Health Officials in North Dakota Clarify Facts About COVID Vaccinations and Variants

BISMARCK, ND (trfnews.i234.me) North Dakota health officials set the record straight on the Delta Variant and COVID vaccinations.
good afternoon everyone and welcome to the kobit 19 delta variant and vaccination webinar my name is molly howell and i’m the immunization director for the north dakota department of health and we are hosting this webinar today because we’ve been receiving a lot of questions about covid19 but specifically about the delta variant north dakota has identified 25 cases that have been confirmed to be the delta variant which is an increase over previous weeks we expect to have another increase tomorrow in the delta variant when we look at the laboratory data and just as a reminder when we say 25 cases of the delta variant that may seem low that’s because not every individual who tests positive for covid do we do that whole genome sequencing on to understand what variant they may have it’s just a small sample and so we more look at what percent of our variant cases are delta and delta is increasing more than any other variant also for our region of the united states the delta variant is the predominant variant and so it is very likely that in north dakota delta is the predominant variant in our state we have seen increases in cases over the past week right now in north dakota we have 292 active cases the majority of our cases are in the 20 to 40 year old age group that is a low number of cases when you think back to our peak last november and december but we’re more concerned with the trend we’re seeing an upward trend in cases uh also our hospitalizations have doubled in the past week um we currently have 20 individuals hospitalized in the past week though we’ve had 38 individuals hospitalized and eight of those individuals are between the ages of 20 and 40 so we are seeing more severe cases in younger age groups and so we wanted to have this webinar today to inform people about the delta variant and about vaccine effectiveness so you can make a better decision regarding whether or not to be vaccinated we’re lucky enough today to have dr paul carson presenting he is an infectious disease physician and professor of practice in the ndsu department of public health he has over 25 years of experience in various clinical capacities and he works with the department of health on a number of projects related to immunizations and infectious diseases including healthcare associated infections antimicrobial stewardship and vaccine education dr carson does not have any um funding to disclose today he does not accept funding from pharmaceutical companies or vaccine manufacturers and so i will turn it over to dr carson so we can all learn more about the delta variant and vaccination thank you molly good afternoon everyone a pleasure to be with you as molly noted the health department and i myself have received a lot of questions about what does the delta variant mean for us does it change things um what might we expect and as many of you probably have seen you know information tends to come fast and furious with uh lots of um new data kind of pouring in all the time so i’ll try and walk through that with uh you today and and help make some sense of that so what what are these variants of concerns versus variants of interest so just as a sort of background when viruses replicate themselves they can be sort of really good at it or they can be kind of sloppy at it and sometimes they make very exacting copies of themselves and sometimes um they make little mistakes or mutations that are not exact copies of themselves um when they make some of these mutations or changes or inexact copies sometimes most of the time that’s not advantageous to the virus it doesn’t help it but occasionally one of those changes may be advantageous and help it spread further or it might enable it to cause more serious disease variants of interest are just noted um variants that have one or more of these changes variants of concern are those variants that have some evidence of either greater transmissibility or contagiousness or greater ability to either escape our immune system from prior infection or vaccines or greater ability to cause more severe disease and our focus right now is on delta we’ve seen you know alpha which was out of the originally out of the uk beta originally out of south africa and gamma originally out of brazil delta variant otherwise known as b1 617.2 emerged first recognized out of india and has become uh now probably the dominant strain around most of the world so what do we know about delta as the world health organization calls it now they they describe it as the fastest and the fittest it seems to be able to out compete all the prior variants wherever it emerges and um we know that the alpha variant which uh again emerged first recognized in the uk uh rapidly replaced the original strain which was first identified out of wuhan china um that variant was significantly more contain contagious in the original strain about 43 and some estimates as high as 90 or almost double the contagiousness of the original strain delta has now been compared to that alpha variant and is about 65 percent more contagious when we look at it in a very good setting to study the sort of thing which is like households where an index case come in comes in and how many um household contacts end up getting infected and it’s about 65 percent more than what we previously saw with the alpha variant which was already you know 43 to 90 more so this is we think at least double at least double what um the prior original strains were for contagiousness and um and we saw that really take uh its toll in india um so india had really kind of escaped big surges or bad surges uh throughout most of the pandemic they had kind of patted themselves on the back for you know thinking they were doing everything right um and perhaps they were perhaps some of it was unrecognized but it really changed um in march and april and then taking off in may in particular in india where they had an explosion of cases there and we had you know some of these horrific scenes of um outside crematoriums burning you know all day and all night to try and handle the mounting dead bodies that uh rapidly exceeded their morgue uh and uh capacities um and interestingly uh an antibody study was just done in the wake of all of this in india cases are on the decline there but an antibody was a study was done on about 27 000 india residents from multiple areas around india and they actually found about 67 percent of uh india residents had evidence of antibodies to uh the coronavirus so that that’s a huge uh number and i’ll remember that number here because i’m going to get to sort of how that compares to where we are in the united states but but it rapidly swept through and and apparently caused infection in almost two-thirds of the population uh of of india in a very short period of time and now it has become the predominant strain in the united states the delta variant is represented by the dark uh orange here you know the lighter or orange is the uk alpha variant and you can see that um as of mid-july 83 of the sequenced variants that uh are being tracked by the cdc are now uh delta and looking at that regionally um it varies from region to region but uh um you know we’re not sampling a lot here in north dakota but around us they some of the states like minnesota sampling quite a few um it’s looking like well in the 90 range of uh variants that are sequenced are delta so it’s here it’s spreading um it’s if it’s not the predominant strain now it it will be very very shortly and i think it probably already is and um this may be uh in part maybe in large