January 28, 2021: The Latest on COVID-19 Vaccinations: A Smilow Patient and Family Forum

January 29, 2021

Information

Hosted by Charles Fuchs, MD, MPH

Presentations by Drs. Kevin Billingsley, Tara Sanft, Kerin Adelson, Ohm Deshpande, and Kim Slusser, RN

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00:04Well it's 702 and why don't we get started?
00:09I want to welcome everyone to
00:11our Smilow Patient Family Forum,
00:14as many of you know this has been
00:17an event that we have been holding
00:20electronically through zoom really
00:22since the beginning of the pandemic
00:25early last year and we we do this
00:29really because we know that.
00:32People want to be informed and
00:35know what's going on,
00:36and it is our goal at Smilow Cancer
00:39Hospital in the old Cancer Center to
00:41keep our patients and our families
00:44informed and know what we're doing
00:46to address this public health crisis,
00:49what we're doing to ensure that the
00:51care of patients is attended to with
00:54the same attention we do always,
00:56and also how we do it in a way that
01:00keeps you and all our staff safe.
01:03Um?
01:04This has been obviously a very
01:07challenging time for all of us,
01:09and we really appreciate everything
01:12you're doing to work with us on
01:15this and and obviously we are here
01:17to answer your questions.
01:19Unfortunately,
01:20today joined by a number of our
01:22leaders at our cancer hospital
01:24and our health system,
01:26and I'll just call out their
01:28names and ask them to just wave so
01:31we know who they are.
01:33So joined today by Kim Slusser,
01:35who is Vice president for patient
01:38services and our Chief Nursing
01:40Officer for Smaller Cancer Hospital.
01:42Doctor Kevin Billinsley,
01:43who's our Chief Medical Officer
01:45and a professor of surgery at Yale.
01:48Doctor Om Desponding,
01:50who is the executive Director
01:51of Clinical Operations for Yale,
01:54New Haven Health System.
01:56A doctor Tarin Edelson,
01:58who is the chief quality officer and
02:01Deputy Chief medical officer for Smilow,
02:04an medical oncologist in the breast
02:06program and Doctor Terra staff,
02:08who is the chief Patient experience
02:11officer and as well medical oncologist.
02:14In our press program.
02:17In our goal today is is really
02:20to share updates to discuss the
02:23the opportunities of vaccinations
02:25as well as with Doctor Sam Self.
02:28Also think about what we can do in
02:32terms of the well being of our patients.
02:39So I'm just gonna I'm
02:40gonna show a few slides.
02:41This is showing up, yes.
02:44Good, so um the agenda is first,
02:47we'll hear some updates from Tim Schlosser
02:50and Kevin Billingsley about what's
02:53going on at smilow during all this time,
02:56Doctor Despond he will share with
02:58us information about the vaccine and
03:01the planning that the health system
03:04is doing for our patients as well.
03:07Doctor Edelson who is our chief
03:09quality officers I mentioned,
03:11has been working with the National
03:14Comprehensive Cancer Center Network.
03:16Which is a consortium of National
03:18Cancer Institute designated Cancer
03:20centers of which we are one,
03:22and we are the Cancer Center for
03:25Connecticut to address how we
03:27work through vaccinations for
03:28cancer patients and then finally,
03:30as I mentioned,
03:32Doctor Sam is going to talk to all
03:35of us about how we support each
03:37other and maintain Wellness through
03:40these very challenging times.
03:43You know from the very start,
03:45and I know I speak for everyone
03:48in the internal Cancer Hospital
03:50and Yale Cancer Center.
03:53We have worked assiduously to address
03:55this crisis and sort of keep our
03:59patients getting the care they need,
04:01and so the principles we laid out
04:04when this crisis began in February
04:07and March of last year was absolutely
04:10remain steadfast to the care of our patients.
04:14Continuing compassionate.
04:15Expert care for all of our cancer patients.
04:19To ensure the safety of cancer
04:21patients recognizing that cancer
04:23patients are vulnerable population
04:25with respect to this virus.
04:27To protect our staff and also to engage
04:30our research community to help us
04:33come up with ways to combat this virus.
04:36And I want to say on this last point I'm
04:40just so proud of all of our researchers,
04:44scientists,
04:45people working in population science.
04:47Who have beyond continuing the important
04:50work in cancer prevention and therapy,
04:53have also put considerable time into
04:57defining a better understanding this
05:00virus and how we ultimately beat it.
05:04So it's been a challenging year
05:06and I think we're all excited and
05:09anticipating the rollout of vaccines,
05:12the development of a vaccine in
05:15the course of 2020 is frankly
05:18unprecedented in the health.
05:20You know,
05:21developments of medicinal chemistry
05:23and health and drug development
05:25in the in the world.
05:27And we're just so pleased to
05:31actually have these things now.
05:34Want to just share with you some
05:37background because we have a lot
05:39of questions and my colleagues on
05:41the panel will answer questions
05:43but just want to review what we
05:46know about these vaccines now.
05:48There are two 2 vaccines RNA
05:50vaccines that are now approved an in
05:52practice one manufactured by Pfizer,
05:55the other one by Moderna,
05:57which I'm sure you've heard of.
05:59How does that work?
06:01Well there RNA vaccines.
06:03RNA is part of sort of the
06:05approach of the building blocks
06:08of ourselves that encode proteins.
06:11Their short lived RNA is not
06:14a permanent lasting molecule.
06:16It's a molecule that actually
06:18only exists temporarily encodes
06:20a protein for cells,
06:22and what the scientists at
06:25Pfizer Moderna did is they
06:28figured out a way to put that
06:31piece of RNA and this RNA encodes.
06:34Apes, the spike protein on COVID-19.
06:40Put that RNA into a lipid or fat particle.
06:45Then put that into the context of a
06:48vaccine which gets injected into your
06:51upper arm and appan that that lipid
06:54particle then enters into ourselves,
06:57where that RNA can then make the protein,
07:00specifically the spike protein.
07:01To be clear, it is not the virus,
07:05it is not capable of causing
07:07a viral reaction,
07:09but it simply elicits that one protein
07:11and what is that for the presence
07:14of that protein do temporarily.
07:17Is it prompts an immune response both the
07:20making of antibodies that fight infection?
07:23As well as other immune cells that fight
07:26infection and by virtue of having that,
07:28you then develop an immunity towards
07:31the virus so that if you were to be
07:34exposed in principle your body would
07:36be able to fight off that infection,
07:39fight off the virus.
07:41Anne, frankly, prevent an infection
07:43and that is the theory behind it.
07:45To be clear,
07:46people ask well RNA that sounds
07:48like genetic code.
07:50Am I at risk at that?
07:52No, the RNA is actually
07:54destroyed relatively quickly.
07:55Overtime after the injection so
07:57it doesn't last in your body.
07:59There's no alteration to your DNA or
08:02genetic code by virtue of this injection.
08:06A second vaccine is under development
08:08and we anticipate that that vaccine
08:11will likely have data from its
08:13clinical trial in several weeks.
08:15Manufactured by Johnson and Johnson,
08:18that vaccine is a more classical
08:20vaccine design. What do they do?
08:23They actually take that same
08:25spike protein gene,
08:26but they put it into a virus.
08:29But a virus that is not harmful to humans,
08:33it's it's basically inert inert virus.
08:36A virus that can't replicate
08:38it can't reproduce,
08:39but it carries that spike protein and by
08:42virtue again of being injected in your arm.
08:46That virus then inserts the spike
08:48protein gene into your cell,
08:51which is again only a temporary
08:54situation where it too will produce
08:57proteins on the surface that elicit.
09:00Antibodies and immune response and in
09:02theory will give you the same protection.
09:06As you, many of you may know,
09:08the Moderna an Pfizer vaccines
09:10require two injections,
09:11three to four weeks apart.
09:14The Johnson and Johnson design is
09:16only one injection, but to be clear.
09:19As I'll show in a moment,
09:21we have data from the Pfizer
09:23and Moderna vaccines.
09:24We don't yet have data from
09:27Johnson and Johnson that we await
09:29at some point in February.
09:31And I just want to show the exciting results.
09:35Both the Pfizer and Moderna RNA
09:38vaccines have a similar result and
09:41this was the Pfizer vaccine was
09:43a study of approximately 40,000
09:46individuals who were tested,
09:48half of whom got the vaccine.
