COVID-19 Updates

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 a
good group and uh we could uh have a
similar group in
all the adult education in the future
that’ll be great um
i want to take a minute to uh welcome
somebody we
all know well rachel prestige dr
with washington university she is the
associate professor of medicine and
also the medical director of the
infectious disease
clinical research unit as well as the
principal investigator of the nih aids
clinical trials at warship
so she got her md and phd at washu
and her clinical and research interests
and her publications cover a wide
in the field of infectious diseases
improving the care of hiv infected
who are co-infected with emerging
but many of us have seen dr presti
during the past year
on the television and on other news
answering questions about covid19
and the development and rollout of the
so we were all um really wanting to hear
what’s going on and first of all what’s
this virus all about
and what’s happening with the rollout
of the vaccine and what can we expect
so we are really blessed to have a
scientist with deep knowledge in this
subject among us
um and i really want to welcome rachel
us and for those of us who may not know
rachel is a member rachel and her family
are members of trinity
long-time members of trinity and so it’s
a great pleasure for us to have her
with us um so she will start with a
short presentation
and then we have time for q a
to do the q a we have um collected a few
from members of trinity and i have
passed that on to
rachel and after that we can
answer other questions um you can i
think it may be a little hard
if you raise your hand but you can also
enter in the chat box and we will be
monitoring that
so without further ado rachel
well thank you um very much this is this
is a nicer audience than i sometimes get
um it’s nice to talk to everybody so
this is
sort of uh let me see if i can make this
work properly
can people see the slides is it the
sharing working
yes okay all right um so yeah so
so this is uh uh
taken from a presentation or the
presentations i’ve done for community
folks and so
it’s just a couple of slides but i
figured it gets everyone kind of on the
same page
um as to what we’re talking about and so
just to start
um this is i know it looks complicated
um in science but this is sort of a
primer on the immune system and
mainly the point i want to make is that
the immune system is a lot more
complicated than just
antibodies um even though that’s what we
talk about a lot and so
um this is a model i mean it’s rsv which
is a different virus
but um but another respiratory virus
very much like coronaviruses
so it infects and actually your initial
immune response is
not very specific it’s directed against
any sort of
invasion or danger sort of signal that
the immune system detects
and you get a lot of inflammatory sort
proteins that that frankly are the same
kinds of things that make you feel badly
so so it’s those proteins that make you
feel icky when you get the flu or
a cold um and then um you have these
sort of innate immune cells that
initially kind of limit the damage but
can’t clear the infection
and then you get this acquired immunity
um that that you know we always talk
about antibodies and that’s
really really important antibodies
actually prevent the virus
later from from coming in and infecting
cells period
but if cells do get infected then there
are t-cell responses
as well um that are to different parts
of the virus and so
so that’s just that’s that’s to get us
kind of on the same page
this is just showing just that adaptive
immune response that specific immune
against a pathogen um and so we talk a
lot about this
the b cell response and the antibody
response but
um but there’s a t cell response as well
so what we are able to measure easily
is the antibody response but but you
should know
that that your body is much more
complicated in terms of how the immune
system actually
um focuses on a pathogen and and has a
specific immune response so that
if you get vaccinated or if you get
the next time you see that um your
immune response is much much faster and
really prevents
um you from getting sick the next time
you you’re um you see that and that’s
sort of how a vaccine works so the first
time you see
an infection that’s shown there kind of
on the
the left you make these antibodies
they’re not
actually really great antibodies
initially and then they um your body
trains on the pathogen to figure out
these are the initial antibodies that
work and it and it makes them more
over time so your immune response
does start to occur about seven days
after exposure to a vaccine
or a pathogen and you start to get that
specific immune response it tends to
improve over time um and
then the second time you um you’re
exposed you have a much
much more robust kind of targeted
um so vaccines work basically
by introducing so classically by
introducing a weak or an active form
of the infection the virus or the
um or other pathogen um
what we’re doing more recently is
um as we know more about these
infections what we’re what we’re
actually doing is figuring out what part
of the virus
is important and so so for the
we figure that the spike protein on the
outside of the virus
is the most important thing to make an
immune response to that seems to be
protective if you have an immune
response to the spike protein
and so um then you don’t have to
introduce the whole pathogen and you
don’t have to introduce a weak
pathogen that might be problematic for
people whose immune system is not very
or might cause um more disease or side
you can just introduce the the the part
of the virus that
you need to make an immune response to
and then your body makes those
and also a t cell response and then they
remember it the next time and
um and so if you’re exposed a second
um you you have a a good immune response
um not always preventing the exposure or
the infection but preventing you from
getting sick from it
um so the vaccines that are
currently available moderna and pfizer
are mrna vaccines which
which is a new kind of vaccine so there
are no
currently available mrna vaccines for
infections but that doesn’t mean that
technology is new so people have been
working on rna vaccines
for at least 10 years so there’s lots of
experience and lots of trials with rna
um and this just happened to be the
first one that
that really moved forward and and
clearly worked very very well
um and so basically it’s a it’s a really
clean and kind of nice way of doing a
you take the spike protein rna sequence
which is sort of the blueprint
um that your cells need to make the
spike protein
um you wrap it up in a little lipid
coating so it gets into your cells
um and then um and then you inject it it
gets the
those little lipid balls with the mrna
get into your cells make the spike
now also happen to induce
