Holiday travel and family gatherings are expected to rebound this year to near pre-pandemic levels, even though COVID-19 is still with us and the flu is beginning its annual spread across the country.
Find out what preparations you should be making now to keep your family healthy this holiday season, with host, Jonathan Fialkow, M.D. and a panel of experts.
Guests:
· Sara M. Panella, Pharm D., a clinical pharmacist with Baptist Health
· Jose Llach, D.O., medical director of the emergency department at Baptist Health Hospital
· David Mishkin, M.D., medical director of Telehealth and Care on Demand.
Holiday travel and family gatherings are expected to rebound this year to near pre-pandemic levels, even though COVID-19 is still with us and the flu is beginning its annual spread across the country.
Find out what preparations you should be making now to keep your family healthy this holiday season, with host, Jonathan Fialkow, M.D. and a panel of experts.
Guests:
· Sara M. Panella, Pharm D., a clinical pharmacist with Baptist Health
· Jose Llach, D.O., medical director of the emergency department at Baptist Health Hospital
· David Mishkin, M.D., medical director of Telehealth and Care on Demand.
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Dr. Fialkow:
Welcome Baptist HealthTalk Podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Miami Cardiac & Vascular Institute, where I'm also Chief of Cardiology at Baptist Hospital and the Chief Population Health Officer at Baptist Health. Holiday travel and family gatherings are expected to rebound this year to near pre-pandemic levels, even though COVID-19 is still with us. This is also the time of year when the flu starts to spread across the country. So, what special preparations should you be making now to keep your family healthy this holiday season? That was the central question of a recent episode of Baptist Health's Resource Live program, which I had the pleasure to host. My guest was Sarah Pinella, a clinical pharmacist with Baptist Health, Dr. Jose Llach, the medical director of the emergency department at Baptist Health Hospital [Nurel 00:01:10], and Dr. David Mishkin, medical director of Telehealth Baptist Care on Demand at Baptist Health South Florida. Let's hear what they had to say.
Dr. Fialkow:
So, David, let's start the discussion with you. Slowly, people have become more comfortable with traveling. Some may still feel uneasy about it. What concerns, if any, should one have, even if they've been vaccinated against flu and COVID-19? So, If someone's coming vaccinated and wants to travel, what precautions or concerns would you tell them they should be aware of?
Dr. Mishkin:
Well, I think that we're in a very different place today than we were a year ago during the holiday season, about giving patients the flexibility and freedom to travel. We have a large percentage of our population now vaccinated. In addition, over the past year, we've really started to develop a lot of other medical therapies, which not only help prevent exposure, but also progression of disease. And as long as we're not seeing high levels of reinfection rates, I think that we can tell our patients in our community that it is safe to travel.
Dr. Mishkin:
But there are certain precautions that we need to really adhere to before traveling, and that is, one, we need to make sure that people are fully vaccinated before they travel. That's two weeks after your final dose. You need to take advantage of widespread testing availability, which is now really become ubiquitous, so whether that's testing before, during or after travel from either symptoms or exposure. And obviously, most important is, especially in public settings and when in transit, you need to wear a face mask. That even pertains to being on airplanes, trains and buses, to really prevent exposure and just maintain social distancing when you can in order to prevent exposure when you're in these indoor public places.
Dr. Fialkow:
So, our community rates in South Florida are fairly low, but we are seeing spikes across the country. So, I think that's great advice, which is make your plans, get vaccinated and be mindful though about whatever precautions you still may take to decrease the spread of COVID and flu, quite frankly. Have you seen a diminution in flu over the last year or two? If so, are you starting to see it as an uptake, David?
Dr. Mishkin:
It's interesting because every time you get exposed to a respiratory virus, you build up immunity that protects you against future exposure. But people last year didn't really reprime their immune systems with the flu. So, we're expecting to see a little bit of increase in influenza exposure and we're starting to right now. And so, in addition to people, somewhat, backing off a little bit of those pandemic precautions with the masks being taken off in large gatherings, we're starting to see those numbers increase. So, we're really advising patients that it's really important to get their influenza vaccine as well because of that concern. And, hopefully, by doing the things that we know we have to do, in addition to getting vaccinated, hopefully those numbers won't be as bad as they were even before the pandemic of influenza.
