 This is the second half of the morning of Thursday, January 13 and the Vermont House Human Services Committee, and what we are going to be talking about and learning about this morning is what, what could what should and an overview sort of a public health response to COVID-19. This is something that whoever would have thought that two years ago more than two years ago we would still be wrestling with something, and we need to figure out if there's something we can do but we also need to learn more about it and what what are the elements and so thank you very much. Thank you for coming and talking with us about it. Appreciate it. Thanks for having me I'm looking forward to the conversation. Well, first I just wanted to say it's it's great to meet everybody and I wanted to start with gratitude. Throughout this pandemic, lucky to live in Vermont where the leadership has been really careful to try to balance the very best cutting edge science with the interests of the state's businesses with our Vibe as a tight knit communities and has been good about communicating how those balancing acts are being navigated. And so I felt lucky, not only that the burden of disease in Vermont has on a per capita basis been less than in other areas of the world, but to see that healthy legislative process happening. The collaboration between the executive branch and the public health department and the clinicians around the state. That points to rhetorical challenge that I have today that I will need your help with which is I can offer medical information and public health information, but I'm acutely aware of the fact that the scope of my expertise does not extend to public health policy enactment so that's, you know, the job of elected officials like you and the people in public health and so I want to make sure I sort of do a good job of not going outside of my reach but but empowering your efforts in that regard with good information. Thank you. I'm thinking that along those lines, a way to think about this moment we're in now in the third year of the COVID pandemic is to think about what is unchanged and known in a stable fashion and what is evolving right in front of us. So we've all have this, this wild sense of just enduring change you know as soon as you think you know the rules. You know COVID has a way of changing them right underneath you and I think that creates its own stresses it's, it's hard for every single one of us in our personal lives. You know, from the standpoint of the scientific community to to have sort of, you know, just the scientific facts changing on a regular basis as we learn more with what has been the most volcanic outpouring of scientific brilliance that I've ever seen. It's difficult from a policymaking standpoint to know you know sort of when has enough changed happens to take a different tact and and and yet I did want to highlight the fact that primarily in January of 2022. The story is the same as it was in January of 2021 that most things are the same even though there is important change we need to grapple with. And so I thought it might be helpful to frame ideas that way, and I'm going to be relatively brief so that I can make sure that I hear from you about the questions that you're hearing from your constituents and that we sort of align to the need that is really there. So what is the same. We know that COVID is airborne, and we know that it spreads from person to person, most easily inside when we're unmasked and when we're unvaccinated or otherwise don't have immunity such as we might get from being infected previously. That leads us to the common sense measures that we've all been using in our lives for years now that still work and are still I think really important to kind of blow the dust off of and help our communities connect to. So we know, I think that probably for me at least the biggest challenge of this pandemic has been the massive impact on our social lives. You know we know that gathering together inside unmasked to eat together, as is natural to do is probably the most effective way to spread COVID-19. And that so my love for my parents and my other loved ones that brings me together with them can be the thing that endangers them. So we have to own that curtailing indoor gatherings is a key piece of this, but we're all looking forward to when that's no longer the case because it hurts. We know that wearing a mask inside can really dramatically cut the risk of that sort of transmission. The mask is better than nothing but it's quite clear that surgical masks are better than cloth masks, and even better masks like KN95 and N95 are better than that. So that has led to the a bit of confusion about, you know, sort of when do I wear what. And so I thought it might be helpful to clarify that I have not worn a cloth mask for well over a year, because I think that equally comfortable equally aesthetically appealing equally available surgical masks are better. And we always were almost always were one of those. There's no data to suggest that any variant is more likely to get through a mask than any other. And we think they still work quite well, despite, you know, for instance, Omicron being more transmissible. I mean, when I'm going to the grocery store and I know everybody else is going to be masked when I'm seeing patients in the inpatient setting who don't have COVID, sort of not zero risk I'm not just home with my wife and my pets hanging out. I'm out there exposed to other people but it's pretty low risk I wear a surgical mask. And seeing a patient who has COVID-19, when I'm in, when I cannot avoid being in a public public space where people are unmasked, then I wear a higher quality mask like a KN95. I have been calls for higher quality masks for everybody. And I see the motivation of that, and I think it's safer to call for that than it was when we had overly limited supplies of KN95 and then 95 masks and we were trying to save them for healthcare workers. But I'm not convinced that that is necessary for every person to wear that kind of a mask. And so when I see somebody in the grocery store wearing in KN95, I kind of think, yeah, they're