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COVID-19 in 2021: Vaccines, Treatments and Other Healthcare Challenges

As 2020 ends, the U.S. is experiencing record high numbers of COVID-19 infections and deaths. There are reasons to hope for better days in 2021, thanks to new vaccines and improved treatments, but experts warn that the pandemic battle remains a marathon, not a sprint.

“With COVID-19, you need up to 75- or 80-percent of people to have immunity to really halt the transmission and to slow it down to the point where we can go back to normal,” said Samer Fahmy, M.D., chief medical officer at Boca Raton Regional Hospital [1]. “We could achieve this herd immunity through vaccination. It’s going to take a huge public health information campaign to make sure that people understand that this is a safe and effective vaccine.”

Dr. Fahmy was among the experts who discussed the latest information on vaccines, therapies and the continuing impact on our healthcare system in a recent episode of Resource Live [2], hosted by Jonathan Fialkow, M.D. [3], chief of cardiology at Miami Cardiac & Vascular Institute [4] and chief population health officer for Baptist Health.

Madeline Camejo, Pharm.D., chief pharmacy officer and vice president of pharmacy services at Baptist Health South Florida, and Rachel Evers, R.N., director of surgical services at Baptist Hospital [5], joined Dr. Fahmy to share their insights on what to expect in the new year. Highlights of their discussion are in the Q&A below.

Dr. Fialkow: “The Pfizer and Moderna vaccines have received something called an EUA. Can you explain what that is?”

Madeline Camejo: “An EUA is the emergency use authorization. It allows the pharmaceutical companies to quickly go ahead and disperse medications to the public. This is only usually granted during public health emergencies, but it’s not just dispensed without review of data. They really do a deep dive on a big section of the safety data before they’re allowed to release it.”

Dr. Fialkow: “So, the EUA does not mean necessarily that we’re cutting corners. There’s been a proper vetting process in the vaccine’s development. Is that true to say?”

Madeline Camejo: “That’s true to say. It’s an independent panel of scientists who actually review the data.”

Dr. Fialkow: “What are the CDC and the Florida Department of Health recommendations regarding how the vaccine should be rolled out in various populations?”

Madeline Camejo: “First, it’s the healthcare workers, the emergency responders, nursing home patients. That is in the first phase, what they call 1A. Once all of those people are vaccinated or the majority, more than 60% is vaccinated, then we start going on into the next phase. 1B is patients who are at a high morbidity risk or other types of essential workers that are needed in United States. Then it’s teachers and everyone out in the public we depend on, and then the last is always the general population.”

Dr. Fialkow: “Any information regarding dates of the vaccine roll-outs?”

Madeline Camejo: “My guess would be that we’re going to stay in phase one for all the healthcare workers and the long-term care folks, probably until about mid-February. Until more and more vaccine comes to the market, then the faster we can get through the phases. But, as of right now, I would say probably that phase two would probably be from February until about April. And then, maybe we could get to the general public closer to late spring, early summer.”

Dr. Fahmy: “I’d like to add to that. We’re all waiting for that moment when we go back to normal and we don’t have to wear masks and we don’t have to distance, but I don’t want to give the wrong message. Just because we have this vaccine doesn’t mean that you immediately should take off your mask or that we should stop the precautionary measures that we have in place. We have to be careful until we know more information.

Dr. Fialkow: “Sam, can you talk about developments in treatments for people who get COVID?”

Dr. Fahmy: “Sure. We are armed today with many more tools at our disposal than we were back in March and April when this pandemic first hit us. The mainstays of treatment in many of our hospitals are medications like remdesivir and dexamethasone, so a steroid and an antiviral drug. When you give them early on in the disease process, they can prevent the lung damage from occurring before you develop COVID pneumonia. No doubt that we have a lower mortality today than we did nine or 10 months ago when this started. A lower percentage of our patients are ending up in the ICU because of the use of those meds.

“We have medications for people that have mild or moderate symptoms that do not require hospitalization. There’s now immunotherapy with medications like bamlanivimab and (the antibody drug from Regeneron) where we can use these drugs to prevent the progression of disease in people who are not too sick. That really takes some of these high risk patients and reduces the amount of patients that end up in the hospital almost by 70 percent in the studies that were published.“

Dr. Fialkow: “We’ve discharged more than 8,600 COVID patients across the Baptist Health system. Rachel, can you give us a sense of the impact of COVID on the staff and the mood?”

Rachel Evers: “Well, we have our moments of our highs and lows, right? Last week, here at Baptist Hospital, we discharged our 2000th patient. To be a part of that moment when he’s walking to his car was an overwhelming sense of pride. And then, we have other days that aren’t such a win for us, right? We experience loss. We see families go through things. We have to take a wife to visit her husband in the ICU to say goodbye. It’s an emotional roller coaster at times and it’s been a very long journey. We’ve been at this since March.

“Healthcare providers, in general, do a really bad job of taking care of themselves. But I think that we’ve learned through this journey that we have to take care of one another, or else we’re not going to be able to get through this. We have to take care of ourselves so that we can continue to celebrate these moments like discharging so many patients.”

Dr. Fialkow: “Madeline, what do we tell people who are afraid of vaccines or distrust vaccines to get them to be responsible and take the vaccine?”

Madeline Camejo: “I think the biggest thing is, what’s the risk? COVID-19 is a huge gamble. Is getting a vaccine that might have a little bit of side effects a big deal, or do you want to face possibly dying from COVID-19? Because there are no guarantees. The virus works differently on everybody. It’s really a personal choice, but come on, let’s get vaccinated so that we all can stop spreading this disease and get to herd immunity.”