Dr. Chan & Dr. Talbot, N.H.'s Top Epidemiologists, On Vaccines & New COVID-19 Variant | New Hampshire Public Radio

Dr. Chan & Dr. Talbot, N.H.'s Top Epidemiologists, On Vaccines & New COVID-19 Variant

Jan 19, 2021

Credit Dan Barrick/NHPR

We talk about the new, more contagious variant of COVID-19, and what that means for both personal and public health, and we learn more about how the vaccine protects you and others, and have to behave safely before and after vaccination. 

Air date: Wednesday, Jan. 20, 2021. 


GUESTS:

  • Dr. Benjamin Chan - State epidemiologist for New Hampshire.
  • Dr. Elizabeth Talbot - Deputy state epidemiologist and infectious disease specialist at Dartmouth-Hitchcock Medical Center.

Produced by Christina Phillips. 

 

 

Transcript:

  This is a computer-generated transcript, and may contain errors. It has been edited for readability and clarity. 

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy, and this is The Exchange.

Laura Knoy:
Amid hope provided by COVID-19 vaccines comes worrying news about a new coronavirus variant said to be much more contagious. Meanwhile, the death toll in the United States has exceeded 400,000 since the pandemic began. Here in New Hampshire, 938 people have died, with the state reporting this week that our current test positivity rate is around seven percent. Today, the state's top two epidemiologists are back with an update and to answer your questions. So send them in.

Laura Knoy:
Our guests are Dr Benjamin Chan. He's the state's epidemiologist. Dr. Chan, welcome back and thank you.

Dr. Chan:
Good morning. Glad to be here.

Laura Knoy:
Also with us, Dr Elizabeth Talbot, the deputy state epidemiologist and an infectious disease specialist at Dartmouth Hitchcock Medical Center. And Dr. Talbot, welcome back to you, too. Thanks for your time.

Dr. Talbot:
Thank you so much for having us back.

Laura Knoy:
So, both of you, here we are, Inauguration Day, a new administration begins.

Laura Knoy:
Dr. Talbot, you first, please. What do you, as a public health official, hope to see from the federal government in these next few critical weeks?

Dr. Talbot:
More vaccine, without a doubt. So I've very much appreciated to see the Biden administration's posted plan, several of which features mechanisms to increase vaccine production. So I think it's understandable that federally they have advocated for prioritization of those who are most vulnerable to morbidity and mortality that is getting sick and hospitalized and dying. But we can't do it without adequate numbers of vaccine.

Laura Knoy:
Yeah, that was the message that we got from our show yesterday. The state is getting ready to move into this new phase of vaccine registration. You know, the systems are being set up websites, phone numbers, community health clinics and so forth.

Laura Knoy:
But the message we also got from folks yesterday, Dr. Talbot, was we need vaccines from the federal government before we can implement this plan.

Dr. Talbot:
That's right. And, you know, there are other features, too, that can help us very much operationally, such as timely and transparent shipping plans. I've heard the phrase and appreciate it very much from where I said that we would rather that they under promised and over delivered.

Dr. Talbot:
But when we don't receive the amount of vaccine we've expected, it can be extremely disruptive to to our operational plans. And the trickle down is that people, of course, are disappointed and frustrated and going unvaccinated longer than anyone wants. So.

Laura Knoy:
Dr. Chan, how about you as the state's top public health official? What do you want and need from the federal government?

Dr. Chan:
Yeah, I think better communication and coordination with local public health agencies.

Dr. Chan:
And I think what we've seen throughout the last 10 plus months of this pandemic is a patchwork of responses across the country with each state sort of taking a slightly different approach to different, you know, different strategies.

Dr. Chan:
And I think there needs to be better coordination with what is happening at local and state public health agencies across the country to come up with a better coordinated national strategy and plan and to respond to this pandemic.

Laura Knoy:
The positivity rate is around seven percent right now. How should we interpret this, Dr. Chan? What does that really mean, a seven percent positivity rate?

Dr. Chan:
Yeah, so the positivity rate has been coming down in the last two, three weeks or so, you know, it peaked just over 10 percent and now it's just below seven percent. And I think that's that's good news. That's a promising trend. But the overall level still remains too high.

Dr. Chan:
The positivity rate looks at the proportion of people that test positive out of everybody that's tested. And so when that number is high, it means that there's likely a lot of infection out in the community that we're missing. When the test positivity rate is low, it means we're doing enough testing to adequately identify infection within within the community.

Dr. Chan:
And so the trend is promising. The overall number still remains too high. We'd like to see that certainly below five percent. And the lower the lower the better.

Laura Knoy:
And another number we have been looking at. Dr. Chan, is hospitalizations. As you know, ICU bed occupancy has risen, as have the number of people hospitalized. Where are we at, Dr. Chan, in terms of our state's ability to care for very ill people who need to be in the hospital?

