Mark Moran [00:00:05] Hi, welcome to TGen Talks. I'm Mark Moran, as COVID-19 continues to dominate the headlines some social restrictions have been lifted and many people are going back to work. But as a result, medical officials report some increases in the number of cases of COVID-19. We're joined on TGen Talks today by Dr. Tyler Delaughder, clinical research coordinator and recent graduate of Midwestern University, to share with us his interpretations of the medical issues surrounding COVID-19, a potential second wave and the effects of social unrest on the spread of the virus. Dr. Delaughder, welcome. Thanks for being here.
Dr. Tyler Delaughder [00:00:45] Thank you.
Mark Moran [00:00:46] A newly minted doctor you see in the news that doctors themselves are getting COVID-19. Did you have any trepidation or nervousness working with TGen on this virus?
Dr. Tyler Delaughder [00:00:55] Yeah, of course. You know, I'm a younger guy, so it wasn't hitting us quite as hard, but still just the idea that I could catch it, not know it, and then pass it on to people who can't afford to get this virus. And then even then, there's long term repercussions of this that we don't even know yet. Eventually, you know, it's going to be part of my job is helping people with this. So that's kind of what drove me is this idea of, hey, this is what you were training for. This is this is what you want to do. So why not take that opportunity now?
Mark Moran [00:01:23] Did you have any specific training in virology or anything like that?
Dr. Tyler Delaughder [00:01:27] We had specific classes, yes. On like virology, epidemiology. So it was interesting to hear about this virus, like the SARS virus, this is not something completely new to us. We've dealt with it before, or at least not the COVID version, first say, but we've dealt with SAR's before and it was completely different in how it hit us. Then it was much more deadly. It wasn't really as transmissible as this one was, which is why this one kind of came as a surprise.
Mark Moran [00:01:56] From that standpoint, you mentioned it kind of came out of nowhere and it incited panic. But as a medical professional, you weren't really allowed panic. So what is COVID-19 look like to you as a medical professional?
Dr. Tyler Delaughder [00:02:07] I'm thinking about the data from Arizona, of course. It looks very similar to almost the flu, in a way. The harder part about it is that we don't yet have enough data to definitively say if it's any worse than the flu. That's part of the problem. We know as a SARS virus, what else do we know about what SARS can do? Try and figure out, well, how easily are people catching this? Is it airborne or is it person to person? Is it droplet? Are there touch precautions? Do we need to be having full respirators every time we're dealing with people or masks are helpful? Questions like that, I think, just turning to that kind of mindset of a more questioning mindset of exactly what we're dealing with is how, at least I'm speaking for myself, dealt with this new pandemic.
Mark Moran [00:02:56] The SARS we're speaking about as Severe Acute Respiratory Syndrome.
Dr. Tyler Delaughder [00:03:00] Yes.
Mark Moran [00:03:01] Which affected a good portion of the world a few years back.
Dr. Tyler Delaughder [00:03:05] Correct.
[00:03:06] You mentioned this looked a lot like the flu. But the last thing you can do as a doctor is tell somebody it's only the flu because you just don't know exactly.
Dr. Tyler Delaughder [00:03:13] And that's the hardest part. People want answers and they turn to you for answers. And unfortunately, you don't have all the answers yet. So, again, I think it just comes down to focusing on what do we know? What do we know right now and how can we help at this point? A lot of physicians are looking at supportive measures, and that's kind of been the cases with a majority of viruses that we didn't have vaccines for. We just look at, OK, how do we help people? What symptoms are they coming in with? What is the worst-case look like? And how do I prepare for that? And specifically the influx of people. Right. A lot of hospitals just got hit suddenly with a huge number of people who needed a bunch of ventilators that the hospital just didn't have because they were already reaching capacity or at capacity. So, it was trying to deal with this new influx and then also getting enough PPE and making sure people were staying safe, because, again, if we don't know, we need to take every precaution necessary.
Mark Moran [00:04:13] How's TGen's testing informing medical practices?
Dr. Tyler Delaughder [00:04:16] TGen is helping medical professionals by having them either come in and get swabbed and then they will report it back out within, we usually say 48 hours. Realistically, what I've been seeing is usually within 24.
Mark Moran [00:04:30] Has there been a huge demand for this information from TGen? And are you really kind of wrapping things up?
Dr. Tyler Delaughder [00:04:35] Yes, absolutely. It's a combination of not only those people reaching out to us because they just don't know who else to turn to you at the moment and also us reaching out to them because TGen was unique in the sense of, right, they were dealing with a bunch of other things up. Talking specifically with the TGen North lab, they were dealing with other pathogens, other research projects that they've been doing for years, and then at the drop of a hat, pandemic hits, they dropped everything and switch it over all of it. It was a lot of overhaul from TGen in themselves. They did a fantastic job with doing everything they could at this time and recognizing that, hey, we're in a unique position here as a genomics research institute in Arizona to be able to give people these tests that they just couldn't get.
