By Gail M.H. Brown, Ph.D.
On Tuesday, March 23, The Mississippi Link Publisher Jackie Hampton, and yours truly engaged in a two-on-one interview with Thomas E. Dobbs III, MD, MPH, the State Health Officer. The purpose of the virtual event was to address the COVID-19 vaccinations in Mississippi as a means to inform and enlighten readers with information straight from the doctor’s mouth.
Below is a recap of that interview:
Brown: Sir, we thank you for this opportunity to share with our readers some of your expertise and the information you will provide for us today. The first question is about the numbers. According to your website, there were 95 cases and 0 deaths yesterday (Monday, March 22), and today, according to your website, they are up to 306 and 21 deaths. Will you tell us what that sharp upswing of the numbers means?
Dr. Dobbs: This is something that we see every week. We do see a delay in the reporting over the weekend, just with the normal weekend activities. And we will see basically catchup reporting on Tuesday. So, basically, anything for Monday’s reporting is really stuff that happens over the weekend, and anything that we report on Tuesday comes in on Monday. So, basically, it is a catchup day. It doesn’t mean that there is a rebound in cases. Sometimes doctor offices won’t report over the weekend or send the labs in until Monday. It’s basically as simple as that.
Brown: So, in essence, are you saying that we are not looking at an embarkment of a surge right now?
Dr. Dobbs: I don’t think so. It is something that we have seen pretty regularly. Our seven-day average has been below 300 for the most recent week, and that’s the best numbers that we’ve seen in quite a while.
Brown: There has been a lot of talk about COVID vaccines not being administered at local health departments. If that is true, will you explain?
Dr. Dobbs: It is largely true, and there is a good reason and a sad reason behind it. The sad reason is that the health departments have been so underfunded that the health departments don’t open every day. And, they don’t have a nurse for every county. So, there is not nearly enough people to do what we need to do. The state support and county support for local health departments have been declining a lot over the past decades. We have half the nurses that we had even five years ago. Compare to 20 years ago, we probably have about a tenth of the nurses that we had. So, part of that is deterioration, and another part of that is the economy has failed. We don’t have the number of staff that we could put in every county. So, we now have 19 [COVID-19 vaccination] drive-through locations that are state-run across the state that can do 1200 shots a day. So, you couldn’t do just the county. That will be in partnership with the Department of Health and the National Guards. Pretty much all of those Health Department folks have been pulled out of the health departments to help with the drive-throughs.
Brown: In your medical opinion, how well are the various vaccines working in Mississippi? And what are the percentages of protection from the virus by each?
Dr. Dobbs: It’s hard to know for sure the precise number. The study we receive is 95 percent effective for Pfizer and Maderno and 70% for Johnson and Johnson. But even better for death and severe illness. If you look at our nursing home numbers, our outbreaks and deaths have declined rapidly. So, we think it’s working very well.
And, if you look at our hospitalizations, they’ve declined very quickly. So, we do think it [the vaccination] is having a major impact. Some real-world studies look at the effectiveness of the vaccine in older folks in nursing homes, and it looks like they are 85 percent even in nursing home settings. So, we see more and more real-world data supporting how important and effective the vaccines are.
Brown: The new one that is out: AstraZeneca. Do you have any data on its effectiveness?
Dr. Dobbs: We do not have a whole lot of information on AstraZeneca yet. We don’t have the FDA data to review. They did release some information that showed that it was almost 80% effective in preventing COVID (asymptomatic illness,) so that’s pretty good. AstraZeneca is made similar to the Johnson and Johnson [vaccine], except AstraZeneca is two shots instead of one. It will be interesting to see how people use it because we already have two really good one and two-shot vaccines. If we add AstraZeneca to the mix, it’ll be interesting to see how the demand is for it. It looks very safe, but we try to withhold any final judgment until we look at the real numbers, and we haven’t seen real numbers yet.
Brown: How would you address the concerns and reluctances some people have about the vaccine?
Dr. Dobbs: Safety is a very valid concern. One of the concerns is that [the vaccine] was developed too quickly. The name Operation Warp Speed may be misleading, which made people uncomfortable. It’s not that the same steps weren’t taken for normal vaccines; it’s just that they were done all together, at the same time, so we didn’t have to wait for one or the other. So, instead of stacking up bricks and you had five bricks. If you stack them up in a line, it is going to be longer. If you say, hey, let’s stack all five bricks on top of one another so that we [may] do all the same safety steps at one time. That’s sort of what we did. They were taken at the same time and thoroughly studied.
