Announcer:
0:00
Welcome to the MedEvidence podcast. This episode is a rebroadcast from a live MedEvidence presentation.
Dr. Stella Hayes:
0:07
So yes, I'm Dr. Stella and I'm happy to have you all here. I'd like to tell you a little bit more about myself before we start. I was born and raised in Nevada and that's where I went to medical school, came out of the Nevada School of Medicine debt-free, thanks to Uncle Sam and the U. S Navy, and then they brought me to Jacksonville to put me in residency in the Naval Hospital up in NAS Jax. So that's where it all began. That's where I met my husband, that's where I had my first child, and then the Navy sent us around the world and eventually back here and 25 years later I retired out of the Navy. That was in 2017. And since then I've been working several part-time jobs. So for the last five years let's see actually closer to seven years I've been doing some telemedicine work, some geriatric work in assisted living facilities and homebound patients, and for about four years I did emergency medicine here at Flagler ER and at the Baptist ERs. So I've seen a lot of people with viral problems. A lot of people with you know everything from mild viruses, not even sure if they have a virus or if it's, you know, they're just worried to you know lethal lethalities from viral illnesses, and I've seen them in a lot of different settings from their homes. Now I see a lot of people at home that call in on telemedicine and, you know, with viral illnesses, asking for help or advice or Paxlovid or treatment. So I talk about this a lot, mostly one-on-one, but here we have a nice little group and I'm happy about that. All right. So today we're going to focus on preparing yourselves and your loved ones for the flu season that's coming up.
Dr. Stella Hayes:
2:31
The various viruses that tend to be more prevalent during the winter, as Dr Hayes says, rear their ugly heads, but we're not helpless against that and there's things we can do to prepare. I'm going to start with a little audience participation here about. This is audience question number one trying to identify these viruses. And what viruses, the viral villains, which ones do you think are going to be wreaking havoc on us this winter? Could it be the rascally respiratory syncytial virus, rsv? Could it be that cantankerous COVID virus, the infamous influenza virus, the naughty norovirus, the bubonic plague, or all but answer E. I'm hearing answer E. That is correct.
Dr. Stella Hayes:
3:41
First of all, the bubonic plagues of bacteria, not a virus. It is still around, but thank goodness there's good treatments about that and it's nowhere near as prevalent Not so much. This area there's, you know, africa and South America is where it's found mostly, and even then it's just a handful of cases and the mortality from it is about 10% treated, whereas untreated it's closer to 60% to 90%, as evidenced by the black death in Europe. But enough about the bubonic plague.
Dr. Stella Hayes:
4:25
We're going to talk about strategies to protect yourself and your family. Another question here how are y'all going to prepare yourselves and the family? Are you going to throw caution to the wind and sing the song Que sera sera, whatever whoopee will be, or get vaccinated and maybe avoid high-risk? You know areas, sick people. If you can't avoid them, try to, you know, protect yourself a little bit against what they may be carrying. You can find out about treatment options when you get sick, or you can do all but answer A Okay, and I think you could even sing the song too. But you know, as long as you take some actions in addition to that.
Dr. Stella Hayes:
5:32
Addition to that, this shows the leading causes of death over the last few years, since 2019, and that's a nice little direction for the COVID black mark to be heading straight, you know, down in a steep descent. This may bring back memories of the bad old days, with COVID right up there, as far as you know, a leading cause of death for most of a year when it first came and we had, you know, no defense against it. We didn't know how to protect against it, we didn't know how to treat it and our four little immune systems had seen nothing similar to this. So it really, you know, could hit us hard. But the first and fifth leading causes of death, the heart disease and stroke, are due to atherosclerosis and vascular problems, with plaque buildup and stuff. So people who are at high risk for stroke are generally at high risk for heart disease and vice versa. And we know that that's got some important contributors of lifestyle that can be, you know, changed or modified or minimized. So we highly recommend trying to, you know, get yourself into the best shape you can to avoid the leading causes of death, and there's nothing like a virus to throw you over the edge, especially if you're already, you know, have some comorbidities or some other, you know, medical problems that make your body and your immune system and your organs not as strong in resistance as you know, a younger, healthier person.
