As UConn Health administers the first doses of the COVID-19 vaccine to health care providers and other front-line staff, Dr. David Banach, UConn Health’s hospital epidemiologist, and Dr. Kim Metcalf, UConn Health’s primary vaccine coordinator, join Carolyn and Chris to discuss how UConn Health is serving as a leader in the fight against the pandemic and to explain the significance of the vaccine in that effort.
(Dr. David Banach, Dr. Kim Metcalf, Carolyn Pennington, Chris DeFrancesco, December 2020)
Chris: The world’s been waiting for it, and at long last it’s here: the first vaccine for COVID-19.
This is the UConn Health Pulse, a podcast to help you get to know UConn Health, and its people, a little better, and hopefully leave you with some health information you’ll find useful too. With Carolyn Pennington, I’m Chris DeFrancesco. We finally have a vaccine that may help us get the upper hand on the COVID-19 pandemic.
Carolyn: And UConn Health is one of a select few sites designated by the state to start administering it. Here to tell us more about this, Dr. David Banach, infectious diseases physician and UConn Health hospital epidemiologist, and Dr. Kim Metcalf, UConn Health’s AVP of pharmacy and ancillary services and primary vaccine coordinator. Thank you both for taking time to join us today. We know you’re very busy.
Dr. Metcalf: Thank you for having us.
Carolyn: So David, we’ve been waiting for what seems like a very long time for this vaccine. How does this change the game from now on with this pandemic?
Dr. Banach: I think this is a huge game changer. You know, we’ve been battling this pandemic now for almost a year, and an it’s taken just an incredible toll on our community, our state, our country and the world. I think when we look at the tools that we have to prevent further spread of the infection to really defend ourselves against infection, we have our preventive measures, but this is really the first really critical vaccine effort to provide some element of immunity to people which will really help prevent people from becoming infected.
Chris: We’re going to have a lot of questions for you, Dr. Banach, as far as how this is all going to work, but also important to how it’s going to work, Dr. Metcalf: How is this going to work? First of all, how did UConn Health become among the institutions chosen to have this very important role in the future of what we do and how we deal with this?
Dr. Metcalf: Yeah, Chris, UConn Health, as you know, is an academic medical teaching facility. We have a large footprint of research here on our campus. And as you know, these vaccines are coming to us in an ultra-cold, special-temperature state. And with that, oftentimes organizations may not have that kind of equipment on hand. Because we have such a large footprint in research, that type of equipment is very common to us. It’s within our nature, we are used to that kind of variability with stability of our research platforms. So it was pretty easy for us to mobilize the right equipment, stand it up, respond back and inform the state that we’re ready to receive large amounts of vaccine to facilitate vaccinating our health care workforce as well as the community.
Chris: Excellent. Now, Dr. Banach, this is going to be most effective if people actually roll up their sleeves and take it. Talk a little bit about why that is so important, starting with the people who are going first, the health care professionals.
Dr. Banach: Absolutely. The critical part of vaccine deployment is vaccine uptake. And we know that our health care workforce is essential in providing care to patients with COVID, but also all of our patients that come in. And keeping the workforce healthy and protected from COVID is going to allow us to preserve all of our critical health care workforce to be able to provide that level of care.
So I think we have the opportunity here as health care professionals to lead the vaccine effort, but it’s really in the interest of the public to be able to encourage all of our health care workers to take the vaccine, to protect themselves, but also to be able to provide care for those who need it.
Carolyn: But of course there’ve been so many questions about the safety, because it was pushed through very quickly, much more quickly than most drugs or vaccines. So what can you say to the people who do have questions about the vaccine? How, how safe is it, really?
Dr. Banach: I think the speed at which this vaccine went to this point in the FDA authorization process is incredible, but I think it’s important for people to know that that speed really focused on specific phases of this whole process. Really it was in the early research and development phase and the manufacturing phase, which occurred nearly simultaneously, or at least in very close proximity. The part that wasn’t sped up was the phase 3 clinical trial. That clinical trial that was performed was incredibly robust, had a very large sample size of over 40,000 individual who have been in this randomized placebo-controlled trial. And the data from it is incredibly impressive, both in terms of the efficacy and the infrequency of side effects.
