Should I Get the COVID Vaccine?: A Doctor's Advice to Therapists
This woman explains the difference between EFFICACY and EFFECTIVENESS
What the COVID-19 RNA Vaccines WILL and WON'T DO
Scientists still researching whether vaccine prevents COVID-19 transmission
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Hi I'm Dr. Tori Olds. A few months ago on my channel I hosted my father-in-law Dr. Richard
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Olds who is an infectious disease specialist to talk to us therapists about how to approach the
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situation with COVID in terms of seeing clients in person or doing telehealth, etc.
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So it's been a while since we posted that video but specifically I wanted to do another
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video today so that we could talk about the new vaccines coming out. I know a lot of my therapists
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friends are asking me questions and asking me to get my father-in-law's advice so i thought
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I'd make this video today. So Dr Richard Olds is a specialist in infectious diseases. He was a former
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dean of a U.S medical school and now he is president of St. George's Medical School. So
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we're going to go ahead and start...you know begin asking about...I guess i'll turn to you Dick.
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The first thing I was really wanting to know about was just with these new vaccines coming out
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what do we know and what do we not know yet. well first of all let's be clear it's not
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one vaccine, it's probably at least five and we know that two of them have been released
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for use in the United States and they are both a new type of vaccine, a messenger rna vaccine.
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We've never had that type of vaccine before so we don't have as much experience with that vaccine.
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The third vaccine which is uh now being released in England is a chimpanzee virus that has been
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altered to encode a protein of the coronavirus and that's a, if you will, a live attenuated
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viral vaccine. We have more experience with those kinds of vaccines that's
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measles, mumps, rubella, polio, yellow fever, those are all live attenuated virus vaccines and then
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eventually we'll get to the last two and one of those last two is a more traditional protein
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vaccine with an adjuvant. That's a chemical that boosts the body's immune system. So when we talk
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about the vaccines we have to be very careful that we know which vaccine we're talking about.
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Now the two vaccines that are available now, the messenger rna vaccines, uh you know are very
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protective, in fact, surprisingly protective. When I reviewed the data on about 40,000 people in one
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case about 30,000 in the other vaccine they were highly effective. They were 95 percent effective
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that means if you vaccinated a thousand people and you compared it with a thousand people that
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didn't get vaccinated the people that didn't get vaccinated, let's say a hundred of them get COVID
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and of those that got vaccinated only five got COVID. Probably more important than just
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that fact is that none of the people that got COVID in the vaccinated group got severely
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ill. So the vaccine protects you from getting sick from COVID and the sickness that you get,
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even though you've been vaccinated, is much milder than the sickness that you would get
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if you weren't vaccinated. So a lot of reasons to take the vaccine. What we don't know yet
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is whether it actually decreases the likelihood of getting infected and we'll know that in a few more
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months but we don't know that yet and so some of the recommendations that we make right now
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are based on the fact that we're not sure the vaccinated people can't transmit the disease
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because we don't know for sure if they get infected but just don't have any symptoms.
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Because the vaccine trials were designed to look at eliminating the disease COVID not the infection COVID.
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So that's really the vaccines that we have now. So we know they're highly effective.
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On the other hand is very important to take a look at the side effects because these are relatively
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new vaccines and here there's uh there's both some good news and bad news. So the good news
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is that now in a follow-up of at least two to three months there were no increase in what I
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would call severe side effects in the vaccinated group versus the unvaccinated group. That makes
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them very safe vaccines. Now granted, it's based on 70,000 people but that's still quite a few
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people. On the other hand, on the short term the vaccines seem to cause more
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very short-term reactivity like sore arms, low-grade fever and this somewhat more disturbing
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thing - an allergic reaction to the vaccine. Now let's be clear about that allergic reaction though.
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People had anaphylaxis which is a serious side effect - people have difficulty breathing. But if the
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vaccine is given in the setting of a healthcare professionals they can give them a shot of
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epinephrine. So although it's a rare complication, it happens immediately. You're going to know that
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it's happened and it's very treatable. So that would not be a reason not to take the vaccine.
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But I would anticipate for those who get the vaccine that they're likely to get a sore
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arm, probably not feel so great for 24 hours. But compare that with the disease COVID, obviously it's
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much better to have a little short-term discomfort from the vaccine than to obviously get COVID
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and run the risk of, not only dying, but people that have recovered from COVID sometimes have
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long-term persistent symptoms. So there's lots of reasons why you don't want to get COVID
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and I would recommend that everyone get vaccinated as soon as it's available for their particular
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group. So you mentioned that this is new technology. So does the fact that it's new technology worry you?
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I'm particularly thinking about the RNA messengers. I don't know much about how that works, so you know
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in my mind, I would think, "oh my gosh is this going to change something in my system, you know 10 years
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from now that will have a negative impact even if they haven't seen it in the first couple months?"