Dr. Stella Hayes:
7:31
This is the. These are the viruses I'll be talking about. We've all heard of the flu virus, or the flu viruses, a whole family of them, or the flu viruses a whole family of them, and the COVID virus, covid-19 being the most infamous one there's. Actually there are other COVID viruses that have been around for a while, but none, unfortunately, that gave us any, you know, immunity to the COVID-19. And then there's RSV. That's been around a long time too, and when I was in training and you know, early in my career, we really only worried about the premature infants in RSV, because they would get RSV and their little airways are so small that if there's a little swelling in there it can really affect them with wheezing and, you know, poor ventilation. So they developed a vaccine to that for the babies many years ago. But now we've got, you know, more awareness about adults getting it. Elderly adults or well, all adults can get it. Most people get it during their lives, but people who don't have much resistance or cushion for sickness, they suffer greatly from it. They suffer greatly from it.
Dr. Stella Hayes:
9:04
The norovirus is one here that we've added in to help increase awareness about the norovirus. Norovirus I misspoke, but this is a norovirus acute gastroenteritis, like a stomach bug, that makes you have problems with your gastrointestinal system. For kids, it usually makes them lose their lunch. For adults, it kind of gets in there deeper and makes them liquidate their assets. It's the leading cause of vomiting, diarrhea and food-borne illnesses in the US. I'm pretty sure I had it about 18 months ago after a trip to Honduras. The ironic part is I'm pretty I think I picked it up in Houston because I was so careful in Honduras and didn't eat any fresh fruits and vegetables, or salads hardly, or seafood. But then when I got to Houston, I'm like, oh, I'm going to have a chicken Caesar salad, a big one, and I ate it. And, sure enough, about 12 hours later I got the classic symptoms and it was miserable.
Dr. Stella Hayes:
10:24
And it's such a strong virus. Most viruses you put them out in the air or on the surface and they'll die pretty quickly if they're not in a host, but this lives on surfaces and, furthermore, it only takes a few particles, one or two viruses to make you sick. Most viruses you need, you know, a good inoculation with, usually like millions of them, and if you only get a couple, say COVID viruses, if you only get a couple COVID viruses, your body's going to take care of that before they make you sick, but with norovirus it just takes a couple, affects all ages.
Dr. Stella Hayes:
11:09
It's also unique in that it can stand up against hand sanitizers, so it's really best to wash your hands with soap and water. If you're on a cruise, say, this is infamous for you know, know, hitting ocean cruise liners, anywhere where there's a lot of people eating together and living together, it's it's context. So the oral fecal route. So yeah, it's not airborne, thank goodness, because that would be a disaster, especially considering it only takes one virus you know to infect you. So yeah, that's.
Dr. Stella Hayes:
11:47
The one good thing about this is that if you're really careful about you know what you touch, your hand, washing what you're eating, how it's prepared, then you can avoid it. If you get it once, it doesn't mean that you can't get it again. So yeah, and why? Some viruses will give you lasting immunity and some don't. I'm not sure why that happens, but most people have had norovirus at least once in their lives and you know it's possible to have it multiple times. The danger of any of the GI illnesses the two main dangers becoming dehydrated and having your electrolytes messed up, you know can be very serious and lethal. And then, yeah, so if you can live, if you can, and if you can live through the three miserable days, usually with just gentle hydration and rest, and if you need to get some IV fluid, that'll certainly help get you through it.
Dr. Stella Hayes:
12:57
The norovirus there's no antiviral against it, it's supportive care. So most people who get norovirus will do like I did and stay in bed. They may call their doctor if they think they're dying, which I actually did they may have to go in and get some like IV hydration, but it's the treatment for it we sometimes call supportive care. So, like I said, with the dehydration and electrolytes, if we can keep those balanced, your immune system is going to take care of this. Three, maybe five days if it's really slow. But yeah, there's no like stomach pumping. I guess if we knew somehow that that salad you just ate has norovirus in it, you know, maybe it could induce vomiting. But you know, once you have the symptoms now you're going to have to get through this three days. There's, you know, some medications Sometimes we'll give anti-nausea medicine if you're throwing up. . The anti-diarrheals I generally recommend against because they can prolong the course of a diarrheal illness. You know you want to kind of let it go. You just want to stay close to a toilet. The anti-diarrheals are okay, like after three days, if you're feeling fine. I want to go back to work, but I still have this urgent, you know problem that I don't want to be far from that's when the anti, like Imodium, might come in handy.
