December 3, 2021 • 29 mins
Ryan Gorman hosts an iHeartRadio nationwide special featuring Dr. Steven Gordon, Chair of the Department of Infectious Disease at Cleveland Clinic. Dr. Gordon offers an update on the state of the pandemic across the U.S. Also, Dr. Carrie Tibbles, Director of Graduate Medical Education at Beth Israel Deaconess Medical Center in Boston, joins the show to discuss her firsthand experience on the frontlines of the pandemic.
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Episode Transcript
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Speaker 1 (00:00):
Welcome to I Heart Radio Communities, a public affair special
focusing on the biggest issues impacting you this week. Here's
Ryan Gorman. Thanks for joining us here on I Hear
Radio Communities. I'm Ryan Gorman, and we have some important
conversations lined up for you coming up in a moment.
We'll get the latest info on the pandemic, including this
new amicron variant, with the top infectious disease expert from
(00:23):
Cleveland Clinic, and then on top to the director of
Graduate Medical Education at the Top Medical Center in Boston
about what it's been like on the front lines during
this ongoing public health crisis. So we have a lot
lined up for you right now. To get things started,
I'm joined by Dr Stephen Gordon, chair of the Department
of Infectious Disease at Cleveland Clinic. Dr Gordon, thanks so
much for coming on the show, and let's begin with
(00:44):
a big picture overview of where things stand right now
with the spread of COVID nineteen across the country. Well, well,
first of all, thank you for having me, and it's
a pleasure to be here in terms of the pandemic situation,
and again as we're into you know now going into
week month, maybe twenty one. Things continued to be I
would say, in this date of flux in here in
(01:05):
the homeland, we're still averaging almost cases UM a day.
These are new cases across the country, although the it's
it's not equally distributed. So where I am now, UM
in Cleveland, Ohio, here in the Midwest, we're seeing a
big search. If you look down in south now things
have cooled off in areas. So throughout this pandemic, I
(01:26):
think we've learned that UM it is not a linear course.
Things continue to be dynamic, But there's still what I
would say, a lot of virus out there. Now that
the delta variant has been with us for a few months,
what do we know about it, especially as it compares
to some of the earlier strains of COVID nineteen that
we dealt with. That's a great question, Ryan, you know,
And when we talk about urna virus is like coronavirus is,
(01:48):
mutations or changes are are part of the kind of landscape.
There are thousands of variants UM, but as we all
know here in homeland the world, it's the delta variant
that is now the predominant drain UM and it does
have some advantages in terms of obviously host factors in
terms of infection as well as transmissibility. So it's a
little bit more transmissible uh than the prior, say, the
(02:11):
alpha or the original strains. In terms of severity disease,
probably no change there, but it has really taken a hold.
And as we look at our what we'd say, our
genomic analysis, at least here in the United States, it's
more than all the isolates that have been sequenced. And
that's been true almost throughout the whole of all. Right, now,
(02:32):
let me get to the question that I think is
on most people's minds. This new variant that we're hearing about.
How does it potentially differ from the delta variant? What
do we know about it so far? So a very
dynamic situation, uh, in terms of here this new variant,
which is kind of the fifth what we call variant
of concerned, it's been named a macron, which in the
Greek alpha alphabets fifteen. It's numeric name is now B
(02:55):
one one to nine, and it was first reported, uh
November from South Africa. It's still in what I would
say in discovery phase. What has created a lot of
attention is the number of new mutations in its sequence,
so over fifty new what we say, unique mutations, including
about thirty in the important spike protein. UH. That's important
(03:18):
because that confers immunity and also pathogenicity. So the uncertainties
that we don't know now is is this more transmissible
than say delta. Do our current vaccines or prior infection
protect against omicron? That's still not clear. And then is
there a different what we say, spectrum of clinical illness?
So not surprisingly as people are looking for it. Um
(03:40):
it's not just as in South Africa now it's it's
greater than two dozen countries, including here in the almand
with the first case identified in California from a traveler
who was vaccinated UH coming back from South Africa. So
a lot of attention. We should know more within the
next couple of weeks as experimental studies in EPI studies
will be done to look at some of these questions.
But the big question I think that people have in
(04:01):
the mind, like you say, is for those of us vaccinated,
you know, is their protection at least protection from severe disease?
And we just don't know that. We don't know that now,
But it does pay it to me when we're talking
about the variants to date. Again, the vaccines that we
have available here in the home month, the two m
R and A's and the Johnson and Johnson are very
effective in preventing severe disease and death from all our
(04:24):
our variants of concern to date. So that is our
our number one what we say, our most important armamentarium
against the virus now are safe and effective vaccines. I'm
Ryan Gorman, joined by Dr Stephen Gordon, share of the
Department of Infectious Disease at Cleveland Clinic. Let me ask
you about natural immunity versus the immunity one receives through vaccination.
(04:46):
Question I've got a lot of the past few months
involves how we end up with better protection through the
vaccines as opposed to our bodies naturally fighting off the
virus after infection. Can you explain how that works? So,
I think for all of us, I mean, we we
have you know, for those of us a little bit
older in the teeth, you know, when we used to
(05:08):
see measles, mom's chicken pox in the community. Um. You know,
these um, although they didn't kill a lot of people,
cause devastating complications and we don't see that anymore, and
that's because we've had effective vaccines in These vaccines are
very durable, and that's been a blessing. When we talk
about respiratory viruses. The one vaccine most people know about
(05:28):
his influenza, right. But influenza also can change, which is
why we need to change our formula each each year.
And again, the point there is not necessarily to protect
you from getting a little bit of a cold, but
to prevent you, hopefully from getting severe disease. With the coronavirus,
it's a similar situation. UM. So getting getting COVID nineteen
(05:48):
does provide um immunity, the duration of which we don't
know UM. However, it also carries with it some risk.
I would much rather get a vaccine to prevent getting
in action and run the risk of not just acute
complications of the infection. But as you know, there is
that that issue about long hauler in long term sequel
a after COVID nineteen that we still don't know. UM.
(06:12):
We still don't know everything about that. UM. We do
know lingering symptoms can occur in many patients even after
the acute symptoms have resolved, and so that's another reason why, UM,
I'd much rather protect myself with vaccine than natural infections.
