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Dr. Aw Answers More Employee Questions about COVID-19 - video transcripts

What do we need to know about vaccines?

Sandra Ramirez (Principal Economic Research):

Hi Doctor Aw, 'm just wondering what do I need to know about the vaccines and are they safe?

Doctor James Aw (Chief Medical Officer):
Well as the world knows, the 1st wave of vaccines are these Messenger RNA vaccines, the Moderna and the Pfizer vaccines.

These clinical trials that came out, they basically did them on 20,000 to 30,000 people.
The good news is because we started to immunize people, now we've got some data on folks getting these vaccines in the millions.

So, some of the preliminary data that's come out in terms of safety for these, particularly the Pfizer vaccine was that side effects are rare, like less than 1% in terms of serious side effects.
But there's one side effect that we're really worried about is called anaphylaxis.

So this is like the severe allergic reaction akin to the people who have like a peanut allergy or bee sting allergy, they always have to carry around an EpiPen, so if you get a reaction, it can be life threatening where you get swelling, you can't breathe and you can go into shock.

So they found that with the Messenger RNA vaccines, there were about 11, 11.3 actually, cases per 1 million doses of anaphylaxis, and most of those folks did require epinephrine, a few of them needed to go to hospital.

Just to give you context, for the flu shot, It's 1.3 persons per 1 million doses.

So, it's slightly higher than the flu shot, but still very rare.

And the good news for anaphylaxis is that it as long — and we deal with this a lot in vaccine clinics — Is as long as after you’ve administered the vaccine, you're in the doctor's office for half an hour later because the median time for severe allergic reaction to the vaccine was about 13 to 15 minutes.

So if you're going to get a bad reaction, you're going to get it within the first half hour, and then if you do the vaccine centre will know how to deal with it by giving you the epinephrine, the adrenaline and then supervise.

So, the good news is that as more and more people globally are getting this vaccine and you’re not hearing about these rare, unusual side effects, that's good news.

So right now, it seems that the wonderful RNA vaccines are safe, now we're going to start to hear more and more about these other vaccines.

They're going to start rolling out like AstraZeneca Oxford vaccine, which is the adenovirus vaccine and then J&J is coming out with one, and then they'll be other ones.

And the good news about the other forms of vaccines is that these are with technologies that we have a lot of experience with, so these are the technologies we've used for our common vaccines.

Now, one theory that has come up in terms of like, kind of nuisance side effects, is with the
Messenger RNA vaccine, is that, as I mentioned it before, you know they've got this Messenger RNA, which is wrapped in this sort of like greasy lipid membrane, and that greasy lipid membrane is made up this thing called polyethylene glycol, which is similar to Polysorbate, and this is used in a lot of product that we see on a day-to-day basis.

We think it's biologically in toothpaste and shampoo, it's in like laxatives.

It’s basically a chemical to keep moisture in and so they're wondering if there might be a connection with that particular element within the vaccine that helps on the delivery mechanism.

So if anyone has a known allergy to these kinds of things then definitely they shouldn’t take it.

The other recommendation from the allergists and the doctors right now is that if you do have a history of developing severe allergic reactions and requiring an EpiPen, or fortunately, you might want to wait for one of the other vaccines that come out and stay away from this one.

But again, as millions and millions of folks get vaccinated, we're going to get more information about safety.

Q: How soon can those of us who are at a lower risk expect to get the vaccine?
Well, this is a million-dollar question.

As everybody knows, you know now we're in the world of logistics and deployment.

So right now, just generally speaking, we're trying to avoid medical hospital collapse, so we're trying to prevent deaths.

So, giving vaccines to people that have a high probability of going into an ICU in the hospital.

So, these are congregate settings, long term care homes, other congregate settings where it's easy to get super spreading events and outbreaks, so that can clog up the healthcare system.
It's also important to vaccinate at the beginning in the first tranche, essential health care workers, so the people that are on the front lines.

