Pandemic public health and safety

May 21, 2021  | 27 min  | Ep 4839 | Podcast | Transcript

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On this edition of Iowa Press, Dr. Megan Srinivas, an infectious disease doctor who has worked with underserved populations in rural Iowa, and Dr. Leyla Best, an infectious disease specialist with UnityPoint Health, discuss the COVID-19 pandemic, including recent changes in CDC/public health safety recommendations, vaccine hesitancy and what's next.

Joining moderator David Yepsen at the Iowa Press table are Kay Henderson, news director for Radio Iowa, and Erin Murphy, Des Moines bureau chief for Lee Enterprises.

Program support provided by: Associated General Contractors of Iowa, Iowa Bankers Association and FUELIowa.

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As policy makers push for a return to normalcy in summer 2021, we gather Iowa medical experts to assess the situation. Checking the pulse of our pandemic health and safety on this edition of Iowa Press.

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Funding for Iowa Press was provided by Friends, the Iowa PBS Foundation. The Associated General Contractors of Iowa, the public's partner in building Iowa's highway, bridge and municipal utility infrastructure. Funding for the Spanish translation of this program has been brought to you by Wells Fargo. Fuel Iowa is a voice and a resource for Iowa's fuel industry. Our members offer a diverse range of products including fuel, grocery and convenience items. They help keep Iowans on the move in rural and urban communities. Together we Fuel Iowa. Small businesses are the backbone of Iowa's communities and they are backed by Iowa banks. With advice, loans and financial services, banks across Iowa are committed to showing small businesses the way to a stronger tomorrow. Learn more at IowaBankers.com.

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For decades Iowa Press has brought you politicians and newsmakers from across Iowa and beyond. Celebrating nearly 50 years of broadcast excellence on statewide Iowa PBS, this is the Friday, May 21 edition of Iowa Press. Here is David Yepsen.

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Yepsen: The signs of a post-pandemic return to normal are increasing. Vaccines have reached a broad section of the adult American population, the federal government has passed massive economic stimulus programs and state government in Iowa has concluded a legislative session with bills to prevent local schools from enforcing mask mandates. To examine what a new normal for Iowans may look like we have gathered a pair of Iowa physicians. Dr. Megan Srinivas is an infectious disease physician with experience in underserved rural populations. She previous ran for the Iowa House as a democrat in 2018. And Dr. Leyla Best is an infectious disease specialist for UnityPoint Des Moines where she leads outreach into smaller health care affiliates. Welcome to you both. Thank you for making time for us.

Thank you.

Thank you for having us.

Yepsen: Also joining us across the table is Erin Murphy, Des Moines Bureau Chief for Lee Enterprises and Radio Iowa News Director Kay Henderson.

Henderson: Dr. Srinivas, this past week Governor Reynolds signed a bill that said that schools cannot have mask mandates and cities and counties cannot force businesses to have mask mandates. What is your reaction?

Srinivas: It's very concerning because a lot of what happens when it comes to any type of control of whether it's a pandemic or a local outbreak really needs to be looking at the local statistics, the local transmission issues and thus put into place local rules to control immediately anything that might occur. With our local populations now being really handcuffed in this fight against the pandemic it's going to create larger obstacles for the state to have to overcome in the long-term.

Henderson: Parents complained to legislators that it should be their decision and that it was government overreach, number one. And they complained that it's better for their kids to be in school in a learning environment where they can see everyone's, their teacher's face and their colleague's face and that it should be their decision. What is your reaction to that?

Srinivas: There's a few things. One, masks do not prevent somebody from utilizing their vision. Masks really cover your nose, your mouth and really should not be obstructing your vision at all. And if it is then we need to do a better fit on your mask. So that is the first misconstrued issue right there. The second issue is if it is the parents' choice then we have a problem with that child who might have been exposed, who might be at higher risk of being exposed because their parents might not believe in vaccination or masking, then being the person that brings in the virus to school and the mask only protects those really around you, not the wearer themselves.

Yepsen: Dr. Best, what is your answer to Kay's questions.

