Healthy at OTC

COVID Town Hall Transcript

Below is a transcript of the COVID Town Hall for Ozarks Technical Community College employees recorded live on Wednesday, Aug. 11. The speakers are Infectious Disease Expert Dr. Robin Trotman of CoxHealth, OTC Chancellor Dr. Hal Higdon and OTC Spokesperson Mark Miller.  The text was created from a recording of the town hall using the transcription service Rev. OTC has not edited the transcript provided by Rev.

Mark Miller:   

Welcome to this Ozarks Technical Community College Town Hall about COVID-19 for OTC employees, and thanks a lot for joining us today. I’m Mark Miller, the college spokesperson, and joining us today is Dr. Robin Trotman, an infectious disease expert from CoxHealth and of course, our Chancellor, Dr. Hal Higdon.

So, first a little background on Dr. Trotman, he attended the University of Texas in Austin for his bachelor’s degree, so his Longhorns will soon join the Southeastern Conference, along with Dr. Higdon’s Alabama Crimson Tide. I got Dr. Higdon to promise that there would be no football trash talking today on the webinar. So Dr. Trotman, rest assured that’s not going to happen. He also went to the Kirksville School of Osteopathic Medicine, with internships and residencies at Mizzou, plus he did a fellowship in infectious disease at Wake Forest University in North Carolina. He’s also an Assistant Professor of Medicine for the University of Missouri, and most importantly, he’s a fellow in the Infectious Disease Society of America. So, most important to our discussion today. So, Dr. Trotman, thank you so much for taking the time to join us today.

I’m going to jump right in with questions that were pre-submitted from our employees. So Dr. Trotman, just first of all, is the vaccine safe to take?

Dr. Robin Trotman:    

So I speak to this and there are about 100 aspects of the safety of these vaccines that people want to hear about. We have it prepared for these, this is going to be casual dialog I hope, because people don’t want cable news talking heads condescending to them and they just want to know honest neighbor opinions. I live in this community, I have family here, kids here.

So here’s the thing that speaks to people the most. I have 12 and 14 year old daughters who both got the vaccine five days after approved for kids. Okay, so that is probably the glaring feature around the safety that… about the two things I care the most about in my life. So my interpretation of all of the evidence about safety resonates so strongly that I would give it to my two most dear treasures in my life.

Here’s the… we’re going to talk about this outside of the context of the misinformation. So if we have vaccinated 180 million people, what have we seen as signals of any type of concern with the vaccine? People’s arm hurts, they get lymph nodes, they have a fever, they feel crummy, I couldn’t hardly get out of bed that night after the second dose, so those are good things. At Cox we vaccinated over probably 105, 110,000 people and nobody has died as a result of the vaccine. So misinformation number one, 12,000 people have died after they’ve received the vaccine. Well, let’s think about numbers and just normal actuarial data, if 180 million people have been fully vaccinated and there’s over 300 million vaccine doses out there. The normal death rate in the human population from car wrecks and cancer and heart attacks is such that there is not a spike in death rates after this vaccine. So it is true that people have died after receiving the vaccine. The vaccine, as Paul Offit would say, and we’ll talk about that later, it doesn’t give you invincibility. It doesn’t make you not vulnerable to car wrecks. So when people say that, what about the 12,000 people who died who had the vaccine? If you put that in the context of 300 million doses of vaccine, it’s what we would expect.

I’m going to just talk about a couple of things that do happen. So there are some signals of some very rare side effects with the vaccine. It’s safe enough that all of these side effects that I’m going to talk about, potential rare side effects, outnumber the rate of the similar conditions from the natural disease. Oftentimes, a vaccine side effect is similar to the disease, just much more rare. So we see Guillain-Barré after influenza and one in a million people with the flu vaccine can have Guillain-Barré. So, these associations exist but they’re far less common after the vaccine.

The first one that people hear about is myocarditis, inflammation of the heart. So, what we know is maybe one in 50,000 young men, adolescent men can have inflammation of the heart. Then you compare that to the rate of myocarditis after COVID. Now, all of these cases of inflammation of the heart, one in 50, one in 70,000 cases have all been reversible, not fatal, and self limited. But if you get COVID, you have about a one in 50 chance of inflammation in the heart as seen on cardiac MRIs. So one in 50,000 versus one in 50. So tested, they looked at Big 10 athletes and they published this is JAMA, so Big 10 college athletes that had COVID, they did cardiac MRIs on them and it’s about a 2.3% of those people had inflammation in their heart because they don’t want these athletes to return to participation and they have a sudden cardiac death. So they scanned their hearts and they found about one in 45, one in 47 had inflammation in their heart. So you got about one in 50 had myocarditis, not always symptomatic but could be if they participated in run track or whatever. Then one in 50,000 after the vaccine, so that’s the kind of risk that we’re talking about.

No decision in life comes without risk, this is not a risk-free decision to take this vaccine. It’s, do you want the risk that you know that rare? One in 50,000 myocarditis and you know this, or do you want the unknown risk of what’s going to happen with the infection? So that’s how I help people understand these safety issues. It’s not a risk-free decision like everything in life, but do you want the known risk which is rare, self limited, or do you want the unknown risk of the disease? So when I tell people I want to be honest and I want to say there are rare, rare side effects. Guillain-Barré one in a million after the vaccine.