Because if you have all the doctors, the nurses, the frontline health care workers at the hospitals off on sick leave, then you're going to have a sort of human resource crisis where the system might also collapse.

And then they're going to start rolling it out to people that are at risk.

So people that are over the age of 65 or or 70, depending on where you live, and then other essential workers that did not have the privilege of being able to work virtually on a laptop.

Their job requires that they are on the frontline every day, grocery workers, infrastructure workers, etc.

And then and then after that will be people that deemed certain chronic diseases in a high risk.

So, we're going in different phases.

Phase one is to avoid crippling of the healthcare system and then eventually roll it out.
Now when are we going to get it?

Well as you all know, most of these vaccines need two shots, so you get an initial shot, then you get a booster in a month and so everything is kind of rolling on these two dose regiments.

Right now, there's a lot of confusion because the supply chain that different jurisdictions are thinking about delaying the second dose.

They’re thinking about in for like, low risk populations maybe having, you know, decreasing the primary dose by 50%, so there's all these different kinds of theories and actually a big debate about what’s the right thing to do.

Long story short, the all the research has been done in terms of giving you long term protection is by sticking to the right schedule, so a baseline dose another at 21 to 28 days, but you do get protection depending on the vaccine, anywhere from 50% to maybe 80% protection in between doses after the first dose, but will never reach herd immunity unless you get that second dose.

And there are some other vaccines like the AstraZeneca Oxford vaccine, which is the adenovirus.

They've done all kinds of different dosing types of trials, looking at the efficacy rate based on whether you give it at, you know, a few months later versus a month, so it's kind of confusing.
But the punchline is that there might be some benefit of delaying the second dose in terms of giving long-term immunity.

So all the academics and the scientists and the public healthcare policymakers are looking at all of these things in terms of how to ration the vaccine.

So, having said all that, people that are lower risk, there's going to be like a couple of tranches.

So January-February is a horrible time right now.

Cases are exponentially rising.

We're dealing with mutant virus, mostly dealing with the indoors. There's a deployment, lessons learned in terms of the deployment of all these things.

Some people are starting to get their second dose, so I think you know, depending again where you live and how well organized things are, hopefully in the spring, you know March and April, the higher risk folks will start to get their vaccines, and then the general population.

Again, depending on where you live, you know, might be early summer. But again, you know, it all depends on supply chain.

It depends on the execution of all these things, and it depends on, you know, how well these different jurisdictions and countries around the world are organized in terms of deployment.

Can you transmit the virus after you are vaccinated?

All the vaccines, I guess, from a general point of view, are playing around with the spike protein, so that little spike protein that looks like you know the crown around the membrane and then your body develops antibodies to neutralize that spike protein, so the virus can attach to the human cell.

So, all vaccines in some form or the other are basically trying to help expedite your body to create these neutralizing antibodies to stop the whole process of the virus engaging.
Now the million-dollar question is most of these vaccines are successful in preventing severe disease, you know.

So if it works, or whether it's 95% protective and some of these newer Messenger RNA vaccines or adenoviruses like you know 70% to 80% protective, and those folks that have received the vaccine, you know, a win is that you don't get symptoms, you don't get severely ill.

The million-dollar question is does it prevent transmission?

So, the fact that you got the vaccine and if it did work, can you still transmit the disease?

So the good news is that some of the data that came out of the Moderna vaccine is they actually studied this question and they found they did these viral swabs on the 1st dose and then close to the second dose and they found that it did have an effect on decreasing the transmission and viral loads in about, I think it's 60%.

So, the thinking is that probably these vaccines will decrease transmission by about 50% to 70%.

You know we’ll have to look at all the data over time.

It is the million-dollar question though, just because you're vaccinated and doesn't mean that you can't harbor a mild asymptomatic disease and spread it.

That's what's unique about this Covid.

So that kind of leads into the fact that we should be wearing masks and doing the usual precautions of washing hands, etc., even if you got the vaccine.