For those who receive two doses of the MR and
A vaccines or one dose of the Johnson and Johnson vaccine,
(06:34):
why is there a need for a third shot now,
a booster shot. Well, at this point, I think when
we talk about um our immune system. You know, one
of that is our what we call our antibodies in
terms of this nature, which do peak after initial exposure
vaccine and then dwindle. UM. And the concept of boosting
(06:55):
is after a certain period of time one would benefit
from another kind of stimulation and to the immune system
with a booster shot. And there are many vaccines you
know that we do use boosters already. For instance, you
know our appatitis v vaccines in the vaccines are a
series vaccines. The human papaloma virus is also a series vaccine. UM.
(07:16):
So what we think about coronavirus, what we don't know
is will this become an annual event um, you know,
similar to influenza, where we'll we'll get a booster and
potentially a different formulation every year. UM. So these are
questions we still don't know, but their rationale behind booster
does come from also studies in countries like Israel where
(07:37):
UM using booster it looked like it effectively diminished what
we call breakthrough infections, especially amongst the elderly or people
who have uh you know what we would say, medical
conditions that put them at higher risk for hospitalization. I
want to get to breakthrough infections those who are fully
vaccinated yet still contract COVID nineteen. First of all, what
(07:59):
do we know about right now? And also what is
the transmissibility like of the virus among those who are
fully vaccinated and contract COVID nineteen compared to those who
get infected and are unvaccinated. So all great questions. Uh
So let me try to break that back down. Uh
So when we talk about UM breakthrough infections, UM, you know,
(08:23):
I think one of the things that that is mistaken
is people look and say, well, I see people have
gotten vaccinated who have had a positive test, uh and
therefore the vaccine is not effective. What we really want
to focus on is not so much people who may
have a mild you know, cold break through affection or
have a positive test. It's really severe disease and hospitalization.
(08:44):
And we know for instance, people who have been vaccinated
versus those who have not. You know, the risk of
hospitalization and depth is ten times less for those that
have been vaccinated. And that's really the most important marker,
not whether someone gets a little bit of a cold
or sniffle uh in my opinion, and then has a
quote unquote positive test. In terms of if you do
(09:05):
get a break to infection, you know, can you transmit
You can't still transmit to others, although the duration of
the virus that stays up there is probably less than
those who have not been vaccinated. And that's why if
you still get a break through infection, the public health
people are still telling you to quote unquote isolate uh
for the ten days. Um, you know, outside of of
(09:27):
the what we say, the breeding space of others who
are not in the I'm Ryan Gorman, joined by Dr
Stephen Gordon Share of the Department of Infectious Disease at
Cleveland Clinic. In terms of contracting COVID nineteen, very basic
question for you, what do we know about that all
these months later? Because early on in the pandemic, we
were wiping everything down. We were afraid we're going to
(09:49):
contract it by touching something then we were told if
you're indoors and close quarters with someone for an extended
period of time, that's when you were most likely to
potentially get infected. So have we learned over the past
twenty plus months another good question run So initially, as
you said, maybe a little bit too much emphasis on surfaces.
I mean, I'm gonna leave in clean surfaces and antigene,
(10:11):
but but we don't need the high level disinfection and
focus on door handles and things. Where this virus spreads
most effectively and most efficient efficiently is in households. So
that's like me and my family, where I'm you know,
close contact without mask, sharing a lot of airspace. Uh
So indoors close contact uh in people um you know
(10:34):
that are not wearing masks like other respiratory viruses, you know,
similar to rhinovirus or influenza virus. The big one of
the big challenges with COVID has been gently speaking with
the flu. You don't have a long period where I
can be contagious without symptoms. It's usually less than a day.
So by the time I have the onset of my aches, chills,
or fever, I'm already know I'm sick. And isolate myself
(10:58):
with With COVID, it's it's more stealth here. So you
might have a period of two or three days before
you have any symptoms where you're infected and can transmit.
And that's that period where maybe thirty cases in the
community and households are being transmitted. So it's you know,
even if you're feeling well with COVID. You know, that's
(11:19):
one of been been one of the big challenges in
infection prevention, is you can still transmit. So when people
are going about their daily lives, grocery shopping, doing some
Christmas shopping, should they be concerned in those situations or
because of the nature of the likely interactions that they
would potentially have, the risk is much lower. You know,
(11:42):
I would what I would say is I view this
as more of a it's it's a what we'd say,
a layered approach, right, and it really depends because depends
on your condition as well. Um. You know, if I
have other you know what I call medical conditions that
I really want to mitigate my risk, I'll be vaccinated
when I go indoors. Um, i will wear a face covering, uh,
(12:05):
because I don't it's hard to predict your contacts with people.
You might think you're being and out, maybe someone will
come up to ask you a question or things of
this nature. So I I just plan on, Okay, I
just assume that everyone else may be infected if I'm
going indoors in terms of this nature, and I control
what I can control, So I will still wear even
though I'm boosted and everything else, uh, you know, in
(12:26):
the abundance of caution, because again, I have parents who
are still very elderly that I visit, and although I
may not get sick with a breakthrough infection, I really
don't want to take any you know, I want to
mitigate my risk of transmitting to others. Aside from the
fact I still see patients every day in the hospital,
and even though I wear my my face covering, you know,
I also want to be very very cautious about my
(12:49):
risk for acquisition. So this is a personal decision most
most in most places. As you know, masking has now
become more of a personal choice, just like vaccination, and
I respect that, but um, but we want to make
sure that people understand. You know, you do your own
risk calculus here in terms of the same thing when
you were going home for Thanksgiving or when you're making
(13:11):
your Christmas plans, whom are you going to be in
contact with? What's your own personal health situation? Um, you know,
how can you protect yourself to the best environment, to
the best way that you feel you should or protect others?
