Tracking the Data: Jupiter Medical Center Shares COVID-19 Update

FineMark Radio: Episode 2 Transcription

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David Scaff: Good afternoon. This is David Scaff with Finemark National Bank, President of the Palm Beach County office. Today we’re honored to have Dr. Charles Murphy, who is a Chief Quality and Patient and Safety officer at Jupiter Medical Center. Welcome Dr. Murphy.

Dr. Murphy: Great to be here. Thank you.

David Scaff: Glad to have you, Dr. Murphy. Today’s topic is a big one, I should say, which is COVID. Jupiter Medical Center puts out a lot of great data, which I really enjoy reading. It keeps me up to date on what’s going on in our community. For starters, how would you like to open this topic and talk about COVID? Maybe something behind the data?

Dr. Murphy: Yeah, well, I think I’d like to start on a positive note. We’ve been experiencing a surge in COVID cases related to the delta variant, and I’m happy to say that over the past two weeks or so, we’ve seen significant declines, both in new cases and in hospitalizations related to COVID. So, we’re very excited that we’re seeing those numbers go down.

David Scaff: That is great. Do you have anything that you attribute that to? Is it running its course or are more people vaccinated? What would you say about that?

Dr. Murphy: I think somewhat it’s running its course. We’ve got somewhere around 60% of the population vaccinated. And of course, unfortunately, there are many people who have gotten COVID infections, particularly during this latest surge. So, I think in a sense it’s running its course.

David Scaff: So, what are the latest numbers for vaccinated people, what percentage of our population has taken the vaccine?

Dr. Murphy: I think that, generally for the country, it’s about 75% of adults are vaccinated, which is, I think, a very good number. We believe that you have to get up to the 85 to 90% range to really get that herd immunity that’s discussed. There are also millions of people who have had COVID infections, and we know those individuals who have been tested and are positive, but that probably is a significant undercount of the actual overall infection rate, so, the belief is that at this point, a large number of individuals have either been vaccinated or they’ve had infection.

David Scaff: Is there a difference that you can talk about if somebody’s had COVID and so they’ve survived it and they’ve developed some antibodies or if somebody hasn’t been exposed to their knowledge and had the vaccine, is there a difference in their susceptibility to future infections?

Dr. Murphy: That’s a great question and it’s really one that’s under active investigation. I’d like to say to the audience that we really develop new information literally every day, every week. And so, these things change very rapidly, and in this case, in the last couple of weeks, Israel released a study, in which they demonstrated that individuals with natural infection actually have substantial protection from COVID reinfection. And that it may actually be better than vaccination, in the Israeli study. There is a second study, which came out of Kentucky, which I think was published by the CDC, which suggested that vaccination is better than prior infection. And then finally, there was also one other study involving the UK. So, it’s really somewhat unknown in a sense. But I think it’s clear that both vaccination and prior infection do provide substantial protection for some period of time.

David Scaff: So, I suppose if I were a person that had not yet been vaccinated, then had not yet been sick, I might prefer to get the vaccination then to go out and try out the natural way of forming antibodies.

Dr. Murphy: That’s very well stated. We would agree with that position.

David Scaff: So, talk about some other sort of common misconceptions that the public might have about COVID and vaccines and that sort of thing.

Dr. Murphy: Sure, well, I think one of the hot topics right now involves boosters and there’s an advisory committee meeting tomorrow about boosters and specifically looking at some of the Pfizer data on boosters. Again, out of Israel, what Israel was seeing was the protection afforded by the two-shot vaccine. The Pfizer vaccine was diminishing after about, six months or so, particularly in the elderly and also in those that were immunocompromised. Based on some of that information, that was why in the US, we recommended that patients who were immunocompromised should get a booster dose. Israel actually started vaccinating different age groups, but now over a fairly rapid period, it moved all the way down to 12 years and older should also receive booster doses. And their data suggests that 10 days after the booster dose, individuals received a substantial amount of protection by getting that booster dose.

And again, after about six months or so, the level of protection provided by that initial vaccination was decreasing fairly significantly. And I think in the US and particularly the HHS with the announcement last month that we were looking at starting booster doses in September, our decision-making was in large part based on that Israeli data. Although there’s a fair amount of disagreements and also politics around this particular issue, the World Health Organization has been somewhat against booster doses based on two things. I think one is that there’s some countries where many people remain unvaccinated, and they would like to focus on vaccinating as many people as possible initially. And then the second piece of information is that the vaccinations appear to be still very good about preventing severe infection or death.

And for that reason, they believe there’s not enough evidence to say that people do require booster doses. So, it’s really those two main facts that the World Health Organization is utilizing. On the other hand is the Israeli data, which again, indicates a substantial falling off of protection by the vaccine after about six months and the belief that by getting the booster doses, you have a substantial ramp up of your antibody levels, even higher levels than were initially obtained with either of the two shot regimens.