Dr. Stella Hayes:
14:36
We're going to compare getting ready for the virus season sort of, to getting ready for the hurricane season. There's, you know, some different some steps to getting ready for the hurricane season. There's, you know some different some steps you can take. For each of these there's advanced planning. You know when it's we don't know. You know when it's far enough ahead of time. Then there's some more expeditious, protective. You know ways you can do to. You know, keep yourself healthy. And then the third step is if you get the virus, because it will get you, despite the best precautions. You know most people in this room, I think, have either had COVID or, you know, have a lot of family members who have so part of this planning, so advanced preparation way in advance. Just like for hurricanes, you might want to have insurance, you might want to make sure your house has got a little elevation, it's not going to flood Well with the viral seasons.
Dr. Stella Hayes:
15:50
There are some good vaccinations out there that can help you get ready for the season, and we'll talk more about you know who should really get those, because not all vaccinations are for every person but there are good ones. But something that is good for every person is to try to get your immune system in shape and to optimize the natural immunity and resistance you have to disease, and that includes just general health. So we know that good nutrition can help. Exercise helps both in the short term and in the long term. One of the things we learned early on is the fact that a lot of your white blood cells that's, your immune system, your, you know, the cells that make antibodies and that kind of are the infantry of your immune system, the white blood cells. A lot of them just kind of hang out on the margins of your blood vessels. We say they're marginalized, they're just kind of hanging out, they're not really in circulation, not going out hunting for invaders. But if you get some exercise and get your heart rate going and get that blood circulating, that demarginalizes your white blood cells, gets them back in circulation and gets them acting. So if you think you might've been exposed to something recently, you might, you know, go for a brisk walk, get your immune system revved up and maybe you'll be able to nip it in the bud. We know that sleep is important and we know that constant stress, you know, reduces your immunity. So stress is bad. A little bit of stress might be good, but constant bad stress is not fun.
Dr. Stella Hayes:
17:48
So let's talk about recommendations for immunizations. First I'm going to show you what the CDC recommends. So they recommend flu vaccines for everybody six months and older and they recommend it at the beginning of flu season. So that's been out for a long time. The earlier studies they did on that. The military adopted that because the studies were showing that there would be fewer worked missed days. I said that backwards fewer missed work days on people who get vaccinated. So even you know the young, healthy population of the military. They were highly encouraged to get flu shots to keep them at work.
Dr. Stella Hayes:
18:36
Sometimes the flu will kind of linger in the spring or come back for another shot in the spring. You know another round with us in the spring, in which case, you know, if it's February, march and they're reporting a lot of flu, you might consider another one at that point, the RSV vaccine. So that's been approved this year and that's recommended for all adults over 75 years of age and people over 60 who are at increased risk for having problems with RSV. So that's a virus that hit our family early this spring. My husband lost his sister, who was 64 years old, and his brother-in-law, who was 65 years old, to RSV in the same month of March and there are certainly two people who should have been vaccinated. I'm not sure if they were. I kind of think they weren't. But you know they had other risk factors and they were both taken from their children in the month of March. From this you know virus. So yeah, this is a bad year for it. Winter seems to be pretty bad for it in general, but I'm glad there's some protection out there now for people who would be at high risk for dying from it or being really sick from RSV, and heart disease would be a risk factor. And then just age, and pretty much the more medical diagnoses you have, the higher risk you'd be.
Dr. Stella Hayes:
20:18
Whether that's kidney disease, liver, even something like Crohn's disease, or affects nutrition and can affect the immune system, any of the autoimmune diseases can affect how efficient your immune system is. The COVID vaccine the CDC is recommending the vaccine for everyone. And then the booster also. They're recommending that. So this year, the booster, these three companies are making it and they tried to, you know, tried to target it towards the strains that are going around. That's pretty hard with as fast as COVID changes and with, as you know, little time as we've had with it, all right.
