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[Music] tonight on the heels of news that covet 19 has claimed the lives of over 500 000 of our fellow americans a silver lining emerges as newly reported cases and hospitalizations decline sharply across the country and as more vaccines roll out and the pandemic response ramps up the promise of healing for an ailing american economy comes into better focus good evening and welcome to rural health matters i'm christina loren we know that you have questions about covet 19 that are unique to rural america and our show offers you a chance to get answers straight from the experts who have been at the forefront of the crisis our number is 877-731-6733 any question that you have about the virus tonight join the conversation 877-731-6733 our phone lines are open now and joining us tonight world-renowned doctor jeffrey gold the chancellor of the university of nebraska medical center he has been with us throughout the entire pandemic joining us a little bit later our special guest tonight vice president and omaha branch executive with the federal reserve bank of kansas city nathan kaufman will be joining us but dr gold let's start with the latest numbers tonight how widespread is covet 19 in rural america well christina we will review the numbers but i just want to underscore what you said a few minutes ago which was we have crossed the 500 000 that's half a million confirmed deaths and while that number has continued to grow and has caused almost uh uh a sense of fatality across our communities when it comes down to that unoccupied chair at the dining room table or your friend at church the choir member the teacher the educator the physician friend of ours that we've lost over and over again uh those numbers are just so real and so uh heart-wrenching it's it's hard to believe that's where we are and tragically we're just not over but let's look at the numbers across our country and as you're right uh there are tremendous trends uh helping us have some light at the end of this tunnel just over 28.1 million confirmed cases in the u.s 55 000 additional cases on sunday yesterday and 1200 confirmed deaths yesterday and just over 56 000 confirmed hospitalizations we go to the next slide you can see what it looks like across rural or nebraska and what you see is there's far less bright red and a lot more amber and even light yellow and a couple of parts of rural america that are even lighter than that indicating that the case growth rate in those communities is substantially down if we look at the next graphic we can see some of those trends across the top five states in the united states and while we were looking at california arizona texas and florida on many earlier shows we're now looking at south carolina new york new jersey rhode island and north carolina but look at those numbers per 100 000 you know the very top is 47 per 100 000 per day compare that to where we were as a nation uh two short months ago where we were in 100 250 per 100 000 a day so a dramatic reduction in the overall number of cases and we have seen some fall off in the number of deaths i think the next graphic shows the top five states and as you see somewhat more geographic diversity in delaware kansas rhode island georgia and arizona again over one death per 100 000 per day but you know we were five times that two months ago so that is a a very significant change across our nation all in the right direction the next graphic uh shows uh some of the trends that we've been seeing since the beginning of the pandemic and so while we are very grateful and very appreciative of all of the hard work that's gotten us down to well under uh you know 40 cases per day nebraska you know came in at about 14.8 cases per 100 000 per day yesterday a fact that i'm personally very proud and and grateful for we still are at a case level that is much higher than the majority of this pandemic and matter of fact if you think back to may and june of last year uh you know if we were at this caseload that would be twice of what we had at that time and we're certainly not at a position to declare victory if you look at the number of deaths over the time since the beginning of the pandemic you also see that they've come down over the last two months but nowhere near down to where we'd like them we are still tragically losing well over a thousand and frequently over 2500 americans per day due to the spread of this pandemic and then finally if we look at hospitalization rates you see they have also come down since the peak that we saw in january at approximately 125 127 000 down to about 55 000 but again nowhere near to where we really need to see them and one of the interesting trends christina is that of those that are being hospitalized more are needing icu care more needing ventilators and the inhospitable mortality still remains at least 25 percent and for some of those sicker icu patients closer to 50 percent so a lot to be thankful for a lot to celebrate but at the same time as we roll out the vaccines still a need for caution absolutely we really need to be careful right now we do not want to see those numbers go back up and tonight we're going to be talking about why the economy in particular is really watching the numbers right now when we bring nate kaufman into the conversation but dr gold what can we attribute the decline in new cases and hospitalizations too is it vaccines therapeutics what's working right now well i think it's multifactorial i think a lot of it is just innate immunity due to case spread you know as i said earlier 28 million confirmed cases probably close to uh between 75 and 85 million cases if you add in all the minimally symptomatic and asymptomatic that were never counted while it's nowhere near herd immunity it's a lot of people particularly in the lower age groups that are the major spreaders of the disease but you know we have immunized and we'll talk a little bit more about it but at least 63 million americans have seen their first dose of vaccine so that's 13 of the american uh population about seven and a half percent have seen two doses