Heather Lee (Host): Hi there, everyone. Thanks so much for tuning into this latest episode of Medically Speaking. Joining me today, Dr. John Sellick, who is the hospital epidemiologist for Kaleida Health, and also the Medical Director of Infection Control. You and I go way back from my news days. You were always one of the people that I reached out to when we needed to hear about flu and COVID. So, you know all of the things.

Dr. John Sellick: And even going back to ebola. So, that was, you know, a lot of memories. You know, going through the neighborhood here, different studios that I've been in, talking about ebola.

Host: Well, we are glad that you were here in our little studio here today. Give me a little bit about your background. How long have you been with Kaleida Health, and how did you get into medicine?

Dr. John Sellick: Medicine was really pretty much the only thing I ever wanted to do growing up. I originally thought I was going to be what we call a lab rat, and that is someone who does laboratory research. You know, after medical school residency and into my infectious diseases fellowship, I decided that I didn't want to spend my life totally in the lab. If I could have worked something out partially, that probably would've been okay. I've always had an interest in epidemiology, going back to when I was in graduate school. You know, epidemiology in the much larger sense of what we see going on in communities, acute disease, infectious disease, chronic disease, you know, disease related to the environment, et cetera. And the field of hospital epidemiology was just blooming at that point, and it was actually started by a bunch of people who had been with the CDCs, what's called the Epidemic Intelligence Service. These are the people that get on the plane and go out and track down outbreaks of things, and they applied--

Host: The boots on the ground.

Dr. John Sellick: Right. In fact, their little lapel pin is a sole of a shoe with a hole in it because the idea is that the way you track an outbreak is you've got to wear your shoes out by getting there and you know, really looking around. So, they applied all those principles to what we do in the hospital. You know, looking at infections related to care, infections coming into the hospital, use of antibiotics, et cetera. And then, it was just kind of a natural fit for me. So, I started at Kaleida-- I hesitate to say in some ways-- in 1987. So, it's been, you know, a pretty longitudinal kind of picture. Now, that was not Kaleida in 1987. It was Buffalo General yet until the late '90s and then became Kaleida.

Host: Well, we are so happy to have your expertise and all of those decades of knowledge. One of the things when I would call you up before, we would talk a lot about the flu. So, we're going to dive right in and talk about flu shots. I guess first question would be: who needs one and when should we get one?

Dr. John Sellick: You know, the easy answer is everybody should get a flu shot. And we know that not everybody gets a flu shot. But we certainly look at people who are older and older can be defined in many different ways. Historically, you know, 65 was the magic number. But we know that in 2025, we have a lot of people in their 50s who have the same chronic diseases that we always used to see in people over 65. So, certainly, you know, people 50-ish and older would be a priority group, particularly if you have underlying disease, heart disease, chronic lung disease, being treated for cancer. You know, being treated for any of the other immunologic things that you see the advertisements on TV for these very expensive drugs to treat inflammatory bowel disease and arthritis and such. Those are all people who we really prioritize. And again, especially the elderly, flu tends to be very devastating in the elderly.

Host: And then if you have any underlying conditions that can exacerbate it.

Dr. John Sellick: It's a multiplier, you know, and it's not even additive sometimes. It's a multiplicative kind of situation. And then, we also look at young, and you say, "Well, why would a kid need a flu shot?" Again, the same thing if you have a kid with asthma, a kid with other congenital things, getting a flu shot is a great idea. Pregnant women, this has been in the news a lot lately. The risk of influenza to pregnant women is fairly high. So again, everybody should get a flu shot. But there are people that we really target and prioritize.

In terms of when to get it, in general, the protection that you get from the annual flu shot lasts several months. So, you don't want to get it in July when it first shows up, or August when the drugstores first get it. But what many of us like to say is by Halloween, you should get your flu shot, because if the flu season hasn't already started, it's going to start shortly after that. So, that's a good rule of thumb.

