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A Mich Med doctor says 'human behavior' continues to have a big impact on how the pandemic plays out

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As cases of the COVID-19 virus decline around the country, Michigan remains one of a handful of states continuing to see a surge in the number of cases.

WEMU's Lisa Barry talks with Michigan Medicine infectious disease specialist Dr. Payal Patel to get an update on how the pandemic continues to impact the Ann Arbor medical system and whether or not much has changed as to how we move through the world as the global health crisis drags on.


Lisa Barry: A year and a half into the COVID 19 pandemic, and there is still much confusion and frustration about its impact on our daily lives. I'm Lisa Barry, and we're fortunate to have many resources in our own community that can help explain and clarify what is happening. And one of them is Michigan Medicine infectious disease specialist Dr. Payel Patel, who joins us now. Thanks for taking the time to talk to us, Dr. Patel.

Payal Patel
Credit Michigan Medicine / uofmhealth.org
Dr. Payal Patel

Dr. Payal Patel: Yeah, of course. 

Lisa Barry: We're seeing COVID cases declining around the country. Yet, Michigan was recently cited as one of five states still seeing a surge in the number of cases. Is there any way you can explain that to us? 

Dr. Payal Patel: Yeah. You know, surges are often influenced by human behavior, which is so unpredictable, and along with that, vaccination rates. And so, I would say a lot of what's going on in these surges that we're seeing is people relaxing, social distancing, handwashing, mask wearing, and that can be responsible for some of the cases rising, as well as having a lower vaccination rate in the community. Overall, Washtenaw County, where we live, is doing pretty well, but often in the state, things can go up and down depending on where you are. 

Lisa Barry: How are things at Michigan Medicine these days? 

Dr. Payal Patel: It's a great question. You know, what we're seeing a lot of these days is we still unfortunately are seeing unvaccinated patients coming in very sick, having to go to the ICU. We also are really busy in the emergency room and outpatient setting, trying to decide who needs to come in, who can get some of these other treatments that we have for COVID-19. But I will see primarily a lot of those people are the unvaccinated that we're seeing coming in. 

Lisa Barry: Have the treatments improved or changed over the course of the pandemic? 

Dr. Payal Patel: Yeah, your listeners may have heard there is a new treatment that is still pending approval, but is going to be an oral option for treatment of COVID-19. But I would emphasize, you know, the best way to prevent even getting sick is getting your vaccines. 

Lisa Barry: Does the perception of just how protected we are by being vaccinated keep changing? I feel like one day we hear you're fully protected, then another day, not necessarily. In any way, you can break that down for us?

Dr. Payal Patel: Oh my gosh, I totally feel everyone on this. And I think, you know, just the way the variants have emerged has been really kind of head shaking for everyone involved. And that is a lot of kind of why things have changed in terms of how one feels after being vaccinated. I do want to emphasize that being vaccinated is really the best thing you can do to protect yourself and your family. And being vaccinated kind of just changes the game in terms of your how risky you should feel things are. If you've done that step, um, you've really done the best thing that you can do. And the next things that you can do are in tight places, you know, continue wearing a mask when you don't know who's around you, but feeling a little bit safer knowing that you're fully vaccinated is a good thing. Most of the people who come in sick when they're fully vaccinated don't end up having to get admitted to the hospital, so that should be reassuring. 

Lisa Barry: But it was pointed out to me by someone recently, who I'm assuming was not vaccinated, that if you're vaccinated, you can still get the virus. Are you hearing that? 

Dr. Payal Patel: Yeah. And, you know, some of the studies indicate that when you look at, you know, you look at people who are vaccinated and if they do get infection, they actually have either no symptoms at all. So, you know, in your daily life, you wouldn't even know that you got infected or minimal symptoms, like something like having a cold. Although, some people do still have that loss of sense of smell. Comparing that to just completely drastically a life change and getting admitted to the hospital, spending weeks--months--in the hospital, potentially going to a nursing home or something like that, I would say that the two options there are very, very different. 

Lisa Barry: So, I have some practical questions for you. What is the risk of a vaccinated person being around an unvaccinated person? 

Dr. Payal Patel: A lot of that depends on that vaccinated person's immune system. And so, that's a really individualized question. So, if you don't have any issues with your immune system, then you should probably still surround yourself with other vaccinated folks. And if you don't know who's going to be around you, wearing a mask makes sense. At the same time, if you're immune compromised, you have something that--some kind of medical history that puts you more at risk, you would try to avoid those situations as much as possible and definitely continue masking as much as possible. 

Lisa Barry: [But what I said and what the variant has brought to us, that is people who are vaccinated are still getting COVID-19. Does being around somebody who's unvaccinated increase that challenge? 

Dr. Payal Patel: Yes. So, if you're in a room of 100 vaccinated people, your chances of getting COVID from each other are much lower than if you were vaccinated, but surrounded by 99 unvaccinated folks, 

Lisa Barry: I've seen this meme of a doormat going around like a welcome mat that says "Welcome. Oh wait, are you vaccinated?" Before you step into my house, answer that question. So I think it's a lot on people's minds still these days. 

