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Alyne Ellis (Host): Welcome to Hally HealthCast, the monthly wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every month on our podcast, we address a new topic important to your health, bringing in expert doctors, nurses, therapists, and specialists who offer advice and answer your most pressing questions. Today, we're talking about COVID-19 and the ups and downs we've gone through lately in our fight against the pandemic.

I'm your host Alyne Ellis. We'll discuss the exciting news about vaccines and answer common questions about them, but we'll also chat about mental health and coping during these difficult times. We have three guests today to give us expertise from three important sets of eyes, physicians, nurses, and pharmacists. Our guests work at Carle Health, a nationally renowned health system based in Urbana, Illinois. Dr. Brent Reifsteck is an experienced Pediatric Hospitalist, a Physician Lead of the Child Abuse Safety Team and the Medical Director of Children's Services. Elizabeth Angelo, who holds a Doctorate in Nursing, is the Chief Nursing Officer and a Senior Vice President. And Linda Fred is a Registered Pharmacist and Vice President of Pharmacy Services.

Welcome to you all. And thanks for being here. Let's jump right in and talk about the good news, the rollout of not one, but multiple COVID-19 vaccines. And finally it feels like we're fighting back against the virus and there's light at the end of the tunnel. So, Dr. Reifsteck, you strongly recommend getting the vaccine.

Brent Reifsteck, MD (Guest): Oh, absolutely. And it's very specific to me as a pediatrician because the current two vaccines that are approved, emergency use authorization only are approved down to age 16. So, pretty much my entire patient population cannot get vaccinated. So, if we have to achieve 60 to 80% of immunity in the population, that includes my kids that can't get vaccinated. So, I need every single adult that is able, once your number comes up and you're able to get that vaccine, I need you to go get it. And I need you to do that because of my kids, because that's how we're going to protect them.

Host: So, what would you say to people still debating whether to get it or not?

Dr. Reifsteck: The basic idea with a vaccine is this is a brand new type of vaccine to the general population, but it's not a new type of technology for science. So, this is a technology that's been studied for decades and they have worked on implementing it for influenza, for example, but a novel pandemic brings a brand new opportunity for them to implement this new technology in the mRNA vaccine that allows us to attack it in a different way. And the hesitation that a lot of people have is, oh, it's brand new. Oh, it came too fast. Well, the come too fast is actually just a function of the fact that as I said, this has been studied for decades and it can be mass produced a lot more easily than vaccine that we have to culture in the lab prior to implementing it and creating it. So, the production's a lot faster. In fact, they were starting to mass produce it before they even got the emergency use authorization. So, by the time they got the green light, they already had millions of doses ready for us.

Host: Now talk just a little bit about how this works in terms of the basics of COVID-19 and the Coronavirus and what that is, and then explain please how the vaccine is needed to treat that.

Dr. Reifsteck: So, Coronaviruses have been around for a long, long time. You know, we have a respiratory panel that we run on patients with respiratory illness sometimes if it's indicated. And before this pandemic, there were four Coronaviruses that were on that panel. And there are other Coronaviruses that are not even important in human disease. So, this Coronavirus is just a virus in that family that happened to mutate in a way that it could come into the human population and infect us and work some pretty bad mess inside of us. So, when that happens and it's happened many times through the course of history, our bodies just don't have a way to fight it off because it's a brand new thing that it's not even seen you know, a version of before.

So, the two things to think about when it comes to this coronavirus or any novel virus, any pandemic, is infectivity and lethality. So, that means how easily can it infect you if you're in the room with somebody who has it, and once you're infected, how virulent is it? How much damage does it do to the body, how likely is it to cause significant illness or even death? And the problem with this Coronavirus is it is significantly more infective and significantly more severe than any Coronavirus that we've ever seen in history.

Host: And it is a respiratory disease, is that correct?

