 Okay, great. So at this point, I would like to introduce Dr. Sklar. So Dr. Sklar is a professor in the College of Health Solutions and advisor to the provost at ASU. He is distinguished professor and associate dean emeritus at the University of New Mexico, where he was a chair of emergency medicine, associate dean and DIO for graduate medical education and the associate dean for clinical affairs. Dr. Sklar received his medical degree at Stanford and did an internal medicine residency at the University of New Mexico and an emergency medicine fellowship at the University of California, San Francisco. He has authored or co-authored over 200 articles in medical literature and written two books, La Cuinica and Memoir about his time working in a rural Mexican clinic and Atlas of Men, a prize-winning coming-of-age novel. He also happens to be lucky enough to be married to a colleague of ours here at ASU, Dr. Deborah Hellitzer, who's the dean of the College of Health Solutions and has four children. Dr. Sklar has also kindly agreed to stay during the break and answer any questions you may have about COVID or vaccines. So please put any questions you have for him in the Q&A box and then he will stay on after and answer them for you. All right, Dr. Sklar, I'll turn it over to you. Well, thank you very much, Michelle. And so as you just heard, I'm a emergency physician and I actually take care of people who get COVID. I also have, unfortunately, the bad luck of several family members who have had COVID so I've had some personal experience and I've also been vaccinated so I can certainly talk about what that experience is all about. But before I begin, I do wanna give some kudos to Dr. LaBear who you just heard. I think what he has accomplished in a very short period of time is truly remarkable. He has developed a team. He's sort of the quarterback and the coach of our team and I'm part of that team and has developed a resource for the whole state that has been incredibly valuable. So kudos to Dr. LaBear and I think we're so fortunate to have him and I'm fortunate to be part of that team. So I'm gonna talk a little bit about vaccines now because I think that's what we're gonna really be mostly focusing on. So vaccines, first thing about it is vaccines work and as you can see here when you have a vaccine, the disease really pretty much disappears. I actually have taken care of people who weren't vaccinated who had some of these terrible diseases such as tetanus, diphtheria, pertussis, measles. So I'm old enough to have taken care of patients with these diseases and in several cases they died of them. Fortunately, now the worst of them, smallpox, tetanus, diphtheria, pertussis have pretty much disappeared. Measles is very little and polio has pretty much disappeared. Influenza we still have, but the vaccines do work. Next slide. And because of vaccines, we're all living longer. So around the turn of the century of 1900, the average lifespan was about 50 years in the US and now it's about 80 and a large part of that is because of vaccination. Children are no longer dying of these terrible diseases and they're living to adulthood and being able to live a long and hopefully healthy life. Next slide. Now we've heard a little bit about COVID and unfortunately COVID is a new disease. And so what that means is we have not developed as a population any immunity to it because it is new. So when we get exposed to a disease, we develop antibodies and in some cases babies are born and they get the antibodies from their mother or they get exposed at an early stage and that helps us fight off the worst effects of the disease, but COVID is new and we don't have any antibodies to it now. Next slide. And I think you've already seen from Dr. LaBear slides that we've been developing several spikes or surges of disease over the last year. Each surge I think has been bad but I think hope that that would be the worst of it. Unfortunately now we are in the throes of the worst surge and I'll come back to that in a moment because what I don't want us to do is think, okay, if we get the vaccine, now we can stop doing a lot of the things that really need to be done to reduce this current surge. I think we're gonna need to have the vaccine and continue some of the public health activities that will reduce our risk. Next slide. So what's a vaccine? Well, a vaccine is a substance that we give that it can be injected or it can be given orally or into the nose and it stimulates our immune system by bringing into the body either a part of a virus or a bacteria that is similar to what the actual virus or bacteria that causes the disease would create or would introduce into the body. And so we then develop antibodies that will attack the actual virus or bacteria when presented to us. So if we get the vaccine in the best of cases, we will develop antibodies and then if we get exposed to the actual virus or bacteria, we now have those antibodies that will attack the virus or bacteria before it causes problems for us. And so therefore we then don't have the severe symptoms or get very sick or die or anything like that. So vaccines can prevent and or reduce the severity of a disease and then reduce the spread of that disease because we don't have, we're not coughing or sneezing. All right, next slide. So there are four types of vaccines being developed right now. And I'll go through these just very briefly mostly focusing on the last, which is the one that we're mostly, that's what people are getting now in this country. And so the four types of vaccines are, first of all, the inactivated vaccine where we actually take the virus and kill it. And then it will not be able to proliferate, but by then injecting it, we are