Wednesday, August 10, 2022

Q&A with Dr. Hubert Spears, University Health Services

By Michael Newsom

University of Mississippi Communications

Dr. Hubert Spears. Photo by Kevin Bain/Ole Miss Digital Imaging Services

The safest, most effective way to avoid COVID is to take the vaccine and wear masks indoors, said Dr. Hubert Spears, a physician with the University of Mississippi Health Services.

He urges everyone who is eligible, but has not received the vaccine, to immediately do so. 

Spears, a native of Grenada who earned his M.D. from the university in 1980, has more than 30 years of experience. He treats patients at the V.B. Harrison Health Center, which houses the student and employee health centers. 

The health center, which has the vaccine available, also offers care for acute medical problems, general wellness examinations, laboratory testing, radiology services, immunizations and some light surgical services.

University Health Services has appointments available and is still treating patients for a range of health concerns. The university has a vaccination website with information about schedules and also coronavirus information to serve faculty, staff and students. 

Spears recently answered a round of questions to provide some updates and guidance for the Ole Miss community during the ongoing pandemic. Here are his answers. 

Tell us the best, most effective ways to stay safe and avoid infection.

Spears: By far the most effective way to stay safe and avoid infection is to take a COVID vaccine. The vaccines are some of the most effective in the history of medicine. 

As amazing as they are, they are not 100% effective, and the nonpharmacologic measures that we have heard on almost a daily basis for 18 months enhance the effectiveness of the vaccines. The most effective of these measures include mask wearing and avoidance of crowds, especially indoors.

How effective are the vaccines against the delta variant?

The vaccines are not quite as effective against the delta variant as their 95% effectiveness against the original wild-type SARS Co-V virus first identified in Wuhan, China, in late 2019. There are various estimates of the continued effectiveness against all severities of the delta variant from as high as 90% to as low as 65% in recent studies done on people over 60 in Israel, even after a third vaccine. 

Despite the fact that there are a significant number of vaccine breakthrough infections with the delta variant, very few are developing severe disease or leading to death, and most of the deaths are in patients with significant underlying diseases. 

How contagious is the delta variant?

In epidemiology, the contagiousness of a virus is usually expressed as its Ro, which is pronounced as R-naught. It is also known as the basic reproduction number. This reflects the average number of people that a person with the virus will infect. 

If the Ro is less than 1, then each person with the virus will infect less than one other person and the disease will die out. The original wild-type SARS Co-V was estimated to have an Ro of about 2 to 3. The delta variant is estimated to have an Ro of 8.5. 

Another way of expressing this is that the delta variant is at least 40% more infectious than the original strain. The measles is said to have an Ro of about 11.

If you have COVID-19 now, how likely is it that you have the delta variant? 

Spears: About two weeks ago, about 85% of the sequenced viruses in people infected with SARS Co-V were delta variant. It is likely even higher this week.

Which behaviors place you at the greatest risk for getting COVID? Are there other commonalities among those infected? 

Spears: Sounding redundant with this answer is unavoidable. Just as in question No. 1, refusal to be vaccinated and disregard for masking and distancing in situations where these measures are recommended are the riskiest behaviors. 

Other contributing risky behaviors include touching of your mucous membranes, including eyes, nose and mouth, with unwashed or ungloved hands after being in public. Touching the eyes is often overlooked. We do it without thinking. We rub our eyes when they itch or feel dry or to clear our vision. 

We pay most attention to not touching our mouth or eating anything that has not been washed or cooked appropriately, but I would say more viral diseases come from touching the eyes. 

Other risky behaviors that promote viral illness are failure to get adequate sleep and adequate nutrition. Stress and substance abuse also weaken the body’s immune response.

There are some reports of different, new symptoms in those with delta variant that we haven’t seen before. Are you seeing that, and if so, talk about some of the new COVID symptoms? 

Spears: There are reports that the distribution of the symptoms for the delta variant are somewhat different. Fewer patients seem to experience the loss of taste and smell and the gastrointestinal symptoms of diarrhea and nausea. 

More of the patients have headache, sometimes as the only symptom. A smaller percentage are presenting with fever. All of these symptoms are still present and none of them really totally new. We have had to have a high degree of suspicion for COVID throughout the pandemic. 

Remember, a significant percentage of these patients have no symptoms at all.

Can we still navigate gatherings and social activities that involve crowds safely, and if so, do you have advice for doing so? 

Spears: I believe vaccinated people should be able to attend some gatherings involving crowds, with some caveats. Even if the other people attending are vaccinated, space out more than usual. Wear masks if seated in a theater or classroom. Avoid prolonged face-to-face time. 

