Panelists will discuss the threat posed by new COVID variants and continued vaccine hesitancy.
Panelists will be asked questions such as...
- Cases have risen from an average nationally of about 10k per day to now 40k in the last few days: how has "reopening" and lifting of mask mandates fueled this increase?
- Reports are that upwards of 95% of new infections and 99% of hospitalizations are unvaccinated: how can these hold-outs be convinced?
- Could a new variant get past the vaccines?
- How have the demographic impacts changed - are minorities and people living in poverty still disproportionately affected?
Media: Do you have some questions? Feel free to email them to [email protected] or bring them to the panelists on camera during the event.
Panelists:
- Dr. Eleanor Wilson, MD, MHS, Associate Professor of Medicine, Institute of Human Virology, a Global Virus Network Center of Excellence at the University of Maryland School of Medicine
- Dr. Perry Halkitis, Ph.D., MS, MPH, public health psychologist, researcher, educator, and advocate who is Dean and Professor of Biostatistics and Urban-Global Public Health at the School of Public Health at Rutgers University
- David Souleles, MPH, Director of COVID-19 Response Team, UC Irvine Accomplished Public Health Executive & Healthcare Leader
When: Friday, July 23, 1PM-2PM EDT
Where: Newswise Live Zoom Room
Transcript:
Thom: Hello, and welcome to today's Newswise live event. As cases continue to rise, especially among the unvaccinated, and in particular, with the more dangerous Delta variants spreading more and more throughout the US, we have three experts here to discuss these and other topics. We have Dr. Eleanor Wilson, an Associate Professor of Medicine in the Institute of Human Virology at the University of Maryland School of Medicine. Dr. Wilson, welcome, and thanks for joining us. I want to ask you to start out with the first question. One thing that's come up is that during early stages of the pandemic, there was a considered undercount or a gap between confirmed cases, who had gotten tested and unconfirmed or asymptomatic people who hadn't gotten tested; is a similar phenomenon potentially happening here with these numbers that we're seeing with 45,000, 65,000 cases in the last couple of days? Is that an undercount?
Eleanor Wilson: It's almost certainly an undercount. In the very beginning, testing was limited; nobody had enough access and so it was really being deployed strategically, and so we were really trying to test those people that we thought were most likely to be positive to really identify cases as quickly as possible. But we know that people can have low symptoms or be asymptomatic entirely and might not get tested. And so you need rapid scaling up of testing to be able to identify as many cases. We know that it's almost always an undercount and then the fact that that testing has really been decreased in favor of vaccination, which is great. But a lot of, at least here in Maryland, a lot of the sites that had been doing rapid testing or that were the convention center or Six Flags or other places that were doing a lot of the testing, have now pivoted to more offering vaccines and there are fewer places to get tested rapidly. So we need to get ramped back up to make sure we're capturing all the cases that are out there.
Thom: Thank you, Dr. Wilson. We also have with us Dr. Perry Halkitis. He's Dean and Professor at the Rutgers University School of Public Health. Dr. Halkitis, thanks for joining. I want to ask you about a recent article published in The Atlantic, Science Writer Ed Yong makes an argument that not all of the unvaccinated people are particularly anti-vaccine. And there's an important group among that group that may still be persuaded. So, I'm curious about your thoughts of reaching those folks. What are their concerns? And how can we communicate to them to get them convinced to get vaccinated?
Perry Halkitis: Yeah, Thom. Thank you for that question. Thank you for organizing us, and thanks to Eleanor and David for being on this panel with me. I do want to add a piece to what Eleanor said. I am one of those people who last March had COVID-19 and wasn't tested, right. So, there are real stories. So, my number was never ever captured in the data. So, there's many, many more people like me. So, Thom, your question is really great because we tend to think of people as one type, you know, Greeks are of one type and women are a certain type and people who are not vaccinated are a certain type. But we know that populations are not monolithic. And if 30 to 40% of people who are in the United States right now will remain unvaccinated, there's a variety of different reasons. Absolutely there's a proportion of people out there who will never get vaccinated, who think this is all not real. There are people who worry about vaccines; there are another probably 5% who are afraid of needles. We don't even have that conversation about needles and how people are afraid of needles. And so, you take all those, and then of course, there are the populations that have experienced horrible atrocities at the hands of the healthcare profession and of medical researchers over the course of our history, who are resistant from that regard. So, what does it say to me? What it says to me is one size doesn't fit all. Absolutely, there are some anti-vaxxers there and the messaging has to be tailored to each of these different groups, if we're going to affect the change in increasing the number to 70 or 80%. Let's recall one more final point that annually, probably 50 to 60% of people get vaccinated for flu. So, I don't know if we're ever going to get to 90% for COVID-19.
Thom: Thank you, Dr. Halkitis. I want to introduce our third panelist. We have David Souleles. He's Director of the COVID-19 response team for UC Irvine. David, thank you so much for joining us. And I want to ask you about the recent big news out of the University of California system announcing that they will be mandating vaccines for their campuses around the state. How is this policy crafted and the decision made and communicating it to your communities?
David Souleles: Good morning, thank you for the opportunity to be here. Happy to join the panel today. So, yes, the University of California system has implemented a vaccine policy for COVID-19 for the academic year beginning this fall. Essentially the policy will require that all students staff and faculty who are on university property or participating in a university program need to comply with the policy by either being fully vaccinated and providing documentation of that vaccination status to the university, or having an approved exception. And we've got a few different categories for exception – medical exception, religious objection, etc. So, really, to your point and to your question that university was very thoughtful about this, it became very clear, I think, to all of us in public health early on that these vaccines were a game changer, that they were tremendously effective, that they were extremely safe and that they were really our opportunity to return to campus in a more typical fashion than all of us have been. I'm assuming my colleagues from the other schools as well; we're all remote in this past year. So, this was really our opportunity as the University of California to get back to that more typical experience that our students would be looking for. So, we are blessed to be attending the campus system with some of the best experts in the world as part of our institution and all of us had an opportunity to provide input into consideration of this policy. The Office of the President for the University of California convened several different working groups who provided input in the development of the policy. We then put it out for public comment, so all of the constituents who interface with the university could have an opportunity to provide feedback before the policy was issued. And we just feel very confident that this is the way to go and it is an important step in assuring the safety and the health of our campus community as we return to in-person instruction this fall.
