It’s been just over 480 days since Chatham County’s first reported case of COVID-19: a resident who traveled to an area in Italy during February of 2020, which later became the site of a COVID-19 outbreak, was diagnosed here on March 6.
On Monday, the county’s 4,750th case was reported — the first positive test in Chatham in at least two weeks.
In between, 89 residents have died from causes related to the coronavirus.
And sometime in the next week or so, Chatham will reach an important threshold in the pandemic’s battle: exactly half of all residents will reach the stage of being at least partially vaccinated. As of Tuesday, that figure was at 49%, with 36,548 Chatham residents having received at least one dose of the COVID-19 vaccine. Forty-six percent, or 34,482 residents, are fully vaccinated.
Both of those numbers are higher than the statewide figures. Across North Carolina, 45% of the state’s residents have received at least one vaccination dose and 42% are fully vaccinated. The state has turned to incentives in an attempt to boost those numbers as the number of those lining up to recieve the vaccine has diminished.
For the two people in Chatham County following the data and the virus most closely, however, that 50% number isn’t high enough. To mark the 50% milestone, the News + Record spoke in depth in the past week with Mike Zelek and Dr. Andy Hannapel around the central question: What’s next?
Zelek, the director of the Chatham County Public Health Department, and Hannapel, the chief medical officer of Chatham Hospital in Siler City, warn that half is not enough.
“If we do not do this collectively,” Hannapel said, “there will come a time and a variant that will evade the highly effective vaccine as well as natural immunity from having the disease and potentially cause a pandemic-like situation again.”
Fifty percent is not the end goal, Zelek said.
“... and we know that those who are not fully vaccinated remain at risk of infection, serious illness, and death from COVID, especially as new variants spread,” he said. “So the work continues.”
Here’s what they had to say:
Chatham County is on the verge of reaching the point where exactly half of its residents are vaccinated against COVID-19. Thinking of the work you (and your staffs at CCPHD and Chatham Hospital) have done over the past year or so … how does that feel, and what does that mean to you?
Dr. Andy Hannapel: It is a significant number in a short period of time and represents a lot of hard work and large-scale planning and execution. However, the number could have been much higher if the pandemic was not politicized, if people were encouraged and challenged to get vaccinated. I have said this before — we, as Americans, can do that which is difficult when we approach problems as challenges and opportunities, and come together for the common good of our neighbors, our community and our country.
The enemy is the virus, not our neighbor. It is time for all of us to step up and take on this personal responsibility.
What’s the significance of that 50% milestone — and is it indeed a milestone?
Mike Zelek: As we approach 50%, I can’t help but reflect on the past year and all our community has been through. I think about the 89 Chatham residents who have passed away from COVID and thousands more who became sick, the vast majority before the vaccine was widely available. Reaching this milestone gives me an even deeper sense of gratitude for the public health and healthcare workers who have been all in on this fight for well over a year, both responding to the pandemic and leading vaccination efforts.
To me, 50% truly is a milestone that I have been eager to hit for several weeks. It means 37,000 Chatham residents have rolled up their sleeves to protect themselves and those around them, to put this pandemic in the past, and to get back to the things we love to do. But 50% is not the end goal, and we know that those who are not fully vaccinated remain at risk of infection, serious illness and death from COVID, especially as new variants spread. So the work continues.
Dr. Hannapel: It is better than a lesser number, but not where we need to be to snuff out the coronavirus and the variants that are more infectious and more dangerous in terms of causing significant illness, hospitalizations and death. If we do not do this collectively, there will come a time and a variant that will evade the highly effective vaccine as well as natural immunity from having the disease and potentially cause a pandemic-like situation again.
Currently, those at greatest risk of the coronavirus are those who are not vaccinated, cannot be vaccinated or the vaccine is not effective due to severe immune suppression (those with immunodeficiencies, cancer, or other conditions requiring medications that suppress the immune system.)
We’ve heard a lot about herd immunity. What does that mean — and where do we have to get in Chatham County before we can use that phrase here? (And I’m curious what number — 70%??? — you think of as “getting us there”.)
Zelek: Herd immunity is a tricky topic and a bit misleading. We often think about a magic number where risk of infection completely goes away.
With an infectious disease like COVID-19 that is global, if there are individuals without immunity the risk of infection and spread remains. One of the challenges is that vaccination rates are not evenly distributed across the population. If you look at the N.C. vaccination map, you will see counties with vaccination rates above 50% or 60% while others are below 30%. Within counties, including Chatham, we see differences in vaccination coverage. COVID-19 wants to spread, and my fear is that if a particular community has a large number of individuals who are unvaccinated, even if overall vaccination rates in the county are high, COVID-19 will eventually get into that community and spread. So while the impact of vaccinations is clear from current case rates, the risk persists. What weighs on us as well is that these cases, some of which will lead to hospitalization and death, are preventable.
