Feb 19, 2021
More than 23 million people in the United States have been diagnosed with COVID-19. Daily death rates are at an all-time high. But, there is hope. As the COVID-19 vaccination rollout gets underway, here’s what you need to know to help you decide if you should get the COVID-19 vaccine.
In this episode of Hilary Topper on Air, Hilary interviews Imei Hsu, a Licensed Mental Health Counselor and Registered Nurse in the State of Washington.
Imei will discuss the COVID-19 vaccine and rollout across the United State. She will touch upon why someone should get vaccinated and how it will make a difference down the road. Learn more about what to expect when getting the vaccine and what COVID-19 long haulers should do. She will also touch upon how to keep yourself and your loved ones safe while you wait your turn for the vaccine.
Imei Hsu is a Licensed Mental Health Counselor and Registered Nurse in the State of Washington. She maintains a private practice by delivering online counseling, with a subspecialty in helping those with Autoimmune Disease and chronic illness. While volunteering for King County Public Health through Medical Reserve Corps in the COVID-19 response in Washington State, Imei has worked in the Isolation and Quarantine centers, COVID-19 testing, Debriefing Groups, and the current COVID-19 vaccination. She is an ultrarunner and Ironman, an avid hiker, and lives with her husband and cat in Redmond, Washington.
More than 23 million people in the United States have been diagnosed with COVID-19 daily death rates are at an all time high, but there's hope as the COVID 19 vaccination rollout gets underway. Here's what you need to know. I'm Hilary Topper. And this is Hilary Topper on air. Today I'm speaking with Imei Hsu, a licensed mental health counselor ad registered nurse in the state of Washington. Welome to the show.
Imei Hsu - Thank you for having me, Hilary.
Hilary - So can you tell us a little bit about yourself and your backgrounds?
Imei Hsu - Okay. I will start off right off the fact that I am not a physician. I am a registered nurse at a licensed mental health counselor. Anything that I say today is purely my opinion based on the data that we know. And it's not a substitute for medical advice from your provider or from any other source, a trusted source on your end.
Hilary - So, let's talk about COVID 19 vaccination COVID-19 has dramatically changed the way we live, we work, our lives. So here comes the vaccine and I want to know from you why someone should get the vaccine. Will it make a difference? And also I know a few healthcare providers who have given me a little bit of a hard time about getting a vaccine. So I know it's a loaded question. There are three questions in one. So if you could help answer those, that would be great.
Imei Hsu - Okay. I'll start with the first question, which is why would you want to get it? And the reason is that whenever there's a virus, there are multiple ways that we can mitigate risk of getting it and transmitting it. One is the one that most of us are familiar with. Wear a mask and wash your hands frequently. So if you're touching things, touching people for any reason, you wash your hands, these are basic mitigating risk practices or behaviors that any person could do, not just in healthcare, but really anywhere. And when you do those, that was social distancing, staying away from sick people, asking those who are sick to quarantine, these basic measures do the heavy lifting of preventing transmission. So we know, and we've seen it, not just with COVID-19, but any other virus that we've ever had to deal with these behaviors make a huge difference. So then why do we need a vaccine? Well, if we ever want to gather together in larger numbers, if we really want to cut down transmission rates and I will talk a little bit more about that later, if we want to be able to be in public without the risk of severe disease. And we've seen that this is very random about who gets severely sick and who has an asymptomatic version of it. And they kind of sail through it very quickly without any symptoms and without long-term damage, we just don't know who, so you'd want to get a vaccine because if you could prevent that, if you had an effective vaccine, Then you're, you're looking at people not getting severely ill and then also most likely not transmitting it to anyone else and increasing that risk for others.
And the health care provider question. Oh yes, I was. I wrote that down, getting to that. So with healthcare providers not getting them, this is a severe issue. They're on the front lines. Majority of them are if they're even in primary care and not necessarily working directly with COVID-19 patients doesn't matter because you have to treat everyone is potentially being a carrier unless they just had it and they're still in that immunity period of time and when they're not getting it, they risk exposures all day long. Now there's one thing about using these basic preventative measures. Hand-washing masks, social distancing, but when you're a healthcare provider and you're seeing say even a hundred patients a day in a very, very busy practice, you don't know who's sick. You don't know who's recovering, you don't know who's asymptomatic, so you have to treat them all as possibly having it. And the possibility of transmissions is higher without the vaccine. I've already discussed that, um, in brief, and I'll get to that more, but at some point you're going to have somebody who's going to have these multiple exposures per day and PPE will fail.
