Mark Moran [00:00:06] Hello and welcome to TGen Talks. I'm Mark Moran. COVID-19. The Coronavirus pandemic has created challenges unlike this country has seen in a number of decades, from school and business closings to social distancing and statistics that attempt to paint a clearer picture of how this virus is mutating, spreading and disrupting the flow of daily life from confirmed cases, deaths, cases by state cases per 100,000. The numbers are staggering, and yet as a nation, we're finding new ways to deal with whatever the virus throws our way. Today on TGen Talks, we're joined by Dr. David Engelthaler, Director of TGen's Pathogen and a Microbiome Division, TGen North. He'll share his thoughts on what we know to date about the virus, where we are in search of a vaccine, reopening America, and perhaps a lesson or two we've learned concerning shutdowns, stay at homes, and more. Hi, Dr. Engelthaler. Thanks for being here.
Dr. Engelthaler [00:01:11] That's great to be here, Mark.
Mark Moran [00:01:13] Let's start by talking about what you're testing and tracking has discovered about COVID-19 from a science perspective. Are we seeing differences from state to state? And could the future of this virus become more regional do you think?
Dr. Engelthaler [00:01:26] This virus is now becoming a human virus and that means it will be found wherever humans are and it's already there. It's spread throughout the world. However, it will act differently depending on the region that you're in and depending on the epidemiology of that region. In New York, where you have a very urban population with millions of people living on top of millions of people, the virus spreads faster, can cause a lot more damage in short order. And that will probably continue to happen in the Southwest. People just live a bit more spread out, just even even in our urban environments, but we're also very rural. So the virus has a very different epidemiology. It probably move slower and then probably cause outbreaks from time to time.
Mark Moran [00:02:10] You hear talk of COVID 2.0. Oh, now is this a disease that will come back around? And if so, do you think it will be as severe during the second or third wave as it has been the first time around?
Dr. Engelthaler [00:02:21] We really don't have a great crystal ball to tell us what's going to happen. However, we do know a few things. We do know a little bit about this virus now. We do know that it's everywhere. Right now, it's already spread throughout the landscape. So as it may drop down and looks like it's dropping down during the summer, it if it comes back in the fall, it's already going to be starting from a place where it exists throughout the land, which means that we could have a much stronger second wave because it's already out there. The other thing we know about respiratory viruses and this is clearly a respiratory virus is that the epidemiology tells us that the virus drop the levels of virus in transmission drops during the summer, but it doesn't go away. It lingers in the background. So I do think it's quite likely that we'll have a second large wave and it may actually be larger than the first because it's already here.
Mark Moran [00:03:15] Viruses tend to lessen in severity during hot months, such as the Arizona summer. Is this good time to work on building up herd immunity versus waiting for COVID to return in the fall when we might see an increase in the number of cases?
Dr. Engelthaler [00:03:30] Given the fact that the virus is seemingly dropping in a number of places and that may absolutely have something to do with the fact that we're moving into our warmer summer months and it may have something to do with the fact that we've already hit the initial peak in most places in the U.S., the virus will likely drop down to minimal levels, which means that a lot of places are opening up. And if it's done responsibly, if we're following these very strict guidelines about making sure our health care system can handle any outbreaks, that we are doing everything we can do to find outbreaks and try to quash them as quickly as possible. And we're protecting our most vulnerable. It does make sense for people to get out and and there's still gonna be disease transmission. And that's not really the worst thing in the world. If it's not hitting the most vulnerable because it's helping us get to some level of herd immunity.
Mark Moran [00:04:23] A number of states, including Arizona, are opening in stages. Is it too soon? And what should we expect right now?
Dr. Engelthaler [00:04:32] Just like going into lockdown, it's always gonna be too soon and it's always gonna be too late. And I think the same is true from coming out of being in a lockdown type of situation. It won't be perfect no matter what we do. What we really have to do is really weigh the risks and the benefits and can we get the benefit of opening up? Of course, the economy will hopefully benefit from that. I think there are some other public health benefits from opening up that people haven't really talked about being cooped up indoors. We've unfortunately seen an increase in domestic violence, an increase in suicides, an increase in those things that we wouldn't normally have. Just because people are kind of locked away with either their problems, their depression or maybe an abusive family member. So we're hoping that some of that will help, you know, be lessened by opening back up and people getting more physical activity. All those things are really important as long as we do the things that are necessary to protect the most vulnerable. If we're not doing that we really shouldn't open up.