So some of these issue I think should help people understand and hopefully give us credibility. I wrote statistics down in case I get specific questions, but yeah, none of the side effects from the vaccine are even remotely on the order of 1,000 times as common as the complications of having COVID-19. I hope that makes sense.

Mark Miller:    

That makes perfect sense. Essentially, we’re just saying is that the risks of getting COVID-19, the health risks far outweigh the minimal risks of taking the vaccine.

One specific question we got two or three times was about fertility, reproductive health for young women. What can you tell us about that?

Dr. Robin Trotman:  

Yeah, that’s a good one because that’s the unknown, that’s an emotional trigger for so many of us and I completely understand why people are hesitant to that, because it’s something that’s hard to prove. If you get a vaccine and you have arm pain or it turned red, you know that side effect but if you have issues and questions around fertility, how are you going to really know?

But let’s just back up and go, where do these concerns come from, and if you really want to go down the disinformation rabbit hole, this is one of the most illustrative issues around public disinformation. It literally has resulted in loss of life, so the disinformation and the fear around infertility and the vaccine has resulted in people not taking the vaccine and becoming sick and oftentimes dying.

Now, the wave we’re seeing right now is very different than a year ago. A year ago, we had lots of older patients from nursing homes. We have parents of school age kids, we have people that I look at that are my contemporaries. So so this issue around protecting that population is probably even more important now than it was a year ago, but if you look at the… if you want to know, do these mRNA vaccines affect fertility? We don’t have any signals of that yet. If you think, if we vaccinated 100… if we vaccinated almost half of the US population, we should see birth rates going down, right? And we’re not seeing that. If you look at the phase three studies where they gave it to placebo and Pfizer vaccine, placebo and Moderna, you had the same amount of pregnancies in the placebo group that you did in the control group, the mRNA vaccine group. So as of now, if you look at the big data, there are no signals of infertility around this vaccine.

American College of Obstetrics Gynecology, they recommend it, these are the people who are out to protect women of child bearing age. I mean, these are the biggest advocates for those people, and they’re the ones who sift through the data and they don’t want anything to affect their population, and they advocate for the safety of the vaccine. So I think this notion of the spike protein and the [inaudible 00:09:17] protein, that’s misinformation, that’s not even remotely scientifically proven. People want to know, well, if you make antibodies to spike protein it cross reacts with placenta proteins, but people make antibodies to spike protein when they get naturally infected, but then they can still get pregnant. So, we have people who were infected last year and they still got pregnant, so those antibodies to the spike protein from the virus and from natural infection versus the vaccine, they’re the same antibodies yet people are getting pregnant. So as of right now, we don’t have any signals of fertility issues, and the data would suggest that it’s safe for those.

I hope that clarifies that, it’s a tricky one that early on we had just a rush of disinformation from people who were disenfranchised Pfizer employees that had a track record of conspiracy theories. So we can see where this was born out of, but we just follow the data, we follow the evidence. We look at, are we seeing a decrease in birth rate? What did the phase three studies show? That’s where the evidence is.

Mark Miller: 

Got you, Dr. Trotman, thank you. I’m going to switch to Dr. Higdon here for a few minutes. Dr. Higdon, we answered many of the questions we got in yesterday when we announced that mask will be required for everyone starting yesterday. Take us through the thought process that got the college to that point of why we decided to require everyone to wear masks and not just the unvaccinated.

Dr. Hal Higdon:  

As the community’s community college, we can’t ignore the data that we see. We see the illness, we see the hospitalization, we see the death rate. Our colleagues at Missouri State and Drury saw the same thing, Springfield public schools, Bolivar schools, Republic schools, and I did not want to be at this place. I did not believe we would be at this place in May when we ended this, but we did not account on the low vaccination rate, we didn’t count on the delta variant. So we took all that into account, if we were at 90% vaccination rate in this community, we wouldn’t be in masking, probably. But until the disease lessens and the vaccination rate goes up, we’re going to have to be masked.

Mark Miller:   

Dr. Higdon, we’re not going to require vaccinations. Take us through that process right now.

Dr. Hal Higdon:   

Right, we’re not requiring vaccinations. The only people who will have vaccination issues are those allied health science students, where the hospitals where they do clinicals require those vaccinations. Obviously that’s beyond our control and we certainly support that decision, but the college will not be requiring vaccination by employees or students.

Mark Miller:  

Dr. Higdon, one thing I got was, well we require other vaccines, why wouldn’t we require this one? We don’t require vaccines as a college, mainly [crosstalk 00:12:16]-

Dr. Hal Higdon:   

Right, we’re not a residential facility. When I went off to school I had to prove my vaccinations because I lived in a dorm. If you go to Mizzou or Missouri State, you do. We don’t have dormitories so that’s not an issue for us.

Mark Miller: 

All right, Dr. Higdon, thank you.

Dr. Hal Higdon:

[crosstalk 00:12:30].

Mark Miller:   

Dr. Trotman, I’m coming back to you here for a few questions. There was a very specific question about the VAERS website or the Vaccine Adverse Event Reporting System. Questioner says that their family members are telling her that thousands of people are dying and you’ve addressed that, but after taking the vaccine. Talk to us about that VAERS reporting website and causality versus correlation.

Dr. Robin Trotman: 

Yeah, I mean that’s a volunteer… so here what we… okay, let me back up. Anytime you have a drug you have what’s called pharmacovigilance, which means we’re going to be vigilant about monitoring for unforeseen complications. Vaccines have always had this adverse event reporting system, which is voluntary, but and they get screened. Now, we also have the app, if everybody’s had the vaccine you had the app and you can punch in how you’re feeling at that day. Then we have ongoing clinical trials. So there has never been a drug in human history with this degree of what’s called pharmacovigilance, so followup and safety monitoring.

