210416-ne-vaccine

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>>BOB ZALTSBERG: This is MORNING EDITION on WFIU. I'm your host, Bob Zaltsberg, co-hosting today with WFIU News Bureau chief Sara Wittmeyer. And we're updating the COVID-19 situation after the Johnson and Johnson vaccine was suspended and we're talking about ways to combat vaccine hesitancy. We have four guests with us joining us by Zoom. We have Penny Caudill, Monroe County Health Department Administrator, Shari Lewis, who is the Greene County Health Department administrator, Dr. Tom Hrisomalos, who's an IU Health Southern Indiana Physicians provider, and he specializes in infectious disease, and Lynn Thoma, HealthLinc Pharmacy residency program director. You can follow us on Twitter at @noonedition and you can send us your questions there, and you can also send us your questions for the show at news@indianapublicmedia.org. Thank you all for being here with us today. Dr. Hrisomalos, good to have you back, and I wanted to start the show with you just to talk about, you know, where we are here in Monroe County with IU Health in terms of the spread of the disease. And then, you know, I'd ask you to talk a little bit about the Johnson and Johnson suspension. 

>>BOB ZALTSBERG: Certainly. Yeah, glad to be back. You know, from - I think people are certainly aware of the statistics, and I think Penny can certainly bring those more up to date perhaps better than I can. We're certainly less - we're seeing less COVID infection than we did a few months ago in November and December, but we haven't - we sort of plateaued at a lower level. The hospitalizations have decreased, but we still have patients who we're treating for this. So we're not out of the woods yet, but I think things look a little bit better than they did two, three months ago, and we're hoping that we don't see any increase in cases as restrictions and so forth are lessened around the state. 

>>BOB ZALTSBERG: Why don't we wait for the Johnson and Johnson discussion, I'll go to Penny next and then Shari and talk about, you know, your different county's statistics. And Penny, I know that Monroe County has kept restrictions in place. We've had some questions to WFIU about how long we're going to be masking here in Monroe County, so if you could just give us an overview and then talk about some of the specifics of the restrictions. 

>>PENNY CAUDILL: Certainly. And I have to tell you, I had some technical difficulty, so I apologize if I missed an earlier question or something. But we are very concerned about the uptick in cases that we are seeing and the variants. The UK variant is predominant now in the U.S. and in Indiana, and we know that that's more easily transmitted, so we are continuing our mask mandate. The current regulations kind of stand as they were at least until May 28, and then the board will meet - the Board of Health will meet on May 4 and they'll look at what the current data is, what the situation is, and make some determinations about what to do next. They could certainly rescind those regulations early or make changes to them early or they could extend it if they - if numbers are continuing to rise and not improving. So essentially, we just need everyone to continue to make their appointments to be vaccinated at their first convenience to do that, but also to maintain all the other precautions that we've been doing this past year or so. And that includes masking, washing your hands, maintaining a physical distancing with people that are outside of your household and unvaccinated and those kinds of things. We can get through this, I believe, if we just continue to do all of those things and get - until we can get people vaccinated and we get a high percentage of that. 

>>BOB ZALTSBERG: Penny, what's the thinking in Monroe County about keeping in more restrictions than the state has after Governor Holcomb lifted a lot of those restrictions? 

>>PENNY CAUDILL: Well, you know, we have been a little bit different from the state - and there are other counties. I think there are about 10 other counties who have kept their mask requirement or other restrictions when the state lessened theirs and took those away. And, you know, I have to say that I'm concerned that part of that relaxation could be feeding what we're currently seeing. We're all tired. We're tired of wearing masks. We're tired of, you know, having to do all of these things. And so when we - I think with the - when we hear and feel like, oh, you know, you don't have to do this anymore, you think that everything is fine and it's not. We're getting there. I don't want to sound, you know, like, you know, I'm totally negative. I think that we're getting there. We're making good strides, but we need to continue to do these things. It's what has kept, really, Monroe County in better shape than some counties. We've had our own challenges and I - certainly everything has not been perfect here. But we have also had situations that have been better than many other counties. Shari Lewis from the Greene County Health Department, you're in a more rural setting and I'd like for you to go over the numbers that you're seeing. Are you seeing an uptick since the mask ordinance was lifted? And is Greene County just following the state's lead? 

>>SHARI LEWIS: Yeah, so Greene County is currently following the state's lead because we're still in a low - very low to moderate spread. We're blue on the county's color-coded metric map, and our Board of Health will look at that and make a determination if we need to instill more guidelines than what the governor currently has in place if we move up in the color-coded map. So, for example, if we go to orange or red, we may incorporate mask mandates - move from an advisory to a mandate again. 