part responsible for the significant uptick in cases that are now being seen in multiple states so um this was just from a few days ago looking at the um cases and surges in different states and you can see uh that in several of the southern states now there’s marked increases in the case counts um starting to get close to what was seen um in their previous largest waves that may be for a couple of reasons i think the obvious reason may be because of delta it also may be like we saw last summer uh during the summer the southern states are very very hot we’re seeing you know very hot summer in most of the united states and in the south when it gets very very hot they tend to go indoors more and sort of indoor congregating and air conditioned air is maybe better at spreading the virus so that might be part of the reason as well let me just focus on three of these states because i think the other part of the explanation may have to do with vaccination rates um so if you look at what percent of the total population is fully vaccinated and we look at those three southern states they’re amongst the lowest in the country the lighter green are the lowest states for vaccination rates total back total population vaccinated in the country and they’re sitting around 34 35 36 of the total population vaccinated north dakota we’re a little better but not a lot better we’re at uh 39.7 percent um contrast that with some of the states right around us like minnesota and south dakota at 53 and a little over 46 percent uh of their uh total population fully vaccinated um so uh what is this delta variant doing in some of these southern states so in mississippi’s sort of a good example it’s clear that delta is causing the surge in cases there it is now stressing and stretching several hospital systems 13 hospitals reported that they had no icu beds available as of about a little over a week ago um attributing that to the delta variant spike um and um it’s been noted that over 90 percent of mississippi’s cocoa 19 cases are among unvaccinated people that’s certainly the trend around all the united states little warning about this you know for future reference as we get more and more and more vaccinated um you will see that number drop you will see that cases may start to be higher in the vaccinated if the proportion may be higher in the vaccinated population so imagine if we had 100 percent of north dakota vaccinated and you had three breakthrough cases uh you could say a hundred percent of the cases are in vaccinated population but of course it would be an extremely low number so you have to look at what’s called the base rate if you’re curious about that sort of thing look up base rate fallacy to see how this is sometimes misinterpreted or misused but right now it is clearly a epidemic in the us of the unvaccinated um there was an editorial in in the paper recently kind of looking uh at north dakota and how we are trending like mississippi and that’s not a good thing on a lot of healthcare measures and and with our vaccination rates being close to theirs it may be a cautionary note for us here in north dakota so um are the outcomes of delta worse what do we know about outcomes and i think the answer is we don’t know but maybe um so there’s some reason to think that it might be um a recent study that was just uh um published online noted that when you swab the throat of people with delta variant infection compared to prior uh variants it’s about a thousand times more virus present in the oral pharynx than in the earlier variants that certainly uh would explain the increased contagiousness or increase increased transmissibility sometimes viral load can also be uh correlated strongly with virulence or or how bad it may affect us so there’s reason to think you know virologically there’s reasons to think why it might lead to worse outcomes a study that was just published from scotland that looked at their public health uh um uh records and database showed that hospitalization rates with delta went up 85 so you were 85 percent more likely to be hospitalized with a delta virus infection than an earlier variant infection there may be some reasons for that to be a skewed skew data if there’s less testing you may be testing the sicker people more but i think there’s reason to believe that at least there’s a component of this that may be truly uh reflective that it it can lead to higher hospitalization rates um and in fact here in north dakota kind of looking at the same thing this is in hospitalization rates in 20 to 29 year olds so young healthy often kind of people that think they’re um you know not at any risk from this and hospitalization rates in that group were relatively low about a half a percent at the highest early on one percent but here in june we’re seeing significantly higher rates of hospitalization in that age group and i uh that may again be an artifact of testing although i can’t imagine it’s that much different from our testing is that much different from you know march uh april uh into may and june uh where we are now seeing a significantly higher proportion of those even young people landing in the hospital with infection which i suspect is being driven by delta so we got several questions before the seminar on whether the vaccine would protect against the delta variant and here i think the news is for the most part pretty good um so when you look at the uk that that’s been ahead of us in all of this delta started to appear in um in the orange here in late april uh rapidly became the dominant uh strain in the uk and and led to a research resurgence or another wave in the uk so it was causing a marked increase in cases there however if you look at their rolling average of cases and then deaths in their second wave which was primarily the alpha variance compared to their third wave which is by far predominantly the delta variant you can see as cases went up and here the denominator is per hundred thousand population and and their proportional deaths um per this is per 10 million population you know deaths went up proportional to the number of cases and this is over time after you know days after that variant was introduced into the population looking at the third wave here um you can see cases are going up but we’re not seeing that dramatic proportional rise in deaths thankfully um and that’s probably because the most at risk population in the uk has been vaccinated um and they are one of the most vaccinated countries in the world right now so um you know cases that are happening there are typically in the younger or the less vulnerable and and some breakthrough cases and people are vaccinated and they don’t get very sick from it so at least as far as deaths in our example in the uk it has not led to a resurgence of of mortality this is a bit of a complicated graph but it’s worth staring at for a couple of seconds um because this gets to what we know which isn’t great yet but we’re accumulating data but what we know about vaccine effectiveness against the delta variants we don’t have really great data from the united states yet but we have data from england scotland israel and canada so on the left here is efficacy against symptomatic infection do i get any symptoms at all and on the right is efficacy against more severe infection hospitalizations so let’s look at the uk england here in their when they had alpha alpha is predominant this is the pfizer vaccine in blue the solid line is full two dose vaccination you can see they were 90 95 percent uh effective against symptomatic infection with delta that dropped um a little uh it’s still in the uh probably right around 90 percent with their astrazeneca vaccine which is a lot like our johnson and johnson vaccine we don’t have astrozenic