Hello and welcome I'm so pleased

you joined us here on the last of our series

of four town halls.

As introduced, my name is Captain Rathki and

I am going to go ahead and pull up my slide deck,

share my screen here with you.

And put this in present mode.

And again, I'm so happy that you're here and joining us

with this - with this last town hall.

As introduced, my name is Captain Rathke,

I'm a U.S. Public Health Service Medical Officer.

I'm a PA, trained in - trained at

Yale School of Medicine and I've been practicing medicine

for 21 years now - primarily specialized

in occupational medicine. Both flight medicine

Dive medicine and general occupational medicine.

but as well as cardiology special - specialized in a number -

for a number of years.

But my main focus today and the main purpose of this meeting

is that - at this town hall, is it's really your time.

This is the time for us to really talk about - and for me to communicate

some, I hope, really practical information for you.

I'm not an HR specialist, I'm not a lawyer

but I am a clinician and so I want to kind of to think of this - this

town hall as a discussion as if you had a medical provider

sitting right at your kitchen table.

And so I'm going to really try to give you that kind of just

no kidding, real talk, practical information.

I hope that you will understand the whys.

Why some protocols are in place.

So whether you remember the protocol exactly or not,

with regards to COVID-19, you will understand the why

and you'll be able to apply that practical information

in your decision making to keep yourself safe,

to keep your coworkers safe,

and also to keep your loved ones safe.

So with that, we'll go ahead and dive right in.

Throughout the pandemic, we've had a number of cycles

and I'm going to put my laser pointer on here.

We've had a number of up and down cycles.

and these were predictable cycles in terms of -

from an epidemiological standpoint, when we look at pandemics,

January was the peak of daily cases of COVID-19

that we've had the entire pandemic.

That's the highest amount of cases we had in one day

and you can kind of see that graph and we've been on

a steady decline since that.

April - there was a little bit of an incline that.

we saw and that was really due to some sudden

protocol changes in the United States in some areas

where we saw people maybe being able to go into restaurants

more readily or dropping mask or increase density of people in indoors

that was permitted in public spaces.

So we saw this little incline throughout the U.S., but now we're -

in just in the last four or five days we started to see a

decline again and that's really great news.

I love to see cases continue to decline and there's a

number of variables that tie into that.

What we see throughout the pandemic as well is,

when we see daily cases, about two weeks after

we see a spike in daily cases, we see an increase in hospitalizations.

And so those trends kind of follow.

They lag behind just a little bit.

and then the part that I think is just the most tragic –

and I know we've lost a number of Commerce family members –

Is that COVID is taking quite a few lives in our country,

and really across the globe.

We're not unique in that aspect.

 And - but in terms of the way the virus works in the cycles,

there's about a two-week lag between daily cases, hospitalizations,

and then fatalities associated with COVID-19.

Some key points I want to - to - you to realize in terms of terms,

and just kind of concepts, with regards to COVID-19, are these four things here:

First thing being, Viral Load.

Viral Load is a concept of, basically, when we think of Viral Load,

we're talking about how much virus is in the human body -

how much live viruses in the body and replicating

within - within the body?

So that's viral load - and that's important and that stuff could be

potentially be related to why some people might get more severe symptoms

where their immune system doesn't bat down that virus as it starts to grow

inside the body, they get much higher concentrations of virus in their body

and thus having more severe symptoms. 

There are other absolutely, from a medical science standpoint,

other variables that tie into that, but that's a simple concept

when we think of viral load.

The nother - another concept that I want you to be familiar with is colonization.

So the virus - where it colonizes.

So the primary way that we get – 

the primary way that we get infected with COVID-19 is by inhalation.

We breathe that in - we breathe the viral particles that are floating in the air - in.

And those - there those particles sit in the back of our nose –

in the back of our throats and so they colonize there.

For some people, those that colonized, viral infection that's in those areas

then starts to migrate down.

People get really bad pneumonias and as well as a number of other

symptoms which we’ll touch on as well.

But that's viral colonization, if you will.

In terms of the way the virus is spread,

how we admit it when you're infected,

is that we exhale the virus.

So when were infected, even if we’re asymptomatic,

when we’re contagious - and will talk about when people

are contagious here in just a second - but when

you're contagious with COVID-19 - you

exhale the virus - and those particles float with each

time you exhale.

Just simply breathing, you admit viral particles.

And those viral particles travel on water particles as you exhale.

So, virus that's traveling on a larger water particle gravity,

carries that down and it drops.

Like I'm sitting in front of my laptop here.

If I were infected with COVID-19

And I'm talk - as I'm talking with you - that

Virus would exit my mouth in the air that I'm breathing.

And gravity in the larger water drops - droplets would

pull it down onto my keyboard.

For smaller viru- smaller water droplets, and by the way,

the smaller - smaller water droplets are produced when

I talk, versus when I breathe.

So when I talk smaller, water droplets are produced.

When I breathe really heavy, let's say I'm exercising,

or I'm shouting at a baseball game, for example - those type of things,

those are smaller water droplets, and they travel further.

Gravity - it takes - it takes longer for gravity to pull them on - on the ground,

but particularly when I'm breathing really heavy.

Like if I'm exercising, or – again - shouting, or talking a lot, then those –

those water particles can be so small that we start to get into a concept

of something called Aerosolization, and those particles can travel actually

pretty far, maybe up to 15 feet.