>>BOB ZALTSBERG: How successful have you been in getting vaccinations in Greene County? 

>>SHARI LEWIS: You know, we started out very well and it seems like once the county opened to - or the state opened to the age range 18 and older, we saw a slowdown. So we definitely see some vaccine hesitancy between individuals from 18 to, you know, 50 years old. It has been very concerning, especially as things are opening up again here in the state of Indiana, to get those individuals interested in getting vaccinated. The best approach that we have now is reminding people that, if you are fully vaccinated, you do not have to quarantine if you're in close contact. And, you know, this may be important to people because it allows them to continue to do some of the things that they couldn't do before under a more restrictive. 

>>BOB ZALTSBERG: All right, thanks a lot, Shari Lewis from Green County. We'll talk more about the hesitancy here in a bit. Lynn Thoma's joining us today, and Lynn is HealthLinc Pharmacy residency program director. And Lynn, we've done several programs on COVID this year, but we've not talked about the pharmacies' role in trying to help eradicate this pandemic. So, you know, I want to ask you to talk about, you know, how this has changed the role of pharmacists and how you're - you know, in your residency program, how you're training pharmacists during this time period. And if you could unmute. 

>>LYNN THOMA: Sure, absolutely. Thanks for the question. So, first of all, I would say that, you know, pharmacies playing - along with, like, local health departments and hospitals and community health centers - playing a large role across the state and across the nation and getting people vaccinated. So we have several chain pharmacies across the state of Indiana and as well as several independents that can vaccinate. So, you know, if you're using that website - the ourrshot.gov - you can certainly choose a pharmacy to get your vaccination at as well. But it's - I don't know if Shari or Penny is the one that said it, we're all just very tired. So that's how things have changed the most because, just like with everybody else, we're doing our normal jobs - so, you know, taking care of patients in the pharmacy, checking prescriptions, doing all of those day-to-day tasks along with giving vaccines. And then my practice site specifically is within a federally qualified health center, so we've been vaccinating since about mid-January and continue to vaccinate now. And so we have really pulled all of our pharmacists out of the clinic for - not full time, but anywhere from, you know, 40 to 80% so that they can help with these vaccination efforts just because, like, we didn't have extra resources when we started this. So our pharmacists, our care team, nurses, our medical assistants have all played a huge role in making sure that we get our communities vaccinated. So that's been huge. And as far as the residency program goes, it's just been a whirlwind of a year all around. So just making sure that they're up to speed on flexibility and adaptability, which I think that they are at this point. 

>>SARA WITTMEYER: I have a question for Penny. So throughout the pandemic, we've seen that most cases and and deaths certainly were among older Hoosiers. And I'm curious, with the numbers ticking up now and more older Hoosiers are vaccinated, what age group are we seeing most of these cases in? 

>>PENNY CAUDILL: Yeah. And in our 1:00 press conference, you'll probably the hospital talk more more about this as well. So I mentioned a couple of weeks ago we're seeing more cases in the 20 to 30 year olds. Certainly we still see cases in all age groups. And, you know, we've got - not everybody has been vaccinated and nothing is perfect, and so you could still get infected even if you were vaccinated. So although that risk of that is low, we're seeing cases in younger people and the hospital has been reporting that more of their hospitalizations as they are increasing are in that, like, 30 to 40-year-old group. So that, again, very concerning and a reason that we want people to be vaccinated. I think the fact that we can see that deaths have slowed drastically, hospitalizations in those older, more vulnerable populations have slowed - that's an indicator to me where we've done a good job of getting people vaccinated, that works and that helps. And so if we can continue to get people vaccinated, I would like to hope that we will see fewer cases in those other age groups as well. 

>>BOB ZALTSBERG: Talking about COVID-19 today on NOON EDITION. We've talked about a lot this year, but there - it's ever-changing, so we're getting into this issue again. If you have questions or comments, you can tweet us at @noonedition with your questions or your comments, and you can send them to news@indianapublicmedia.org. Dr. Hrisomalos, I - to follow up on what Penny said, I was talking a couple of weeks ago with Dr. Handell, who's the chief of medicine, as you know, at IU Health South Central Region. And he said that - he's also an E.R. doc, and he said that there were people presenting to the hospital every day still who were infected with COVID. Is that still the case, to your knowledge? 