Thom: Thank you, David. I want to open the floor for questions from our audience. And we have a question already now from Dan Keller of Keller Broadcasting. Dan, if you'd like to go ahead and ask, your audio is live now.
Dan: Hi, Dr. Walensky of the CDC recently said that the Delta variant is the most transmissible respiratory virus she's ever seen. How does it compare in R naught, both to the original COVID Delta virus as well as to measles, which I thought was the most transmissible up till now?
Thom: Thank you, Dan. I think Dr. Wilson has an answer for your question. Go ahead, Dr. Wilson.
Eleanor Wilson: So, absolutely, measles is extremely transmissible and it's something we worry about. And that's one of the main reasons that we perseverate on trying to get people vaccinated against measles because it can be so easily transmitted. So, a lot of things go into the R naught and it is really a reflection of how many people can be infected from one infectious person. And it has to do with how long the virus remains active, how close people have to be, how long it hangs out in the air. The original R naught of COVID, the original Alpha variant, varied a little bit but it was really thought to be 123 and then it's gotten a little progressively more transmissible as time has gone on. The R naught has gone up. So, it's thought that the Beta variant might have been somewhere around four to six, and then the Delta variant is thought to be somewhere close to eight to nine. Measles is still probably the most transmissible virus. It's R naught in the worst case scenario is about 13. But, I mean, measles, the infectious disease story about measles is that somebody can be in a room and then two hours later, somebody else can come in the room after the first person has left, and get measles. So, hopefully the Delta variant isn't quite there yet. But we do know that the amount of time required for face to face, within six feet contact to infect somebody is really probably less than a minute with the Delta variant, which does mean that it can be extremely quick and transmitted.
Thom: Thank you, Dr. Wilson. I believe Dr. Halkitis wants to add to that.
Perry Halkitis: I do. I just want to say really quickly, like those of us who have been doing this kind of work like Eleanor and others on around viruses, whether it be HIV or SARS-CoV-2 always talk about a concept called viremia – the amount of viral load, the amount of circulating virus. And what appears to be true for the Delta variant, which is, let's face it, only the latest Greek letter where there's a lambda out there already, it’s said a 1000 times higher level of viremia. So, with that, it becomes much more infectious, it creates much more burden on the body and as a result so much more transmissible.
Thom: We have another question from our audience. Robert Adler asks, we have several reports from Israel suggesting that the Pfizer and perhaps other vaccines are provided very limited, for example, 39% protection against the Delta variant. Is this a questionable outlier or something that we should take a lot more seriously? Dr. Wilson, Dr. Halkitis, any thoughts about that?
Perry Halkitis: Eleanor, you want to go?
Eleanor Wilson: I'm happy to start. Thanks. We're still learning about all of these different variants. You know, there was just a New England Journal paper out yesterday that confirmed some of the things that had been reported already in pre-prints and preliminary data, that most of the vaccines still retain very high efficacy against the Delta variant. There are outliers that show reduced efficacy of some of the different vaccines versus some of the different variants, and we will track all of those. But it's important to wait until things are published until things have been verified and reviewed before we really know. This virus has been moving so quickly. We've all been acting on preliminary information and then trying to wait for the follow-up. So, it's important that we keep tracking that information to really know. Right now we know that vaccines are really the best way to protect yourself, but it's part of an entire strategy of masking, of social distancing, of being careful, of limiting interactions. And so I think the best approach to this virus is still the multipronged one, but vaccination is absolutely a central component of that.
Perry Halkitis: If I could ask what Eleanor just said, I'm in complete agreement with what she said. And look, I mean, this is a work in progress. We don't know, right. Every single day is a new piece of information here. But common sense, given the breakthrough cases, would argue that perhaps there's an issue at hand here. So, as Eleanor said brilliantly and thank you for saying this, the masks still have to be there, the distancing still has to be there. I think we're going to get to this topic later but what happened a month and a half ago was that we said, okay, everyone's vaccinated. You know, United States is open, right. And all of a sudden here we find ourselves again. So, we have to think about this as a whole conglomeration of behaviors that have to happen together.
Thom: Very good point, Perry. And I want to dig further into that because as this big topic here is that the spread is mostly among the unvaccinated, reports of 95% in some areas or more being unvaccinated, and especially hospitalizations and deaths being, practically exclusively the unvaccinated. So, how has that reopening, the CDC announcing a few months ago that the vaccinated people can begin to go maskless and largely that was reported by the media and, I think, taken by maybe skeptics as permission for everyone to go maskless? Do you think that that contributed to this rise and the current surge?
Perry Halkitis: I don't know. I think it's, so I'm going to put the onus on people. So, people have brains and they make decisions, and they have to take care of their health. And so, as soon as CDC did create an environment where people felt that they didn't need to have as much protection but I will tell you this anecdotal data. I know three people: one in their 20s, one in their 30s, one in their 50s, perfectly healthy, no underlying conditions, vaccinated, breakthrough virus with symptoms, right? I have 6 other people who have become familiar with today from my colleague in Alma, Georgia, fully vaccinated, hospitalized. So, absolutely, what has happened is that people have taken the vaccine as an opportunity to get rid of all those other behaviors. I will say only what I do because I think it is critically important for scientists like us to say what we do, not just what we preach. And for me, any public space that I'm in, where I am not aware that there are people, when I know we're not aware of who the people are, which are highly crowded, I avoid the highly crowded ones. But even the other ones like the gym, like the supermarket, like the Walgreens, I wear a mask and I am vaccinated. And the other thing we should be doing is we should, and I think Dr. Wilson would agree with this, is start to rev up our testing again. I literally an hour ago went and had an antigen test, here at my house, just to make sure that I have not been exposed, given what the dynamics are with the Delta variant.
Thom: I want to toss this also to David and in your region in Southern California and we've seen the news that California still is one of the states with some pretty high numbers. How do you feel that these recommendations and as Perry put the onus on people, maybe these recommendations weren't quite heard or followed as closely as they should have been and get us where we are today?