the sort of danger signal
that your immune system needs to say
this is something i should make an
immune response to
and um and and then you make the
antibodies against the spike protein
you also make fairly decent t cell
responses against the spike protein as
so a couple things to remember that the
immune response
um induced by the vaccines is just to
the spike protein not to the entire
um and so that becomes important a
little bit later
but the other thing is mrna never gets
incorporated into your dna or your cells
um it gets in it makes the protein and
it gets very rapidly
degraded and that that rapid degradation
is the reason that those
vaccines need that really cold storage
because they they don’t last very long
once you thaw them because because there
are ways of degrading that rapidly
which which is nice it means that it’s
not sticking around and causing
side effects or other harm um
but but it does mean you need that cold
so this is kind of the advantages of
rna vaccines um
the the new vaccines that are coming out
um from jansen and astrazeneca
which are expected to be um at least
jansen is at the fda and is expected to
approved by the end of this month
those are viral vectored vaccines so
there are
approved vaccines the ebola vaccine is a
viral vector vaccine
there’s a lot of work that’s been done
on these
even though they’re called viral vectors
they’re they’re basically
sort of um weakened cold viruses
adenoviruses um they can’t replicate
they can’t cause a cold um
so their main goal is then to get the
um that you need to make the spike
into the cell and um and then they also
um don’t stick around a long time um
and they um they do a good job of
stimulating the innate
immune response and the t and b cell
response the same as
rna vaccines do um so you get good
um immunity um and
none of them sort of integrate into the
cell they’re sort of naturally degraded
um they stimulate the immune response
pretty quickly
the advantage of the viral vector
vaccines is that
um you don’t need a
cold cold storage so so they can be in
the refrigerator for three months which
which makes them much easier to
distribute um so and we’ll talk about
some of those in just a little bit so
this is
the spike protein um so if you look on
the left that cartoon
has as is of the coronavirus and those
knobby looking things sticking out
that’s the spike protein so if you think
of the virus as like a ball
all around the outside of it is studded
these little um spike proteins and so
you could see
that if you had an antibody that that
could bind to those
you would prevent the virus from getting
into your cells and
causing an infection in the first place
one of the important parts of that spike
protein is shown in the
sort of blown up version there as that
purple piece that’s the receptor binding
that’s the part of the spike protein
that binds
um to a receptor on your cells called
and allows the virus to get into cells
so that’s clearly an
important part of the virus and if you
make antibodies against that
um you know you could see how that that
would prevent your
um the virus from getting into cells and
then there on the right
um is just one of the early animal
studies with
one of the vaccines that was directed
against the spike protein and you can
see if you use a sham
vaccine so a vaccine that doesn’t have
the spike protein
all those black wiggly lines is all the
virus that’s replicating in those
and if you vaccinated them um with so
this was
this was using multiple different sort
of slight variants of the spike protein
um and this was one of the really good
ones where you saw no replication then
of the virus after you vaccinated
with the spike protein so just some of
the animal data there
there’s all sorts of talk about how we
maybe did this way too fast
um but but all of the steps um
were gone through including all of the
animal models to demonstrate
um that that this was an effective way
vaccinating um so
so there is a little bit of a difference
and i alluded to it before between your
vaccine response
and the antibody response to infection
as a whole because the vaccine is just
um just directed at the spike protein
but you can see
in the little cartoon of the virus that
there are all sorts of other
things there there’s all sorts of other
colors um including
matrix protein there’s that red is the
nuclear protein
as well as as rna of the virus
so um the antibody tests
that people can get commercially
um were actually made against the
nuclear protein
so if you go and get your antibodies
um and you know if you go to an urgent
care or you go to your doctor and you
say i want to know
um if i have antibodies against um the
the those what they’re testing is
whether or not you have antibodies
the nuclear protein mostly some of the
tests are against the spike protein but
most are directed against the nuclear
which means that if you got vaccinated
your test will be negative your antibody
test will be negative
so um so it doesn’t make sense to go and
get your antibodies checked
after you’ve been vaccinated because
we’re not measuring the same thing
um and you’ll just make yourself nervous
that you didn’t get a good
immune response to the vaccine when when
you really just got the wrong test done
so it’s it’s something that we’re
hearing a lot from
people who are worried about making sure
they’re immune thinking well i’ll go
check my
levels of my antibodies um and you and
you should be aware that the the spike
um that you get vaccinated against isn’t
the same antibody test
so um so you’re not you shouldn’t you
shouldn’t do it
um unless you’re worried that you may
have been infected
um and you want to see if you’ve had a
past infection
frankly i’m not i’m not sure that
there’s a whole lot of utility of doing
at this point period except in large
studies to see how many people have been
in a population
so the other thing to know
is um you know a vaccine induces your
body to have
an antibody response an immune response
but we also have these antibodies that
can be given as therapy
so um so basically they’re sort of
passively transferring an immune
to somebody who’s currently sick or
in some situations who’s been exposed
to the virus and so
have some limited efficacy if you give
them to people
at the right time they can prevent
people from getting sicker
if you are already making antibodies
they are not additionally helpful
but it is a treatment that is now
becoming more available
i think the concern we have is that
those antibodies were directed against
the original coronavirus and it’s not
clear how well they’re going to continue
to work if we get more
variants that that are circulating in
the community
so um but that is something that that
you could ask your
physicians about if um despite
all of your efforts to keep from getting
the coronavirus if you did get
sick if you did test positive and you’re
