0:04

Welcome back to season two of

0:06

Beyond the Needle a physician's guide

0:08

to increasing COVID-19 vaccination

0:10

rates . I'm Carl Lambert , a family

0:13

physician and a member of IAFP , and

0:15

I'm an assistant professor of family medicine at Rush

0:17

University Medical College . This podcast

0:20

series is brought to you from the Illinois Academy

0:22

of Family Physicians , IAFP , through

0:24

the Illinois Vaccinates or IVAC

0:26

project . Joining for this podcast

0:29

series is provided by the Office of Disease

0:31

Control through the Illinois Department of Public

0:33

Health . For more information on

0:35

the IVAC project and receiving free

0:38

CME credit for these podcasts

0:40

, visit illinoisvaccinates . com/podcasts

0:42

. Thank

0:46

you for joining us as we come together

0:48

to vaccinate against COVID-19

0:50

.

0:55

Hello, this is Corinne Kohler with another episode

0:58

of Beyond the Needle podcast . I

1:00

am here today with Dr . Santina

1:03

Wheat and I am Dr . Corinne

1:05

Kohler . We're both family physicians very

1:07

active with keeping up with the COVID-19

1:10

pandemic . Today we're going to talk

1:12

a little bit about some of

1:14

the changes that we've seen with

1:17

the ending of the public

1:19

health emergency designation by WHO

1:22

and also what the changing landscape

1:24

might be for the future

1:26

of COVID-19

1:28

. As I mentioned , I'm Dr

1:30

. Corinne Kohler . I'm a family

1:33

practice physician in central

1:35

Illinois , and Dr

1:38

. Wheat , if you'd like to introduce yourself please .

1:41

Sure , I'm Dr . Santina Wheat . I

1:43

am a family physician at Erie

1:45

Family Health Center in Chicago , Illinois

1:48

, and I'm the program director for the Northwestern

1:50

McGaw Northwestern Medicine Residency Program at

1:52

Erie Humboldt Park . I'm looking forward to this conversation

1:55

.

1:55

Okay , great . So I think

1:57

we're all aware that WHO

2:00

ended the public health emergency

2:02

in May , which also CDC

2:05

obviously also ended its designation

2:07

. So let's talk a little bit about

2:10

what the impact of removing

2:12

that designation might have on us

2:14

and what changes you've seen , Dr . Wheat

2:16

.

2:17

Sure , let's actually start with

2:20

the things that we are going

2:22

to continue to see . So , most

2:25

obviously , covid is still here

2:27

. We know that people are

2:29

still getting sick from COVID , despite

2:32

the fact that people might not always have

2:34

it in the front of their

2:36

mind . So we still have a need

2:39

for testing availability

2:41

and we still have a need for vaccines

2:43

for those who have not been vaccinated

2:45

or , when we have new variants , be able to provide

2:47

that additional information .

2:51

I agree , and going forward

2:53

knowing that COVID will continue

2:55

to change or continue

2:57

to have variants and that we continue to

2:59

need to be surveillance

3:01

and new information

3:03

. Research into COVID is really

3:06

not going away . If anything , it has increased

3:08

and we will continue to see

3:10

that . What other impacts have you seen

3:13

?

3:15

So I also just want to

3:17

make a mention to

3:19

the fact that we've seen so much vaccination

3:21

happen in individual offices and

3:24

in individual pharmacies , and

3:26

one of the concerns that people had

3:28

about the public health emergency

3:31

ending was that we might see some of

3:33

that funding go away for the vaccines

3:35

. But for the individuals providing

3:38

the vaccines , we know that

3:40

, at least through the end of this calendar year

3:42

, that there will still be the additional

3:44

reimbursement that's provided

3:46

for the COVID-19 vaccine , and

3:48

so we we should all

3:51

continue to encourage the

3:53

organizations that we support to

3:55

provide this important vaccine .

