Dartmouth-Hitchcock Health COVID-19 Video Update, April 21, 2021

– Hi, I'm Dr. Michael Calderwood, Chief Quality Officer here at Dartmouth-Hitchcock Medical Center. I'm gonna spend the next 20 to 25 minutes talking about COVID-19 with
some updates for patients, staff, the community,
and members of the press. And we're really gonna
focus on common questions that we've been receiving. There will be a time at
the end where I can come to questions that we are having submitted. So I want to welcome you all
to submit those questions. We'll try to get to as many as we can. I do wanna start with a brief update for folks of where we are
both here in the United States and then more locally in New Hampshire. Over the past week, there have been an average
of 77,000 new cases of COVID-19 reported daily
in the United States.

That is up about 25,000 from where we were on a
daily basis a month ago. And similarly, in New Hampshire, we're seeing our number of cases increase back to where we were around Thanksgiving. And so, while we had reached
a new low in mid-March, cases have been on the rise, and we've seen about a doubling
up until about a week ago, and we are beginning to see
things show some improvement, and we're hoping that
that trend will continue.

In terms of hospitalizations,
here in New Hampshire, we've also seen a doubling. And so, we are up to around 130 patients who are hospitalized with
COVID-19 across the state, and this is something that's
being closely monitored to understand which
direction that is going. Thankfully though we have
not yet seen an increase in the number of deaths from COVID-19 back to where we were when
we were hitting our peak in January of 2021. What we are seeing, however, is that those who are being most impacted in terms of cases and hospitalizations are shifting towards younger age groups that have a lower rate of vaccination. This highlights the fact that we need to really think
about what we can do to keep ourselves and our community safe.

So many have heard that New Hampshire has lifted the statewide mask
mandate as of last week. But I wanna remind folks that all cities within New Hampshire, and many towns, as well as many businesses,
continue to advocate for masks, and mandate, in many cases, masks. We're all frustrated that
this pandemic is not over, and we want to remove our masks. But if we remove our masks too early, and we don't maintain that
physical distance from others, it's only going to prolong our fight. So what can you do? We're getting more and
more people vaccinated.

We can gather in homes with
others who are vaccinated. We can remove those masks
in private residences, as long as those around
us feel comfortable. We do have to recognize that people have a different level of comfort. And so, you may gather with some who still want those masks on, and we have to respect their wishes. What this means is that we
often will go into a home wearing a mask, and see
what others are doing. If we have conversations,
everyone's been vaccinated, we feel comfortable, we
can take those masks off. As we go out into the community, we have to think about indoor environments where we don't have a lot, or as good ventilation as we
may in an outdoor environment. Can we physically distance from others? And when we can't, can we wear a mask to protect ourselves and others? And this will be particularly important as we go into the summer.

We're going to begin to see things like sporting venues and
fairs that are opening up, and it's exciting that we're at a point where we actually can begin to think about re-engaging in a lot of these activities. But these are times
where we're going to have a prolonged exposure to others. And so, we want to think about that mask as a key part of our defense. We need to remember, as has
been spoken about by many, that none of the vaccines
are 100% effective. And while those who are
vaccinated are much less likely to become severely ill to the point where they require hospitalization, or die from this illness, they
can still transmit to others. We are hearing about cases
of breakthrough infections. Often, with people who
have milder symptoms, don't always know that they
are carrying the virus, and are out and about in the community. And so, that mask is an added layer as we think about what we
can do to protect others before we have a higher percentage of our population that's vaccinated.

Currently, the New Hampshire
Medical Society is urging individuals, communities, schools, and businesses to really
to continue to advocate for mask use until we at least achieve 70% of our population that
is fully vaccinated. At the same time, we
want to begin to see that our community rates of
infection are on the decline, and I mentioned earlier,
we have in the past month been seeing an increase.

Where are we now? If we look across the United States, 33% of adults 18 and older
are fully vaccinated. Within New Hampshire, that is 35%. So that is a great start, but it's only halfway
to that number of 70% that we need to achieve before
we can really begin to say we can back off on a lot of the things that have been keeping us safe. So what I will say is
that for all who can, getting vaccinated is
both highly encouraged, and for many should be
considered a civic duty. This is really what we need to get to the point where
we can end this pandemic. A lot of questions about
the safety of vaccines continue to come up. I think it's important to
recognize that at this point we have given over 200 million
doses of COVID-19 vaccines to over 130 million people, and that number is increasing every day.

We are getting incredible
amounts of safety data. This is tracked very closely by the CDC. You can go on their
website, and actually look, and find in real-time data
on what is being reported. We know that significant side
effects are extremely rare, and each one of these is investigated. In fact, we recently had
a pause on the J&J vaccine after six individuals developed a rare form of blood clotting. We need to understand though
that this was six individuals out of close to 7 million
doses of the J&J vaccine. So this was less than one in a million in terms of the risk of that side effect. I wanna highlight for folks
that it is much riskier to actually get illness from COVID-19. Amongst those that fall
ill from this virus, we know that one out of every five has a risk of blood clotting, some of these very severe,
including things like stroke in individuals at a young age. The CDC and others have
been looking at the data, and we expect that by later this week we will have further guidance on the use of the J&J vaccine, and we expect that we will
begin giving this vaccine to some potentially as early as next week based on that guidance.

