April 30, 2021

Questions about COVID-19? — 4-30-2021 (video)

Watch the latest community update on COVID-19 and Mission Health from William Hathaway, MD, Chief Medical Officer for Mission Health.

(Video transcript)

[Nancy] Hi. I am Nancy Lindell, Director of Public and Media Relations for Mission Health and HCA’s North Carolina Division. And I’m here today with Dr. William Hathaway. He’s our Chief Medical Officer here at Mission Health and HCA’s North Carolina Division. And we are giving an update on our COVID numbers, and also wanted to talk to you about vaccines today. So, welcome, Dr. Hathaway. Thanks for joining us today.

[Dr. Hathaway] Thanks Nancy, I appreciate it. It’s been a while since we’ve been together, so it’s good to be…

[Nancy] It has.

[Dr. Hathaway] …Back here sharing information.

[Nancy] Well, one of the reasons we haven’t been much together and I guess we can start out there is that since mid-January, our COVID numbers and hospitalizations have gone down.

[Dr. Hathaway] Yeah. Absolutely. We saw a tremendous rise that began actually in late November and peaked in the second week in January in western North Carolina with respect to cases and hospitalizations. Just as a reference, Mission Hospital itself had at its peak about 140 patients in house with COVID-19 illness. And that number dropped pretty dramatically and significantly down to the low teens in March. And then we’ve since rebounded a little bit up into the 20 to 30 to 40 range for patients hospitalized at Mission Hospital.

[Nancy] Well, in any event, it’s really nice to see things start to return to some sort of normal, but we are not out of the woods yet.

[Dr. Hathaway] Yeah. I think you’re exactly right when you say that. The new normal will be some low-level activity of COVID in our community, and that’ll depend on how much people practice their social distancing and how quickly people get the vaccines that are now becoming increasingly available. We know the vaccines are highly effective and safe at decreasing the transmission and decreasing the severity of illness. And we know, of course, we’ve known from the beginning that practicing the social distancing, wearing the mask, washing your hands, waiting six feet apart, minimizing that intimate contact in an unvaccinated state really decreases the spread of the illness too.

[Nancy] And now we’ve reached a place where the vaccine in our area is pretty much open to everybody. 16 and older are starting to be vaccinated, my daughters have been vaccinated.

[Dr. Hathaway] Well, right now, as you said, there are three vaccines available. The first two that came to market worthy, MRNA vaccines produced by Moderna and Pfizer. Those are vaccines which require two separate injections, 21 to 28 days apart for maximum effectiveness. And we learned in a series of clinical trials that they were both highly effective and highly safe at decreasing the spread of the disease.

[Nancy] With regard to the MRNA science behind the Pfizer and Moderna vaccines. There’s a lot of rumblings out there, especially if you pay any attention to social media, from some are concerned about getting the vaccine.

[Dr. Hathaway] So, in vaccine technology, our goal is to introduce a foreign substance into the body. In this case, it’s a protein that the body then develops an immune response to. When we get infected by something, our body produces antibodies and develops immunity to that infection. And what we’re doing with vaccine technology is creating an artificial exposure so that we develop those same antibodies and immunity without having to have the illness. And so what we’ve done in this circumstance is we take MRNA, which is one of the building block blocks of life, and it codes for proteins.

[Dr. Hathaway] And specifically, it codes for a protein that is produced by this virus. So we inject it in these small micro bubbles, the body recognizes that produces the protein, and then we produce antibodies against that protein. It cannot integrate into your DNA. There is no vaccine related chip technology that tracks people or sends any information to the government. None of that actually happens. And the studies show that it’s 95 plus percent effective.

[Nancy] So when you talk about 95% effective, you are looking at 5% of people who are possibly still going to get the virus. However, not as seriously as if they weren’t vaccinated.

[Dr. Hathaway] We see that every year with the flu vaccine. We know that the flu vaccine on average is 60 to 70, sometimes 80%, sometimes 50% effective, depending upon the strain of the virus that we’re seeing in a given year. And so we don’t expect this to be 100% effective. We do know, however, that even if you get the illness, having had the vaccine previously decreases the likelihood dramatically that you’ll have any serious sequela from it, and almost takes it to zero that you’ll die from the illness.

[Nancy] Of people who have been vaccinated, who maybe have had a unique reaction to it that’s more than just some fever, chills, that kind of thing, what are those circumstances and what causes that?

