Dr. Hathaway Division Chief Medical Officer at North Carolina Division - HCA Healthcare
With the rise in COVID-19 cases, Highlands-Cashiers Hospital’s CEO Tom Neal reached out to HCA Healthcare chief medical officer Dr. Bill Hathaway so they could have a question-and-answer panel at the special called Highlands Town of Commissioners meeting on Monday.
“We have definitely seen a rise in cases,” Neal said. “More importantly, the Delta Variant is far more contagious than Alpha. Most people are aware that I am fully vaccinated, and I am still able to catch it and spread it to other residents. That is why I am taking precautions to protect the residents, workers and patients of the hospitals.”
In just three weeks, Hathaway said the number of people hospitalized has gone up drastically.
“In short, I think people are well aware that we have seen a tremendous increase in the number of cases,” Hathaway said. “We had our peak number of hospitalizations in January of this past year. We had 140 to 160 patients hospitalized at one time. We dipped to a low number of eight patients at the beginning of July. Since that time, we have seen a substantial increase, now hovering at 40 to 50 patients on a regular basis in just three weeks. This is in large part due to the Delta Variant. What’s concerning about the Delta Variant is that it is much more transmissible. It is three to four times more transmissible than the other viruses.”
Most recently, Hathaway said they learned that there was a large outbreak of the Delta Variant in Barnstable County, Mass.
“Barnstable County is a resort area not much different from Western North Carolina,” Hathaway said. “Many people got together and there was an explosion of cases. Now, we weren’t surprised to see an uptick in cases after the July Fourth holiday. That is what happens. We have seen it before back at Thanksgiving, Christmas and Easter. What surprised us was the amount of people that who contracted the virus that were previously vaccinated.”
It was published by the CDC last week that there were 469 cases out of that outbreak. Out of the 469, 346 of them were in vaccinated people.
“It was a much higher number than we anticipated,” Hathaway said. “The good news is that the vaccinated people were not very sick. They had very few hospitalizations and they didn’t have a lot of illness. What we have also learned is that the fully vaccinated people were still able to transfer the virus to other people. The vaccine still works, and it prevents people from getting ill. The message should not be, ‘Don’t get the vaccine because it doesn’t work,’ it prevents severe illness and that is important.”
Hathaway said 50 percent of the adult population is vaccinated, but it is not enough to fight off the Delta Variant.
“Across the country, out of the people that are hospitalized, 97 percent of them are not vaccinated,” Hathaway said. “The population that is still getting the sickest is the unvaccinated.”
Highland’s mayor Patrick Taylor asked Hathaway what his outlook would be going into the fall for the Western Carolina Region. Hathaway’s answer? “My crystal ball is cloudy.”
“My crystal ball is cloudy. I bought a lot of Windex, and I still couldn’t get the images clear,” Hathaway said. “I think there are a couple of different possibilities. We still have an opportunity to flatten the curve. Now, we have new weapons to flatten the curve. We have masks and now we have the vaccine. It all depends in large part on how we socially distance when we are in groups and how well we vaccinate the remaining part of the population.”
Hathaway said he understands the hesitancy of people not taking the vaccine and thinks they will have to approach each and every person that is hesitant and figure out what their specific concerns are.
“We all have different reasons for why we do or don’t do things and I am very respectful of that,” Hathaway said. “I think there is no doubt that if you are not vaccinated then you are at risk for being part of the chain of transmission to people who could get very ill and end up in the hospital. This is a very serious disease. It has a one to two percent mortality rate, which is far higher than influenza. Anything we can do to vaccinate our communities, socially distance when we can, and wear a mask that would be my agenda.”
Highlands local Jerry Moore asked Hathaway about the impact more and more hospitalizations would have on the local hospital.
“If more and more people get sick and need to be hospitalized, how will that impact our hospitals? How does that impact people that need regular, every day medical care?” Moore said. “I think to me, our healthcare workers and our hospitals are my biggest concern.”
Hathaway responded saying that the other illnesses have not been put on hold because of COVID. Meaning, ER’s and hospitals would get backed up.
“We are still having strokes, heart attacks, babies being born, COPD flare ups and appendixes needing to be taken out,” Hathaway said. “When those beds are being occupied by COVID patients, then our ER’s back up, our capability to transport people to different regions where they need to get high intensity care slows down and that all becomes a problem. I want our staff to be vaccinated, not because they will transfer it to other people, but because I want them to be able to come to work. I can’t afford to have people out of work when we have a nursing shortage, because who is going to care for you when you get sick.”
In order for a virus to mutate, it has to reproduce. According to Hathaway, unvaccinated people give the virus more time for the virus to mutate.
“It is a random chance event when they are putting together the string of amino acids that create a protein,” Hathaway said. “When it mutates, sometimes it puts in the wrong amino acid. Sometimes, that kills the virus. Other times, it makes the virus stronger, like the Delta Variant. If we stop the reproduction, even in asymptomatic healthy people, then we decrease the chance of another variant. We are just another mutation away from another variant. We are looking at having booster vaccinations in the future, similar to what we do with influenza.”
If you have been infected, Hathaway still suggests getting the vaccine.
“The antibody levels definitely go up hire for those that get the vaccine after they have been infected,” Hathaway said. “A vaccinated person can still transfer the virus though. You can actually go into the nasal passages of an infected person and check the viral load. The weird thing about the Delta Variant is that even in people that have been infected and are fully vaccinated, the viral load is still as high as it is in unvaccinated people.”
As far ask mask wearing goes, Hathaway said they have proven to be very effective at stopping the spread of COVID-19.
“They have been proven to be as effective as a moderately if not highly approved vaccine if used properly,” Hathaway said. “I find them not to be very inconvenient. I am a doctor at a residential camp for kids during the summer and the kids had to wear a mask and they were OK. How inconvenient can it be for me to save someone’s life?”
Moore again asked a question about incentivizing vaccines in exchange for mask wearing.
“If there is a mask mandate again, people are going to be mad about it,” Moore said. “You may tolerate it, but there are kids, teachers and several others that don’t want to wear it. Is there something that we could incentivize people with to get the vaccine and shed the mask?”
Hathaway responded by bringing up herd immunity.
“Herd immunity is directly related to how transmissible a virus is,” Hathaway said. “The more transmissible a virus, the higher the percentage of people you must have vaccinated to get herd immunity. The example we use is measles, which is highly transmissible. You have to have 95 percent of the population immunized to prevent outbreaks. We thought with the Alpha Variant that that number would be about 70 percent. You probably heard those numbers and Biden talking about getting to 70 percent by Fourth of July. With the new variant, that number is even higher. It is probably about 80 to 90 percent now.”
To stop the new variant, Hathaway said they have to use all of the weapons in their arsenal right now.
“If we only use some of the weapons we are going to keep going up and down,” Hathaway said. “Even if we use all of the weapons, we may not stop it completely, but it’s a better chance. You fight a battle like this with everything you got, not just with your left arm or just your right arm, you use both. At least that is the public health’s way of looking at it.”
By Christopher Smith