[Music] heat [Music] hey hey [Music] heat [Music] heat [Music] heat heat [Music] heat heat [Music] heat heat [Music] heat heat [Music] heat heat n [Music] heat heat n [Music] um okay alhamdulillah dear colleagues ladies and ladies and gentlemen Uh first of all I would like to welcome you here in this scientific event uh where I’m sure that it’s going to be a very added value for all of us to highlight our updated data and sharpen our experience in a very important topic that is related to the infectious disease that and of course uh before I start I would like to thank the Saudi society for family and community medicine for having This scientific event under the umbrella of the prestigious society which has been working very hard for the past three decade to enhance our capabilities as a physician to be in a competency to defend our community and to establish the well-being for our society so as you know our transformations have a vibrant society thriving economy and ambitious nation so we started by vibrant society it means that we are working for the best interests of our society and our community and our nation so we would like to have healthy people they enjoy the complete state of physical mental social and spiritual wellbeing and not only having no disease or infirmity so this is our role and being in fact as a primary care physicians where I’m proud to be one of you we have been appointed to be the gatekeeper of the healthare system the first contact with patients and we look into the patient in total and unfortunately the healthcare system has fragmented the human being within the complicity of the health care system into different organs systems particles and and parts so our healthare system globally not only nationally is an organ oriented departments so what is our role as a primary care physician to integrate all these parts and to put it in its own format and the human being format and pay respect and on top of it to deliver the things that is needed and in fact we are delivering not only the curative medicine but we are also providing our patients with the basket of services which is which is preventive curative and rehabilitative so this is our role ladies and gentlemen’s to work for the best interest of our organizations and our community and our nation so before I start I would like to thank um FISA for giving us this wonderful opportunity to be tonight together and I would like to thank Fixes for the wonderful organization and before I start I would like just to pave the way and set up the stage by saying that we all remember the pandemic of COVID 19 it was one of its kind globally uh that no other infection hit the globe the way the pandemic of covid-19 uh had hit all the health care system and we have been founding that huge and highly sophisticated healthcare system are collapsing one after another why because no we were not prepared to have this kind of u infectious disease pandemics we always f focus on non-communicable disease hypertension diabetes and the lipidmas and cardiovascular disease and so forth but we don’t pay much attentions on uh the return of the dragons which is the infectious disease like covid-19 and we remember that millions of death and millions of hospitalizations and there was a global and national shutdowns of all the activities but here different countries have to came with different strategies countries that focus on economy which totally collapse and and countries which focus on the well-being of the human being which thrives and and survive like what we have done so uh so however there was a wise man said once the world will never be the same after covid-19 and this is exactly what happens ladies and gentlemen’s we have witnessed that we have learned the prevention much more than any time much more than ever so we started implementing the preventive services in terms of acceptance of vaccinations because it was mandated for for us to have the vaccine for COVID and we have reached the herd immunity for the first time never had been reached before not only this but also we have learned certain uh certain skills how to prevent the infection to be spread so the social um the social distancing the use of certain sanitizations and even the etiquette of cough and sneezing we learn a lot of things and of course this has been impacted our uh our soon recovery from the pandemic in no time with a very less uh devastating uh consequences so but the question ladies and gentlemen today uh is is the pandemic is over yes it is over but COVID 19 is still there and of course as you know our society in our society we have certain people at risk we have elderly populations we have people with multiple co-mobidities so they constitute this kind of risk and they have a high suscept susceptibility to have this kind of infections as you know the year 2045 is a crucial year for all of us why because in this year we are going to double our populations in the Kingdom of Saudi Arabia to reach 72 million people and the same year we are going to have the highest level or the highest evidence or or prevalence of chronic disease like hypertension diabetes obesity smoking and so forth of course these confounders subject and even the life expectancy of our populations it will reach up to 81 now we are we are talking about 78 years of age but in the in the in the in the in those years we are going to reach 81 so we are going to grow older and we are going to carry along with us a lot of co-mobidities and definitely majority of our populations will represent the elderly populations rather than the young population that we have today so definitely we have to prepare ourself very well and we have to make sure that we are well equipped with the knowledge and the skills and the v vigilance enough to witness this kind of threat that is coming so as I said our role as a family physician and primary care physician is very important and I think it’s today we are going to shed a light on the covid-19 and we have been privileged to have two of our eminent speaker Dr muhammad uh Dr dr muhammad Samudi and Dr tat minister Misani they are eminent figures and expert in the field so without any further ado ladies and gentlemen because um uh we have I would like to give enough time for our speaker to enrich us with updates so I would like to introduce Dr muhammad Samoodi dr muhammad Saludi is assistant professor Omar Kuri University Mecca and he’s a consultant of medicine infectious disease and transplantation infectious disease in Kingfad Armed Forces Hospital uh in Jedha so uh he’s going to talk to us about uh the Paxid the new approach to outpatient uh treatment for COVID 19 and I would like to remind you be ready with your questions you can write it down or you can have the mic to uh deliver your questions to the speakers or even you can uh for the for the online uh attendees they can send their question through the Q&A box and then we’ll be able to send a question to uh our speakers the next speaker will be Dr misani he will be joining us virtually online so I would like on your behalf ladies and gentlemen to welcome Dr muhammad Samudi dr muhammad the floor is yours al J um in the beginning I would like to um thank um the Saudi Society of Family Medicine and uh uh Fizer and and Fix for um their kind invitation um today we’re going to talk about it’s a kind of old topic but we are going to have um different flavors today uh on that and hopefully uh everyone will enjoy with us today uh I think Dr we didn’t meet for a long time so in that duration I I became an associate professor now of infectious disease in Moran University so uh you know in the beginning I will be sensitive of saying assistance but but after that it’s okay okay all right uh bismillah so uh our talk today about uh paxlovid the new approach for outpatients treatment for covid so we will go through uh um uh like different concepts in in in the outpatients and how we select those patients uh for the uh nerv or the backloid uh to uh to use the max benefit for for those kinds of patients so let’s go so the presentation was made by the help of uh of uh FISA representative uh miss al-Manssuri okay so our contents today uh we are going to define who are the people at risk for to progress for severe COVID uh what is the indirect effect of severe COVID uh on the high-risisk group um antivirus underuse and antibiotic overuse and early detection and treatment to prevent the progression uh to severe COVID uh Paxlovid clinical trial data and the backlo uh evidence so u co 19 um is an enduring global public health issue and ongoing so as Dr rasher said the the pandemic is is is gone but we still have COVID around us and we have a lot of mutations ongoing mutations a lot of mutation that makes the COVID sometimes more aggressive sometimes more aggressive to to to to distribute or to spread uh between us and we have a high-risisk group that we are worrying about them that those people they are at risk to develop severe COVID which is our goal to try to avoid uh uh that this progression as much or as powerful as we can so as we as we say uh the CO is still there so since December 20 uh 24 we still have like uh uh a lot of a lot of cases as you see a lot of reported COVID uh uh uh cases uh more than uh uh 7 millions uh deaths since uh the pandemic until December uh 2024 so that means as we mentioned CO’s still there the aggressiveness the mortality the morbidity of COVID still there so we need to continue fighting we should not stop here and the the the respiratory viruses usually have like seasonal effect so usually uh the majority of the respiratory viruses uh occurs in the winter season so and that’s why we uh usually uh get our for example flu shot or the influenza vaccine we get it from October to March right during the winter season and after that we don’t get it but COVID usually is all the time we can see COVID in the summer in the spring uh in the fall in the in the in the winter it’s all over the year so that’s why we need to pay attention to