SDPB's Lori Walsh welcomes South Dakota Department of Health Secretary Kim Malsom-Rysdon to talk about the COVID-19 vaccine and what we can expect in the days ahead.
Find it on Apple Podcasts or Spotify today.
Lori Walsh:
Secretary Malsam-Rysdon, thank you for sitting down with us today. We appreciate your time. It's such a busy time as well, so thank you.
Kim Malsam-Rysdon:
Absolutely. Great to be here.
Lori Walsh:
We are living out, I've been saying, in kind of a split screen life right now in the sense that on one hand we've had such a difficult November, and on the other hand we also know a vaccine is around the corner and there are the first glimmers of hope. So these two things are unfolding at the same time. We know that people will die in South Dakota waiting for a vaccine that exists, but yet we are also thinking this is the beginning of the possible end to this pandemic. Let's start with the vaccine part of that split screen and the hope, but the enormous logistic challenges that are going to come with vaccine distribution. What do you know today about the doses that are coming and how are they being distributed throughout the state?
Kim Malsam-Rysdon:
Sure. Well, I share everybody's anticipation for vaccines. I think that's really going to be a game changer in our ability to beat back this pandemic. And so it's really exciting news. What we're waiting for right now is the FDA to provide an emergency use authorization, first probably to the Pfizer vaccine, because that was applied for first. Once that determination is made, which we expect to be this week or certainly next week, then the federal government will be deploying that vaccine to states. We have already determined where that vaccine will go. We anticipate getting 7,800 doses. 7,800 doses.
The way these vaccines work, for folks that aren't aware, is the Pfizer vaccine and then the second vaccine that we expect to get are both two dose theories. And so that means the person who gets their first shot has to get a second shot of that exact same vaccine. You can't change them around. And so the logistics around some of that is very challenging. But nevertheless, we'll have 7,800 vaccines to work with from that first Pfizer shipment. And then the federal government will hold back another 7,800 doses so that that first group who gets vaccinated will have their second dose available. We'll be working with our healthcare systems, especially our larger health care systems, in the state. The first vaccines will be dedicated towards those healthcare workers and other staff who are providing that frontline care to COVID patients in our states. So that'll include folks that work in ICUs, who work in COVID units, who work in long-term care settings, who are taking care of COVID patients. And so that's really where we're going to see those first doses get allocated.
Lori Walsh:
Who's making the decisions? Is it state by state? Is there a federal guideline to say this is where you want? Or would the choices made in Minnesota or Wyoming be vastly different than the choices made in South Dakota? Are the choices made by Sanford different from the choices made by Monument Health? Like where do some of those final decisions lie?
Kim Malsam-Rysdon:
Well, states do have some discretion, but we're guided by the recommendations of a CDC panel that has met extensively through the entire process of vaccine development so that we could see fair and equitable distribution. And so that committee did just meet last week and I think we had some inkling of where they were going to go. And so our plan was very well-aligned with what they were recommending. And so we're going to start with that frontline COVID-serving healthcare worker. And by healthcare, I just want to be clear that that means all of the staff that are taking care of folks with COVID. It's not just doctors and nurses. It's going to be other staff that are in those settings and helping to make sure that we're able to treat COVID patients.
Our next population will be those residents in long-term care facilities. And so we know that they're extremely vulnerable to having poor outcomes if they contract COVID. That's where we do see a lot of the deaths happening, is among that very vulnerable group. And so those two populations are really the first population that you'll see most states focusing on. And that's consistent with what those recommendations were at the federal level.
Lori Walsh:
Those initial 7,800 doses are not going to get to nursing home residents yet, are they? That's not enough to go through for frontline workers, is it?
Kim Malsam-Rysdon:
That's correct. And so that very first group of healthcare workers is comprised of about 19,000 individuals across the state. Then when we talk about that long-term care population, and that includes folks living in both nursing homes and also assisted living centers, that's about another 11,000. And so what we know about that very first allocation of vaccine that we'll get is that it won't get through that very first group. What we hope is that with the second vaccine, that's the one that's being developed by Moderna, that will be the second one that comes online. And we anticipate that to be a couple of weeks after the Pfizer vaccine. Preliminary numbers, again, this is not quite solid yet, but we may see as much as 14,000 doses in that first round of that vaccine.
