2021-07-22 BTB - Dr. Rebecca Dutch (COVID-19 Update)

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KODY KISER: Welcome to Behind the Blue. I'm Kody Kiser with UK Strategic Communications and I'm joined this week by UK Chief Communications Officer, Jay Blanton. In her work as chair of UK's department of Molecular and Cellular biochemistry, Dr. Rebecca Dutch partners with researchers and faculty from multiple disciplines across the University of Kentucky.

Now Dutch is taking on even more research responsibilities as she was recently appointed Vice Dean of research for the UK college of Medicine. In her new role, she will oversee and encourage research from basic areas to clinical applications and more for the college.

On this week's episode of Behind the Blue, Dutch returns to share her thoughts on a wide range of pandemic topics including, Delta and the other variants of the coronavirus, who it's most affecting, and the likelihood of becoming infected with or without the use of vaccines. Understanding the differences in the messaging coming from the CDC versus the World Health Organization, what efforts can be taken to get vaccination rates up among the population, and more.

JAY BLANTON: We are happy to be joined again on Behind the Blue by Dr. Rebecca Dutch. And Dr. Dutch actually, between the last time you were on and today when you are joining us, you've had a bit of a title change here at the University of Kentucky. Can you tell us a little bit about what your new title is and what all that entails.

DR. REBECCA DUTCH: Yeah. So actually this is a very recent change on July 1, I became the Vice Dean for research for the College of medicine, which is an exciting position and to be a challenging position. So essentially, my role is to oversee and really encourage, stimulate, and work with all the research that happens in the college . And the College of Medicine has a very, very large research footprint.

So we're talking about hundreds of millions worth of funding and everything from clinical to basic research. So it's a pretty exciting thing to take on and I'm excited also because there's so many amazing people in the College that I get to work with in that role.

JAY BLANTON: That sounds excellent. We definitely pride ourselves here on the level of research and the level of the amount of students that we were able to get involved and immersed in research early. I know we talk about that a lot with incoming students that even as a freshman, you can get involved with research on various degrees and so that does sound like a challenge, but one that's probably going to be very rewarding.

So we want to talk a little bit about our COVID situation in a broad sense, but also look at some finer more granular things regarding here on the UK campus. But basically give us a little bit of a level set of where we are today, even from a state level or national level as far as our approach and how we're handling the coronavirus.

DR. REBECCA DUTCH: Yeah, absolutely. So we are in a much better place than we were, I think the last time we talked. Really one of the game changers has been the introduction and then the why-- the slowly wider spread usage of vaccines. So all of the data from the last eight months as we've been releasing and moving out these vaccines, really backs up what we saw in the trials.

And that is that these vaccines in the US it's primarily the mRNA vaccines with some use of the J&J vaccine. But they all do a tremendous job of preventing serious illness, hospitalization, and death. That's the goal of these vaccines. It's not impossible to catch COVID when you're vaccinated, it's much more difficult to transmit it-- to catch it and transmit it. And it's extremely rare for you end up in the hospital or to pass away from it.

The few cases a lot of people with extremely high risk conditions or a very specific immune disorders. So for those who have been vaccinated, that really changes the landscape. And that's why the CDC a number of months ago recognized that by saying that people who were vaccinated could now essentially assume they were fine. They could take off your masks, you can not worry about distancing anymore, and you can get back of going to normal life.

So in that sense things are really good. But we do have both in the state and in the nation essentially two groups of people. We have vaccinated people who I'm not particularly worried about. My father is 88 and he was vaccinated and we're going to go to a family camp together and he will be around a lot of people. And I think he will be fine.

But then we also have a large group of Americans who are not vaccinated. And I know this is a controversial subject for some people. I will say that the controversy is primarily based on misinformation and a lack of understanding of both the issues of the vaccine, but also the potential complications with COVID. It's a combination of people who are worried about all the things they hear, there's so many scary rumors out there about vaccines.

All people who think COVID it's not that particularly big a deal. We still know COVID it can be really serious, it can kill a lot of people. We're also now dealing in terms of the landscape with what we call long COVID. The estimates about 10% of people who've had it and we think that's going to probably be over 10 million people that are going to end up dealing with long COVID in this country. Those are people who have long term health effects related to having been infected. That's serious.

