Speaker 1: My name is Vince Slaughter, thirty six years old from
Speaker 1: New York, and I work in the veterinary field, and
Speaker 1: this is my COVID experience. Last April, I had become ill.
Speaker 1: I thought that I had like a sinus infection or something.
Speaker 1: I tried to wait it out until I just started
Speaker 1: coughing up blood constantly. I went to the hospital and
Speaker 1: sure enough, I was COVID positive, and I also had
Speaker 1: pneumonia that I'd gotten through COVID. So I was admitted
Speaker 1: and I was in that hospital for a month and
Speaker 1: I really didn't improve. But at the end of that month,
Speaker 1: that hospital they were becoming overcrowded with COVID patients. They
Speaker 1: kind of rushed me out, even though I told them
Speaker 1: that I didn't feel like I was any better or
Speaker 1: ready to go, but they discharged me. And two days
Speaker 1: after they discharged me, not only was I still coughing
Speaker 1: up blood, but when I moved around, I felt like
Speaker 1: I was going to black out. I would just lose
Speaker 1: all my energy that was just exhausted. So I went
Speaker 1: back to the hospital and I was only there for
Speaker 1: about a day and they transferred me to a larger,
Speaker 1: far more competent hospital. And two things were found out
Speaker 1: at that hospital. The first being that I had an
Speaker 1: abnormal blood clot in one of my lungs that effectively
Speaker 1: killed off one third of my lung The other being
Speaker 1: that since I was fighting COVID pneumonia and I was
Speaker 1: compromised from the damage to my lung, ME, who was
Speaker 1: a at the time, a thirty five year old athlete,
Speaker 1: was in clinical heart failure. The virus had attacked my
Speaker 1: heart aggressively and I was in heart failure. That's what
Speaker 1: was going on. I was taken to ICU and a
Speaker 1: number of things were done. There was a tube placed
Speaker 1: in my back that was constantly pumping out all sorts
Speaker 1: of gunk from my lungs. I had neck congelos placed
Speaker 1: on both sides of my neck. I had some sort
Speaker 1: of port put in my chest. I was barely conscious
Speaker 1: a lot. I was hallucinating as well. Things got really
Speaker 1: bad and they had to install balloon pump in my
Speaker 1: leg to keep my heart beating. The only solution was
Speaker 1: that I needed a heart transplant. They found a donor
Speaker 1: and that's what happened. I had to have a heart transplant.
Speaker 1: I was in the hospital for over three months, just
Speaker 1: shy four months actually, and I've had to go back
Speaker 1: several times since just because my immune system is compromised
Speaker 1: now due to the transplant. When I was healthy enough
Speaker 1: after the transplant to be weighed, I went from going
Speaker 1: into the hospital as a two hundred and ten pound
Speaker 1: combat athlete to being one hundred and fifty three pounds.
Speaker 1: Life's been hard since. I can honestly say, it's ruined
Speaker 1: my life. People tell me, oh, you're so lucky you survived,
Speaker 1: but you know what, like, I don't feel lucky. I
Speaker 1: don't feel lucky.
Speaker 2: I work as a case investigator on the COVID response
Speaker 2: in Georgia. My role includes calling people who have tested
Speaker 2: positive to gather data about their symptoms and medical history,
Speaker 2: collect their close contacts for contact tracing, give guidance for isolation,
Speaker 2: and connect the cases to resources. I've spoken to hundreds
Speaker 2: of people who have had COVID, most of whom who
Speaker 2: have had mild to moderate cases, and many of whom
Speaker 2: have had severe cases, some later died. The emotional toll
Speaker 2: can be a lot to bear, and the work never stops.
Speaker 2: In the current surge, we cannot even begin to reach
Speaker 2: everyone who is sick, and the most we can do
Speaker 2: is hope that they are okay. The story I want
Speaker 2: to share happened shortly before Christmas. My team was focusing
Speaker 2: on school aged children in an effort to control transmission
Speaker 2: in schools before they return from break. I spoke to
Speaker 2: a mother whose two children had tested positive and she
Speaker 2: was quite sick herself.
Speaker 3: She was very.
Speaker 2: Helpful in giving me information about her children and very
Speaker 2: attentive to the the guidance I gave her. Towards the
Speaker 2: end of the call, she revealed her husband had tested
Speaker 2: positive first and was now in the hospital on a ventilator.
Speaker 2: I offered my condolences and told her I would connect
Speaker 2: her to available resources to help pay his medical bills.
Speaker 2: She replied, thank you for your help. I just hope
Speaker 2: he doesn't die on Christmas. I don't want our kids
Speaker 2: to associate his death with Christmas. I have dealt with
Speaker 2: death and grieving loved ones.
Speaker 3: For months now.
Speaker 2: It was all a part of the training, and the
Speaker 2: mortality rates have become background noise to my daily life.
Speaker 2: But this woman's story hit me in the pit of
Speaker 2: my stomach. I took a few minutes to gather my
Speaker 2: thoughts and then moved on to the next case. I
Speaker 2: found out a week later that this father passed away
Speaker 2: the day after Christmas. I knew the hospital he was
Speaker 2: in was using tablets on tripods to allow people to
Speaker 2: say goodbye to their loved ones. The image in my
Speaker 2: mind of this woman and her children saying goodbye for
Speaker 2: the last time on a screen turns my stomach. I
Speaker 2: am angry, I am heartbroken, and I am so tired.
Speaker 2: The only hope that I have is that the vaccine
Speaker 2: will be able to win the war that those of
Speaker 2: us working in public health have been fighting for almost
Speaker 2: a year.
Speaker 4: Hello. My name is John and I'm a paramedic in
Speaker 4: northeast Texas. I have worked for eight years in a
Speaker 4: small community approximately an hour and a half east of Dallas.
Speaker 4: I staff a duel medic and ice you on twelve
Speaker 4: hour rotating shifts. Many of the patients in our community
Speaker 4: are older. They reside in rural farming areas. We also
Speaker 4: have a large Latin American population in our community due
Speaker 4: to a sizeable manufacturing industry. We began to see an
Speaker 4: influx of cases in late March at one of the
Speaker 4: industrial plants in town. Due to many cultural as well
Speaker 4: as socio economic reasons, The virus spread like wildfire, faster
Speaker 4: than we expected and faster than we were prepared for.
Speaker 4: By mid May, our town of less than thirty thousand
Speaker 4: had more than eight hundred and fifty cases and made
Speaker 4: regional as well as national headlines. We had no more
Speaker 4: ICU bed or ventilators. Our dispatch was completely unprepared, and
Speaker 4: we had no system in place to properly warn crews
Speaker 4: of probable cases. In April, my partner and I were
Speaker 4: sent to a house for a simple anxiety attack. That's
Speaker 4: all the information that we had. Upon entering the home,
Speaker 4: the patient was found sitting in the floor, gasping for breath,
Speaker 4: and a tinged hue of blue around her lips let
Speaker 4: us know she was in severe respiratory distress. She began
Speaker 4: to plead in one word sentences for help. The patient
Speaker 4: was using a nebulized breathing treatment, which we know to
Speaker 4: be contra indicated in COVID patients. The haze of the
Speaker 4: expired vapor of that breathing treatment surrounded my partner and I.
Speaker 4: Blindsided by these severe symptoms. My partner and I were
Speaker 4: caught with our metaphorical pants around her angles. We were
Speaker 4: wearing none of the appropriate PPE. We had gloves and
Speaker 4: surgical masks.
Speaker 5: That's it.
Speaker 4: The patient's oxygen saturation was fifty percent. The decision was
Speaker 4: made to innovate her despite her lack of PPE. That
Speaker 4: same patient died and our ICU two days later due
Speaker 4: to complications of the novel coronavirus. Three days after the incident,
Speaker 4: I began running fever. I had body aches, a cough.