It has also been thoroughly studied. If you look at 30-40,000 people in the efficacy and safety studies, that’s been really good. For the folks who said, “Hey, I just wanted to wait to see what’s going on,” in Mississippi has given over a million shots and hasn’t seen any bad outcomes.
What we have seen, and I’ll just be honest and very clear. Some people feel achy after the shot. Some people feel fatigued for12- 24 hours. And, if you’ve had COVID before and you do get one of the shots, it’s going to make that a little bit worse with fever and stuff, so that can happen. We haven’t seen anything severe. In this country, we’ve given 90 million shots. So, we’re making good progress. We haven’t seen anything bad. So, if you are one of those folks who are waiting to see what happens, 100,000,000 shots should be enough (Dobbs chuckled).
There are a lot of issues, too, and a lot of it is trust that the science is there for everybody. One of the things that we’ve done is that we’re working with different community and faith leaders, black physicians, and nurses. We let them ask the question to see what they want to do, and they all got vaccinated ( in public). In Mississippi, (you’re not going to believe this), in Mississippi, with our history of lagging, we are the No. 1 in vaccinating African Americans.
Dr. Dobbs: Because we have matched the percentage of the population that is African Americans is 37.8%, and last week 38.1% of our vaccines went to black Mississippians.
Hampton: That is so great! You mentioned the fact that those who have had COVID may have more symptoms. One of our readers sent me this question to ask you, “I am 75 years old (female) and had both vaccinations. Each time I had body aches, chills, and stomach problems.” Then she said, “I was told that this is a sign of having a good immune system.” Can you explain if that is possibly a true statement and how this works towards helping her immune system?”
Dr. Dobbs: Yes, ma’am, exactly what your body does when you’re exposed to something like the vaccine, (sometimes the flu shot will make you feel achy), it’s training your body to fight off the infection. Part of the training process is your body creates inflammatory chemicals. It’s the chemicals that your body makes that cause the achiness. It’s these chemicals that the body uses to fight infection. When you get the vaccine, your body launches these chemicals to teach your body how to fight it in the future, and it’s a part of the process. You’re not getting COVID, or anything other than an immune system activation. The flip side is that if you don’t get the immune activation, it doesn’t mean it doesn’t work. I didn’t have any symptoms; I was happy about it, but it doesn’t mean the vaccine doesn’t work.
Hampton: “Are you saying that your immune system is better than my immune system because I did not have any side effects?” That is not the case.
Dr. Dobbs: We don’t know for sure if there’s going to be some variation in the amount of immune response based on symptoms, but the body is so complicated that you can’t predict what will happen with a different person. This person may have a previous non-coronavirus cold, so their body would amp up even more because their body had a cold with the coronavirus before. There are a lot of factors that go into every person.
Hampton: There’s another question, “How long does the vaccine work?”
Dr. Dobbs: Great question. We really have pretty good confidence that it’s going to last at least a year and probably more for most people. Based on the immune response level and how long it lasts, it will be long-lasting and maybe a lot longer than that. Certainly, there are different parts of your response. Part of it prevents you from getting sick at all, and part of it prevents you from getting really sick and dying. It looks like the vaccine is really good at preventing illnesses and death.
Brown: According to recent reports, there have been other strains identified in Mississippi. [Will] you elaborate on any of those strains to let our readers know what they can expect? Is this a grave concern, especially in terms of being vaccinated?
Dr. Dobbs: We have seen different, new strains, and the one we’ve seen mostly is what we call the “UK variant,” which really started up in England. We’ve seen 10 of those. We have several more that are under analysis that are probably going to be identified as UK variants. Their worry is worse because they are more contagious and a little bit more deadly, so that is a concern. The good news is the vaccines work great for the UK variant, which is another reason to get vaccinated. We’ve only had a dozen or so of these. It’s still a minority of the cases, even though it’s a good chance that it could end up being a predominant strain if we’re not careful. That’s one reason why we still want people to wear masks and be careful about going to social events indoors because we don’t want it to spread. We do have another variant that was recently identified in Harrison County that is from the South African strain. It’s not more deadly, it probably is a little bit more contagious, but the challenge is the vaccine; at least the Johnson & Johnson vaccine is not as quite as good for this one. Maybe the others, but we don’t know so much for that. The one case that we did have was related to foreign travel for someone who returned from South Africa recently. So, we don’t think it’s spreading in the community. It probably was a travel-associated case. That’s kind of good news, but we still want to make sure people are isolating and quarantining and that sort of thing.