Now, what we don't know, Lori, is how much vaccine we'll be getting on a weekly basis after those initial amounts. We do expect them to be smaller. But every week we will be turning that vaccine around and it will be getting to communities as soon as we get it. Again, we're working with healthcare systems across the state to be ready to deploy it.
And to your question about does it matter if it's Sanford, or Vera, or Monument, or Mobridge, or Watertown, kind of who's going to get it based on that, who's going to get it will really be directed by that statewide plan. So we'll be helping them identify first those healthcare workers and then those long-term care residents. And then from there, we'll get to other healthcare workers, first responders, and kind of down the line. So we'll work very closely together so that we're getting the vaccine where we need to get it.
Lori Walsh:
There's that word again, unprecedented. But an unprecedented logistical operation. Are you ready from a Department of Health standpoint and what you now know about what the healthcare systems throughout the state, individual hospitals, rural hospitals, what have you, are you ready to distribute the volume of vaccines, should they come in more quickly than anticipated?
Kim Malsam-Rysdon:
I think we are, Lori. We've been working collaborative layman healthcare partners since August. And so we have been running through tabletop exercises. We've been talking through, the first vaccine has a very cold storage requirement and it's very specialized and that has certain challenges associated with it. So we've planned around that. The second vaccine has kind of more typical refrigeration type requirements. And so talking through those kinds of logistics, talking through how we communicate with people, "Hey, it's your time to come and get your shots," and just all of those kinds of things have been something that we've been working on now for some time. And our healthcare providers are just really good. They're really well-organized, they've got good communication channels. They've got good teams built around these kinds of operations. And we're very confident we're going to get the job done.
Lori Walsh:
You've been working aggressively on this pandemic since January, really, if not a few weeks before. You and I discussed the shortages of testing supplies from the federal government. We've talked about PPE and how states had to bid against each other for that. When it comes to vaccine distribution, has the United States smoothed out some of those challenges? Specifically, are we competing with other states to get doses? And do we anticipate that the federal government is going to be any better at distributing this vaccine than they were at tests from the CDC early on in the pandemic?
Kim Malsam-Rysdon:
Yeah, I think there's a big difference right now with how vaccine distribution and allocation looks. And so states aren't going to be competing against each other in the same way that we maybe saw with testing supplies or PPE. And that's because the federal government has procured the available vaccines and they will be distributing to states on a fair basis. They're going to be distributed to states on the basis of their populations. And all things considered, I guess that's probably the fairest way to do that. I'd love to be seeing more vaccine in our state, but again, it's being distributed equally and all states are really wanting to do the same thing we are, and that is get people vaccinated from COVID so that we can really get back to normal as soon as possible. So I think with that federal purchase of vaccine, and then that federal allocation on the basis of population, that will look a lot different than what we saw earlier in the pandemic.
Lori Walsh:
Are tribal communities considered part of this overall Department of Health of South Dakota logistical distribution? Tell us a little bit about if any ways that's different.
Kim Malsam-Rysdon:
Sure. That's a great question, Lori. Thank you for raising that. So tribes across the country had the option of selecting if they wanted to be part of the state distribution in which they're located, or if they wanted to work through Indian Health Services for distribution of vaccine. Tribes in this state, as in many other states, chose to get vaccine distribution from IHS. And so we'll be working to make sure that tribal members know how to access vaccine through those channels, and that we're making sure that we've got good communication, and that we're just making sure that everybody understands how to get the vaccine and when their time is, to be ready for that.
Lori Walsh:
Do people who have already recovered from COVID get the vaccine?
Kim Malsam-Rysdon:
That's a great question. We've had that a lot as well. The CDC just answered that for us on Friday. And really, folks that have had COVID are not going to be excluded from getting a vaccine. And that's because we really just do not understand how long a person may be immune if they've already had COVID, how long that immunity lasts. And so again, we don't want to deprive people of the benefits of vaccine. And so folks that have already had COVID will be eligible as well.
Lori Walsh:
Pivoting a little bit to the other side of that split screen, which is what's happening in South Dakota right now, there are some states who, on their websites, have detailed breakdowns of where people are getting infected. So citizens can make decisions about bars, or hair salons, or gyms, or school, things like that. Do we have a sense in South Dakota of that same kind of granular look at where infections are spreading across the state?