Speaker 4: I was more tired than I've been in my entire life.
Speaker 4: Ostensibly I contracted that very disease that was ravaging our community. However,
Speaker 4: I'm thirty years old, I'm physically fit, and I have
Speaker 4: no pre existing conditions. Due to the lack of the
Speaker 4: testing nationally, I was denied a test. Needless to say,
Speaker 4: I recovered. I've been back on the front line since
Speaker 4: returning fourteen days after my initial symptoms. I believe mts
Speaker 4: and paramedics have a unique perspective as well as a
Speaker 4: unique challenge during this pandemic. Hospitals, clinics, and other health
Speaker 4: care facilities have some amount of control over their environments,
Speaker 4: entering into patients' homes and interacting with these patients in public,
Speaker 4: many times without full knowledge of what the circumstances are.
Speaker 4: We are many times at the mercy of our environment.
Speaker 4: We have had to adapt and overcome the ever changing
Speaker 4: variables as they occurred during this pandemic. I have been
Speaker 4: lucky to work alongside many wonderful employees, and I have
Speaker 4: exceptional leadership where our work, including a chief who has
Speaker 4: been an immense help through it all. He's helped us
Speaker 4: with all the challenges that we face, giving us the
Speaker 4: resources that we need, as well as helping us with
Speaker 4: the physical and mental toll that this has taken on us. Obviously,
Speaker 4: my story is not unique. Nearly half a million MS
Speaker 4: personnel in this country have endured the same hardships for months.
Speaker 4: Some have even lost their lives doing so. Now, with
Speaker 4: the rates increasing in and the hospitals working at the
Speaker 4: cusp of full capacity, we continue to work and continue
Speaker 4: to adapt day after day to this pandemic.
Speaker 6: Thank you so much to everyone who provided their first
Speaker 6: hand account for this episode, and thanks to everyone who
Speaker 6: has sent in a first hand account or filled out
Speaker 6: the form. We really appreciate it.
Speaker 7: Yeah, thank you so much for sharing your stories with us.
Speaker 6: Hi, I'm Aaron Welsh.
Speaker 7: And I'm Erin Allman Updike and this.
Speaker 6: Is this podcast will Kill You.
Speaker 7: Yeah, welcome to a long awaited another update episode in
Speaker 7: our Anatomy of a Pandemic series, where we cover all
Speaker 7: things COVID nineteen.
Speaker 6: Yeah, this is Aaron. This is our fifteenth episode.
Speaker 7: I honest, we can't believe that we've made this many episodes.
Speaker 7: That's so many episodes.
Speaker 6: It's a lot, it's a lot, but.
Speaker 7: There's so much to cover when it comes to this pandemic,
Speaker 7: and so we just feel like we really have to
Speaker 7: cover it all.
Speaker 5: Yeah.
Speaker 6: I mean, we've learned so much in terms of virology
Speaker 6: or epidemiology, but we've also learned as this pandemic has
Speaker 6: gone on, just how much we still don't know or
Speaker 6: how much our knowledge about this virus, or about this pandemic,
Speaker 6: or about the disease that the virus causes, how much
Speaker 6: all of these things have changed from our earlier understandings.
Speaker 7: Exactly, which brings us to the focus of this particular episode.
Speaker 7: This week, we're addressing all of the new things that
Speaker 7: we've learned about the disease caused by the stars COVID
Speaker 7: two virus, that is, COVID nineteen. We'll touch on things
Speaker 7: like what is long COVID or how long does immunity
Speaker 7: actually last? Or what is the impact of infection on
Speaker 7: pregnant people?
Speaker 6: But before we get to that and so many other
Speaker 6: questions about COVID nineteen, we have some very important business
Speaker 6: to take care of. Yeah, we do, Aaron. It is
Speaker 6: quarantin any time, It's quarantin any time. What are we
Speaker 6: drinking this week?
Speaker 7: We're, of course drinking Quarantiny fifteen, so creatively named.
Speaker 6: Quarantini fifteen has vodka, It has grapefruit juice, It has
Speaker 6: some Maraschino liqueur and a little splash of grenadine. And
Speaker 6: we will post the full recipe for this quarantini as
Speaker 6: well as the non alcoholic Lasybrita on our website this
Speaker 6: podcast will Kill You dot com, as well as on
Speaker 6: all of our social media channels.
Speaker 7: Any other business Aaron, that we have to discuss.
Speaker 6: There's the usual.
Speaker 1: You know.
Speaker 6: We have a bookshop dot org affiliate account, We have
Speaker 6: a good Reads list. You can find those things on
Speaker 6: our website, where you can also find transcripts, alcohol free
Speaker 6: episodes and merch, oh merch. Yeah, and we also are
Speaker 6: still soliciting first hand accounts for this COVID nineteen series.
Speaker 6: And so if you would like to submit yours, please
Speaker 6: head to our website where you can find a link
Speaker 6: at the top of the page as well.
Speaker 7: All right, let's get to the meat of this episode,
Speaker 7: shall we.
Speaker 6: Let's do it.
Speaker 7: We were fortunate enough to chat with not just one,
Speaker 7: but two awesome people today who answered our many, very
Speaker 7: long list of questions about all the things that we've
Speaker 7: learned about COVID nineteen in this past year.
Speaker 6: We were joined by doctor Critika Capali, infectious diseases physician
Speaker 6: and assistant professor at the Medical University of South Carolina
Speaker 6: and whom you may have heard on a previous episode
Speaker 6: in this series, as well as doctor Jason KINDRICHUK, Assistant
Speaker 6: Professor and Canada Research Chair in Molecular Pathogenesis and Emerging
Speaker 6: Viruses at the University of Manitoba.
Speaker 7: We recorded this interview on March sixteenth, so keep that
Speaker 7: in mind. If you hear any numbers, things may have changed.
Speaker 7: And we'll let them introduce themselves right after this break.
Speaker 5: I'm Jason Kinderchuck, I'm a PhD.
Speaker 8: I have an Assistant professor in Canada Research Chair in
Speaker 8: the Molecular Pathogenesis of Emerging Viruses at the University of Manitoba.
Speaker 8: In the Department of Medical Microbiology. Most of my work
Speaker 8: focuses on both the pathogenesis as well as the transmission
Speaker 8: and circulation of emerging viruses, including ebola and coronaviruses.
Speaker 3: And I'm Kritica Capoli.
Speaker 9: I'm an infectious disease It's phys position and assistant pro
Speaker 9: foster in the Division of Infectious Diseases at the Medical
Speaker 9: University of South Carolina, and my area of research and
Speaker 9: interest is in emerging infections and biosecurity. I am interested
Speaker 9: in looking at the clinical care and pathogenesis of emerging
Speaker 9: infections and understanding how we can better prepare for outbreaks
Speaker 9: and pandemics.
Speaker 3: And I was doing that before commentavirus Hite awesome.
Speaker 6: Thank you so very much for taking the time to
Speaker 6: chat with us today. We're very excited to hear what
Speaker 6: you have to say about all of our many questions.
Speaker 6: So let's dive in. So in our Virology Update episode,
Speaker 6: which we released a few months ago, we talked about
Speaker 6: how this virus is transmitted, but how much does the
Speaker 6: infectious dose or the amount of virus that a person
Speaker 6: is exposed to, how much does that play a role
Speaker 6: in whether they will get the disease or how severe
Speaker 6: the disease might be.