Host: Let's say you were, you know, immunocompromised and you got it a little bit earlier just to be safe. Can you get a booster? Can you get an additional shot? What's the timeframe?

Dr. John Sellick: It's possible to get an additional shot, and that used to be part of the plan. We have a hard enough time getting people to get the first one. So, we don't talk quite as much about getting a second one. But in certain groups of people, it's definitely possible to get a second one.

Host: And is it true that you look at previous flu seasons in the southern hemisphere to try to predict what strain we might be dealing with, how bad the flu season might be, and then that helps to work into the vaccine and the creation?

Dr. John Sellick: That's exactly how it works. You know, the southern hemisphere is at the opposite season of what we are. So, what typically happens is you look at what's going on in the southern hemisphere at the end of their season, and then think of that as probably spreading northward as the climate switch.

And that's one of the things that we go with. The problem with that is flu is absolutely unpredictable. There's some biological things about influenza virus that are different than other viruses that allow it to mutate very rapidly. So, sometimes we say, "Well, here's what we think it is based on what they saw in Australia, New Zealand, et cetera." And then, what we wind up seeing is something different. Most of our flu vaccines are still produced in eggs. Influenza viruses are naturally bird viruses, so they grow very well in eggs. The problem is you can only yell at the hen so much to make those eggs. And the companies that do it, they have it, you know, they really have it worked out well. But they need a certain amount of lead time. So, what we're hoping is that with the mRNA technology, is that we would be able to, you know, not that you can just run in the back room and make a new batch, but that we would be able to get closer to the start of our season to see what actually may be circulating.

Host: Yeah. So, there's not much time for things to change.

Dr. John Sellick: That's right. Usually, January, February is when the decision is made. What's going to go into our flu shot for that fall? So, a lot can happen in those months.

Host: I have heard people say, "I got a flu shot and it didn't do a thing," or "I got a flu shot and it made me sick or gave me the flu."

Dr. John Sellick: Yeah. You can't get a flu from the injectable flu shot. Not only is it a killed vaccine, it's not even the whole virus, it's just fragments of the virus. The live intranasal flu vaccine, you could get a mild respiratory illness from that. Now, many people when they get a shot will feel kind of crummy for a couple days. You know, pain, maybe some aches and pains. That's your immune system working. So, that's a good thing.

Host: It's flipping the switch, saying, "We recognize this."

Dr. John Sellick: That's right. "It's time to get going." So, you know, we don't see that. You know, using the current jargon, you know, that's not a bug, that's a feature, is what it comes down to. The problem that we see with flu vaccine and COVID vaccine and RSV vaccine, these are viruses that live on our respiratory surfaces. So, this is different from, say, measles and chickenpox, where these viruses go through our blood system, through our circulatory system. That's why you get the rash all over with these things. Our immune systems handle it differently.

So, these vaccines for these viruses that live on your respiratory mucosa, the respiratory linings are usually not quite as effective. But, you know, in a good year, we usually get at least between 40% and 60% benefit. And the benefit is measured many different ways for someone like me who's hospital based, the big benefit is do I keep you out of the hospital? Do I keep you out of the ICU? Do I keep you out of the morgue? Those are the big benefits. Many times, the testing is done in the community to see how well they work to keep you out of a doctor's office or urgent care or emergency room. So, again, they're not a hundred percent, but they're quite good. And especially people with chronic diseases, you know, one of the things that became a discussion with COVID, which, you know, we may get to is, "Well, are people really dying of COVID or are they dying of something else?" And we've known for decades now with flu, and we now have the evidence for COVID, we now have the evidence for respiratory syncytial virus, RSV, that if you have underlying disease, this may cause you to have a heart attack. This may cause you to have a stroke. This may cause you heart failure.

Host: It's the domino effect.

Dr. John Sellick: That's right. So even though you say, "Okay, this is not an issue of the viruses chewing up all the cells in your lung, but it's causing other things to happen." And again, this is very, very well worked out, showing that people who come to the hospital with respiratory infections have a higher rate of having a heart attack in the months after that. So, there are many reasons to do this.

