Transcription:

Prakash Chandran (Host): After months of anticipation, development, clinical trials and regulatory reviews, the COVID-19 vaccines are finally here and being distributed all over the country. But what's the latest status? And how does it affect you? We're going to talk about it today with Celia Mills, a Registered Nurse and Administrator of Care Coordination and Community Health and Dr. Stephanie Crapo an Emergency Department Medical Director, both at Ridgecrest Regional Hospital.

This is the Ridgecrest Regional Hospital podcast. I'm Prakash Chandran. So, it's great to have you both here today. Dr. Crapo, let's start with you. We all know that this vaccine was released in record time. And I think the question on everyone's mind is, is it safe?

Stephanie Crapo, MD (Guest): It is a great question. And it's one that I get asked a lot. So, many people do call this process rushed, but I don't think that actually characterizes the way this all shook out. The vaccine is being distributed to the public with the FDA's emergency use authorization or EUA. But that doesn't mean that corners were cut. So, the study went through the usual three phases, phase one and two, determining the safety, with phase three, showing the vaccine's effectiveness. Phase three of the trial actually used over 40,000 participants, had good numbers, over 95 immunity, once people had two doses and the participants were monitored for two months after the final dose.

Under normal circumstances, after phase three, the FDA would require a two year monitoring process before they give that FDA approval. This two year wait is not to test the vaccine safety or effectiveness. We already established that in phases one through three, but to see how long the immunity lasts, i.e. does it need more boosters after a year or two. So, using the FDA's EUA instead of waiting for the full FDA approval, allows us to get access to the vaccine without having to wait those extra two years. It's just as safe as any other vaccines, since bad vaccine reactions typically happen closely after the injections, not months or years later. The COVID vaccine trials are still ongoing as they still need the two years of monitoring before they get that FDA approval.

Host: Yeah, that's very reassuring to hear. And you talked about the different phases of development, but I also know that there are different phases in which this vaccine is being rolled out. So Celia, I want to move to you. Can you talk a little bit about these rollout phases for the vaccine?

Yes, certainly. So currently we are vaccinating in phase one and phase one B phase one a are your healthcare workers, residents in skilled nursing facilities and assisted living facilities, LA paramedics, EMPS. Dialysis centers, public health, field staff, and people who are working with, clients out in the community.

And then phase one B, which is the most recent phase to open up, includes individuals that are 65 years and older emergency services, food and agriculture, and, Also excitingly education and childcare. And we are working with, local schools and childcare facilities to assist getting that employees vaccinated so we can get our kids back to school.

Host: And Celia, do you know anything about the timing of when these phases begin and end? You know, you mentioned the first responders are in that first phase and then the elderly and then it opens up a little bit more, but what can you tell us about the timing? And also more specifically when someone like myself, I'm almost 40. When can I expect to get it as well?

Celia: That's a question I'm sure a lot of people have. So, we have had three phases already in process. Phase one-a with those critical frontline people I was talking about people in acute care, also dentists, pharmacists, people at skilled nursing facilities, including residents and the staff, and also in assisted living facilities. And we've been vaccinating those people for some time since the vaccine came out. Just recently Kern county announced that we would open phase one-b, which is the 65 years and above. And so, this is the current phase that can be vaccinated along with anybody eligible in phase one-a. And Kern County has been pretty good at watching how we are vaccinating, how many people were vaccinating and opening up the phases, once they feel that we've completed enough vaccinations in the phase that we're currently in.

So, we're looking at coming soon people who are educators and childcare, other emergency services, grocery store workers, people working in agriculture and then phase one-c would be coming following those people 50 to 64 year olds. Sorry, we haven't got to you yet. And anybody aged 16 to 49, who has underlying diseases or disability and other essential operations. And then following that, we'll open it up to other age groups who do not have serious illnesses. So, that would be the phase that you would fall into.

Host: And just one more clarifying question here, how do I get notified when I can take the vaccine? Do I get a letter in the mail? And most importantly, once I get any sort of notification, where can I go to get it?