taking an extra measure of precaution and that's fine. But I think some people find them uncomfortable and sort of, you know, a little hard to breathe in for long periods of time and they don't really want to and I wouldn't want to feel obligated to push them too hard. But I do think the message that surgical masks are really important and comfortable and better than cloth masks is important. I'm going to ask a question and zoom a show and tell. Is this a surgical mask? Yeah, that's sometimes also called a procedure mask, but that's a surgical mask usually comes in light blue like that. Yes, okay. I wish I had a KN95 with me so that I could do a show and tell of my own but I think right where I'm sitting I only have one. Oh, that's not true. I do. I thought my briefcase would contain a whole bunch of masks. It's kind of ridiculous. So here is a KN95 mask. Sometimes it has a little bill to it or sometimes you'll see them horizontal. And then a N95 is that circular one that sort of really holds on your face quite tightly and I don't have one of those with me. All right, so curtailing gatherings indoors with people outside of our households is important, but only for a finite time we have to get back to living as humans. Wearing a mask when indoors with people outside of your own household is important. Before actually talking about vaccines, I wanted to talk about one context that is easy to forget that and that is it's so natural to get together and eat food together. That sometimes people will be super careful about wearing masks and lots of context but then get together to share a meal together with people they love inside without masks because I find it difficult to eat with a mask on. That's a really high risk transmission time. I've dramatically cut that down in my life but in certain special occasions I've been really careful and I'll talk about that in a second to do that but I think it's important to sort of say routinely doing that is quite high risk. And of course has massive impacts, particularly in the hospitality industry that we really have to wrestle with. Excuse me, Dr. Leahy, we have a question from representative McFawn. Yeah, happy to happy to take that. Thanks, Madam Chair. The surgical mask. That's a single use mask is it not. The question you know I think early on the guidance has been that many of these things were single use but we're learning that that they still work quite well for over. You know they get a little moist if you wear them all day long. And so usually what I'm doing is I wear a procedure mask. If I'm wearing it all day long like when I'm seeing patients all day at the hospital, and then I'll use a new one the next day. But if you're sort of selectively using a mask in some circumstances in a day but other times like this on a video call and don't need one. It works perfectly fine to keep the same mask over a period of days so that it's a cumulative day long of use that then you say, getting gross, let's get rid of it. So I would say that you know over weeks that I'm not doing intensive clinical time and I'm doing video calls like this or teaching like at the med school this morning like it was on video, it may take me a week to change my mask out because I've really only used it an hour a day or something like that. Yeah, and can you sterilize the surgical mask in like we have a sterilizing machine that sterilizes with oxygen. So is that work. Yes, it does and that's been also helpful for in 95 masks that have much better supply but but sometimes they've been in tight supply and that's how we've been able to keep them going for multiple uses. Most people don't have that sort of sterilizing but if you have access that does work. And Dr like we have a question for another question from representatives small. Thank you madam chair and thank you Dr Leahy. I've come accustomed personally to where those cloth masks one because they have those fun designs on them. So wondering why has the guidance shifted away from cloth masks and towards can 95 and 95 or the surgical masks. That's a great question me and I think I think cloth masks are a little bit more comfortable and you're absolutely right that just the ability to make a fashion statement with one of those boring blue masks is really hampered and that that's hard for me to. I, you know, get high quality four ply black ones so you can't even see it because it's so fashionable, but that's not enough. The guidance has shifted because there are sort of two levels of evidence that suggest the cloth masks aren't as good as the surgical masks. One is sort of basic science stuff where people in the lab have looked at how well particles of a certain size can cross through those things. They can virus size particles and have them cross through a cloth mass it does help, but it's about 20 30% less likely to stop the that particle than a surgical mask, probably because the weave of the fibers of the surgical mask has fewer holes in it. The same thing has been true in epidemiological studies there have been a few out now looking at mass requirements, showing that they reduced the community incidents of disease and showing there was a big study in Bangladesh in particular showing that surgical mass were clearly better. I think the mask that you can wear is better than nothing and so I think some people are going to find the surgical mask unacceptable and so I say hey go for the cloth mask. I think the solution other people have found is to put a cloth mask over a surgical mask so that it's that extra layer of protection and also they can have the logo or whatever they want shown. Wonderful. Thank you. Yeah you bet. Okay, so transitioning from masks to vaccines. We in Vermont have led the nation in vaccination and it has made a massive difference in our hospitalization and in mortality rates. The likelihood of being having severe disease from covid in vaccinated people is around 25 to 30 times lower than it is in people who are vaccinated. I think one of the communications challenges in the pandemic is that that protection from infection is not perfect from vaccination. And so I think sometimes people can struggle