Wednesday, October 5, 2022

A COVID update from Novant’s safety chief

The first time I spoke with Dr. David Priest was on a Zoom call a few days before last Christmas. I had just been diagnosed with COVID.

Dr. David Priest

Dr. Priest was doing a conference call with reporters, updating the pandemic situation. I joined the call because I was planning to write about getting COVID. I wanted to hear from an expert. Priest is Novant Health’s chief safety, quality and epidemiology officer.

I was jittery because this was before the Paxlovid rollout, and my antibody infusion wasn’t until the next day. I recall being calmed down by the call. I had gotten my first two shots and my booster was just three months old. He said folks like me were probably going to see a mild case. Dr. Priest had a reassuring bedside manner on Zoom.

I made a mental note to follow up with Dr. Priest. I wanted to know more about the fellow who was the public face of Novant, a large, multi-state health care system, during this pandemic.  And so, I did, recently.

Things are a little quieter now than during the Omicron spike that got me last winter. But we’re not done with COVID.

“We, as an organization, still as recently as last week had 160 patients in our hospitals with COVID,” said Dr. Priest.  “And if that were happening in a flu season, we would be shocked, right? We would be [saying] ‘What a terrible flu year.’ But it all becomes relative.

“People just want to move on. They’ve had it, they’ve been vaccinated, or both.  I think it’s happened not because it’s gone, but because people have moved on.  They’ve survived their bout with it, and they’re just tired of dealing with it.  So, I think part of it is just public fatigue.”

Medical heroes

Dr. Priest, 49, lives and works in Winston-Salem.  He graduated from Wake Forest University with a degree in biology in 1995, and Wake Forest medical school in 1999. (He also has a master’s in public health from the University of Florida.) As he progressed through medical school and a residency, he discovered his life’s work. “I just found that infectious disease physicians were my medical heroes.”

“My only concern, honestly, was that I wasn’t smart enough to do it, because they were on this plane where they just talked about esoteric things, unusual diseases.  I called them the internists’ internists.”

Before 2020, if you saw Dr. Priest on the news, it was flu season. Maybe a West Nile case or measles. If there was something bad going around, he was high on the list of experts reporters would call.

Doing this prepared him for his role in the pandemic, when the ability of hospitals and public health officials to communicate has been tested. This is the first pandemic of the Twitter/Facebook era, and concerns and sometimes misinformation about vaccine safety spread on social networks. But nearly 12.2 billion vaccine doses have been given globally through last week. “It’s safe,” said Dr. Priest. “It’s not new technology anymore. It’s been put to the test.”

Yet, 23% of North Carolina adults have not gotten any vaccine. At the end of August, there were more than 1,100 North Carolinians hospitalized with COVID, on an average day. That’s down from more than 5,000 in January, but this thing has a tendency to flare up. In April, hospitalizations were down in the 300s.

A phone call

Dr. Priest was on vacation – he recalls it being late January/early February in 2020 – when he got a call from someone at Novant “who said, ‘Hey, you know this thing is happening in Asia, and we have a team member who’s there and coming back. What should we do when they get here?’”

He would spend a good chunk of the vacation on the phone, focused on how to screen folks who had been in Asia and were coming back to the U.S.

“And so we started planning pretty rigorously. And it was about March the 8th when all hell kind of broke loose,” Dr. Priest recalled.

That was a tumultuous week. Cases were popping up in North Carolina and around the country. Cruise lines were canceling. Hand sanitizer was selling out. Universities were moving online. Manufacturing plants were closing.

One focus of hospitals was to just get essential stuff. “We had a pretty good stockpile of PPE. [Our] sourcing people did a good job. We had a lot of testing swabs.”

But the whole testing issue was a contentious subject. There were regulatory roadblocks put up by federal agencies, like the Centers for Disease Control, that slowed testing.

“We got a little bit of pushback early on, like ‘Don’t do as many tests as you’re doing.’ And we were like, ‘We have the ability to do it. We’re going to test.’ And then, of course, the people who asked us to not do that came around later and said, ‘Oh, yeah, you need to be testing.’”

“I think there was some thought then that ‘This isn’t going to get that big. We’ll try to do contact investigations. The local health departments, they’ll evaluate cases and isolate people around the cases.’  And we all knew they didn’t have the resources to do that when it got as big as it did.”

Public health, he said, has been designed in the U.S. to deal with “community issues” such as sexually transmitted infections, he said.  “And they do a great job of that.  But they’re not funded to deal with something on the scale of a global pandemic.”  There is a lack of national coordination, said Dr. Priest.  “Every state is different. Even within states, things are different. Local health departments don’t always report to the state health department, depending on the state you live in.  And so, the response is very difficult to coordinate.”

When a pandemic like COVID breaks out, “the thing you need right off the bat is a really robust way to immediately identify cases, and immediately test people, and immediately react to that.  That was severely lacking.  Remember, there was a very small number of testing kids the CDC had, like a handful, and they didn’t work.”  That put us “way behind in being able to test, and then it obviously was all in the country before anybody really realized it.”

What did work well was the rapid development of vaccines, he said. In fact, the criticism was that it happened too fast. But that was because, usually, development of a vaccine has a number of time-consuming obstacles that need to be overcome.

“Before the pandemic, if I’m someone who wants to develop a vaccine, I’ve got to find funding for that. I’ve got to get research grants. I’ve got to develop that technology. I’ve got to get volunteers that will be willing to go into studies.

“In this particular case, a lot of boxes got checked pretty quickly.  Very motivated governments poured billions of dollars into the effort. There were thousands of volunteers who said ‘I’ll go into clinical trials right now.’ No one had to recruit anybody.

“And then mRNA technology, which had been around longer than people realize, was sitting there.  It had been tested some but was really looking for a case study. And along came a pandemic.”

Traditionally, vaccines were basically a weakened germ injected into our bodies to create an immune system response. Messenger RNA was different, an instruction manual for cells to create a protein that would stimulate the immune system to create antibodies. And as variants of the pandemic have changed, a new set of instructions can be produced to deal with that.

That’s why I’m scheduled to get my next shot Wednesday, the updated bivalent booster designed not only to deal with the original COVID, but the Omicron variants BA.4 and BA.5 that have been circulating around. “This will be the first time you’ll have the ability to get a vaccine that’s been altered to be more specific to these more recent Omicron variants.”

“Just like we do with the flu shot every year. There’s an attempt to match the flu shot with the different flus that are circulating in other parts of the world.”

Promoting vaccines

Throughout the pandemic, Dr. Priest has been urging folks to get vaccinated. That was his message last December when I first heard him. Most of the COVID patients on ventilators in Novant’s hospitals were unvaccinated. It wasn’t a message everyone wanted to hear.

“Being a COVID celebrity is not all it’s cracked up to be,” he said.  “You get some hate mail and nastiness on the Internet.”

Fundamentally, he sees himself as an educator. “My belief is that physicians are at their core teachers.  I had the privilege of going to a language school, and I learned medical language.  It doesn’t necessarily make me smarter than the public or smarter than my patients. Medicine is a language. It’s often a language of terms that are way more complex than they need to be.”

His mission, during a difficult time, has been to explain, in terms folks could understand, what they could do to protect themselves and their loved ones.

He mentioned a passage in the Scriptures in which Mordecai says to Esther that she had come to her position “for such a time as this.”

“I kind of look at it like that. It just happened to be that the safety and quality officer at Novant Health was an infectious disease doc when the pandemic hit. And so, I thought, well, this is what I was put on earth to do right now. So, I’m just going to do it.”

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