Each week, the Firelands Regional Health System management team has held hospital incident command meetings as a response to the pandemic. Firelands Chief Medical Officer, Dr. Scott Campbell, traditionally shares an update on the state of the pandemic.
In a recent all-staff email, Dr. Campbell shared the following summation of where we stand today in the midst of the pandemic. Keep in mind that this information was current based on the best information available at the time of posting. Due to the ever-changing dynamics of the pandemic, some information may change.
1. COVID Fatigue
Let us be honest, we all have it. Back in March, we were all on high alert. We were afraid to be around other people, we were afraid to go to the grocery store, we were afraid to breathe as we passed by other people. We had blisters on our hands secondary to the overuse of hand sanitizer. As the pandemic stretched into summer, our vigilance waned. We became less afraid of the virus, although it did not become any less deadly.
Coronavirus was initially seen as an acute threat, and then inevitably became a chronic threat. We certainly perceive risk differently for an acute event, i.e. a man with a gun in front of us, versus a statistic of a chronic threat. For example, how many deaths by gunshot there were in a city in a given year. If it does not affect us directly, we lose interest. Initially, we could not take our eyes off of the news, off of our phones and social media, then we became somewhat numb to the daily barrage of information and the mounting statistics. The reality is that for many, this will never be an acute threat unless it affects us personally.
Many people do not appreciate the gravity of this virus, becoming numb to numbers. Numbers such as the almost 200,000 U.S. citizens having died from the illness. It is only natural to become desensitized. The bottom line is, we cannot let down our guard.
The virus does persist in our communities, still is causing significant morbidity for many people, and is still killing nearly 1000 people a day. It is a normal human response to become complacent. The more you get away with, the less risk-averse you become. If you go to a gathering where you think you are taking a chance of getting COVID, then you do not get it, you will be more apt to push the envelope a little bit more the next time a social event occurs. If you skip a social event or gathering, there is no gratification for doing so. You just feel bad because you are not getting to do what you want to do. Do not let you or your family become a statistic. Do not wait to take this seriously until COVID comes knocking on your door. This is certainly a test of endurance, let’s stay strong and buy time until we can get this behind us with a fewer human cost.
2. "I am not worried, if I get it I get it"
You do not want this illness! There is no shortage of literature on the morbidity of this disease. We often concentrate on mortality. While it is realized that the mortality rate is extremely low in younger people, there are numerous reports of younger people having prolonged symptoms from this disease, missing multiple days or months of work. Our own coworkers have reported lengthy persistent symptoms after contracting the disease. People that have gotten this disease back in March still having loss of taste and smell, chronic fatigue, chronic cough, neurologic issues, brain fog, and inability to think clearly. So even if you feel that you are low risk and are unlikely to die, do not be fooled that this disease will not cause you significant misery. Everyone, no matter their risk factors or age, needs to be diligent.
3. "This is no different than influenza"
In any given flu season, we see an average of 30,000 flu-related deaths. Depending on the strain of the flu, some years will produce up to 60,000 deaths. We have a long way to go with this virus before herd immunity occurs, and already just under 200,000 people have died. Although there are similarities in that the flu is a respiratory illness, both are spread by droplets and can be spread person-to-person, COVID is thought to be much more contagious and easily spread between people. We still do not know the mortality rate, since we have no idea how many people actually have the disease. COVID seems to have more super spreading events than flu.
Both diseases seem to be most significant for older adults and people of underlying medical conditions. In general, the risk of complications for healthy children is higher for flu compared to COVID-19. Certainly, children can become infected with COVID-19, and by all means, can spread the disease. They are just thought to have less-severe illness from the disease in general. However, infants and children with underlying medical conditions are at increased risk for both flu and COVID-19. Do not minimize the severity of this illness.
4. "Only 6% of all reported COVID deaths in the United States were actually from COVID."
This has been showing up on social media and Internet sites. This has been falsely taken out of context. The CDC has been keeping records, since May, of all COVID related deaths. With each of those COVID deaths, they have listed the patient's comorbidities as well. This is not new information. If a COVID death occurs and the person who dies has absolutely no other medical problems, then only COVID will be recorded on the death certificate as the cause of death. In other words, only 6% of all COVID-19 deaths had COVID-19 listed as the ONLY cause of death. In the other 94%, the patient had COVID-19 AND other comorbidities such as hypertension, obesity, chronic lung disease. Those people with the underlying illnesses contracted the disease, COVID-19 then led to their subsequent death. The fact that they went on to die was exacerbated by their underlying comorbidities. That is basically what we are saying when we say that people in an older age group or with multiple comorbidities are more likely to die from the disease. Do not be fooled; the numbers, if anything, are under-reported. COVID-19 has directly caused or contributed to well over 190,000 deaths in this country…so far.
