Inside The Hospital | Understanding COVID-19 (ft. Taylor Heald-Sargent, MD)
One thing that's funny. Is that in the scientific community? People have been saying that this is not somebody. I quoted in my dissertation many years ago from a paper in two thousand ten that sent the next corona virus endemic. Not a question of if it's a question of when remakes is this choice but I certainly will continue as I've always had to give my honest assessment of the scientific and data. That is really the evidence that I base my judgments on. Welcome to inside the hospital. Medicine remixed original series that focuses on healthcare workers on the front line of the current pandemic and gaining insights from their unique perspectives. On last week we checked in with board certified allergist and immunologist Dr Akilah Jefferson. Who fills us in on creative therapeutic approaches that are being tried for those fighting cove in nineteen the long process of developing a vaccine and the public health implications of a pandemic? Like this one on today's episode. We have another special interview for you as we'll be hearing from Dr Taylor healed sergeant. Who is currently finishing up her final year of Pediatric Infectious Disease Fellowship. At Annan Robert H Lurie Children's Hospital of Chicago she's also an expert virologist with interest in the Krono viruses as she has a PhD on the cellular entry of SARS. Covy one for those. That don't know what's ours. Covy one is. It's the virus that was implicated in the initial SARS epidemic of the early two thousands and is the crow virus most closely related to SARS colby to the virus implicated in the current pandemic. Today's episode is also special in that a longtime close friend of mine and medicine remix supporter. Dr Guano Thacker will be conducting the interview with Dr. He'll sergeant also I Larry Children's hospital finishing his third year in pediatric residency. And Getting Ready to start working as a hospital as the summer were pumped to share this interview with you and we hope you enjoy listening to this episode as much as we did putting it together. Here's donal so I wanted to start things off by asking. You have your last five to six weeks looked since. Kobe has really started to take over the headlines. Has Your Day to day changed at all or anything like that. I think similar to pretty much everyone around the world. It's completely changed. I am currently mainly in the lab studying a different virus in transplant patients And most lab projects have been stopped. Because you can't do lab work remotely. So most scientists have been sent home from the labs everything put on pause but with that in a bunch of us you know have some experience with a virus or have just other viruses and are generally who has a lot of us have band together and tried to think about how as a scientific community we can help with this. Camac and so even those of us that can't get into a lab have been talking about the research projects can do and trying to figure out ways safely that we could conduct some research. So I've been working for the past few weeks with some other people at my institution trying to figure out if what clinically we can learn from patients because at least from our institution. We're looking mainly at pediatrics. And some young adults but it seems. Pediatrics is thankfully been spared. A lot of severe disease. Sore question has come up. What's making kids so unique and so tried to collect data around that Both clinical epidemiologic data but also clinical samples that we can then use making it back into the lab to study some of the immune responses or study. Some of the things in kids so I've been participating with other researchers trying to clan research and I know other research is really interesting some labs that have been able to that haven't even been clinical labs that just have expertise in for example testing and running the PC are essays. They Dave completely shifted over and have really gone all in and helping out with this and trying to figure out how they can scale up testing and converting there. What was research into clinical labs? And it's really interesting to see the scientific community shift their whole focus onto this pandemic and just seeing what they can do to help out. Yeah I would agree with you. It's been super cool. Just kinda watching. From the periphery to see how people who may not necessarily their day to day. Responsibilities may not necessarily have been geared towards his corona virus pandemic. They're coming together in so many different ways and finding out ways that they can help or shift or pivot there an initial sort of approaches or their targets to help any way they can with this current of ours pandemic. It's been really cool to see people stepping up like that. Yeah it's really nice isn't a in across. Anyone can contribute anything. You know the people that can so are making masks so it makes late that the scientists are trying to do the science to learn about the virus. Exactly Taylor you were mentioning that some of what your research currently has shifted to right now to hell under Santa's pandemic a little bit better is why kids are being spared and what's What's been going on not my telling us if there's anything new or interesting you've learned. Yeah I mean not nothing yet. It's still early days and a lot of with the literature is right now is case reports or clinical series of -cations and just what we can glean from them from more easily done labs and some of the more sophisticated tests. They're going to take a little bit more time It was noticed even with the first stars that kids was kids were not as effective clinically but that was taken under control so quickly that you know not a whole ton of research were able to be done in the intervening years though. Researchers have tried to look at some differences in animal models and young old But it still is really difficult to pinpoint. Why kids aren't as affected. There's a lot of theories and hypotheses out there ranging from maybe some pre existing differences in their immune response because everyone's exposed to krona viruses every year Kids will get them in. Adults will get them in. It's just often a common cold and we don't usually