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COVID-19 Vaccines in St. Louis
Missouri and Illinois are moving into the next phase of COVID-19 vaccination and we know there are lots of questions that need answers. As the details are worked out, please encourage your friends, family members and neighbors to pre-register for the vaccine. They will be contacted as soon as their eligibility window opens and the vaccine supply becomes available.
*If you need help, please do not hesitate to contact the church and leave your name and Karen Schriefer or the church office will contact you as soon as we can.
Thank you doing your part to speed the process, together we can help to stem the tide of deaths and harm that the pandemic is unleashing upon our country.
Vaccination Presentation by Dr. Rachel Presti
Dr. Rachel Presti, who has been leading COVID vaccine research for many months. Dr. Presti is an Associate Professor of Medicine and Medical Director of the Infectious Diseases Clinical Research Unit (ID CRU) at Washington University. She discussed the vaccine rollout and answered many questions.
Video Transcript
thank you all for joining us as agood group and uh we could uh have asimilar group inall the adult education in the futurethat’ll be great umi want to take a minute to uh welcomesomebody weall know well rachel prestige drpresidentwith washington university she is theassociate professor of medicine andalso the medical director of theinfectious diseaseclinical research unit as well as theprincipal investigator of the nih aidsclinical trials at warshipso she got her md and phd at washuand her clinical and research interestsand her publications cover a widespectrumin the field of infectious diseasesincludingimproving the care of hiv infectedpatientswho are co-infected with emergingvirusesbut many of us have seen dr prestiduring the past yearon the television and on other newsreportsanswering questions about covid19and the development and rollout of thevaccineso we were all um really wanting to hearwhat’s going on and first of all what’sthis virus all aboutand what’s happening with the rolloutof the vaccine and what can we expectso we are really blessed to have ascientist with deep knowledge in thissubject among usum and i really want to welcome racheltous and for those of us who may not knowumrachel is a member rachel and her familyare members of trinitylong-time members of trinity and so it’sa great pleasure for us to have herwith us um so she will start with ashort presentationand then we have time for q ato do the q a we have um collected a fewquestionsfrom members of trinity and i havepassed that on torachel and after that we cananswer other questions um you can ithink it may be a little hardif you raise your hand but you can alsoenter in the chat box and we will bemonitoring thatso without further ado rachelwell thank you um very much this is thisis a nicer audience than i sometimes getsoum it’s nice to talk to everybody sothis issort of uh let me see if i can make thiswork properlycan people see the slides is it thesharing workingyes okay all right um so yeah soso this is uh uhtaken from a presentation or thepresentations i’ve done for communityfolks and soit’s just a couple of slides but ifigured it gets everyone kind of on thesame pageum as to what we’re talking about and sojust to startum this is i know it looks complicatedum in science but this is sort of aprimer on the immune system andmainly the point i want to make is thatthe immune system is a lot morecomplicated than justantibodies um even though that’s what wetalk about a lot and soum this is a model i mean it’s rsv whichis a different virusbut um but another respiratory virusvery much like coronavirusesso it infects and actually your initialimmune response isnot very specific it’s directed againstany sort ofinvasion or danger sort of signal thatthe immune system detectsand you get a lot of inflammatory sortofproteins that that frankly are the samekinds of things that make you feel badlyso so it’s those proteins that make youfeel icky when you get the flu ora cold um and then um you have thesesort of innate immune cells thatinitially kind of limit the damage butcan’t clear the infectionand then you get this acquired immunityum that that you know we always talkabout antibodies and that’sreally really important antibodiesactually prevent the viruslater from from coming in and infectingcells periodbut if cells do get infected then thereare t-cell responsesas well um that are to different partsof the virus and soso that’s just that’s that’s to get uskind of on the same pagethis is just showing just that adaptiveimmune response that specific immuneresponseagainst a pathogen um and so we talk alot about thisthe b cell response and the antibodyresponse butum but there’s a t cell response as wellsoso what we are able to measure easilyclinicallyis the antibody response but but youshould knowthat that your body is much morecomplicated in terms of how the immunesystem actuallyum focuses on a pathogen and and has aspecific immune response so thatif you get vaccinated or if you getinfectedthe next time you see that um yourimmune response is much much faster andreally preventsum you from getting sick the next timeyou you’re um you see that and that’ssort of how a vaccine works so the firsttime you seean infection that’s shown there kind ofon thethe left you make these antibodiesthey’re notactually really great antibodiesinitially and then they um your bodytrains on the pathogen to figure outokaythese are the initial antibodies thatwork and it and it makes them morespecificover time so your immune responsedoes start to occur about seven daysafter exposure to a vaccineor a pathogen and you start to get thatspecific immune response it tends toactuallyimprove over time um andthen the second time you um you’reexposed you have a muchmuch more robust kind of targetedresponseum so vaccines work basicallyby introducing so classically byintroducing a weak or an active formof the infection the virus or thebacteriaum or other pathogen umwhat we’re doing more recently isum as we know more about theseinfections what we’re what we’reactually doing is figuring out what partof the virus[Music]is important and so so for thecoronaviruseswe figure that the spike protein on theoutside of the virusis the most important thing to make animmune response to that seems to beprotective if you have an immuneresponse to the spike proteinand so um then you