Dr. Michael Ellis - COVID-19 Update

Transcript

Voiceover:
Welcome to a special edition of Prescribed Listening from the University of Toledo Medical Center. Today's guest is Dr. Michael Ellis, Chief Medical Officer at UTMC Dr. Ellis graduated from the United States Military Academy at West Point and served 20 years in the US Army. He is board certified in internal medicine and infectious diseases. Dr. Ellis will discuss the current state of COVID-19 and the continued importance of getting vaccinated.

Dr. Michael Ellis:
My name is Michael Ellis. I'm the Chief Medical Officer here at UTMC, and I'm also an infectious disease physician. The one thing that I would say about the COVID pandemic is it really has demonstrated the reality of the interconnectedness of people just around the globe. So no matter where you are, you ultimately can impact other people. So when we look at COVID in the community, we also have to look at what's happening around the world, what's happening in our country, what's happening in our state, what's happening in our county, and then what's happening even in our local community. Right now if you look at what's going on in the state of Ohio, we've had about 50,000 cases every week. We look at a tool that the CDC generates that forecasts so we can look out ahead and it has confidence intervals so that we can look at what's the best case trend over the next couple of months and what's the worst case trend over the next several months.

Dr. Michael Ellis:
I'm never very the optimistic about how things will go. I usually plan for the worst case scenario. So the worst case scenario is that we continue to have an up trending over the next several months as we enter into some cooler months and things like that. And people are indoors more and in closer proximity. The forecasting models are that over the next couple weeks, we'll actually see a down trend. So we hope for that, but we plan for the worst. The Delta variant has thrown a wrinkle into how the trajectory of the pandemic was going really around the world. But I think that we should be prepared for different variants. And this is always going to be a moving target until it just runs its course.

Dr. Michael Ellis:
And we just need to focus on the things that we can control, namely vaccinations, preventive measures, developing therapeutics. The thing about the Delta variant is... And the dust hasn't settled on all the nuances of the Delta variant. It seems to be more transmissible. It seems to be able to cause more severe disease and the transmissibility has to be taken into context with the incubation period. And so something being a little bit more transmissible can get easily magnified. So if with the original strain of COVID, I infected two people and then those two people infected two people several days later, you can see that that population of infected people is going to grow. If with the Delta variant, you infect five other people you can quickly see that in a matter of weeks, those two numbers can quickly diverge.

Dr. Michael Ellis:
So that assuming all these factors and nobody's vaccinated, and nobody's already had COVID, left to run its course over a couple months COVID could infect... COVID Delta variant could infect 3000 people as opposed to only 30 people. And so that's why just being a little bit more contagious can really start to over time, really exacerbate things and put a strain on education, work, healthcare facilities. So that's why the Delta variant has really changed the course a little bit.

Dr. Michael Ellis:
Obviously the vaccines that were developed are to prevent hospitalizations, severe disease, and death. And so those vaccine still do that and you can still have some breakthrough infections. And even with Delta, but if you have a breakthrough infection with the Alpha variant, you're going to infect fewer other people. But again, if you have a breakthrough infection with the Delta variant, even though it's mild, you can still infect quite a number of other people over time.

Dr. Michael Ellis:
If you look at the endpoints of these studies, they really were aimed, and rightfully so, at preventing hospitalizations and deaths. Those are very clear endpoints that are easily measured. It takes a lot more of a robust study to look at asymptomatic infections or even mild infections. So the breakthrough infections have always been possible, but not always well tracked. And people can show up with either mild or symptoms that they may not normally have thought too much about in the absence of a global pandemic. But now if they have stuffy nose or sore throat or affected taste or smell, they may go to the doctor and get tested. And even though they're going to be better in a couple of days, they will have contracted COVID. So all throughout the pandemic, variants have been tracked and you should expect variants to develop. All viruses will mutate over time, especially with different epidemiological pressures and even vaccines or therapies, they will adapt.

Dr. Michael Ellis:
And not so much as adapt as mutate. And so there are variants that are being followed by the CDC. They classify variants in terms of the impact on public health. So they have variants that they're just monitoring, variants of interest, variants of concern, and variants of high consequence. So those are the classifications. As an example, Delta variant is a variant of concern. There are others that probably have been in the media, there's a Mu variant it's being tracked. Right now in the United States the Delta variant is causing the majority of infections, the vast majority of infections, and only a small proportion about 1% right now are being caused by this Mu variant. But that is a variant that they're tracking to keep a close eye on.

Dr. Michael Ellis:
Again, there are factors that can alter the trajectory of these things based on how many people are vaccinated, how many people have natural post-infectious immunity, and then the season, what people are doing, how they're gathering or not gathering, things like that.