not so sick that you need to be in the
um that that that is a treatment that is
becoming available
um through throughout the community so
um okay so but back to vaccines um
this was sort of back
oh sort of early summer what the time
frame was
for the different vaccines that we were
looking at and so the initial vaccines
that were going to be tested were pfizer
and moderna
um it’s important to know that part of
the reason that those are the first
vaccines that
came up is is mainly because they’re
actually easy
to make so as soon as we knew the
sequence of the virus
people could look at um what the
sequence of the spike protein was
make that rna package it into those
little lipid
balls and and they were ready to go very
very quickly
the viral vector vaccines take a little
bit longer because you have to actually
grow those
in cells because they are they are
similar to viruses so they need to be
replicated in cells you can’t just make
um easily in the lab and then the
vaccines that are
um are probably going to come up a
little bit later
are recombinant protein vaccines so
these are vaccines where you get
you make the spike protein itself
so the body isn’t making it but you’re
making it in a lab
and then injecting it so it’s a lot
harder to make
proteins than it is to make rna or
the dna that you make for a vector
and so those have been a little slower
to come along
but then um and then there are there are
vaccines that are not
as talked about as much in the u.s but
one of the chinese vaccines
is an inactivated entire coronavirus
kind of like the traditional vaccines
um that we used to give i mean we still
give them but
but that we used to develop where you
just inactivate the virus you kill the
virus and give the whole virus
um the time frame for for
vaccines was was the same as it is for
any other
vaccine or actually any other drug
you initially do you develop the vaccine
you test it in animals you
certify that it is safe and effective in
animal models and
that it is you know that doesn’t have
off-target effects
and then you do clinical trials and
there’s really three phases to those
clinical trials phase
one is usually small maybe a couple
hundred people
study where we look to see in young
generally and young healthy people
are these are these safe and maybe do we
get an immune response
so a little bit of safety um and then a
little bit
of you know what is the dose that works
best to get an antibody response
um phase two is more
dose responsiveness um
and so more um a larger study that’s
maybe got
a couple hundred people up to a a couple
thousand maybe
um where you look to see um
which which um vaccine gives you the
best sort of antibody response
in a population that is a little bit
broader so not just young healthy but
but a more diverse population and then
phase three are the studies
that we do to really make sure that
is effective so we’re still collecting
data we’re still collecting information
how how you induce that antibody
response but the main
point of the phase three studies is does
it prevent people from getting sick
um from the vaccine or from the from the
after you get vaccinated um and so those
are large sort of
tens of thousands of people studies and
then after that
it goes to the fda all the data goes to
the fda they take a look at it
and the way the fda worked for
this particular for coronaviruses was
that they
put out information about how to do
emergency use authorization because
we’re under a medical emergency
and so all of these are sort of
indicated as being
step wise and you wait between them but
but there is a little bit of overlap so
the fda
is involved in the design of the studies
they are looking at the data all along
and for many of these vaccines then that
large scale production and distribution
actually started way at the very
beginning and so
um so these companies were making
lots and lots of vaccines um even before
they knew
um whether or not they would work um and
the government
said we will buy them if they turn out
that they work and they’re safe
um and so so there are a couple reasons
that we could go fast
but all the same steps were in place um
so these are the vaccines um that
are currently under emergency youth
authorization the pfizer and the medena
and and some information so so basic
information about the vaccines and then
on the side there i have for comparison
um some of the other vaccines that
people get all the time and the studies
that were done to approve those
so there were 43 000 people enrolled in
the pfizer
study that went to the fda to get
20 000 of them were over age 56
i’m not sure why they chose that age
group but but just so that you know
these are not
only tested in young healthy people they
were tested in
um in older people as well pfizer
actually did also do their studies in
kids and they’ve extended that as well
to see if if these vaccines work in kids
and then about a third were
non-caucasian so
persons of color hispanic
black native populations asian
populations so non-caucasian populations
there was a lot of talk initially that
the vaccine studies were not enrolling
diverse populations so i’m just putting
out the numbers there
that that was recognized early and i
don’t think there was as much publicity
about the fact that it was actually
addressed and and
um and there was a huge diversity
actually much better than a lot of other
um clinical trials similar numbers were
seen from moderna
um and then you can see that 95 efficacy
um i’ll talk a little bit about that
those numbers i think are very confusing
to people
um because they’re not really written in
so so it’s efficacy based on the time
period that you’re looking the number of
and basically how many cases were there
in people who got the placebo vaccine
how many cases were there in people who
got the vaccine so you can see there are
162 cases in the placebo
in eight cases in the vaccine um
suggesting you prevented 95
of the cases if if it were zero percent
effective you would see a 162 cases
in the vaccine as well and you only saw
eight so
you prevented that many cases that’s
where you get the 95 percent efficacy
and you can see that there were nine
severe cases
in um in the placebo arm and one severe
case in the vaccine arm
for for pfizer um and then the numbers
are there for madonna as well very very
um a little bit more cases um in terms
of number
more severe cases um in the placebo arm
there um
and and no severe cases in the in the
arm in in the modern vaccine um
astrazeneca i don’t have all the data
they’ve done multiple studies worldwide
but they are still
they still haven’t published their data
from the u.s
uh run study um that is a 30 000
participant study and so we’re we’re
waiting to see what that data looks like
jansen just just put out their data
they enrolled 44 000 people um
a third of them were over the age of 60.