don’t have tointroduce the whole pathogen and youdon’t have to introduce a weakpathogen that might be problematic forpeople whose immune system is not verystrongor might cause um more disease or sideeffectsyou can just introduce the the the partof the virus thatyou need to make an immune response toand then your body makes thoseantibodiesand also a t cell response and then theyremember it the next time andum and so if you’re exposed a secondtimeum you you have a a good immune responseum not always preventing the exposure orthe infection but preventing you fromgetting sick from itum so the vaccines that arecurrently available moderna and pfizerare mrna vaccines whichwhich is a new kind of vaccine so thereare nocurrently available mrna vaccines forotherinfections but that doesn’t mean thattechnology is new so people have beenworking on rna vaccinesfor at least 10 years so there’s lots ofexperience and lots of trials with rnavaccinesum and this just happened to be thefirst one thatthat really moved forward and andclearly worked very very wellum and so basically it’s a it’s a reallyclean and kind of nice way of doing avaccineyou take the spike protein rna sequencewhich is sort of the blueprintum that your cells need to make thespike proteinum you wrap it up in a little lipidcoating so it gets into your cellsum and then um and then you inject it itgets thethose little lipid balls with the mrnainsideget into your cells make the spikeproteinnow also happen to inducethe sort of danger signalthat your immune system needs to saythis is something i should make animmune response toand um and and then you make theantibodies against the spike proteinyou also make fairly decent t cellresponses against the spike protein aswellso a couple things to remember that theimmune responseum induced by the vaccines is just tothe spike protein not to the entirecoronavirusum and so that becomes important alittle bit laterbut the other thing is mrna never getsincorporated into your dna or your cellsum it gets in it makes the protein andit gets very rapidlydegraded and that that rapid degradationis the reason that thosevaccines need that really cold storagebecause they they don’t last very longonce you thaw them because because thereare ways of degrading that rapidlywhich which is nice it means that it’snot sticking around and causingside effects or other harm umbut but it does mean you need that coldstorageso this is kind of the advantages ofthoserna vaccines umthe the new vaccines that are coming outum from jansen and astrazenecawhich are expected to be um at leastjansen is at the fda and is expected tobeapproved by the end of this monththose are viral vectored vaccines sothere areapproved vaccines the ebola vaccine is aviral vector vaccinethere’s a lot of work that’s been doneon theseeven though they’re called viral vectorsthey’re they’re basicallysort of um weakened cold virusesadenoviruses um they can’t replicatethey can’t cause a cold umso their main goal is then to get thednaum that you need to make the spikeproteininto the cell and um and then they alsoum don’t stick around a long time umand they um they do a good job ofstimulating the innateimmune response and the t and b cellresponse the same asrna vaccines do um so you get goodum immunity um andnone of them sort of integrate into thecell they’re sort of naturally degradedum they stimulate the immune responsepretty quicklythe advantage of the viral vectorvaccines is thatum you don’t need acold cold storage so so they can be inthe refrigerator for three months whichwhich makes them much easier todistribute um so and we’ll talk aboutsome of those in just a little bit sothis isthe spike protein um so if you look onthe left that cartoonhas as is of the coronavirus and thoseblueknobby looking things sticking outthat’s the spike protein so if you thinkof the virus as like a ballall around the outside of it is studdedthese little um spike proteins and soyou could seethat if you had an antibody that thatcould bind to thoseyou would prevent the virus from gettinginto your cells andcausing an infection in the first placeumone of the important parts of that spikeprotein is shown in thesort of blown up version there as thatpurple piece that’s the receptor bindingdomainthat’s the part of the spike proteinthat bindsum to a receptor on your cells calledace2and allows the virus to get into cellsso that’s clearly animportant part of the virus and if youmake antibodies against thatum you know you could see how that thatwould prevent yourum the virus from getting into cells andthen there on the rightum is just one of the early animalstudies withone of the vaccines that was directedagainst the spike protein and you cansee if you use a shamvaccine so a vaccine that doesn’t havethe spike proteinall those black wiggly lines is all thevirus that’s replicating in thoseanimalsand if you vaccinated them um with sothis wasthis was using multiple different sortof slight variants of the spike proteinum and this was one of the really goodones where you saw no replication thenof the virus after you vaccinatedwith the spike protein so just some ofthe animal data therethere’s all sorts of talk about how wemaybe did this way too fastum but but all of the steps umwere gone through including all of theanimal models to demonstrateum that that this was an effective wayofvaccinating um soso there is a little bit of a differenceand i alluded to it before between yourvaccine responseand the antibody response to infectionas a whole because the vaccine is justum just directed at the spike proteinbut you can seein the little cartoon of the virus thatthere are all sorts of otherthings there there’s all sorts of othercolors um includingmatrix protein there’s that red is thenuclear proteinas well as as rna of the virusso um the antibody teststhat people can get commerciallyum were actually made against thenuclear proteinso if you go and get your antibodiescheckedum and you know if you go to an urgentcare or you go to your doctor and yousay i want to knowum if i have antibodies against um thecoronavirusthe those what they’re testing iswhether or not you have antibodiesagainstthe nuclear protein mostly some of thetests are against the spike protein butmost are directed against the nuclearproteinwhich means that if you got vaccinatedyour test will be negative your antibodytest will be negativeso um so it doesn’t make sense to go andget your antibodies checkedafter you’ve been vaccinated becausewe’re not