CO more than the other viruses and uh so some someone will say like we already took the vaccine so why we are worrying about about uh covid so we are seeing a breakthrough through the vaccinations the the reasons behind that as you see in the in the in the in the diagram so the breakthrough of the covid is either could be because of the immunity characteristics could be because of our mucosal membranes is not that uh uh uh strong enough to to protect ourself from getting the virus could be because the the vaccine parameters some you know as as you know the immunosiness uh people at after age of 50 um their immune response is weaker than the other population so this is also a factor we have some immuno compromised patient around us and this is could be uh as a host determined uh uh uh um cause for getting um the the the infection viral properties we as if you remember many mutants it happens after the pandemic we heard about we have heard about the England uh mutations we heard a lot a lot of mutations that happen some of them fatal some of them is very aggressive and very fast to spread between between people so that’s why after the mutation the efficacy of the vaccines it may go down so this is the definition of CDC and who uh of the severity of COVID so I want you to focus on the mild and moderate because this is our uh um the target uh group that we need to focus on so as you see the mild that COVID u symptoms such as fever cough and fatigue and the moderate is associated also with difficulty in breathing and mild pneumonia and those people they usually get recovery without hospitalization or any advanced medical uh care so we want to pick those people and avoid them to progress to severe COVID which is need hospitalization and sometimes they need ICU and ventilation and the mortality rate is higher than other population such as in the mild and um the severe uh the moderate uh in the WH they usually just call it non severe and severe for the non severe as you see um 6% at risk for hospitalization and uh and 3% for the moderate to be uh hospitalized and the in the risk of hospitalization increase with the age and increase with some factors such as obesity diabetes cardiovascular disease chronic kidney disease active cancer and those people that we need to pay attention to those people they are the high-risk group to progress from mild to moderate symptoms to severe which increase the morbidity and mortality and that’s what we are going to focus on the next slides so these are uh as I mentioned in the previous slides u the the considerable uh uh proportion of population at high risk for to progress to uh severe COVID age is the highest or the strongest risk factor so patient above age of 50 and as as as far as we go in the age the risk to move to severe COVID is higher than the other age group uh race and ethnicity is not as strong as the other conditions such as cardiovascular CKD uh COPD and cerebrovascular uh chronic liver disease cancer immunosuppressive patients such as transplant population HIV and etc and we are going to talk about each one in individually so if we talk about the diabetes uh in in multiple studies like if we start with the first meta analysis it showed like 35 observational studies with the diabetes and the mortality and the morbidity with those patients is higher compared to the regular population and even the other studies as as you are seeing the mortality and also uh uh uh the morbidity such as ICU admission ventilation all is getting worse so in summary individual with diabetes they are having high morbidity and mortality rate compared to the other group so we need to pay attention to them when they are getting COVID uh if we are talking about the cardiovascular uh risk associated uh with COVID 19 outcomes so as as you are seeing uh u uh in the population based cohort study uh was uh uh conducted in adults between age of 40 to 84 in England and also showing the same uh uh uh impact that cardiovascular risk if you see here uh let’s see if you see here like from hypertension from first uh they calculated a score for a cardiovascular disease called QR R IK score and if this score is below 10% that’s considered low cardiovascular risk and if it’s more than 10 we’ll call will be called as a high risk so if we see in between every every time we go up in that in that risk score the the progression to uh severe COVID is going to be higher so we need to pay attention to those uh uh population even simple hypertension they put them at risk to progress to severe COVID uh the risk of severe COVID uh uh increase in patient with high BMI um remember the first study that was uh published in New England Journal of Medicine from first big trial they were talking about cardiovascular if you remember diabetes and they were talking about obesity and since that time obesity all the time is associated with poor outcome with COVID so we need to pay attention to that obesity is usually associated with hospitalization obesity you will see it is associated with using of ventilation ICU admission and prolonged hospitalization in the hospital multiple studies as you see uh were done and one of uh the most important one that the one that uh was done in in uh in England um in 20 to 2021 and it showed that as you see the number of ICU admission uh uh ICU stay the cost the hospital cost is all worse if the patient uh uh BMI more than 30 look at the last column is compared to the other columns it’s higher uh uh um uh numbers which indicates that obesity is a true risk factors that we need to pay attention to uh patient with cancer and face a higher risk uh to progress to severe COVID and this is not only with COVID patient with cancer and using uh immunosuppressive medication either biological therapy chemotherapy it alters their immune response to any kind of infection and one of them is COVID 19 and once we are dealing with a cancer patient with any kind of infection bacterial viral parasitic fungal whatever we need to pay more attention because their progression to to complication is higher is higher than the other population and mortality their mortality is is high because you are just using the antimicrobial uh uh agents without the help of their immune system because their immune system is not strong enough to fight with you so usually the imunocmpromised patient that’s why they progress uh uh to severe form of the disease very fast and as you see here uh uh one of the uh uh studies that were conducted in the cancer patient uh look at the kapla meer curves uh you will see all the curves with cancer patients higher than the other population if you look at the ICU admission if you look at the mortality of the COVID and uh uh um if you look to uh to the morbidity and the mortality is all higher uh like assessment hospitalization ICU admission mortality all higher with uh cancer patients so that’s given us give us an idea not only as I told you not only with COVID we need to pay attention with cancer patients uh chronic kidney disease and this is also a nationwide uh impatient study uh was done in in in USA uh in 2020 with they were comparing the patient with uh kidney disease free to the advanced kidney disease to the end stage and also the same thing the morbidity mortality with uh with with the progressed kidney disease is higher comparing to the others for example u patient with with with uh free of kidney disease uh the risk is lower but when we advance to chronic kidney disease the risk will go up and with endstage uh uh kidney disease the people on diialysis or on renal replacement therapy the highest risk is there so chronic kidney disease endstage uh renal disease they are at risk to uh progress to severe COVID uh patient or people living with HIV are more likely to die from COVID uh u either with or without being a male increasing at increase the age more than 50 having malignancy on top of of the HIV chronic liver disease heart failure hypertension just having an HIV with COVID will put you at risk to progress for uh severe COVID but if you add on top of it these other factors the mortality here is very high so that’s why um in in in in my HIV clinic usually one of um the projects that we need to be careful other than to give them their medication to make sure that they are their viral load is suppressed and they are on appropriate therapy no side effect blah blah blah we need to make sure that they are up to date on vaccination that’s we are doing as excellent project excellence project in in the clinic that we have like a checklist of all vaccines ination we are putting it we don’t let anyone to leave the clinic until we check all vaccines that he already took it or at least we discuss with the patient and he agreed or he he rejected it and we are having a very high uh uh response rate of vaccination on those on those group um as we mentioned age is the strongest predictor uh of hospitalization ation and death in COVID 19 as you see uh any time we move to uh to the higher age the hospitalization will increase and also the relative risk for death is is getting higher as well as you see all the curves is go to uh to the right and also the bars is increasing uh the time that age is is increasing as you remember uh we we have mentioned like a lot of things uh um in the conferences remember when we talked about the RSV infection anytime the age is increasing the RSV severity is worse anytime the aging is increasing the shingles or the herb zuster it it it it becomes like worse with a complication so if we if we are noticing aging is one of the very important factors in infectious diseases and we need to be careful with it and we have mentioned that in many events immunosinence here is the main uh driver for driver for that and uh we have mentioned it what was the reason behind it and why we are uh uh paying attention to those people and sometimes guidelines they just classify patients if you are more than 50 or less than 50 vaccination if you are more than 50 less than 50 for example menitis the