How the COVID pandemic pushed healthcare forward

Dr. David Priest, Novant Health chief safety, quality and epidemiology officer, has been integral in leading the charge against COVID-19. Listen as Dr. Priest discusses what the future of viruses may look like, why public health should stay outside of politics, and key lessons learned while combating the pandemic.

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Gina DiPietro 0:04
Welcome to Industry insights, a healthcare podcast presented by Novant Health. I'm Gina DiPietro, and I'll be guiding the conversations in each episode. In this podcast I talk with Dr. David Priest - chief safety, quality and epidemiology officer at Novant Health - who has been integral in leading the charge against COVID-19. We dive into how the pandemic has changed the landscape for infectious disease positions, why public health should stay outside of politics, what the future of viruses may look like, and key lessons learned while combating the pandemic. Thank you for listening.

Gina DiPietro 0:45
Dr. Priest, tell us what an infectious disease physician does. And before COVID-19 what things did you work on?

Dr. David Priest 0:54
An infectious diseases physician is a sub specialized internist. So after you go to medical school, you do internal medicine residency, and then you choose to sub specialize within internal medicine. So for instance, a cardiologist specializes in heart care and oncologist specializes in cancer care and infectious disease. Physician sub specializes in infection. So every patient we see has an infection of some kind. And what's great about being an infectious diseases medicine is it's incredibly broad. So any part of the body can be infected. And so you get to interact with all the other medical disciplines. The terrible thing about being infectious diseases physician is that it's so broad, you're expected to know things about things you've never seen, and tropical diseases. And so that can be intimidating and a little scary when you're not focused on a say a single organ system. But that's what to me is made it fun how broad it is. So we work on a variety of things. We do Tropical Medicine, we do hospital cases, like sepsis. patients with cancer who've developed infections we do emerging infections like Ebola, we help deal with influenza, we do orthopedic infections. So really anything you can imagine that's an infection, fixing the heart valve infections, the central nervous system, sexually transmitted infections, we also care for those with chronic viral infections like HIV or Hepatitis B, or C. So it's a really broad, exciting field.

Gina DiPietro 2:30
Do you think that there was more early community concern to something like Ebola than COVID-19? And if, so why would that be the case?

Dr. David Priest 2:39
I think there was. One is just the fact is the mortality rate for Ebola is much higher than it is for COVID. And so I think that that's a scarier proposition for the general public. I think there was actually really more known about Ebola this last time. I mean, we'd known about Ebola for several decades, and people knew how deadly that was. And, and they knew that if they acquired it, the risk of death was quite high. I think COVID was a little different. I think they saw people saw it, even if this was inaccurate, they thought, well, maybe it's some kind of flu. I've had the flu before, it's probably not that bad. And so I think the response to the public was a little different. Also, we got control over Ebola, at least outside of Africa more quickly, was a devastating problem on the continent of Africa. COVID has gone on for many, many months. And so it almost has the sense of complacency that comes along with it. Because of how long we've been dealing with it.

Gina DiPietro 3:44
The world anxiously awaited a vaccine for COVID-19, which could put an end to this pandemic. But at the same time, concerns are raised that a vaccine created quickly might not have had enough time to vet long term issues. So from a historic perspective, how has the vaccine development and the testing process for COVID-19 been in comparison to vaccines for things such as polio, or smallpox and others?

Dr. David Priest 4:12
The current vaccines that are coming out for COVID are mRNA vaccines. And I'm incredibly excited about this technology. The idea around mRNA vaccines is actually not as new as people think, for a number of years, researchers have been using this type of technology or we're testing it for a variety of medical problems, including infections and cancers, actually, traditionally, the way a vaccine is made is you have to take a virus or a bacteria or whatever micro organism you're trying to protect people from, and you have to alter it in such a way that it's weakened. And then give it to the person to hopefully get them to make an immune response. So they're protected against whatever that virus or bacteria or micro organism is. When you do that, that process is potentially painstaking, expensive, can take months and years, people remember flu shots have traditionally been grown in eggs. So you have to have warehouses full of eggs. It's a, it's just a time consuming hard process. What's exciting about mRNA vaccines is that's not necessary. So rather than trying to get people a weakened version of a micro organism, instead, we're saying we're going to teach your body to make a protein that's on the side of the micro organism. And that's what's going to give the immune response. So mRNA, vaccines can be developed very quickly, and be made much more quickly. The reason it took a few years for these to come to the point they can be used is that mRNA is very, very fragile. it degrades very quickly. And so there were important technological advances that actually help protect the mRNA by putting a little lipid around it, and also storing those vaccines that very cold temperatures. And so once those things were worked out from a technology standpoint, then the vaccine could move forward. So while it seems like oh, this happened very quickly, actually the background on it's been around for some time, is it unusual to have multiple versions of a vaccine with different formulas like we do with Pfizer, and Moderna and several other global companies, it's really not that unusual. Manufacturers can ake the same type of vaccine. And we want that, right? We want different companies coming at a problem as important as this from several angles. And you want them to, to, we want the best one to rise above the others. And if they work equally, we want to use them all. I mean, we're in such a situation, now that we need all the vaccine help we can get. And we want to be safe and effective. And I think both of Pfizer maternal products are both safe and effective.