of vaccine but let's also be very frank uh i think that these anti-viral therapies everything from rendez-severe to convalescent plasma and of course now to these new monoclonal antibodies are also very effective we recently looked at a large population of long-term care residents here in their early stages of covid that is to say these are all individuals over 75 years of age who had test positive covit were highly symptomatic all treated in the first 72 hours after their symptoms started and we've reduced the mortality rate from about 20 down to just under 5 in that group so a four four and a half fold reduction in mortality so i think it's a combination of more immunity in the community better protection and the use of these anti-viral agents that have been effective and we need to just keep this up until we get more vaccine into the arms of americans absolutely which was snarled last week distribution anyway because of potent winter weather what are you hearing about the recent weather impact on distribution are we slowing getting slowly getting back to on track now getting back to normal you know i think we are christina you know before the massive cold wave and all of the power outages and snow and icing conditions that have so tragically affected our nation uh hard to believe all that occurs at the same time as this pandemic we were taking it along at about between 1.6 and 1.7 million doses of vaccine being administered per day uh the five-day rolling average is now closer to 1.4 million a day so that's 300 000 fewer doses per day but i'm going to guess when we start to see the impact of what happened over the weekend i can tell you here in nebraska as the weather has warmed the supply chain has been reestablished uh we're we're pretty much back to our full distribution load and i'm going to guess not only are going to be at full distribution but we're actually going to exceed uh as a nation those previous numbers and again will no longer be limited by weather and access but will be limited by the supply chain okay we're going to continue to watch that very closely we did hear reports all across the country even in states that didn't get brutally cold like florida that we had to still face these delays in getting the actual shipments to their location so that's something that we are hoping to see back on track as well we're going to go to the phones william of mississippi is our first caller tonight that's a state that had to deal with some cold weather thanks for dealing with that and thanks for joining our conversation tonight we appreciate you william well thank you for taking my call and that weather caused us to be uh postponed our first shot we got of moderna and scheduled for the second couple of weeks ago now and we're scheduled for this weekend to get it and my question first and foremost is uh my wife and i have had the first modernity shot i am a diabetic and i have had a stroke i saw the other day something about the first shot of modernism like 85 percent effective uh would what would the doctor advise me to go on to get the second or to take my chance with just the one william it's a great question and i think some of the preliminary data that's now been rolled out by both pfizer and moderna have shown reasonably high efficacy rates from the first dose but we don't know how long that lasts and if you can top that off and get to 95 percent particularly with your medical conditions that you have i would strongly recommend that when you have access to it that you go ahead and roll up your sleeve and get it done you know the the research that was done on both the pfizer and the moderna products have shown that the lasting effect uh is best after two shots there's nothing magic about the four weeks you know five could be equivalent or even possibly even better or you know nobody really knows because the study wasn't done that way but my best advice to you is when your turn comes for your second dosing for your wife by the way to go ahead and do it thank you for that call william we really appreciate it dr gold a lot of people have been watching and waiting they've been waiting to see if there's going to be an emerging star amidst all of the various vaccines now that we've been able to study the efficacy a little bit longer do we have any emerging stars from the list that's available right now well you know if in the overall world of vaccine the pfizer and the moderna products themselves are as close to star quality as we've seen in a really long time you know we are so used to getting flu vaccine but that's about on an average about a 65 effective vaccine on it and even in a good year might be 70 percent effective uh the pfizer and the moderna products are 95 and 94 effective respectively they are effective in the younger age group meaning the 18 to 25 year old group they're effective in the over 75 year old group they're effective in people with multiple medical problems uh and you know those are remarkable numbers so i would never say it's impossible to do better but we're you know to get to 98 99 efficacy uh that's going to be incredibly uh unusual because of the variability in people's uh innate immunity in response to the vaccines i think one of the bigger questions is not going to be uh whether the vaccine is safe and effective or more safe or more effective but how long it lasts and how it does with some of these variants and i think that's what we're going to start to see across the country and around the world you know we've been very focused on the variants that we've seen from the united kingdom from south africa and from south america some there have been anecdotal stories of vaccine escape there have been anecdotal stories of reinfection and that's where we're going to start to see the differences because there have been some reports from some of these large manufacturers of a significantly lower amount of vaccine efficacy particularly after the first dose so that's what we're going to have to follow very closely but right now in for what we're seeing in the united states in spite of increasing numbers of the uk variant recommendation