When you start talking about 300 million doses out there and you talk about vaccinating the world, and we’re looking at these with vigilance, that it’s never been done before with any drug. We all take medicines that have not had this much experience both in clinical trials and in pharmacovigilance. So this is being followed with incredible scrutiny.

Then what you do is you look at the fact that, like I said, people are going to die after they receive the vaccine. I mean, I don’t think that anybody ever suggested that the vaccine is going to provide immortality to people, it just doesn’t. So the VAERS reporting systems reports numbers, outcomes, and death rate, and that doesn’t make a causal link at all. So people are going to have cancer, they’re going to have car wrecks, and there’s going to be traumas immediately following the vaccine. When you start talking about numbers of 300 million doses, you’re going to look for things like disproportionate death rates in the vaccinated group versus the general population. We have those statistics, the deaths get reported. So we know percentage of car wreck deaths and we know percentage of… so that’s where those numbers come out, it doesn’t tell you that this vaccine caused that, we’re not seeing an increased death rate in the population, short of COVID-19.

So what we do know is we know that in one point in time we were having 2,000 deaths a day from those severe infections. That is going to affect the national death rate, but we’re not seeing that from the vaccine. So to your point, causality versus that a death is linked, it’s pretty clear.

Then we look at our healthcare system. I mean, how many have we vaccinated through CoxHealth? Over 100,000 and we’re not having people die from unexplained causes, we haven’t seen that at all. So, yeah, that’s a hard one to put down. People just hear that, that one’s easy to beget on social media platforms but yeah, there’s not a causal link.

Mark Miller:   

So then the big question is, okay, so you’re telling us it’s very safe. Then why does it not have full FDA approval and only the emergency use authorization? Can you talk to us about the difference there and that extra scrutiny it has to get beyond the EUA?

Dr. Robin Trotman:  

So the emergency use authorization, so first of all, this vaccine went through the same clinical trials that any other product goes through, through the FDA. Phase one, phase two, phase three. Here’s the difference, when the government through Operation Warp Speed said we’re going to underwrite this process, we’re going to pre-purchase vaccines so that the manufacturers don’t have the risk. So the manufacturers can build the manufacturing facilities, hire the people, buy the vaccine making stuff in advance of seeing it go through phase one and phase two and phase three. So the infrastructure was already there.

When a phase one study’s done, they send it to the FDA, they look at it, they wait on a hearing in maybe six months, then they go to phase three. The FDA said this is important, we’re in the middle of a once in a lifetime existential crisis. We need to expedite our normal bureaucratic train that goes so slow. So they put these studies actually in tandem, so phase one, phase two, phase three can run without having to wait on a period where you’re waiting on the FDA and some sort of hearing. So that really squeezed the time down, that’s the same process you would go through full licensure through the FDA.

When a drug or device or vaccine gets full approval from the FDA, everything gets authorized, the manufacturing process gets scrutinized, it’s a completely different process than saying the vaccine is safe, because what’s going to happen is other manufacturers are going to come in and use that same technology and that same blueprint. So they have to approve the whole process, you understand? They have to be able to say, “Here’s how you keep your factory clean, here’s you have quality assurance,” so that someone else could come in and do that behind. That’s what full FDA approval looks at.

You do want to have safety data several months out, and we didn’t have that urgency. I mean, we’ve been given this vaccine for over a year, so we have far more safety data than many fully licensed drugs that are out there right now. I mean, way more, and we’ve been giving the phase two studies, were way before August of last year. So we have tons of data, the FDA probably around September will put the rubber stamp on it, but again, they have to look at the factories, make sure everything’s standardized. All of the process of manufacturing, quality assurance, maybe mid-September. That’s what they have to assure to get full approval so that anybody could come in behind them and duplicate that and make with consistency the same vaccine or drug.

So yeah, I mean it’s a global health crisis, we don’t have the time to ensure that it’s standardized so that anybody can pick that up, and that’s the difference in the EUA.

Mark Miller:     

So maybe just what I heard you say is, the medical portion of it, the testing portion of it to make sure that there are no side effects and things like that, that all has happened. Really, it’s more the bureaucratic, the checking of the facilities and all that stuff, that’s still what is awaiting full FDA approval.

Dr. Robin Trotman:  

[crosstalk 00:19:14].

Mark Miller:    

The safety portion, the safety for human beings, that’s done and they’re sure of that.

Dr. Robin Trotman:

Yes, so those phase three studies, let me explain something. If anybody is a science person, you’re going to really get a kick out of this. When you do science, you have to wait on enough of the disease, if you have a disease, you’re trying to prevent it. You have to be able to show separation with the vaccine group and the placebo group. When there’s so many cases in the community where you’re given the vaccines, they showed that separation really quick. I mean, the vaccine studies, they gave it to 30,000 people, they thought it was going to take months and months but there was so much COVID infection that the vaccine group separated from the placebo group. It would’ve been unethical to continue to give people placebo at that point because they knew they were saving lives. That is the hallmark of a very powerful study when you can’t even… when it finishes you have enough patients in enrolled to show statistical significance so significant that it would unethical to continue to give placebo to people.

