This week look at the vaccine rollout in Israel that has managed to achieve >50% of the population with at least one vaccine received, how they achieved this and what we can learn from the data that has already emerged on the effectiveness of the vaccine in preventing disease and death due to COVID19
We also look at the just-released updated guidance on face coverings from the CDC: Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021 and the updated guidance on what and how to wear masks
Raw Transcript
Fred Goldstein
Hello, this is Fred Goldstein and welcome to this week’s COVID insights to action discussion group. We’re excited you’ve chosen to join us as well. I’m joined again this week by my esteemed physician colleagues, Dr. Nick van Terheyden and Dr. Louisa donya. And we’re going to get into a couple of different discussions today and happy to accept any questions or comments you might have. We’re going to start by talking a little about Israel, what’s going on there, what we’ve learned from the from those who’ve been vaccinated, and how that might apply here in the United States. And then we’ll move on to discussing masks and some of the newer thoughts around masks and wearing them and why those thoughts are coming up, as well as what people are beginning to recommend. So why don’t we start first with a little discussion on Israel? And they’ve obviously been moving ahead, vaccinating a fair number of people. So perhaps, Luis, would you like to start with that?
Luis Saldana
Sure. Sure. I could start with that. Yeah, I’ve been following this. You know, following their work, they’re very closely. They’ve been given a Pfizer vaccine essentially trying to get everybody vaccinated. Certainly they have an issue with the Palestinians, there’s that have been criticized for human rights things for not giving it to the Palestinians. But, you know, besides that issue, I still think there’s a tremendous amount for us to learn about one the process, but to the impact of broad vaccination, especially in higher risk groups. And, and I think we can pretty much draw some, some some nice conclusions or some nice insights from that. You know, again, this isn’t a formal study, but but I think there’s some pretty good insights. One, they’re still struggling with the overall numbers, they have other issues. They’re actually kind of in the midst of a third lockdown, I think now, but particularly they’ve vaccinated over 50% have received at least one vaccine. And so, you know, are partially vaccinated. And a lot of the numbers that I’ve seen among the groups that are vaccinated at age groups, show that in those that are fully vaccinated are a huge drop in the number of cases in those age groups, a significant drop 39% in the number 8% of hospitalizations in those groups, and 31% of the same and you know, in terms of the, the illnesses as well, so really seeing pretty dramatic impact. On the population level, this is these are population level impacts. And essentially, from what we see there, there’s a couple of things we can draw is that nobody’s going to get severe illness, if they’ve been fully vaccinated, at least promoted seen up to download, I’m not going to kind of draw any conclusions with variants and things like that. But certainly they’ve had variants around and they’re probably still struggling with some of the very, you know, some of the variants there, as well. But there’s another thing that’s really important to draw from their experiences that it looks like there’s going to be decreased transmission, as well as a result of the broad vaccination. And that can be drawn from the fact that if they look at kind of overall viral loads, the viral loads in the country are dropping. So I think that’s gonna also impact the severity of illness is dropping. And this is probably a reflection that they’re actually slowly the transmission among, you know, throughout the country, by this broad vaccination program, we weren’t sure whether we could draw us conclusions before this experience. But I think based on this experience, there, I think it provides a lot of hope for us here in the United States, in terms of, you know, the way we’re going with, you know, our vaccination efforts here, wrapping up, we’re now over 10%, I believe, are vaccinated at least partially vaccinated of the population, especially the higher risk groups, and I think we’ve already seen decreased deaths, a significant drop in decrease deaths, and in the nursing home populations, which were vaccinated early on. So. So that’s, that’s a little bit of what I kind of took away from, from what I’ve seen from the Israel experience.