3:58

Absolutely . I think that , as

4:00

people have seen , the designation

4:03

public health emergency ending it

4:05

does not decrease the

4:07

impact of COVID . It's still

4:10

transmissible . We're still seeing long

4:12

COVID . We're still seeing year-round

4:14

illness from COVID . It's not

4:16

quite as seasonal as influenza appears

4:19

to have been in the past . But , yes , we

4:21

definitely need to continue to

4:23

remain vigilant to changes , remain

4:26

a diligent about educating

4:28

our patients and the public about the

4:30

need to vaccinate and

4:32

being aware of any new

4:35

changes that appear on the

4:37

horizon . One of the things

4:39

that probably will not

4:42

change also

4:44

is just some of the impact that

4:46

we have all seen on our practices . So

4:49

you know , things like telehealth

4:51

will , for the most part , continue

4:54

, perhaps with some

4:56

changes in terms of establishing

4:59

care . As a telehealth patient , we

5:01

will probably continue to see testing

5:03

, although maybe not as

5:06

required for routine

5:08

procedures , but still the need for testing

5:11

is still there , that need for

5:13

practicing good public health measures

5:15

If you are infected with COVID , the same

5:17

way you would if you were infected with influenza

5:20

or RSV or any of the other viral

5:22

respiratory illnesses . I don't

5:24

think that education

5:27

has changed .

5:29

I think you're absolutely right on that , and

5:32

it's interesting though , because , as we've

5:34

had a lot more exposure , there

5:36

has been a change in the

5:38

perception amongst just

5:41

about everyone , I think , about

5:43

the impact of COVID

5:45

and the need for vaccines . But

5:48

, as clinicians , I do think it's it

5:50

really behooves us to continue to

5:52

educate our patients

5:54

on just like the influenza

5:57

virus , like yes , you may contract

6:00

COVID and have a mild case , but

6:02

there's still the possibility of severe illness

6:04

that comes along , and so it is still

6:06

worthwhile to be

6:08

testing to make sure you stay up

6:10

to date on vaccinations to

6:12

isolate from others when you're sick

6:14

, so that you can try to

6:16

decrease the transmission along the way

6:19

.

6:20

So one of the major

6:22

changes that I was aware

6:24

with the ending of the emergency

6:27

designation was the changes in

6:29

data collection . Some of us are very

6:31

data driven and knowing

6:33

that that data is

6:35

not quite as robust as it

6:37

has been really should not change

6:39

our focus as clinicians . But,

6:42

if you're some one of the clinicians that's very

6:44

data driven , you will notice that there

6:46

is a lot of decrease

6:48

in the data collection . We don't have those

6:50

daily data reports . We don't have

6:53

some of the robust surveillance

6:55

. It's more of what we do for going

6:57

forward is what we do for influenza surveillance

7:00

on more of population-based

7:03

and not only that

7:06

.

7:06

I think we have to keep in mind

7:08

that whatever is being reported to us

7:10

if we are receiving reports , is

7:13

going to be always an

7:15

under representation , because now that

7:17

the home COVID tests are available

7:19

, as they happen for a while , those aren't

7:22

all necessarily being reported . So

7:24

there might be much more burden

7:26

of disease within our communities that we're

7:28

unaware of , just because most

7:30

of what we're receiving is going to be the

7:32

testing that's from institutions .

7:36

Thank you very much for pointing that

7:38

out . So what other

7:40

changes have you been aware

7:42

of with the ending of the public health

7:44

emergency ?

7:46

I will say one that is actually positive

7:49

as a change is we're no longer

7:51

having the fears of the

7:53

lack of personal protective

7:55

equipment .

7:57

Yeah , I think there is more availability

7:59

of that and it's becoming

8:01

much more acceptable . So I know , when I go

8:03

out in the community , some people are masked

8:06

, some are not . You know it's become much

8:08

more just . This is the way you know

8:10

life is . But then

8:12

again we just hope that those good hygiene

8:15

habits have been engraved enough

8:17

that we will continue forward those with those

8:19

. But yeah , having that lack

8:21

of fear of what's next

8:24

and what's coming , I think has definitely been

8:26

beneficial to the health care community .

