Ask Us Anything About… Rising COVID-19 Cases

Barbara Schindo – Good afternoon, and thank you for joining us. You’re watching Ask Us Anything About Rising COVID Cases. My name is Barbara Schindo. According to the New York Times, yesterday, August 9th, over 235,000 new cases of COVID-19 were diagnosed in United States. To date, the United States has seen over 36 million of COVID-19, with more than 617,000 deaths. In Pennsylvania, the Department of Health reported today that 276 additional positive case — additional positive cases of COVID were diagnosed. Bringing the statewide total to over 1.2 million. Joining me today to talk about our recent rise in COVID cases and how to keep yourself and your families safe are Dr. Catharine Paules, an infectious diseases physician at Penn State Health Milton S. Hershey Medical Center. And Dr. Patrick Gavigan, an infectious — a pediatric infectious diseases physician at Penn State Health Children’s Hospital. Thank you very much, Dr. Paules, Dr. Gavigan, for joining today. We appreciate your time. But also for anybody who’s watching this with us, whether you’re watching live or you’re watching this on playback, we welcome your questions for Dr. Paules or Dr. Gavigan about the rising COVID cases. Please feel free to type your question in the comment field below this post and we will get a response for you. So I want to start — we have a lot of things I would like to cover. So I want to start by talking about some of the — we’ll call, you know, hot topics and big headlines that we’ve been seeing a lot lately. So, Dr. Paules, I want to start with you. So let’s talk about the Delta variant, the newer, newish, COVID variant that’s been making a lot of headlines. We’ve been hearing a lot about new cases of the Delta variant. Can you talk a little bit about what do we know about the Delta variant and how big of a concern is it?

Dr. Catharine Paules – So, like a lot of — a lot of this pandemic, we’re learning in real-time about the Delta variant. So every day the information that we’re receiving is changing. What we know so far is that there were mutations in the virus that occurred that seem to make this particular virus more transmissible. Over two times as transmissible as the initial ancestral strain. As well as likely a little bit more lethal in terms of patients ending up in the hospital and even dying. Although, again, we’re getting this information in real-time, so we’re still learning a lot about this variant.

Barbara Schindo – Okay. Thank you, Dr. Paules. And we’ll start — one question we’ll start with on the pediatric side for Dr. Gavigan. Headlines we’ve been seeing a lot about big upticks in pediatric COVID cases. We’ve seen some — some reports of hospitals in the south being overwhelmed with pediatric inpatients. Is that something we’re seeing here? Are you — are you seeing a lot of pediatric COVID patients right now?

Dr. Patrick Gavigan – Yeah, it’s a good question. We’re definitely seeing more now than we were probably a month or two ago. In general, we’re certainly not at a point here at Penn State like a number of places in the south are or overwhelmed. But the numbers certainly tend to kind of mirror and parallel the adult cases. So generally, as those adult cases rise, we see rises in the cases in our pediatric population, too.

Barbara Schindo – And, you know, one other — one other thing we hear a lot, I think, or a lot of people might believe, is that kids don’t get sick from COVID or won’t get as sick from COVID. You know, so is — I know that’s not necessarily true, that people think, but does — you know, what do we know about the Delta variant and kids? Does it make kids sicker? Like, are we seeing the same — the same thing as we’re seeing with adults?

Dr. Patrick Gavigan – Yeah, another great question. And similar to kind of what Dr. Paules said. We’re still not really sure. There have been some people that have felt like, you know, the kids that they’re seeing now are maybe a little bit sicker than in the past. But we don’t really have enough data to know just yet whether or not kids are truly getting sicker than this one than with previous variants. I think the important thing to know is, yeah, kids aren’t getting as severely ill as frequently as adults. But we still see kids get very sick with COVID. You know, there have been I think over 300 deaths nationally in the past year from COVID-19. So it is — it is a potential cause of really severe illnesses in kids.

