Banking on KC – Dana Hawkinson, M.D.
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Kelly Scanlon:
Welcome to Banking on KC. I'm your host Kelly Scanlon. Thank you for joining us. With us on this episode is Dr. Dana Hawkinson, the medical director of infection prevention and control and an infectious disease physician at the University of Kansas Health System. He's here with us to provide an update on efforts to combat COVID-19 in the Kansas City area. Welcome, Dr. Hawkinson. We appreciate your time with us today.
Dana Hawkinson, M.D.:
Thank you so much. It's great. It's great to be on.
Kelly Scanlon:
About the current COVID-19 situation in the Kansas City area. What do the trend lines indicate, and where do we seem to be headed?
Dana Hawkinson, M.D.:
I think if you look back since March of 2020, overall, there's an increase in the number of cases in the Kansas City area. There is an increase in the number of hospitalizations, and of course, deaths. We have been accustomed now to thinking we are a little bit better off than some of our other country members, especially on the coasts. Our numbers are not as bad as those. Certainly if you look at LA County and the troubles that they're going through, from what we've seen in New York, Louisiana, Chicago, those places, we've been very lucky here in the Kansas City area.
Dana Hawkinson, M.D.:
But just because of that doesn't mean that it still is not bad. It certainly is bad. We at the health system here, in the hospital, we still have a lot of patients that are taking up beds and capacity that normally should not be here in the hospital and should not be taking up those beds and that capacity. We have reached a plateau, but we have reached other plateaus earlier on in the pandemic as well. Currently, we have about 120 to 130 total patients that are in the hospital because of COVID. But certainly, those numbers are greater than they were say, six months ago when we would have 30 or 50 or 80. Overall, the numbers are at a plateau, but they are still not as good as we would like to have them. They are not as low as we would like to have them. But I think, in general, we in the Kansas City area have been very fortunate that we haven't reached those capacity issues and those PPE issues and those vital and critical drug issues that we've seen with some of our other cities in the United States.
Kelly Scanlon:
We've been hearing a lot recently about various mutations of the virus. Have any of those been detected in Kansas City? And what are the implications of a mutating virus like COVID-19?
Dana Hawkinson, M.D.:
Initially, early in the pandemic, in the spring and the summer, there was talk of this one particular variant, which was the D614G variant. And what that means is there is an amino acid change at position 614 in the spike protein itself, in the virus. We saw that, that started to predominate, although it didn't really matter clinically. It didn't change. It didn't make the disease more severe. It didn't make it less severe. It was just what we had seen. We have to understand that viruses, especially these type of RNA viruses, they mutate on a regular basis, or they have changes during their replication process that make them different from the original viruses that may have infected that person. There is typically in-host evolution going on, and that's just part of the replication process, so it's not unusual to have some of these changes.
Dana Hawkinson, M.D.:
Now, what we have seen from these new UK and South Africa variants is that it is associated with multiple changes or multiple mutations. And is there an effect? There is the consideration that it is more transmissible, and maybe you create higher amounts of the virus in your body, and so it's more transmissible. There's also the consideration that it binds more tightly with the receptors on our body, so therefore making infection risk much greater.
Dana Hawkinson, M.D.:
We don't know the full impact of that yet. However, those things are being studied. Right now, it doesn't seem to look like there is any impact in the severity of disease, meaning creating a more severe or critical illness than what we had seen from the original Wuhan strain. But is there a concern that these variants are going to evade the immunity provided by our vaccines? We don't know that yet. That is currently being studied. There are studies ongoing. There is early data, preliminary data that hopefully will be coming out soon.
Dana Hawkinson, M.D.:
As far as in the Kansas City area, to the best of my knowledge, there have only been, I believe, four states in which the variants have been detected. I think Colorado, California are really the main ones. From what we know from a call the other day, Kansas is doing active sequencing, but in general, in the United States, we aren't doing a lot of sequencing to understand that. However, in the sequenced isolates that we do have, I believe they haven't found any of the isolates or the variants yet at this point in time. But certainly I think all the states are probably ramping up their active sequencing of the isolates to try to identify if those variants are present.
Kelly Scanlon:
What about people who've already had COVID? Are they at greater risk of getting it again with one of these new strains?
Dana Hawkinson, M.D.:
We know in general that you are always at risk of getting reinfection. We have to understand the immune system is certainly complex. The main issues that we're looking at when we're talking about, are you going to evade the immunity provided by vaccines? This is related to really the antibody response, and mostly it's this neutralizing antibody to the spike protein. The spike protein is the main protein that we have seen in the images that is kind of protruding from the virus itself. If that makes changes, is it going to evade the immune system? Meaning, in your question, if you've had the virus once or the infection, could you get reinfected? Certainly, we know that you can get reinfected with viruses that are not the variants that we're talking about, but other COVID. Again, we have seen that and know that there's good published data.