So until we have a better handle on, are we in an endemic situation, or are we still in an epidemic situation, so meaning is it uncontrolled spread amongst communities around the world –– pandemic?

Or is it an epidemic — uncontrolled community transmission around where you live?

Or is it just an endemic situation for which it's easy to diagnose, it's easy to contain, it's easy to prevent when you go into those areas.

So when we're still sort of an epidemic, high community transmission, reproductive rate, north of two, you know, you still gotta wear your mask, you still gotta wash your hands, you still got to practice common sense.

And then 2021, it should really be the year about don't infect somebody else.

So, you know, don't do anything that will keep, that will give this virus a chance to keep propagating, keep propagating.
And the other thing too is unfortunately no vaccine is 100%.

So, you still might be in the, you know 5%, 10%, 20% side of the equation for which the vaccine didn't work.

So, until the world's got a handle on this virus, you know, it still makes sense to practice, you know, the usual wearing masks, etc.

It will get better.

You know it's going to get better all the time.

It doesn't feel like that right now in the next couple of months cause we're going through a surge, but it will get better over time.

But you still have to practice the commonsense things about avoiding transmission.

When will we reach herd immunity?

So, herd immunity is a very important concept.

It basically means that, do enough people in the population have immunity against the virus so that it is very difficult for a virus to spread within that community?

And there's a threshold of the amount of people that have immunity, so even if other people are at risk or having infection, it's not going to cause an epidemic or a spread.

So, the way they calculate these things like herd immunity depends on multiple factors.
Things like what they call the reproductive rate.

You know, how easy is this thing transmittable between people, person to person, how effective a vaccine is.

So, things like the measles, which is highly transmissible, people get really sick, but the vaccine’s very effective, you know, 90% plus is what you want in terms of coverage.

Something like polio, maybe it's like 80% plus.

For something like Covid, so we're still learning a lot about it, but we know it's highly transmissible.

We've got vaccines now like the Moderna and the Pfizer vaccine that are over 95% protective.
But again, it depends on where you are in a hot zone and you're not in a hot zone like the United States might be a bit different than obviously New Zealand or some of these island states, but generally speaking it's around, I'm reading like 60% to 70% of people would need to be immunized with this vaccine to at least get us to a situation where we feel more comfortable that we've acquired herd immunity.

And then you know, you probably read this kind of old news now, but you know, there are some advocates in 2020 that said, what about natural herd immunity?

By you know, what about people getting the infection, are they immune?

Well, that's true, like if you do get the infection studies now show that you probably have protection for about like 6 to 8 months.

But the reason why that's not a good strategy of just like everybody getting infected is because it's unethical, really to have deaths that are otherwise preventable, particularly now that we have a vaccine.

So that's not usually a good strategy to just let you know the virus go wild.

So really vaccines are the way to go in terms of controlling this. So, the good news is that — the great news is that we've got lots of vaccines in the pipeline.

We've got good problems right now, it's all about deployment.

The science is there, we’ve figured out a way to make this thing and get into people's arms.
These vaccines seem safe.

We've got different options for people that have allergies and you know it's just going to get better and better.

So, it's going to be rocky at the beginning because this is all new to us, you know at scale having to deliver this to massive populations, but it will get better over time.

Will the vaccine work on the new strain?

Max Bala (Senior Analyst, Service Desk):

Hi Doctor Aw, what can you tell us about the new mutation of the virus?

Will the vaccine work on the new strain?

Doctor James Aw (Chief Medical Officer):
Well, thanks for that question, it’s a great question.

So, as we know with these coronaviruses, mutations are not uncommon, so you know it's estimated that maybe one or two mutations happen on a monthly basis.

In the early spring of 2020, we found out about some new mutations that didn't have an impact in terms of transmission.

And then there was some noise in mid-2020 about mink farms in Scandinavia where there was some mutations between humans.

