2021-12-09 BTB - Dr. Rebecca Dutch (COVID-19 Update)

[00:00:00.00] [MELLOW MUSIC]

[00:00:14.94] KODY KISER: As the University of Kentucky nears the end of the fall 2021 semester, COVID-19 infection rates have once again started to rise across the state. Now a new variant, Omicron, creates a new set of challenges for the commonwealth, country, and world. As the Vice Dean of Research for the UK College of Medicine, Dr. Rebecca Dutch oversees research for the college, from basic areas to clinical applications. Dutch also serves as a member of UK's START team, an interdisciplinary group of UK HealthCare physicians and clinical and research leaders at UK that continue to develop strategies to ensure safe and healthy operations on campus.

[00:00:56.76] I'm Kody Kiser with UK Strategic Communications. And I'm joined this week by UK Chief Communications Officer Jay Blanton. On this episode of Behind the Blue, Dr. Dutch returns to the podcast to discuss UK's current state of play in handling the coronavirus pandemic, sharing her thoughts on a wide range of pandemic topics including the Omicron variant, what it means for testing and vaccines, best practices for the university community, and more.

[00:01:27.77] We are happy to be joined again by Dr. Rebecca Dutch. Dr. Dutch, thanks so much for being with us. The last time I think we talked was July. And we've had a few things change since then.

[00:01:40.45] REBECCA DUTCH: Yep.

[00:01:40.85] KODY KISER: So we've had-- we've seen some numbers go down. But now we've got a new strain of the coronavirus, this one known as the Omicron strain.

[00:01:51.43] REBECCA DUTCH: Yep. Yeah.

[00:01:52.13] KODY KISER: What exactly do we know so far about this particular strain?

[00:01:57.26] REBECCA DUTCH: So technically we call it a variant. It's a different-- it's another SARS-CoV-2. It just has changes within the genome sequence.

[00:02:06.38] What do we know so far? We know that it has significant numbers of changes in the genome. A lot of them are clustered in the spike protein.

[00:02:14.90] It was first picked up in South Africa. We don't for sure if it was-- that's the source of the original virus, or if they just were the first to discover it. South Africa and their scientists are actually some of the world leaders in sequencing a lot of SARS-CoV-2 genomes. So they may have been the first just to pick it up.

[00:02:33.08] We know that emerging evidence suggests-- and I'm going to use these words really carefully, because we're in the very early days with that then that it may be more transmissible than Delta. Evidence for that includes the fact that in South Africa, it is overtaking Delta as the strain-- or the variant that they're seeing most. That's the biggest evidence.

[00:02:55.79] And they're seeing some of that in other places. And that would suggest that it transmits very well. There have been some reports-- for instance, in Norway they had a Christmas party. And at least from the details that came out of it, it was a corporate Christmas party. And someone was at the party who brought this variant. And something like 60 people caught it.

[00:03:13.80] So it may be very transmissible. The reason I say "may be" is we still don't know all the details about it. We're basing this on very early information. It's also possible that somehow it just was in larger groups, for some reason, or something else that individually it's not more transmissible. So they're going to need more data to really say that.

[00:03:34.85] But right now we're treating it as if it might be more transmissible. So that's the concern that we've already seen with Delta, when it became more transmissible, that the spread can go up.

[00:03:45.83] The big question that we are still gathering data on is whether it's more what's called "pathogenic," and that is capable of making you sick or killing you. That, obviously, is the most critical question, because if it is, that becomes, obviously, a much bigger risk.

[00:04:03.69] The good news there is so far, all of the data that we're seeing suggests it is not more pathogenic. Now again, I'm cautious because when you're a scientist and you have two weeks' worth of data, you know you're still trying to build the whole picture. But so far there is no evidence this is more dangerous. And that's really good news. And in fact, there are some reports it may be less pathogenic.

[00:04:27.26] But these are all right now what we call anecdotal reports. You're getting reports from different areas. South Africa is saying, for instance, their hospitalization utilization is not going up, even though their cases are. And then oxygen use is not going up, and all these other things. Those would be really good signs that this is not making people any sicker than the previous ones. And we still don't know if it's making them less sick.