menitis combo it’s different if you are more than 50 and if you are below than 50 it’s another regimen vaccination some some vaccines you are not allowed to take it if you are below 50 and you have to take it above above age of 50 so that’s why I’m just giving you more examples just to pay attention to the age that is a good factor factor or strong factor in infectious disease field okay uh what’s beyond the direct effect of COVID 19 in patient with underlying condition so here we were talking about the like what co uh um uh will do on like or sorry what the coorbidities will do on covid like if the patient have we have mentioned patients with diabetes age aging uh CKD cancers HIV will make the covid worse right so let’s talk on the other hand what what covid or any kind of infection will do on the comor morbidities itself so if we are talking about uh um uh um co like chronic illnesses such as hypertension we are seeing a lot of infections or even if you have a common cold you’ll see like your blood pressure usually is high and at a certain time if that infection is getting worse that blood pressure will will will go down uh because of and will cause something called severe sepsis or severe sepsis or shock and sometimes with COVID or or respiratory infections if you have a COPD it you will go to COPD exacerbation some people with heart failure they get worse and they get a heart failure exacerbation if they got infection not only COVID uh cancer the same thing because those cancer patient and and and patients with on immunosuppressive regimens such as transplant or or autoimmune diseases you know what they do when they get infection first thing they do they lower their immunosuppressive regimen medication or they stop them so what’s going to happen to help our immune system to fight the infection with us so what’s going to happen to the primary disease will exacerbate Crohn’s patient biological therapy the patient will have Crohn’s exacerbation at risk for having Crohn’s exacerbation patient for example with MS multi like multiple sclerosis they are on biological therapy and they get infection they get COVID they lower down the the dose or they stop it the patient will go to MS exacerbation so it’s it’s you know you are trying to catch it from here it comes from there uh diabetes also a lot of studies showed that infection itself remember what is the most common cause of DKA like diabetic ketocidosis exerbation or or or admission to the ICU after missing or non-compliance with the dose infection infection is the second most common cause of DKA of hyper or smaller coma with with with hypoglycemia so why because it increases the insulin requirements and that insulin is not enough for for that requirement so the patient will go will become hyper glycemic okay so it increased the insulin resistance so usually infection itself like in general will do that and COVID specifically because uh some studies were showing that COVID itself will increase the risk of being hypoglycemic and increase the insulin resistance a patient hospitalized with severe COVID at high risk of hospitalacquired infection that’s very important uh if if you are if if you are being hospitalized for anything you are at risk for hospital acquired infection that’s why um I like I I just before coming to to here I I had a patient he was like asking me uh did the hospital did the right thing of discharging uh my brother from the hospital he just uh came down from ICU and he stayed one day in the hospital and discharged is that appropriate at least he needs to stay for about a week then he become stronger then he discharge I’m like no the safest place for your brother is the home not the hospital is the most dangerous place for your brother because of these things immobilization just lying on the bed he’s at risk for DVT putting needles taking drawing bloods changing secretion he’s at risk for bloodstream infection putting a fully catheter he’s at risk or kouty catheter related infection um changing the secretion uh nurse is handling two patients not sure if we are uh having a sick patient be beside him so he’s at risk for hospital acquired pneumonia the doctor came inside and and with with a rushing he was uh uh called to see another patient he didn’t take like a very a good precaution to the other one now this patient is at risk for hospitalacquired infection no matter what is the organism so hospital is not a safe place and that’s why COVID increase immobility that guy he’s in the ICU or he’s in the floor he’s not he’s not uh uh moving he’s at risk for DVT he’s not moving at at risk for uh uh increased secretion developing hospital pneumonia at risk for a lot of blood sampling a lot of blood test at risk for bloodstream infections so being hospitalized for COVID is increased risk of hospitalacquired infection and also not not even that now look at this so we are using a lot of antibiotics to those people so beside getting the infection you are not giving you are not getting an easy infection you are getting the most or the strongest infection in the world you are getting the MDR organism the multi-drug resistant the difficult to treat organisms and we are using a very difficult antibiotics and we don’t know if they’re going to help or not and a lot of them such as chistine chistine is a very potent antibiotics and we usually use in hospital infection but it’s a very nephrotoxic And I saw a lot of people we used chiston and they ended by having diialysis for the rest of their life so it’s not a luxury or not something like uh safe for us to stay in the hospital okay so COVID 19 secondary infection higher mortality than uh uh uh the people without the other infection and this is also another study showing that patient with the secondary infection they are having higher hospital stay they are having higher mor morbidity and they are having higher death or mortality so that’s why we are uh um uh uh stressing on early discharge all the time like the good hospital is every day to remind their physician discharge the patient that doesn’t need evaluate if your patient needs to stay in the hospital if no need discharge every day assess the need of folly catheter you don’t need the folly catheter take it out every day assess if you need a central line you don’t need it get it out every day you assess if you need a ventilator you don’t need it take it out all of these risk for having infection having more complications uh the continues strongly recommend uh backflow treatment for mild to moderate so as we mentioned the high risk that’s We strongly need the backslavid the people with immuno deficiency syndrome and we have mentioned them and uh such as organ transplant HIV autoimmune receiving imunosuppressive regimen so it’s strongly recommend to give those patients uh uh backslid if they are uh presenting with mild to moderate covid but the one that we need to consider the the who is uh asking us to consider using of Paxlovid in moderate risk group that age uh people u above age of 65 and as we mentioned obesity diabetes chronic conditions such as COPD CKD and chronic liver disease cancer disabilities we need to consider using them and I will show you the MO uh guidelines regarding those kind of people so despite the de the demonstrated effectiveness and guideline antiviral are underused yi we we have mentioned like the efficacy the benefits and uh and what is the consequences if we are not using it but I think we need more awareness that’s why we are here uh we are here we are uh staying here in this room to have more awareness to ourself and to to the other medical staff that please catch those people as early as you and determine them if they are uh your target start the backloid as soon as possible to avoid more complications and that’s what we are doing here uh um uh and we are showing that we are still behind a lot of people like see uh less than 50 uh uh% of the adult above age of 65 of outpatient diagnosed with covid receive the recommended antiviral uh medication so that’s why many factor factors we will talk about them in the next slides so one of them the early diagnosis so once you suspect COVID please do the testing please target uh uh um uh your goal just pick the the disease do the PCR do whatever is available in your in your hospital to find the diagnosis as early as you can because early diagnosis in any in all infectious disease field it will decrease the mortality uh uh remember like in in sepsis if you are delaying the diagnosis and starting the antibiotics the mortality will increase about 7% per each hour antibiotics every 1 hour we delay the antibiotics and delay the diagnosis the mortality will increase by by seven around 7% and the same thing here any because we will talk about like why the time it matters in in in uh um in backslid so early detection and treatment of very important to prevent severe outcome uh so in in um in the WHO uh the the recommendation is to to give the backslid within the 5 days of developing of the symptoms so that’s why we need a early detection of the disease as soon as possible and as soon as possible determine your target just put the the classification for your patient if the patient if your patient is in mild to moderate and is high risk uh to uh um to develop severe COVID such as imunocmpromised patient is strongly to start backlov if they are in the moderate risk group such as uh cardiovascular COPD chronic kidney disease consider using it and in our MO guidelines they are asking us to use it okay so we have mentioned that just do the testing whatever is available diagnose the the case positive people start the medication as soon as possible within the duration so the antiviral treatment is predict reduce the viral transmission so it’s not only like one of the benefits of uh adding the antiviral it improve the symptom the severity of it prevents sorry the progression to severe so it improves the symptoms and also it improves or uh uh it decreases the duration of the disease so instead of the