Dana Hawkinson, M.D.:
What we don't understand is how much immunity will you have if you get infected with this two really main variants that we're talking about, the South African and the UK? How much immunity are you going to have if you are infected previously, just as you asked? We don't know that question. We hope that you will have some antibody response because you're not only making one type of antibody. You're making multiple types of antibodies to all of these little pieces or areas on the spike and also other areas on the virus as well. But in addition to those antibody responses, which are created by B cells, you have other responses, most notably the T cell response, and the T cell response is extremely important because we know that people who have recovered from COVID, when they check antibodies in a very small population or subset of population, they may not have any antibodies, but what they do have is this other T cell response.
Dana Hawkinson, M.D.:
But as a short answer to your question, yes, we know that you can be reinfected. You can be reinfected prior to even knowledge of any of these variants. How is it going to affect if you are reinfected after that initial infection, if you are reinfected with one of these variants? We don't fully understand or know, but we would hope you would have some sort of immunity, again, to protect you from getting disease that requires hospitalization or severe disease that requires, obviously, hospitalization in the ICU.
Kelly Scanlon:
Yeah. There's lots of questions and people want answers. But when you think about it, in such a relatively short amount of time, so much has become known, but there's still a lot of research to be done. You've mentioned the vaccines, and that was really good news that we received several weeks ago, the announcement that vaccines are available to help to combat the virus. For our Kansas City area listeners, what can they expect about when they can be vaccinated, and how do they go about arranging a vaccination?
Dana Hawkinson, M.D.:
Yeah. We still don't know that fully. Again, right now, the vaccines are all really allocated and distributed by the federal government. But as we learned today and talking with one of our guests, we also do understand that within that federal government allocation and distribution, the states can make their own decisions as to exactly who and when to vaccinate the general population.
Dana Hawkinson, M.D.:
It's really unclear. One of the answers we got was maybe hopefully in a month that can roll out to the general population. But even within that general population, you are still going to prioritize those most at risk of severe disease, and that will start with prioritizing those people that have a certain age distribution. And whether that is starting at 75 or 70 or 65, from what we have learned, the states are able to make those decisions. Certainly, we need it sooner rather than later. We know that there is going to be help from those commercial pharmacies, such as Walgreens and CVS.
Dana Hawkinson, M.D.:
But I think the biggest break point at this, the biggest stopping point at this, is the actual supply, and it's getting that supply to those facilities, whether it's the health system, so we can vaccinate our most vulnerable and at-risk patients, or whether it is to those commercial entities to start vaccinating, or even the health department so they can vaccinate people in their communities as well. I think it's a combination of getting that supply to those places, and then, from there, moving to see what are the restrictions, and what are those populations that we are going to start with to vaccinate?
Kelly Scanlon:
Basically, we need to stay tuned to the media and to other outlets for these types of announcements to know how those are going to be rolled out in the categories that you just described.
Dana Hawkinson, M.D.:
Yeah, absolutely. Vaccines are produced relatively easily, and we know that they have been ramping up production since late in the summer or early in the fall on the anticipation that they would work and be approved, so hopefully the supply issue will become less and less of a problem. And as we are moving now through this new year, through 2021, especially in January and these next few weeks, we will see that supply be able to be distributed to the states, to the local communities, to really get everybody vaccinated.
Dana Hawkinson, M.D.:
But as of right now, the main focus for the most part in the United States has been those healthcare workers and those most at risk, such as those nursing home patients. And a lot of those things that are showing that Kansas is behind in vaccination is really what we believe is more of a data reporting issue. We have gotten a lot of vaccine. The state has gotten a lot of vaccine. We have been able to vaccinate a lot of our employees, as designated by the FDA and the CDC, to those employees and people that have come under those first few designations to get the vaccine, so I think we have done a very good job of being able to get the vaccine into the arms of those people that are designated as in that first group, and that's the healthcare workers and the frontline workers.
Kelly Scanlon:
Talk to us about the vaccine's effectiveness. When is immunity achieved, how long the immunity is expected to last with these initial vaccinations?
Dana Hawkinson, M.D.:
Yeah. Great questions. We don't consider you to have full protection until about two weeks after the second dose. After that first dose, the efficacy of preventing disease is probably in that 50 to 60 range in the overall broad categories. But really, after that second dose for Moderna or Pfizer, you're really looking at a 95% efficacy. And what does that mean? That means that you are going to have that much less chance of getting disease, and especially severe disease, with getting those two vaccine doses compared to if you did not get any vaccine whatsoever, so they look both very efficacious.