Brown: Once you have identified and located the variants in the state, what procedures do you take when trying to isolate them from spreading throughout the state?
Dr. Dobbs: We actually have special teams we’re putting together to work on the variants so that we can do a more detailed investigation. We can do an additional assurance that folks are isolating when they’re sick, quarantined if exposed, and tested for variants to see if family members and friends have gotten it. That’s sort of the basic public health epidemiology response that we have to do. Unfortunately, there aren’t very many of these, but the UK variant is pretty common in the country. It is predicted that it could be a large proportion of cases and even a dominant strain in the near future.
Brown: Would you advise anyone that’s concerned about the variants to go on and get vaccinated?
Dr. Dobbs: Get vaccinated. It’s going to protect you from the variants.
Brown: [It appears that] there are still many young people who do not get the seriousness of COVID. What are you all doing to provide more education and knowledge to the community, especially those who may not have access to social media and online news?
Dr. Dobbs: We’re really focused on people 50 and older. That’s where all of our deaths and hospitalizations are. So, we really want to get everybody over 50 that has medical issues vaccinated as much as we can. Over 60% of people over 75 in Mississippi have been vaccinated. Half of Mississippians are 65. Our priority is to get to get the other half vaccinated. We have a lot of mechanisms trying to communicate with older folks and people with medical issues and with their doctors, so that’s good news and one of the big pushes.
We’re going to do more with schools to get the word out with colleges, partnering with colleges to get young folks vaccinated. That’s where a lot of risks are (congregate settings) college and schools. We have a focus on social media (kid-based) on why it’s important. It is challenging, because, in all honesty, kids don’t really usually get that sick. Some do. Some may even die, but it’s pretty rare. The biggest challenge is that they give it to their family members. It’s going to be two parts, we’re going to ask the kids to get protected if they can, but absolutely, 100%, gotta get that aunt, uncle, that grandma protected. So, it doesn’t matter if she’s exposed to the grandkid or the bag boy at the grocery store that we have a common pathway of protection for everybody who’s at risk.
Hampton: Dr. Dobbs, what do you say to an adult over 50 who says, “I’ve never had the flu shot, never had the flu, take good care of myself, I do all the social distancing, I wash my hands all the time, I take vitamins,” and then they say “So if I take the same precautions that I’ve taken all of my adult life in hopes of me not getting the flu, why can’t I take those same precautions and not have to take the COVID-19 vaccine.”
Dr. Dobbs: Well, it hadn’t worked so far. We’ve had 7,000 people die, and a lot of those are the same people who would’ve never thought they would get COVID. It just doesn’t work. It’s not a matter of you being careful. This is a new virus. Maybe you don’t get the flu because you had some strains when you were a kid with strong immunity. But you didn’t have COVID before; you’ve never had COVID before just because you’re strong right now. Our immune systems have never seen this before, so we don’t have any pre-existing protection from years ago. This is the opportunity to get that protection.
Hampton: So many are asking, “How can we prevent ourselves from getting COVID-19 in other ways other than the vaccine?” And the answer is always vaccine.
Brown: I know many people would probably want to know or get your opinion on whether their children should go back to school in a class setting. Some say they want to be given the option because they are still not satisfied with the safety. If where we are now in Mississippi, given that we have administratively opened up, what is your opinion about the school safety?
Dr. Dobbs: I think there are multiple approaches to this. I think some kids strive in underlying environments (my child does quite nicely in underlying environments, who is 18 and a senior in high school). A lot of kids don’t try, so it’s a trade-off by not being in class. Probably for most kids, they need to be back in class. Other things that we need to do is, all teachers can get vaccinated if they want to. If you’re worried about it, now the vaccine is a choice. The parents and grandparents need to get vaccinated, so that’s good. Get them protected.
We see very clearly that we will try to push for the whole rest of the year that Mississippi schools will use masks for kids in classrooms. That’s very important! Kids really don’t spread COVID in a classroom if they’re wearing masks. Where they spread it is on the bus going to a football game, dance team, or choir practice, when they’re all together. If we have them separated and wearing masks in the classroom, we’re good. Lunch can be kind of challenging. I think part of it is making sure your school has a good safety plan. Thinking about those extracurricular activities, if your kid is 16 or older, get them vaccinated. That’s great. We have the opportunity now.
The main thing is that it’s so bad for kids to get it, because they can kill their parents. But if the parents and grandparents are vaccinated, it changes the equation a little bit, and we can put the benefit of the child’s education a little bit more in the equation where that kid is. I think it’s time for most kids to start transitioning back into in-person classes, because most of them need it. But I think those other safety measures really need to be in place.