Dr. Fialkow:
So, Jose, as we recognize that people are traveling, a lot of the travel will be to be with family, some of whom haven't seen each other for quite some time. For those traveling to be with family, any precautions that you're giving them. Talk a little bit, again, about the vaccination, but anything in addition to that regarding precautions. Speak a little bit about, maybe, age... Are there any recommendations about being exposed to people of various ages when you're traveling to visit family?
Dr. Llach:
Yeah, definitely. If you're, basically, going to go visit a family member, let's say this family member is immunocompromised, meaning he's got cancer, is being treated for cancer. As you know, like you're saying, Fialkow, is a little bit older in life, you definitely want to take the precautions and you definitely want to protect yourself so you can protect them at the same time. You, definitely, want to avoid those settings like a concert, hockey games, basically areas where a lot of people are going to be together for the most part, especially if you're going to go see those people that are, basically, more immuno compromising itself. Nonetheless, if you are going to go to these locations, you definitely got to... Like Dr. Mishkin said, you want to wear your mask and you want to wash your hands.
Dr. Llach:
In fact, every time I go in anywhere with my wife, we always wash our hands. And, basically, as soon as we get back into the car, we clean our... The steering wheel with alcohol and we clean our hands with alcohol. So, basically, it's protecting yourself to protect your family in the long... At the end, again when you go visit them, nonetheless, if you are... If you have any symptoms of fevers, chills, cough, definitely get tested before you go see them. And if you feel that you're in doubt that the testing is negative, but there's a possibility, you want to be cautious and you want to, basically, sustain from traveling so you don't get sick at the end of the day.
Dr. Fialkow:
That's great advice. Protect yourself, but also think you're protecting the people around you, so take into account who you might be exposed to. And we understand the emotional nature of wanting to be around family, but with the proper precautions, we can all maintain each other's safety. Sarah, Dr. David did mention a little bit about the timing of the vaccines, but for people who are going to travel, what are the recommendations you would make regarding timing? When you get a vaccine you're not, necessarily, getting the benefit of the vaccine the next day. So, do you have any... Can you give us any information regarding timing of a vaccine and maybe, including in that, would be a little bit of the timing of the boosters and how... What the recommendations are right now for boosters?
Sarah:
Yes. In regards to the vaccine, if you know you're traveling, you want to plan ahead to get the vaccine, to protect yourself and to protect others around you. So, typically, the turnaround time, you have to get the two doses and it takes about two weeks to get fully immunized after that second dose. So, if you do plan ahead... It's always good to plan about a month and a half, around 45 days, prior to your travel date. You do have some immunity after your first dose. So, if you weren't able to plan ahead, at least plan for now, get your dose. And hopefully some of it kicks in prior to the holiday season for at least that first series. If you're in the zone for boosters right now, what they're recommending is that you get your booster at least six months after your last dose or the last of your series, your second dose, unless you got Johnson and Johnson, you can actually get it two months after that first dose of the Johnson and Johnson.
Dr. Fialkow:
So, planning your vaccine and your travel around your vaccine is clearly something that has benefit and we recommend. Jose, there's still variation regarding states and countries requiring negative COVID tests before traveling. What are we recommending regarding getting tested before one travels. How soon? And then to that end, what about returning any particular guidelines towards getting tested before you come to the country or when you come back getting tested again, if you're going to be exposed to people who might be at risk?
Dr. Llach:
That's a great question. Yeah, you definitely... Actually that was, sort of, what happened to me with that. A few months ago, basically three months ago, traveling to St. Thomas Islands. And there was still the... Should we... There's was still... Testing requirements were still influx in itself, to be testing or not to be testing. I went to the airport, I didn't get tested just because I was still flying within the United States. Nonetheless, when I got to the airport, I actually had to go and get tested. Luckily, there was a testing center at the airport where I got a quick COVID swab. Me and my wife got a COVID swab and, luckily, we were negative and we're able to upload it into the system. We got the green light to travel to Saint Thomas Islands out in the Virgin Islands in itself.