The important thing to realize, though, is –

whether I'm indoors or outdoors as I exhale, those –

those particles - they start to disperse, if you will.

They - they're not as close together.

They – they get further and further apart -

the further away they get from me.

Now that happens more readily outdoors than it does indoors,

and that's an important concept when we think about

CDC guidelines as we talk about that outdoors versus indoors

and then lastly the concept that I want you to be familiar with is: Viral Dose.

So when we think of - remember, I told you the primary

way that we get COVID-19 as we inhale it, we breathe

the water- those viral particles.

When we think of Viral Dose - how many viral particles

I breathe in – that's the Viral Dose that I'm talking about.

So the more viral particles I breathe in, the more likely I am

to get infected with COVID-19.

And that's the concept of Viral Dose.

So that's the real basic crux of COVID-19 in the way it spreads.

I'll talk a little bit more about that here in a second.

There are some unique aspects about COVID-19,

but I also want you to be aware of it, and this is what's

made this pandemic so difficult to trace.

On the right-hand side, here I on the information I presented,

One of the unique aspects of this particular coronavirus

is the fact that up to 33% of individuals that get infected

with COVID-19 are completely asymptomatic.

They have no symptoms, but yet they're just as contagious

as somebody that is symptomatic.

That's really hard to track.

In fact, a lot of viruses out there, you're not contagious

- and bacteria - you're not contagious until you're symptomatic,

but with this particular virus, you're contagious -

you can be completely asymptomatic, but just as

contagious - as people that do have symptoms.

In addition to that, the people that do get symptoms,

usually from the day that you get exposed to someone with COVID-19 –

symptoms usually are present or noticeable by an individual

about day 5 to day 7 after the time you're exposed to COVID-19,

but you're contagious with the virus at around day 3 or day 4.

So, day 3 After being exposed, you're contagious and you’re -

and your spreading the virus, but you’ve not exhibited

any symptoms, and if you're going to get symptoms, you typically

don't even show those symptoms until day 5 or day 7.

Again, very difficult to track from a public health standpoint.

It's been difficult.

If thre is any kind of silver lining at all with this –

outside of the fact that a lot of people are asymptomatic.

Is the fact that people that do get symptoms -

on the left hand side here - the people that do get symptoms,

overwhelmingly had very mild to moderate symptoms.

So 81% mild-to-moderate 14% severe symptoms

and 5% critical symptoms, but very challenging to track

from a public hands health standpoint and to get under control.

Additional complications that we've seen with COVID-19:

First, let's start on the right-hand side here,

one point I want to point out to you, and that is individuals

that you see two scans here.

Here you see a scan of a human here that is normal.

They don't have COVID-19, and on the right-hand side here,

this is a human that has a person that has really severe COVID-19.

And so what you see is this:

This dark space right here: these are the lungs

and dark space means there's no fluid.

It's all airspace and clearly, with lungs we want air in lungs.

These are very healthy lungs on the right hand side

Here, this is an individual that has severe COVID-19.

And so, all that white space in there is fluid and so, I think –

very visually - you can see why people have so much difficulty breathing

with COVID-19 with all the fluid that they have in their lungs.

Additional complications on the left-hand side here:

People that get more severe symptoms of COVID-19

are the – they get - things like neurological disorders,

there's inflammatory processes that happen,

cardiac issues we've seen documented with COVID-19,

hypercoagulability, which is easy clotting that is associated with

people that had more severe symptoms of COVID,

kidney disease, and multi-inflammatory syndrome in children.

All things - complications - for people that have

more severe COVID-19, that we've seen.

Very complicated - still learning how that process really

ties into COVID-19 as a medical community.

But it's been deeply concerning and something that's been

on our mind, certainly, if you've been following some of these type of things.

Hopefully none of you have had family members experience

some of these really bad symptoms here on the left-hand side

but certainly a lot Americans have.

The next thing that’s complicated about COVID-19,

in terms of things I want you to understand,

is that the virus has been mutating.

It's been mutating the entire time.

And it mutates fairly frequently. In fact, the mutation is been

helpful in tracking where viruses are going from continent

to continent throughout the pandemic.

It's been tracked, certainly within the last number of months.

The U.S. is really stepped up the effort and genomic testing -

of testing variables or variance, sorry of the COVID-19 virus

and really trying to better understand what is really present

in the United States.

What I want you to take note of though right now is,

this on the bottom left-hand side of this nice graph,

that the COVID-19 - COVID-19 - Commerce COVID-19 team created.

Thank you very much for all your help on these slides.

But the B117 - so that's what we call the UK variant.

It's not to pick on the UK, doesn't even mean, necessarily,

that UK - that's where this variant actually really started,

it just means that's where we first identified it as a public health community,

and it helps us track as it moves across the planet and moves

from human, human, and that's why we tie locations to it.

So B117 - and the reason that I want to draw your attention to that,

and I realize this is a little small, but on this graph here B117 currently,

right now is the predominant variant within the United States.

Depending on which piece of literature you're looking at,

it's anywhere from 30% to 50% more contagious

than some of the previous variants that we've had in the United States,

but 44.1% of all the variants that are present United States

are the UK variant, and it's by far the most prominent one

we see in the United States.

So how do how do we battle this?

How do we keep ourselves safe?

How do we keep our loved ones safe our coworkers safe?

How have we been accomplishing all the great things we've

accomplished in Commerce, despite the pandemic?