Moderna and Pfizer vaccinations
do continue at this time, and in fact, Dartmouth-Hitchcock
Medical Center is now one of the places where you
can sign up to be vaccinated. And then, before I go
to the questions, I do, I want to acknowledge that we probably are only at the beginning of the impact of this virus. We are beginning to learn
that 10 to 30% of people who recover from COVID-19
report lingering symptoms that can at times last more than 12 weeks. These can be things like
shortness of breath, rapid heart rate, body aches, fatigue, and brain fog amongst others.

And for some, these symptoms are mild, but for others, they can be debilitating. And so, Dartmouth-Hitchcock
Medical Center is launching a clinic for those with
post-acute COVID syndrome, sometimes referred to as long-haul clinic, or long-haul COVID. More information on this clinic
is available on our website, and we will provide
emails and phone numbers for you who are interested, and your primary care
providers can access that if that would be helpful
for you as individuals. We continue to learn about this virus, about post-COVID-19 symptoms, and these types of care centers are gonna be really
important as we think about our comprehensive and coordinated approach to COVID-19 aftercare. So I do see that we have some questions, and I'm gonna answer those.

The first question is about
what is the right percentage of the population that
needs to be vaccinated? And there isn't, there's
not a perfect number. A lot of people talk about herd immunity, and we've heard people
talk about 70%, and 80%. The actual percentage
is based on two things. It's based on the effectiveness of the vaccine that people are getting. And so, as we see new variants, some of these vaccines might
become slightly less effective. That's why we need to get more
and more people vaccinated as quickly as we can. The second is viruses tend
to transmit to more people depending on which
variant you're looking at.

And so, if you have a variant where you're going to infect more people, you need to have more people vaccinated. We're using 70% as the number
that we want to get to. And so, that is really what
we are trying to achieve, and we think at the current
rates of vaccination we can be there by early summer. But again, that requires that all who have access to a vaccine step forward and get their shot. Another question is, "I'm
already fully vaccinated. "Why do I still need to have
a COVID test before surgery "when being admitted to a hospital?" And this is something that we're actually looking at quite closely. And so, we know that amongst those that have had pre-procedural testing, your chance of having a positive
test drops significantly after being vaccinated. At the same time, we know
that you may not have the same symptoms, and
we're going to bring you into an environment where
you may undergo a procedure where we can aerosolize
some of that virus, or put you in a room
with others who are ill, and we wanna make sure we're
doing everything we can to protect others in the community, and to make sure that you
are going through a procedure where you're not gonna
have an adverse outcome because of a virus you
didn't know that you had.

Third question is, "If all
of the adults in our house "are vaccinated, but the kids are not, "what's the biggest risk to our household "at this time regarding COVID-19?" It's a question that we get a lot. And so, what I will say to that is we know that children are much less likely to end up with severe illness, to be hospitalized, to die. And so, we actually have had
no deaths under the age of 20. What we are really focused
on is thinking about transmission to others in the household. And so, as we're thinking
about what we can do locally versus regionally and across the country, those conversations
are slightly different. If you're choosing to
gather with another family in your home, do folks
all need to wear masks? Some people may have a conversation and feel the adults were all vaccinated, it's a small gathering, no, we do not.

Now, that's a different conversation if you're talking about
going to a theme park, traveling on a vacation. We need to think about those risks, particularly if you're then returning, and going to schools,
participating in sports, and thinking about what that could mean for transmission to others. Fourth question is, "Is
the J&J vaccine safe "for people with a mutated gene?" They don't specify what
the mutated gene is. We know that the clotting
that is being seen is similar to Heparin-Induced
Thrombocytopenia, or HIT. And so, they're looking
at the genetics of that. Again, it's a very small number. And so, they're looking at all sorts of different risk factors
to identify commonalities. So at this time, I can't answer specifics about any mutated gene. Next question is, "Is it safe to fly?" And so, again, it is safe to fly.

You have to think about what
you do to keep yourself safe. And so, I continue to advocate that all who are on planes
continue to wear a mask both going into the terminal,
going through check-in and security while waiting for your plane. Those are actually probably
the highest risk periods, in the busy terminal. On the plane, because of the air handling, it's actually a lower risk. We know that on planes
people take off masks to eat and drink. And so, it's important to realize that there will be times when
those masks are off, but we're trying to limit the amount of time that that occurs.

Some people on planes are
choosing to wear two masks, or to wear an N95. We don't know if that is
actually more protective. We think that two masks may provide a slightly higher level of protection if others around you
are not wearing a mask, and that's why some choose to do that. If everyone's wearing a mask,
a single mask is effective. The bigger thing, rather
than just the airplane, is thinking about when you're traveling, who are you engaging with? And we tend to be more
social in our travels, and we eat out more often,
and we go to larger events. And we wanna think about what we can do to protect ourselves in
terms of physical distancing, in terms of masking when
we're around others. And that's it in terms of the questions that we're receiving. So I really appreciate the opportunity to speak with you today. Please continue to visit
our website, dh.org, for the most up-to-date
information to stay informed. Take care, good day..

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