Dr. Hannapel: Herd immunity is real. Vaccination rates should be as high as possible to achieve this state to protect those who are unable to receive the vaccine or who do not mount an immune response once they receive the vaccine. The concept is that if you have an outbreak of disease, the more of the population that is immune, the smaller and less significant the outbreak will be. We are not at that point.
In every major trend, there’s a tipping point — an idea or a practice moves from skepticism to accepted. We don’t think twice about chicken pox, measles, and other types of vaccines. Two questions related to that: First, what are you seeing now, versus a year or even a few months ago, in terms of peoples’ views of the virus itself? And have we reached a tipping point of our understanding of COVID-19?
Zelek: Overall, we have learned so much about COVID since early in the pandemic. Here in Chatham, I think most have taken the virus seriously since early on. As challenging as the last year plus has been, that has been key to preventing an even worse situation. This response by the Chatham community is reflected in vaccination rates. That said, we are still constantly learning more about COVID and my hope is that this knowledge continues to translate to behavior change. At this point, that would mean increased vaccination rates.
Dr. Hannapel: We know enough about COVID-19 to shut it down. PERIOD! We have had tremendous innovation and advances in the COVID–19 vaccine and treatment that we have the ability to not just limit its spread but shut the virus down. That is what is so disappointing. We have the ability, but we don’t have the level of personal responsibility and collective commitment to see this through.
And second, what are you seeing now, versus a year or even a few months ago, in terms of peoples’ view of the vaccination? What will it take us to reach a tipping point?
Zelek: We actually surveyed the Chatham Community Cohort (a representative sample of Chatham adults) in May/June 2020 about their intentions around vaccinations. At that time, 71% planned to get the vaccine when it became available. At this point in the vaccination rollout, around 60% of adults are at least partially vaccinated. I remain optimistic that we will reach the number in last year’s survey, but, true to all aspects of this pandemic response, it will take our collective efforts as a community to get there.
What we are learning is that many of those who have not yet gotten vaccinated are still planning to do so or are at least open to it, and that family and loved ones are critical messengers to support them in this journey. We encourage those who are already vaccinated to share their experiences with loved ones to continue to normalize vaccinations while also serving as resources for reliable information.
Dr. Hannapel: There is less deliberation from those who had been on the fence and wanted to see how the vaccine would work and the side effects. Those folks have stepped up and are getting vaccinated. There continues to be a segment of our population that will not get vaccinated. They are listening to the misinformation and minimizing the risk of the virus to themselves and others around them. It has tragic consequences, especially when this can be avoided.
What’s your take on providing cash and other types of incentives for people to get vaccinated? Do you see that working? Any negatives with these types of incentives?
Zelek: I know there are many strong feelings about this topic. Small incentives like the $25 gift cards the state has begun distributing may help those seeking vaccination to overcome barriers, such as transportation costs or time off work. We are still waiting to see what impact these incentives, including the Summer Cash Drawing, will have on vaccination rates. My hope is that vaccination rates will continue to rise, whatever the reason.
Dr. Hannapel: I always think about the economics of incentives. We are trying to affect human behavior. If there are benefits from this behavior change in the individual that affect the whole population, then incentivize this behavior. Also: the cost of treating disease is exponentially higher than the cost of vaccinations. The avoidable, high cost to our society of people dying early or being significantly disabled due to COVID-19 is worth the reasonable incentives employed to affect behavior change.
Thinking about the vaccines, for those who have been reluctant to get the vaccine because of its emergency use authorization (EUA) approval, what will have to happen before the vaccine gets FDA approval — and will that make a difference, do you think, for those reluctant to get vaccinated?
Zelek: It is important to be clear that EUA requires a rigorous scientific review and ongoing monitoring, which is what we have seen with the COVID-19 vaccines. To date, more than 300 million doses of COVID vaccine have been administered in the U.S., so we are not talking about experimental vaccines. My view is that continuing to normalize the vaccine will have at least as much impact as FDA approval, and that is why we continue to encourage residents to talk with their family and friends about their experience getting vaccinated.
Dr. Hannapel: I do not know if reluctance will diminish once vaccines achieve full FDA approval. I hope so. Over 3 billion COVID-19 vaccines have been administered worldwide, more than 320 million in the U.S. — it should be clear that the vaccine IS THE TIPPING POINT.
What has expanding the EUA to those ages 12 and up meant, in what you’re seeing?
Zelek: As a department, we have extended our communications and information efforts to that group and to their parents. We’ve created new webpages — chathamcountync.gov/covidvaccineyouth in English and chathamcountync.gov/covidvacunajovenes in Spanish — with information on the COVID-19 vaccine specifically for teens and their parents to answer questions and provide resources. We’ve also been working with schools across the county to serve as a hub for information and questions.