We have these groups that are not sure why they should be vaccinated or they chose not to be. Their risks are still there. And the concern is as we move forward that because most people are removing masks and that distance are nearly more, regardless of vaccination state. Even though the CDC says, they mask, stay distance.

As we get back together the virus has plenty more potential to spread than among unvaccinated people. As we get new variants, we'll talk. We will continue to see new variants right now but a lot of people talk about delta. Delta appears to do a better job of spreading in populations. And we're seeing the rise. Delta is becoming the predominant strain in much of the US. We're seeing a rise in total infection numbers, hospitalizations.

Again, these hospitalizations are almost all people who are not vaccinated with a tiny exceptions of a few people with very specific pre-existing conditions. That's scary too. That's because there are places that have amazing vaccination rates, other places that don't. For instance at UK HealthCare, we have written up in AAMC because the vaccination rate here is over 94%.

So when I come into work in the College of medicine and walk through the hospital section, you really have a good sense that people around you have taken their own health and those of health around them and take it serious have been vaccinated feel safe, UK campus has done a tremendous job of getting its faculty and staff vaccinated. And I know we're pushing with students student vaccination rates.

If I understand it right, are quite a bit above national average for vaccinations. And that's unusual in that age group. So that huge kudos to the people here have push that. But you can go places in the country where vaccination rates are well below 30%.

JAY BLANTON: Are we even talking about those delta variant if more people were vaccinated?

DR. REBECCA DUTCH: Probably not. If we vaccinated all eligible adults and people over 12, any variant has a lot less opportunities to develop. Certainly, the spread and the large number of cases are primarily among unvaccinated people, hospitalizations almost exclusively among unvaccinated people. So the more we vaccinate, the less we're concerned about variants.

The other thing is the more people that this virus can grow in, the more opportunities it has to make new copies of itself, the more likely we are to suddenly have another variant. Right now we've been very fortunate every variant we're seeing is still effectively dealt with where the vaccines that we have. But it is certainly possible a new one could emerge that isn't as effectively dealt with and then we need to go back and boost and all of those kinds of things.

So we really are looking at a scenario where the vaccination states are going to determine your risk. Different communities are clearly very different. You can see that in what's happening in the US. They're sending emergency health into some regions like Missouri had huge problems. And there's other regions who don't have that much of an issue, but that's mostly vaccination rate.

JAY BLANTON: It seems like one of the things that's not been maybe stressed or it gets talked about but not in a way that I'm sure is coming across to people is this idea that, the delta variant being more contagious but not necessarily more deadly per se. But I'm starting to see stories where this is starting to really start to pick up infections in people under the age of 45. That younger people--

DR. REBECCA DUTCH: Yeah.

JAY BLANTON: --used to think they were not susceptible to it.

DR. REBECCA DUTCH: Yes. Trust me, I know. I know some people that age who thought they were safe and they got quite sick. Delta. There's anecdotal data that says Delta is more deadly, but there's none of the studies so far really bear that out. And it actually makes sense viruses when they evolve the thing that makes a virus if you want to call it win, win the race is to get to more people.

The better you transmit, that's the fitness test. It does nothing for a virus to kill its host, it doesn't make it more likely to win are more likely to get on to the next host. So becoming more transmissible or having that transmission more likely to get you a good robust infection, is what a virus will evolve to. But what I think we are seeing is that vaccination rates are appearing all over the place. But if you look at people in the highest risk groups in the elderly, people who are really serious secondary or pre-existing conditions that might make them more likely to be very sick, vaccination rates are higher.

So almost 80-year-olds are getting vaccinated because the risk is so clear. And therefore when something like delta spreads, we don't see a lot of those groups in the hospital anymore. What we're seeing are was what was probably there before. We always had young people. I believe the first COVID patient at UK was I remember like 29 years old. So we've always had young people, it's just now we notice them more because the vaccinated older people are not ending up in the hospital.

So I don't think there's really data to prove that Delta is more likely to make a young person sick. It's just that you're more likely to get infected and particularly because it's spreading and if you're not vaccinated, you take off your mask and you walk among lots of people, it's easy to spread it to you. So vaccines are probably the biggest change in landscape, definitely the biggest change landscape.