Dr. Chan:
Yes. So our hospitals are still open. They're still able to provide the necessary and emergency services to people in the community. But they're certainly feeling the strain of the pandemic in terms of capacity and workforce. And, you know, this is going to vary hospital by hospital.

Dr. Chan:
We're on a call twice a week, in fact, with hospitals around the state assessing, assessing their assessing their condition. And so this is another area where, you know, the trend is promising.

Dr. Chan:
The daily number of people hospitalized with COVID-19 has decreased over the last couple of weeks from a high of around 330 people statewide hospitalized to around now 250. So while the trend is promising, the overall number still remains again, too high. You know, 250 people hospitalized throughout the state is still double the number of people that were hospitalized at the peak during our first wave of the pandemic.

Laura Knoy:
Yeah, it's interesting, I've heard other public health officials talk about slight decreases in some of these numbers, but then they compare it to the last peak in April and it doesn't look great. And Dr. Talbot, to you, what's the danger zone in terms of health care system capacity? What are you looking at there?

Dr. Talbot:
So we've already heard from Dr. Chan that the hospitals are still functional in terms of all of their services, and that's very important to us because we know that there are indirect impacts of covid on our population, people who are not able to get other kinds of care that they need or are reluctant to seek health care for fear of acquiring disease.

Dr. Talbot:
I'm very proud of our hospital systems for controlling in hospital transmission. That's just not a feature of what we see in New Hampshire. And that speaks to a tremendous effort on the part of every hospital and health care provider.

Laura Knoy:
Have you seen, Dr. Talbot, hospitals having to adjust their care then yet at all based on, you know, the rising number of hospitalizations?

Dr. Talbot:
There are always shifts in the operations that hospitals undertake. So, for example, we heard the hospitals were preparing to take care of their sickest patients by expanding places where ventilators are functional. So just moving patients around.

Dr. Talbot:
In other words, cohosting that is keeping like ill patients together in some different wards. So we're pleased with, of course, the state adoption of eye protection. So either goggles or face shields. So lots of adjustments happen behind the scenes at hospitals. And again, I've been very gratified by the partnership between the hospitals and the states and and also their clear intentions to to maintain safe and full operations.

Laura Knoy:
And Dr. Chan, if this does continue to, you know, spread, as you said, what's the plan for hospitals? Are we going to put up surge sites like the ones that we saw back in the spring outside some of the the major health care centers, those those big white tents that we saw?

Dr. Chan:
Yeah, it's a it's a good question. And one of the critical limiting resources that we have in New Hampshire and actually nationwide is really staffing. Right. And so if we were to set up surge centers, we would need to find a way to staff those centers. And so right now, there's not a plan to set up certain centers, although there is always that option in that possibility.

Dr. Chan:
Before we would get to that point, we would look to the hospitals to shift the resources, as Dr. Talbot was just talking about. And that would include probably having hospitals, making the decision to cancel elective surgeries, elective procedures to offload the burden of patients and patient care on hospitals.

Dr. Chan:
And there are some hospitals that have taken that step already to start to to ramp down or cancel elective surgeries because of the increased burden on health care systems. And so hospitals have been able to manage by shifting resources from one area to another. And likely we would look to hospitals to implement more steps like that before we talk about opening certain centers. But certainly that remains an option if things get very dire in the future.

Laura Knoy:
Dr. Chan, Marie in Hopkinton writes, Please tell us why Johns Hopkins positivity rate is at ten point four percent percent and Dr. Chan is giving us a lower rate Marie. Thank you, Dr. Chan. We've talked about this before, so go ahead, please.

Dr. Chan:
Yeah, so I think what's the person is talking about is Johns Hopkins report on New Hampshire data. And I want people to our data as probably the most most accurate. You know, a lot of these other sites outside of New Hampshire are pulling or scraping data that we we normally report. And so it's going to vary depending on what you include in the numbers.

Dr. Chan:
When we talk about a seven percent test positivity, we're talking about that being a seven day average, so averaged out over seven days and looking at full antigen and PCR test combined. So I can't speak to exactly what Johns Hopkins is reporting because I don't have those numbers in front of me. But it is important to look at whether we're talking about a single day test positivity versus a seven day average.

Dr. Chan:
And when you're comparing state to state, it's important to look at, you know, does the state include just PCR tests or PCR and antigen test as we do in New Hampshire.

Laura Knoy:
I want to ask both of you about the new variants, Dr. Talbot, first, please, can you describe this new strain of COVID-19 that we've been hearing about for a couple of weeks that was first uncovered in the UK?

Dr. Talbot:
The virus under investigation or a virus of concern, as it's called, in these scientific circles, it did emerge in southeast England in September, noting, you know, pretty dramatic rise in the number of cases there. The genetic analysis of that virus showed that it does have mutations compared with the parent strain that has changes in its genetic recipe.

