This week VeiligHealth Insights to Actions with Luis Saldana, MD, MBA, FACEP and Fred Goldstein we discuss the latest mutations of the SARS-CoV-2 virus (B117) and what this means to our ongoing efforts in mitigating the spread of #COVID19 and we talk about the current Vaccine distribution
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Raw Transcript
Fred Goldstein
Hello, everyone, and welcome to this week’s COVID insights to action discussion group. I’m Fred Goldstein with a Campbell health and I’m joined today, as always, by the two physicians are fantastic physicians, Dr. Louis saadani and Dr. Nick van Terheyden. This week, we’ll be discussing mutations and vaccine distribution. We’re glad you joined us. Again, if you’d like to get involved in this, you’re more than welcome to say, Yes, I’d like to come on, and we’ll put you on screen or you can ask questions, and we can just hear you through audio. Or you can submit your questions or comments through the q&a chat box below. So with that, we’ll go ahead and get started with our two topics today. So who would like to go first on this mutations issue? Nick, or Luis?
Yeah. Oh, well, we got to go ahead. Go ahead. And
Nick van Terheyden
first off, I think one of the important things to point out is people have a tendency to label things in this case, they’re labeling it the UK variant. And I, I just want to point out that it was identified in the UK, although it may not have been first found that was where they had genomic surveillance, it’s actually called b 117. And, you know, that’s the label that I’m going to use throughout this webinar. So viruses have a tendency to shift we call it this genetic drift, it’s part of their natural behavior to survive. They’re constantly fighting other threats, not just human beings that are producing vaccines and all these other things to try and combat them. And they have this. And in the messenger RNA, world, there seems to be a higher prevalence of these changes or mutations that take place, we have multiples. In fact, there are visuals out that you can see with all the variations that are present in these different variants. What’s interesting and significant about this one is b 117. Is that it makes it more transmissible, it’s not more lethal, as best as we can tell. But what it seems to do is allows it to spread much quicker. And the best analogy that I’ve seen around this that I think helps people understand we talked about 15 minutes, if you have a 15 minutes exposure with an individual that has COVID-19 you’re considered a contact and should go into quarantine. In the case of this variant, it is so much more transmissible, the equivalent might be just six minutes or maybe a little bit more, but certainly less than the 15. That’s for me the best visual to think about this, this thing spreads like wildfire comparatively speaking.
Fred Goldstein
So Louise, do you think about that? Are there things we should do different or consider differently?
Well, I you know, I think one I think it shows one of these these mutations make the kind of references I’ve been going on for for a while. As far as that goes. I think one of the things that has led to this one kind of going like wildfire, as Nick said that we’re seeing in in the UK and Europe and starting to maybe see here as well, is is is that because of the high transmissibility, it’s it’s likely to drive out the the current variant and and that’s one thing I think an important point to point out is we’re talking about mutations, but as Nick called it, the variant could be 117. It’s actually a combination of mutations. So each variant is a combination of different mutations that add so the B 1178. Guys eight mutations or something, but but the concern is the is the increased transmissibility. And and so I think that’s one of the reasons you’re seeing the lockdown in Europe and the UK, is because really, the only way to kind of get this from kind of taking over as the dominant kind of tie or variant is is to drive that R value down. So it really takes kind of more intense public health measures than what we’ve been seeing. And unfortunately, it’s at a time that here with without the contribution at very least, we don’t think that it’s the major variant here united states that we don’t do a lot of sequencing. But it we still are at a tremendous place in terms of the spread of COVID now, so the real fear is that this even drives it into another yet another surge or an ongoing surge. And this one’s already causing tragedy. You know, here in the United States, you’re seeing, you know, hospitals overloaded er is overloaded. You know, it’s a we’re gonna we’re to disaster point in this country right now.
Nick van Terheyden
And if I can find, what I want to add to that is that, you know, what I’ve heard repeatedly is, well, it’s not more lethal. So why should we care? While we care, because if you put it in a population, it’s going to impact more people. And at the same level of lethality, if you’ve infected more people, you’re going to get more death. So what we’re seeing is an increase in lethal effectiveness of this virus, because we’re infecting more people, and we’re doing so quicker, that’s highly significant. And it’s impacting our health systems and our health workers who can’t deal with the overwhelming and I would reference back to the the phrase that people will remember from some time back flattening the curve. So trying to spread that disease, or the number of cases as much as possible, so that the resources we’ve got available that can treat and can successfully combat the disease are going to be available for all the people that have it at the time that they have it as opposed to having this massive peak that we can’t cope with, as we’re seeing certainly it appears to be in California, for example.
