Transcription:

Caitlin Whyte: As hospitalized COVID-19 patients begin to rise again, Health First wants to keep Brevard community members informed so they can stay safe and well. So we're talking to Dr. Jeffrey Stalnaker today. He is the Chief Clinical Officer of Health First.

This is Putting Your Health First. I'm your host, Caitlin Whyte. Now, doctor, we're talking about Omicron today on top of everyone's mind. So to start us off, how is this variant different from previous COVID variants?

Jeffrey Stalnaker, M.D.: You know, we've had a Beta and Alpha and Delta and Gamma and so on, and what's a little bit different about Omicron is those previous variants had roughly, you know, 10 to 12 sort of mutations within that spike protein, the part of the virus that allows it to attach to our cells and infect us. In that area, Omicron has 36 mutations, that's three times as many mutations. Though it's not necessarily the number of mutations is what they are and where they are.

So when we get a new variant, you have to kind of think of it in three different ways. One, does the mutations in this variant make it more infectious, number one, and/or does it make it more virulent? In other words, are you more likely to get sick if you have it and be hospitalized or worse? And then the last thing you have to think about with the variant is do these mutations, are they going to allow it to sort of get around our immunity, if we've had a vaccine or we have natural immunity, the variant somehow protecting the virus against that?

And you never know when you first get a variant, you know, which of those things are going to be impacted until you study it in the population. But as it turns out with Omicron, it's definitely more infectious, about three times more infectious than Delta was. It does appear to be less severe when you get the infection. So we're seeing less folks ending up in the ICUs or on ventilators. And it pretty much has been shown in the laboratory and so on that, like the other variants as well, that our immunity is not as strong as it was against the original or the wild strain, that those mutations have, you know, created some defense for the virus. And we're seeing that particularly with Omicron, as opposed to Delta in that we're seeing a lot more folks who are vaccinated, but also getting COVID, fortunately very mild if they're vaccinated. But with Delta, we just didn't see as many people in the community as well getting it compared to Omicron.

Caitlin Whyte: Now tell us what you've been seeing at Health First. Has there been an increase in COVID patients?

Jeffrey Stalnaker, M.D.: Sure. So yes, our hospitalizations are up. When we had the Delta surge back in the summer, about a third of our beds were occupied by COVID patients. This time around closer to about 20% of our beds that are being occupied by COVID, so we're having less folks hospitalized. Unfortunately, it's catching us in the winter where our capacity is normally up anyway unrelated to COVID. So we're feeling almost a very similar strain in terms of bed occupancy that we saw in the summer because we have more non-COVIDs in as well.

Caitlin Whyte: Now, I know testing can get pretty confusing these days. I have a few questions myself about it. So when should we test after a suspected exposure? Is there a delay after exposure? How is that all working out with Omicron?

Jeffrey Stalnaker, M.D.: Yeah. So testing is very confusing and there's been a lot out there. And there is not necessarily an absolute right answer. So the CDC has some guidelines out there. Some folks in the public health sector have criticized the guidelines. Maybe they're not perfect, but they're trying to strike a balance between the fact that we're having issues with getting tests. We have supply chain issues again, where tests are not necessarily readily available or at least to the number of people who are being infected with Omicron, so you have to make some compromises.

So first of all, if you're exposed, it's important to determine is it really high risk exposure or not? And the high risk exposure is if you're within six feet of someone for a cumulative 15 minutes or more where you haven't taken any precautions like masking. So that would be more the kind of thing that would occur maybe within a family or perhaps close friends that have gathered for a holiday or whatever. So if it's not a high risk exposure, really there's no point in testing at all, and your test is going to be negative. Highly likely it will be negative, so no point. Take precautions and that's all you have to do.

If it's a high risk exposure, and again, you're not having any symptoms, and there's some controversy around this, but honestly, in my opinion, probably never need to end up having a test. If you have no symptoms, you should take precautions, you should wear a mask. But the reality is your test, particularly early on, is highly likely to be negative. And these tests become more likely to be positive as you get further into your disease, sort of maxing out around day three or four. So for example, the next day, and I get a lot of phone calls for this, "Hey, I was around a friend and now they have COVID. I'm fine. Should I go get a test?" Right? And it's like, "No, because it's likely it's going to be negative." It's been a day. So really, you know, you're kind of at some risk over those first five days. Just to be careful, wear a mask, look for symptoms. But, you know, again, there's some controversy. Do you test? Do you test at day five? Or do you just go about your business, wear a mask for those 10 days and move on?