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and just from your perspective understanding the science of that, how worried are you about the
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newness of these vaccines? Well, in science you can never say never and so you know we just
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don't know what the long-term consequences might be, but let's look carefully at how that vaccine
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works, because how it works would suggest that it's very unlikely that there's long-term complications.
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So remember that some viruses, DNA viruses actually have the potential of actually inserting their DNA
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into your genes, like the AIDS virus and this is an RNA virus and the vaccine itself is a
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messenger rna vaccine. Now how does that work? Well in your body, in the nucleus of your cells,
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is your genetic material which encodes in DNA not RNA, DNA. Now how does that genetic message
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get to the rest of the cell to produce proteins that you need to live? Well they use the DNA
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template to make a messenger RNA template which carries the message for proteins. It diffuses out
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of the nucleus, it goes to an area of the cell called a ribosome and then that's used as a
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template to add amino acids to produce the desired protein. Now what this vaccine does is it basically
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inserts itself in that process by providing new messenger RNA that attaches itself to ribosomes
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and encodes for a protein that is normally on the surface coat of infected cells, the so-called
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"spike protein." Now the good news in that scenario is that messenger RNA doesn't hang around for a
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long time because once the message is given and you produce some protein your body doesn't want it
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to continue to make that protein. It wants to shut it off so messenger RNA has a relatively low short
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life expectancy, if you will, in the cell. So I would expect that a vaccine based on messenger RNA, you
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know, any side effects you're likely to get from you'll probably see in two to three months. So it's
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I think not absolutely certain but I think it's unlikely that there'll be long-term side effects
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with that vaccine. Now the live virus vaccine, that's the third one that's coming out. You know
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that vaccine has the ability to obviously cause an actual infection in the person and so there we
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might worry about complications that are sometimes seen with live virus vaccines. That you could
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stimulate somebody with multiple sclerosis or lupus to have a flare of their disease.
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and the fifth vaccine, if you will, the one that has an adjuvant,, the protein vaccine
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we know that some vaccines that have adjuvants also sometimes stimulate in people
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immune responses that you don't want. So although we really don't know what the complications of all
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five of these vaccines, in many ways the messenger RNA vaccines, in my opinion, are likely to be very
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safe. The big drawback with those vaccines is they are tough to deliver logistically.
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one of them requires, you know, -70-80 transportation and even the other requires
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it to be frozen for a period of time. So the live attenuated virus vaccines, that third vaccine, the
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AstraZeneca vaccine, is not only cheaper but it's a lot easier to give. So I think within
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a few months people will have a choice or there will be multiple different vaccines available
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and you know I think they all are likely to work, even the third vaccine is highly effective.
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Then depending on your own personal circumstance you know, if you can
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choose, well then you can choose between them but I certainly would have no difficulty taking any
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of the new messenger RNA vaccines myself. In fact, I plan to get vaccinated as soon as my group becomes
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available. So as I mentioned it's been a few months since we talked, actually that was at the beginning
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of COVID, so a lot of things have changed about our understanding of transmission and how COVID works.
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Since that original interview can you go over some of those changes for us?
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Well there's a couple things that have changed since the last time i did a video with you Tori.
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One of them is that our understanding of how the disease is transmitted has changed and that has
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made some of the early recommendations have to change. So people don't like change, you
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know, they want us to tell them all the answers at the beginning and they don't like the
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idea that they may change. But since it's a new virus and we're studying it all the time,
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it's not surprising that some of the things we thought at the beginning are not true now.
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Now one of the more important things is when I talked to you last time we assumed
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that most of the transmission of the coronavirus was in large lipid droplets that you cough, sneeze or
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breathe into the air, and those large lipid droplets are heavy and they will fall out
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of the air usually within three to six feet and there's where that six foot, you know, safe distancing
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came from, that phenomenon. Now that we've studied the virus more, unfortunately, about
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10 percent of the virus transmission is in very very fine lipid droplets that don't fall out of
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the air and they stay in the air and so they can move around the room as the air flow goes. So
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it's no longer particularly safe to go to a restaurant or a bar, take off your mask and
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say well i'm keeping six feet from people, because that air is circulating around. So
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our thinking about, especially indoor, transmission has changed a lot and you
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can see in many states that now have sort of out of control transmission. One of the first
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things they do is they shut down the bars and in restaurants that are indoors because outdoors is
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many orders of magnitude safer than indoors. Now even with masks, indoor transmission
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is a little more worrisome because it's basically circling around in the air. Now the second, if you
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will, problem that has developed since last time I talked to you is the good news is we have a lot
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more tests for COVID but the bad news is there's a lot of confusion about them and even doctors
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are not using those tests appropriately. So let me try to explain a little bit about the tests.