Best: As a physician I am very concerned because I agree with Dr. Srinivas that kids are not fully vaccinated yet. They can still transmit the infection. And remember that we still have these pockets of folks that are considered vulnerable in the community, maybe grandparents or parents who are on medications or have a decreased immune system. We don't know how strong of an immune system they can develop against the vaccine. And so we need to be very cautious with that. And I agree that we have to be careful when we say it's our right to use a mask and decide when our kids want to do it because we want to prevent the risk around us and we need to remember that as of now we don't have kids fully vaccinated. And it was kind of surprising to me that this happened two weeks from the end of the school year.

Murphy: So who should be making this policy? Dr. Best, we'll start with you. Is there not something to be said for having a statewide policy so there's no confusion? Or should it be local school boards? Should it be local public health departments? Where should these policies be coming from?

Best: When you ask me that I kind of start thinking about what I felt has been a failure throughout the whole pandemic and it has been the miscommunication, the lack of alignment between the message that the science experts, the health care providers are getting with the lawmakers' message. And this is what is creating a lot of confusion in the community. I wish we had a unique message that was out there to the community. I have to recognize that as a health system we have been very stern about that trying to bring accurate and timely information to the community in different ways, social media and our own websites and small videos to educate the community about it.

Murphy: Dr. Srinivas?

Srinivas: I have to agree a lot with what Dr. Best has been saying. This pandemic has really presented a unique situation where we have siloed people who are experts in the subject matter away from the policy making aspect. In the past when it comes to salmonella outbreaks, E-coli outbreaks, even when we're looking at Hepatitis A outbreaks in this country we've always seen that partnership happening, when it comes to other public health issues such as smoking in public. We've seen that partnership happening between the experts and the people who are making the policies. The fact that the science is being turned into a partisan issue is really concerning and it has been throughout this pandemic.

Murphy: Dr. Best, you mentioned that communication and education. The CDC recently adjusted its recommendations on masking and there was some timing with the way it played out in the news cycle that made some people, some people kind of pushed back and said, well they're sending us mixed signals. How do you feel? Has the federal government, has the CDC been solid and consistent in its messaging to the people about what precautions they should be taking, when it is and isn't the right time to wear a face mask? Or could they have done a better job with that?

Best: Unfortunately when we think about all these changes we find a lot of confusion. I totally understand the community, the folks in the community being confused because we change sometimes, in the past every other week we were changing recommendations. And that can get very confusing for people. But we need to admit and recognize that what the CDC is stating with the recent mask mandate guidance changes is based on what we have learned from the protection of the vaccines, that we know that actually they are very effective and we are allowing fully vaccinated people to be able to not wear a mask. But we need to start by defining who are the fully vaccinated patients or folks in the community and those are the ones that got their 2 shots of the Pfizer or Moderna vaccine or 1 shot of Johnson and Johnson just two weeks after that. We cannot extrapolate that to people who have not been vaccinated or kids who are not even fully vaccinated yet.

Yepsen: Dr. Srinivas, let me ask you a follow up question. What do you say to people who say that the problem with all these mandates and the do this, do that thing is number one, stuff seemed to change all the time. One week there was one set of rules and another week there was another thing. And the second one is, the cure has been worse than the disease. We shut down the American economy, people lost their jobs, they were put in their homes, there were mental health issues involved, children wearing masks scared. What do you say to that? Wearing a mask may be the right thing to do but it came at a price.

Srinivas: So the issue with that comparison is it is really a false dichotomy. There has been this whole false narrative that it is either livelihoods or life when in reality they go hand-in-hand. If we had been able to follow through with a lot of these mitigation techniques such as wearing a mask we could have easily opened up Iowa a lot sooner, boost our economy, enable people to safely go about shopping, go about going to restaurants, being able to have a little bit more normalcy than we've had throughout this entire past year. But the issue is, if we don't do mitigation then we're going to have complete uncontrolled spread and that is when things need to be tightened to control the spread, save people's lives, not overwhelm our health care system. And having this false narrative has only created more misinformation. And a lot of that goes back to the messaging that Dr. Best was referencing, having our policy makers and our experts at the same table agreeing on the messaging.