even identify exactly. What Corona virus a patient might have? You wouldn't even get tested for it. So is it something that kids are exposed to those north other front viruses more and so their immune systems can react a little bit differently to this one or is it something different about their immune system that it's a different level of maturity in the adults and the kids and the kids for some reason their developmental maturity of the immune system is better at controlling. The virus or doesn't overreact to the virus. Some people think maybe it has to do with actually the receptors of the protein that the virus uses to get into cells to infect cells It's kind of like the doorknob that the virus has to latch onto to open up the to the to the inside of the cell People have started to see some differences. Perhaps in the levels of that protein and kids versus adult. So that's another avenue that's currently being explored but we don't have answers yet. Gotcha but it's like there's a lot of different things worth looking into an worth exploring. I I really think so. Yeah that's amazing. So you mentioned that current viruses already do exist inter-community and that they're going to continue existing long after this a Kobe. Nineteen pandemic is over. That's something that when I tell my friends or family that you know at the hospital. We see Corona virus viral infections frequently during the close season in our pediatric population set. Something that they're kind of shocked to hear about and so I was wondering maybe talk a little bit more about what those more coming corona viruses are that exist community. What sort of illnesses? They seem they seem to cause. Yeah you brought up the point that the common currency viruses. They usually have some sort of seasonal circulation or you see them more in the fall and the winter and when you would everybody feels like they're getting a cold one of them could just be a corona virus and we don't often know exactly what krone viruses infecting. What person because we don't always test everybody? That has a common cold but if kids get more sticker someone gets more sick they might get. What a pc our test to see what the viruses that's causing ill and sometimes it comes up that it's a criminal virus. There's a couple of different cousin corona viruses that have different names like NFL. Six thirty or forty three or h one but the names don't matter as much than they actually will tell. You hear what they are but it really. They're kind of general more mild viruses compared to the first SARS or merged that are in this current SARS two that are much more clinically clear in addition to causing just kind of more upper respiratory tract infections. Like the common cold sometimes they can go on like you mentioned have bronchiolitis or else sixty three for example was associated with cruch so kind of a barking cough and kids but for the most part they tend to stay in the upper airway and not go so much into the lower lungs like the other viruses. Any there's always an exception to the rule so people certainly can die of more mild viruses but just not to the extent that we're seeing now with the SARS too. Yep that makes sense okay. A little bit of your research background so your research background. Taylor is in the CORONA VIRUS SARS. Covy one that correct. Yeah so I actually looked at SARS buyers the first one but then also comparing it to sixty three which is another one of those mild colonel viruses and I was trying to figure out or look at differences and similarities between those two to see if we could figure out why one was more mild was more severe because they actually use the same risk factor that same doorknobs to get into cells. They use the same protein at sixty three and both of the stars. Okay yeah they all use what's called to to get into south even though they have such very different outcomes in the end. Yeah definitely seems like even though. There's some similarities. There are certain things that are making the SARS virus a little bit more more severe than the than the others. Can you tell us a little bit more about for those that maybe don't remember that early? Sars epidemic from the early two thousands a little bit more about sort of what went on there and a little bit more about the virus that seems to have caused that specific epidemic so that first. Sars epidemic was in the early two thousand it in the beginning at kind of looked like what this one looked like I. I started noticing with this SARS to back in right around the turn of the years. Like New Right New Year's Eve a there is reports of this weird pneumonia in China and nobody was really paying too much attention of case reports. Then that was similar to kind of what happened in the beginning of SARS except for it was more kept under wraps into the world community. Didn't get to know too much about it for a number of months until it was spreading even more and earth SARS one of the big differences is. It's much easier to control with Typical affection prevention and control measures so like everything that we've tried so far. Everybody knows you know you wash your hands. You've probably cops. But then going up to the more higher level control measures where they'll test or someone to have the infection and then isolate that person or trace do with called contact tracing and look to see who is that person been in contact with and then isolate all of those people. Those methods really worked to control the first SARS so although it started out similarly in there were some rumbles and then it grew into more in Asia a few cases outside of Asia including some in Toronto. The different little outbreaks areas little the outbreak areas. We'RE ABLE TO BE CONTROLLED. More just with epidemiologic controls and part of that might have to do with back that people really spread that virus after they were pretty symptomatic so you could see someone coughing with a fever and just isolate them. We now know for this starts to that you can be feeling fine and still spreading the virus so it makes those infection measures of isolating symptomatic patients and isolating people that could be shutting much more difficult. Sure sure that that makes sense was set from I guess from a sort of severity