And those are all personal choices. One final question for you,
and this has to do with the vaccines. Some people
are going online and they're doing their own research and
(13:32):
they're coming across information about the vaccines that appears to
be different from what they're hearing from public health officials
in terms of the safety of these vaccines. What do
we know because so many people have been vaccinated, not
just here in the US, but across the world, what
do we know about safety of the vaccines and any
potential side effects things like that? Another great question. You know,
(13:55):
these have been I think some of the most studied
UH vaccine know globally now that we have had and
they are safe and effective. And again, if you looked
at the way they were rolled out, it wasn't just
the pre clinical trials but also post clinical trials. But
those of us got vaccine. You've got text you know,
you got texted making sure from you know how you're doing.
(14:16):
And so what we know is for all the vaccines,
the most common side effects you see are just local
what we'd say reactions that you get with any vaction vaccine. Uh,
you know, maybe a little ache there, some people might
have a little bit transient fever. Uh. Sometimes a little
bit of swelling in the limph note there, but relatively minor,
all self limited. Some of the other signals, uh, you
(14:37):
know we talk about with the MR and A vaccines,
especially in the younger males, the second dose, there's been
a signal for what they say a little bit of
inflammation of the heart, which is usually self limited, but
still one in one in a million in terms of
this nature. Uh. So what we know now is they
continue to be extremely safe, extremely effective. Uh. And now
(14:59):
we're down in the age group as you know, for
five year olds and above, and again no other additional
safety signals that have thrown us off. And this is
not just in the US, but globally. The other side
of the coin, Ryan is is we look and where
cases occur and where the hospitalizations and deaths are. They
are still primarily segregated by those who are not immune,
(15:22):
no vaccinated versus vaccinated. So we see that every day
in the hospital in terms of who's admitted with severe disease.
In terms of this and remember what, we're still having
a proud a thousand deaths a day here in the homeland,
uh now twenty months into it, after we have effective
preventive treatment with the vaccine. And so that's the real
(15:44):
target is is still to try to convince people who
are hesitant about receiving the vaccine and are not immune,
um you know, to please stick the arm out and
get the jab for themselves and for their love. With
Dr Stephen Gordon, share of the Department of Infectious Disease
at Cleveland INEK with an update on the pandemic for ut.
Dr Gordon, thanks so much for the time and insight.
We really appreciate it. Well, Ryan, thank you and thanks
(16:06):
for all you do in um in happy how how
they seasoned to you and your listeners and same to
you all right. Finally, let's turn to Dr Carry Tibbles,
director of Graduate medical Education at Beth Israel Deaconess Medical
Center in Boston. She's here to talk about working on
the front line against COVID nineteen for almost two years now.
Dr tibbles. Thanks so much for joining me, and first
(16:27):
of all, tell us about your experience and what you've
seen and witnessed firsthand. Well, thank you, Ryan. It's great
to be here today with you. When I think back
over these last twenty months, UM, it really is just incredible.
One how long it's gone on. And as I think
back to those early days, you know, just what it
was like, I think for me being here in Boston.
(16:50):
You know, we started to hear in February about this
you know, unusual virus that was popping up in China,
and you know, a couple of patients would us about it,
but we don't think we dreamed that once the door opened,
what was going to happen for us? You know. So
it's a busy emergency department physician. Um, we have you know,
sixty beds were right in downtown Boston. And I remember
(17:14):
in late sort of like the first week of March,
when we had our first patient show up at triage.
They had traveled in China, right in the Providence Muhan
and they came back and they had cold symptoms, and
we were like, oh wow, what do we need to
do here? You know, and we put this patient in
(17:35):
an isolation room. We had six or seven people all
gound up in full PPE to go see them because
we were trying to figure out what's happening. And then
you fast forward a week and a half later and
we had set up a full respiratory unit in our
lobby and we were starting to process lots and lots
of patients. That happened so quickly, so for me it
(17:56):
was life changing in about two and a half weeks,
where all of a sudden, everything we were doing had
turned to be able to care for these patients and
to combat the virus in our city. And how have
the different waves impacted frontline workers? Because it seems there
will be this surge in patients that need help and treatment,
(18:20):
and then it'll slow down a little bit, and then
it will come back, and that back and forth must
be very taxing. No. I really appreciate that you asked
that question, Ryan, because I think that is really critical
to understand the experience of frontline workers right now. I
think that first wave was really just all encompassing, as
(18:43):
we had to reorganize our hospital guide as much PPE
as we could. We even had the Harvard engineers coming
to our emergency department to learn to develop new swabs
for us because we were running out of swabs to testations.
So that was just all encompassing and everybody was all
ends on deck. We found emergency housing for people who
couldn't go home, someone like myself, my son who is immunecompromised.
(19:08):
I had him live in northern Maine with my family.
So we were doing all of these drastic things in
that early early phase um and also for myself in
in medical education. Overseeing the residents and fellows who were
learning medicine during this was really really an incredible time
of its sort of even asking you know, wow, what
(19:28):
did I get myself into, you know, when they were
realizing their own personal risks. So that was the first
four months and we really banned it together. But then
at the end of that we were tired. One. We
were really missing the ability to connect meaningfully with our
colleagues just in a conference or you know, for these
students to learn and to learn together in a classroom.
(19:51):
We couldn't do that for their training, so it was
starting to impact their training. And just as it seemed
like it was letting up a little bit, the next
wave hit and We felt like we were right back
to where we were, only this time in some ways
we were more experienced and there wasn't the uncertainty of
what does this disease do? I think we we had
(20:13):
learned and that knowledge was there, and there was a
lot of benefits to that. But people were extremely tired
and worn out. And to be honest, some of my
older colleagues had left medicine and we all of a sudden,
we're facing staffing shortages and such, and so we went
into the fall that second wave a little depleted, to
(20:34):
be honest, more experienced and resilient, but yet there was
some depletion there as well. Um Ryan Gorman joined by
Dr Carry Tibble's director of Graduate medical Education at Beth
Israel Deaconess Medical Center in Boston. When it comes to
frontline workers and what you've seen and what you've had
to go through, you have patients who have been dying
(20:55):
because of COVID nineteen and they're not able to see
an interact with their loved ones. That must really weigh
on frontline workers who have been exposed to that kind
of thing throughout the course of this pandemic. It must
really take a toll on their mental health. I really
appreciate that question. I think one of the things I
(21:18):
was most proud of when I saw both the residents
that I oversee and my colleagues doctors and nurses caring
for these patients is how they just emotionally invested in
their patients and stepped in and almost took on the
role of the family member, you know, connecting them by
an iPad, holding holding their hands, being there with the patients,
(21:41):
trying to help them not feel alone and feels connected
to their families. We actually had some of our residents
um in other specialties like pathology and radiology who maybe
one it's busy actually making a lot of phone calls
to families, joining the primary clinical teams, making phone calls,
connecting with the families. So I think we played an
(22:01):
incredibly important role in in sort of communicating with the
family and almost stepping in as a surrogate um surrogate
family member. But over time, that emotional toll starts to
weigh on you a little bit when you're doing that
day after day and maybe not feeling is connected to
your own family and to your friends and to the
(22:23):
activities that used to sustain you outside of medicine that
can really start to wear you down. And we're seeing
the effects of a tired workforce right now, particularly as
the sort of after and long term sects of a
COVID are starting to affect hospitals like backups and procedures
of now lots of people who need things done, and
(22:46):
our hospitals are too crowded as well. And the mental
health burden that is placed just in our society in general,
where we have so many patients seeking care for mental
health kind of overwhelming the system. So now you have
a tired group of doctors and nurses caring for a
patient population that has a lot of needs right now,
(23:06):
and we want to be able to meet those needs.
