By Greg Bassett

While the past 18 months have been a test for everyone, the time span has been especially challenging for Dr. Steve Leonard.

As President and CEO of TidalHealth, the region’s health care conglomerate, he has been facing a historic pandemic, navigating the worst labor shortage in the history of modern medicine and working to keep the public informed on a health matter that even puzzles immunologists.

And now — as if things weren’t challenging enough — his regional hospitals are facing a surge in new Covid-19 cases.

Leonard, who has headed TidalHealth since 2017, took time Monday to answer Salisbury Independent’s questions about the latest developments in the world of Covid-19.

Q. Why won’t some people get the vaccine?

A. The numbers these days are really not much different than historical hesitancy rates for vaccines. There is a percentage of folks out there who are the perennial skeptics and they’re hard to engage from an evidence perspective.

The vast majority of those who are vaccine hesitant are that way because of health concerns.

(The Pfizer vaccine) was FDA-approved today and I’m hoping that will help, as I’ve had some people say to me, “I’ll get it once it has approval.”

I tell everyone to talk to their doctor about the vaccine.

Q. What is the current situation with infections?

A. We had 46 Covid patients in (TidalHealth Peninsula Regional), another 16 up at Nanticoke (Memorial), so that’s 62 in today.

That’s every bit as much as we had in (the hospitals) during the April and May surge.

We don’t test for variants, we just test for Covid positivity — the state lab does sampling to check for variants but the majority of variants are Delta.

So, it’s out there, it’s real, it’s happening, and it’s easily spread.

Q. Are vaccinated people becoming infected?

A. The vast majority of folks who are in the hospital are unvaccinated, and the majority of folks who are having a hard time with it are unvaccinated.

There are folks out there who are saying, “If I get vaccinated, I can still get it.” Yes, that’s true, but what’s indisputable is hospitalizations, severe Covid and death are much, much less likely in the vaccinated population and if you do get it.

Much like with the flu vaccine, you’re more likely to have a much more manageable course of the disease.

We’re trying to engage as many people as possible and tell them the vaccine is FDA approved. Go talk to your doctor.

Q. Are people as severely sick as they were before?

A. No, there’s less mortality — we lost one over the weekend here, one over the weekend at Nanticoke. There are fewer Covid patients in Intensive Care than previously, so mortality is less.

This is something I often tell folks: “Is it less mortality because we’ve just gotten better at treating it?” — that could be a factor as well.

We think that it’s less acute, since we have fewer people in the ICU, but we do know how to manage it better.

Q. How many vaccinated people have come down with Covid?

A. Here’s what people have to remember: In its best study, the vaccine was 90 to 95 percent effective. That means 5 to 10 percent of the people did not achieve an immunological resistance response sufficient to be successfully vaccinated.

So if you vaccinate 10 million people, you have a lot of people — 500,000 to 1 million people — who did not achieve an antibody response.

So what does that mean? There will be people out there who become infected regardless. Still, 90 to 95 percent (protection) is still really good.

Q. What about booster shots?

A. How long you have the protection is starting to become a valid question.

For example, I was vaccinated when it was made available to health care workers in the winter, so I’m at about that eight-month mark.

And that’s the whole booster conversation that’s beginning now.

So there is a question about long-term efficacy. Is it (the protection) as good today as it was back in January? Maybe not. That’s why they’re talking about boosters.

Q. What’s TidalHealth’s stance on vaccinations?

A. We believe that unless you have a valid medical reason — or if you have a religious belief that affects your decision — we believe it is safe and effective  to have the vaccine.

We are not mandating them (for our employees) at this point in time. Officially, we have been waiting for FDA approval, and then we’ll re-evaluate. We’ve been waiting for more data to come in and what we haven’t seen in the data are some of the nuances with medical contra-indications.

There is a tendency to over-generalize. There are some medical situations where one vaccine might be better than another for someone, so that’s why we’ve been waiting for FDA approval and we’re going to evaluate it.

There could be some conditions out there — a very, very small number of conditions out there — some vascular conditions or whatever — so we want to see the full FDA picture of it.

Q. So you will push for all of your  employees to get vaccinated?

A. I want to see the whole team get vaccinated, but I also need a team to take care of patients.

My preference is to engage, engage, engage with education to address concerns, because I think it’s safe, but again — going back to the evidence — these same folks who take care of patients also have beliefs that I want to respect.

We’re not at a point today where I can tell you we’re mandating it, or not going to mandate it.

The governor (Larry Hogan) has put out an order that if you’re not vaccinated, you have to be tested weekly for Covid, and obviously we plan to adhere to that.     

Q. You’ve been called upon to advise schools on the mask issue. Wicomico will require masks; Worcester and Somerset won’t.

A. I don’t know if there’s a right or a wrong answer here. I’ve seen different approaches to this. I don’t think either is wrong.

I do think masks do work inside and they are an important part of the equation.

During the height of Covid, if you think about it, we used masks and gowns and we were taking care of Covid patients, and our staff did not acquire Covid at a rate any greater than people did outside the building. This was pre-vaccination.

So what does that tell you? That tells you that personal protective equipment does keep staff safe and does keep patients safe from Covid.

Is a mask part of that equation? Yes. Then I can see why people might want to wear a mask and might encourage people to wear a mask because chances are, especially when you are close to someone, it is helpful.

(In Wicomico), I think they chose to do masks because if I have an outbreak in a classroom and they’re wearing masks, then I don’t have to shut the classroom down. So I understand that approach.

Do I think masks are helpful for students? Absent any data, I don’t think it hurts. It’s probably a cautious approach, but I can understand why they’re doing it.

Q. Where do I get advice on the vaccine and booster shot?

A. Go to your personal medical provider. That’s my No. 1 recommendation.

If you have a concern, please talk to your doctor.

Don’t go online, don’t talk to a friend. This is not a phone-a-friend time. This is a talk to your physician time — they’re the best ones to position you to receive advice.

From a TidalHealth perspective, we are highly supportive of vaccinations. We believe they are safe and effective.

There are a lot of folks out there getting vaccines at this time and lots of doctors and pharmacies giving it. The Health Department is giving it. But from an advice perspective, your primary care provider is your best option.

Q. Are Covid-19 patients overwhelming the system?

A. When people choose not to get a vaccination it’s not just about them, it’s about their loved ones, it’s about their parents, it’s about their grandparents, it’s about their friends.

They’re not just making a choice for themselves, they’re making a choice for all of those other people because you can very easily be asymptomatic and carrier and — boom — you go out and get someone infected and kill them.

One study said that up to 50 percent of Covid carriers are asymptomatic. And if you’ve made a choice not to get a vaccine, and you go see your elderly parent who happens to be obese, then you’ve put them at risk. It’s not just for you — it’s for them.

From a health care worker perspective, I can tell you — all health care workers across the country are exhausted.

They’re tired, and the last thing they want to be dealing with right now are more Covid patients.

The work they do is amazing, but when you do it every day with the gowns and the garb and the heightened level of “I’ve got an infectious disease” — don’t get me wrong, we’ve taken care of infectious disease patients for a long time — but when every one of your patients has it — that stress — every health care worker across the country is just exhausted.

Not to mention, we are extremely busy with other stuff. It is the busiest this place has been in years.

I call it deferred maintenance. People weren’t able to do health maintenance for a year, a year and a half, and — guess what — people didn’t just stop needing it. Miles got put on.

It’s busy. It’s the busiest and most stressful I’ve even seen in  my 20-plus years here at this facility. We are very sympathetic to the team because they are under such stress.