with why would it still be worth getting vaccinated if I can still get infected. And I think the most important message is because it will save your life that people who get vaccinated are far less likely to have more than a cold. One challenge is that not only are our hospitals primarily now seeing severe illness and people who are unvaccinated, but it's also true of people who are vaccinated but have medical reasons not to have an ideal immune response to the vaccine. So if you are older than 65 and your immune system is not quite as strong as it once was or if you have a medical condition that leads to immune compromise or some other vulnerability, the virus can get around that that vaccine. It is still much less likely for that person to die but they can sort of get some disease if they're unlucky. That means that a vaccine only approach to containing COVID-19 is sadly not enough and thus we're still talking about vaccines and masking and other measures. But I think it's really important to say that places like Vermont where the vaccination rates are high, the death rates have been quite low. I feel incredibly thankful that the age of vaccination is dropping and so now we're getting down to kids who are five and older and studies are ongoing and younger kids. Every age category must have proof of safety and efficacy before they get vaccination because we don't want to be experimenting on people. And I've just been stunned at how effectively scientists and clinical investigators have shown that these vaccines not only are incredibly safe with very rare side effects that are serious, but also they do stop people from getting infection and most importantly they save lives. This is true of people of all ages and I hope it's true of kids under five and I hope they get access soon although it will be months. Importantly, we've learned that booster vaccinations do enhance protection from deadly COVID-19 compared to just getting the original series. And so I anticipate in time what fully vaccinated is is going to include for most of us a third shot. We are certain that this is the case for people over 50 and people with medical conditions and it is likely that not as well proven for younger people that a booster shot is helpful. We also know that boosting helps immunocompromise people. So that's who it's most important to boost. For me, if I was picking which one intervention I would do, which is of course not the right solution in the COVID pandemic, I would pick to get people newly vaccinated over people getting boosted. It's your increase in your benefit of finding that unvaccinated person and saving their life from the initial vaccination than there is from boosting me. But we can do both and we are and that's what we should do. Omicron has changed the vaccination story a little bit in a way that really hasn't changed the masking story to the best of our knowledge. We think that Omicron is more transmissible and more likely to therefore reach any of us, but there aren't data yet that it thwarts our surgical masks. Vaccines, it's a little more complicated story where it is clear that even vaccinated people can have breakthrough infection more frequently with Omicron than with the Delta and other variants. What's also still true is that vaccination remains incredibly protective against hospitalization and death, even against Omicron. So if I'm vaccinated and boosted, I would not be surprised if I got it because protection against infection is lower. But the vastly most likely outcome is that I'm going to have the snipples for a few days. It's going to be really inconvenient. I'm going to do my best to avoid spreading it to somebody more medically vulnerable and then I'll be fine. That means that giving a booster shot to the people who are most at risk of severe disease is incredibly important. It can save their lives. So important to residents of lunch and care facilities, people over 65 and people with medical conditions. And so that's why that's important to do. I think really importantly, we need to be clear in our messaging that even that drop in protection from infection doesn't mean it's something that we don't want to do. It's still the most important way we save lives. The last technology I just wanted to highlight is testing. So fortunately, in the last several months, we've now got the ability not only to do a PCR test, such as we've been doing in the hospital since the very beginning of the pandemic, but a rapid antigen test that you can do at home in 15 minutes. What we know is that the rapid antigen test is not quite as sensitive as the PCR test. And sometimes in medical settings, that's a problem. But actually with COVID, it's quite helpful because we know the PCR can detect people who are probably just have fragments of the virus left over in their body after infection but aren't transmissible. Whereas the rapid antigen test is a pretty good gauge of whether you're contagious or not. So that leads to two really useful ways to use the rapid antigen test. One is before you're going to see somebody and one is after. So I mentioned that I have not gone out to eat with my friends, much as I love to, is hardly at all over the last couple of years. We basically get together outside for a walk in a snack or do it by zoom. But for a very, very special occasion, a couple of months ago, I went out to dinner with some friends inside. I tested with a rapid antigen test right before we met up. They tested right before we met up. And that's how we made sure that we were not contagious at that moment. And for the next several hours, we could still have picked it up from the few other people who are in the restaurant at that moment. But at least I knew I wasn't going to be the one who transmitted to somebody else. But since I was in that restaurant and could have been exposed to somebody who, you know, was there but didn't know that they had contagious disease. At five and seven days after that exposure, I tested again so that I knew the next week I could work on the clinical service and not endanger my patients. So testing right before you want to see somebody on that very rare event, you're