Wellstar Health System infectious disease specialist Dr. Danny Branstetter spoke with the Journal Friday about how the fourth wave of the pandemic is straining Cobb hospitals and how it compares to the winter surge, as well as masking in schools and the FDA’s decision to grant the Pfizer vaccine full authorization.
This interview has been edited for length and clarity.
MDJ: We’re starting to approach numbers not seen since the winter surge, as far as number of cases, hospitalizations, deaths. Could you tell me how the situation today compares to the situation in December, January, February.
Dr. Danny Branstetter: We are seeing a huge increase in the number of new infections in our communities. That’s No. 1. But we’re also seeing a huge number of hospitalizations related to those new infections within our community. And the slope, the rapidity with which this is going up, is faster than any time previously in the pandemic, which is a big concern for us.
In the December, January timeframe for the third phase of COVID, our peak for a system peaked out at 763 patients in the hospital in one period of time that were COVID positive. Today, we are up to 668.
Q: It’s kind of shocking that the numbers are where they’re at, given roughly half of Georgians have had at least one dose of a coronavirus vaccine.
A: I think it speaks to a couple of things. No. 1, what we know about the characteristics of those who are requiring hospitalization ... 92% of those in the hospital are unvaccinated. It is very clear that what’s driving this hospitalization is the unvaccinated. So even though we’re 50% vaccinated in our community, (with) at least the first dose, the population of unvaccinated is driving this, and that includes in Cobb County. We have 107 people on the ventilator in our hospital(s), of which 103 are unvaccinated. But in Cobb County, 33 of those (hospitalized for COVID) are on ventilators and 32 are unvaccinated. So that is a huge, huge difference in what’s driving this particular surge.
Q: According to the Georgia Coordinating Center, which lists the diversion status of the state’s hospitals, WellStar Kennestone and WellStar Cobb hospitals’ status is “severe” with intensive and critical care units of both requiring diversion. Can you tell me what that means?
A: What that means is that when we go in diversion, that’s a signal to our partners like EMS and our transfer partners, people who send patients in — because Kennestone is a regional referral center — it signals to them that we are available, however, there is substantial delays in the times of care. So if it’s a critical illness, they may be best served in another location to get them the appropriate care that they need in a timely fashion. Not that we can’t care for them eventually. It’s just the delay in care is a concern that we need to signal to our partners, that we need to be looking to the best place to care for them in the timely manner in which people deserve.
Q: You’ve mentioned before that hospital capacity is something that can change, that WellStar has built into its hospitals the ability to make room in the event of another surge. I’m wondering, have you had to tap into that capability?
A: What we saw in the winter surge, which we’re getting very close to needing to do (now) is, a lot more redeployment of personnel. So pulling people from other departments to staff the inpatient — so they may be an outpatient clinic provider, specialist, nurse, those kinds of things, care partner — they may be pulled to go to inpatient care, emergency care areas in order to provide for this increased demand that we’re seeing at our facilities.
But what we haven’t had to do is do that full deployment like we did last winter. But we’re getting close. And we haven’t had to go on elective diversion. So surgeries and procedures that are truly not emergencies or urgencies, we have not had to implement full elective procedure diversion yet.
Q: The FDA just granted full authorization to the Pfizer vaccine for people 16 and older, where previously it had been available only under emergency use authorization. I know the technology it’s based on is similar to that of the Moderna coronavirus vaccine. Why hasn’t that one been granted full authorization yet?
A: It’s a little bit behind ... on the trial dates, so Moderna, it started a little bit later. Moderna did apply for full FDA authorization recently. So, if we follow Pfizer’s path, about three months to full approval ... in the next eight to 10 weeks, we should probably hear about full approval for Moderna as well.
Q: And Johnson & Johnson?
A: Johnson & Johnson’s even further behind. So I’m anticipating we may hear something by year end for Johnson & Johnson.
Q: (Ever) since the coronavirus vaccines were federally approved for emergency use, public health officials have told us they’re safe, they’re effective, don’t wait to get your shot. With that recent full approval, was the wait for that approval simply a matter of red tape and paperwork or should it impact our understanding of or confidence in the efficacy or safety of the Pfizer vaccine?
A: Two things: No. 1, it went through a full review. So this should increase our confidence that safety has been looked at, efficacy has been looked at. So instead of just, you know, a week after they submitted the paperwork getting a checkbox, they went through all this data that was submitted and made sure that this is truly vetted appropriately.
The second thing I’d like to point to, just to kind of reiterate: Side effects, adverse events are being scrutinized with all COVID vaccines, and I want to point to the history that we’ve recently looked at with our vaccinations and that’s the Johnson & Johnson vaccine. They paused the vaccine when they saw a signal just with seven cases out of a couple of million doses given. So, safety, efficacy death rates ... any adverse events are being scrutinized really, really tightly, even if very few are showing up. ... So it should increase our confidence even more, that this has been appropriately vetted.