measuring the same thingum and you’ll just make yourself nervousthat you didn’t get a goodimmune response to the vaccine when whenyou really just got the wrong test doneso it’s it’s something that we’rehearing a lot frompeople who are worried about making surethey’re immune thinking well i’ll gocheck mylevels of my antibodies um and you andyou should be aware that the the spikeproteinum that you get vaccinated against isn’tthe same antibody testso um so you’re not you shouldn’t youshouldn’t do itum unless you’re worried that you mayhave been infectedum and you want to see if you’ve had apast infectionfrankly i’m not i’m not sure thatthere’s a whole lot of utility of doingitat this point period except in largescalestudies to see how many people have beeninfectedin a populationso the other thing to knowis um you know a vaccine induces yourbody to havean antibody response an immune responsebut we also have these antibodies thatcan be given as therapyso um so basically they’re sort ofpassively transferring an immuneresponseto somebody who’s currently sick orin some situations who’s been exposedto the virus and so[Music]thosehave some limited efficacy if you givethem to peopleat the right time they can preventpeople from getting sickerif you are already making antibodiesyourselfthey are not additionally helpfulbut it is a treatment that is nowbecoming more availablei think the concern we have is thatthose antibodies were directed againstthe original coronavirus and it’s notclear how well they’re going to continueto work if we get morevariants that that are circulating inthe communityso um but that is something that thatyou could ask yourphysicians about if um despiteall of your efforts to keep from gettingthe coronavirus if you did getsick if you did test positive and you’renot so sick that you need to be in thehospitalum that that that is a treatment that isbecoming availableum through throughout the community soum okay so but back to vaccines umthis was sort of backoh sort of early summer what the timeframe wasfor the different vaccines that we werelooking at and so the initial vaccinesthat were going to be tested were pfizerand modernaum it’s important to know that part ofthe reason that those are the firstvaccines thatcame up is is mainly because they’reactually easyto make so as soon as we knew thesequence of the viruspeople could look at um what thesequence of the spike protein wasmake that rna package it into thoselittle lipidballs and and they were ready to go veryvery quicklythe viral vector vaccines take a littlebit longer because you have to actuallygrow thosein cells because they are they aresimilar to viruses so they need to bereplicated in cells you can’t just makethemum easily in the lab and then thevaccines that areum are probably going to come up alittle bit laterare recombinant protein vaccines sothese are vaccines where you getyou make the spike protein itselfso the body isn’t making it but you’remaking it in a laband then injecting it so it’s a lotharder to makeproteins than it is to make rna orthe dna that you make for a vectorvaccineand so those have been a little slowerto come alongbut then um and then there are there arevaccines that are notas talked about as much in the u.s butone of the chinese vaccinesis an inactivated entire coronaviruskind of like the traditional vaccinesum that we used to give i mean we stillgive them butbut that we used to develop where youjust inactivate the virus you kill thevirus and give the whole virusum the time frame for forvaccines was was the same as it is forany othervaccine or actually any other drugyou initially do you develop the vaccineyou test it in animals youcertify that it is safe and effective inanimal models andthat it is you know that doesn’t haveoff-target effectsand then you do clinical trials andthere’s really three phases to thoseclinical trials phaseone is usually small maybe a couplehundred peoplestudy where we look to see in younggenerally and young healthy peopleare these are these safe and maybe do weget an immune responseso a little bit of safety um and then alittle bitof you know what is the dose that worksbest to get an antibody responseum phase two is moredose responsiveness umand so more um a larger study that’smaybe gota couple hundred people up to a a couplethousand maybeum where you look to see umwhich which um vaccine gives you thebest sort of antibody responsein a population that is a little bitbroader so not just young healthy butbut a more diverse population and thenphase three are the studiesthat we do to really make sure thatsomethingis effective so we’re still collectingdata we’re still collecting informationabouthow how you induce that antibodyresponse but the mainpoint of the phase three studies is doesit prevent people from getting sickum from the vaccine or from the from thevirusafter you get vaccinated um and so thoseare large sort oftens of thousands of people studies andthen after thatit goes to the fda all the data goes tothe fda they take a look at itand the way the fda worked forthis particular for coronaviruses wasthat theyput out information about how to doemergency use authorization becausewe’re under a medical emergencyand so all of these are sort ofindicated as beingstep wise and you wait between them butbut there is a little bit of overlap sothe fdais involved in the design of the studiesthey are looking at the data all alongand for many of these vaccines then thatlarge scale production and distributionactually started way at the verybeginning and soum so these companies were makinglots and lots of vaccines um even beforethey knewum whether or not they would work um andthe governmentsaid we will buy them if they turn outthat they work and they’re safeum and so so there are a couple reasonsthat we could go fastbut all the same steps were in place umso these are the vaccines um thatare currently under emergency youthauthorization the pfizer and the medenavaccinesand and some information so so basicinformation about the vaccines and thenon the side there i have for comparisonum some of the other vaccines thatpeople get all the time and the studiesthat were done to approve thoseso there were 43 000 people enrolled inthe pfizerstudy that went to the fda to getapproval20 000 of them were over age 56i’m not sure why they chose that agegroup but but just so that you knowthese are notonly tested in young healthy people theywere tested inum in older people as well pfizeractually did also do