[Dr. Hathaway] Well, the whole goal is to set up that immune response and that immune response releases a series of chemicals within the body that fight off infection. And interestingly, a lot of those chemicals are what make us feel bad in the first place when we get the infection. So if you think about the flu, most people have experienced influenza and you know that you get a sudden onset of chills and aches and pains and your skin hurts and then you feel terrible high fevers. A lot of that is the body fighting off that infection. And so we get a little bit of that kind of a response when we get the vaccine administered to us through the injection in a muscle, and that’s to be expected.

[Dr. Hathaway] It’s a sign that the vaccine actually is working.

[Nancy] And we’ve had recently in the past couple of weeks in the news, the Johnson & Johnson vaccine, and that there were, I believe, six people out of 6.8 million that were vaccinated who had some clotting issues with that vaccine.

[Dr. Hathaway] Yeah. That’s an interesting story. There are two additional types of two vaccines of the adenoviral vector type. So instead of an MRNA vaccine, it uses an adenovirus, which is a virus that typically causes the common goal. It uses that technology to deliver the material that then creates the protein that we respond to. And so these adenoviral vector vaccines, which include the J&J and the AstraZeneca vaccine have been associated with a clotting disorder. And now we know that COVID-19 also causes clotting problems, but we know too that these vaccines have a very, very, very low incidence of what can sometimes in all honesty be serious clotting disorders.

[Dr. Hathaway] But whenever we use a technology or a therapy, whether it’s a medication or a vaccine, we weigh the risks of the therapy against the risk of not getting the therapy of getting the disease. And in this circumstances, we’ve learned clearly, although we don’t know the exact number, that the incidence of side effects with the Johnson & Johnson vaccine serious side effects is very, very low, as you said, perhaps as low as one in a million. But we also know that the serious side effects from COVID are far more frequent, including a 1% or a one in 100 chance of dying from the illness.

[Dr. Hathaway] And so whenever we look at how we treat large populations of people, we have to weigh those benefits against the risk. And if I know that if a hundred people or a thousand people get the illness, 10 of them are going to die, but not even one will have a serious side effect from the vaccine, then the benefit really falls in favor of giving the vaccination.

[Nancy] For those out there who are concerned about the fast development of the MRNA vaccine, since there’s two of those and that’s currently what we’re using, this was fast-tracked and it’s not FDA approved and all of those questions. What would you say about that?

[Dr. Hathaway] First, that I appreciate everyone’s concern. I think that we should be cautious when we develop new therapies and we should look at them closely and with a microscope to make sure that they’re safe. I would also say that I think despite the rapid development, the compressed timeline that we used to develop these vaccines, that it was based on technology that had been in development for many, many years, over 10 years, that we had a headstart because we were looking at a vaccine for very similar illness, but not the same as COVID-19, so we had this sort of technology ready and waiting.

[Dr. Hathaway] And then rather than do our analyses one step after another, we sort of did them in parallel instead of in series. And so looking at the data, we enrolled well over 70,000 patients in the initial clinical trials, which is a very large number, and we saw very high efficacy of over 95%, about 95% for each of these vaccines. Since that time, we’ve administered tens of millions, hundreds of millions of each of these vaccine doses. And we’ve tracked people closely for side effects, and we have not seen serious side effects related to the vaccine.

[Dr. Hathaway] So back to your original question, I appreciate people’s concerns. I want people to be comfortable with what we’re doing. I personally am very comfortable with the science behind the vaccine development. I got a Pfizer vaccine myself, and I’m very comfortable recommending that to my patients. And in fact, my son, Will, actually received the J&J vaccine, and I was very comfortable in having him get that vaccine.

[Nancy] And did he experience any side effects with this?

[Dr. Hathaway] None that we haven’t all experienced, which is a sore arm, some tiredness and achiness a little, he actually as young as he is, had a robust immune response to the vaccine and had a little bit of a fever, but nothing that lasted more than 24 hours. And he’s good as gold right now.

[Nancy] So is there any reason that you can think of that someone would not want to get this vaccine?

[Dr. Hathaway] I mean, understanding that people have hesitancies about vaccine, I don’t want to out of hand dismiss that concern. I personally think that the vaccines are very, very, very safe and the history of vaccines show that we have done far more to eliminate illness and promote wellness through vaccine technology than we have ever had major problems. So right now my recommendation is that everybody should be getting the vaccine, that they’re safe and effective, and that the risk of not getting the vaccine outweighs the risk of doing so.

[Nancy] Can we talk about the difference between what occurs for something to get emergency use authorization versus what will it take for it to be FDA approved?