standpoint and more specifically a mortality Sam point was that initial SARS epidemic from wartime great standpoint a little bit more severe than the mortality rate. We're seeing with this SARS outbreak. Yeah it's well. It's hard to compare exactly because the the level of spread has been very different and also testing wise. We haven't probably tested. Everybody has been possibly infected with SARS to front virus. So right assessing exact mortality. It's difficult because you don't know. How many eight symptomatic or mild infection throughout their that. We're not catching so it. Seems like they both can be severe but I don't know exactly the comparison I think they're probably similar in their mortality rates. But it's it's a moving target right now. Is there any sense that we learned from the SARS the initial two thousand two epidemic that we could have applied in the case of this one before it became so severely present in the community? Well one thing that's funny. Is that the scientific community and people have been saying that this is not somebody. I quoted in my dissertation many years ago from a paper in two thousand ten. That sent the next. Colonel Virus Pandemic. It's not a question of if it's a question of when it really is was apparent to scientists that this was a warning shot at first SARS and then murders also that this is not something that was just a bad luck once it's GonNa keep happening and that's because they are animal reservoirs that have grown viruses. In fact some people have said that corona virus pandemics are kind of originally made pandemic because the bat population especially in China has circulating Heiresses in it that are very similar to these to the SARS virus. And that's where they think both of these stars viruses came from and they're they don't require much Shumba from a back host to a human host and then the next jumping from human to human luckily with murders when it made the jump from animals to humans didn't make that second jump from human to human so it went from camels to humans and then it kind of sizzles out but for SARS once it gets into humans it can spread everywhere and there were some lessons learned in that we knew that it was possible but unfortunately as population in the whole world really. We didn't do too much. We didn't prepare know probably but we did continue some research in animal models and so we were at a better place now than we were back then in terms of understanding some of the half Balaji that can result from Toronto virus infections and having some clues about beans or antiviral agents that might be useful because SARS one and starts to their names the same thing because they're really close and that's kind of Nice so a lot of the research that was done in thirds one is helping US learn about thirty two Gotcha Gotcha so when we talk about this animal to human transmission method. It does seem like it's something that happens frequently or at least not infrequently especially with this bat to human transmission. Now we've had the SARS epidemic from the early two thousands that started the swayed and also now this current pandemic with the be to virus also Having started this way does this fact that it's happened now twice in the last twenty years. Does this speak more to any general trends between animal and human interactions that maybe we should learn from an. How can we learn from this and understand this a little bit better to maybe prevent future outbreaks? Like this from occurring. Yeah I don't. I'm not an expert on so much on that area but it is in the last couple of decades. There have been some emerged looking back. Historically they can trace back the the relatively mild corona viruses to and originally animal reservoir sometimes bats sometimes how they can say but these events happened thousands of years ago. So is this just how corona viruses come about into the population that it makes zoonotic emergent? It goes through the population. Maybe a severe infection but then just kind of keep circulating at lower levels who knows because those original events probably happened a lot long ago right why we had to recently. I don't know if that's because the animal reservoirs have a circulating population that can make that jump a lot more easily now or is it because of some chefs in human animal. Interactions is it because of climate change and or urban spread. I'm not sure I know a lot of people are asking those questions. Yeah it sounds like they're new. There's a lot to look into going forward so with this specific virus with SARS Kobe. To what is the typical clinical presentation were seeing with people? Who are infected with us. Well it can range anywhere from no symptoms to severe respiratory pneumonia and death. So it's quite very quite the SPEC most people it's hard to say because obviously there needs to be more testing in bigger studies done to see what the majority would present with. But if you're going to have a clinically symptomatic disease. It seems like fever is usually a component of it and then sore throats or some sort of upper respiratory with hough is often what we think of You can also have gi things which means you can have diarrhea or vomiting and that was also a feature of some of the viruses like the SARS virus. In the first time they founded it could also induce more diarrhea and in addition to the respiratory symptoms and the virus can infect both the respiratory tract and the gastrointestinal tract. Really interesting when you think about it in terms of other respiratory viruses because usually beat you're more limited to just one area of the body that gets affected so that's an current area of investigation. What's actually going on in the gastrointestinal tract so you can have those respiratory symptoms fever then the typical chemical course I would say is probably most people will get better but there is a population of people that will progress to have more severe disease and to have especially in more pneumonia and that can actually sometimes cap in in the face of decreasing amount of the virus. Which is really paradoxical. Because you'd think that if you have weren't worse infection you must have a lot of iris around But this was seen for the first SARS and this is