What it’s meant practically is that we have seen more people vaccinated against COVID-19, which is always a good thing. According to NCDHHS data, in the first week 12- to 17-year-olds were eligible, the week of May 10th, 47% of vaccinations were given to 12- to 17-year-olds, or a total of 336 youth. Overall, that age group has made up 4% of those at least partially vaccinated in Chatham County.
Based on census data, we estimate that 24% of Chatham residents aged 12-17 have received at least one dose and 18% are fully vaccinated. We have worked with other providers to ensure Pfizer is available across Chatham, and also coordinated with Chatham County Schools to offer vaccinations through StarMed at the high schools. We will continue these efforts to increase vaccination rates among Chatham’s younger residents while also monitoring EUA status for this age group in other vaccines. For example, the Moderna vaccine has submitted to extend its EUA to 12-17 year olds as well, and a decision is expected soon.
Dr. Hannapel: Those adolescents and their families will have a level of relief and reassurance when these young people return to school in the fall. It is what families are doing to protect each other and get back to normal. Or as close to normal as we can get!
Let’s talk about the Delta variant. Why should we be concerned about it on the whole? What do we know and not know?
Zelek: The Delta variant has been classified by the CDC as a “variant of concern,” which is defined as “a variant for which there is evidence of an increase in transmissibility, more severe disease (e.g., increased hospitalizations or deaths), significant reduction in neutralization by antibodies generated during previous infection or vaccination, reduced effectiveness of treatments or vaccines, or diagnostic detection failures.” In layman’s terms, variants of concern spread faster, lead to more severe illness and/or do not respond as well to treatments.
The Delta variant — first called the “B.1.617.2” variant — is still relatively new. But it has already been found to spread faster than the versions of COVID-19 we’ve seen before, and it has shown resistance to some COVID-19 treatments. There could also be an increased risk of hospitalization from this variant compared to others.
The good news is that the vaccines still offer protection against the Delta variant, especially in preventing severe illness and death. Right now, those across the country who are hospitalized with COVID-19 are almost always unvaccinated. The Delta variant is all the more reason to get vaccinated against COVID-19.
You can learn more about the Delta variant and its impact on N.C. at these links:
• https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html
Dr. Hannapel: The Delta variant is more contagious and virulent than the U.K. strain. The U.K. strain started in the U.K. in November/December 2020 and quickly became the predominant strain in the U.K. in January. It is now the predominant strain in the U.S. In the past month, the Delta variant is between 60-90% of the dominant strain in the U.K. and now up to 20% in the U.S. The Delta variant has become the dominant strain in much less time than the UK strain took. Watch out for what comes after the Delta variant.
And regarding the Delta variant … for those of us fully vaccinated, are we protected?
Dr. Hannapel: Yes. Fully vaccinated individuals are protected.
Zelek: Yes, especially in terms of preventing serious illness and death. But it is important to get all required doses of vaccine.
And for those not vaccinated?
Zelek: Those who are not vaccinated are at high risk of getting infected with this variant, as it is expected to become the dominant variant in North Carolina in the coming weeks. This could also threaten the progress we have made over the last several weeks and months in terms of reducing COVID-19 infection rates.
Dr. Hannapel: They are more at risk than they were a year ago. Delta variant is more infectious and more virulent.
What’s the latest medical word on the need for booster shots for those already vaccinated?
Zelek: We do not know for sure what the future holds for booster shots, but they will likely come at some point, perhaps early in 2022. However, if you are not yet vaccinated, you should not wait for booster shots, as the vaccines currently available are effective and our best option at keeping COVID-19 at bay.
Dr. Hannapel: The likelihood of a needed booster increases the longer that COVID is allowed to incubate in our population. The longer that the disease is widely circulating, the more likely more variants are produced and instead of being “variants of concern” — they will become “variants of high consequence.” These would be variants that are not covered by current treatments or vaccines.
Dr. Hannapel, you’ve made the statement: “Every death due to COVID is an avoidable and unnecessary death.” Yet we still see people who say they’d rather get COVID than get vaccinated. Pro football’s Cole Beasley, for example, says he’d rather retire than get vaccinated. “I will be outside doing what I do,” he said. “I’ll be out in the public. If you're scared of me then steer clear, or get vaccinated. Point. Blank. Period. I may die of covid, but I’d rather die actually living.” How does each of you react to that?
Dr. Hannapel: It is unfortunate, potentially tragic and absolutely avoidable. The greatest risk today from this virus is to those who are not vaccinated, those who choose not to be vaccinated and those who cannot be vaccinated. Since we have the vaccine(s), every death is an avoidable and unnecessary death. That bears repeating, again and again and again.
Zelek: If you want to be out in public living your best life, your best decision is to get vaccinated. If you want to drive a car, wear a seatbelt. If you want to play football, wear a helmet. Otherwise, you might not make it to the fourth quarter.
