Avish Nagpal, MD: Yeah. So currently we are, as of recording this podcast, the booster shots or rather the third dose, not technically a booster shot, is available for people who are immunocompromised. What that means is that their immunity is not up to par, which could be related to a natural condition like a congenital immunodeficiency or acquired immunodeficiency, which can happen when we give people chemotherapy or they undergo organ transplant or bone marrow transplant, or they are on medicines that kind of suppress their immunity to fight the autoimmune disease, like ones we see in dermatological conditions or rheumatological conditions.

So, those are the patients who generally do not develop a very good immune response, whether to an infection or to a vaccine. And if they do get infection, they are more highly to have complications because of lack of protective immunity.

What we try to do is we have seen in studies that they may not develop enough antibodies with the first two doses of the series or the single dose of the series in case of J & J vaccine. So we try to do an additional dose in order to make sure that their body has enough stimulus to develop their own immunity. So those are the people who are eligible to get the booster shots right now. Whether the general public needs a booster or not, that remains to be decided. The FDA is meeting, their scientific advisory committee is meeting today as we record this. So by the time we put this out there may already be a decision and some guidance.

There is some data from Israel showing that it may be beneficial for general population, especially the elderly to get a booster vaccine five or six months after their series to kind of ramp up their immune response. But, we don’t know how long it will last once it gets ramped up. But that’s what is being discussed in the scientific community right now. So, we’ll have further guidance and some policy changes coming up in the next week or so.

Host: Sure. So switching gears again now, when it comes to getting the flu shot and the COVID-19 vaccine we have had some people ask questions on how that works. So first, do you need a specific amount of time between the two shots?

Avish Nagpal, MD: No, not necessarily. It’s common for us to give multiple vaccines together. You do not cause overload on the immune system. Our immune system is exposed to multiple environmental antigens every day. So, giving two different vaccines at the same time is completely safe. That’s a routine practice, even in little kids where we give vaccines that protect against four or five diseases at the same time. Or we give more than one vaccine at the same time through different injections. So, so this is a common practice and there’s no concern about overloading the immune system by giving both of them together.

Host: Some have asked if they’re mixed together. How would you respond?

Avish Nagpal, MD: No, they are not mixed together because they are different vaccine technologies. They are different antigens, and the storage is different. And the syringe we use is different. So they are not mixed together. They’re two separate shots.

Host: What’s the best timing to get the flu shot, to ensure protection?

Avish Nagpal, MD: Sometime in fall, like right now. Typically over flu season peaks around, middle to late winter. So, if we get flu shot in fall then the protection does last five to six months to cover us through the winter season. So, now is the best time to get the flu vaccine.

Host: Awesome. Well, Dr. Nagpal, I know that we covered quite a bit of ground today, any closing remarks that you’d like to make on anything that we talked about?

Avish Nagpal, MD: Well, if you are still on the fence about the vaccine please go ahead and get one. It is safe, it is effective. And if you have specific questions due to your specific medical condition, don’t wait on reaching out to your primary doctor who knows your history. Well, there are very few contraindications to getting the vaccine – a most likely answer is going to be that, yes, you can get vaccines safely, but if you want to discuss that with your primary doctor, don’t wait on it. Time is running out. We are dealing with a very highly transmissible virus here and you can see it, people can spread it asymptomatically so the best thing you can do to take matters into your own hand and make sure that you are doing your best to stay healthy is to get the vaccine.

Host: Awesome. Well, thanks again so much for doing this today, Dr. Nagpal.

Avish Nagpal, MD: No problem, Simon, have a great day.

Host: Thanks, you too. And, thank you for listening. If you liked what you heard today, give us a thumbs up and a follow. Sanford Health produces podcasts on a wide number of topics, and we’d love if you became a longtime listener. A reminder for all of your medical news, you can head over to Sanford Health News. The website there is news.sanfordhealth.org.

Thanks again for listening. I’m Simon Floss with Sanford Health News.

Posted In Coronavirus, Expert Q&A, Fargo, Physicians and APPs

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