David Souleles: Well, yeah, I think putting some of this into context as well, so when we talk about and when we hear various reports out about levels of vaccine in our communities, they're recorded out in a variety of different ways that are not necessarily meaningful from a public health protection perspective. So, reporting out the number of people who've received one dose of a two dose vaccine, interesting. That doesn't confer the level of protection you need in the community to really have it be effective. When you report out on the people, the percentage of people who are eligible to receive vaccine, who've been vaccinated, that's great news, but we have a whole population under the age of 12 who are not able to be vaccinated. And so, we really, from a public health perspective need to be looking at the percent of the total population that has been vaccinated in the United States. We're still below 50% when you look at that number, we're at about 48%. That is nowhere near enough in order to stop the spread of Covid-19. The spread is fueled by unvaccinated people but we know that there can be breakthrough infections. And as more people are vaccinated, you're going to see more breakthrough infections, and all of that then contributes to the increase in cases that I think we're seeing everywhere. So, I know communities across the country are struggling now with which public health interventions to implement based on the rising cases, and it seems like a cut and dry decision but we've got communities that are incredibly fatigued and an economy that is trying to get back to levels, restaurants that are trying to survive and stay open. So, all of those factors, I think, go into trying to balance out community by community the levels of intervention you do and the payoff you get from those interventions in terms of reducing the risk and reducing the spread. And it's going to be different from state to state and community to community based on transmission levels. Here in California, for example, Los Angeles County, based on the trends, they were saying re-implemented a mask mandate. So, I think we know the tools that work. It's not rocket science. Public health tools, these basic tools of communicable disease control have been around for decades – masking, physical distancing, vaccine. They work, they are tried and true. We just have to be judicious in how we implement them in ways that will get us the best outcome for our communities.
Thom: Thank you, David. I want to go to Dan Keller again, for a follow-up about the infectiousness of the Delta variant. Go ahead, Dan.
Dan: Dr. Halkitis, you said that the Delta variant has about a 1000 times the level of viremia. Is that viremia or respiratory tract secretions, which would seem to be the important thing in terms of transmissibility? The second thing is, masks have proven to be very effective in reducing flu last season, 1000 cases as opposed to, say, 30,000. Assuming that they're as effective for COVID as it is for flu, that would give you a tremendous advantage if you have both vaccines and masking. Some Governors, Asa Hutchinson and Arkansas and Kay Ivey in Alabama have finally gotten some religion and are going around and asking people to get vaccinated, but they refuse to do mass mandates. Would an economic argument convince any of these people, do you think to change their tune?
Perry Halkitis: Dan, I love all your multi-level questions. I'm going to start backward from the end and work backwards. I would say that I'm pretty convinced that we find ourselves in the situation today on July 23rd in the United States, you know, one of the richest countries in the world with regard to COVID-19 because of economic decisions, because individuals have been influenced by the need to reopen businesses or what have you, perhaps too quickly. I say that also and I have to provide context here as somebody whose father was an immigrant who owned a grocery store, and I recognize what damage that would have done to our family. So, I think that absolutely decisions have been made economically. Number two to your point, masks and this is also relates to the reopening. Masks have become symbolic. Masks are the condoms of 2020-2021, right, and they become a symbol of what political party you're in, what political part of Asia you are. So, I don't think that decisions are being made on masks based on public health indicators but based completely on political indicators. And what we have to do is shift that dialogue. So, I'm going to have people really understand that masks and vaccines and distancing are critically important with each other. And I think we're seeing increasingly those who have been resistant in the past to encourage vaccination, changing their tune. Finally, viremia. So, I'm going to use the HIV parallel because it's the area that I know the best but I'll ask Dr. Wilson to correct me or auto-correct me if she needs to do that. But with HIV, it's the amount of circulating virus in the blood. The amount of circulating virus in the blood is an indication of how much virus there is in the semen and the other secretions. So, here the viremia, the level of virus for Delta variant is in the blood is an indicator of what would then be in the secretions and the other bodily systems of the person. Eleanor, would you agree with that?
Eleanor Wilson: Yeah, I think it's a good indicator. So, it does seem relative to the other variants of COVID. The Delta variant has much higher viral loads, which probably reflects a higher amount of virus in the mucosal surfaces, in the nose and then later, as the disease progresses, there can be higher viral levels within the lungs or in other places within the CNS, although the question is still out on that exactly what levels make it into the CNS, the central nervous system. But we don't know exactly what the levels are of Delta variant in any of these specific places but we know that they are much, as you said, much more likely to be higher than the Beta variant or the Alpha variants because they are so much higher in the blood already. And there's no indication that they would be different for this virus. So, those studies are still ongoing. They're still in review. There's definitely the suggestion that that is what is driving the increased transmissibility of this variant.
Thom: Thank you very much for your follow-up questions, Dan. I’m going to next call on Deb Wood from NurseZone. I have enabled your audio, Deb, if you'd like to ask this yourself.
Deb: Yes, I'd like to know what the reason might be to not let people get a third booster shot. Pfizer's recommended it. There was a study, I think, of Israel that suggested it, and yet the CDC is really buckled down on that, no, we don't need boosters.
Thom: Thank you, Deb. Dr. Wilson, what are your thoughts about that?