Barbara Schindo – Okay. Thank you, Dr. Gavigan. And a question for you, Dr. Paules, another headline that — we’re seeing the term breakthrough cases. So I think a lot of people are wondering what is a breakthrough? What’s a breakthrough case? What does that mean and how can people protect themselves?

Dr. Catharine Paules – A breakthrough case, at least what’s being referred to in the media, is a case that occurs after vaccination. And we’re definitely seeing more breakthrough cases with Delta than we saw previously. Which isn’t surprising because we know that the virus has mutated. Now the vast majority of those breakthrough cases are pretty mild, but we do occasionally see people, even vaccinated people, that end up in the hospital.

Barbara Schindo – Okay. And we’re getting some questions rolling in from viewers here. So we’ll start with a question from — from Linda. And I’ll kind of put this out there. And I think either — either or both of you might be able to offer and answer to this. So Linda says she was — she’s been around a person who has had COVID and now she is feeling sick. She says she has a headache and a slight fever and a sore throat. Should she be worried? What — what should Linda do?

Dr. Catharine Paules – I would say, Linda, you should call your doctor and have them go through your symptoms with you and what kind of health problems you might have. They very likely will recommend that you get a test for COVID and they’ll be able to help you from there. And we actually — if you don’t have a primary care doctor, we have on-demand and you would be welcome to contact one of our physicians that way.

Barbara Schindo – Dr. Paules, great point to bring up on-demand. We can make sure to share a link in the comments section to our on-demand website and app. Just in case — as Dr. Paules said, if you don’t have a physician, we can help you out there. We have another question from Chelsea. I think this question would be good for Dr. Gavigan. We’ve seen — something we’ve seen is a little bit of a surge in respiratory RSV-type viruses that are typical of winter. But they — you know, we got a little bit of a delayed surge from that. Why do you think that is?

Dr. Patrick Gavigan – Yeah, that’s a great question. And I don’t know if we know 100% why. But I think most people suspect that, you know, the protocols that we had in place over the fall and winter when we usually see these respiratory viruses. The protocols that we had in place to prevent COVID – namely, masking, you know, social distancing – worked not only to, you know, help decrease the spread of COVID but also decrease the usual kind of respiratory viruses. And then as we kind of peeled back some of those protocols it allowed for these — these, you know, more typical winter viruses to emerge in the summer.

Barbara Schindo – Dr. Gavigan, this kind of will be a follow-up from that question because I was going to ask if you — we’ll kind of lump this together because I was going to ask you about this anyway. Because parents are getting, you know, concerned about back to school. And, you know, some schools are saying wear a mask, some schools are saying it’s going to be optional. So I think a lot of parents are thinking what should I do? Should I send my kids to school with a mask? What’s your recommendation? What do you — what’s your advice to parents as we head back into the school year?

Dr. Patrick Gavigan – Yeah, you know, I think most of us feel pretty strongly that the AAP recommendations and the newer CDC guidelines that recommend masking for basically everyone, you know, K through 12, regardless of vaccination status, is really the best way to go. You know, I think [inaudible], you know, kids, a majority of which aren’t eligible for vaccinations, together in schools, you know, that’s really a kind of ideal situation for this virus to spread. We know that the, you know, the protocols like masking, good hand hygiene, try and — try and do physical distancing, work — you know, worked in schools to help, you know, really decrease the spread of COVID. So I think it makes sense, and we really kind of strongly recommend that any kid going back to school, regardless of vaccination status, wear a mask.

Barbara Schindo – Okay. Thank you, Dr. Gavigan. So the reason I kind of thought of that coming off that question about a surge in respiratory cases. Is do you expect that maybe when kids go back to school there might — the number of RSV cases and, you know, colds among kids might — might continue to increase?

Dr. Patrick Gavigan – Definitely. Especially I think if we’re kind of in a mask optional or, you know, a lot of kids not wearing masks. I think, again, these — you know, masking and protocols work to kind of reduce the spread of COVID and, similarly, will reduce the spread of other respiratory viruses. As you bring all these kids together, you know, if those kind of protocols aren’t in place, then I would definitely expect those to increase.