Dr. Talbot:
And some of those changes are in the so-called spike protein. So everybody's seen that graphic out there with those red knobs on it. To those knobs are the spike proteins and they facilitate the virus's uptake into our own cells. So it's an extremely important part of the virus. And seeing those spike proteins adapt to be more efficient and uptake is concerning. It's already in more than 50 countries.

Dr. Chan:
And December 29th, it was first reported in the United States and Colorado, importantly, in a person who had not traveled and had no contact with someone who had traveled. So as it's emerged in the U.S. there, there are now 76 cases reported and 12 states. And it's possible that it's a bit more widespread than that.

Laura Knoy:
This is what viruses do, right. Dr. Talbot, should we really be surprised by this? Viruses mutate and change.

Dr. Talbot:
That's exactly right. So all organisms make small mistakes in replication. Viruses are famous for this. HIV is one of the worst.

Dr. Talbot:
Very sloppy. Flu is very sloppy. And that's why we have to get a flu shot each year. And it replicates itself is a bit careless. So the coronavirus has shown itself as also having this propensity, making some mistakes along the way. And some of the mistakes are favorable to the virus. And so they're selected for, if you will, they they have a selective advantage.

Dr. Talbot:
So you're right, this is normal for viruses. But but we certainly hope that the mistakes that it makes doesn't favor the virus over the human. And here we have a virus that now is shown to be more transmissible again by virtue of the fact the spiked protein is adapted.

Laura Knoy:
Disappointing news after there was some excitement at the beginning of the year over the rollout of these vaccines. And speaking of the vaccines, Dr. Chan, how effective are the two vaccines that we have right now in this country against this new strain? Do we know?

Dr. Chan:
So we haven't seen good, solid data to give a number or vaccine efficacy against this new U.K. variant or the B117 strain. What we do know about this new variant, this new strain of the virus is, as Dr. Talbot mentioned, it appears to be more infectious, more transmissible person to person because of this these mutations and the spike protein.

Dr. Chan:
But there is not evidence that it causes more severe disease or more death. And there is not evidence of that immunity from prior infection to a different strain or immunity from vaccination is less in this new strain. The concerning thing about this be one one seven strain that was first identified in the UK is that it's, you know, at maybe approximately 50 plus percent more infectious, more transmissible when it gets into a population, it can spread more easily.

Dr. Chan:
More people will become infected, that greater number of people will lead to more hospitalizations, more deaths. But there's not evidence right now that the vaccine is less effective against this new strain.

Dr. Chan:
I should mention there are other strains, as you alluded to, that are emerging on the global level. There's a strain that was identified out of South Africa. And there's another one out of Brazil, And there's much less known about these variants, these other variants. They haven't yet been identified in the U.S. It's only the U.K. variant that's been identified in the U.S. But we're still studying to learn how how the vaccine might protect against not only not only the UK variant, but also these other emerging variants around the globe.

Laura Knoy:
J.J. in Pembroke is calling in. Hi, J.J., you're on the air. Go ahead.

Caller:
Hi. Thank you. I'm a physician. I have retired many years ago and have been doing advocacy for Public Health Association. And I'm part of the task force that the Public Health Association and the Office of Health Equity put together last spring. And one of our subgroups, which I'm part of, has focused on prisons and jails. And it's been very difficult to get much attention to this problem. And now we have some major outbreaks. And I'm wondering how we're going to help do more to protect all of us, actually, because just as with other things, the spread into the community from prisons and jails and the demand on resources, if people should start getting deathly ill from those outbreaks is really important.

Laura Knoy:
Jj, it's really good to hear from you, especially given the work that you're doing in this area. And Dr. Talbot, to you first. I think his concerns about institutional outbreaks at correctional facilities, long term care facilities, other settings that we've seen. Go ahead, Dr. Talbot. Your thoughts there.

Dr. Talbot:
Indeed, thank you, Joe.

Dr. Talbot:
The outbreaks that we are observing and in the corrections are, of course, concerning. And again, I speak to the importance of partnership with the Department of Corrections and the staff there to make sure that all the infection control processes are appropriately in place. And I'm sure they are. We also know that the facilities are very actively looking to bring vaccine on site or mechanisms for such. For those persons who are appropriate within our phase one be so, for example, those who are older than 65, 65 and older or those who may have medical comorbidities are certainly appropriately able to access vaccine. So establishing the partnerships and the mechanisms are a very important part of what we're doing right now. You're absolutely right that these. The virus takes advantage of congregate settings of all all types, so thank you for raising that issue.