So that’s how the vaccine’s made it to fruition so fast, because there was so much disease. If it was a rare infection, if it was tetanus, I mean, we would never… we would still be studying it because we don’t have enough tetanus cases to show benefit with a vaccine. So yeah, all of the study outcomes, all of that, that’s the same as the medicine that you’re taking for your thyroid or your blood pressure or your diabetes. An identical process with even more pharmacovigilance. So but yeah, it does make people nervous because you go, how did they do a phase three study so fast? Well, because the burden of the disease was so high that they were able to show a difference between placebo and drug quick.

Mark Miller:     

Got you, well then I think a lot of people’s concerns then, a lot of the questions we had. How can we know the long-term side effects or potential long-term side effects of the vaccine if it was in this compressed time period?

Dr. Robin Trotman:  

Well, I mean so at that point in time, I would argue, how do you know the long-term side effects of getting COVID-19? I mean, you don’t know the long-term side effects of the apple that you just ate. We know that this mRNA that we inject in your muscle is gone pretty quick, your body has mRNA in it all the time. It chews it up, you have digestive enzymes in your cells to degrade it, that mRNA is gone, the lipid nano particle is out of your system.

So we haven’t ever had a vaccine that had a one-year post surprising side effect ever in the history of vaccines. There’s never been a vaccine where two years later we went, oh, oops. All of these things, once you give them to five or six million people, you see the side effect, that vaccine is gone. So there’s no precedent for somebody to say, “Well, what about in 10 years?” Well, I mean what about the energy drink that you just ate? You have no idea what’s in that. At least I can tell you what’s in this, and I can tell you the disposition of all of the compounds that are in the vaccine, and they’re gone. So, I feel safer with the disposition of that vaccine in my body and what’s going to happen, than I do the long-term side effects of COVID.

I have a whole clinic full of people that still can’t walk up a flight of stairs, their brain still is foggy, can’t smell, they missed work, they lost their job because they were out sick and couldn’t perform their function. So I mean for people going through OTC, if you’re about to come out and hit the workplace, you want to be bombproof. You don’t want to go get a new job tomorrow and be out for three weeks with COVID, that’s not going to look good with your employer. So this really is the way out, especially for young people going through training and trying to find employment.

Mark Miller:    

Talk to us a little bit about, people were vaccinated but still got COVID or they’re vaccinated and we’re hearing that people… can you still spread COVID? Those are…. what does it mean that oh, I got vaccinated, I still got the disease, or I may be asymptomatic and we’re hearing that you can spread the disease. Can you talk about those issues?

Dr. Robin Trotman: 

So it’s a respiratory virus, so there’s a five day incubation period. Somebody coughs in your face and you have virus in your nose and your throat. Your immune system is in your blood and your lymph nodes, some in your throat, but it takes a few days for that to rev up and do its thing. So you’re vaccinated, you may get a runny nose because the virus is replicating in your nose. We know that we can find viral RNA in your nose but we don’t find a lot of viable virus, and those people don’t go on a get sick. So never before was this virus advertised as preventing infection. Infection means somebody coughs in your face, that virus is coming in your nose. It’s not a barrier, a mask is a barrier, a face shield’s a barrier, and it’s going to replicate in your body and it’s going to be detectable with a swab, but you’re not going to get critically ill. Now with the delta variant, we’re seeing rare cases in people with weak immune systems who do end up in the hospital but it’s very, very rare.

So yeah, you can still get infected if you don’t take care of yourself. That’s why you guys are going to have masks even for vaccinated people because I can’t guarantee that I don’t cough something in your face, I don’t talk, put respiratory droplets in your face and they you transmit to somebody unvaccinated, and so we have to stop that chain. Every time this virus replicates in a different person, it mutates and it’s going to mutate and escape our vaccines and our own immunity and three years from now if we don’t get a hold of this, we’re going to be back where we started.

So yes, there are chances you could get infected, you will not likely get sick and end up in the hospital. Your duration with which you can transmit the virus is going to be shortened incredibly. Your illness duration statistically is going to be shorted, and you’re going to transmit way less. So when they… the study that you just looked at from Massachusets, that’s what changed the masking with the CDC. I mean, that was based on them being able to detect RNA in people’s nose, which is exactly what you would expect if you were unmasked, somebody coughs in your face. So the distinction is, it is intended to prevent severe disease.

Mark Miller: 

Hey, Dr. Trotman, I’m going to switch back to Dr. Higdon. Are you okay to go a little past 4:30?

Dr. Robin Trotman:   

Yep.

Mark Miller:     

Because I got 4:27, I’ll try to be quick here, but Dr. Higdon, people want to know, what are our quarantine rules for those who are vaccinated and exposed or unvaccinated and exposed?

Dr. Hal Higdon:   

They’re different than last year because we didn’t have vaccination but if you’re vaccinated and exposed to someone who has COVID but you do not show symptoms, you do not need quarantine. If you are unvaccinated and exposed, whether you are symptomatic or not, you must quarantine. If you’re symptomatic regardless of vaccination status, you must quarantine for 10 days.

Mark Miller:   

All right, and we’re going to fire up the contact tracing, case management, I mean that’s been going all summer. We haven’t had as many students on campus, but that’s going to going, right?

Dr. Hal Higdon:  

You’re right, so if you’re an employee or a student and you test positive or that whole protocol, you will contact just like you did in the spring. Hopefully everybody will be vaccinated and masked by the time school starts and we will have very low incidents, but knock on wood.