about 59 were white
45 percent hispanic or latinx 19
black and 9 native american so um
nice broad population this was enrolled
in the us
south africa and south america um the
thing that’s different so the
effectiveness on that one that came out
is 66
against infection and against
symptomatic infection
um the difference is that they had 468
and that’s mainly because pfizer and
modena were enrolling their studies
um earlier in the summer and so
their cases were coming
there in in sort of september october
november um and then jansen got was a
little later getting started
um and their cases enrolled sort of
november december
january when um we were in the middle of
big spike and we were starting to see
variants um
one of the things to note is that 57
efficacy in south africa
um 90 of the cases seen in south africa
were the
were the variant virus so
maybe a little bit less effective at
infection the other thing that’s
important to note though is that
that in the vaccine arm i don’t have all
the numbers yet but
in the vaccine arm they saw no
and they saw no deaths from covid
um in the placebo arm they had five
people die from covid
um during the study so the pfizer and
um didn’t report any
any patients dying from um from kovad
in in either arm so
so it’s actually um
there’s more information i think about
how well jansen works to prevent
hospitalization and death because there
was more severe disease and more disease
overall seen
in the dancing
so um just just to um
compare if you uh i think probably
several folks have gotten
the shingrix vaccine
that study enrolled 15 000 people
so half to a third of the number of
people enrolled in each of these
um coronavirus vaccine studies and
um and saw 210 cases however
it took three and a half years to to do
um whereas it took um you know four
months or so four or five months
for each of these studies to enroll and
accumulate cases so
so yes it was done more rapidly it was
done more rapidly because
um we had tremendous um support from the
community and so we had
enrolled you know tens of thousands of
people within
um really within about two months um
each of these studies enrolled
on all their participants in in around
two months
um and um and then there was so much
covert going on that we got the same
kind of numbers of cases
um that took three and a half years for
the shingrix vaccine
um really in you know two to three
months for um
for the coveted vaccines um so so you
can do things quickly
if you have lots of people enrolling in
and you have lots of cases going on um
and that’s part of it and the other way
you can do things quickly
is if the companies don’t have to spend
a lot of time
um proving uh
you know demonstrating that that things
to investors and financiers they
they can instead get the data
that that by all of the measures um that
we would
typically use that these things work and
should be moved forward
um and the money was already available
um so there were hundreds of
of people of companies and
industry and academia trying to develop
these vaccines
we just haven’t seen that with any other
infectious disease
because so many people wanted to address
so so the other differences between the
vaccines or how many doses there are and
most of them are two the jansen vaccine
that was tested is a single dose
vaccine the side effects there are side
they’re mainly fatigue headache sore arm
joint pain
much of which resolves within
a day or two and and we’ve seen a couple
of allergic reactions but
but um i think i’ll have a little bit
more on that later
um if you think about the millions of
people who’ve gotten the vaccine
um the the side effects are are really
no worse than any other vaccine that
we’ve seen
and then that storage temperature again
is is different between the different
okay this is the data
i think it’s nice to see this because
it’s really impressive actually so um
the red line
is people who got the vaccine the blue
line is people who got
a saline injection and then on that
on the graph there on the y-axis is the
number of people who got sick
and so had symptoms and tested positive
for covert
and so you can see that um in the first
two weeks or so this is the pfizer
vaccine in the first two weeks
those two lines kind of kind of overlap
and then you just don’t see many more
cases out you know
to three months or so
when they when they stopped it and and
um and
looked at the data whereas there’s a
continuation of increasing number of
in the placebo arm um the blow up
is just those first 21 days just to show
you kind of
you start to see that break off around
10 days after the initial vaccine
so this is an even this vaccine you get
two doses
one at day zero one at day 21 you can
see that they’re starting to be
an effect even before you get the second
and then the same is true for moderna
you can see how those two curves really
you know a little bit before you you
actually start to see
before the second dose so the second
dose for mederano was at day 28 you can
see that those two
two numbers actually um are those two
curves actually
um spread apart um before the second
i don’t have the data for jansen because
it’s not been made publicly available
yet but
um but the curves look similar actually
for jansen as well
just the just the numbers are a little
different um
so that’s that’s really the main stuff
about the vaccine
um there’s some special circumstances
they didn’t study pregnant
pregnant women they didn’t study people
who had
immune suppression um from like
medication or cancer
or advanced hiv disease or things like
that so they did study people who were
hiv infected but they had to be
well controlled and and have pholo
normal immune responses
they did study people who’d had past
cancers but weren’t actively on
um and and the main reason um pregnancy
is problematic because there are a lot
of extra regulations because we don’t
want to expose
pregnant women and their and their
babies um to an untested vaccine
and so it’s a little controversial
um but um that’s
that’s the way the studies were done
there are
no safety concerns for either of these
and the recommendation is if you are
pregnant or
if you are immune suppressed