The primary strategies have been here on the left-hand side,

and these have been very effective, but they're not without cost either.

And we'll talk about some of the cost of these in a second

and I don’t mean fiscal, per se, but psychological.

But the real pieces here that are a mask, and so hopefully,

when you think of masks and how masks work.

The reason masks are such a critical part, if you remember

the way that you get COVID-19,  is admitting viral particles.

So the mask - when you wear it – actually fair amount of those

viral particles, and what particles do get admitted

out the sides of your mask.

It keeps them  fairly close.

It keeps that cloud of viral particles - if you happen to be

infected with COVID-19 - fairly close to you.

The second piece, which I think,

hopefully, makes a lot of sense now to you as well,

is physical distancing.

The further away – you’re away from another

human being, the less likely you are to

breathe in viral particles from somebody

that might be infected.

So physical distancing has definitely been a key part of our strategy.

And certainly outdoors, the risk is far, far less than it is indoors.

When you're indoors, those viral particles can build up because

of closed ventilation and as a result, the concentration, the viral load,

if you will – the Viral Dose - I'm sorry, is much higher.

So the person that’s breathing, that would walk into that space

and breathe that air is more likely to get COVID-19,

so physical distancing is important.

Again, kind of in that same concept, having a very closed

circuit of people that you're exposed to, avoiding large,

public areas where there's large gatherings, and then hand hygiene.

That's been an evolving concept throughout the pandemic,

and what I mean by evolving - initially we thought touching

a surface and then touching your mouth, eyes, and nose was

much more contributory to getting infected than what we think

it is now, particularly in just in the last couple of months

CDC’s released additional guidance with regards to hand –

hand washing and hand hygiene.

That's different than previously relati – with regard to COVID

because it's just not thought that that's a primary transmission.

Is it possible? Yes it is.

If you're touching something and then touching your mouth,

eyes, or nose, that might have viral particles on it.

In other words, somebody sneezed or had been sitting at a terminal

for a long time breathing and talking, and then you come in

right afterwards touch it, and then touch your mouth.

It's potentially possible you could get COVID-19,

but if you simply just wash your hands practice good hygiene,

wash your hands before you eat after, you use the restroom,

that's sufficient, and that should protect you.

The likelihood of you getting COVID-19 that way if you're doing –

practicing just the simple hygiene practices is really, really small.

The primary way is breathing it in - breathing viral particles in.

And vaccines. That's our newest mitigation effort, and we're definitely

going to kind of dive into that a little bit more.

So with regard to diving in vaccine development in United States,

I think it's important for you to conceptualize just how all

three of these vaccines that we have in the United States were

developed under the emergency use authorization - that are

released now under their emergency use - use authorization.

I think it's an important concept of realize that

no shortcuts were taken with this.

Typically, the way vaccines are developed in terms of the phases,

it takes a long time to develop a vaccine, so there's a phase,

there's a break, and then there's another phase and then a break,

and another phase.

It's a sequential way of attacking, or developing, a vaccine.

So the way these were developed so quickly are not by taking shortcuts

but they were done simultaneously - the phases were – all at the same time.

And so, again - not a shortcut. They were just done simultaneously.

And so, with that, and with the emergency use authorization piece,

the CDC has been following these vaccines very, very

closely in the United States.

And I'll talk about some evidence to that very point.

So there are a number of different mechanisms that are being

used to follow these vaccines to ensure they’re safe for the public

in the real world environment just to make a plug for V Safe,

when you go and get your vaccine, you'll be offered an opportunity

to download an app.

You download the app and you can submit any symptoms

that you have.

That information eventually funnels straight into CDC and CDC data,

so that's a great mechanism for you to participate in tracking

symptoms associated with these vaccines -

these three new COVID-19 vaccines.

Some points I want to make about the three vaccines.

So there's the Pfizer vaccine, the Moderna vacine,

and the Johnson & Johnson vaccine.

When you read the data for these things,

sometimes it's a little confusing, particularly if you're

at a place where you're - which vaccines should I get?

Well, the thing about the Pfizer, Moderna and Johnson & Johnson

vaccine is that it's not apples for apples when you're looking at the

published data for these. 

So these vaccines were researched in different parts of the globe.

And at different time frames, and that's really important.

Like the Johnson & Johnson vaccine, for example, is one of the

more latecomers, in terms of when they were doing their clinicals trials.

But there were variants available variants out there, like the

South African variant that was studied in South Africa -

Johnson & Johnson was.

And so the numbers that they were producing, or the stats

that they were producing in terms of efficacy

are just a little bit different.

What's also confusing is the way the three companies actually

produced or published the data - their efficacy data,

it was a little different as well.

Which I think causes confusi- confusion when you're

trying to compare these three vaccines.

The big takeaway is that the Pfizer and Moderna vaccines

are two shots and the Johnson & Johnson is one shot.

The Pfizer vaccine is 16 and older, whereas Moderna and

Johnson & Johnson are 18 years and older.

But in terms of the numbers that they produce and with regards

to efficacy they're talking about symptoms.

They're not talking about how well it prevents you from

getting infected with COVID-19, they're talking about symptoms

and how it relates to severe symptoms, particularly, but as well as

mild-to-moderate symptoms for those people that get infected

after being fully vaccinated with one of these three things. 

So let's dive into what I really want you to know about these,

I think, is the takeaway about all three vaccines.

All three vaccines are nearly 100% effective at preventing

you from dying from COVID-19.