Speaker 8: Yeah, so this is such a good question, right, And
Speaker 8: I think really we're maybe getting a better glimpse into
Speaker 8: what this looks like in particular when we think about
Speaker 8: this idea of infectious dot So certainly, I think we're
Speaker 8: still somewhat of an infancy in understanding what is the
Speaker 8: specific amount of virus that you need to be exposed
Speaker 8: to to get infected. There's been some modeling studies that
Speaker 8: have suggested it's a bit higher than SARS, but a
Speaker 8: little lower than MERS, so somewhere in the kind of
Speaker 8: the hundred particle range. But a lot of that is
Speaker 8: somewhat subjective, right, So we're saying, okay, that that is
Speaker 8: the number you need. But there's also this aspect of
Speaker 8: exposure time, and I think that's become maybe a little
Speaker 8: bit more prominent the past few months. We've talked about
Speaker 8: these super spreader events, We've talked about things like people
Speaker 8: being in closed settings. That it's not just a function
Speaker 8: of the amount of virus that somebody is exposed to
Speaker 8: it at one moment in time or that static moment
Speaker 8: in time, as much as it may be about the
Speaker 8: accumulation over a specific period of time, and I think
Speaker 8: that's really important. I think we're we're getting to gain
Speaker 8: a better understanding of the fact that listen, a few
Speaker 8: of people that are in in closed settings and they
Speaker 8: are you know, uh, you know, subject to poor ventilation,
Speaker 8: and you have somebody that is releasing virus, even if
Speaker 8: they're releasing virus at a low rate, you probably are
Speaker 8: going to have people that are going to be continually
Speaker 8: exposed and you have that overall accumulation. So I think
Speaker 8: that that is is starting to give the syndication of
Speaker 8: the fact that we have to think about this not
Speaker 8: as just a static number, but also a function of
Speaker 8: the situation as well as a gain the person themselves
Speaker 8: and whether or not there are biological consequences that allow
Speaker 8: them to to basically take up more virus or are
Speaker 8: more vulnerable or susceptible to virus than others.
Speaker 3: That makes sense.
Speaker 7: So, speaking a bit more about viral shedding by in
Speaker 7: fact people, how soon after being exposed does someone become
Speaker 7: infectious and how does that infectivity change over the course
Speaker 7: of a person's infection.
Speaker 8: Yeah, this has been a kind of a long standing question,
Speaker 8: right is you know, when somebody's exposed, how long does
Speaker 8: it take for them to start shedding virus, and I
Speaker 8: think again, we're getting a much better picture. You know,
Speaker 8: doctor Moode Sebek has done some really great work, I
Speaker 8: think in providing good kind of contextual data looking at
Speaker 8: you know, overall infectiousness and periods of infectiousness for COVID
Speaker 8: nineteen and in for shedding and stars COVD two. And
Speaker 8: I think again, we look back at this idea that
Speaker 8: the majority of people within five to six days post
Speaker 8: contact or post infection or are likely going to start
Speaker 8: to have symptoms. In some cases that may trail out
Speaker 8: a little bit longer to twelve days. But if we
Speaker 8: look at that and we take that average, we take that,
Speaker 8: say that five to six days when people are usually
Speaker 8: showing symptoms, well we know that now it looks like
Speaker 8: that infectious period when you can actually recover it affectious
Speaker 8: virus from that person tends to be about two days
Speaker 8: prior to symptom onset and then somewhere in the neighborhood
Speaker 8: of up to about ten days.
Speaker 5: Post symptom onset. So that starts to give us a
Speaker 5: picture that.
Speaker 8: Even within you know, the span of a day three
Speaker 8: or day four post exposure, that you would potentially have
Speaker 8: somebody that is starting to be able to release virus.
Speaker 8: And then I think, again, when we look at all
Speaker 8: the clinical data that's kind of been a crude over time,
Speaker 8: what we're getting, I think a good perspective of is
Speaker 8: the fact that people are are likely most infectious in
Speaker 8: that you know that kind of one day to two
Speaker 8: days just prior to symptom onset to about five days
Speaker 8: post symptom onset.
Speaker 6: Okay, gotcha. And so because you know, we know that
Speaker 6: the amount of virus shed changes throughout clinical disease, how
Speaker 6: much does it change, you know, sort of looking at
Speaker 6: a different sort of snapshot, how much does it change
Speaker 6: across different severity of disease? So are people who are
Speaker 6: severely infected, are they shedding more virus? Are they more
Speaker 6: contagious than those who are asymptomatic?
Speaker 8: Yeah, Again, I think we're starting to get a better
Speaker 8: picture of what this looks like, right, And I think
Speaker 8: in particular, when we think about this idea of asymptomatic
Speaker 8: patients versus those that are pre symptomatic versus those that
Speaker 8: are symptomatic, certainly, you know, some of the household contact
Speaker 8: data suggested that people that are asymptomatically infected seem to
Speaker 8: have a much lower secondary attack rate than what people
Speaker 8: that are symptomatic or pre symptomatic do. So that sorts
Speaker 8: of suggest that people that have you know, basically mild
Speaker 8: or asymptomatic infections likely are going to lead to lower
Speaker 8: numbers of infections based on the amount of virus that
Speaker 8: they release as compared to people that have more moderate
Speaker 8: or more severe symptoms. But there's also kind of a
Speaker 8: converse to that when we think about this idea of
Speaker 8: people that are severely ill. I certainly know that that
Speaker 8: people that are severely ill may have a longer period
Speaker 8: at which they're able to release infectious virus, But the
Speaker 8: likelihood is also that those severe disease cases are probably
Speaker 8: also going to be hospitalized or receiving care. So the
Speaker 8: likelihood is that those people that are severely ill, even
Speaker 8: though they're releasing a lot of virus, are probably not
Speaker 8: going to be, you know, in a position where they're
Speaker 8: going to be exposing a lot of additional people in public.
Speaker 8: So again, I think we get back to this phase
Speaker 8: of saying that somewhere, you know, kind of in between,
Speaker 8: you know, people that are mild to moderately ill and
Speaker 8: kind of looking at the viral loads from the data
Speaker 8: that we have in that kind of primary infectious period,
Speaker 8: it probably still follows that, you know, somewhere again in
Speaker 8: that zero to five day range that people that are
Speaker 8: moderately ill or mildly ill probably are going to have
Speaker 8: the greatest ability to release virus during that period.
Speaker 7: That makes sense. So overall, we're now like a full
Speaker 7: year into this or even longer, and we've got a
Speaker 7: much better picture of the spectrum of disease that SARS
Speaker 7: covid two can actually cause, like you mentioned already, from
Speaker 7: asymptomatic infections to very severe or even fatal outcomes. So
Speaker 7: could you walk us through a little bit this spectrum
Speaker 7: of disease in terms of symptoms or clinical observations, first
Speaker 7: talking about like how many people really are asymptomatic, and
Speaker 7: then what a mild infection looks like and what moderate
Speaker 7: or severe cases are like, Like what proportion of cases
Speaker 7: are we talking about that are very severe versus mild
Speaker 7: versus completely asymptomatic.
Speaker 9: Sure, so, as you mentioned, we have a much greater
Speaker 9: understanding of the clinical syndrome that we see now, and
Speaker 9: I think that you know there are very various definitions
Speaker 9: out there for patients who are infected, and you know,
Speaker 9: some of these criterias may overlap or vary across the
Speaker 9: different guidelines that we see, but for the most part,
Speaker 9: you know, when we talk about patients are asymptomatic or
Speaker 9: pre symptomatic, these are people who test positive for socoby
Speaker 9: two via the nucleic acid amplification test or amagen test,
Speaker 9: but they have no symptoms consistent with COVID nineteen. And
Speaker 9: then the next step up that we would consider patients
Speaker 9: who have mild disease, and these are people who have
Speaker 9: you know, various signs and symptoms of COVID nineteen.
Speaker 3: So these are the very non specific symptoms.
Speaker 9: So patients who could have fever, cough, headaches, muscle aches, nausea, vomiting, diarrhea,
Speaker 9: and then loss of taste or smell, which has become
Speaker 9: one of the characteristics that we see with this viral disease.