that you should get vaccinated if
if you’re otherwise able to if you’re in
one of the groups that’s getting
um and and and people are looking
now there were people who got pregnant
there were women who got pregnant
on the pfizer in the mederena trials and
there were no adverse events associated
um with getting a vaccine
and then getting pregnant but there
weren’t enough to really say for sure
how safe it was but but they didn’t see
any problems with it
um we do know for pregnancy that
um that covid is much much more severe
so um so it’s best to best to protect
okay i’m going to skip this actually
unless people have questions
i know people have questions about the
variants right now
there are there are more and more the
two that we’ve talked about the most are
uk variant and the south african
variants they both have mutations in the
spike protein
and the uk one has one in the receptor
binding domain
um they both currently appear to be
prevented by the vaccines but maybe not
quite as well as the original virus
strain the antibodies and convalescent
plasma may be somewhat less effective
these new strains they do appear to be
more infectious
and i think are part of the reason why
we saw
huge sort of spikes in numbers of people
and being infected
in the uk and in south africa
they are um they are present in the us
and are now being tracked it’s a little
unclear i think
still if they’re more um
dangerous if they cause if they have a
higher mortality rate than their
original strains
um the thought is that these are maybe
arising in people who have
in immune systems that are not effective
preventing and clearing the infection
and they have sort of long-term shedding
and the virus is actually mutated
what we don’t know is is is this going
to continue to happen
are we going to have variants that
eventually completely
negate the effectiveness of the vaccine
i think those are all
um things that people are concerned
about but
but we really don’t know yet whether or
not that’s going to happen
part of the reason i wanted to tell you
a little bit about the immune system is
is just that that
that it’s not just the antibodies so the
antibodies definitely decrease
after you get infected but we can detect
and that’s
there we can detect t cell responses
and and long lived b cell responses
six even nine months after
um infection um we’re and we’ll be
looking at that
in the vaccines as well so even with
antibody levels decreased
the immune system has sort of squirreled
away information
um to protect you moving forward um
so overall you know the vaccines um that
that have gotten eua are an under
consideration for it
they were large scale studies um they
have efficacy
they work just as well as most commonly
used vaccines in fact
if we ever had a flu vaccine that worked
as well as even
even the the jansen vaccine or even some
of the vaccines that we that we think
haven’t worked very well in this if we
had a flu vaccine that worked out well
we’d be
jumping up and down for joy so um they
they appear to be just as safe um
i think people worry about that a little
in terms of we don’t have long term data
but in reality for
for the currently used vaccines most
side effects from vaccines actually
in the first two months after
vaccination so we don’t see
side effects from vaccines because
they’re gone
essentially there’s there’s no um part
of the vaccine left
um in the body after really a couple of
and and so um so we don’t
typically see side effects that occurred
you know years later
so they haven’t been studied in people
who are
pregnant or immune suppressed but but we
are getting data on that already
there are a lot of things going on in
social media
um about um the covered vaccines maybe
uh microchips uh it doesn’t make sense
they’re multi-dose vials i don’t know
how you would
manage to get the microchip and know
which person you injected into if you’re
taking five or six or seven doses out of
a single vial
um also i would think you would see the
microchip and we don’t make them that
small and
people really wanted to track you they
would probably use your phone anyways
um there’s also a social media thing
that says that they cause infertility
um and and it doesn’t make any sense at
all so and there’s no data
and clearly people have gotten pregnant
after they’ve gotten the vaccine so
anyways i’m gonna end that the the
stop the sharing and then we can we can
answer questions
um or however you wanna do this george
um thank you rachel that’s great um
uh you i know you have already answered
some of the questions
that came in um if you could go through
uh you know whichever you feel like
answering um
please go ahead and that might enlighten
us a little bit more
and then people can um chime in and ask
questions as well
yeah so okay so one of the first
questions and i think this is
um infection rates and deaths seem to be
going down
are we doing something right well
hopefully um what does the spring look
like i wish i had a better crystal ball
um so there are a couple things going on
i i think
um we have been doing something right i
that it’s clear that more and more
people are wearing masks
um there definitely have been you know
the uptake for vaccines has been um
you know it’s been it’s been problematic
i think getting it rolled out
um in a in a reasonable way um
and part of that has to do with the fact
that the storage is complicated and the
distribution is complicated
um the other thing to think about is
that coronaviruses are winter viruses
and so so i think um
the the winter um spike that we’ve been
um could also be in part predicted by
the fact that
that this is the season where you see
coronavirus infections
um and so i think the combination of
people getting vaccinated and the
weather getting warmer
should make the spring better i think
moving on to the second question and
sort of
taking it from there the variance could
make that a little bit more complicated
so what we don’t know is if the variance
took off
and spread um would would that
cause a spike like they saw in the uk um
so i i think that’s i think that’s the
reason why the public health messaging i
think sometimes feels a little confusing