Gina DiPietro 6:57
And since there are multiple versions of the COVID-19 vaccine, how can people know that they're all safe?

Dr. David Priest 7:03
So both the Pfizer materna products are using mRNA technology and because that mRNA is so fragile when it's given to you and only lasts in your cells about 24 to 48 hours, and then it degrades. So there's really no mechanism that would lead to the long term problem or a situation where you have a long term side effect. Now in the short term, you may have what we call expected effects, where you get the vaccine, and then you have the symptoms that are consistent with an immune response to your arm can hurt, you get a little little low grade fever, maybe some redness you have kind of the blahs for a day or two. And that quickly goes away in both the trials. With Moderna and Pfizer, there were no long term serious safety events that were noted. And so we feel very good about the safety profile not only from what was observed in the trials, but also the mechanism and how the vaccines work. Now other vaccines could come to market and we would have the same demands of those vaccines show us that this vaccine is both safe and effective. Moderna and Pfizer both reported around a 95% effectiveness rate for their vaccines, which is frankly incredible. We think about the flu vaccine that we give every year, which often is effective less than 50% of the time doesn't mean you shouldn't get it actually the more of us that get it no matter how effective it is, the better. But compared to our yearly flu vaccine, these are incredibly effective vaccines.

Gina DiPietro 8:31
Another question for our listeners... Ethically, many leaders want to wait for the vaccine. Most people don't want to be the leader, the celebrity or the athlete who's accused of taking a dose of the vaccine from someone more in need. I know even Pfizer CEO said he would wait his turn to get the vaccine because he doesn't want executives to cut the line. But at the same token leaders and celebrities have incredible influence and can encourage others to get the vaccine. What would you recommend leaders do? Should they be leading by example to show people that they wouldn't encourage people to do anything they wouldn't do? Or wait until most people have gotten the vaccine to ensure that, you know, the people who are most in need have the opportunity to get vaccinated?

Dr. David Priest 9:18
Yeah, so that's a great question. This is a really fine line to walk for leaders. Because to your point, we want to show that we have confidence in the vaccine, we want to publicly say we've gotten it. At the same time leaders and executives are often not the individuals who are on the front line, particularly in health care. We've seen controversy around the country related to this topic. So the what we've tried to do it in our organization is to say we're gonna we're gonna try to balance this we're certainly not going to give vaccine to executive leaders who are working from home ahead of our phase 1a team members -nurses and doctors and Environmental Services staff and respiratory therapists and those individuals who are caring for COVID patients every single day. They deserve, they're risking their lives. They deserve to get vaccine first. And that's what our approach has been. But we do have key leaders, particularly key leaders, who do you see patients who have publicly gotten the vaccine and say, Look, we believe in this. So there is a little bit of tension there. And you have to work that out, I think, maybe in your organization. But I would lead with those most at risk. And then some key just a few key leaders to ensure that that people are understand the vaccine is safe and effective. And look, we understand there's vaccine hesitancy. And so we need to do those things to get people to understand this is safe, and they should do it. But you have to be careful about how you approach it.

Gina DiPietro 10:50
I want to go back to a point that you made, you mentioned herd immunity, it's really important that people buy into getting the COVID-19 vaccine to get this pandemic under control, right?

Dr. David Priest 11:03
Absolutely. And we think 70 to 75% of our communities need to have some degree of immunity, either from having COVID or having the vaccine or both. In order for this to really slow down and let us move back to, you know, the way we lived before all of this happened. And so that's that's why we're emphasizing that we have that the vaccine is safe. And we're really encouraging individuals to get it. We understand vaccine hesitancy, particularly in certain parts of our community that have had historic healthcare disparities, the African American community and the the history that that community has had with the healthcare system has not always been good. And unfortunately, things like Tuskegee and other experiments like it really builds a sense of distrust within the African American community, which is entirely understandable. And so we need to work through that. And we have leaders, African American leaders in our organization who have gotten the vaccine and are helping with that messaging. We are not going to get to herd immunity if we don't get all parts of our community equitably immunized.