Laura Knoy:
Well, and to that point, Dr. Chan, you know, Dr. Talbot said it best, the virus does take advantage of congregate settings. Is that an argument, Dr. Chan, for vaccinating all prisoners, not just those who have health conditions or who are over 65?

Dr. Chan:
Yes, so if I can just make the point before I answer that question, that in the first wave of this pandemic, we saw very few, if any, large prison or jail outbreaks.

Dr. Chan:
And so I just want to make the point that what happens in the community affects all of our institutions, whether that's, you know, prisons and jails, the long term care facilities, you know, public schools, our workplaces, our ability to conduct, you know, activities of daily living. And so it's really on all of us to make sure that the level of community transmission go down and when they go down, remain low.

Dr. Chan:
Because if we don't, we have situations like what we're seeing in our community outbreaks and long term care facilities, outbreaks that at prisons and jails. And we want to avoid the virus getting into these congregate living settings where we know it can spread very easily. You know, so to your question, yes.

Dr. Chan:
We want to get vaccine out to everybody in the state. You know, that includes, you know, staff at prisons and jails. That includes residents at prisons and jails. But the reality of the situation is that we are getting about 17 to 18000 doses of vaccine per week and we have hundreds of thousands of people that that need the vaccine. And so we're in this situation that, you know, nobody or many people are not happy about, where not everybody can get the vaccine that wants it and not everybody that we want to give the vaccine to is able to get it. And so as a state, we have made the decision to prioritize delivery of vaccine to those who are most at risk of severe disease.

Dr. Chan:
You know, people over the age of 65, people with multiple medical comorbidities or medical health conditions. And that includes people wherever they may be, whether, you know, they're working there in a long term care facility, that they're in a jail or prison. If they meet those criteria as being at higher risk for severe COVID-19, they can get vaccinated. But we have taken that approach to prioritization instead of prioritizing specific populations or essential workers.

Laura Knoy:
Let's take another call. This is Ann in Pembroke and you're on The Exchange. Thanks for being with us.

Caller:
Thank you. I'm a resident of New York. My husband and I had the virus in April, my husband passed away. I survived. Now I'm in New Hampshire with my daughter and grandchildren. I am not a resident. Will I be able to see vaccine in New Hampshire or do I go back to New York?

Laura Knoy:
Oh, and I'm so yeah. And I'm sorry about your husband. That's a terrible thing. Dr. Chan, can somebody who's living here, not a permanent New Hampshire resident, but living here right now get the vaccine if she's over 74?

Dr. Chan:
Yeah, and thanks again for that for that question. And I'm sorry also to hear about your husband and to hear what you and your family have gone through. You know, I think this is this is a question that we have started to get. And I think there are some issues here that we still need to work through as a state. And there have been situations where people have, you know, driven up from another state to try and get vaccinated in New Hampshire. And we are not allowing that.

Dr. Chan:
And part of the reason that we have to be restrictive on who we give the vaccine to in terms of out-of-state residents is the federal government is allocating vaccine to state based on their persons, based on the population and where a person lives.

Dr. Chan:
So, for example, and in your case, the federal government is giving your vaccine to the state of New York, I believe, to have on hand to to give to you. We see. Right. So so when when these numbers this becomes a numbers game. When we look at the numbers, you know, we are beginning we are being given vaccine by the federal government to vaccinate as many people as we have listed as residents in the state of New Hampshire. And so this gets into a difficult situation where we are aware of people that have been, you know, moved to New Hampshire and have been living here for months and months possibly. But the official residence is in another state.

Dr. Chan:
And unfortunately, we don't have that vaccine that has been allocated to New Hampshire for people that are residents of other states. And so I think the short answer is that right now, the vaccine would not be available to people that are residents of other states. But these are issues that we continue to hear about and we'll need to continue to work through as as we hear about these types of situations.

Laura Knoy:
I have another question about the new variant for you, Dr. Talbot. Given this new variant, given what you and Dr. Chan have told us about how much more transmissible it is. Do we need new mask guidelines? Because as I'm sure you know, in other countries, they're starting to say, look, these regular reusable cloth masks do not provide sufficient protection against this new COVID-19 variant.

Dr. Talbot:
Clearly, we need appropriate attention to masks that are of the quality that we described previously, and it's to apply at least a surgical grade or medical grade is likely better than than the homemade masks because of the way that it can shield the side. So we are very happy to revisit issues of what makes a good mask.

Dr. Talbot:
You know, we've all seen masks that may be fashionable but but are not well fitting and they're sliding down over the nose and they require very frequent hand adjustment and such and the phenomenon of gaiters, where maybe they're one ply and again, don't don't seal up the the the exhaled breath, for example. So we are all about making sure people are wearing the right mask all the time, whether we have this variant or not.

Dr. Talbot:
I wanted to make one more comment about the variance when. The MRSA platform has been intentionally chosen because it is probably one of the ways that one of the best vaccine strategies that changes quickly.