Mark Miller:      

Testing this semester, Dr. Higdon, we’re not going to have on-campus testing?

Dr. Hal Higdon: 

We did on-campus testing when testing was rare, hard to find. You can now go to the health department, you can go to the hospitals, you can go to Walgreens, you can go to CVS, so. You can go get testing so we won’t be doing testing on campus.

Mark Miller:       

hen you talked about quarantining, so if you’re exposed or if you’re symptomatic, what’s in place for employees who may have to quarantine for themselves or for a sick child?

Dr. Hal Higdon:   

We have a very generous sick leave and vacation pay and vacation leave and personal leave, and if you’re out sick you would use your leave just like normal.

Mark Miller: 

I think Dr. Higdon, it feels like 100 years ago but it was just March of 2020, we shut the college down and moved everything online and then slowly brought back those lab classes. I think everybody’s wondering, what are the chances we could get back to that?

Dr. Hal Higdon:      

Barring a massive outbreak of disease, that would be something we’d do in consultation with the health department, people like Dr. Trotman, Mercy and Cox. I don’t see that happening, we learned a lot of important lessons, by the end of that semester we had figured out in tech ed and health sciences how to do socially distanced labs, that sort of thing. But the big thing we learned is that masking works. Dr. Trotman told us early on it worked, we listened, and I don’t think we’re going to have any problem making those work here in the fall or hopefully when this will be lessened by the spring or even the spring. My hope is that we end masking as quickly as possible but that’s up to the disease, and frankly it’s up to our employees and our students to get vaccinated if they’re not already.

Mark Miller:     

[crosstalk 00:28:34], right? So-

Dr. Hal Higdon:      

Yeah, if only OTC gets vaccinated, it doesn’t do any good.

Mark Miller:      

That’s right, yeah.

Dr. Hal Higdon:       

[crosstalk 00:28:42].

Mark Miller:     

We can be 100% [crosstalk 00:28:43].

Dr. Hal Higdon:

Southwest Missouri.

Mark Miller:       

We still have to live in the world, right?

Dr. Hal Higdon:    

Right.

Mark Miller:           

So Dr. Trotman, Dr. Higdon talked about masks. Talk about those, do they help slow the spread of disease? Are there negative impacts to wearing them? I mean, some people are saying they cause diseases.

Dr. Robin Trotman:       

Yeah, so they… yeah, the cause disease is misinform… here’s the thing. This virus has a lot of allies. Never would I have thought that we would have a pathogen that had allies, and the allies are the misinformation people who go online. The virus is not being transmitted because of mask.

This is the question I ask people, if I have COVID and your grandma’s standing in front of me, do you want me to sneeze with a mask on or without one on? Do you want her to have one or without? So, if the answer to that question is no, then we can’t really advance this conversation past right now. So if you say, “I don’t want to mask and you’re sick and my grandma’s going to get coughed on,” so once we make that assumption that we know that a physical barrier probably decreases transmission. Is it always 100% effective? Well, probably not, nothing is, but when you’re talking about a hospital system that I run the infection control, where we have 100… at one point in time we were having hundreds of healthcare workers exposed every day. Okay, patients, come in, we don’t know they have COVID, healthcare worker has a mask on, they didn’t get sick. Okay, so I watched this happen every day because remember, our testing took remember way back a year ago, it took us a couple days to get test results back. Now we all test in-house, but we had exposures every day and when the healthcare worker had on eye protection and mask, they didn’t get sick, they didn’t test positive.

There was a great article, and I’ll try to email it to you, that had a list of 49 articles, scientific papers showing efficacy of masks. We published the case at Great Clips, if you remember back a year where the hairdresser was sick and none of the clients got sick. So we know this, we’ve done this over and over, and there’s so much confirmation bias where people want to grab onto one anecdote or one non controlled paper, but I always just rewind it back to the fact, if I’m going to cough on your grandma and I have COVID, do you want us both to wear a mask? If the answer’s yes, then let’s just start building on that faith.

There are no adverse consequences of wearing a mask. I’ve had one on… I work 12 to 13 hours a day every day. I mean, four months without a day off almost, and had a mask on the entire time. No adverse consequences, I just can’t think of what it would be short of this misinformation.

Mark Miller:

Well, that has a followup. Many people live with children who are too young to get vaccinated or those who are immunocompromised. So I think what they’re wanting to know, especially our faculty who are face to face with students so often, if they’re vaccinated and wearing a mask, how confident should they feel that they’re not going to take that home to their kids or to their immunocompromised loved ones or something like that?

Dr. Robin Trotman:

So if you’re vaccinated and you have good mask compliance, meaning everyone in your campus is wearing a mask face to face, the probability of getting infected is pretty low. We know this within our healthcare system, with 12,000 employees, we’re watching these things happen, people test positive.

Here’s where they do get sick, and here’s where we do have healthcare workers test positive who are vaccinated. They don’t get severely ill, but theoretically yes, they could go home and transmit it to their vaccinated loved one who’s immunocompromised and responds less well to the vaccine. So if somebody’s getting chemotherapy and they were vaccinated, they may not respond as well and then that worker who got exposed can transmit to them and maybe they have the sniffles for a day. So that chain is going to happen and the mask might be ineffective, but here’s what we learned. Over 18 months, the majority of our transmissions in our healthcare system were behind the scenes, they weren’t patient to patient, they were either at home or they were in the break rooms where people took their guard down. So we had outbreaks within certain units in the hospital or certain clinics that were all linked when we traced them, back to the break rooms. People take their mask down, they’ve learned since then, and they sit and have lunch and chat like we have to do as humans. That’s where we saw the outbreaks.