because we say
the you know get the vaccine the vaccine
is our way out of this
but then once you get the vaccine we say
you still have to wear a mask and you
still have to socially distance and
still do all the same things
i think frankly until we get better
control of
of this we should do everything
that we know works um and then when we
see the numbers continue to go down and
when we see what happens with the
um you know that that we can start to
open things back
up um and um
if if you get the vaccine it’s clear
that even the south africa variant is
still provides um there’s still
protection from that
against severe disease and death so the
main the vaccine really prevents you
from getting
really sick which is what we really need
to get past this
um i don’t think we’re going to make the
coronavirus go away
i don’t think covet’s going to wait it
going to go away period but
um but i do think we can get to a point
um where it becomes more like
the flu or or
the seasonal coronaviruses where if we
can protect the people who are really
really at high risk
by vaccinating them that that we can
start to be able to treat this i think
it’s clear that the hospitals have
gotten better at treating covid
and that if they’re not overwhelmed then
the mortality rate
goes down um there’s a question about
why the vaccine rollout is being done so
poorly i
don’t have a good answer for that except
i think it is really complicated
um and we have not
funded our public health system um
over you know the past years and decades
the way we probably should
um i think to some extent the public
health system is the victim of its own
success so we had a better public health
you know back decades ago when there was
still a lot of syphilis and
tuberculosis and and other infectious
that we needed to deal with as
those infection rates went down we
figured okay we’re fine we can
we can start cutting um the public
um infrastructure and i think it’s clear
that um
we we need to be better ready as a
to deal with this kind of these kind of
i i do think there’s infrastructure that
that was available to do for example to
do the vaccine studies there was
pre-existing infrastructure
and that’s partly why that actually
worked really really well
but there wasn’t as much pre-existing
infrastructure for
for distribution of vaccines on a public
health measure um
and that’s why that has not gone as well
so it it’s a matter of sort of funding
and priorities and
and so on so um
there’s a question about long-term
effects of covad i think people are
trying to understand that there there
are post-infectious
um long-term effects of a lot of
infectious diseases
um that are you know seem to be sort of
um side effects um
i i think we’re still trying to figure
what those are um and what’s the best
way to treat them
it’s not clear that they’re infectious
you know that that they happen long
long time after the virus is gone
um and you know
um we have difficulty i think
sometimes in in then treating something
where we don’t
understand how it works um
what i’ve told people there are some
um that that are in the community
that are following what they call long
haulers people who have
chronic symptoms um months after they’ve
gotten over covered
some of it is if you’ve got very very
severe covet and you were in the icu for
a month
um it doesn’t doesn’t matter what
disease you get if you’re in the icu for
a month
it’s probably going to take you you know
a year or more to recover from that
um it’s just a sort of debilitating
both to your body and to your brain and
you know what we tell people is to
do the same kinds of things that we tell
people to stay healthy in general you
make sure you’re getting enough sleep
make sure you’re getting
exercise to the extent you can make sure
that you’re eating healthy
and and and unfortunately we don’t have
a whole lot more than that although
it’s always reasonable to to
see somebody in one of these long hauler
clinics so
um when will life return to normal i
don’t know what normal
is gonna be um there are
i i think um it’s much
it’s it’s likely that schools will
in a much more normal sort of way in the
um to what extent are we going to need
to continue to wear masks
i i don’t know i think eventually
um we can maybe stop wearing masks um
some of the time
i will tell you that we have had like
nothing of a flu season this year so
masks actually work for other
respiratory viruses very very well
and so we may not have completely
knocked kovad but we
did knock the flu by wearing masks so
um i think there is some thought that
maybe it’s not an unreasonable thing
um to wear a mask in the winter virus
um you know when you’re when you’re in
large groups and large crowds and so on
um best information
for the disease so there are a lot of
good websites so
cdc puts out good information johns
has a great um dashboard that gives you
information about
about um the um
the sort of progress and and both
vaccination and
infection um and then um
actually the new york times has some
really nice stuff as well so
those are the three places that i like
when i want like a
thing and and actually um i think both
the city and the county health
departments now have
decent websites that tell you um how to
get vaccinated how to you know what’s
going on with the disease and
and and get good information so
um what surprised me the most
um i guess what surprised me the most is
how political it got
uh you know um
it it seems like seems like it shouldn’t
have gotten political
it seemed like we were all sort of
should have been fighting the same virus
with the same
um sort of scientific information
um and i think so i think that’s what
surprised me the most
anyways okay i’ll let other people talk
i’m sorry
okay so um you can raise your hand or
just ask question i think
maybe you can hear i see
yeah i don’t see anything in the chats
i have a question george um
is this going to be like the flu where
we’ll need to get some kind of a shot
every year and if so like when would
that start
so for example i’m getting my second
shot this week when would i need to get
another one or
have they even looked at that yet i
think we don’t know