>>TOM HRISOMALOS: Yeah, we still see quite a few patients. The elderly cases - you know, I mean, those individuals who have been vaccinated seem to have decreased, but there's plenty of transmission in the community and we're still seeing active cases and we're still admitting patients with COVID for sure. 

>>BOB ZALTSBERG: So, you know, with more and more people vaccinated - and this is - we'll start with you, but then anybody can jump in on this question. You know, a lot of people do believe that, since they're vaccinated, that they can sort of go out and live their lives the way they always have. I mean, what precautions should people keep taking? For instance, if, you know, six or eight or 10 people who are vaccinated want to get together somewhere in a restaurant or for dinner, is that a safe thing to do? Should they stay outside? I mean, what are precautions you think people who are vaccinated should continue to take? 

>>TOM HRISOMALOS: Sure. There are a lot of still unanswered questions, and that's why we want to be a little bit cautious about this. The CDC certainly says that individuals who have been fully vaccinated can meet in small groups with other individuals who have been fully vaccinated and not have to take quite the same precautions. But when you're out and about in the community, there are people who are not vaccinated, there are people who may be carrying the virus asymptomatically, we still don't know entirely how readily people who are vaccinated might be able to still transmit some virus. I can tell you we have admitted people to Bloomington Hospital with COVID who have been fully vaccinated, so that certainly does happen. So we still want to be cautious until we get enough of the population vaccinated that we really see a dramatic decline and, you know, the number of new cases approaching zero. Then we'll all feel that we can open things up and be free to do whatever we want to do. 

>>BOB ZALTSBERG: I want to emphasize something you said and make sure that I heard you correctly, because I think that most people who've been fully vaccinated - and I count myself as one of them - have thought, well, you know, if I - even if I get COVID, it's not going to be very serious. But you just said that people who have been fully vaccinated have still been seriously ill enough to be admitted to the hospital, correct? 

>>TOM HRISOMALOS: We have had those cases, yes. I think being fully vaccinated is great and it decreases dramatically your risk of getting it and it does decrease the severity of illness, but it's just not 100%. 

>>BOB ZALTSBERG: OK. Lynn Thoma, I wanted to move on to the whole question of the Johnson and Johnson vaccine. In the pharmacies that you - the pharmacy you work in and the pharmacies that you have - or in the health care facility you work in and the pharmacies that you work with, is the J&J vaccine used very often? 

>>LYNN THOMA: Yeah, so we actually were able to get the Johnson and Johnson vaccine as a part of the federal program, so we started administering it, I believe, the week of March 8. So we've been administering it for for some time, and we were actually getting to the point - before we paused earlier this week - that that's what people's preference were. They appreciated the one dose, the convenience factor. And so more people were calling in, asking for the Johnson and Johnson vaccine than the Moderna vaccine. And then, of course, you know, as of Tuesday, we - it put a pause on administering that vaccine and we have just seen hesitancy go up dramatically. It's been scary. So we had our schedule booked out through this Friday and then gave everybody the opportunity - thankfully, we had enough supply of Moderna that we could have switched everybody over, but gave everybody the opportunity - and so, for instance, today - I can just throw out some numbers - we originally had 200 people scheduled. At the beginning of the day to day when I started drawing up doses, that number was down to 152. And right now, I'm looking at the schedule, it's 131. So we've had 70 people drop off of the schedule since Tuesday. So it's a little disheartening. We're just really going to have to, you know, fight this hesitancy, encourage people to get the vaccine and also letting people know that the best vaccine is the one that's available today. It's the one that you can get today. So, I mean, that's just kind of been some of our experience thus far. Hoping to get an answer from Johnson and Johnson, though, sooner rather than later. 

>>BOB ZALTSBERG: Let me follow up on that. Have you - so do you think the reason is that people had - were sort of just ready to get that one shot and then have two weeks of it taking effect and then be over it? And so maybe they're they're sort of playing the odds, thinking, well, if I wait a couple of weeks, maybe I'll still be able to get that rather than go through Moderna, which essentially is a two-shot, six-week process. 

>>LYNN THOMA: Sure. I think it goes both ways. So we've seen - I mean, with the calls that we've made and calls we've had coming in, we've seen both sides. So either, A, like, they don't want to get a vaccine at all anymore because they're scared, or they're going to wait out that Johnson and Johnson and kind of see what happens. 

>>BOB ZALTSBERG: OK. Sara? 

>>SARA WITTMEYER: We got a question that I think, Lynn, you're probably best equipped to answer. It says a year ago we thought it could be almost two years before a vaccine was ready. What changed and how do we know this is our most effective solution? 