09:51In this case is known as B and
09:54T162B2 or a pussybow just saltwater
09:57injection and what we're looking at.
10:00Here is the likelihood of
10:02developing infection up here on
10:05the Y axis and time since that first
10:08injection here on the horizontal axis.
10:11And as you can see in the blue,
10:14the people who got the placebo did
10:17have development of a COVID-19
10:19infection overtime, but in contrast,
10:22you'll see there's a slight uptick
10:24in the people who got the vaccine,
10:27but by day 12 this is blowing up
10:31this little section of the graph.
10:34It's flat, there really are
10:36no new and no new infections.
10:39Meaning that it is profound protection
10:41between this blue line and this red line.
10:44And if you look more at
10:47the statistical results,
10:48you can see several findings,
10:50namely for those people who
10:52were more than seven days after
10:55the second dose of the vaccine.
10:5895% protection.
10:59Meaning that if you compare the rate
11:02of infection for the people who had
11:05placebo versus those who got the vaccine,
11:09there's a 95% reduction.
11:10Now, to be clear, we were hoping that
11:14the production would be 60 or 70%.
11:16This is far beyond our expectations
11:18and really impressive.
11:19One other statistic that you will hear
11:22about is what was the protection,
11:24not after the two doses,
11:26but after just the first dose
11:28and you'll see it here.
11:30It was about 52%.
11:32We're protected just after the first dose.
11:35Does that mean you should only get one dose?
11:39I don't think so.
11:40You want 95% protection and we
11:43anticipate that once getting committed
11:45to getting either the Pfizer Moderna
11:48that you'll you will get the second dose,
11:51that dose will be available to you.
11:53Be encouraged to get it.
11:55An 95.95% protection is really incredible.
11:58We I just want to be clear.
12:01We have a number of questions that
12:04have already been submitted online.
12:07Among the questions that actually have
12:09come in is is this being recorded.
12:11The answer is, if I'm not mistaken,
12:13Renee,
12:14it is and will be placed online
12:16so that for those individuals that
12:18you know that want to see this and
12:20could make it this evening,
12:22they will be able to view it online.
12:25Another question that other questions
12:26have come in and we can take during
12:29the question and answer session section,
12:31is safety of the vaccine and frankly
12:34the safety appears to be quite excellent.
12:36In terms of long-term concerns,
12:38while it's still early,
12:40but we don't see any long-term safety issues,
12:44there are people after the second
12:46dose who do get what may seem like
12:49a bit of a flu like feeling 24 hours
12:53after getting the shot.
12:55It's it's typically transient.
12:57You're not going,
12:58you're not getting the infection.
13:00You cannot get COVID-19 from the vaccine,
13:03it's just an immune response and a
13:06robust immune response.
13:08We are about 20% of people who get
13:11the Pfizer vaccine can get a flu like a flu,
13:14like feeling,
13:15about 40% of the people who get
13:17Maderna can get a flu like feeling,
13:20but usually gone after 24 to 36
13:22hours and people can take Tylenol for that.
13:26Another question that arises is
13:28well it once I get
13:30vaccinated, does that mean I can go
13:33about my business and the answer is?
13:36Only in the context of what we
13:38need to be doing when COVID-19,
13:41so you still need to wear a mask.
13:44You still need to physically distance
13:46and you still need to be careful because
13:49until our public health authorities tell
13:51us that it's time to go back to normal,
13:53we all need to be very careful.
13:56It will be reassured getting the vaccine,
13:58but we still want to be careful
14:00because one thing we don't know,
14:02we know that getting the
14:04vaccine does protect you, but.
14:06Does it prevent you from
14:08transmitting the virus?
14:09That is, you can get the vaccine.
14:12You might have actually been exposed to it.
14:14You may feel fine, but you may
14:17harbor it briefly and transmit it.
14:19So almost an asymptomatic infection.
14:21That's a good thing for the
14:23person who got the vaccine,
14:24but you don't want to put
14:25other people at risk.
14:26So you gotta wear a mask even
14:29after you get the vaccine.
14:31We'll have a lot more time for questions.
14:33Let me turn over now to my colleagues,
14:36Kim Slusser and Kevin Billingsley for
14:38updates on what's going on and smile.
14:42Hi Charlie, thank you for the
14:44opportunity part of this forum.
14:46I also want to say thank you to all of
14:48those that are joined us this evening.
14:51It's just wonderful to see
14:53so many people here with us.
14:55Passkey weeks have been an
14:57exciting time is Charlie.
14:58As mentioned as our teams have been
15:01receiving their vaccine and doing
15:03our part is light yellow Haven
15:05health system calls crushing covid.
15:07We've had such a great response
15:10from our smiling staff,
15:11close to 73% of our Smiler staff
15:14specifically have received
15:15their first dose of the vaccine,
15:17with many already receiving
15:19their second dose.
15:20I'm really glad we're having
15:22this form this evening,
15:23as I know that our patients have been
15:25calling their care teams wanting
15:27to know more about the vaccine,
15:29and we are fortunate to have doctors respond.
15:31Ayane Adelson,
15:32here with us to share information with you.
15:36I also wanted to take an opportunity
15:37to thank our community for those
15:39patients that received and completed
15:41this survey that was sent out recently.
15:43We wanted to get our patients opinions
15:45on what they value in regards to
15:48timeliness and availability of appointments.
15:50What you really want,
15:51you may want offered and Tele health,
15:53cancer care services,
15:54and if you would like to take advantage
15:57of untraditional hours of operations.
15:59We've learned a lot through coalbed
16:02and we've developed many of these
16:04initiatives to keep caring for
16:06cancer patients through the pandemic,
16:08and we wanted to get our patients
16:10opinion about or.
16:11These are these sustainable opportunities
16:13for us and delivering your care.
16:15We sent out this survey to thousands
16:18of our patients and received responses
16:20from nearly 700 individuals,
16:22which is actually a wonderful response.
16:25While we are still going through
16:27all of the feedback,
16:28I wanted to thank her smile,
16:30a community for completing the
16:31survey as it truly helps us in our
16:34journey to transform Karen awaited
16:36matters to you and your loved ones.
16:38There's also been a lot of questions
16:40regarding what we're still doing to
16:42keep our patients and staff safe as
16:44we are now in this new stage in the pandemic.
16:47With the rollout of the vaccine.
16:49At this point,
16:50as Charlie mentioned,
16:51we continue with all our pre appointment
16:54and pre admission screenings and follow
16:56all our state and CDC guidelines.
16:58We are still either through my charter
17:01calling screening for exposure to
17:03covid prior to your appointment.
17:05We are still maintaining our
17:07screenings at the front door of our
17:09facilities and wearing our masks.
17:11Our staff continue to self monitor
17:13their temperature and for other
17:15signs of cold air choice today.
17:17As I turn it over to Kevin,
17:19I want to thank everyone again for
17:21spending the evening with us and
17:23trusting us with your care, Kevin.
17:26Thank you Kim. I'd also like to sound sound.
17:29My note of gratitude for the trust that you,
17:32all and your families place in us
17:35here at Smilow and at the Yale Cancer
17:39Center for providing your cancer care.
17:41We are relentlessly committed to your
17:44ongoing safety both in your cancer care
17:46as well as in shepherding your care.
17:49Through this period of a pandemic.
17:52I think one of the things that I
17:55I would like to share with the
17:57audience is that one of the things
18:00that we are continuing to do,
18:02which is which is difficult,
18:04but we believe there are sound reasons
18:06to support it for patient safety is
18:09that we have continued to hold fairly
18:11restrictive policies around patient visitors.
18:14And that limits the number of people
18:16who actually come into the hospitals
18:18hospital and it makes it difficult for
18:21patients who are getting inpatient
18:23cancer care as a surgical oncologist.
18:25I have a number of patients who are
18:28in the hospital sometimes for several
18:30days at a time,
18:32and I can assure the audience that
18:34both myself as well as all of our
18:37surgical teams and the other clinical
18:39teams providing inpatient care
18:41are going the extra mile to keep
18:44in touch with families and.
18:46Loved ones at home so that you
18:48are hearing directly from us.
18:50Even though you are not seeing us in the
18:53hospital making rounds as we usually do.
18:56We're also working hard to make
18:58sure that all patients have some
19:00support with using technology,
19:02phones, iPads,
19:03other devices to help keep in
19:06touch with family.