in the u.s but we have johnson johnson they’re very similar platforms that was uh not as efficacious from the beginning around 68 i think percent if i remember right um and that dropped down to about 60 against symptomatic infection scotland pretty similar uh to uh england overall like with the pfizer vaccine israel has been a bit of an outlier here israel is reporting uh some more significant drops um and there’s a lot of debate in the sort of medical and public health community about how they’re calculating that and how they’re doing that but they’ve reported a drop from you know in the high 90s for uh effectiveness against symptomatic infection down to the 63 64 range and they put out a recent more recent report and these are news releases these aren’t actual published data so we we haven’t had a chance to really look at how they’re doing this and how they’re calculating this they’re saying maybe even as low as 39 percent for protection against symptomatic infection but again they’re an outlier uh england scotland um showing much better protection with pfizer canada showing very little drop um uh from alpha to delta and even with one dose um you can see uh not huge amounts of drop uh some here with one dose protection but then go over to the side with against severe infection you know uh surrogate being hospitalization and very little drop off uh at all um and so i think uh what we see from you know the overall uh um mortality rates in the uk and the overt looking at effectiveness and vaccinated uh population um the story is still very good against um severe illness and deaths one of the questions comes up that came to us beforehand is people who got the johnson johnson vaccine which is again a lot like this astrazeneca vaccine a little bit lower efficacy against symptomatic infection but still very good even with one dose here against the severe disease we do not think at this point there’s any need to recommend doing anything more if you’ve had the johnson johnson vaccine that may change as data rolls in but at this point we don’t think people need to be overly concerned given the very high levels of protection with these types of vaccines against what really matters hospitalization and death so kind of summarizing that we know that delta spreads faster into more people it does seem to be causing uh um young people to be infected more and maybe uh more significant outcomes or worse outcomes in young people it looks like it may be more likely to put you in the hospital and i i think a lot of experts are saying and i tend to believe this myself is that if you have not yet been infected or vaccinated um you’re highly likely to be infected sometime in the next 3 6 12 months these are as we know in the family of coronaviruses coronaviruses have been around us a long time these are the viruses that cause the common cold all of us have been infected essentially all of us have been infected with one of these by the time we’re four years old these viruses um transmit in the same way but they’re unfor unfortunately much more dangerous um so there’s no reason to think this is not going to continue to spread amongst all of us who have not either been infected before or been vaccinated and then finishing with that is vaccines are still looking very protective or particularly against severe disease um so a lot of people talk about you know mortality while i’m young i’m healthy i’m not likely to die um so i already talked about hospitalization your hospitalization is much higher than uh the death rates you’re a lot more likely to land in the hospital from infection um across all age groups um but i think we need to really be thinking hard about uh what we are seeing now with this long covid and it is literally every day a new publication is coming out in our medical literature on uh studies looking at the long-term effects of coronavirus infection and it’s it’s troubling so this was a study uh published in the journal american medical association the summary of 45 studies uh out there and found overall 73 of people this was predominantly hospitalized people not exclusively but predominantly hospitalized people had at least one or more symptoms up at least 60 days out after their diagnosis so two months out the majority of people are still experiencing some kind of symptoms most commonly fatigue difficulty breathing loss of memory um new diagnosis of anxiety or depression persistent loss of taste and or smell now i’m going to show you some data in a second here kind of take take note of loss of memory new diagnosis of anxiety or depression persistent loss of taste or smell and let me show you some other interesting data that may help explain uh some of that but um even if you had milder infection and were not hospitalized this was a study looking at six-month follow-up this was a small group so it’s not a huge study um but these were outpatients with milder disease and you know even in that 18 to 39 year old age group uh over 25 percent had one or more symptoms uh going out six months after their diagnosis and that went up substantially as you got older 30 percent in the 40 to 64 year old age group and over 40 percent in the over 65 year old age group um this was another study just published uh looking at a big italian accord because they got they got their infection very early on so now they have one year data on follow-up after their group of infected people so this was a mix of hospitalized patients and outpatients um about sixty percent i think were had been in the hospital about forty if i’m remembering about forty percent had been outpatients and here again one year out sixty nine percent had one or more symptoms again most often fatigue weakness they reported sleep disorders muscle and joint pain cognitive problems ability to concentrate think memory and respiratory problems like shortness of breath these are substantial uh um ongoing problems lingering months to maybe even a year or more out in this study i i found uh recently published um uh very fascinating this is this was a a study from the uk where they previously had been doing a long-term study looking at a variety of different things like brain structure in a group of british people from the uk so they had all these background mri scans of the brain on people they i think they’re doing this yearly or every other year and they said hey let’s take a look at our group of people with all these serial brain scans and look at the ones that got covered and compared to them to the ones that didn’t get covered so they matched them up by age and underlying medical health and underlying conditions and they took a look and compared 394 coveted patients with 388 well-matched controls who had been getting these serial brain scans before and after the covet epidemic and what they found was a very interesting and troubling they found that the coba 19 patients had significant shrinkage in the gray matter of their brain in five different areas of the brain those areas of the brain are those areas responsible for taste smell memory and emotions so when you see reports of increased anxiety disorders increased depression ongoing troubles with taste or smell difficulty concentrating and you have correlates of gray matter brain changes in the brain in people and these uh let me uh tell you these were almost all outpatients not severe disease not hospitalized patients but predominantly over 90 95 were outpatients with mild you know to moderate disease not requiring hospitalization now that’s that’s very troubling in new england journal medicine just put out a perspective piece kind of you know cautioning the health care systems to get ready for our next national they’re calling it health disaster which is long-haul covet that we