Dr. Danny Branstetter, a specialist of infectious disease at the Cobb-based Wellstar Health System, has given several interviews to the Marietta Daily Journal over the course of the pandemic. This week, he spoke about the recent uptick in cases, the status of phase three vaccine trials and other treatments in development and how to celebrate the upcoming holidays safely. This interview has been edited for length and clarity.
Q: For a while, our (coronavirus) numbers in Georgia and in Cobb County were dropping. They fell so much that local school districts felt comfortable bringing children back for in-person learning. That trend unfortunately seems to have reversed and the numbers are ticking upward again.
A: Yeah, we are seeing an uptick as well here in Cobb County, for our numbers of COVID-positive patients. And that not only means not only the positive test results, but we’re seeing a slight increase in our hospitalizations as well.
Q: Do we understand why those numbers are going back up? Is it just that we have to assume people aren’t social distancing or handwashing or mask wearing as well as they were before? Or is there maybe something that we could point to that is causing this spike?
A: This is always going to be multifactorial. So we’re not only going to see that it’s probably some lapses in mask wearing, social distancing, handwashing that could be always tightened up. ... (But) I really can’t say that that’s the only explanation. We are seeing ... increasing cases among sports teams. So as groups get together for longer periods of time, those are kinds of things that would certainly lead to an increased rate of infections and spread throughout the community.
Q: Where do we stand with regards to hospital capacity and testing?
A: Testing supplies are adequate. I don’t know of any shortages that we have. Wellstar and other health systems continue to evaluate as many testing platforms — that’s the type of tests that we can use to diagnose disease like COVID — so we can make sure that we can get faster turnaround times (and) easier tests, so it’s not so inconvenient to get it collected (and) the process may not be so hard to tolerate, because those nasopharyngeal swabs are horrible. But as far as turnaround times, right now, for our inpatient, in my experience and what I’m told from our lab directors is, we’re getting about a one- to two-day turnaround time for our inpatient particularly.
Q: A number of vaccine trials are in their third and final phase. How are those going? Do we have a clearer picture of how effective these vaccines might be and when they might be available?
A: So those are questions to be answered ... I think that we’ll understand more and more about that in the months ahead. And I suspect we’ll (have) a better picture or solid picture of that after the vaccine is actually rolled out. I think what your listeners and readers may want to know, is, what is the biggest thing that one may be advised to look at in these vaccines? And I really think it’s safety. So how safe is this vaccine for me to take? ...
There are multiple vaccines that are being tried. Right now, there’s at least four in phase three trials in the United States. ... As far as availability, it’s anyone’s guess as far as when that’s actually going to be. But if the trials continue to progress in the manner that they are, and with the current success that they’ve had, without any significant road bumps, it’s not impossible to believe that we may see our first vaccines before the end of the year.
Q: And are there any promising treatments aside from a vaccine that are under development, something that might even bring us to a point where we don’t necessarily need to rely on a vaccine?
A: I want to remind you and your listeners and readers that it is important that we have two things, two tools at our disposal to help break a pandemic. One is a treatment that’s effective for the majority of the population. So if they do get infected, or do get the illness, that we are able to treat it successfully and limit the spread beyond those (people) as well.
And the second thing is a preventative vaccine that is effective. So those two things are needed to break this pandemic. So it really is going to be (that) we really want both, to be as successful as we can to break the pandemic. As far as where we are in promising treatments. ... It’s not been as robust in the responsiveness that we would like to have seen to each of the individual treatments that have been in trials so far. What it’s probably going to be at the end of the day, it’s probably going to be some combination of treatments, rather than one single agent.
There is some efficacy seen in things like remdesivir and antiviral medication, and with the plasma use in some populations as the antibody therapies. But there’s also some anti-inflammatory medications, dexamethasone, a steroid, for example. And using those in a combination is probably what we’re going to see may be the most effective, until we really learn some more about the virus over the next few months.
As far as, (whether) there other drugs that are coming out or other treatments — absolutely. So we’re in trials right now with new medications, even at Wellstar. We have some antivirals coming online, (those are) medications (aimed) directly at the virus that potentially can be used both inpatient in the hospital as well as outpatient (settings). ... And then there are antibody therapies, like plasma ... So we have those in current trials, not only for inpatient, but also outpatient (settings). So if you get diagnosed by your primary care doctor, an urgent care clinic or walk-in clinic, we can get therapies before you need to be in the hospital.
And then finally, the other trial that’s going on is a preventative trial. So it’s a medication, it’s an antibody therapy ... to protect people from developing COVID. If you live with someone who has COVID, and they’ve been recently diagnosed or infected, then you come in and you get the medication before you develop symptoms as a preventative approach to that. We call that passive immunity instead of the active immunity that a vaccine would give. Passive, (means) we give you the protection, your own body doesn’t develop it and it’s (effective for) a shorter period of time.