Barbara Schindo – All right. Thank you, Dr. Gavigan. And we have some more questions coming in. So I’m going to group two of these viewer questions together because we have some similar questions from Tracy and Kristy. And, Dr. Paules, I’m going to send this question to you. Tracy and Kristy are wondering, how are we testing — how do you know if you have the Delta variant? Are we testing differently for the Delta variant over other strains, and how — how do you know that’s the variant you have?

Dr. Catharine Paules – That’s a great question. And so, typically, you would not know for sure if you just went into a clinic and had a test done. Here at Penn State Health we actually do some — we call it surveillance sequencing so that we can see which types of isolates we’re having here. So, basically, after the test is done, we then send it for a specialized test to look for a Delta variant. At this point, though, the vast majority of the cases that we see in this region are Delta. So it’s a pretty good assumption that that is what you have if you test positive.

Barbara Schindo – Okay. Thank you, Dr. Paules. And just — we’ll put — you know, because we’re getting a lot of questions about the Delta variant. Some people saying they’re feeling sick. You know, let’s — so let’s talk a little bit about vaccination. I think that’s a good question, that’s an important thing. Why — I think both of you can maybe explain, why is it so important to get vaccinated? I guess we’ll start with Dr. Paules because, as we know, adults are able to get vaccinated but not yet the full pediatric population.

Dr. Catharine Paules – So, I think there are three main reasons that I advise people to get vaccinated. The first is it’ll have some protection against symptomatic illness. In the past, it has very good protection against any kind of symptoms, but it still has pretty good protection against this. So even though we see breakthrough cases, it’s still important to get vaccinated just to keep you from getting sick. The second piece is it’s excellent at preventing hospitalization and death. We almost never see vaccinated people in the hospital or dying from this disease. And so that’s a really good reason to get your vaccine. And the third reason is the only way to keep more variants from arising, even a worse one than we’re seeing with Delta, is for everyone to get vaccinated. It gets — it allows — the virus doesn’t have as many places to spread and thus these mutations don’t occur. So by getting vaccinated, you protect yourself, you’re protecting people around you, and you protect the community at large.

Barbara Schindo – Okay. Thank you, Dr. Paules. And let me ask you, Dr. Gavigan, as we know — so vaccinations are available for kids who are 12 and — 12 and older. And a lot of parents, you know, are thinking about should they vaccinate their kids? What should they know? What should parents who maybe have not yet vaccinated their kids who are eligible and are thinking about it or may be on the fence, what advice do you give to them?

Dr. Patrick Gavigan – Yeah, I would, you know, echo a lot of the points that Dr. Paules made, in that these vaccines are extremely effective and they’re effective in this age range. This, you know, 12 to 16, 12 to 18 age range. They also appear to be extremely safe. So the risk of any side effect from them, especially any serious side effect is extremely low. So I know that they work and that they’re — they’re safe. And, you know, again, I think a lot of — you know, one of the reservations that a lot of people have is that, you know, kids aren’t getting sick from COVID. And, again, I would just caution that — that sort of belief because, again, we are seeing kids that get hospitalized with COVID. We know they can get severely ill with acute COVID. And we know that there are, you know, kind of post-infectious complications that can happen too. So we see kids get admitted to the hospital with significant inflammation. A multi-system inflammatory syndrome that usually happens after a COVID infection, even a COVID infection that’s pretty mild. And there’s also, you know, kind of more and more concerns about, you know, what are being described as kind of long-haulers or kind of these persistent symptoms after COVID. And we’re seeing that in kids as well.

Barbara Schindo – Wow. Yeah, that’s a lot of really good information both from Dr. Paules and Dr. Gavigan about the importance of vaccinations and why you should consider a vaccination for yourself and for your kids. And just one more, Dr. Gavigan, before we get to a few more of your questions. What do we know about, you know, a possible timeline for kids younger than 12? I know a lot of parents are waiting to make the decision and are doing research now for when it’ll be available to their kids.

