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Health

UIHC Epidemiologist Talks Booster Shots, The Need For Iowa Leaders To Step Up And The Safety Of A Football Weekend

Iowa Gov. Kim Reynolds at a coronavirus news conference in September. After previously dismissing the need for a mask mandate, Reynolds on Monday abruptly changed course amid an upsurge in new cases in the state.
Charlie Neibergall
/
AP file
Iowa Gov. Kim Reynolds at a coronavirus news conference in September.

"COVID isn't going away."

Those were Gov. Kim Reynolds' words this week.

Reynolds is again urging Iowans to get vaccinated against COVID-19 as infections and hospitalizations have been increasing around the state, due to increased activity as well as the spread of the highly contagious delta variant,

Dr. Melanie Wellington is associate hospital epidemiologist at the University of Iowa Hospitals and Clinics, where she is a pediatric infectious diseases specialist. Wellington spoke with Ben Kieffer on River to River about where Iowa is in the pandemic and how best to reduce risk to ourselves and others.

This transcript has been edited for length and clarity.

Ben Kieffer: "State data mid-week showing unvaccinated people accounting for 79 percent of people hospitalized for COVID-19 statewide, 90 percent of people in intensive care units. Give us a snapshot of the data you're watching here in Iowa, and how we compare to other states."

Melanie Wellington: "We are pretty similar to most other states. The country, as a whole, is seeing this increased surge in cases and in deaths and, particularly, we're seeing a lot more cases this time around in kids, probably because we're just moving around more and exposing our kids more. And we have to remember, of course, that vaccination is pretty much the best thing somebody can do to protect themselves from getting hospitalized or into an intensive care unit. But our 0 to 11-year-olds still can't be vaccinated because we don't have enough safety data there yet to approve the vaccine in that group. We're really watching carefully to see what happens with the kids right now."

"You are a pediatric infectious disease specialist, so when kids are infected, do they differ from adults in the range and severity of symptoms?"

"They really do. Kids can have very subtle symptoms. This can be just a runny nose or a fever in a kid, whereas an adult might get quite sick. The good news about kids getting COVID is it's incredibly rare that they would need to be hospitalized or in an ICU. Extremely rare. But the problem is there's a lot of kids. And so if we have a lot of kids getting infected, some of them are going to have some pretty bad luck and end up with severe disease. And that's really something that we really need to work to prevent."

"And kids, in terms of becoming 'long-haulers,' so-called, with chronic symptoms that exist long after the immediate symptoms are gone, are those affecting kids as well?

"They are, but as you might imagine, they're a little bit harder to track. If a four-year-old is taking a lot of naps, or feeling "brain fog," or having trouble concentrating, it's not so easy to tell that apart from their normal behavior. But we're definitely seeing those long-haul symptoms in kids, and it's a little bit easier to pick up in adolescence, so that's where we see it the most."

"You see an uptick in infections among Iowa's young people. Can you draw a line between that uptick and the return to school now that kids are back physically in classrooms?"

"Well we haven't really been back in school in long enough to see the absolute result of what will happen there. And there's a huge surge amongst everyone in Iowa right now, so it remains to be seen whether we'll be able to see the effect of school or whether the whole thing is just going to be bundled up into one big surge, but we definitely are seeing a lot of kids and getting a lot of reports of kids getting exposed or having positive tests when they're at school."

"This week, Gov. Reynolds declined to comment, to recommend whether students should wear masks in schools. She said that her opinion doesn't really matter, because state law bans local districts from making masks a requirement. I'm wondering what you think of that comment. Does it really not matter what our leaders, what our elected officials, say about wearing masks?

"Well, I think that we, as a community, tend to respond to our leaders. And whether that's an elected official, a community leader, a sports leader or any type of role model in the community, anybody that people are looking up to right now is a role model, and those people really need to step forward and wear their masks and encourage others to do so."

"At that news conference with a governor, it was announced that Iowa will increase the frequency of its online COVID-19 dashboard updates from once a week to three times a week. They'll also include the percentage of hospitalized people who are unvaccinated. How important is it to increase this reporting? Tie that to stemming the increase in infections. Why does that make sense?"