Kim Malsam-Rysdon:
Sure. So let me maybe just share a little bit about the demographics of what we saw in November. November was a month where we saw a lot of cases of COVID. And actually, the highest rate of cases happened among people that were 40 and 49 years old. And so right kind of in the middle of the pack. That age group accounted for about 15% of our cases in November. We also do look at different kind of aspects of the demographics. And so K through 12 schools, both in staff and students, that was about 12% of the cases that we saw in November. Thankfully, we saw less than 4% of our cases, about 3.8% of our cases, were among our long-term care population, both residents and staff. However, we also know that that particular group, among residents especially, can have a lot of impacts on getting COVID at a much larger rate than younger people and healthier people.
When we look at college and university staff and students, we saw less than 3% of our cases happening among that group. What we do know, Lori, is that it's all about exposure. And if you're going to places like restaurants and bars, those are places where we know exposures happen because we know that your folks are involved in activities that actually spread more respiratory droplets. And that's how COVID is spread. And so eating and drinking at bars, coffee shops, restaurants are where we're seeing a lot of exposures happen. And so really asking people to be careful in those settings and really just limit those exposures. Because vaccines are super exciting and they're really going to be a game changer. But as we've already talked, it's going to be some time before we see the volume of vaccine available that the general public can get vaccinated. And so we do need people to still take those precautions that are necessary for several months.
Lori Walsh:
There was a time early on in the pandemic when the Department of Health released information about there was an employee who was working at this restaurant, in this town, between these hours on Saturday. That stopped. Was that because of volume, or was that a different policy change?
Kim Malsam-Rysdon:
That's not because of a policy change, but I do think that the world of contact tracing and investigation has dramatically changed since we've started. And so here in November, and even earlier, we really had to think of ways that we can collect information about people with COVID that were different than how we started the response. So we're using technology to a much greater degree. Right now, 95% of people who are identified as having COVID are going to get a text or an email from us telling them that we've got important health information to share with them, and that we need them to link into a portal. Once they do that, there's a check where we ask people to enter some information that's only known to them to make sure that we've got the right person. And then we do, really, an interview using technology. And that's just because with the numbers being what they are, that's an efficient way to get to people.
I do think it's easier to lose some of the granularity. People's memories aren't as good if there's not somebody on the other end kind of helping them maybe remember where they've been. And so I think you just see kind of a natural evolution that the information that we're getting looks a little bit different. But certainly, if we're made aware of a COVID exposure in a public setting where people may have been exposed and we can identify them, then we will definitely put out a public notice.
Lori Walsh:
So this is speculation, but if you could wave a magic wand and have as many human contact tracers as possible, unlimited amount, versus the technology assisted by artificial intelligence that was really functioning like it probably will be six months from now, or as we continue to learn, which do you think is actually the more effective public health response? The human or the evolving tech?
Kim Malsam-Rysdon:
I think it really depends. And so where I think the role of technology has been great is we're just able to reach folks. And I think people in South Dakota are great. I think other states have had bigger issues with people that just don't want to engage at all. And I don't think that's the case in South Dakota. So I think technology has definitely played a role with us getting to folks. And I think that's really important. Where I really think that that human voice becomes important is where we've been able to target that in certain settings where we know COVID can be more easily spread because of the population, or because of the environment.
And so what's really been really neat to see is that that first line use of technology has helped us then really use our in-person resources for places like long-term care facilities where, again, we know COVID can be really devastating. Places like K through 12, schools, where kids might be coming into contact with lots of other people and you want to be able to get out quickly some messaging around that. Places like daycares where, again, because of the environment, the situation looks very different from one daycare to the next. And so really deploying our in-person resources in a way where they can be most effective towards our response, I think is really a good place to be. And so I think we've got a good combination of both strategies happening right now.
Lori Walsh:
From the data that you have seen, I know that we're not shutting anything down in the state, but if you could, without consequence, eliminate an infection source, is there something that you just think, "If only people wouldn't do this, or wouldn't go here, or we could solve this," what continually comes up for you that says that is really getting us every week?