Dr. Stella Hayes:
21:11
And then the norovirus, the vaccine there's not a vaccine against it and this kind of goes back to your question about can't you treat the norovirus? We can't treat it, and can you vaccinate against it? That's a good question. I'm going to get to that more because we're actually doing a study on that, so we'll tell you all about it. But first I want to talk about some good news with the flu. So there's whole families of flu. There's the A family, flu A, influenza A, and the B family, the influenza B, and each of those families have multiple members and the scientist's job every year is to try to figure out. You know, but it does change gradually. Up until this year, we'd been using the quadrivalent vaccine that protected you against four types of flu influenza viruses the H1N1, you remember when that was a bit of a epidemic a few years ago and then the H3N2 is a, you know, prevalent one. And then the influenza B, the victoria type. The good news is that there used to be another influenza B, the Yamagata, and that hasn't been detected since 2020. So we think that one has gone extinct. We'll see. So they're not having to add that to vaccines, all right.
Dr. Stella Hayes:
23:08
And then the RSV vaccines. There's three of those approved the M-Resvia, that's the mRNA vaccine. That is for RSV. It's for RSV Because it turns out with the mRNA that technology is quite versatile. You can rev it up very quickly to a new virus and that's how we were able to get the COVID vaccines out so quickly. You know, vaccines out so quickly, incredibly quickly, compared to other vaccines.
Dr. Stella Hayes:
23:52
That took, you know, decades to, you know, develop. The mRNA was kind of ready to go, just waiting for. You know which message do you want us to send? You know they were all these messengers RNAs, ready to go out and give messages. What message do you want us to send? And part of that is thanks to Dr. Hayes's work at Mayo developing mRNA technology. So it's a very versatile type of technology to have and you know, I think it's really making a good impact.
Dr. Stella Hayes:
24:27
All right, so these the Erezvi has the protein antigen. Those are the older vaccines that are, you know, still very good and still being used. That's FDA approved down to 50 years old. So just because it's approved by the FDA doesn't mean it's really recommended. Doesn't mean it's really recommended. So the CDC, as I said, recommends it for people everyone over 75 and then people over 60 who have other conditions. The Mresvia is the mRNA and that, and the Abrysvo is the other one that's out there. So you've got three options and you know they're all protective. I don't recommend one over the other personally, but I do recommend you get it if you're at risk for a severe case of RSV. And one last comment about RSV kids carry it. So if you have grandchildren snotty-nosed grandchildren that are all over you all the time and I hope some of you are blessed with that that they do carry viruses. And if you have a lot of interaction with little kids or school age kids, you know that would be one more factor to consider.
Dr. Stella Hayes:
25:55
As far as if you're going to get vaccinated, so for the norovirus, since there's no vaccine out yet, you have to take other measures to prevent, you know, catching it. So it's good to wash your hands with soap and water, good to make sure the shellfish is thoroughly cooked, especially in certain parts of the world or the country, the warmer waters, it's easier for norovirus to live on. The shellfish. Disinfectants help. And then the vaccination is available on clinical trials, and we're doing one, so that's people who would be eligible for that, or anyone over 18. And the trial includes, you know, the vaccine versus a placebo and, you know, trying to figure out if the vaccine is worth it to give to people to if they get to bypass those three to five miserable days of having the norovirus. We love to enroll people in those types of, you know studies that you know most people qualify for. You know some of our studies are only for people with, you know, severe heart failure, you know, with these criteria. But this one you know most people would qualify for if you're 18 and over, if you want to help out with the norovirus study.
Dr. Stella Hayes:
27:33
So step two in this hurricane prep and virus prep is to, during the viral season to, you know, be a little more careful about your exposures. You want to, you know, try to avoid going to places where there may be a lot of sick people. I can't avoid that because I work with sick people so I try to just not get exposed or not get that critical number of viruses that would give me the sickness. And having test kits on hand can come in handy. The home testing. They sell tests for flu and COVID a lot of times in the same swab and that can be very helpful. That's worked out well with telemedicine.
Dr. Stella Hayes:
28:29
So when people call me for telemedicine, sometimes they'll have it all, their case all wrapped up. They'll say you know, I went on, I just got back from Canada or London or wherever and somebody was coughing on the plane and my husband got sick yesterday and now I'm sick and we just both tested positive for COVID, . And you know we're worried because we have diabetes and or you know, or you know, for whatever reason, they're worried that they're going to get really sick and they want some Paxlovid, and so sometimes that's some of those cases are pretty cut and dry. It's like, okay, here's your Paxlovid. Thank you for you know, putting this all together and if they hadn't had that home test, it'd be just a little more questionable. It's like, well, there's a lot of other things going around right now. How do we know it's COVID? Better than a telemedicine service with a stranger? Is telemedicine with your own doctor if they are offering that service? Long COVID.