There was a survey down by the Pandemic Action Network
that found doctors and nurses say the pandemic caught them
off guard. Why do you think that is? I think,
as as I was mentioned, I think that's a great question.
As I was mentioning earlier, I think the rapid nature
(23:28):
where all of a sudden we were hearing about this
virus to where it had totally changed the world and
changed our world is a big piece of that. As
I think to be honest, it's unprecedented nature, even though
there had been other We've certainly taking care of respiratory
viruses in the past, and as an emergency position, I'm
trained to take care of multiple patients, you know, disaster situations.
(23:52):
I think the magnitude of it and just how it's
so totally changed how we were delivering care and what
was required of us, I think is why it caught
us off guard. And then I think, very quickly, it
also revealed the vulnerabilities in our system in terms of
how much personal protective equipment do we have, how easily
(24:14):
can we access it, do we make sure people are
trained to use it, and how well do we communicate
when protocols are changing quickly? How well do we communicate
that All of those things I think we had to
learn very very quickly, um, you know, and accelerated as
we responded to this pandemic, But those things weren't necessarily
(24:34):
in place when the pandemic started. Tell medicine is another
good example of that. The ability to connect electronically with
your patient remotely. That really accelerated during the pandemic, but
when we started we were doing it a little bit,
but not to what was required once COVID hit. I'm
Ryan Gorman, joined by Dr Carry Tibble's director of Graduate
(24:55):
medical Education at Beth Israel Deaconess Medical Center in Boston.
You mentioned the growth of telemedicine a moment ago throughout
the course of this pandemic. Are there other things similar
to that that have really developed and evolved and are
more widely used now as a result of the pandemic
that you think will be beneficial for all of us
moving forward. I think the pandemic particularly shed light on
(25:21):
the differences in care among many of the communities in
our cities where we saw drastic outcomes if you had
access to care. We saw it particularly in Boston in
our Black and Hispanic communities, and I think we've really
working hard to figure out innovative ways to go even
(25:43):
deeper in to reach those communities to make sure they
have the care they need. And I think the light
of the pandemic has shown on that is really important
and something we cared deeply about before, but I think
has accelerated our just urgency to care for all members
of our community and our city. I think that's first
of all. I think second of all, it opened up
(26:04):
an opportunity for collaboration among hospitals that I don't think
existed as to the level that it does now. I
think for myself, we started some meetings of those of
us who oversee education with all of the teaching hospitals
in Boston, and we should have been collaborating like that
for years. So I think the health challenges in our
(26:25):
society right now require us to break down silos and
work together as institutions for the common good of our city.
And I think those are the types of things in
addition to the technology that's developed. Certainly, I was fortunate
to work at that Israel Deaconis Medical Center where one
of the vaccines was developed, and to see that vaccine
(26:49):
come out after years of the viral research that that
lab had been doing was incredible. And so I think
advances in science are really important. But I think more
importantly is just how we're advancing as as a as
a healthcare um just community to better take care of
our cities. Another thing you alluded to a few minutes ago,
(27:09):
the PPE issues that we had especially early on in
this pandemic. Where we at with that now, and what
are some of the things that we really need to
make sure we're on top of in the event of
another pandemic down the roads, make sure that doesn't happen again.
I think that's a really really important question, and I
(27:31):
think we have gotten a lot smarter about how to
use for personal per types of equipment. But I think
the fact that the survey from the Pandemic Action Network
revealed that in many places across the country doctors and
nurses are still going to work concerned that they don't
have adequate PPE to keep themselves safe, I think is
(27:51):
an important finding and something that needs to be addressed.
And I think there are hospitals where you can walk
in and feel reassured that you nowhere to find your PPE,
and other hospitals that are struggling to meet that need.
And I think that's something that needs to be addressed.
Just across the board question for you, I think we
all recognize the tremendous work that's been done on the
(28:12):
front lines during this pandemic, But is there more that
needs to be done than just the thank yous that
I'm sure all of you are continuously receiving. I think
that's a really, really um crucial thing to raise. I
appreciate you asking that question. Um, I certainly have appreciated
the thank you of both from you know, people that
(28:35):
I meet, but also my patients. But as I think
about moving forward, I am worried about, um the burnout
that I'm seeing in healthcare workers, and so I think,
what we really need to pay attention to our larger
sweeping programs that are addressing mental health needs of healthcare workers,
(28:56):
that we're making sure we have structured spitals and resource
hospitals where people can come to work do a really
good job but not feel like they're being overstrained and
burdened every day because of the needs. And that takes
a lot of planning and it takes a lot of resources.