[Dr. Hathaway] For something to get full FDA authorization, we wait for that safety information to come along over years and years. But we know that the crisis was real, it’s a pandemic, that the risks to life across the globe was huge, and that the benefit of this based on the data that we had far outweighed any risk of delaying its authorization. Now, that being said, we are continuing to track as much data as we can to look for any late quality that might come about, late side effects. And so far, we just haven’t seen any, and that to me is really reassuring.

[Dr. Hathaway] What we might see in the future is that we need a booster shot, which accounts for the changes in that spike protein so that we have the right antibody recognizing the strain that’s prevalent in the community. In our community right now, most, we’re still predominantly the original strain. There’s about 20% in our community that is from the United Kingdom, the so-called United Kingdom variant, or 1.1.7, as it’s referred to and that is still very susceptible to our current vaccines. We know that there’s some mutants from South Africa and Brazil that have changed a little bit more.

[Dr. Hathaway] And while the vaccines work against them, they may not be as highly effective as they will be in the future when we have vaccine specific for those strains. We know that the more we have immunity in the community, phrase that we’ve used for the last year and a half, the lower the likelihood there’ll be transmission. Now, a couple of things that are important. In order for the virus to mutate or change and evade our vaccines, people have to continue being infected. So our goal is to decrease as many cases as we possibly can so that we don’t see mutant strains that then come and escape our vaccines.

[Dr. Hathaway] Knowing that we can decrease their ability to change by decreasing the infection rates, it’s really important that we act now to minimize infections. The more the virus replicates in our bodies, the more likely there is a chance that we’ll develop a strain that evades detection. And so the faster and more quickly that we can get to this concept of herd immunity or protection across the population, the less likely there’ll be any chance that we run into problems with dramatic flare in virus cases as we move forward. So it’s really important to emphasize now is the time to get the vaccine.

[Dr. Hathaway] There’s lots of vaccine available right now. And for those people who are hesitant or waiting to see how other people have done, my word and my advice is now is the moment. Please do it for yourself, do it for your families and do it for the rest of the community, especially those who may be even more vulnerable than you are to the potential sequela of this serious infection. I’m hopeful that in the future, at worst case scenario, it’ll be like the flu where we can prevent infection with a booster vaccine each year.

[Nancy] When we get to a place that we’ve got 70, 80% of the community is vaccinated, are we then looking at mask-free places?

[Dr. Hathaway] Until we have greatly diminished the incidents of COVID-19 in the community, we’ll still be obligated to wear masks. We don’t know who else has been vaccinated. We know that the vaccines aren’t 100% effective, even though they’re highly effective. And so it’s important for people to realize that we’ll still be in a masked world for some time, but I think that’s okay. I don’t know if we’ll ever be mask-free, if you want my opinion. There is lots of talk right now about being mask-free outdoors because of the air circulation and the lower rates of transmission.

[Dr. Hathaway] So I think that’s a possibility. I personally have learned that I’ve liked having 16 months of not having a single upper respiratory tract infection or cold. And part of that is because I’ve been wearing a mask whenever I think I’m in a place of public exposure. The inconvenience to me of wearing a mask is so small in the benefit of not just getting COVID, but of not having other infections, I’m going to continue to manage.

[Nancy] I think we’re heading at least in the direction of it not being mandatory, but more, like you said, personal choice to do so. And as we continue to vaccinate the community, those mandates may lessen whether or not people continue to make a personal choice to wear the mask.

[Dr. Hathaway] I couldn’t agree with you more and it’s a personal choice. It’s a health decision. It’s a community care decision. It’s a decision to protect your neighbors. It’s about social responsibility to do the right thing for yourself, your family, your friends, and our community.

[Nancy] So we’re still in that place right now where I think the last I looked we were about at little under 50% maybe of the state that is 100% vaccinated. So we’re not there yet as far as keeping up with our three W’s.

[Dr. Hathaway] No. That’s exactly right. If we get to 70 or 80%, it may change. But right now we’re critically dependent on wearing a mask, waiting six feet apart, washing your hands, being socially distant in a respectful fashion. And I think we’ve learned that we can do so and still carry on the life business of our community.

[Nancy] Thank you so much, Dr. Hathaway, for that wealth of information from a scientific and medical standpoint. If anybody has any questions about where to get the vaccine, missionhealth.org/covid19 is our page, and we do have a listing there of places in the community where you can make an appointment to get your vaccine.