Fred Goldstein
Yeah, I think some of the changes in the LA market are pretty astounding to see that and and some of the decisions they’re having to make within the hospitals now around that. And as many people talk about this issue, it’s not just the the availability of beds, it’s the availability of qualified staff, to staff those beds. And and also it’s, it’s raised another interesting point, if a ton of your healthcare people get called into the hospitals, you may not have as many to be distributing vaccines, to which I’m seeing now some people talking about here, here locally, and some others who are trying to say, Well, I can volunteer, but now I’m called back in and things like that. So it’s going to raise some interesting points. I saw some other thoughts. One, obviously, we’ve talked a lot about the aerosol on the inside spread. And this obviously raises that, as you mentioned, Nick, maybe it’s a shorter time period with somebody or and so that indoor issue really becomes strong. And I think I can’t remember who it was. Maybe it was Dr. Fauci on the others who said, this may be a time to begin start looking at using an N 95. For other people, obviously, the question then becomes, we got to make sure we have enough for healthcare workers. Any thoughts regarding something like that?
Nick van Terheyden
Well, so I just want to be clear, when I talk about the 15 and six minutes, that’s not fact, it’s just a demonstration of the principles, in case anybody’s confused. But I think it’s helpful in sort of thinking about this. But you know, Louise made this point. And, you know, this is the critical aspect, every single mitigation measure that we can come up with, reduces the spread and reduces the opportunity for an individual that has it to spread. And I would say Central, so the N 95 is an interesting one, and you raise the exact challenge that I think we know it will be good. I also know that people will be challenged wearing those things, having worn them, you know, they’re hard, they’re tough. But the other one that I think is so incredibly important is testing. If we can test and do so rapidly, we can identify those individuals and focus on that, you know, individual putting them into quarantine so that they don’t spread it as far and wide because if they’re more infected, it’s more important to get them out of commission and out of spreading the disease as quickly as possible, but everything else counts as well.
Yeah, I I agree. Nick, I think that a while interesting, I think the issue is we don’t have enough people wearing masks. So I think a you know a you said and it brings up all kinds of things. How long are they you know, can you keep using them as far as that goes? Do they fit well? If it doesn’t fit well, it doesn’t operate as an N 95. And, and thing so so I think more than anything, and I think Nick it with the testing the testing and Tracy have to get so aggressive with it and and i know nobody wants to hear this but we’re the top three places in the world right now for for COVID. Spread are Arizona, California and Rhode Island. three states are ahead of every other country in terms of the the rate of spread. And and so that in itself is alarming. And yet you don’t hear any talk about lockout. I’m not being pro lockout. But I think we tend the fact that we don’t even discuss it is concerning in terms of of having to take serious action because you know, you know, Nick
Fred Goldstein
mentioned about the ICU staff but it’s not like staffing supplies, we can run out oxygen, they there was the the video or bottle in Egypt, they ran out of oxygen and I see a whole ICU patient, all ICU, a patient died because they ran out of oxygen. And and and so I think we’re at a, an unprecedented crisis point in this country. And we’re not acting that way. In distribute distributing the vaccine and in in any of this, we’re not where they act, you know, the the level of action is not matching the crisis we’re seeing. So, you know, before we get to the vaccine and things, that the end of the day, it’s really about doing what we’ve talked about people doing, but even more intensively, in a sense, really watch any kind of indoor activity, if you can go without doing that, do that. Wear your masks, wash your hands, keep your distance, because this is something that just spreads easier. So the more you can mitigate those three strategies we know that work, the better off we’ll be. Right? So let’s then move on now to this other concept that we’ve talked about, which is the vaccine is distribution. And you briefly mentioned that Luis, what are you seeing? And where are we with that?