>>LYNN THOMA: I'll answer that question to the best of my ability, and then if somebody else wants to jump in, that would be great. But as far - I know a lot of people have concerns about the vaccine and how quickly it rolled out. But - sorry about my email notifications coming through here. But what we do know is that this process went quickly because it could and we had the resources to make that happen. So typically, like, with a drug or a vaccine, that - it goes through three phases of clinical trials. So phase one, phase two and phase three before it goes to the FDA for approval. Well, in this case, with the vaccines, those trials were overlapping so that we could get the vaccine to the public quicker. So no steps were missed, but we just had those trials overlapping. Additionally, once the vaccines got to phase three of the clinical trial, distribution started. So that - or not distribution, sorry, manufacturing started so that, when the vaccine was hopefully approved, it was kind of, you know, like waiting on bated breath for that approval. So that manufacturing could allow for distribution as soon as the vaccine was approved. So that's why, in December, we saw with Pfizer and Moderna, that vaccine was approved and it was at sites the next day and being administered, I believe, in some cases, like, within 48 hours. So that's kind of how the process worked. If somebody else wants to answer the question about how we know this is the best solution, I don't know if I have a great answer for that off the cuff. 

>>BOB ZALTSBERG: Dr. Tom, do you want to try that? 

>>TOM HRISOMALOS: I'd say - I'd concur and I would say two additional things. One, this vaccine development was accelerated because we had SARS in 2002 and we had already studied this virus in detail, and this is just - this is a very similar virus to what we experienced back then. Secondly, this platform, the messenger RNA vaccines, is not new. They've been working on these for over a decade. And, in fact, this was one of the vaccines that had - this type of vaccine was developed to treat Ebola. So we were already running when we had - when they started to work on this SARS-COV-2 vaccine. They already had a lot of experience, understood the virus, understood the platform. And as well as what was just commented - that, you know, the development, manufacturing and the studies went simultaneously so they could speed that process. But these are - the messenger RNA vaccines, speaking of those initially - those are remarkably good vaccines. I mean, if you look at it from a scientific standpoint, they're well thought out, they're targeted. You know, I expect that this will be a platform for vaccines going forward - that influenza vaccines and so forth may migrate to this type of manufacture rather than the older systems that we use because they offer so many advantages. So that's good. In terms of controlling an epidemic, there's really only a couple of things that are really going to be effective. Obviously, vaccination is number one. That's how we get ourselves out of this. Otherwise, we're going to be dealing with, you know, restrictions and isolation and masks and problems for many, many months to come. 

>>BOB ZALTSBERG: How do you get that message to people? And I guess I'm going to ask Shari Lewis first about - how do you get that message to people? You were talking a little bit about hesitancy in Greene County, and Lynn was talking about hesitancy and - that she's seeing now. How do you convince people of what Dr. Hrisomalos said, that vaccination is how we get out of this? How do you convince people that? 

>>SHARI LEWIS: Well, we're working interactively with current groups and advisory boards here in Greene County like Pace and other coalitions to get the word out about vaccination. And since they've actually changed, that's where we've seen the hesitancy again through this younger population and just encouraging them that, you know, with the new CDC guidelines, that once you're fully vaccinated, you can participate with other people who are fully vaccinated, as well as not be required to - or a team, if you come in close contact. You just watch for symptoms for, you know, those sorts of things, according to the CDC. So what this does is it allows you not to miss work or to miss a sporting event that they have been wanting to attend all year. So that's the way we've tried to get people in our clinics to get vaccinated. Right now, we're at about 17% of the population fully vaccinated, and, you know, we see that as a ways to go. 

>>BOB ZALTSBERG: Penny, what's that number in Monroe County, and how have you gone about trying to recruit people and convince them that vaccination is the right way to go? 

>>PENNY CAUDILL: Now we have about 23% of our eligible population that's been fully vaccinated so far. That continues to to grow, and, certainly, we have some advantage in that we've got IU Health Hospital that has been doing vaccination clinics. We've had the health department clinic at the convention center. IU is now doing their students, and we're transitioning - we've kind of got two health department clinics going, the one at Assembly Hall. I know they've done, I think, 8,000 of their students already. So that is certainly helping. Everything Shari said I would agree with. And I think the other thing is trying to get people in various communities, you know, every social network has a leader in it and champions that people look up to. And it's finding those people who are supportive and who can help encourage others and help them maybe get their questions answered. These are still, you know, very safe vaccines. From what we've seen, the system is working. The reason that J&J is on this pause and that those conditions were worth seeing was because of the system that's in place for identifying adverse reactions so that they can be looked at. So the system is working. And I think that we can take some confidence in that, that the system is working. Vaccines in general are very safe, and we encourage people to take them. But finding those champions in the community, I think, is what will help us through this. And so I'm going to say this other thing, Indianapolis Motor Speedway, the state has had several clinics there switch to Moderna with this pause, and they, too, have had a lot of cancellations. So they are now vaccinating this weekend without an appointment. So I just - they just put out a press release that just came across my my desk, so people can go to Indianapolis Motor Speedway this weekend and get a dose of Moderna without an appointment. 