Speaker 9: But typically these people don't have any shortness of breath,
Speaker 9: they don't have any abnormal chest imaging. And then the
Speaker 9: next stage of disease that we tend to see are
Speaker 9: people of moderate disease, and these are people who have
Speaker 9: some lower respiratory disease on their critical assessments imaging, and
Speaker 9: they may have a little bit of hypoxia or low
Speaker 9: oxygen saturation on broom air. The next severity of disease
Speaker 9: would be what we call severe illness, and these are
Speaker 9: people who have an oxygen saturation less than ninety four
Speaker 9: percent on room air, and they might be breathing pretty fast,
Speaker 9: so they're breathing greater than thirty breaths per minute, and
Speaker 9: they have pretty significant longonful trips. And then the most
Speaker 9: severe illness is going to be what we call critical illness,
Speaker 9: and these are people who have respiratory failure. These are
Speaker 9: the people who are intubated and have multiple organs involved.
Speaker 3: With their starchcobe too.
Speaker 9: And I think, you know, we're still getting a idea
Speaker 9: of the number of people that are asymptomatic presymptomatic versus
Speaker 9: those who go on to develop critical illness. You know,
Speaker 9: last reports are estimate that about thirty percent of people
Speaker 9: have asymptomatic pre symptomatic infection. However, you know, we are
Speaker 9: still learning more about this disease than what percentage of
Speaker 9: the people have asymptomatic disease versus go on to develop
Speaker 9: moderate to severe and critical illness.
Speaker 6: Yeah, so the symptoms, like you mentioned, there's this huge
Speaker 6: spectrum of disease, and you know, how much do these
Speaker 6: symptoms or the general course of disease, how much does
Speaker 6: that vary from person to person, Like how predictable is
Speaker 6: this virus.
Speaker 9: Well, there's lots of things that go into determining how
Speaker 9: a person is going to respond to getting this disease, right,
Speaker 9: So we know that underlying co morbidity play.
Speaker 3: A huge hole.
Speaker 9: People are who have things like cardiovascular disease, chronic lung disease, diabetes,
Speaker 9: if they're obese, if they have chronic kidney disease, those
Speaker 9: types of things, you're going to put them at higher
Speaker 9: risk to having a more severe disease. Additionally, we know
Speaker 9: that if you're older, that's going to put you at
Speaker 9: higher risk. So some of the data from the sea
Speaker 9: showed that if you're eighty five years or older compared
Speaker 9: to someone that's five to seventeen.
Speaker 3: Years old, you have an eighty times higher.
Speaker 9: Risk of being hospitalized and over seven thousand times more
Speaker 9: likely to die. So it's you know, significantly higher given
Speaker 9: your age compared to someone who's younger. So there's so
Speaker 9: many different modifying factors that you have to look at
Speaker 9: when you're looking at how a person's going to react
Speaker 9: compared to another person.
Speaker 7: So kind of along those lines, while a lot of
Speaker 7: people who become infected will have their symptoms resolve within
Speaker 7: a relatively short period of time, it seems that others
Speaker 7: are experiencing much longer term issues with lung performance or
Speaker 7: even kind of a fogginess. Can you talk about some
Speaker 7: of these lingering effects of infection and how frequently they
Speaker 7: seem to occur.
Speaker 9: Yeah, that's a really great question, and it's another aspect
Speaker 9: of COVID nineteen that we're still learning about. It's what
Speaker 9: we call long COVID now, and it's really not known
Speaker 9: why some people's recovery is prolonged.
Speaker 3: You know, it's not sure if it's related to.
Speaker 9: Persistent byrnia due to a weaker absent antibody response, if
Speaker 9: it's related to some other inflammatory or immune reaction. So
Speaker 9: we're still learning about it, but a lot of what
Speaker 9: we're seeing our long term respiratory, musculo skeletal, and neuropsychiatric
Speaker 9: sequalae in some of these patients, and it's occurring in
Speaker 9: about ten percent of people who've had COVID nineteen and
Speaker 9: many of these patients recover spontaneously, but it takes a
Speaker 9: long period of time with holistic support, rest, symptomatic treatment,
Speaker 9: and gradual increase in activity. And you know, these patients
Speaker 9: will require some focused assessment, you know, So if they're
Speaker 9: having prolonged shortness of breath, really trying to do some
Speaker 9: focused assessment on their respiratory functions, so looking at things
Speaker 9: like pulmonary function testing, more focused imagings, pulmonary rehab. If
Speaker 9: they're having neurological symptoms, maybe doing some for their brain imaging,
Speaker 9: neuropsychiatric testing. And again, like I said, holistic support, a
Speaker 9: lot of focus is now going into trying to understand
Speaker 9: why these things are happening and how we can better
Speaker 9: support these patients.
Speaker 6: Gotcha, Yeah, So how much has our estimate of the
Speaker 6: case fatality rate changed over the course of this pandemic
Speaker 6: and how much of that is due to you know,
Speaker 6: better testing ability or is it also you know, being
Speaker 6: able to actually treat some of these cases or provide
Speaker 6: supportive care. So can you talk a little bit about
Speaker 6: sort of this case fatality rate and what goes into it?
Speaker 9: Sure, So I think this is something that we're also
Speaker 9: beginning to get a better understanding of I think it's
Speaker 9: really important to understand the difference between the infection fatality ratio,
Speaker 9: which estimates the proportion of debts among all infected individuals,
Speaker 9: and the case fatality ratio, which estimates the portion of
Speaker 9: deat some monk identified confirm cases. So to measure an
Speaker 9: infection fatality ratio accurately, we need to know the complete
Speaker 9: picture of the number of infections and that's caused by
Speaker 9: a disease, and so in the early stages of a pandemic,
Speaker 9: most estimates of fatality ratios are based only on the
Speaker 9: cases detected, and so it can be underestimated. And so
Speaker 9: I think as we've gone along, we're identifying more and
Speaker 9: more cases and through better testing and better surveillance methods. However,
Speaker 9: I still think, you know, we have to continue to
Speaker 9: do more testing, and because there may be asymptomatic cases
Speaker 9: out there that we haven't been detecting and testing for,
Speaker 9: we still have some work to do to further identify them.
Speaker 3: So I think we're doing a better job, I think
Speaker 3: we still have some work to do for that.
Speaker 7: And so you kind of talked a little bit already
Speaker 7: about how we know that there are some people who
Speaker 7: are at higher risk than others, even though we know
Speaker 7: that no one is entirely safe from this virus. Can
Speaker 7: you talk a little bit more about some of those
Speaker 7: risk factors that seem to be associated with severe infections?
Speaker 7: And I've heard things like is there any link between
Speaker 7: blood type and risk of infection?
Speaker 8: Things like that, Yeah, you know, from my standpoint, I mean,
Speaker 8: I think doctor Capaly, you know, kind of touched on
Speaker 8: some of these, but from kind of a uniquely you know,
Speaker 8: Canadian aspect. I mean, one of the things that we
Speaker 8: certainly have been very i think awakened to throughout COVID
Speaker 8: nineteen was just how much age has played into severe
Speaker 8: and fatal disease. Certainly, when you look at at our
Speaker 8: fatality rates, we have a massive over representation of people
Speaker 8: that are seniors and people that are above the age
Speaker 8: of sixty five, in particular of those that are in
Speaker 8: long term care facilities and in personal care home. So
Speaker 8: certainly I think we're getting quite the perspective on the
Speaker 8: role of age. But then of course we look across
Speaker 8: different groups, we certainly see that much like with other
Speaker 8: you know, emerging effects diseases, that there's a disproportioned effect
Speaker 8: in UH certainly in minority groups, UH, in people that
Speaker 8: are in lower socioeconomic status.