19:08One of the things that I do encourage
19:10my patients in all patients and
19:12families coming into the Center for
19:14care in the outpatient arena to do
19:16is if you do not have a support
19:18person or loved one with you.
19:21Really use your phone, use it.
19:23Use an iPad,
19:24use a tablet,
19:25get someone on the phone with you
19:27so that you have the benefit of
19:30another set of years listening
19:32to that clinical encounter.
19:34We are completely supportive of that.
19:36We've adapted our practice style
19:38to embrace this,
19:39and I think that this is actually
19:41been one of the great learnings
19:43that has come out of the pandemic
19:46is that we are all increasingly
19:49comfortable with using these.
19:51Technology interfaces to help create
19:53a sense of family engagement.
19:55In these clinical encounters.
19:59Just stop.
20:00Shifting gears a little bit,
20:02I want to share with the audience that.
20:05Although we have continued to have
20:08some operational changes in our
20:10in our care here at smilow,
20:12some of our services are in
20:16altered locations.
20:17It has been possible for us to
20:20proceed with all of our clinical
20:22care at really full pace,
20:25were functioning on the inpatient arena,
20:27giving inpatient treatments,
20:28bone marrow transplant stem
20:30cell transplant cell therapy,
20:32as well as complex surgical care
20:34at all of our at our main hospital
20:37and delivery network hospitals at
20:40full speed as we continue to do
20:43in our infusion units
20:44in outpatient treatment areas,
20:46including our multiple sites of radiation.
20:49Onkologie so with that I would
20:54also urge people to remember that.
20:57Cancer is not the only threatening health
21:01problem that we face and you are safe to to
21:05pursue your your background medical care.
21:09Please do not put off routine medical
21:12care follow up with your primary care
21:15physician for any concerning symptoms.
21:18Try to maintain your scheduled
21:20visits and of course,
21:22if you have scheduled screening
21:25exams for for cancer please.
21:27Do everything you can to follow
21:29up with those.
21:30Well, we do have some delays and
21:32things like screening mammography.
21:34We are working as quickly as
21:35we can through that backlog,
21:37and that is an important part of
21:39the service we deliver and we look
21:42forward to providing that for you.
21:44So thank you.
21:48Kevin Kevin, thank you for those updates.
21:51So let me turn now to Doctor on
21:54Despond a who is here to share updates
21:58on vaccination and planning through
22:00the L New Haven Health System. Thank
22:04you, Charlie and thank you
22:05all for for being here.
22:06I'll just share a couple of slides
22:09to frame the conversation here.
22:11So this is just this is just a
22:13basic timeline of where have how
22:16vaccinations have transpired.
22:17Here at Yale, New Haven health,
22:20just for some context as
22:21as illustrated at the top,
22:23the initial approval by the FDA
22:26for Pfizer took place on the 11th.
22:28We actually started consistent
22:30with the public health guidelines
22:33to vaccinate our health care
22:35workers a short five days later.
22:37Immediately thereafter,
22:38on the 18th,
22:39the Moderna vaccine was approved and we
22:42have been using both of those vaccines
22:45in our vaccination programs thus far.
22:47So we have initially focused again
22:49based on the guidance given to
22:52us from the state on vaccinating
22:54our health care workers,
22:55and we have some about 34,000
22:58individuals in the health system
23:00which includes our medical staff.
23:03Who are eligible for vaccination is a
23:05part of our health care work workforce.
23:07We've been fairly successful.
23:09We've,
23:09as of today,
23:10were around 68% of our health care
23:13workers are vaccinated or goals
23:15to get to 80 and we are on our way
23:17and we are continuing to press
23:20forward and getting to that goal.
23:24At the beginning of January we started
23:27actually towards the end of December we
23:29started planning on how we would really
23:32pivot to vaccinate the general public.
23:35It's a critical part of our mission
23:37in serving the communities to
23:39support and provide vaccination,
23:41and we have done so in a way that
23:44is scalable and can get very big
23:47indeed as depending on the amount
23:50of vaccine we we we received.
23:53So we initially piloted vaccination of
23:54the general public at several of our
23:57Northeast Medical Group ambulatory sites,
23:59and on the 22nd of January we
24:01started putting up some of our mass
24:03vaccination sites which are now.
24:05We currently have five sites up
24:08and the specific locations are
24:09listed in the in the bottom left.
24:11So in granite in the granite area,
24:14it's the Brunswick School in the Bridgeport,
24:16Milford area.
24:17It's currently the person
24:18center in Milford in New Haven.
24:20We have three sites to Floyd
24:23Little Athletic Center.
24:24In the heart of New Haven,
24:26the Westdale West Campus,
24:28which is in West Haven and the Lanman Center,
24:31which is attached to the Payne Whitney Gym,
24:34also in the heart in New Haven in New
24:36London region we have Mitchell College's
24:39are our most recent mass vaccination site.
24:42In addition to that we do have a
24:44limited quantity of vaccination,
24:46limited amount of vaccination available
24:48at the six Northeast Medical Group
24:50Ambulatory sites listed in the middle,
24:52and as we look forward.
24:54We are very.
24:55We plan on putting up a mass vaccination
24:58site at the University of Bridgeport.
25:01Mohegan Sun and other places
25:03as we go forward.
25:05So a couple of points just around
25:07health care worker testing.
25:08The reason that we continue to
25:10focus on this is that you know,
25:12consistent with what Charlie and the
25:14rest of the group have discussed
25:15on many of these town halls,
25:17our commitment is to.
25:20Is to continue to provide the
25:22highest quality care for patients
25:23in the safest way possible.
25:25So we,
25:25in addition to the typical
25:27public health interventions,
25:28wearing masks, hand hygiene,
25:29and social distancing,
25:30we now have a fourth and extremely
25:32effective intervention in vaccines.
25:33So that is all the reason we have
25:36focused and we continue to focus
25:38on health care workers is that we
25:40want to keep our patients safe and
25:42to make sure there are locations,
25:44especially for cancer patients.
25:45But for all of our patients are
25:47as safe as humanly possible.
25:49The other pieces that we want to
25:51make sure that we can continue
25:53to provide supportive care.
25:54Without any interruption,
25:56and as you know,
25:57health care workers have been at higher
26:00risk associated with covid and you
26:03know that can take them out of work.
26:06So vaccination is a key piece
26:08of preserving our workforce
26:10for protecting our work.
26:11Our health care workers,
26:13and by extension,
26:14continuing to provide care regardless of how.
26:18How intense the pandemic continues to be.
26:23In terms of just go to the next
26:25slide just to illustrate where we
26:27are here at Yale, New Haven Health,
26:29and there are a couple of things
26:32I want to draw your attention to.
26:34These data are a few days old now.
26:36I think it does have the 24th,
26:38but nationally about just over 4 million.
26:4041 million doses have been distributed,
26:42but only run 21 million and this is
26:44probably a little higher now and maybe
26:46in the 25 or 26 range have actually
26:49been administered into individual,
26:51so that's a national utilization
26:52of the mid 50% range.
26:54Obviously there's been a ton
26:55reported in the press about this,
26:57and that's not this is not the speed that
27:01anyone feels is where we what we would want.
27:04Alright, Connecticut,
27:04as you are also probably aware,
27:06has been doing better and the
27:08utilization rate is in the mid 60s,
27:11which is something I think
27:13all of us should be proud of.
27:15And at the top right is young Haven health,
27:18so as you can see, we've again these dose.
27:22These numbers that 59 or 60,000
27:24are a few days old,
27:26so it's higher now.
27:27But the most important number is
27:29that 92% utilization.
27:31What that tells us is when we get
27:34the vaccine.
27:36We get it into people and 92% of all of
27:39our doses are used up and administered on
27:41a weekly basis and that remaining 8% is,
27:44you know, some of that.
27:45We just keep in as a buffer and some
27:48of that just it really fluctuates a
27:50few percentage points depending on
27:52which time point in the week you look at it.
27:55Because we get the vaccine
27:58shipment once a week so that 92%.
28:01Number tells you that we have figured
28:03out the operational issues that are
28:05needed to deliver these vaccines
28:07into people as quickly as possible.
28:10We are ready to take care of everyone.
28:13We are ready to vaccinate and the
28:15only thing we are really waiting
28:18on is is vaccines,
28:19which I'll which I'll touch upon in a moment.
28:23The bottom graph really
28:24just shows the trajectory.