So I think the latest CDC guidelines is to not test. Here in the state of Florida, the Florida Department of Health is suggesting not to test and they tend to be a little more aggressive with their COVID advice, but I think it's probably prudent. I'm not sure there's a lot to be gained. You also have to consider, you know, what kind of tests, because some have more false negatives than others. If it's a PCR, that's a pretty sensitive test. If it's an antigen test, what people call the rapid test, not as sensitive and so more likely to get a false negative anyway.

Caitlin Whyte: Gotcha. Well, like you mentioned, winter brings patients into the hospital for plenty of other reasons that aren't COVID. So what is Health First doing to keep non-COVID patients safe?

Jeffrey Stalnaker, M.D.: So, yeah, our program, which is really from the very beginning in early 2020, beyond sort of beefing up our normal processes around sterilization and that type of thing, I think people really need to understand this is a respiratory virus and though those other things are very important, you really have to consider, you know, what you're doing to protect people from respiratory exposure. So since the very beginning of the pandemic, we have required masking within our clinical facilities. We've never gone off of that. So if you're a visitor or an associate that works in our hospitals or our clinics, you do have to wear a medical-grade mask. That's important.

The other thing we did was we have been able from the very beginning, and even at the peak of the Delta surge, we've been able to put COVID-positive patients in negative pressure rooms. We made a lot of renovations, so to speak, in our facilities in a short to intermediate term, allowed us to take regular rooms and turn them into negative pressure rooms. So throughout, we've been able to handle all of these folks. So that's certainly also, you know, increased the safety factor. You know, we have robust requirements with our associate health department around monitoring folks who may have symptoms, may have COVID, distinguishing exposures and high risk exposures, making sure that, you know, we keep them out of the environment, work remotely or whatever until it's safe to do so.

And then the last thing is just encouraging everyone to get immunized. It does make a difference, though you can certainly still get COVID if you're immunized and we've seen a little more with Omicron. There's still many, many more people in the community or in the hospital with COVID who are not immunized. It makes a huge difference. So for us, the vaccine is important.

Caitlin Whyte: Well, wrapping up this conversation, doctor, what can our community members do? You, me, everyone else around us, what can we do to keep each other safe?

Jeffrey Stalnaker, M.D.: I think moving back to where I ended, get immunized. It makes a huge difference, not just for yourself, but your family, for the people around you. It's not going to stop the spread of COVID. COVID is going to be here a while. We've got billions of people around the world who are not immunized. And so probably, you know, variants will keep coming. But if we're immunized, the chance of us getting it is much smaller, the chance of us transmitting it is much smaller, the chance of us requiring healthcare resources. So right now, we've suspended elective surgery in our hospitals because we don't have the bed capacity. So again, if we can avoid folks having to be in the hospital, taking up those beds and those resources and the staff, we can deliver other types of healthcare, the normal type of healthcare that we do that right now is being disrupted by COVID. So if there's one single thing that the community can do and folks in the community can do, is be immunized.

Caitlin Whyte: Wonderful, doctor. Well, anything else that we didn't touch on that you'd like people to know about COVID in our area?

Jeffrey Stalnaker, M.D.: I think we've done a good job as a community and in healthcare, whether it's our system or our other healthcare system colleagues in the community, we've all banded together to sort of get through it together. And I believe we'd done the best that we could do. The only sort of disappointment I have is I don't think we have, you know, high enough percentage of individuals immunized that reasonably we could. And so we're continually encouraging folks in our community, the single most important thing that we can do.

Caitlin Whyte: Well, doctor, we so, appreciate you joining us this first episode and keeping us briefed on the Omicron variant and how it's affecting our community. To stay up to date on COVID-19, visit hf.org/staywell. This is Putting Your Health First. I'm your host, Caitlin Whyte. Thanks for tuning in.