Below, Assistant State Health Officer Dr. Karen Landers with the Alabama Department of Public Health discusses COVID-19 misinformation as one of the l
Below, Assistant State Health Officer Dr. Karen Landers with the Alabama Department of Public Health discusses COVID-19 misinformation as one of the leading causes of people refusing to get vaccinated, why schools should require children to wear masks this fall, why young people are disproportionately refusing the vaccine and what concerns her the most about the contagious Delta variant. You can also listen to the full interview in the podcast above.
You appeared on CNN with Jake Tapper this week where you discussed the state’s low vaccination rate. You and others in the public health community have been loud and clear in that we are at a critical moment, some doctors even calling it an emergency, but that we can return to a level of normalcy if we can just increase our vaccination rates and mitigation efforts. But despite our best efforts so far, the state has struggled. If that message, the science and data are so clear, how can we convince people to do that?
Dr. Karen Landers: I think that’s a huge challenge right now. What I remind people is it is my job both as a physician and as a public health officer to provide the best science-based information that I can to each and every patient. And we’re really speaking to the entire state of Alabama as patients of the Alabama Department of Public Health, because that’s what we do. We promote and protect the health of the citizens of Alabama. Certainly, I’ve had patients decline my medical advice before, but that still does not prevent me from carrying out my responsibility as a physician. And that is to give my patients sound, scientific medical advice that will improve their health and hopefully save their lives.
So I think the challenge here is that persons are receiving information from sources that do not have their best interest at heart, frankly. We as physicians of the state of Alabama are trying to protect citizens and save people’s lives. So I think that information should be coming from people who have training, knowledge and experience. And in addition, the ongoing spread of information that is damaging to people’s health and well-being about the vaccine, that information is coming from people who do not have knowledge of this vaccine in terms of development, the way vaccines work, the approval process — sewing misinformation that is hurting people. That is one of the hardest things here. I do not want to see people harmed for receiving misinformation that subsequently causes pain and suffering because they took the wrong advice.
How can the state fix the problem with misinformation that is contributing to the low rate? What role can the Department of Public Health play in it?
My goal and my responsibility is to provide correct medical advice. The department has been out every day doing that. I’ve certainly appeared on media outlets throughout the state of Alabama and even nationally regarding this particular subject. I think what is left here is continuing the efforts of other groups that work with the Alabama Department of Public Health. I think the Medical Association of the State of Alabama continue to do a great job reaching out to our members with more fact-based information physicians can use with their patients. Certainly physicians have looked at and studied information on COVID.
Let’s say, for example, you are a primary care pediatrician. You are well-versed in COVID, but you also have patients with other illnesses you see all day long. So for the Medical Association to be able to provide you additional facts and information…or you’re a cardiologist and you see the complications of COVID but you also see other persons with cardiovascular problems every day. You might need more information about the general basic science behind the vaccine. Just to be able to say I’ve read a couple of articles, but I don’t have time to read every article, so these are the points that are coming from the Medical Association an Department of Public Health. And I really think just continuing to support our medical community in its fight against COVID. Our medical community wants to take care of all patients, not just patients with COVID-19. We need to get our COVID-19 down so we can continue to provide high quality care to all patients.
And speaking of misinformation and perceptions people have, I’ve seen people say “I’ve already had COVID, and now I’m fine, so I don’t need the vaccine,” or “I know someone who got the vaccine and still got COVID, so that’s proof it doesn’t work.” Could you clear that up, that having COVID doesn’t give you lifetime immunity and contracting COVID after getting vaccinated does not mean the vaccine isn’t effective?
To address the first question, we know that when people get COVID, they have some immunity for a period of time. That level of immunity can vary from one person to the next. Not everyone’s immune system reacts the same way. But what we do know is that we have had a number of cases of reinfection in the state of Alabama, and those persons have had COVID and contracted it again. And we also know, from scientific data, that if you follow these patients who have had COVID, after several months, their immunity wanes. But also if you look at some data that is in persons who have had COVID and have received the vaccine, their ability to mount an immune response is extremely high because they got vaccinated after they had COVID. So there is science on both ends of that, and we really have to remind people that the disease does not confer long-term immunity and that persons who have had the disease do not have the durability or long-term ability to mount an immune response as much as those who have been vaccinated. There is science behind it. We are learning every day. We are continuing to see more information on this. There are many experts in the field speaking out on this. There’s still a lot we don’t know.