So up until now, we had a number that you could call. And anybody who called that number and left a message for us. We have your information and we are calling you back. However, now we're switching to a different form of scheduling people. And what you can do is you can go to. My turn.ca.gov and sign up to get notified on when you're eligible and where you can go and how to schedule again.

That is my turn.ca.gov. and. They will notify you when it's your turn to be vaccinated plus where you can get your vaccination. You can also follow when your face may open up by looking out the, Kern County public health website at the COVID 19 vaccine schedule. And that will let you know when your face is about to be, or is open for vaccination.

Host: I, for example, look at that website and see that I am eligible to take it, where exactly what I go? Do I go to my local pharmacy? Do I go to the hospital? Talk a little bit about that.

Celia: So, yes, we can provide vaccines at the hospital. We've actually worked out an excellent process for doing that. It's going to be what we call a drive-through experience. So, you'll be in your car the whole time, including collecting the information before the vaccination, receiving the vaccination and then being monitored for 15 minutes after the vaccination. We ask that people wear comfortable clothing so we can access the shoulder because that's where we give the injection. And after your 15 minutes are up, a nurse will evaluate you to make sure that you're, you're good to go home. We have also heard that local retail pharmacies will be receiving some of the COVID vaccines and they are taking appointments also.

Host: Dr. Crapo, I'd like to shift to you for a minute. What exactly happens when you get the vaccine?

Dr. Crapo: So, after you have the injection, you'll be monitored briefly at the vaccine clinic for an allergic reaction. Severe allergic reactions have been noted to happen from this. Although it is very, very rare. More commonly people will have some of the side effects that have been reported such as pain and swelling at the injection site, sore muscles, fever, chills and headache.

Host: And I just want to expand on the process of getting the vaccine itself. I hear that it is in two separate shots. And so can you talk a little bit about the first shot, it's efficacy and then when the follow up shot is administered,

Dr. Crapo: Sure. The, it's not uncommon for vaccines to be given in two shot series. If you look at the pediatric vaccination schedule, you'll see that many of those vaccines are in multiples in order to get complete or the full efficacy of the vaccination. So, after the first shot of the COVID vaccine, we're seeing somewhere around 50% immunity and after the second, it's closer to 95% effective. And then, sorry, I think you had a second part to your question.

Host: Yeah. The second part to the question is just around when the second shot gets administered.

Dr. Crapo: Oh, thank you. When a second shot gets administered depends on which vaccine you get. With Pfizer, the recommended timeframe is 21 days after your first shot. And with Moderna, the recommended timeframe is 28 days after your first shot.

Host: And Dr. Crapo staying with you. You know, I think the general consensus is that everyone should get vaccinated, but I'm wondering if there are people who actually want to take special precautions before getting their vaccine. For example, if you fall within a certain age demographic or you are pregnant, can you speak to this a little bit?

Dr. Crapo: Absolutely. I'm happy to. In the phase three trials with the 40,000 people, they evaluated the effectiveness and safety of the COVID vaccine in all sorts of different populations. So, let's address some of those specific situations here. First, is the elderly and it has not been shown to be unsafe in elderly, and it is definitely recommended. And they, as Celia said, the elderly are one of the first groups that are recommended to receive the vaccination. Next, if you've had a severe allergic reaction to medications, you should talk with your physician prior to receiving the vaccination. The ingredient list on these vaccines is short and does not include some of the more common allergens like eggs.

So, it's most likely that you will still be able to receive the vaccine, but you should talk to your physician first. If you've had a prior vaccination of something else within the past 14 days, you're supposed to wait until that 14th day in order to get the COVID vaccine. And that's just because they did not study the cross-reaction of concurrent vaccination. If you've had prior COVID illness, that is not exclusionary to getting the vaccine, but COVID illness should give you some immunity to the infection, to re-infection I should say. And so you can wait up to 90 days to get your vaccine, but you're not required to wait up to 90 days. You just need to be asymptomatic from your COVID illness. If you had COVID and were treated with some of the medications such as monoclonal antibody infusions, or convalescent plasma, you need to wait 90 days after receiving those medications in order to get the COVID vaccine. And for people who are immunocompromised, they are still recommended to get the vaccination, although it is possible that they could have a decreased response to the vaccine.

