Welcome back listeners to The Whole View, episode 41.! (0:27)
Sarah corrected Stacy, this is episode 401.
One of the things that Sarah is finding to be challenging during the coronavirus quarantine is the lack of things that mark the passage of time.
Every day seems the same, which is disorienting.
This time has been eye-opening to Stacy from a quality of life standpoint.
If you missed the announcement on episode 400, this show is now The Whole View.
However, it is the same podcast, just with a new name.
This week Stacy and Sarah are going to jump right in and talk covid-19.
Stacy is in week six of quarantine.
If you are enjoying this show, please leave a review.
And if you left a review when the show was The Paleo View, please leave a new review.
This will help people find the updated show.
Sarah has received some amazing compliments on the coronavirus podcast episodes that have aired so far.
“Thanks for all of the amazing actionable content during this health crisis! I’ve been tuning in to the podcast every week.” - Mariel (4:43)
“I’m a long time listener, one of those who’s gone back and “caught up,” I know Stacy, but they were so helpful! I mainly attribute the fact that I’ve maintained control of my RA for 3 years without my double dose of DMARDs to you two! Saved my life! Thank you both for all that you do. It would be an honor just to be given a shout out on the new show: The Whole View, congrats! I can’t wait to hear the first episode!” - Amy
“Thank you for all the energy and passion you put into every episode! I learn something new every time and I've even gotten my husband to listen along with me.” - Renee
Sarah wanted to give a special shoutout Charissa who does all the pre-show prep and is Sarah's, Chief Operations Officer. (6:47)
Charissa goes through all the listener questions and the podcast inbox and organizes them into topic groups.
She then helps Stacy and Sarah put together their recording calendar, and puts a ton of time in the pre-production projects.
Sarah wanted to say a huge thank you for all that Charissa does.
She was a huge help in collecting and organizing the questions for this week's show.
The first question is, what is our way out?
The scale of shutdowns globally is unprecedented.
This is unique in human history.
These shelter-in-place orders have had a huge effect on the global economy, with unemployment numbers extremely high.
All of this has been done to flatten the curve, which Sarah explained in greater detail.
One of the big challenges with this virus is that it has a high hospitalization rate.
This virus is highly infectious and is a strain on the healthcare system.
Because this is such a challenging virus and we don't have a treatment yet, our only option has been to quarantine.
So the question is, how do we get back out? And life as normal?
The way to get beyond this is that we need one of three things to happen.
The first thing, which will be the most effective, is herd immunity.
Sarah broke down the way that herd immunity works.
In the absence of herd immunity, the other big thing that would get us back to life as normal would be an effective anti-viral treatment.
There is also the option of using medications that would prevent the virus from infecting a person.
However, this is much less likely since there aren't many drugs that are effective that do this.
In the absence of those two options, the other option is to do these shutdowns and quarantines long enough to ramp up testing capabilities.
There were countries that ramped up testing at the beginning who were able to successfully slow the spread of the virus.
More on the Three Options
There are challenges with each one of these three cases, which Sarah will breakdown further. (18:42)
None of these scenarios are fast.
The fastest way out is probably the discovery of an effective antiviral.
There are a number of candidate drugs that are being tested.
Many have been shown to kill the coronavirus in test tubes.
However, this doesn't mean that the drug will successfully reach the part in our body that would make it effective.
Understanding safe dosages is critical.
We actually don’t have many truly effective antivirals.
For example, Tamaflu can decrease the duration of influenza illness by 30% to 40%, and decrease flu severity by about 40%.
However, it only works if taken in the first 36 to 48 hours of illness.
As commonly taken, it shortens the duration of flu by about a day.
It has not been proven to have a positive impact on hospitalizations or mortality of seasonal, avian, or pandemic influenza.
There are some good examples of effective antiviral treatments though.
The best example we have is the antiviral cocktail that is given to HIV positive patients.
Sarah explained the way in which the HIV cocktail works in the body.
We do have these examples of antivirals that can be very effective.
The Need for Data
However, what we need right now for covid-19 is randomized controlled, double-blind clinical trials of the antivirals that we already have.
We need to look for drug combinations, and we need to establish risk profiles.
Safety is a huge concern with antivirals in general.
Many have high adverse reaction rates, which is why we don’t have an antiviral for the common cold.
Data is needed to make decisions.
