Transcription:

Scott Webb: This COVID 19 podcast from New Hanover Regional Medical Center was recorded on January 11th, 2021.

There was no blueprint in America for how to deal with a deadly pandemic, but New Hanover Regional Medical Center had a response plan and predictive models in place even before lockdowns. And joining me today to discuss the pandemic, how things are going at NHRMC and when we can all expect the vaccine to be available to the masses is Dr. West Paul. He's the chief clinical officer at New Hanover Regional Medical Center.

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Scott Webb. So Dr. Paul, thanks so much for joining me today. We're talking about COVID-19 primarily today. Well, let's start here with NHRMC's response to COVID. What type of patient flow have you seen throughout the pandemic?

Dr. West Paul: It's been very interesting as we've watched our patients and really dating back to March, we saw an initial surge. We called it a surge then, it was very much smaller than what we're seeing now. And really, we had started planning for this surge in January. We had gotten notification about this new novel virus that may or may not be spreading. So we had made plans very early in this pandemic about where patients would go, what the flow would look like. And we had heard about the tough problems with PPE and all of the stuff that you actually needed to care for these patients. So we began that planning just then.

Now we have seen, I call them surges, and sometimes a little bit stabilization of our numbers, but we are, definitely over the past probably four to five weeks, in what we would consider a surge of our patient population around COVID-19.

Scott Webb: Yes. It sounds like you were prepared early on, as you say, as early as last January for that surge, and that now we know what maybe a surge really looks like. So how are you dealing with things now? How did you prepare for this current surge, if you will?

Dr. West Paul: So we did a lot early on with some predictive models and we had some outlandish numbers and some low numbers. So we had phased our response throughout the organization to change what we were doing, how we were utilizing PPE, how we were doing certain surgeries, whether they be elective or not based on the number of patients we had in-house. And we got a pretty good burn rate of the stuff, our PPE, our supplies that we would use, and some estimation of our staff, which really has served us very well. We've adapted.

As we've seen it, we did have a rather large surge in July, but nothing compared to what we're seeing now. Actually, a lot of our predictions and planning has held true. The team has done an incredible job. It really took everyone to help plan this through, but we have bumps in the road as with anything as you get more and more patients in. You'd see where the flaws in your initial plans were, but we were fast to adapt. I will say our nurses and our doctors and our team members and, really, everyone has learned to adapt. All the great ideas about how to handle this surge has really come from our frontline staff. Whether it be physicians, nurses, EVS, anybody, they really know how to handle these patients.

Scott Webb: Yeah. That's great to hear. And as you say, the frontline workers, they know best often, right? And it's so great that upper management has been listening to them and it's so great that a lot of the models and predictions have come true, but yet, you’re still dealing with a lot of patients. And I think for a lot of us, we’re thinking that, really, we won't really begin to see the light at the end of the tunnel until the vaccine is available to everybody and everybody who wants to or has to get the shot can do that. So let's switch gears a little bit and let's talk about the COVID 19 vaccine and just start here, how was the vaccine produced?

Dr. West Paul: So it's interesting. The two vaccines we have now that have been approved by the FDA for emergency use are very intriguing. They were actually the products of years of research, really decade or two ago in this technology in developing a vaccine using what's called messenger RNA. I like to say we're using the virus' own genetic code against it by being able to produce the proteins that the virus would use to enter our body, a different way to really hype our immune response to prevent those viruses from ever entering.

So it really is a new technology. It's a new way of producing the vaccine. But the actual methodology, the technology, is at least a decade old, but we finally have been able to bring it to bear against the deadly disease.

Scott Webb: Yeah. And it's really amazing, the predictions we were hearing early on about how long it might be before we had a vaccine. Really amazing, unprecedented, not only the virus, but how everybody has come together, scientists and corporations and the entire medical community, right.? It's interesting to use this term, but really at warp speed, right?

Dr. West Paul: Yeah, it has been a truly amazing. The technology and, I will say, biotech within this country in general has been accelerating leaps and bounds over the past two or three decades. I'm a scientist by original training, have been amazed, and I think it's showing that progress right now of how quickly we've been able to produce a vaccine that is truly effective, 95% from what we're seeing, which I personally as a physician have never seen that type of efficacy in a vaccine at a rapid pace. And I don't think it should be overlooked the way this vaccine is produced.