is to strongly move forward with the vaccines that we have available to us which of course are pfizer and moderna now the yanston product uh the j product is going to go through its food and drug administration fda hearings later this week and hopefully it safety and efficacy will be at a reasonable level after it's evaluated by the fda panel and if that's the case they will start to ship into the united states as well which has a lot of interesting characteristics first of all it's a single dose vaccine and secondly it doesn't require the same very stringent refrigeration for transport and logistics so it will have a lot of advantages particularly for rural america yeah and you've got the protein versus the mrna aspect as well which many people are waiting for just for that reason they would rather have the traditional type vaccine so really appreciate you always keeping us up to date we're going to pause for a moment we still have time for your call we're just getting started tonight 877-731-6733 is the number to join our conversation and after this vice president and omaha branch executive with the federal reserve bank of kansas city nathan kaufman joins the conversation more rural health matters right after this welcome back to rural health matters i'm christina loren joining us once again the chancellor of the university of nebraska medical center dr jeffrey gold and now we welcome vice president and omaha branch executive with the federal reserve bank of kansas city nathan kaufman joins the conversation nathan we have a vast audience some know economics inside and out and others might need a little bit of a refresher but let's start with a quick rundown on what the fed is and its role in curbing the economic downturn caused by the pandemic well that's a great question christina and thanks for having me again today in very simple terms the federal reserve is the central bank for the united states and what we are able to do is by taking an input and monitoring trends and conditions in the economy ultimately adjust conditions that provide a boost to economic activity when conditions warrant it as in the past year when we've been in the midst of the crisis and then at other times still recognizing that there may we may want to for example restrict activity if we feel as though inflation is becoming more of a concern so really trying to think about how broad conditions warrant an adjustment to the cost of money interest rates and borrowing costs you know you've been in the game for a long time you know what you're doing you watch the trends here in in the united states what do you see when it comes to the current health of our economy and where do you see it headed over the next year or so um so we've been obviously interacting a lot with dr gold and his team the past year because so much of the economy has been predicated on the path of the virus of the pandemic and now with the vaccines so much of what we've observed has been unevenness in the economy due to some of those developments for example we've seen some segments of the economy doing very well manufacturing construction activity very high some businesses in some positions some jobs have been okay whereas other parts of the economy have struggled thinking about restaurant closures hotels and travel those industries that have depended much more on people gathering that that disparity or that unevenness has still persisted and really much attention still being focused on the vaccines um due to the potential for optimism people may start moving around a little bit more yeah well you know the dow is still in record territory let's talk about consumer confidence and economic sentiment right now across the country how does optimism that covet numbers are falling and vaccines continue to roll out how is that playing into the broader economy i think the first thing i would say is that there are some expectations of economic activity beginning to pick up maybe later this year again much of that really is tied to very carefully following the path of the of the virus and of the vaccines we we follow all of the same charts that dr gold had shown to start out the program with because economic activity will depend crucially on what that looks like so i think that there are some there's been some increasing optimism that people will start moving around and and returning to behavior that they may have had in the past which is a good thing for spending a good thing for the economy so some some optimism but still some cautious optimism i would say absolutely and we look forward to continuing this conversation with you we want to go back to the phones for a moment though and bring fred into the conversation he joins us from michigan tonight go right ahead fred i want to know why we got kobe 19. we got that but i want to know why we got so many other variants out there running around are they introducing themselves from rogue nation yeah fred so you know unfortunately uh this has been predicted since the very beginning of the pandemic the the more the virus replicates the more it spreads the more likely it's going to make a mistake in its own genetic material the sars cov2 virus which is a novel coronavirus is an rna so-called zoonotic virus meaning it starts off in the animal world and then through a genetic mutation adopt to infecting human beings and once that happens as the amount of spread of the virus increases so does the amount of the mutation so perhaps a million to one the genetic mutations will kill a virus it will not be able to mutate anymore but that one in a million mutations that makes it more successful then starts to propagate and so you look at parts of the world where there's a lot of viral spread you're going to be seeing a lot of different mutations and so most of these mutations are very minor they're not consequential to either the fatality rate from the virus or to the ability to spread but the variance that we've been most focused on are those that are coming from the united kingdom that are coming from south africa and are coming from brazil and these variants are at least more transmissible