David Scaff: So, I guess we’re on hold until some more studies are done and we can get some agreement from different organizations as to whether we should have a booster or not. And when that might be.

Dr. Murphy: I think there’s a substantial push towards boosters in the US. It is unclear what the recommendation will be, but it looks like potentially the Pfizer booster dose will be recommended for probably everyone over the age of 16 or so. And then I think they haven’t had a chance to review the data by Moderna, although the data that is out there also supports booster doses. But I think that that will be delayed. I think the other topic which is of current interest is vaccination of school-age children. So the five-year-old to 12-year-old age group. I think that we expect the data on that age group to be available in September. It generally takes the FDA six to eight weeks to review that data and really go over the information in depth and make recommendations. So, it’s possible that recommendations for school age children will be coming out, either in December or January, something in that timeframe, unless the FDA decides that they want a longer timeframe of information in order to make the decision about either an emergency use authorization or for approval.

David Scaff: Very good. So, I’m a reasonably healthy person in my mid-sixties. I’ve gotten two doses of Moderna some time ago. With the Delta variant and different spikes in cases over the last several months, what should I feel comfortable doing? And what should I still be cautious about?

Dr. Murphy: If you’re in an area where there’s a significant number of cases, which frankly is most of the US, currently I think that it makes sense to avoid large groups indoors. I would be cautious about that. I would tend to still be wearing a mask, I would tend to be still social distancing. Those are the things that one can do. I tend to eat outside at restaurants when I have that option. And again, what we’re seeing, is although early on in the delta surge, more than 95% of the individuals were unvaccinated that were requiring hospital admission. We’ve actually seen that number trend down.

So we’re seeing more vaccinated patients requiring hospitalization which is why I’m recommending that one should still be cautious and should still do some of the other available measures to try to reduce one’s risk, because it is possible when you are fully vaccinated to still get a COVID infection. It tends to be asymptomatic or mild. But there is a percentage of individuals who then would require hospitalization and become even quite ill related to COVID infection. So particularly when you’re in a hotspot, you really should be cautious at this point.

David Scaff: So, I’ve gone back to dining outdoors as well. No indoor dining, lately. But it sounds to me like if I’m playing golf and my other three partners are fully vaccinated and I’m outside, I might be okay.

Dr. Murphy: I think that would be the case. I think I would feel comfortable doing that.

David Scaff: Well, that’s great news and I’m going to be sure and share that with my wife, because it’s something I would not like to give up on Saturday.

Dr. Murphy: But I will share a story that was published about an outbreak they had in California in a school. And there was a teacher who was symptomatic, who went to the school for two days, teaching her class and was sometimes not wearing a mask when reading aloud to the children. There were five rows in the class. Eighty percent of the children in the first two rows became infected. And 28% of the children in the following three rows became infected for a total of 50% of that class who became infected. So, the delta variant is very contagious. And for that reason, I think that some caution should be utilized. I think, again, if you’re talking about some sort of gathering indoors with a large group of people, I would personally try to avoid being in that situation. I think if again, if you know that everyone is vaccinated, if the area has good ventilation, if people are masking, then I think that that helps. But again, I think one should be cautious at the current time.

David Scaff: So, if you have school-aged children, it sounds like you’re still in favor of taking the precautions of the mask, whether mandated or not.

Dr. Murphy: I am. And I think the science, you know, you can find science on both sides or studies on both sides, but I’d say the preponderance of the evidence is that masking and social distancing, and hand hygiene does help prevent the spread of viral infections, particularly those that are born either by droplets or aerosol. And so, this is true of the COVID virus, as well as the flu virus. And so, again, there’s something called the reproduction number that we talk about. That is a number that when it’s above one, it means a pandemic is increasing, and when it is going below one, it means the numbers are shrinking and I would call it fairly solid evidence that through masking, social distancing and hand hygiene that you can actually drive that reproduction number below one. So, I think that it is one of the elements that we should take seriously and certainly, I would feel much more comfortable, if my child was in an environment where people were masking.

David Scaff: In your example, in the story that you just gave about the teacher and the first few rows of students. I missed that. Did you say the teacher was or was not vaccinated?

Dr. Murphy: The teacher to my knowledge was not vaccinated but did test positive for COVID related to this incident.

David Scaff: So, I’m going to ask you a question about those who choose not to get vaccinated, and I’m not asking you to be a psychologist in this particular case, but in your role, you must talk with peers in the industry, and there’s a percentage of medical staff that choose not to get vaccinated. What do you and your peers discuss when talking about that issue?