covid to stay for 10 days it usually it the the duration we will see it in the next couple of slides uh two to three days lower than the expected uh uh time so it improves the duration and the severity of the symptoms and the most important one hospitalization and mortality so let’s talk about the most important trials that uh proves the the efficacy of the backloit which is uh epic HR u phase 2 so EPIC uh this is uh E for evaluation P for protease I inhibi uh uh uh uh uh inhibition uh for the high-risk uh uh group uh population um for paxlovid so the study was the the main objective to evaluate the safety and the efficacy of the backslid in an unhosized mild to moderate and the the the treatment was to give the back sloid uh u as as you see 300 migram every 12 hours for 5 days and the selection criteria age more than 18 confirmed and symptoms less or equal to 5 days with more one or more than sign of symptoms of COVID at the day of randomization and more or equal to one characteristics or or coexisting condition associated with high risk progression as we have mentioned in the previous slides and let’s see what happened and as you see it’s just uh like almost one to one uh randomization the main the primary endpoint to look at the hospitalization and the mortality uh up to uh day 28 and we have secondary endpoints so here are the the the demographics or uh uh of our patient as you see we we we picked our patient above uh uh um u uh based on the inclusion criteria and as you as we see uh the BMI uh were like the number of more than close to 2,000 uh smokers hypertension like variety of comorbidities uh if we see like uh um um the the group at uh on the comparing the placebo to to the backloid we were seeing like a great effect so mortality almost zero not almost mortality is zero and uh improvement and hospitalization uh were uh statistically significant compared to the placebo group so hospitalization which is morbidity and mortality uh were uh statistically significant uh decreased in the backslavit group compared to the placebo and uh here as you see the hospitalization uh at uh at age of uh 28 uh in the patient treated uh with this 5day symptoms also the kapla meer curves uh it’s much better in the uh the backslav group and they where no mortality were uh u noticed there so the backloid was associated with reduction of severe COVID across the various patient group here if we uh we did like a subgroup analysis we will notice the same effect in elderly age group in in in male gender in patient to in obese patients in patient diabetes hypertension and uh and uh and uh uh immuno compromised people in monoconal uh medications so all groups were associated with low morbidity and low uh mortality as well so the backloid was associated with reduction also in healthcare utilization so if we are decreasing the morbidity and decreasing the mortality what is the end result of that less hospitalization less hospital stay less using of of of antibiotics less developing of resistance less uh uh low number of complications so the patient will be discharged home uh uh u and very quick so all hospitaliz like hospitalization uh based complication will be decreased in this group as well so the backslid safety profile has been also consistent with the clinical trials so multiple clinical trials were were done and in the in the epic HR also they were assessing the uh uh um adverse reaction and there were no actually major adverse reaction compared to the placebo group and less than 2% incident of serious adverse reaction uh that needs to discontinue uh the medication so in term of efficacy the medication was effective in term of safety the medication was safe that those two factors ma they are the major factor for any medication that you want to use in any field you need effective medication um not also effective if we are if we want to be very precise we need cost effective medication and safe to Boo Pakovic can be used in a certain or special population yes so the most important one that we always u want to make sure before using any medication is that medication safe with a renal impairment is this medication is safe with a liver impairment is this medication safe with this medication that the patient already on so with the kidney uh impairment uh it’s okay to be used uh without uh uh uh any dose adjustment if the GFR more than 60 and below 90 uh um renal uh impairment between 30 to 60 we need the dose uh uh should be uh uh adjusted but in GFR less than 30 we it should be avoided uh with a patient with liver impairment um uh in severe with the child book class C uh we should not use it otherwise we can use um uh without any dose adjustment uh the we are using uh a booster usually retonavir is a boosting to make the medication more potent and more strong and once we are using a ronavir or pras inhibitor in general they have the the the uh potency to be a microsal enzyme inhibitors microsal or cytochrome enzyme inhibitors that means I’m inhibiting other medication to be excreted from our body so they are at risk for developing toxicity so be careful when you use this medication to check all drug drug interaction with the back with the backloid to make sure we are not uh uh um falling in in in in a complication i still remember one of the patient we were using daronavir retonavir it’s one of the anti-hiv medication and the patient was taking simicort inhalers for asthma he became cushinoid because of that was a very potent microsal inhibitors and that patient after 3 months he came with a cushing syndrome because of that so they are very strong microal inhibi in in inhibitors and they are at risk to develop toxicity from other medication especially in imunocmpromised patient that they are on biological therapy they are immunosuppressive regimen we they are on antibiotics for a serious infection we don’t want to harm the other uh medical condition that the patient already on on the other hand also we want to make sure that we are not using other medication that can increase or decrease the level of the backs of it so it’s vice versa so we need to make sure that backloid is not uh harming other medication and the vice versa on the the backloid uh other things anaphilaxis uh Stephen Johnson uh uh the the uh toxic uh epidermiculis these are the things that if you see it we should uh um stop or discontinue the backslavit uh we have mentioned that we need to focus on both sides on the backslavit group and on the other medication we don’t want any toxicity or we don’t want to decrease the efficacy of the other medication because of the interaction so always always always check the interaction between the backslavid and the other medications uh real world uh evidence I will move just uh very quick on these uh just in summary these are couple of studies after the uh the trial is just supporting the efficacy and the safety of the backslid as as well as uh uh uh epic HR have mentioned so here is the the first one uh is it were showing um um the backslid were having uh an excellent impact on the com the patients with coorbidities and and and decrease the the mortality and the morbidity as at the same time and the um other studies also compare uh checking on the hematological malignancy autoimmune immunosuppressive regimen with people with solid organ transplants and as we are seeing the numbers there are very uh uh uh positive outcomes when we use a paxlovid in those group to avoid progression to severe COVID and here also uh uh the other the other studies are showing if the patient are receiving uh uh the the the backlo it uh within uh the five days the diagnosis and the the duration of the symptoms the improvement the develop the progression to to to severe COVID all decreases either in heological malignancy or in the other uh groups uh safety also these are studies on the safety showing that more than 90% of the reported cases were non serious uh consistent with the serious adverse reactions and also supporting that the uh the epic HR and epic uh standard risk uh studies that showing there is no serious adverse reaction were uh uh noticed in in the study and the other studies were supporting the same thing um let’s just summarize COVID 19 pandemic is over but we are still dealing and handling COVID patients uh beyond the direct effect of COVID the patient underlying condition face significant additional risk as we have mentioned despite the effectiveness and the guidelines we are still underusing antiviral such as Paxlovid and we are overusing antibiotics and uh we have just mentioned that early detection is very crucial and very important to target or to reach to our uh goal because early detection means we are going to hit the duration of list or of 5 days and once we hit the duration of 5 days and we determine our population we can use the Paxlovid right away and RCTs we have just mentioned the epic HR uh showed that Paxlovid is effective and safe uh to be used and the real world evidence supporting the Epic HR and very quick this is our uh uh uh national guidelines and if we if we look to the um the mild to moderate symptoms here they are asking us to consider uh the backslid But in in in the Saudi guidelines they are uh um one of things they they just decrease the age remember in the epic the age was 18 and more but if we look in in the Saudi guidelines in the bottom is 12 and more so they are considering and they are giving us the chance to using it even if the patient uh below age of uh 18 and above age of 12 exclusion criteria also here I would just like uh uh stress on the age of 12 these are the exclusion criteria but above age of 12 we can using it and thank you uh thank you so much uh Dr muhammad for this uh very illustrative presentation uh you have taken us in a journey exploring where we stand here uh out of covid uh pandemic and how we are uh handling our any perceptions towards our community you have highlighted the risk populations and the impact of COVID on those people at risk and the covid uh with co-mobilities and how it is react and then finally you have landed into um the treatment with paxld and you have shown us um the evidence that support the efficacy and safety and finally we had a recommendation from ministry of health regarding uh the use of baklavet so thank you so much and now we would like to move to the second speaker uh Dr trat Misani uh he’s a a consultant fun medicine and geriatric and uh in Albaha University and he has been an activist in fact in participating with us under the umbrella of Saudi society for fun and community medicine with a lot of contribution to this kind of activities as a speaker uh so his topic today is going to be very important and it will shed light on the other spectrum of the echo uh system that we are living in towards handling the covid which is the vaccine hesitancy and vaccine fatigue and the vaccine recommendations which we are supposed to uh you know interact uh with so I would like to welcome you Dr dad and Dr he was supposed to be with us here today but he will be online so I will just leave the floor for you Dr if you can hear us please i can hear you
