Vital Signs: Back-to-school vaccine timing and other health news

CATHY WURZER: This is Minnesota Now. I'm Cathy Wurzer. It's time for our segment "Vital Signs." Each month, we talk about topics that are important to your health. And we take a deep dive into medical news of what's top of mind at the doctor's office.

Joining us is Dr. Jon Hallberg, a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School. Welcome back.

JON HALLBERG: Thank you, Cathy. Great to be here.

CATHY WURZER: Thank you. I was just talking to our colleague Dr. Mike Osterholm about the new COVID boosters. They've arrived in some places in Minnesota. But I'm wondering, have you seen them yet at your clinic?

JON HALLBERG: Not yet. I think that-- and I know that Walgreens, for example, is taking orders, as it were. People can sign up for a slot to get it. We'll be getting ours in early September. And I think that's probably fair to say for most clinics, most pharmacies.

But the buzz is out there, and I don't think I have a single wellness visit or physical exam where people are not asking me about it. What do you think I should do? When will be available? What's the best timing? All the standard questions.

CATHY WURZER: Timing. That's hard. That's hard. I'm trying to figure out what to do myself.

JON HALLBERG: Yeah, I think if people are at high risk, so 65 plus, have some kind of a immunocompromised condition and/or have a chronic illness, getting it as soon as possible is a good idea. I mean, as we all know, it's out there. It sort of never went away.

And I think for those folks-- and if we could do this the perfect way, it'd be like those folks go first. And then everyone else just wait till October or something like that. But honestly, if people are at the pharmacy and they're inclined to get it, get it. There's no reason to really wait.

CATHY WURZER: And I'm a caregiver of a person who has multiple issues. And that's why I would like to get vaccinated so I don't give--

JON HALLBERG: Get line, Cathy. Get it.

CATHY WURZER: --that person anything. You know what I mean? And of course, we have-- we're seeing these COVID spikes. I wonder if you think it's going to level off somewhere along the line here.

JON HALLBERG: Probably. I think of this all the time that we do flu shots, influenza vaccines, in a sense, as a souvenir from 1918, right? Over 100 years ago, we had this worldwide pandemic of influenza. It never left. It's just morphed. And there are waves. And some years are worse than others, depending on what the variant is and how it evolves and changes and adapts.

And I think COVID's going to be the same thing. And so we'll have these spikes. And we're all trying to make sense of it. Why did it spike in the summer? It doesn't make sense. And why is it spiking now or not now? And I don't know that we know.

It's not like it has a life of its own, per se. Or it's not a sentient thing. It's not thinking about things. But it just is. And we breathe air. And it's airborne. And there's no way to 100% avoid exposure. So it's here to stay in some level.

CATHY WURZER: Dr. Osterholm was saying that there is some level of frustration because there really isn't a COVID season like a cold and flu season, to your point, so it's like a moving target.

JON HALLBERG: Yeah. I think we think that in the past, like, OK, it's fall, winter. We're indoors. We're on top-- you know, people are put in close proximity to one another. The air is drier. Probably more likely for a virus to take hold in our nose or the back of our throat.

But yeah, the coronavirus, the COVID virus is tricky. It seems like it just doesn't care about seasonality and humidity and things like that.

CATHY WURZER: Let's talk a little bit broader here about childhood vaccines, because I was talking to Dr. Osterholm about that as well. What are you hearing from your colleagues about the take-up for childhood vaccines? There's still requirements, right, for schools?

JON HALLBERG: Absolutely. And strong recommendations. Sometimes there are things that are really kind of required, others that are strong recommendations. I think it's pretty hard to have a conversation with a family and not talk about vaccines. And why is one important? Why are they all important, frankly? And weighing that.

I think there's maybe, in my own practice, a little not hesitance exactly, but a little more interest in having conversations. It's not just an automatic thing maybe the way that there was-- I don't know if there ever was a heyday for it. But certainly when I was a kid, you just didn't even think about it, right? I remember going to school and having air guns.

CATHY WURZER: Yes!

JON HALLBERG: I'd line up and-- right? And we'd get shots like it wasn't an option. We just lined up one after the other--

CATHY WURZER: In the gym. Went through. Boom.

JON HALLBERG: Exactly. The cafeteria.

CATHY WURZER: Yes.

JON HALLBERG: And that was maybe-- that was then, and this is now. And it is much more of a thoughtful conversation. But at least in my own practice, I mean, there's not much hesitance. It's just I think people want context.

CATHY WURZER: What things should parents be thinking about as their kids go back to school? Yes, vaccines. Any other tests or anything else to be thinking about when they get to the doctor's office?

JON HALLBERG: Well, so when we talk about kids going back to school, wellness visits occur year round. There's no time limit. If a kid is four to five, they come in for that visit. If they're younger than that, [? they're ?] babies and they have a very regular cadence that they come in. So it has nothing to do with the school schedule.

In my experience, most of this is kids going out for sports, and they need a sports form filled out. That's got a seasonality to it, and it has a shelf life. It's good for two to three years sometimes. So you've got to do those.