um i don’t think this is going to be
like the flu
um coronaviruses don’t change the same
way the flu does
um so the flu actually um
changes every
you know the way it replicates it
its surface proteins every year um and
we know that the vaccine doesn’t work
for the next year you need to keep
updating it um so my
expectation is um
that we may need to cover the variance
and we may figure out because this has
happened with other vaccines we may
figure out
we need a booster and you know
hopefully it would be a booster you know
in a year um
it does look like immunity you know i
showed that the immunity starts actually
fairly early but
it does appear that immunity continues
to improve actually after the vaccine
um you know for the first three months
six months or so part of it is we just
don’t have that information yet
so i don’t think we can say for sure i
don’t think this is going to be
another shot that you get annually like
like the flu vaccine
but i think we may need a booster we may
need to cover
variants as they come up
oh it looks like there’s something about
other countries in europe doing with
vaccines they’ve not done as well
even as we have i think it’s improving
it’s uh you know
infrastructure for doing these and and
getting this done has been highly
um getting access to the vaccines has
been somewhat variable
um i think there is a concern that we’re
going to wind up you know
that rich countries are buying up the
um and i really do think the hope was
that um that jansen and astrazeneca
um would be effective um there’s some
concern about astrazeneca not being as
against the uk strain not uk against the
south african strain
and so south africa had a ton of
astrazeneca vaccine to give their folks
and then
pull back on it so um both of those
vaccine platforms and those companies
have um have a
vaccine have given like the
infrastructure to give the vaccine
um throughout africa because they were
they were using them for the ebola
vaccination um process
right so there’s a question from nigel
what’s the best arguments against uh
vaccine skeptics
yeah i think i think it’s mainly just
talking to them and finding out what
their concerns are
um so what i’ve heard mainly from people
so i mean if you have somebody who um is
a rabid anti-vaccine kind of person i
think that’s going to be hard if they’ve
never gotten a flu vaccine
you’re probably not going to talk them
into a coveted vaccine
if they you know really do think that
they’re going to be um
that there’s going to be a a tracker
that the government is going to attract
them with
if they get a covered vaccine if they
don’t you know if you
if you can’t get past that the main
thing that i’ve seen is that people
just don’t they think it was done too
fast and they think it was political
um and um and i think just the
information um
the that these were done with more
people than
other vaccine vaccine studies that that
you know for commonly given vaccines
like shingrix and hepatitis vaccines and
the pneumovax and you know all these
vaccines that we give people all the
if you let people know like no no no
this was not done
um in a smaller group this was done with
more people and there were more
um there’s more data about how well they
um also um what i’ve heard from a lot of
people is
well i i’m not i’m not gonna be the
first one to get the vaccine in general
what i tell them is oh you are far from
the first like
this has been in you know millions of
people at this point and we just want to
make sure that
that you have access and that you’re in
line so
um other thing on several lists do i
have any websites where you could sign
up for vaccines
i don’t have good um
i think it’s i think you still have to
find the different
vaccine um you know sign up with your
you know if your mercy or bjc or
or ssm they all have
a sort of list that you can sign up on
the county and the city have
lists as well you know i i think that is
part of the problem hopefully eventually
this is going to wind up being in
um in uh
in you know your local walgreens and and
be easier to get but it’s going to take
a while before it gets to that point
um there’s a question about
by vaccinated individuals yeah so
um so it is clear that vaccine doesn’t
prevent you from getting
infected it prevents you from getting
um and um and so there is
concern that vaccinated people could
still get sick
and um not sick could still get infected
could still shed the virus and
potentially pass it on to other people
and that’s why that’s why
we tell people after they get vaccinated
to still wear a mask
so the masks have never been to protect
they’re a little bit to protect you
the masks are mainly to protect
everybody around you so it’s a public
health thing
because the masks work very well to
prevent you from transmitting to other
they work slightly less well at you
getting the
virus from from somebody else who’s not
wearing a mask
so um if everyone wears a mask then you
get that double protection and people
are most protected in that
situation um and then there’s a question
about um
why didn’t this virus disappear and when
stars immerse did
um some of that had to do with the fact
that sars and mers
were there well two things one they were
much more
virulent um than kovid
so they had a higher mortality rate and
and we
tend to see that um
and um if if something
kills people too quickly it often kills
people too quickly for them to pass it
along to too many other people
um and um so there’s there’s that but
then the other
thing is um it is pretty clear that
people are
infectious their like peak of infection
um risk for transmitting covad
um occurs um just before they’re
whereas stars and mers you weren’t
really um you weren’t really
transmitting until you got really sick
um and so then you can tell people if
you’ve got a fever if you feel sick
stay home whereas um you are probably if
you’ve gotten covered you may be
transmitting to people for several days
before you even know you have covet
um and so so i think i think that’s
that’s what was happening was
it just made it much harder to actually
control it and now it’s in so much of
the population
um it’s likely to become like one of the