It took care of minks and then of course in the fall, in November, there was a spike of about 20 to 30% of cases in southern England, which was found to be highly transmissible, and now this new strain down in South Africa.

One of the interesting things about these mutant strains was that the reason why the UK was so good at picking this up was that they’re really ahead of other jurisdictions in terms of doing genomic sequences.

So, they were very good at doing these genome sequencing on these different mutants, so they're able to pick this up.

The reason I'm bringing that up was that these other mutants were probably circulating already in multiple countries, and in fact at the time of this taping, this UK variant is across several countries.

Now, one of the things about mutations that’s a bit different about the UK mutant virus is that typically when the SARS-CoV-2 infects someone it lasts in your system for a couple of weeks.

It's sort of in your system, out of your system.

It doesn't give a lot of time for it to generate sort of a viral fitness mutation so it can propagate and infect the host.

So, some of the hypotheses or theories about this mutant virus that’s come out of the UK is that maybe it was propagated in immunocompromised hosts.

So, people had weakened immune systems and they were fighting infection for a longer period of time.

So, for which the Covid virus had a chance to mutate and change things.

So, we had multiple mutations happening at the same time, which made it more easily transmissible.

So that's what they think happened.

There's also another theory that some of the folks that got convalescent serum, so they got the antibodies of the blood from people that had survived Covid, and they gave that medication during the clinical trials to other folks.

Whether that onboarding of other kinds of antibodies with those people also created an opportunity for longer time for the virus to sort of figure out about how to mutate.

Having said all that, so the other theory about this Covid mutant that's coming out of the UK is that they think that most of these mutations affect that spike protein.

So that protein I was talking about before that's on the membrane that allows the virus to connect to this thing called the H2 receptor on the human cell.

They connect to the virus and can kind of enter the human cell and replicate, so you think a lot of these mutations affect the spike protein.

So one of the things that they think with this UK variant is that it's more effective in terms of the way that spike protein attaches to that H2 receptor, and also might make it easier for people that have respiratory infections to get a viral load.

More people can affect it, it's easily transmitted, maybe it lasts a bit longer, so that's one of the theories.

The good news is that the way that vaccines work is that they work on multiple levels, not just generating antibodies.

They create a whole immune response.

So historically, you know vaccines tend to be able to handle these mutations and I just read this morning, a preprint, not peer reviewed, that some studies on the Pfizer vaccine, and they're going to be doing studies on the Moderna vaccine.

They found that this mutation virus in the UK really didn't affect the efficacy of the vaccine.

So, the thinking is that we’ll have to watch it closely, but the story really about this mutant vaccine, it’s more about transmission, making it easier to transmit but not necessarily affecting severity of disease.

And so, the vaccine probably won't be less efficacious in this mutant virus, but we'll have to see.

The South African strain, a similar story to think a super spreading event that might have happened was for college kids that were celebrating, you know, after their exams and they start to get this spread of this virus, so we're also watching that.

That also has been spreading in quite a few countries right now, so fortunately for now, the vaccines seem to work, but obviously when you have this higher transmission of a mutant virus, then the denominator gets bigger, so more people are infected.

Even if the proportion of people that pass away is small, but if you have a higher denominator then you get more deaths, so it's something that is of concern.

We have to watch it very carefully and we probably will get more mutations.

Hopefully not one that has these multiple mutations that make it more transmissible, and hopefully never getting a mutation that will cause an increased severity of the disease.

So that's why it's so important to get this vaccine strategy deployed around the world.

Is there anything I can do to mitigate the impact of the virus?

Daniel Avola (Specialist, Education & Training):

Hi Doctor Aw, first I want to say thank you for all your hard work during these unprecedented times and keeping us all informed here at OMERS.

My question for you is, is there anything I can do to mitigate the impact of COVID-19?
Does vitamin D help?