Yepsen: Dr. Best, I'll start with you. Just give me the state of the coronavirus right now in Iowa. What is going on with it?

Best: Well, as you know the infection rate has decreased. It has taken a very long time to do that I think. In my perspective we could have done probably a better job with that as a nation by following some of the mitigation measures and being compliant with that. And now that we have the vaccine we are seeing more than 1.2 million people already vaccinated and as of now I believe it's 2.5 million people at least that has gotten the first shot of the vaccine. My concern is that if we go back to leaving it up to people, or leaving it up to the folks wearing their mask we may see an increase in the transmission rate and we are going to go backwards rather than keep going with the solution of this. We want to get out of the vaccine and I feel that the way we can get out of this pandemic is by being vaccinated. We need to be very careful that this is, I tend to talk to my residents -- against the variants, we need to be ahead of all of the variants that we have.

Yepsen: Dr. Srinivas, same question. What is the state of the coronavirus?

Srinivas: So, as Dr. Best was alluding to we really only have about 40% of our population fully vaccinated here in Iowa. And unfortunately when we have such a low vaccination rate and we try to go back to a normal, completely normal style of living without masks, without mitigation, despite having a presently relatively low transmission rate of about 3%, that is going to spike because if people act like they are now immune to the virus even if they haven't gotten the vaccine that is only going to create more vectors for the virus to infect and spread. And if we continue to do that unmitigated we’re going to have a resurgence after we have worked so hard to really keep things down.

Yepsen: Is there a danger that we're letting the good times roll a little too soon?

Srinivas: Very much so, very much so. And this is what happened last June as the WHO even alluded to yesterday during their announcement. We let the good times roll a little bit too soon during the summer last year thinking  things were outdoors and we started to see massive spikes all over the world. And right when we're about to get on top of it we don't want to let that happen again.

Henderson: Dr. Best, public health agencies in 99 counties in Iowa were asked to do things that they have never done before. What is the status of public health and its outreach in Iowa?

Best: We always have improvised and learned a lot through this pandemic. I can tell you personally as a physician, as an infectious disease doctor this last year or 15 months I believe it has been, and counting, it has been a roller coaster of emotions and learning a lot. I step into different arenas completely different to what I do on a normal daily basis for my patients, which I normally see patients in the hospital and in the clinic all the time, into going and being part of committees, as part of the command for the system where I train to help the system to be prepared throughout the pandemic. So we all have to adjust. This has been a very difficult year for everyone, even for the kids, for health care workers. So we need to keep a very open mind that we all are learning and we are actually changing policies and recommendations based on the most recent updated information from science and we need to be very open to that.

Murphy: Dr. Srinivas, you mentioned the vaccine rollout. We are at a point where the demand has waned for getting the vaccine. Are we at that kind of saturation point where everyone who really wanted it has it and now we're trying to get to those people who are holding out for whatever reason? Is that where we are in the rollout essentially?

Srinivas: I wouldn't quite say we're there yet. There are still people who just because it really opened up widely in April to everyone, there are still people who are finishing their second vaccine or who are in the process of really scheduling their first vaccine towards the end of April. So there is still that lag period where that information has to get to people and people have to start signing up and doing things. But then there is a whole other population, the children, who really haven't had the opportunity. And we just opened it up to 12 to 15 year olds and we're going to see a lot more people getting vaccinated. Hopefully with the trials that are happening now we'll have even younger children being able to get vaccinated before school starts.

Murphy: How soon might that happen?

Srinivas: So right now the trials have been ongoing for a couple of months. I'm hopeful that we'll get some information and even have it in process before school starts in the fall. But of course it's all going to depend on what the clinical trials show.

Murphy: Dr. Best, once we get through those groups and there is that remaining population left that for whatever reason they haven't gotten the vaccine yet, how do we encourage more people to sign up so we get to a point where we feel confident that enough people have been vaccinated to get us through this pandemic? How do we reach those people that may be on the fence right now?