one of those lessons that we learned that actually as levels of the virus seemed to go down patients might get worse and they noticed a lot of increased inflammation so your immune system just trying so hard to control the virus that it almost goes out of control and system actually can start damaging the patients and damaging lungs and two can lead to a lot of those immune cells. Going into the lung. Where you really want your air to go not cells to be filling in some of those patients if not intervened on They can progress then to having debt because of the overwhelming immune response to the virus that at that point might even be long gone. And that's what we kind of think about in in the clinics. We're seeing that. The first phase can be maybe about a week and then if anybody's experienced the infection some people have said then once you go into that second week sometimes people get more ill or their neighbors aren't going away or they're they're cop is getting worse and their oxygen levels are getting lower. And that's when we think the immune system might believe me playing a bigger parts. There are certain groups of people that are considered a high risk for having a serious infection. East groups of people include people like the elderly those with coexisting conditions such as heart problems or lung problems. Those who smoke and even people with Conditions that compromise our immune system. But we know. These people aren't necessarily considered only high risk for Kobe nineteen. They're considered high risk in general for any illnesses or any infections. But with this illness where saying that people who are quote young and healthy also seemed to be a pretty severely affected to a lesser degree of course but still happening. They're getting severe illnesses. Ed even dying from this illness. Is there any idea as to why is younger and Healthier Group of people seem to be Getting affected so severely bad as well. Any infection can cause mortality in low risk groups being pediatrics. I'm sure you've seen this because you know kids that are usually confide off the flu and do fight and some of them ended up in the ICU severely. Ill and die. Even though they don't necessarily have identified risk factor will unfortunately have to talk it up to almost bad luck sometimes in most cases. So there's always going to be those low risk patients that you just don't know why they're getting such a severe infection right. The risk factors that are coming out for Corona Virus Starts Tobin to sorry Per Cova. Nineteen seem to be like you said. Some of the more traditional ones older age was a big risk factor for having severe infection having a pre existing heart condition lung condition and then the healthcare setting. It seems like having exposure in the healthcare setting is a risk of more severe infections. So a lot of the young cases that are severe are coming out of the healthier setting. It's not completely clear what related to some people have the size of has to do with a more virus. Initially being exposed to more virus and higher amounts of virus early in the infection that could be leading the worst of these and that's one possibility there are also some factors that need to be confirmed out there but some people are saying that Our patients that are male more at risk or if you have a higher body mass index you're obese or overweight of humour might be a combination of some of those factors that aren't as a parent as being a ninety year old with heart disease but they might also be playing a role in some of these younger patients. Who get really ill right now. If that's very interesting night you bring that up. I was actually planning to ask you about the disproportionate amount of healthcare workers. That seem to be Getting sick from this and more so getting severely ill from it and it sounds like what you're saying is one of the hypotheses again. It sounds like there needs to be more more research done into this but that the exposure to the higher load of the virus may seem to be playing playing a role for for the specific individuals in this specific population. It's definitely a possibility that it's just that they're exposed to more of the virus and that help you refers get a higher dose of infection so to say right he also no health workers on the front lines are stress. They're probably not taking care of themselves. Bashar also probably have some immune system differences that the immune system are fast. And you're eating great healthy meals and you're getting a lot of sleep and you're not being very stressed the exact opposite of what the Hell Erebus. They're probably facing right exactly. It's that's such an unfortunate scenario right now Taylor. I wanted to switch gears here a little bit and talk about an idea that I feel like a lot of people have been talking about. It's been circulating in the news and also people even within the healthcare community seemed to be sort of talking about it and that's the that this Khurana virus and specifically this Kobe. Nineteen is only a winter virus and that once these sort of warmer temperatures. Come around like here. What we're starting to now see Glimpses of in Chicago once he sort of warmer summertime temperatures. Start coming around that. This virus is going to slowly start fading away in that in the summertime. It won't be as much of a problem. What do you have to say about that? I would love to have summer back if we'll go to the beach so I certainly hope that's true but the bottom line is no one knows for sure. This is a precedent scenario. The hypotheses that people that have been cited for why we think that the virus might see three during the summer months and looking at it from other. Krahn viruses is that both viruses are susceptible to a UV radiation from the Sun. And so they don't last as long as surfaces one of the ways that you can transmit viruses and why we say. Wash your hands all the time that if you touch something that someone who is infected touched someone infected such as visit and you touch it a few minutes later. That virus could be transmitted on that surface. So you didn't necessarily come into contact with that person you just happen. Grabbed the grocery cart after them so the hope is that the UV light