It should still be helpful again, but it could have a decreased response. And for women who are pregnant or breastfeeding, they're in a population that is also very highly recommended to get the COVID vaccination. I'm actually breastfeeding my eight month old son and I received for the second dose of the vaccine yesterday. I felt that it was one of the best ways I could protect my baby and my family.

Host: Yeah, that makes a lot of sense, Dr. Crapo. I wanted to talk to you a little bit about how long it takes for the vaccine to take effect. And, you know, we've all heard about its efficacy in terms of protecting you, but once you get vaccinated, are you still able to spread the virus as well?

Dr. Crapo: Yes. Well, the short answer is yes. So, somewhere between 10 and 14 days after receiving your vaccination, you have your, the highest level of the immune response that you're going to develop. And so, that's when we're starting to see the immunity develop. You can still get infected in between your shot and the full immunity. So, that's something to be aware of. And just like every vaccine, it's not 100% effective. So, people who are vaccinated can still get the infection. So, this means that you can also still have spread or you can still spread the virus after you've been vaccinated. This is why it is so important for us to continue measures that we've been doing through this whole pandemic, such as wearing our masks, staying six feet away from people who do not live in your home, hand-washing, all of this, after we have been vaccinated.

Host: So, just as we close here I wanted to talk to you a little bit about what you might say to people that are still nervous about taking the vaccine for whatever reason. You know, Dr. Crapo, you had talked a lot about even though this vaccine was done or approved in record time, it's still followed all of the criteria necessary for any vaccine to be released. But what might you say to the people that might still be apprehensive and Celia we'll actually start with you?

Celia: Oh, well, thank you very much. I think my point for anybody who is nervous is that the benefits of being vaccinated for yourself, your family, the community, far outweigh the risks. I received my first vaccine on Monday. I was a little delayed because I actually unfortunately got COVID 19. I was diagnosed I think four days before I was due to have my first dose. And having, you know, had the disease, I will say that it is not pleasant and I'm a relatively healthy person. And it takes a long time to get over. So, you, you do really benefit from not having less of a risk of catching the disease or having lesser complications from it.

And also you're safeguarding your loved ones and the community. And I had minimal reaction to it, even though I had had COVID fairly recently. I waited 20 plus days. But very minimal reactions. So, I really took it for protection for my family and with the hopes that this time, next year, we won't have to be talking about COVID and encouraging people to get vaccinated and that we will have returned to something close to normal.

Host: Dr. Crapo, do you have anything to add?

Dr. Crapo: Celia said all of it. And all I have to add is that COVID-19 is a really bad virus, with a mortality rate of nearly 2%, which means that it has killed and is going to kill a lot of people, when you consider the millions of people infected with this virus. We also don't know about the longterm effects that this virus may have on lungs and other organ systems involved.

And the more research I do on this vaccine, the more confident I am with its safety and effectiveness. It all boils down to this for me, I believe that just as Celia said, I believe that the side effects of the vaccine are a much lower risk than COVID infection itself. So, I encourage all of my patients, family, and colleagues to get the vaccine when it becomes available to them.

Host: Well, this has been a hugely informative conversation. Celia and Dr. Crapo, I truly appreciate your time. Thank you so much. That's Celia Mills, a Registered Nurse and Administrator of Care Coordination and Community Health and Dr. Stephanie Crapo, an Emergency Department Medical Director, both at Ridgecrest Regional Hospital. For more information, please visit rrh.org/covid19vaccine. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been the Ridgecrest Regional Hospital podcast. Thanks so much. And we'll talk next time.