Meaning, unless you are perfect about it every single time, and we're human, it's going to happen. And that's why in the front end of the coronavirus pandemic, when it hit the shores, you saw healthcare providers die. Of this because they were being exposed in the ICU where it's extremely dangerous. The minute that you go to intubate somebody, the minute that you go and try and ventilate them, the minute you do anything where secretions can start flying into the air, these exposed ICU nurses, doctors, staff members, and you saw death happen in there. So, yes, they need to be prioritized. And depending on what state that you're in, that rollout of the vaccine differs quite widely. I mean, I'm in front of you right now talking and I already got my first dose, should have happened earlier, later in December for me, but it got delayed just a little bit, but I do know in my state, ICU doctors, nurses, frontline workers in EMT, fire responders, anybody in that first responder category we're rolling through starting December 17th.
Hilary - That's great. Now. We've heard the term COVID-19 long haulers. What exactly is that?
Imei Hsu - A long hauler, a person who got COVID-19 got a positive diagnosis and became severely ill. And instead of having a more routine recovery, somewhere in the line of four to six weeks, post their, their diagnosis and their illness. That they start showing a number of different, more chronic issues, meaning chronic, meaning that it goes past four to six months. Now that we've been in the state almost a year. You're starting to see we've already started to see a number of people pass the six month period where they are not recovering. So they're showing up with cardiomyopathy, they're showing up with significant lung scarring where these were healthy 30 year olds, healthy 40 year olds, healthy 50 year olds. People that didn't have any significant disease challenge before they got sick. And now they can't walk around the block of their house without feeling extremely fatigued, having these kinds of symptoms. With no real response to any type of treatment we have other than standard for those specific conditions. Like you treat the cardiomyopathy, but there's all these residuals leftover. It's leaving a lot of our healthcare professionals, frankly, scratching their heads about what more can be done for them.
Hilary - Now does the COVID vaccine work for people who are long haulers?
Imei Hsu - So currently, I will refer to everyone who's listening to this, to the CDC website. Cause it's, that's where we get most of our information as it rolls out from the manufacturers. The recommendation is if you haven't tested negative for COVID after you've passed through a period of time where you were positive, you built immunity and then you should be negative for COVID 19. There was a period of time where it's recommended. You can go ahead and get vaccinated because there's a chance. One that you could get again. And two, because we now have three documented variants flying around in our nation that you should get, um, you should get vaccinated. And then it depends on which vaccine you get. There will be guidelines from these specific manufacturers on the timeline of when you should be vaccinated.
Hilary - Now, there are people who may be symptomatic and they don't know that they have COVID-19. If they get the vaccine, will there be any implications?
Imei Hsu - Well, the recommendation again is for the individual vaccinations. So when you come through, when it's your time in the phase in the state that you're in to get your vaccine, they will screen you. So in your state, they will screen you according to the manufacturer's questions around that. And if you fail any one of the questions there, they will delay your vaccination until it's in the safe period of time. So I think that's the better way to answer it is because we now have at least two and possibly in the next month or so we may have four different types of vaccines. So I don't want to say for sure which one's going to be under what category, but there is some understanding that for the two that are available now, Pfizer and Moderna, there is a period of time post if you had COVID positive. You were COVID positive. There's a period of time where your immunity is enough that you don't need to be vaccinated and you may choose to wait. And so you would want again, go to the manufacturers that listed there and be screened for whether or not you want to wait.
Hilary - So our current president has chosen to do that. Since he too was vaccinated, sorry he was not vaccinated. He chose not to be because he had been COVID positive and it seems like there are a lot of people out there who say to me, I had COVID already, I don't need the vaccine, but that's not really true is it?
Imei Hsu - No, it's not because we do have some cases and again, it was on the CDC site and you can refer there that it is possible to get COVID again and now with three variants that are in our system, one of them showing in the early stages to be easy to transmit that it's a good idea to go ahead and be screened for the vaccine. So my overall idea that I'd like to urge listeners today to consider when it's your time to be offered the vaccine, please strongly consider getting it and then be screened so that if there's a reason you shouldn't get it, I think that's a better way to go look at why you shouldn't get it through the screening questions, assume that you should, until you're told.
Hilary - Now let's talk a little bit about the vaccine. How does it work? What can you expect when you get it and how will you find out when you get yours?