Mark Moran [00:05:39] You mentioned herd immunity. Where do we need to be? And we'll reopening. Help us reach that number.
Dr. Engelthaler [00:05:46] We don't know those specific number we have to hit for herd immunity. But what's being talked about is somewhere between 60 and 70 percent. If we have a population that is 60 to 70 percent immune, that virus is gonna have a very hard time finding someone else to infect that isn't immune. Those are numbers that you usually can't get to unless you have a vaccine or unless you have a lot of disease spread. New York goes through a few more waves like it did in the past couple of months. They may actually hit that level through amazing cost and toll, which is really unfortunate. However, by opening up, we're at least just going to continue to increase immunity that every percentage point you increase, the immunity decreases the chance that the virus actually gets from one person to another person.
Mark Moran [00:06:37] All right. Let's switch gears and talk about the vaccine work that's going on. What are the hurdles to get a vaccine safely to market today?
Dr. Engelthaler [00:06:45] One of the biggest hurdles that we have right now for getting a new vaccine for this COVID-19 virus is that we've never really had a successful Coronavirus vaccine. However, there's been a lot of science and technology and engineering know-how, biomedical engineering, to develop vaccines that actually can provide protection to this virus and other similar viruses. We know that there are actually a number of great what looked to be great candidates already in the early parts of clinical trials. And those are the ones to show that the vaccine is safe and it doesn't hurt people. Certainly don't want severe adverse events from a new vaccine. The next stages are difficult to take a long time because what you're going to show is that the vaccine provides a protective effect. And that means you've got to study a population over a period of time to show that the vaccine provided protection versus those who didn't get the vaccine. And that takes several months. Then we also have to have the production of the vaccine to a level that it can actually start to be used in large populations. And then there's the distribution of that vaccine. And that's not just thinking about here in the U.S. with this is a global problem. And it doesn't make any sense for us to just think about it from a U.S. perspective. This problem exists anywhere. It exists everywhere. And so the vaccine manufacturing distribution plans have to take that into account.
Mark Moran [00:08:14] What gives you hope that will develop an effective vaccine against COVID-19? The science, the technology, what's going to be the game-changer?
Dr. Engelthaler [00:08:21] The current COVID-19 viruses we know it is a type of coronavirus that really is originates at animals and gets into humans. The other ones that have been like that that we've seen have been SARS from almost 20 years ago. And then MERS, which was the Middle East Respiratory Syndrome virus, which came out about 2012. These have caused very high fatality rates and there were some initial attempts at vaccines, especially at SARS, because it was spreading pretty quick, but then it fizzled out and therefore a lot of attention around developing a vaccine for it also fizzled out. But we fast forward 20 years. Science and technology is just tremendously advanced, especially in biomedical sciences and in vaccine development. So we already have some good candidates. The early science scientific data shows that there's likely to be some good response to these new vaccines. So I have a lot of hope that we'll have an effective vaccine and maybe decided upon by the end of this year. So potent potential production and distribution to those that most need it by early next year.
Mark Moran [00:09:31] You hear people say, I've never had the flu vaccine, I've never had this or that vaccine. How important will it be for people to get vaccinated once a vaccine is developed?
Dr. Engelthaler [00:09:41] One way I like to look at this is that vaccines are a real public health measure. And when people hear the word public health of the phrase public health, they think some government agency or whatnot. But public health is really on us to maintain the health of our families in our communities. In one way we do that is following those recommendations such as washing your hands, staying socially distanced. All of the things that have been put into place. But another way is to get a vaccine once it's available and understand that that's one of the most important things we can do as a society to not only slow down and prevent transmission, but to save grandma and grandpa and all of those that are most at risk from dying. So it's really incumbent upon us to be able to use this great new technology to really stop this virus in its tracks.
Mark Moran [00:10:35] Our guest today on TGen Talks is Dr. David Engelthaler, Director of TGen Pathogen and Microbiome Division TGen North. I'm Mark Moran.