So yet when the worked face to face with patients with COVID, everybody wore masks, they didn’t get sick. So, I think that it’s one of those things where it works if you keep your guard up all the time but if you have that distancing, if you can find ways where you can eat and drink and be separated in space or time, it could be done. Those areas you can take your mask down, but boy, if you’re trying to keep operations going and you want to go through school and you’ve paid tuition, and you want to make sure you’re in-person for your education, which is your soon to be livelihood, it’s your talent, it’s your new identity, you want to be in class and you don’t want to be quarantined. So get vaccinated and wear a mask, and then you won’t be quarantined for exposures or isolated for infection. I mean, this is your one shot. I look at it with my kids, I’m like, this is important. High school first day, so I want them bombproof.

Mark Miller:

Oh yeah, bombproof is a good way to put it. Bombproof from anxiety of starting high school would be good for parents too, right?

Let me talk to you a little bit about testing, a couple of things. A lot of people said flu nearly disappeared. We were all wearing masks, we were social distancing. Some people I think thought maybe COVID cases were misdiagnosed and they were really the flu. Are there two separate tests? I mean, do you test people’s nose swab for COVID and influenza? I mean, how do you know those weren’t influenza?

Dr. Robin Trotman:          Yeah, so that misinformation, I’m glad you asked that. We have tests that detect multiple respiratory pathogens. The main tests that we use test for influenza, COVID, Flu A, Flu B, and COVID. We didn’t see Flu A or B this year, I mean, incredible. Greene County was having three or four cases and we were still running influenza tests because remember early on, we were looking diligently for COVID infections because we didn’t know a lot about the virus. We tested with high scrutiny for influenza, looking for flu, and just didn’t see it across the US.

The way that PCR testing works, it cannot be false positive COVID because of influenza. They’re not the same family of viruses, the testing technology’s not the same, we used specific influenza test, we even have the cartridges, our main test that a lot of hospitals use that detects the genetic material of Flu A, B, and COVID. Rarely would we have somebody co-infected. We had a couple of those early on, but no, flu went away because of all of the mitigation. We saw a good uptake in the flu vaccine this last year.

Mark Miller:

Can you educate us about the PCR antigen tests and their accuracy level, and maybe what those differences are?

Dr. Robin Trotman:

Yeah, so the PCR detects the RNA of the virus, it’s very sensitive, it looks for dead or live virus genetic material, not live virus. So if I get COVID and you do a PCR test on me, that will detect the RNA pretty early, so just the genetic material of the virus. Even when I’m better, it will detect it for several days afterwards, maybe months. We learned all this last year, we had people who were infected and they had a positive test 90 days later. So that’s the PCR, because what happens is you’re white blood cells eat the virus, they still live in your lymphoid tissue, your lymph nodes. Those white blood cells have that RNA in them because they killed the virus, and so a lot of times you’re detecting dead RNA.

The antigen tests looks of the antigen, the protein on the outside of the virus, so you need actual virus. So it has a shorter window of positivity, so it may take another day to become positive and then it’s become negative quicker. So somebody could theoretically on the tail end of their disease have a negative antigen test or at the very front, but when the antigen test isn’t as good as the PCR as far as sensitivity, meaning it might miss some people, but when there’s a lot of cases out here, a positive result in an antigen’s a positive test, but when the cases start to go away, that test can have false positives, but like for instance if there was no COVID, then a positive result might actually be a false positive but when it’s high, those are all… and we confirm these for months and months. We did antigen tests, confirmed them with PCR. So your window for antigen’s a little less good, it’s a little less sensitive, and PCR can stay positive for months or weeks.

Mark Miller:

Got you, thank you. One questioner wanted to know, are hydroxychloroquine and ivermectin effective treatments for COVID?

Dr. Robin Trotman:

Yeah, I mean I wish. So here’s the people who say that I’m on the nickel for pharma, let me put that to bed, that I’m getting paid by big pharma. That’s the incentive, right? Remember, the government bought those vaccines, we don’t pay for those vaccines. Nobody gets any money, they’re not FDA approved so they’re not marketed, so there’s no drug rep out there selling these vaccines, and no doctor anywhere in the US gets paid any money for anybody getting a vaccine. Now there’s fees that hospitals can charge insurance for administering the vaccine, but no doctor gets money for the volume of vaccine that’s used.

The same goes with hydroxychloroquine, our healthcare system when we first had discussions that it worked, we bought a bunch of hydroxychloroquine for a lot of money. We hoped and hoped that it was going to work. Not only did the clinical trials, where you do randomized placebo control trials, so you give half the people hydroxychloroquine, half get placebo, and they end up in the hospital the same amount. You can only do those studies for so long, and when the data are so compelling, you have to stop, you have to move on. So we’ve moved on from hydroxychloroquine. I’ve taken care of hundreds of patients who took hydroxychloroquine and ended up in the ICU. I’ve seen thousands of patients with COVID, it’s all I do all day.