Eleanor Wilson: So, I think the first thing is we're trying to get as many people vaccinated with the two dose regimen as possible. We know that that correlates with protection, we know that that works pretty well against all the variants that are currently circulating; we have new confirmation of that. So, I think that's really the first public health goal is to try to get everybody fully vaccinated with whatever regimen that they take. We have absolutely seen that there are certain patients particularly immune-compromised patients, solid organ transplant patients, and others who do not develop zero protection, do not develop protective antibodies after those two doses. And we have seen anecdotally, although it has not yet been reported in a prospective randomized control trial or anything else, where people who are immune-compromised to get subsequent boosters are able to develop that correlative protection that we can see in their blood. So, in some of those patients, we've seen that they have, solid organ transplant patients that I care for or others who have sought out additional boosters have been able to achieve the correlative protection that we've seen in immune-competent, normal patients. So, I think, in those particular instances, a third booster might be indicated. Now, if it's because the initial vaccines don't cover a new variant that comes down the pike, then we do know that a booster might be required in the future. And that's absolutely something people are setting me and I just is sponsoring a heterologous challenge, so a booster with a different vaccine than the one you originally received because some companies might be able to gear up to respond to different variants faster than others, and so that's absolutely something we need to know. And Maryland and I know other sites across the country are all recruiting for those studies now. Other things in terms of if there are new variants that have different variants or different risk factors, you know, a third boost that could be tailored to address that absolutely might come down and that would be useful to do. But right now, there's not a whole lot of data that you need a booster and the focus has really been on trying to get as many people as possible to complete the vaccine schedule, vaccine series with their original vaccine rather than trying to continue to perpetuate that. We have good data right now that COVID infection and COVID vaccination and more with COVID vaccination that actually infection itself, that the seroprotection in response to the vaccination does persist for at least 8, 10, 12 months out, and so right now the focus is getting as many people as possible to that point rather than boosting their responses that we know are already there.
Perry Halkitis: Can I also lift up something that Eleanor said at the beginning, which is, I think, amazing. It's a human behavior issue here. We can't get human beings to take both two vaccinations. Now we're going to ask them to take three vaccinations. So, I think what the CDC is thinking is given the virology that Dr. Wilson has provided you that if we can just focus right now on getting people fully vaccinated with a two doses, then come time we can focus on a third dose among the general population.
Eleanor Wilson: And to piggyback on that, it's a global infection. And so, yes, the United States has just under 50% of our population, and we have some people in some places where the vaccine is expiring because they can't find people to give it to, but we also need to vaccinate everyone in the world. People travel, you know, we know this virus moves. This virus can get halfway around the world faster than anybody else and so we need to make sure that everyone has access.
David Souleles: And I just add, within public health, we try to take actions based on data. We try to make sure that what we're doing has a solid sound justification that the data, that the science is showing us is going to be valid, and so I think that is the process that we are in right now in this country with the CDC and with the manufacturers trying to agree on where we're at with the data, and the value that that intervention would provide in terms of improving our situation compared to, say, as Eleanor was indicating and Perry, getting everybody who's not yet vaccinated, their first and second doses.
Thom: We have a question from Rich Mendez at CNBC. Rich, I've enabled your audio if you'd like to ask your question.
Rich: Thank you. Thanks so much for taking my question. So, with the Delta variant spreading and mask mandates coming back, even in counties with high vaccination rates, like we're seeing in California, how could this all affect back to work plans in the fall, actually for companies that don't plan to have an immunization requirement? Thank you.
Perry Halkitis: I answered, Rich. I answered this. I answered a similar question this morning about schools. It's July 23. Every day is a new piece of information. Schools start around September 1st. We're all planning to go back to the office as a run; I'm actually back in the office part time now. I think, Rich, we don't know, right. I think it's like right now we're waiting for the data to show us how rapidly it continues to proliferate, the virus, how many people continue to get sick. And I think everybody's just taking, like holding their breath hoping that we can get through this bump with this Delta variant and the Lambda and the Omicron and whatever else comes next, and we go back to work in the fall. But I think I'm going to stay hopeful that we are resilient. I'm going to remain hopeful that people are starting to give the right message and challenge misinformation. And I'm going to remain hopeful that we're going to probably have some back to work normalcy, never really back the way it was before in the fall.
David Souleles: Yeah, I would just add that in public health when you're looking at the health of communities; again, we've talked about this. You've got some basic tools that you can use. And we always try, and we're talking about COVID here, but this is really for any communicable disease control effort that local and state and federal health officials are trying to deal with. You always try to start with the least restrictive measures that will get you the best benefit, and you escalate the measures as the need arises based on what you're seeing in terms of case rates and transmission. And I think that's what's going to have to happen community by community, business by business, in consultation with local health authorities and looking at the situation on the ground and local communities, is to have those conversations and to be aware and present because again, a month ago, six weeks ago, a lot of folks were not thinking we would be where we are today. And here we are, right. So, when I talk with folks, I talk about the fact that we are, while we may have ebbs and flows here in terms of transition, we are by no means out of the woods with only less than 50% of the US population fully vaccinated. So, this virus is going to do what it's going to do, and it's sometimes going to surprise us and we just are going to have to continue, I think, to be flexible in our approaches to school and to work based on what will be needed to control transmission and communities if rates begin to get too high.
Thom: We have a question from Randy Thoms from a Radio Station based in Ontario. Randy, I've enabled your audio, if you'd like to go ahead and ask your question.
Randy: Yeah, thank you, here in Fort Francis directly across from International Falls, Minnesota. My question is Canada's allowing fully vaccinated US residents to visit for non-essential reasons such as tourism and shopping beginning.
Thom: Sorry about that, Randy. Your audio should be enabled again. That was my mistake.
Randy: No worries. You hear me now?
Thom: Yes, go ahead.
Randy: All right. So, as I mentioned, Canada is allowing fully vaccinated US residents to visit beginning August 9th. Given what you're telling or what I've heard, should Canada be concerned? And should our border communities like mine be concerned given the rise in cases in the US and I have a follow-up too?
Thom: Dr. Wilson, Dr. Halkitis, any thoughts about border policy?
Perry Halkitis: I mean, yes. I think, yes, you should be concerned. I mean, I think that, as David said a few minutes ago, where we were six weeks ago is not where we are today on July 23rd. And so, I think, the next week will be very telling as we continue to see how the Delta variant emerges as we see what's the United States’ federal government and the CDC begins to try to change and implement. And I think the Canadian government will have to keep an eye on all of that. I think, in fact, all governments have to keep an eye on that. Again, I'm going to remain hopeful that things will get under control. But yes, it should be a concern.
Thom: David, do you have anything to add to that? I know being based in Orange County and your past experience as a county public health official, you're not exactly on the border but you're close to it, the other border obviously not with Canada. But what are your thoughts about any of these kinds of interstate and international travel restrictions that might be needed?