Dr. Payal Patel: Definitely. And I, you know, at the end of the day, I would also remember that it's really the unvaccinated person that's at risk in that situation. The CDC still says, you know, for someone who's unvaccinated, travel isn't really recommended, whereas if you are vaccinated taking precautions, you can travel. So, it's a huge change in the risk if you're vaccinated or unvaccinated. 

Lisa Barry: That was going to be one of my next questions. I'm hearing people planning trips and going to see shows and getting on airplanes. And as an infectious disease specialist at Michigan Medicine, you good with that? 

Dr. Payal Patel: Um, you know, I understand people wanting to do all of those things. It's been a long time. What I would say is if you're vaccinated, remembering that, like we said, human behavior is really what drives some of these infection rates. So, if you're going to be around a lot of other people, let's say, in the airport or in a theater or at an outdoor music festival, I would say physical distancing as much as possible, handwashing, mask wearing. That's not only going to protect you from COVID-19, it's going to protect you from all of those other winter viruses to you and get your flu shot. 

Lisa Barry: Where are you on going to the movies? 

Dr. Payal Patel: Oh, gosh. I'll say that I haven't been to the actual movies since all of this started, and I do miss them. Um, if you wanted to go to the movies, I would recommend it makes sense to probably stay masked. And if you can't stay masked, maybe you shouldn't go.

Lisa Barry: I always hate to ask this question because I know a lot of local restaurant owners in the struggle they've been going through, but are you comfortable as an infectious disease specialist saying it's OK to eat inside a restaurant? 

Dr. Payal Patel: Oh, this is a good question. So, I think as you're considering like, you know, an outdoor dining versus an indoor dining, especially as we move into the winter... 

Lisa Barry: Right. 

Dr. Payal Patel: It's, you know, it's a difficult question. You've already changed your own risk by becoming vaccinated. If you have become vaccinated, you want to think about ventilation in that space. Is that a spot where you are just huddled up to the next person? Or is there some space between you and other tables? You know, is it a very, very small cramped restaurant, or is it pretty open and airy? Thinking about all of those things, as well as your own risk, your own immune system, your vaccination status, it's kind of a case-by-case basis. 

Lisa Barry: Holidays are coming up. Dr. Fauci recently said trick-or-treating is OK this year, so we're happy about that. But people are also thinking ahead to Thanksgiving and Christmas and other holidays where friends and family gather. What are your thoughts on that? 

Dr. Payal Patel: I totally agree that trick-or-treating is the way to go, so definitely on board with that. I think as you think about your Christmas plans, your Thanksgiving plans, you know, there's employers that are mandating vaccines in their employer, why not do that with your family? You know, if you're worried about your unvaccinated child, and I'm hoping that kids are going to be vaccinated by Thanksgiving, it is totally fair to set a rule that if you're going to come to Thanksgiving at my house, you know, I'm going to need you to be vaccinated. That's going to, again, protect you, people you care about, people who are older than 65, children, unvaccinated people who can't get the vaccine yet. I think that that makes a lot of sense as you're thinking about the holidays. 

Lisa Barry: And what is your view about booster shots? 

Dr. Payal Patel: Ooh, booster shots. Great question. So, first of all, you know, trying to--I know there's so much information out there. I would say the CDC is a great resource. So, if you're over 65 or you have some sort of immune compromised situation, hopefully you're already thinking about getting your booster. If you fall into a group that aren't in those early groups. I think that such as someone who's out and about in your job or, you know, even if you're healthy and you're kind of just concerned and asking all the questions that you've been asking, Lisa, I think that it makes sense to get the booster. We're still learning a little bit about when the optimal timing is going to be. 

Lisa Barry: Yeah. 

Dr. Payal Patel: But I think that if you get it now versus next week versus two weeks from now, all of those things make sense in their own way. And just trying to stay tuned to the news as we get more recommendations about that timing.

Lisa Barry: I think that leaves people kind of hanging, though. At first it was, I guess, get your boosters and then we are hearing, well, the FDA is not necessarily saying you should, and I feel like that's gotten more confusing recently. 

Dr. Payal Patel: It has, I think that the way that the science is coming out is who are the populations that need the booster ASAP. And those are the folks that we know have not had the same response to the vaccine as most of us. And so, those are the folks that really need to get that third shot earlier and quicker. Now, if you have the same outcome with a booster or just a little bit better with the booster than you would have with the second vaccine, that's what scientists are trying to tease out--to really inform patients who are thinking about that third shot. 

Lisa Barry: And flu shots. Got to get those? 

Dr. Payal Patel: Yes, and it is okay to get your flu shot and your booster at the same time, especially if you're over 65. Definitely get the flu shot, though. 

Lisa Barry: So much to take in. Dr. Payel Patel, Michigan Medicine infectious disease specialist. We're always grateful for your expertize and input with us here on WEMU. 

Dr. Payal Patel: Thanks for having me. 

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— Lisa Barry is the host of All Things Considered on WEMU. You can contact Lisa at 734.487.3363, on Twitter @LisaWEMU, or email her at lbarryma@emich.edu

Lisa Barry was a reporter, and host of All Things Considered on 89.1 WEMU.
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