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the gold standard test is called a polymerase chain reaction, so-called pcr test. That's a very
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sensitive test and it uses an amplification step to find even very small numbers of viral particles.
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The newer tests which are called antigen tests, often referred to as rapid tests,
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do not have that amplification step and so they're significantly less sensitive. And what's happened
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is instead of using those tests to determine if a sick person has COVID or not, and both of them
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could be used in that setting, they're used if you will to try to keep people safe, like we're going
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to screen everyone with a rapid test every single day and then we'll find out who's sick and that'll
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keep that transmission from taking place. Well you can see the disaster that happened at the White House
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is an example that no, those tests can't be used in that way. Probably the biggest mistake that I
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see happening all the time now is a person has a contact with a friend that has covid and they
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rush to their doctor and they say I just had a contact with a person who tested positive
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for COVID and they immediately want to get a test to see if they got infected. Well the problem with
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that strategy is it takes at least three to five days for that test, even the pcr, the more sensitive
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test, to turn positive and so if you, let's say run to the doctor and you get tested immediately,
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it's too soon for that negative test to mean that you're not infected. You've got to wait at least three
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to five days and so you can see the scenario. You get exposed to somebody. You're very worried about
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it and you go and you get tested immediately. You haven't waited that three to five days. The test
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comes back negative and you say "oh thank goodness I'm not infected." No you could easily be infected
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if you had been tested later and that's why you can see that although quarantine for 14
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days is still the recommended quarantine in some states, they will quarantine for 10 days
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and then test them and if they test negative at that point, they will release them from quarantine.
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That 10 days is beyond the three to five day limit for exposure. So too early testing,
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especially with the antigen test, has led to a lot of transmission because people wrongfully
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assume that they weren't infected. And even with the antigen test, even at the right time, what's
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the percent that you could get...? Yeah, antigen tests have about a 30% false negative rate. That's really
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pretty darn hard. Whereas the PCR has single digit false negative rates. The worst setting is to be
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screening an asymptomatic person with an antigen test, that has almost a 50% false
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negative rate. So the very worst place to use those rapid tests is for somebody that
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was exposed to COVID, doesn't have any symptoms and is worried that they might have contracted it,
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that's not a very good test for that. You've got to wait a bit longer and you've got to have
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a PCR test. So Dick, what recommendations might you have, if you were a therapist, how would you
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be thinking about, is it time to go back and see clients in person or continuing you know doing
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telemedicine? What does the vaccine change for us? Well I think the good news is that I think
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therapists have done extremely well by doing virtual therapy and I would continue to do that
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because that continues to be the safest thing. Now i would recommend that all therapists go and
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get vaccinated themselves. Now it's going to take two shots. Depending on which shot you're talking
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about, it's either three weeks apart or a month apart, but it'll take about a month or so to be
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vaccinated. But even if the therapist is vaccinated I think that I wouldn't go back to in-person
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counseling unless both you and your patient have been adequately vaccinated and the reason for that
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is that we still don't know whether a vaccinated person can't get infected. We know they can't get
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disease, but they can't get infected. So you don't want to inadvertently give it to your patient who
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is unvaccinated and on the other the flip side, you don't want your unvaccinated patient
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to come into your waiting room walk, etc. with other people who may be unvaccinated so
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my recommendation is stay with virtual counseling until both you and your clients become vaccinated.
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Now if in three or four months we know that the vaccine will protect you against
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infection as well as protect you against disease, well then that might be a time when you might
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try some in-person therapy still trying to make sure that your unvaccinated patient
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doesn't get the infection so you still gotta probably wear masks
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in the waiting room you gotta wash your hands and all do all those things i think until our
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entire country, basically, is vaccinated. I think the safest thing is to continue with virtual therapy
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and why do you say that is that because of the waiting room issue? Well it's partly the waiting
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room issue, but remember that until we know whether vaccination prevents infection, you as a therapist
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could become infected not get symptoms because you've been vaccinated. We know that vaccinated
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people now hardly ever get symptoms but we don't know whether you can transmit the disease or not.
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Now we're going to have to test all those people who were immunized three or four months ago in a
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few more months and find out if the vaccinated group,
in addition to getting less symptomatic
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disease also didn't get infected because they may actually have gotten infected just as commonly as
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the unvaccinated group it's just that none of them got symptoms
. Now if that's the case then the
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vaccine is good for you, but it isn't necessarily good for preventing transmission. So Dick, thank you
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so much for talking with us today and sharing your expertise. I hope this was useful for you
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viewers and thank you for watching. Thank you so much for watching. If you found this video helpful
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you can help me out by liking and subscribing or if you're a therapist and are interested
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in training with me while earning online CEUS, feel free to visit my website toriolds.com
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