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By Anne Blythe
David Wohl has been on the frontlines battling COVID-19 for the past seven months, helping to set up crucial testing sites both in Chapel Hill and in underserved Lee County communities.
The infectious disease specialist at the UNC Chapel Hill medical school also has been treating patients sickened by the novel coronavirus at UNC Health.
On top of that, he’s a principal investigator in a vaccine trial underway there.
The 56-year-old physician is no stranger to taking on tough diseases as a healer and researcher. He’s also been in the thick of treating Ebola in Africa, where he worked in Liberia during the outbreak of the deadly hemorrhagic disease that sickened 28,600 people between 2014 and 2016 and led to 11,325 deaths there.
Wohl is the site leader for HIV Prevention and Clinical Trials at the UNC-CH department of medicine.
Earlier this year, in an interview with Positively Aware, The HIV Treatment Journal of TPAN, Wohl noted parallels between what is happening now and what he experienced in West Africa.
Wohl told the journal that he was impressed the Liberians were able to social distance for more than a year. Once the outbreak was over, the Liberians celebrated it as a strength with bumper stickers that said “Liberians Are Survivors.”
Wohl stressed that he would like to see this country come together similarly to embrace what scientists and researchers say works to slow the spread of COVID-19.
“Any of us who’s been on a plane or in a crowded area outside or inside knows masks are important yet the disdain that’s being still shown even after infection is running throughout the White House for masks is just perplexing to me,” Wohl said.
Missed messaging opportunity
As Wohl trumpets the marvels of science and research being deployed during this pandemic, he worries that setbacks in the fight against COVID-19 could occur as the number of cases grows in the White House while the messaging remains the same.
“With the president and his inner circle — and a widening circle now being diagnosed with SARS COVID 2 infection, I think there’s an opportunity,” Wohl told reporters in a Zoom meeting on Wednesday. “And the opportunity is there to send messages that this is a very serious infection.”
But Wohl said that President Donald Trump missed that opportunity after his hospitalization at Walter Reed National Military Medical Center to take a new stance against a virus that has shown no signs of abatement.
“Instead what we see filled in is some posturing regarding domination, regarding not letting the virus beat you and sort of an upbeat approach that I think we’ve seen before,” he said.
Cases expanding, not receding
More than two dozen people in Trump’s orbit have now tested positive for COVID-19 since he announced his positive test a week ago, one of whom was Sen. Thom Tillis, a Republican from North Carolina.
As flu season begins, Wohl said, this is the time to get aggressive against the virus.
“It is expanding in many parts of the country, not receding,” he said, noting sharp increases in a number of midwestern states. “We’ve lost 210,000 people as we all know, maybe more because of undercounting of the number of people who have died due to COVID-19.
“So it’s very frustrating as someone who’s a treating physician and who wears sometimes a small public health hat to not see messaging to take this more seriously.”
In North Carolina, hospitalizations ticked up above 1,000 this week, according to the state Department of Health and Human Service COVID-19 dashboard. As of Thursday, at least a half dozen counties across the state reported the number of positive tests far above the 5 percent level where public health officials prefer it to be.
In Robeson County, the rate was 12.6 percent this week with neighboring Scotland County at 12.2 percent. The other counties with high rates of positive tests were all rural: Nash, Caswell, Moore and tiny Avery counties were all above 10 percent, with other rural counties reporting higher rates while urban counties such as Wake, Mecklenburg, Buncombe and Forsyth have managed to push rates below 5 percent.
Finding new COVID treatments important, too
Wohl said he’s frustrated by how many, including the president, have downplayed the importance of mask wearing and other public health interventions.
But he was glad that the need for better treatments has recently received attention.
Trump’s physicians have been using an aggressive treatment regimen, according to Wohl, one using monoclonal antibodies that are not yet widely available. The president also received supportive oxygen, steroids to reduce inflammation and remdesivir, which has proven to reduce the length of hospital stays.
“The events over the last week have really stressed the need for us to move the needle and try to find treatments for people who are becoming progressively more ill with COVID-19,” Wohl said. “We’ve been spending a lot of time appropriately thinking about vaccines, but I do think having the conversation also include treatment is incredibly important.”
In a video uploaded to Trump’s twitter account, the president gives a few details about his treatment at Walter Reed. The president now is tweeting about and touting the experimental monoclonal antibody therapy he received.
