“It’s the abstract versus the tangible experience that’s the difference between Australia and the US, but we’re all still fighting the same foe.”
At our Employee Forum on 9 February, we gained valuable insight into the COVID-19 Phase 3 trials and vaccination from Monash Health alum, Dr Cameron Wolfe. Cameron is an Associate Professor of Medicine at Duke University Hospital, North Carolina, and has firsthand experience of the impact COVID-19 can have on the community and the healthcare workforce.
Cameron provided vaccination safety, and efficacy information and the results so far as they completed vaccination of 15,000 employees that morning. Duke also ran major Phase 3 trials of the Pfizer and AstraZeneca vaccines of which Cameron participated. Those who were present at the forum can attest to leaving with a deeper understanding of what we have to gain from vaccination, not only from a clinical perspective but in our own life as Cameron shared a personal account of his team’s emotional journey.
We’ve provided excerpts below from the candid and insightful discussion between Cameron and our Chief Executive, Andrew Stripp, but you can have the full experience of the video discussion here.
We hear a lot in the media about what’s happening in the US, how has it been?
“The peak for us at Duke was three weeks ago with 210 admissions in a single day into intensive care with up to month-long stays to wean patients off ventilators. Today alone, we discharged 3,000 patients. We are now down to 150 admissions a day, but our hospital alone still has more inpatients than across all of Australia.
Healthcare worker infections have, for the most part, tracked with the waves of community spread. At Duke we’ve had 2,200 colleagues sick with COVID-19 which is not an insignificant number, it’s awful to be blunt. And while there were only a couple of deaths in that group, they hit hard. I’m very familiar with the feelings. The first time one of our nursing colleagues passed away, that was a kick in the guts for a team that’s worked hard to see one of their own fall.”
You’re well into the vaccination program for your employees; how is it going?
“It’s finally feeling different! Following the Thanksgiving, Christmas and New Year increase where you didn’t know how high it would go and hard to anticipate what to expect and what you have to cancel. Now to finally see it tip back down is a weight off people’s shoulders. And it has corresponded with us chronologically with some of those vaccine numbers reaching a point where we think we’ve penetrated our employee base well enough that they’re not getting sick. We’ve had a sizeable drop off in the last 2-3 weeks as people are now getting into their second dose and beyond. The rate has fallen quicker than the decline in our community incidence, which has to speak to the vaccine now kicking in.
The feel-good part has also just finally kicked in in the last couple of weeks. You take the pressure off people when you finally don’t see so many of your colleagues get sick to be brutally honest. There’s a toll not only on elective treatments and procedures but on the workforce.
Anxiety among my colleagues has faded, and it’s faded as they see people around them go and get vaccinated. It’s amazing how much people just want to see the ball start to roll and then realise this is underway it makes sense, it’s important. They feel they can actually do something about it and not be constantly stuck behind a quarantine wall. Stuck behind not being able to travel. Stuck with the unending wall of patients that keep coming to us. They could start to take control at last. Slowly that hesitancy is fading away mainly because people see that those who are vaccinated are not getting COVID! They’re okay without the side effects they were worried about.”
We’ve had some concern here about the rapidity the vaccine was developed and if it was rushed. Can you tell us how this happened so fast and remained safe?
“The concern about that is shared on this side of the Pacific too. But I saw this from a different view because I participated in our Phase 3 trial. I now know I was actively vaccinated. Having experienced the trial, I am now more aware of how methodically trial safety data is collected. I still have the app on my phone to update the data on my symptoms as they track information on how durable the vaccine will be. I also felt that, quite frankly, I couldn’t sit in front of my patients let alone colleagues if I hadn’t rolled my sleeve up for the trials. You’ve got to walk the walk.
I would say that it’s worth remembering that yes, it was quick, but let’s think about why that was the case. We’re in a pandemic and for the US that meant around 4,000 deaths a day at its worst, which is horrendous, and this was a compelling pressure for research and government to make things efficient. Also typically a biochemical company will have multiple active trials going at the one time. This past year they just focused on COVID.
The mRNA vaccines for us is not a new technology; there have been many mRNA candidates under development for years, and researchers pivoted for COVID. It’s not that the technology is new.
They also could enlist many more people onto the trial upwards of 70,000 in theirs alone for Pfizer and Moderna. This gives far more robust data than what you would anticipate at that approval point.
They were able to fast track not on the safety aspects but through other means such as ready access to safety data shared in the public domain. There was an intentional investment in getting factories and facilities up and running before the vaccine was even approved as a way of ‘hedging’ and not having to wait for distribution channels to be in place. They set FDA review meetings well ahead of what would normally be a longer timeline.”