>>SARA WITTMEYER: Penny, I read a lot of places that folks were hoping the Johnson & Johnson vaccine could really help them reach populations like the homeless and folks in rural areas because it was just that one shot. I'm curious, is that something that you were doing here in Monroe County? And if so, is there a new plan to reach those sort of more vulnerable populations? 

>>PENNY CAUDILL: The short answer is yes. That's exactly what we were doing. And we had not received a lot of Johnson & Johnson vaccine, so for us, there wasn't a big switch, right? But we were using it for homebound. We had used it in our shelters, and we were using it to kind of schedule and plan out some more difficult-to-reach folks that might have challenges coming back twice, those kinds of things. And so we had to switch anyone who already had an appointment or those kind of clinics were scheduled. We had to switch that to Moderna, which, from a logistical standpoint for us, means that two visits. And so now you've got that that clinic, that location, you're going to twice. So now you can't do a different one, you know, several weeks out. So it does make things more challenging in that respect. But we will continue to pivot, just like we have all this last 15 months or so. We pivot every day, it seems, as something new comes our way. 

>>SARA WITTMEYER: Mmm hmm. And can you remind us, how effective is it if folks don't come back for the second shot? 

>>PENNY CAUDILL: I don't - you know, Dr. Hrisomalos, you might have a better - I don't have any kind of a specific number on the first shot. Certainly you get your greatest effectiveness after your second dose of Moderna or Pfizer, and we want people to get both doses. That's what's most important. But I don't know, Dr. Hrisomalos, do you know off the top of your head? 

>>TOM HRISOMALOS: After the first dose, the protection from a single dose is probably in the range of 60 to 70%. But - which is not bad, necessarily. But we don't know then the duration of the immunity. The second dose, not only boosts the immunity, it prolongs it. So for that reason, we certainly want people to get two doses of the mRNA vaccines. 

>>SARA WITTMEYER: Right. Well, we've got another question, and Dr. Hrisomalos, I think this is probably for you. Someone is saying, I'm fully vaccinated, but my kids are not. What is safe for us to do? 

>>TOM HRISOMALOS: Yeah, all these all these kinds of questions are always difficult ones because it depends upon the circumstance and what the kids have been doing and so forth. If you've been fully vaccinated and you have, let's say, some younger grandkids that have been - who are well and who have not put themselves in high-risk type settings, you can probably visit safely because you've been fully vaccinated. But, you know, when we talk about these kind of settings, it's a matter of risk, what's high risk, what's low risk. But those kind of circumstances when you're meeting with nonvaccinated people are not no risk. 

>>BOB ZALTSBERG: All right. We're talking with several guests today about the COVID-19 vaccinations and about the pause in the Johnson & Johnson vaccine. If you want to send us your questions, you can send them to @NoonEdition. We're on Twitter, and you can also send them to news at indianapublicmedia.org. Want to continue with Dr. Hrisomalos for just a minute here, and I hope we don't get too far in the weeds. But the question that I would have is six out of 6.8 million people, that's how many people I think have been sickened by the Johnson & Johnson vaccine. How does that - can you put that in perspective for us about, you know, in epidemiology? Why do you stop a vaccine from rolling out at that small number? 

>>TOM HRISOMALOS: Sure. That's, as you mentioned, that's a very, very small number. The reason they put the vaccine on hold is to look more carefully. You know, this was not entirely an unexpected situation. They were watching very carefully to see if this - there may be any such side effects since the AstraZeneca vaccine that's being used in Europe and around the world had noted some similar episodes of thrombosis and blood clots. And since it and the Johnson & Johnson vaccine are both adenovirus vector-based vaccines, they wondered if there might be something similar. So they were looking and waiting and watching. And as mentioned by Penny, the vaccine adverse event reporting system, you know, was used and pick this up very quickly. So six cases in 6 million is a very low number. For example, it's estimated that we have, I don't know, five to 10 serious allergic reactions to penicillin when we prescribe that for every 10,000 doses. And so, you know, this is dramatically smaller than many risks that we take every day with other prescriptions, with other medicines, with other medical treatments. So very, very, very low risk, but certainly a serious one and reasonable, I think, to pause to make sure we understand the spectrum of the clots, where they develop, how they present, make sure that all physicians know what to do to recognize them and understand the correct therapy for it - and so reasonable for those reasons to give it a pause. But hopefully we'll be able to resume using this vaccine in the future. 