Kim Malsam-Rysdon:
Sure. It's really just people getting together with folks that are not part of their normal circles. So we've talked in the past about kind of maintaining your bubble, and when we have things like holiday celebrations, which everybody wants to do and I so appreciate that, and so when you layer on just activities that naturally lend themselves to getting together with people and hugging and just doing things that show up, it's just really, really hard for people to not do those things. And I don't think I would wave a magic wand and say you can never do those things, but we really want people to be careful. Because it's just that person-to-person contact that really does lead to transmission.
And so the people that I know, and I've heard a lot of anecdotal stories about Thanksgiving and how it did look different this year, and we're going to need that to happen again for Christmas and to happen again for New Year's. And I know people are tired, but if they can just really think hard about ways that they can still have a meaningful holiday season without some of the risk factors that might've been present in prior years. And hopefully we'll get back to the way we want to celebrate in future.
Lori Walsh:
Let's talk about hospital capacity a little bit. That's been something we've been watching as sort of a benchmark from the beginning of this when we all, in March, stayed home so that hospitals could prepare to flatten that curve. The back to normal plan was launched in May. And then November, we have really the deadliest month of all. When you look at hospital capacity, from your perspective, what are some of the things that you are looking for? It's more than just a number. How do you pick that apart and say, "Our hospital capacity is holding strong. This is an anticipated surge." And when do you start saying, "Oh, we can't sustain this. This is urgent."
Kim Malsam-Rysdon:
Sure. I think you're right on that it is more than numbers, but numbers are really, really important as a baseline. And so, I think it's really important that people know that the numbers that they see on the DOH website and the covid.sd.gov website are those numbers that are reported directly from our health care partners. And so, there's not an interpretation of those numbers. Those are the numbers of staffed beds that are either being used by somebody with COVID or with another condition or that remain available. But numbers, like you said, don't tell the whole story. We need to make sure that we're maintaining some capacity for that unknown. And we had some days in November that we saw occupancy higher than it's ever been. But nevertheless, we did still see some capacity and that was really important.
That's an important benchmark to make sure that we can't have everything full on a given day because we know we've got to prepare for the unknown. We do also look at where we're at with staff. We did see some days in November in particular, where we saw a lot of staff of hospitals that were out with COVID. And that's something that of course, is very important because maintaining that healthy workforce is critical to having hospital capacity. And that's in large, part why we're focusing on that group first for our vaccination efforts so that they can stay safe and healthy. Some of the ways that we kind of gauge all of those things is obviously we get daily reports on the numbers themselves. And again, those are point in time.
And I think any hospital administrator would tell you that what they reported at 8:00 AM is going to look very different at noon and look very different at 5:00 and look very different at 8:00 PM. So they really are fluid numbers, but that combined with very regular communication opportunities, Dr. Clayton, our state epidemiologist and myself, we have a weekly call with the CMOs of the three large systems, just to see, what are you seeing what's behind those numbers? How are you doing with staff being sick? How are you doing with transfers within your systems and being able to take people from other systems, whether that's IHS or what have you. And so, just getting a sense of really where facilities are at.
We also do a weekly call with all hospital leaders and long-term care leaders on a weekly basis. And that's a place where we talk about things that are impacting both long-term care facilities and hospitals. And oftentimes, that'll be transfers from hospitals to long-term care settings. And how are those things happening and how are we making sure that again, we're getting people to long-term care, but that they're safe them on term care settings as well. So communication really does have to augment what those numbers look like.
Lori Walsh:
Yeah. About transfers, can you help me understand how those transfers are measured in the sense that if you send 5 people or 10 people to another state for their care, then are you counting that in your hospital capacity in the hospital where you sent them from? Help me understand how those numbers are compiled.
Kim Malsam-Rysdon:
Sure. I think it's helpful to think about out-of-state transfers in particular, just as a topic in and of itself and really outside of COVID because out-of-state transfers happen for a variety of different reasons. They might happen because a person needs a level of care that's not offered in our state. And so, you might need to be getting to the twin cities or Denver because of your medical situation literally can't be served in South Dakota. You might be transferred out of state because you live on the border of South Dakota and it's actually closer for family to visit you if you go across the state to Marshall, Minnesota or to a facility in North Dakota than to go all the way across South Dakota. And so, geography does make a difference. And there's good reasons why people transfer out of state.