Host: And it could be, you know, a mild inconvenience versus a severe illness.

Dr. John Sellick: Correct.

Host: We talked about COVID shots. I feel like 2020, 2021, and even into '22, you heard about so many people getting them, getting their boosters. You know, we had the cards right where you would check off when you got the dose. Are as many people getting the COVID shots today and how important is it to get them?

Dr. John Sellick: No, we've had a hard time selling the newer COVID shots. And I think that for microbiologists, infectious disease person like me, that's been insanely interesting how a new disease develops. Because I mean, this is a new disease for humans. And we're at a situation now worldwide that, as long as things keep going with the virus the way they are, you know, most of us have immunity either from having had COVID having had vaccine. Or if you've had both, your immunity is actually even better, the booster effect that you get with that. So, I think a lot of people feel that, "Geez, the last time I had COVID, it was just like a bad cold. Why am I going to bother with this?" But again, you get back to that idea that if you have underlying diseases, if there's something wrong with your immune system, this may not be as simple as having an episode of a common cold or whatever.

Host: And maybe having that conversation with your doctor to talk about your potential risk and, you know, the risk versus reward.

Dr. John Sellick: Yeah. And again, the same kind of thing, everybody can get one. But we really target, you know, the over 50, especially the over 65 people with chronic diseases, people who are on immunosuppressive drugs. And then, at the other end, again, kids and pregnant women. Pregnant women have bad outcomes if they get COVID when they're pregnant.

Host: And we're talking about an entirely new dose, not a booster, right?

Dr. John Sellick: We don't know that yet. There had been a discussion earlier in the year about whether we would continue to use the same booster or whether we would use a tweaked version. And on the original CDC advisory committee, there was difference of opinion on which we should do, which is absolutely excellent. That's the way science works, is that you've got to look at data and see what you come up with. But there will be something available, and we'll see what it is, especially as we, you know, each year go into a new respiratory virus season. You know, we're looking at what's going to be circulating.

Host: What is your response to the misinformation that's out there regarding vaccines, their efficacy, their safety? What would you say to those folks?

Dr. John Sellick: Well, for someone my age, I had measles, I had mumps, I had chicken pox, I had rubella, I had fifth disease. We had all of those. I still remember, even though it was 65 years ago, I still remember having measles and being very ill from that. And we know that, you know, with measles, probably one in several hundred to one in a couple thousand kids who get measles will either develop encephalitis or will die from measles. And we've lost the institutional memory of that. You know, my parents have passed away long ago, et cetera. So, nobody remembers what went on back in the '40s, '50s, '60s, when people would get sick and have these things. So, the vaccines that we're using right now are all extraordinarily safe. And in spite of what people say, they've all been tested against placebo.

Now, each year's flu shot is not retested against placebo because we'd never be able to get it produced in time for the flu season, but the original ones were. And then, we compare the antibody response to the new one to what we had before. But all of these other vaccines have been compared to placebo and the benefits far outweigh any risk with any of these. You know, the messenger RNA does not modify your DNA. We've been through the measles vaccine and autism; multiple, very large studies have looked at this and show that this is not the cause of autism. So, I think we always try to approach this from the scientific point of view and sometimes what we have to do-- years ago, I saw someone who was like the Vice President for Science of the American Academy of Pediatrics and she was on probably after you got to go home and get back to bed. She was on the morning Today Show, and she said, "I'm a pediatrician, I'm a mother. My kids are vaccinated. My patients are vaccinated," and we need that strong message that this is safe and that this is something that we need to do.

Host: It's not something that you would recommend to a patient if you weren't going to recommend it to your own family or get it yourself.

Dr. John Sellick: Exactly.

Host: Are the most serious cases that you have seen or even deaths when it comes to COVID and flu among people who were not vaccinated?