Dr. Patrick Gavigan – Yeah. I think from what I’ve been hearing it’s — we’re probably looking at, you know, maybe mid-winter may be the earliest I’ve heard. For kind of a 5 to 11 age range would be, you know, be late 2021, but I think we’re probably looking, you know, early 2022 at the — at the earliest.

Barbara Schindo – Okay. It’s certainly something that we will keep our eye on. To everybody who’s watching and submitting questions, I want to say thank you. For anybody who hasn’t yet submitted a question and has a question, we welcome your questions for Dr. Paules and Dr. Gavigan. Please feel free to put them in this comment field and we’ll get an answer for you. We’re going to start with a viewer question. This is from Josh, and I’ll give this one to you, Dr. Gavigan. This one’s a two-parter. I think I can — I can answer the first part. Josh wants to know how many kids are currently hospitalized with COVID at Hershey. So I can tell you that at Penn State Health Children’s Hospital today there’s one pediatric inpatient. And Josh is also asking, is it safe to send kids under four that struggle to wear a mask to daycare?

Dr. Patrick Gavigan – Yeah, I think that’s a great question and one that I think a lot of parents are kind of struggling with. You know, obviously, you can, you know, do your best to get kind of these toddlers to wear a mask, but they’re probably not going to keep it on for the full time. I would — I would really encourage you to — to talk with your kind of daycare and see what sort of policies they have in place. So, you know, is the staff wearing masks? Are there kind of temperature and, you know, illness screening at the door? What are they doing to kind of help prevent spread amongst, you know, staff and students? You know, the safety — obviously, the risk is going to be probably a little bit lower if you’re wearing a mask. But there are still other kinds of protocols and policies that the daycare may be able to put in place to kind of, again, minimize the risk of transmission.

Barbara Schindo – Okay. Thank you very much for that. Thank you for your question, Josh. And thank you, Dr. Gavigan. We have — I’m going to lump two other questions together. I’m going to start with you for this one, Dr. Paules. We have questions from Titus and Janetta. They’re both asking about booster shots. Do we think booster shots will be required? And if you get a booster shot, you know, if booster shots do wind up being a recommendation, should you get them from the same manufacturer that you got your other doses?

Dr. Catharine Paules – So we’re all waiting to hear about booster shots. The ACIP, which makes a lot of our vaccine recommendations are actually meeting on Friday to discuss booster shots, and I’ll be listening to that meeting. I think it’s very feasible that we will see booster recommendations. Particularly, in certain populations, like those that may not have responded well to the first and second doses. Those would be people that have abnormal immune systems and potentially some of the frailer elderly. And I think the thing to really be cognizant of is we need to follow the data as it comes. The recommendation today may be different from the recommendation in a month as the science evolves. And so I’ll be watching that very closely and making those recommendations to my patients once we have more data. And then in terms of the second point, which is also a great question about using a different manufacturer. There are a lot of studies being done right now to look at both immune responses and safety after getting one type of vaccine and then another. So, again, I’ll look to the ACIP for guidance on this, as those are the experts. And I’ll certainly communicate that to my patients and to any of you in the community that have questions. And, Barbara, if it’s okay I’d just like to get back to the questions about the masks in the daycare.

Barbara Schindo – Oh, absolutely.

Dr. Catharine Paules – Because I just wanted to add to what Dr. Gavigan had said that it does help when you’re able to wear a mask. But it’s really key that everyone be wearing a mask because masks are most effective when everyone wears them. There’s a big component of source control that occurs. So it’s not just protecting you the mask wearer, but if you’re sick you’re protecting others by wearing that mask. So looking at your daycare’s masking policy as a whole is really important.

Barbara Schindo – Okay. Thank you, Dr. Paules. And that’s actually the perfect segue to go — to go back to masks because we have another question from Nancy. And Nancy is asking about academic and emotional development. Do you — are masks — is it worth wearing masks for kids if it — does it cause any interference with their academic and emotional development? Like if a kid may be struggling with wearing a mask, is it worth it for them to continue to wear a mask?