and in some early studies there's some data that shows that they have higher case fatality rates so for that reason more transmissible and higher case fatality they attract our attention the real question is however is are these mutations significant enough that they can escape either our innate immunity after we've previously been infected that is to say our body's ability to fight off the virus or whether they can escape the effects of the vaccines that we have because the vaccines are very specific to a certain part of the protein complex of the outer shell of the virus now assuming both of those facts are incorrect that is to say these new variants are susceptible to our innate immune systems and to our vaccines that would be typical of most of the mutations we've seen and we frankly care very little if however either of those facts is untrue that is to say the virus can escape the vaccines or escape our own innate immunity and runs the risk of reinfection uh or what we call vaccine escape that's when we start to get really concerned about it and hence that's why we are so focused on some of these variants but there have been thousands of variants identified since the beginning of this pandemic and the overwhelming majority of them are non-consequential all right thank you so much for that call fred next up is carolyn from indiana thanks for joining us carolyn go right ahead if the virus is dead you know that's injected into our body why like with pfizer must it be kept so cold well the virus is there's no live virus or dead virus in the pfizer or the maduro products they are made from something called messenger rna which is the road map for our cells to build proteins that then stimulate our immune systems to create long-standing immunity to these viruses so what we're protecting is this very fragile mrna complex that is then used to stimulate our bodies to make these proteins but you're absolutely right some of these other vaccines do not have anywhere near as significant refrigeration qualification so for instance uh one of the very exciting things about the j j vaccine is that not only is it a single dose but it can be shipped under more standard refrigeration there was recently a report for instance that the pfizer product is stable for 14 days in a standard commercial refrigerator freezer i mean those are all things that we are really going to change the availability of these vaccines and frankly are going to be very very important in rural america where the ability to maintain that refrigeration is nowhere near as widely available as it is in large medical centers all right thank you so much for that call carolyn we appreciate it let's bring nate back in the conversation nate we've spoken with you and with esther george the president of the kansas city fed on what the fed is doing during the pandemic to curb that sharp blow to the economy interest rates adjusting those for example do you think your moves so far have worked and what other tools do you have that can help improve conditions going forward you know that it's a great question and you know going back to some of the earlier conversation i think a big part of what we want to be able to do is make sure that we're gathering input from many different parts of the country and it's a hard question to answer because i think there are some parts of the country that have seen conditions improved whereas other parts of the country are still struggling so for us trying to make sure that we're talking to as many communities as possible i think is an important part of that there are still some tools that the fed has in terms of trying to provide additional accommodation for right now as we've been in the midst of this for you know going on a year now it's really just trying to be patient and seeing how some of the conditions that we're observing connected to the pandemic or broader economic trends are evolving before deciding on next steps but there but we're still obviously recognizing that there are a lot of risks and some households still struggling with you know lack of employment from a fed perspective how is the pandemic impacting the ag economy in particular if we take it a little bit more on the granular level how is the ag imp the ag impact on the industry really playing out right now for our farmers and ranchers what are you hearing from them well it's been really interesting to see how that's played out the past year because going into 2020 there were maybe some concerns that agriculture was still in a fairly challenging environment that had been building off of the previous years we then saw conditions extremely concerning in april as many people remember some of the the closures of meat packing plants and other things that had corresponded with some of the shutdowns that were happening at the time since then we've actually seen conditions improve quite a bit in large parts of the country we've seen the price of some of our key commodities like corn and soybeans increase pretty dramatically so there have been some opportunities for many producers to see some some profits and and lock in some things for this year that actually has has improved a bit um and again like everything else though that's going to depend a lot on the conditions that we see globally and connected to the pandemic you know when you look at the broader economy right now and consumer sentiment are people saving more than their spending how is that balancing out right now yeah that's also a good question and going back to last year when there was a lot of stimulus being provided both by the federal reserve but also fiscal policy in the form of government payments the tendency is often when households or businesses feel that there is a lot of uncertainty that they do tend to save a bit more and so we've seen that transpire the past year with some of the stimulus some of that is understandable as there is still a lot of uncertainty about the job market about where maybe the ability to pay the rent might come from so the hope is that as some of the vaccination process improves and as we start to see a reopening of some