[00:04:49.46] KODY KISER: And that's where we've been talking for the last couple of years, hasn't it, with-- this is not going to go away. But ideally what you want is even if it becomes more contagious, it becomes less lethal, less likely to make you very ill or hospitalized.

[00:05:05.82] REBECCA DUTCH: And that's a really important point. So in when you think about these viruses, early on, in the first few weeks, I think people hoped we would have SARS-CoV-2 show up. We'd beat it, like with SARS, the original SARS. And it would go away. We'd never see it again.

[00:05:20.36] But very rapidly, most virologists were saying, eh, we're probably going to have this one with us permanently. It's going to become what's called endemic. It's going to be a virus we just all live with. And I think that this is one more sign of that.

[00:05:34.85] You're getting-- this variant appears, if it truly does transmit better but is not as dangerous, that would be actually in many ways good long term, because it means most people, their first exposure, if they haven't been vaccinated, will be to something that might not-- certainly won't be more dangerous.

[00:05:51.08] The hard part will be we still have a lot of people in the world who aren't vaccinated. And that is likely to mean we still have a lot of people who end up in the hospital from this one. But over time, I think honestly we're all going to get vaccinated. Or we're all going to get the virus. That's what the world population is looking at.

[00:06:09.86] And therefore, you just can expect long term, we're going to live with it. Even if you've been vaccinated, you may in the future then get a case of it. It just boosts your immune system again. If you're a healthy person, you'll come through it OK. You'll feel crappy for a couple of days. You'll go on and maybe not experience it again for a few more years, just like our normal human cold viruses.

[00:06:29.82] I mean, we don't like-- we don't think about this when we're healthy people. But the normal for human coronaviruses that cause what we think the common cold, they can kill people who are elderly, who are immunosuppressed.

[00:06:42.51] JAY BLANTON: So this is-- maybe-- and we've talked about before, and you've repeated that it may very well be just be endemic and part of our lives. We've got to move on and manage, as we have with other viruses. But the mutations we keep talking about-- Delta, now Omicron-- will that kind of thing keep happening? Or does that happen with other viruses and we just don't talk about it so much because of-- just the cold's part of our lives, the flu is part of our lives? Or are we seeing all these mutations because we haven't gotten to a level of vaccination where we're sort of stopping that from happening?

[00:07:18.77] REBECCA DUTCH: So mutations within viruses is what's expected. We knew from the beginning we'd see it with this. Actually, just last Friday in my virology class here, we talked about virus evolution and how it happens.

[00:07:33.74] So there's a couple of different factors that say how many we'll see. One of them is how often a mutation's made when the virus replicates. And what are called RNA viruses, like SARS-CoV-2, their polymerases make more mutations than, say, DNA viruses. And they all make way more mutations than our cells do when we make copies of our genome.

[00:07:55.34] So that's the first factor, how-- and so for RNA viruses, like flu and like SARS-CoV-2, we do see more. SARS does have some help. It has something called proofreading. But it still is far more error-prone in its replication mechanisms than anything involving DNA.

[00:08:14.20] But the other thing we look at is not just how often you do it, but how many times you do it. So let's say you make a mistake one out of every million times, though in this case it's probably one out of every 10,000. If you only copy-- if you only make one new copy, you won't get that many mistakes. If you make a billion new copies, you'll get a ton of mistakes. So the fewer times these viruses can get a chance to make lots of copies, which is have a really productive infection, the better.

[00:08:45.95] So that's one of the big advantages for vaccination. Even if you catch it, the data says you tend to catch it, beat it, and defeat it relatively rapidly, where people who haven't been vaccinated take much longer, even when they're healthy. And some of them keep long COVID going, where they've got an infection going for quite a long time.

[00:09:04.01] So the things that generate variants are the natural processes of this virus, and the number of times they get to make copies. And so anything we can do to reduce that is good. So yes, we do get variants in cold viruses. You get variants in the flu, which is why we-- one of the reasons we keep getting new flu shots all the time. It's something we just expect to see.

[00:09:23.74] But the fewer we can get by vaccinating the population, the better. And that's-- but it is a natural process. It's what we would expect.

[00:09:33.01] KODY KISER: The thing with variations as well is that sometimes those variations happen that are not beneficial to the virus. It may evolve some sort of thing that makes the spike proteins not adhere as well. And those tend to-- so for as many variations as we get, there are a lot of those variations that kind of phase themselves out, natural selection-wise.

