HJAR Sep/Oct 2021

HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2021 11 Editor Do you have an idea of how many staff are offline because of COVID, either sick or in quarantine? Dillaha I don’t. You would have to ask the individual hospitals or the hospital asso- ciation. Not only do we have staff offline because of quarantine or illness, but many of the hospitals have large numbers of vacant positions that they cannot fill. Editor Before I start with mine, what are the top objections that you’re hearing to the COVID-19 vaccine? Dillaha I’m hearing often that people feel that they are adequately protected because they have had COVID-19 illness. I’m also hearing that people feel that they can pro- tect themselves from COVID-19 illness by maintaining a healthy lifestyle. Other things are that people don’t feel confident in the safety of the vaccine, and they don’t have a lot of information about how the vaccines were developed and tested in clinical trials, so they are thinking that the vaccines are less safe because they were developed so quickly. Editor Several U.S. senators who are MDs say this basically: that they are not going to get the vaccine or that their constituents are immune, because they have had COVID-19 in the past and that we’re not taking immunity into consideration — that there’s such a push to get the vaccine out that we’re not taking the natural immunity that has been acquired by these folks who have already had the dis- ease. What do you have to say about that? Dillaha Well, I would say that people who have had COVID-19 can get it again. We don’t know, at this point in time, how to determine whether or not a person who has had COVID-19 is immune from getting it again. We know that neutralizing anti- bodies to the spike protein are important, and we can measure the level of antibodies, but we don’t know at what level a person’s antibody needs to be to feel confident that they’re immune. Of course, the higher the levels, the more likely they are to be immune compared to lower levels. That’s the background situa- tion. People who have had COVID-19 are not likely to develop long-term immunity to SARS-CoV-2. We know that the other coronaviruses that people get that cause the common cold, people do not develop lifelong immunity to those viruses, and the immunity wanes, and they can get those viruses again and again. I think it is a mistake for people to assume that because they have had a virus, that they have lifelong immunity for it. There are numerous viruses that people get that we don’t develop lasting immunity for. People who get COVID-19, they vary in terms of their level of neutralizing antibody that they develop. The more severe the dis- ease, the higher the level of antibody; the less severe the disease, the lower the level of antibody. Vaccination, in general, the level of neutralizing antibody is higher than people who have had COVID-19. It’s likely, with the Delta variant, that peo- ple will need that higher level of neutralizing antibody, especially if their illness was ear- lier in the pandemic and they didn’t have the Delta variant to begin with. In general, as I said, the vaccines develop higher lev- els of neutralizing antibody, and that could explain part of the difference in the effec- tiveness of the vaccine. Editor Is that the reason that the effi- cacy of the Johnson & Johnson vaccine is not as strong as the other two, because they’re using the older school or the older methodology? Dillaha I have not yet seen a comparison of the Johnson & Johnson vaccine with the Moderna or the Pfizer vaccine, so I really can’t say whether it’s less effective or more effective at this point in time. I do know that all three vaccines work really well to keep people out of the hospital. That’s an important factor at this point in time, because we have such a high level of hospitalizations occurring where the Delta variant is surging. Editor Breakthrough cases are happening with this Delta variant, and a lot of folks are blaming it on the unvaccinated. Does that mean that if all of us were vaccinated, SARS-CoV-2 would have died out? How do we know that? Dillaha The more people who are vacci- nated, the less transmission there will be in the community and the less likely people who are fully vaccinated would be exposed. The high rate of spread in the community is assisted by low rates of vaccination. That puts everyone, not just the fully vaccinated people, at increased risk for infection. “I think it is a mistake for people to assume that because they have had a virus, that they have lifelong immunity for it. There are numerous viruses that people get that we don’t develop lasting immunity for.”