Dr. Llach:
So, you definitely want to do your homework when you buy your tickets. In fact, before you get your boarding pass, you have to show that you're negative for COVID, especially if you're traveling internationally. If you're flying nationally, you don't have to, but if you're flying internationally, you definitely want to do your homework and look at the details, because, in fact, you jump online, it will tell you if you need the COVID test to the country, you're flying to.
Dr. Llach:
Usually, the studies does show is that one to three days before you travel, you should get the COVID test. Some countries, right, require the PCR and the antigen test. So, you definitely want to figure out which test they actually require at that specific country you're traveling to. And on the way back, you also want to get tests because when you're coming back into United States with a.... From a foreign country, they will require most likely antigen or PCR COVID test as well, depending on the country you're coming from. So, you definitely want to do your homework. And there's a good app called VeriFLY. That's a good app that you definitely want to download if you're traveling, because it'll give you all the requirements and information you need before you travel to these locations.
Dr. Fialkow:
So, it is confusing, but there are good sources of truth so to speak and VeriFLY will be one. You could ask your doctor, again, go online and look for those resources. Because it does... It can vary a little bit country to country. So, make sure you're prepared. Sarah, children. So, again, we'll be traveling and a lot of adults will be vaccinated. What are we recommending about children and COVID 19 or the flu part of traveling? Are there any specific recommendations towards protecting them, whether vaccination or other modalities?
Sarah:
Yeah. So, if your child is eligible for vaccinations... With a COVID vaccine, children's five years and up are recommended to get the vaccine, they should definitely get the vaccine. And then if they are not eligible, they're outside of that window, between the ages of two and five, best thing for them to do is mask up, stay safe. And if you can keep... Like my little one, who's under the age of two safe and, kind of, close together, clean the area as well as possible, keep your distance. I think those are the best things that you can do. Now, that's with the COVID vaccine. With flu vaccine, six months and up are eligible to get the flu vaccine. So, anyone who can get vaccinated during this time to try to prevent those diseases, that would be great. And that's how we can protect our children. And I know that's close to my heart being a new mom and a mom to be at the same time, so...
Dr. Fialkow:
Thank you. David, we all know for anyone that travels, one of the most significant fears is getting sick while you're traveling. No one wants to see doctors they don't know, or even finding medical care. So, what, kind of, recommendations would you say for someone who might be traveling either locally... So, someone traveling to Florida, how do we handle it? And if someone, themselves, one of our patients or someone in our community is traveling away from home, when someone gets sick, what do, what, what resources are available for them?
Dr. Mishkin:
I think the Most important thing is preparation. Before you travel, have a plan in place and, kind of, do some research on your destinations healthcare resources. So, that way, when you do get sick, you know exactly what you need to do. Maybe figure out, if you're going somewhere that is more urban or domestic, like Miami, you know that you have, kind of, an abundance of resources of different healthcare systems like ours to be able to take care of patients. But if you're going somewhere more remote or international, do your homework before you leave. So, therefore, if you do get sick, you can actually show up and have a plan in place of how to seek healthcare. Make sure that you look to see which countries, especially internationally are recommended by the CDC to avoid non-essential travel, and then also consider traveling with a partner.
Dr. Mishkin:
So that way, if you do get sick, you have someone to help take care of you or assist with your care. As always, you have to make these decisions based on your own personal health history and your loved one's health history. But really the most important thing is to be prepared. And that's why even for Telehealth... Our Telehealth app, we actually have it as access on our phones. So, even if you travel anywhere in the United States, you can access with just the push of a button, a Telehealth app, to get at realtime advice from a medical professional who can help advise you. And that's a great resource as well. It's almost your own real side assistance when you do leave town. And we recommend things like that as well. And that's the benefit of these types of technologies, to be able to get real time help managing your symptoms and whatever you may need.