There are some other changes. We have therapeutics, particularly monoclonal antibodies. So if you are someone who is gotten COVID for some reason, either you weren't vaccinated or you're somebody who's got an immune disorder. That means your vaccine didn't-- you weren't allowed to be vaccinated, for instance, or some conditions that you cannot be vaccinated.

And there are some very good monoclonals which are given in the first week really change people's chances of how ill they'll get or whether they'll die. We didn't have those a year ago. There are reports of New potential antivirals that we may see coming out in the relatively near future.

So those are all huge pluses. So we have a lot of tools against this virus we did not have a year ago and that as I said, is really made it. Life seems very normal for a lot of us now. The virus is still there, we do have to be careful, but we're so much more back to normal than we were the last time we talked.

JAY BLANTON: Last numbers that I saw statewide were probably I think they were somewhere in the 48% to 50% range of completely vaccinated, I think that probably tracks with our national rates of being completely vaccinated. And I think that's not necessarily a clear cut divide between those who choose to or those who do not. We've also got to take into consideration children. And specifically children under 18-- or children under 12.

DR. REBECCA DUTCH: Under 12.

JAY BLANTON: There are currently trials going on. What can you tell us about that as far as what those trials are like.

DR. REBECCA DUTCH: So there are trials going on for kids under 12. And I think it's 5 to 12 but I'm not positive but the bottom number. They have to do it. The very youngest will be the last trials to be run. And in fact, UK is one of the sites that's running a trial for Moderna looking at kids and if you're interested in having your children participate in that, I believe you can still sign up.

Those are really important because those kids currently don't have the option to be vaccinated as we look at return to school other things, the CDC I believe is still recommending masking, unless you're vaccinated. If you're under 12, you can't be. The hope is that we would have answers to that, I'm hoping by sometime early fall to how the trials went.

I have not heard any reports of any significant complications coming out of those trials, which is really good news. I wouldn't have expected them based on what we've seen in all the other age groups, but you have to test them be very careful with it. And of course it's a really good point. Some people are not vaccinated because it can't be all of our kids under 12, and then people with certain conditions.

And we need to all be very aware of that when we vaccinate, or if we can be vaccinated we're protecting those people. And I think it's something we all should be very aware of if for instance, we're working with kids under 12. That anything we do to reduce the risk that we could spread it is really important. Because you're hearing multiple stories of kids go to a camp and everybody comes back with it, or a worker brings it to the daycare and suddenly you have to kids have it and they all take it home. Those kids it's our role to protect them.

JAY BLANTON: There's a lot of recommendation from the CDC about what to do. If you're vaccinated is supposed to be vaccinated, obviously the World Health Organization has its own set of recommendations. Help us understand what's being recommended what we should take from this for you to move forward.

DR. REBECCA DUTCH: First of all, what's the difference between the two that you talk about. The CDC, Centers for Disease Control is very much focused on the situation in the United States. And therefore from that situation what they think is going to be safe or acceptable. The World Health Organization is looking at the worldwide situation and trying to make recommendations based on that.

Why that difference, why do I say that's different? Well, I'm going to go out and feel like my life is pretty normal, right now. I've been fully vaccinated since I guess very beginning February. That's not the case in a lot of the world. Our option to walk into Kroger and get vaccinated is not what's going on in most of the world.

I think the last time I checked, was just last week 2% of people on the African continent have been vaccinated from what I've heard. Many of those are not. Countries are not scheduled to get significant amounts of vaccine until sometime in 2023. We're going to think that this was a distant memory and there are places in the world that are not going to have a vaccine at all.

My husband is currently teaching a course to students in Taiwan for three weeks, having tremendous difficulty getting any vaccines. And so then the WHO show is making recommendations on things they are looking at, of course, is that therefore we have a world where lots of people aren't vaccinated, have no option to get vaccinated. Very few places have high vaccination rates. Are some. Israel in the United Kingdom or above us in terms of their vaccination uptake, but there's a lot of places of struggle even parts of Europe have struggled to get enough vaccine.

They look much more like we did back in March when people who want to be vaccinated get all excited when they got that appointment. So that's part of the difference. So the CDC specifically looks at this country and what they're saying is that we have a high enough vaccination rate, we've looked at what's going on. So therefore, they're recommending if you've been vaccinated, you don't need your masks you don't need to distance you are OK.