David Souleles: I think, again, and we know that there are a number of them already in place, still in place, and that CDC really takes the lead on that in terms of determining both restrictions for incoming transportation to the United States, but also in recommendations and alerts and awareness to our population of places they shouldn't go, as do other countries, right. And again, this is one of the tools that public health has. If you look at the tools, you want to be as least restrictive as possible, but as things begin to escalate or if we determine that there are countries with high transmission rates, again, that's where those types of advisories come in. So I won't necessarily opine on the specifics of a country. But it is, again, clearly a tool that we have available to us based on what we're seeing globally in terms of transmission.
Thom: We have a question from Brent Johnson at the Newark Star Ledger. Brent, I can enable your audio if you'd like to ask this yourself, or I'd be happy to ask it for you.
Brent: Sure, I can ask. Dr. Halkaitis, this is especially for you. We’ve spoken a lot about New Jersey and how it's one of the states that is one of the higher vaccination rates at 70% of eligible adults. But cases and hospitalizations are again on the rise, how concerned should a state like New Jersey that has a high vaccination rate be about cases rising and do restrictions need to come back?
Perry Halkitis: Yeah. Hey, Brent, how are you?
Brent: Good. How are you?
Perry Halkitis: Good, good, good. So, again, I want to echo one of the points that David made earlier, which is about the vaccination rates and just the generic numbers that we get about the state overall, what we don't see are like what is happening in subpopulations and in sections of the state and what have you. So, that one number, while good, it is not what is happening throughout the state. That said, the 49 deaths due to breakthrough infections that were reported by Governor Murphy on Wednesday of this week are an indication that there is a concern. So, to your point, Brent, I think that Governor Murphy will be looking to the CDC and Judy Persichetti to the CDC for their guidance. But I would not be surprised if some level of mask wearing and distancing were to arise again if this pattern continues to follow that we've been seeing over the course of the last week. So, it's possible, Brent; it's very possible.
Thom: Thank you very much for your question, Brent. I want to go next to Alakananda Dasgupta. I've given you the ability to turn your audio on if you want to ask this question yourself, or I can ask it for you. Okay, so Alakananda asks, there's a new preprint study out of Liverpool that shows that the longer interval between the two doses of the Pfizer vaccine may confer greater immunity and higher antibody levels and helper T cells. Do any of the panelists have thoughts about this? Dr. Wilson?
Eleanor Wilson: Yeah, I think, first of all, I would say that it's been amazing to see the level of sharing that we see with preprints. And it's wonderful to see this data as it comes out. But it's really important to follow up and make sure that it holds true. I know there have been a lot of retractions from preprints and so it's really important to continue to follow that data and make sure that what is published really holds up. That said, so, in terms of studies that have shown different intervals for the Pfizer vaccine, so I think somebody else had also asked in the chat about the different measures of seroprotection, looking at immunologic protection in general, looking at antibodies versus T cell or cellular mediated protection, and those are very much open questions with respect to this virus. We do know that antibodies in particular do correlate with protection and so that is really the one that we are most familiar with from looking other vaccines that mediate protection in terms of hepatitis B, in terms of measles, mumps and rubella, other things that we have, a great deal of experience with, we know that the antibody titers really strongly correlate with protection. And while T cell mediated immunity or other kinds of cytotoxic immunity might actually be very important for longevity, right now we're really just looking at protecting against an exposure. We know that antibodies are an accurate representation of how protected somebody might be against, at least the severity of the disease. So, that's the one that we've really mostly chosen to focus on. We do know that the levels of antibody mediated protection are relatively high with both of the mRNA vaccines and pretty much all of the vaccines that are currently available. And so, in terms of looking at optimizing the vaccine efficacy, I think both Pfizer and Moderna have continued to look at dose adjustments or interval adjustments or boosting and other ways to optimize that protection. But I think, as we've said repeatedly, vaccines and trying to get as many people fully vaccinated as possible is really the primary goal in a way that we already know works, and then we can debate some of the specifics as we get closer or if that becomes more relevant but right now, just getting over the goal line. And again, as we've said over and over, as everybody in the panel has said, this is really just one tool in the toolkit for ending this pandemic – vaccines, social distancing, contact tracing, all the different kinds of policies that we're talking about. I think it can't be overemphasized enough there. I think Australia is a great recent example. They have wonderful contact tracing and didn't really, you know, in the beginning they didn't really think they were going to need to get as many people vaccinated. And then one outbreak of Delta really led to a larger outbreak and reintroduction of restrictions there. So, it's clear that we're going to need to use every tool in the toolkit to really address this.
Thom: Thank you, Dr. Wilson. Another question from the chat from David Bradley at Science Base. He gets into some questions about new variants emerging. There's been confirmed cases of a new novel variant in the UK this week. And so, his question being governmental, economic concerns – are these things likely to perpetuate the pandemic for many years? This dovetails nicely with another question that I wanted to ask the panelists about, the possibility of further variants emerging, whether those variants can escape the vaccine. And I'd love it if all of you can respond to this in general because I think that this is just a giant question mark that we all have as it continues to spread among unvaccinated, does that mean it potentially mutates to become more and more dangerous, escape the vaccine and continue circulating year after year after year?
David Souleles: We are a big variant factory in the United States right now because of the levels of vaccination. I mean, that's just the reality. Variants occur because transmission is able to occur. The more people that are fully vaccinated, the less places the virus has to go, the less likely you are to see variants emerge. So, in my opinion, we are incredibly vulnerable to additional variants. And we've already seen it. It's not hard to predict, right. I mean, at the levels of vaccination we have in this country right now, we are very vulnerable to variants. And the variant could be less of a problem or it could be more of a problem. But that's the challenge that we're facing, not getting to the levels of vaccination that we'd like to get to, in order to really reduce the opportunity for that kind of production of variants to occur. And as long as that's the case, we're going to continue to have these conversations about levels of restrictions and what is the balance between restrictions, and allowing economies to fully operate and reopen. I mean, it's just the reality of life today, I think.