What have you seen in terms of safety of the vaccine since vaccination of the population has begun?
“Today, the US has just passed the mark of 35 million first doses given. You get the breadth of numbers that you should see safety signals if they were there and reassuringly we are not. There’s no reason to be concerned outside of some allergy responses which we now have solid evidence are less than 1 in 100,000 cases of severe allergies.”
How did you feel after being vaccinated?
“I had symptoms commensurate with what data has shown. The first dose I had a sore shoulder bit like a tetanus shot. After the second dose, I did feel ill, which is normally seen in up to half the recipients. This is common with an mRNA vaccine you can feel the effects for the second dose. In the morning, I felt feverish, headache, and fatigued after the second, but I felt great by lunchtime. So it is the typical profound on-off feeling that many recognise is just a part of the healthy, robust immune response.
We can tell people very clearly that if you get fever, chills, fatigue, headache, and muscle soreness, which are gone within 12-24 hours, it’s the vaccine. But if these persist, you need to get tested, or if you lose your sense of smell, taste or get a cough or are breathless, that’s not typical vaccine side effects and warrants a test.”
Is there any indication of how long immunity from the vaccination can last?
“We don’t perfectly know. Moderna has robust data that things are pretty good at six months and they have projected two years, but it’s not known. But the vaccine’s longevity is not key for me. I have 150 beds full of patients today; I don’t mind if this lasts only six months. I just need to get people protected. Durability is important, but it is least important against safety and efficacy, and both of those look like they’re going gangbusters for us at the moment.”
What have you seen are the long term symptoms following COVID-19 infection?
“Long term effects include pretty high readmission, upwards of 10-20%. We see DVTs and post-inflammatory problems. We have a clinic where half to two-thirds of my patients come back at two months saying ‘I don’t feel like where I was’. We’re beginning to learn about some of those long term inflammatory implications. Even in the people who don’t necessarily need ICU treatment, we have set up pulmonary clinics for longer-term recoveries.
We try to help them out of a very stiff and fibrotic picture they get left with that never gets represented in mortality statistics published in the US. The country is likely in a month or so cross half a million deaths. That pales compared to the number of people left with some residual pulmonary scarring or inability to do their work at the levels they used to or levels of morbidity that are not mortality. It’s been a big learning curve and one that I wish I didn’t have to go through.”
How do you perceive the mood of your colleagues now?
“We’ve had to deal with deferments of things like bypass surgeries and anything that would take up an ICU bed. But there are the psychological issues that have started to grow. Our staff burnout rates here are sizeable and within the general population. It hurts to be locked down intermittently for twelve months it takes its toll, and we now see the vaccine as a way out of that.
It’s been important for our leadership to show boots on the ground presence. It’s been crucial to have senior staff out on the ward rounds. Staff are now volunteering at the vaccination clinics as a way of giving back. They want to do something that makes them feel good; that’s what’s really refreshing it’s a break from that steady onslaught of people turning up in your ED.”
Looking back at Australia, how do you feel about what’s happening here?
“Looking at Australia, I’m proud, absolutely. I look back at Australia when talking about what can be done well when people follow messages, they understand, and leadership is coherent. Australia has been ahead of the curve with sequencing and understanding transmission cycles and how to stop them.
Our nearly 500,000 deaths have only bought us less than 25% community immunity. We have a long way to go. So I’m proud of my colleagues in Australia for their work, but I’m also cautious that it’s not over for you.
Australia’s urbanisation is high, and that’s what allows COVID to spread is proximity. I think it is a reiteration to say you guys have done remarkably well compared to Eurpe and North America. Still, you have the landscape in terms of dense population that can afford an outbreak to take place, and you caught a glimpse of that in July and August. I am grateful for all my family and friends in Australia that it got under control, but I wouldn’t rest on your laurels.
The whole point of what you guys have gone through in the last 12months is to safely get you to this point; it was to buy time for a vaccine to be developed. Whilst we have the morass over here, in Australia you don’t have that in-your-face visibility of how difficult things could be. What do you buy with 12 months worth of cautious restrictions? You buy yourself the chance to get to that point without going through the quagmire we have.
In the US, finally, a lot of our hesitancy and sceptisism of masking and general discourse has faded in the last months because we have, heaven forbid, reached a threshold that enough people actually know someone who’s died that you can’t keep escaping this it is that real. And I don’t think you’ve had that in Australia it’s easy for a healthcare worker who’s been taking care of a patient to understand its reality, but it is a very different impetus when you see someone you love go through it.
It’s the abstract versus the tangible experience that’s the difference between Australia and the US, but we’re all still fighting the same foe.”
Approved by Louise Kanis, Executive Director Public Affairs and Communication