Dr. Murphy: Sure. Well, I’d say one thing is over 95% of our physicians are vaccinated. So, at the physician level, we had people really knocking down our doors to get vaccinated, but you are correct overall. There have been a significant number of healthcare personnel who have not gotten vaccinated. The number one reason still tends to be concern over the vaccine safety and believing that we still don’t have enough time that’s taken place where they can feel confident about vaccine safety. And, I understand that perspective. I mean, we’ve really only had vaccines available for a year and a half. So when you start thinking about what are the long-term effects, I mean, I understand why people could be leery about that. On the other side of the ledger though, is you know, there’s over 600,000 people that have died of COVID in the US.

So, the information we have, with hundreds of millions of doses under our belts, is that the serious adverse events of vaccines tend to be somewhere in the one to 10 per million shots range, whether it be the myocarditis that impacts some with the vaccines, whether it be the blood clotting, that’s associated with low platelet counts, that we’re discussing, or even anaphylaxis to vaccines, all tend to be in that very low occurrence range. So, we’re really confident that in a short-term perspective, the vaccines are very safe. There’s a vaccine adverse event reporting system that’s very robust, and this is being tracked very carefully at a national level. And again, I feel very confident the vaccine is safe. I also feel very confident that the vaccine is very effective. You know, the early effectiveness of the MRNA vaccines is right at 95% for preventing severe illness or death.

So really the whole development of the vaccinations is an amazing accomplishment over a short period of time. When it was four or five years previously before we could get a vaccine rolled out. So, I think that that’s been a tremendous success from our scientists and our system to get this rolled out so effectively and have so many people that are vaccinated at the current time. And as a healthcare professional, I would certainly like to see people avail themselves of the vaccine, but again, safety concerns tend to be at the top of the list for why people don’t get vaccinated. One other plug is that all of the major obstetrics and gynecology societies, so, the American College of Obstetrics and Gynecology and the Society for Maternal and Fetal Medicine, they all recommend the vaccine for pregnant women and women of childbearing age, because those individuals, pregnant woman, are actually at very high risk of getting severe disease. So, vaccination is certainly recommended by the major societies in that situation.

David Scaff: Well, I think that’s right. It sounds like we’ve done an amazing job in my view about bringing vaccines to bear. And we will find out the long-term issues sooner or later, but we know about problems with COVID and what happens with people that get it. If I read your background, correctly, Dr. Murphy, you have a background in cardiology and thoracic surgery, is that right? So, what evidence has already developed, or what concerns do you have in that field about the long-term effects, from having gotten COVID?

Dr. Murphy: Yeah, no, that’s a great question as well. And there is this syndrome of long COVID, which probably impacts at least 30% of individuals who have COVID where they’re having long-term effects for weeks to months. Some of those can be cardiac events, when you do imaging such as MRIs or cardiac MRIs, heart MRIs of the heart in patients who have had COVID, there’s a significant number who have abnormal scans after COVID. So there, although we talk about myocarditis or an inflammation of the heart muscle occurring with vaccination, it actually can also occur with COVID infections as well. There also are long-term lung impacts. So, patients remain short of breath for weeks to months. Fatigue is a major element. There are some impacts on the brain, such as sort of what is described as a brain fog or forgetfulness. So again, this is something that we’re really learning about as we go, but there are certainly a significant percentage of patients who have a COVID infection who have long-term significant health impacts that certainly affect their ability to do things like work and have normal activities.

David Scaff: Great, well, Doctor, as I predicted at the beginning of this, we’ve been a little over 20 minutes and, I feel like we could go on for quite a while. I would like to bring one last question to you, back to our community and Jupiter. You know in 2020, Florida was like a number one destination for people moving out of other states and many of those settled in our community. What sort of impact has it had on Jupiter Medical Center and what kind of resources have you had to add and anything that you’d like to speak to about that?

Dr. Murphy: Sure. No, you’re exactly right. There’s been a definite migration to Florida. We’ve seen an increased number of visits to our emergency room, an increased number of setting records for operations performed in a given month, setting records for numbers of deliveries in a given month. The healthcare in Florida also has tended to be seasonal historically, with the snowbirds who are up north in the summer and then come down here for the winter. We’ve seen some of that seasonality go away. Individuals have chosen to stay in Florida and not do the snowbird-type thing. And so, it has become busier year around. I would say now, we would love to be adding staff. I think one of the challenges that we, and almost all healthcare organizations, have had is that there are actually shortages of nurses and several specialty areas within healthcare, in large part due to the COVID crisis. But we actually have, at the same time, been busier than ever. We’ve struggled with having and maintaining the staff to provide that care. So, it’s definitely a challenge across the healthcare industry.

David Scaff: Well having said that, you guys do a wonderful job for our community, and I want to thank you for that. And I want to thank you for giving your time today to talk to us about this topic, Dr. Charles Murphy. Thank you so much.

Dr. Murphy: And I’ll just close by saying, please get vaccinated if you’re a candidate.

David Scaff: Great. Thank you.

Dr. Murphy: You’re welcome.