And then kids going off to college, that's a big one because suddenly, they're heading out. And they're maybe going out of state. And they need a form filled out for college. They are trying to decide, do they do the college health plan? What do you do when you need medications sent across state lines? Or how do I get established in another state?

So I find that's actually a big part of what we do that has that kind of seasonal quality to it. But yeah, routine well-child visits, we're doing when they're young. We do vision and hearing screening. We make sure they're up to date with immunizations.

And then there are some immunizations like meningitis, which really have a sort of a-- I don't want to say herd immunity idea. But the fact when you have lots of people in a space like a dormitory, certain diseases can spread more readily in those places. So we want to make sure that our college-bound students have had their meningitis immunizations, for example.

CATHY WURZER: Getting back to the smaller kids, since the pandemic, many parents are more cautious about sending their kids to school when they might be sick. And some experts think that might be contributing to the high rates of absenteeism in schools. How sick do you think kids have to be to be kept at home nowadays?

JON HALLBERG: Yeah, I mean, this is interesting. And I think, in some ways, the common-sense aspect of this has never changed. But I think things did change with COVID. And now the pendulum-- pendulums swing one direction. And then they swing another. And maybe this is kind of like a course correction. It's kind of righting a little bit.

And so what we're coming down to is, look, if a kid has a fever, do not go to school. And the rule of thumb with that is a kid should be fever-free for 24 hours, and it shouldn't require things like Tylenol or acetaminophen, Advil, ibuprofen to bring it down. They should just be naturally fever-free for 24 hours.

If a kid has vomiting and diarrhea, please do not send that kid to school. Some of this is just really common sense. But the American Academy of Pediatrics, the CDC are saying, look, if the kid is not having a fever, they've got a runny nose, they've got a bit of a cough, maybe a little of a headache, they can actually go to school.

Again, common sense would say the kid's coughing, maybe wearing a mask would be a really good idea just to keep those droplets contained. Really encouraging kids to wash their hands makes sense. So kind of common sense for the most part.

CATHY WURZER: While we're focusing on parents, I'm curious about your take. Surgeon General Vivek Murthy put out this new advisory this week, last week-- parents under pressure and how stressed parents are nowadays. I mean, parents have always been stressed, I guess I would say. But it seems more so nowadays, according to the surgeon general. Do you see parents struggling in a different way than perhaps our parents did?

JON HALLBERG: Oh, gosh, yeah. I think, yeah. First of all, you often got both parents are working many times, not just one, sometimes more than one job. You've got kids. I see this among my own colleagues, physician colleagues who've got kids.

And one parent has been working at home. Now that company is saying, you can't do that anymore. You've got to come back to the office. We can't afford an au pair. We can't afford a nanny. We can hardly afford daycare. What do we do?

Social media, kids opting not to go in. They're saying that one out of four kids has hit this higher level of absenteeism from school. And of course, it's going to have implications in how they do in school. Yeah. It just feels like there's just a lot going on. And parents are absolutely stressed and more stressed than they have been in the past.

CATHY WURZER: And they feel isolated, evidently--

JON HALLBERG: Yeah. I can see that.

CATHY WURZER: --which is interesting.

JON HALLBERG: Yeah. And we're more socially connected than ever. And yet, paradoxically, there's this isolation. And people feel like they're kind of cast adrift or they have to fend for themselves or figure this out. And it is tough.

CATHY WURZER: I wonder what can be done about that. You're in a doctor's office. If you have a patient who actually expresses some of this to you, what's the answer?

JON HALLBERG: Well, I always think about that. I'm in medicine. I'm a health care provider. I'm a family physician. I'm not a social worker. But we look at families in the context of all of that stuff. And so I think, A, I want to be an empathetic ear. I want to be a safe place to land.

Sometimes just airing it to somebody is helpful. We have a social worker. I will sometimes plug people into that person to help out. We have a behavioral health clinician. And maybe they really do need some initial counseling or some therapy or some help with some kind of strategizing. Encouraging people to be connected.

And also, this stress can lead to depression, can lead to generalized anxiety. And so that may require actually medication help. People are getting insomnia. They're lying awake at night because they're thinking about 1,000 things, and they just can't get to sleep.

And so are there some safe strategies we can employ or even occasionally medication that can help with that, even if it's just temporary, just to kind of get over a hump that's really insurmountable? So it's like so many things. It's multifactorial. There's no one answer. There's no simple solution. It's just a lot of little things to try and help with.

CATHY WURZER: But thanks for being a safe space.

JON HALLBERG: Yeah, I think we all do that. I mean, we really-- primary care done well is that safe space. It's that health care home, that landing space. That's why we do what we do.

CATHY WURZER: Glad you came in again this month. Thanks.

JON HALLBERG: My pleasure, Cathy. Thank you.

CATHY WURZER: Dr. Jon Hallberg is a family medicine physician at Mill City Clinic and a professor at the University of Minnesota Medical School.