Dr. Stella Hayes:
29:35
Covid, you know, made such an impact on the world and there's a few mostly bad, you know, of course, but there's a few good things that came out of it. One of the things I appreciate from it is it really gave people a respect for viruses. Before COVID came, it was so common for me in the emergency room to see a person who's sick and they think they're dying. But you know, their chest x-ray is okay, their labs are okay, they're oxygenating fine and you know their blood counts show us it's probably not a bacterial problem, they don't have sepsis or anything, and so we'll tell them it looks like you've got a virus and they'll say just a virus. Viruses don't make you feel like this, doc, it's got to be something else, it can't be just a virus. Well, people aren't using that term as much now with COVID it's like, okay, it's a virus, you know, but I've got whether that's COVID or some other viruses that are making them feel miserable.
Dr. Stella Hayes:
30:41
Back to the question though long-term COVID. Okay, yeah, so long COVID. The reason I started with the respect for viruses is because these long-term symptoms from a viral illness have been described before. You're familiar with chronic fatigue syndrome. That's what can happen after the Epstein-Barr virus gets you, and then other viruses named or unnamed, you know, have caused prolonged problems with people. But COVID really takes the cake as far as having the most members in the long COVID club.
Dr. Stella Hayes:
31:27
You know COVID was so different in so many ways. You know the way it hit different people different ways as far as symptoms, and you know the number of people who report lingering symptoms after a severe case of COVID. Fatigue is almost always one. Yeah well, the cough from COVID can last for months Long. Covid often has doesn't have to have a cough, it doesn't. There's no, you know, one particular symptom it has to have, although fatigue is pretty much a must, I think.
Dr. Stella Hayes:
32:10
Autonomic dysfunction, where you get tired really easily, shortness of breath, inability to, you know, do the same amount of exertion you had before, and you know that will affect you for a time. After pretty much any respiratory illness you get, you know you're not going to be able to jump right back to climbing three sets of stairs or however much you could before, but with long COVID those lingering symptoms go longer. So it's not so much the particular symptoms you know with memory, brain fog yeah, yeah, that is yeah. That and fatigue are probably the top two. The older you are when this happens, the longer the brain fog can last and the longer you're going to have to wonder is this going to get better or not?
Dr. Stella Hayes:
33:09
Because you know cognitive decline is a thing, unfortunately, and you know it affects, you know, a great number of people to some degree. And so if you're, you know none of us could learn as quickly as we could when we were in high school. As far as memorizing things, you know being able to think quickly and learn new things. I think I don't want to speak for everybody here, but I know I certainly have a lot more trouble, you know, learning new things than I did. So you know some of that is, you know, kind of a expected decline in cognition.
Dr. Stella Hayes:
33:56
When you get a COVID virus or any you know severe illness that throws you for a loop, you can get brain fog. You know some medications cause it, some treatments cause it and I know it's very unsettling and concerning, especially for people who, you know, don't know if it's going to go away. But unfortunately there's no real treatment for brain fog or for, you know, cognitive decline. You can't blow the fog out, so you know you just have to wait and see. I guess you know if you or someone you know has that brain fog Again. I know it's very frustrating and very concerning. I don't know if you're going to be able to think the way you used to think or that you want to think. It can affect a lot of aspects of your life.
Dr. Stella Hayes:
35:03
Is there any validity to the vitamins you're advertising on TV? Oh yeah, there's vitamins being sold for memory. we know that good nutrition is helpful and we know that food is medicine and you know if you're getting the right nutrients, then that can make a big difference in your mental health and your cognitive health as well as your physical health.
Dr. Stella Hayes:
35:37
As far as the supplements, I think that's very individual and probably depends a lot on your diet. You know, we know, that getting substances through food is better than getting substances in a pill, is better than getting substances in a pill. You know food has all the other, you know other substances you need to absorb, that. You know fish oil that's in the fish, whereas the fish oil in the pill doesn't have all the other extra proteins and stuff that may help its function. So I'd say, with the you know the medications and stuff, as far as I know most of them are safe. I think one of the biggest downsides to them is their cost. They're very expensive and I don't think they've really been proven to help things. So I know when I was doing my neurology rotation at Mayo Clinic when I was a resident, a lot of people would come in with memory issues and at that time they were recommending vitamin E. They stopped doing that because they showed that actually no, it's not helping. And there's others that have kind of come and gone as far as supplements that are showing some promise, or might show some promise, but unfortunately most of them have failed. They are making some advancements in medications for dementia, for Alzheimer's, but that's another topic altogether.