Nick van Terheyden
So I think great points, you know, it’s maybe worth just saying a couple of things about the Israel approach, and you know, why it’s a little bit different. And also sort of reconcile one of the things you often hear as well, that’s Israel, or it’s that, you know, the US or whatever, they’re different, actually, they represent a lot of what we have here, they’ve got, you know, a mix of healthcare combinations, you know, put the issue of the Palestinians to one side, but you know, just within the country, it’s, it’s, you know, they’ve got challenges, they certainly got political challenges, let’s be clear, they’ve had more elections, that I think I’ve had birthdays in the last couple of years. So, you know, lots going on there. But they took a really pragmatic approach to this, which was, we’re going after the high risk groups, but they addressed it on an age group basis. And we’re going to be, you know, simple in that approach, in that if we go to an institution, which is going to get everybody in the institution, you know, and not worry too much about, gosh, we got somebody that’s young, so there was none of this missed opportunity. There was also, you know, a clear sort of approach to appointments so that people got appointments, but an understanding that sometimes that gets messed up. And they had a sort of a well recognized process that said, Hey, if you want to hang out at these places at these times, you could line up for any spare doses. And in the instances where the spare dose line didn’t exist, and they had something leftover, they went out and found people to issue and they gave them the second appointment at the time. So really pragmatic, very sort of rapid, and they’re way ahead. So you know, Louise sort of cites the US, I’m okay, 10%, I was gonna say, nine, the next highest is the UK at 14. And there’s nobody else after that. So they’re just streets ahead. So there’s lots to sort of recommend it. And I think the important thing here is, if you want to suppress these variants, you need to stop the virus period doesn’t matter how you do it, and we can do it lots of different ways. But viruses when they replicate and get into other people, they produce variants. So the less they get to do that the less variants we have to do deal with the foster we’re going to sort of suppress this whole thing. And that’s been very effective. I think I’d be surprised if they’ve seen maybe they’ll see variants coming in but I’m willing to bet that they’re not generating variants that because they’re suppressing the on all
Fred Goldstein
right, it’s it’s been interesting to read some of the, of what they what they did operationally, you know, there are four health plans in Israel, but they have really strong electronic health records, as we’ve talked about. So they’re able to rapidly identify the individual and say, we’re gonna go get this group then we’re gonna get this group that we’re good this group through those four health plans. They also apparently paid two to three times the rate the United States paid for each dose and, and put out a fair chunk of money and then made the deal with Pfizer to go ahead and say, we’re gonna give you de identified data that you can then use
To further study and learn about the vaccine, and that, while that’s had some questions from a privacy standpoint, and that kind of thing, it clearly allowed them to rapidly when they bought a lot of the vaccine, and then obviously made a deal to get more in as quickly as they can. So be curious to see how it goes. I also did notice that they announced yesterday that all of the immigrants who are in Israel, whether legally or illegally, are going to get vaccinated, they’re just going to ask you to show your name and something and they’re not gonna have any data to say whether you were here legally or not in the country. And they’re gonna vaccinate that group now to which is nice to see. So hopefully, we’ll begin to see that kind of thing spread out a little bit, as you mentioned earlier, Luis, with some of the other issues faced over there. Are there are there? Obviously, we’re seeing this reduction in deaths and other things? Are there any other unique insights? We’re getting out of that early on that that complaint as to a better thing, and they announced they’re going to open the schools except through 10th through 12th? grade, I think our 11th and 12th. But the others are reopening now. Anything else going on there?
Nick van Terheyden
Well, I mean, the the rates of infection has declined, and it declined pretty early on, if I recall, it wasn’t, you know, they reached, I want to say it was around 30%. And they started to see these effects quite early on. So, you know, if I was to pick out something, there’s hope, if we can get to some level better than the 9%, which just seems inadequate at this point. You know, I don’t know what to say about the money side of it. I mean, paying more just meant that they got to the front of the line. Okay, you know, not everybody can do that. Ultimately, we’ve all got to get, you know, in line, but I it’s it’s the just get it done was the most important thing in all of this to really be effective in rolling this out. We’ve got vaccine that’s sitting on the shelf, as I understand it in the US. That’s inexcusable in my mind.
Fred Goldstein
Yeah, my point on the dollar amounts paid for it was that they’re actually getting a lot of pushback from the country itself. You know, why did you spend that much for that?And one of the other things I saw that was interesting, maybe one of the YouTube can comment on this is that they began to see effects after the first shot.And is that right? And see reduction? correct?
Luis Saldana
That’s correct. That’s correct. They didn’t start seeing some protections. Probably, maybe I’ll couple of weeks after the first the first dose of things. And that wasn’t, you know, that wasn’t clear that was going to happen. So yeah, that was, you know, alerting. And then, you know, again, two weeks after the second dose, it seems like, again, I don’t think they’ve had a single severe case. And the number of cases among vaccinated individuals has been, I’m not going to say zero, but it’s almost zero.
Fred Goldstein
And from a, from a medical perspective, and you know, given the nature of vaccines, obviously, this was Pfizer, can we assume a donor is going to be similar? And is there a way to then say, well, one done differently might be similar as well, or we just don’t know yet?
Nick van Terheyden
Yeah, I think we’re both pausing for thought I don’t want to jump into that and say, I, whenever I hear the word assume, and medical and science, Major, I’m always a little bit leery. It’s not unreasonable to think that that might be the case. But I don’t think there’s data to support it. I think what’s interesting about the Israel experience is, you know, and you highlighted it, Fred, the fact that they’re offering back this data, you know, privacy issues aside, gives you some insights. And if you can tie that back to infection rates, and so forth, they may well be able to report and show some demonstrable benefits on the Pfizer vaccine because they’ve got this wealth of millions of data points.