The exceptions being they're still asking for masks and public transportation, so buses, planes. Will say I flew a few weeks ago planes are running completely full, but there are people are masking. That's what the idea that in those situations everybody's in such close quarters and they have no choice who they sit next to. So if you were someone who couldn't be vaccinated for some reason, you don't have any choice, but who you're sitting to, particularly if you need to fly for some reason. They're trying to protect people.

I believe they're still recommending that the kids under 12 maintain their masking and distancing within groups. So that is going to be an interesting thing when we get into the fall and we see what happens with school because that would mean younger children would likely still be vaccinated. So it would still be masked until we can increase the amount of vaccinations in that age once it's approved.

They're looking at that scenario, the World Health Organization is still looking at the broader scenario of countries that have almost no vaccine and less access to other things that might help people. So for instance here, if you're unvaccinated and you showed up at a doctor and you're in your 50s and you have a preexisting condition and you have COVID, you're likely going to be offered monoclonal antibodies, because that is going to make a huge difference in whether you end up in the hospital a week later.

But those aren't freely available in much of the world. They're are relatively expensive, they're not easy to get. So WHO is generally a little bit more conservative in the kinds of things that they suggest are OK to do. And at least that's how I generally take their recommendations.

While in the United States, I look at the CDC recommendations. I know you look at the CDC recommendations when we make decisions about what is or is not appropriate. But if you were traveling, the WHO conditions become important because that's what a lot of the rest of the world would be looking at.

JAY BLANTON: You mention the recommendations we look at the situation you're on the START team that has been following the literature and making recommendations in terms of operations set. Where do you think the University is, is it positioned well to open in the fall and be a lot more.

DR. REBECCA DUTCH: I'm impressed with where we are. I'm very impressive with what's happened over at UK Healthcare. I think we're ready to go. The recommendations will be that just like the CDC, if you're fully vaccinated you are not going to need to mask or distance. You are still being asked to mask and distance if you are not.

Now I think we all know the challenge there is that we're not going to be asking for people's cards or doing this on the honor system. And there are plenty of people who don't. They may not be vaccinated but they also aren't concerned so they take that mask off, or they don't distancing. That will be the challenge that we'll face. Because depending on what's coming through we may see some more cases.

But if we're getting already our student population up above that 60%, if can get that at the 70-80%. That's really good. And we know the faculty is quite a bit higher than that already. So I feel very comfortable about what we've done about going back. At this point the University has not mandated the vaccine, and of some universities in the country have. A lot of universities are waiting and looking to see what happens with the FDA and their approvals.

Right now vaccines are under emergency use authorization, which is a little bit different. But Pfizer has filed a while back now for the permanent authorization for their vaccine, which would take it off of emergency use in which case I think a lot of universities will go back and look at whether they should be mandating vaccination, like we do for some of the other vaccines.

So I think in general we're in good shape. I'm sure there'll be some contentious stuff about this. I just want to stress again get vaccinated. There's new data coming out of that not just not only verifies how important it is in terms of hospitalizations. All you've got to do is talk to any doctor who is dealing with COVID in hospitals. They'll tell you what they're seeing under same people.

There's a lot of new studies saying, even if you've had COVID before, get your vaccine. It's as if, even you had COVID before you get that first vaccine, you actually come up to that level most people who've not had COVID do after their second shot, you get after shot one. But prior to shot one you do not have the same levels of immunity as someone who's had COVID as a people who have been vaccinated. And that it turns out that it does a really good job and it does a much better job vaccinated against some of these new strains that we're seeing like Delta.

JAY BLANTON: We've seen recently that Pfizer made the announcement that most preemptively or a little prematurely where they were talking to-- someone made an announcement talking about booster shots. Right now we're looking at probably about six to 12 months window of effectiveness for the vaccines. Possibly more we just haven't reached that time where we are trial people have had it that long. What do people need to take away from that. Booster shots are not something we need to be thinking about right now, correct?

DR. REBECCA DUTCH: Don't go to your local Kroger and ask for a booster shot, they don't exist. I think all Pfizer was trying to signal is that they are, what I would take away is that they're monitoring this. And if and when they feel that the boosters are going to be needed in order to keep the population safe, they will roll them out.