and we are now seeing major health systems establishing dedicated clinics multi-specialty clinics to trying to treat and manage people with long-term problems and debility from their prior covet infections so you know we are faced with uh you know choices here it’s and and we’re faced with like how to do the sort of calculus on this how to choose and what what i’ve tried to show you is you know kind of what happens with um you know when you choose to sort of take your chances with the virus and i and again i will reiterate i think you know if you have not been previously infected and you have not been previously vaccinated it’s likely for the majority of you it’s a matter of time that you will be exposed and probably infected with the coronavirus most people will do pretty well but i’ve given you some of the data on what uh can happen um versus um what happens when you take the vaccine so people are trying to weigh risks and benefits right so we need to know uh what are the risks of vaccine and every drug we take and every vaccine we trade take has potential risks so let’s look at those so this is actually already a little bit old this is july 12th we’ve got i don’t know it’s pretty close to i think 190 million uh people that have been vaccinated in the us now and um so that’s a lot of people that we’ve been looking really hard at i mean these people are under a microscope with a number of different surveillance systems that are in place to to understand uh safety and risk we we have traditional symptoms that we’ve had for a long time and we have some new systems that have been put into place that we haven’t used before so we’ve put these under very intense scrutiny some people have heard about the vares or vaccine adverse reporting system that’s one of several different mechanisms multiple different layers of monitoring that we do and it’s actually not the best one it’s it’s useful as sort of an early warning system of detecting things it doesn’t tell us at all about what’s the background rate of these uh uh problems for that you need a control group and we have systems for example the vaccine safety data link that links large health systems electronic databases to compare vaccinated people to unvaccinated people for any kind of question that we’re looking at and these are very robust very useful systems for trying to understand risk and so one of the important things we need to understand whenever you hear somebody say so many people died after the vaccine or so many people had a stroke after the vaccine or so many people had a heart attack after the vaccine it’s very that always has to be contrasted with what’s the background rate of those problems had they not gotten vaccinated this is called a controlled trial so that’s why you hear you know doctors and public health officials get most excited about when we have data from randomized controlled trials or even non-randomized controlled trials what we call epidemiologic studies so what happens when you take 10 million americans over let’s say two months if we gave them something completely benign a sugar pill and watched them and by the way at our peak that’s about how many people we were vaccinating a week about 10 million people a week so just take a given week of vaccinated people um when we were vaccinating the most like in um february or so and watched them for two months this is what we would expect to see 4 000 heart attacks 1700 blood clots almost 4 000 strokes almost 10 000 new diagnosis of cancer and 14 000 deaths so when somebody says somebody died after the vaccine or somebody got a stroke after the vaccine or somebody got a blood clot after vaccine you kind of have to shrug your shoulders and say okay um what does that mean when i know this many people are going to die or get a stroke or get a heart attack regardless of what i give them if i gave them nothing and so we look at that we we do that we try and compare this to background rates we try to compare them to uh control groups and what do we find there are some things that have uh uh certainly shown up certainly we know that like you know the the kind of well-reported side effects of the vaccine like a sore arm or headache or muscle aches or low-grade fevers those are fairly common those can occur in a quarter to sometimes uh sore arm over half of people they’re short-lived uh they tend to be fairly benign um lasting typically one to two days what we’re mostly concerned about obviously is the more serious adverse events and what has been identified by that intense scrutiny there are some anaphylaxis in about two to five cases per million um the thrombosis and thrombocytopenia syndrome that’s been reported with the j j vaccine this is that unusual clotting uh disorder that’s been identified overall it’s about three out of a million people it’s um highest in younger reproductive age females i’ll get more into this in a second now we’ve been hearing about the guillain-barre syndrome a type of um uh autoimmune paralysis that can occur after the j j vaccine that’s been about eight cases per million that’s predominantly found in older males and then myocarditis after the pfizer moderna vaccines the mrna vaccines overall that’s about 3.5 per million in adults about 25 per million in those under 30. and i’m going to get more into that because that’s one of the highest rates of something that we see so we’ll take a little closer look at that but this is what’s been identified with intense scrutiny so what the first thing i’d point out from that is we’re finding needles and haystacks i mean these are extraordinarily rare events and our system is is finding them and looking very hard all of us doctors get multiple alerts from the cdc and our health departments like look for these report them uh send them in we need to know about any and all of these and um and they may not capture everything but they’re capturing uh um of serious adverse events we know that a lot of these systems capture the majority um you sometimes hear they they capture very low numbers that’s we don’t we’re not very good at capturing the sore arms and the headaches and the muscle aches in these reporting systems where you are pretty good at capturing the serious adverse events so let’s take a little closer look at one of these let’s look at that myocarditis in males which is the high risk group it’s for whatever reason it seems to be much higher in in males and particularly young males so this is this is actually a different published study this this estimates uh are on the high end of things there are other estimates that are about half of this but i chose the high end so let’s look at the highest estimates of risk of myocarditis and particularly in males and let me just focus for a second on the 18 to 24 year old age group so because i’m at a university we have a lot of college students let’s focus on them because we have some interesting data that we can compare them to so in that 18 to 24 year old male group it’s about 45 to 56 cases of myocarditis heart inflammation per million uh doses given um and let me just point out almost all of those have recovered well it’s that it’s not caused any permanent problems uh has not led to hospitalization the vast majority um but it’s something of concern and anybody with inflammation the heart sounds kind of scary right so let’s just kind of put it in the middle there let’s say 50 per million cases um per i’m sorry 50 cases per million doses given let’s compare that to some data that we just recently got from a published study um on big ten athletes uh so this is from the big ten conference um it’s like more than ten universities they looked at 13 universities and they uh so they did cardiac mri imaging on athletes so these are people in their prime