going to see them indoors unmasked. It's really useful in checking at five and seven days after exposure as a way to get out of quarantine. Or if you're infected, it's a way to help ensure that getting out of isolation is safe if you wanted to get back to work after a case of COVID. There have been, go ahead. I was going to say in terms of timing. When my family got together in August, we, we, we tested. But some of us, myself included, tested the day before. Because then I was going to drive my whatever. So is that the wrong thing? And is it, or is it naive to think that, okay, I tested, you know, I tested myself that, you know, the night before or the day before, the day before. And they said, okay, and you're good. And then so I got in my car and drove down to, to the Cape so I could be with my family. So should I instead have tested in the parking lot of where we were staying? Yeah, it's a great question. I think lots of people are asking this. The difficult reality is that a negative antigen test gives you a handful of hours of confidence that, that you don't, you're not contagious now and you won't be for a little bit. It is unfortunately possible that you, you know, sort of recently acquired infection were not contagious in that moment you tested, but the next day than the amount of virus rose in your body and you could become contagious. So for instance, my in-laws live in Massachusetts about three hours away. They'll test before they leave the house they don't waste the drive and then come on up. And then if they stay overnight with us, we'll test serially to make sure that I'm not transmitting to them most importantly because they're older than I am. But they'll do the same just out of consideration to me and because I work in the hospital. So yeah, unfortunately testing the day before doesn't give you enough assurance because the virus can change that quickly. So speaking of change, I've been highlighting where Omicron is not changing things and where it is. So it does not change as far as we know, masking guidance, although it does make me that much more careful if I'm in a place where there are not masked people to make sure I wear a good mask. It doesn't massively change the vaccine story, but it takes the edge off an infection, but it's still vaccines are incredibly important. Testing, there was a rumor that Omicron maybe made the rapid antigen test less useful. That's still being evaluated scientifically, but the latest studies suggest that it's actually equally good at testing Omicron. We think that the disease of Omicron sort of comes on faster and goes away a little bit faster. And so this stuff that we were just talking about about timing of testing it might be that, you know, maybe that window that you need to retest again gets a little shorter and how long you're going to be contagious gets a little bit shorter. But it's early days and I think the take home messages the tests we thought might work differently with Omicron, really not the case, still a really important tool to use. I did want to mention one other aspect of testing which is population level testing. We've heard a lot of stories about the CDC guidelines about going back to work after you've had a case of COVID-19 or school contact tracing. One, I think clear message that can be helpful to get out there because there's a lot of confusion about this is that while it's helpful for me to test right before I do a very special high risk event or to test after exposure at a population level, it's becoming much less useful. The reason for that like in the hospital we're stopping doing contact tracing. In most cases and the same you know as the case in schools, the reason for this is that there are just so many cases of Omicron out there that each of us is so surrounded by people who are positive that doing contact tracing is one overwhelming because there's so many cases that the people that are doing it can't do it all. There aren't enough people to do it. And what they find is you're surrounded by people and so it's not even clear what you're going to do with that information it's just like you're surrounded. And so the so there's a disconnect there that we can help clarify for people which is the tests are great for individual personal use, but that's the reason why they're not being used in schools and workplaces to the same degree because it becomes infeasible. I see representative Wood has a question. Thank you. Thank you, Dr. Leahy. My question relates to. So now that we see that Omicron is the dominant virus. Does it actually replace the Delta variant or are they both sort of like they're out there at the same time. You know, all we hear about is Omicron we don't hear anything about Delta and so I just wondering from a public information perspective, has it replaced the other or is it just now more dominant. That's a great question. As of now we think that Omicron has replaced Delta. It did so with incredible speed much faster than Delta became the dominant virus it really only took a couple of weeks for it to do it but now by far but but nearly all viral isolates around the United States including a Vermont or Omicron. There are a couple of exceptions but it's Omicron. One important for some of the reasons I've highlighted is also, I guess a side light that's more of sort of a clinical thing that maybe is less important for public messaging. But we do have available treatments that are actually quite effective, both outpatient and inpatient, and that replacement of Delta with Omicron has taken some of those things off the list because they don't work against Omicron. Additionally, we do have oral pills that work we do have IV treatments that work and so we do have a miraculously better number of arrows and our quiver against this virus. Thank you Madam Chair. Doctor, there's been some discussion about a second booster shot. Is there any evidence that I mean scientific evidence that that's a good thing to do for a person that's over 65 with a an underlying problem. Not not for most people yet. It's it's a you know one of the big questions and during through the pandemic has been are we going