However, at this point, we know that the mRNA vaccine Pfizer Moderna are doing a very good job against every variant that's out there. I believe the last paper I've seen those who are in the very earliest trials which are on March 23 2020 was for the very first vaccinated people are still maintaining a nice immune response.

They will need to follow both antibody levels but also what are called memory cells that make antibodies. Those are actually the things that long term keep us safe and T cell immunity. And so they'll be following all of those to see what's going on. So how I would take away from that is they are keeping an eye on it. But you have to remember they also have to keep an eye on-- relative do we need a booster, or we keep making more vaccine than the rest of the world needs.

And at this point there's no good evidence we need boosters yet. And I'm sure that the FDA will be asking for good data before they authorize boosters just simply because you don't give shots unless you need to.

JAY BLANTON: If we don't need that in regards to our campus numbers, in regards to our state, and even national numbers, how can we get vaccination rates up? It's been seen that the giveaways that some states have offered up with monetary giveaways. I think some state recently offered free beer if you get vaccinated. Some of those have received a little bit of backlash and they're not quite as popular as they may have thought. So what do we try to do in order to get people to get vaccinated.

DR. REBECCA DUTCH: I wish I had a great answer to that. I think it's a combination of things. We keep listening and trying to respond to concerns. I think it's very telling that doctors are-- they are not only being get vaccinated their families. I believe that at the pediatric trial here the thing a lot of people who are-- a lot of kids who are in there are the kids of health care providers because they know how serious COVID could be, they know how safe these vaccines are.

So we need to keep talking to people. And first listening to why are you worried and trying to respond to it. But I'm not positive that's going to be enough. Some of the misinformation out there is really hard to deal with because even if you present the actual information, it's hard for people to believe. We have such a contentious society right now. It's hard for people to believe it.

We may hit a point when some places will start-- as soon as that Pfizer gets a permanent approval, I'm guessing we're going to start seeing more mandates, particularly in health care organizations, schools, places like that, that are comfortable with mandated lots of vaccines for a long time. That may help. And unfortunately I wish this wasn't the case but I think in some cases, people won't get vaccinated until someone they know ends up really sick or dead. And that's really, really sad. That is not what you ever want to see happen.

But I think that's maybe the situation that we're in. It will help as soon as the vaccine is approved for kids under 12 because they're a certain portion of the population. That's basically can't get all the way about two to 80% or 90% when you have a bunch of your kids people that can't be vaccinated that will help. But I think it's going to take time and patience.

I'm afraid some places and the rest of the world will out to vaccinate their population way beyond what we do for a long time. And that will be too bad. I hate to be the country that is continuing to fight COVID, when other countries have it figured out because we're not vaccinating as many people.

JAY BLANTON: Speaking of rumors, there's a lot of contentiousness in Washington and even some in the scientific community over the origins of the virus, in terms of whether happened naturally, the transmission from an animal to human, or now more discussion about whether it came from a lab in China. What do you make of this controversy? What should we take from it?

DR. REBECCA DUTCH: First, it is very controversial. So understand as I will tell you what I understand from my perspective. First of all, you have to separate trying to understand what really happened from the agendas on both sides. And I think that those agendas have made this conversation much more difficult.

First of all, do I think this virus was engineered purposefully for what is happening. There I am incredibly confident saying no. Why am I incredibly convincing no? Because I know how much virologists know. And it's only in the movies that virologists know enough to design a whole new virus that would do what this virus is doing. We don't. That is not true.

We're still trying to figure out with lots of viruses what changes did what. And this virus have all sorts of changes you wouldn't have predicted, it has a new gene or when I was a kid. I had someone ask, well, maybe China was just way ahead of us on that. No. That's not where the state of the field is. So this isn't a mad scientist out there doing something horrible. So that particular scenario I'm very comfortable ruling out.

What about this memo that says this came out of wildlife. The thing is that's the scenario that makes the most sense to virologists. Why do I say that? It's because we've seen it over and over and over again. We know the original SARS came out of wildlife, we know MASS came out of wildlife, we know how Hanta virus, Nipah virus is a whole series of zoonotic emerging pathogens that are coming out of the animals into human populations.