You know, well, I think it’s basically it’s a situation when you have when you have nobody in charge, that’s this is kind of what you get, there’s really nobody that’s, that’s in charge or responsible for the process, all we’re seeing is basically 50 different plans, and probably even more than 50, because different counties within different states have different plans. on it, there’s no communication about getting how many doses, that type of thing, which really leaves people scrambling. So it’s so far, there’s no way to say it’s not it hasn’t been an unmitigated disaster. And I think it’s important because at the same time, we’re seeing, you know, the variant that we just talked about, and so we’re seeing this ramping up, and we’re moving like this, you see Israel, they’re, they’re vaccinating, I could have already vaccinated 15% or country and, like, a significant portion of the vulnerable population, so So, but they’re at the same time seeing that ramp up as well. So it’s gonna be very interesting to watch their experience, I think we’ll be able to see if you’re able to, with a vaccine to kind of, you know, if that helps to, to kind of stop this at least the overload of the hospital, by reducing the severe cases can release reduced to severe cases and, and transmission. But But I think the other thing that we can’t, I think forget is seeing over the holidays, Thanksgiving and Christmas, is the role of small gatherings, relatively small gatherings of either one family, or multiple parts of a family in in one household, and how those have led to tragic, you know, kind of super spread or type of events and things. And and so, so I think those type of events, we have to be, you know, very, really talk about those eating in restaurants. Again, I think you said the aerosol, I think it’s aerosols spread, right now, it becomes that much more important.
Nick van Terheyden
Yeah, and it’s maybe was sort of tackling some of the things that have come up about vaccine distribution. So let’s, you know, just stipulate, as of, certainly yesterday, I’m not sure today, but you know, we’re, we’ve maybe gotten 30% of the doses available into people’s arms. So we’ve failed at that sort of the last few inches, mile, whatever you want to call it. And we really have to focus on that. If we’ve got available doses, they should be flying off the shelves into people’s arms. And, you know, carry on with that process, but what I keep hearing is sort of flexing and variation of the Define dosage schedules, that some of the variants that I’ve heard half the dose, and let’s just get the first dose in. And whilst I understand the desire to maximize this, I would quote somebody that I read and say, we really can’t afford to abandon science, and try and guess our way out of this crisis. And by that, I mean, we know what works, we need to apply that and we need to do it faster and better which we can do. We run the risk of not understanding the output or the impact of this if we do those things, and we create mistrust and distrust with the population that is already concerned about these vaccines, if you start to change the rules and say, well, we’re just going to do this and see what happens. People are already concerned and saying, I’m not willing to take this vaccination. This just for me, causes some challenges. So I think we have to stay the course. But get better at it. And you know, as Louis says, it needs a national policy to sort of take this on and really focus and deliver against it.
Fred Goldstein
Yeah, I know that here in Florida. We’re seeing each county approach it very differently. I think one of them is using Eventbrite to schedule it. Another one said you had to schedule but they had these long lines, just started giving people shots, and then the people were scheduled. So it really does need a focus on the logistical side of this thing. Because as you also understand that a large number of vaccines are being held or have not been shipped, because then been told where to send them yet. And so it’s it’s a really interesting dynamic. And as you said, when you have 1000s of counties around the United States making various decisions around this, it just, it just can get very tricky and difficult. So it’s also interesting, just as kind of a side note, because I don’t know that there’s any one right answer. You mentioned Israel, Luis, and they targeted the very elderly and began working down to control the death rate, while others are looking at a different approach. And and thinking regarding that, because there probably isn’t a right answer. It’s just some different ways to look at it.
Yeah, I think there isn’t a right answer. I think you look at the situation right now in the United States. And I expect in Israel to saints, what’s our biggest crisis, it’s the healthcare system is overwhelmed. So when you’re when that’s the case, you want to reduce the serious illness. So I agree with that top that top down. At some point, when you’re dealing with transmission, you then can start go chase down from the bottom up, and try to reduce the transmission by going after the young people the new variant. The B 117, actually is felt to be properly spread more by young people and children even it’s even more transmissible in those groups. I think and so, so that makes sense for for those, so but I think you have to look at what is the current situation. And to me the current crisis is these to be your cases that are ending ending up in the, in the, in the, in the hospitals in our ICU, and we got to offload that system right now. So, so I would agree with, you know, starting with that group, at least at the beginning.
