State epidemiologist Dr. Angela Dunn sees a silver lining in the Utah vaccination appointment systems that were overwhelmed Wednesday: “It’s a really good sign that there’s so much demand among our older adults to get vaccinated.”
Dunn answered readers’ questions about COVID-19 and vaccinations in a live Facebook question and answer session with The Salt Lake Tribune. She covered topics from how and when to get vaccinated, to the effectiveness of the vaccine, to what those who opt out of vaccination can do to stay safe.
Last week, Gov. Spencer Cox issued an executive order aimed at speeding up Utah’s vaccine distribution. As part of the plan, teachers started getting vaccinated Tuesday, and people 70 and older will begin Jan. 18.
Dunn addressed concerns from those two groups and others in her 30-minute interview. Her answers have been edited for clarity and length.
Teachers
How worried should a teacher who’s not vaccinated yet be about possible transmission from asymptomatic students?
We’ve done a lot of research into this in the state of Utah, using our data here. And what we found in elementary schools is that there’s a really low rate of transmission between students and teachers, and even between students themselves, when everybody’s wearing a mask in an elementary school setting. That risk increases as you get to middle school, and definitely increases as you get to high school. But we do know that wearing masks in the school setting does prevent that transmission.
A reader said he teaches in a room with good air exchange, Plexiglas around his desk and a nearby UV light-killing air exchanger. How long after students leave should he wait to remove his N95 mask?
What we’ve learned throughout this pandemic is that the virus actually doesn’t really transmit that easily from objects, so we don’t have to worry about that. It’s still good to wash our hands and to clean regularly, but we don’t have to be wiping down our groceries and things like that.
With regard to the air, it doesn’t seem to linger that long in the air, either. But to be safe, a couple of hours is probably safe. [But with the circulation and ventilation described by the reader,] it is probably a matter of minutes for his situation because of that good air circulation.
Another reader said he owns a private Montessori school, and 80% of his teachers have either signed up for the vaccine or already had COVID-19. What should he say to the 20% who say they are not going to get vaccinated?
That’s fine. We’re not here to force people to get vaccinated. What we need is the vast majority of people who can get vaccinated to get vaccinated. And those who choose not to take the vaccine need to be extra cautious in terms of physical distancing and mask-wearing to protect themselves and those vulnerable populations who may not be eligible for the vaccine. So, those who don’t get vaccinated, really pay more close attention to your symptoms. Stay home if you’re in close contact to anybody who has COVID. And stay home if you have the most minor symptoms at all.
Residents 70 and older
What procedures are being set up for those who are 70 or older to sign up and get the vaccine?
A lot of our local health departments actually started sign up Wednesday. And I will tell you, the demand is off the charts. Some of the ways to actually get scheduled have crashed because so many people are trying to get scheduled. So, it’s a mixture of phone call and web. A lot of our messaging has been to the kids of the older adults, so that they can help their parents get set up.
If somebody wants, they can call in [to the coronavirus hotline at 1-800-456-7707] and they can get registered through the hotline, as well. So, right now we’re doing a mixture of web and phone calls.
The Salt Lake County Health Department website crashed Wednesday morning. What do you recommend in those instances? Would Intermountain Healthcare or University of Utah Health be better suited to handle this than local health departments?
I will say again, our local health departments are well equipped for mass vaccination and are working with our health care system partners to make sure that that is fluid.
For people who are having trouble signing up today, I would say don’t panic. It’s OK to sign up tomorrow or the next day. You will get a vaccine. And a few days or a few weeks won’t make a huge difference. We have a vaccine for you. So, I would just relax for today and call again tomorrow when the systems are back up and running.
On Tuesday, the Centers for Disease Control and Prevention recommended that people 65 and older should be vaccinated as soon as possible. Is there any discussion about lowering the age from 70 to 65 in Utah?
That did come as kind of a surprise for every state because up until yesterday, the federal government had been resisting opening it up. Again, this is a supply-demand equation here. And what we know in Utah is that we have enough supply to vaccinate the 70-plus population through the end of February. And we’re looking at our supply and our populations in the other age groups to see how quickly we can start opening it up. So, that is on the top of everyone’s mind right now.
The vaccine
If I’m vaccinated, what protection does it offer my family? If I’m exposed to COVID-19, can I expose my family?