[00:10:02.67] REBECCA DUTCH: And that's a fantastic question. And that's-- you're exactly right. So there's no-- when these mistakes are made, they're not-- there's nothing intentional about any of this. It's just random errors put in during the process of replication.

[00:10:16.82] Many of them go in in places that make that particular new virus genome that was made completely un-functional. They put a mistake in a place you can't have a mistake. That one's never going to get used. But they make so many of them that that doesn't matter. You can throw away a ton and have-- then you have others that have mutations that might turn out to be beneficial.

[00:10:37.98] And then what you'll see is that mutations that help spread the virus-- and those that give you more transmissibility-- they emerge as-- we call them the "winning mutations," because those viruses get to spread more. They're spreading more because of those mutations. So then we see them more.

[00:10:57.20] So you're completely right. Lots of mutations happen that don't do anything good for the virus. Some of them destroy-- would absolutely disable a virus. Those are discarded. And you select for the ones that give you an advantage. And it's not that the virus is selecting. It's just nature and life are selecting.

[00:11:15.86] JAY BLANTON: So given the pace of vaccinations and what's going on in the country and globally, not to be Debbie Downer, but are we looking at another winter like last winter of dealing with this, or in the way we're dealing with it?

[00:11:32.72] REBECCA DUTCH: I would say yes. I mean, obviously all of this is trying to predict. But at this point, we still have an awful lot of unvaccinated people in the country. So they represent a population who will get it and keep it for longer.

[00:11:47.93] One of the reasons they are-- and the biggest reason they're suggesting boosters now for people is not that the vaccines don't do their big intended job, which is to keep people-- reduce your risk of hospitalization and death. They're still working beautifully for that. But in the early stages after vaccination, you seem to have such a high antibody response, for most people, that you don't even get much productive infection at all.

[00:12:11.19] And so we're trying, basically, to downplay having any people with-- these vaccinated people have any infection that they could spread. And that seems to be that for six months. So that's why the recommendation is for boosters. So the more people we boost, the more people we vaccinate, the better we will be.

[00:12:29.12] Are we likely to see more spikes across the country? Yes. I think so. I mean, right now, UK and Kentucky, we're doing well. Or we're less than a third of where we were at our highest hospitalizations in September. So that's good.

[00:12:42.62] Campus has done amazing with its vaccinations. That is so, so important. But we'll probably see more spikes back up again. Often they come after holiday events and other times like that, when people who are either unvaccinated or people who their vaccines were a long time ago and they get exposed, they don't get sick. But they do have some virus they could spread on, spread it on to someone else.

[00:13:06.48] So yes. I think this winter we'll keep seeing things, hopefully not as bad as in the past. And then the more times we get exposed, the better our immune systems are at dealing with it. So I still think by next summer, we're going to see everything pretty much reopened up. That's my hope. That's crossing my fingers.

[00:13:24.59] And in that sense, a new variant like Omicron, if it truly does spread well but not make you more sick, may protect by getting people exposed another time to something that doesn't hospitalize them or kill them necessarily, but starts to build their immune systems up, because we certainly have people who haven't been vaccinated. And they're going to get exposed to some variant. I'd rather it be a variant that's not really pathogenic.

[00:13:53.73] KODY KISER: I know people-- it seems to be a lot of concern about breakthrough cases. We hear that all the time. And it seems to be one of those things that you see in the news that-- and I could be wrong about this. But personally, I feel like it gets a little bit more attention than maybe it is quite necessary, as far as to be a scary kind of thing.

[00:14:12.69] Because I just read some information out of a couple of places, Washington State and Minnesota both, they were reporting between 1% and 3% cases were breakthrough cases. And of those, it's like 0.13% who are actually hospitalized. So the number is really, really tiny. But to that, it does seem that being vaccinated helps.

[00:14:37.77] Because of this new variant, one thing I guess we should ask about or talk about is our tests. Are the tests still going to work? And the vaccines, are the vaccines still going to work as designed? Or is there going to be some concern from the pharmaceutical companies to change some things up?