We have patients on ivermectin right now, that’s the big craze. There were originally studies that had signals that it reduced the amount of RNA in your nose, but when you test ivermectin versus placebo in large, multinational randomized placebo control trials, it doesn’t help. So at a certain point in time you can’t continue to give something that in randomized placebo… just because a doctor says he gave 100 patients last year ivermectin and they get better. Well, we had 300 patients that got vitamin C and they got better, because remember, most patients didn’t end up in the hospital before the delta variant. So of course the doctor says I gave it to 100 people and nobody ended up in the hospital. That was the normal course of the disease untreated.

Now with delta, we have an ICU and there are dozens of people who’ve taken ivermectin in the hospital. It doesn’t… we have not seen it been the curve and when you apply the rigor of science, we’re all trying to look at things through an objective lens. I hope it worked, I mean I hoped and hoped it would work. I don’t want to do this anymore, I don’t want to see people sick in the hospital. We hoped that it would work, but really, I can’t ignore these compelling randomized placebo control trials. That’s all, and people can take that or leave it. I know people are dug in out there, I wish it worked, but they could come in our hospital right now, dozens of people who’ve taken ivermectin and they still get unfortunately, still get sick.

What we do know and this is a PSA on my behalf now, the monoclonal antibodies do work. So if somebody gets infected, you really need to call your doctor and look at the monoclonal antibody, the Regeneron, the REGEN-COV Infusions. Those really do help, both in the evidence, in the literature, and in our experience. So I would not waste people’s time on ivermectin, I would probably go and again, those are emergency use authorization, they’re distributed in a different way, hospitals aren’t making money on these, we’re not buying Regeneron and making money. It’s the government has subsidized this. So those drugs do work and I really, really want people to seek those out if they get sick and get infected.

Mark Miller:

Dr. Trotman, I’m going to have one more question for you, a few more for Dr. Higdon, and then wrap it up. One thing a lot of people wanted to talk about or have you talk about is, how do they talk to their friends, their students, their family members, their colleagues, who are reluctant to get vaccinated? Tell us maybe what you see every day and how many people who you’re treating who aren’t vaccinated versus those who are vaccinated, their level of disease, talk to us a little bit about that.

Dr. Robin Trotman:

I mean, it’s an existential crisis right now. The healthcare systems are stressed, this is a pandemic of the willfully unvaccinated. So this is a self-inflicted problem right now. As Dr. Higdon said, we have choices right now and we have the opportunity to do something.

So I tell people, if you’re reluctant to take the vaccine, I admit, this is not a risk-free decision. Both have risk, there’s side effects, risks, but do you want the known risk that we know is very small, or the unknown risk? Now again, a year ago, I would’ve said, “If you’re healthy, save the vaccine for the old people, for the immunocompromised, just take care of yourself, you won’t end up in the ICU.” Shadow me for a day, 20 to 30, 40 year old people, contemporaries of mind, seemingly healthy, in the ICU critically ill. We didn’t think this would happen, I used to be able to predict who was going to get critically ill. I used to be able to say, “Well, 92-year old patient on steroids, immuno… she’s not going to do well but he’s going to do fine.” Anymore, we can’t predict that.

We’re out of ICU doctors, we’re out of nurses, we are struggling as a healthcare system to take care of this preventable disease. Do we see people in the hospital that are vaccinated? Rare, we do, I mean I can’t lie. The vaccine was never reported to be 100% effective in preventing symptomatic disease, but they are rare. Almost all of them, you could’ve predicted who’s going to get vaccinated yet get sick because their immune system was already weak. They wouldn’t have responded to any vaccine.

So I tell people, picture an ICU with 70 patients, the median age, meaning half are above and half are below, being 50 years old. That’s very different than a year ago. A year ago we had nursing home outbreaks with 90 year olds and it was awful. This is worse because this is people our age. The healthcare workers, the nurses, RTs, they’re taking care of patients that they’re looking at in the mirror, it’s that compelling. So I tell people it’s a pandemic of the willfully unvaccinated, you need to take care of your community, you need to think altruistically, and then think about it in terms of risk. You don’t want to be in the ICU, you do not want to see me in one of our ICUs. It’s not good, and unfortunately this delta variant is more severe, people get sick faster, we’re pretty confident in this. So it is about risk, it’s the risk you know or the risk you don’t know. So that’s how I try to help people wrap their mind around it.

Then I will send you the link or you can post that link to that Echo that we did with Dr. Paul Offit. He really does a better job than I can of quantifying those risks and giving you the speaking points to say, “Yes, that risk is there, myocarditis in a young man can happen. Here’s the numbers after COVID, here’s the numbers after vaccines.” So, I try to listen when you’re talking to family members and loved ones and they’re really reluctant to take the vaccine. I really try to listen, I try to hear their concerns, validate their concerns, a lot of uncertainty. Understand where they get their information, that’s important.

Then just trust your trusted health experts. The only vested interest I have in this is human health, that’s it. There is no financial gain, I want this over, I want to get back and go to concerts and feel comfortable. So that’s about all I have to offer.

Mark Miller:

Dr. Trotman, thank you so much. Hang on one second, really quick. We got a couple of things just about classroom management with Dr. Higdon. Dr. Higdon, should instructors from seated classes allow students to voluntarily attend virtually?

Dr. Hal Higdon:

That is a question really I would not want to interfere in the provost’s role, that is Dr. McGrady’s role. Dr. McGrady, the deans, the department chairs, would be better to answer that. Obviously we’re in a very different position than we were last year but I’m going to leave that to Dr. McGrady.