Imei Hsu - Okay, your state should have some kind of infographic from the department of health may have released it to public health or your primary care provider's office may have also supplied phase finder information that helps you see which phase one, two or three or four you should be getting it. And it's a little bit cloudy right now at this early time. One, because we had a delay in how many actual doses were available per state, but you can start there, do a phase finder search and then see where you should be getting it. So if you're in healthcare, technically, if you're a first responder of any type you should be in phase one, and then from there for, there's a couple of other caveats that are really important, if you are black indigenous or person of color, specifically looking for Hispanic, and then after that Asian, after black and indigenous, those people also go to the front of the line of the health care workers, because their communities were hit much, much harder than all the others in the United States. So we have that data already that they should be prioritized. And if you have any question, if you're listening to this and you have any question about that, again, go on the CDC website or appeal to your department of health in your state. Because you really should be at the front. The problem is that sometimes if you're not in sort of the main part of the system of your state, like you don't work for a hospital, but you work for a small private practice, but you're seeing patients, you may not have been prioritized simply because they didn't know about you. And so it's important for you to advocate for yourself. If you are a firefighter, your state's already advocated for you, or they should have, because you are on their radar. If you're in that caveat of being a BiPAP and a first responder advocate for yourself, go to the front of the line. And then for everybody else that infographic from your state should tell you where you are in phase. And if you have any questions about it, usually it comes with a bunch of screening questions. So for example, if you are in your fifties, so you're not 65 years old, but you happen to be living in a situation where you're taking care of an aging parent that may qualify you in your state to go closer to the front align, maybe phase one, one B or one C, but still in phase one to be prioritized for vaccination, including your aging parent. Some people did not know that. So it's important to get that information out. And then with the new administration, just days away from stepping off in and taking over operation warp speed. We are getting information that there will be more prioritizations in phase one. And that would include teachers who are going to be ready to go back to work either in a hybrid model, sometime in-person teaching and some time, teaching from a remote location, trying to do this in the safest way possible. So there's more prioritization happening and that also has to be coordinated with getting enough doses and then depending on which. Which actual company or brand of vaccine you'll be receiving also determines where you'll be in phase and what options and choices, because with the first two Pfizer and Moderna, you always have to match a person with the same dose for that second booster dose, you cannot mix Pfizer and Moderna. So, if you got a Pfizer first, you can have Pfizer your second one, and there'll be a specific number of days that you can get that second one, same for Maderna. So it's a little bit more complicated and making certain, everybody gets a matched dose.
Hilary - With the second dose. Do they tell you once you get vaccinated, the time that you should get the second one, do you make an appointment at that point? Or do you have to go back online and try to go through this whole New York state has a crazy crazy system.
Imei Hsu - Well, again, that's going to, depending on your state, I've seen in some places, you know, long lines for people trying to get to a vaccination site and I can only speak to my state is that we have a very robust way of documenting how we collect the information on making certain that people get a dose matched, and then they get scheduled for their second one. So when that information's all inputted in, they're usually given a date range that they can get their second one in and schedule it immediately.
Hilary - Now let's talk a little bit about the 18 year old, uh, kids out there. Should we be concerned about them, you know, anybody 18 and younger getting the vaccine, at what age should they not get the vaccine or should everybody get the vaccine?
Imei Hsu - So the main answer to that is based on the manufacturer. And I do want to step backwards and realize that, I didn't actually answer the other question. You said, how does these vaccines work? So I'm going to combine those two questions together. The vaccine works, the two that we have right now, they're both RNA vaccines, which is messenger RNA. And basically they were coded with the DNA information that's matched to that specific virus that we got from China when they documented what this thing is. And that information is super important, because for those who were designing this vaccine, they want to match it specifically to the DNA content of this virus. Because when you do that, you have a much better chance. You don't have to shoot in the dark, you know exactly what you're dealing with and this type of vaccine, an M RNA or messenger RNA vaccine has been in the making for 18 years. So, this is not new. It's been used in other places, but the technology behind it is not brand new. What is new is that specific DNA structure being matched to that. So they could create a vaccine and that is why the effectiveness rates on Moderna and Pfizer are so high. With the flu vaccine, as a comparative, we get lucky if we get, you know, 50 to 70% effectiveness against that specific strain and every year we've got to research to guess what we think the next strain will look like. And that's why we have a quadrivalent flu vaccine available. We basically put four different strains together or the vaccine fights for different strains so that you have better coverage. But this one, they were able to use that DNA structure. And the way it works is that you introduce the vaccine into the body and this small dose. And it basically primes the body to be able to recognize the spike protein that. Everybody knows that it's part of that funny looking Coronavirus, you know, infographic that lots of us have seen, it looks like a Bumble ball, right? With all these different little lobby things on the outside or lugs. And then that spike protein is where basically it's kind of the focal point of that virus. And when you do that for the body, what ends up happening is that when you give that second dose 21, some days later. Body