We know and have known for a long time that bat populations in China are full of coronaviruses. And lots of different ones. So all of those things make people lean very heavily in the field towards us being something of natural origin. I'm not surprised that we haven't identified the host species, the specific progenitor yet. It's hard. We don't have that for Ebola virus yet.

We think probably Ebola has a back host that we've actually never identified the real source of Ebola virus, because those experiments are really difficult to do. How do you track down every animal and see which little population of bat has this one thing. And I know the studies in China of coronaviruses and that's a massive diversity of viruses in these bat populations.

So that's why in general scientists lean very heavily towards that scenario. That's somewhere over time and that other things could have happened over a long period of time, we have multiple back and forth and back and forth events. Until some events started to take hold in the population. So that's where I think I would give it the vast majority likelihood that that's still a naturally occurring virus.

But one thing that comes up. Is it possible that the will Hawaiian Institute of Virology was working on these viruses and accidentally released this. So is it possible for me to prove that didn't happen. Well, first it's very hard to prove something didn't happen particularly, from the other side of the world. There's not good reason to think it did. Why do I say that.

So first of all, as I said they would have needed to have something they were working on that got released. There's no good evidence that is the case that there was anything close to this in their databases. There is discussion. So for instance, a biologist I know Daniel Anderson, she was actually at the Hawaiian Institute working there in the fall. She left sometime in November. So there was no indication to her that anything unusual was going on.

She said she certainly didn't hear anything about people hitting the hospitals. The woman in charge of there was off at a Hendra Nepa meeting in December talking about different viruses, I honestly think if she thought there was a major outbreak emanating from her Institute. She would have been unlikely to be leaving the country and off talking about completely different viruses. We just don't have any evidence to say that happened.

The genetics of it don't really fit with that. We don't have any people from that Institute that seem to have antibodies to it that earlier. Colleague of mine pointed out that because there's been this speculation that this discussion that there's a report from somewhere. We don't really know how it came about that there were three workers in that Institute that ended up in the hospital on November. We have no verification that if they were, we don't know what it was.

But someone point out well if it was COVID given of people who end up in the hospital with COVID versus of people who don't end up in the hospital, most of the people in that Institute or around there should have had an infection and three of them ended up in the hospital. But there's no evidence for that, but serology on the workers most of them are apparently negative. But that's report.

But what are some of the problems. One has been China honestly has been not very forthcoming. I don't know if they're concerned about reputation, they just simply don't want to share. They've not been particularly great about answering questions that people want to ask. And I'm separating this. I know a lot of scientists in China they are wonderful people, but I think that their government does not necessarily that doesn't encourage free exchange of information and seems to have tried to shut down a lot of Information now.

Unfortunately when you try to shut down information, that's a problem. I will say from the virology standpoint. In some ways, I think virologists may have done themselves a disservice when a year ago they just said, that's impossible. This is what it is. I think we should have had a very open reasoned discussion at that point about why people didn't think that was possible.

Because in retrospect, I think some people think, my goodness that they were trying to hide something. I think that was instead a concern that when we worry about the spread of viruses from animal populations, I teach a biology class before. The last slide in my biology class, let's say we talk about emerging infections. We always end with the idea. That there's going to be new ones is going to come out. We're going to have to not accept common it's coming again.

And this is long before COVID. So our worry was that you'd shift from with a very real worry to a worry about a mad scientist out there creating a virus and there wherever, which is not what we think is happening. And that I think is why some people are trying to say, let's not. This is not. We're moving on to something else. But maybe we should have had a much more open discussion earlier.

And maybe if we'd done it right away, China might have been more forthcoming. I don't know that they would have been though. So that's how I feel. Can I tell you it's absolutely impossible that there was any kind of lab work. I cannot tell you is absolutely impossible, because obviously we have no access to any of that information. But from a likeliest scenario, the likeliest scenario is absolutely that this is something that slowly came in out of the animal populations and that we're going to have other things similar in the future.

JAY BLANTON: I feel like this is a kind of a constant conversation or a constant battleground that we face in that generally people don't have enough of a scientific background to really follow a lot of this stuff or have a good grasp or good baseline of it. But at the same time there's maybe this impression that if you explain something people aren't going to get it.

