January 23, 2021

Questions about COVID-19? — 1-23-2021 (video)

Watch the latest community update on COVID-19 and Mission Health, including information on the COVID-19 vaccine, the numbers of local cases at Mission Health and more from William Hathaway, MD, Chief Medical Officer for Mission Health.

(Video transcript)

[Nancy] Hi, I’m Nancy Lindell, public relations for Mission Health, and I’m here today with Dr. William Hathaway. He’s our chief medical officer for Mission Health and HCA’s North Carolina division. We’re here today to give you an update on our COVID numbers, and also to talk a little bit about the vaccine, and answer some frequently asked questions that we’re hearing. Hi, Dr. Hathaway. Welcome.

[Hathaway] Thank you, Nancy.

[Nancy] Thanks for joining us today, to talk to our community about how things are going at the hospital. What are we seeing? What are the trends? How are the numbers post-holiday?

[Hathaway] Thank you. I’m glad to be back here. It’s been a while since we’ve updated the community, and so to have an opportunity to share some information has really… I’m grateful for that. The numbers are interesting to say the least. We of course, had the Christmas and New Year’s holidays, that led to a rise in the cases after that time. But I am at least hopeful, if not pleased, that we have not seen quite as high a rise as I would’ve thought. We peaked about a week ago, in terms of the total numbers in the health system, and since that time we’ve been flat, with a slightly downward trend over the last couple of days. Now we’re three to four weeks out from Christmas and New Year’s respectively, and so I’m hopeful that we’ve seen the worst of what we were going to see from the gatherings that took place at that time.

[Nancy] And from what we were seeing with the rise, we were looking at… I think I looked back at December 1st, and we had 49 people in Mission Hospital at that time. And we, this morning, had about 120, 30 people in the hospital. So, it’s a significant rise. Even though we flattened out a little bit from continuing to rise, we still have a lot of people in hospital.

[Hathaway] If you go back to right before Thanksgiving, we had a more than tripling of the total numbers in the hospital and the health system, and the same kind of numbers we’re seen both locally, in other health systems, and across the state. The hospitalizations peaked about six or seven days ago across the state, and they’ve been flat, or slightly down since that time. But dramatically higher than before Thanksgiving. We’re learning to live with the higher numbers, I guess.

[Nancy] And we’re also seeing… just to explain to people…. when we have these gatherings, like Christmas and that sort of thing, we see at the hospital sort of delayed rise. I mean, the cases increase across the state, but the hospitals see that increase a little bit later.

[Hathaway] Typically, the sequence of events goes, a rise in cases… that’s usually seven to 10 days after a mass gathering or an event… and then a rise in hospitalizations 10 to 14 days after that. And then the deaths follow 14 to 21 days, because when people get sick of course, it takes time. What was interesting to me, is that our peak was really seven to 10 days after Christmas, we started to see the hospitalizations. So it was a little bit earlier than I had expected. I’m not really sure how to explain it. I’m just grateful right now that things have stabilized. And we hope that with people’s continued attention to wearing masks, and waiting six feet apart from each other, and washing their hands, and just practicing good, for a lack of a better word, social hygiene, that we’ll see a continued plateau, and hopefully a drop in cases.

[Nancy] That would be wonderful, if that would happen. As we look ahead, I know the community is excited right now. The world is excited right now. We’re starting to vaccinate people. We’re starting to come out from this. But as you said, we need to continue to be vigilant. We’re not out of the woods by any stretch.

[Hathaway] No, we certainly aren’t, and the vaccination process has begun. It was December 17th that we received our first vaccine shipments, which was, as everyone knows, just a really remarkable feat that we had safe and effective vaccine produced in such a rapid time period. And then we started vaccinating the very next day at Mission Health System, as did other places in the community. And for our hospital system… and we focus predominantly on that 1a group, which is the healthcare worker group, and we’re still finishing up that group… we vaccinated over 6,000 people with first doses, and an additional 3000 people with second doses. So, we’ve administered over 9,000 vaccinations. If you look across the county, across the 18 county region, similar kinds of numbers as we’re trying to get vaccinations in as many people as possible.

[Nancy] And that’s pretty amazing considering, as you said, that was December 17th, and here we are about a month later, looking at almost 10,000 vaccines administered. So that kind of gives people a good timeline, as to how this process is rolling out.

