Covid-19 Panel Q&A
SCRC Panel on COVID-19
Given recent developments, should we trust the CDC or FDA?
We can trust both organizations - they have reputable scientists. The goal of the FDA is to make sure treatments are safe and effective, while CDC has a goal implementation of approved treatments.
You mentioned that the number of infections has leveled off in the US. Do you have any projections for that number to decline or rise again towards the end of the year?
Everyone is expecting another surge of cases in the Fall, for the following reasons: 1) children are going back to school, 2) with cases coming down now, communities will be allowed to reopen as they come off the state watchlist, 3) the cooler, less humid weather is likely to help COVID survive and spread better than during the summer.
fivethirtyeight.com has a COVID-19 projection page that compares different models. They’re each based on a set of assumptions and differ in their projections. But we all know that it’s hard if not impossible to predict where this pandemic will go — are we at the beginning, the middle or the end? And so much is based on human behaviour. Issues like school reopening and reopening of public venues will also have an unpredictable effect. Finally, it’s important to think of the US pandemic as a collection of different regional outbreaks — with different trajectories.
If one is not contagious 10 days after symptoms, would that not mean that people in hospitals with severe symptoms are mostly NOT contagious, and they could in fact have visitors? And the staff would not have to worry about getting the infection?
The CDC recommendations for severe COVID-19 infections are that they are considered to be infectious for longer, up to 20 days.
Any work with the sewage testing? How many in “group” COVID test for the students?
Some places are working on sewage testing. It turns out to be more complicated than I had certainly realized. Most UC campuses don’t have great sewage pipe “maps” or access points to enable sewage testing with the degree of accuracy to pinpoint specific buildings
Is there a possibility of convalescent plasma antibodies eliciting an immune response in the host? That is, are these not foreign proteins injected into the host’s blood?
Indeed, but fortunately the incidence of severe adverse effects (allergic and related serious reactions) with convalescent plasma is low (less than 1%).
Is there a way to take some of the regularly donated blood (to Red Cross and other locations) and test it for exposure to the virus, to see how prevalent the virus is, and / or to identify convalescent plasma?
There is a study to look at the national blood supply to look at COVID prevalence. Less so for convalescent plasma. Known COVID-positive patients are usually directly sought out for this.
While there are major efforts underway for developing vaccines and cures for Covid-19, should there be equal efforts to prevent or eliminate the spread of misinformation about the virus? How can the scientific community help us better implement the preventive measures we already know can help reduce the spread of the virus?
Panel discussions like this are a good start, but you’re selecting for people who want to find good information. We need to become smart consumers of information, whether about COVID-19 or any matter, especially given how much info, right or wrong, is on the internet. And I think the COVID-19 pandemic is a wake-up call for the need for good, general scientific education for everyone. Also, we need good and trusted leadership
How far along are we in the process of creating a vaccine for the COVID-19 virus?
At least 8 vaccines funded by US (Operation Warp Speed), with three in phase III trials. So earliest possible approval with adequate phase III trial data would be end of 2020, and more likely early 2021.
How rapidly does SARS-CoV-2 mutate, and will that make a vaccine unachievable?
It mutates at a similar rate to other coronaviruses, I believe. There have been mutations in genes that are likely to be involved in the immune response for a vaccine, but I do not sense that the vaccinologists are particularly worried about this.
What is the current educated guess as to when UCI hospital staff can or will get vaccinated?
Health care workers are likely to be prioritized for receiving vaccine, so earliest possible would likely be early 2021.
Would you take a vaccine that came out under this administration?
Given everyone’s impatience for a vaccine, not just this administration, I would look for reputable reports on the quality of the phase III data that come out.
If it’s not possible to make a vaccine for the common cold, how can we make a vaccine for COVID-19?
Vaccines could be made for common cold viruses, but one problem is that there are many of them. In addition, unlike SARS-CoV-2 and the flu, common cold viruses generally don’t lead to serious complications and death, so there is not as much reason to develop vaccines for them.
Is it plausible for a vaccine to be developed that requires inoculation every 1-2 years and will allow herd immunity?
Yes. The yearly flu vaccine is a good example. Most experts are also anticipating that people will need more than one dose of COVID-19 vaccine, like the Hepatitis B and Shingrix vaccines.
What does the future of treatment and vaccination for COVID-19 look like?
Fortunately, some FDA-approved treatments are already available and more effective ones will likely be approved overtime. Similarly, there is now cautious optimism for an effective vaccine, since early reports have been reasonably promising and several vaccines are now in development.
What is the Oxford vaccine, and will we have access to it?