The definition of an exposure is still spending a cumulative 15 minutes in a 24-hour period within 6 feet of someone with COVID. This means that when you are eating with someone outside your bubble, you should try to sit more than 6 feet away. 

Meals are times that masking is impossible and is probably the times that most COVID cases are contracted. This often happens in break rooms at work. It is still possible to have an enjoyable meal with good conversation while sitting 6 feet apart. 

Of course, anything that can be enjoyed just as well outside as inside should occur outside. When indoors, pay attention to ventilation.

Can you suggest any other precautions we should all take in our daily lives? 

Spears: I would add that we should participate in stress-relieving activities. Stress and lack of rest decrease the immune response. Prolonged exposure to the extremes of temperature is also detrimental. 

Avoid people with known SARS Co-V unless you are wearing effective PPE (personal protective equipment). Also, avoid people who have obvious symptoms of viral illnesses such as coughing, sneezing, hoarseness or a flushed, febrile appearance.

There is a lot of misinformation out there. As a physician, where would you advise UM faculty, staff and students to look for the best, most reliable information about COVID-19?

Spears: I would advise checking the Centers for Disease Control and Prevention and Mississippi State Board of Health websites frequently. I also read the JAMA (Journal of the American Medical Association) Network COVID-19 Updates: updates@jamanetwork.org. and briefings from the NEMJ.org (New England Journal of Medicine).

For detailed discussions by doctors that take the time to explain issues regarding COVID in understandable terms, I like to listen to the weekly interviews by the Mississippi State Medical Association with Dr. Thomas Dobbs, the director of the Mississippi State Department of Health, and Dr. Paul Byers, the state epidemiologist, that are broadcast via Facebook at 4 pm on Fridays, with rebroadcast available any time after that.

Why should someone still have to wear a mask indoors, even if they are vaccinated and still stay more than 6 feet away from others?

Spears: As we all know, this guideline was dropped for a while, once a significant number of people had been vaccinated and the ability of the vaccines to all but illuminate the ability of vaccinated people to transmit virus with the earlier variants was demonstrated. 

However, with the delta variant, vaccinated people who get breakthrough infections, even with no symptoms, can have enough intact viral particles in the nasal passages, where the immunity to the virus is less than it is in the lungs, to spread the virus to others, including the unvaccinated, who are much more likely to develop severe disease. Wearing a mask and distancing decrease the chance for this scenario.

Are younger persons more at-risk for severe illness and death from the delta variant?

Spears: First of all, young persons are more at risk to get the virus percentagewise than earlier in 2021 because most of them are not vaccinated and many of the older adults have been vaccinated. Since a higher percentage of them are getting COVID (18% of the recent cases are less than 18 years old), a higher percentage of them are among those persons with severe disease.

The highest percentage of persons who develop COVID and go on to die are still the elderly. We have seen children in Mississippi who were healthy before getting COVID die in the last month, whereas with the earlier strains, the children who died had underlying disease.

What should someone do if they think they have COVID-19?

Spears: First of all, don’t come to work or expose yourself to anyone. Call and arrange for a test. We offer these at the health center. There may be situations where it may make more sense to get your test elsewhere. We will be glad to discuss that with you. There is no competition between testing sites that makes us want to out-test other centers. 

Even if you have been vaccinated, if you have symptoms, you need to isolate until your COVID test results are back. There are some symptoms that would indicate that you need to go to the emergency room rather than a clinic, though it is unusual for the illness to start with these severe symptoms. 

If you can’t catch your breath, if your lips appear bluish, if you have chest pain or if your family notices lethargy or change in alertness or has difficulty waking you up, you must go to the emergency room.

Is University Health Services still seeing patients for non-COVID-related issues? 

Spears: Yes, at this point, we are able to see patients as usual. We have slightly decreased the number of routine wellness physicals per day, but appointments for these are still available. 

We are not overwhelmed, so there is still room for distancing and rarely is there more than one or two persons in the waiting room. 

Do you have any advice for convincing someone to get their vaccine?

Spears: I must say, I have not been very successful in changing anyone’s mind. I think pointing out some advantages of being vaccinated in addition to not getting sick, not being miserable for a long time and not dying, you could point out that if you are vaccinated and get exposed to COVID, you don’t have to quarantine and miss work and lose money due to not having leave days. 

You also don’t have to miss out on fun and interesting things while you are quarantining at home. 

Try telling them that another thing you may avoid is “long COVID,” which you can get even with a mild case and which could last for a very long time, for all we know. It might work to point out that 100% of the Ole Miss football team has been vaccinated, especially if they have the type of season we are hoping for.


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