Best: I think it is very important education to the community. I feel that there are many, many folks out there that are refusing the vaccine because they are afraid, they hear things about the vaccines, they have some myths that prevent them from getting vaccinated. And I think it is very important for us as physicians to be available for our patients to talk to them through those. I also like to take the opportunity when I see patients in my clinic for follow ups of other reasons or other diagnoses to talk about have you been vaccinated and without pushing because I'm not pushing people or making them get the vaccine but I want to understand what their fears are. And I have been very happy to be able to help some of them, some of them are completely refusing and I cannot do anything else about it. But I think it is very important the education and be able to talk to your doctor. I always counsel the patients, if you have questions seek your doctor's advice.

Henderson: Dr. Best, we're seeing statistics from health care institutions, nursing homes, hospitals where a great share of the staff are refusing it. What does that say about vaccines?

Best: I think that once again we have to go back to education and this is something that as a system we are trying to tackle because we have seen that, seen pockets of staff in the system that are not getting the vaccine or reluctant to get the vaccine and one of the things that we are doing is having weekly videos or answering questions from the staff, from the health care workers in general about the vaccines, trying to mitigate some of these questions and concerns.

Henderson: Dr. Srinivas, other states are having lotteries. Get a vaccine, you can maybe win a million dollars. Is that something that would be effective in places in Iowa where there is great reluctance to get the shot?

Srinivas: So we've seen the incentive systems do work. We saw in New Orleans just having people who are willing to vaccinate out during the time when people are going out and night and saying hey, this bar is partnering with us, we'll give you a free drink if you get your Johnson and Johnson one shot vaccine, it was extremely effective. So there is a lot of messaging, there is this whole attitude of convenience that we also need to meet. There are incentives that we can utilize. But then there's also the issue of inequities when it comes to vaccine availability that we need to address that has often unfortunately been overlooked. If you look right here in Iowa we're actually one of the worst five states in the country when it comes to equity between the races that have been vaccinated. Here about 2.5 times as unlikely for a black person to have been vaccinated as a white person just based on race alone.

Yepsen: So what do we do about that?

Srinivas: We really need to create partnerships with these different communities that have ways to access populations, that they are able to trust. So Broadlawns for instance, they partnered with a local church that works a lot with a black population here in Des Moines and they were able to meet them where they are, they were able to help with transportation because they brought the vaccine to them.

Yepsen: Is there anything about Iowa that makes us unique in battling this disease and our population? We're an older population, rural. We have a large meat packing sector. Anything that you can see that makes us different that means our approach has to be different?

Srinivas: Language is a huge barrier because we do have a large migrant population because of our farms, because of our meat packing industry and in our rural set of living and our economics we do need to overcome language barriers. But then because of that and because of the migration issues surrounding this there's a lot of fear amongst some of my patients who are worried that if they show up for a vaccine they're going to be questioned for papers or they won't be given a vaccine. So there's a lot of information that we just need to override and bring vaccines to people where they are.

Yepsen: Dr. Best, language barriers?

Best: Absolutely. I totally agree with that being one of the biggest concerns. And we have to get to these communities with understanding what are their concerns and their needs to get the vaccines. This is extremely important to get vaccinated people in Iowa. But I do agree that the language barrier is a big issue here. And I know that we have people actually sending messages through social media interviewing physicians in other languages to give a more direct message to their own communities.

Murphy: Dr. Best, this is all the first round of things. Do we have a sense yet, are we going to need a second shot, they call it a booster sometimes? Do we have a sense of whether we'll need to ask folks to get this again?

Best: We don't know yet. Pfizer has mentioned that they are preparing a booster shot. But we don't know for sure if we are going to get to that point. Actually some of the virologists in the world feel that actually we won't need one but it's too soon to know.

Henderson: Federal funds are coming down. Dr. Srinivas, how should those be used in the health care setting if available?

Srinivas: So it's going to be a multitude of things. When it comes to the health care setting what happens outside of health care is actually so important to what happens within health care. That is really the whole aspect of the social determinants of health, enabling people to have successful quality of life and livelihoods enables them to have better health. So really being able to support people in their everyday goals of trying to have a quality of life when it comes to food, when it comes to giving their kids transportation, education, that is going to help us enable them to have better access to preventive care such as vaccinations, such as information like seeing a doctor, seeing a provider that can help them with their health. So that is really what we need to have a holistic approach with a lot of these funds.