And I don't think that's the case, I think if you took a measured approach to explaining things. A lot of people, most people would probably go, I see now, I understand, I didn't have a background with this but--

DR. REBECCA DUTCH: We have a lot of smart people in the world and they don't have to be scientists or virologists. There are lots of smart people and they have some tough people so we explain things to them or I don't even have to be solid. But people take the time to explain something, many people they get what you're talking about, they ask. I've had some phenomenal questions asked me and people have no background in science whatsoever.

So I think these kinds of discussions are important. But I do worry that one of the things that triggers this is to portray what happens when [INAUDIBLE] do and say in the movies. They're either usually mad scientists who create something bad, or if they're going to-- the good side then usually they can solve it really fast.

If you think about the movies about pandemics. Years ago there was an old Dustin Hoffman movie. I swear he saw a pandemic in a trailer behind his house in like a one week period. And so we're all thinking, oh, there's what that's it. But if they really wanted to, they could fix this fast. There must be other stuff going on. But the thing is that's not reality.

And so I'm not saying that virologists don't know a lot, we do. We know so much more than we used to. That's why we have vaccines so quickly now. But there's all sorts of limits to our levels of understanding and viruses are really complex.

JAY BLANTON: It seems like one of those things like don't have a good understanding of how cancer works, but you go to an oncologist because you've gotten some disheartening results through talking with your oncologist and whatever you do on your own. Most people tend to be quick learners and they start to have a grasp of terminology. And that's true for anything, any kind of thing that you go to see your doctor for. If you have a condition you tend to pick up these things quickly, because you are more immersed in it.

DR. REBECCA DUTCH: Yeah. And you get it.

JAY BLANTON: So if we were to ask you and we are very appreciative of the time that you've given us and we want to wrap things up. If we were to ask you to, I guess put on your magic hat, as we move towards the fall. And again, I feel like we've danced this dance before possibly where it's summertime, people are out, they're eating outdoors, they're doing things outdoors are going to baseball games, they're going to the park, they're doing outdoor activities.

As we move to the fall and the weather starts to turn and we start to get to colder weather and people start to come indoors, what are we facing this fall that may be the same or may be different from what we were facing last fall.

DR. REBECCA DUTCH: So I'd say my magic hat on, I could be wrong. But it's going to very much depend on the community you live in and your own vaccination state. There are regions of the country. The Northeast which was hit really hard by COVID last year has a very high vaccination rate. I don't think we're going to see massive surges in New York City or other places like that. The vaccination rates are going up, but we will see increases, we will, particularly help kids get vaccinated.

But areas of the country with low vaccination rates, I think we're going to see significant surges, we will see more people in the hospital. I don't think the numbers will go as high in those places because the highest risk people are more likely to have been vaccinated. So that's what I would predict we're going to see.

The good news would be that we have some new tools to fight back for people who do get infected. If you choose not to be vaccinated and you are in any kind of risk group when you go and you are told you've got COVID and they offer you a monoclonal take it. Do yourself a big favor. It's a very sad story.

Recently a husband wife in their 50s who both got COVID at the same time and the wife accepted the monoclonal and the husband that I'm just fine. And week and half late, the husband was dead and the wife was fine. So take that so seriously. So that's what I see that we're going to surge more in some areas than others and we will surge primarily related to vaccination state.

With the other thing I foresee is that we're going to have to continue to struggle with long coats. We have a lot of people who have got significant medical issues related to previous COVID infection. And that's going to continue to be something we have to figure out how to deal with. Hopefully and how to improve for some of those people getting vaccinated actually helps them. About 40% of them improve once they get vaccinated, but some have heart or lung or other damage that is long term going to make things more difficult. So as a society, we're going to have to adjust and help with that.

So I predict we're going to go back to very normal in most places, but we're going to get a lot of people-- there is still going to be a lot of people will get sick until such point as most people either have the virus or been vaccinated.

JAY BLANTON: Excellent. This has all been great stuff. Dr. Rebecca Dutch, thank you so much for being with us today. We appreciate it, and I'm sure we will check in with you again sometime in the future.

DR. REBECCA DUTCH: I thank you very much.

JAY BLANTON: Yeah. Thank you.

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