So if there's anything I want you to remember about vaccines,

that's what I want you to remember.

All three vaccines are nearly 100% effective at

preventing you from dying from COVID-19.

Moderna is about 90% effective at preventing

severe symptoms that lead to hospitalization and

then Pfizer and Johnson & Johnson nearly

100% effective at preventing symptoms

that lead to hospitalization.

But I think those are very, very strong numbers and

definitely a takeaway that I would want you to know, if

you were going to remember any numbers about vaccines.

Those are the ones I want you to remember.

The other thing I want you to look.

at here, which I think gives a great trend,

is that when you look at this - and I realize it's kind of small - 

you don't necessarily need to be able to read the numbers

on here to interpret what I'm going to -  the reason I put this

on here, on the right hand side.

But as you go from left to right, that's time frame.

And so these little small blue bars here as they go up, these are

cumulative number of people in United States

that are getting vaccinated.

So this is a cumulative amount of people in the 

United States that have been vaccinated,

and then this red line right here are the

seven day average trends of people hospitalized

due to COVID-19.

So, right here at the peak - this is in January of this year -

was the peak amount of people in the hospital due to COVID-19,

and what we see is this nice steady drop here, 

as we see a nice steady incline in vaccines.

And so it's almost a 1 for 1 as you punch that out statistically.

A ratio for - in terms of  individuals that are getting vaccinated,

versus decreased hospitalization, when you look at it just ratio

numbers in general.

And you can see they seem to, very strongly, just visually even

correlate to one to another, and that's still panning out and seems

to be true at this time for this month 'cause this data goes

right to the end of March.

I don't have April included on this right now.

Additional takeaways that I think are really important

for you to realize that I hope will be very practical

for you and help you understand some of the reasoning

behind guidance that's out there:

The first thing is, is that I told you already that

COVID-19 vaccines are nearly 100% effective

at preventing death and severe symptoms, right?

But in terms of the literature right now, there are

four small studies out there - I wouldn't call

it the bulk of research - I wouldn't call it definitive research

yet - but out of the four studies there, the effectiveness

of all three vaccines at preventing infection - again,

we're not talking about symptoms - infection,

actually preventing you from getting COVID-19.

Their effectiveness is between 80 and 90%.

Three out of the four studies leaning more towards 80% than 90%.

That means there's a 20% chance that after being fully

vaccinated - and by the way fully vaccinated means 2 weeks after

your second dose of vaccine or if you get the Johnson & Johnson,

after your one shot - but two weeks after your last shot, you

are protected from getting infected about 80%.

That mean there's 20% chance that you could still get infected.

Bcause it's so effective - the vaccines are so effective

at preventing symptoms, you probably are going to be

either asymptomatic or have just mild symptoms,

but you can still get infected and spread the virus.

About 20% risk of doing that.

And that's why when you're fully vaccinated and you're in

public spaces, it's still recommended when you're around

people that aren't vaccinated, including children, that you

still wear your mask when you're in these places.

CDC has relaxed some guidance out there, as I'm sure

you saw this week with individuals that are outdoors

no longer need masks, as long as you're

not in large crowds, or are in certain types of setting- settings.

I talked about fully vaccinated already.

Additional things you should realize is

that you shouldn't get a COVID-19 vaccine at

the same time that you're getting a different

type of vaccine like a flu shot.

Just one vaccine at a time, with regards to COVID-19.

That's the only one you want to get at the time you get vaccinated.

Additional misnomer or myth I want to.

Dispel out there is that it is impossible.

impossible for you to get COVID-19 -

get infected with COVID-19 from a COVID-19 vaccine.

They're not live virus.

You cannot get COVID-19 from that.

It is highly recommended - if you go

to the next block here - that you try to

get your second shot at the scheduled time.

So for Pfizer is 21 days after your first shot.

For Moderna it's 28 days.

But CDC does allow you some additional grace time,

if you will, if for some reason you miss

your second shot appointment, that's OK.

It's not all for naught.

It's not like you're not immune anymore.

You have up to 42 days to get that second shot

if for some reason you just can't make your

time frame for that second shot.

In terms of all three package inputs are

the package inserts they - all three

just have one thing in terms of caution for individuals

that should take pause before they get a vaccine.

The universal thing among all three vaccines is that if you've

ever got - ever got an allergic reaction to a different vaccine

that was really serious, you should probably talk to your doctor -

your medical provider, prior to getting the COVID-19 vaccine.

That brings me to Johnson & Johnson, which you may have

some questions about, and I don't blame you.

I would have questions about it as well if I wasn't tracking it so closely.

So the Johnson & Johnson vaccine as of April 23rd,

the pause the - in terms of it being available in United States -

the pause was lifted.

And it was determined that the benefits of the vaccine far outweighed

the really rare symptoms that we saw with that.

So, how rare was it?

Currently, right now, on the CDC website there - they've published,

15 out of- there were 15 cases of a kind of a rare type of blood clot

out of eight million doses that were given in the United States.

So 15 out of eight million were reported

of this rare, but severe, type of blood clot.

All 15 cases were in women from ages 18 to 59 years old.

Now there are two additional cases I've seen, kind of

floating out there in the news.

I've seen it talked about, but I've not seen the literature

on these two cases - or the scientific literature -

to validate whether it's real data or not,

yet the two additional cases which would make

17 out of 8,000,000 if that is true.