Dr. Reifsteck: Yeah, primarily respiratory and that's how many viruses are spread. You think about chickenpox and you think about the rash all over the body, but it's a respiratory virus, just like many of the others. So, it invades through the respiratory tract and then it can cause symptoms and cause damage in many other organ systems. And we know this as we've studied more about it and that point of entry, that point of invasion into the respiratory tract is where the vaccine comes into play because the spike proteins that make it look like a crown under a microscope, which is why it's called coronavirus because Corona is Latin for crown; that spike protein is what the mRNA in our vaccine codes for. So, the vaccine basically tricks our own cells into making coronavirus spike protein. Then our body labels that as foreign, but our bodies are not making full Corona virus, just the protein, that invades. So it's pretty ingenious actually.

Host: Well, let's also talk a little bit about the value of herd immunity and how the vaccine can help to stop the spread.

Dr. Reifsteck: I love this question. Partly because it's an area that is still being explored. Herd immunity is something we know a lot about. There are two ways to achieve herd immunity. One is through vaccination and one is through natural infection. And the goal here is, we are all part of the same herd and what we need is enough people to be immune to the virus that, that herd of immune people protects everybody else.

Host: And the vaccine is very effective 94 to 95%.

Dr. Reifsteck: Correct? Yeah. So when you follow the vaccine series, once you finish, like I got my second dose yesterday. So, within about a week or so, I will have less than a 6% chance of catching Coronavirus should I come into contact with it. So, the goal here is to get to some threshold and experts go back and forth because it involves a lot of math, and there are a lot of different variables. But we're talking about somewhere between 60 and 80% of the general population needing to be immune, either by vaccination or by natural infection before we can achieve that herd immunity, which will knock this virus down to the point where it's not going to pass through the population as readily.

Host: That's very interesting. So, Linda, as a pharmacist, perhaps you can tell us a little bit about how the vaccines were made and approved and what this shows about their safety.

Linda Fred, RPH, MPA (Guest): So, I think we need to all understand that the vaccines are very safe. The production process and the approval process from the FDA, although it was modified for these vaccines, I believe still has produced a vaccine that's very safe and effective to use.

Host: And talk a little bit about the scientific approval process.

Linda: So, one of the things about the approval process with these vaccines is that we've been doing research on these types of vaccines for many years all the way back at least to 2003, where there was a SARS outbreak in other parts of the world. So, the SARS vaccine development process is not new. I think the other thing that's really key is that the because of the urgency of needing to get vaccine to the market, they were allowed, the manufacturers were allowed to essentially run various phases of the vaccine production process simultaneously instead of sequentially. So, they were able to get a finished product in a much shorter timeframe.

As Dr. Reifsteck has already alluded to this is an mRNA vaccine, so there are a number of different ways that vaccines can be produced. Many people are familiar with either a live attenuated vaccine or a killed vaccine production process. And those types of processes actually use either a weakened form of the live virus or a killed form of the virus, or a small component of the actual virus to generate the vaccine. But this is an mRNA process. So, there's no actual virus material in the vaccine. I think that's a question that a lot of people have had. There's no opportunity to transmit the disease by taking the vaccine because there's no viral component of the virus within the drug. The mRNA process as Dr. Reifsteck was talking about, it uses messenger RNA. That's what the M in mRNA stands for, so, messenger RNA is our body's mechanism of passing information from cell to cell. So, this mRNA brings essentially a pattern for how to make the spike protein, and then we produce antibodies against the spike protein.

And there are a lot of benefits to doing the mRNA process, because it does allow us as Dr. Reifsteck alluded to, to bring these products to market much more quickly. You don't have to do a culture process to produce viral components to make the vaccine so it's quicker to produce. And it's also, more adaptable to different types of viruses in a shorter timeframe. So, again, I think that it's just important that everybody get the vaccine as soon as they are able to do so. As soon as you're eligible please come in and get the vaccine.

Host: So Elizabeth, from a nursing perspective, what are your thoughts on the safety of getting vaccinated?