And right now, it looks like both of these vaccines that are approved will cover any of the variants that have emerged. So it does look like they cover those variants we've heard about in the UK and now South Africa well. But even if a new strain came available, these vaccines, the technology to produce them, are very nimble at changing that vaccine, adding a few changes to the genetic code and producing one that can actually attack new viral variants too if needed. Right now, not needed. The vaccine will cover all the viral variants. So that's unheard of in vaccine production.

Scott Webb: Yeah. And as you say, the efficacy 90, 95% is just off the charts. Again, unprecedented.

Dr. West Paul: Yes, absolutely. And it has to do with the way the vaccine fields its response in the body. Again, this may not only hold advantages for treating infectious diseases, but we're looking at other things such as treatments of cancer with things such as this, not necessarily vaccines, but ways to induce our body's immune system to fight off cancer, to fight off other types of diseases.

So a lot of us that are looking at this technology are very much intrigued and hopeful that this fight against COVID will actually yield some gains in other diseases that we've been dreading.

Scott Webb: Yeah. That would be amazing. And it's hard to find silver linings through all of this, but as you say, there may be some positive medical scientific benefits on the other side of this. And you know, we're still debating in this country, a lot of people, whether or not to get the flu shot. Even though everyone says in the medical community, "Get the flu shot. It's available. It's good. You need it. Get it," people still are unsure about whether or not to get that every year. So when we switch and we now talk about COVID-19, what are your thoughts about folks getting the COVID-19 vaccine, if and when it's available to them?

Dr. West Paul: I will say one thing about the flu shot, because it's been intriguing this year, we have not seen any cases of flu as of yet this year in our medical center, which is truly amazing. Now that being said, we've had the highest uptake of flu vaccine in this country we have ever had before. So yes, it does prevent the flu. I'm sure that masking and washing your hands certainly do also, but that has really helped us. We were very concerned about an influenza epidemic along with a COVID epidemic.

Now, COVID we know is much more infectious than influenza. Spreads similarly, but in a very different way and is a lot harder to prevent. So we know that, but it certainly is proven for that. But as for the COVID vaccine, we're dealing with a disease that right now has moved into the number four leading cause of death for the year. It is a dangerous virus. It is a virus like none of us in the medical profession has ever seen before. We still don't know a lot about the virus, but we do

know the mortality is quite high in certain groups. If you're older, if you've got some co-morbidities or problems, other health problems, we know it can be quite deadly up to 20, 30%. And some of those individuals, that's part of the reason why the vaccine rollout has really been looking at healthcare providers and then patients 75 years and older and are nursing home or long-term care facilities. So we can actually get those most vulnerable populations first because we know mortality can be quite high.

That being said, even infected, the hospitalization rate for this virus is incredibly high. That's something we don't really see for influenza. We do in certain populations, but my gosh, with COVID, the hospitalization rates and a lot of that's because of the breathing issues and the oxygenation problems where you actually need oxygen to breathe. So it is paramount importance to get this vaccine.

Scott Webb: Yeah. And I've heard that the incidence of flu have been down dramatically. And, personally, I've never felt better. And I think a lot of it is because of washing my hands and sanitizing and wearing my mask and all those things that have been really stressed and emphasized during the pandemic. I'm sure that's a big part of it, right?

Dr. West Paul: Absolutely. We've even noted from some of our pediatricians that typically treat childhood asthma and children that have severe respiratory diseases, they're not seeing anywhere near the numbers they typically see. So there's some, again, benefit from wearing masks. Wearing masks prevent disease. It prevents not only COVID but other diseases. So yeah, we are seeing some benefit with that.

Scott Webb: We've heard about some of the side effects of the COVID-19 vaccine, Bell's palsy and some other things. So let's talk about that a little bit. What are the side effects? Should they be any reason for concern or concern enough not to get the vaccine?

Dr. West Paul: I can say from personal experience, I've had my first dose. I'll be getting my second dose at the end of the week. So I certainly see this as vital, particularly for healthcare providers as we go forward.