to get this every year or are we going to get done with three and call it good like with a hepatitis B series and and really for most people the answer to that hasn't been answered in big studies. There are some small studies looking at people who are very immunocompromised, suggesting that they can get up to normal vaccine responses with that extra dose. And so currently we're just targeting folks who are quite immunocompromised for getting that extra dose, but I'm not routinely recommending a second booster until better evidence shows that it's necessary. Representative Rosenquist. Oh sorry representative McFawn did that answer your question. Yes, thank you. Representative Rosenquist. Thank you Madam Chair. I'm just curious. You just started talking about what I guess people refer to as therapeutics drugs or treatments that can treat people for this disease. Once they have it, whether they're vaccinated or unvaccinated, but there seems to be quite a bit of dispute over whether some of these are effective or not. And there seems to be very little information out there on what are the effective therapeutics and I guess further to that would be, would it be useful for people to have some of those therapeutics at home to take. So they don't express or get to the point where they have to be hospitalized. So I was wondering if you could answer that obviously there were some that were considered were derived from veterinarian type products and people were concerned about that, but presumably they have made a human version of that therapeutic. Thank you. Yeah, happy to help out. You know one of the, it's been really quite remarkable to think that there have been illnesses like HIV and hepatitis C that it's just taken us decades to develop effective therapeutics for but for coven given the worldwide need. It's been remarkable that we now have, you know somewhere around a dozen effective therapeutics that have been proven effective for sort of a spectrum of disease we have a monoclonal antibody called a view shell that can help. Very high risk people stay protected from getting infected. We have an oral drug called packs low bid that is currently an heavy shell this being used in Vermont, the oral pill packs love it is now in Vermont pharmacies and limited supplies and can treat people who are at high risk who have active coven and leads to about an 85% reduction in death and hospitalization. We also have an ID drug for people who can't get packs love it called Citrovimab that can have has a similar reduction and hospitalization and death. There's a drug called remdesivir, which is more controversial and use and severe disease but clearly reduces death and hospitalization when given to people who have sort of just the beginnings of disease, now being used in hospitals. The oral pill called malnupiravir that can, if you can't access any of those can also be helpful, although it only reduces hospitalization and death about 30%. So it's not as good and so not preferred. And then if you're unlucky enough to end up in the hospital and sicker there's an array of drugs that have also been proven and randomized clinical trials like those others to work that includes the steroid dexamethasone, the immune modulator which is a map. Some people think remdesivir helps some don't. And then there are a couple of other sort of niche products, bear a sit nibs another one that we use. So we have sort of this array of drugs. There's also been interest in lots of other drugs such as you alluded to and sadly those would have been great because we already had them available and the evidence was really pretty bad for it. There was, I'd say an internet based enthusiasm for them that I'm hoping fades away, because I think it was largely born of desperation and suspicion of the medical establishment but when you have an array of really proven effective therapeutics that we all think work that desperation goes away and I think we can just agree hey doctors will choose what's good and, and they do and it saves lives and thank God for that. So yeah it's been great and I think one of the challenges is going so fast that it's difficult for me focused on this in my career on infections in my career to keep track of it all there's so much information out there. It's very, very difficult for primary care physicians to keep track of it because it's moving so quickly, and even more so for the for the general public because of course they're paying attention to other stuff to. And so, but fortunately we've put out guidance for the clinicians all around the state about which to pick first which to use seconds and lots of sites out there including from the NIH and the infectious diseases Society of America that for anybody who wants to go into the details can kind of tell you which study and all that stuff. So I hope that helps I know I went I geeked out a little bit into the details but I thought it might also make a point that man there are lots of difficult to pronounce words out there in case some of your viewers are feeling artificially expert in the topic. Thank you very much it certainly was quite an array. Can I ask a follow up or not. It says to do with vaccination of children, let's say less than 12 years of age or what have you. There seems to get probably because of the Internet you get conflicting information. There are a number of people that believe it you're more at risk to have kids vaccinated than your than not because of some of the adverse reaction. Children especially get to the vaccination that might not be an immediate thing might be further down the road. The, what's it called the swollen heart that's not the right term but I mean that it's something that affects the heart that people been talking about. I'm curious at what point do you equate the risk of the vaccine versus the chance of being badly affected because we also know children at least up to this point have been very minimally affected by the virus. So, at what point do we make that decision and vaccine is worse than the disease. Thank you. I think lots of parents, including me grapple with us. The way I think of it is this one the impact of