Fred Goldstein
Right. Right. And one of the other things I found interesting, is it kind of a little different thing on this vaccine was, there’s always the question when you’re doing your initial studies, whether you’ve got a broad enough population, is it a representative population of the of the people in the country, we’ve seen some bias in some of these AI tools, things like that, that can flow over from doing things like that. But it turns out I was seeing obviously, there’s a real issue with obesity now showing up and, and impact of the disease on people who are obese versus others. But the vaccine was actually tested in a representative sample that included folks who were obese at the same rate as they are in the general population to show the impact that it actually helped because there was some concern, I understand, for example, in the flu vaccine doesn’t appear to work as well and individuals who are obese for various reasons. So that was nice seeing obviously, as we get more of this data out of Israel, that’ll help us as well. Let’s get on to the second topic, unless there’s anything else to add there and talk a little bit about masks. There’s been a lot of change, not a lot of change, but a better understanding now, both because of the variants coming out and their their impact on spread. And the effectiveness we now know of masks and that’s changed a little bit. Maybe Nick= Want to start out with that one a little bit? What’s happening with them?
Nick van Terheyden
Yeah, sure. I mean, I, you know, masks seems to be the ever recurring changing theme that people can play them or you said not wear masks, and we should wear masks, which is it? You know, well guess what that science continues. And, you know, there were some very good reasons why there’s been a shift in terms of the advice. But we know categorically from as far back as 1918, with the flu pandemic that occurred that at that time that masks are effective, there’s no question. Now, what’s happened. And what’s changed over the course of time is, of course, we’ve had all of these people piling in to do some incredible studies, both looking at, you know, different materials, we saw a study, I want to say this was several months back, which sort of looked at different materials, very thin materials, not as good. You know, some of this is fairly obvious. I think one of the things that’s come out and the guidance that’s very clear now is, so we’re hearing a lot of double masking. I think the good news is we’re seeing it from the leaders in this space. So I’m I want to say that in many of the instances in the White House and the press briefings, if you note, people are actually showing you can see that they are wearing two masks. And, you know, I think there’s a some variation in where you put the surgical mask I you know, the CDC guidance is pretty clear, surgical mask, followed by a cloth mask, and in fact, some guidance that tries to make it as tight fitting as possible, very similar to the 95, which is essentially a sealed experience and then adding an additional MOS. And what I felt was really interesting, I think, if I looked at the picture correctly, it was a gator, a sort of, you know, pull up thing that you put over the surgical mask was an additional sort of capability, even a thin Gator that was pulled up over a surgical mask so to or multi layered, improves efficiency, maybe not quite to the n 95. But gets you to that point. And it’s extraordinarily effective and so important with these highly transmissible variants that we are really trying very hard to suppress the spread of.
Luis Saldana
Yeah, I’ll just gonna add what yeah, that CDC did come out today. And I urge everybody to kind of look at least see the visuals of the graphics that the CDC share today. But basically, the bottom line, it says worried a massive hits tightly to your face can help limit spread of the virus that causes COVID-19, which I think, especially with variants, this is probably the biggest thing we can do to stop variants. And they say in lab tests with dummies exposure to potentially infectious aerosols decreased by about 95%, when they both wore tightly fitted masks, the options were a medical procedure mask with knotted ear loops, and tucked inside or a cloth mask over a medical procedure mouse. So you know, any any variant of that, but though, they’re talking about about 95%, protected, you know, so so that’s impressive, other effective options to improve it include mask fitter, you can buy these, you know, over the counter Amazon, it’s called a mask better, or as Nick mentioned, nylon covering over the mask. So that’s the Gator type thing over over a mask. So now you may see somebody with a gator. And I may be okay, if they have a mask underneath, you just get you know, you may not know what they’re wearing underneath. But But I think now we have so much clarity on this, and certainly with the bind administration has imposed more mask mandates. So they’re really reinforcing the importance of this. And we we know that nationally, we’re seeing cases drop, hospitalizations dropping in and a lot of these variants, and many the UK has had a similar drop, even though they have variants as well. And I think the key is two things, the vaccination, the things you talked about today, the vaccination and and really good quality masking. So I think those two things and we can we I think we can ensure that even if we do have another spike related to barriers, that it won’t be as large or sustained a spike as we’ve seen before. I’m pretty optimistic. I’m more optimistic on that if we if we continue on the path of vaccinating and worrying about, you know, efficiently and effectively.