Dr. Patrick Gavigan – So I think there’s probably kind of two parts to that. I think, you know, again, a lot of young kids are probably going to struggle trying to wear a mask the full day. And I think, you know, working with them and, you know, being understanding of that makes sense. But I do think that wearing masks is kind of worth the inconvenience that it causes. Again, really, our goal with kids in school is — the big goal, and we know the most important thing is to get them back to school in person. I think there’s plenty of data and evidence out there that kids learn best in person in school. And, you know, the potential risks, or theoretical risks, of masks I think are far outweighed by the benefits to, you know, decreasing the spread of COVID and keeping kids and staff safe so that we can continue to have kids learn in person in schools.

Barbara Schindo – Okay. That is very helpful information because, I mean, I — you had mentioned daycares, you had mentioned schools. I know that — I’m not a parent myself, but I have a — I have a lot of friends that are parents and they are, you know, very — a lot of good information here to share with them because they’re all wondering, you know, what should we do for back to school? And, you know, while we’re talking about — about these environments, what do we know — Dr. Gavigan, what do we know about — kind of about the spread of the Delta variant? Is there any reason for parents to be concerned if their kids are going back to school and they are, you know, on the playground with other kids? Can it — is it spread aerosol or is it — could it maybe be spread through touching surfaces?

Dr. Patrick Gavigan – Yeah, I think — I don’t know that we know that it spreads any easier on surfaces than prior COVID strains. It certainly spreads, you know, more readily through respiratory, you know, contact or through, like, droplets. But I think — again, I think the — the typical hand hygiene that people have kind of been preaching for the past, you know, year and a half, two years now, should really be effective. And not only is it going to be, you know, helpful in preventing COVID spread, but it — again, going back to all these other respiratory viruses that we’ve seen kind of crop up. It’s really going to help kind of reduce that spread as well.

Barbara Schindo – Okay. Thank you, Dr. Gavigan. And, again, out to everybody who’s watching with us. If you’re watching this live or if you’re watching this on playback, we welcome your questions about rising COVID cases for Dr. Paules and Dr. Gavigan. We’re getting some more questions here. So the next question we have is from Michael, and I’ll ask this one to you, Dr. Paules. Michael is wondering, could over-vaccination be a problem? Like, could — if — would there be a problem if too many people get vaccinated? Would it hurt more than help due to mutations of the virus?

Dr. Catharine Paules – So, actually, the key way to keep mutations from occurring is to vaccinate as many people as possible. It gives less people for the virus to spread to. And there’s also data where they’ve looked at viral mutations in people that have been vaccinated versus those that haven’t. And this is pre-Delta, so I’ll just preface that. But there’s less mutations that arise de novo, and that may be because they don’t replicate as much because the — their immune responses are already starting to control the virus. So the key is everybody gets vaccinated both here and globally and we sort of truncate some of these mutations.

Barbara Schindo – Okay. Thank you, Dr. Paules. And we have — I have another kind of related viewer question, so I think that’s a really good segue. So Trisha is asking, do you anticipate that more variants will continue to develop?

Dr. Catharine Paules – Yes, I do. I mean, we’re a global community. So there will be variants that arise all over the world. And how much they spread and how much they impact certain groups will be determined, in part, by vaccination status in those regions. You know, I think we’d all like for COVID to cease to exist, but that may never occur. And that’s what we see with other respiratory viruses. So the key is to get everyone vaccinated to keep — to slow down mutations. And, you know, similarly to what we do with things like influenza. We may need to adapt our vaccines over time to protect against different variants. And I’ll let Dr. Gavigan chime in as well.

Barbara Schindo – Dr. Gavigan. Anything to add about — about variants and concerns for variants from your — from your perspective?

Dr. Patrick Gavigan – I don’t think so. Although, I’ll be honest, Dr. Paules has cut out on my screen so I can’t hear her or see her right now [laughing]. So knowing her, I’m going to assume that she probably covered everything and more than I could have covered.