So the side effects we've seen a lot in various vaccines of any sort. When we try to stimulate a person's immune system to fight off a virus, there can be some side effects. They are very small. What we've seen typically, and I can quote, the initial group, so really with the Pfizer vaccine and the Moderna vaccine, which are the two that are out very similar, use the same messenger RNA technology, about 40,000 individuals in each group underwent the initial trials, which is a fairly large number as it goes for vaccines.

But again, over a short period of time, but we analyzed the data, most of the side effects we've seen that were greater in the vaccine group than the placebo group. In other words, these trials were done blinded. In other words, the participants didn't know if they were getting salt-water placebo versus the real vaccine, so we could adequately assess these side effects.

So most of them we've seen have been very low. A lot of them have been sore arm. I can say I had a little bit of a sore arm. It felt like my flu shot last year, but sore arm. Some people will get some fever. Fevers up to a hundred typically is what we're seeing. Some people will get a few chills, usually very short lasting. And I think right now, for the second dose of the vaccine, it is predicted about 15 to 17% of individuals will feel a little bit tired, a little bit achy, maybe a little low-grade fever for 24 hours, usually it's very self-limited.

One of the ones that we hear a lot about is something called Bell's palsy, which is an effect of the facial muscles around a nerve. It has been interesting in the placebo group, so the group that just got a sham injection, you can say salt water. the number of Bell's palsy out of that 40,000 was two in the saline group. In the actual vaccine group, the number was four out of 40,000. So you can see the incredible low numbers. And certainly you got to say as side effect, Bell's palsy is usually self-limited and recovers. Some does not, but again, a very low side effect. And what we were seeing is about equivalent to any other vaccine you get, either it be shingles or flu or anything else. So really nothing that much out of the ordinary.

Now, all of that being said, most of our vaccines that we use these days have been tested for years. We've got years and years of experience with the vaccine in millions of people. So we are watching closely and I say we, but the FDA and the CDC have real time updates on any safety features associated with the vaccine. So there's real time reporting as they go forward looking at this. But certainly, we see that it's safe and effective, but we will keep it monitoring as we go forward, as millions of people do get this vaccine now. That's why the registration actually is pretty tough when you get this vaccine because they want to track on a real-time basis any potential side effects. So they're fed back immediately. So we are seeing that.

But again, I think as healthcare providers and our nurses and our physicians have seen the devastating toll this virus can take on patients, we're first in line, we've had an incredible uptake here at New Hanover Regional Medical Center, almost 80% plus of our physician staff have taken this vaccine and very close to 65%, 70% of our nurses. And as they go through shifts, they're still taking the vaccine. So it's been an incredible uptake for the front lines.

Scott Webb: Yeah. That's amazing. And I'm glad to hear that you got the first dose and you're doing well. And it always encourages me when I talk to doctors and nurses and they're getting the vaccine because they need it, of course. I think I know the answer to this already, but should we still wear face coverings after we get the vaccine?

Dr. West Paul: Absolutely. And that seems a little bit strange to say, but we do not know if you can still transmit. Even though you may not get the virus, systematically, you may not feel that you have symptoms, but you still may be able to transmit the virus. So we're not going to take any chances. What we want to see is that this vaccine helps us stop this virus and really ends this pandemic. So until we know that these numbers are slowing down, even us in the hospital, which again, almost all of our physicians, almost all of our nurses, we're still wearing masks, we're still washing our hands. We're still taking this incredibly seriously because until we start seeing that downward turn in our hospitalizations, which we have not seen yet and we are pretty sure is going to continue to go up for some weeks now, we want to do everything we can to stop this pandemic.

Scott Webb: Yeah. And I just have this feeling and I've invested in a number of face coverings and masks that I really like, my favorite sports teams and things to motivate me to keep wearing them. I've got the million-dollar question for you, doctor, when will the general public, when will I, when will people listening to this be able to get the vaccine?