One of those was actually male, and breaks the theme

of all females between 18 and 59 years old. 

So more to come on that.

But again, extremely rare. And the thing that.

I wanted to point out here that I think is so incredible is that.

15 cases - it only took 15 cases - and actually.

when the pause began, there were only 8 cases

that were known at the time.

And that was enough for the monitoring system -

the safety monitoring system for vaccines - these COVID-19

vaccines to pick it up and actually pause distribution

in the United States.

And that's a really sensitive, robust safety system.

I think that's amazing.

I don't know that I've seen that sensitive of a public health system

for safety with so few cases triggering a pause.

These things are being watched very, very closely.

All three vaccines. I think that's a great news story -

a good news story, actually.

If you've had COV- or Johnson & Johnson vaccine, within

three weeks, there's primary symptoms that I have listed here:

Severe headache, back pain, neurological

symptoms, severe abdominal pain, shortness of breath,

leg swelling, some tiny spots that happen - red spots

all over the body or sudden, easy bruising.

The primary things that you really emphasized particularly CDC website,

depending on what medical literature you're reading, but - is severe

headaches and severe abdominal pain that happens pretty sudden,

pretty rapidly, and with those symptoms in individuals that get the

Johnson & Johnson vaccine, they should seek medical care very quickly.

And then last point that I think is really important is,

as of April 23rd, out of over 200 million people that have received

the Pfizer and Moderna vaccine, there have been no reports

of blood clots associated with it.

So just wanted to emphasize that.

Which brings me into the next point here that I think is important.

We're kind of pivoting topics.

So, one was very clinical in the terms of medical science and

now we're kind of getting into the psychological aspects of COVID-19.

So in March of 2020, there were some public health experts that were - really

kind of mapped out with the pandemic was going to look like

and they talked about phasing of the pandemic.

And we've seen those phases kind of come and go,

in fact, about 3 phases if you will, depending on how you

calculated when phases start-started and and subsided - 

where the peaks and troughs are of the COVID

cases themselves.

But the other thing that they had predicted is that despite

the multiple iterations of COVID-19 phases through a pandemic,

what they were predicting is that we will see a steady incline

with no peaks and troughs, just a steady incline,

the longer the pandemic lasts, of stress, grief, loss, fatigue and burnout,

anxiety, depression, substance use, and suicidal thoughts.

And so that was in March of 2020.

Well, did that really pan out?

What do statistics say right now - whether that's true or not?

Well, in June of 2020 - and this was looking at just

the month of June - and that's an important point here -

but looking at just the month of June, CDC reported

that 40% of U.S. adults reported struggling with

mental health/substance use.

When we look at the prior year - and this is a cumulative amount

we're comparing - just as one month to what we saw cumulatively

for the entire 2019 year - there were only 20 to 30% in 2019 of people

that reported - adults that reported - struggling with

mental health and substance use.

Even more startling is, as you jump down to here,

11% in the month of June, 11% of U.S. adults seriously

considered suicide - just the month of June.

Again, not a cumulative total at a very minimum

for 2020, we're going to see 40% or 11%

but those numbers climb throughout the year.

This number is thought for all of 2020 - CDC has not produced that

data yet - but for all of 2020 to be somewhere between 15 and 17%

most likely at a minimum, in terms of adults seriously

considering suicide in 2020 alone.

And this number being closer to 70% cumulatively

for 2020 in terms of adults struggling with mental health

and substance abuse.

In terms of just what you and I might be feeling

on a on a day-to-day basis, I wanted to put this slide up here

because I wanted you to know that you're not alone.

There are been a number of workforce surveys out there.

This one happens to be from the Harvard Business Review,

but there's a lot of them out there and they all have very similar

numbers as to what you and I are feeling.

89% of respondents in this particular survey said that work life

was getting worse for them as the pandemic went on, or keeps going on.

85% said that they were having - they were struggling with wellbeing

and it's been slowly declining.

62% are struggling to manage their workloads.

As we go down here, as you would suspect, particularly as virtual

school is still going on in a lot of areas, people were struggling

with the concept of balancing home and work, and home

schooling specifically.

Very, very impactful and very personal for all of us.

And so, whether you're a medical professional like me,

or whatever your personal specialty might be, this is a

very human experience for all of us.

We're all experiencing times, and have all had peaks and

tra- we're all experiencing stress.

We have felt at times feel, we've felt overwhelmed at times.

I know I felt that at different times throughout the.pandemic.

I'm sure you felt that as well as we kind of go through

these peaks and troughs.

It's been mentally tolling on all of us.

So, more specifically, on - as far as getting to

something that I wanted to touch on with you

and that's - that is the concept of burnout.

So, in terms of burnout, one of the biggest things

that we've seen with burnout is that - is that we're in this

concept where we're just clicking from meeting, to meeting, to meeting.

There's no break.

You don't get up from a boardroom and then walk down the hall and

go somewhere else to a next meeting.

You don't get those intermissions.

You can, literally, just click, click, click, click, in terms

of just in the federal workforce overall.

On the whole, people are working more hours

than they did before and in terms of just trying to keep

up with things, keep up with emails, but we're

in a state right now of an unsustainable

workload, and there's a number statistics that pan that out.

If I had time, I would go through with those with you.

And they're not just unique to the U.S. workforce, but

also apply to the federal workforce.

A perceived lack of control - it's been very difficult to really

follow the COVID science as science develops about this virus.