But I think as we are trying to keep our
communities healthy, keeping our frontline workers healthy is a really
(29:19):
important part of that. All right. Dr Carry Tibbles, Director
of Graduate Medical Education at beth is Real Deaconess Medical
Center in Boston. Dr Tibbles, thank you so much for
the great work you've done on the front lines, and
thanks so much for coming on the show. Well, thank
you for having me. It's been great to be here,
all right, And that I'll do it for this edition
of iHeartRadio communities. As we wrap things up, one offer
big thanks to all of our guests, and of course
(29:39):
to all of you for listening. I'm Ryan Gorman. Will
be back, same time, same place, next weekend. Stay safe,
Welcome to I Heart Radio Communities, a public affair special
focusing on the biggest issues impacting you this week. Here's
Ryan Gorman. Thanks for joining us here on I Hear
Radio Communities. I'm Ryan Gorman, and we have some important
conversations lined up for you coming up in a moment.
We'll get the latest info on the pandemic, including this
new amicron variant, with the top infectious disease expert from
(00:23):
Cleveland Clinic, and then on top to the director of
Graduate Medical Education at the Top Medical Center in Boston
about what it's been like on the front lines during
this ongoing public health crisis. So we have a lot
lined up for you right now. To get things started,
I'm joined by Dr Stephen Gordon, chair of the Department
of Infectious Disease at Cleveland Clinic. Dr Gordon, thanks so
much for coming on the show, and let's begin with
(00:44):
a big picture overview of where things stand right now
with the spread of COVID nineteen across the country. Well, well,
first of all, thank you for having me, and it's
a pleasure to be here in terms of the pandemic situation,
and again as we're into you know now going into
week month, maybe twenty one. Things continued to be I
would say, in this date of flux in here in
(01:05):
the homeland, we're still averaging almost cases UM a day.
These are new cases across the country, although the it's
it's not equally distributed. So where I am now, UM
in Cleveland, Ohio, here in the Midwest, we're seeing a
big search. If you look down in south now things
have cooled off in areas. So throughout this pandemic, I
(01:26):
think we've learned that UM it is not a linear course.
Things continue to be dynamic, But there's still what I
would say, a lot of virus out there. Now that
the delta variant has been with us for a few months,
what do we know about it, especially as it compares
to some of the earlier strains of COVID nineteen that
we dealt with. That's a great question, Ryan, you know,
And when we talk about urna virus is like coronavirus is,
(01:48):
mutations or changes are are part of the kind of landscape.
There are thousands of variants UM, but as we all
know here in homeland the world, it's the delta variant
that is now the predominant drain UM and it does
have some advantages in terms of obviously host factors in
terms of infection as well as transmissibility. So it's a
little bit more transmissible uh than the prior, say, the
(02:11):
alpha or the original strains. In terms of severity disease,
probably no change there, but it has really taken a hold.
And as we look at our what we'd say, our
genomic analysis, at least here in the United States, it's
more than all the isolates that have been sequenced. And
that's been true almost throughout the whole of all. Right, now,
(02:32):
let me get to the question that I think is
on most people's minds. This new variant that we're hearing about.
How does it potentially differ from the delta variant? What
do we know about it so far? So a very
dynamic situation, uh, in terms of here this new variant,
which is kind of the fifth what we call variant
of concerned, it's been named a macron, which in the
Greek alpha alphabets fifteen. It's numeric name is now B
(02:55):
one one to nine, and it was first reported, uh
November from South Africa. It's still in what I would
say in discovery phase. What has created a lot of
attention is the number of new mutations in its sequence,
so over fifty new what we say, unique mutations, including
about thirty in the important spike protein. UH. That's important
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because that confers immunity and also pathogenicity. So the uncertainties
that we don't know now is is this more transmissible
than say delta. Do our current vaccines or prior infection
protect against omicron? That's still not clear. And then is
there a different what we say, spectrum of clinical illness?
So not surprisingly as people are looking for it. Um
(03:40):
it's not just as in South Africa now it's it's
greater than two dozen countries, including here in the almand
with the first case identified in California from a traveler
who was vaccinated UH coming back from South Africa. So
a lot of attention. We should know more within the
next couple of weeks as experimental studies in EPI studies
will be done to look at some of these questions.
But the big question I think that people have in
(04:01):
the mind, like you say, is for those of us vaccinated,
you know, is their protection at least protection from severe disease?
And we just don't know that. We don't know that now,
But it does pay it to me when we're talking
about the variants to date. Again, the vaccines that we
have available here in the home month, the two m
R and A's and the Johnson and Johnson are very
effective in preventing severe disease and death from all our
(04:24):
our variants of concern to date. So that is our
our number one what we say, our most important armamentarium
against the virus now are safe and effective vaccines. I'm
Ryan Gorman, joined by Dr Stephen Gordon, share of the
Department of Infectious Disease at Cleveland Clinic. Let me ask
you about natural immunity versus the immunity one receives through vaccination.
(04:46):
Question I've got a lot of the past few months
involves how we end up with better protection through the
vaccines as opposed to our bodies naturally fighting off the
virus after infection. Can you explain how that works? So,
I think for all of us, I mean, we we
have you know, for those of us a little bit
older in the teeth, you know, when we used to
(05:08):
see measles, mom's chicken pox in the community. Um. You know,
these um, although they didn't kill a lot of people,
cause devastating complications and we don't see that anymore, and
that's because we've had effective vaccines in These vaccines are
very durable, and that's been a blessing. When we talk
about respiratory viruses. The one vaccine most people know about
(05:28):
his influenza, right. But influenza also can change, which is
why we need to change our formula each each year.
And again, the point there is not necessarily to protect
you from getting a little bit of a cold, but
to prevent you, hopefully from getting severe disease. With the coronavirus,
it's a similar situation. UM. So getting getting COVID nineteen
(05:48):
does provide um immunity, the duration of which we don't
know UM. However, it also carries with it some risk.
I would much rather get a vaccine to prevent getting
in action and run the risk of not just acute
complications of the infection. But as you know, there is
that that issue about long hauler in long term sequel
a after COVID nineteen that we still don't know. UM.
(06:12):
We still don't know everything about that. UM. We do
know lingering symptoms can occur in many patients even after
the acute symptoms have resolved, and so that's another reason why, UM,
I'd much rather protect myself with vaccine than natural infections.