The hydroxychloroquine initial trial was unblinded, uncontrolled in 20 patients, and excluded severe illness from the study.
All these types of trials are supposed to do is indicate whether something is worthy of further study.
Sarah shared more on this study out of Brazil.
Preliminary findings suggest that the higher CQ dosage (10-day regimen) should not be recommended for COVID-19 treatment because of its potential safety hazards.
Such results forced us to prematurely halt patient recruitment to this arm.
Given the enormous global push for the use of CQ for COVID-19, results such as the ones found in this trial can provide robust evidence for updated COVID-19 patient management recommendations.
There is promise with antivirals as a treatment for covid-19.
However, it is very important to take preliminary studies with a very large grain of salt.
We need bigger studies to prove efficacy and safety, which takes time.
Matt made a very rare appearance on the show to add this breaking update to Sarah's recommendations. (31:55)
More tricky than antivirals is vaccine development.
One of the things that is really important to understand is that vaccine development, especially for a new virus, takes years.
The fastest vaccine that has ever been developed was for mumps, which took four years.
The Ebola virus vaccine was a close second and took five years to develop.
We are trying to develop a vaccine for the coronavirus in a year, which is unrealistically optimistic, given the challenges with developing vaccines against other members of the coronavirus family.
Covid-19 is the seventh identified coronavirus that infects humans.
The early vaccine development for 2002 SARS cause vaccine-enhanced immunity in rodents.
Not all antibody responses are protective.
By the time they had a candidate, researchers were unable to test their SARS vaccine candidates for effectiveness in humans because they would have had to inoculate a population that was exposed to SARS, and the disease was effectively wiped out using public-health measures before that could happen.
What is happening now with covid-19, is that vaccine research is picking up where SARS vaccine research left off.
We need to understand the antibody response to covid-19.
There have been some studies that show that the bodies producing several different types of antibodies when it is infected with covid-19.
However, they are not all neutralizing antibodies.
The chances of a vaccine causing vaccine enhanced infection are still there with covid-19.
Sarah shared information from this study.
The Complexity of Vaccine Development
It will be complex to develop an effective vaccine against the novel coronavirus.
There are many different vaccines that are in phase-one clinical trials.
We will need to do the human trials at the same time as the animal trials in order to expedite the timeline.
It will also take a huge investment in mass-producing vaccines.
Once a vaccine is proven to be effective, it takes six months to a year to mass-produce that vaccine to the level that we will need to achieve herd immunity.
We hope that the SARS vaccine research was progressed far enough that picking up from that for this related virus will help expedite the vaccine development.
Stacy shared her appreciation for these facts.
These details help to give perspective.
There is this whole other side of it, which is developing natural immunity by people getting infected. (41:25)
However, there are still some questions as to how immune people are after getting the disease and how long that immunity lasts.
Sarah shared information on this study out of China on antibodies in coronavirus cases.
There is still this piece of science that needs to be figured out and researched.
We need to understand what kind of antibodies need to be produced by our bodies to be immune, and how much.
Once we know that, we need to know how long those are going to last.
One of our ways through this is by ramping up testing, which needs to be done on both active infections and immunity.
There have been a ton of antibody tests that have been rolled out.
This is interesting to Sarah because tests have been introduced without basic science to interpret the data.
Tests don’t have high enough specificity or sensitivity.
Poor sensitivity means false negatives, poor specificity means false positives.
We need the antibody tests to be better, and we need the diagnostic tests to be a rapid test. (47:33)
Right now, testing is taking five to twelve days to get results back.
We need a diagnostic test that acts very much like the rapid strep test.
Once we have the testing capabilities and we have a good enough handle with the shutdown, then we could potentially start returning to a more normal life without waiting for a vaccine or antiviral.
This requires a huge amount of tests.
Sarah explained that way widespread frequent testing would help.
However, contact tracing presents privacy issues with smartphone tracking.
This is a resource-intensive process.
Stacy added that she loves the idea of using tech for these purposes!
Sarah shared more on the flaws in this approach.
We need to be able to take the human resources out of contact tracing, and crazily ramp up testing.
We need to be testing as many people per day as we have tested total in America so far.
Then we need to do these targeted quarantines based on who has been exposed.
We also need to better protect our healthcare workers.
While the mortality rate from covid-19 increases dramatically with age, the hospitalization rate is still really high in young people.