[Hathaway] And it’s for 400,000 across the state so far. Now that seems like a big number, but I got to tell you, that we need to get to 7 million people in the state, which is about 70% of our population, before we’ll really get the benefits of what vaccination can look like in terms of preventing spread in the community. So we have a long way to go, and we knew beforehand that it would take time. It just takes time to get the vaccines into people. And so we asked the communities’ patience, as we target different patient populations.

Right now, the state has asked us to focus initially on healthcare workers, who are facing COVID patients, and skilled nursing facility workers, who are taking care of the most vulnerable in our population. And then those elderly people who actually live in skilled nursing facilities. That was the first group that we’ve targeted. Since then, the recommendations continue to change. They’ve added on additional tiers. And now the state is asking different groups to approach the 75 and older population initially, and then more recently it was opened to 65 and older. So those groups will continue to evolve and open up over time, and we’re just hopeful that people will one, be patient, and two, then get their vaccine. The state has a campaign called, Your Spot Your Shot, and we want everyone to get the vaccine. We believe they’re safe and effective.

[Nancy] Well to that point, there’s a lot of questions out there about the vaccine. Some people can’t wait to roll up their sleeves. Some people are a little nervous about it.

[Hathaway] Sure.

[Nancy] So you’ve had the vaccine, I’ve had part of the vaccine, what was your experience like?

[Hathaway] So my experience was good. To me it was very similar to any vaccine that I’ve gotten in the past, and most recently, for me of course, my age group, it’s the annual flu vaccine. And typically you have a little bit of local tenderness or soreness, but they’re very small needles, and the actual injection itself is almost imperceptible, you don’t feel a thing. There’s some site tenderness later. I had no side effects after the first vaccination, and then following the second vaccination, which was for the Pfizer vaccine, which is the one I received 21 days later, I had not unexpectedly, a little bit of muscle aches, a little more tenderness at the site, and just some feelings of tiredness. Other people told me that they’ve experienced low-grade fevers, and that’s what we expect based on how the vaccine works.

If people remember the principles of vaccination, what we’re doing is stimulating an immune response in us. We’re giving something foreign to our bodies, that our bodies recognize as not part of us, and then our body kicks in and it does two things. It produces antibodies, and it produces a cell-mediated immunity, to fight off the infection later. And that process, when we get that, it’s very similar to a lesser degree, of having the infection. We’re fighting off… A lot of our symptoms that we feel in a viral illness, are related to our bodies’ own response to fighting off that infection, a release of a host of different chemicals, interleukins, and other inflammatory mediators, that make us just feel run down, that achiness, the fever, the chills. And so, probably 10, 15, 20% of people are experiencing some low-grade symptoms that last about 24 hours. They’re very easily handled with ibuprofen, other nonsteroidal anti-inflammatory drugs, or Tylenol. And that’s what we recommend people take, to help blunt the side effects that they might experience.

[Nancy] So some of the questions that I’ve heard from the community… I just sort of gathered in my mind a few things that I think people might want to know the answer to… and one question I’ve had is, “When you give the vaccine, are you giving the COVID-19? Is that within the vaccine? Is that how it’s made?”

[Hathaway] So the vaccines that are currently available in the United States are two. One is produced by Pfizer, and the other is produced by a company called Moderna, which is out of Boston, Massachusetts. And both of those vaccines are a new technology, that’s based on something we call messenger RNA, or RNA. RNA is the chemical in the virus, the genetic material that allows the virus to replicate. And we’ve taken a segment of that viral RNA, that codes for a protein, and then when we inject that into people, our bodies actually produce that protein, and then we respond to that protein to make the antibodies I talked about before. But there’s no live virus, there’s no attenuated virus. It is biologically impossible for people to become infected with COVID based on the vaccination. All that we’re giving them is a little piece of protein, that then produces another protein, that our body recognizes as foreign, and that we fight off.

[Nancy] And then, as far as people getting vaccinated, wondering, “How long’s that going to last? Am I going to have to get vaccinated every quarter, or every three months, I’ve heard it only lasts?” That kind of thing. What do we know, to this point, about that?

[Hathaway] So optimistically, we’re hoping for lifelong immunity. We won’t know, because we’re just early in the process of gathering the data to know how long that lasts. We do have very good safety data now… coming out for almost six months out from when the vaccines were produced… that says, both one, that it’s safe. That there aren’t serious long-term sequelae or side effects that we recognize. And number two, that there are measurable antibodies and immunity, related to having had the infection. So I can’t give you a definitive answer, only because there hasn’t been enough time, but there’s no reason to believe that we wouldn’t have at least moderate, if not long-lasting immunity.