So, our guidelines have changed and progressed as we got

more knowledgeable about COVID-19.

As we go out in public, there's a tremendous amount of stress

that's uncomfortable for a lot of people.

Just trusting that the person that you're beside in the grocery

store is doing the right thing and they're not showing up in the

grocery store when they're sick and contagious,

when they're knowingly sick.

Or have tested positive.

And we've had a really big problem with that in college campuses

where individuals unpredictably from a - from a medical or

from an epidemiological standpoint, unpredictably, college students

that were - after they tested positive that morning on a COVID test,

still showed up to parties in the evening,

knowing that they were - they were positive.

Still going out and mingling with other people.

And that's not to pick on college students.

We've seen, we've seen times where society responses

to COVID-19 have been really kind of all over the map.

And so we really do have to trust, and have had to trust one

another on a day to day basis, maybe in ways that we are not used to.

So this perceived lack of control, insufficient rewards for effort,

and so as you're clicking from meeting to meeting, you don't get

that time right after a presentation where somebody says,

"That was a really helpful presentation, I appreciate that."

Or, "What you said in the meeting really made all the difference."

You don't get that feedback so you don't get that

sense of reward for the effort that you're doing in

this type of environment, particularly virtual environment.

Lack of supportive community.

We've lost our work family.

A lot of us that relied on people at work as kind of our social support.

But also, we're just haven't been able to see family members and some

of those family support systems as often throughout the pandemic.

And then mismatched values and skills.

So, a lot of skills that apply to the workplace in person,

haven't nec- don't necessarily feel like

they apply so well in the virtual environment.

So, some people feel like they're not able to

use the things that they're really good at in this type environment,

some of the skill sets that they have, virtually.

So how do we beat burnout?

Or really having a sense of purpose?

And this takes a deliberate effort to find purpose in the work that you do,

your interactions at home, really reaching out and building a support system.

Having a sense of purpose and finding the sense of purpose of

the virtual meeting that you're in.

Super important, but takes a deliberate effort and maybe

a little different effort than you're used to having.

Having a manageable workload. This is super important.

It's OK to say no sometimes, and we should say no, and it's OK

and healthy to have white space on your calendar.

And we should have white space on our calendar.

It's just not sustainable to jump from meeting to

meeting to meeting all day long, nonstop.

And then feeling that you can discuss your mental health at work.

This really gets to mental health stigma.

Having a healthy place to talk about mental

health issues, about feeling stressed is

not something particularly in the federal workforce

that were used to having, but I'm starting to see the spark of

change and the workforce in general,

and that's such a great thing.

And that's such a healthy place to be as well.

To really decrease that mental health stigma

and to be able to talk about those things without feeling like

you're going to be judged, or repercussions as a result.

Having an empathetic manager, particularly, as it relates

to workload, and then having a strong family

of - sense of family and friends.

That really gets to the support system that was talking about.

 And then one other point I want to touch on too, is this concept of languishing.

You see - you see, this term used more and more in

behavioral health literature, mental health literature, and

Simply what languishing means in terms of a bigger health standpoint is this

feeling of being somewhat joyless or aimless is some people label it as kind of a COVID fog.

Just kind of feeling down or the blahs, but it really just gets

to the point of not feeling like you're flourishing and thriving.

And so how do you do that? How do you counteract this just

kind of blah feeling that you may be feeling?

Well, really look for new challenges.

Look for new professional challenges, new projects,

and then challenges at home.

Pick up a new hobby - but new challenges really help

give us a sense of purpose in life.

And then enjoyable experiences: Really be deliberate

about putting things on your calendar each day that are enjoyable to you.

So, carve out space in your day to make sure that you allow

yourself to do something that you find enjoyable.

Super important.

And then find that meaning or purpose in your work.

And then the last point before we get ready to jump into your questions

here, is that in general, our federal workforce, we've not been

taking good care of ourselves throughout

this pandemic, and that leads to secondary

consequences of COVID-19.

So, it's not just getting infected with COVID, or not getting.

infected with COVID, it's the secondary consequences of

us not taking care of ourselves.

So in the Federal Employee Health Benefit program,

basically your federal insurance program, when we

look at the amount of claims for preventative care services

compared - in 2020 - compared to 2019,

Annual wellness visits fell by 18%.

Colonoscopies - 32%, Mammograms - 23%, Pediatric Immunization - 16%,

Prostate exam - 16%, and Women's Preventive Exams - 36% drop.

That means these are all things that - all screenings,

if you will, ways that we take care of ourselves and catch problems

early before they become medical crisis, we've been

ignoring and not getting done.

These numbers have not been really very - have not been

improving so far that I've seen in 2021 either.

So that's incur- that's discouraging to me

and I just wanted to take a pause here

and say, please take care of yourself.

Don't ignore those- those health screenings

that you normally do.

So before we jump into your questions, specifically, I have a poll up here.

Your feedback is important. This is the last of our four

town halls that we're doing right now in this series, at least.

But your feedback is important.

Should we consider doi- doing any future COVID-19

presentations? Your feedback as to what those look like

would be really, really helpful, and I  appreciate your feedback on this things.

So your questions, specifically.

Diving into your questions. Question one, and I have 13

questions here that we're going to get through.

And these slide decks will be available to you.

They'll be posted so you'll be able to see these written answers

to these questions too.

I'll go through them pretty quickly, but you'll be able to

read through them later on.