their studies inkids and they’ve extended that as wellnowto see if if these vaccines work in kidsand then about a third werenon-caucasian sopersons of color hispanicblack native populations asianpopulations so non-caucasian populationsthere was a lot of talk initially thatthe vaccine studies were not enrollingenoughdiverse populations so i’m just puttingout the numbers therethat that was recognized early and idon’t think there was as much publicityabout the fact that it was actuallyaddressed and andum and there was a huge diversityactually much better than a lot of otherum clinical trials similar numbers wereseen from modernaum and then you can see that 95 efficacyum i’ll talk a little bit about thatthosethose numbers i think are very confusingto peopleum because they’re not really written instoneso so it’s efficacy based on the timeperiod that you’re looking the number ofcasesand basically how many cases were therein people who got the placebo vaccinehow many cases were there in people whogot the vaccine so you can see there are162 cases in the placeboin eight cases in the vaccine umsuggesting you prevented 95of the cases if if it were zero percenteffective you would see a 162 casesin the vaccine as well and you only saweight soyou prevented that many cases that’swhere you get the 95 percent efficacyand you can see that there were ninesevere casesin um in the placebo arm and one severecase in the vaccine armfor for pfizer um and then the numbersare there for madonna as well very verysimilarum a little bit more cases um in termsof numbermore severe cases um in the placebo armthere umand and no severe cases in the in thevaccinearm in in the modern vaccine umastrazeneca i don’t have all the datathey’ve done multiple studies worldwidebut they are stillthey still haven’t published their datafrom the u.suh run study um that is a 30 000participant study and so we’re we’rewaiting to see what that data looks likejansen just just put out their datathey enrolled 44 000 people uma third of them were over the age of 60.umabout 59 were white45 percent hispanic or latinx 19black and 9 native american so umnice broad population this was enrolledin the ussouth africa and south america um thething that’s different so theeffectiveness on that one that came outis 66against infection and againstsymptomatic infectionum the difference is that they had 468casesand that’s mainly because pfizer andmodena were enrolling their studiesum earlier in the summer and sotheir cases were comingthere in in sort of september octobernovember um and then jansen got was alittle later getting startedum and their cases enrolled sort ofnovember decemberjanuary when um we were in the middle ofthisbig spike and we were starting to seevariants umone of the things to note is that 57efficacy in south africaum 90 of the cases seen in south africawere thewere the variant virus somaybe a little bit less effective atpreventinginfection the other thing that’simportant to note though is thatthat in the vaccine arm i don’t have allthe numbers yet butin the vaccine arm they saw nohospitalizationsand they saw no deaths from covidum in the placebo arm they had fivepeople die from covidum during the study so the pfizer andmodernaum didn’t report anyany patients dying from um from kovadin in either arm soso it’s actually umthere’s more information i think abouthow well jansen works to preventhospitalization and death because therewas more severe disease and more diseaseoverall seenin the dancingso um just just to umcompare if you uh i think probablyseveral folks have gottenthe shingrix vaccinethat study enrolled 15 000 peopleso half to a third of the number ofpeople enrolled in each of theseum coronavirus vaccine studies andum and saw 210 cases howeverit took three and a half years to to dothatum whereas it took um you know fourmonths or so four or five monthsfor each of these studies to enroll andaccumulate cases soso yes it was done more rapidly it wasdone more rapidly becauseum we had tremendous um support from thecommunity and so we hadenrolled you know tens of thousands ofpeople withinum really within about two months umeach of these studies enrolledon all their participants in in aroundtwo monthsum and um and then there was so muchcovert going on that we got the samekind of numbers of casesum that took three and a half years forthe shingrix vaccineum really in you know two to threemonths for umfor the coveted vaccines um so so youcan do things quicklyif you have lots of people enrolling instudiesand you have lots of cases going on umandand that’s part of it and the other wayyou can do things quicklyis if the companies don’t have to spenda lot of timeum proving uhyou know demonstrating that that thingsworkto investors and financiers theythey can instead get the datademonstratethat that by all of the measures um thatwe wouldtypically use that these things work andshould be moved forwardum and the money was already availablesoum so there were hundreds ofof people of companies andindustry and academia trying to developthese vaccineswe just haven’t seen that with any otherinfectious diseasebecause so many people wanted to addressthisso so the other differences between thevaccines or how many doses there are andmost of them are two the jansen vaccinethat was tested is a single dosevaccine the side effects there are sideeffectsthey’re mainly fatigue headache sore armjoint pain[Music]much of which resolves withina day or two and and we’ve seen a coupleof allergic reactions butbut um i think i’ll have a little bitmore on that laterum if you think about the millions ofpeople who’ve gotten the vaccineum the the side effects are are reallyno worse than any other vaccine thatwe’ve seenand then that storage temperature againis is different between the differentvaccinesokay this is the datai think it’s nice to see this becauseit’s really impressive actually so umthe red lineis people who got the vaccine the blueline is people who gota saline injection and then on thaton the graph there on the y-axis is thenumber of people who got sickand so had symptoms and tested positivefor covertand so you can see that um in the firsttwo weeks or so this is the pfizervaccine in the first two weeksthose two lines kind of kind of overlapumand then you just don’t see many morecases out you knowto three months or sowhen they when they stopped it and andum andlooked at the data whereas there’s acontinuation of increasing number ofcasesin the placebo arm um the blow upis