Yepsen: Dr. Best, you work at a hospital here in Des Moines. There are concerns in the rural hospitals about how the pandemic has affected them. What are the needs out there? And what needs to be done to make sure our rural hospitals survive this?

Best: That has been a big job definitely. What we have tried to do particularly as a health system is to work system wide trying to expand to the most rural areas to be available for them. And we started with things like, for example, creating a hotline for COVID that was staffed by us, the infectious disease physicians, to be available for the community doctors to call and ask questions on what to do with their patients, how to manage patients in the rural areas. And we have continued with a series of education with webinars and stuff like that to kind of keep the staff, the providers up-to-date as well. And always recognizing that if they have any questions, if patients have any questions, they need to get to their doctor.

Henderson: Dr. Srinivas, there has been a lot of discussion about improving the heating and ventilation systems in big facilities like schools. Is that effective?

Srinivas: So, ventilation is really important at helping to reduce transmission. Ventilation can be as simple as having windows open and having a breeze helping to circulate the air within a room. But the better available ventilation is the better it is at reducing actual transmission between students. But the best thing that we know is masking. It really prevents a lot of these concerns. So if we can just continue to have students mask in school having to spend a lot of money on ventilation isn't going to be as big of an issue, especially as more and more people get vaccinated.

Yepsen: Dr. Srinivas, and both of you really, what are the dos and don'ts of dealing with someone who doesn't really want to get the vaccine. Maybe you have a loved one, maybe someone watching this program. What are the dos and don'ts of trying to convince people that they ought to get the vaccine? We're Americans. We don't take kindly to people telling us what to do. That's why we're Americans. So, what do you do in a case like that?

Srinivas: So the first thing is really to understand the other person's perspective. So any time I see a patient that has hesitation I don't give them information, I instead ask them why are you concerned? What are your questions? What are your worries about this vaccine? I let them ask me the questions so that way I can really address their fears. And in all honestly, every single clinic I have had since the vaccine has been available to my patients I have been able to change the minds of at least one person by merely answering their questions.

Yepsen: Dr. Best, same question.

Best: I fully agree with Dr. Srinivas. I think that listening to our patients is very important. And as she said, not giving a lecture. Nobody wants to be lectured, right? We want to hear and understand what is preventing them from getting the vaccine because a lot of times we can convince them. After talking to them a lot of my patients have left the clinic saying we are going to get the vaccine.

Henderson: Would it have been better if the vaccine had been distributed to health care agencies rather than mass clinics?

Best: I think that would have been an amazing thing to do, more available for the providers to have it in the clinic. Unfortunately, logistically it has been an issue in the refrigeration for Pfizer particularly, it has been a very limiting factor.

Yepsen: And unfortunately we're out of time. Thank you both for taking some of your time to be with us today, we appreciate it.

Thank you so much.

Thank you so much for having us.

Yepsen: And we'll be back next week with another edition of Iowa Press at our regular times, 7:30 Friday night and Noon on Sunday. For all of us here at Iowa PBS, I'm David Yepsen. Thanks for joining us today.

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Funding for Iowa Press was provided by Friends, the Iowa PBS Foundation. The Associated General Contractors of Iowa, the public's partner in building Iowa's highway, bridge and municipal utility infrastructure. Funding for the Spanish translation of this program has been brought to you by Wells Fargo. Fuel Iowa is a voice and a resource for Iowa's fuel industry. Our members offer a diverse range of products including fuel, grocery and convenience items. They help keep Iowans on the move in rural and urban communities. Together we Fuel Iowa. Small businesses are the backbone of Iowa's communities and they are backed by Iowa banks. With advice, loans and financial services, banks across Iowa are committed to showing small businesses the way to a stronger tomorrow. Learn more at IowaBankers.com.

Iowa Bankers Association
Associated General Contractors of Iowa