Perry Halkitis: To David's point, I'm 100%, there, David. You know, there's Lambda. Lambda has been identified in Texas, which is another variant, and I'm going to come back to this point of drawing a parallel with HIV. When we detect somebody to be HIV positive, we hit hard and we hit early, we start them on medications right away so their viremia doesn't increase. And then they have potentially life expectancies that seem normal, that are somewhat normal. If we had hit hard and hit early and vaccinated almost the majority of the majority of our population, this would not be happening. But with every transmission, with every reproduction, we increase the possibility that a variant will come along and none of the vaccines will work.
Thom: Dr. Wilson?
Eleanor Wilson: Yeah, I'm a virologist. I work with RNA viruses, and that's what this is. You know, they don't have editing function, they make mistakes, they thrive on it. And that is exactly how this works. The more the virus replicates, the more variation, the more mistakes and maybe happy mistakes that allow increased transmissibility, unfortunately what we haven't seen yet, but which we could see increased virulence. So, absolutely, it's important to stop the replication of this thing, stop the transmission of this thing and stop. Stop it.
David Souleles: Which is also why I think states across the country and CDC and others have really been investing in building our infrastructure around the ability to do the sequencing that needs to be done because if you can't see what's going on, it's like driving a car without the windshield wipers on, right. So, the sequencing really provides us a window onto what is happening. And I know there are efforts across the country, certainly here in California, to really enhance the ability to really get that sequencing done and as many of the positive cases as possible. University of California, several of our labs across the campuses are participating with California Department of Public Health and statewide efforts to really amp up our capabilities.
Thom: We have another question in this vein from Jodi Bergeron in the chat. She's asking if any of the panelists have thoughts about a potential universal Coronavirus vaccine. And I just want to mention, for context, as the original SARS-CoV-2 virus was able to infect humans, it was the spike protein coating. And that's essentially what the current mRNA vaccines are looking for and able to help your immune system identify. So, if that coating were to change dramatically, how well can we create the next generation of virus to adapt to that change and would a universal Coronavirus vaccine be capable of such a thing?
Eleanor Wilson: So, people are working on it and I think that would be a dream. We would love that. You know there are four different Coronavirus, non-SARS-CoV-2 but four different Coronavirus variants that circulate in the population seasonally. And so if we had a vaccine that worked against all coronaviruses, that would be great. When I used to work at the NIH in the vaccine research center, I had a little bit of contact with the group working on a universal flu vaccine, and I know all of us know how well that's worked out. I mean, viruses change, our immune responses change; they shift over time, they have drift, they make leaps and bounds because this is what they do. And so it is extremely difficult to develop universal vaccines. It would be great and I know people are actively working on it. I think it's something that will eventually be our Holy Grail and hopefully something achievable. But right now we're working with the variants that are or the vaccines that are designed against the variants that we have circulating. But to your point about updating these, I think one of the things that's most exciting about these new mRNA vaccines is that they can be pretty quickly updated. It's a matter of updating the sequencing of designing exactly where you would like the immune response directed and they can be updated relatively quickly. And there's been some indication on behalf of the FDA that if the mRNA vaccines are updated to respond to a new variant or to respond to a new episode, to respond to a new spike protein, that they could go through a more expedited safety and efficacy testing and then get out into the population all that faster, now that we have so much experience with mRNA vaccines. And they are new. People have been developing mRNA vaccines for decades or for years, they've been working on them. But these are the first ones really used in people and they seem to be doing very, very well. And so it's really promising how quickly they could hopefully pivot, if needed.
David Souleles: And came off of what Eleanor just said. I mean, the other side of that equation is the delivery, right. So, one of the advantages we have today that we didn't have back in December is we have established the delivery models, so all of those issues about supply chain and cold storage, and how you track from vaccine, dose one the vaccine, dose two, have been developed. So, we wouldn't be in the same place that we were six months ago with a booster because we've got the structures and the systems and the distribution in place now, which I think took a lot, and I'm not sure people realize how much of an investment and an effort that took to really get those structures in place so that we could effectively and rapidly deploy.
Thom: A follow-up question from Dan Keller. Dan, if you want to make your audio live, and go ahead and ask.
Dan: This is probably mostly for Dr. Wilson – what do you think stand with small molecule inhibitors either for post exposure prophylaxis or treatment, if you can freeze the spike protein in the free pre-fusion form or keep the binding domain from binding? And the other thing is, if we have various variants, and we need multivalent vaccines, do you see them as a mixture of mRNAs? Or can you incorporate a lot of molecules, a lot of mutations into one mRNA molecule and still preserve the structure of the resulting protein?
Eleanor Wilson: Yeah, those are two very different questions and without nerding out too much, although I'm happy to. So, I think in terms of co-formulating mixed vaccines with mRNAs from different variants, I think that's something people are already looking at putting those together and how that would be done. And I think that would be a really promising way to get closer to the idea of something that would approximate a universal Coronavirus vaccine, something that might work against the seasonal variants as well as these pandemic variants that we've seen. And so I think that that's something that's absolutely, that we'll see more data on. I think in terms of small molecule inhibitors, I think I choose to lump that with a lot of the different therapeutics and I think they've been, the pace of information and the pace of development is really breathtaking for those of us who've been involved in some of this and seen things before this time and then during this time. And so it's changed rapidly. I think, in terms of post exposure prophylaxis, some of the things we've seen with monoclonal antibodies or with other therapeutics have really been very promising. They're starting to really be looked at. I think it's still, I haven't seen as much from small molecule inhibitors that are as close as the things we're currently using with monoclonal antibodies. I haven't seen as much as with the therapeutics we're currently using in terms of steroid therapy or other immune-suppressants like IL-6 Tocilizumab and some of those other things that we are actively using. I think those are a little bit further away. There's a range of them that are in preclinical development and without getting into too many of the specifics, I think we're still going to see more about that too.
Thom: Thank you, Dr. Wilson. Another question from the chat from Robert Adler, mentions hearing from the unvaccinated, issues still concerning the safety of the vaccine. And largely folks in that camp point to data concerning deaths following getting vaccinated, although not necessarily hard evidence that it was caused by the vaccine. How can we, in the media, so directly from someone in the media asking how they can better understand and contextualize those kinds of figures?