just those first 21 days just to showyou kind ofyou start to see that break off around10 days after the initial vaccineso this is an even this vaccine you gettwo dosesone at day zero one at day 21 you cansee that they’re starting to bean effect even before you get the seconddoseand then the same is true for modernayou can see how those two curves reallyreallydifferentiate[Music]you know a little bit before you youactually start to seebefore the second dose so the seconddose for mederano was at day 28 you cansee that those twotwo numbers actually um are those twocurves actuallyum spread apart um before the seconddosei don’t have the data for jansen becauseit’s not been made publicly availableyet butum but the curves look similar actuallyfor jansen as welljust the just the numbers are a littledifferent umso that’s that’s really the main stuffabout the vaccineum there’s some special circumstancesthey didn’t study pregnantpregnant women they didn’t study peoplewho hadimmune suppression um from likemedication or canceror advanced hiv disease or things likethat so they did study people who werehiv infected but they had to bewell controlled and and have pholonormal immune responsesthey did study people who’d had pastcancers but weren’t actively onchemotherapyum and and the main reason um pregnancyisis problematic because there are a lotof extra regulations because we don’twant to exposepregnant women and their and theirbabies um to an untested vaccineand so it’s a little controversialum but um that’sthat’s the way the studies were donethere areno safety concerns for either of thesecircumstancesand the recommendation is if you arepregnant orif you are immune suppressedthat you should get vaccinated ifif you’re otherwise able to if you’re inone of the groups that’s gettingvaccinatedum and and and people are lookingnow there were people who got pregnantthere were women who got pregnanton the pfizer in the mederena trials andthere were no adverse events associatedwithum with getting a vaccine[Music]and then getting pregnant but thereweren’t enough to really say for surehow safe it was but but they didn’t seeany problems with itum we do know for pregnancy thatum that covid is much much more severeso um so it’s best to best to protectyourselfokay i’m going to skip this actuallyunless people have questionsi know people have questions about thevariants right nowthere are there are more and more thetwo that we’ve talked about the most aretheuk variant and the south africanvariants they both have mutations in thespike proteinand the uk one has one in the receptorbinding domainum they both currently appear to beprevented by the vaccines but maybe notquite as well as the original virusstrain the antibodies and convalescentplasma may be somewhat less effectiveagainstthese new strains they do appear to bemore infectiousand i think are part of the reason whywe sawhuge sort of spikes in numbers of peopleand being infectedin the uk and in south africathey are um they are present in the usumand are now being tracked it’s a littleunclear i thinkstill if they’re more umdangerous if they cause if they have ahigher mortality rate than theiroriginal strainsum the thought is that these are maybearising in people who havein immune systems that are not effectiveatpreventing and clearing the infectionand they have sort of long-term sheddingand the virus is actually mutatedwhat we don’t know is is is this goingto continue to happenare we going to have variants thateventually completelynegate the effectiveness of the vaccinei think those are allum things that people are concernedabout butbut we really don’t know yet whether ornot that’s going to happenpart of the reason i wanted to tell youa little bit about the immune system isis just that thatthat it’s not just the antibodies so theantibodies definitely decreaseafter you get infected but we can detectand that’sthere we can detect t cell responsesand and long lived b cell responsessix even nine months afterum infection um we’re and we’ll belooking at thatin the vaccines as well so even withantibody levels decreasedthe immune system has sort of squirreledaway informationum to protect you moving forward umso overall you know the vaccines um thatthat have gotten eua are an underconsideration for itthey were large scale studies um theyhave efficacythey work just as well as most commonlyused vaccines in factif we ever had a flu vaccine that workedas well as eveneven the the jansen vaccine or even someof the vaccines that we that we thinkhaven’t worked very well in this if wehad a flu vaccine that worked out wellwe’d bejumping up and down for joy so um theythey appear to be just as safe um[Music]i think people worry about that a littlebitin terms of we don’t have long term databut in reality forfor the currently used vaccines mostside effects from vaccines actuallyhappenin the first two months aftervaccination so we don’t seeside effects from vaccines becausethey’re goneessentially there’s there’s no um partof the vaccine leftum in the body after really a couple ofdaysand and so um so we don’ttypically see side effects that occurredyou know years laterso they haven’t been studied in peoplewho arepregnant or immune suppressed but but weare getting data on that already[Music]there are a lot of things going on insocial mediaum about um the covered vaccines maybehavinguh microchips uh it doesn’t make sensethey’re multi-dose vials i don’t knowhow you wouldmanage to get the microchip and knowwhich person you injected into if you’retaking five or six or seven doses out ofa single vialum also i would think you would see themicrochip and we don’t make them thatsmall andpeople really wanted to track you theywould probably use your phone anywaysum there’s also a social media thingthat says that they cause infertilityum and and it doesn’t make any sense atall so and there’s no dataand clearly people have gotten pregnantafter they’ve gotten the vaccine soanyways i’m gonna end that the thestop the sharing and then we can we cananswer questionsum or however you wanna do this georgeum thank you rachel that’s great umuh you i know you have already answeredsome of the questionsthat came in um if you could go throughuh you know whichever you feel likeanswering umplease go ahead and that might enlightenus a little bit moreand then people can um chime in and askquestions as wellyeah so okay so one of the firstquestions and i think this isum infection rates and deaths seem to begoing downare