Barbara Schindo – [laughs] Always the joys of technical difficulties that always seem to happen here. We will do a few more — a few more questions for both of you here. And we’ll start with a question that I’m kind of wondering, and I’ll start with you, Dr. Paules, on this one, too. We also are hearing a lot about vaccine hesitancy in people — people who have some concerns about the vaccine. Should — how concerned should people be about things like, you know, the side effects they hear about, such as, you know, heart inflammation or neurological issues that may be caused by the vaccine?

Dr. Catharine Paules – There are very, very, very rare side effects to these vaccines. And so if you have particular questions about a side effect, it’s always worth talking to your physician about that. But the benefit of the vaccine in terms of preventing hospitalizations, preventing death, and preventing long-term [inaudible] of the virus far outweigh these very, very, very rare side effects. And I will say, too, that the best person to talk to about any concerns you have about vaccination is your physician. And physicians have really led the way here. Over 95% of physicians are vaccinated for COVID. So we’re leading by example, and we really want to have this conversation with you. I love it when somebody comes into my office and they say, you know, I’ve heard these things about the vaccine, but I want you to tell me should I get this vaccine? You know, does it work and what kind of side effects does it have? I really appreciate when patients come to me and ask that question.

Barbara Schindo – Okay. Thank you, Dr. Paules, that is great advice. The best course of action is probably for us to talk with your physician. Tell them your concerns and they will talk it through with you. We have another question. This one I’m going to give to Dr. Gavigan. I’m going to send this your way. This is from Carey. Carey wants to know what is your advice would you give to parents with kids under 11 who need to be in school but masks aren’t mandated? Oh, maybe Dr. Gavigan’s — maybe we all cut out on Dr. Gavigan’s screen. Can you hear me, Dr. Gavigan?

Dr. Patrick Gavigan – I apologize, I can’t hear anyone anymore.

Barbara Schindo – No, no. No worries, that’s okay.

Dr. Catharine Paules – Barbara, do you want to type it into the chat and I can — I can try to give a preliminary answer?

Barbara Schindo – Yes, it’s in the chat in the — in the Facebook comments, you mean, or in the chat here?

Dr. Catharine Paules – I think in the other chat because I can’t see the Facebook chat.

Barbara Schindo – Okay. Okay. Actually, what we’ll do is since we’re having some — some technical issues with Dr. Gavigan, I think what we’ll do then is just wrap up with just one more question. And I’ll give this to you, Dr. Paules. What — what do you say to — what’s your advice — what do you say to people who — who at this point in time are still skeptical of what they hear about coronavirus? You know, they hear there’s new cases and cases are rising but they maybe don’t believe it or they think it’s false information? You know, what information — what do you share with these — with people who think like that?

Dr. Catharine Paules – I try to remember that we all start at a different place. So I’ve been on the frontline of this for a year and a half. I’ve seen these patients come into the hospital; I’ve seen them die. I’m seeing it again. And this time, the population is younger. We’re seeing patients that don’t have the typical risk factors now get sick enough to need a breathing tube and, in some cases, die. And so I really try to explain to people this is — this is not, you know, a made-up thing. This is a very, very, very serious infection that you do not want to get. And we’ve been lucky enough — and, really, a scientific triumph that we have these vaccines that are so effective. They keep people out of the hospital, they keep them from dying, and they’re very, very safe. And so I strongly recommend to almost everyone to go ahead and get that vaccine and to do everything you can to protect yourself and to protect others from getting this disease.

Barbara Schindo – Okay. Thank you very much, Dr. Paules. Thank you very much for your time and all of your expertise. And thank you also to Dr. Gavigan for joining us here today. I know there are some folks who have questions in the chat that we did not get to yet, but we will. We will follow up. We’ll follow up with Dr. Gavigan and Dr. Paules, and we’ll get some questions back to you just in the chat. And if there’s anybody who’s — who’s watching this who still has a question, watching this on playback, feel free to enter — to enter your question anytime and we’ll get an answer for you. So thank you again for your expertise and thank you for watching.