Speaker 5: People that are in underserved communities.
Speaker 8: So I think it certainly is open to gain our
Speaker 8: eyes to the fact of, you know, the differences in
Speaker 8: how UH effect diseases, you know, really affect different segments
Speaker 8: of our population. And then of course we look at
Speaker 8: the underlying you know, kind of medical complications that are
Speaker 8: related to this, whether we look at somebody that has
Speaker 8: cardiovascular disease, or we look at people that you have
Speaker 8: a a high BMI or who are you know, obese,
Speaker 8: or those that have diabetes, those that have you know,
Speaker 8: are you compromised, or positions uh, you know, such as
Speaker 8: those that have cancer. I think we certainly realize more
Speaker 8: and more that there is a broad spectrum of people
Speaker 8: that are susceptible to to severe disease. And yes, we
Speaker 8: have an overrepresentation of people that are seniors, but we
Speaker 8: cannot discount the people that are overrepresented across other groups
Speaker 8: as well, and I think that's going to continue to expand.
Speaker 8: I think certainly as we start to go through the
Speaker 8: data more and more from from across different countries, I
Speaker 8: think we'll get a better perspective of how that looks.
Speaker 8: And again, in particular within minority groups, you know, what
Speaker 8: the particular risk factors UH may may have have also
Speaker 8: been within there that we think about this idea of
Speaker 8: blood groups. I mean, certainly, you know, there was quite
Speaker 8: a bit of discussion, and there was you know, this
Speaker 8: discussion that you know TYPEO was related to less spear disease. Well,
Speaker 8: there's been some additional data that's come out fairly recently
Speaker 8: that has said, you know what, there isn't Actually it
Speaker 8: doesn't There doesn't appear to be a link between this.
Speaker 8: So I think we're still trying to figure out what
Speaker 8: all the data says. Certainly there are standouts that we
Speaker 8: know are related to more severe disease and worse outcomes.
Speaker 8: But I think it's the you know, these kind of
Speaker 8: more finite symptoms and finite biological factors that we still
Speaker 8: have to spend some time trying to understand a little
Speaker 8: bit more deeply.
Speaker 6: Yeah, and so what do we know even though it's
Speaker 6: sort of even though there might be a lot more
Speaker 6: to uncover as the pandemic goes on and as the
Speaker 6: data are analyzed and so on. But at this point,
Speaker 6: what do we know about pregnancy and infection with COVID nineteen.
Speaker 6: Are there risks and do the risks vary depending on
Speaker 6: when during pregnancy somebody may be exposed or infected.
Speaker 9: So that's a really wonderful question. You know, the full
Speaker 9: impact of infection with stars COVID two in pregnancy is
Speaker 9: still being learned and being understood. We know that pregnant
Speaker 9: women with coronavirus disease are increased risk for severe illness
Speaker 9: and they may be at risk for preterm birth. There
Speaker 9: are definitely some surveillance systems out there. One of them
Speaker 9: is the CDC has a Surveillance for Emerging Threats to
Speaker 9: Mothers and Babies network that has been collecting data looking
Speaker 9: at a pregnant women who have COVID nineteen to see
Speaker 9: what happens to women who are infected and their babies.
Speaker 9: You know, one of the things that have been discussed
Speaker 9: is that you know, if women who are pregnant are
Speaker 9: hospitalized for COVID nineteen, they should be definitely monitored closely
Speaker 9: and be at a facility where they can.
Speaker 3: Have the highest level of care.
Speaker 9: We know that they should be given a multi specialty
Speaker 9: approach to care with maternal fetal medicine ID PALMARY critical care. Also,
Speaker 9: the most recent NIH fidelines also recommend that, you know,
Speaker 9: any of the therapies that we would use and non
Speaker 9: pregnant women should be also given to pregnant women to
Speaker 9: help treat them appropriately. So you know, in terms of
Speaker 9: any of the other data, you know that data is
Speaker 9: still being collected and being looked at. But other than
Speaker 9: the pregnancy data that shows that they might be at
Speaker 9: risk for full preterm birth, we're still learning about.
Speaker 7: It makes sense, so we know that it appears that
Speaker 7: people who recover from COVID nineteen do have at least
Speaker 7: some immunity to the virus that lasts for at least
Speaker 7: a few months. Do we know any more about the
Speaker 7: duration or kind of the nature of immunity and the
Speaker 7: risk of reinfection, especially in light of the new variants
Speaker 7: that we're seeing.
Speaker 8: Yeah, I think we're starting to get some perspective on that,
Speaker 8: right and certainly doctor Florian Kramer and others.
Speaker 5: Have have really led the charge in trying.
Speaker 8: To take a look at what this looks like. But
Speaker 8: we have to I think, first of all, we have
Speaker 8: to maintain some perspective that you know, we're fourteen months,
Speaker 8: you know, roughly fifteen months I guess now posts SARS
Speaker 8: CoV two emergence. So our understanding of long term immunity
Speaker 8: is pretty limited. When we think about even those first
Speaker 8: cases from China that you know that ended up in
Speaker 8: the hospital and then recovered, you know, the data is
Speaker 8: longer term, but it's I wouldn't necessarily call it long term.
Speaker 8: So I think, you know, we're still certainly an infancy
Speaker 8: and understanding that. But right now, it looks like for
Speaker 8: the most majority cases that we see, there's at least
Speaker 8: you know, good memory within the immune system out to
Speaker 8: around eight months post infection. So certainly in regards to
Speaker 8: antibodies directed against the virus, it looks like those are
Speaker 8: maintained for longer periods of time. It looks as well,
Speaker 8: like T cell responses that that other aspect of our
Speaker 8: immune system, our longer term immune system and our and
Speaker 8: our immune memory also is maintained for you know, all
Speaker 8: boards of six months or longer. So I think it
Speaker 8: gives us a picture that, yes, there certainly is some
Speaker 8: aspect of immunity that that appears to be carried long term.
Speaker 8: The difficulty in this is try and understand how that
Speaker 8: relates to susceptibility to subsequent infection, and whether or not
Speaker 8: we see any sort of immune waning, and of course
Speaker 8: how that looks across the population. Is it the same
Speaker 8: in seniors as it is in somebody that is in
Speaker 8: a middle aged group versus somebody that is, you know,
Speaker 8: nineteen or younger. And I think we're, you know, game
Speaker 8: what We're trying to see what that looks like. And
Speaker 8: that's been one of the drives to try and promote
Speaker 8: vaccination because at the very least we understand that people
Speaker 8: that are getting exposed to vaccine, that are getting exposed
Speaker 8: to a constant amount of viral anagen or a constant
Speaker 8: amount of the particular gene that we're using, that they
Speaker 8: will get a robust response that's maintained certainly with the variants.
Speaker 8: That's added a new variable for us. Right when we
Speaker 8: look at data coming out of out of Brazil, in
Speaker 8: particular the data that came out of Matos Brazil, there
Speaker 8: has been a lot of question about, you know, what
Speaker 8: was the potential for reinfection with the P one variant
Speaker 8: of that was first identified there or with Wistar's CoV
Speaker 8: two in general, and does some of the kind of
Speaker 8: high burden we've seen of disease in subsequent waves within
Speaker 8: that area. Does that suggest that there is immune waning
Speaker 8: after a certain period of time and that's why we
Speaker 8: have seen such high amounts of infection even though there
Speaker 8: seemed to be a high serial prevalence within the population.
Speaker 8: That would suggest that a lot of people have been
Speaker 8: infected early. And I think we don't specifically know yet,
Speaker 8: and that's what makes it difficult.
Speaker 5: Certainly.