Mark Moran [00:05:20] It seems like it was an all hands on deck thing right away.
Dr. Tyler Delaughder [00:05:22] Absolutely.
Mark Moran [00:05:23] The entire medical community. Let's talk about herd immunity. And we hear that a lot that maybe we shouldn't be so cautious. Maybe we should. For those of us who aren't in a vulnerable population, to just be exposed a little more and create a herd type immunity. I know they've done it in some European countries. What's your take on that?
Dr. Tyler Delaughder [00:05:43] So I guess let's define herd immunity first. Herd immunity, right. Is that you reach a certain threshold of the population that is now immune to said disease. So then that means whatever other smaller percentage, let's just throw a number out, like, let's say 10 percent of the population doesn't get this vaccine or doesn't get exposed they're protected because the other 90 percent does have immunity. And thus, if they never catch it, they can't give it to that other 10 percent. Right. So that's what it means as herd immunity. The problem with that, again, coming and all comes back to just not having the data is we don't know yet if these people are catching COVID, are developing an immunity that's meaningful. We just don't know that yet. And so the problem with that is you need that in order to have herd immunity. There have been promising, really one promising study showing some good immunity from a vaccine that was made. I think that's leaning in the right direction. I think that is going to be a better way to get this herd immunity we're looking for is getting a vaccine out there. So that way, people obviously don't have to go through with the actual disease itself or be carrying it around for some unknown amount of time. They can just get that in at inactivated virus, get immunity and then move on from there.
Mark Moran [00:07:00] From a medical professional's position, are we looking at masks, social distancing lines on the floor in the grocery store, and that type of thing until then?
Dr. Tyler Delaughder [00:07:10] Good question. That's what everyone wants to know is what do we do until we get this miracle vaccine, right? I believe we have to do it by state by state case, right. We're keeping very careful track of exactly how many new cases are popping up. We're now more on top of that than we were before. And we're continuing to ramp that up. Like you said, we're getting the blood testing now instead of just swabbing. Hopefully we'll be having even saliva testing going on. I know TGen is working hard at getting that done for more long term kind of monitoring. The hope is that we see a decrease or no new cases pop up for, let's just say like a week or two. And then at that point, you can maybe move out a new phase of, OK, now, people don't need to wear these masks anymore. And you don't need to enforce the six-foot distance anymore. Obviously, you can leave that up to certain places that are higher risk, maybe still keep the hospitals kind of under more lockdown than, say, your grocery store and whatnot. But hopefully after you see less and less new cases or no cases at all for even a month or so, I think at that point you can safely say, hey, we've decreased the transmissibility of this. So it's no longer just sporadic through communities. So I can feel comfortable saying, hey, unless you know of somebody who is actively having some kind of symptom, I think this virus might be kind of on its downswing. More dormant sense so it should be safe to move around.
Mark Moran [00:08:39] A phased-in approach rather than just saying, okay, masks off lines here.
Dr. Tyler Delaughder [00:08:44] Yeah.
Mark Moran [00:08:46] How does TGen genomic work inform doctors who are actually treating patients with COVID?
Dr. Tyler Delaughder [00:08:51] TGen genomics research is helping doctors look at why is it affecting some people more? Are some people more susceptible than others? And that's been a question that popped up right from the get-go. Are more people susceptible to this just because of them being in lower socioeconomic standing? Or is there something actually going on here? Is there some kind of genetic component? Because there's been some research showing that African-Americans are getting hit harder by this on average, that they seem to get more...They get infected more often than the general population and they seem to have worse symptoms. And at first they thought, OK, maybe this is just they tend to have more comorbid issues. Right. They have high blood pressure, heart disease, diabetes, stuff like that. But then once we accounted for those factors, we still notice now they're still getting it worse than the rest. So why is that? And that's where the genetics part comes in. And I think that's going to be a really big question that TGen is diving headlong into.
Mark Moran [00:09:56] Dr. Delaughder, clinical research coordinator here at TGen, doctor of Osteopathic Medicine. Dr. DeLaughder, from the medical perspective, what do you think we can expect in the fall?
Dr. Tyler Delaughder [00:10:08] I think there's going to be a second wave. Looking at it, it does behave very similar with a transmission rate between people like the flu, you kind of catch the flu you give it to somebody, you kind of cough and shake a hand and then you touch your face. Right. That's very similar to how we always kind of worried about the flu. And if you're having symptoms, wear a mask and you know, you're coughing, you have a fever, whatnot.
Mark Moran [00:10:28] Could it be theoretically worse because the virus is already here and reinfection could in fact and even broader segment of the population?