we doing something right wellhopefully um what does the spring looklike i wish i had a better crystal ballum so there are a couple things going oni i thinkum we have been doing something right ithinkthat it’s clear that more and morepeople are wearing masksum there definitely have been you knowthethe uptake for vaccines has been umyou know it’s been it’s been problematici think getting it rolled outum in a in a reasonable way umand part of that has to do with the factthat the storage is complicated and thedistribution is complicatedum the other thing to think about isthat coronaviruses are winter virusesand so so i think umthe the winter um spike that we’ve beengettingum could also be in part predicted bythe fact thatthat this is the season where you seecoronavirus infectionsum and so i think the combination ofpeople getting vaccinated and theweather getting warmershould make the spring better i thinkmoving on to the second question andsort oftaking it from there the variance couldmake that a little bit more complicatedso what we don’t know is if the variancetook offand spread um would would thatcause a spike like they saw in the uk umso i i think that’s i think that’s thereason why the public health messaging ithink sometimes feels a little confusingbecause we saythe you know get the vaccine the vaccineis our way out of thisbut then once you get the vaccine we sayyou still have to wear a mask and youstill have to socially distance andstill do all the same thingsi think frankly until we get bettercontrol ofof this we should do everythingthat we know works um and then when wesee the numbers continue to go down andwhen we see what happens with thevarianceum you know that that we can start toopen things backup um and umif if you get the vaccine it’s clearthat even the south africa variant isstill provides um there’s stillprotection from thatagainst severe disease and death so themain the vaccine really prevents youfrom gettingreally sick which is what we really needto get past thisum i don’t think we’re going to make thecoronavirus go awayi don’t think covet’s going to wait itgoing to go away period butum but i do think we can get to a pointwhereum where it becomes more likethe flu or orthe seasonal coronaviruses where if wecan protect the people who are reallyreally at high riskby vaccinating them that that we canstart to be able to treat this i thinkalsoit’s clear that the hospitals havegotten better at treating covidand that if they’re not overwhelmed thenthe mortality rategoes down um there’s a question aboutwhy the vaccine rollout is being done sopoorly idon’t have a good answer for that exceptthati think it is really complicatedum and we have notfunded our public health system umover you know the past years and decadesthe way we probably shouldum i think to some extent the publichealth system is the victim of its ownsuccess so we had a better public healthsystemyou know back decades ago when there wasstill a lot of syphilis andtuberculosis and and other infectiousdiseasesthat we needed to deal with asthose infection rates went down wefigured okay we’re fine we canwe can start cutting um the publichealthum infrastructure and i think it’s clearthat umwe we need to be better ready as acountryto deal with this kind of these kind ofpandemicsi i do think there’s infrastructure thatthat was available to do for example todo the vaccine studies there waspre-existing infrastructureand that’s partly why that actuallyworked really really wellbut there wasn’t as much pre-existinginfrastructure for[Music]for distribution of vaccines on a publichealth measure umand that’s why that has not gone as wellso it it’s a matter of sort of fundingand priorities andand so on so umthere’s a question about long-termeffects of covad i think people arestilltrying to understand that there thereare post-infectiousum long-term effects of a lot ofinfectious diseasesum that are you know seem to be sort oflingeringum side effects umi i think we’re still trying to figureoutwhat those are um and what’s the bestway to treat themit’s not clear that they’re infectiousyou know that that they happen longlong time after the virus is goneum and you knowum we have difficulty i thinksometimes in in then treating somethingwhere we don’tunderstand how it works umwhat i’ve told people there are someclinicsum that that are in the communitythat are following what they call longhaulers people who havechronic symptoms um months after they’vegotten over coveredsome of it is if you’ve got very verysevere covet and you were in the icu fora monthum it doesn’t doesn’t matter whatdisease you get if you’re in the icu fora monthit’s probably going to take you you knowa year or more to recover from thatum it’s just a sort of debilitatingboth to your body and to your brain andyou know what we tell people is todo the same kinds of things that we tellpeople to stay healthy in general youknowmake sure you’re getting enough sleepmake sure you’re gettingexercise to the extent you can make surethat you’re eating healthyand and and unfortunately we don’t havea whole lot more than that althoughit’s always reasonable to tosee somebody in one of these long haulerclinics soum when will life return to normal idon’t know what normalis gonna be um there arei i think um it’s muchit’s it’s likely that schools willreturnin a much more normal sort of way in thefallum to what extent are we going to needto continue to wear masksi i don’t know i think eventuallyum we can maybe stop wearing masks umsome of the timei will tell you that we have had likenothing of a flu season this year somasks actually work for otherrespiratory viruses very very welland so we may not have completelyknocked kovad but wedid knock the flu by wearing masks soum i think there is some thought thatmaybe it’s not an unreasonable thingum to wear a mask in the winter virusseasonsum you know when you’re when you’re inlarge groups and large crowds and so onum best informationfor the disease so there are a lot ofgood websites socdc puts out good information johnshopkinshas a great um dashboard that gives youinformation aboutabout um the umthe sort of progress and and bothvaccination andinfection um and then umactually the new york times has somereally nice stuff as well sothose are the three places that i likewhen i want like athing and and actually um i think boththe city and the county healthdepartments now havedecent websites that tell you um how toget vaccinated how to you know what’sgoing on