Every person that transfer out of state isn't necessarily because they couldn't get the services that they needed in South Dakota or that it just made more sense for them to go out of state. So those things happen actually, every single day for COVID and for non-COVID reasons. And that's just part of how healthcare works. Now, where we get concerned is when there are services that a person could get reasonably in South Dakota but they're not available in South Dakota in a reasonable way. And so, that's where we would get concerned about out-of-state transfers. I'm aware of some media reports are not aware of that happening in any major volume of cases. Where we've seen transfers, it's been kind of part of the usual patterns of care. I will say though, November, we probably did see more of those than we've seen up to this point and I will tell you, Lori, that today the hospital numbers are looking as well as they have for some time. We've got better capacity now than we did have on some of those days in November.
Lori Walsh:
Yeah. Would the public know? When you say you haven't seen that volume that would give you a concern, is that number folded in anywhere? Is that being reported anywhere that we sent those transfers, that the hospital decided for whatever reason that it was time to transfer these patients. That data is not part of the hospital capacity number. Those are separate data points.
Kim Malsam-Rysdon:
Yeah. That's correct, Lori. So the numbers that you see again are going to be people that are in South Dakota hospitals. That's that daily number, and that can include people from other states and often does. Because again, we're measuring South Dakota hospital capacity. And for that purpose, it doesn't matter where they're from. We want to know how many beds are being used in South Dakota and how many are available. The other number that we report on is that ever hospitalized number. Those are just folks from South Dakota that have ever been hospitalized from COVID. And so, they are two different things and they're used for different purposes. But again, those are really about South Dakotans and ever being hospitalized or anybody that's in a hospital bed within South Dakota on a daily basis.
Lori Walsh:
Okay. I think for many people, especially in November, as stark as it was the deadliest month on record so far, we hope it is the deadliest month in South Dakota ever in the sense that we hope that things are better from here on out, not that that makes November any better. Many people were waiting for the governor to issue some kind of policy change. What I want to ask in the sense of, is she going to issue a mask mandate? We saw medical providers get together. We saw Mask Up South Dakota. We saw Sioux Falls mask ordinance, all kinds of things. From your perspective with the Department of Health, are there numbers that trigger some kind of policy change for you? Are you using that data to say, "And now, we're going to do this differently," in a way that maybe the public doesn't see? Tell us about that.
Kim Malsam-Rysdon:
Well, I think that's a good question, Lori. I think what I would tell you is that it really takes us all working on a lot of different mitigation strategies at the same time to see effective COVID response. And so, it's not one thing or another that's going to really have an impact on COVID. It takes us wearing masks. It takes us staying away from people. It takes us all staying home when we don't feel well and isolating. It takes us getting tested if we think we have COVID or if we have been around somebody with COVID. It really does take a layering of all of those things together to have an effective response. I've told people this and I can't say it any more sincerely, that if there was any one thing that would change the numbers on COVID and really be a game changer, we'd be doing it, but it really does take all of those things in tandem. And it takes people willing to comply with those things.
And I think we've seen in other states that there's been a lot of different approaches to different policy decisions, everything from locking down everything to widespread mandates. I think that there's ... The jury's out on how effective any one of those things is in and of itself. It really does take us doing all of those things as much as we can and doing those over time to have an effective response. And so, again, the governor has been very clear. She's not going to be mandating things. She's going to continue to provide information to people. And that's what we at the Department of Health have been doing. And we're seeing greater use of those mitigation strategies I think, than we've ever have. And we need people to keep doing that. I wear a mask when I'm out and about. If there was anybody else in this room with me, I'd have a mask on and that's just how we work and that's how we operate. And that's just part of the strategy, but it also takes all those other things to be effective.
Lori Walsh:
Do you make specific recommendations to the governor about policy like mask mandates? Have you said, "I think it's time, governor"?
Kim Malsam-Rysdon:
Yeah. I'll tell you. I have not advised on that we have a mass mandate in and of itself. And I'll tell you Lori, mandates have to be enforced. They have to be enforceable and they have to be something that people can live with. I just personally feel that the better attack is to continue to provide information to people so that they can make the right decisions for themselves. We see people doing that across the state. We're seeing them do it more and more, and that's going to be the way that we continue to respond to COVID in our state.