yes thank you
okay um good evening everyone first I want to thank you all for uh either attending virtually or physically and I want to thank the Saudi Society of Family and Community Medicine Fix and our sponsor for tonight’s event Fizer for giving me this opportunity to join you all tonight today I’m going to be speaking about the vaccine hesitancy and fatigue management in the older adult population and before I proceed I want to thank Dr muhammad Samani for his very informative lecture so first thing I want to move on I’m going to put some um present my highlight so this is going to be the outline for uh tonight’s lecture i’m going to give a brief introduction and a background of what we call vaccine hesitancy and fatigue then we’re going to take a a global overview and perspective about the vaccine hesitancy and fatigue then we going to narrow our vision more into our region of the GCC and Saudi Arabia and how is that impacting us then we’re going to um talk a little bit about the factors influencing the vaccine hesitancy and fatigue in the older um older adults community in Saudi Arabia and what strategies to combat that hesitancy and fatigue then the conclusion so when we talk about the u can you see the screen okay so when we talk about the um vaccine hesitancy it’s um generally means that there is a delay uh or refusal from the patient side of taking the vaccine even though it’s available but what does fatigue mean fatigues mean that patient already took the vaccine and even though the patient will need a repeated dose to maintain um a good immunogenicity toward the uh of the vaccine in the system they are fed up they are tired and they are burnt out and there’s many reasons for that so these are basically the definitions of vaccine hesitancy so having a problem to initiate taking the vaccine even though it’s available and fatigue because of the burnout of receiving a lot of information and for because of um overselling of the uh vaccine information to the older adults they get tired of it and they refuse to take frequent booster doses because of that and actually vaccine hesitancy is a problem that was recognized by the uh WH in 2019 as one of the top 10 um strategic uh burdens and barriers uh in the older adults and globally the importance of aging population uh in the context of co 19 is very crucial because 90% of co death globally occurs in those who are 60 and above so let’s take a quick look at the global overview and um how did the world do concerning that in term of vaccine uh hesitancy and fatigue so since the vaccines was um introduced at uh by the end of uh 2020 so in December the uh there was an excellent pickup of the vaccine globally almost like twothird of the uh world population received the vaccine in its series of the as an initial dose and we can see that in the United States in the European Union and in uh East Asia but after that after completing first dose second dose or third dose uh and the recommendation of taking booster doses uh was rolled on by the health authority in different parts of the world especially for the older adults the uh we’ve started to notice that there is significant drop on picking up on the vaccine and taking the booster dose so there is almost like at least 20 to 40% drop of older adults proceeding with receiving the booster doses then this is what we call again the fatigue and again there is a lot of reasons for that we’re going to talk a little bit about them some studies looked into that and they compared the data of 23 countries seeing what are the reasons for the hesitancy to begin with and it seems that there is um a global theme uh of reason for the hesitancy where we can see that up to 60% of people he whom they didn’t receive the uh initial series dose they had concerns about the side effects of the vaccine and of course this is not the only thing that we uh notice about the co 19 this is a very common phenomena and theme for all different kinds of vaccines after that the lack of trust in government or health system let’s say the belief that the covid-19 is not serious up to 25 to 40% of people were thinking that the misinformation and conspiracy beliefs especially in the era of social media um and there’s a lot of misinformation going on and you won’t be surprised to see this trend um uh to be growing um more and more over the upcoming few years uh because you can see such um um information being spread by let’s say the officials in the uh one of the biggest health care systems in the world which is in the United States for instance the health um minister of um the United States RFK he debunked the benefits of um vaccines and he promote that there is no significant uh benefit from that and the opposite that it may promote different diseases according to him so also the low perceived personal risk so people may think that since we are sitting at home especially for the older adults who um they are bedbound so they don’t go out they’re perceived that we’re not at risk we don’t need to take the vaccine which is not true so the fatigue form actually from um getting the series of booster doses after that started to grow after the year 2022 but what about here in Saudi Arabia so in Saudi Arabia let’s take a look first of all of how did people perceive vaccination and let’s take the influenza vaccine as um a milestone before uh the covid-19 pandemic and after that if we look at the GCC area we can see that Saudi Arabia the pickup of the vaccine was pretty low less than 40% in the population but after the co 19 there was a significant improvement of picking up of the influenza vaccination especially in an older adult and we can compare that with the um United Arab Emirates and the Kuwait we still see that trend where older adults start to focus more in taking up on um influenza vaccination and we can see that reflected uh also in the co 19 at some point but not um not exactly the reason is behind that if we take a look at this graph over here we can see an excellent pickup as Dr ashra mentioned at the beginning that we reached what we call the herd immunity for the first time um during the pandemic especially because of um all the legislative and logistics uh bring up and the governmental regulation that been put in place to enforce everyone to take uh the vaccine but unfortunately we saw that there is a trend of very slow pace of picking up on the booster doses of the vaccines especially for the um highly needed population so population home are at risk or the older adults so 20 23% had received the booster in the early of 2022 but almost like 68 of the total population fully vaccinated by February by that time but the post booster dose uh pickup was um very low and we looked into the reasons why would uh the global population why not to take the vaccine and we wouldn’t be surprised to see that the same reasons that um was reported globally for people not to take the uh booster shot uh for the CO 19 is also repeated in Saudi Arabia so let’s take a look what are the usually the factors influencing the uh patient hesitancy and fatigue especially in the older adults and for that there’s a framework um from the W that looks into what are the five reasons for uh vaccine hesitancy so and that looks into the first C which is confidence so is there a confidence between the um patients or population in general and the health care authority or is there a confidence between the patients and the health care professionals so doctors nurses um dieticians um health educators so in general then it look into um a calculation but before we move into the calculation it’s worth mentioning that according to different meta analyses here done in Saudi Arabia um the confidence between the health care professionals and the older adults is very high the older adults in Saudi Arabia they trust the ministry of health and their recommendations then they trust the health care professionals and this percentage reach up to 80% so when you put that in contrast to the what they usually see in the social media you can easily debunk any rumors uh with good education and addressing the patient um concerns which are actually are very reasonable concern so the second thing is the calculation weighing the best the risks and benefit of taking the vaccine and this is actually very important the way Dr muhammad Simmani explained how the disease may impact the patient uh morbidity and causing mortality there is also other aspects I would I want to uh bring in here is that the quality of life can be impacted um in a big time especially for the older adults if they get admitted to the hospital their admission in the hospital getting discharged from the hospital they need a very lengthy journey of returning back to to their baseline and for myself as a geriatrician I focus on three things I focus in making sure that my patients are independent on themselves as much as possible secondly I want