Elizabeth Angelo, DNP, RN-BC (Guest): Yeah, great question. I think there's been so much care and deliberation that's been put into place to make the vaccination process itself really safe. We're operating off of evidence-based guidelines and following such strict hygiene and protection protocols that the risk of coming in to get vaccinated is incredibly low, extra cleaning, social distancing. We're taking all of those precautions to make it a really safe experience. And, you know, I just want to add, that nurses are excited to get this vaccine and that it represents just a meaningful, tangible, step that we can take to address the events of the past year and to build toward a more hopeful 2021. So, it's been exciting to see colleagues get the vaccine. For many of them, it's really emotional and exciting. We've been waiting for this a long time.

Host: Yeah, thank you all for that. And it's just incredibly hopeful and hopefully it'll ease any worries that people might have had. So, in terms of logistics, can you tell us a little bit more about who is able to get the vaccine and when, and let's begin with Dr. Reifsteck please?

Dr. Reifsteck: So they came up with a tiered approach and that was all designed to get protection to the front lines first Behind the scenes at the hospital, there's just an inordinate amount of folks who are benched because of exposure or because of quarantining or because of isolation. Like Elizabeth said, we are very, very careful and follow strict guidelines about how we are delivering care. So getting vaccine to that frontline first, to protect our frontline workers and to see all of them so excited, all of us, you know, getting to the front of the line to make sure that we can be protecting the patients that we care so much about is great. And then, it'll go out to frontline workers in the community as well as our at-risk populations would be next. And then folks down the line as time goes on. So the tiered approach is set up to try and get the vaccine to the highest risk people first or the ones with the most exposure. And that's what's been exciting to watch.

Host: And then right behind that is people who are seniors. I think it's either age 75 or 65, which, which is it?

Dr. Reifsteck: Each one of those is in a different tier. So, right now we're doing 75 and above in our county, but 65 and above will be next. And some counties are already doing that as early as Monday. So, it just depends on where you're at. And how many doses of vaccine landed in your location.

Host: And I'm assuming that all of us have got to be patient for a while because we’re talking about a huge number of people in line here.

Dr. Reifsteck: Yeah. And in the beginning they were holding back. If you signed up, you were signing up for two doses and they were holding back that second dose to make sure that we were getting the same manufacturer for that second dose. They've talked about releasing that but everybody does need to try and be patient. You've done a great job since last March of social distancing and taking all the precautions and wearing a mask in public. The end of the road is in sight. So, keep doing it just a little bit longer, be patient with us. Everybody's doing their best, but we'll get you your vaccine.

Host: So, there's also a way that you can get information on social media. So, I'm wondering if you can talk a little bit about that.

Dr. Reifsteck: Well, social media is a double-edged sword. You can get lots of great stuff there and lots of misinformation. So, it's important to go to the, the good sources, the CDC, and your trusted medical providers and things like that. But sharing and posting about the positive aspects, because this is a really positive thing and your support one way is #VAXupILVaxupIllinois to help show your support and show that yeah, I'm going in to get it. You know, we all post our vaccination pictures. Once we got our vaccine, we take our picture and post it, just to show that hey, I'm getting it too. I want you guys to all get it when it's your turn that's a great idea.

Host: Yeah, thanks for explaining that. It's pretty exciting. And I understand that once we get the vaccine, we'll need to return a few weeks later to get a second shot. Can you tell us a little bit more about that? And also about how much the vaccines cost Linda.

Linda: Sure I'd be happy to speak to that. So, both of the vaccines that are currently available on the market do require two doses. One of them is a three-week interval between the two doses and the other one is a four weekend interval. And so it's important when you come in to get your vaccination, your first dose, that you're confirming your availability for the second dose. You're not fully immunized against the coronavirus until you do get that second dose. So, it's very important that you come back either in three weeks or four weeks to take care of that, to complete your vaccine.

Host: And what about the cost?

Linda: The cost at this time is being fully covered by the federal government Locations that are providing immunizations do have the ability to bill for the administration fee or the cost of the people who are there to provide the vaccination, but that will be billed to insurance. And there is at this time, no expectation of costs to be passed along to the people who are being vaccinated.

Host: And to find out more, I understand you can call your insurance company with the member ID.

Linda: If you have any questions about your coverage, you can look on the back of your member card and there should be a number there that you can call for additional information about your coverage.