What we know about vaccines, about the COVID vaccines, specifically for Pfizer and Moderna, is that it prevents an individual from getting sick if they’re exposed to COVID. What we don’t know yet is if it prevents you from transmitting it if you don’t have any symptoms. And the reason we don’t know that is because time was of the essence in getting a vaccine out. So, the trials really focused on preventing illness. Now, there are studies going on to determine if the vaccine actually prevents you from being able to transmit COVID after you’ve been vaccinated, even if you don’t have any symptoms.
That’s why it’s just so important we still recommend individuals continue to wear face masks and physical distance as much as they can, not only because we need it to be the social norm until we reach 70 to 80% of our population being vaccinated, but also that there is a small chance that the vaccine might not be as good at preventing transmission.
The people in the first vaccine trials are trailblazers in helping us find out how long the vaccine is effective, right?
Yeah, absolutely. The FDA [Food and Drug Administration], because we needed this vaccine so quickly, followed them for two months before getting an EUA [emergency use authorization]. So, we know that the immunity is great for two months and even longer, now that we’re following these individuals who were in the trial. So, we’ll continuously get new information and relay it to the public as we get it.
When might more vaccines be available in the U.S.?
For both the Johnson & Johnson vaccine and the AstraZeneca, I’m hearing that it could be somewhere in the February timeframe. So, definitely in the early spring, it seems like we will have more options for vaccination, which is fantastic.
If you’ve already had COVID-19, do you need the vaccine?
We know that somebody who has been infected with COVID can assume they have immunity for 90 days after they’ve recovered from COVID. So, we don’t recommend that people get the vaccine within those 90 days. You can, but again, we have limited supply, so it’s better to wait until after your 90 days of immunity to get the vaccine. But we definitely want you to get the vaccine if you’ve had COVID because that’s how you’ll get more long-term and more robust immunity and protection.
The window to get the second dose is 21 days for the Pfizer vaccine and 28 days for Moderna. Is there a period where if you wait too long to get the second dose, you won’t get full protection or you’ll have to start over?
Again, this is one of those things we don’t know. But we do recommend that you just get it as close as you can to that 21- or 28-day window. A couple of weeks late isn’t going to make a difference, and that’s for sure. But we will learn later kind of what that — it’s called a catch-up schedule — would look like. But, for now, just get the second dose whenever you can get in and try to get it as close to the 21 or 28 days as possible.
If a person gets infected with COVID-19 after their first dose of the vaccine, should they still get the second dose?
In order to get the second dose, you should be free from symptoms from COVID, feel good and be out of your isolation period. But we still want you to get your second dose.
A reader said her mother told her that having COVID-19 doesn’t always produce antibodies, so she doesn’t see the point in getting the vaccine. The vaccine produces plenty of antibodies, right?
Absolutely. That’s why we need people who have had COVID to get the vaccine because it’s a more sure way to get protection.
Have we seen people have allergic reactions to the vaccine in Utah?
Luckily, knock on wood, we haven’t really seen a lot of severe reactions here in Utah. We are tracking that on a daily basis. But again, if you’ve had a history of anaphylaxis or severe allergic reaction in the past, make sure you have your EpiPen with you; talk with your provider before getting the vaccine.
Are there common allergies, like shellfish or peanuts, that are a warning sign for COVID-19 vaccine sensitivity?
Not that I’ve heard of, because neither one of those ingredients are in the mRNA vaccine.
Will the vaccine be safe for women who are pregnant or wanting to become pregnant?
Currently, the COVID vaccine is recommended for pregnant individuals. Because pregnancy is one of those high-risk conditions for severe disease. Again, we don’t have tons of information on the impact of the COVID vaccine on pregnancy. It is thought to be safe. And, for example, our pregnant health care workers have received it. If it’s something you’re considering, I encourage you to talk to your health care provider, so you can get more detail about the risks and benefits there.
Do we know when vaccines will be available for people younger than 16, and whether it will be safe?
Those studies are going on now. Hopefully, more information will be available before the fall.
Readers asked about the B117 variant of COVID-19, the fast-spreading version of the coronavirus that was first found in the U.K. It’s been spotted in some U.S. states, including in Colorado. What do we know about the variant? Have we seen it in Utah yet?
You know if you have a variant because you do whole genome sequencing on the viruses. It’s kind of like looking at the DNA makeup of a virus. And we do that in Utah, which is great. We’re not able to do it on every single infection, but we do it on a good subset of all of our infections, and we haven’t seen the variant yet. That doesn’t mean it’s not here. It just means it’s not super prevalent.
