This week Fred and I discuss the concerns regarding variants including a recently pre-published article (Evidence for increased breakthrough rates of SARS-CoV-2 variants of concern in BNT162b2 mRNA vaccinated individuals). That has some people worried that they can still get infected with COVID19 – the so called ‘Breakthrough’ infections. We review the details of the study and how to interpret the data in that context and consideration such as LongCOVID, vaccine hesitancy and the rush to open seen in some parts of the country
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Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with accountable health here helping employers work with their employees to improve their overall health and benefits program. So Nick, we’re seeing a lot of attention paid to this study out of Israel talking about breakthroughs. And obviously, you get some of these clickbait headlines that you always talk about and things like that. So what’s really going on with that issue?
Nick van Terheyden
I can’t be the only one that’s singing the Queen song Come on the breakthrough, right? So breakthroughs, what are they? Well, they’re, you know, this happens with viruses, they mutate, we’ve talked about that in the past. And as they mutate some of the capacity to overcome the body’s immune systems, works better, essentially, you know, it’s this constant battle, we’ve been in a battle with all of these pathogens over the course of all of human history, and this is happening again. So what’s happening with all of these variants, they occur as a natural consequence of the way that these viruses replicate, and there are hundreds of them, not all of them around relevance. In fact, in the professional environment, we talk about variants of concern versus variants of interest. And those are the ones that are causing problem. We certainly heard about b 117, also known as the UK variant and the South African variant. We try not to use places, but that’s how everybody remembers them. It’s a bit like naming thunderstorms, not thunderstorms, tornadoes, no, not tornadoes, we’re
talking about the Florida hurricane experience.
Nick van Terheyden
That’s why we do it, we don’t use names that don’t associate with the place, but they do associate with some poor person, then has to be so anyway, separate issues. So the South African variant seems to be causing a little bit of concern, and there was a study a people very difficult to interpret, because all the data isn’t there. There seem to be a preponderance of South African variant breakthrough. So they had the vaccination. And they still got infected with COVID-19. But some things that play into this one small number of people to, I think, in all of those cases, they hadn’t received the vaccine, and had the opportunity for the immune system. So it was within 14 days. And we all know that you have to wait for an extended period of time, a minimum of 14 days. And that also depends on the sequencing, whether it’s the second dose and so forth, to really retain the maximum level of immunity. And we also don’t know what the outcome was, did they get infected and have severe illness? And we think, based on trying to understand what was going on that that wasn’t the case, which is normal. It’s the same as getting the flu vaccine, still getting flu, but you get a milder version of it.
Fred Goldstein
Interesting. So the only one question I would have for you, Nick, that could potentially be problematic was with this is if there was some long COVID associated with that or something like that. But other than that, not a huge issue at this point.
Nick van Terheyden
I think that’s a great point, Fred. And I think it’s going to be the subject of a future conversation between us, we definitely need to talk about long COVID another interesting point, I know there was somebody or some group that tried to rename that to something else, but nobody’s using it because we can’t remember but we all remember long COVID long COVID the long term consequences of suffering the disease seems to be more associated with higher intensity infections, but we don’t know we’ll talk about that in more detail. But you’re right. There is some potential for that.
Fred Goldstein
But still, again, it’s a small number. It was eight individuals I understand from that study.
Nick van Terheyden
Right, exactly. small number of people. What else is going on?
Fred Goldstein
Well, as you know, Florida is constantly doing this reopening. And we now just had a giant event here in Jacksonville no match required 15,000 people at a big old wrestling tournament. So be interesting to see. They did say that individuals were not complaining or harassing or either way those wearing masks or those not wearing masks but the vast majority were not 15,000 in an indoor arena packed in I think it may see a few 1000 more than that but it was packed and we also had the go ahead the bulk of it you
Nick van Terheyden
know it’s interesting to hear that because as I think about people that go to an event like that, that are wearing masks so there’s there’s at least a mentality there. I wonder why they ended up going when all these other People weren’t wearing masks.
Fred Goldstein
yet. It’s an interesting question. And it’ll and it’ll be fascinating to see what comes out of this because they did mention that people came from a number of other states. So they were all coming. It’s a big national event first time that it’s been done in over a year. Now, here’s an interesting idea, we’re seeing this vaccine hesitancy, and it suddenly crossed my mind. A lot of those wrestlers wear masks. So why couldn’t they have made custom masks like the wrestlers, ones that were kind of cool, and handed them out? Maybe it would be a way to insert a few more people who showed up to wear masks.
Nick van Terheyden
Well, what a great idea. So that brings on the the whole issue of vaccine hesitancy which, you know, we’re now in that mode at this point in the United States where we we have lots of vaccine available if you’re over 16, pretty much. It’s wide open wider in some states than others. But essentially, the limits now are people’s acceptance, a willingness, how do we overcome that?
Fred Goldstein
Yeah, it’s a fascinating one, I understand this from the numbers this week that it’s the first week we’re seeing a drop in the total number of vaccines given. And it’s a it’s one of if you can’t mandate it. And obviously, there are major issues with mandating this kind of stuff, you’ve got to come up with some form of incentives. Although How do you determine who has it, etc. But it you’ll see some restaurants and other places are going to require this. And I think that’s sort of what needs to happen. basketball games are talking about sections with it. There needs to be something to help other individuals understand the benefits to them and to all of us, and to getting vaccinated and incentive in some way employers are doing it with some dollars and other things. But we need to make some broader approaches.
Nick van Terheyden
I think the additional point here is, you know, shout out to all those community physicians, the general practitioners who work one on one, long standing relationships with people in the community, they’ve supported them, they give them advice on what they should and shouldn’t do from a health standpoint, Hey, stop eating that sugar. Gosh, you should do the following things to be healthier. And that’s the same level of interaction that needs to occur to give people comfort. This is not a mandate issue. This is about explaining the pros and cons. And the fact that I wear a seatbelt in the car, doesn’t mean I’m not going to die in a car accident just means I’m taking the best precautions based on the evidence. And we need to help people understand that because we as humans, are terrible at assessing risk. And we have to help those individuals.
Fred Goldstein
Absolutely. We’ve done that discussion on risk before and it’s something we have to do to help people get get a better understanding of the risks and rewards of doing this and why it makes some sense. So again, another fantastic week, Nick, I hope you have a great week coming up and this is Fred Goldstein with accountable health thanks so much for listening. If you’d like more information, please go to accountable health LLC comm or to the incrementalist comm that the great set. And back to you, Nick.
Nick van Terheyden
So I’m gonna ask you to re record that. I think I can’t I don’t want to Oh, you can’t
Fred Goldstein
anymore. Yeah. So
Nick van Terheyden
just do your your finish again, in three, two, you call it
Fred Goldstein
- So once again, a fantastic week. Nick, if anyone has any questions, please come to accountable health LLC. com. Reach out to us. We’d be happy to help you with information. And we look forward to talking to you again next week.
Nick van Terheyden
And this is Dr. Nick on the incrementalist here with incremental insights for better business, better health.