5. COVID-19 Vaccines
It is certainly hard to keep up with all of the vaccine information. There are multiple vaccines, but basically just a few front runners. Several are showing very promising results, and are leading to good production of neutralizing antibodies which would possibly prevent the illness or lessen its severity. Either way, you look at it, we have a novel virus and a novel vaccine. We have no experience with either of these. This, by all means, causes uncertainty. More money has been thrown at this vaccine effort than ever before in history.
In the past, there would be phased trials of vaccines which would eventually lead to FDA approval. The company would then start generating the massive quantities of vaccines needed to vaccinate the public. Due to the excessive money involved, they are already looking to produce the vaccine prior to having the proof that the vaccine will work. If subsequently, through clinical trials, the vaccine is found not to work or cause harm, then all of the previously generated vaccines will be discarded. This is enormously expensive. But this also allows us to move forward at a faster rate.
The FDA has come out and stated that they will not rush through a vaccination that is not deemed to be safe. In spite of this, there are still significant concerns from the general public. Will the vaccine be pushed through due to politics? Will the vaccine be expedited at the expense of safety? As you may have heard, vaccines normally take several years to produce and vet for safety. That being said, I do feel that there are significant safeguards in place to make sure that this vaccine is as safe as possible within the timelines that we have set. There are many in the scientific community that would be very vocal if the vaccine was rolled out before it was thought to have gone through the proper scrutiny.
Just recently, Dr. Stephen Hahn from the FDA came out and made a statement regarding mortality decrease with convalescent plasma. His facts were not accurate, and the scientific community jumped all over him. This led to an immediate retraction. Many in the scientific community realize that the worst thing you could do is to roll out a vaccine that causes harm to many, thus thwarting many years of vaccination progress. I will feel comfortable getting the vaccine if it has gone through all of the proper channels, the FDA approves it, and the majority of the scientific community feel that the process has been legitimate.
Recently it was noted that the Oxford vaccine trial was halted due to a possible side effect in one of the volunteers. This is a normal process. If you give the vaccination to 15,000 people, and placebo to 15,000 people, inevitably someone will have a normal course of illness after the vaccine that is totally unrelated to the vaccine. There is no way to know without going back and studying it. Was the illness caused by the vaccine or was the illness going to happen with or without the vaccine? This is why they do human trials. This information has been updated and they now know that the person did receive the vaccine, not the placebo. This should not be seen as a major setback, but instead the normal process of vetting a vaccine.
6. "I do not get the flu vaccine because I do not get the flu"
The reality this year is that it is more important than ever to get the flu vaccine. It’s possible to have the influenza virus and not have any significant symptoms. One could then pass it on to a family member who could have a severe illness develop. There are also multiple reasons, especially for healthcare workers, to get the flu vaccine. If you were to have both the flu and COVID 19, you will inevitably have a higher risk for severe outcomes. If you give the flu to a COVID-19 patient, you could be causing their death. It is important to protect ourselves, our workforce, and our patients going into this respiratory season which could be unlike anything we have ever encountered before. The vaccine is really the only tool in the tool kit we have to protect ourselves from influenza.
7. Can I get re-infected with COVID-19?
This is a tough one to answer with some recent evidence that has come out. It seems very unlikely in the short-term that we will get re-infected with COVID-19. There is a question of how durable the immunity is, or another words how long will it last. It is likely that for at least 3 months there is a very, very slim chance of reinfection. Remember that you can shed virus particles detected by DNA amplification for several months. This has been studied extensively.
The thought is that you are not actually infectious once you are 10 days beyond your initial diagnosis, no fever for 24 hours, and your symptoms are improving. Beyond that period, you may still test positive. This is because the PCR testing is extremely sensitive and detects remnant RNA particles of the virus. Therefore you will stay positive longer than you are infectious. The question is if you are 4 or 6 months out from your infection and you test positive, have you been re-infected? This is thought to be possible, although extremely rare. In spite of the millions of cases, there have only been a handful of reports of possible reinfection. They have shown that a different subtype of the virus has shown up in a couple of patients that were initially infected, then subsequently retested many months after the original infection. This is certainly concerning, and questions the durability of the immunity. Of course, even if you can become re-infected, the question is whether the immunity gain from first-infection will prevent the second from being severe. It is thought that the vaccine would cause a much longer immunity than natural infection, due to the specific engineering of the vaccine.
8. COVID Response Conclusion
Going forward, we will continue to monitor the medical science behind the coronavirus, sticking to facts, not the politics. We will continue to put our heads together with the medical staff to guide the hospital through this pandemic, trying to avoid myths, trying to sort out fact from fiction, doing whatever it takes to minimize the havoc that this virus intends to wreak on our community. Our decisions will always be directed at what will keep our healthcare workers and our patients the safest. It’s important to stay strong and support each other. Try not to be too judgmental of others, realizing that no one has all of the right information, it is hard to know what to believe, and there will continue to be much confusion around a virus that we have never seen before. We are in this for the long haul so let’s continue to take it seriously so we can minimize its impact.
Scott Campbell, MD, FACEP, Chief Medical Officer at Firelands Regional Health System