Perry Halkitis: People can walk out on the street and get hit by a car too. And the bottom line here is with the deaths related to the vaccination, this is a piece of information that's being used and manipulated in a way that's perhaps not to the benefit of our country. The number of cases of complications related to the vaccines and the number of deaths related to the vaccines are negligible amounts, given the millions of doses that have been given to 0the United States. So, I think the best thing you can do in the media is compare it to the safety of getting on a plane, the safety of crossing the street, the safety of falling off a ladder, and you will see that the danger associated with the vaccination for COVID-19 is much smaller than any of those other conditions.
Eleanor Wilson: And much smaller than complications from the Coronavirus itself. I get that question all the time. People ask me, well, I've seen these reports of my corditis. Yes, my corditis is much more common with COVID than any of the vaccines and I think that's important to say.
David Souleles: And I think, came off of something Eleanor said earlier, the preprint headlines, the headlines from the preprint articles that then later get retracted, well, that message lingers, right. People don't go back and say, oh, that guy retracted, it really didn't play out. Or that was a single study and a small population and doesn't necessarily have applicability to a population level. So, I think Dr. Fauci the other day said something along the lines of if we had this level of vaccine misinformation during polio, we would not have resolved polio, right. So, we're in a whole different world now where it is hard to tell, in many situations, good information from bad information, and particularly around COVID-19 vaccines. And I think our challenge with that other 50% of the population that needs to be vaccinated, as Perry said, they're not a monolithic group of folks. They're all over the map in terms of their issues and concerns. And one of the things we found here at UC Irvine, we actually, we've had an onsite contact tracing program, that's how we got through the last year working in partnership with local public health. But we converted those folks to also do vaccine navigation services. And really, we outreached to 30 plus 1000 students and talked to a lot of folks who are in a whole lot of different places. And it's those one on one conversations with people to try and meet them where they're at, address their specific concerns, target them, direct them to good, accurate information and know that it's a person by person conversation at this point that really needs to happen. And we need that happening in doctor's offices, we need that happening in churches, we need that happening anywhere that people are gathering. People hearing from their peers and seeing that their peers have gotten vaccinated, that helps too. So, we've got the tools available to this, we've really to us, we've just really got to apply them on a broad scale. And media messaging is important, but also that one on one human conversation and meeting people where they're at, to try and get them to the place where they're comfortable to be vaccinated.
Perry Halkitis: Can I just add one more recommendation, Thom, for the media because I think there's a generational effect here. And I'm not worried about the Gen Z, and I'm somewhat less worried about the millennials. Who I worry about with this information are my generation – the Xers and the generation before me, the Boomers, and this is a generation that didn't grow up with social media, that barely knows how to use their Facebook accounts, that cannot tell you what's real from not real. So, I think you guys, you all, have a role to play in helping older folks and I put myself in that camp, although I'd like to think that I'm savvy, figure out what is real from what is not real because they are just using these tools without having grown up with them and they are being bombarded with all this misinformation.
Eleanor Wilson: Absolutely. I think it's something that David said is so true, I mean, they're not monolithic. I talked to a ton of different people. I talked to family members, I talked to patients, and everybody has a different reason and I think it's so important to just encourage people to keep talking. Nobody wants to be lectured at, nobody wants to be yelled at but just say, okay, I understand your concerns. I can give you this information. But have you talked to your doctor about it? Have you talked to your family about it? Have you talked to your granddaughter who has asthma about this? I mean, everybody is connected to and cares about other people in their families, in their communities and so if you can put them in touch with those people and make it very clear who they're getting vaccinated for, who they are impacting with these decisions that it does help. It takes a lot of conversations but it works. You just have to keep doing it.
David Souleles: And sometimes it's just problem solving too. So, we talked to student athletes, for example, who were concerned about – not concerned about getting the vaccine but concerned about the side effects and its impact on their training or their competition. So, for them it's, let's problem solve, let's strategize a gap in your competition so that you can deal with the side effects if you get them right. So, it's the night shift worker who couldn't figure out when they get vaccinated based on their sleep patterns and their work patterns. And so again, working with them. So, it says one on one conversations and trying to meet people where they're at and not lecture to them but listen and hear, provide information. And sometimes for us, we've seen in our vaccine navigation program, it's not one conversation, it might be three, it might be four, it might be five, and we're going to be there as long as it takes to get that person comfortable to be vaccinated.
Perry Halkitis: You've touched on something really important here in this conversation, which is like, it would be great if we live in a society where altruism and empathy drove people's behaviors, but it does not. And selfishness does and to David's point, how is this going to affect the athlete and what it's going to do to that person's life is going to have a much bigger effect than getting that person vaccinated. I will tell you one quick story. I went to an engagement party two weeks ago at my cousin's daughter, and we were all there and they were mostly vaccinated, and I wore masks part of the time. And there was a person at my table, who was a person, a gentleman of my age, who had a five year old son. And he had not been back to me because there are always conspiracy theories about it. And I said to him, look, if something were to happen to you and you were to die, I guess I would be sad but it wouldn't really affect my life. But that five year old’s life would be completely changed. He was vaccinated the next week.
Eleanor Wilson: Good job.
Thom: That's compelling. I would love to dig a little bit further into something that, David, you were just mentioning about, and Perry, you too about convincing these holdouts. There was a recent Axios/ Ipsos poll; respondent... 55 to 70% of the unvaccinated respondents said they were not at all likely to change their mind and get the vaccine based on issues such as easier access, paid time off or celebrity endorsements, and a few other questions. None of those things were able to sway the respondents, again, to the tune of 55 to 70% of the unvaccinated, depending on the questions. How do you think we can get through to some of those folks, even like you said the student athlete, David, who maybe needs a week out of training, a busy single mom who needs paid time off, whatever else that might be? A lot of people seem to be saying that some of those things aren't going to convince them either.