28:26The appointments by day and the
28:28breakdown between Pfizer and Moderna.
28:31Thus far,
28:31the bulk of our vaccine doses administered
28:34have been Moderna going forward.
28:36It will be primarily Pfizer,
28:39but from a practical purpose it
28:41doesn't really matter which one it is.
28:44The point is that we are vaccinating
28:47people effectively and as of today
28:50actually the total dose is given
28:53is is at the 5555 thousand range.
28:56So what I want you to take away from that,
28:59I think is stop sharing.
29:02Is that number one?
29:04We're following the public health guidance
29:05as laid forth by the state of Connecticut.
29:08Currently,
29:08those individuals who are eligible
29:10other than health care workers
29:12or people who are 75 and over.
29:13So we currently have a number of sites open.
29:16What we don't currently have.
29:17What's sort of our challenge right
29:19now is that we just we don't have.
29:22Our schedules are not as open
29:24as we would like them to be,
29:26and the reason is that we haven't
29:28been getting enough vaccine.
29:29So this week is sort of one of our big weeks.
29:32We are. Vaccinating 12,000 people this week,
29:35we've been able to vaccinate 3500
29:36people in one day earlier this week.
29:39And if you've seen some press about
29:41the sites, if you go to the sites,
29:43you see that there are a lot more.
29:46There's a huge amount of capacity,
29:48so we're we're all set up.
29:49We have this staff, we know the model,
29:52and as soon as we get the vaccine we are.
29:55We are.
29:55We are ready to scale up at a moments notice.
29:58So as I mentioned first.
30:00Right now we're vaccinating
30:02individuals who are 75 and over.
30:04We expect the state of Connecticut to drop
30:06that to the people who are 65 and over,
30:09probably in the middle of February.
30:11What we don't currently know is
30:13exactly where the where individuals
30:14with chronic conditions or conditions
30:16that place them at elevated
30:18risk when they become eligible.
30:20We know that they were going to
30:22be eligible well before you know,
30:24the average healthy person with
30:26no clinical issues,
30:27but we're still waiting for that guidance.
30:29So that's just something that we don't know.
30:32But I think again the message should
30:34be rest assured that when we are able
30:37to and we have the vaccine, we will.
30:39We are ready and we are ready to
30:41meet that need and provide the
30:43vaccine as quickly as possible.
30:45A few other questions you
30:47know people have asked,
30:48you know, can I get?
30:49Will I be able to get it
30:51at my smile care center?
30:53I think my answer would be I hope so.
30:56In the mean time you know,
30:57as Charlie mentioned,
30:58these are the two vaccines we currently have.
31:00Our M RNA vaccines and they need to be
31:02kept extremely cold and it's logistically
31:04difficult to distribute and keep them.
31:06You know,
31:07in all the places in the system.
31:09So right now we're really focusing on
31:11keeping it to a limited number of locations.
31:13I think as we get more vaccine,
31:15we figure out the operational issues
31:17we would like to increase that.
31:19Availability and I think,
31:21especially when the Astra Zeneca
31:22and the more importantly I think
31:25the JNJ vaccine become available.
31:27That's something that will be much
31:29easier to stock and distribute and
31:32administer in all of our ambulatory sites.
31:35So I'll stop there I can.
31:37I'm happy to take some questions.
31:39Will keep answering.
31:39I'll look at the Q&A as an answer there,
31:42but thank you for having me just rested.
31:44The rest assured that we are keeping
31:47our carries as safe as possible and we
31:49are eager to provide the vaccine to you.
31:52Well, thank you and really congratulations
31:55to you and your entire team and really
31:58setting the model of of roll out.
32:00'cause I what I certainly heard and I
32:04hope everyone on this call is heard is
32:07that the only thing that is in your way
32:10is just getting supply and the fact that
32:13you can get 92% plus of the doses into
32:17peoples arms quickly really just speaks
32:19to the fact that you've set up systems.
32:23At once we get the supply up.
32:25You're going.
32:25You're going to get it to our patients.
32:28You know, I'll I'll,
32:29we're going to open it up to
32:31sort of questions at the end,
32:33but let me just before I turn
32:35to the next speaker,
32:36let me just offer up one question.
32:38I'm seeing a lot of is do you
32:40have a sense of supply chain and
32:42how that's going to look over
32:44the coming weeks and months?
32:46Yeah, no, that's
32:47that's. That's the right question I.
32:49So as I said, we have a fair amount.
32:52It's this week is a very weak.
32:54Next week we expect to vaccinate,
32:56probably between 5 and 7000.
32:58Again, you know that's
32:59not where we want to be.
33:01We're building this model to be
33:03able to vaccinate forty 40,000 or
33:06more individuals on a weekly basis.
33:08So we have a pretty scalable model.
33:10The issue is that I think in the
33:13next month it's the supply is
33:15going to be a little constrained.
33:17What think people have probably
33:19heard that you know with the
33:21transition of the new administration,
33:23there is a lack of transparency.
33:25Even at the federal level about where
33:27the doses are and how many they actually
33:29have on hand and how to distribute that.
33:31We are all optimistic about the
33:32fact that in the next 10 days the
33:35administration will be able to make
33:36those links understand where things are
33:38and really put the federal government
33:40back on the footing where it should
33:42be such that those those doses get
33:44distributed out in a more effective
33:46and effective way in a higher number.
33:48So I think that you know
33:50next week it will be OK.
33:52The week after I think probably the
33:54two weeks after that are probably
33:55going to be the low watermark in
33:57terms of how many doses we receive,
33:59probably on the order of.
34:01Order 5000,
34:02but I think we are all optimistic that
34:04after that we will get #1 the transparency.
34:07An early warning about when the numbers
34:09that we will get such that we can plan.
34:12And then we also will actually see
34:14more dose does actually come to us.
34:16So I think that by the probably the
34:18third week of February things are
34:20going to ease up substantially,
34:22but the next two to three weeks are
34:24going to be a little tight on our
34:27end in terms of the availability,
34:29I will say that we are opening
34:31schedules fairly regularly, so if you.
34:33You know if you are over 70 age
34:36of 75 and or eligible as such,
34:38I encourage you to check back on the
34:40website at you know periodically
34:42because availability does become open.
34:44Although the demand does demands pretty high.
34:46So it goes pretty quickly.
34:48But we we open schedules on an ongoing basis,
34:51so if you don't see it initially
34:53come back again and hopefully will
34:55have something for you.
34:57Home thank you and I I.
35:00There's a by the way,
35:01I like we definitely getting
35:03your questions online and even
35:05before and we will come to it.
35:07But I do want to also allow our
35:09other speakers to share their
35:11thoughts and then we'll open
35:13it up to the entire patent.
35:15Our panel.
35:16So as I mentioned,
35:17Doctor Karen Adelson is our Chief
35:19Quality Officer and actually
35:20has been to participating in
35:22Guideline Group that the National
35:23Cancer Institute Cancer centers
35:25have been working on four
35:27guidelines for cancer patients
35:28with respect to the vaccine and.
35:31Karen has been gracious to join us
35:33tonight to share the results of that work.
35:36So, Karen, thank
35:37you. Thank you. Thank you Charlie.
35:39I just want to say for all
35:42of us who work in smilow,
35:44we are really so happy that in
35:46the months to come we are going
35:49to be able to offer you the
35:51vaccine that is going to be able
35:53to eventually allow you to start
35:56living life more normally again.
35:58And we know how important that is. Just
36:02a few really big picture points.
36:04I don't have slides, but I've seen
36:06questions from our patients coming in,
36:08and I there's some things I just
36:11want to be able to tell you.
36:13So the clinical trials that were
36:15done that brought these vaccines to
36:17market that proved they were safe
36:20were done in healthy individuals,
36:21not in patients with cancer.
36:23So when we had to set about making guidelines
36:26and recommendations for the vaccine,
36:28we really had to base those
36:30guidelines on our knowledge.
36:32Of immunology and on our
36:34knowledge of cancer biology,
36:35so again, not really based on the
36:38patients we saw in the trials,
36:40but it's really important.
36:42I want everyone of you to realize this.
36:45There is absolutely no reason to
36:48believe that the vaccine will put you
36:51at any higher risk than anyone else.
36:53So we believe fully that this vaccine
36:56should be incredibly safe in cancer patients.
36:59Furthermore,
36:59we know that patients with active
37:01cancer with different kinds of cancer,
37:04blood cancers and solid tumors.