COVID-19 on on children is massive and it partly has to do with how it impacts their parents and partly how it affects the children themselves. It turns out that around the United States, because of the massive death toll of COVID-19 now exceeding 840,000 people, that means that somewhere around 130,000 children have lost a parent. So vaccinating those parents is really critical but of course, there's a benefit, a little bit of vaccinating the child and protecting the parent, but we would only vaccinate the child if it really benefits them personally. And the other thing that we've really learned is that although children are definitely less likely than adults to end up in the hospital and have severe disease, they do have huge medical impact. So actually currently we're in the middle of an unprecedented surge of hospitalizations from children with thousands upon thousands of children in the hospital right now in the United States. I should clarify, I'm not talking about Vermont. And so it's a huge impact that isn't as big as the adult impact, but one that we really want to minimize. It's a much greater threat than other vaccine protected diseases. Also, it's a pain to be a child and get a non-life threatening version of COVID-19. And so I figure if we can protect them from that, that would be great. But all those benefits have to be better, bigger than the downsides. And there are downsides at vaccination. They're quite uncommon in anyone, including in children beyond a sore arm and a fever for a day or so. But they do sometimes happen. You mentioned myocarditis that has shown to have a slightly elevated rate in adolescent boys only. That's an important side effect. Fortunately, that has been self-limited and not led to enduring disease and the vast majority of the young boys who got this. But would I want my teenage son who did get vaccinated to get that? No. Did I talk with him about that? Yes. Did I think that it was worth it for him to get protected from hospitalization and loss of parent and all that? I think on balance it did. I think that balancing act has to be rethought with each age area. And so when we look under five, same math has to apply and we have to make sure it's worth it. Because it has to be good for the children to do it. And so far it is. But I think it makes sense for parents to hear that scientists are weighing those pros and cons and to watch the public CDC hearings where those data are weighed against each other so that they can trust that people are really thinking hard about it. Thank you very much. Sure. Dr. Leahy, we have lots of questions. And before I let folks loosen the questions, I want to know, because we have about 15 more minutes of your time. If there are things that you want to make sure that you get out first and then we'll ask our questions. Thank you very much for that opportunity. I guess there was, I had one semi-medical semi-personal point that I wanted to just to make today beyond the importance of curtailing indoor social gatherings, wearing a mask when you're indoors with people outside of your household, getting a vaccine and using testing wisely. And that is, it relates to the gratitude that I talked about at the beginning. I think it's a piece of pride and I think also a guide for the future that Vermont pulled together to debate where we should to consult the data and to set it next to other considerations like the economy and our social lives and weigh them thoughtfully as a community. And largely we have not have the same level of divisiveness and public denigration and negativity that we've seen in other contexts. And I think that is partly why we have done so well. Partly for me that like all of you I'm sure the pandemic has been a very hard time for my family and for professionally, but I have gotten solace from knowing that my neighbors are thankful and they are caring for more for me and they deserve to be protected. And I've been thankful that our state leadership has at all levels worked hard to protect us and I know that that professional adult caring tone that does allow for debate, but it's healthy debate not calling each other names and throwing out misinformation has been partly why we've been able to save more lives. Because people have been less confused by disinformation. People have been less alienated by being shamed by guidance they've been better educated because they weren't turned off by what people said. So I just wanted to say thank you to you for for the way you've contributed to that to the thoughtful way our elected officials have made decisions and, and I hope it's something not only that we can lead the world continue to lead the world and doing, but also that we will continue to save lives until we get to the end of this damn thing. Well, thank you. Thank you for that Dr lady and thank you for your work in terms of doing this. Thanks. And for your educating us and in that continuation vein, we have at least three questions we have one from represent Whitman, who probably was geeking out with you about those chemicals that you can't pronounce because he can pronounce them all. Thank you Madam chair, and thank you Dr lady for all this information really appreciated as well as your message. I just wanted to ask my question was actually the same as representative Rosenquist about therapeutics. Those chemicals, but I did want to just follow up on one thing that you said, which was that some of the outpatient and inpatient treatments aren't as effective against Omicron. Am I getting that quote correct and did that kind of applied to all of those therapeutics that you were listing. Thank you. Thank you for asking that clarification and also you reminded me there was a piece of representative Rosenquist question that I didn't address about whether these treatment should be in people's home so let me try to address both of those. The treatments that I did mention are the ones that retain strong activity against Omicron. And so it's sort of nice that we have an array of three or four effective outpatient treatments and a similar number of inpatient treatments. What has been unfortunate is that we have lost some