Dr. Talbot:
So if we were to find the current messenger RNA vaccines were not a perfect match kind of thing. And we're assured that the scientists could make changes to that vaccine very quickly. So I wanted to give you that background because I find that very strategic and helpful in my understanding of our dependance on these vaccines right now.

Laura Knoy:
So the RNA platform, Dr. Talbot, is sort of the formulation of these new vaccines. And I'm glad you said that, because I have read that, too, that, you know, these vaccines could be altered to respond if necessary. We've seen this, the scientists approved and tested and created these so quickly, but there's all these backlogs in terms of production and distribution. So in a way, it's reassuring to hear that the vaccines could be altered. But in a way, Dr. Talbot, I wonder, would we run into the same situation with an altered vaccine?

Dr. Talbot:
You're right, of course, that this won't happen on a dime, but I think, again, the encouragement I get from it is that it can certainly happen faster than, for example, our flu vaccine strategy, where we have to get chickens to lay eggs and then grow it up. And, you know, that's not nimble. But but the MRSA and other genetic vaccine strategies are ones that at least the recipe can change extremely quickly. And then production changes and would not require the same degree of FDA, CDC Advisory Committee on Immunization Practices review. It would be a trivial change that would would be as fast as possible in terms of redeployment.

Laura Knoy:
And Dr. Chen, in terms of your Office of Public Health, what are you guys going to start telling Granite Staters about the quality of their masks given? Again, lots of discussion in this country and new rules coming out in other countries saying you need better masks.

Dr. Chan:
Yeah, so so I think there's a couple issues there.

Dr. Chan:
And I think that the more key issue is just getting people to wear masks in the first place.

Dr. Chan:
As I'm sure you and your listeners are aware, there's continues to be a statewide mask mandate. And so we continue to encourage people to cover up their nose and mouth. Both.

Dr. Chan:
You know, sometimes you see people wearing masks over the over their mouth, but not their nose and mask needs to be well fitted and go over both the nose and the nose and mouth. And those masks are intended to prevent a person's respiratory droplets from spreading to other people. But there's also likely some protection that those masks offer individuals. The CDC does have guidance for what is considered an acceptable mask. You know, a mask should be, you know, well fit around the nose and mouth. As Dr. Talbott alluded to, the more layers, the better.

Dr. Chan:
So, you know, a two or even three layer mask is better than a one layered mask. And then what's a little bit less clear but worth some attention is that the material of the mask is also likely of importance. So some of these store bought masks that are made out of I think polypropylene may be better than homemade masks because of the material and the ability of that material to filter particles and droplets. And some of these materials also have an electrostatic charge to them, which helps to trap the moisture droplets that people are either breathing in or exhaling.

Dr. Chan:
And so some of these store bought masks that are multiple layers and and, you know, fit snugly around the nose and mouth are probably going to be better than home-made cloth masks. That might only be one layer, but but the effectiveness of some of these masks, I think we don't have good numbers or good data on. And I think it comes down to simply getting people to wear masks in the first place and practice the social distancing, avoiding group gatherings. These are still the primary ways that we have to control and prevent spread of COVID-19.

Laura Knoy:
I did get an email from Larry, Dr. Chan about asking about the relative benefits or deficiencies of different types of face coverings, surgical cloth, bandanas, neck pull ups, et cetera. I have been seeing Dr. Chan more and more places saying the neck pull up isn't good enough. What about that?

Dr. Chan:
Yes. So I think that that we would certainly support businesses and organizations in taking that stance, because I think we believe that those kind of neck pull ups likely are not as good as a store bought, you know, three layer, you know, fitted mask that has your loops and, you know, that goes over the nose and, you know, crimps over the nose as well.

Dr. Chan:
The better the fit, the more layers like the better. The mask is at preventing spread of droplets. So, you know, just putting that out there that that likely there are some masks that are inferior to others. And so. We recommend the better formfitting masks that have multiple layers of fabric, but not everybody may be able to buy those math, you know, or to go to the store and purchase them.

Dr. Chan:
And if that's the case, then, you know, wearing some mask is better than wearing no mask.

Laura Knoy:
Dr. Talbot, we got lots of questions from listeners about the impacts of vaccination.

Laura Knoy:
John wrote. He says, Isn't it true that getting the vaccination does not keep you from getting, carrying and transmitting the virus? It keeps you from coming down with the virus and getting sick. But we still need to keep social distance, wear a mask, limit travel. Is that true? Beth also has a similar question. I'd like to hear from the good doctors, their recommendations about this. I'm due soon for my second Moderna shot. Like everyone, I'm aching to be with my family I haven't seen in months, especially my only grandchild who is one year old. How safe is it for me to visit them in Vermont a couple of weeks after getting my second vaccine? And if it's OK to be indoors, should we all continue to wear masks? We've gotten lots of questions like this from our listeners.