with the disease andand and get good information soum what surprised me the mostum i guess what surprised me the most ishow political it gotuh you know umit it seems like seems like it shouldn’thave gotten politicalit seemed like we were all sort ofshould have been fighting the same viruswith the sameum sort of scientific informationum and i think so i think that’s whatsurprised me the mostanyways okay i’ll let other people talki’m sorryokay so um you can raise your hand orjust ask question i thinkmaybe you can hear i seeyeah i don’t see anything in the chatsi have a question george umis this going to be like the flu wherewe’ll need to get some kind of a shotevery year and if so like when wouldthat startso for example i’m getting my secondshot this week when would i need to getanother one orhave they even looked at that yet ithink we don’t knowum i don’t think this is going to belike the fluum coronaviruses don’t change the sameway the flu doesum so the flu actually umchanges everyyou know the way it replicates itchangesits surface proteins every year um andsowe know that the vaccine doesn’t workfor the next year you need to keepupdating it um so myexpectation is umthat we may need to cover the varianceumand we may figure out because this hashappened with other vaccines we mayfigure outwe need a booster and you knowhopefully it would be a booster you knowin a year umit does look like immunity you know ishowed that the immunity starts actuallyfairly early butit does appear that immunity continuesto improve actually after the vaccineum you know for the first three monthssix months or so part of it is we justdon’t have that information yetso i don’t think we can say for sure idon’t think this is going to beanother shot that you get annually likelike the flu vaccinebut i think we may need a booster we mayneed to covervariants as they come upoh it looks like there’s something aboutumother countries in europe doing withvaccines they’ve not done as welleven as we have i think it’s improvingsoit’s uh you knowinfrastructure for doing these and andgetting this done has been highlyvariableum getting access to the vaccines hasbeen somewhat variableum i think there is a concern that we’regoing to wind up you knowthat rich countries are buying up thevaccinesum and i really do think the hope wasthat um that jansen and astrazenecaum would be effective um there’s someconcern about astrazeneca not being aseffectiveagainst the uk strain not uk against thesouth african strainand so south africa had a ton ofastrazeneca vaccine to give their folksand thenpull back on it so um both of thosevaccine platforms and those companieshave um have avaccine have given like theinfrastructure to give the vaccineum throughout africa because they werethey were using them for the ebolavaccination um processright so there’s a question from nigelumwhat’s the best arguments against uhvaccine skepticsyeah i think i think it’s mainly justtalking to them and finding out whattheir concerns areum so what i’ve heard mainly from peopleso i mean if you have somebody who um isjusta rabid anti-vaccine kind of person ithink that’s going to be hard if they’venever gotten a flu vaccineyou’re probably not going to talk theminto a coveted vaccineif they you know really do think thatthey’re going to be umthat there’s going to be a a trackerthat the government is going to attractthem withif they get a covered vaccine if theydon’t you know if youif you can’t get past that the mainthing that i’ve seen is that peoplejust don’t they think it was done toofast and they think it was politicalum and um and i think just theinformation umthe that these were done with morepeople thanother vaccine vaccine studies that thatareyou know for commonly given vaccineslike shingrix and hepatitis vaccines andthe pneumovax and you know all thesevaccines that we give people all thetimeif you let people know like no no nothis was not doneum in a smaller group this was done withmore people and there were moreum there’s more data about how well theyworkum also um what i’ve heard from a lot ofpeople iswell i i’m not i’m not gonna be thefirst one to get the vaccine in generalwhat i tell them is oh you are far fromthe first likethis has been in you know millions ofpeople at this point and we just want tomake sure thatthat you have access and that you’re inline soum other thing on several lists do ihave any websites where you could signup for vaccinesi don’t have good umi think it’s i think you still have tofind the differentvaccine um you know sign up with youryou know if your mercy or bjc oror ssm they all have[Music]a sort of list that you can sign up onthe county and the city havelists as well you know i i think that ispart of the problem hopefully eventuallythis is going to wind up being inum in uh[Music]in you know your local walgreens and andbe easier to get but it’s going to takea while before it gets to that pointum there’s a question aboutre-transmissionby vaccinated individuals yeah soum so it is clear that vaccine doesn’tprevent you from gettinginfected it prevents you from gettingsickum and um and so there isconcern that vaccinated people couldstill get sickand um not sick could still get infectedcould still shed the virus andpotentially pass it on to other peopleand that’s why that’s whywe tell people after they get vaccinatedto still wear a maskso the masks have never been to protectthey’re a little bit to protect youthe masks are mainly to protecteverybody around you so it’s a publichealth thingbecause the masks work very well toprevent you from transmitting to otherpeoplethey work slightly less well at yougetting thevirus from from somebody else who’s notwearing a maskso um if everyone wears a mask then youget that double protection and peopleare most protected in thatsituation um and then there’s a questionabout umwhy didn’t this virus disappear and whenstars immerse didum some of that had to do with the factthat sars and merswere there well two things one they weremuch morevirulent um than kovidso they had a higher mortality rate andand wetend to see that umand um if if somethingkills people too quickly it often killspeople too quickly for them to pass italong to too many other peopleum and um so there’s there’s that butthen the otherthing is um it is pretty clear thatpeople areinfectious their like peak of infectionum risk for transmitting covadum occurs um just before they’resymptomaticwhereas stars and mers you weren’treally um you weren’t