"It really is important to us to have accurate, as close to real-time data as we can, because we need to be making adjustments in our behavior. And so the more information we have about where we are today in terms of this spike, we know how much to restrict different types of behaviors. How many different extra safety protocols we should take. Now that isn't to say we shouldn't be safe. Everyone should still be wearing their mask, minding their distance and doing whatever they can to help prevent spread. But if we do start to need to do things like changing plans for schedules or changing events or moving an event from something that was going to be indoors to something outdoors or something that was outdoors into something that's online, we really need to know where we are right now. And when the data is only updated once a week, it's not so easy to see where things are going."

"Let's talk about booster shots. Top federal officials have told the White House to scale back a plan to offer booster shots to the general public later this month, saying that regulators need more time to collect and review all necessary data, according to the New York Times. Where are we with booster shots? Will they begin this month here in Iowa or anywhere else in the country? Is that still undecided?"

"I think it really is undecided. It seemed like it was decided before but it wasn't really. What was really sort of put out there before was the date at which the regulatory commissions were going to announce their analysis of the data and their recommendations. So it wasn't that we were an absolute go for the booster shots, but more they wanted everybody to get ready so that if we were going to start them immediately, we would have a plan in place and were ready to do it. And we still do have that plan, and it is still in place, and we still are ready. Because the more data we get, the more we're able to respond appropriately. And you never know what data will help us understand how things are going will come out tomorrow. So we always want to be ready. But if the regulatory folks need some time to reanalyze that data or if they've got new data coming in soon, it would be important for them to have a chance to really look at everything we know before they're making a big decision like that."

"This week, Dr. Anthony Fauci said it's likely that three doses of the vaccine are needed for full protection. We'll wait for the after FDA approval, but he cited two Israeli-based studies showing a decrease in infections among people who got a third booster shot. Does that mean the third booster shot would be full and durable protection in the long term or the first of many booster shots depending on what we discover about this virus?"

"I guess it depends on what you mean by long-term. I don't want to try to quibble over terminology, but remember that the coronavirus — the virus family that COVID is in — is the common cold family. And everybody knows, common colds are something you have to deal with all your life. And so it's very unlikely that we would have lifelong immunity to this virus, because we don't have lifelong immunity to any of its closest relatives. So, long-term like that, we're not going to have long-term immunity. But the good news is that the studies that have been watching immunity in the first people who are vaccinated this time last year, the people who are the studies are showing they're still having very good levels of antibodies, which is the easiest to measure of the immunity.

And 'get vaccinated' is the message. You know, it doesn't ensure anything we're seeing breakthrough infections here but much, much less severe symptoms. There's just no question: you need to get vaccinated, right?"

"Absolutely. And the breakthrough infections are a little bit kind of funky to understand. When a vaccine protects you from an illness, we call it a relative risk reduction. In other words, it decreases the chances of problems, and that is definitely true. And if you're vaccinated, you're something like 20 times less likely to be hospitalized than if you're not. So that's a relative reduction. The problem is when there's this much transmission going in our communities, even with vaccinations, some people are going to get infected, the good news of course, as you mentioned, is that those people who do get those breakthrough infections tend to do quite well. And it's very unlikely that they'll get really sick, but it's the amount of transmission going on that's driving how many people who are vaccinated get infected."

"College football returns this weekend. Packed stadiums. Encouragement to wear masks, but here in Iowa, no mandate. I wonder, do you as an epidemiologist and pediatric infectious disease specialist think it's safe to bring your family to a stadium, sitting shoulder-to-shoulder, hours-long with tens of thousands of other fans. Even though it is outdoors, is that safe?"

"So I tend to avoid using the word 'safe' as an absolute. Because nothing that we do in life can be said to be 100 percent safe, and everything that we do — whether it's driving down the road to pick up groceries or walking across the street at a busy intersection — everything that we do has some risk to it. And so nothing is absolutely safe. And whenever we make these choices for ourselves, we have to think about the benefits and the risks. And each family is going to have to think about how many people in their family are at risk of severe disease. What's the situation, do they have kids that can't be vaccinated. That sort of thing."

"So it does increase risk. There's no doubt about that."

"Right. Just one little thought of the football game: Herky, the character Herky, is not going to be wearing a mask, and the only reason is — spoiler alert — there's actually a person inside that costume, and that person has to see out through the mouth. So apologies that Herky's not wearing a mask, but he would otherwise."