Dr. Michael Ellis:
The people who are being affected most right are the unvaccinated group, I would say that unvaccinated group of all ages. So if you look at vaccine acceptance in the state of Ohio, if you take all age groups, about 54% of the state of Ohio has gotten at least one dose of a COVID vaccine, but that percentage of acceptance differs between age groups. So if you are over 70 years old, it's well over 80% have received a vaccine. If you look down at the 20 to 29 year old age group, it's less than 50%. It's about 48%. So we see younger patients than we did before, but we still see older patients who have not been vaccinated. Those are still clearly a high risk group, regardless of what variant is out there if you're older and you get infected with COVID, you are at more risk of having severe disease.

Dr. Michael Ellis:
So again the population that we're seeing in the hospital is overwhelmingly, well over 90%, are unvaccinated people. So wearing masks can be really discouraging for people, especially if they've been vaccinated. The question they have is, "Hey, I get the vaccine, why should I have to wear a mask?" Well, there's two reasons for that. Number one, you can still get the Delta variant and get COVID. Granted it should be mild but the thing that's beyond the individual is that if you do get infected, you're able then to transmit this. And so with a virus that's more transmissible, it's prudent to prevent all illness that you can so that minimizes the number of people who are ultimately going to get infected. Masks are easy, they're effective, and they're effective across a number of viruses, not just COVID. And that's why we saw a fewer other respiratory illnesses last year, including influenza.

Dr. Michael Ellis:
So I think that besides COVID wearing a mask right now is a good thing to just try to reduce all respiratory tract infections, including influenza and RSV or respiratory syncytial virus so that we're not overly taxing the healthcare system that is already strained.

Dr. Michael Ellis:
Yeah, so public health policy is a little bit like marketing in many ways. So obviously they have the individual person's health in mind, but they also look at others. So especially the more vulnerable, I think in a lot of ways, the removal of the mask mandates that were in place up until the spring, the late spring, removing those was a way to say, hey, look, if you get a vaccine, you can take off your mask. I think what happened was that message was received so that people who had not been vaccinated stopped wearing a mask as well.

Dr. Michael Ellis:
So you had a combination of a more transmissible virus coinciding with people taking off their masks. So I don't think it was necessarily a bad idea to remove those mask mandates. Again, I think with a global pandemic, you have to be flexible and people should not be surprised that messages have to change and we have to adapt. And I know it can be a strain on people emotionally, but we just have to be as flexible and as resilient as we can.

Dr. Michael Ellis:
So the best way to protect an individual and his or her loved ones is to get a vaccine and wear a mask as recommended, especially in close spaces, around people that you don't know their vaccine status. So for children I would follow whatever their school district and their school is recommending. That doesn't prevent anybody from also asking their children to wear a mask, especially in public places. So that's, again, a very low tech, highly effective way to prevent their kids from getting COVID.

Dr. Michael Ellis:
So right now, the Pfizer vaccine is approved for children 12 and older. Just this last week, they completed and published some results that they'll take to the FDA for children age five to 11. So I think there's going to be more to follow over the next few weeks about the vaccine status for children under the age of 12. So booster shots have been a moving target and a lot of discussion has been focused on booster shots. Right now, the clear recommendation is for immune suppressed people, especially those who are transplant recipients to receive a booster. Just yesterday the CDC recommended that vaccines with the Pfizer vaccine, be given for people over the age of 65, and then also healthcare workers who are at high risk for contracting COVID.

Dr. Michael Ellis:
I think that over the coming days, we'll have a clear idea about how that will finally look and how that will be rolled out and implemented. Boosters are going to be important for certain groups of people, for sure, especially the immune compromised and the elderly. I also think that we can't take our eye off the ball and we really need to focus on the unvaccinated people. Again, although boosters are important, what we know for certain is a primary vaccine is very important. And from a public health perspective, I would like to make sure we focus on getting vaccines to the currently unvaccinated people. So the most important things I think people should know about COVID are that they should protect themselves, and by doing that protect everybody else. So recognizing as we talked about at the beginning that we are all interconnected, no person is an island.

Dr. Michael Ellis:
So choosing to get a vaccine protects yourself, but it also protects other people. And it helps to bring stability to the healthcare system, and then really it allows people to get on with their lives so that kids can go back to school, so people can work. Those things have to continue. And that's why it's important for individuals to protect themselves with a vaccine, to wear the masks when they're asked to, and choose a more selfless duty minded approach to the pandemic. These vaccines have been demonstrated to be safe. I think that the best people can do is to protect themselves with a vaccine, and then at the same time, protect others by doing that. So if they're on the fence about whether they would like a vaccine, I would opt for more the altruistic side and go ahead and get a vaccine.

Voiceover:
Thank you for listening to Prescribed Listening from the University of Toledo Medical Center, to learn more about the provider you heard on today's show, visit UTMC.Utoledo.edu. Prescribed Listening will be back next week, subscribe on Apple Podcasts, Spotify, or wherever you enjoy listening.