>>BOB ZALTSBERG: Sorry I'm not going to be able to remember her name, but we had one of the researchers on the AstraZeneca vaccine, one of the people that was involved with the the trial, the study that was being done at IU on that vaccine. And she said exactly the same thing when it was paused earlier for the first time, that this is the system working because once you see something, you shut it down, you try to fix it and then you bring it back up. So Penny had a comment, right? 

>>PENNY CAUDILL: I did. The other thing that I just want to add is that, you know, they are the CDC and the ACIP are looking at this data. We don't know yet that it is - that there is a direct link to the vaccine. And so that's also part of what they're looking at, right? So is this a kind of a cause and effect, or is there some other link between these individuals? And so I know that they said they expect to have some sort of recommendations at the end of next week after they've looked at all of the data. So just, you know, we don't know yet kind of what's going on, so... 

>>BOB ZALTSBERG: Lynn, tell me - you were talking about the people that have have decided they aren't going to get the vaccine today, that they've already made a reservation, do you - I know that there were - there was some - I read a story, I can't remember where it was out of, about trying to really fortify that waitlist in various places. Do you have a system in place where you can have people on a waitlist that are ready to come in so that none of the vaccinations are wasted? 

>>LYNN THOMA: Absolutely. So this was easier before we - you know, it was open season, as I think some people are calling it. But, yeah, we do. So we work with community groups - so some local colleges, business owners - to just ask them who still needs the vaccine, who's ready to get it, you know, at any, like, given time. Would they be able to come over to get the vaccine? Or we can go to them. So we really, like, utilize those community partners so that we're not wasting. 

>>BOB ZALTSBERG: And I want to ask Shari Lewis about the people who are getting the vaccine in Greene County. I know we've had information come in to us at the station that, in the rural areas, not all the vaccines are going to rural residents, that people who live in a city - like, somebody who - again, Dr. Handell told me a couple of weeks ago that, if you wanted to get an IU health vaccination, it would take it - like, three weeks to get an appointment. But if you wanted to go out to Paoli, it would - you could to get it the next day. So are you keeping statistics on - data on where your patients are coming from? 

>>SHARI LEWIS: Yes, we are. With Greene County, we have several vaccination clinics. We've got the health department who's doing - we're doing an average - besides our (unintelligible) clinics, on a regular basis, we are doing 600 vaccinations. We have the hospital that's using Pfizer. They're roughly doing 400 a week. And our FQHC is doing about 100 vaccinations a week. So between all of us, we have - 73% of those vaccinating are Greene County residents. The others are from surrounding counties. 

>>BOB ZALTSBERG: OK. Penny, do you have similar numbers in Monroe? 

>>PENNY CAUDILL: Well, we certainly have done a lot of vaccinations. I don't know exactly how many people have been residents. I would say most of our people are our residents, I know that we have a lot of residents who have went other places in order to get them because the demand has been very high here in the county. And the main thing is that we want people vaccinated, so we want all Hoosiers to get vaccinated wherever they can get it. 

>>TOM HRISOMALOS: I think one other - if I can make one other comment, just to make sure it's clear, is this unusual side effect - this cerebral venous sinus thrombosis that has put the Johnson and Johnson vaccine on pause - is not seen with the other vaccines. There have been no cases - zero cases of thrombocytopenic clotting like is being looked at for the Johnson and Johnson vaccine. There have been none of those cases with Pfizer or Moderna. 

>>BOB ZALTSBERG: And that - think it's worth repeating. None with those two and six out of 6.8 million with Johnson and Johnson. 

>>TOM HRISOMALOS: Absolutely. There - yeah. 

>>SARA WITTMEYER: Dr. Hrisomalos, what about folks who have gotten the J&J vaccine - because I know several people and they are a bit anxious. I mean, what would you advise them now? 