“I went in, I wasn’t feeling so hot and in a very short time they gave me Regeneron,” Trump said. “It was, like, unbelievable. I felt good immediately. I felt as good three days ago as I do now. So I just want to say, we have regeneron, we have a very similar drug from Eli Lily and they’re coming out, we’ve tried to get them on an emergency basis.”
Trump goes on to say he thinks people in the hospital will have access to monoclonal antibodies soon.
But in a Zoom discussion about vaccines hosted by the Duke Initiative for Science and Society on Wednesday, Eric Topol, a California cardiologist and founder of Scripps Research Translational Institute, cast doubt on how readily available monoclonal antibodies will be to the greater population.
Studies on the monoclonal antibodies have not been large and they have yet to be proven safe and effective in Phase 3 trials. Even if that happens, Topol said scaling up production for widespread use would be costly and not likely to happen any time soon.
“I’m actually pretty keen and I have been on the monoclonal antibodies, but they can’t be made in large quantities and they’re going to be very expensive,” said Topol, who often calls out the president on Twitter. “It’s unrealistic to think that a lot of people are going to get this stuff.”
President’s treatment compared to others
In his discussion with reporters on Wednesday, Wohl outlined how a more typical patient might be treated without access to the monoclonal antibodies given to Trump.
“I think the president received a very aggressive course of medicines,” Wohl said. “Two of the three are readily available to people right now.”
“So if someone is hospitalized, they can get remdesivir if they require oxygen,” Wohl continued. “If somebody is progressing and needs even more oxygen, oftentimes we use dexamethasone. So these are standard.”
Physicians across the country have been using convalescent plasma for very sick patients, using plasma from people who recovered from COVID-19 illness with hopes that the antibodies within can help fight the virus.
Monoclonal antibodies are copies of antibodies that survivors of COVID-19 infection have made, Wohl explained. They target different parts of the virus protein.
Wohl stressed that more data and safety research are needed on the experimental monoclonal antibody treatment that Trump received.
“At UNC and across the country, we are studying monoclonal antibodies in early treatment of COVID-19, specifically outpatients because that’s where you really want to use a therapeutic,” Wohl said. “When someone ends up in the hospital, you are rescuing them. What I really want us to do is to find a treatment preventing people from needing hospitalization, maybe even decreases their shedding of the virus to other people.”
He’s rolling up his sleeve
Trump, who told people weeks ago that a COVID-19 vaccine would be available before the election, despite different public health officials assertions that would not be the case, has now acknowledged in the Twitter video that a rollout before Nov. 3 would not happen.
“I think we should have it before the election, but frankly the politics gets involved and that’s OK, they want to play their games,” Trump said.
Public health teams and researchers have been critical of how much politics has played a role in the response to the pandemic, much of it coming from the president who continues to downplay the damaging impact of the virus despite being infected himself.
“I think the politicization of this has been one of the sorrier stories of this pandemic and, again, another missed opportunity,” Wohl said. “Instead of rallying around our scientists and our thought leaders in the medical community, I think again, we’ve seen the administration use this as kind of a flag to say, ‘Look we’re going to be successful.’ And it’s become even an election issue, and I think that’s really unfortunate. It should be divorced from that.
“What we should be doing is rallying around the science, let the science take its place.”
Wohl is the principal investigator in a Moderna vaccine trial underway at UNC. By Wednesday morning, 150 people had enrolled and Wohl expected there to be 200 by the end of the day.
“Clinical trials, including the vaccine trials, have been stood up in incredible amounts of time,” Wohl said. “I mean really to be able to condense — and it’s not because people are cutting corners — it’s because people are working hard, seven days a week, you know, long hours, to design these things, implement them.”
The research is being done rigorously, Wohl stressed.
“Studies are designed well,” he added. “The issue is people interpreting preliminary data too soon and to make inferences from those data that can then lead to changes in care and policy. So that’s where I think that danger comes.”
There always is some risk involved, he said, as with trials to develop therapeutics. But Wohl is confident that researchers and scientists are plowing ahead with safety at the forefront.
“Look, I’m going to put my money where my mouth is,” Wohl said. “I’m going to sign up for a vaccine study. I can’t be in the vaccine study here at UNC because I’m an investigator. But when Duke opens up their vaccine study, I will roll up my sleeve and I will get vaccinated. I don’t know what else I could do to convince somebody that it is safe to be in this.”