"I have concerns about the vaccine.

There are too many unknowns at this point.

They just released a statement this morning.

that one of them may only last for six months.

Is that true?"

So the answer is, is that - what we're - the question really gets

to the concept of durability of a vaccine.

How long immunity will last?

Well, there's just not a lot of data.

It's thought that vaccines, from a public health

standpoint are going to be, in terms of

durability or how long the immunity will last, 

may last up to a year.

The part of the immune system that the vaccine triggers,

which are T-helper cells, tend to lend themselves to -

tends to lend itself to a longer immunity versus just

a couple of months, but we don't have the data.

And that data, I'm very grateful, is not being published

without something to support it.

So what we have enough data to say is that immunity lasts

for six months, or the durability of the vaccine last for six months.

I suspect that's going to go to a year, 12 months, and

already, there are clinical trials underway by all three vaccine

companies saying to have boosters - annual

boosters - one year boosters - just like a flu shot.

In fact, the CEO of Pfizer went so far as to say that he predicts

an annual COVID-19 booster requirement for the next decade, at least.

Next question: "What happens during cold and flu season

when immunity defenses are down?"

Well, honestly, immunity isn't down during the cold season

or during colder months.

What happens is, is that viruses like the Coronavirus

tend to be a little bit more hardy in colder, drier weather.

Coronavirus, particularly, is really sensitive to sunlight, and so

if we're spending - as people - we're spending more time

indoors, that means we're in closer - closed airspaces

and as a result of being in closed airspaces, particles

don't spread far - as far apart.

Our Viral Dose, if you will, the amount of particles we

breathe in is greater, and were more likely to get infected

during those months.

So those are really the contributing factors as to why we see

an incline in cases in the fall, winter, and in early spring.

Question three: "Masks can be uncomfortable. Do you have any tips on how

to make mask more comfortable when wearing them for long periods of time?"

Well, CDC has a really great website on talking about just that.

Having to wear a mask all day long can be extremely

uncomfortable, and the contributing factors are

the type of fabric, how easily the air moves through the fabric,

the fit, the size, the nose bridge, the type of

padding around the metal nose bridge, if there's metal- 

metal nose bridge, the straps where there's little plastic pieces

on the back of the piece of the straps,

the straps that are pushing up against your ear, tightness,

all contribute to comfort.

And so I'd recommend getting on the website and they give you -

on CDC website - they give you some great tips there.

Next question: "How effective are HVAC systems in

removing COVID-19 from the air?"

That's really involving science, and honestly a lot of -

a lot of research went into that, and this field if you will.

As far as indoor air quality, more so than then previous years for sure.

And I don't know that this science is completely evolved,

certainly talking about the size of the room,

the airflow within the room.

Some of the key things that have been taken away

from more recent research with regard to HVAC systems

is really minimizing to the greatest - greatest extent possible,

if your HVAC system can even do this,

really eliminating the amount of recycled air.

That, clearly, is going to decrease the efficiency with which

it heats or cools, but having as much fresh air in a room as possible,

disperses those particles.

Doing things outdoors clearly is better than indoors.

Opening windows, if you can, really helps.

Next question: "Is there any data regarding the risk

of transmission from person-to-person in office, with or

without masks to a person in a neighboring office?"

Again, this really gets to - let me describe - let me put it this way.

In a scenario, let's say somebody is in their office,

their walls go all the way to the ceiling.

They have their door closed they're talking on the phone for an hour.

They're asymptomatically infected with COVID, so they don't know

they have COVID, but they're infected with - and

they're emitting the entire time they're talking on the

phone they're - emitting viral COVID particles in the room.

And so, that cloud of space - the amount out of particles

floating in the room - are a lot.

Somebody knocks on - pardon me - someone knocks on the door,

the person puts their mask on, and the person walking into the room

has their mask on, but there's a room full of viral particles

there that this person with their mask is walking in on.

And so the chance of them getting infected

is much higher in that kind of closed airspace.

So, following the executive order of wearing your mask

in spaces, indoors is highly recommended.

And from a public health standpoint I would recommend

that you keep doing that.

So, hopefully helps answer that question.

Next question here: "What do community transmission levels

need to be for businesses such as daycares to reopen?"

Well, what we're really getting to here, is we're talking

about this concept of herd immunity, and how many people

have to be immune to COVID-19 to prote-

to protect those people that aren't Immune to COVID-19?

So, with this new UK variant that is now the predominant variant

- again over 40, getting closer to 50% of all cases in United States -

since it's more contagious, that means we need a higher number

of people immune to protect ourselves, from a herd immunity standpoint

than we would with variants that are maybe a little less contagious.

So the literature right now kind of kind of swings between - I've seen as low as

75% to 95% depending on what you're reading -

what medical literature you're reading -

the consensus right now is around 85%

of the entire American population.

That's not just adults, 'cause if you think about the -

you know, some of the recent newscasts, talk about 50%

of adults in America are vaccinated, right now.

That's not including children.

We have to include all human beings with which a person

with which the virus is transmitted.

So we need 85% of the entire population,

including children, to achieve this herd immunity.

So clearly we still need to push and still be vigilant

about getting vaccinated across the country to

reach any kind of numbers that are going to be

substantial for herd immunity.

But we're already seeing a decline in cases, which is really

hopeful - and hospitalizations - due to COVID, per that chart I showed earlier.