8:30

Also with the changes that are coming along the way

8:32

. I know that I was very

8:34

concerned myself with the end of the public

8:36

health emergency about what that meant for

8:38

the availability of vaccines

8:40

and the coverage of

8:43

vaccines , and it's been really

8:45

wonderful to see that

8:47

there are plans for continued coverage

8:49

for vaccines . That might change

8:51

for some individuals what

8:53

the options are right now . So , specifically

8:56

those with private insurance

8:58

, there might be some changes

9:01

as far as co-pays that

9:03

are needed for vaccines , and so it will be really

9:05

important as clinicians for

9:07

us to talk to our patients I

9:09

talking with their insurance

9:11

companies about what co-pays might there

9:13

be . So hopefully there will not be many of

9:15

those , and for those who are seeing patients

9:18

who are not insured , there

9:20

is really great information that all

9:22

children who are eligible for vaccines

9:24

for children will continue to receive

9:27

covered COVID-19 vaccines

9:29

and for adults who are not insured

9:31

, who are often the hardest part or hardest people

9:34

in my experience to get vaccines for

9:36

, HHS has announced a

9:38

program called the Bridge Access Program

9:40

for COVID-19 vaccines and treatments

9:42

, which will maintain access

9:45

for those who are uninsured once

9:47

the vaccine moves over to

9:49

the commercial market .

9:51

Thank you for pointing that out . I think as

9:53

our vaccine landscape

9:55

changes , we will need to be diligent

9:58

as clinicians as to what

10:00

is available where it's available

10:02

. Certainly with commercialization

10:05

you know which pharmacies will be offering

10:07

it -

10:10

Will there be co-pays ? But

10:12

we do know that

10:14

CMS has said that they

10:17

will continue to pay

10:19

that reimbursement on COVID

10:21

vaccines , at least until the end of the year

10:23

. So hopefully that will not have a great

10:26

impact and , as Dr . Wheat

10:28

mentioned , the uninsured adults

10:30

will have an avenue . Any

10:32

children that are covered under VFC

10:35

or VFC plus or will

10:37

continue to be , have

10:39

access . I think to remind

10:42

providers that there is a website

10:44

called Illinois Vaccinates . com which

10:46

is a cooperation

10:49

between various of the state

10:51

organizations that will have up to

10:53

date information , including where private

10:56

vaccines will be available and such

10:58

. Certainly , one of the things that

11:00

we are aware of in terms of

11:02

the change in landscape will be the change

11:04

in the vaccines that we will

11:06

be seeing this fall

11:08

, as it has been recommended

11:11

that all further vaccines

11:13

right now will be monovalent

11:15

so that we will just have the Omicron

11:17

component in future vaccines

11:20

starting this fall .

11:22

That's absolutely right , and I will

11:24

say I have a little bit of trepidation

11:27

about the counseling that's going to come along

11:29

with this . But as I've been thinking about

11:31

how I'm going to talk to my patients about this , I'll

11:34

share my thoughts with everyone is

11:36

to talk about this

11:38

similar to how I talk

11:40

about the flu vaccine , in

11:42

that every year we know that the virus

11:45

changes a little bit or

11:47

potentially changes a lot , and

11:49

we really depend on

11:51

the people who are monitoring the

11:53

infections to look

11:56

at how that virus is changing over

11:58

time and to plan for vaccines

12:00

that are going to be able to directly

12:02

impact that Not just my patients

12:05

I've been telling my children . It's like I just think

12:07

this is going to be something that we're

12:09

going to get a flu shot and you're going to get a COVID

12:11

shot every fall . That we're going to make

12:13

sure that we're protected against the

12:16

different strains that are coming to have our best shot

12:18

of if we do get sick , then

12:20

it won't be so bad , or if

12:22

we get lucky , then the vaccine

12:24

will help prevent the disease

12:27

altogether . And so just really

12:29

being able to talk to our patients

12:31

and our colleagues honestly about

12:33

how the changes

12:35

in these plans really mean that

12:38

there's been sufficient attention

12:41

paid to how the virus has changed . Just

12:43

because of public health emergency's ending doesn't

12:45

mean that we stopped paying attention to it

12:47

. It just means that it's become

12:49

part of our daily

12:52

activities and it's going to

12:54

the same processes that other

12:56

diseases that we watch out for are going

12:58

.