them to live the highest quality of life as much as possible and thirdly I want to prevent them from getting admitted to the hospital as much as possible so putting the risks of not taking the vaccines uh for the older adults enlisting all that not just for the COVID 19 but uh all different kind of vaccines is very convincing for them the third C is convenience is it easy to get the vaccine or not so even though there was a lot of investment in the infrastructure especially in technology of making things easy for the uh older adults uh to book an appointment with the primary healthcare centers or any healthcare provider they prefer still they face a very difficult time um proceeding with such technologies so especially for the older adults who are sitting at home is it convenient for them to leave home especially they are bedbound and to go to the primary healthcare center to receive the vaccine it’s actually extremely difficult and here comes the home healthc care services or the mobile clinic where uh they should make this pretty easy so the barriers to get the vaccine actually is pretty significant technological um distance finding the appointment so creating something that would make the um experience and giving the appointment for the vaccine is very crucial complacency is the vaccination being seen as a low priority and this is what happened um since at the beginning of 2022 so what happened is that since the news about the SARS COV 2 starting to wan off and become in the background and people were getting tired and tired and stressed out and having anxiety about the pandemic they tried to forget everything about the pandemic and so they tried to avoid delaying anything um in their health concerning that uh period of time and so even if we offer the vaccine for them they will refrain from uh agreeing on taking the vaccine for many reasons either because of what they saw in the social media or they have um someone they know who suffer from a side effect which we all know that uh all vaccines have a a general side effects and a local side effects so all these things together will refrain those patients from uh getting being compliant with the vaccine and agreeing to take it so the collective responsibility willingness to protect others again um someone who is sitting at home especially for the older adults they don’t perceive um that there is any need for them to take the vaccine since they are isolated from the outside world but again this is not true so when a study was published looked into the top reasons for the co 19 vaccine hesitancy among the older adults in Saudi Arabia so this table here is pretty similar to the one we saw earlier com uh looking into the percentages um of the reasons of vaccine hesitancy globally but in Saudi Arabia it was the fear of side effects which was about 27 up to 42% so here when we start talking to our patients about the importance of getting the vaccine we need to explain to them and emphasize that yes there is side effects to the vaccine but again these side effects are the same side effects of any other vaccine and they’re limited usually they stay between 2 to 3 days and they can um take let’s say paracetamol to control any symptoms of any emerged so doubts about the vaccine safety and efficacy and of course that was a very uh hot topic uh over the past couple of years um looking into whether or not the vaccine is safe or not we need to say something here we shouldn’t be denying that there was some incidents happens across the world because of uh some concerns of the safety and efficacy of the vaccine but also at the same time we need to emphasize that um the vaccine that being provided um by and purchased or provided by the Ministry of Health and the Kingdom of Saudi Arabia they’re targeting the best and highest quality of vaccines and so not everything that they hear or see in the social media are true so low perceived risk so again they’re home 10% of people they um have hesitancy or fatigue of taking the booster shots because of that lack of trust in the vaccine again we see this um um globally in a highest percentage than in Saudi Arabia misinformations or myth again in the social media WhatsApp groups family network and here comes uh a very important part of the whole chain which is the family member patient may be on very excellent medications not necessarily I’m talking about vaccine but any other medications that may help in controlling their chronic conditions unfortunately uh family members may uh advise their um brothers sisters especially if they’re elders uh not to take too many medication that may be beneficial for them or they know someone who started the medicine that caused some side effects so this is very important to educate the whole family so physical logistics access barriers about 8 to 12% of patients in Saudi Arabia again it’s worth me mentioning that that the level of trust between the health care professionals and the older adults in Saudi Arabia and comparison to other health care systems is pretty high okay so we talked about the different uh the framework from the WH and the five Cs and again we need to in how we can fix the confidence we need to empower the providers to answer the safety and efficacy questions and here comes the uh um the importance of education what we’re doing here tonight is very important because when uh we empower ourself with more informations of how we can um answer the questions and the concerns about without dismissing without dismissing the patient concern we need to embrace that first of all and we tell them yes some of the informations we need to dissect these informations and uh misinformation that they have and we need to answer them one by one in a scientific way complacency so uh personalized risk reminders this is a little bit um outside the um outside the clinic encounter because this will need implementing a very sophisticated EHR uh or uh electronic health record system where we keep reminding our patients uh about um the importance of taking their vaccine either for the co or the for the influenza or uh for any other vaccine like the ISV for instance convenience so making the walk-in uh appointment uh easier if possible because for some patients when they try to book an appointment through the application let’s say Sahhati and they see that maybe um for them since they’re ready now to take the vaccine but their appointment will be after a couple of days or maybe for any reason either the vaccine is not available or anything similar they may postpone this idea of taking the vaccine for unknown time so making making it very easy with a single click uh booking a schedule in order to get the vaccine is very important drivethrus home vaccinations um all these things should help the patient um hesitancy and being reluctant to receive the other doses or any other vaccine beside that combining the vaccination so encouraging patients to take the uh co 19 vaccine along with the influenza vaccine um so taking multiple vaccines should make it also easier for the patient calculation giving in graphics flyers uh comparing the risk of ICU admission versus the vaccine adverse events could be very convincing for the patients and the collective responsibility so messages to the family um and younger adults that they need to take the vaccine in order to prevent um the disease moving into their loved ones sitting at home so basically uh we looked into the global perspective we there is um a lot of burd burden and fatigue uh most probably and reportedly because of uh the a lot of information that been giving to the older adults about the importance of vaccination so the strategy should be retailored again this should be done in a multiaceted way at the level of the encounter in the clinic organization level at the uh country level so different strategy needs to be uh approached here in order to fix that problem um the uh reporting of the number of cases of COVID 19 is very important um because we do still have pockets of uh some surge especially before Haj uh season we see we saw a spike even though it wasn’t reported uh at some level but uh it is there as Dr muhammad Samudi mentioned and we need to um protect ourselves and our loved one especially with the surge of uh the chronic diseases and the uh to listen the burden in the healthcare system this should conclude my presentation to you all thank you all for being patient and u thank you Thank you so much uh Dr tad for this wonderful presentations which highlighted a very important part that um could enhance and promote the good uptake of uh the vaccines uh so now I would like to invite Dr muhammad to come over the stage and Dr you’ll be with us to receive the questions and uh uh we have been privileged to have our uh colleagues who are online with us there are more than 1,000 attendees and they have sent me many of the questions but I would like to give you the the privilege of uh giving giving us the questions from you as physically attending audience so I will open the floor if you have any question please you have the mic any questions questions okay okay mic please can you get the mic since I’m I’m the victim always you’re not