For those who receive two doses of the MR and
A vaccines or one dose of the Johnson and Johnson vaccine,
(06:34):
why is there a need for a third shot now,
a booster shot. Well, at this point, I think when
we talk about um our immune system. You know, one
of that is our what we call our antibodies in
terms of this nature, which do peak after initial exposure
vaccine and then dwindle. UM. And the concept of boosting
(06:55):
is after a certain period of time one would benefit
from another kind of stimulation and to the immune system
with a booster shot. And there are many vaccines you
know that we do use boosters already. For instance, you
know our appatitis v vaccines in the vaccines are a
series vaccines. The human papaloma virus is also a series vaccine. UM.
(07:16):
So what we think about coronavirus, what we don't know
is will this become an annual event um, you know,
similar to influenza, where we'll we'll get a booster and
potentially a different formulation every year. UM. So these are
questions we still don't know, but their rationale behind booster
does come from also studies in countries like Israel where
(07:37):
UM using booster it looked like it effectively diminished what
we call breakthrough infections, especially amongst the elderly or people
who have uh you know what we would say, medical
conditions that put them at higher risk for hospitalization. I
want to get to breakthrough infections those who are fully
vaccinated yet still contract COVID nineteen. First of all, what
(07:59):
do we know about right now? And also what is
the transmissibility like of the virus among those who are
fully vaccinated and contract COVID nineteen compared to those who
get infected and are unvaccinated. So all great questions. Uh
So let me try to break that back down. Uh
So when we talk about UM breakthrough infections, UM, you know,
(08:23):
I think one of the things that that is mistaken
is people look and say, well, I see people have
gotten vaccinated who have had a positive test, uh and
therefore the vaccine is not effective. What we really want
to focus on is not so much people who may
have a mild you know, cold break through affection or
have a positive test. It's really severe disease and hospitalization.
(08:44):
And we know for instance, people who have been vaccinated
versus those who have not. You know, the risk of
hospitalization and depth is ten times less for those that
have been vaccinated. And that's really the most important marker,
not whether someone gets a little bit of a cold
or sniffle uh in my opinion, and then has a
quote unquote positive test. In terms of if you do
(09:05):
get a break to infection, you know, can you transmit
You can't still transmit to others, although the duration of
the virus that stays up there is probably less than
those who have not been vaccinated. And that's why if
you still get a break through infection, the public health
people are still telling you to quote unquote isolate uh
for the ten days. Um, you know, outside of of
(09:27):
the what we say, the breeding space of others who
are not in the I'm Ryan Gorman, joined by Dr
Stephen Gordon Share of the Department of Infectious Disease at
Cleveland Clinic. In terms of contracting COVID nineteen, very basic
question for you, what do we know about that all
these months later? Because early on in the pandemic, we
were wiping everything down. We were afraid we're going to
(09:49):
contract it by touching something then we were told if
you're indoors and close quarters with someone for an extended
period of time, that's when you were most likely to
potentially get infected. So have we learned over the past
twenty plus months another good question run So initially, as
you said, maybe a little bit too much emphasis on surfaces.
I mean, I'm gonna leave in clean surfaces and antigene,
(10:11):
but but we don't need the high level disinfection and
focus on door handles and things. Where this virus spreads
most effectively and most efficient efficiently is in households. So
that's like me and my family, where I'm you know,
close contact without mask, sharing a lot of airspace. Uh
So indoors close contact uh in people um you know
(10:34):
that are not wearing masks like other respiratory viruses, you know,
similar to rhinovirus or influenza virus. The big one of
the big challenges with COVID has been gently speaking with
the flu. You don't have a long period where I
can be contagious without symptoms. It's usually less than a day.
So by the time I have the onset of my aches, chills,
or fever, I'm already know I'm sick. And isolate myself
(10:58):
with With COVID, it's it's more stealth here. So you
might have a period of two or three days before
you have any symptoms where you're infected and can transmit.
And that's that period where maybe thirty cases in the
community and households are being transmitted. So it's you know,
even if you're feeling well with COVID. You know, that's
(11:19):
one of been been one of the big challenges in
infection prevention, is you can still transmit. So when people
are going about their daily lives, grocery shopping, doing some
Christmas shopping, should they be concerned in those situations or
because of the nature of the likely interactions that they
would potentially have, the risk is much lower. You know,
(11:42):
I would what I would say is I view this
as more of a it's it's a what we'd say,
a layered approach, right, and it really depends because depends
on your condition as well. Um. You know, if I
have other you know what I call medical conditions that
I really want to mitigate my risk, I'll be vaccinated
when I go indoors. Um, i will wear a face covering, uh,
(12:05):
because I don't it's hard to predict your contacts with people.
You might think you're being and out, maybe someone will
come up to ask you a question or things of
this nature. So I I just plan on, Okay, I
just assume that everyone else may be infected if I'm
going indoors in terms of this nature, and I control
what I can control, So I will still wear even
though I'm boosted and everything else, uh, you know, in
(12:26):
the abundance of caution, because again, I have parents who
are still very elderly that I visit, and although I
may not get sick with a breakthrough infection, I really
don't want to take any you know, I want to
mitigate my risk of transmitting to others. Aside from the
fact I still see patients every day in the hospital,
and even though I wear my my face covering, you know,
I also want to be very very cautious about my
(12:49):
risk for acquisition. So this is a personal decision most
most in most places. As you know, masking has now
become more of a personal choice, just like vaccination, and
I respect that, but um, but we want to make
sure that people understand. You know, you do your own
risk calculus here in terms of the same thing when
you were going home for Thanksgiving or when you're making
(13:11):
your Christmas plans, whom are you going to be in
contact with? What's your own personal health situation? Um, you know,
how can you protect yourself to the best environment, to
the best way that you feel you should or protect others?
And those are all personal choices. One final question for you,
and this has to do with the vaccines. Some people
are going online and they're doing their own research and
(13:32):
they're coming across information about the vaccines that appears to
be different from what they're hearing from public health officials
in terms of the safety of these vaccines. What do
we know because so many people have been vaccinated, not
just here in the US, but across the world, what
do we know about safety of the vaccines and any
potential side effects things like that? Another great question. You know,
(13:55):
these have been I think some of the most studied
UH vaccine know globally now that we have had and
they are safe and effective. And again, if you looked
at the way they were rolled out, it wasn't just
the pre clinical trials but also post clinical trials. But
those of us got vaccine. You've got text you know,
you got texted making sure from you know how you're doing.