12:59

I agree I have often referred

13:02

to the influenza vaccine

13:04

during this time as another

13:06

virus that changes

13:09

in mutates and

13:11

we are constantly changing our

13:13

vaccine and sometimes we get it right and

13:15

sometimes we're behind on that influenza

13:17

vaccine . But I think the important

13:19

thing is with the

13:22

COVID vaccine , along with influenza

13:24

vaccine , is that the real purpose of the

13:26

vaccine is to prevent that serious

13:28

illness and death . Yes

13:31

, you may still get mild illness

13:33

and unfortunately , you're still

13:35

probably able to transmit

13:38

it , but it is there to

13:40

help prevent the serious illness

13:42

and death and the wear and tear

13:44

on our healthcare system . Hopefully

13:47

, going forward , our healthcare

13:49

system will be able to rebound a little bit from

13:52

some of the wear and tear that

13:54

COVID has provided in

13:56

terms of stress

13:59

on staff and resources and

14:01

such like that . So I am looking

14:03

forward to that . I

14:06

do think that , as clinicians

14:09

and providers , one of the important things

14:11

to do is just to really keep

14:13

track of where your information sources

14:16

continue to be . We've

14:18

all been aware of lots

14:21

of good information and a

14:23

lot of misinformation out there and

14:25

just knowing that as we go

14:27

through and we're looking at guidance

14:30

that we're using those really

14:32

robust sources . So

14:34

your CDC , your

14:36

HHS , your CMS

14:39

for your coding and

14:41

also then for us in Illinois

14:43

our Illinois Public Health website

14:46

and Illinois Vaccinates

14:48

for up-to-date information

14:50

as to what is coming .

14:52

I think that's right and I think that that

14:55

should be something that we said . Going

14:57

back to the , what really hasn't changed ? I

14:59

think that the information

15:01

is going to continue to change , is going

15:03

to continue to be updated , and so we

15:06

all will need to stay on top of those

15:08

websites , as you mentioned , and Speak

15:10

with our organizations about how

15:12

our processes are changing along the way . I

15:15

do think that this change in vaccine

15:17

this year will will be a big difference

15:19

for some locations . I think we'll have to watch out

15:21

for where the vaccine

15:24

is available and make sure

15:26

that , if it's becoming less available

15:28

for some of our patients , that we're doing some focus

15:30

counseling on .

15:31

This is how you get it , and also this is why

15:33

I think it's important , even if it's a little

15:35

bit more difficult to get

15:38

to that vaccine than it was in the past

15:40

one of the things that lessons

15:42

that I have definitely taken home

15:44

during this whole COVID

15:46

journey has been increased flexibility

15:49

as an individual , responsibility

15:52

just as a citizen , but also

15:54

, very much so , increased flexibility

15:57

as a clinician . How I did

15:59

it yesterday may not be how I

16:01

do it today , and probably will

16:03

be different than how I do it tomorrow . So

16:05

, again , being aware of those resources

16:08

, communicating , being

16:10

open to the fact that this is not

16:12

, this is not static , this is something

16:14

that has changed or will continue to

16:16

change and Certainly I think

16:19

one of the positives has been just

16:21

increased communication . Increased

16:23

communication especially amongst

16:25

providers and amongst Organizations

16:28

that I've seen , and hopefully that will continue

16:31

to happen , also going forward

16:33

.