37:06May be more vulnerable to the risks
37:08of getting a COVID-19 infection and so
37:11for patients who have active cancer
37:13and an active cancer treatment.
37:15It's that much more important that
37:18you get the vaccine in the protection
37:21that the vaccine will give you.
37:24There's some other questions
37:25that continue to come up.
37:27What about my family?
37:29And will my family members
37:31be able to get vaccinated?
37:33So the guidelines that we developed in
37:36this and CCN committee that was working,
37:39we really would love to see household
37:41Contacts and family members getting
37:43vaccinated because they put our patients
37:46at the highest risk for infection
37:48just by living in close proximity.
37:50But because the vaccine has still
37:53been in such limited supply.
37:55The current guidelines say that your
37:57family members should get vaccinated
37:59with the group in which they fall.
38:02In terms of age and medical risk.
38:04But we do hope an endorse that
38:07this may change overtime.
38:11The real concern
38:12is not that the vaccine
38:14could cause you harm, but that if you're
38:17on certain kinds of cancer treatment,
38:20you may not amount as robust
38:22an immune response as somebody
38:24who's not on cancer treatment.
38:26And so it's going to be really important that
38:30you communicate with your treating doctor,
38:32your hematologist, your oncologist,
38:34your surgical oncologists,
38:35your GY, an oncologist about the
38:37timing of your vaccine.
38:39So, so there are.
38:41For most patients who are on
38:43our standard cancer treatments,
38:45we absolutely believe you should get
38:47the vaccine and just have a conversation
38:50with your provider about when in your
38:53treatment cycle might be the best
38:55time for you to get that vaccine.
38:57There are select and small numbers of
39:00patients who have been so severely
39:02immuno compromised from their
39:04treatments like patients who've had
39:06a very recent bone marrow transplant
39:08or car T cell procedure somewhat.
39:10Maybe patients who are on chronic
39:13use of drugs like Rituxan.
39:15An Ivy IG that we don't know how
39:17Briskin immune response they'll make,
39:19but we want you to talk to your
39:22doctor about when the best time
39:24for you to get that vaccine is.
39:26Because we.
39:27We again we want all of our patients to get
39:31that vaccine in the protection it brings.
39:33Those are my big picture comments
39:35and then as more specific questions
39:37come in about different scenarios,
39:39I'm happy to answer them.
39:43Karen, thank you. Let me just.
39:45There's one question that keeps coming
39:47in that I wanted to you've kind of
39:49alluded to it, but it amounts to.
39:52People who were on active therapy.
39:56Should they hold their therapy
39:57so that they can get the vaccine?
40:01So most likely the answer to that is no,
40:04we want you to continue your treatment
40:06and we want you to get vaccinated.
40:09But there are so many different treatments
40:11and so many different regiments
40:13that we do want you to talk to your
40:16doctor and decide you know when
40:18in your treatment regiment or your
40:20treatment cycle would be the time
40:22in which you would be most likely
40:24to Mount a good immune response,
40:27and that would most likely be,
40:29you know, not that I'm in your
40:31treatment where you're white.
40:33Blood cells go the lowest.
40:35But again, talk to your doctor
40:37and they will absolutely work
40:38with you to plan the timing.
40:40And then Karen, another question
40:42before we turn to terror sample,
40:44is a number of questions that relate
40:47to should patients with cancer.
40:50Would it be better?
40:51Is there a particular version of the vaccine?
40:54Period Moderna Pfizer Johnson
40:56Johnson maybe even Astra Zeneca
40:58were that to be approved or any
41:01of them better than another for
41:03a cancer patient?
41:04That's a great question.
41:06So Interestingly the two approved vaccines,
41:08the Moderna and the Pfizer RM
41:10RNA vaccines which actually got
41:13their start in cancer treatment,
41:15is how these drugs were.
41:17This class of drugs was initially developed,
41:20so those two vaccines, the approved ones,
41:23are almost like fraternal Twins.
41:25Equally effective, have similar side
41:27effects and both require two doses,
41:29so there's no reason to
41:30prioritize one over another.
41:32The best one for you is the one that is
41:35available on the day that you can get it.
41:39Future vaccines to come.
41:41I wouldn't venture to make
41:43a recommendation until we
41:44see how effective they are.
41:46You know,
41:47there's a high bar now with
41:50vaccines that are 9495% effective.
41:53Thank you, Karen,
41:54and now turning to our last speaker.
41:57I think for those of you who have
41:59been on several of these forms,
42:02one we always want to take time
42:04out during the forums to address
42:07supportive care and Wellness.
42:08Be cause it's hard enough having
42:11cancer or having to care for
42:13family members with cancer.
42:15And this has been a particularly
42:17difficult year, and Doctor Tara Samp,
42:19who is our chief patient Experience
42:22Officer as I know, been.
42:23Working with our teams or patients
42:25families to try to ensure that we
42:28have everything we can in place to
42:30help people through this and terror.
42:32Thank you for for joining us
42:34and sharing your thoughts.
42:36Thank you Charlie and thanks everyone.
42:38This has been a great discussion and I know
42:41that I could listen to Karen Adelson talk all
42:44night about cancer patients and vaccines.
42:47And I know you were just recently interviewed
42:50on our podcast Yale Cancer Center answers
42:52and so for people who wanted to hear more,
42:56I would encourage them to find that
42:58podcast wherever you listen to podcasts,
43:00and Renee can correct me if I'm
43:03saying the wrong information.
43:04I do have one slide to share an.
43:08You know, I just I do think
43:11that it's important to echo.
43:12That while we get our vaccines
43:15and the operations and all of
43:18our patients vaccinated,
43:19we need to continue to support each other.
43:23And this is a very isolating
43:26time for many of us.
43:28If you're feeling particularly
43:30isolated or depressed, you know we
43:33want you to reach out immediately.
43:36When I was asked to present tonight,
43:39I reached out to my colleagues
43:41who are in social work,
43:43integrative medicine, palliative care,
43:44and they all volunteered
43:46to come here tonight too.
43:47We are eager to help.
43:49It's a privilege to be with you at this time,
43:53and we have many,
43:54many offerings that you can choose from.
43:57These are just a few websites that.
44:00Will link you through to different
44:02support groups we have, I think,
44:04about 20 support groups that we offer
44:07and the website lists all of them.
44:09You can choose as appropriate
44:11for you in your setting.
44:13Integrative medicine, you know,
44:17focuses on.
44:18Doctor Sofer says all the things
44:20that we had before medicine,
44:22so the healthy things that we know
44:24work for diet and exercise and sleep,
44:27and they have a number of offerings
44:30and a really lovely website.
44:32And then we have teamed up.
44:34The survivorship clinic has teamed
44:36up with integrative Medicine to
44:38also offer a supplements clinic.
44:40The palliative care services
44:41are located in patient,
44:43an outpatient as well as the survivorship
44:45services which are mostly outpatient,
44:47but we all do in person and virtual visits.
44:51We think of ourselves as an extra layer
44:54of support no matter what setting
44:56you're in or what your issues are,
44:59and this is just a quick visual of
45:01the Integrative medicine website,
45:03and you can see here that they have
45:05links to many different offerings,
45:07and I again I don't want to take up too
45:10much time, but let's stay connected.
45:12We're all one big community and no
45:15matter what we're here for you all along.
45:17So it's been a privilege to be
45:20with you tonight to Ann.
45:22Can't stop sharing now.
45:24Tara, thank you, Ann.
45:28A number of questions that relate to
45:30the work you do before I open it up
45:33to the general panel and thank you for
45:36sharing all those programs and and
45:38making them available to our patients.
45:40But independent of the programs you know,
45:43what advice would you give
45:45patients and families during these
45:46challenging times suggest?
45:48You know? Stay emotionally well
45:51in what is a profound challenge.
45:55Oh
45:55well, you know, I think.
45:57I wish I had the magic words
46:00to make everybody feel good,
46:02but I do think something that
46:04comes to mind to me often is loving
46:07kindness an it's a meditation
46:09practice that basically allows you
46:11to be kind to yourself and kind to
46:14others and be patient and gentle.
46:16This is unprecedented. Times.
46:18We're all doing the best we can do.
46:21And so you know,
46:22I hope that we can feel that towards
46:25ourselves that that kindness
46:27an and some patients as we.
46:30As we wait for this terrible
46:32pandemic to become better controlled.