Laura Knoy:
Dr. Talbot, if somebody's been fully vaccinated, both doses, can they still spread the virus to somebody else?

Dr. Talbot:
Simply put, we don't know the trials for the many vaccines were shown to be efficacious on the basis of, you know, they worked to prevent symptomatic disease. They simply didn't study whether the vaccines were preventing asymptomatic karaj and therefore the potential of spreading to other people, to other people. So, you see, we don't know the answer. It's not that they don't, but we have science coming to us on a very regular basis suggesting such. And we're very hopeful.

Dr. Talbot:
We want everyone to get their second dose of vaccine 14 days after their second dose. We believe you have achieved your protection from this vaccine, either vaccine and therefore we do have some changes within our state policy regarding how you participate in some of the community mitigation strategies we've talked about so many times before. And I know Dr. Chan wants to talk about that.

Dr. Chan:
Yeah, I was just want to add that no vaccine is going to be 100 percent right, 100 percent effective. And so we know that even people who were previously infected can become reinfected again. And we suspect, although, as Dr. Talnot mentioned, we don't have good, solid data on this, we suspect that even people who are fully vaccinated could likely pick up infection and spread it to other people. Again, this is something that's still being studied.

Dr. Chan:
We know that the vaccines are very effective at preventing symptomatic COVID-19, but how effective they are at preventing asymptomatic infection and spread, we just don't know. And so even people that are fully vaccinated need to continue to practice all of the recommended mitigation strategies. We continue to discourage nonessential travel. We continue to discourage, you know, social and group gatherings with people outside of the immediate household. People continue to need to practice social distancing and wear face masks when around other people.

Dr. Talbot:
All of these measures still apply even for people that are fully vaccinated, because we just don't know how effective the vaccines are at preventing reinfection, asymptomatic reinfection and then possibly spread to other people. We're still learning about the virus. We're still learning about the vaccines. The vaccines ultimately, I think, are going to be our way out of this pandemic. But right now, until we have a high level of coverage population wide with the vaccine, everybody needs to continue to practice all of the recommended community mitigation measures, even those who are fully vaccinated.

Laura Knoy:
So what does that mean, Dr. Chan, for the bigger picture, the, you know, so deeply desired return to normal that everybody is seeking the herd immunity that we're all longing for? What is what you just said mean for that that vision?

Dr. Chan:
So I think that this is going to be a process, right, and it's going to be a process that plays out over months. As we go through the different phases of vaccination, as we get more vaccine available in the state and make and can make it more readily available, there will be a point. And we can't predict when that point will be that we are able to relax restrictions further.

Dr. Chan:
But that time is not now because of the low level of vaccine coverage throughout the state. So, you know, I will I will also make mention that people who are fully vaccinated, we are saying, do not need to quarantine if re exposed.

Dr. Chan:
But everybody still needs to practice those mitigation measures. But we don't want vaccination to be seen as a free pass to travel to, you know, gather in groups, to meet with other people that, you know, you wouldn't normally meet with now if you weren't vaccinated.

Dr. Chan:
So there are reasons and benefits to getting the vaccine going to protect you. It's going to likely protect those around you. It's going to, you know, prevent someone from needing to quarantine if they're exposed or to quarantine if they're exposed again. But all the other mitigation measures remain, you know, in place and recommended even for people fully vaccinated.

Laura Knoy:
Here's a question from Kathy that just came in. Dr. Talbot, I'll throw to you how effective will getting just one shot be for those getting vaccinated?

Dr. Talbot:
Thanks, Kathy. We have limited data. I hate to have that as my theme for every answer answer I provide, but in fact, the manufacturers of these vaccines didn't set out to test one dose. They set out to test both. So we have some small groups of people who only got one that they measured those the degree of protection they had. And it looks like there is some protection after one dose, maybe 50 percent for the Pfizer beyond presentation of vaccine. And the number we have is 80 percent from Moderna.

Dr. Talbot:
I want to say again, those were small numbers of people, so there's not so much confidence in those numbers. And then the other important feature of that was that was one point in time. And we have every expectation that if you get one dose of vaccine, it's likely that will not be durable protection, that that even compromised amount of protection is going to go away faster than if you get both doses.

Laura Knoy:
So you need that booster shot, as it's been called. Dr. Talbot.

Dr. Talbot:
You really do. And therefore, we're being very transparent with everyone regarding the fact that we expect these vaccines to create side effects that suggest your immune system is activated so that soreness at the arm, maybe some fatigue and headache and even fever in some proportion of people with that first dose. And it may be more for the second dose. So we want people to go into it knowing that risk benefit is favorable and that we expect these side effects. But but in general, it is going to be really favorable for durable protection to go ahead and plan for that second dose.