seasonal coronaviruses where we’ll
always have it but
hopefully less virulent less of a of a
public health problem
um if you’ve had covid you should
continue to wear a mask
it’s it’s clear that if you’ve had coved
that you are
somewhat protected from getting coveted
again but not completely so you can get
infected again you could get infected
the same way as
as people have been vaccinated you could
get infected and not have symptoms and
transmit so you should be wearing a mask
so that you can protect other people
so um anyone else have a question
any any hands up or i don’t see anything
more in chat
tim your question was answered
uh yes it was okay so
rachel i just put it in the chat but um
maybe you could talk a little bit more
about the recent cdc advice for double
yeah um so
i think we should be practical with this
so um
i double masking clearly um works better
um a lot of it depends on what kind of
mask you’re using so
you nobody should be double masking an
n95 that is
horribly uncomfortable and unnecessary
the n95s actually it has to do with sort
of layer of filters so n95s actually
have multiple layers in them
and some of the surgical masks that they
use in the hospital also have multiple
in that single mask so the issue really
comes up with
um with if you’ve bought the surgical
type masks
you know online and you’re maybe not as
certain about the
the quality of it um the double masking
what seems to work best
i think about it is that it fits better
so the the mask should cover your your
nose and your mouth um and you shouldn’t
have air coming up the top or coming out
the sides because then it’s not doing
any good it’s going it’s still going
um you know the idea is you don’t want
to breathe
the same air that other people are
breathing and so you want to be
breathing through the mask
so what happens is if you use a surgical
kind of mask
but it has gaps on the side and then you
use a cloth mask that fits better over
um you’re you’re more likely to have it
kind of tailored to your face
in a way that um that um
that protects you better um that being
if the mask is making you so
that you can’t breathe or that you have
to keep taking it down to talk to people
to feel comfortable then that’s not
doing you any good at all if you have to
take it
down so if
i think what some people have said and
the other thing is people say that it
hurts their ears
um which i totally understand um what
you can do there are the masks that tie
behind your head sometimes i think find
people find those more comfortable
and find it easier to get those to fit
in a way that
that um that actually covers your mouth
and your nose um
so yeah i think if you’re you know if
you are if you are mainly staying at
and you know you want to you’re going
out um to a place
like a grocery store you’re going out
someplace where you’re worried
um and it’s a limited time frame and you
can do it comfortably without
without feeling like um
you know you’re you’re suffocating um
then it’s probably a good idea to double
and then for us sort of lay people do
you sort of consider the kn 95s to be
almost equivalent for a to an n95 for a
yeah yeah i mean they’re not exactly the
same but but they’re probably and
they’re it’s going to be uncomfortable
to wear something in addition to a k
and 95. um so um yeah if it fits to your
and you don’t feel um if you don’t feel
air coming up
you know up to your eyes and out the to
your cheeks
you know so if you can breathe if you
breathe in and out and you can feel the
mask moving in and out and not air going
out the sides
then it’s fitting well and and it’s
probably effective
what about people like brian and me who
have beards
yeah so the n95s don’t work very well
when people have beards because it does
sort of leak out and so then you might
want to think about
um you know if you can get it to kind of
cover or if you you know
those are the situations where like the
masks that have a tie
sometimes will fit better okay thanks
um i think we are at five o’clock but um
rachel before we go i’d like to there
was one question that came in
from uh trinity that i like to ask
which is really about the um healthcare
um and you know those you you guys who
are for the last one year have been
doing the heavy lifting
and um the question was um
how can we be advocates or how can we
what what can be done
yeah you know um i think what hurt
healthcare brokers
the most was was people not you know not
wearing masks and not taking things
um you know because you feel like um
and and people saying things like it’s
just a cold
um you know uh that we’re overreacting
or we’re we’re doing something um
you know when if you’ve been in the icu
and and
you’ve seen people dying then you know
it’s sort of an
extra sort of um pain to have people say
this is not this is not that big of a
deal um
and so you know one of the things that
really upset me always was that people
are like it’s
it’s it’s just like the flu and i’m like
well you know the
flu is actually pretty bad too we we see
people die from the flu as well so
um so so that that kind of stuff you
um but otherwise i feel like
healthcare workers have actually gotten
a lot of support
um and
you know the the people that i feel like
we should be supporting
are you know the grocery store workers
and the delivery drivers and
um and you know and the the
the folks in sort of um emt and
and um police and stuff
uh you know who who who still are are
even the people working in restaurants
um so
so i think you know be kind be kind to
to um other people recognize that
that everyone’s sort of dealing with
this their own way and and
um and then be patient i think
you know um we all we all want to get
back to
something normal um and um
i i i think we’ve gotten a lot of love
from the community and and i i really do
appreciate it so
okay well thank you very much rachel
this has been wonderful um
i really appreciate within it in your
busy schedule to
you know that we were able to find this
one hour to
have your time with us so we appreciate
it thank you very much
thank you very much thank you all for
joining me today
it’s nice to see everybody

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