I think it’s important also, when we talk about that, to remember that, while these vaccines were reported to be 90-plus percent effective, 94, 95% effective, they were effective in the setting of continuing to wear masks, and continuing to practice social distancing. And so, that’s critically important. At least at this early stage, it’s very important that people don’t forego the barrier methods, both space and shielding, that protect us from the virus, and washing our hands. That, coupled with the vaccine, gives it 95% effectiveness.

[Nancy] I was expecting our numbers to rise after there was a lot of rallies and gatherings before the election, and I thought we would have a rise in cases at the hospital, and that did not materialize. It did however, after smaller indoor gatherings. So as you and I sit 12 feet apart, that really is still the standard, to wear your mask, to not gather indoors in small gatherings, and to social distance still, until we can get through the number of people we need to be vaccinated.

[Hathaway] I think you’re exactly right about that. If you’re with people whom you live with all the time, obviously we can’t wear masks all the time, or we’ve made that concession that we’re not going to. But when you’re with people who are outside your own household, it’s really important that you wear a mask. And even after my two shots that I’ve received, and theoretically with full immunity at this point in time, I wear my mask all the time. Both as a message, and as a sign of respect, but also because that’s how the studies were done, and I want to be sure that I have maximum protection, and that I don’t share the virus with someone else.

[Nancy] And that is still possible. So you can’t be infected with the virus, or get sick from it, but you could carry it to somebody else.

[Hathaway] It’s really interesting. So if you look at the two large clinical trials that were done with these viruses, a total of 77,000 patients, there’re about nine, 10, 11 in each of the two trials, that actually became infected, after they had received the vaccination. So like we said, it’s not 100% effective. For those who were infected after being vaccinated, their symptoms were not severe. There was a mild illness. So although they had the illness, it was mild. But that tells us, that while this gives us something we call effective immunity, or disease-limiting immunity, it’s not a bullet proof vest, okay? It’s not sterilizing immunity that prevents you completely from not being infected. It does dramatically decrease your likelihood of being infected, and it dramatically decreases your chances, if you are infected, of spreading it to someone else. And that’s why we’re pushing for widespread vaccination.

[Nancy] So as the state continues to distribute the vaccine to us, initially because we are vaccinating our workers, of course, and then as they continue to distribute to the local health departments and that sort of thing, what kind of timeline, or not really timeline, what can we tell people? Where should they look? Should they be looking at their county health departments to find out when their tier is, and when they might be able to get vaccinated?

[Hathaway] I think it’s a constantly moving target. Our ability to vaccinate people, depends on two things, one is the supply of vaccine, and the second is people to administer the vaccine. And if we were to try to vaccinate… I ran the numbers previously… and if we were to try to vaccinate 7 million people, which is 70% of our population in North Carolina, and get them all done in a year, and it takes two vaccinations per person, we need to be doing 40,000 vaccinations a day, for a whole year, across the state. And so that’s a big number, and we’re not quite at that number. We’re ramping up and we’re trying to get it distributed to the Walgreens, and the [CVSs 00:14:36], and the Walmarts, et cetera, in addition to the health departments, and to doctor’s practices, but we’re not there yet. So, that information will come out. Right now, the best place for the community, is looking towards the health departments, and we will make sure that we post on website, available information as it comes to us.

[Nancy] So Dr. Hathaway, I think there’s a lot of people out there looking forward to getting the vaccine. There’s some people hesitant to do it. What would you say to anybody who’s hesitant to get the vaccine? What safety concerns are there? Do you have any? What would you say to that?

[Hathaway] The first thing I’d say is, I appreciate people having an apprehension. I think it’s healthy for us to understand what we’re doing, and why we’re doing it. And so anybody who comes to me and expresses concern, I understand that. At the same time however, I want to reassure people, that I believe, and that the science supports, that the vaccines we have against this virus, are truly safe and effective. It’s true they were developed very rapidly, but that’s because we had an urgent need, and we had large amounts of patients that we can enroll in trials to prove the safety and efficacy. The speed with which we did it, didn’t compromise our principles that we use to approve vaccines, or medications, or any other therapies. In particular, these two trials that were done for the Pfizer and the Moderna vaccine, they enrolled almost 80,000 patients between the two of them. And in those 80,000 patients, they showed a marked reduction, a 95% reduction, in the number of people who were infected.