Doctor James Aw (Chief Medical Officer):
Yeah, I think that you know, some of the things I'm reading about is vitamin D, vitamin C, zinc, and the reason why these supplements have come up in the past is because these supplements have been studied in the past in terms of their effect on the immune system and their effect on inflammation oxidation.

However, most of the data is pretty sparse right now, and for instance vitamin C You know they've shown in past respiratory viruses that if you take high doses of vitamin C, maybe it makes a difference in terms of decreasing severity.

I think there's no evidence right now that vitamin C would help with the Covid virus.
I think some groups are maybe looking into it, but there's no harm in taking vitamin C, but I don't think it gives you an advantage.

Zinc also is supposed to be a supplement that helps with your immune system and antibody response.

Again, taking an over the counter supplement, I think is not harmful, but no studies that I'm aware of right now it shows it has a competitive advantage as it relates to Covid.

However, there is some stuff about vitamin D.
They have found that vitamin D deficiency, which is very common, as you know, it's also noted that vitamin D is the sunshine vitamin.

You know you get sunshine, you activate your vitamin D, it’s good for bone health, worse in the winter months, better in the summer months.

They have found that vitamin D deficiency has been associated with worsening severity of Covid disease, but there's not a causation link.

It thinks that vitamin D affects your immune system response.

So, as you know, for those people they get Covid and they get really sick, they go into the hospital, and some of those unfortunately need to get onto a ventilator, there's this progression of multisystem failure.

Where you get this inflammatory spike, so this thing called the cytokine storm where you get this flooding of your system of inflammatory cells.

So, you think that vitamin D might actually help attenuate that so you don't get that cytokine storm.

There's been some conversations though about will vitamin D affect your ability to generate an antibody response.

So, the Long story short is vitamin D is always good to take for multiple reasons, and in my practice most people take 2 to 4000 units a day, just as a general preventative health measure.

I think in the time of Covid there's no downside.

And taking vitamin D within the normal prescribed doses, I think there's no advantage of taking super high doses of vitamin D, but I think it is worthwhile to take your blood levels just to make sure that your vitamin D levels aren't low, particularly during Covid.

And with respect to other things it’s sort of the commonsense thing is, you know, people with chronic diseases are most at risk, so you know, watch your weight, do your regular exercise, do all the public health measures.

But those are the main things right now, I think we know on the preventative side really is both general common, sensible things that protect your immune system.

What role does winter and cold weather play in transmission?

Melissa Martens (Senior Associate, Global Leadership and Digital Learning):

Hi Doctor Aw, I was wondering what role the cold and the winter play in transmitting the Covid virus.

Doctor James Aw (Chief Medical Officer):
Thanks for the question.

I think at this point really, the cold situation is really about people being indoors.

So, when you have poor ventilation, close contact with big groups and you're doing social things where you're not wearing a mask, I think that's what really increases your risk.

So, I think that really is the main issue around the cold.

We know that this pandemic has been on fire around the world, regardless of what season we’re in, so I don't think it’s the cold weather itself.

It's more about how it reflects human behavior.

What does it mean if a virus becomes endemic?

Laura Halstead (Executive Assistant):

Hello Doctor Aw, what does it mean if a virus becomes endemic, and if COVID-19 becomes endemic, how will that impact our lives?

Dr. James Aw (Chief Medical Officer):

Thanks for that question, as the world knows, we're in a pandemic, it’s a global situation.
Epidemics, just in terms of you know vocabulary, is when there is sustained transmission, where the medical community is having a hard time controlling or containing the infection.

Endemic is when the virus is alive, it’s still circulating within the human population, different communities.

However, it hasn't created a situation that's crippled or strained the healthcare systems.

And so, there's lots of diseases right now that are endemic around the world.

One that comes to mind right now is yellow fever.

It’s one of these infections that you get from a mosquito bite that can lead to a hemorrhagic fever.

That happens in Africa and South Africa — sorry, South Africa and South America.
And the reason I’m bringing that up, is that that is prevented by a vaccine called yellow fever vaccine.