of their health in almost 1600 athletes after they recovered from recent sars kobe 2 infection so uh what did they find so cardiac mri is the most sensitive test for looking for inflammation in the heart so very sensitive it’s one of our best tests for looking for myocarditis or heart inflammation they found that 2.3 percent of those athletes had evidence of heart inflammation from the virus i don’t know we’re not talking about the vaccine here we’re talking about the virus 2.3 so let’s just sort of put that in in better numbers here so our young man is trying to decide should i take his chances with the virus or should he take his chances with the vaccine vaccine risk if you kind of boil that down he’s got about a one out of twenty thousand chance if he’s in that 18 to 24 year old age group um and again that’s on the high side other estimates put that more at one to forty thousand but i chose the high end one out of twenty 000 chance that 2.3 percent translates in with the virus about a 1 out of 43 chance of having myocarditis that’s just one thing we’re talking about myocarditis we didn’t talk about long covet we didn’t talk about hospitalization we didn’t talk about the very small risk of death those are all also things that um this young man might might have to contend with so just even on the myocarditis thing alone the the the risk the vaccine are um the rest of the virus greatly greatly outweigh the risks of the vaccine on that one parameter alone kind of putting this all together let’s look at the risk in males in all the different age groups 18 to 29 30 to 49 50 64 65 plus here with the johnson johnson vaccine i’m showing this most of us haven’t been vaccinated with that but some have it’s we’re giving out a lot more of the mrna vaccines but looking at the guillain-barre syndrome and the thrombosis and thrombocytopenia syndrome it’s um uh um these are these events are rare except for like in um more elderly males for the guillain-barre about 14 to 17 per million doses um but you know kind of looking here two to three seven to eight uh you know kind of peaking with the guillain-barre out in this older male group with johnson and johnson contrast that with the risk of hospitalization and death based on recent numbers so not our worst this is based on recent numbers with hospitalization rates and deaths um from starting about june 19th so when we’re when we’re much lower what’s our what’s our what’s the risk so hospitalization death light blue is hospitalization dark blue is death i mean it’s vastly outweighed uh the risk of hospitalization and death vastly outweigh these risks of guillain-barre or the ttp syndrome in all age groups um so uh let’s flip over to um the risk of myocarditis um this is uh now with the mrna vaccines and again in that young male group 18 to 29 it’s a bit higher that this these estimates are that from another data set that puts it a bit lower here at that 20 to 27 per million contrast that with hospitalization and death i just showed you the myocarditis from it so skipping that let’s look at hospitalization and death here again significantly outweigh even in that young healthy group you know 300 hospitalizations prevented um you know assuming a million people were exposed to the virus um versus a million people exposed to the vaccine let’s look at females because the risks are a little bit different here a guy ombre is very low risk but the ttp that thrombosis syndrome is a little bit higher especially in reproductive age females contrast that with hospitalization death it’s vastly overshadowed again vastly many more problems with hospitalization or death prevented then these conditions which can be terrible but for the most part usually uh are are reversible they can be very serious though myocarditis in women not very high risk that has not shown to be a big problem it’s very rare and here again um uh mrna vaccines uh prevention of hospitalization death um this is how many cases would be prevented by that same group being vaccinated vastly over shadows these risks so if all this data seems a jumble hard to kind of understand i’ve been asking people do a simple experiment of your own just just your own anecdotal observation data shows from a pew survey around the country that two out of three americans two-thirds of us know someone who’s been hospitalized or died from covet and i’d ask you think about it do you know someone who’s been hospitalized or died from covet um i do uh these were public examples so i’m not disclosing any health information these were in the newspapers and well publicized on the news when senior jeffrey wald was the dear friend of our family he was my pastor for 12 years uh he then moved to jamestown where he was the pastor of the basilica there in jamestown died at the age of 56 from covid and that was a significant loss to my family and my children who knew him very well dave andol had been running for the state legislature he grew up on a ranch about two miles from where i lived uh northwest of bismarck where i grew up for part of my life i babysat him and his sisters um and when i was in middle school he’s 55 years old when he died those were two people that i knew fairly well he was a friend of my brothers these were publicized cases so i’d ask again who do you know and then i’d ask you to think and if you’re one of those one-third of people who don’t know anybody you can probably go one step removed from yourself and think about somebody that you you know an acquaintance that you know or you know you know someone to know someone and i asked this i’d ask a similar question who do you know that’s been vaccinated and do you know anyone that’s been hospitalized or died of the vaccine personally do you personally know anyone who’s been hospitalized or died of the vaccine um and i i will say there might be some urban legends out there that you’ve read but in your personal experience of the people you know have been vaccinated how have they done and just think about uh think about them now another question uh that we’ve gotten a fair amount of is you know i’ve already had covid uh i should be protected right do i need the vaccine and i think that’s a fair question that that’s a very reasonable question and and the answer is i think simple answers we don’t really know for sure how well protected we are but let me walk you through what we kind of do know um so this was a study that was uh recently published by the cleveland clinic and they followed their healthcare workers overall a fairly healthy group um uh probably working age people um over five months now this was pre-delta by the way so we don’t know what delta does to this type of information but over time their unvaccinated workforce just got more and more and more infections until you know over the study period about five percent of them have become infected over that period of time and that and they weren’t looking for infections this is just self-reported like hey i tested positive i can’t work uh for the next uh 10 days and then they looked at those who had been um previously infected i’m sorry not previously infected and vaccinated and none of them got infection but to be fair they looked at their previously infected and unvaccinated and none of them got infected over this five-month span of time so that looks pretty good for both groups vaccinated and infected relatively presumably you know young healthy workforce although you know there’s going to be a mix of risks in there but for the most part looks pretty good this is a different study larger much larger this was out of denmark they have a huge you know uh public healthcare database that they can mine for this kind of data and here they looked a little further out six to seven months and this