46:35And then you know,
46:36of course staying connected.
46:38I think as a community has so
46:40many benefits not just to getting
46:42through the pandemic,
46:43but to getting through cancer
46:44care in general.
46:45An it really is a privilege for
46:47all of us to be part of your team,
46:50and so I hope that you can feel
46:52that an an reach out to us and
46:55take advantage of our support.
46:59Tara, thank you. So let me now open it
47:02up to questions and I just want to say
47:05up front we we've received about 70
47:08questions online and prior to the forum
47:11we received somewhere in the vicinity
47:13of about 50 Ice admitted advance and
47:16I just want to say that obviously we
47:19want to address everyone's question.
47:22They'll always be an opportunity to
47:24speak to your provider with questions
47:27we're going to get to as many as we can.
47:30Many of them fall into similar categories,
47:32and obviously I think my colleagues will
47:35do their utmost anticipate other questions.
47:37Let me start with some of the practical ones,
47:40and I'll take turns you on.
47:431st number of questions that relate to.
47:46You know well specifically all in the
47:49theme of Will will Smilow or Yale,
47:51New Haven health.
47:52Contact me for my appointment when
47:54the vaccine is available.
47:56Or do I reach out to the health system
47:59or my doctor? How does that work?
48:02Yeah, it's a great question.
48:04It's something that we've been
48:06talking about a lot about.
48:08I think the answer will change
48:10dependent once the inventory increases.
48:12Right now we are not calling individuals
48:15in particular what we are doing is
48:17that our practices have the ability
48:19to identify the patients who are,
48:22you know, within the they can identify
48:24their patients who are currently 75 or
48:27over and they can let them know about
48:29the fact that there is availability.
48:32We have sent out some.
48:34Mychart messages to patients
48:35who are 75 and over,
48:37indicating that this is now
48:39available and guiding them to
48:41the website as we get forward.
48:43I think we are.
48:45I would hope to use some of
48:47our registries that to enable
48:50people to be identified and.
48:52And you know,
48:53we receive a message of some sort,
48:56but currently we are not calling
48:58patients to schedule right now it is.
49:01It's more of a self scheduling
49:03thing with a layer of notification.
49:05One vaccine is available.
49:08Tim, was there anything you wanted to
49:10add to that other question that came in?
49:13I need something like.
49:14Well, yes, I guess I think the only
49:16thing I would add is that we do have
49:19the you know ability on our website
49:22on the whole system website to to
49:24sign up to receive information when
49:26you're eligible to receive the vaccine.
49:28So you can do that right now and then.
49:31That's a way that if you go to the white,
49:34if the Yale New Haven Health System website,
49:37there is a place right there where you
49:40can sign up for that so that you will.
49:43Receive information as soon
49:44as it's available.
49:46That's great and I I guess we should.
49:49We should have.
49:50Our patients should download
49:51if they can download my chart.
49:53To their phones.
49:54Is that fair to say? Yeah,
49:57I think that'll make that'll make
49:58things easier for a lot of reasons.
50:00I will say that it's not absolutely
50:03mandatory that we you know the
50:05self scheduling interface is
50:06actually it's a web based thing,
50:09so it's not absolutely required,
50:10but if you do have my chart it
50:13will make things a lot easier.
50:15Thank you Kevin.
50:16Dr Billingslea a number of questions
50:19in the here and I'll read one,
50:21but it's a theme I've been super
50:23cautious throughout the pandemic.
50:25Haven't seen my family
50:27or friends since March.
50:28Following vaccinations,
50:29what would be the indicators
50:32needed before I might safely
50:35resume going out in public?
50:37Great
50:37question and I think it's
50:39on all of our minds.
50:41What we do know is that.
50:44You will start to get some
50:46protection after the first dose,
50:48and I'm talking about you know the the
50:50the the vaccines that we have most
50:53available at this time are the Moderna
50:56and the Pfizer which are two DOS program,
50:59one separated with a three week interval,
51:01one by four week interval. Um but.
51:06You really need to get both doses and
51:09what we know from the trials is the.
51:12The real full level of protection
51:15will not be for about a week to
51:1810 days after the second dose.
51:21Now that being said,
51:23we are reminding people that although that.
51:27You should be protected.
51:29You should continue to use precautions.
51:32Continue to wear your mask.
51:35Continue to be safe, but yes,
51:37at that point you should have
51:40some immunological protection.
51:43Thank you. Um? Home a number of
51:46questions and I think related to a
51:49question I'd ask Karen before when
51:52they come do they get to choose,
51:54let's say 3 or 4 approved?
51:56Do they get to choose which one they get?
52:01Yeah, so the short answer is no,
52:04and here's why. Number one that
52:05you know as Kevin just mentioned,
52:08the two vaccines we currently have,
52:10or both M RNA vaccines.
52:11They both have efficacy rates of
52:139495% essentially equivalent.
52:14We at the health system had declared
52:16them therapeutically equivalent,
52:18and so is this date and
52:19so so has the country.
52:21So we receive we don't know
52:23exactly which vaccine we receive.
52:25As I mentioned as.
52:26A list rated on the chart before we've
52:29been giving both and, so there's.
52:33What we have is what we give.
52:36You know there's been a
52:37lot of concerns earlier,
52:39data indicated or seem to suggest that
52:41the Moderna vaccine was associated
52:43with more frequent vex side effects.
52:45The subsequent data that seems
52:46to be that came out illustrated
52:48that the actual frequency of
52:50side effects is about the same
52:52between the Pfizer and Moderna,
52:54but the specific side effects
52:56are a little bit different.
52:57With Moderna you get a little
53:00bit of swelling under the armpit
53:02on the on the side that you get.
53:04Injected on with Pfizer.
53:06There's a slightly higher rate of fever.
53:08Both have muscle aches and joint aches,
53:10so it's you know there's a little
53:13there's not a whole lot of difference.
53:15The side effects are just
53:17sort of an inconvenience.
53:19They only last for a couple of days
53:21and really have no material difference,
53:23so there's no different.
53:25There's no ability to choose between
53:27M RNA vaccines now as we get more
53:30vaccines if we have more available,
53:32you know?
53:33For some reason,
53:34there may be a reason to choose
53:3611 between the other convenience.
53:37You know.
53:38If you're leaving somewhere or
53:40there's a difference between one A1
53:41dose vaccine versus A2 dose vaccine,
53:43these are things that make that
53:45choice a little bit more important,
53:47but in general,
53:48I think the answer is going to be
53:50you're not going to have a choice,
53:52just based on how this is being distributed.
53:56Thank you. Karen, is there any?
54:00Cancer treatments or type of
54:02cancer such that somebody
54:04should avoid getting vaccine.
54:08So patients within three months of
54:10a bone marrow transplant that has
54:13completely depleted the bone marrow of
54:16all immune cells are really not likely
54:19to get any benefit from the vaccine.
54:22So generally our guidelines recommend
54:24waiting until you're 3 months out
54:27from your transplant. Similarly,
54:29potentially with car T cell treatments.
54:31And then there's some other treatments
54:34that are not in absolute contraindication
54:37to responding to the vaccine. But that may
54:40at least slow your immune response,
54:43or may make the vaccine less effective.
54:46Those are people who are on high dose
54:49steroids for long periods of time.
54:51Patients who are on the drug
54:54rituximab may have what we would
54:56call a blunted immune response,
54:58and maybe patients who
55:00receive Ivy IG therapy.
55:02But I would say don't rule yourself
55:05out under any circumstances.
55:06Just bring your specific questions
55:08to your treating, hematologist and
55:10oncologist and they will work with you.
55:13To figure out the very best time
55:15for you to get the vaccine.
55:17Thank you, Karen Terra.
55:19I neglected in my introduction to point
55:22out that not only are you the chief,
55:25patient experience Officer,
55:27you also leave the survivorship
55:29clinic and there actually are a
55:31number of questions related to that.
55:34Namely, should patients who have completed
55:36their cancer treatment sometime ago.
55:38Are they considered different or different
55:41risk related to those in active therapy,
55:44and will they also be
55:46prioritized for the vaccine?
55:50Um, yeah, that's a question I answer
55:53or try to answer 20 times a day.
55:57And you know, the good news is
55:59that patients who are long-term
56:00survivors or outside of active
56:02treatment and on surveillance,
56:04you know, tend to have mostly
56:06recovered immune system,
56:07and so their risk doesn't seem
56:09to be as high as other cancer
56:12patients who are on treatment.