Speaker 8: I think, you know, we're probably looking at you know,
Speaker 8: reinfections that again or not, they're more the exception not
Speaker 8: the norm at this point for regarding the data that
Speaker 8: we've seen. But we're also at a point of saying
Speaker 8: we don't really want to test that hypothesis. So if
Speaker 8: we can try and cut transmission and we can get
Speaker 8: people vaccinated, the likelihood is that we're probably going to
Speaker 8: see lower numbers of new variants that are going to
Speaker 8: merge because there will be no ability for the variants
Speaker 8: to merge if transmission is cut. And we suddenly reduce
Speaker 8: any concerns about that question.
Speaker 6: M Yeah, fingers crossed that that the immunity will Yeah,
Speaker 6: So throughout this pandemic, how has treatment for people with
Speaker 6: COVID nineteen changed. Are we any better at treating people
Speaker 6: with severe cases now than we were, you know, a
Speaker 6: year ago, or eight months ago, even six months ago.
Speaker 9: Yeah, So I think that's another really interesting question. So
Speaker 9: I think a couple of things have happened. One, I
Speaker 9: think we are better at treating patients, and I think
Speaker 9: we have a couple of therapeutics that help. So let
Speaker 9: me tackle the first part of that question first. So,
Speaker 9: I think that in terms of how to support patients
Speaker 9: who have critical disease, we've gotten better at managing them.
Speaker 9: When we first sorted seeing these patients who had significant
Speaker 9: disease that were intubated, we had a difficult time managing them.
Speaker 9: And I think throughout the course of this pandemic, our
Speaker 9: really wonderful critical care doctors have really gotten used to
Speaker 9: being able to manage them.
Speaker 4: Right.
Speaker 9: So we have intubation protocols, we have chemical ventilation protocols,
Speaker 9: we have protocols for proning these patients, which I think
Speaker 9: has really helped in how we manage them. And the
Speaker 9: support of care and managing these patients have really become protocolized,
Speaker 9: which has helped in terms of.
Speaker 3: Improving the care for these patients. Concominantly, we definitely have.
Speaker 9: Information for how to treat these patients. So, you know,
Speaker 9: we have a couple of therapeutics that may help, right, So,
Speaker 9: we have form decipear that has been the only therapeutic
Speaker 9: that has been approved by the FDA for the treatment
Speaker 9: of COVID nineteen that is recommended to be used in
Speaker 9: hospitalization of a patient. We have dexithi zone, which was
Speaker 9: found to improve survival in hospitalized patients requiring oxygen and
Speaker 9: having the greatest effecting patients who are ventilated.
Speaker 3: So those two therapeutics are.
Speaker 9: Pretty much routinely given now to patients who are hospitalized.
Speaker 9: So I think it is a combination of things. On
Speaker 9: top of that, you know, we have when patients are
Speaker 9: hospitalized with severe COVID, it's not uncommon that we find
Speaker 9: them to have super employed bacterial infections, so making sure
Speaker 9: we appropriately manage those infections as well. So I do
Speaker 9: think it is a combination of things that have happened
Speaker 9: over a period of time, you know. But that being said,
Speaker 9: you know, these patients still become critically ill and can
Speaker 9: be very difficult to manage, and they have numerous complications
Speaker 9: throughout the course of their hospitalization, and so we still
Speaker 9: have a long way to go in trying to figure
Speaker 9: out how to more effectively treat this disease.
Speaker 7: Yeah, that makes total sense. So a lot of kind
Speaker 7: of the very positive news that everyone's talking about with
Speaker 7: COVID nineteen has really focused on these new vaccines that
Speaker 7: we have. So, speaking of these vaccines, what do we
Speaker 7: know at this point about these different vaccine candidates in
Speaker 7: terms of their effectiveness against new variants that have emerged,
Speaker 7: And what does it really mean if these vaccines are
Speaker 7: in fact slightly less effective again some variants than they
Speaker 7: are against others.
Speaker 5: Yeah, such a great question. Right.
Speaker 8: So, you know, we're in this period of I think,
Speaker 8: kind of the intense optimism because the vaccines. Not only
Speaker 8: have you had a single vaccine that has looked amazingly well,
Speaker 8: we've had multiple vaccines developed within the span of you know,
Speaker 8: twelve months or just around twelve months that all seem
Speaker 8: highly efficacious, and that certainly has I think, kind of
Speaker 8: renewed the sense of optimism. But we have this new
Speaker 8: variable with variants that have emerged and ones that will
Speaker 8: potentially subsequently emerge. You know, our understanding of how the
Speaker 8: vaccines behave in regards to the variants, is still you
Speaker 8: kind of growing right, So we have we have some
Speaker 8: inference at least from looking at antibodies from those that
Speaker 8: have been vaccinated that would suggest, you know, that most
Speaker 8: of the vaccines seem to have decent neutralizing activities of
Speaker 8: the anybodies that they generate still seem to be able
Speaker 8: to neutralize the different variants. The B one three five
Speaker 8: one variant that that was first identified in South Africa
Speaker 8: certainly has created some issues. It has been the one
Speaker 8: I think that that everybody has been quite focused on
Speaker 8: in regards to this idea of anybody escape. But you know,
Speaker 8: I think we have to also look at what we're
Speaker 8: seeing in terms of real world data right now. So Oxford,
Speaker 8: as for Zenica, their data at least with the one
Speaker 8: seventeen or one one seven looks quite promising. They still
Speaker 8: have you know, I think it was what seventy five
Speaker 8: percent fac rate, And as well, we're seeing real world
Speaker 8: data coming out of the UK where administration of Oxford's
Speaker 8: vaccine has really made a massive reduction in or led
Speaker 8: to mass production in transmission in cases. So I think
Speaker 8: you can make the argument that even in an area
Speaker 8: where B one one seven is is circulating. We're actually
Speaker 8: seeing a great benefit at the population level of the
Speaker 8: Oxford vaccine. Same thing for Pfizer that gained real world
Speaker 8: data from the UK also would suggest that that we're seeing,
Speaker 8: you know, really good effectiveness within the population. Maderna, I
Speaker 8: think there's some data certainly to suggest that that in
Speaker 8: regards to anybodies that there are still is neutralizing anybody
Speaker 8: that is there, But we don't know the efficacy yet
Speaker 8: in the population. And Novavax, you know, and Johnson and
Speaker 8: Johnson certainly when we look at B one three five
Speaker 8: to one, they have had lower reported efficacies against that variant.
Speaker 8: But again I think we have to, you know, kind
Speaker 8: of move ourselves back a step and say, okay, when
Speaker 8: we think about the variants, what have we seen in
Speaker 8: regards to transmission in the community. Certainly B one one
Speaker 8: seven has been a concern because the increased transmissibility has
Speaker 8: led to a broad distribution and overtaking of circulating strains
Speaker 8: B one three five to one. We haven't necessarily seen that.
Speaker 8: Certainly in South Africa it has been an issue in
Speaker 8: an ongoing issue. Here in Canada, we've had cases, but
Speaker 8: we certainly haven't seen the explosiveness that we've seen with
Speaker 8: B one one seven. So I think again with the vaccines,
Speaker 8: the more that we can get these vaccines out, all
Speaker 8: of which seem that at least so far have some
Speaker 8: capacity to reduce transmission to some extent, that will help
Speaker 8: us with control of these variants. And I think that's
Speaker 8: the important factor, is if we want to try and
Speaker 8: push back the experience, if we get people vaccinated, we're
Speaker 8: going to reduce transmission, and that really, to me at
Speaker 8: least is one of the most critical factors at this point.
Speaker 9: M M.
Speaker 4: Yeah.
Speaker 6: So one of the early concerns about the vaccines was
Speaker 6: that they may not prevent asymptomatic infections. So maybe if
Speaker 6: you were even still fully vaccinated, you may not get
Speaker 6: the disease, but you could still spread the virus to
Speaker 6: other people. But you know, it's a few months now
Speaker 6: since these vaccines have been implemented widely. What do the
Speaker 6: latest studies show about that?