Lori Walsh:
One more question, because I know you have a full day ahead of you, but I did want to ask with the state budget address, Governor Noem on Tuesday will talk about what her recommendations are. We know there's a lot of federal money that has come into the state. The state budget is doing better than expected. We also know that this pandemic is not going to vanish with the first 7,800 doses of vaccine. Are there things that you're requesting for, that you are requesting that you think federal money or state money can be spent to ramp up our COVID response in the state and do better than we are doing now?
Kim Malsam-Rysdon:
Sure. So towards that end, we really had a great opportunity, both at the department of health level, where we've had a lot of federal support. Just to kind of give you a sense of that, our budget is just about $105 million give or take in a given year. We've had over $60 million in federal funds provided to help us with our COVID response so far. We have been able to free up those dollars and plan to use those starting in 2021, because we've been able to access many millions of dollars of the state's CRF funds that the state's been provided that will then expire at the end of the year. And so, that's really been helpful to help us pay for things like testing. Right now, just here in the last several weeks, we've been able to offer home-based saliva testing for household and other close contacts of any positive case.
And so, to make that available to people, we've been able to pay for that out of those other federal funds. That lets our federal funds go further. And so, I really am optimistic that we'll have the funding that we need to continue to ramp up testing, make that ubiquitous across the state to make sure that we've got funds to help support the administration of vaccines. And we've been able to contract with those health systems to do that. And so, I'm very optimistic that we'll have the funding. We're still seeing issues with things like supply chain on some of those kinds of things, but I don't think it will be a funding issue. It will be a supply issue more than anything. That's a good thing in terms of this response.
Lori Walsh:
And speaking of vaccines, it's been unseasonably warm so far, but it is influenza season.
Kim Malsam-Rysdon:
Yes.
Lori Walsh:
And how are we doing on getting our flu vaccines distributed and getting people to sign up to get those flu shots this year?
Kim Malsam-Rysdon:
Yeah, well that is a great question and something that we've talked about several times, so thank you for asking that, Lori. Really important that people get their flu shots this year, more than ever. Vaccines are safe and effective. And if we can prevent people from getting influenza and passively needing to go to the hospital and possibly even dying, we want to do that. And so, every year we really encourage people to get flu shots. This year, more than ever, because of course, the symptoms of influenza mimic the symptoms of COVID. And so, we just want people to take advantage of getting vaccinated. This happens to be National Influenza Vaccination Week, so it's even more timely that you're asking that question. So far, we've seen over 315,000 people in our state be vaccinated against influenza, and those are great numbers. But unfortunately, that is actually less, it's about 6,000 people less than we saw vaccinated this time last year.
And so, we are behind and we need people to really step up and do the right thing and get vaccinated. Influenza vaccination is safe. It is effective. If you become vaccinated and you do still get the flu, you're going to have much less symptoms, much less severe symptoms, and just overall, weather it better. You can go to our website at the Department of Health and find where to become vaccinated. You can also go to flubug.org and find places to become vaccinated in your community. But we really want to see people take advantage of that, especially folks that are over age 65. That's a group where we're actually seeing fewer people vaccinated as well. And I know people are being careful. They're trying not to go out and really again, kind of stay in that bubble. But for the purposes of vaccination, we need people to do that. There are safe ways to do it. Again, call ahead and make an appointment. A lot of these are even drive through opportunities in your communities, so please go out and get your flu vaccine and stay safe this winter.
Lori Walsh:
Yeah. Sometimes I think we've normalized a lot of bad behavior around the flu and we've done so much reporting on how much people suffer with COVID-19. They're not the same thing. The death rate is much, much higher. Having gone through a really bad flu one year, I never want to experience that flu again and the flu vaccine was worth it for me every year after that. I think sometimes, if you've experienced it and it hits a little closer to home, the flu shot matters a lot. Kim Malsam-Rysdon is the Secretary of the South Dakota Department of Health. You've been very generous with your time today. Thank you so much for that and we'll talk to you next time.
Kim Malsam-Rysdon:
Thank you, Lori. Take care.