Nick van Terheyden
So, um, one other thing around the variant in the vaccine, I think, you know, there’s obviously some concern with the vaccine still work. There’s no data currently to suggest that, you know, vaccines not going to work to be clear, and it may have slightly reduced effectiveness, possibly we don’t know. And, but the data based on the durability of immunity seems to suggest that a we got a durable immune response that by that, I mean, it lasts for an extended period of time what that is known, certainly at least eight months based on the study that I was reading, and, and that response is improved if you’re vaccinating, and you’ll get a durable response with the vaccination, and also the system that’s been developed in under 12. Well, it’s not under 12 months, but we’ve delivered a vaccine in under 12 months, this messenger RNA vaccine from Pfizer, and blanking on it on moderna. Donna, thank you, is flexible, that’s a flexible system that allows you to pivot to a slightly different model and produce a new vaccine, which is wow, how brilliant is that? So I think, you know, not not not a challenge, not a problem specifically, but, you know, certainly something we have to watch out for. Yeah. And
Fred Goldstein
you raise a really good point, I think it’s a it’s a, it’s a really positive point, we are seeing that ability of immunity to hang on for a fairly long period at this point, like eight months. So that’s some really good news. And hopefully, it’s they can do further out and do more studies. We’ll see. Maybe it goes out much, much further. Maybe it doesn’t, we just have to wait and see on that. But that’s good. I know. We had a question here. It’s really two of them. And one of them was on what do you think of the j&j vaccine is it will require one shot? Well, actually, there’s three here. And then how do we get the non vaccinators to take the vaccine, which we can probably get into, as well, as we discussed a little bit about the named mutation, I think, as you pointed out, it’s of concern because of the spread, but we don’t and but it looks like it’s about the same in terms of how how, how much it impacts your body physically, etc. From that perspective, but it certainly is a concern about its ability to spread more rapidly and then put a greater weight on the healthcare system to have to deal with that increase in patients. Pretty much it so how about the new j&j vaccine? Any thoughts on that with the one shot?
Yeah, I mean, they’re And certainly that’s, you know, it’s certainly more attractive and you kind of gain it out there. We haven’t seen the data on that. And I know j&j some time back also talked about doing a trial. And I’m not sure if they actually do have a trial for doing two doses and see if that boosted it up, because we don’t have the same kind of think of the numbers that we had for Pfizer and materna. So it’s kind of too early to tell, you know, the same with the Astra AstraZeneca, we did you know, to retail those are, those are different technologies, and they are there, but they’re more traditional context, vaccine technology than the messenger RNA RNA vaccine. But But, you know, I think the idea with the two messenger RNA vaccines is that the first one, the first one is kind of priming the system. And the second one, you know, is kind of the one that that, you know, that kind of boosts really boosted response and things. And that’s why I think some of the discussion or has been around, Well, how about if you do the first one and kind of delay the second one? And I agree with Nick, I think, you know, we don’t have the basis to do to do that. Now. I mean, in a crisis point, who knows, but I would advocate for that. I think it’s gonna be great to have multiple vaccines, because they all have work slightly different. And one of the things about the immunity to this COVID-19 is that is that it is poly kind of poly? You know, I don’t know what you say, poly, and it’s multiple levels. Does that mean it? So it’s not easy to measure. But that also makes it you may have different sponsors that, say, even if you get it, you don’t get it severe case, or you have minimal cases or, or things like that. So, so. So again, I think it will add to that, and, you know, j&j and AstraZeneca, I think would be great for the global kind of getting a more globally and things like that. I think it’ll also be, it’d be better for us to have more options for sure.
Fred Goldstein
And an interesting point, Nick, I’d like to get back to around mRNA versus the newer vaccines, which I believe more on the the standard way, we’ve created vaccines that an mRNA vaccine can be updated more quickly than the other types, is that correct? So you can as this virus might mutate, you can adjust to that.
Nick van Terheyden
Yeah, I’m maybe not exactly correct. But I want to say, Chinese scientists published the sequencing of SARS, COVID, to virus, and within a week, they had messenger RNA candidates based on that sequencing, that’s how quick this stuff moves, and they can essentially attacked and you know, Louise’s point, the best visual I have for that, if you imagine the picture that we’re all familiar with, now, it attacked different parts of that spike protein, and potentially other plant parts of the, you know, surrounding area. So it’s it, you know, is addressing all of those areas. And if it changes, you essentially re sequence it up there, update your messenger RNA still have to go through trials and all of those things. But we have an established process that worked and worked pretty well, which I think is good. The other additional comments about the Johnson and Johnson if if they do demonstrate, you know, good immunity with one dose, good news, much simpler. So you know, once and done is obviously going to be easier than calling people back. So that would be great. But we’ve got to validate that. And then on the point around non vaccinators, I think, you know, the first is demonstration of applicability. We’ve seen a lot of that both from, you know, I don’t know if I’ve seen any celebrities. Not that I care too much about them. But I’ve seen a lot of physicians take it, I’ve said and stated categorically I mean, I’m not in any of the priority groups. I would take it if somebody showed up at my door right now.
Fred Goldstein
Well, I know, Nick, you’re not a baseball fan, probably. But Hank Aaron took it in Atlanta.
pretty old, I think he probably a couple more bad conditions to get.