(14:16):
And so what we know is for all the vaccines,
the most common side effects you see are just local
what we'd say reactions that you get with any vaction vaccine. Uh,
you know, maybe a little ache there, some people might
have a little bit transient fever. Uh. Sometimes a little
bit of swelling in the limph note there, but relatively minor,
all self limited. Some of the other signals, uh, you
(14:37):
know we talk about with the MR and A vaccines,
especially in the younger males, the second dose, there's been
a signal for what they say a little bit of
inflammation of the heart, which is usually self limited, but
still one in one in a million in terms of
this nature. Uh. So what we know now is they
continue to be extremely safe, extremely effective. Uh. And now
(14:59):
we're down in the age group as you know, for
five year olds and above, and again no other additional
safety signals that have thrown us off. And this is
not just in the US, but globally. The other side
of the coin, Ryan is is we look and where
cases occur and where the hospitalizations and deaths are. They
are still primarily segregated by those who are not immune,
(15:22):
no vaccinated versus vaccinated. So we see that every day
in the hospital in terms of who's admitted with severe disease.
In terms of this and remember what, we're still having
a proud a thousand deaths a day here in the homeland,
uh now twenty months into it, after we have effective
preventive treatment with the vaccine. And so that's the real
(15:44):
target is is still to try to convince people who
are hesitant about receiving the vaccine and are not immune,
um you know, to please stick the arm out and
get the jab for themselves and for their love. With
Dr Stephen Gordon, share of the Department of Infectious Disease
at Cleveland INEK with an update on the pandemic for ut.
Dr Gordon, thanks so much for the time and insight.
We really appreciate it. Well, Ryan, thank you and thanks
(16:06):
for all you do in um in happy how how
they seasoned to you and your listeners and same to
you all right. Finally, let's turn to Dr Carry Tibbles,
director of Graduate medical Education at Beth Israel Deaconess Medical
Center in Boston. She's here to talk about working on
the front line against COVID nineteen for almost two years now.
Dr tibbles. Thanks so much for joining me, and first
(16:27):
of all, tell us about your experience and what you've
seen and witnessed firsthand. Well, thank you, Ryan. It's great
to be here today with you. When I think back
over these last twenty months, UM, it really is just incredible.
One how long it's gone on. And as I think
back to those early days, you know, just what it
was like, I think for me being here in Boston.
(16:50):
You know, we started to hear in February about this
you know, unusual virus that was popping up in China,
and you know, a couple of patients would us about it,
but we don't think we dreamed that once the door opened,
what was going to happen for us? You know. So
it's a busy emergency department physician. Um, we have you know,
sixty beds were right in downtown Boston. And I remember
(17:14):
in late sort of like the first week of March,
when we had our first patient show up at triage.
They had traveled in China, right in the Providence Muhan
and they came back and they had cold symptoms, and
we were like, oh wow, what do we need to
do here? You know, and we put this patient in
(17:35):
an isolation room. We had six or seven people all
gound up in full PPE to go see them because
we were trying to figure out what's happening. And then
you fast forward a week and a half later and
we had set up a full respiratory unit in our
lobby and we were starting to process lots and lots
of patients. That happened so quickly, so for me it
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was life changing in about two and a half weeks,
where all of a sudden, everything we were doing had
turned to be able to care for these patients and
to combat the virus in our city. And how have
the different waves impacted frontline workers? Because it seems there
will be this surge in patients that need help and treatment,
(18:20):
and then it'll slow down a little bit, and then
it will come back, and that back and forth must
be very taxing. No. I really appreciate that you asked
that question, Ryan, because I think that is really critical
to understand the experience of frontline workers right now. I
think that first wave was really just all encompassing, as
(18:43):
we had to reorganize our hospital guide as much PPE
as we could. We even had the Harvard engineers coming
to our emergency department to learn to develop new swabs
for us because we were running out of swabs to testations.
So that was just all encompassing and everybody was all
ends on deck. We found emergency housing for people who
couldn't go home, someone like myself, my son who is immunecompromised.
(19:08):
I had him live in northern Maine with my family.
So we were doing all of these drastic things in
that early early phase um and also for myself in
in medical education. Overseeing the residents and fellows who were
learning medicine during this was really really an incredible time
of its sort of even asking you know, wow, what
(19:28):
did I get myself into, you know, when they were
realizing their own personal risks. So that was the first
four months and we really banned it together. But then
at the end of that we were tired. One. We
were really missing the ability to connect meaningfully with our
colleagues just in a conference or you know, for these
students to learn and to learn together in a classroom.
(19:51):
We couldn't do that for their training, so it was
starting to impact their training. And just as it seemed
like it was letting up a little bit, the next
wave hit and We felt like we were right back
to where we were, only this time in some ways
we were more experienced and there wasn't the uncertainty of
what does this disease do? I think we we had
(20:13):
learned and that knowledge was there, and there was a
lot of benefits to that. But people were extremely tired
and worn out. And to be honest, some of my
older colleagues had left medicine and we all of a sudden,
we're facing staffing shortages and such, and so we went
into the fall that second wave a little depleted, to
(20:34):
be honest, more experienced and resilient, but yet there was
some depletion there as well. Um Ryan Gorman joined by
Dr Carry Tibble's director of Graduate medical Education at Beth
Israel Deaconess Medical Center in Boston. When it comes to
frontline workers and what you've seen and what you've had
to go through, you have patients who have been dying
(20:55):
because of COVID nineteen and they're not able to see
an interact with their loved ones. That must really weigh
on frontline workers who have been exposed to that kind
of thing throughout the course of this pandemic. It must
really take a toll on their mental health. I really
appreciate that question. I think one of the things I
(21:18):
was most proud of when I saw both the residents
that I oversee and my colleagues doctors and nurses caring
for these patients is how they just emotionally invested in
their patients and stepped in and almost took on the
role of the family member, you know, connecting them by
an iPad, holding holding their hands, being there with the patients,
(21:41):
trying to help them not feel alone and feels connected
to their families. We actually had some of our residents
um in other specialties like pathology and radiology who maybe
one it's busy actually making a lot of phone calls
to families, joining the primary clinical teams, making phone calls,
connecting with the families. So I think we played an
(22:01):
incredibly important role in in sort of communicating with the
family and almost stepping in as a surrogate um surrogate
family member. But over time, that emotional toll starts to
weigh on you a little bit when you're doing that
day after day and maybe not feeling is connected to
your own family and to your friends and to the
(22:23):
activities that used to sustain you outside of medicine that
can really start to wear you down. And we're seeing
the effects of a tired workforce right now, particularly as
the sort of after and long term sects of a
COVID are starting to affect hospitals like backups and procedures
of now lots of people who need things done, and
(22:46):
our hospitals are too crowded as well. And the mental
health burden that is placed just in our society in general,
where we have so many patients seeking care for mental
health kind of overwhelming the system. So now you have
a tired group of doctors and nurses caring for a
patient population that has a lot of needs right now,
(23:06):
and we want to be able to meet those needs.