Q: Have we learned anything new about the virus since we last spoke?
A: I think there are still many things to be learned about this virus (such as) how it’s transmitted. We know that it’s a respiratory virus, (but) what does exactly it take to get infected? ... How long is someone infectious? Since we last spoke, (it’s) become clearer that’s somewhere — probably at the maximum — around 20 days or so. But most people probably are infectious for around 10 days and that’s it. ...
But we still have more to learn around that. We still have more to learn about the outcomes of the infection. I think that’s the biggest black box that we as health professionals worry about. Because even if you survive this disease, you may have a complication down the road as a subsequent effect of the infection. So we’re still learning who’s at risk for those (long-term effects), what all those are, how long those last, and how might we respond to treating those.
Q: And those long-term complications — what seems to be the most prevalent?
A: The ... one that most people (probably) hear about is the loss of taste and smell. ... We know people may have it for a day or so. But there are certainly people with weeks or longer that have this complication. And we know that in a few cases it doesn’t return.
Q: And how is the current flu season shaping up?
A: The first thing I want to do is reflect back into the early part of 2020, when COVID was first starting to really get ramped up (as well as) all our efforts here in the United States. And we were still in the middle of flu season. And what we saw was an increased number in flu tests, because we were trying to make sure that people didn’t have the flu and this was actually COVID, since our COVID testing was still getting ramped up. So we increased the amount of flu tests that we’re doing, asked people to social distance, wear a mask, stay home if you’re ill, all those kinds of things. ... And what we saw was a dramatic drop of cases of influenza, despite a huge ramp up in testing and looking for it. So what that tells me is that our measures that we put in place to try to prevent the spread of respiratory illness was very effective during flu season.
So we got to continue to adhere to those even though we’re tired of them. We’re all tired of them. We all want a break but it’s time to double down on that just because the flu season is coming up. ... We all should be getting a flu vaccine unless there’s an absolute contraindication (such as having an underlying symptom that could make it dangerous to take a particular drug and) your doctor has told you not to get one. ...
The thing I want people to remember, though, is to keep healthy otherwise. Keep your diabetes in check, your heart failure, your lung disease, ... (keep) seeing your doctor, making sure you have a good plan to keep those managed well in the coming months. And stay on your medications if needed for those chronic diseases, because that will help not only keep you healthier, but also if you happen to get the flu or COVID or both, unfortunately, this year that you’re more likely to survive because those chronic diseases are managed.
Looking at our partners, looking at our other health systems across the world, particularly in the southern hemisphere of the earth — where it experiences flu a little bit earlier than we do here in the United States — they have had fairly mild flu seasons compared to historic levels. And that is probably because of all the mitigation methods I just spoke about. ... So with the vaccination and deploying all these methods to prevent respiratory infections that we’ve been hounding on since February, March, I think we can make a good impact and flu season may not be that bad this year. But it will depend on us following and adhering to all those things to be successful.
Q: Halloween and Thanksgiving are coming up. How can people celebrate those safely?
A: We got to find some ways as communities to be able to continue to do the things that are important to us. ... But the key word is “safe.”
(For) Halloween, certainly incorporate masks into your Halloween costumes. And if you’re a candy giver, if you’re out there passing out candies in your community, we want to make sure that you’re doing it safely. So having pre-packaged gift bags or individual bags, so you can grab one at a time for your trick or treaters, or have some kind of local event where you have it already put together for the trick or treaters to come and just pick up (or) their own individual baskets, something of that nature.
If you’re going to have an event or some kind of activity, outdoors is better. ... And again, the shorter amount of time in contact with people, the less likely transmission is to occur.
We certainly have a Thanksgiving, Dia de Los Muertos coming up, where people get together, they like to have meals and spend a lot of time talking and interacting. Those are going to be very challenging for us because those are ripe to transmit the virus. So I want people to be aware of that. It is something that is a perfect setup and a perfect storm, not only to acquire (the virus) yourself as you visit, but then take it back with you as you leave or visit others. So it’s really thinking about, maybe you get together, have to-go boxes at Thanksgiving meals, individual serving kind of things, trying to do other activities than eat together in a buffet style. ... Celebrating virtually ... or maybe having smaller gatherings. ... Those are some ways that we can try to innovate this holiday season.
Nothing replaces the old ways, but we’re in the middle of a pandemic. The biggest concern is that our old way of celebrating these holidays is just going to put us at such an increased risk to not only acquire but spread this disease.