Speaker 8: Yeah, the data I think is suggesting that, certainly for
Speaker 8: Oxford is as well as a leave for Pfizer, that
Speaker 8: they have been able to show that there's been at
Speaker 8: least some evidence for reduced transmission. Just looking at at,
Speaker 8: you know, the amount of virus within the nasal passage
Speaker 8: within people that have been vaccinated and subsequently had been exposed.
Speaker 8: So I think it's kind of a good news storm, right,
Speaker 8: but also at the same time it should, you know,
Speaker 8: kind of not maybe becomes that much of a surprise
Speaker 8: that if we have vaccines that ultimately are able to
Speaker 8: protect against severe and fail disease, so you know, they
Speaker 8: take that severe disease down to something that is more
Speaker 8: moderate or even in some cases down to a very
Speaker 8: very vile disease, that period of infectiousness is probably going
Speaker 8: to be fairly limited. And I think that that also
Speaker 8: probably plays at least some component into this, And so
Speaker 8: I think it's it's important for us to understand that,
Speaker 8: you know, there are the vaccines. While initially I think
Speaker 8: we were all hopeful that they would just at the
Speaker 8: very least cover severe disease and protect us from that,
Speaker 8: now we're going to more data to suggest that in fact,
Speaker 8: they likely reduce transmission and hopefully that that will impact
Speaker 8: and lower rates of asymptomatic transmission. And I think again
Speaker 8: in the real world settings where the larger vaccination campaigns
Speaker 8: have occurred, we're seeing that play out. Certainly we're seeing
Speaker 8: transmission rates and cases dropping substantially, very very quickly, and
Speaker 8: I think that's very reassuring.
Speaker 7: Absolutely, that's what I wanted to hear.
Speaker 6: Yeah, so as the light at the end of the
Speaker 6: tunnel gets closer and closer, even though it sometimes doesn't
Speaker 6: feel that way. What is something that you hope we
Speaker 6: take away from this pandemic, either at a personal level
Speaker 6: or you know, as a society.
Speaker 9: I think on a personal level, one of the things
Speaker 9: I will take away has been my appreciation for the
Speaker 9: amazing collaborations and friendships I've made across the country and
Speaker 9: across the world because of this pandemic. I've made friends
Speaker 9: with people that I probably never would have made friends
Speaker 9: or collaborations with because of this disease, and I think
Speaker 9: that that has really been an amazing opportunity for me.
Speaker 9: So I think that's something that I will cherish. And
Speaker 9: I think also really speaks to the power of science
Speaker 9: when things get really bad, you know, seeing how the
Speaker 9: world comes together, and I find that to be very
Speaker 9: humbling and very special. From a societal perspective, I really
Speaker 9: really hope that people will take away the importance of
Speaker 9: investing in preparedness, investing in the global health security agenda.
Speaker 9: We have a very short attention span, and when things happen,
Speaker 9: we get up in arms and say we're going to
Speaker 9: do something, but then as soon as it's done, we forget.
Speaker 9: And I really think that if this pandemic has shown
Speaker 9: us anything, it's that we do need to invest in preparedness.
Speaker 9: We need to invest in strengthening healthcare systems, we need
Speaker 9: to invest in surveillance. And this can't be a one
Speaker 9: time thing. It's something we need to do longitudinally. And
Speaker 9: I really hope that as a society we can put
Speaker 9: our differences aside and recognize the importance of doing that.
Speaker 3: So that when.
Speaker 9: The next infectious disease's outbreak comes along, and it will,
Speaker 9: that we will be prepared and we will be ready,
Speaker 9: and that we recognize that this is a global threat,
Speaker 9: not a threat that affects certain people, certain races, or
Speaker 9: certain ethnicities, that this is something that affects all of us.
Speaker 8: Yeah, and you know, I think I would compliment a
Speaker 8: lot of what said doctor Pauly said. I mean, certainly
Speaker 8: from a personal standpoint, I much like herself what it
Speaker 8: was involved in in the Bowle epidemic in West Africa.
Speaker 8: You know, there's an aspect of it that I think
Speaker 8: for both of us and all those that I know
Speaker 8: that that were involved in in that outbreak as well
Speaker 8: as other outbreaks.
Speaker 5: It certainly it changes you.
Speaker 8: It changes your perception and your viewpoint on infection diseases,
Speaker 8: but it doesn't necessarily impact your family and the people
Speaker 8: around you, And that certainly is something very different. I
Speaker 8: mean for me with you know, with a young family,
Speaker 8: with a you know, a two and a half year
Speaker 8: old at home. This was one of those kind of
Speaker 8: first instances where there was the question of what is
Speaker 8: going to happen, you know, what is the world to
Speaker 8: war going to look like as we go through the pandemic.
Speaker 5: But but doctor Capouli said.
Speaker 8: It very well that there was this immediate response with
Speaker 8: with people across the globe that certainly I would have
Speaker 8: never been in contact with had it not been for COVID,
Speaker 8: and I think it really energized all of us and
Speaker 8: certainly made us feel as if there is a global
Speaker 8: community that is working together at a moment's notice to
Speaker 8: try and come up with novel answers and novel techniques
Speaker 8: and diagnostics and vaccines. And therapeutics to fight back against
Speaker 8: infection diseases. So there's that aspect that I think a
Speaker 8: personal standpoint has changed me from a broader perspective. As
Speaker 8: much as I'm an optimist, there's a pessimistic side because
Speaker 8: I look at COVID nineteen and I think, is this
Speaker 8: going to be the thing that finally changes global perspectives
Speaker 8: on how we deal with emerging in effects diseases or
Speaker 8: is this going to be the same as post stars
Speaker 8: and post two thousand and nine pandemic flu and post ebola,
Speaker 8: Where yes, our attention span is opened for a few
Speaker 8: months or a couple of years, but then the interest
Speaker 8: drops off outside of the research community and more so
Speaker 8: within governments in funding communities, And that's concerned for me.
Speaker 8: I think we have to appreciate that when we look
Speaker 8: at emerging affects diseases, these diseases disproportionately affect low and
Speaker 8: middle income regions of the world and emerge in those regions.
Speaker 8: Our preparedness and our ability to deal with these as
Speaker 8: a global community is going to be reliant on ensuring
Speaker 8: that we have basically the safety nets and the early
Speaker 8: warning systems, not only in our own countries, but more
Speaker 8: so within those regions where we know these diseases are
Speaker 8: going to emerge from. To increase our preparedness, and we
Speaker 8: have to be prepared to work with locals within those areas.
Speaker 8: So I hope that this will change things. I hope
Speaker 8: that there are enough younger voices in the generations around
Speaker 8: me and the generations below me that have been invigorated
Speaker 8: by this and want to instill change so that there
Speaker 8: is actual change post COVID.
Speaker 7: Thank you so much, doctor Kupali and doctor Kindrichuck for
Speaker 7: taking the time out of your schedule to talk with us.
Speaker 7: That was an amazing conversation.
Speaker 6: Oh my gosh, so much information. It was incredible. We
Speaker 6: covered so much ground.
Speaker 7: We really did. So let's, as always go over the
Speaker 7: five most important take home points that we learned, shall we.
Speaker 6: Let's do it all right?
Speaker 7: Number one, Well, there are still some unanswered questions as
Speaker 7: per usue about what the infectious of virus might be
Speaker 7: in this case. One thing that has become clear is
Speaker 7: that exposure time is a really important indicator of risk,
Speaker 7: So not just how close you might be standing to somebody,
Speaker 7: but also how long are you in contact with people
Speaker 7: and in what context, like are you indoors versus outdoors.
