- Hello and thank you.
Thank you, everybody.
I'm not go--
I don't have a lot of PowerPoints
and I thought I would give a little bit of an update
about the vaccines, the two
and there's a new one coming out.
And then open it up for questions from everybody.
I'm an infectious disease physician.
I mostly see patients in the clinic
and round in the hospital.
But I've been asked back in October, at the end of October,
to help head up our COVID vaccine effort
at the University of Michigan and at Michigan Medicine.
So, currently, we've given about 60...
Almost 70,000 vaccines.
Unfortunately for the last two to three weeks
we've only been able to give second doses of those vaccines.
The two vaccines that are out right now
include these two classes of vaccine called mRNA vaccines.
One is from Pfizer and one is from a Moderna.
Many of you out there have already gotten those.
These two vaccines are very safe
and they're extremely effective,
about 95% effective.
There's a new one coming out now called Johnson--
From Johnson and Johnson.
It's a little bit different the way the vaccine works,
but it essentially does the same thing.
It protects you from getting infected
and getting symptomatic and getting sick when you get...
When you come into contact with COVID 19.
So, we're waiting.
Today, the FDA or I think it was yesterday,
the FDA said that they approve it, their committee.
And now it's going to go to the CDC
and probably by mid next week,
we will be starting to give that vaccine also.
It's not clear if it's only a one-shot.
The Moderna and the Pfizer vaccine are two shots
as many of you know.
The Pfizer shot is separated by three weeks
and the Moderna by four weeks.
This new one coming out is only one.
There may need to be a booster in the next year or so,
but most people are just going to get one dose.
It has been shown to be 66% effective overall,
which on the surface looks worse
than the other two vaccines,
but, it is very effective.
None, of the patients who--
None of the patients died
and very few had severe disease.
So it was 85% in preventing severe disease.
So, it's very similar to the two vaccines
we currently have been giving.
And I think it will be a great addition
to the vaccine program that we have
as well as the one the State has.
They're very safe, two of these vaccines.
The Pfizer and Moderna, the biggest side effects
have really been in site injection pain,
almost 80% of people get that.
Some people get muscle aches,
I got muscle aches after my second dose.
Some people--
Very few people will get fever
and most of this occurs with the second shot
not as much with the first shot.
Currently at the University of Michigan
we're still finishing up with our healthcare personnel
at the hospital.
And we're also vaccinating our patients
who are over the age of 65.
It's been--
It started out quite fast
to get our our healthcare workers vaccinated,
but then the pipeline for the vaccine slowed down a bit
as many of you know.
Hopefully in the next month and a half to two months
we're going to see increases in the vaccine delivery.
And so, the prediction by Anthony Fauci
who is my guru for sure,
is that we will probably see...
We may even see more supply than demand for vaccine
by the end of April or early May.
So, the spring will bring many things, a nice warm weather
and hopefully much more vaccine for everybody.
You know, I will stop there and answer questions.
I know there are questions related to the vaccines efficacy,
the new vaccine, the priority categories in Michigan.
But I wanted to leave that open
and see what you all were most concerned about.
And I can answer those questions.
So I'll stop there and take questions right now.
Are there any questions about the vaccine?
- [Male attendee 1] I have a question.
- Yes.
(indistinct)
- [Attendee 1] Register, first is to get scheduled for...
I got the call to say that I could register.
And when I did, there was nothing left.
They said, "Try again later."
- Yes. - So,
how do you get there faster?
I mean, as soon as I got the (indistinct), I did it.
- I know, it's very difficult.
What we've been--
What happened, and this is at Michigan Medicine,
is that correct?
- [Male attendee 1] Yes.
- Yeah.
And, what we do is we send out tickets to people
who are eligible and who fit the criteria.
And then those people are allowed to make an appointment.
We send out many more than the appointments that we have
just because we know that people aren't going to sign up.
And so the problem is a lot of those,
we've only been getting,
we're going to get first dose vaccines this week
for the first time.
And so as soon as those slots open up, they were taken off.