Dr. Stella Hayes:
37:21
All right, so step three if you've been unable to avoid getting sick, what are you going to do when the virus gets you? What are you gonna do when the virus gets? Ya? Well, there's lots of home remedies and some of them are helpful and some of them are not. The ones that are helpful, I'll tell you right now rest and hydration, definitely helpful. The ones that are not there's a long, long, long, long list of that. And then there's, you know probably, some that you know well. Vitamin C is showing pretty well, especially if taken early in the course of a virus. And zinc, you know, might be helpful. We were recommending that for COVID, zinc and vitamin C and vitamin D, but again, those don't have the legs or the history and hard proof of rest and hydration as being good home remedies.
Dr. Stella Hayes:
38:27
Quarantine is more of a way to try to make the buck stop here as far as not passing your virus on to other people when you know you're sick. These antivirals Paxlovid and Tamiflu so Paxlovid is for COVID and Tamiflu is for the flu. Those are much more available now. You know, when they first came out we were when. Well, I'll talk about Paxlovid. When it first came out, we were really stingy with it and it's like you don't qualify because you're only 64. And you're, you know, and good, you're too healthy for this. We're saving this for the 90-year-olds or the 103-year-olds and the people with more medical problems. Now they'll give it to anybody, not to say that I recommend it for everybody. Young, healthy young people in their 20s, 30s, people in their 20s, 30s, 40s, even 50s, if they're healthy. I often will kind of talk them out of taking Paxlovid. But people who are, you know it was developed to keep you out of the hospital, paxlovid. So people who are at risk for getting really sick with COVID, paxlovid is a nice way to take the easy route. It kills the virus for you. So you usually feel better pretty quickly on Paxlovid and there's some pros and cons, just like there are with any medication. But it's out there and your doctor will help decide if you're a good candidate for it.
Dr. Stella Hayes:
40:08
As far as other treatments, it's kind of like the norovirus. It's supportive care for you know COVID. So when people were getting this terrible COVID pneumonia that made your lungs look like cotton balls on the x-ray and, you know, was killing people. What we could do for them is give them oxygen, because if you're taking oxygen supplementation you can oxygenate a lot better even if your lungs aren't working real well. Sometimes ventilation like, if you know, sometimes the ventilators would help just get that oxygen in there and get you through the COVID pneumonia. But, you know, usually it wasn't severe enough to need a ventilator, thank goodness. Well, at least those who survived it didn't have it severe enough to need a ventilator. They were supported with fluids or electrolytes or cough remedies, symptomatic treatment, and there's a lot of that.
Dr. Stella Hayes:
41:17
All right, another question here this is about home remedies. Which of these historical remedies for the flu have been proven effective? The onion necklace that's what the ladies there are demonstrating. A glass of whiskey? That's a popular remedy, that's what I use. Okay, hydrogen peroxide in the air? Oh my God, mom's chicken soup, mom's chicken soup, or none of the above? Some people are kind of edging towards the chicken soup, but officially it's none of the above. Yeah, I would question that too. I think some chicken soup can do a lot for the soul, for the body. So can a glass of whiskey,
Dr. Stella Hayes:
42:17
Going back to your question about long COVID, this so viruses can give you prolonged problems and there's a lot of factors. You know. Why do some people get long COVID and some people don't, and there's more factors than we know. But one factor that seems to play a role is the severity of the illness you get. So if you had a really bad case of COVID you're at higher risk for having long COVID. But this slide's mainly showing how the vaccines sort of reduce the risk for long COVID People who were getting the original virus.