The rate of severe illness requiring hospitalization is not that different between young, healthy people and either people with preexisting conditions or who are older.
Continuing Our Work Together
We have to figure out how to carefully return to life as normal bit by bit so that we don't completely overwhelm hospitals.
This is the part that is painful and heartbreaking for Stacy to deal with.
Thinking about those healthcare professionals and those other people on the frontlines and the sacrifices that they are making.
We are coming together as a community to help those people who are still fighting that fight and who are risking their lives.
Stacy focuses on these realities, which makes all the other frustrations worth it.
She has so much to be grateful for, and these are the pieces she focuses on.
We can all find something to give us that compassion for those who are fighting on the frontlines.
Sarah shared on the struggle of sympathizing with those on the front lines who are facing a very different set of challenges while trying to also process and address your own personal challenges.
It is very important to give people permission to know that their struggles are valid.
Do not dismiss the challenges that each one of us are having.
Also, work to maintain awareness about the things that deserve gratitude.
From a mental health perspective, it is really important to be able to appreciate that we have these challenges.
Then be able to apply a solution-oriented mindset to them.
If you are feeling frustrated and overwhelmed, something that has given Stacy hope and something to look to is donating time, resources, and money when they can.
The other group of questions that have come up has to do with reinfection. (1:02:44)
There have been some reports out of South Korea and China where they have people who tested as negative and then were rehospitalized a couple of days later after testing positive.
It is probably a testing failure.
We know that in the course of covid-19, people who are going to have a mild course of the disease tends to resolve in 10 to 14 days.
The moderate to a severe course of the disease is a four to six weeks recovery timeline.
So around that 10-day mark, people start to feel like they are getting better.
If they received a false negative, and then developed into a severe case, this is what would have led to hospitalization.
The reinfection cases are likely a result of false negatives with testing.
Thus far, the research shows that people cannot actually be reinfected with the virus, at least on the time scales that we have been dealing with.
Sarah shared information from this reinfection study out of Bejing.
There was another study on reinfection out of China that Sarah shared on, which you can find here.
Right now the data points to once you've had it and gone through the other side, you should be good.
We don't know if you will be good for the rest of your life, or a few years, but definitely for the next little while.
Do non-medical grade face masks really make a difference? (1:08:49)
The answer is yes.
Face masks reduce our aerosol exposure by a combination of the filtering action of the fabric and the seal between the mask and the face.
In order to have an effective homemade mask, you want both a material that will do a good job of filtration and you want it to fit around your face well.
You still want to social distance and be very careful about what you are touching.
Still, work to not touch your face while you are out of the house until you have had the opportunity to thoroughly wash your hands.
Also, when you take the face mask off, you want to think of it as if it is contaminated.
You want to take it off carefully and put it directly into the washing machine, and then wash your hands again.
Think of the mask as a contaminated surface.
There was a study done on homemade masks made of different fabrics and how effective they are based on the various design factors.
This is not an N95 mask that is going to protect you against everything.
It is still really important for two reasons.
One, if you have it and don't know, it is going to contain a large amount of the virus in which you are shedding.
This will reduce your risk of infecting others around you.
Second, this is going to help you if you are exposed to an infectious person.
The virus exposure, how much you are exposed to when you are infected, is a major contributor to the severity of the illness.
One of the challenges that healthcare workers face is that they are being exposed to so many different particles when they do get exposed, due to their proximity with so many different covid-19 patients.
This is why we need the appropriate levels of PPE for our healthcare workers, and we need them to be able to change them between patients.
If you are exposed to the virus when you are out of the house, but you are wearing an air mask that reduces your risk by 75% you just decreased your inoculation dose by 75%.
Statistically, this will increase the liklihood of a more mild course of the disease.
Stacy learned so much in this episode and thanked listeners for asking these questions, and Sarah for taking the time to research and answer these questions.
If you have enjoyed the show be sure to share it with people in your life who you think would also enjoy the show.
And leave a review and rating on whatever platform you enjoy listening in.
Stacy and Sarah thank you so much for following along on the Whole View.
It is taking Stacy and Sarah a little bit of time to get use to this change.
We have received so much great feedback on this change, and Stacy feels like we are celebrating this milestone as a family.
Thank you for being a part of this community!
We will be back again next week! (1:21:40)