regarding the it is very beautiful i mean when Dr muhammad mentioned that he gave us a very good panoramic view and really I appreciate your aggressiveness i think this is a very important because re relying on uh some sort of giving a time or um frightening of some whether to fade anything else i think it’s to go ahead go ahead hard with antibiotic and safe 7% of mortality i think that is a huge number so what do you recommend from the different aspect okay we start the whatever the management would you like I mean to go for positive lifestyle in combination with the therapy your recommendation regarding the get a patient outside of the hospital for the best so what shall we recommend for those uh patient when they are outside okay okay so one of the things that I I would like to mention if you are seeing we are uh working very fast and very hard of developing uh uh more uh uh diagnostic testing such as molecular testing you will see we have a lot of uh um u uh u models such as like we have a blood multiplex it’s just like a data of blood organisms and we are just like putting a a sample there and once we are putting a sample there it will tell you which bacteria that sample it match which DNA it match and this is the results so you are dealing with E.coli in the blood in less than half an hour menitis multiplex you just put a drop of cif on this on this multiplex on this kit and in couple of minutes they would tell you you are dealing with a stryptocus pneumonia uh uh culture so you will stop all the antibiotics just keep the vancom zone we are having also a stool multiplex we have a lot of diarrhea and you don’t know what are you dealing with and in in in a second you know that this is salarella so once we are having those fast things so just like get them out of the hospital if we have a medications and during uh staying out of the hospital we have to uh uh make them safe and make them uh uh uh protected from other people to get infected uh it depends on what kind of infection you are dealing with it’s either you are in the hospital if they need isolation just is isolate them at home if they need just a droplet isolation just tell them to wear a mask like try to make their life also easy and protective as much as you can to just accommodate them outside the hospital
i assume you are to go ahead with even for triple antibiotic yeah if if we we are discharging patient with osteomiitis on triple antibiotics mhm sometimes with culture negative osteomiitis I cover all the bases such as gram positive gram negative and any robes sometime I reach to three antibiotics yes
I don’t mind at all
i may change I mean to Dr ra regarding the um this kind of I mean old age which is very critical and GFR what is the your criteria for giving some sort of uh strong antibiotic for those uh aged people thank you very much uh for your question uh before I answer this question I just want to return back to the uh original question too so when as Dr muhammad Samani said uh hospital is not the best place for anyone especially for the older adults to stay there for many reasons causing delirium nocom infection and etc developing DVTs so and I know that Dr muhammad is also sitting in some of the committees uh that focuses on all path and discharging patients from the hospital on a suitable antibiotic to treat these uh infections so usually any helm health care that is very established either in governmental side or also the private sector can help and ease the transfer or down uh step from the hospital admission of a general wall down to the house and you also asked about um what can the patient do uh in term of you know uh getting quickly to their baseline usually if the patient is stable enough they can start the uh physical therapy at the same time in order to you know regain what they lost during their hospital hospitalization uh concerning the second questions for the older adults we don’t have uh like a contraindication specifically for the older adults in taking some of the antibiotics especially if it’s a life-saving as you mentioned unless there is a real issue with you know depending on the pharmacocinamics and dynamics and kinetics of antibiotic and how is it going to be um getting rid of out of the body uh it Worth mentioning here for us as gerediatrician we don’t usually rely on the just the creatin level to estimate the kidney function in order to uh adjust the dose of the antibiotic uh according to their need we usually go with the creatinine clearance so the GFR um is is very important you need to calculate that if it’s not reported in the labs in your institution you need to make the calculation according to the weight and the age because you will be surprised that even though the patient have uh a normal creatinin level but their GFR will be less than 60 so this is something of course that we need to be special um attention to okay thank you so much um Dr tarat I think I have a question for you Dr muhammad uh regarding uh how effective is the paxelv uh in against the current variance of uh sars kovvi uh in terms of uh the new variance that’s circulating is it effective
yes it’s it’s very effective and the the the current mutation it doesn’t affect the efficacy of of the backlo it so it’s effective against the majority of the uh uh uh mutants uh which is the most current one the Omicron omicron yes so it’s very effective
any other circulating variants coming up apart from
yes uh yeah a a lot of some a lot of uh of of variants uh um every day they are uh uh um studying but for now no any like major threatens like majority of of of mutants or or or varants they are just like uh affecting the spread not the mortality too much okay thank you so much uh Dr tran there is a question from the audience who are online uh what communication strategy have proven most effective to counteract hesitancy so the communications strategy so uh the first good thing is that there is an established good trust between the health care professionals and the patients in Saudi Arabia and you can build on that um usually what happens during the encounter especially with the older adults so they come with a very long list of co-mobilities uh a long list of medications and you focusing into that you have a very limited time in the clinic to address everything so usually we don’t tend to think about the vaccines as one of the thing that we need to talk to our patients too but when we keep in mind that um we have to put the uh immunization the same thing that we talk to families parents about the pediatric immunization we need to talk about the gerediatric immunization we need to incorporate that during any visit even if it’s at the end so when we start talking about that first we know we need to know what vaccination they received before um and B from there we if you start introducing the vaccine immediately um you might get blocked out honestly so first of all you need to ask about the history of vaccinations of them then you mention if there’s one of the vaccinations are not taken let’s say influenza vaccine or the RSV vaccine you need to uh incorporate that this is something that was um uh recommended by the ministry of health so and this is going to give you an anchor to make it very easy for the patient to open up and accept and because again most of those patients they will refuse vaccines uh because they have misconception um and a lot of myths that they have either from social media or WhatsApp groups so when you throw the imo honestly name over there you’re going to give this anchor of credibility along the of the patients confidence in Saudi Arabia on the healthare professional then you going to receive the questions and they’re definitely going to ask about the side effects and the efficacy of the vaccine here you need to mention that that the benefits so the you need to do the calculation of the patients most of patients if they see you uh recommending the vaccine they will con get convinced about that but what happens is that if we have ourself as health care professionals we have this um inner uh misconception of the vaccines themselves we won’t be recommending that so education to the healthcare professional uh having incorporating that as a part of any visit of an older adult if the hospitals can incorporate uh an alarm for the physician to help them identify patients who didn’t receive the vaccine it will be very helpful and again be ready and open to embrace all the patients concerns don’t um block them let them say everything um that they have in mind then we need to reassure them we have the data we have the support of the ministry of health um as a supervising uh body for everything being approved and given uh in the kingdom we have our goal toward um a healthy um prosperous society we have our goal toward uh longer life expectancy all these together should convince the patient to receive the vaccine
thank you Dr and I would like to mention here that it’s uh it’s our job to believe that vaccine that vaccination or vaccine are very powerful tools that could prevent you know mortality and morbidities and safeguard our community and in fact we have to learn how to counsel patient in fact uh who have some kind of vaccine hesitancy because it’s an art of skill soft skills that we have to learn uh within the limited hour minutes of encountering with patients we have to learn how to utilize those minutes and make sure that we deliver uh the proper communication to convince the patient and to convert the patient perceptions toward the vaccines and I truly believe that vaccine should be there in all encounters regarding the specialties even if you are doing some specialty far away from vaccination but again you have to learn how to promote vaccine how to enhance the uptake of vaccinations in your uh institutions and wherever you are so collectively we can forward and direct our patient to the vaccination clinic and then we will get the the objective that we would like to have but Dr muhammad there is another question for you any biomarkers or clinical predictors help to identify patients who would be benefited most from backlov so the most important one is the the CDC and the WHO uh these are the strongest evidence that we should all like follow as we were following u um the MO and the MO they are like depending on uh those recommend the risk of antiviral resistance emerging with increased use of blobet so for now up to now we don’t have uh these things but as an infectious disease yes yes it might
there is yeah that’s the the
smart yes
there isn’t limitations to use of it
yeah usually no and usually the resistance for the viruses is is extremely rare
okay
it this the bacteria is smarter than the viruses usually it’s very difficult and very hard to to develop resistance in a virus