of our treatments that did work against Delta so for instance there was the intravenous monoclonal antibody. And also the combination BAMLA, NIVMA, MAB and EDA7MAB these were medications you may have heard that President Trump received when he had COVID-19. They did have efficacy against the prior versions similar to what the monoclonals were using now use, but unfortunately those no longer work and so we've stopped using them, but kind of through the luck of the draw, one of those is the Trova Mab still does work and so that's the one we're using exclusively. And so that one challenge throughout the pandemic has been shortages. We were worried primarily about shortages of ventilators and it turned out that in some states that was a problem but in Vermont that is never, we've never had to ration ventilators. But shortages of staffing is something that we could talk about today and the threat of health care collapse I guess is something I haven't touched base on if you wanted to. But the related to your question, shortages of medicine is a real issue. So it turns out that there are something like 60 doses of Pax Lovid each week available for the entire state of Vermont. Something like 100 doses of Satrova Mab for the entire state of Vermont each week, 500 doses of the less preferred drug Malnupiravir available each week. And unfortunately those numbers are just not nearly enough to meet the clinical need. That means that we have to be really thoughtful about the way we allocate them. And so partly clinicians are given guidance about who's the highest risk people who should be given it. And partly when we're using those intravenous medications, we are rationing them in our hospitals all around Vermont. Currently, we use criteria put forward by the NIH to figure out who most needs it who's most at risk. But sadly that means that there are people who really I want to be able to dose I want to be able to protect them from hospitalization and death, and I can't there just aren't doses. But at least keeping them centralized that makes it so that at least we can make those determinations whereas we chat about home it would just be rich white guys who would have it and I might not need it as much as somebody else. But hopefully that will change I know that the big drug companies are being encouraged to ramp up production. Oh no. My, my puppy I think just got attacked by my cat, but my wife will look into that. But anyway, so right now we're in a time of rationing of those resources that I hope is temporary. Thank you for that. Thank you representative Bromstead. Thank you. Thank you. Thank you, Dr. Leahy for being here. I, my question is around variants. And I think we all are weary of the next variant and get nervous that we might get excited that we're getting close to the end of one variant and only to hear that a new variant is jumping in. And I, I think of all of the people right now who go out and say, Oh, this one, you know, I'm a cron isn't that serious, I'm going to, I'm not so worried about it but the more and more people who get it, though, at least what we've heard in the past is the more chance for a new variant but then also that really variants come from everywhere in the world and so if we can just vaccine and get vaccinations out to the rest of the world, then we can control variants. So I'm confused and wonder if you could help. This is I think the multi trillion dollar global question right now. And I think we all know that the more transmission there is of the virus, the more variants can happen. And so anything we do to reduce transmission will help you may hear of a Wall Street Journal op ed to the contrary which is utterly false. I would say it's just utterly upside down more transmission more variants is the story. That's accompanied by this other pattern that you alluded to which is the more people who are vaccinated or who have been previously infected the more immunity we have in the population. The more that's a mild disease for for the average person. And so the sort of the societal importance of all those cases starts to shrink. So the hope is that at a certain point. We will stop caring about coronaviruses in much the same way we didn't care about coronaviruses in 2018. We knew that they were there but who cares it's a cold. That's the hope that we'll get back to that because we'll have enough people in the population who are in some way immune. We won't have so many cases in our hospitals, and we'll say you know what we still have some cases if you're unlucky, but it's it's not so many that it makes us have to take special measures as a society to protect against that. So when do we cross that threshold I think is essentially a another way to address your question. And for me I think it boils down to not the case counts which are becoming increasingly irrelevant. But how the, the number of cases of severe disease are impacting our society and impacting the ability of the health care system to address them. I think if we get to a place where the rates of hospitalization and death from COVID disease not incidental, but directly related to the disease are low enough for our health care system to be able to manage them. And if it's low enough so that we as a society sort of feel and this is where elected officials come in, that's kind of like influenza and its level of impact, we should flip back to living life as we used to and feel thankful that vaccinations and other measures are there. And then you know hey if it mutates in some new way we can always put our mask back on but we shouldn't expect that we'll always be doing it. When will that come. Gosh you know anybody tells you they can predict the future well that's lying to you right. It looks like Omicron is already peaking in South Africa in New York City and in Boston and so we're hoping that that wave is short and that perhaps that time we've all been waiting for is going to show up in March. But it's too soon to tell because what about the next variant and will that affect hospitalization. So for me, I try to zoom back a little bit and not focus as much on which variant it is and all that. Okay, what's the