reallytransmitting until you got really sickum and so then you can tell people ifyou’ve got a fever if you feel sickstay home whereas um you are probably ifyou’ve gotten covered you may betransmitting to people for several daysbefore you even know you have covetum and so so i think i think that’sthat’s what was happening wasit just made it much harder to actuallycontrol it and now it’s in so much ofthe populationum it’s likely to become like one of theseasonal coronaviruses where we’llalways have it buthopefully less virulent less of a of apublic health problemum if you’ve had covid you shouldcontinue to wear a maskit’s it’s clear that if you’ve had covedthat you aresomewhat protected from getting covetedagain but not completely so you can getinfected again you could get infectedthe same way asas people have been vaccinated you couldget infected and not have symptoms andthentransmit so you should be wearing a maskso that you can protect other peopleso um anyone else have a questionany any hands up or i don’t see anythingmore in chattim your question was answereduh yes it was okay sorachel i just put it in the chat but ummaybe you could talk a little bit moreabout the recent cdc advice for doublemaskingyeah um soi think we should be practical with thisso umi double masking clearly um works betterum a lot of it depends on what kind ofmask you’re using soyou nobody should be double masking ann95 that ishorribly uncomfortable and unnecessaryumthe n95s actually it has to do with sortof layer of filters so n95s actuallyhave multiple layers in themand some of the surgical masks that theyuse in the hospital also have multiplelayersin that single mask so the issue reallycomes up withum with if you’ve bought the surgicaltype masksyou know online and you’re maybe not ascertain about thethe quality of it um the double maskingwhat seems to work besti think about it is that it fits bettersoso the the mask should cover your yournose and your mouth um and you shouldn’thave air coming up the top or coming outthe sides because then it’s not doingany good it’s going it’s still goingum you know the idea is you don’t wantto breathethe same air that other people arebreathing and so you want to bebreathing through the maskso what happens is if you use a surgicalkind of maskbut it has gaps on the side and then youuse a cloth mask that fits better overitum you’re you’re more likely to have itkind of tailored to your facein a way that um that umthat protects you better um that beingsaidif the mask is making you souncomfortablethat you can’t breathe or that you haveto keep taking it down to talk to peopleorto feel comfortable then that’s notdoing you any good at all if you have totake itdown so ifi think what some people have said andthe other thing is people say that ithurts their earsum which i totally understand um whatyou can do there are the masks that tiebehind your head sometimes i think findpeople find those more comfortableand find it easier to get those to fitin a way thatthat um that actually covers your mouthand your nose umso yeah i think if you’re you know ifyou are if you are mainly staying athomeand you know you want to you’re goingout um to a placelike a grocery store you’re going outsomeplace where you’re worriedum and it’s a limited time frame and youcan do it comfortably withoutwithout feeling like umyou know you’re you’re suffocating umthen it’s probably a good idea to doublemaskand then for us sort of lay people doyou sort of consider the kn 95s to bealmost equivalent for a to an n95 for alaypersonyeah yeah i mean they’re not exactly thesame but but they’re probably andthey’re it’s going to be uncomfortableto wear something in addition to a kand 95. um so um yeah if it fits to yourfaceand you don’t feel um if you don’t feelair coming upyou know up to your eyes and out the toyour cheeksyou know so if you can breathe if youbreathe in and out and you can feel themask moving in and out and not air goingout the sidesthen it’s fitting well and and it’sprobably effectivewhat about people like brian and me whohave beardsyeah so the n95s don’t work very wellwhen people have beards because it doessort of leak out and so then you mightwant to think aboutum you know if you can get it to kind ofcover or if you you knowthose are the situations where like themasks that have a tiesometimes will fit better okay thanksum i think we are at five o’clock but umrachel before we go i’d like to therewas one question that came infrom uh trinity that i like to askwhich is really about the um healthcareworkersum and you know those you you guys whoareare for the last one year have beendoing the heavy liftingand um the question was umhow can we be advocates or how can wesupportwhat what can be doneyeah you know um i think what hurthealthcare brokersthe most was was people not you know notwearing masks and not taking thingsseriouslyum you know because you feel like umand and people saying things like it’sjust a coldum you know uh that we’re overreactingoveror we’re we’re doing something umyou know when if you’ve been in the icuand andyou’ve seen people dying then you knowit’s sort of anextra sort of um pain to have people saythis is not this is not that big of adeal umand so you know one of the things thatreally upset me always was that peopleare like it’sit’s it’s just like the flu and i’m likewell you know theflu is actually pretty bad too we we seepeople die from the flu as well soum so so that that kind of stuff youknowum but otherwise i feel likehealthcare workers have actually gottena lot of supportum andyou know the the people that i feel likewe should be supportingare you know the grocery store workersand the delivery drivers andum and you know and the thethe folks in sort of um emt andand um police and stuffuh you know who who who still are arebeingeven the people working in restaurantsum soso i think you know be kind be kind toto um other people recognize thatthat everyone’s sort of dealing withthis their own way and andum and then be patient i thinkyou know um we all we all want to getback tosomething normal um and umi i i think we’ve gotten a lot of loveandfrom the community and and i i really doappreciate it sookay well thank you very much rachelthis has been wonderful umi really appreciate within it in yourbusy schedule toyou know that we were able to find thisone hour tohave your time with us so we appreciateit thank you very muchthank you very much thank you all forjoining me todayit’s nice to see everybody