Gina DiPietro 12:13
What do you think the future of viruses like COVID-19 looks like? Meaning, do you think that we'll continue to have outbreaks of new viruses, maybe not to the scale, but in the future?

Dr. David Priest 12:24
I think invariably there will be other pandemics. The key is when and I think we're certainly not done with this one. There also are concerns that in any pandemic, could the virus mutate in such a way that it becomes more transmissible, more infectious, would require adjustments to the vaccine? I think all of those things are possible. From kind of early in the pandemic to more recently, we've seen reports of mutations in SARS -COV2, to the virus that causes covid. Those mutations have made the virus more transmissible, but to date, we have not seen that it caused it to cause any more serious infections. But that can change over time. And so that may change how our vaccine approach works. So for instance, if enough mutations occur to the virus, that the current vaccines are not as effective, we would have to adjust those, and perhaps you're getting a new vaccine every year against COVID to protect you. We don't know that yet. Right now, the mutations that have been seen are, we believe are still covered by the current vaccine. But it just speaks to our need, as a nation and globally to put more resources into public health, more resources into pandemic response, more resources into monitoring situations and having the appropriate testing we need for individuals and certainly monitoring at our borders and the borders of other nations to ensure if these things are detected, we get on those we get on these things quickly. If you remember the original SARS epidemic pandemic was obviously much smaller. And the reason it was was individuals didn't transmit the virus if they didn't have symptoms. So you knew who was contagious because they had symptoms. In COVID, SARS-COV2, you could transmit the virus and have no symptoms. That is why it's been so much hard to get our arms around it compared to what was happening with original SARS. So the characteristics of whatever that virus is are really important. And I think invariably, there'll be other pandemics, we just need to be better prepared.

Gina DiPietro 14:33
Many of our listeners are business and government leaders who want to do anything they can to prevent this type of mass pandemic from happening again, from your personal perspective, what have we learned as leaders that we can do differently in the future?

Dr. David Priest 14:47
I think there's been a lot of hard lessons. I think when times are good and there are no outbreaks or pandemics. We tend to cut back on public health funding. I think when there is a budget crunch of some kind, sometimes that's the first thing to get removed. And I think this teaches us that's not a good idea. We need to make sure we do have those, the capability to monitor for outbreaks around the world. We have some systems that do that. But we need to have more systems that do that we need better cooperation across national lines, in order to have early warning systems when these kind of things develop and have the ability to develop diagnostics, and vaccines and therapeutics more quickly than we did with COVID. And I think the other thing is, we have to make sure that public health stays outside of politics as much as possible. I understand that often leaders of these public health organizations are appointed or occasionally elected leaders have some jurisdiction over public health. And so it's hard to totally avoid politics. But when public health becomes a political football and gets thrown around, we found through the this particular pandemic, that that's not as used, it's not a useful thing it doesn't allow that are the public health officials and our scientists and our physicians to do the things they need to do to protect the public. And I think the other thing I would say is more unified national message, I think will be helpful for the next pandemic. Because it's kind of there's kind of confusion, there's been some confusion and look, the guidance can change over time. That's okay. As we learn more, we have we need to be able to give new advice and make new guidelines as we learn more. But the message wasn't very unified. And I think that fostered distrust, and also allowed rumors and false statements about COVID to be spread online. And I think online is the other piece, right? We live in an age of this of social media and online influence, which has some benefits, but also has some downside when small, contrarian voices can get amplified with things that are true. And so we are the constant battle to explain to people that the things you're hearing about about COVID or the vaccine are not are not true. So I would say making sure public health is in a position needs to be improving communication. Improving diagnostics and monitoring are all important pieces of what we need to be doing when the next pandemic comes.

Gina DiPietro 17:33
On behalf of Novant Health team members and our listeners here, thank you so much for your leadership and helping Novant Health and our communities navigate this pandemic.

Dr. David Priest 17:42
Thank you.

Gina DiPietro 17:47
Gina DiPietro again. Some great information there from Dr. Priest and a well deserved thank you for his leadership throughout this pandemic. We hope you'll join us for a future episode where other healthcare leaders and influencers provide insight on everything from digital healthcare and consumerism to care transformation. Keep your finger on the pulse of healthcare with Industry Insights: A healthcare podcast presented by Novant Health. Thank you for listening.