16:34

I think you're absolutely right . I hope that that is

16:36

something that we continue to see going forward

16:38

and , as you said

16:40

, that things will be changing on a day-by-day

16:43

basis . One of the other things that I

16:45

think All of us need to pay attention

16:47

to , particularly here in Illinois

16:49

, is that we are Clinicians

16:52

in a state that often serve

16:54

people that are coming from other states too . There

16:57

are several states that border us , and sometimes people

16:59

Cross over to receive care

17:01

to work and so sometimes receive

17:03

care closer to where they work , and so

17:06

it is important for us to also keep

17:08

that in mind , as the resources that are available

17:10

here in Illinois might be slightly different

17:12

than some of those bordering states , and so it would

17:14

just be helpful to pay attention

17:17

. If you are someone that's caring

17:19

for people in those bordering states

17:21

, to pay attention to how things are changing

17:23

in those states as well , because it might impact access

17:25

for your patients .

17:27

Oh , I agree , especially as we start

17:29

looking at perhaps changes in regulations

17:32

pertaining to health and also

17:34

sending controlled substances

17:37

across state lines , of all kind

17:39

of gone used to the increased

17:41

laxing those regulations during

17:43

COVID , but again that that may

17:45

change and we need to be staying

17:48

on top on top of that . So I

17:50

really appreciate your pointing that out

17:52

. I'm not in a particularly collar

17:55

area but we do get for

17:57

us . Where I am with the University

17:59

of Illinois , we get a lot of international

18:02

students and people that are visiting scholars

18:04

and such like that and all that can

18:06

impact all their health

18:09

insurance coverage is not just COVID

18:12

. So keeping on top of that

18:14

is Definitely something

18:16

that's on my radar .

18:18

Absolutely , and I hope that

18:20

COVID is just staying on people's

18:23

radar . As we alluded to before . Some

18:25

people have just become a little bit more comfortable with it

18:27

. It felt like it's not that

18:29

important to stay on top of

18:31

, but I hope , as clinicians

18:34

at least , that we're still paying attention to the

18:36

things that are changing and how

18:38

our processes for our patients will need a

18:40

change based on this , and will still advocate

18:42

for the needs to ensure

18:45

that access remains

18:47

, particularly with the programs

18:50

that are providing the

18:52

bridge access and knowing that as

18:54

co-pays start , that it might be an impediment

18:56

for some of our patients , and so just sort of being

18:59

the good advocates that we can be for our patients

19:02

along the way .

19:03

Oh , I agree and thank you so

19:05

much for pointing that out

19:08

and the fact that we just need to continue

19:10

to be vigilant and

19:12

diligent and aware of

19:15

everything . And again , the resources

19:18

, and again , just because one

19:20

designation has disappeared

19:23

, the disease state itself is

19:26

still there , as we , you know , summer

19:28

tends to be a little bit more

19:30

relaxed with respiratory illnesses

19:33

, but certainly as fall comes

19:35

in and with the change of vaccines , will

19:37

definitely need to be vigilant

19:39

on that . Any closing

19:41

thoughts, Dr . Wheat ?

19:44

I would just say a reminder

19:46

that the different resources

19:48

continue to be updated . They

19:50

continue to be available for you . I hope

19:52

that you will continue to reach out and

19:55

I hope that everyone feels

19:57

comfortable with the idea that

19:59

COVID is still here and

20:01

there's lots of resources for us

20:04

to stay on top of to help

20:06

keep our patients and ourselves

20:08

and our families safe .

20:10

I would definitely like to put in a plug

20:12

for illinoisvaccinates . com website

20:15

, IVAC, IVAC boot camps

20:17

and information that are on that website

20:19

, as well as CDC

20:21

for their continued

20:24

updated information and they

20:26

still have excellent patient education

20:28

handouts . Watch for more information

20:30

as we make the switch to monovalent vaccine

20:33

this fall , as there'll

20:35

be more information on changes

20:39

with that and dosing . I

20:41

would like to thank you for joining us

20:43

this evening . Thank you to

20:45

Dr . Wheat for the great

20:48

conversation that we were able to have

20:50

and again I

20:52

think our words are to stay vigilant , stay

20:55

safe .

21:00

Thank you to our expert faculty and to

21:02

you , our listener , for tuning into this

21:04

episode . For more episodes

21:06

of Beyond the Needle , please visit

21:09

IllinoisVaccinates . com . Here

21:11

you'll also find links to an online toolkit

21:13

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21:16

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21:20

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21:24

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