>>TOM HRISOMALOS: Sure, absolutely. So one of the other reasons why the pause took place is the six cases of this cerebral venous thrombosis - this thrombocytopenic, which is sort of a unique subclass of blood clotting - but that was identified in about the first 50% of people who received the J&J vaccine. Because of - a good number of people have received that vaccine in the last two weeks, and this blood clot - seeing this blood clotting issue - if - you know, associated - it seemed to occur perhaps six to 13 days after the dose. So there may be people who received the dose who might have some risk if, indeed, this is all confirmed and true. And so that's another reason for pausing. So what are the symptoms that we're looking for in patients as we're trying to look at this and study it? It would be things like headache, nausea, vomiting, lethargy, seizures, things of that sort. And if you had anything that was of concern, you could go to the emergency department, go to your physician, and you should be able to pretty easily do a blood count, look at the platelets and determine whether this condition exists or not. 

>>SARA WITTMEYER: OK. And Dr. Hrisomalos, I have one more here for you. There's a Dr. Christopher Murray, he's a director of Institute for Health University at the Washington in Seattle, but he is predicting that, you know, new cases are going to go down over the summer but then we're going to see quite a surge in cases by the end of the year, just as people get vaccinated and they start moving around a lot more. So I'm curious if you've looked at any of these models and what you think's in our future? 

>>TOM HRISOMALOS: Well, that is, of course, the concern. And as petty - as - I'm sorry, as Penny mentioned, we're worried about the variants. They're more transmissible and they appear to cause more severe disease, and so we could see increasing cases, particularly if we have inadequate levels of vaccination by the time fall comes. We didn't really see a dramatic seasonal pattern so far with this virus. It seemed like it was pretty prevalent throughout. But what he says is certainly a concern. These vaccine companies, particularly Moderna and Pfizer, are working on, wondering, considering, along with the FDA and NIH, whether they should be preparing booster doses for such eventualities. Moderna has already stated that they have a booster dose directed against new variants that they might make available as early as late this fall. So good questions. And boy, we want to vaccinate everyone now so we don't end up with that kind of scenario later this year. 

>>SARA WITTMEYER: And what do you think - and maybe Lynn can chime in too - about people who are going to start needing boosters? What do we expect there? How long could this immunity last before people need to start getting boosters? 

>>BOB ZALTSBERG: So we're really sort of jumping the gun when I speak about those things because we really don't know how long immunity lasts. There's good immunity with both - with all of these vaccines, but published from Pfizer and Moderna good immunity out past six months from immunization. And I think everyone suspects that immunity will last at least a year or two and maybe even longer. So we are following those people now to see how long to the antibodies last, how long the immunity lasts. When do people - do people get reinfected? Do they not? So I think we'll know over time. But they want to be prepared so they can have a booster available if it became necessary. 

>>SARA WITTMEYER: OK. And Penny, we've gotten several questions from people who are starting to travel again - that they have to get tested within a certain time frame of going on these trips. What do you recommend for folks like that who are trying to figure out how they can meet these requirements to travel? 

>>PENNY CAUDILL: Yeah, that can be a difficult challenge in terms of when they need to - how quickly they need to get those results back. Certainly there is not a wait like there has been. You know, there - we've had times when it was difficult to get in for testing and then the turnaround time was long because there were so many tests being done. So the turnaround time right now is pretty short. I would say usually it's within 48 hours. Most places we still currently have two places open - kind of, I would say, community sites. We have the community site at Morton Street that is open and free and people can go in and get tested. It is a PCR test. If someone is symptomatic, we have rapid antigen testing that can be done. But certainly, if you're symptomatic, you don't want to be traveling. And then the Optim site at the Armory is still open as well. That's secured, I believe, through June. And the state secures those and will determine whether or not they'll keep them on past June. So those are the two primary locations. I mean, certainly some of the pharmacies and, you know, physicians offices - they can be available as well. But it can be a bit of a challenge if you need it quickly, and I don't have a perfect answer except to say that those are your options at the moment. 

>>BOB ZALTSBERG: The university's continuing its mitigation testing too. That's a different kind of test than you're talking about, Penny? 

>>PENNY CAUDILL: Well, they are continuing to do mitigation testing and they do an enormous amount of testing and it is wonderful, but it's not kind of routine, I want to - you know, I need to travel and I need a test. They may accept that test, if you had had it done. I think that they - I always get nervous kind of talking for somebody else there. I think there may be an element of requesting a test at the university. But for the most part, they're telling people your time - it's your time to come in and get tested. 