Dr. Tyler Delaughder [00:10:38] I think what you're getting at with that is kind of another side that we've been thinking of. And again, kind of mentioned was, is this going to mutate on us or not? Really a question of if, but when all viruses mutate, they're highly mutate-able. That's kind of one of the big issues with viruses. Some are a little easier to follow than others. And, you know, with the flu, we always kind of throw out, hate to call it a guessing game. It's not a complete guess. But, you know, every year we have a new vaccine trying to anticipate what the next flu is going to look like. Right. And sometimes we get it. Sometimes we don't. It's not as effective sometimes. So that's going to be the big question with this, how mutable is it? Can we predict it? And can we keep up with new vaccines if it is mutating at such a quick rate?
Mark Moran [00:11:24] We've only had a couple of pandemics in the history of our world that have been quite this significant, and you talked about a mutation. Are we going to be living now in a world where we're constantly in danger of deadly pandemics? I mean, something else next year, or the following year?
Dr. Tyler Delaughder [00:11:41] I think pandemics are going to always be part of our history, unfortunately. That's just how nature tends to work. It surprises us and comes up with new ways to come at us. It's almost kind of its own beauty, right. We can't fully predict what nature is going to do. And a part of that, too, and this is getting into a whole philosophical side of it. We don't have to go here with it, but we like to remove ourselves from nature. We don't really when we describe nature. We describe it in a way that's outside of us. But at the same time, I think what we realize is that we are shaping it as much as it's shaping us. This virus came out of a fish market that was not following proper protocols. That was our fault. It was a human mistake. That was not just a random mutation that came out of nowhere. And then somebody somewhere caught it from some bat that came by like it was a market that wasn't doing the right protocols. So that was a human error. I feel like as long as we're here, we're going to have new pandemics from some unforeseen thing that we're now following. But, I don't think it's something that needs to be a oh, it's the world's ending apocalyptic kind of thing. Right. At the same time, I think what we can learn from this is seeing what are we not doing to prepare for this? We should have something in place to anticipate, hey, we see this every 20 years or so new pandemic comes out maybe next time we should have something in place to deal with that next time. So I think that's going to be the better way to look at it. It's just anticipated plan for the worst, hope for the best.
Mark Moran [00:13:16] And when we talk about the spread of this, we've seen a lot of civil unrest in our streets lately just with protests and some peaceful and not so peaceful demonstrations. How do you think these protests are affecting the COVID-19?
Dr. Tyler Delaughder [00:13:29] Spread from a medical standpoint, protests are not helping us with this COVID spreading and we've already seen increases in cases just specifically here in Arizona.
Mark Moran [00:13:37] Could that help with herd immunity?
Dr. Tyler Delaughder [00:13:39] Theoretically, again, maybe it would depend on if these people who are catching it are keeping an immunity that is meaningful. I mean, if you want to compare these two, I don't know if you're familiar with pox parties that people used to have back in the day. I guess this is kind of a form of that.
Mark Moran [00:13:55] That would be where people whose children had the chickenpox all get together in plays with the kids would get the chickenpox and then you'd be immune from it. Theoretically, for the rest of your life.
Dr. Tyler Delaughder [00:14:03] Yes. And I don't know if you're familiar with how that went, but obviously, that was quickly discouraged.
Mark Moran [00:14:09] Yes.
Mark Moran [00:14:10] How is the medical field preparing for this second wave that you feel is sure to come in? How's TGen going to be involved in that?
Dr. Tyler Delaughder [00:14:16] The way that people are preparing are medical professionals are preparing for that is one with the decrease in the cases means that we can start getting more PPE because hopefully, we'll be using less of it.
Mark Moran [00:14:28] Personal protective equipment.
Dr. Tyler Delaughder [00:14:29] Gloves, gowns, little visors and everything. Respirators, even more ventilators. Trying to get more equipment is a big part of it because that's where it hit us the most, is we don't have the necessary equipment to help people and keep others safe from this. So that's one way. But specifically from how TGen has been helping them is keeping their finger on that pulse. That was a big push or trying to get this new protocol out is getting people screened now and getting a big popular portion of the population here screen now so we can get a baseline of, OK, this is kind of what we're dealing with. This is how the cases seem to be trending, a continuation of the cases that we're seeing, or is this a ramp up or increase in cases because we've ramped it up in terms of the number of swabs and everything that we've done.
Mark Moran [00:15:16] As usual, interesting research happening at TGen in cutting edge science. Dr. Delaughder, thanks for being here.
Dr. Tyler Delaughder [00:15:21] Thank you, thank you for having me.
Mark Moran [00:15:22] For more episodes of TGen Talks, visit TGen.org/tgentalks TGen is an affiliate of City of Hope. TGen Talks, I'm Mark Moran.