Laura Knoy:
Ok, so Dr. Chan, that raises another question. Given the shortages that you and everybody else have talked about, that New Hampshire and other states haven't gotten as many vaccines as they thought from the federal government. What does that mean for someone who got their first shot but now is waiting for the second shot? If they wait too long, you know, does the whole thing kind of fall apart?

Dr. Chan:
The short answer is no, and we have been assured second doses will be available to the people that need second doses. But even if someone's second dose is delayed for whatever reason they can, they can and should still get the second dose as soon as possible after they're sort of due date for that second dose. And there's no need to restart the series. Right.

Dr. Chan:
So the timeframe between the first and the second dose is going to vary depending upon which vaccine somebody gets. The time frame for the Pfizer vaccine, second dose doses given 21 days after the first dose with a Moderna vaccine is 28 days. But even if somebody is, you know, 30, 60 days out from their first dose, they can still get that second dose. They should just get it as close to that that date that they're supposed to get the second dose as possible.

Laura Knoy:
Let's take a call, Kate is calling from Plymouth. Hi, Kate. You're on the air. Welcome.

Caller:
My question is about nursing homes. My mother is in a nursing home and she's received both her shot, but the nursing home is still saying she's not allowed to leave. Come to our home to go to lunch, pepper a haircut, et cetera. So I want to know what the state answer is on that. It feels like it's gone from protection at the nursing home to cruelty by not letting them still see their family.

Laura Knoy:
Ok. I'm glad you called. And it's great, Dr. Chan, that her mother got both doses already. That's fantastic. But yes, some frustration there. What's the you know, mom's been vaccinated and she needs to get out.

Dr. Chan:
Yeah, and and thank you for that question.

Dr. Chan:
This is an issue we continue to hear frustration around, and I will say I will sort of echo what was previously said, that this is a process. Right. And so it's great that people are getting vaccinated. It's great that they're getting two doses of the vaccine. But but no vaccine is going to be 100 percent.

Dr. Chan:
And we're still learning about the effectiveness of these vaccines to prevent asymptomatic infection and transmission after being fully vaccinated. And so we are taking a slow stepwise approach to relaxing restrictions. And so that includes that with long term care facilities, a lot of the restrictions that have been in place are remaining in place for the time being, even for people that are are fully vaccinated.

Dr. Chan:
That that doesn't mean that people cannot have visitors, that people can't leave the long term care facilities. You know, that those, you know, visitation and, you know, people going out out of the facility remain a possibility. And that's going to vary somewhat facility by facility. But getting vaccinated again is not a free pass to letting all restrictions down. And so there still needs to be some caution and precautions in place against someone who even somebody is fully vaccinated, being re exposed, possibly picking up the virus asymptomatically and bringing it back into the long term care facility that could then perpetuate another outbreak, especially among people that are are not fully vaccinated.

Dr. Chan:
So there's still need to be precautions in place. And I think that that's part of the frustration that people are seeing, is that, you know, yes, people should be fully vaccinated, but that's not a free pass to, you know, letting all restrictions down.

Laura Knoy:
Wow. Dr. Talbot, it's almost like it's only half the puzzle. So Kate's mom probably won't get covid now. That's good.

Laura Knoy:
But she still doesn't know if mom will transmit it to other people, including Kate herself. And that's extremely frustrating, especially 10 months into this thing. And we've seen the psychosocial impacts on elderly people, kids, everybody, but, you know, especially the elderly shut up in their rooms sometimes for months on end. So it's almost like we need this other piece of the puzzle before we can celebrate. Dr. Talbot.

Dr. Talbot:
You know, I definitely hear that frustration on a daily basis. I'm also aware that those who work and care for people like Kate's mother are are very frustrated and we all want to be out of this now. And it's just one of the most dynamic spaces of our transition.

Dr. Talbot:
You know, I do think that this is light at the end of this long, dark tunnel. But how long is the time in the tunnel yet, and I hear that I want to tell you that we are very actively engaged with with the long term care facilities, licensed facilities, working together to make rational evidence based decisions on behalf of of all the residents who are most vulnerable to illness and death here. I would offer the intersection of what we recommend with also what the CMS is advising these licensed facilities. That's the federal agency that dictates how they are able to allow visitation or others to. So we're on a balancing act there between what decisions we can take locally and what's being dictated from on high.

Laura Knoy:
And here's an email from Carol. Dr. Chan, I'll throw it to you. How do you check to see if someone is having a reaction to the vaccine, if it's done as a drive through?

Dr. Chan:
Yeah. So I think it's important to differentiate between different types of reactions. Some are normal expected reactions or side effects from the vaccine. But I think what the person is maybe what Carol may be referring to is allergic reactions. And so, you know, everybody that gets the vaccine is going to be monitored for 15, maybe 30 minutes after receiving the vaccine, even at these drive through vaccination locations.