So it doesn't mean that you won't be able
to get in to get a vaccine soon,
but it means that for the moment
you'll have to wait til the next round of clinics open up.
We should be getting
a more reliable first dose series of vaccines.
So, hopefully within the next couple of weeks
you'll be able to get in.
So I'm sorry that that's happening
but unfortunately it's happening to a lot of people.
And it's just the way that we're scheduling,
it can frustrating I know.
- [Male attendee] Well, actually I got my notice
on an email,
so should I wait--
(indistinct)
- I'm sorry, I didn't hear the last.
You got your notice on an email?
- [Male attendee 1] Right.
And, (mumbles) that you send out tickets,
so, I'm not...
- Yeah, no, I'm sorry it's not, it's an email.
It's that email allows you to be able to schedule
at some point.
So just keep checking in to that email
and you ought to be able to get a appointment at some point.
And the other way to go, there are many other places.
So what I tell people right now,
is apply to as many different areas.
There are the pharmacies that are giving vaccines,
there's the local health department.
We're working with the health department
and you may be able to get a spot at the health department
before you do with us,
because they're getting more of the vaccine
at this point too.
So, keep trying, you will get a vaccine soon.
- [Male attendee 2] Okay, I have a question, doc.
- Yeah.
- [Male attendee 2] Oh.
- Oh, you went out, sorry.
- [Female attendee] Can we ask everyone
to type their questions in the chat?
Melanie is gonna go ahead
and take care of the question and answer.
- [Melanie] Yes, please, please do that.
So, one of the questions that I'm looking at here...
Dr. Hill, type your question in the chat
and I'm gonna get to you I promise.
"Why is with--"
This is about the Johnson and Johnson vaccine.
"Why is it just one shot and why does it look worse at 66%?
How's that gonna help?"
Let me speak a little bit about that.
- Yeah, that's a good question.
And I'm just looking at the data,
actually before this conference
I was looking over that data.
It's just, I think, 60 for the--
The cutoff at the FDA is 50% effectiveness.
So they feel that any vaccine that is 50% effective
will be good.
Now 66% of efficacy means that it is a little worse
in terms of overall efficacy.
But if you look at the people that ended up in the hospital,
so it was 85 to 90% effective
for people who ended up in the hospital.
Meaning very few people did.
And nobody died in the group that got the vaccine,
so, the vaccine efficacy for mortality was a 100%,
the same as it is for Pfizer and Moderna.
So, when you look at the efficacy of these vaccines,
don't only look at people.
It prevents getting symptoms, yes,
but what you're looking for,
does it prevent me from going into the hospital?
Does it prevent me from dying eventually?
And the answer is that the Johnson and Johnson vaccine
is about as good as Pfizer and Moderna for doing that.
So, yes.
Just to dig a little bit into it.
Unfortunately, you're not gonna have a choice
if there are many vaccines at one place
they're gonna set you up to get...
When people are signing up for us, it depends,
if they go to Brighton Health Center
they're gonna get Moderna.
If they come to the university and at the stadium
they're going to get Pfizer.
So, it's very difficult to predict.
And you can't ask for one over the other right now.
You may be able to in the future.
The important point here is they're all safe.
- [Melanie] Okay, thank you.
Does the J and J vaccine contain mRNA?
- No, it's not an mRNA vaccine.
And it contains--
What it is, is it's called an adenovirus virus vaccine.
So what they do is they take human adenovirus
that doesn't cause severe disease in humans.
They inactivate; they cause it not to be able to reproduce
inside the human.
And then they put in the gene to produce
what's called a spike protein.
And essentially, then they give you an injection,
those viruses infect the cell, but they don't reproduce.
But then in the cell, they produce the spike protein
and then your body creates a response.
So, it's a more--
It's the type of vaccine that's been used more in the past
than the mRNA vaccine.
So in one way, people may accept that a little bit more.
- [Melanie] Thank you for that.
"Is there one vaccine
that you would recommend more over another?"
- No.