56:16And, you know,
56:16in terms of prioritization,
56:18I guess I'm going to have
56:20to defer that to Karen.
56:23You know you're our patients,
56:24but I do think that we're going
56:26to have to wait and see what
56:28the guidance is on that.
56:30Yeah, I think you know the beauty
56:33of surviving cancer is that you're probably
56:36not at especially high risk, so there's.
56:38There's a good side to that.
56:41An an your you will end up falling
56:43into the category that you fall into
56:46based on your other medical problems.
56:49So if you have heart disease or lung disease,
56:53you may be considered in the category
56:55of somebody who has a comorbidity that
56:58would bring you to an earlier vaccine.
57:01Then I healthy individual who doesn't.
57:03So again, you know you're probably going
57:06to need to talk about your specific
57:09situation with your individual doctor at
57:11the point in which vaccines are being
57:14rolled out to people with comorbidities,
57:16I would say if you're a survivor
57:19but has long term complications
57:20of your cancer treatment,
57:22something like graft versus host
57:24disease or pulmonary fibrosis,
57:25that alone would bring you
57:27to a higher priority list.
57:31Karen Karen, thank you Kim.
57:33A number of questions which I know
57:35you field regularly regarding visitors
57:37both inpatient and outpatient.
57:40That's Milo, you know?
57:41Where are we at now?
57:43Where do you sort of see the
57:46likelihood for change and that?
57:49Obviously that's it's difficult
57:50for families and patients and
57:53love to get your thoughts on that.
57:57His name is Charlie.
57:58Right now we are at a place where we're
58:01continuing all of our visitor restrictions
58:03for all the things we talked for,
58:05all the reasons we talked about earlier,
58:08we're just not at a place where we
58:10could start to allow more Visitation.
58:13I think Kevin talked earlier about how
58:15we know how hard it is for our patients,
58:18whether they're in the hospital or
58:20coming into our clinics or radiation
58:22therapy centers or our infusion centers.
58:24We know how hard it is to come in alone.
58:28We do have exceptions.
58:31That you know, obviously,
58:33that that if it's absolutely
58:35needed for visitor to come in,
58:37there are certain exceptions that we have,
58:40especially for those patients
58:42that unfortunately are nearing
58:44the end of their life and having
58:47a family member there with them.
58:50But it's really to safeguard the
58:52safety of all of our community.
58:54All of our patients,
58:55their loved ones, and our staff.
58:57We still have the same visitor restrictions
59:00that we've had for several months now,
59:02and we do those pre screening
59:05phone calls still as well.
59:06But as Kevin mentioned,
59:08we really want to utilize our technology,
59:10so we really want you to feel free
59:13to you know during your clinic
59:15visit you can say wait a minute.
59:18I really want to get my.
59:20Husband wife my best friend
59:22on the phone here.
59:23I really think somebody needs
59:25to listen to this with me.
59:27You can FaceTime them.
59:29We if you don't have the technology
59:31we have technology to help you so
59:34please if we haven't offered it to
59:36you please feel free to stop us and
59:39and tell us that you need to get
59:42somebody on the line if if you need
59:45your family to here to be there with you,
59:48even if it's through the phone or.
59:51Virtually through through FaceTime resume.
59:53So we are we are here to make sure that we
59:57do everything we can to accommodate having.
01:00:00Having your your support,
01:00:02I'm near you,
01:00:03even if it's not how we
01:00:05have traditionally had it,
01:00:06but as soon as we can safely have
01:00:08you have your support with you,
01:00:11we will be welcoming your friends and
01:00:13families with open arms and it's a big
01:00:16part of how we deliver cancer care,
01:00:18so you know we want to bring
01:00:20it back as soon as we can,
01:00:22but it needs to be safe.
01:00:24Kevin,
01:00:25I don't know if there's anything
01:00:26more you want to say.
01:00:31No, I completely agree with
01:00:33all of those comments.
01:00:36Thank you both home.
01:00:38Some questions what is 95% protection
01:00:41means that in a related point,
01:00:44is that mean I have a 5% chance of
01:00:48getting the infection if I get vaccinated?
01:00:52Yeah, that's the question.
01:00:54So there's a slight difference in
01:00:57efficacy and effectiveness, But yeah,
01:00:59the 95% rate numbers essentially
01:01:02means one out of 20 individuals
01:01:04may not Mount the immunity that's
01:01:07sufficient to prevent COVID-19 illness.
01:01:10So yes, that said,
01:01:12it's as you mentioned earlier, Charlie.
01:01:17So it's a fairly unbelievably
01:01:19effective high and encouraging number.
01:01:21Most vaccines do not have
01:01:23those kinds of performances,
01:01:25so these are these are really
01:01:27special and exceptional vaccines
01:01:29that we were lucky to have.
01:01:32Can I say something about
01:01:34herd immunity just? So so
01:01:36related to what Tom said,
01:01:39is that if enough people in the
01:01:42population have that 95% immunity,
01:01:44the chances that one person who's
01:01:47infected would bump into another person
01:01:50who doesn't have immunity goes way down,
01:01:53and so the 95% vaccination rate or
01:01:56immunity rate should really end up
01:01:58protecting the whole population.
01:02:02Yes. Thank you, um.
01:02:03A cabin or are there certain medications
01:02:06that one should or should not take
01:02:09when they get the vaccine and or should
01:02:13they avoid shortly after getting the vaccine?
01:02:16And I think they're probably referring
01:02:19to like. A motor in Thailand?
01:02:21I mean, that seems to be many
01:02:23of the questions and obviously
01:02:24others can chime in as well,
01:02:26but it's we've gotten a
01:02:27lot of questions on that.
01:02:31Well, I I actually may
01:02:32punt that one to Karen.
01:02:34I'm going to say in my view,
01:02:37I don't think this is been well studied.
01:02:40I think most motor Inn and Tylenol.
01:02:43Are fine and will provide symptomatic
01:02:46relief for people who have low grade
01:02:50fever and symptoms after vaccination, but.
01:02:53Karen White out or on?
01:02:56Why don't you guys chime in as well?
01:02:59The I think the package insert
01:03:02that you get says you can take either
01:03:05an you should you know, treat your
01:03:08symptoms and not not suffer stoically.
01:03:11Yeah, I would agree.
01:03:12I mean, I think I might even go a
01:03:14little further and say, you know?
01:03:16Then maybe the night you go to
01:03:18sleep after getting the vaccine.
01:03:20It may just make things a little
01:03:22easier to take something you know
01:03:23these so I know I called these
01:03:25side effects an inconvenience,
01:03:27but they are real and you know,
01:03:28they may keep people out of work.
01:03:30You feel pretty bad for a little
01:03:32bit and it is a little bit.
01:03:34It's two days, it's three days.
01:03:36It's not going to be more than that,
01:03:38but in the meantime, you know it.
01:03:42Make your life a little easier to
01:03:43take a little Tylenol and ibuprofen as
01:03:45long as it's safe for you to do so.
01:03:47You don't have renal issues or
01:03:49liver issues that would prevent
01:03:50you from taking them.
01:03:51I think that you know,
01:03:52make it a little easier on yourself.
01:03:56Thank you, thank you both
01:03:58for three of you, Tara.
01:04:01Number of questions you know.
01:04:03Obviously, there's been some controversy
01:04:06about vaccinations in general.
01:04:08In in the let us say social media.
01:04:12Should our patients and smilow be
01:04:15worried about people who go online
01:04:17suggesting that vaccines are bad?
01:04:22Well, you know, I think that.
01:04:26We have to be very careful with where
01:04:29we get our information and in general,
01:04:32social media probably isn't the most
01:04:35reliable source because people can
01:04:37post things that are actually not
01:04:39news that they're they're not real.
01:04:42So I think you know this is a great forum
01:04:45that we're disseminating information tonight.
01:04:48We have a website dedicated to
01:04:50covid resources for patients.
01:04:52Ann and I would suggest that,
01:04:54as it's been said, multiple times
01:04:57that patients ask their providers.
01:04:59You know to clarify any questions,
01:05:01so we hear a smile.
01:05:02Firmly believe in the power of
01:05:04medicine and science and vaccines,
01:05:06and we encourage all of our
01:05:08patients to take them.