Dr. Fialkow:
If someone's traveling and access our Telehealth solution, is one able to get medication prescriptions called in as well, even if they're not local?
Dr. Mishkin:
Absolutely, because we have the ability to take care of patients the same way we do locally in on Telehealth app, as we do in any of the states in the continental US, which is great. So, we always say to patients that if you do have any type the healthcare symptom, when you are out of town, please use our app and it's a great resource to be able to get care.
Dr. Fialkow:
Jose, following up on the boosters. And Sarah had mentioned that you're not fully immune until after two weeks after your second dose for the mRNA vaccines, for example. How long does the protection last? What's the data regarding how... When you get the vaccine, how long it lasts and then give us a little bit of the information supporting why the boosters are felt to be important. Are there some populations where it maybe is more important, for example?
Dr. Llach:
Definitely. So, basically, you definitely... Studies have shown that the immunity, the antibodies in your body who protect start weaning down, basically, at the six month mark, which is why they're recommending the... per the CDC to get vaccinated with a booster, like Sarah saying earlier, at the six month mark. So, you definitely want to do your homework, you want to get the booster. Specifically, for those who are healthcare workers, teachers, people who are immunocompromised, you definitely want to do your homework and get the booster as soon as you can, because during that time, in the six month mark, is when your COVID antibodies, until your antibodies in itself that protect you, start weaning down at that time. So, you definitely want to get the booster at the six month smart.
Dr. Fialkow:
So, Sarah, another area of confusion, which we can elaborate on is the flu vaccine and the COVID vaccine. Talk a little bit about how they're different, if you will. And more importantly, tell us what we recommend for the two vaccines. Are there any interactions between the two, for example, if you get a COVID vaccine, will it, you against the flu. So, talk a little bit about why it's important to get both vaccines.
Sarah:
Sure. So although both are viruses, they're different types of viruses. So, you can get your COVID vaccine, but it will not protect you against the flu. That's why it's really important to have both vaccines... To get both vaccines, excuse me. And if you're at the doctor's office or if you're in the pharmacy, getting the vaccine, you can get both at the same time, be one visit and done. And if you are of 11 years or older, you can also get this shot in one arm and have one just very sore arm for a little bit of time, but it's okay to get them at the same time. I know, initially, it was recommended to separate them out, but I think it was more so we... For us to understand any side effects related to the COVID vaccine. So, that would be... The recommendation is to get both because one will not protect you against the other. And we really want to cover these two viruses and protect ourselves and others from it as well.
Dr. Fialkow:
Again, guys, this is great information. I think at this point, we'll start taking some questions from the audience and we'll start with David, Dr. Michigan. David, if someone... Is there a difference in the kind of travel and the risk? In other words, I guess the question is, kind of, if someone travels by plane or car or airline, cruise, different recommendations towards vaccines and risk and safety methodologies?
Dr. Mishkin:
We, kind of, recommend that you take, kind of, a universal approach to traveling. We know some types of travel are a little bit more dense than others, especially if you're traveling to more populated areas, traveling on crowded planes, buses, trains, going through airports. Most important thing I think is prevention. Wearing masks, practicing the best type of social distancing you can, is going to give you the best opportunity to be safe when you travel. But in inevitably the key with traveling is really to make sure you do all the things ahead of time, not only to protect your immune system through those recommendations that we've been offering through this, as well as to also... Anytime you do get symptoms or you feel those things to get tested and make sure that you inevitably are not going to expose anyone else.
Dr. Fialkow:
Sarah, if someone's had the two vaccines and did not have significant side effects, can they be assured that they won't have significant side effects with the booster?
Sarah:
I wish I could say yes, but it's not assured. Everybody is reacting very differently. I know my personal experience, after my second dose, I did develop some slight fevers that were lasted about 10 hours, but resolved with medication that helped with fevers. My booster dose, I got nothing. I had a sore arm for a few hours and then it was nothing, but I've also heard people who had a little bit more experience with the booster. So, although it's... I would love to say you... If you didn't experience it with the first two, you might not experience it with the third, but I can't guarantee that, it's very different. Everybody's been experiencing.