Dr. Chan:
So there are safety processes that have been set up at these drive through vaccination clinics to make sure that people have the ability and are appropriately monitored for 15 to 30 minutes after receiving the vaccine, per you know, which is in line and consistent with, you know, federal guidelines about how to safely implement these these vaccines.

Dr. Chan:
But I do want to mention that people can expect some normal side effects after vaccine, after receiving the vaccine that are not considered allergic reactions, you know, in the one to two days after receiving the vaccine. Going to include local injection site reactions like pain and redness and swelling and even potentially systemic reactions, side effects to the vaccine, headaches, muscle aches, even fever and chills have been reported. And the one or two days after receiving the vaccine. These are normal vaccine side effects that have been reported. And even if somebody has these types of side effects, they still can and should get their second dose of the vaccine. I think what what we're talking about primarily are allergic reactions like anaphylaxis, HIV's body rashes, that sort of thing that should potentially prompt further evaluation.

Dr. Chan:
But there is a monitoring period to to look out for these reactions after vaccination. But certainly somebody could have an allergic reaction in the hours after they received the vaccine. And so if someone does have an allergic reaction, they should be on their phone with their primary care provider or for more serious allergic reactions, which are rare, by the way, you know, seek more urgent care, you know, through an emergency department, for example.

Laura Knoy:
You know, Dr. Talbot, the last time we talked, we were in the middle of the holiday season. We talked after Thanksgiving, but before Christmas. And you and other doctors were very worried about gatherings as a source of transmission as college kids came home, as extended families gathered for Christmas. What does the data show, Dr. Talbot, about whether those fears were realized?

Dr. Talbot:
We are indeed hearing anecdotally that persons who participated in gatherings are recognizing those as potential points of transmission so that the data is still being realized from those events of Christmas and New Year, which, by the way, in covid time, seem to me like a lifetime ago.

Dr. Talbot:
Yeah, I hear you, you know, and I guess I'd like to hearken to to the fact that when we talked last, we were just getting The Moderna on the Pfizer vaccine and look what's happened in a month, you know, we're really rolling with that. And in that spirit, I also want people to know that there are two more vaccines that are are likely to be coming to us. And this could greatly alleviate some of the challenges we have with regards to delivering to everybody in a timely way. So the Novavax and the Johnson and Johnson vaccines might might be coming to us in the next months. So they're certainly more on the horizon. That's that's going to get us out of this, you know, terrible time together.

Laura Knoy:
What is the data showing us? Dr. Talbot, about where most of the transmission is happening?

Laura Knoy:
I get that, you know, there's community spread sort of everywhere. But what does the data tell us about the behavior we really should avoid? Is it a small gathering, whether with family or friends? You know, we've got Super Bowl coming up so people don't want to have their traditional Super Bowl party. Is it is it restaurants? Is it schools? As you know, in some countries, the schools in the stores are open, but the bars and restaurants are closed. So what do we know, Dr. Talbot? Where is the spread really happening?

Dr. Talbot:
We still believe that that it's close contact without masks, enclosed spaces. That's the risk.

Dr. Talbot:
And so you've described a Super Bowl party pretty well for the most part, because people are eating and drinking and close together on the couch and jumping up and down. So that is of concern. Schools, we have not realized we've not seen a lot of in classroom transmission. And that's to the credit of our school partners who have worked hard to increase social distancing and force masking in difficult circumstances and et cetera. Restaurants are another place, bars or another place where people generally are there because they are going to unmask to consume. Yeah, and these are closed spaces where people are in close contact, often face to face. So indeed, as as this pandemic emerges, some of these gatherings clearly appear higher risk than others.

Laura Knoy:
Dr. Chan, looking back, what do you hope that state public health officials have learned over the past year about, you know, your role in educating the public about this unprecedented disease?

Laura Knoy:
What did you learn from 2020 and how are you going to apply that to 2021, Dr. Chan?

Dr. Chan:
Yeah, you know, I think one of the there have been a lot of difficulties around this pandemic. But I think one of the things that this has really highlighted is the need for intensive, targeted communication.

Dr. Chan:
We're learning about the virus. We're now learning about the vaccines. Our partners in the community need to be informed, the public needs to be informed, everybody throughout the state needs to be informed about what's going on with the pandemic, with the virus, with the vaccine.

Dr. Chan:
And that's that's a huge effort that we will continue to put resources into to make sure that people have the most accurate updated information so that they can take action, protect themselves, protect their communities, protect their family, get vaccinated. That continues to be an ongoing effort that remains, I think, critically important.

Laura Knoy:
Well, both of you, we have run out of time, but we will talk to you again soon for now. Thank you for being with us.