of the economy that some of that spending may pick up and benefit the rest of the economy as well all right i appreciate having you on board and just addressing these questions i know they're not the easiest of questions but you do such a good job every time you join us so thank you for your expertise next up we're going to go back to the phones nancy from north carolina joins the conversation nancy [Music] all right we're going to go to philip of indiana thanks for joining us phillip go right ahead yes uh christina thank you for having a great public service thank you for a great rfd tv and my question is um i'm an older retired farmer i'm 71 reasonably good health i had my first flu shot i had my uh our regular flu shot and then i had my first shot of pfizer and my second shot of pfizer and my question is do you think i've been told since it's pfizer i've been needing another one and they're also i've heard rumors that we may need one every year so i just wondered what the the doctors thought was our back yeah philip great question and uh the most truthful answer is uh we don't really know at this time but i'll tell you what my best guess is that yes we will need a boost and uh whether that'll be six months or nine months or 12 months from now i think a lot's going to depend on what happens with these variant virus strains that we've addressed a little earlier in the show but the current projections are that the uk b117 variant will become the most prominent variant in the u.s by mid-march to late march and if that's the case that's going to increase the infection rates a bit uh and so it's a it's a race between getting immunity due to the vaccines and how fast these variant strains will progress we are currently both here in our medical center but the cdc and many other large universities are actually studying the persistence of immunity let's not forget that when these vaccine trials were done they were based on 60 70 80 days of experience with these vaccines that's a very short amount of time so we know short term they're extremely effective what we don't know about is how long that's going to last so i would say if we can get our our nation and for that matter our economy our schools our churches our businesses back to a near normal state and the worst price we have to pay for that is another jab in 6 or 12 months sign me up for it all right thank you so much for that call we sure appreciate you phillip next up patty from south dakota joins the conversation thanks for joining us patty go right ahead thank you thank you dr gold i have a question for you here where i live people are declining to take the kovid shot and it concerns me because they're scared that it's new can you please give us a history of like when it the coronavirus was discovered and i believe 1960 and it was then really researched in the 90s could you explain to the listeners that this is not a new new thing it actually has been researched for a long time thank you very much well you're exactly right patty we have known about the impact of coronaviruses you know think about you know i've been practicing medicine for a long time but i think back to my medical school days and we learned about coronaviruses when i was in medical school so we've known about the impact of these viruses their structure how they impact people for a very long time now this virus the so-called novel sars cov2 virus is a little bit different than the others but it falls into this large category that we know a tremendous amount and by the way in terms of these mrna vaccines that have been developed we've been researching the science on mrna vaccines in this nation alone let alone worldwide for more than 10 years so we have a lot of experience in developing mrna vaccines now there is no question this is the largest rollout of mrna vaccines in our history but there is no reason to believe based on the extensive amount of data that we have today that these vaccines are not effective and that they're not safe so put it in the positive they appear to be extremely effective and extremely safe i mean the the serious event rate associated uh with these vaccines is roughly about two per million injections i mean uh compare that to uh one percent chance of dying from the virus nationwide and if you're an older individual i mean if you look at our long-term care facilities here in nebraska and and compare that to across the united states i think as of last weekend 38 percent of all of the deaths in the united states occurred in those facilities so if you can get a and and that 2 per million infection a 2 per million event rate is just the number of people that have an event i mean the number of deaths are you know reportable on one hand so nothing is completely safe and nothing is completely effective 100 effective but if you wait getting the infection and what that does to our hospitals and to our economy into our schools there is no question that these vaccines are both safe and effective and should definitely when you know my advice to our communities that we serve here is that when your turn comes roll up your sleeve and get the vaccine all right you know let's talk about side effects for a moment because we often get viewer questions about side effects whenever you get a vaccination or even a flu shot for that matter are side effects part of it and are you seeing that seniors are more likely to have side effects to the actual covet 19 vaccination yeah so we don't call them side effects we call them vaccine reactions because the overwhelming majority i mean things like soreness of your arm perhaps a low-grade fever a little bit of malaise perhaps a headache those are not uncommon particularly after the second dose they typically last a day or so and then they're gone tylenol is a very good treatment for them and we don't recommend ibuprofen if you can avoid it however those are things that demonstrate the fact that your body is responding to the vaccine which means you're making antibodies that are going to help you knock off that virus if you are exposed to it so those are the things we actually want to see it turns out