any actions towards the stewardship you know regarding this antiviral Uh yes so that’s why we said it’s if positive that’s the only time to use it but don’t use it empirically okay
i don’t recommend using um right uh Dr todd uh a question for you from the audience uh how do we handle patients questions about the evolving nature of of mRNA technology and the longterm safety okay this is an excellent question because some of the people perception was even from a very renowned uh scientists they were promoting that uh the biggest human experiment of was done during the uh covid-19 pandemics with introducing new technology but again we need to know that this technology is is not that new honestly but uh it uh it’s it’s been establish published for many decades but uh it wasn’t introduced uh let’s say um in a broad way until the uh co 19 happened and uh there was a pre um significant urge to come up with vaccines quickly uh but again it’s not a it’s not a new thing it’s not a totally new technology it’s been going on and we studied very well over the past couple of decades and there is uh new applications uh going on uh and more studies not just for as a as a vaccine but as an antiviral vaccine but uh for other conditions like a malignancy too so um um of course this is a very also valid question because we we shouldn’t be denying the fact that some also some of the patient who received the vaccine and we see that in a clinic in a daily basis so some of the patients they develop maybe some side effects that wasn’t known before like idiopathic hericaria again we need to um receive these questions uh a millions and millions of hundreds of millions of people receive the vaccine that doesn’t mean that side effects shouldn’t shouldn’t happen it can happen but again uh the uh the the majority of patients did very well it was a very lifesaving vaccine for uh during the pandemic and uh this is an area of of research now but uh again it’s not new
thank you so much uh Dr as a guriatricians definitely are encountering a problem of uh vaccine hesitancy among your elderly populations who are very difficult to convince and knowing that these uh populations of group they they require to have multiple vaccinations almost five six vaccines you know so how do you tackle this kind of uh hesitancy in that particular group who are very difficult to convince yet they require more vaccination than any other populations thank you very for your question because this is totally true so uh the older adult vaccination start with the 50 even though 50 years old is not considered like in a geriatric age group but starting with the uh vaccine against the herpes zoster we u we start talking about such a vaccine um again we don’t we introduce for myself I introduce the vaccine I start talking about the prevention uh but I Don’t get frustrated from the beginning if from the first visit the patient said no so what happen is that uh they will hear from you they will say let me think about it this is very typical so they will say let me think about it they will go home they will ask their friends they will they will look into the social media if they see and there is a lot of positive things like the ministry of health uh uh camp vaccination campaigns for the older adults um asking any healthcare professional and family um testimonials or any um older adult influencer let’s say they will see these things in the media that will make them when they come in the second visit they will mention the vaccine that you talked about to to them uh in the previous visit so don’t get frustrated from the first time just introduce it and put a schedule for them and combine it as much as possible so they don’t get frustrated because of that
excellent my last question for you Dr how many vaccines can you give at a time for your juratic populations for your judici how many vaccines you can give at one single encounter at a time and this is one of the modalities that we encounter you know uh we we we we handle it as a strategy to not to have a missed opportunity of having that particular patient who require these kind of vaccines in one visit we give multiple shots so how how how big because I have encountered in one of the military recruits they they give seven vaccines at a time four and three seven you okay um so I can encounter and I saw it myself so how about you Dr okay so if let’s assume that we have a patient who’s completely ready to receive all the vaccines so how we can how we can combine these vaccines so it’s it’s a little bit different so we return back to the manufacturer and the recommendation from the ministry of health or Saudi FDA concerning that was talking specifically about the uh SARS cove 2 COVID 19 vaccines you can combine that with the uh influenza vaccines uh they can also look at the ISV vaccine you can you can give the ISV vaccine with no problem along with that um but but concerning the uh let’s say the herpes zoster vaccine um um not pretty sure but maybe Dr muhammad Samoodi can help with that uh because the number of vaccines that we can administer so we have the herpes zoster we have the numokcoal vaccine and we have the 20 now so it’s gonna be very helpful instead of giving the patient the 13 then the 23 uh after that uh a year after that so uh we can easily combine most of these vaccines unless uh it was contraindicated manufacturer but I cannot recall anything that contradic course you need to give it not in the same side for some of these vaccines and you need to give
her disaster in two doses yeah sure uh my last question for you Dr muhammad uh any evidence that uh early outpatient treatment with batsvet reduced the risk of long co uh yes so some observation studies they are talking about that um and also um if you see they are decreasing the duration of the symptoms of the acute and also some of the observation studies but we didn’t talk about it here it decreases the long co yes that’s that’s true and a lot of of upcoming studies talking about that and regarding the inactive vaccination we do have like a rules in in infectious disease that you can give up to three vaccinations inactive uh without any problem in the same visit okay
and we usually don’t like to combine more than one uh uh um life attenuated vaccine in in per one visit yes all right i think this was the last questions and before we end I would like to ask uh the two speakers to give us one recommendation one single recommendation from you Dr muhammad regarding the importance of using Pakovette in a short window of 5 days for moderate for mild to moderate cases of uh covid patients with those people at risk so what is recommendations for our colleagues in the primary care um try to be ready all the time for your target and early detection is the most important part
thank you so much uh Dr todd another statement from your side regarding vaccine hesitancy vaccine fatigue and uh vaccine recommendation uh don’t be tired and fatigued from uh introducing incorporating vaccination uh during your visit discussing that um among all the different co-orbidities with the older adult if it doesn’t happen in the first visit don’t worry the next visit be very sure that patient will return back to you asking about the vaccine um when they can take it thank you so much Dr and coming to the end I would like just to conclude that uh the coid9 pandemic is over but still the virus is there and the infection is there and we encounter on our day-to-day practice in primary care and family medicine and even other specialties patients who are coming with covid and I think we have learned that there is special risk populations that we have to identify among our total populations of patients that we encounter every day we have to know that uh the early interventions with to to to treat patient early stage with mild to moderate COVID using a paxelvet which has been proven to be efficacious and safe and tolerate tolerable we have to make sure that the the drug drug interaction has to be considered otherwise we are going to provide the patients with uh the safe medications that could be you know uh save our patient from hospitalizations from deteriorations and severe complications again we have came to uh uh shed light on the vaccine hesitancy and the vaccine fatigue and I think this is the state of art of all of us as a primary care physician that we have to develop our skills and we have to be vigilant enough to identify those people who have to have the vaccine we have to generate an ecosystem within our uh institutions using our nurses in the triage to ask patients according to the age and according to the risk whether they have taken those vaccination or not and then they can initiate the process you have to in uh utilize the international awareness days for any disease and keep the vaccine as one fixed campaign that has to be incorporated with all the educations campaign that you have it across uh your uh activities as u as a healthcare provider with this ladies and gentlemen I would like to thank you for being with us till the late hours of tonight on your behalf I would like to thank our guest speakers who have been quite informatives and rich uh in in their uh updates and giving us their thoughts and expertise uh Dr muhammad Asani Asanoodi and Dr tarat Misani and I would like to thank Faer company for giving us this wonderful opportunity and I would like to ask them in fact to give us more and more about this very interesting topic a special thanks goes to FEXes for the wonderful organization of this and uh and I would like to thank the online attendees who have been with us more than a thousand and thank you for the wonderful questions that I have re I have received from them and this is not you know shed a light that we have a quality quality questions that we have quality audience that they are giving us this kind of interested u uh questions for this kind of discussions till we see you again ladies and gentlemen i wish her a good day okay yeah sure [Applause] you are going to be with us for the photo
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