[00:14:55.80] REBECCA DUTCH: Those are fantastic questions, Kody. All right. So let's first look at the vaccines and what they do.

[00:15:01.14] They were tested and intended to decrease your rates of hospitalization and death. We just don't-- we don't expect our vaccines to keep you from ever being any productive infection, because when a vaccine gets your immune system going, your immune system has to see the virus that came in to get going. So you expect to get something in there.

[00:15:24.15] Surprisingly, the mRNA vaccines in particular did quite a good job, in the early stages after vaccination, of keeping people from even getting any kind of productive infection. And what we think is that in the early stages, you get a really high antibody response. That means you have circulating antibodies, that even when the virus gets in and tries to get a foothold, it basically beats it back right away.

[00:15:45.15] But normally, our bodies don't keep high circulating antibodies to everything we've been exposed to, because it just-- it would frankly be unhealthy to have that many circulating around for so many different things. But what they do do is have this amazing response where-- first, where they generate new antibodies as soon as they recognize it, and second, their t-cells come in. And that t-cell response is critical for fighting back.

[00:16:11.80] And so what we see is that even months and months after your vaccine, people may have a breakthrough infection. And it's not really breakthrough. We never-- the vaccine companies never said, this will keep you from being infected. They said that it will keep you from getting really-- it will really reduce your odds of being very ill or dying.

[00:16:31.26] Even when people are getting it, we're seeing that people who end up in the hospital, it's a much, much lower risk of that if you've been vaccinated. And your risk of death is much lower. And for instance, right now in UK's hospital, in our ICU, we do not currently have anybody with COVID who was vaccinated who's in the ICU or on an intubator.

[00:16:48.24] We have had some people. If you are someone with really serious underlying health conditions, you're elderly, particularly if you're immunosuppressed, you're under chemotherapy, you're on immunosuppressive drugs, your risks are much higher. Take it really seriously. Be very cautious.

[00:17:06.13] So that's how vaccines work. Now, how about this new variant? So far we have a lot of what looks like pretty good news.

[00:17:14.04] Number one, we have-- tests seem to work just fine. The tests are designed to work for something that's going to work just fine with this variant. That's not going to be an issue.

[00:17:25.14] We have a whole panel of different treatments with monoclonal antibodies that people can have. At least one of them may be compromised based on where we think it binds and where the changes are. But we have others that there's no indication that they are compromised. So we still have tools available to treat, if you were to get it. And that's really important.

[00:17:45.24] How about, are vaccinated people more likely to get infected with this new variant? There, we don't know the answer. There's some sporadic case reports that might suggest yes. But the people who are getting it are-- they're asymptomatic or very mild. But there's such sporadic reports, we don't know the answer yet. What we certainly aren't seeing so far is any evidence that vaccinated people are getting really serious infections that put them in the hospital at the kinds of rates we see with unvaccinated people.

[00:18:16.15] So at this point, we still have exactly the same advice we've had. Your best bets are get yourself vaccinated. If it's been six months since, get your booster. If you are a healthy person without underlying effects, live your life. Mask in places where you're in large crowds. If you've been exposed, get tested.

[00:18:38.58] And be aware of whether you're around somebody with underlying conditions, because that's when you'd want to be really cautious. If you're going home for the holidays, for instance, and you're going home to a grandparent who's immunosuppressed or very ill, get tested before you go see them. Just be careful.

[00:18:52.74] But that's-- I mean, Omicron isn't changing my behavior right now. I think that we just keep following the same things we've had. Scientists will figure out more. But for now, nothing in the news about this looks terrifying at all to me.

[00:19:07.66] KODY KISER: I do want to ask. You brought that up. We are seeing a rise in our numbers here in Kentucky and around the country as well, possibly due to Thanksgiving gatherings and things like that, and also people relaxing maybe a little bit. As we head into our December holidays, what do our students here on campus, who are going home, or just our listeners in general, what do people need to-- I mean, is this type of spike expected to continue? What do people need to know or take heed of as we head into-- and I know you kind of mentioned being careful around people.

[00:19:41.05] REBECCA DUTCH: I think the spikes will keep going up after any time when we have large gatherings like that, where you're going to be particularly indoors. I think as we saw through the fall, the big outdoor gatherings are not-- we expected them not to be as serious. And it was true.

