By Steve Carroll, Pathologist
Member, Providence Church, Charleston

Exhaustion with precautions has set in

We’re at a very delicate time right now. The COVID-19 pandemic has dragged on for months and a great deal of exhaustion with COVID-19 precautions has set in. 

However, we do have an end in sight with the recent announcements about promising vaccines (more about that below). The challenge that this is raising for us in health care is that many people are tempted to abandon the precautions recommended by the Centers for Disease Control (CDC) because they think that COVID-19 is nearly over.

The problem is that we’re in the middle of a major surge in the number of COVID-19 cases and COVID-19 associated deaths in the United States. Abandoning the precautions recommended by the CDC right now will make this surge even worse and result in the needless deaths of many people.

What we’re doing at Providence

At Providence Church, we are still not meeting in person—both church services and Sunday school are being held virtually. However, our church leadership recognizes that our membership is really missing seeing one another in person.

Because of that, I have been speaking with our ministry about what we can safely do to have limited in person events. If we are going to have such events, we must continue to follow essential precautions: social distancing, wearing masks, avoiding physical contact, washing our hands regularly and limiting the number of people who can attend these events.

We are also assessing how much square footage we have in our Fellowship hall and then calculating how many people we think that we can accommodate within that square footage while still maintaining appropriate precautions.

Our pastors will then offer church members the chance to attend special services such as at Christmas Eve. However, they are asking members to register their intention to attend these services in person in advance and then limiting how many can attend—if more want to attend than can be accommodated in a single service, they’re planning to set up multiple services. Precautions such as these should allow us to meet safely on special occasions.

Covid isn’t our only concern right now

I would also urge everyone to remember that COVID-19 isn’t the only deadly infectious disease that we will be encountering in coming months. We’ve now gotten into flu season—flu is more dangerous than many people realize (although, to be clear, most conventional flu strains are no where near as deadly as COVID-19), so please be sure to get your flu shots this year.

I would also suggest that you talk to your family doctor and ask them whether there are other vaccinations that you should get such as the vaccination against pneumococcal pneumonia. We have occasionally seen patients get infected with both COVID-19 and another disease such as the flu at the same time; that’s a deadly combination.

Steve provided this Covid update at the request of CBFSC because he is a member of CBFSC-affiliated Providence Church in Charleston and has extensive experience working with Covid.

Why Steve is qualified to talk about Covid

I am a pathologist and have been responsible for leading our efforts to develop and expand COVID-19 testing in the state of South Carolina.

In that role, I have worked with other pathologists, our infectious disease specialists and hospital leadership to establish sites in Charleston and at numerous other locations throughout the state where people potentially infected with COVID-19 can come to be tested.

A large part of our testing is designed to detect the genome of the virus itself, either in nasopharyngeal swabs (swabs that are inserted up the nose) or saliva.

We have also developed tests to determine whether someone has antibodies to COVID-19, which would indicate that they have been previously infected. We are testing people who have been admitted to our Hospital, people out in our communities, the student bodies of some of our colleges and the employees of businesses that are trying to re-open.

About the vaccines

For the next several months (probably until at least early to mid-summer), we’re going to need to take precautions in church such as I outlined above. What will help us get back to normal is the wide availability of an effective vaccine and having people do the responsible thing and get vaccinated.

Remember, vaccines don’t save anyone—getting vaccinated is what protects you.

So far, we have seen some very promising results in clinical trials with the vaccines from Pfizer and Moderna. Both vaccines showed 94-95% effectiveness in clinical trials, which suggests that they’re going to be very good vaccines.

The Oxford-AstraZeneca vaccine has also showed very good results in clinical trials, coming in at 90% efficacy.

To put this in perspective, the FDA was willing to accept 50% efficacy for approval, so these three vaccines are all much, much better than was needed for approval.

That why they’re moving ahead for approval by Emergency Use Authorization (EUA). Right now, one important question is which of these is going to be easiest to distribute.

This may be driven by what’s necessary to store the vaccines. The Pfizer vaccine has to be stored at -70°C (this is in what we call an ultra-low freezer), while the Moderna vaccine can be kept at -20°C (the temperature that our household freezers reach).

In contrast, the Oxford-AstraZeneca vaccine can be stored in a regular refrigerator. This potentially means that the Oxford-AstraZeneca vaccine may be easier to distribute, particularly in rural areas where ultra-cold freezers are hard to come by. All three of these vaccines are given as a series of two shots.

The three phases of the challenges ahead

We still have some challenges ahead for getting everyone vaccinated. Right now, the plan is to break the distribution of the COVID-19 vaccine into three phases.

Phase 1

In Phase 1, a limited number of vaccine doses would be available. In this Phase, the vaccine would be administered to healthcare personnel, non-health care essential workers, adults with high-risk medical conditions that confer high risk for severe COVID-19 disease and people 65 years of age or older (including those living in long term care facilities).

Phase 2

In Phase 2, it is expected that a larger number of vaccine doses would be available.

During this Phase, the plan is to ensure vaccine access to all critical populations that were not vaccinated during Phase 1 as well as beginning to expand vaccination into the general population. 

Phase 3

In Phase 3, there would be sufficient vaccine available for the entire population and the vaccine would be available to all that wanted it.

Right now, best estimates are that we’ll get to Phase 3 by early to mid-summer.

About Steve’s education and qualifications

My wife and I have been members at Providence Church since 2015.  I currently serve as Chair of the Providence Finance Committee.

I received my B.S. in Chemistry, Vertebrate Zoology and Anthropology from the University of Memphis in 1981. I then attended Baylor College of Medicine, where I received my Ph.D. in Cell Biology in 1986 and my M.D. in 1988.

I trained as a postdoctoral research fellow, Anatomic Pathology Resident and Neuropathology Fellow at the Washington University School of Medicine (1988-1994) prior to joining the faculty in the Department of Pathology at the Washington University School of Medicine.

Before accepting my current position, I was a Professor of Pathology, Neurobiology and Cell Biology at the University of Alabama at Birmingham (UAB) and the Director of the UAB Division of Neuropathology.

While at UAB, I served as an attending neuropathologist at the University of Alabama Hospital, the Birmingham VA, UAB Highlands Hospital and Alabama Children’s Hospital.

I was a Scientist in the UAB Alzheimer’s Disease Research Center, the Mental Retardation Research Center, the Center for Aging, the Center for Glial Biology in Medicine, the Civitan International Research Center and the Center for Neurodegeneration and Experimental Therapeutics as well as being as a Member of the Comprehensive Neuroscience Center and a Senior Scientist in the UAB Comprehensive Cancer Center.

I am a practicing neuropathologist certified by the American Board of Pathology in Anatomic Pathology and Neuropathology. My research program is funded by the National Institutes of Health, the Department of Defense and the Children’s Tumor Foundation.

I am an Associate Editor for the American Journal of Pathology and the Journal of Neuropathology and Experimental Neurology and serve on the Editorial Board of Neuro-Oncology, the flagship journal of the Society for Neuro-Oncology.

Steve provides weekly updates on our Facebook page, usually on Thusday mornings.

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