>>BOB ZALTSBERG: I want to talk about the challenge that you've all faced and met to a great degree with dealing with this public health crisis and the logistics of it. I want to start with Shari Lewis in Greene County, and then I'll go to Lynn and then Penny. But just the idea of setting up these clinics and getting a vast number of people either tested for a time and then vaccinated for a time, and the challenge of doing that when it's really not been done before to this level in quite some time. 

>>SHARI LEWIS: Sure, I can really appreciate that question as well. Being a rural county - and Greene County is unique in the sense that we have such a huge landmass and just getting from one side of the county to the other for individuals seeking service can provide a huge challenge for individuals. So for us, that's been the most difficult aspect of what we do, trying to get services to all. So being able to be mobile has been beneficial to us in terms of hosting additional public clinics and central to the county, like at our 4H fairgrounds. Also, resources has been a concern here in Greene County. For us, you know, just as a state, as a whole, you know, we are issued funds based on your population. But when you're setting up a clinic, you know, your startup cost is going to be the same no matter, you know, if you have 100,000 residents or 30,000 residents. So being able to work around financial constraints has been a concern. And for us here at Greene County, without the help of volunteers, we would not be in the situation that we are in now and the number of individuals that we've been able to vaccinate. So, you know, those have been the challenges for us in the rural community. 

>>BOB ZALTSBERG: Yeah. I think I'm right when I say this, that Green County is the second largest county in the state by size, even though you have a small population. 

>>SHARI LEWIS: Yes. 

>>BOB ZALTSBERG: All right. Lynn, can you address that too? 

>>LYNN THOMA: Absolutely. I definitely like agree with all of those sentiments. I mean, just like the resources in general, kind of like I already spoke to, has been a huge issue for us because we didn't have extra resources to start these clinics. So we've just been pulling our staff out of, like, you know, normal day-to-day activities in the clinic to be able to run these vaccine clinics. And most of our - I mean, definitely in our large offices, we run vaccine clinics all day Monday through Friday. And then at our smaller clinics, we do two to three a week. And beyond that, we also go out into the community and give vaccines, you know, partnering with homeless shelters and migrant workers. And we've done a lot of events like that. So that's on top of those clinics that we're running, you know, all day long in the clinics. And then we're also doing some at-home vaccinations. And we're actually going to be one of the partners with the state to give in-home vaccinations. So, yeah, it's just - it's been a lot. We're all kind of like I said at the beginning, we're all tired. But I think that's (laughter) across the board. Everybody is tired of Covid and everything that's going on, so just, you know, doing our best. I do think it's better to be on this side of Covid than, you know, on the beginning, because at least we, you know, are at the point where we're vaccinating people and making some headway. 

>>BOB ZALTSBERG: Penny, we have about two minutes ago. You want to add something? 

>>PENNY CAUDILL: Sure. Well, I would echo all of those things. And, you know, without volunteers that we've had, without other community resources, you know, for us, our firefighters are helping with homebound. We went from, I think, 50 Medical Reserve Corps volunteers to we've got well over 500 now. All of those things are partnerships with the university, and the hospital, and the city and the university. And that's the other challenge that we've had is that we have, you know, a large university that again is very blessed that they had the type of testing program that they've had and the good relationships that we've had. But again, resources on every level - and I know this is - you know, this has tasked everyone's resources - the hospital, the private sector, but certainly public health. And public health in Indiana is not funded well, and everybody is doing their very best. But we've also had to move staff from normal routines. And, you know, we stopped the issue of birth records and inspect septic, you know, installations and all of those kinds of routine things that go on. So everything changes every day. As I said, we pivot constantly. 

>>BOB ZALTSBERG: All right. Well, thank you very much. We are out of time. And thank you, Penny Caudill from the Monroe County Health Department, Shari Lewis from the Greene County Health Department, Dr. Tom Hrisomalos from IU Health Southern Indiana Physicians and Lynn Thoma from HealthLinc. Thank you very much for everything you've done during this. You've done a great job. For producer Bente Bouthier and my co-host Sara Wittmeyer and engineer John Bailey, I'm Bob Zaltsberg. This has been NOON EDITION. 

>>UNIDENTIFIED PERSON: NOON EDITION is a production of WFIU Public Radio. A podcast of this program is available at wfiu.org/noonedition. Production support comes from Smithville, fiber Internet, streaming TV, home security and automation in southern Indiana. More information at smithville.com and from Bloomington Health Foundation, partnering with local organizations and citizens to invest in programs that address our communities' health needs. Bloomington Health Foundation, improving health and well-being takes a community. More at bloomhf.org.