And to answer your second question, if we look at the effectiveness of the vaccine, some of the data indicated that with the mRNA vaccines, we had about 94-95% protection in the population that was studied. With Johnson & Johnson, it was a little lower, but still good protection. Practically speaking, now that we have had millions of doses of vaccine given, we see that we do have some vaccine breakthrough. And we expected that. If you are a person with immunosuppressive conditions, other underlying significant medical conditions that will affect your immune system, you may not respond as well to the vaccine as an otherwise healthy person. However, we see that we have fewer hospitalizations among people who have been vaccinated, even if they have vaccine breakthrough. We have fewer severe illnesses among people who have been vaccinated. And we have fewer deaths among the fully vaccinated.
So again — data, science, information from persons who work in this field and do this type of work and see these kinds of outcomes. And that’s really my plea to all Alabamians. If you look at the outcomes of COVID-19 and persons who have been fully vaccinated and then you look at the outcomes of COVID-19 for persons who haven’t been vaccinated, the persons who have not been vaccinated, right now, are making up almost all of the hospitalizations that we’ve had. I don’t want to see anyone die from this disease that I think could be significantly reduced or prevented by taking a vaccine. And that’s what keeps me going here every day. I’m just trying to save lives. That’s what we in the Alabama Department of Public Health are trying to do. Get this vaccine out there. Keep people from dying. Keep people from being hospitalized, and keep people from having these severe complications from COVID, such as the long COVID, which can be seen even in children.
You told Jake Tapper that the data shows that it’s younger people who are disproportionately refusing COVID-19 vaccine, people who perceive that they’re younger and healthier and therefore do not need the vaccine, or they are continuing to buy into misinformation. What does the data show in terms of how the Delta variant and COVID are impacting that age bracket lately?
We can’t sequence every specimen in the state of Alabama, but we know one of the laboratories [at UAB], almost all their specimens they sequenced recently were Delta. And we know that Delta is more contagious. And when it’s more contagious, that means there are more people that are going to contract this. And for every person who contracts COVID, keep in mind, that person can infect and probably does infect several other people. Data varies on that. I’ve seen with the SARS-CoV-2, two-to-five other persons may be infected from a person who has SARS-CoV-2 without that person even knowing they’ve transmitted it. And with Delta, we could be looking well above five people being infected by someone with this variant. What we’re seeing is more disease. When you see more disease, even in younger persons, you’re going to see more hospitalizations and potentially more severe outcomes. The data is still being looked at in terms of how severe the Delta variant can be. We’ve seen some information that indicates it can be a more severe illness. I would like to see more data on that. I make my decisions and recommendations on the best scientific data I have. But the reality of it is still leading to more hospitalizations and potentially more complications from that.
What I hope people are starting to hear is whether you’re infected with the variant or the SARS-CoV-2, we still have data to indicate that the vaccines are effective and will reduce your chance of contracting this disease. We’re now at a point where we have a very contagious variant out here. Persons can contract it and infect other people around them. I don’t think anyone wants to intentionally cause disease in another person. If we have COVID, then we can infect other people and cause them to have COVID. We could harm these people. Nobody wants to do that. Alabamians aren’t like that. We want to take care of our citizens, families and loved ones. We don’t want to hurt other people. This is what I hope people can understand. When you’re talking about getting this disease, not only are you running the risk of having your own problems, but running the risk of infecting other people who didn’t realize they were around you and you caused them to have this infection, and they could have a poor outcome.
This is a really severe variant, and every time someone’s infected, it also gives not only an opportunity to infect other people, but also it gives that virus an opportunity to do something with its own genetic material that makes it able to escape the ability of the body to fight off that infection and/or the ability of the vaccine. So we’re going to get another variant out there. I hope it won’t be called “the Alabama variant.” I really worry about that because viruses mutate. They take these opportunities. And we don’t need to give this virus this opportunity. This virus does not deserve another opportunity to infect another Alabamian.
I want to ask you about children. We are seeing widespread recommendations to require masks in schools this fall regardless of vaccination status, including reportedly from the CDC this week. Is that in line with the Alabama Department of Public Health? Should schools require masks? [Note: After this interview took place, the CDC did announce this week that everyone in schools should wear a mask regardless of vaccination status.]