societal impact are our hospitals struggling to manage all the cases. We should still have special precautions. Are we having an unacceptable toll of loss in our over 65 and medically compromised people. If so then we must still fight as a community against it, but if it gets to a place where it's perhaps more than we were used to but not that much in our healthcare system can deal with it. I think then we as a society have to say come on it's enough we have to live our lives. Thank you. And I think my household thanks you because that is my evening question. Daily basis. Say hi to john for me. Representative Rosenquist. Thank you. I'm just curious about antibody testing. I know my wife when she finally got vaccinated back in May I think it was anyway, she didn't get any reaction at all and she always gets quite a reaction just to enable even the normal influenza shot in her arm as well should get be get very hot and all that. So he had no reaction. So she went ahead and got, presumably, an antibody test, and it was negative. So obviously that concern her because, you know, presumably antibodies would have been created by, by the, by the vaccine. But I'm just curious, maybe why there isn't greater emphasis on testing people to see if they have the antibody, and would not need further vaccination or booster or what have you. Maybe comment on that. Thank you. Yeah, be happy to your point to an unmet scientific need. And maybe the best way to think about this is to, to make an analogy to antibody testing for hepatitis B. When I test somebody for to see if they're immune to hepatitis B I can tell because there is more than one antibody that I test, whether they are immune because they've been infected, or whether they're immune because they've been vaccinated or whether they're immune. Unfortunately, in COVID what we have now is just one antibody test and all it can tell me is whether I've been infected. We know that people who have been infected have some level of protection from future disease. We know that that protection is much less than the age of Omicron. But one of the things we don't have clinically is a good antibody test that can tell you if your vaccination took. And that's a real hole. I would love to be able to distinguish between those two. I expect that will come. You know, it turns out in a research context, investigators have shown that certain kinds of antibody levels do correlate with protection. Those antibody levels are different from the antibody levels that you can check in the clinical context. But what I hope and unfortunately that assay is super complicated and the kind of thing that a normal clinical lab cannot do. What I'm hoping is that some smart dweeb in a basement somewhere figures out how to come out with a second antibody test, and you get both of them done and you can just say, ah, look, you got vaccinated and you got infected and you can see that your level of protection is X. But unfortunately, that's for the future. Thank you very much. Um, doctors, thank you. This has been an incredible hour and a half and informative wish you could perhaps foretell the future, but I appreciate that you can't. All I can say is just invest in plastics. That's my big advice to you. Sorry, that's an obscure reference to the graduates, right? That's all right. That's, you know, that's all right. And on some level, some of us have been looking for something different than the common sense responses that you talked about and the fact that yes, we're all getting tired. We're getting tired of being alone or the social isolation. We're getting tired about not eating and being inside with our friends. And some of us at the whole boat load of very attractive face masks that now we will have to figure out something else. The, the, what you talked to us and, you know, about the science, but also about the testing and then the importance of testing and the immediacy. And then the immediacy before you do something if you want to be safe with this group and then the importance of testing five is now is it both five and seven or five to seven days. Yeah, the ideal thing is five and seven. I think one of the practical realities is that tests are expensive and sometimes they're hard to get nowadays. We hope that the 500,000 free test of the Scott administration and the 10 million tests that the Biden administration are putting out there eases that difficulty in which case ideally it would be five and seven days but like if I could only get that one test from the government and probably use it at seven days to say good. Okay, great. And before we wrap up, we have one last question from representative Rosenquist. Yeah, I'm sorry if that's so many questions but great at answering all this information, but I was I read someplace and I can't remember where I was. There's something about that the PCR test the current PCR test was after December 31 was no longer authorized under the special Protection Act or whatever. And I was just curious was that incorrect or has it been reauthorized or what happened. Yeah, that was a it was a quirky piece of information that I think led to some confusion so it turned out that that PCR testing is something that we use on a daily basis and clinical medicine for a number of things it's pretty old technology and they just adapted it for COVID-19. There was one time limited company specific PCR authorization that did expire on the 31st. But there are multiple PCR platforms and use and very highly reliable and, and so that was just kind of an administrative detail that didn't really speak to the efficacy of the test. So we use that every day in the hospital to detect cases and people who have symptoms. Thank you very much. Yeah. And again. Thank you. Thank you so very much for being so informative and for taking time away from your practice to to be with us this morning. It's very much appreciated. It's good to see you and thank you for your work too. I really appreciate it. Thank you. And thank you committee. 1145 and it's this this morning's testimony is over, and we will actually have some more expert testimony around COVID-19 this afternoon starting at 1.