[00:19:53.50] Big indoor gatherings are an issue. So there, what I'd just be very conscious of is, who are you gathering with? If you're gathering with a bunch of healthy people and they've all been vaccinated, and you are all comfortable with the idea that it's a possibility you might catch it, but you'll keep track of it, you're healthy, you're not too worried because you've been vaccinated and you'll keep track of it, then it's not that big a worry.

[00:20:16.75] If you're going to gatherings where there are people who are higher risk, be careful. That's when I'd say be really careful. If you, for instance, know you're going to be spending time around someone who's immunosuppressed, I would not spend much-- I would not be over there particularly without a mask or hugging your grandma, or whatever it is, until you've had a test and you know, OK, I'm not-- there's no chance I'm spreading this on, because that's the group that, vaccinated or not, remains at high risk.

[00:20:45.14] So I'd say just be very aware of who you're around. Think carefully about that. And make good decisions. And we'll probably have to keep doing that for a while. The more new antiviral drugs we get, the better off we'll be, because when we have people who are immunosuppressed who catch this, the earlier we can start giving them therapies, the better off we'll be.

[00:21:06.40] JAY BLANTON: Now, the university has announced that it's at a 90% level of either partially or fully vaccinated. And we've had some reporters ask us, even, what does that mean in terms of the immunity of the campus? Or some are calling it community safety. Or what can you say about that, and what you think the institution ought to be doing looking at it going forward?

[00:21:27.49] REBECCA DUTCH: Well, honestly, when I come to work, I figure I'm at the safest place I could be in the state. And the combination of vaccination and the fact that we're still masking indoors and being cautious with that, I think that we've taken all the right precautions to do everything we can to keep ourselves open, and people in class in person, and people able to interact while still doing it safely.

[00:21:51.16] That high vaccination rate provides an awful lot of protection to the people around you, including to the small percentage who cannot be vaccinated, or who are vaccinated but have other underlying health conditions. And that's one thing to always remember. If you're of a small group, you know them really well, you may be sure no one has an issue that might put them at higher risk. But as soon as you get into larger groups, you probably don't know. So again, just be careful.

[00:22:16.63] So we've done a great job. That 90% just blows me away, in terms of the number of people who stepped up to say, yes, this is what I know I should do. And I'm doing it for my community.

[00:22:29.84] KODY KISER: I think that is a good thing to point out too, because we-- for so long, we kept thinking this is just something that our elder population get. And those numbers were so high. Once the vaccination started to roll out and that population started to get vaccinated and those numbers came down, then it kind of pulled the curtain back on, oh, yeah, everybody 40 and under is still very susceptible to this as well. We just weren't seeing it because the other numbers were so high.

[00:22:54.42] REBECCA DUTCH: Yeah. It's all about what your odds are. If you were in that older group-- I know, for instance, my parents are in their 80s-- your risks, if you got this, were high, depending on what you look at. It's 8% to 12% sometimes, some of these things for either mortality or hospitalization, depending on other things.

[00:23:14.29] If you're a healthy 35-year-old, your risk is right low. But if you get 10 million healthy 35-year-olds infected, you will have people who die from it. And that's what we're really starting to see as it rolls across the population, as we move to everybody being exposed at some point through either the vaccine or their first infection as an unvaccinated person, you see healthy people passing away.

[00:23:36.82] And it's really sad. When I talk to people who work in the hospital system, one of the things that's hardest for them is losing people that they didn't think they needed to lose, that they thought if only something different had been done, this person might not have passed away. And that's really hard.

[00:23:56.27] So yeah. No one is completely safe from this. It's just a question of what our risks are.

[00:24:04.77] KODY KISER: Definitely something to be mindful of. And we hope that everyone does take precautions and does do the things that they need to do to stay safe and keep others around them safe. Dr. Becky Dutch, thanks so much for being with us.

[00:24:18.03] REBECCA DUTCH: You're welcome.

[00:24:18.18] KODY KISER: I'm sure that we will check in with you sometime after the new year.

[00:24:22.26] REBECCA DUTCH: OK. All right. Thank you.

[00:24:23.40] KODY KISER: [CHUCKLES] Thanks.

[00:24:24.30] [MELLOW MUSIC]