I would--
From my own standpoint,
if these are available in the future,
I would take either one of these, any one of the three
and there'll be more coming out.
- [Melanie] Okay.
So, when we have several more and thank you.
This is a great discussion everyone,
please continue with the questions.
So the next question is,
"How are we working with community groups
to provide vaccine
to disproportionately affected communities of color?"
- Yes.
And we've--
So the State, the State is really pushing that well.
They're using the SVI,
which is the social vulnerability index.
And social vulnerability looks at...
It looks at race, ethnicity, economic status,
it looks at 15 different points
of possible inequities there.
And so, at the University of Michigan
the other thing we're doing is, for our great--
our over 65 year old patients,
we're looking at the high, our high S--
Looking at our patients in high SVI zip codes
and we're offering vaccine to those groups first.
So, there's a very, very concerted effort.
In Washtenaw County, we have what's a low SVI, because--
So, SVI; social vulnerability index
goes from zero to one.
If you have a lot of vulnerability, you're a one
the lowest vulnerability is zero,
Washtenaw County is 0.2.
Detroit is probably 0.8 or 0.9.
So, the State is using those markers, those...
That scoring system to end up going to those areas.
So it's working out, I think that's a good thing
and it's worked.
I think it will work out well to get to vulnerable areas.
- [Melanie] So, just to follow up on that.
So, one of my concerns is that we have these colleges here
and we have universities,
I wonder how that impacts that SVI number, right?
Because we do know that we have some zip codes
within the Washtenaw County that are very vulnerable.
- Yes.
- [Melanie] And I wanna make sure
that while we are using this SVI as a way to strategize,
in that the vaccine distribution
that we're not forgetting these very vulnerable groups
right here in our county.
So what do you think we can do to mitigate that?
- Yeah, and so what we've done in Washtenaw County,
our health director, Dr. Juan Marquez
is looking at whether we can get extra doses
for our lower SVI areas within the Washtenaw County.
So, we have to look at that.
And I think within university,
within Michigan Medicine within our vaccination program,
there's an active effort to look at those areas too.
So, we're trying and we're gonna to continue to try.
- [Melanie] Well, thank you.
That's good that's on the radar.
So we have seven more, so I'm gonna go through quickly
and we're gonna go through these.
"So, how will it affect the black person
over the age of 60 with allergies, the vaccines?"
What might that be?
- "With a history of allergies."
It says. - Yes.
- Yeah, it should be fine.
And actually person who is over 60
will probably have less side effects,
younger people have higher side effect rates.
But the efficacy will be the same.
So, overall it will be the same efficacy.
The allergy doesn't matter.
So the only thing,
only if you've had what we call an anaphylactic
or a severe allergy
to a previous to this vaccine that you're gonna get,
then we would say you probably can't get it.
But otherwise, if you've had a peanut allergy,
allergy to bee stings, allergy to shrimp, all of those,
you can still get the vaccine and it's safe,
they'll just watch you.
- [Melanie] Thank you.
"So once you get your full dose of vaccinations
is it safe to go out for meals to restaurants?"
(Dr. Cinti laughs)
- That's a very good question.
I would follow what Dr. Jennifer Granholm was doing,
'cause she's really follows the science and she is--
I'm sorry, Whitmer, did I say Jennifer Granholm?
Our governor, Whitmer.
- Big glitch.
- Hell, yes.
She's great and she's following the science
and she's following Dr. J's recommendations.
So, they have opened up the restaurants,
I don't go to restaurants.
I think you have to take your mask off
and there is still a risk.
Now, if you've been vaccinated, yes, you're protected,
I have to say that.
But you could get infected from somebody else,
you'd be asy--
You could still be up in your nose
and you could pass it to somebody in your family.
So, it to be a--
Or somebody else.
So to be a good steward of a vaccine prevention,
I think it's a good idea not to go at this time.
I wouldn't, I'm not going to the restaurants.
- [Melanie] Thank you.
"Will these vaccines be an annual norm with boosters
like the flu shot?"
