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Scott Webb (Host): There's only one way to defeat COVID-19 and its variants. Everyone who is eligible must get vaccinated. The vaccines are safe, effective, and free. And joining me again today to emphasize these points is Dr. Mahendra Poudel. He's an Infectious Disease Specialist with SVMH. This is Ask The Experts, a podcast from Salinas Valley Memorial Healthcare System.

I'm Scott Webb. Dr. Poudel, it's great to be back on with you again. As we were just discussing, I wish we were speaking under different circumstances, but we're still talking about COVID-19 and we're going to talk about the Delta variant today. But before we do that, you know, recently California mandated that all healthcare workers be vaccinated against COVID by September 30th, 2021. I just want to ask, are you surprised that there are still healthcare workers that haven't been vaccinated?

Mahendra Poudel, M.D. (Guest): I know there is enough evidence that these vaccines are safe, highly effective, and we really need to protect our healthcare force at this point, because we are already seeing an uptick in the number of cases, there is a surge going on in our community. And I would absolutely agree with the mandate that the state has come out with kind of sad that we have to have these mandates rather than, everybody getting vaccine voluntarily because of it pandemic, raising new variants and a third surge coming on. And I hope, all other business besides healthcare workers, would follow this suit and keep their workforce safe and keep their families and their coworkers and their community safe.

Host: Yeah, I couldn't agree more. And we are in the midst of another surge, unfortunately, both locally in Salinas and Monterey, nationally, internationally. We just can't seem to defeat COVID-19 and its variants. So, let's talk about the variant that's top of mind right now. Why is this Delta variant of COVID-19, so much more contagious than the original virus and even other variants that we've seen?

Dr. Poudel: So, the Delta variant originally was found in India and it used to be called the Indian variant, but has kind of and recently we named all the variants based on the Greek alphabet. And this variant is very concerning for particular reasons that it is highly infectious. It could be about 70 to 80% infectious than some of the older variants.

And the reason is it has a certain mutation on its spike protein that makes it highly transmissible and it's really fit for the respiratory system. And, the main other reason is that the viral load in the nasopharynx of an infected patient can be close to 1000 times higher than the original variant.

So, as the virus is in really high concentration in the respiratory tract, it seems to be still longer than the other variants. So, it's highly infectious and you don't even need to come in contact with a symptomatic patient even. Asymptomatic carriers as they have really high load of virus in their nasopharynx can easily transmit the infection.

And we still have a significant number of population, both nationally as well as locally, unvaccinated. And this highly infectious variant and a significant population of unvaccinated people is a perfect fit and as it transmits so easily, unvaccinated and other vulnerable people are almost certain that they're going to get infected.

So, this variant is extremely concerning because it's highly infectious, you get very high viral load, and there's still a significant amount of unvaccinated population around us.

Host: Yeah, as you say to kind of paraphrase, it does seem like a perfect storm. You know, it's highly infectious, highly transmissible, so many people still unvaccinated and it's just a perfect storm for what we're seeing in the surge and uptick in cases at the hospital. And I know there was a time, not that long ago, where we didn't have people hospitalized with COVID, which was great, but now SVMH has patients in the COVID ICU again. And you were speaking about the unvaccinated. Do you know the patients in the COVID ICU where they vaccinated?

Dr. Poudel: You know, going back in the winter, December, January, February, we were at our peak of our surge and we had about close to hundred patients hospitalized. We were converting our regular floors into COVID floors. We're struggling to find staff resources. And you know, it was like a battlefield in our floors, but over time with the advent of vaccines, as more people got vaccinated, the numbers plummeted to the point that we didn't have any patients on our floor, we're getting back to normal, life felt like there was no pandemic. The census was you know, close to pre-COVID, our surgeries started picking up. It was a good feeling, but it didn't last very long with this Delta variant. Now we have patients in our intensive care unit. Most of those are critically ill. And over the last about three, three and a half months, majority of the patients that have been hospitalized with symptomatic infections have been critically ill and have died at Salinas Valley Memorial Hospital, predominantly have been unvaccinated individuals. And this is the trend. We are not just not seeing at our hospital. That's the trend locally, as well as nationally. And you know, most of those patients seem to be younger, mostly unvaccinated, which is really unfortunate because the vaccines, as I mentioned earlier, they are highly effective and they're extremely safe. And this is what we call a vaccine preventable disease and if you get the vaccines, you would not be here in the hospital, critically ill on ventilators. So, it's really important to realize that the vaccines are doing what they're supposed to do, meaning they're preventing severe illness and they're preventing death.

Host: Yeah, they are. And I want to make sure that we emphasize those points. You know, much like the flu. Even if you get the flu shot, you can still get the flu, but you likely won't end up in the hospital because of it. It's similar to COVID-19. As I've tried to explain to my kids, it doesn't mean that you can't get COVID. You can, even if you've been vaccinated, but you likely won't end up with a severe case, won't end up in the hospital. Won't end up on a respirator. And hopefully won't die from it. And that's really the key point. That's what these vaccines do. They keep people out of the hospital, right?