Carolyn: And what about the people that apparently, if you’ve got allergies, I guess with the United Kingdom, some people are having reactions, that they have allergies?
Dr. Banach: There were a couple of cases that were identified in the United Kingdom of individuals who developed allergic reactions after the vaccine. It should be noted that those individuals, and I believe there were a couple of individuals who had that reaction, had what seems like a predisposition to develop an allergic reaction. They’ve had allergies in the past, at least that’s, what’s been reported. I anticipate we’ll learn more about this, but I think it’s really important to think that even though we did see a couple of individuals who had allergic reactions, that is very common in terms of any medication that we administer, any vaccine that we administer. There may be some need to give a little extra attention to individuals who have had severe allergies in the past, like anaphylactic-type allergies, but I think that it’s important to look at that in the big picture and realize that this is a pretty infrequent occurrence. And it’s also important to know that if that ever were to occur, at least here in UConn Health, we have all the measures in place to be able to address that immediately. There’s an observation period that’s required after receiving the vaccine.
Carolyn: Oh, there is, I was wondering about that. So you’ll have them sit to the side? Kim, do you wanna talk about that?
Dr. Metcalf: Yeah, sure. Our vaccine stations have a observation location that folks who have just been immunized will stay there for 10 to 15 minutes and be observed if they have any type of anaphylactic-type reactions.
Dr. Banach: I think the immediate hypersensitivity reaction is really the thing that we we’d want to monitor for, it sounds like from what’s been described that that was the circumstance with the individuals in England. Again, I think we’ll hear a little bit more about those, but we do have the system in place to monitor for those immediate reactions.
Chris: Dr. David Banach, UConn Health, infectious diseases physician and hospital epidemiologist, I’ll have some more questions for you about dispelling myths in a minute. Dr. Kim Metcalf, you’re serving as our primary vaccine coordinator for the UConn Health COVID-19 vaccine effort. Let’s talk about the big picture, kind of the rollout. Right now we’re doing front-line health care employees, or all health care professionals are going first, and then where do we go from there?
Dr. Metcalf: Correct, right now we are looking at all direct and indirect health care workers, both at UConn Health as well as in the community. And our community catchment area assigned to UConn Health is Farmington, Canton, and Avon. After that, we’ll be moving on to the next phase, and we expect UConn to be very much engaged in those next phases, which include individuals like our critical workforce in the state. These are individuals that keep our grocery stores open. These are individuals that serve the general public in many ways. So we’ll be moving on to that as well as our high-risk patient population, we’ll be moving into that phase as well. And UConn Health will be a leader in vaccinating in the subsequent phases, and we will have our vaccination stations are remaining live and available for the general community to be able to receive the vaccine.
Carolyn: Do you anticipate — because you do need a booster shot, right, what, 21 days later? — Do you anticipate any problems with getting people to come back in and get that booster shot?
Dr. Metcalf: We do. We do our best to plan, but we know things do happen and folks may not make their next appointment. But we do have a vaccine call center, which will be following up on any missed appointments to reschedule folks to come back and get their booster. It’s important to finish the full regimen so that they can achieve the highest efficacy that the vaccine can offer.
Carolyn: And it has to be the same vaccine, right? If you’ve got a Pfizer vaccine, you can’t get a Moderna next time, right?
Dr. Metcalf: Excellent question, Carolyn, yes, it has to be the same manufacturer. So if you did receive a Pfizer vaccine your first dose, your second dose must be a Pfizer vaccine.
Chris: All right, Dr. Banach, what do we know so far about this vaccine that maybe might convince a few people who might be a little hesitant, “You know what, it’s OK to do.”? Like we already talked about, “Wow they really rushed this through.” Well, they only rushed through the production part of it, they didn’t rush through the science part of it, which is I think assuring.
Dr. Banach: And I think that’s the most critical way to think about it. So the phase three clinical trial showed us a lot. It showed us that the efficacy of the vaccine of 95% and preventing COVID-19 infection, you know, is really remarkable. I think when we look at other types of vaccines we don’t see that level of efficacy for many vaccines. And I think what it also showed us is that the rate of side effect would be really quite similar to what we see with other vaccines, like flu vaccines. There were a sizable number of folks in the trial that developed some localized skin discomfort at the injection site, but that’s pretty standard for many vaccines. Additionally there was a small percentage that developed some fatigue, maybe even some low-grade fevers, but really nothing that would be too out of the ordinary for a vaccine. So I think that data really helps provide some assurance that the vaccine can be effective and the side effects are what we would have anticipated.