Host: So, thanks so much for explaining that. Elizabeth turning to you now, any last thoughts about the vaccine?

Elizabeth: Sure. One thing I'd like to share is just how important it is for everyone to continue the good practices that we've began around masking and hand washing and social distancing. As we discussed, it's going to take a while to distribute the vaccine to everyone who needs it. And there's still going to be vulnerable members of our population like kids for whom the vaccine isn't approved. And so it's still important for all of us, even after we get the vaccine to be diligent around masking and avoiding close contact with sick people.

Host: Very important advice. So, switching gears, I wanted to talk a bit about mental health and wellbeing. The past year has been so tough for so many of us. And it's really hard to cope with all the ways that the pandemic has affected our lives. Elizabeth, I know that your nurses are on the front lines, seeing thousands of people every day, but how do you think the public is doing?

Elizabeth: I think that this year has been challenging for everyone, and it's so important for us to talk transparently about the impact to mental health from all of the additional stress and uncertainty and isolation. And so, I think many people are dealing with a level of anxiety and depression that they potentially haven't experienced before. And it's so important to reach out for support. There's never been more resources available virtually for mental health and so many therapists and support groups have taken those services online to be more accessible, even when we can't gather together physically. So I think those feelings are pretty normal and very widely felt at this point and certainly nothing to be ashamed of.

And then, there's things that we can do to care for ourselves that really do make a difference in terms of combating anxiety and depression, things like being physically active and staying connected with loved ones, even if that's a telephone call or a FaceTime, instead of in-person. Those things are so important in helping us to maintain a sense of normalcy when so much around us is just different.

Host: So, in terms of medicine, Linda, anything that you might recommend or don't recommend.

Linda: So, there are a number of medications on the market obviously, for depression, anxiety managing stress. But that's a very individual decision that a person should make with their healthcare provider. There are a lot of non-pharmacologic things that you can do as well to reduce stress, meditation, yoga more exercise just a lot of other types of opportunities available.

Medications are the right choice for some people, for many people, but you need to have that conversation with your provider. I think it's important that we all also understand that there'll be, as those were said, are normal feelings to have right now. And that we need to not associate stigma with having to be medicated or needing to use some additional means of relieving stress or anxiety at this time.

Host: Yeah. And finally, I know just how tough this year has been for adults. And I can't even begin to imagine how scary and stressful it might be for kids. So as a pediatrician, Dr. Reifsteck, can you talk a little about any advice for parents? How can they help their kids cope with all that's been going on?

Dr. Reifsteck: I love that question because the reality of things is kids are in the here and the now. They don't dwell on things like we do as adults. And they really do take their cues from the adults around them. So, the best thing you can do for children, is be honest, be realistic and be calm because they're going to take their cues from you. And really what they're looking for is, is it going to be okay? And it is, it's going to be okay. We're going to get there. You know, one thing that I harp on whenever I give a presentation or a lecture, usually when I get to the end, because it's usually not a fun subject that I'm talking about is this world is not going to take care of us.

So, we have to take really good care of ourselves. And really, really good care of each other and being calm and nurturing and making sure you know that whatever you're going through, how you react to it is going to rub off on the kids. So, taking a moment, taking a breath and making sure you're not hiding things, be upfront and honest, kids are resilient and they can handle a lot more than we give them credit for. They're also a lot smarter than we give them credit for most of the time. So just allowing them to be a part of it and making sure they understand it's going to be okay.

Host: That's such helpful advice, Dr. Reifsteck. Thank you so much. And thanks to all three of you for taking time out of your busy schedules to talk with us today. And, please thank all your fellow doctors and nurses and pharmacists for all that you're doing to keep our families safe during these difficult times. Really their courage and your courage is inspiring to all of us. And there's definitely going to be better days ahead. The vaccines are truly a game changer.

Dr. Reifsteck: Absolutely.

Host: That concludes today's Hally HealthCast. I'm Alyne Ellis. Tune in next month, when we talk heart health and keeping your ticker ticking. Hally Health is your partner in helping you live your healthiest life. Visit hally.com for resources, information, tips, and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in next month.