the and by the way after the second dose uh the numbers vary a good deal by age and and other factors but it's somewhere between five and seven percent perhaps in some populations as high as 10 percent but in the older age population particularly those over 75 the numbers of even immune reactions that we're seeing are far smaller and so in the you know in the under 18 age group that we're currently doing research with to see about rolling this viral vaccine program out to obviously we want to make sure that we have immunity in our school-aged children but you know we're trying to get a dose down to a level that will create immunity without causing a lot of these vaccine reactions whereas in the over 75 population the number of reactions are really fairly few and far between and and not severe all right thank you for answering another tough question nate let's bring you back into the conversation for a moment because a lot of us are kind of looking around we're seeing that traffic is not coming back to what it used to be at least not yet and we've all talked about going back to normal will that happen or do we need to change the way that we look and do things after the pandemic and its economic impact what are you expecting to change and maybe go back to normal well i think that at least some of the things that we would expect would return back to a bit more normalcy would be things related to going out to eat at a restaurant or some aspects of travel i think some of the things that we are obviously still trying to understand to what extent they may be permanent for example would be people choosing to work from home for a part of the time or maybe being a little bit more reluctant to take an international trip some of those sorts of things that may still take some time to see how they play out so what that means i think in the end is that you likely will see some industries som sorts of jobs that will improve more quickly than others and some businesses that may still struggle for some time as they're trying to figure out what this looks like longer term yeah i think that's kind of what we're all wondering right now and hey if traffic doesn't come back i don't think a lot of people are going to complain about that across the country especially in rural america all right 877-731-6733 is the number to call and join our conversation tonight we're going to pause for a quick break but we still have time for your question want to make sure that you get answers from the experts that's why they're here moral health matters right after this welcome back to rural health matters joining us once again dr jeffrey gold the chancellor of the university of nebraska medical center and tonight nathan kaufman the vice president and omaha branch executive with the federal reserve bank of kansas city joins the conversation as well we still have time for your call 877-731-6733 ryan of indiana joins the conversation thanks for joining us ryan go right ahead yes um i live in wayne county indiana and every year on average 930 people die and in 2020 i call the county health department there were 1120 people who died and also every year in the united states between 60 and 80 000 people die from the seasonal flu and this year no one died from the flu and i'm just wondering what the doctors think about all that well ryan they're both very valid points and i'll address them both for you uh the first is let's talk about the flu the prevalence of typical seasonal influenza just like we saw six months ago in the southern hemispheres uh for us u.s wide and indeed across all of western europe and other parts where we have data have shown almost complete obliteration of the flu and the amount of hospitalization that we've got due to influenza across the u.s is markedly down and it just makes the point that social distancing hand sanitizing face masks avoiding gatherings the same thing that stops the spread of covid dramatically changes the incidence of influenza however if you look at the mortality rates across our nation since the beginning of this pandemic and you track that against the number of confirmed cases of covet-related death what you'll see depending upon the state and the community anywhere between a 25 and a 50 percent higher rate of death and what that is definitely attributable to is the non-confirmed deaths that are due to covet or covid related that is to say there are people that are passing away at home in long-term care facilities hospitals etc that may not have a confirmed diagnosis of covid at the time that they pass away and as a result of that because their diagnosis is not confirmed they're not classified as a covet-related death they may be a so-called pui a person under investigation for covid but if you don't have active confirmed laboratory covid uh the individual who passes away is not confirmed as a covert death and those statistics are stunning so you know we talked earlier about 500 000 americans that today and since the beginning of the pandemic have lost their lives to this disease those are individuals that have had confirmed cases of covet that number is probably far closer to a million americans which is uh just uh beyond belief to think about what that could mean to our nation in such a short period of time and by the way is not over even though we're just crossing the half a million confirmed case mark uh it would not be at all surprising if we cross 600 650 000 before we can put this in the rear view mirror so all the more reason to take care and to observe the precautions and as i understand it dr gold the pandemic has actually decreased life expectancy in the u.s did you hear about that sure well let's face it uh being the fact that the older americans are more vulnerable that if you look at the mortality statistics uh individuals over 70 or 75 are looking at a 20 to 25 percent mortality uh you know i there were some statistics that were published uh that looked at the populations by state and i won't mention the states by name but where one or two percent of their populations over 75 passed away due to covet not one to two percent of their nursing