Dr. West Paul: So that is a million-dollar question. Right now, we're following our state's lead. They are determining when we can move through the phases. And just to explain, there is a rationale to the phases. So the first 1A phase was to those healthcare providers, the people on the frontline taking care of these patients, as well as to nursing home or long-term care facility residents. Again, the very most vulnerable that we have, including the staff of those long-term care facilities, because we know the highest mortality, death rate of those individuals, the highest hospitalization rates. So 1A, which we are through, it doesn't mean we don't still give them people that have been a little bit reluctant in 1A. They've seen the rest of the people get them, they'll go, "Yeah, I think it's time for me to get one."

I don't think the scoring system has made this very easy to understand, but 1B1 is all patients 75 and older, which is a large portion of our population. Because regionally. I think in the county, we're looking at somewhere around 17,000 to 18,000 people. And again, the rationale behind all this, these are the patients that are most vulnerable. These are the patients most likely to be hospitalized. That'll help our hospital not run out of resources. So I think very legitimate. And then there will be other phases coming, including 50 and over that work in healthcare, 50 and younger that work in healthcare.

When will we be able to get it? I think as we move through these phases, I think we'll all be available to get it probably sometime-- and I might be optimistic here-- probably sometime mid-February, end of February or March. We do have an issue in this country with delivering the vaccine. It hasn't been producing it, which has been unusual, it's been delivering the vaccine and I think we've had a bit of a slow start.

I will say here at New Hanover Regional Medical Center, we had an incredible vaccine team assembled and was really able to put vaccine in arms to almost 4,000 individuals in our healthcare system within several weeks. Just really phenomenal in how they did it and organized it. Now, some of it is a captive audience. We know where you live and we know how to communicate with you when you've already got charting done here, so it's a little bit easier than the general population, but I will say the health department has done a great job too.

And as we spread this to other practices, the last thing we want to do is leave vaccine in the freezer. It doesn't work in the freezer. It only works when it's in your arms. So that's gotta be a high priority of the state, a high priority of us as we move forward. And we're trying to as much as we get in the week is to empty our freezer in the week and get it into arms. That's the plan.

Scott Webb: Doctor, as we get close to wrapping up here, is it safe for children and pregnant women to get the vaccine?

Dr. West Paul: So right now, it is approved by the Society of OB-GYN for pregnant women to get the vaccine. We would like them to have a discussion with their physicians, their OB, before they do it. But right now, FDA has approved for pregnancy, so not a problem. We have several studies going on right now for children that are 16 and under. Right now, the age cut-off is 16 and over. You can get the vaccine without issue. I'm pretty sure that'll be signed off on probably within the next two to three weeks and we'll hear about that. I do not see a reason for them not to get it, but again, wait for the research. Coming forward, that'll come relatively quickly.

We know that children are less likely to show symptoms and also less likely to get sick, but it does not mean they do not get sick, and they can certainly spread the virus also. But it does look like that children do not spread it as much as adults do, so that's why we're focusing on the adult population first.

Scott Webb: Doctor, so great having you on today. Anything else you want to tell people about New Hanover's response, of the COVID-19 vaccine? When we might get it? Anything else? Any parting thoughts?

Dr. West Paul: No. I just got to give a lot of credit to this organization. They've done an incredible job at facing this pandemic. It's been very interesting. I talk with other chief medical officers around the state and, I think, just comparing notes and where we are and how we've planned, the team has done incredible job at maintaining where we are, and that's been very great to work with. It's always nice working with a team that's really outperforms everyone else. Not that we're a little competitive, but we're always a little competitive. But again, this is not over yet. I guess that's one of my main things. And we've been through this a long time. It's getting very fatiguing. I said at the beginning that this is a marathon, not a sprint. We're probably at the last four or five miles, but we still aren't over yet. And we've just got to maintain some of that resilience going forward as we get through this.

Scott Webb: Yeah, I think you're absolutely right. And that's a great way to finish. I think that we're all a bit fatigued, but the finish line is somewhere there. We can kind of just make it out, but we do need to stay resilient and vigilant and we will all get through this together, especially with the work you are all doing, that great, you know, team approach and all hands on deck. So Dr. Paul, thank you so much for your time today and you stay well.

Dr. West Paul: Thank you very much.

Scott Webb: Learn more about COVID-19 and get the latest on vaccine distribution at NHRMC.org/coronavirus. And this is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I’m Scott Webb. Stay well.