Dr. Stella Hayes:
43:01
Well, let's see, this talks about the Delta. Actually that was like the second major wave of COVID, because the original one we didn't have the vaccine so we can't really study that one. But for Delta in the Delta era. So the purple lines there, so the top line, those were unvaccinated people who had got the Delta, which was a very severe strain of COVID, and you can see their incidence of long COVID was much higher than people had been vaccinated here. This purple line in the Delta era, that was the most demonstrative or clearly seen. And then in the Omicron era that's the green line. Same thing happened there the unvaccinated in the pre-Delta era. So that's from the you know, original wave that came through. That was pretty. That was very similar to the Delta wave that hit unvaccinated people.
Dr. Stella Hayes:
44:19
All right, this is our next to last question what percentage of the US adults have been vaccinated with the updated that's this year's vaccine in the last 12 months? We'll take a vote here. Do you think it's as high as 75%, 55%, 22%? Oh, I gave away the answer. Sorry, that was your guess. All right, yep, yep, good, and this was in May, so it probably is a little higher than 22% now. So I like this slide because it goes back to the seasonal variation of these viruses the COVID, influenza and RSV and you can kind of see the seasonal pattern. So this is kind of lumping it all together in the US. I'm sure there are some data sets that tweeze it out as far as what about Michigan versus you know Florida, it out as far as what about Michigan versus you know Florida. But overall there certainly is a kind of seasonal variation to be hitting in the winter.
Dr. Stella Hayes:
45:32
Now COVID kind of got out of bounds here this summer and gave us another good spike. Fortunately it wasn't a real severe strain like Delta and you know it wasn't killing people as much or as effectively as the previous COVIDs. And yeah, that's my hope that COVID will continue to just get a little weaker in general. And then our immunity is, you know, kept high enough that it's, you know, not so much of an issue for us anymore. I think people now are more aware of contagious diseases and you know the fact that if you're right up, you know, together with a bunch of people, there's a higher chance of having a virus out there. You know even people who aren't symptomatic yet might be shedding some viruses in the you know air they breathe out. Certainly people with who are coughing and have a fever are probably spewing viruses and keeping your distance from them is a good idea.
Dr. Stella Hayes:
46:34
Some clinical trials so here in St Augustine, in this very site, we've got clinical trials for the norovirus. I touched briefly on that, so we're enrolling for that right now. But also a very exciting news we got very recently is that we're preparing to do a study on COVID boosters of oral versus shot. So wouldn't that be awesome if you could get your COVID booster in the form of a pill instead of a shot, and this center here may help answer that question to see if that's a viable option going forward. In Jacksonville they're doing doing an influenza mRNA trial for people 50 years and older. So that's just seeing if there's a better flu shot out there, and they're also doing the oral COVID vaccine booster in Jacksonville too. So if you have anybody who thinks might be interested in doing that, have them, keep in touch with us.
Dr. Stella Hayes:
47:55
All right, so the key takeaway points from this are to try to be prepared for the viral season. Don't just sing the song, you know. Try to get yourself prepared. Have a plan and um, you know your plan. Be prepared for what. If I do get it, you know you can do a lot of the figuring out beforehand if you're a good candidate for Paxlovid or for um. You know antiviral therapies and so by the time you get you know COVID or a flu, you might know if you should be in touch with your doctor or if you should. Just you know, if people who aren't, who don't really need those antivirals, they're just going to tough it out at home like they would any other virus, unless they get really sick, in which case they'll come to the hospital and we can give supportive care and help them recover.
Dr. Stella Hayes:
48:58
All right, the last question here about the Spanish flu, because you know, covid isn't our first rodeo as far as bad viruses that have really taken a toll on the populace. It happened a little over 100 years ago, the Spanish flu. Who in here has had a relative who died in the Spanish flu? Anyone? Yeah, I had a great, great uncle who died of that 50 million deaths worldwide. It just started like a flow Sore, throat, chills, fever and then usually gets you through your lungs. Yeah, the soldiers were hit hard, so that was during the war and a lot of barracks housing together, and it was caused by one of our old, familiar friends, one that we've been reacquainted with when it came out again in like what? 2009 or something, um, h1n1.
Dr. Stella Hayes:
50:11
So we're getting vaccinated. If you take the flu shot, you're getting vaccinated against the spanish flu, but it's still out there after 100 years causing problems and that was considered the world's deadliest flu pandemic. You know from from a flu virus. Which of these answers is correct? All of the above, all of very good, smart audience. Okay, all right. Great
Announcer:
50:41
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