Mark Miller:

Then we talk about flexibility, Dr. Higdon, on due dates, expectations on attendance. I mean, we’re pretty much back to normal unless a student is impacted by COVID, right?

Dr. Hal Higdon:

We are back to normal, we’ve been back in person for a year, unlike some of our sister institutions in other parts of the state, Southwest Missouri, we safely went back to school last year and we were masked and we’re going to be masked again. So I would say it’s all systems normal, but I always know that our faculty and staff have a heart for students. I would say that to be as flexible as you can, keeping in mind that they’re here to learn and they can’t learn if they’re no in class or attending virtually. Again, I would refer to Dr. McGrady and the deans on that.

Mark Miller:

Sure, and again, [inaudible 00:47:06] here on working in pairs or groups. Avoid working in groups, but there are just some classes it cannot be avoided. So we just want everybody to do their best to keep everyone safe.

Dr. Hal Higdon:

The only thing I would say is if you’re vaccinated and masked, I’d feel a lot better about being in the classroom than I would be unvaccinated and masked. One of the two are good, both of them as Dr. Trotman said, bulletproof or bombproof. We want that, if you believe in superheroes, you want that shield around you like Captain America, and that’s the vaccine.

Mark Miller:

Raise deflector shields. So Dr. Trotman, you’ve been very generous with your time. We thank you, we appreciate the work you and all the other healthcare workers do to keep our friends and loved ones healthy. This has just been so educational. Do you have anything you’d like to add that we may not have addressed here today?

Dr. Robin Trotman:

Yeah, I mean I have a personal interesting in the welfare of OTC because I have a clinic, I have a practice, I run infection control in our hospital. Your students and some of your faculty are in our building, I want them to be well. That’s it, that’s the only driver, the North Star of all of this, all of our time, unrelenting efforts in our healthcare system is human health. So I do care about those people because I have people I work intimately with that trained at OTC. So I do have a vested interest in it and that’s all it is, and I hope that people will come away with this.

There is one more medical issue. People want to know if they’ve been infected, should they get an antibody test, and this is I’m sure a question we’ll get, and then not get vaccinated. But there was an MMWR that was just published, great infographic if you want to look at it. If you’ve been infected and you get vaccinated, your neutralizing antibodies are through the roof. You want to talk about superhero status, superhero powers, that would be the person who was previously infected and got two mRNA vaccines. That’s a good situation to be in, that’s one where I would feel comfortable being in a classroom with 100 people masked and I wouldn’t think twice about it.

So the big question, if you’ve been infected, should you get vaccinated? You got to wait until you’re no longer symptomatic, you’re out of your isolation period. Sometimes I tell people wait, maybe wait a month, make sure you’re feeling better, and then get vaccinated anyway. Then you’re in the best situation.

Mark Miller:

Well, I said I wouldn’t ask any more questions but you just raised one. If you have had COVID, that doesn’t mean you’re bulletproof and you don’t need to get vaccinated, right?

Dr. Robin Trotman:

No, we have reinfections, it’s a hard number to quantify, how many people have been previously infected that get sick. You do have pretty good durable immunity but it’s probably not as robust. It does last a long time but it probably doesn’t fire up as good. So I recommend people, you get COVID, get over it, wait a month or so, make sure you feel better, and get your two shot mRNA vaccines.

People ask about the Johnson and Johnson vaccine, there is a group of people that we don’t give it to. We don’t give it to women of child bearing age because there is a risk or increased risk of blood clots. It’s less than smoking, so the Johnson and Johnson blood clot risk is way exponentially less than smoking and some other issues that increase your clot risk but it is out there, some platelet issues. So young and middle aged women I recommend they don’t receive the Johnson and Johnson vaccine. They can but it’s, we’re talking in the orders of one in several hundred thousand risk, but it is there.

So yeah, if you’ve had COVID, go ahead and get vaccinated but wait until you feel better. Then like you said, my [inaudible 00:50:53] is just trust those of us in the public speaking world and maybe even just think about flipping your civil duty and responsibility to that of altruism, and maybe not for people who see the polarization of our community and our society, that doesn’t help. This is not a red or blue issue, this is a humanity issue. So think about it through that lens, think about it through the traumatized nurses that have had five young people die in the last month, think about your duty and responsibility.

Then get through your classes there and stay safe and get out in the workforce, we need people right now. That’s my PSA.

Mark Miller:    

Dr. Trotman, thank you so much. Dr. Higdon, final thoughts?

Dr. Hal Higdon:      

Dr. Trotman did a better job than I did. I would just say if you’re an employee of the college or a student of the college and you’re watching this and you’re not vaccinated, you should be convinced after this. Don’t listen to misinformation, listen to smart people. I’ve always found that if I listen to people smarter than me, I do better. There’s nobody I respect more in this town than Dr. Trotman and the organization he works with and Mercy and our health department. They’re here to help us, please listen to them.

Mark Miller:    

Hey, my rule is, I listen to people who are smarter than me and that’s why I’m a good listener, so. So faculty, if you have any other questions of an academic or classroom management question, please talk to Dr. McGrady, email her. For other questions we may not have answered here today, you can send those to communications@otc.edu, but I appreciate everyone who submitted questions. I tried to get to them all here today, we planned to go half an hour, we went almost an hour because Dr. Trotman was so awesome and again, we thank you so much.

So, thank you everyone for attending today. Dr. Trotman, thanks for being our special guest. Hey, have a good evening.