Fred Goldstein
Yeah, because one of the one of the concerns I had as a, as I’ve noticed people thinking about and I saw some studies on this talked about this issue that as the vaccine went out, it kind of almost like took the air out of the balloon a sense of getting nervous. And so a lot of people I was afraid we’re going to, you know, take a little bit easier. And I haven’t seen that be the case yet. Obviously it’s a concern. I saw one study which said People now considered this a moderate problem versus a major issue for them. And hopefully, we won’t see that behavior because you’re right until we get to this point where we’re vaccinated and have good immunity. And as a group, wearing a mask is gonna continue. What about some of the thinking now we’re beginning to hear some differences regarding that of people who are vaccinated meeting together? And what do we know there? And in other words, everybody in my everybody in that I know is vaccinated, we can all get together, do we need to wear masks or not? current thinking I know vouch you said that might change coming in earlier,
Luis Saldana
I think. I think we will. I think we will see some CDC guidance on that in the next week or so I think, I think what we will see that I think the reason they’re one reason they will do that is almost like incentivizing the vaccine, I think you’re going to start seeing these, these incentives. So, so I think TBD is what I’d say. For now. It’s to say, you know, the same precautions. I’ve certainly, you know, I’ve had been vaccinated for over a week, 10 days now for my second vaccine, and I hadn’t changed the thing in terms of how I do it, I think I’d be very reluctant to, to change my behavior. Because if it’s worked for me, I’m not gonna, I’m probably not gonna change with us. I just have absolutely, you know, really important reasons that’ll, that’ll draw me out of that.
Nick van Terheyden
And it’s kind of interesting, you know, you talk about the incentive, I think that’s an important aspect of this. I mean, you know, we know what works, we know what’s best. But you know, there is a balance to all of this to to get compliance. And, you know, if you can find a pathway that’s more acceptable, it’s one of the reasons why end 95 are not the best option, really, because they’re just pretty tough to put on. But these alternatives with, you know, the loops that essentially create a much tighter seal, and I’ve seen a video of this, and it’s quite impressive, but it’s not as oppressive as the N 95. mask, it gives a little bit of laxity. And I think the same is true with these incentives, you know, balance things out so that you get people complying, so that we all win by pulling in the same direction.
Fred Goldstein
Yeah, that makes a lot of sense. And speaking of incentives, and it sort of reminded me, I’d seen one one at some employer groups are now incenting their employees, by giving them a bonus for getting the shots. Yeah, you know, seeing that as a possibility as well. And I know, you know, when I consider the whole indoor thing, and indoors is still nervousness. For me. It’s the one and the two, you know, one on top of the other, and I do notice the fit is much better. And I can really tell that I don’t have leakage around the side as I would if I just wear that surgical type mask. So that’s been very helpful from that perspective. I know we’ve got folks on listening, if you’ve got any questions or anything, please feel free to put them into the chat box, or you’re welcome to join us if you’d like we appreciate you joining us in this event. As we think going forward, Now, obviously, we’re starting to see people talk about what the what the summer or the fall might look like. You talked a little bit Luis about what we may see another spike, you know, given the variance, but maybe it won’t be as big. Are we beginning to now think a little bit further out as to what we might be able to do versus what we’re doing now? Is that is that something we can at least start to consider at but look further closer to that date? Or do we continue to just say, we’re going to be like this for a long, long time.
Luis Saldana
I think gepa you’re going to continue to see progressive kind of return towards normal over over time, it’s not going to be normal, because we’re not going to think we’re gonna be returning to offices and have big gatherings and things like that. Even restaurants, I think it’s going to be people will be slow to kind of return though in some places, you know, restaurant never has, has really changed too much. But no, I think we will, again, they’re, you know, following the Israel kind of experience that they you know, they have started to kind of, to kind of do that. We will continue to see some some slow opening, I think they’re going to be very cautious in that I think the CDC is going to be extra cautious, lagging and not gay not ahead of themselves. That that’s that’s my sense.