home residents one to two percent of the entire state population over that age group that's a dramatic change in life expectancy and it's heartbreaking as well because those are family members those are fellow americans that we lost to this pandemic let's switch back to the economic side of things for a moment nate how does this economic downturn compare to other periods of economic distress in this country yeah we often do compare how this last recession the last year or so has compared with for example what we often describe as the financial crisis in recession in 2008 and 2009 that particular crisis was very different if people remember there would have been obviously concerns with the housing sector banking and other places that generally made that recession very different we saw certain kinds of jobs being affected much more than others and it wasn't the services sector so much that was affected in that last recession what's been very different about this recession is because of you know obviously people avoiding gatherings and doing things where they're where they may be required to travel is that those services industries have struggled a lot more so you know it's affected a different segment of the population and affected different households differently just based on you know the nature of this crisis versus those that we've seen in the past you know let's try to break it down a little bit more if we can for our audience talk about the fed's connection to rural areas and the indicators that you look at in terms of agriculture community banking and other issues how is rural america faring well rural america has actually been maybe a bit better the last few months than some other places simply because we have seen some conditions in agriculture improving a bit more many of our viewers will know that in this in the six and seven years prior to this agriculture had been struggling a bit commodity prices had been low farm incomes had been down and so in large parts of the country it had been a challenge that's not to say though that every every industry or every region is experiencing that the same and that various is as a theme of of what we've been seeing this past year is that some regions are doing much better than others and so we've seen some some places maybe doing a bit better but um also still recognizing that there's a lot of risks to be aware of you know you sure do watch out for our farmers when it comes to mitigating those risks you were very highly respected among the ag community i don't know if all of our viewers know that i want to make sure that they do all right we're going to go back to the phones nancy of north carolina joins the conversation now thanks for joining us nancy go right ahead thank you and we sure do appreciate this program and y'all been having about because it has been very very informative and we'd like to thank y'all for doing that and also my question is well we're scheduled to get our vaccine second vaccine next week and we were just wondering we've got our family members kids grandkids that are you know not eligible right now for it because of their age how long will we be considered safe in order to be around them and them not vaccinated are we safe after our two weeks or three weeks or four weeks or what well nancy you know people ask that question uh all the time and unfortunately the vaccine well let's take the positive side of it uh two weeks after your second dose your antibody response is going to be as strong as it's probably going to be at any time unless you're actually exposed to the virus again but it's not a hundred percent certainty that you're completely protected from either getting infected or from heaven forbid getting hospitalized or even passing away as a result of this it's probably going to be you know no one has a crystal ball but i'm guessing late summer early fall until we can achieve herd immunity and there are a lot of different factors that go into that prediction one has to do with the availability of the vaccine second has to do with the willingness of our communities farmers and ranchers people that live in our big cities to roll up their sleeves and get vaccinated thirdly has to do with the prevalence of these mutation strains we've been talking about for some time now but all things being equal that's probably when we're going to put our masks aside a bit and begin to resume near normalcy uh in our communities so i would say to you uh you know until your grandchildren and children are immunized you will be safer two weeks after your second dose of vaccine but will that give you the safety to be with them without a mask without socially distancing uh you know my best advice to you is probably not so you know you can be with them but wear a mask maintain some distance it's a heck of a lot better than not being able to see them and that's been particularly helpful in our long-term care facilities across the country because this amount of social isolation that has occurred in these settings has been absolutely dramatic and the ability to get family members in even if socially distanced and wearing a mask to meet with some of our senior citizens and to express their love to them has been critically important so all the power to you and i i wish you the very best and time always time you want as much time with the ones that you love as you can get so you want to keep that in mind as well and especially when you think about those in nursing homes all people want is more time all right we are going to go back to the phones terry of florida thanks for joining the conversation go right ahead hello dr gold uh i'd like to know if there's any possibility of having an oral vaccine any time within the near future yeah so i am not aware terry of at least of the vaccines that are currently in phase 2 phase 3 trials of an oral variant of that and that is because the digestive enzymes in your stomach would probably render the protein constructs are not viable now at some point it may be possible to develop a vaccine that is immune to your gastric protein and then when it gets into your small bowel into