Chris: And you kind of want a little bit of side effects, right, because that shows that it’s doing its job?
Dr. Banach: Exactly. I think the way we think about side effects, they can be something that we would want to happen. These vaccines generate a very robust immune system, which is exactly what we want to provide that protection. And sometimes as part of generating that immune response, people do feel fatigued, people do feel some low-grade fever, but that can be OK. And I think it’s important to think about the bigger picture and really understand what these vaccines are doing and what might be a totally reasonably acceptable effect to have afterwards.
Carolyn: So if you’ve already had COVID and recovered, you do not need to get this vaccine?
Dr. Banach: Actually that’s a common question that we get, and the current recommendations are likely to support getting the vaccine, even if you’ve already had COVID. What we know is that the immune response from COVID infection will give some immunity. We don’t know how long that lasts for. It looks like, from what we’re seeing, it lasts for at least 90 days, but I think the vaccine would provide sort of additional support to build a more robust immune response afterwards. I think what we do know is that the individuals that have had COVID recently, say in the last like three months or so, even though they would still be recommended to get the vaccine, they wouldn’t be sort of at the top of the list, because we know that they’ll have some element of at least a short-term immunity from their infection.
Chris: And we want to reiterate, and this a challenge we face with other vaccines, like influenza, getting the shot is not going to give you COVID-19.
Dr. Banach: Right, that’s critical. These vaccines do not have any live virus. They can’t actually cause a COVID-19 infection, and that’s really, that’s very important to know. There are some other vaccines out there that are a live-virus vaccine, things like the measles vaccine, but this is not that at all. There is no live virus contained in this vaccine. So if you do get symptom, it is not because you were infected with COVID-19.
Carolyn: And do you anticipate that this is going to be like the flu vaccine in years to come then you’re just going to have to get this COVID vaccine every year?
Dr. Metcalf: It’s hard to say at this point, because we don’t know how long the immunity will last. We don’t know if this will be something that is every year.
Dr. Banach: I agree. I think that’s going to be one of the most critical pieces of data that needs to be collected moving forward. Those individuals who are vaccinated, there’s going to be ongoing data collection on whether or not they have antibodies that remain high for the months, maybe even years, after getting the vaccine. But they’ll also be followed in the clinical trials to see if they do develop COVID infections, say, a year after they receive the vaccine. And that helps give an understanding as to how durable the protection is over time.
Carolyn: So when can we stop wearing masks?
Dr. Banach: That’s a great question, probably one of the questions that’s at the forefront of everyone’s mind. I think the only answer I can say is, not yet. I think the vaccine is such a critical part of being able to turn around the pandemic, but I think there’s still a lot that we need to be thinking about when we’re looking at scaling back our preventive measures like wearing masks. First we’d have to think that we want a very large proportion of the community to be vaccinated and have some immunity to COVID-19. That’s really important. The other critical piece of information that we need to learn is after a vaccine, is there any virus that can still linger, say, in the nose, over time that may potentially be infectious?
But I think the biggest piece is ensuring that we get enough immunity in the community to feel confident that we can start scaling back some of these measures. And so in the short term, we’ll continue to wear masks, we’ll continue to emphasize all the other prevention measures like social distancing, avoiding gathering, and hand washing, in at least the near-term future.
Chris: Dr. Kim Metcalf, the primary vaccine coordinator for UConn Health, and Dr. David Banach, UConn Health hospital epidemiologist, before we say goodbye, and again, thank you for joining us, one final appeal to the importance of getting vaccinated with COVID-19.
Dr. Banach: I think one of the key perspectives is that as health care workers we’re offered this incredible opportunity to be leaders in the vaccine effort. We can sort of demonstrate our commitment to turning around the pandemic by doing this, and the rest of the community is going to be watching what happens with health care workers in terms of their acceptance of the vaccine. So I think there’s a critical piece of leadership within our health care communities in terms of impacting the public health and vaccine uptake.
Chris: And that’s our time for today. For Drs. David Banach and Kim Metcalf, and Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe, so you can catch us next time, and please share with a friend.