was how well protected someone was if they had previous infection so what were the re-infection rates and you can kind of see for people under the age of 65 you know pretty good not perfect though um about 20 percent of the 35 to 64 year olds weren’t protected about 17 of the under 35s weren’t protected from reinfection that fell significantly in the over 65 year old age group down to um you know 47 or 53 percent weren’t protected from their prior infection so that’s a little bit of a cautionary uh note there um now what percent of us have been infected that’s kind of a big question we’re we’re actually looking to try and do a study on this in north dakota to get a better answer of you know what how many of us have already had it and might be immune or protected this is a collection of data from the national institute of health and collaboration with um hospital systems and health care systems that draw blood around the country and they’re taking some of that serum and looking to see what percent of it have antibodies this is anonymous they’re not you know tracking individuals so it’s all anonymized um and what they’re what they found over time is this really kind of went up uh starting in january this is out to about may of this year and overall they found antibodies and this is antibodies to the virus not to the vaccine and there is a way of distinguishing that 22 percent of the us population has antibodies from prior infection as of may 2021 that’s not homogeneous it’s uh kind of spotty i started to enter this on a map because they have it by individual state and you can kind of see you know highest in the sort of um central midwest you know 37 in ohio uh states right around us you know kind of low in minnesota and montana pretty high in south dakota for whatever reason north dakota is not included in these surveys i don’t know why it’s like one of the only states that’s not included in these surveys so it’s a gray box when you look up north dakota so we don’t know where we’re at i would estimate we’re probably close to south dakota because we ran sort of neck and neck with them with hospitalizations and deaths they exceeded us by a a bit so i would estimate that we’re a little below this i would estimate we’re in the high 20 percent range 27 28 29 something like that but don’t know for sure but that’s kind of what we’re looking at so when you’re trying to figure out are we at herd immunity well by natural infection we’re nowhere close by adding vaccines on top of that you have to kind of figure out what what percent of the vaccinated population overlaps this population that had prior infection and i think you know at best we’re maybe looking at you know 50 60 60 plus percent of us have some form of immunity either through vaccination or prior infections that leaves a lot of people still out there susceptible uh to the virus so you know should i get vaccinated if i’ve had prior infection um i think it’s a reasonable question to ask um a couple points i would make why i would i would advocate for for getting the vaccine um one there doesn’t seem to be a downside that doesn’t seem to be you know any increased risk or harm and then a few other things we do know from some studies on immune function these are now test tube studies so these aren’t clinical studies so these aren’t as good as like a clinical study we’d like to see the clinical data but let’s look at the test tube people who had minimal to no symptoms from their infection so the people who really kind of got by without getting very sick make much less antibodies than people who were sicker and they fade quicker up to 40 percent in one study lost their antibodies even by a couple months out if they had ver if they had no real significant symptoms so are they protected don’t know i’d be a little nervous if i was one of those i you know oh i tested positive but i had no symptoms at all very minimal symptoms am i protected i’d question that um we know from a study that was looked at with the madeira vaccine that vaccinated people in that study made about 10 fold higher antibodies than those with prior infection typically higher antibody levels typically predict better protection and lasting longer now this is a test tube study it’s not a clinical study so i can’t say that certainly but um it it looks suggestive and then a couple of other studies looked at antibodies from the vaccine and compared those with antibodies from prior natural infection in the test tube against variants so they looked at the alpha variant the uk they looked at the p1 variant from brazil they looked at the um variant from south africa and they did not look at delta i have not seen any data on delta so i can’t answer this but with these other variants the antibodies were better um the vaccine-induced antibodies were better at neutralizing those variant viruses than the antibodies from people who had prior infection so we have some evidence to think that vaccine-induced immunity may be better i’ve read some things now in the news and people posting i you know natural infections better we don’t have any evidence that and i’d say at least in the test tube or what we call in vitro or in the test tube suggests the opposite but that this question remains to be answered we get several questions about children i i think we need to see the data of the vaccine trials that are being done in children under the age of 12. we’ve got moderately good data on children um you know age 12 to 18. um i don’t have time to do you know we could do a whole talk on this but just a few points i would make we have had now over four million cases in the us in children it is absolutely true that they do much much better than adults um and uh and fair better but we have reports of sixteen thousand hospitalizations in children that’s only from 23 states that report on this so i i suspect that number is a fair amount higher maybe double given that we only got less than half the states reporting there have been almost 4 200 cases of the multi-system inflammatory syndrome in children this is a pretty serious illness that really can lay a kid out and put them in the hospital make them very sick um it can affect the heart it can affect number of joints and so on um it’s not well understood but uh pretty hard to see when when your kid gets this and there have been almost 350 deaths from 43 states that are reporting on this so these are much much lower than other age groups but they’re not inconsequential i also would say that we we really don’t know what’s what’s the prevalence incidence and prevalence of long coveted kids there are increasing reports of this of children with lingering ongoing problems after covet lots of research and and research dollars being put into looking at this right now and how significant a problem is this um what might we expect but i think this is a question question mark out there that we have to weigh when we’re worried about you know what’s the vaccine risk we need to worry about what’s the long-term virus risks uh even to our children and then uh if you haven’t read about this uh outbreak in this gymnastics facility you should be aware of it because this might be a little uh hint of things to come for us as we get back to school so um this was an outbreak reported uh of delta variant in an oklahoma gymnastics facility during a gymnastics uh meet i believe and in that facility an infect an infected child came into the facility and um spread it to 26 other uh gymnasts and staff members in that facility um those people then brought it home to another 21 cases of their household contacts the attack rate was 20 percent in that gymnastics facility in other words 20 percent of the exposed people got infection was pretty high compared to other outbreaks