able to then develop antibodies to the actual virus or bacteria or parts of the bacteria. But that's an inactivated vaccine. Then there's protein-based vaccines where some of the surface proteins from a virus or bacteria are injected. In this case, it would be the COVID spike protein. And then that is used to stimulate our antibodies. Then there's the viral vector vaccine. So what happens is some of the viral DNA is actually put into another virus that is not a dangerous virus. And then that virus is injected into the body and then the DNA creates RNA and then the proteins are produced that our antibodies then respond to. And then the one that we now have is the gene-based vaccines. That's the Pfizer and Moderna vaccine that we're giving out right now in Arizona and all over the U.S. And in that case, we're giving some of the messenger RNA. It's actually, it's injected into the body. And I'll show you how that works. But as it gets into, and here's a picture of it where the RNA is encased in a little fat nanoparticle. It's a little tiny molecule that carries the RNA into the body and protects the RNA from being destroyed before it actually gets into the cells. And then that RNA produces the spike proteins which then cause antibodies to respond to those proteins just as if we had an infection from the virus itself. So it's really quite a unique type of vaccine and because of the way it was developed it was actually done very quickly. So those are the four kinds of vaccine and this is the one that we're currently using. Next slide. Now, unfortunately there are some complications and some side effects from the vaccines. The most serious complication is anaphylaxis. It's very rare, but anaphylaxis may have heard of people who have really severe reactions from bee stings or they may be allergic to peanuts or something like that. And that's a reaction that the body has where you develop a rash and difficulty breathing and sometimes the blood pressure will go down and you feel very sick. Fortunately, it's very rare. I think there've been out of a million doses about 10 cases. And the people who have had those really severe allergic reactions are usually people who've had other kinds of bad allergic reactions to other kinds of either food or get bee stings or something like that. Many of them already have the EpiPen which is the way we counteract those allergic reactions. But it's also the reason why if you get vaccinated we'll ask you stay for at least 15 minutes to make sure you don't become one of those people that have the anaphylactic reaction. And then if that were to happen they have the medication right there at the site that they can administer so that you'll be fine. In any case, that's the most severe reaction. The more common types of reactions are not so severe. Usually just soreness in your arm that develops about 12 hours after the injection. The injection itself is pretty painless but people will develop pain in your arm. Sometimes a little fever, weakness, achiness, things like that. And most people have had those reactions for the second vaccination. The first one usually goes pretty well. The second one, some people, maybe five or 10% will have more of these side effects but they last maybe a day or so. And if you take Tylenol you're usually fine. So not a really bad reaction. Next slide. Now I want to talk a little bit about what we call vaccine acceptance. It's really important that we get people to take the vaccine because that'll be our way of getting rid of this pandemic is to get everybody vaccinated. And there's a real variability and acceptability of vaccination based on countries. The US, about 60% of us are willing to be vaccinated. About another 30% or so are sort of on the fence and hopefully as they watch others get vaccinated and not have any bad effects, they'll be willing. And that is about 10% that are just really against getting vaccinated. And so our plan is really to try to get the 60% who want to get vaccinated to be able to get vaccinated to make it easy so that there aren't really impediments. And I'll talk a little bit about those in a minute. But so that again, they get vaccinated and then for the 30% who are on the fence to also be able to provide the information and hopefully support from families and friends to get them vaccinated. And the 10% who don't want to get vaccinated that may be an uphill battle to convince them but hopefully they'll eventually come around and do that. Next slide. So how do we raise vaccine acceptance? And again, as many of you who are involved in education and I think you'll have a very important role with that. You'll be developing trust among your colleagues and eventually with students when they start to get vaccinated, we can't do that yet, but eventually we will I think, just being able to educate people about the vaccine. So developing trust is very important. And over the last few years, I think trust in our whole system has been sort of challenged by problems related to science and truth and so on. So we need to rebuild that and do it through education. Also social media leadership, I think with the Biden administration coming in and requiring everyone to wear masks and providing leadership by showing that that's important, hopefully that will be helpful. And then as I mentioned earlier, reducing the barriers so that when people actually get onto websites, they can actually get their appointment and feel confident that they'll get the vaccine and making sure the logistics are really very, very efficient so that when folks go to get the vaccine, there aren't long waits and that we're able to do it well. So those are ways of I think improving vaccine acceptance. Next slide. Now I did mention