What we know so far is that it does seem to be able to transmit, or it’s more infectious than the other variants. But I will tell you that viruses mutate. That’s what they do. And the COVID virus has mutated at least once a week from the beginning of this. So, this isn’t unexpected. The good news is we have reason to believe that the vaccine is still protective against this new variant. It doesn’t change our public health practice much, other than mask wearing and physical distancing is the same way to protect yourself against this variant.
Utah’s rollout plan
Can you talk about the process, from the public health side of things, that led to Gov. Cox speeding up distribution?
With any vaccine distribution schedule, it depends on how much vaccine we get. Our federal partners are able to allocate us however much they’re getting from the manufacturers, and they’re distributing it to states. So, it’s really interesting that we’re kind of in this flux. The week-to week-basis, we understand how much we’re getting from our federal partners, and so that has an impact on who we’re able to vaccinate.
The other piece that added into the speeding up of teachers being vaccinated is the uptake of our health care providers, and that kind of really early group of the frontline health care providers and our health care workers caring for patients in person. We had leftover overdoses, basically, and so we were able to speed up our timeline for who gets vaccinated.
Gov. Cox said that county and regional health departments are in charge of giving out the vaccine. How is that going to streamline the process?
Our local health departments, this is what they do best. They do mass vaccination clinics. We are prepared for that at the local level, and they’ve already proven it. Davis already has a mass vaccination clinic set up, and they successfully are getting a lot of people through it. And we’re talking about mass vaccination. We’re talking about thousands of people being vaccinated every single day through these sites. So, what we need to do is get more vaccine to our local health departments so that they can get the shots in arms.
What has the last week and a half been like with Gov. Cox in charge?
He is definitely a very engaged leader that understands all kind of, down to even the details, of what’s going on with the response, and what needs to happen moving forward, and is asserting that leadership in a really effective way, especially around vaccines. Because we all know that vaccination is our way out of this, and we can’t wait to get there soon enough.
Some places have had leftover doses, which the state has then reallocated. How does that work?
It’s a collaboration between our local health departments and the hospitals that have extra doses. We have a whole chain process that makes sure that, logistically, the vaccine is safe and stored at the appropriate temperature the whole time. The local health department can procure these extra doses from the health care systems to incorporate into their mass vaccination clinics.
We have such a good collaborative community here between the locals and the health systems, which is great.
Are doses going to waste? And are there ways to prevent that?
When people are talking about waste, a lot of times they’re thinking of a vaccine that has already been thawed. Once a vaccine is thawed from the Pfizer dose, you only have about five hours to use it. So, if there’s a no-show to a vaccination appointment, our local health departments actually have a list that they go down and they call people to come in. If somebody is scheduled for the next day or the next week, they’ll give them a call and have them come in earlier and then open up that future spot to somebody else.
So, we do have a way to make sure we’re not wasting any doses.
What’s the plan for notifying people in the future that it’s their turn to be vaccinated?
I would say first, in general, if you go to coronavirus.utah.gov/vaccine, you can sign up for a weekly email in Spanish or English that will help you. Of course, we’re going to work with our media partners to get the word out. But then for specific communities, we are going to use our community health worker infrastructure that we already have, and we’ve been using it for testing, quarantine and isolation. And now we’re going to add on vaccination, as well. So, looking for leaders that are already embedded within populations that are hard to reach and making sure that everyone gets the information they need.
The percentage of positive tests has been hovering around 30% in Utah. Is there a plan to try to get that number down? Is it based on more testing, or is it just based on people not getting sick?
That is an indication of how much community spread we have here in Utah. The way to get it down, it’s going to be the same thing I’ve been saying for a year: Wear a mask. Physical distance. Stay home when you’re sick. That’s the way to get it down. And, now, get your vaccine.
A reader said she was frustrated that her primary care physician didn’t have enough information about when she and her husband should get vaccinated. What are the state health department and local health departments doing to communicate information to physicians?
We are building our physician work group and the communication channels, apart from the channels I just mentioned, to make sure that everyone has the opportunity to get the information.
I will say when it comes to vaccine, especially with Pfizer and Moderna, the two that are out right now, because they have such specific storage requirements, and we need to get it out very efficiently, the best information you can get is going to be from the state health department or your local health department website. They’re the ones with the vaccine, and they’re the ones with information about when you can get it.