The Oxford vaccine is the AstraZeneca vaccine, one of the frontrunners. The US government is supporting the Oxford vaccine trials, so there is expectation that the US will have access to it, although the amount of access remains to be determined and will likely to a subject of strong debate.
Will the proposed COVID vaccine be recommended for patients 90+ years old?
The issue of who to vaccinate first is an important one that hasn’t received enough public discussion. It’s likely that there won’t be enough vaccine initially, so choices will have to be made — presumably prioritizing health care workers, individuals at high risk for severe disease, first responders. Older patients are at high risk too so that will be an important discussion. We know that some vaccines don’t work as well in older individuals, e.g. the flu vaccine
If a covid vaccine is developed by another country what are the odds of them refusing to supply it to the US due to our current president’s hostility toward the WHO. etc?
The US government is financially supporting some, but not all, of the international frontrunners so that US citizens can be first in line. The allocation of effective vaccines will be a HUGE national and global issue.
If someone gets a vaccine and travels to a country that people are not vaccinated, is there still a risk to get covid?
It depends on how effective the vaccine is
Testing and Treatments
Is there food scientific evidence showing that convalescent plasma is a safe and effective treatment for COVID-19?
Reviews are somewhat mixed. On the one hand, the medical community has a comfort level with convalescent plasma as a generally safe and effective therapy for many conditions, but the efficacy data from the trials was not as great as many hoped.
What is the role of stem cells in all this?
This remains to be seen, although CIRM and others are funding stem cell projects aimed at COVID-19.
What do you think of the current treatments available?
All three of the FDA-approved treatments - Remdesivir, dexamethasone, and convalescent plasma - are considered effective in the right setting and are used broadly in the US.
How accurate are these tests for COVID-19?
PCR tests have always been accurate. Interestingly, there is now more discussion about the PCR tests being too sensitive! Initially, there were a lot of bad antibody/serology tests, but the FDA has placed warnings on many of these, and with the advent of time, there are now good antibody/serology tests available as well. One still needs to be careful about inaccurate antibody tests out there, however!
What are the opportunities for participation in clinical trials?
There are many opportunities, which continue to grow. The challenge is often that the clinical trials require just the right kind of patient at just the right stage of a disease, so many potential participants do not end up qualifying for the trials, which can lead to disappointment. That being said, we are always so grateful for those willing to participate in clinical trials as well as their families.
What is the best treatment currently for a seriously ill COVID patient?
Perhaps the treatment with the best data so far is dexamethasone or other corticosteroids for severe COVID-19. The New York Times has a good website called Coronavirus Drug and Treatment Tracker. There are not a lot of good, large treatment studies yet.
Where does the antigen test fall into the two branches of the “testing” tree?
The antigen test is also intended to be a diagnostic test that detects someone who is contagious (like the PCR test). The antigen tests are uniformly less sensitive than PCR but can be done at the point of care. So these would be great to implement. The problems are that the manufacturers cannot make enough of them, and the throughput can be quite low.
What do you think about saliva-based testing?
Many more saliva tests coming out, some already FDA approved. Saliva is turning out to be a good specimen type for detecting the COVID-19 virus. Labs typically do not like dealing with saliva (e.g. the “gooeyness” can cause machines to go down), but the lab testing community is quickly warming up to saliva. Including UCI.
What do you think about the sensitivity and slowness of usual diagnostic tests and how that affects containment of the spread?
This has to do with the point that because the PCR tests are quite sensitive, the PCR tests can be positive for months even after an individual is no longer contagious. Absolutely true, which is why CDC does not recommend any testing for at least 90 days after someone has a positive test.
Dr. Haseltine said there is a quick test like a pregnancy test that is far less expensive and could be produced easily. Is this true?
Yes, there is. Not as sensitive, but less expensive. The throughput (i.e. the number of tests that can be done) can be quite limited. The biggest problem is availability - the manufacturers cannot keep up with demand. There will be more and more so-called “point of care” tests coming out, however, so there is hope the situation will get better.
Mask Wearing, Social Distancing, and Other Measures
It has been over 6 months now that we citizens cannot get access to COVID-proof masks which would allow us to more freely rejoin society while we wait for a vaccine. There are WAY too many people out there wearing simple bandanas or even worse the neck gaiters that recent studies have shown are worse than nothing. What can we do to get effective masks? The criminal failure of the government, mostly federal, in responding to the pandemic has left us on our own.