Dr. John Sellick: They're usually among people certainly with COVID. We developed a very large experience with this, unfortunately, early on that people who were unvaccinated, who had no preexisting immunity had much worse outcomes. You know, that's probably moderated a little bit. But we're still seeing literature, you know, medical studies developing the theme that it continues to be, even though we have this community-wide immunity to infection, this continues to be a major cause of death, probably more than flu even. You know, it's definitely the way friends, patients, whatever they ask me, I tell them, "This is a benefit to you."

Host: Yeah. You mentioned RSV. What is it? What are the symptoms? You know, I hear with some of the champion kids and the families that I work with who are very young, "My kid had RSV, my child had RSV," you know, in some cases, hospitalized because it became that serious. But it's not just kids, right? Adults are susceptible as well.

Dr. John Sellick: Yep. RSV is respiratory syncytial virus. It falls into the category that I can safely call crummy little RNA viruses. I like to call them something else. But these are small RNA viruses that have evolved to do very specific bad things to mammals. Humans are mammals. RSV, for instance, when I was in medical school and, you know, early in my career, this was always kid disease. And for instance, last year, the year before, at Oishei Children's are just overwhelmed with RSV cases in the winter. My youngest grandson, who does not live locally, was hospitalized for three or four days with RSV when he was, you know, probably about six months old.

Host: What is it about the little kids that forces that hospitalization? What's happening to them that it becomes that serious?

Dr. John Sellick: Yeah. They have no immunity. So, the only immunity they have is whatever antibodies that they pick up from mom, which is one of the driving reasons to get women RSV vaccine late in pregnancy so that they get their antibodies level up. So, they give that to babies and get the baby through those first few months where their own immune systems are not able to develop this.

One of the things that's happened in the so-called molecular era, so again, you know, going back into ancient history, when I was getting started in my career, pretty much the only way you found viruses, you had to grow them in cells. You know, viruses don't grow on an agar plate, you need living cells. But now that we have all these molecular tests, which became much more common during COVID because we needed them, so now we have found over the past decade, 15 years, that RSV is a major problem in the elderly. There are times that, you know, in a less busy flu season where we may have as many elderly patients with RSV in the hospital as we do with influenza--

Host: Could you get both together?

Dr. John Sellick: You could get both together. Not common, but we do see people get both. So, this is another compelling story in terms of vaccination, because we have very good RSV vaccines now, recently some data coming out showing that clearly they prevent these other bad things like having a heart attack after you have RSV.

Host: And so, you said older adults or adults in the elderly can get the shot. Mom passes the immunity when they're very young. But can children then get the RSV shot when they hit a certain age?

Dr. John Sellick: They can at a certain age. I don't know-- since I don't do pediatrics, I don't know how much that's being done. But from the internist perspective, we're encouraging certainly everybody over the age of 75, that's where the risk really starts going up. And in the group, maybe 20 years younger than that, you know, that 50 to 65, 75 age group, that they should get it too if they have chronic lung disease, heart disease, those kinds of things.

Host: I know that we're not in the season where people generally think of ticks and Lyme disease. We want to switch gears and talk about that. But this is something that you have seen even in the dead of winter, right?

Dr. John Sellick: Yeah. The ticks don't go south with the birds. They hang around. You know, they kind of go underground, as it were. But if you get these warm stretches, they will come out. So if you're doing outdoor activities, obviously, we're always worried about the ixodidae ticks or the deer ticks because that's what transmits Lyme disease. But there are other ticks that transmit other diseases. So, people who are, you know, avid hikers and campers who say, "Well, I want to go to the Blue Ridge Mountains," or "I want to go somewhere along the Appalachian Trail or whatever," number one, you're going to be in a warmer part of the country where there are going to be more ticks around, plus you're also going to be exposed to other diseases like Rocky Mountain spotted fever, which even though it's called Rocky Mountain, most of it occurs more in the eastern part of the country. So, you know, I've seen Lyme disease in January during a warm winter.