Dr. Poudel: That is absolutely true. And you know, we're trying to get that message out to the unvaccinated population because that's what they need to understand is, they need to keep themselves safe. They need to keep their families safe and their community safe. And we have a very powerful tool right now to do that, which are the vaccines. And those vaccines are again, safe, effective. They are easily available and they're free of cost.

Host: Yeah, they are. And it's just amazing that we even have them. You know, there was a time when we were talking about the possibility of vaccines and you know, expediting that timetable, how long it normally takes for vaccines. The fact that just during this year, year and a half, that we have vaccines to protect people, to keep them out of the hospital, to keep them from dying is truly amazing.

And we just want everyone to get vaccinated so that they don't end up in the ICU. They don't end up dying from COVID-19. And I want to ask you, I've been hearing about breakthrough cases and what does that mean exactly? And can you explain what those are?

Dr. Poudel: Well, I think one thing that we need to understand is nothing in this world is a hundred percent effective, just like everything else. Vaccines are not a hundred percent effective in preventing infection. They are doing exactly what they have shown in clinical trials, which is we already talked about. They are keeping people out of the hospital, out of ventilators and they have prevented deaths from COVID-19. Given these highly infectious variants, you can get what we call a breakthrough, but it's symptomatic and mildly symptomatic infection. Even in clinical trials, they were 95 to 97% effective.

So, there's still three to 5% of the people that can still become infected with COVID-19. What we've seen is these breakthrough infections, which you get after completing the series of vaccine, they are either asymptomatic, or they are very mildly symptomatic, which is exactly what the vaccine is supposed to do is it does prevent severe infection, but you can get few cases of breakthrough infection and that's okay.

That means you don't end up in the ventilator and the breathing machine. And that's why CDC came out with a guidance that you need to stay masked while you're indoors in unventilated areas so that you don't transmit the infection to the people around you.

Host: you Yeah. And you mentioned masks and face coverings. You know, the kids are going back to school, Doctor and vaccines are now available for kids 12 and older. So, when I have you talk about the importance of kids wearing their masks, face coverings in school, regardless of their vaccination status.

Dr. Poudel: Kids really excited to go back to school. They have been out of the school for almost a year and half. And to get that in-person interaction with other kids of their age, to be in the school with teachers. They're going to love it. But again, with the Delta variant, which is highly transmissible, still a significant amount of population unvaccinated.

And rising number of cases locally, as well as hospitalization, parents are being anxious. They're asking all these questions. Is it safe for my kid to go back to school? How am I going to keep my kids safe? How am I going to make sure they don't bring infection home? Or we don't give the kids infection and those are legitimate questions.

I think as a parent, what you can do is number one, make sure you get vaccinated. Because you don't want to give your kids COVID. And as long as you build a barrier of immunity around the kids, meaning everybody who lives at home is vaccinated, hopefully their teachers are vaccinated and if they're eligible, meaning 12 and older that they get vaccinated so that they can protect themselves and people around them. For kids who are not eligible for vaccine, again, it's very important to build this wall of immunity or protection around them, parents, teachers, friends, and make sure we ask them to mask while they are indoors in their classrooms, especially if they're unventilated, and try and maintain social distancing as much as we can. And when they're outside, masks are often optional.

I tell my kids, you know, when you're inside the class, make sure you're masked and you're masked appropriately, meaning your, you cover your nose, your mouth, and then when you're outside, you can take your mask off. But it's probably okay if you want to keep your mask on because these variants are again, highly infectious.

So, I think if you're eligible for vaccine, make sure your kid is vaccinated. If they're not eligible, then make sure they are getting all the other mitigation measures like masking and hand hygiene and social distance and avoiding crowds. That way the kids hopefully will be safe and they protect themselves and they don't bring infection home.

Host: I love the way you put that. You know, building the wall of immunity around them, you know, and I was discussing with somebody about all it takes is one person who gets COVID and gets into a house. And you've got some who are vaccinated, some who aren't vaccinated. And as you say, all we can do is just kind of build that wall to the best we can.

So, if the parents are vaccinated, the kids are vaccinated. Teachers are vaccinated, we can just try as best we can and then do all the other measures. Like face coverings, distancing, hand sanitizer, and so on. When do you think that the vaccine will be available for children under 11 and do you suspect ever be a point when infants and toddlers can also be vaccinated?

Dr. Poudel: I know there are clinical trials going on, especially of the mRNA vaccines for younger than 11 years kids. They're still working on the dosing and the frequency of the vaccination. Do we need just half the dose? Is single dose enough? So, you know, we're hoping we get data from these clinical trials in the near future. Based on experts, we think it should be available by the end of fall or towards the end of this year. But again, you know, it's important that we vaccinate people around kids as much as we can, make sure they're using masks, and if you're expecting a baby, if you're pregnant, if you're breastfeeding, then also make sure you're vaccinated so that you don't give your kid COVID-19. Again, these vaccines are highly effective, and extremely safe.

Host: Well, Doctor, it's been great speaking with you again. I'm looking forward to part two of our series and listeners, be sure to check out part two and for more information, visit svmh.com. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or even a family member and subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask The Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.