The Alabama Department of Public Health follows the guidance of the CDC. That will be the recommendation. The American Academy of Pediatrics has discussed this. The Alabama Chapter of the American Academy of Pediatrics has also put out information on this. We’re pediatricians. There are over 60,000 of us that are members of the American Academy of Pediatrics. I’m very proud to be a member of the Alabama chapter and absolutely support their recommendation as well to do this. We want to protect children. Keep in mind, persons under 12 years of age don’t have an opportunity to be vaccinated. Schools did a great job last year when there was universal masking and they were following the other mitigation standards. They absolutely did a wonderful job.
Subsequently, there has been some data to show that if you have kids in a classroom and they’re masked and maintaining their three feet of social distancing, if both persons are masked, you’re really not having a situation of transmission of COVID. If everybody’s masked in the classroom and there’s three feet of distance, you’re not going to put those kids at home for home quarantine if they are exposed to COVID as long as they’re asymptomatic. I think that’s huge. And it’s data-driven. This is just a way to protect our children. I don’t really enjoy wearing masks. I do it because I’m a physician that also works in TB control. But it’s something we have to do now. I’m a mother. My children are grown. But I understand where parents are coming from here. And I know parents want their children protected. They want their kids back at school and in a safe learning environment.
Dr. Michael Saag at UAB told me children are more at risk with Delta variant by virtue of the variant being more contagious in general. We’ve reported on children who are currently hospitalized in Alabama and surrounding states. What is your biggest concern as it relates to children and COVID right now, specifically with the Delta variant running rampant?
I believe Dr. Saag’s statement is spot on. More kids getting COVID, more kids being at risk for complications of COVID, more kids being hospitalized, and the potential to lose children to this virus. Every child’s life is precious, and we don’t want to lose any children in the state of Alabama to a disease that we can have so much impact in reducing or preventing. It really touches my heart and breaks my heart to think that we’re going to lose more children in the United States and that we could lose children in the state of Alabama to this deadly virus.
In all your years working in the public health field, can you recall a moment like this where such an alarming rate of Americans or people in Alabama have refused a potentially life-saving vaccine or basically rejected medical science in this manner? Is this unprecedented for you?
I have not seen this in my many years as a physician. I graduated from medical school in 1977. So I’ve been a doctor for a long time. I’ve not seen this happen. Certainly I’ve had instances where people might decline medical advice or a vaccine or preventative measure. But the reality of this particular situation is something I have not seen before. It’s very disturbing because we’re just talking about medical advice here. I’ve had some people decline what I recommended, but certainly not to this level. We are talking about life-saving and life-altering situations here.
I’m probably one of the few physicians still practicing medicine that has ever seen a case of measles. Measles largely went away prior to my career. People think of measles as another childhood disease. What they don’t realize is that measles can have severe complications, lead to death and lead to some long-term neurologic problems, even in people who survive. Likewise, when I was a young doctor, we saw bacterial illnesses such as haemophilus influenzae type b — it was a very prevalent bacterial pathogen — and also pneumococcal pathogens. Extremely prevalent in my career. I saw some very severe outcomes. We just don’t see those diseases almost at all anymore as a result of these vaccines that have come out against pneumococcal subtypes and also the haemophilus influenzae type b. Furthermore, chickenpox. We’re getting to the point that people don’t see chickenpox anymore. And while people might say chickenpox is a disease of childhood, in my career, I saw extremely severe situations with chickenpox. I saw some children with necrotizing fasciitis (a rare bacterial infection), and you just don’t normally see that. Chickenpox can lead to neurologic diseases and complications. There are things I saw go away in my career.
Now, to think of myself in the twilight of my career…to see something that is not being considered seriously and not be considered as a disease that certainly we don’t completely understand the full scope of but we know that persons can have long-term consequences, and we’re seeing that. We’re 18 months into this, and we’re seeing these problems continue to occur in people that have had COVID. So it is really disturbing. It’s distressing. But at the same time, it’s a motivator for me. It’s literally a motivator to say that I can’t give up. I can’t give in. I have to continue to provide factual medical information, the same information that I provide to my own family. The same information that I provide to my own children, who by the way are vaccinated. And just to be able to say to the citizens of Alabama, listen to the scientifically based facts. Listen to people such as Dr. Michael Saag and Dr. Jeanne Marrazzo world-renowned infectious disease specialists, and they have the best interests of the citizens of Alabama at heart, as do all of us that are working in this field.
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