goes, hm, I've seen this before. And it mounts an immune response, a small one all by it makes you feel like he has a cold or flu. You might have some chills fever. Maybe even a little diarrhea or nausea that lasts about no longer than 48 hours for the average person. Whereas the first dose, not the booster, but the first dose you might just have injection, sight muscle soreness feels like you got the MMR. Which many of us remember in childhood, it's like, oh, wait, my arm hurts, it feels like that some people will have some very mild symptoms, like a headache, a little bit of fatigue the next day or so the arm soreness goes away, maybe four days tops and most people don't report any other symptoms. There's a very, very small component of citizens that may experience some stronger symptoms and then a very small group that may have the more rare allergic reaction, which would happen to any vaccine, not just this one and may not even be responses to the vaccine components themselves, but rather just because they are sensitive people. And so that's how the vaccine works. That's what you can expect from dose one. And dose two, we have some vaccines that are going through the phase three clinical trials that are likely to be approved. In the next couple of months, one of them is AstraZeneca. Another one is the Johnson Johnson. When you're now looking at a single dose vaccine, there can be some other options available, which is lesser efficacy, but only one shot. Less response to it in terms of symptoms, but we can get people to have some pretty good coverage and this can be rolled up very quickly. So we're hoping that that will help everyone, now to the question of, should we be vaccinating 18 year olds or 17 year olds? Uh, it depends on the manufacturer's recommendation of how young we can vaccinate safely until we know more, again, these vaccinations were approved, not by the FDA, but for emergency use authorization. And then it'll be later as we collect more data that will formally be probably FDA approved, because that is a much longer process. So got to go by the manufacturer for right now and see how that's working. But the reason why you want to even go for younger and healthier people is that we've seen that this coronavirus does not discriminate by age, young people have died. Young people have gotten sick and even middle-aged healthy people, or even below middle age have gotten it and have had devastating results. So we want to try to vaccinate all adults at minimum. And that they're probably going to be seeing how young we can vaccinate too. So just like chickenpox, B-cells other childhood diseases, we can go younger and younger as we understand more about what ages we can receive the vaccination safely.
Hilary - This was so enlightening. I really, I was so informative and thank you very much. I really appreciate you coming on. Are there any last thoughts that you'd like to share with our audience before we wrap this up?
Imei Hsu - I think the big question on everybody's mind and my heart goes out to all of you who are thinking this thought is when are we going to go back to normal? And that's been, you know, on our minds from day one, as a healthcare provider course, there are so many things we have lost. This coronavirus has affected people's mental health as we've not been able to gather with people we love. We have not even been able to be at the bedsides of those who are dying. We have not been able to travel, which is a huge part of our experience to know more about our world and to see that we have more in common with one another. And when we travel and see how other people live, then if we stay in slurry, Insulated in our homes. So it's a really huge loss for everyone. So we want to know, when are we going to come back to normal? And at first there was some speculation that we would be back to normal, the end of 2020. And my reaction was, yeah, right now, that's not happening. And then others said, okay, let's be more optimistic. Normal's going to come back in July of 2021. And I still kind of rolled my eyes at that because they didn't understand that it's never really been about not having enough doses for at least the United States. I'm not talking about the rest of the world, but we have populations where it's going to be very difficult to get vaccinations to remote countries and those who are not wealthy, but just when we start talking about the U S it's never been about getting enough doses, it's been about the administration. How do you get this many millions of people accepting the vaccination readily, unless they really are disqualified from getting it for some health reason. How do you get shots in arms? There are not enough healthcare providers and you can't just train anybody who's unemployed to do something that doctors, nurses, EMT, perhaps, medical assistance at a higher level of care are trained to do. So. And this comes down to me just recently I had my first fainter in the office, meaning the person, uh, just doesn't like needles. And this is a possibility for those who just don't like needles or pain, how to respond to being vaccinated, not the vaccine components themselves. And because I'm trained, it's like the back of my hand to be able to help somebody through that safely so that there's no injury and that person can recover very quickly. And it was a success and it went very, very well, but I dread the idea that somebody who doesn't have that training would simply be asked to learn how to do this. Let's say we take some from the national guard who don't have medical training and say, we want to train you to just fax innate, there's problems with that. So we're never going to roll it out fast as we want to, until we get the mechanisms in place which costs money and time, and I'm hopeful in the new presidential inauguration happening and the continuance of operation warp speed that we will speed up so long story made short. I'm looking at much later in 2023. Or, sorry, 22 or 21 to start seeing the beginning of normal and 2022, really to see normal. Which is a return to a lot of the activities we have, as long as people don't get COVID fatigue, which is to everything you know now. And when you get the vaccine, until we find out more about transmission rates, continue washing hands, wearing a mask, continue to socially distance, treat everyone as if they might be asymmetric in symptomatic carriers and take care of one another as best as you can while we get through this together.
Hilary - Awesome. Thank you so much. And how can people get in touch with you?
Imei Hsu - Best way to get in touch with me is you can go online and Google my name. Imeihsu and you will find me across a number of different channels. I think if you have medical questions again, I would refer you to ask your provider, if you have specific questions about today's interview.