There was a survey down by the Pandemic Action Network
that found doctors and nurses say the pandemic caught them
off guard. Why do you think that is? I think,
as as I was mentioned, I think that's a great question.
As I was mentioning earlier, I think the rapid nature
(23:28):
where all of a sudden we were hearing about this
virus to where it had totally changed the world and
changed our world is a big piece of that. As
I think to be honest, it's unprecedented nature, even though
there had been other We've certainly taking care of respiratory
viruses in the past, and as an emergency position, I'm
trained to take care of multiple patients, you know, disaster situations.
(23:52):
I think the magnitude of it and just how it's
so totally changed how we were delivering care and what
was required of us, I think is why it caught
us off guard. And then I think, very quickly, it
also revealed the vulnerabilities in our system in terms of
how much personal protective equipment do we have, how easily
(24:14):
can we access it, do we make sure people are
trained to use it, and how well do we communicate
when protocols are changing quickly? How well do we communicate
that All of those things I think we had to
learn very very quickly, um, you know, and accelerated as
we responded to this pandemic, But those things weren't necessarily
(24:34):
in place when the pandemic started. Tell medicine is another
good example of that. The ability to connect electronically with
your patient remotely. That really accelerated during the pandemic, but
when we started we were doing it a little bit,
but not to what was required once COVID hit. I'm
Ryan Gorman, joined by Dr Carry Tibble's director of Graduate
(24:55):
medical Education at Beth Israel Deaconess Medical Center in Boston.
You mentioned the growth of telemedicine a moment ago throughout
the course of this pandemic. Are there other things similar
to that that have really developed and evolved and are
more widely used now as a result of the pandemic
that you think will be beneficial for all of us
moving forward. I think the pandemic particularly shed light on
(25:21):
the differences in care among many of the communities in
our cities where we saw drastic outcomes if you had
access to care. We saw it particularly in Boston in
our Black and Hispanic communities, and I think we've really
working hard to figure out innovative ways to go even
(25:43):
deeper in to reach those communities to make sure they
have the care they need. And I think the light
of the pandemic has shown on that is really important
and something we cared deeply about before, but I think
has accelerated our just urgency to care for all members
of our community and our city. I think that's first
of all. I think second of all, it opened up
(26:04):
an opportunity for collaboration among hospitals that I don't think
existed as to the level that it does now. I
think for myself, we started some meetings of those of
us who oversee education with all of the teaching hospitals
in Boston, and we should have been collaborating like that
for years. So I think the health challenges in our
(26:25):
society right now require us to break down silos and
work together as institutions for the common good of our city.
And I think those are the types of things in
addition to the technology that's developed. Certainly, I was fortunate
to work at that Israel Deaconis Medical Center where one
of the vaccines was developed, and to see that vaccine
(26:49):
come out after years of the viral research that that
lab had been doing was incredible. And so I think
advances in science are really important. But I think more
importantly is just how we're advancing as as a as
a healthcare um just community to better take care of
our cities. Another thing you alluded to a few minutes ago,
(27:09):
the PPE issues that we had especially early on in
this pandemic. Where we at with that now, and what
are some of the things that we really need to
make sure we're on top of in the event of
another pandemic down the roads, make sure that doesn't happen again.
I think that's a really really important question, and I
(27:31):
think we have gotten a lot smarter about how to
use for personal per types of equipment. But I think
the fact that the survey from the Pandemic Action Network
revealed that in many places across the country doctors and
nurses are still going to work concerned that they don't
have adequate PPE to keep themselves safe, I think is
(27:51):
an important finding and something that needs to be addressed.
And I think there are hospitals where you can walk
in and feel reassured that you nowhere to find your PPE,
and other hospitals that are struggling to meet that need.
And I think that's something that needs to be addressed.
Just across the board question for you, I think we
all recognize the tremendous work that's been done on the
(28:12):
front lines during this pandemic, But is there more that
needs to be done than just the thank yous that
I'm sure all of you are continuously receiving. I think
that's a really, really um crucial thing to raise. I
appreciate you asking that question. Um, I certainly have appreciated
the thank you of both from you know, people that
(28:35):
I meet, but also my patients. But as I think
about moving forward, I am worried about, um the burnout
that I'm seeing in healthcare workers, and so I think,
what we really need to pay attention to our larger
sweeping programs that are addressing mental health needs of healthcare workers,
(28:56):
that we're making sure we have structured spitals and resource
hospitals where people can come to work do a really
good job but not feel like they're being overstrained and
burdened every day because of the needs. And that takes
a lot of planning and it takes a lot of resources.
But I think as we are trying to keep our
communities healthy, keeping our frontline workers healthy is a really
(29:19):
important part of that. All right. Dr Carry Tibbles, Director
of Graduate Medical Education at beth is Real Deaconess Medical
Center in Boston. Dr Tibbles, thank you so much for
the great work you've done on the front lines, and
thanks so much for coming on the show. Well, thank
you for having me. It's been great to be here,
all right, And that I'll do it for this edition
of iHeartRadio communities. As we wrap things up, one offer
big thanks to all of our guests, and of course
(29:39):
to all of you for listening. I'm Ryan Gorman. Will
be back, same time, same place, next weekend. Stay safe,
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