Dana Hawkinson, M.D.:
And the interesting thing with the Moderna data, they did show such a great efficacy in preventing severe disease. They had 30 or 31 people who did not get the vaccine, but got the placebo, go on to get severe disease. But in the people that got the vaccine, none of those people got severe disease, so that means none of them had to go to the ICU. None of them had to get ventilated. I think efficacy is extremely good right now.
Dana Hawkinson, M.D.:
How long will that last? We just don't know. We know that, certainly in this small amount of data that was presented, you should have immunity. We know from other studies in people who've had natural infection that you will have antibodies ranging anywhere from 60 days up to eight months, and it depends what study you're looking at. You will have all that range in just natural infection. With what we're doing with the vaccine, we should be able to elicit enough antibody response, but also that T cell response that I discussed. Hopefully that immunity will last six months or more, nine months or more, maybe a year. We don't know yet. Those studies will be ongoing. But we are crossing our fingers to hope that we will have those durable or those long-lasting immune responses.
Kelly Scanlon:
Even with the vaccine, life is not going to go back to normal right away. Even with people being immunized, what other measures will be necessary to stop the spread of this virus?
Dana Hawkinson, M.D.:
Yeah. That's a great question. We know in all of our guidance right now and all of the CDC guidance and NIH guidance is that even if you've gotten those two doses, and again, we have to be very clear right now, the amount of people that have gotten vaccinated is extremely small in the United States. We know that after the vaccination people need to continue to wear the masks, not meet in large gatherings, continue to social distance. And I know that's difficult. We are social creatures. We want to be out to dinner. We want to be in family gatherings for the holidays. We want to do those thing. Right now, we just are unable to do that, so it is very important that after your first dose of the vaccine, after your second dose of the vaccine, you really need to continue to do those non-pharmaceutical interventions, or NPIs, to help prevent the spread of the disease.
Dana Hawkinson, M.D.:
We don't know how long that will last, but we really have to follow what the data shows. We have to continue to do those things so that we don't overwhelm our healthcare system, so that we don't run out of PPE or critical drugs, so that our essential workers can continue to work to protect us, whether that's the police officers, the fire department, the EMS. But it's also our supply chain drivers who are driving our goods to stores every day that we need to be buying and doing so that we can live our daily lives. We understand that it has been a long road. I think it will still continue to be a long road, but it is much better, and we have much more knowledge than when we started. We know what can protect people, and that is masking, distancing, not meeting in large groups. The vaccines will help with that as well.
Dana Hawkinson, M.D.:
But right now the vaccines will not negate the reasons to be doing those other things that I just mentioned. We have come a long way as far as treatment. That includes the monoclonal antibodies to help prevent hospitalization. It includes the remdesivir, along with anticoagulation and the steroid dexamethazone if you meet the criteria for use. But yet, all of these things still don't negate the need to do those non-pharmaceutical interventions. We hope that coming down the pike, there will be more vaccinations available. This will help everything as well. And certainly, maybe even different kinds of vaccinations. We also hope that there will be better therapeutics or better drugs to use against the disease, as well.
Dana Hawkinson, M.D.:
But right now we don't have that. The best means to keep everybody safe and healthy is to continue those pillars of public health, which is the masking, not meeting in large groups, the distancing. There is light at the end of the tunnel. We are getting closer to that end of the tunnel, but we are still not fully there.
Kelly Scanlon:
Even with that light at the end of the tunnel, we have to have continued patience, continued vigilance. Dr. Hawkinson, we appreciate your work day in and day out and the work of all healthcare professionals and frontline workers to eradicate this virus. Thanks for taking the time to update us on this episode of Banking on KC.
Dana Hawkinson, M.D.:
Thank you.
Joe Close:
This is Joe Close, president of Country Club Bank. Thank you to Dr. Hawkinson for joining us on this episode of Banking on KC. We appreciate your update and insights into the status of the coronavirus in the Kansas City region, the rollout of the vaccination, and what we can likely expect in terms of progress during the next several months. We are grateful to Dr. Hawkinson and the scores of health care professionals, frontline workers, and public safety personnel who are waging a daily battle against the coronavirus, carrying out essential functions and keeping us all safe.
Joe Close:
We can all do our part as well by modeling the health and behavioral guidelines that have been shown to mitigate transmission of this virus. We're all on this journey together, and if we work together, we'll arrive sooner rather than later to a time when we've put this virus behind us. Thanks for tuning in this week. We're banking on you, Kansas City.
Joe Close:
Country Club Bank. Member FDIC.