Mark Moran [00:10:43] Obviously, it's not a one size fits all situation when it comes to treatment. What are you seeing in terms of disparity in how this virus behaves and how the effects are different from person to person?
Dr. Engelthaler [00:10:54] We're really seeing a great menagerie of types of syndromes or diseases that are being caused by this virus. And the vast majority of the diseases that we're seeing are some type of respiratory disease and some people that's mild in some people's very severe and becomes kind of acute respiratory distress that requires hospitalization and ventilation. But there's a lot of these outliers, reports of multi-system failure, reports of increased stroke, reports of other types of outcomes. And so that's not unusual when you have two things. One, a pathogen that's infecting literally billions of people, or will be. And you're gonna have lots of different possibilities that come out of that in a lot of things that are just one-off. They don't happen again or they happen very rarely. And that's just natural. Just be based on the numbers. The other is that this is a brand new virus attacking the human system. And we're not adapted to it and it's not adapted to us. We know how it gains entry into human cells. It uses essentially a pathway that is found in a large number of human cells and that is allowing this virus to affect different systems. And so, you know, you get these strange symptoms like people are losing their sense of taste and smell. That could be because the virus is actually gaining entry into nerve cells in especially, you know, in the head space. And that's where it's having an effect. We would have never expected to see something like that. That's because it's a new virus into the virus where a new host along those lines.
Mark Moran [00:12:29] Are there any myths out there that you can dispel about COVID-19? What should we know?
Dr. Engelthaler [00:12:34] A lot of people are concerned about products they may be getting and whether that's, you know, packages from Amazon are food that's coming from maybe these meatpacking plants where they've seen outbreaks before. And are these things at risk for exposing us? There haven't been any documented cases of people being exposed to getting the disease from a product that was contaminated in a factory or in a packing plant. And then and then going on to infect the consumer doesn't mean it can't happen. But, you know, people have pathogens all the time and they work in these facilities all the time. And we don't see outbreaks from that. When we're thinking about with meat processing plants are their food processing plants, there are actually a lot of safeguards in place so that we or the workers don't infect the product. But even if it does that usually and actually rarely could turn into something that can cause an infection in the consumer. We don't think that there's necessarily a higher risk here with this virus, even though it seems to act a little bit differently than other viruses just because of that process. And we know how to control that process pretty well.
Mark Moran [00:13:45] Dr. Engelthaler, we seem to have gained a fair bit of knowledge in a short amount of time about COVID-19. What lessons have we learned from this pandemic and how do they prepare us for future outbreaks?
Dr. Engelthaler [00:13:58] One of the lessons that I think we're getting is that it's really critical for us to make concerted and conscientious efforts to use the best of science and technology to not only respond to disease outbreaks as quickly as possible but also to look for these possibilities and have surveillance systems that can detect these new pathogens in places we're not expecting. We have to figure out how do we do surveillance for the unexpected. I think we're getting better at it, looking for the things we expect. But this was unexpected. It was also a little bit of a failure of imagination because we knew that these types of viruses can come out of wildlife, particularly in this case out of bats and can sometimes survive in humans. We should have been looking forward all along. And so I think that that's going to change. So it's a that's a lesson learned. I think another lesson is it didn't take very long, but it did take probably a couple of extra weeks for the regulatory process to try to keep up with the spread of this virus. The regulatory process slows us down and in every way. But it adds a lot of benefit for health and safety. However, once we figured out that some of those rules can be eased up, it allowed for in this case testing to happen everywhere where was actually being held back because of the regulatory process. I think the same thing is true, trying some of these drugs, repurposing drugs. The regulatory process has changed enough now that it's becoming really easy for doctors to do clinical trials on these solutions. So I think there's going to be a really strong look at the overall regulatory process so that it can move as quickly as the virus.
Mark Moran [00:15:45] Dr. David Engelthaler, fascinating stuff as always, from TGen North. More to come, I'm sure. Thanks for your time today.
Dr. Engelthaler [00:15:51] It's great to be here, Mark.
Mark Moran [00:15:52] You've been listening to Dr. David Engelthaler, Director of TGen's Pathogen and Microbiome Division, commonly known as TGen North. For more episodes, visit TGen.org/tgentalks TGen is an affiliate of City of Hope for TGen Talks. I'm Mark Moran.