we’ve seen in earlier variants the attack rate in households is 53 which is a lot higher than what we’ve seen in um earlier reports of secondary transmission in the household when you looked at the cases by vaccination status 85 of the cases were unvaccinated um six percent or three of the people uh were partially vaccinated four people were fully vaccinated so this points out vaccine isn’t perfect pretty darn good the vast majority of the people that got it weren’t vaccinated um uh but it can it can break through and this is part of the reason why we need more of us vaccinated to kind of protect those you know handful of people that don’t seem to get full protection and two of these people ended up in the hospital one requiring the icu and bear in mind that a majority of the people in that facility were children 63 weren’t were too young to be eligible for vaccines that means they were under the age of 12. so uh uh you know um if it was more adults you might have expected you know potentially more uh hospitalizations and and so on so it was predominantly exposures in in children so this high attack rate this rapid spread in a facility with a largely unvaccinated uh population of kids going back to school i think we’re going to be seeing uh we’re going to be seeing these flares hopefully uh you know our kids do well um as uh for the most part they have in the past but we’re gonna be preparing ourselves for you know how to contend with flares and outbreaks again in in in our kids as they congregate and then as you saw in that outbreak they brought it home to their household contacts to their circle of loved ones um and we all have connections to someone who’s at risk from covid um so if we’re not worried about ourselves who in your family might be at risk i mean we all have uh grandparents we we know often have family members who are immunocompromised or have health conditions that put them at much higher risk and we know that up to 10 by some of those studies aren’t protected even from severe illness so 90 protection is great 10 you know people that may be at risk for hospitalization or even you know death you know who in our family is among that 10 percent um and we don’t know until it strikes or happens so again you know we have that ability to choose but what i’ve what i’ve tried to show you is that the benefits of vaccination vastly in in all of us in the kind of healthcare profession and and public health um you know see this is vastly outweighing the the risks um the benefits of you know uh not getting vaccinated and taking your chances with the virus and that’s why you see you know an ama poll american medical association poll showing 96 of doctors are vaccinated i mean they they they see the value of this and jump to the front of the line when they were able so i’ll just finish with i i hope this helps you in some of your deliberations and your own kind of balancing and weighing risks and benefits um you know if you are now a little more ready to kind of you’ve been been you know there was a lot of people i think understandably watching from the sidelines kind of sitting on the fence wanted to see how things played out we’ve got a lot of data now to see how things are playing out and i’ve tried to share a portion of that with you today if if this helps you with that you know decision to maybe move towards vaccination you can find a place you know lots of health systems are doing this now lots of pharmacies are doing this now public health clinics are doing this it’s not shouldn’t be that hard for you to find a place to get a vaccine if you aren’t certain you can go to vaccines.gov and find um a place near you so i’m you know with five minutes left molly i know there’s the ability of some people to ask questions it looks like maybe you’ve handled a number of those but um anything you want me to try and address yeah sure thank you dr carson yeah i think you addressed a lot of the questions that we received prior to the webinar today um but one thing i was wondering if you could touch on is you know i think people do hear a lot about these breakthrough infections or people who got vaccinated and they’re still getting covered or they’re hospitalized or have died um can you touch more on maybe why that’s happening and then also can you get covet from the vaccine are these people getting covered from the covid vaccine so the last one’s very easy it’s it’s not possible to get covered from the vaccine it’s not a virus it’s um it’s one little bit of material genetic in the mrna vaccines that makes one tiny piece of the virus not anywhere near enough of the components of the virus to cause an infection so it helps us train our immune system to recognize that one tiny piece of the virus when we uh are confronted with it um so it’s physically impossible for it to cause infection um we aren’t we have no vaccines in the country that are um the whole virus either killed or inactivated we don’t have any vaccines like that there are vaccines with for other infections that are like that we don’t have any vaccines like that for for um covid um to the question about uh you know hearing about people who have had breakthrough infections i guarantee you you are going to know people that have breakthroughs uh over time because as you vaccinate more and more and more people um the the infections that do occur are going to be increasingly proportional in the vaccinated but what you have to ask is what’s the attack rate how many people in that vaccinated group are infected compared to how many people in the unvaccinated group are infected every time you look at that it’s vastly more in the unvaccinated group will get infected than in the vaccinated group and if you just think about this if we have five to ten percent of people um that aren’t protected from the vaccine that’s from the clinical trials just let’s take ten percent if i have uh um 200 million people vaccinated which is what we’re approaching here soon if i have 200 million people vaccinated that means 20 million people didn’t get full protection or didn’t get the benefit of protection from the vaccine they’re at the same risk as the unvaccinated group but 180 million people did get protection so you will when you have 20 million people who are or have equal susceptibility to the unvaccinated population yeah you’re going to hear about these reports you’re going to hear about breakthroughs interestingly overwhelmingly those breakthroughs um uh have been in the elderly and in people who have immunosuppressive conditions so i saw a recent report that it was about half of the breakthroughs that especially the ones that were landing people in the hospital more serious have you know conditions that make them a little a little less likely to respond well to the vaccine you know maybe not don’t have as good of an immune immune system and i think that explains the other question i think we often hear from people who haven’t yet been vaccinated well if you’re vaccinated why do you care if i’m vaccinated or not and so that is kind of the concern is that those of us who are vaccinated not all of us are a hundred percent protected against coped especially our elderly and immunocompromised may not be protected and that’s why we have to kind of put a bubble around them by all of us getting vaccinated you touched a little bit on how much more contagious delta is do you want to add anything to that i know some people are talking about what the r naught is of delta versus previous strains can you kind of explain what that means yeah so you know r naught is a is a term epidemiologists use it’s called the reproductive number it’s it’s a measure of contagiousness and what it measures is um in a homogeneous population so with what this would