Q: According to Reuters, the World Health Organization’s director general said this week, “the data on the benefits and safety of a COVID-19 vaccine booster shot are inconclusive.” Well, will you be getting a booster shot?
A: I think it’s clear that booster shots are very much a benefit in those who may not have a robust immune response. And that is what the FDA said with those moderate to severe immunosuppressed patients such as those with solid organ transplants or certain types of malignancies, or (who are) on immunosuppressive medications.
There’s more and more data coming out about the duration of antibodies and (people) may be more susceptible to symptomatic infections, and that the booster shot — I do anticipate that we’ll all be recommended to get a booster, which is not uncommon. We see that with yearly dosing of influenza (vaccines) as well. So it’s certainly in the realm of expected that we get a booster shot for respiratory viruses. If the recommendation comes in September or later this year from FDA and CDC that that booster shot is beneficial, then yes, I will be getting a booster shot.
Q: Just to be clear, that body of data recommending that booster shot, in your view is growing?
A: That body of data is growing, and it does appear to be beneficial, at least in the antibody response. Does that prevent infection after the antibody response goes up, and prevent death if an infection does occur? Those (questions) take a little bit more time, but that data we should have in the next few months.
Q: In May, the CDC published a study that found ... according to a New York Magazine article published last week, that “Distancing, hybrid models, classroom barriers, HEPA filters, and, most notably, requiring student masking were each found to not have a statistically significant benefit. In other words, these measures could not be said to be effective.” I’m wondering whether you’ve seen any studies that do show masking among students to be an effective way of limiting spread of the virus, and whether you agree with the CDC and American Association of Pediatrics guidance telling students to mask, regardless of vaccination status?
A: My perspective on this is, we know there are things that can be implemented that have the potential to reduce the transmission and acquisition of respiratory viruses, and they’re cost effective ... and with very minimal adverse events, except for irritation on the face. So in my mind, it does definitely have the potential to reduce the risk, and we know that we’re in the middle of a pandemic. So whether we’re vaccinated or unvaccinated, I think that (mask wearing) should be encouraged, and that we should all band together to do whatever we can do to get through this together as safely as possible, to reduce the number of infections in our community, so we can move on. (Vaccination has) the clearest, biggest benefit, and then washing your hands, watching your distance, wearing your mask, increasing ventilation, doing things outdoors, spending less time in big groups, getting tested if you’re symptomatic or exposed, doing the quarantine if you have COVID-19 and getting early treatment monoclonal antibodies for 12 and above, definitely reduces the likelihood of shed and spread.
Nothing is 100% going to be the golden ticket here. We haven’t come across that yet, but using all these tools that are available to us is the key in my mind, so it’s not relying on just masks or just barriers or just ventilation, it’s using whatever tools we can, in combination, because we’re deploying everything to keep everyone as healthy as possible.
Q: What should people in the Cobb community do in order to reduce the burden on Cobb hospitals?
A: The first thing is staying healthy, right? So everything that we know to do to stay healthy. Get plenty of sleep, reduce your stress, eat right ... implement everything you can to avoid getting infected.
And then encourage those, if you got vaccinated, encourage those who may be a little bit hesitant to get the vaccination, because it’s important that we have those one-on-one conversations.
Second thing is, if you think you have COVID or been exposed, there’s a few things that you can do that expedite your evaluation that may not need to be an emergency room or even an urgent care (visit).
Mobile apps have all kinds of virtual visits now, so you can do that, and they may recommend you get a home test kit, or they may send you to one of the sites for testing, like the DPH sites, to go get tested. ... It’s actually probably quicker and less wait time to do it that way, than it is to go and sit in an emergency room, and if you’re not exposed, there’s a bigger chance that you’re going to go where a lot more sick people are, and contagious people are, so it’d be best to stay at home and probably more convenient to handle it in that measure.
Now if you’re short of breath (or) having significant symptoms, definitely go to the emergency room. We’re there for you. That’s what it’s there for, we want to encourage people not to delay their care if they’re having an emergency. But if you’re having mild symptoms, or think you’ve been exposed, please access those virtual visits, talk to your primary care doctor, as well use the mobile sites for testing.
Q: Is there anything that we haven’t discussed that you think folks should know?
A: That would be thinking about my colleagues during the middle of this pandemic, this fourth surge, and thinking about their mental well being and health. You know, early on in the pandemic, we heard shouting in the streets, right? And we’d go home after our shifts and there would be lots of noise and cheers because we knew they were all together. Then, people put up signs and things like that.
Right now, there’s a lot of frustration because it seems like it’s this war of vaccinated versus unvaccinated out there right now. That’s not what it’s about. We’re all trying to get through this together, so anything we can do to kind of continue to encourage each other, to support each other and reinstitute that fondness together right now I think would go a long way to helping the mental well being of our staff and frontline providers out there.