So keep up the good work, and please encourage your family members

and your coworkers to get vaccinated.

Next question: "Can you please provide some guidance for

parents who have unvaccinated children? How

can parents include vaccinated, including vaccinated?

parents minimize the risk of exposing or transmitting the virus

to unvaccinated children?"

So, simply, as I told you, vaccination trials are

underway for children right now.

Until they are available, all we have is the same

strategy we've been using the whole pandemic.

So anytime your child is in public, you're going to

want them to be masked.

And you're going to want to social distance to the greatest extent possible.

And that's the way you're going to keep your child

safe and keep them from getting COVID-19.

The next question: "What is the latest available information

on the prevalence and impact of long haul symptoms

in those who - in those who contracted COVID-19?"

So, whoops. I think I - I think I messed up there. There we go.

So in terms of long haul symptoms, this is really something being

very, very closely followed and not completely understood.

There are a couple of working theories for this,

and I won't dive into those working theories here,

but realize that in terms of long haul symptoms - 

and what I mean by long haul symptoms - individuals that

got infected but recovered, but still have these residual symptoms

that persist for months and months after being infected.

And so you can bet your bottom dollar that in terms of long haul

symptoms in COVID-19, this will be something we're talking

about for years to come in the medical community,

of people that have these residual symptoms from COVID-19,

as we try to better understand why they have these long -

these symptoms that persist for such a long time after

already recov- fully recovering otherwise from COVID-19.

In other words, not being contagious anymore.

Number 9: " I have an elderly relatives who have been

vaccinated but are periodically visited by friends or relatives

who refuse to wear masks or get vaccinated.

The speaker said that vaccines have 100% - are 100% effective

against death and severe symptoms, but is there still

a risk, particularly for the elderly?"

So, there is a little bit of research to show

that there are a couple contributing variables.

Age might be one of them - might be.

Again, we don't have a bulk of research here to say this,

where some people may not have quite a robust response

to vaccines as others, which means they're not quite

as protected as others.

Still very effective. Still very important to get vaccinated,

but their immunity may not be quite

as much as it is in somebody else.

Certainly someone that is immunocompromised that gets vaccinated,

is not going to have the same immune response and have

the same efficacy of the vaccine as somebody that has a

fully functioning immune system.

But again, still important to get vaccinated.

Any protection, particularly in something that's so effective

at preventing you from dying from COVID-19.

Very, very important. Hopefully I answered that question for you.

So just I know I'm 2 minutes after, I'll probably be 6 minutes after the hour here.

So just a couple more minutes. We're almost through these questions.

Next question: "I'm of the impression that immunity is most

probable as a result of exposure to the virus. Even more so than

being vaccinated. Yet people that fought the disease and are - are considered

to have no immunity are considered to have no immunity until vaccinated.

Is that because it is too difficult to track cases versus vaccination?

Can you share the recent findings showing vaccinations help prevent

contracting or sharing the virus?"

So the big takeaway here is that actually,

the bulk of the science shows that you get a

much more robust immune response from getting

vaccinated versus recovering from COVID-19.

In fact there's a number of case studies just

within the United States, not even to mention the cases

we've seen across the globe, but just even in the United States,

where people, after they've recovered from Covid-19

have gotten reinfected with COVID-19

as early as 90 days afterwards.

And so in terms of immune response and the robust

Immune response you get from vaccines, it's - even

if you've reco- you've been infected and recovered from COVID-19.

That's why it's recommended that you still get vaccinated.

Question 11: "What are the best and worst case scenarios we

might be facing in the coming years giving existing COVID-19 variants?"

Again, that really ties the most likely to getting those

annual boosters to really account for some of the variants out there.

Which is kind of the same thing we see as the flu virus

mutates constantly. We're constantly trying to keep up

and an alter the flu vaccine annually, to keep up with

the most serious variants out there to keep people protected and safe.

You can expect that we'll see very similar things with COVID-19.

Second to the last question here: "Who cannot, or should not

get a COVID-19 vaccine?"

Really, it ties to - if you've had a severe reaction to COVID-19

before, you should talk to your medical provider.

But CDC has - again, just list every medical condition

that you can think of just about and tells you whether

or not you need additional - additional medical guidance

before you go get vaccinated or not.

It really spells that out, and I put hyperlinks

in the slide here.

Again, these slides will be publicly available.

And then will last question: "Which COVID-19 tests should I get

and how do I get one? How common are they are false positives?"

So the gold standard for COVID-19 testing is something called

polymerase chain reaction testing - PCR testing.

And so this is the gold standard in the both sensitivity

and specificity of these have really improved over time.

Sensitivity speaks to how often you're going

to get a false negative. Alright?

And so for most PCR testing right now,

that ranges somewhere between 90 and close

to 100% sensitivity.

Which means it's pretty unlikely you're going to get a

false negative.

Specificity is nearly 100% across all

PCR testing, specificity speaks to how often

you're going to get a false positive with

a COVID test, and so it's very unlikely

you get a false positive.

If it if a COVID test comes back positive, it's positive.

In other words, you're infected with COVID

at the time that you got the test.

So, with that I just want to thank you so much for joining

us for this town hall.

I hope it was really practical, useful information.

That was the intent for you.

Please take care of yourself, while taking care of other people.

And if you haven't gotten vaccinated, please consider that as well.

Thank you so much.

I hope you have a great upcoming weekend and

I hope someday to be able to meet you in person.

Take care.