Do you? - We don't know.
So, the answer is probably.
And the question is...
I think the question is,
is this going to be yearly?
Or is it going to be every one or two years?
Right now, what's going on,
we're seeing some variants that are coming around.
And if these variants end up being the major strains,
then the companies will reformulate.
For example, Pfizer and Madrona will produce other vaccines
to be able to give boosters.
So I think the answer to that is yes.
How often we'll have to get boosters isn't clear yet.
- [Melanie] Thank you.
So, another person asks,
that they've had both doses of the Moderna vaccine
post 14 days after the second shot,
are they still able to contract the virus
and spread it to others?
I think I heard you say yes to both.
- Yeah.
Yeah, the answer to that is we think,
we don't know for sure.
The studies on that are not great.
There is some data coming out now
that being vaccinated decreases transmission rates
from you to somebody else by about 60%,
it's not a 100% though.
So, we're gonna get more data on that coming up.
- [Melanie] So this is interesting, thank you.
So, do we know...
I don't know if it's been discussed yet,
but how safe these are longterm?
And if they have long-term implications down the road that--
Does anyone know that?
In any other country, anyone else doing these studies?
- So, the answer is that to that CDC is doing those studies.
So they're collecting all that data.
Other countries are collecting that data.
Typically with vaccine research,
the worst parts of vaccine side-effects
should come within the first two months.
And that's why they waited two months
before approving these vaccines.
It's not like other medications that you take every day
that might have effects months, years down the line,
even decades down the line.
These, you'll get 'em.
People were concerned because the mRNA vaccine
is a piece of genetic material,
but it gets destroyed right away.
So it doesn't get into your DNA and it doesn't change you,
it doesn't even...
It doesn't even go across the placenta
and get into women into the unborn children.
So, if we can give it to our pregnant patients also,
so, no.
I think the long-term effects are--
We're gonna follow them.
But the prediction is that there won't be any.
- [Melanie] Okay,
So, we're down to our last two questions
so we can stay on task.
"So, there are a lot of people
that have received the first dose
but have not received a second dose due to delays.
If these individuals are not able to receive the second dose
within the timeframe, will this impact have any effect
on the vaccine, the first dose?"
How will that?"
- No.
So the first dose will give you some protection.
We don't know exactly how much
of the both of the Moderna and the Pfizer.
The Johnson and Johnson is just one dose to restate.
You can get the second dose, the CDC says,
anytime afterwards.
And it will be safe and it will give you
the boost that you need.
There people who are in the hospital
after getting their first dose,
they don't have to get their second dose
while they're in the hospital.
They can be discharged, they can get better
and then they can get their second dose.
So, it's okay to delay that.
They said two weeks and three weeks.
But again, that we do that with other vaccines
to people who don't get them,
we just get them the next time they come into clinic.
- [Melanie] Excellent.
So here's our last question
and then we'll move on to our next speaker,
which will be Dr. Gerard.
"African-American and native Americans
have the highest morbidity rates, that's possibly political.
Do you think these populations will be prioritized?
And are they making any medical efforts
being to de-stigmatize the fears of these communities?
What are those efforts to de-stigmatize fear?"
- Yeah, that's a huge topic.
And the answer is yes, they are at increased risk.
They ar at increased risk of morbidity,
ending up in the hospital and dying.
And so, we're focusing on those groups.
The SVI is one way,
the social vulnerability index is one way.
And we do, I've been going around to do talks
because even within the hospital,
folks in our environmental services, our transporters,
there've been a whole bunch of groups
where there's been some...
What we call vaccine hesitancy,
which is people who don't wanna get vaccine,
right now they might.
And so we do have to do more education.
We're doing that and we're trying to get out there.
I'm trying to do talks when I can
to just say how good these vaccines are.
So thank you for that question.
Now, we have to continue to be better at doing that though.
- [Melanie] Thank you so much Dr. Cinti
for your expertise, for your time.
- Sure.
- [Melanie] This morning, we really appreciate you.