children and the tests that were done on the vaccines did not include children. So at this point, the Pfizer vaccine has been approved for children 16 and over and Modana is 18 and over. So unfortunately, younger children, although there are tests now going on to show that it's effective and safe in children, we don't yet have approval to vaccinate children. But I think that'll probably come in the next few months. Next slide. So what do we need to do now? Well, as I mentioned, because the vaccine is surging in our community, we do need to continue to limit the current spread. And we are having five, six, eight, 10,000 new cases in Arizona every day. So we need to do the things that we know will reduce that spread, such as wearing masks, staying home as much as possible, social distancing, quarantine of people who are exposed or who have the illness, then making sure that we do vaccinate everyone possible, trying to get to 80 or 90% immunity and doing that through education, social support and logistics. We also do need to provide good medical care for the people who do get sick. And that's sort of what I do. So I take care of people who get very sick in the emergency department. And I think we are doing better with that, but sadly we are still losing people, some people who get really bad cases of COVID and it's heartbreaking. Whenever I go into the emergency department and see people who were healthy previously come in and are really suffering, and then I can tell that they're probably not gonna make it. And it is really heartbreaking to see that. And it is real. That's why when people say, well, is this a hoax? Absolutely not a hoax, it's real. Also providing financial support to people who get COVID. And I have a family member who works in the restaurant community and he got ill, he's a server and didn't really have any financial support from the restaurant where he worked. And so he had to take off two weeks from work, didn't get paid. And as you can see that that's really a disincentive for people to either be tested or to report or to quarantine because there's no financial support for them. And we need to do better on that, hopefully we will. And then we have to have health policies that really are more effective than what we've done so far. So I'm gonna end there and hopefully we'll have a little bit of time for questions. I'm really open to any questions you have, personal, clinical, vaccine, although this is about vaccine, this is really also your chance to talk about any questions you might have. So Dr. Sklar, we do have a question here. So between the first and second doses of vaccine, if someone is displaying COVID-like symptoms, do they need to quarantine? Also once vaccinated, if exposed, will they still need to quarantine? Yes, so the answer so far at this point is yes and there's a few reasons for that. First of all, after the first vaccine, you are somewhat protected, but you're not totally protected. So you could get COVID after the first vaccine and could then be spreading it. So if you do have symptoms of COVID, you should get quarantine and be tested. Now, the challenge is that some of the side effects of the vaccination are similar to COVID. So for example, fever, achiness, those are all very similar to the actual disease. And so that can be a bit of a challenge. And so we do ask people who are having those symptoms after they've been vaccinated to monitor themselves. And if they continue to have those symptoms, that they should actually get tested and quarantine and until their test is then found to be negative. But the answer is yes you can and you can also get the virus, get the disease even after you've been fully vaccinated. It's not a hundred percent, it's about 95%. So there are gonna be 5% of people who can, who will still get COVID even with vaccination. Great, thank you so much. So someone else asked after having COVID, how long should someone wait to receive the vaccine? Yes, well, that's a great question. And as it turns out, probably about 20% of our population in Arizona probably have had COVID. And what the recommendation is, is that you wait about 90 days or so. I would say because we know that there is a fair amount of protection after you've actually had the disease because you essentially created antibodies for most people who have it, they do create antibodies. Although it's probably less so if you had a asymptomatic case. So if you had COVID, but had no symptoms, your antibody production is a little bit less. But still, you are somewhat protected after you've had COVID. And so we recommend about a 90 day period before you get the vaccination. And that also allows us to prioritize people who haven't had COVID to get the vaccine who have no protection. So that's the recommendation at this point. Great, thank you. And one last question for you before we move on. Where is the science with getting vaccines for adolescents and teenagers? Yeah, so for adolescents and teenagers, if you're 16 and over, you can get the Pfizer vaccine. And so it was tested on groups like that. 18 for the Moderna. There are studies right now going on in younger children. I think probably we'll have it down to about age 12 soon once that data is reviewed and analyzed. So I would anticipate in the next month or two that we'll be able to include children under, well, down to the age of about 12, but that hasn't yet been validated. That's what it looks like. And then hopefully younger children after that. Wonderful, well, thank you so much, Dr. Slarvi. Really appreciate you taking the time to be here with us today. And I know I certainly learned a lot from your presentation. So thank you so much. Yeah, well, good luck everybody and hope you learn a lot today.