An option is to go with a cotton mask that has a pocket and add several layers of melt-blown fabric or woven polyester. These are essentially the materials surgical masks are made from - however, while there may be some protection added it is not at the same filtration level as a K95 mask. The reality is that the efficacy of masking depends on everybody wearing one - yours protects them, and theirs protects you. The good news is that many masks, which are now much more available, are effective at decreasing person-to-person transmission. As you point out, bandanas and other coverings like them are now known to be not as good.
Should we be wearing goggles, glasses or other eye protection along with our masks?
It is true that Sars-CoV2 can be acquired if virus droplets contact the eyes. But eye protection is not currently recommended except when there is high risk of virus droplet exposure, such as in the hospital with a COVID-19 patient
Given the majority of transmission is via droplets, would regular face/inside of nose washing with warm water and soap following being outside make sense? (Obviously after first doing thorough washing of hands)
My question about face washing was about reducing the exposure after going outside and interacting. If one has had some random droplets come on the face or be drawn into the nose (same as exposure by touching on hands), would not wash with warm water and soap decrease that exposure, making virus particles wash away or decrease dosage at least? I heard only one recommendation like that for airplane travelers
Probably not, since the source is the respiratory tract. You might reduce the virus in the nose immediately, but it will come back fairly quickly during an active infection. If you’re talking about protecting yourself, that could work, but washing your hands frequently is tough on the skin so the same will be true of your face. So it depends on how often you do it and how frequent your exposure. If you’re the infected individual, as Dr. Monuki presumed, you’d have a hard time keeping up with the virus in your nose.
Antibodies and Reinfection
Any information on COVID-19 reinfection?
There are now a handful of very credible reports of reinfection, as anticipated by the experts. Too few, however, to know with any certainty what reinfection means yet.
Thoughts on the implications of the Hong Study confirming reinfection of COVID in some patients after 4 months?
This one was considered promising by some because the second infection did not cause symptoms. However, other credible reinfections have been associated with symptoms. Too early and too few examples to really know what reinfection means yet.
How long do COVID-19 antibodies stay in your system?
At least months.
I have a friend who tested positive for COVID-19 in February. She had no symptoms. How long must I remain socially distanced?
She would be considered non-infectious at this point, so no additional precautions in addition to the normal ones (social distancing, hand washing, and mask-wearing).
What is herd immunity?
This refers to the protection from person-to-person spread that an entire population benefits from when enough of its people have immunity. Not everyone needs to be immune for the population to have herd immunity, and the percentage of immune people necessary for herd immunity depends on how infectious a particular virus is. For a particularly infectious virus like measles, it is estimated that 94% of people need to be immune. Estimates for COVID-19 are fortunately lower, with estimates in the 60-70% range.
What risk is there for those with type 1 diabetes?
According to the CDC, individuals with type 1 diabetes may be at increased risk of severe COVID-19 — there isn’t enough known. In contrast, individuals with type 2 diabetes ARE at greater risk of severe illness.
I have heard that your risk of infection may depend on how much viral “load” you ingest. Can you discuss?
Yes the amount of virus, or “viral load” seems to be important. For many infections, there is a threshold amount of the infectious agent that is needed to acquire the infection. A related question is whether the viral load might affect the severity — that we don’t know
At what point is obesity a risk factor? How much higher above the normal weight is considered a reason for higher risk?
According to the CDC, obesity with a body mass index (BMI) over 30 is a risk factor for severe COVID-19. You can find BMI calculators online — height, weight and gender is used to calculate your BMI
Now, excess adipose tissue can lead to adverse consequences for at least two reasons: 1) obesity creates a chronic inflammatory state (higher circulating levels of white blood cells) and these may dysregulate the immune response to the SARS-CoV-2 virus; and 2) in obese people, the lungs do not aerate normally, and blood and airflow to certain parts of the lung may be diminished and lead to increased viral reproduction and, ultimately, inflammation in the lung.
Research and Knowledge
What do you think about the ‘Achilles heel’ COVID discovery at Northwestern University?
This one does not strike me as groundbreaking, but does provide an additional avenue for therapy development.
Is there any infectious disease that has reached herd immunity without the intervention of an effective vaccine?
Yes at the community level — a concept used to explain why measles cases in Baltimore in the 1930s went down after an outbreak, even in susceptible individuals. There has been speculation that herd immunity may explain why the outbreaks ended in Northern Italy and NYC.
Regarding the 1918 pandemic, how did it end? There was no vaccine correct? The graph looks like it ended after the third spike after about a year and a half?
It’s not known how the 1918 pandemic ended — the estimates of 25-35% infected don’t seem high enough for herd immunity. But another way to look at it is that maybe it didn’t really end. Instead, the same H1N1 influenza virus returned every year in the form of seasonal flu.