And these are one of these situations where the severity of the disease is so bad that you require an immunization certificate to show that you're protecting against the yellow fever vaccine before you enter or leave those kinds of countries.

So back to Covid, because Covid has infected so many people, because the denominator is so high, because the challenge of immunizing the amount of people that you require for the whole world is going to be something we're going to be dealing with over the next 12 months, if not longer.

It is likely that you know, this Covid virus will remain endemic in different pockets around the world.

However, the good news is that we've got vaccines, we're gonna have many more coming.

They'll be better tests, there’ll probably be better control measures in terms of crossing borders.

Then we’ll be able to contain these things and over time, eventually, we’ll hopefully get herd immunity or enough people will be immunized or protected so that it will void uncontrollable spread.

Will things get better in 2021?

Vipin Jain (Director, Process Excellence):

Hi Doctor Aw, this is Vipin.

I have a question for you, will things get better in 2021?

Doctor James Aw (Chief Medical Officer):
Well, you know, it's been tough.

So, it’s been a tough year, but 2020 is behind us.

What did 2020 give us?

It gave science a lot.

We discovered vaccines, we discovered treatments, we discovered how to diagnose things.

We’re starting to plan and protect our essential healthcare workers.

We’re also figuring out how to triage medical cases.

Mortality rates have improved because we’re more familiar with this enemy called Covid.
But also, what we've learned is that social distancing, you know human behavior, washing your hands, etc., hygiene measures, simple things really make a difference.

They really help to flatten the curve, so these things work.

So, 2021 is about execution, deployment of these vaccines and you know we can't give up now.

Like we've come this far, and you know, now is not the time to let your guard down.

So now is the time to just stick to your guns and wait for your turn until you get the vaccine, wait till enough people within your community get the vaccine and we've just got to collectively, you know, ride this through.

So, the next couple of months are going to be difficult because we're social animals and we, you know, it's hard for us to kind of maintain certain behavior for long periods of time that we've seen in past epidemics.

So it's not like we're blaming anyone or pointing any fingers, but now is the time to double down and to really pay attention cause we've come this far, so it's not the time now to let up cause science is on the way.

The other thing that's, you know, going to keep us going through it all this is, you know, it sounds a bit cliché, but kindness and so if you find a way to help others and to serve it'll it will make things easier to tolerate as we go through some of the tough months.

And so it will get better.

You know there is a light at the end of the tunnel.

There is a plan, you know all plans, you know, no plans perfect, but if you have a good plan you can execute it quickly.

At least that's a good start as opposed to having the perfect plan or wait until everything is perfect.

So, action is required right now and then all of us together need to really pay attention and stick to the basics and the details, and then it's going to get better, it's going to get better once spring hits, the summer hits.

I'm hoping in the fall of the year we’ll start to kind of have some normalcy back to our lives, and you have you know this Covid thing won't seem as scary.

It might be something we have to live with, it might be something that we’ll have to have vaccines for for a long period of time.

It might be something that, depending on if it's endemic, you know where it pops up during different seasons or different countries that we’ll just need to be more careful when we go visit these places.

But, you know, I'm confident that we'll get this behind us, that we’ll move on, and hopefully they'll be other lessons learned so we can prepare for the next one.

Cause there will be other viruses that come, but hopefully that this generation will have learned something about how to take care of the disadvantage, and some of the in equities in our system to make sure that the vulnerable are protected for the next time.

And I'm also very excited to hear more about other scientific developments in technology in terms of treatments and vaccines and testing, and different kinds of controls so that we can all get together and go back to what I love is Raptor games and going to concerts and hanging out with people.

So, we're going to get there, but now is not the time to let your guard down.

Now is the time to sort of like bear down, stick to the basics and wait your turn.

Let the vulnerable people get taken care of and then we’ll get through this together.

So, it’s gonna get better, it’s gonna get better, but now’s the time to really stick to your guns.