Nick van Terheyden
Yeah, I think it’s very hard to predict. You know, prior to COVID-19, I was, you know, happy to predict a year, two years, five years out, this is what’s gonna happen, you know, with all this confidence and all this has taught me is that, you know, those predictions, like many of these things sort of fall by the wayside. It’s very hard to sort of have an assessment as to what’s going to happen I you know, I like to sort of pitch towards Louise’s point. Have hopeful nurse of where it’s going to be, but also tempered with some reality that says, you know, we have got to execute on all of the things that we know. I mean, if we done that nine months ago, we might not be in this hole, we’re now sort of digging out, I think I’m excited about the change and the improvement based on sort of, you know, some positive leadership examples set by folks, all of that good. But we’ve got a lot of ground to cover, we have seen it being effective. I mean, just look at the countries that you know, have fractional numbers of disease and problems relative South Korea is a good example. I mean, that they’re not absent any disease, but, you know, small numbers relative to us, even some countries in Africa, where, you know, they focused on these things, and people took it all, seriously. So we know, it’s possible, we just have to execute. I think the other hopeful thing that I saw this week was increased mass compliance. That’s a shocking statistic to me, given all the, you know, I that’s my freedom, it’s this, it’s that, you know, I think people are terrified that they’re going to be living with this for the rest of their waking life. That’s not the case. But you know, we have to pull in the same direction using all of the tools that we know. Because the more that we apply, that the faster we can actually bring this under control. And that’s worldwide, it’s not just new at great, we get COVID under control in the US. That’s not good enough, because there’s still all this international travel and train we’ve got to overcoming worldwide.
Luis Saldana
Yeah, and I’ll say one more thing that it’s kind of been a little quiet, it’s been certainly overshadowed by the vaccine is the government is also ramping up testing. And I, especially the use of rapid tests, is something that’s going to be worth following, they invested a lot or gave a lot it towards the E Ll USB test, which is a company out of Australia, that has a self administer test. And thanks. So that’s gonna be a space to continue to watch it. As far as that goes, I think all these things are, are part really part of a of a of a more thoughtful strategy, which has really sorely been lacking, it’s really looking at this very holistically. And I think that leads to you know, we’re talking about returning to normal. Maybe even next time we talk about maybe a look at travel, what’s the future of travel? How does that look, it’ll combine some of the things that maybe we’ve talked about over over time, even within the country or outside the country. You know, I think that’s going to be interesting, because it’s probably going to combine a lot of these things, the masking, the testing and the vaccination, I think we’re all going to be huge factors in in watching that area.
Fred Goldstein
I know that early on, you know, we obviously as we were working with some of the clients early was this idea of testing, you know, and now that sort of become the norm. And I know, Louise, you sent out some links to some articles, I believe, on some large employers that are now implementing, or maybe was unique testing. Services. Yeah, banks, like large banks, were doing a lot of testing and things, I think that’s gonna become also much, much more normalized for for folks, you know, and kind of have to have people in in the office or in, you know, it facing facing customers, such as well, yeah, I think we, you know, need to remind people that, obviously, as you talked about, you know, it’s not, you still got to do the math, you still got to do the hand washing, you still got to keep your distance, you know, and testing is still a critical piece of this. Yeah, the vaccines, the vaccines here, we got to be doing some testing. And what’s the other positive out of this? I heard that the flu
Nick van Terheyden
you know, for 2020 2021 is like zero, almost. I mean, why is that because we’ve been so good, you know, being clean and you know, preventing the spread of the disease. So, you know, there are some silver linings, we’ve learned some things about all of this. Nobody paid any attention to flu before in this country. People went to work with flu, what on earth were they?
Fred Goldstein
That’s true, Nick. And hopefully we can we can change some of that behavior going forward with other conditions as well, if they don’t show up in the office with to keep from from spreading. And we’ve got you know, I think one of the, as you talked about, one of the good things around this was early on making sure as an employer, you have a policy that it’s okay to call in sick, right, do something. It’s a sniffles, or whatever, please don’t show up. Whereas before it was more, you know, at the end states get on in here, man. We got to get some work done. Right. So that’s a good change. Definitely a good change. Anything else you guys would like to add or any questions from anybody? We’ve got just a few minutes left?
Nick van Terheyden
Well, I mean, I would just say it’s that that improvement in public health doesn’t stop, you know, let’s suppose you know, with with all good things happening, COVID-19 disappears. It’s no longer a problem. We don’t, you know, nobody ever says the word COVID-19. Again, you know, in 2022, that doesn’t change, all of the value add that’s happened. And change is necessary for employers for colleges, it requires a sort of virtual health approach that was very similar to what we had in the factories, and I think people are going to need help and support to be able to deliver that, from experts that understand this from a population health from a, you know, disease disease management. And that’s really one of the areas that I think we Excel and, you know, are excited to help our clients and offer them.
Fred Goldstein
Absolutely. Yep. Well, it’s been a again, another fantastic discussion this week, getting into Israel and their vaccinations and some of the things we’ve learned from that as well as masks. And if you’d like any more information, or would like to reach out with us to get some help on anything, please feel free to go to our website, which we’ll have down below, or give us a call and we’d be happy to talk to you. So thanks again, Nick and Louise for another fantastic week. And thanks to all of you who attended. We’ll have next week’s topic up very soon up on the registration page.