typically mean or not the basic are not is in it in like an unvaccinated population um where everybody’s more or less equally susceptible um when you bring a person into uh that population what how many new cases will they typically spread it to how many new people will they give it to um the estimates for the original uh coronavirus were it was quite variable but it was typically landed somewhere around 2.5 to maybe 3.5 um i have i looked to see if there’s any good published data on the delta variant on this where they’ve actually done some studies i haven’t found that but i’ve seen some pretty smart people in this area estimating it to be around six uh maybe a little higher again getting to probably about twice as contagious as the earlier uh earlier strains all right and um we do have a question it looks like about guidance on mask wearing for north dakota residents vaccinated or unvaccinated now i know this afternoon uh cdc is going to be coming out with it sounds like updated guidance on mask wearing uh but did you have any comments on mask wearing as of how it stands right now for vaccinated versus unvaccinated individuals that’s sort of hoping to avoid mask questions because you’re just sort of guaranteed to make you know some segment of the population upset one way or the other um i think i was glad to see mask uh mask requirements falling you know and going away for for vaccinated people i think we we need to like get ourselves back to more and more of a semblance of normal as we are are vaccinated i think the delta variant is is gonna um is gonna challenge us us a bit here because we have a lot of people that aren’t vaccinated yet we don’t we don’t like the idea of like asking people show us your vaccination status and prove that i mean that that doesn’t go too far or go very well um my my suspicion will be uh i i’m gonna punt that mostly to what the cdc recommends and i’ll probably you know take the party line of you know whatever the cdc recommends i’ll probably recommend my suspicion is is that they will recommend that vaccinated people can still uh forego mask wearing unless the prevalence and they’ll probably set it at some level is at a certain level in your community in your city or your state or whatever that if you’re having x number of cases per you know hundred thousand population or whatever that you consider um re-implementing uh mass guidelines i i suspect that’s where they’ll go but i don’t know and i i would just say let’s wait and see and i should recommend too that uh right now if you’re immunocompromised and concerned about potentially the vaccine not working well um you may want to consider masking and avoiding large gatherings especially gatherings when there’s a high number of people unvaccinated or may your loved ones may want to mask around you so that might be something you want to consider if you’re immunocompromised um we didn’t really touch on this but um we often get asked about i mean i know you showed hospitalizations long-haul coveted other things to consider but as far as death goes i think um some people think copic deaths were somehow inflated uh in north dakota or in the united states can you just talk about what the data is out there regarding ovid and death yeah so you know to the people who kind of think um you know doctors are sort of wantonly slapping coveted labels on people who who are dying i just say take a look at the data that’s that’s been tracked for years and years and years on weekly mortality uh by the cdc if you google cdc excess mortality they’ve been trending for many years what’s the what’s the number of reported deaths from anything so forget a covet label just forget somebody having a covet label on on their death certificate and look at the cdc data on uh deaths from anything from 2015 through 2019 compared to 2020 for every week of the year starting in march there were at the lowest 10 more deaths to the highest about 70 more deaths every week of the year um throughout 2020 and going into 2021 it’s now fallen thank thank god it’s fallen back to uh prior 2015 and 2019 trends so my question to people who are kind of doubting that is what was causing all those uh extra deaths i mean you know if you think it’s like loneliness or you know lockdowns or whatever okay maybe but the obvious answer is cobit and and when you look at those extra deaths the vast majority of them had a coveted uh diagnosis attached to it but if you even remove that we have to explain why there was 30 40 50 60 70 more deaths week on week on week throughout 2020 compared to our prior five years what was doing that and then i think we just have time for probably one more question i think something that comes up from people who haven’t yet chosen vaccination is you know there’s just going to be more variants coming we’re going to need booster doses we don’t know what the effectiveness of the vaccine is going to be against future variants can you kind of talk about why people should maybe consider vaccination knowing that there likely will be variants in the future sure so i you know i have a few thoughts on that so one is i mean we need to contend with the immediate problem at hand i mean we have an immediate kind of threat to our unvaccinated population and yeah we might be you know theoretically we might be kicking a can down the road a bit but there is value in trying to have some immediate uh improved uh protection against all these kind of bad outcomes that we’re seeing but um uh so far um the news that i think is looking pretty good that we may not need any boost or may may not need it for several years uh there’s now a couple of good studies that looked at memory cells memory immune cells in the bone marrow and in our lymph nodes looks pretty good uh with the current vaccines inducing the type of cells we like to see for long-term immunity the other reason to if we can get you know most everyone vaccinated so that the spread is way way down the virus doesn’t have a chance to mutate into new variants we we actively intervene in its evolutionary process in trying to escape us third i would say you know even if we have partial protection so i mean these vaccines have been amongst the very best of any vaccines we have we have vaccines that are um that we take that aren’t nearly this good but they give us partial protection even if we have partial protection and variants can break through more easily it’s uh less likely that they will make us real sick and when we get exposed to those variants then we’ll have you know we that sort of charges our immune system again you know you get exposed you get a little you know hopefully mild infection you’re all the more able to fend off the next exposure in the next variant so um it’s sort of mounting layers of uh of protection and um and i think the news is good it it may change it may turn out that one of these escapes current vaccine-induced immunity and we need some kind of a booster and we’ll cross that bridge when we come to it right now i don’t think the evidence is looking very strong that that’s necessary yet all right well thank you dr carson for your presentation today i i hope it it gave everybody something to think about when you’re weighing your decision regarding to get coveted vaccine or risk getting coveted illness but if you do have additional questions about copay vaccination or covet illness you’re encouraged to talk with a trusted health care provider contact your health care provider and get your questions answered about copin 19 and vaccination otherwise i just want to thank everyone for attending today and this webinar will be posted on our facebook page and website for viewing at a later date so thank you dr carson and thank you everyone thanks for having me [Music] you