Host: Because what's the first thing we do when it's nice outside? We head outside, right? In the winter.

Dr. John Sellick: That's right. You want to go out. And especially if it's really warm, "Wow. Isn't this great? I don't have to wear my down coat. So, I'm out here, you know, trail running in shorts and a tank top or whatever," the ticks are ready to latch on.

Host: What do we need to know about a tick bite or a tick latching onto you? At what point does it become dangerous? At what point can I just remove it and forget about it? Walk me through the steps.

Dr. John Sellick: Yeah. Ticks are interesting. When you look at them biologically, so what they do is they have a proboscis, as Jimmy Durante used to say, you know, noses that actually has like little saw tooth edges on it.

Host: So, they can get in there.

Dr. John Sellick: It plants it in and it makes it harder to get it out. Some of them also produce something that's almost like a glue that allows them to stay attached. Because basically what the tick is doing, and many of these things are transmitted by female ticks, is they're taking a blood meal in preparation for developing the next generation of ticks.

So, most of the time, you know, I grew up at the other end of the state where Lyme disease was much more common earlier than up here. And pretty much any place, parks, campgrounds and things, there are always signs up, you know, "Please check yourself." So when you come in from running or hiking or whatever it is, you check. And if there's a new tick, you can remove that and pretty much forget about it. It takes probably at least 24 hours, some cases longer, to transmit anything. So if you get it off quickly, you don't have to worry about it.

Host: They can be anywhere, right? In your hair.

Dr. John Sellick: Yeah. Absolutely. Absolutely. So, that's why the other advice, if you are out running or, you know, whatever it is that you do, wearing long clothes, tuck your pants into your socks, light colors, so it's easier to find them if they latch onto you. Now, obviously, even in Buffalo in July, if it's 95 degrees, you're not going to have on long shirt and long pants. So, that's where a repellent comes in.

So, you know, when I play golf, at least my legs, I'm always well-covered with DEET because I know if I have to go wandering into the brush, that, you know, there may be a tick. And then, when I get home, you know, I check myself, I check the backs of my legs with a mirror.

Host: Do they like certain parts of your body or is it just kind of wherever is convenient?

Dr. John Sellick: Wherever. Many ticks don't even have eyes. What they do is they sense heat and motion and they hang on-- and it's called questing. They hang on the end of the blade of grass or a leaf or whatever. So, they're just sitting there. So when they come by and they say, "Oh, this must be Heather, temperature 98.6. As soon as she gets here, you know, boom, I'm going to--"

Host: They hitch a ride.

Dr. John Sellick: You know, they don't jump, they don't fly. You know, it's contact with the vegetation.

Host: So, what if you discover one that has been on for a while? Will it look different? Does it look fatter or engorged? And then, how do you remove it? And then, do I save it? What do I do with it?

Dr. John Sellick: Yeah. It's a little bit complicated, but they do become engorged. So, you know, you can go to cdc.gov or many other places and look at pictures of ticks. So even though when they're nymphs or even when they're adults, you know, they're very tiny, especially the deer ticks, the ixodidae ticks, they may look like a little freckle, except that they move once they're on you. But then, once they take their blood meal, they get quite large.

So, you know, there are all kinds of nostrums about how to remove a tick. You have to do it carefully with a pair of forceps, tweezers. That's why I told you about the saw tooth nose that it sticks into you. You have to take them out very gradually. You know, if you just wig out and say, "Oh my God, there's a tick on me," and you start doing that--

Host: You're breaking it off, right?

Dr. John Sellick: You're going to break it off, but the salivary glands are still in there. So, you want to very carefully get it out. All of the other old things like putting nail polish on it.

Host: Using cigarettes, I heard.

Dr. John Sellick: Using cigarettes. You know, that's all nonsense. What you have to do is, you know, very, very carefully wiggle it out.

Host: Yeah. Close to the skin, right?

Dr. John Sellick: Yeah, exactly.

Host: So, do I save it? And I mean, do you take it somewhere if you're concerned that, you know, it might be contaminated with Lyme?