01:05:09And and I hope that all of our
01:05:11patients feel comfortable bringing
01:05:12questions or if they see something
01:05:15that seems legitimate on social media,
01:05:17bring that to us and we can discuss it.
01:05:21Here,
01:05:22thank you, and by the way,
01:05:23one of our one of our attendees
01:05:25thought thinks your child is adorable.
01:05:29Can be under bedtime, and so you're
01:05:31hearing her now in the background, but
01:05:33I would concur, there's a question,
01:05:35and actually I think it's a very good point.
01:05:37It's a question in a comment, which is,
01:05:40you know, please make sure that
01:05:42people understand that this is free
01:05:43of charge so they don't get scamed.
01:05:45People might take advantage and
01:05:47call you to say you can get
01:05:49the vaccine if you pay for it.
01:05:51Do you want to just talk
01:05:53about that a little bit? Yes,
01:05:55thank you for that question, Charlie.
01:05:56You're right,
01:05:57it's a very important question so.
01:05:59At all of our map vaccination sites we.
01:06:03Let me start by saying there should be.
01:06:06At no point should you have to reach
01:06:08into your own pocket and and and
01:06:10hand over any money for this vaccine.
01:06:13We are what we're doing is we will
01:06:15for individuals who do have insurance,
01:06:17we are billing insurance for a small
01:06:19administration fee and that is how
01:06:21the federal government has set up
01:06:23the payment to cover some of the
01:06:25costs associated with vaccination.
01:06:27So we will bill insurance.
01:06:28We will not. There are no copays.
01:06:30There's nothing out of pocket.
01:06:32And if individuals do not have insurance
01:06:34they will not be charged at all,
01:06:36so it will be.
01:06:37You should at no point have to
01:06:39pay anything for this vaccine.
01:06:40So if someone tells you otherwise,
01:06:42walking directions thank you.
01:06:44I'm Karen, directly for patients
01:06:46who are being scheduled for
01:06:49cancer surgeries or procedures.
01:06:51Should they postpone until they
01:06:53get vaccinated and or will they get
01:06:57vaccinated before their procedure
01:06:59because they're getting a procedure?
01:07:03Unfortunately,
01:07:03I don't think that a scheduled
01:07:05procedure is necessarily going to
01:07:07accelerate the vaccination process.
01:07:09You know, as we've talked
01:07:12about so much of this is.
01:07:15Just a product availability issue.
01:07:19Ultimately, I think it is really
01:07:22important to proceed with scheduled
01:07:24or planned cancer surgery.
01:07:26I think the the potential or an real
01:07:29risks of delaying surgical therapy
01:07:32for cancer far outweighs the risks.
01:07:35And this speaks to the point
01:07:38that I think both Kim and I made
01:07:41earlier that we really continue to
01:07:43exercise extraordinarily vigilant
01:07:45efforts to maintain maintain
01:07:48safety in the operating room.
01:07:50And in the in the hospital for patients
01:07:54who are getting getting care here.
01:07:56Great, thank you.
01:08:00And I'll turn this one.
01:08:02I will offer up to any of our panelists.
01:08:05There's been a number of
01:08:07questions regarding the anecdotes,
01:08:09news about allergic reactions
01:08:10that have been, you know,
01:08:12a promulgated because of the.
01:08:15Limited number reactions that have curd.
01:08:17One is what do we know about that?
01:08:20Should that be a concern for patients?
01:08:23At any of our panelists
01:08:25want to take that one? I
01:08:27might I might take a crack and Karen,
01:08:30you can add so number one.
01:08:32People with histories of allergies are not
01:08:34prevented from getting these vaccines.
01:08:36So what if you had a severe allergic reaction
01:08:38to things like penicillin or something else?
01:08:41What we do is you will wait a little
01:08:43longer after you get the vaccine
01:08:45to be observed to make sure that
01:08:48nothing is happening. There is.
01:08:50There's no allergic reaction that prevents
01:08:52you from getting from getting the vaccine.
01:08:54All of our vaccination sites are equipped
01:08:57with people who can respond to any sort of.
01:09:00Emergency,
01:09:00we have the meds there so there's no.
01:09:04There's really no
01:09:05contraindication care enough.
01:09:08So, so the
01:09:10rates are really really
01:09:11low of severe allergic reactions,
01:09:13so you may hear about it in the news.
01:09:17But given the massive numbers
01:09:18of people being vaccinated,
01:09:20the chance of you having an
01:09:23allergic reaction is tiny.
01:09:25For patients who do have a real
01:09:27allergic reaction, and again,
01:09:29it's extremely rare to the first dose,
01:09:31we would probably have you see
01:09:33one of our immunologists before
01:09:35getting the second dose and would
01:09:37give you the second dose in a
01:09:39controlled environment just to
01:09:41make sure that we have everything
01:09:43around you to keep you safe.
01:09:46Thank you another, I'll just add
01:09:48the number of the number of people
01:09:50who have actually had allergic
01:09:52reactions here that we know is is true.
01:09:55Anaphylaxis is 1. We've had a few
01:09:58others with questionable allergic.
01:10:01Reactions, but true anaphylaxis.
01:10:02There has been one person out
01:10:04of the 40,000 people that we
01:10:06have vaccinated so that just,
01:10:07you know, goes to Karen's point
01:10:09that it is very very very
01:10:11very well. Thank you both.
01:10:14Because the Johnson Johnson and the
01:10:18Astra Zeneca vaccines are a virus,
01:10:21should cancer patients avoid that
01:10:25particular version of the vaccine? There. I
01:10:30think probably the answer in
01:10:32general is. You know what I'm
01:10:35going to defer the oncologist
01:10:37here. I'm a simple internal take that one,
01:10:39so it's but you know it is a virus,
01:10:42but it's it's a virus that is not
01:10:44harmful to humans and it is incapable
01:10:47of multiplying or replicating. It's.
01:10:49It's actually essentially a dead virus.
01:10:51It's not, it doesn't have the ability to
01:10:54do what viruses don't because they've taken
01:10:56that part of the genes out of the virus.
01:10:59Still, really, all it is,
01:11:01it's just a vehicle to put the.
01:11:04Gene the the one gene for kovid
01:11:07to generate the immune response.
01:11:09So it's not all people you know
01:11:11people may have heard that if
01:11:13you're getting cancer therapy,
01:11:15don't get a live virus vaccine.
01:11:17This is not the Johnson, Johnson,
01:11:20AstraZeneca are not live viruses,
01:11:21they are essentially dead viruses
01:11:23'cause they can't replicate.
01:11:25They can multiply in your body.
01:11:27So if you get if you go well, firstly,
01:11:30neither of those vaccines are approved,
01:11:32but if they are.
01:11:34And you go to the one of our
01:11:37offices and that you were offered.
01:11:39The Johnson and Johnson.
01:11:41That's fine, obviously.
01:11:42But first we want to see the
01:11:44results will get them in February.
01:11:46But at the moment,
01:11:48if you were to get vaccinated,
01:11:50unless things change,
01:11:51it will only be the RNA viruses
01:11:53which are not viruses and vaccines
01:11:55that only the RNA vaccine. Rather.
01:11:57And that's Moderna and Pfizer.
01:12:00So let me just say it's it's 8:15
01:12:03and I think terrorist kids need to
01:12:06go to bed and probably all of us
01:12:09need to get some rest for tomorrow.
01:12:12I want to really thank our panelists,
01:12:15Kevin Billingslea on Despond Ekim
01:12:18Slusser Karen Adelson Tera synth.
01:12:20I also want to thank Aliza Folsom and
01:12:22Renee Gaudette for pulling this together.
01:12:25I notice that we almost I think
01:12:27we had up to about 600 people
01:12:30on the on the system here,
01:12:32and that does include people who
01:12:34were probably watching through
01:12:35alternative things online.
01:12:37So really an extraordinary turn out.
01:12:39Obviously this is of great interest,
01:12:41so I just want to say,
01:12:43Doctor Charles Fuchs can send
01:12:45director and physician Chief want
01:12:48to thank all of you for attending.
01:12:50We really appreciate your courage through
01:12:52all of this and you know you have.
01:12:55You should know we're here for
01:12:56you and we're always available.
01:12:58We didn't get there every question,
01:13:00but you can always reach out
01:13:03to us with your questions.
01:13:05You're important and we are
01:13:07going to make sure that we all
01:13:10get through this pandemic,
01:13:12get vaccinated and move on with our lives.
01:13:15So for now.