Where do obesity, diabetes and COPD [chronic obstructive pulmonary disease] fall in the list of preexisting and underlying conditions in getting the vaccine?
What we know is that 65 plus, regardless of underlying conditions, is at the highest risk for severe disease. And then younger than that, we start looking at high-risk conditions. We’ve got obesity, COPD, heart disease, diabetes. So, what’s really important for us is to look at our population and make sure we have enough vaccine to cover those with high-risk conditions. We’re currently looking at those numbers and detailing that out now. Again, it’s going to be a combination of age and high-risk condition, because that’s how you get the people who are at highest risk for severe disease.
A reader said he is 26 years old and doesn’t have any underlying conditions, but he’s considered obese. You’ve got somebody who’s young, but they have a comorbidity. How do you balance that out when people get vaccines?
When we look at our information in the outbreak here in Utah, what we see is that the highest risk for hospitalization with these high-risk conditions, with the comorbidities, really starts at the age of 45. It seems like your age really does protect you against getting severe disease. So, when we have such a limited supply of vaccine, we’re going to be looking at kind of older adults, kind of middle-age adults with comorbid conditions, and moving from there. Our younger populations, fortunately, just aren’t seeing the burden of severe disease, and so, likely, they will be lower in the prioritization list.
Why are employees who work in stores and restaurants not higher in line for the vaccine?
To get a vaccine out to as most people as quickly as possible, there are two things. We need to have something very simple to message, so the public understands when they can get it, and then simple logistically to pull off. When we look at our information and the burden of severe disease, it really does depend on age and high-risk conditions. When we’re looking at trying to be efficient as possible and get through all Utahns as quickly as possible, hitting those who are at highest risk for hospitalization first, we decided to go with age, and then potentially higher-risk conditions moving forward as criteria.
I do want to say that I think this is the right way to go because it will make a really efficient system, so eventually everybody can get the vaccine sooner, rather than having to kind of adhere to specific criteria and check, you know, are you really an employee? What is an essential worker? All those details can slow down the process so much that it becomes inefficient. And what we want to do is make sure we get 70% of our population vaccination as quickly as possible.
Why are universities rolling back on mandatory testing and only doing it at the beginning of the semester?
That had to do with supply of testing and the ability to get it done. They are testing everybody within the first 10 days of coming back, which is fantastic. And then they’re going to do random testing throughout the year to find pockets and see if they are seeing as much spread. But I really think doing this initial push of testing will help prevent the spread that we saw in the fall.
A reader asked why the rollout is taking so long. That’s a problem everywhere, isn’t it?
I would say the beginning was slower than everybody would have liked, and that’s a national problem. We are picking up so much great momentum here in Utah. I mean, just Tuesday we vaccinated 16,000 people. So, again, as we’re getting the vaccines in the hands of our local health departments, who are well-equipped for mass vaccination, things are going much quicker. It’s opened up to 70 plus now. Like I said, the demand there is off the charts that we’re breaking the registration system. So, I do anticipate that this momentum is just going to continue, and the speed is going to continue to pick up.
Do you feel like we’ve enlisted enough staff support to dole out enough vaccines to reach 60 to 70% of the population by August?
Right now, our limiting factor is actually just the number of vaccines we’re getting. As we get into the spring and more vaccinations become available, we do have staff surge plans of bringing in staff, for example, from the National Guard, from our Medical Reserve Corps, in order to ensure that we can run a seven-day operation and get people vaccinated as quickly as possible.
Is there a way for people to volunteer to help get vaccines out?
I would say go to your local health department’s website, and they’ll have a Medical Reserve Corps application, and that’s how you get started. They’re taking applications now, and there’s various trainings that are needed right now. So, even if you don’t have an M.D., there’s still use for people.
Do we know what percentage of the population of Utah has already contracted COVID-19 and have recovered from it?
Recovered is hard because we know that there’s long-term symptoms associated with COVID, and those are followed at the health care system provider level. We, as a state health department, don’t follow individuals long enough to understand all of that. That’s why work with our health care system partners. So, I guess in short answer, no, but we do have that recovered definition on our website that says people who are three weeks out from their infection and haven’t passed away, as a very, very crude metric. But time will tell when we’re able to look at all of our data in retrospect on how many people actually have long-term effects.
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