Brown: Getting back to the 16 and older, just to make sure that we’re clear. Is it 16 or older with underlying conditions or just 16 and older period?
Dr. Dobbs: Period. Every 16-year-old.
Hampton: Dr. Dobbs, is there anything you can do to convince our Governor that a mask mandate is absolutely needed?
Dr. Dobbs: I was happy that he was willing to push it hard when we were most desperate. To be honest, I think he’s made some hard calls and been criticized for it. I’m proud to see that Mississippians are doing better with masking now without a mandate than we did in the summer with the mandate. I think we’ve learned. So, what we will continue to do is really push not only for individuals to do it but also for church groups, businesses, school operations, industries, chicken plants, production, and restaurants with a vested interest in their businesses. The best way to protect your business is not to spread COVID. The mask is very important. We learn more and more how important that is. Part of the equation is if we pair that with the vaccinations, I think we will be in great shape going into the summer.
Hampton: Let me ask one other question. It is regarding Medicaid expansion, especially right now during the pandemic where we know so many African Americans are poor, without jobs, etc. Why is it that the Medicaid expansion is not in the best interest of all Mississippians, according to our legislature? Help us understand why it’s not in our best interest as Mississippians and African Americans.
Dr. Dobbs: Hopefully, we understand better that everyone needs health insurance, and Medicaid expansion is one of those ways. Maybe we’ll find a way; politics is everything. Perhaps we can find a version that palatable to Mississippi, like Indiana, did. Even Mike Pence expanded Medicaid in a version they found okay. I remain ever hopeful that we can find solutions for Mississippi. I think in the legislature, there was a lot of interest to look at how you expand Medicaid benefits to protect more Mississippians.
There are small steps. I know this year there’s an effort to make sure that pregnant women get Medicaid for a year instead of two months after delivery. I think it’ll be better for the future to get more folks covered. There are multiple options at the health department, and as a population health person, we believe that everybody needs insurance. It’s important, so we’ll continue to advocate for that.
I want to add that the health department has a program to buy insurance for people who live with HIV. If you have somebody who lives with HIV and doesn’t have health insurance, the health department will pay for it. If you want to share that with your readers, have them contact their doctor and make sure this because we will sign them up for health insurance.
Brown: With the state having to open up a little bit more than many people expected. Last September, you issued the order that if anybody is diagnosed with COVID, they are supposed to quarantine as soon as they find out they’re diagnosed. Will you let our readers know whether that order is still in place, and what are the consequences if they defy that order?
Dr. Dobbs: It is still in place, and it’s a state-wide health order that if you’re diagnosed with COVID, you cannot go to work. You have to isolate yourself at home, so you don’t spread to other people. That’s for 10 days. You need to stay home. Not that we would do it very often, but we could. It’s a fine or either some jail time, depending on how it was approached. If someone was maliciously spreading covid, it’s against the law. The same thing comes up with tuberculosis for somebody who’s contagious, and they refuse to take their medicine. In the interest of the general public health, we have to take legal action—the same thing with COVID. You have a responsibility to your family and community to not spread it around if you’re diagnosed with a deadly, dangerous disease.
Brown: Say, for example, you’ve gone home and quarantined, but your employer says you have to come back to work, or you will lose your job. Is there any protection for individuals who may deal with such situations?
Dr. Dobbs: I don’t think an employer can do that. I think that is illegal. They may not pay you. That’s a gap in our system, but I don’t think they can fire you. That’s the Family Medical Leave Act (FMLA). You can’t fire somebody if they’re sick. I don’t think that’s legal at all, I think it’s against the federal law to fire somebody, but you may not get paid. A lot of people don’t have paid sick leave. Just know that there are so many places in the state to get vaccinated. We have hour drive-throughs, we also have county partnership drive-throughs, hundreds of clinics across the state that have vaccines too. We’re trying to get it everywhere.
The Mississippi Link later inquired of Dr. Dobbs’ office about a concern one reader had about the aftereffect of COVID-19 called the “COVID Brain” or “Foggy Brain,” a staff official shared this emailed response:
“COVID-19 can have real lasting side-effects, including “foggy brain.” The disease is new, so research on lasting side effects may take a while.
Side effects are serious and include heart and lung issues, foggy brain, loss of smell and taste, body aches, fatigue, etc. That is why it is so important to get the vaccine as soon as possible.”