Nick van Terheyden
And, you know, that’s good news, because they demonstrate, you know, and the more data in the more demonstration of that, I think helps mitigate that so that people can see that this is not, you know, and then obviously combating the MIS and disinformation. No, there aren’t any chips embedded in and, you know, some of the stuff that circulates, that gains oxygen, but has no validity in the science or the basis, in fact, and I believe if I is that the EEOC has said you can make it a requirement of your work, because of the safety issue around coming into work. Now, obviously, there are all kinds of issues with requiring vaccines and things like that, that that’s why we’re dealing with this. So it’ll be interesting to watch over time how that goes. Yeah, I’ll be the first to say I will hold up my hand and say I’m not a lawyer. And I struggle with all of this. Yeah. Yeah. And I
do want to point out one thing, JJ by They actually are doing two different phase three trials, one with one dose and one with two dose. So it’s a two dose ends up being more effective that may end up being a two dose to those vaccinations. So I think you know, you know, TBD, TBD on that one, just just kind of want to
Nick van Terheyden
follow the science. That’s what we say always.
Fred Goldstein
Yeah, absolutely. I know. We’ve got another question up here. Regarding folks who are long haulers are really struggling with code for a long period of time. And picking diabetic patients looks like it’s asking, do you have to change medications or dosing? I would think one we really don’t know that yet. Is that probably true?
Nick van Terheyden
I’ve not seen anything that talks specifically to that. I think what’s very clear now is that long haul is is a genuine condition. It’s affecting we know some data points about it four times more women are affected or impacted than men, as long haulers. We have some foundation as to why but we don’t know why in some individuals and not in others, I think it’s going to be something that we have to watch. And it’s it makes all of the things that we’re doing now to prevent the disease. More important, because you may not get the severe disease and die from it. But you may end up so we want to prevent as much of that as possible.
Fred Goldstein
Yeah, I think that’s a great point. It really is about prevention. And I know, there was another big study being launched on potential neurological issues, but we just don’t know, it’s just so early. So it really is about preventing this and keeping yourself as safe as you can until we can get these vaccines out to everybody. Right.
Right. Yeah, I think it would be reasonable to believe that it could impact the pancreas and, and diabetes, just like you said, the brain and the heart, we know the lungs, kidneys with kidney failure issues. So so I think a it’s reasonable to consider that it could have has implications for for those folks. And I think we’re gonna learn a lot more about that. As we’ll continue to see more and more on this autoimmune angle to that to you know, to this being that this is really good at some more, but also immune response that we’re that we’re seeing and causing the long hollers.
Fred Goldstein
Yeah, I think we’re at a really interesting point, the science is obviously advancing as rapidly as it can. And so many people have gotten into this, and really looking at all the different unique issues caused by COVID, and how to protect yourself from COVID, etc. And we sort of know that protection ideas, we’ve got some vaccines out. And so it really is now back to us and our personal behaviors, which is what that one question was about getting vaccines etc. And I do think I did have somebody on my podcast coming out next week, who worked in both the Obama administration, the Clinton White House, both of them and HHS, and is an advisor, and he said, obviously, there will be a huge focus on communications going forward to help us and the country better understand what are some of the things we should be doing to move forward quickly?
Nick van Terheyden
And I’ll pick the highlights all the positive in all of this, you know, for the diabetic question and long holders, you know, we don’t want we don’t know that. That’s because we don’t have, or we didn’t have the data because we didn’t have the people nobody had the disease prior to let’s say, January, roughly speaking. So now we’ve got data. Just look at what we achieved. When we focused on and focused on preventing the disease, we’re going to have the same focus, I believe, on those long as I don’t anticipate, you know, right. That’s it, we, you know, we’ve solved this crisis. And the good news is, we’re going to learn, understand and be able to address that as we learn more about this disease with so much effort and science focused on that. So we can’t answer the questions, but we will be able to.
Fred Goldstein
Yeah, fantastic. We’re coming up on the end of this 30 minute discussion group. If you have any other quick questions, you please put them in the chat box, or you could actually email them to us at at info at accountable health llc.com, we’d be happy to address those for you. We thank you all very much for joining us this week. And obviously great to hear the thoughts from you, Nick and Luis and once again, we’ll be every week Wednesday at 4pm. So please join us for those and happy to talk to anyone about how we might be able to help them if they have an interest in getting some more information. Great. Thank you all