your gut that would be absorbed and and make you immune similar to some of the polio vaccines that we've been using uh for a long time there are of course flu vaccines that are nasally administered just a quick spray and you breathe them in so those are maybe in the pipeline down the line but right now of the major uh warp speed products that are available and in production in the united states certainly the major products that are available in russia china and india to the best of my knowledge and i hope somebody corrects me on this if i'm wrong are injectable products all right i want to pose this final question to both of you and it's kind of a tough one i'm sure there was a definitive answer but we probably wouldn't be doing this show right now but when do you think that we can say that we're safely out of the woods from the pandemic are there markers that we're going to be looking for economically and medically i'd like to get an answer from both of your perspectives dr gold let's start with you well i think from the medical perspective it's all going to be driven by hurt immunity and what is referred to in the medical world as zero prevalence of antibodies that is to say when we get to the point that our antibodies that you and i have either as a result of infection or as a result of vaccine will be adequately effective to protect us from subsequent infection of the current variance and future variants of the virus that's when we're going to be back to near normalcy now all of those things being equal the current fda and cdc projections are for believe it or not october 26th now that is predicated on the current rate of production and availability of vaccine it's predicated on americans rolling up their sleeve when their turn comes and getting immunized now hopefully production will double and hopefully americans will roll up their sleeve uh when the time comes but those are two big ifs and if that if neither of those turns out to be true that is to say we can't ramp up production and that if there is hesitancy of a significant amount to the vaccines that are currently available all bets are off so we need to stay laser focused on getting these vaccines out and when they come to your community and your turn comes please show up dr gould would you say that getting everybody vaccinated is the best route to economic recovery without a doubt anything that we can do that will stop the transmission of this virus eliminate hospitalization allow our businesses to open our restaurants our hotels our travel industry etc and many many of the other small and large businesses in our country uh that's the security that we need and then we need to take the technology that we've learned and focus it on cancer and focus it on inflammatory diseases autoimmune diseases etc we have learned so much from this we're going to have a whole new armamentarium of drugs to fight these other diseases and that's where i think a lot of the economic prosperity and quality of life is going to come from and in the near future and maybe that technology will save more lives than we actually lost down the road so i appreciate you bringing up some optimism that's great to hear that dr gold all right nate what key indicators are you looking for when you can say that we're safely out of the woods economically well one of our main goals at the fed is really to ensure that as many people have employment opportunities as possible that they would feel optimistic about their opportunities in the broader economy so we're looking at things like job market data we're looking at wages we're looking at other metrics that you might consider as it relates to household finances and we do feel optimistic that we will see a pickup in some of that activity and very much ties into what dr gold's comments were about vaccination and thinking about how people are maybe moving around a bit more freely so we're looking toward the latter half of this year and feeling more optimistic that we might see some improvement but still recognizing that if people have you know maybe change their behavior about how they see opportunities for employment or or some of their buying habits there may still be some risks out there so part of our concern is still recognizing that some people may not see the same kind of opportunities as others just as some of the longer lasting effects of the pandemic endure okay well we only have a few moments left i got to ask all my questions dr gold do you have any final thoughts maybe something you wanted to say that we just didn't get to tonight yeah you know christina there is no question that there's light at the end of the tunnel and there's a lot of good reason to be optimistic but this is a time to really bear down on the non-pharmacologic interventions to continue to wear your mask socially distance and do all of the things that we know work until we can get to that point of successful herd immunity i am very confident that the vaccine pipelines will continue to expand but we just need to be super vigilant until we get there so this is a time just to bear down and do all of those things that we know work and as a result of that we will save lives on a daily basis all right thank you both so much for joining us tonight unmc chancellor dr jeffrey gold and nate kaufman the vice president and omaha branch executive of the federal reserve bank of kansas city we know how precious both of your time is we really sincerely thank you for being here for us now if we didn't get to your question tonight you can still get it in leave us a voice recording with your question on our hotline i want to give you the number you might want to grab a pen but if you have a pen you write it down you can leave us your message at your convenience and we'll get it answered on the next show that number is 855-776-6147 and remember we will be here for you every monday night ith brand new live episodes of rural health matters 6 eastern 5 central right here on rfd tv rural america's most important network thank you so much for joining us wishing you and your family a beautifully blessed evening we'll see you next monday