Dr. Fialkow:
I had it worse with the booster, but again, it's very running anecdotal. So I guess, it's, kind of, like, prepare for the worst, but expect the best, but as per travel, certainly if you're going to get the vaccine, if you're going to get the booster, be worn, maybe not to be traveling the next day in case you don't feel so great.
Sarah:
Yeah. And that helps with that 14 day window too. So, just make sure you... You're going to also need that two week window to make sure you get immunity backup.
Dr. Fialkow:
From the booster as well. Jose, if someone has... And we alluded to it, but if someone has the flu vaccine and the COVID 19 at the same time, which we certainly think is safe, does it increase the risks of side effects from one or the other or the risk of side effects will be the same, whether they have them?
Dr. Llach:
Yeah, basically, you never... That's not the question we don't know, because what happened is that you might not get side effects, like Sarah was saying earlier. She had it for the... For the second one she didn't have it. For the second dose, she did have it for the booster. She didn't have any side effects, but all depends on the person, nonetheless. But these are reactions that we're getting is a good thing. Believe it or not, people are like, "Oh, I don't want to get the vaccine, because I'm going to get sick." That's not true. What happens actually, you're building antibodies or you're building your protection to your body to protect it from these viruses and COVID in itself. And one thing I tell you is nobody's died from the vaccine. Many people have died from COVID.
Dr. Fialkow:
It's interesting when I feel my own experiences, but I talk to patients and everyone who's... We laugh if you got a little reaction for the vaccine, I was sitting watching football. I said, "Well, I started feeling achy and took some Advil, but I'll do it again tomorrow." I mean, in no way is the reaction going to prohibit anyone from getting vaccinated. So, I appreciate them... appreciate that. Sarah, going back, are there any medications that someone should... Someone may be on that would make the vaccine more dangerous?
Sarah:
Not really. No. I mean, there's nothing really that's there that will make it more dangerous or not. One of the recommendations that comes out with any vaccine is that, a lot of people want to premedicate to try to avoid some side effects, like the fevers, like Advil or Ibuprofen or Tylenol. There are some studies that do show that it might actually blunt the response of the vaccine. So, it will work as well, but you could take it afterwards. So, I always say, if you're on it, that's okay. It's not... I don't think there's a big issue with it, but there is no medication that will make your reaction worse to my knowledge. No.
Dr. Fialkow:
Fair enough. And then last question, I'll send to David, and it's a little bit of a tough one. The quote of the question coming from the audience members, "With COVID fatigue happening, do you expect COVID surges during the holidays now?" I would imagine not long haul COVID but just the fatigue of all the mitigation strategies we have. Any thoughts on what you may be seeing or expecting?
Dr. Mishkin:
Yeah. I think it's very regionally dependent, especially with weather changing up north, climate's becoming colder, people are indoors a little bit more. And so, there's, potentially, an opportunity for more exposure, but I'm hopeful with so much of our population becoming vaccinated, that we're going to, hopefully, see less of a surge that we did at this time last year. In addition, it's super hard for us to distinguish between symptoms of influenza and COVID. So, that's why it's so important that patients do get vaccinated for both. So that we can try to prevent progression of both of these viruses. And in addition, it's so important that people keep in mind that the vaccine is to prevent you from getting this virus, but it's also to prevent you from getting the severe symptoms if you do catch it. So, we really want to make sure, especially with influenza, that we're telling people, "Get vaccinated, because if you do even catch influenza, it's going to be much more mild than it would, potentially, have been if you didn't."
Dr. Fialkow:
To our listeners, remember that you could send us your comments and suggestions for future topics at baptisthealthtalk@baptisthealth.net. That's baptisthealthtalk@baptisthealth.net. On behalf of everyone at Baptist health, thanks for listening and stay safe.
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