Speaker 7: Do you have good air circulation versus very poor circulation,
Speaker 7: all those sorts of things. We also know that the
Speaker 7: majority of people will start to show symptoms about five
Speaker 7: to six days after infection, but they're contagious to others
Speaker 7: starting about two days before symptoms appear, and this infectious
Speaker 7: period lasts for at least ten days, So that means
Speaker 7: that as early as three to four days after exposure
Speaker 7: is when somebody could begin shedding virus even before knowing
Speaker 7: that they're sick. And I think that really highlights why
Speaker 7: and how masks, which we know are so important, have
Speaker 7: become such a big component of risk mitigation in this pandemic,
Speaker 7: since they are what's preventing us from exposing others even
Speaker 7: early during infection when we don't know that we're sick.
Speaker 7: And while some data suggests that people who are asymptomatic
Speaker 7: or in that kind of pre symptomatic phase might be
Speaker 7: less contagious than someone who is symptomatic or like severely ill,
Speaker 7: if behaviorally those people are walking around interacting with more people,
Speaker 7: then they might be actively infecting more people than people
Speaker 7: who are severely ill, even though those are the ones
Speaker 7: shedding more virus because they end up hospitalized with their infection.
Speaker 6: Yeah, and number two, speaking of asymptomatic versus pre symptomatic,
Speaker 6: this is a conversation that has gone on throughout the
Speaker 6: course of this pandemic, and truthfully, we still don't have
Speaker 6: a perfect handle on what proportion of cases are truly
Speaker 6: asymptomatic versus those who test positive without symptoms but then
Speaker 6: go on to develop symptoms a few days later, which
Speaker 6: is what we would call pre symptomatic. Overall, about thirty
Speaker 6: percent of people that test positive fits somewhere in this category,
Speaker 6: so they are testing positive for SARS COVID two without
Speaker 6: having any active symptoms. We just don't know exactly how
Speaker 6: many of those go on to develop symptoms. And speaking
Speaker 6: of symptoms, we know a lot more now about what
Speaker 6: exactly they look like, and there is a huge range
Speaker 6: of symptoms from pretty mild and nonspecific, aside from like
Speaker 6: a loss of taste and smell, which is one of
Speaker 6: the few kinds of like hallmark symptoms of COVID to
Speaker 6: critical disease involving multi organ failure. And while age is
Speaker 6: a major risk factor for disease severity, it certainly isn't
Speaker 6: the only one. And we've seen even young and otherwise
Speaker 6: healthy people become severely ill and die from COVID.
Speaker 7: Yeah, number three long COVID. So this is a phenomenon
Speaker 7: that we've recognized now that this pandemic has been going
Speaker 7: on for over a year, and it's causing persistent, in
Speaker 7: some cases, pretty debilitating symptoms long after someone was initially
Speaker 7: infected with the sarskov two virus, and in some cases
Speaker 7: symptoms are reappearing even after someone seems to have recovered completely.
Speaker 7: It seems like about ten percent of people, and I
Speaker 7: have actually heard even higher estimates on some other news sources,
Speaker 7: are experiencing things like neurologic problems, which can range from
Speaker 7: brain fog to severe psychiatric changes or muscle weakness or
Speaker 7: persistent lung and breathing problems, really long term effects, and
Speaker 7: this is it's a lot more common than I realized, Aaron, Yeah,
Speaker 7: for sure. Yeah, And people who are experiencing this can
Speaker 7: take a very long time and need quite a lot
Speaker 7: of support and symptomatic treatment to actually get to a
Speaker 7: point of full recovery. At this point today, we still
Speaker 7: don't know exactly what the cause of this is, whether
Speaker 7: it represents like a persistent viroemia, so someone still has
Speaker 7: virus infecting them, or whether it's some kind of immune
Speaker 7: inflammatory reaction. We're still trying to understand why and exactly
Speaker 7: how this is happening.
Speaker 6: Yeah. Number four. There is kind of good news though,
Speaker 6: in that immunity does seem to last for some time
Speaker 6: at least, but just due to the nature of this
Speaker 6: being a brand new virus emerging for the first time,
Speaker 6: like just over a year ago, we still don't have
Speaker 6: long term data on this, and when it comes to
Speaker 6: new variants and their ability to evade our immune responses
Speaker 6: and reinfect those who have already had COVID. While this
Speaker 6: is definitely something that's concerning, we do have ways to
Speaker 6: prevent it. So cutting down and slowing transmission as much
Speaker 6: as possible is going to ensure we don't test the
Speaker 6: limits of immunity, and this will also help prevent new
Speaker 6: variants from emerging, since less transmission means less opportunity for
Speaker 6: viral mutation.
Speaker 7: Number five. Finally, the best news of all is that
Speaker 7: we have multiple highly effective vaccines, which is truly incredible.
Speaker 3: It really is.
Speaker 7: Yeah. In the US as of today, which is March
Speaker 7: twenty fifth three vaccines are already licensed and being distributed.
Speaker 7: Several more are being used across the globe, and while
Speaker 7: some of these vaccines do seem to be slightly less
Speaker 7: effective against some of these newly emerging variants, it also
Speaker 7: seems as though these vaccines not only prevent against disease
Speaker 7: but also have the capacity to reduce transmission, which is thrilling.
Speaker 7: This is still an ongoing area of research, but the
Speaker 7: data are really promising. It seems as though some of
Speaker 7: these vaccines might be helping to reduce infection, not just
Speaker 7: disease from infection, and even in the cases where they
Speaker 7: might be a little less effective at preventing infection, the
Speaker 7: role that these vaccines play in reducing disease severity and
Speaker 7: shortening a course of illness likely plays at least some
Speaker 7: role in reducing the likelihood of transmission. Since we know
Speaker 7: that infectiousness seems to vary with the course and severity
Speaker 7: of disease. This is really really great news because, like
Speaker 7: we've mentioned several times throughout this series, reducing transmission and
Speaker 7: spread of the virus reduces the likelihood of new variants emerging,
Speaker 7: not to mention less people getting sick and dying. It
Speaker 7: has been a very very long year full of so
Speaker 7: much heartbreak and unbelievably depressing news, and we have spent
Speaker 7: a lot of time in many of these COVID episodes
Speaker 7: kind of really focused on all the bad news. So
Speaker 7: it's really nice to be able to end this episode
Speaker 7: with some real, actual light that seems visible in this
Speaker 7: dark tunnel that we're all in.
Speaker 6: I know, the light at the end of the tunnel
Speaker 6: does still seem far away, but it does.
Speaker 7: I feel like it's getting closer though, I hope.
Speaker 6: So maybe it's just that good news takes longer to
Speaker 6: sink in than the bad news.
Speaker 7: Yeah.
Speaker 6: Well, this was such a great interview. Thank you again
Speaker 6: so much to doctor Capoli and doctor KINDRICHUK for taking
Speaker 6: time out of their schedules to chat with us.
Speaker 7: Yeah, thank you so much. And thank you again to
Speaker 7: the providers of our first hand accounts and to everyone
Speaker 7: who has sent in your stories. We really appreciate it.
Speaker 6: Yes, and thank you to Bloodmobile for providing the music
Speaker 6: for this episode and all of our episodes.
Speaker 7: And thank you to the Exactly Right Network, of whom
Speaker 7: we're very proud to be a part.
Speaker 6: And finally, thank you to you listeners for listening, We
Speaker 6: really appreciate it. You allow us to keep doing this
Speaker 6: thing that we love to do, and so we are
Speaker 6: forever eternally grateful.
Speaker 7: Yeah. Yeah, we would never be able to make even
Speaker 7: our regular series, let alone this COVID nineteen bonus series
Speaker 7: if it wasn't for you all listening, So thank you.
Speaker 6: Yeah. Well, until next time, wash your hands, you filthy animals.
Speaker 9: Um um um um um