And up to five, six months out now, from the administration of these vaccines in the trial population, we have not seen any serious side effects. Are there side effects? Sure. There’s local tenderness, and swelling, there’s some myalgias, muscle aches, joint aches, some fever, some viral type symptoms that people experience, but we have not experienced any major, serious, life-threatening side effects that we’re aware of. Now there’s a small portion of patients who have an allergic reaction, and we have to watch for that, but in terms of long-term scientific problems, we haven’t seen any.

And the science behind these vaccines would not suggest that, that’s likely. There’s not additives or chemicals in the vaccines that we know of that are causing a problem, and this RNA technology that we’re using, is really safe and effective, and does not have any known side effects at this point in time. Now I’m not going to be so bold as to say, we won’t learn more going forward. We’re gathering data every day. We’ve administered 16 million doses already of these vaccines, and we’re gathering the data on those patients. And if we discover something, we will let people know. But right now, I’m confident enough that I took the vaccine myself. I’m confident enough that I’ve recommended to my family, when they’re available to get it. And so I would tell people, that I have full faith that it’s something that can be safely administered.

[Nancy] I think on that point, it bears noting that the hospital employees are not being required to get the vaccine, so the fact that you received it, was voluntary on your part.

[Hathaway] That’s right. And the other thing I want to bring out is, we tend to see, in certain what we call historically marginalized populations, or people in lower socioeconomic groups, or different ethnic and racial groups, a fear, or a tendency to avoid vaccines, and/or new therapies, because of an… just what I’m going to be blunt about… is an inherent mistrust of the medical community. And there’s a whole host of reasons for that, and I appreciate where that mistrust has come from. That population, the people of color in our community, the people who are frontline workers, the people who are facing COVID every day in their daily lives, are the ones who are disproportionately affected by the virus, and they’re the ones who will disproportionately benefit from getting the vaccine. So, if they have concerns, if you find yourself in that group, I want to tell people, reach out to your family physician, reach out to healthcare provider, get your questions answered, and then we’d really, really strongly encourage you to go ahead and get the vaccination.

[Nancy] And we do have information on our website, @missionhealth.org, that you can visit, and look up in the Frequently Asked Questions. If you have concerns, read about the vaccine. Read about how it works. That’s what I did. I read about it to figure out what this technology was, how they were going to be using it in different ways that don’t even regard COVID. So there’s a lot to be learned there. It always pays to do your research, right?

[Hathaway] Absolutely. I also think that we’re going to be seeing a host of new vaccines come to market over the next three to six months. Some of those vaccines will be a different technology. We have long used, what we call inactivated virus vaccines, where the virus has been inactivated and we still develop an immune response, but it’s not capable of reproducing in our bodies. I suspect we’ll see some of those come to market. There are some additional ones where we’re actually injecting, not this RNA chemical, that I spoke about previously, but a protein into the body from the virus, that the body develops this immune response to, this protective immune response. So there’ll be more and more technologies come out, each virus… or vaccine… is a little bit differently, but it affords the same protection against the virus.

[Nancy] I think I read somewhere too that, maybe it’s the Johnson & Johnson vaccine, that you only need one of those. Is that something you’re seeing too?

[Hathaway] Yes. I mean, if you think about measles, mumps and rubella, as our childhood vaccination series, those are given in a series, so we get this booster effect. We prime the pump as it were, the body recognizes it as a foreign substance, and then as we’re stimulated against it again, it comes back into our body, we have a booster effect which affords additional immunity. Some vaccine technologies require that, others don’t. It just depends on how the trial’s been conducted.

[Nancy] Well, I hope that answers some of our vaccine related questions for today. Thank you so much, Dr. Hathaway. And I think we just want to close with reminding everybody, that we still COVID wary, that we all need to be vigilant in wearing our masks, waiting 6 feet apart, and washing our hands, and just social distancing still, until we can get everybody vaccinated.

[Hathaway] I think it’s important that we remember, that there are certain people who really are on the frontline, and those are all the workers who are involved in healthcare, both at the hospital, in the community, and our frontline emergency medical technicians and others. And then also, the group of people who are volunteering to help get the vaccination into people. And I want to get my deepest and most heartfelt thanks to them for the work they’ve done, the work they continue to do, to help our community heal from the illness and prevent the illness from spreading. They’ve been described as heroes, and they remain heroes today.