David Souleles: Again, I think from my perspective, we've got a variety of tools available to us. So, here at the University of California, the vaccine mandate policy is certainly going to help. That'll motivate some people who might not have been motivated before. It's a tool. It's much like wearing your seatbelt is required in the United States and you get a ticket if you don't, right. So, that's a tool. But then people have to choose to do that behavior, right, they have to choose to do that behavior. And so, I think we need to look at all the tools that are available to us and my guess is, again, if we had individual conversations with those folks who've responded to those basic questions, when you dig into it, there's a range of hesitancy there and there may be some folks you'll never reach. But I believe the vast majority of people we can get to a place of being comfortable to be vaccinated. It's that peer to peer, it's that talking to your health care provider, it's, again, understanding the individual issues and concerns that somebody has. I think we can do it; we need to invest in it, right. This is tried and true public health work, and the poor public health system in this country has been not well-funded for the last several decades. And we saw what that did when COVID hit, right, we were not as prepared as we needed to be. And hopefully, this has been a wake-up call to governments across the country, about the importance of investing in public health to keep our communities safe and healthy.
Thom: Perry, do you think school mandates and jobs requiring vaccinations are an important part of this? Or what other ways can we influence this?
Perry Halkitis: Yeah. No, I was exactly going to say that, Thom. So, I would say two things in response to the point that David made and to the data you gave us, which is like – so, we're talking about half of the half, right. So, there's another 25% out there who are more malleable, well, let's focus on them and get them vaccinated, number one; and then the remaining 25%, here's what I feel. And I'm going to take the more tough New York guy stance, which is the following – if you live in a civil society and you want to navigate spaces like concerts and schools and jobs, and by concerts I mean Taylor Swift concerts because she's my, I love her now.
Thom: What about Olivia Rodrigo, Perry?
Perry Halkitis: I guess I'm too old to know who she is. But you need to be vaccinated. Macron did it in France; we need to do it here in the United States. Children go to schools, they have to be vaccinated for measles and rubella and have you, or they're homeschooled. This should be the exact same thing here.
Thom: Dr. Wilson?
Eleanor Wilson: I think one thing that's interesting and you cited that Axios/ Ipsos poll and when you're asking people, why aren't you vaccinated? Oh, well, would this carrot get you? Oh, well, how about the super tasty carrot? Oh, but how about this carrot with money? I mean, then you're just getting people to dig in and it's important to realize that a lot of people don't realize quite how much they're influenced by norms and how much we can make this a norm. And we keep saying, David keeps saying, Perry keeps saying, you know, it's these one on one conversations and as people who are unvaccinated start to emerge and things open up and they come out and they're talking to their loved ones, they're talking to their friends, they're talking to people they see on the street, hopefully again we can all talk to people we see on the street, and realizing that people are vaccinated, that there has been higher uptake that people have done this and it has gone well. I think also, the mandates do work. It's this expectation; if it's not even, oh, well, how do you feel about the vaccine? Would this convince you? And more like, oh, have you been vaccinated yet? Those are different questions. And the answers get just a little easier every time somebody is asked. It’s a repetition game. Sorry, I didn't mean to.
Thom: Yeah, we have time enough, I think, for one question. And I want to harken back to some comments that were made a few minutes ago about how the unvaccinated and the unchecked spread among them is essentially a variant factory. David, I'll borrow that term that you used. So, we have a question from Benny Weiss, who's a Professor at the National University of Mexico here in the chat, are fully vaccinated persons at all potential variant factories if they were to get infected? And I guess part of the thinking behind that being that much in the same ways that we have now, drug resistant bacteria. Is there an idea in that, that if a vaccinated person gets COVID, are they potentially creating a super form of that bug that is more able to infect the already vaccinated?
Eleanor Wilson: So, we know that people who are vaccinated, well, we know there are breakthrough infections, but those infections, if somebody is vaccinated and they become infected, we know they're less likely to be severely infected, less likely to be hospitalized, less likely to die. All the things we really care about. And so along with that, they are less likely to be productively infected in such a way that they would replicate the virus at high enough levels to be able to generate a whole lot more variants in that viral sequence, and less likely to generate enough virus to really transmit. Now, it's not impossible, and it might change as we go on. But it is not yet thought to be really as much of a risk. The biggest risk is really in people remaining unvaccinated.
Thom: I want to make a comment about that and you tell me if this is correct, Dr. Wilson. The virus doesn't decide to mutate because it's having a hard time killing you, right. It mutates because it replicates billions and billions and billions of times. And every time that the RNA copies itself, there can be errors, right?
Eleanor Wilson: Exactly.
Thom: So, it's not like the virus has to reach into a toolkit that magically makes it able to infect you worse if you're vaccinated.
Eleanor Wilson: Yeah. No, exactly, I love how you put that. It's not, the virus doesn't have intention, the virus just wants to make copies of itself, it does it in a sloppy manner, it introduces errors. Some of those errors are more successful than others. Some of them are terrible errors and it dies out faster. We haven't gotten that lucky yet. But it just makes errors. Some of those errors are successful and so if we give it fewer opportunities to replicate, fewer opportunities to make errors, we win.
Thom: David, Perry, any additional thoughts you want to add to this final question?
Perry Halkitis: I mean, it's exactly as I want to say – it's probability, it's probability theory. The more you do some, like I can flip a penny five times and get five heads. But I assure you, if I do it 5000 times, I will get 2500 heads. So, probability theory says, you increase the likelihood of something happening, then you increase the likelihood that variants are going to and it continues to reproduce, you increase the likelihood of variants.
David Souleles: And the public health message and all of that is, if you want to see this thing come to an end and if you want to not have to worry about whether you need to mask indoors or not, we need to get our population vaccinated. We need our vaccination rates much, much higher. That is really priority number one for getting to something that is more close to what our lives were before January of 2020.
Thom: Let's all hope that's so, David, and thank you to all of our panelists for joining. We'll go ahead and wrap things up. So, David Souleles at UC Irvine, Dr. Perry Halkitis there at Rutgers and Dr. Eleanor Wilson at University of Maryland. Thank you all panelists, a great discussion, really appreciate it. And I hope for all of the media on the call that you've got some good ideas to incorporate into your work. If you want to do any follow-ups, we're going to make sure to share with you the contact information for the PIOs, the communicators at each of our panelists’ home institutions and we will share with you the video and the transcript of today's panel. With that, I'll say thank you very much to everyone. Have a great day. Stay safe, stay healthy and good luck.
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