Dr. John Sellick: It's a little bit controversial. In the early days of Lyme disease, the health department would-- the regional entomologist, the insect guy would identify these. That has not happened for years. The commercial labs, you know, you could put it in a cup or screw-top cup and take it to your family doc or whatever and take it to one of the commercial labs, and they'll identify it for you. It doesn't really help us all that much. You know, I'm more concerned that if you all of a sudden have this engorged tick on you and you never noticed it before today, you would potentially be at risk, depending on what kind of tick, where in the country you're getting it, you would potentially be at risk of Lyme disease, Rocky Mountain spotted fever, whatever.

Host: What are some of the signs and symptoms of those? What are we looking for? I know with Lyme disease, oftentimes you hear of the bullseye rash, but not everybody gets that, right?

Dr. John Sellick: That's right. Not everybody gets it. And going back to what you said before, if this thing bites you on the back or on the back of a leg, you may not see it and, you know, maybe your spouse or significant other who says, "Hey, gee, what's that? What's that red thing on the back of your leg or on your shoulder?" or, you know, whatever it is. You know, most of these are infectious, either viruses or bacteria that get transmitted. So, you would have a lot of the non-specific things. You would have fever, aches, pains, maybe chills. Rocky Mountain spotted fever can be a very severe obviously spotted fever. The spots are the rash over your body. The classic Lyme disease is the erythema migrans, which can look like a bullseye. Sometimes, it doesn't look like a bullseye. You know, sometimes it's just a big red thing.

Host: And what's the treatment? Because some people have very severe cases of either of those two.

Dr. John Sellick: Yeah. Yeah. So when someone comes in, for instance, my January person that I told you about, she came in probably a week after it had happened. And she had a beautiful iPhone picture of what her arm looked like when it was fresh and it was still there when we saw her. I don't even bother doing testing in a case like that. I just gave her antibiotics. And that's the recommendation because early on the blood test may not turn positive. It may take weeks before the blood test turns positive.

Host: Is there a cure for it or is this something--

Dr. John Sellick: Yes. Yep. Lyme disease is a bacteria and you get treated. That's the end of it.

Host: Yeah. If it is not treated, then it could be something that's--

Dr. John Sellick: Then, it can become more common. Uh. And in fact, the reason it's called Lyme Disease, L-Y-M-E, not L-I-M-E, is because it was discovered in Old Lyme, Connecticut by a rheumatologist named Allen Steere, who said, "Gee, it's summertime. And I've seen eight kids with what I would normally say was juvenile rheumatoid arthritis, but there should not be that many cases." So, this was when we first identified this Borrelia spirochete that causes it, but very susceptible to antibiotics.

Host: So, just be careful, be vigilant, and we can avoid a lot of these issues.

Dr. John Sellick: That's right. You know, again, depending on your activities, if you can cover your skin, that's great. If not, a good insect repellent is another place where people, "I don't want to put DEET on me." DEET's been in use for decades. It's very safe. It stinks. It can be irritating to skin into high a concentration. Picaridin is another product. Both of these, if you go to any of the pharmacies or big box retail places, you'll see these on the shelves next to one another.

There are a lot of other kind of home nostrums, other different oils and things that are supposedly natural. Natural does not make something safe just because it's natural. And many of them are not very effective. So, I always encourage people to stick with either DEET or Picaridin because we know that those work.

Host: Lots of good advice. Really enjoyed our conversation today. Thanks for being a part of it.

Dr. John Sellick: Thanks for having me. I'm always glad to do these, and anything I can do to help educate the population is great.

Host: Something tells me we might be tracking you down in the future for another podcast visit.

Dr. John Sellick: That's right.

Host: All right. Okay. Dr. John Sellick, hospital epidemiologist for Kaleida Health. Thanks so much for being here.

Dr. John Sellick: Thank you.

Host: And we hope you tune into our next episode of Medically Speaking.