from the sun and the warmer temperatures actually might prevent that virus from lasting so long on that shopping cart handle and so maybe that will slow down the spread. Sure others have pointed out well. It's spread pretty well in southern Asia in Singapore civil warmer areas. That didn't seem to work so well for them. They weren't really protected show. There's there's a lot that's not known. Another factor though. Is that people in the summer. They're not congregating indoors and coughing on each other spreading it directly. So that's another thing in the summer. We're definitely outside more. And we bite that fee in close quarters with people but I think a lot of the sort of thing is already put that one method of spread decreased it already so I certainly hope that we will have decreased spread in the summer but only time will tell Yup Yup for our listeners. When you listen to this we're not by any means saying that. Just because there's some evidence that that you'd be radiation seems to decrease viability of as far as that's not a reason to go out on the beach and start Sunday with your friends so please don't do that. They're not outweigh the benefits. The cancer still exists. Exactly exactly where you're sunblock. People is there her as far as we know right now with the current data were seeing with either this virus or some of them more similar viruses from the past. Is there any data or research to suggest that are pregnant? Patients MIGHT BE AT HIGHER RISK. Or if there's any evidence that there could be any sort of vertical transmission of this infection right now. There's not any evidence of that as much as it's been looked into At least no evidence that the pregnant people are more severely infected or have worse outcomes necessarily and there hasn't been any data that's really shown transmission from a mom to a newborn baby happening in utero or when when they're still inside the mom but there have been very young infants that have tested positive and whether that came just from being exposed right after birth. It's not clear and then I think people have been worried that what if this is something like Zepa were nine months down the road. We see the impact of the virus. And we just don't know yet at it. We didn't see it with other viruses. We haven't seen that necessarily that signal But there are ongoing research efforts right now to look into that class. John got it. Got It so more to come on that hopefully. Yeah and hopefully the reason that we're not seeing any reports is because it's not happening. Sure sure so right now. That's that's the strongest fast. But it's still being looked into got it got it. That makes sense. Thank you so now that we've talked kind of a lot about this fire as people. It's affecting what sorts of things we're seeing what the virus in terms of a clinical picture. I know right now. We talked a little bit about sort of how. There's unfortunately del Miracle Drug Right. Now or miracle therapies available. What is there anything right now? In terms of medications or other sorts of therapies. That is promising or could you? Maybe just take us through some of the therapies and some of the drugs that are being researched and looked into right out. Yeah so some of these. Some of the drugs that are being used right now are drugs. That are commonly used for other indications to their drugs that have already been made and they're available right now from pharmacies. Which is one thing that we need. If we're going to combat something very quickly you can't come up with a drug on its own and bringing a drug to market figuring out a drug that works against a specific disease or a specific virus would take years of looking at the bench and then bringing in clinical trials and everything. So it's it's nice to be able to use drugs that already exists but with that we know that these drugs weren't designed fight this virus specifically even though they might work in a test tube so to say or in the lab working in humans is a whole different ball game so I know that there have been some reports of drastic. There have been reports of different. Hiv medications like Lapenne Aveer Retana ear and Even using I saw some report in the media the other day about trying to use an anti parasitic drug Ivermectin which was tried in one lab experiment and seemed to work and so there's varying levels of support for these treatments but none of them have really seemed to work all that well but of course studies need to be done in these need to be used in the context of cynical trial so that we can actually compare this drug to another drug head-to-head or this drug to nothing had had to see if it's actually making an impact the trials that have come out so far the reports that have come out before so far have been very small and haven't actually answered the question of these work and the signals seem to actually indicate that they might not make that biggest with different. Fortunately but some of the treatments though that might have some promise are ones that would impact the immune system itself. Because I mentioned that most people will get better from the infection just by clearing the infection with their immune system but some people have that overactive immune system that can cause disease. Not being if you can find that. Goldilocks moment that moment. Where the virus has the new systems reacted enough to fight off the virus but before it's reacted too much and it's causing damage if you can get in that moment and put in some sort of drugs just kind of Paul the immune system causing damage that might actually be a really promising cure or treatment for the virus. Now the thing that you're going to have to figure out is what patients are going into. That responds where their immune system is going out of control. Identify that patient and then at what point do you give that drug? How much do you give you give it once you give it multiple times and those are questions that are being investigated also and other clinical trials arm and I think those have a lot of promise to them because antivirals you have to remember? You WanNa take those as soon as you're infected but you might be infected and not feel that bad for a few days so it's hard to catch people when they're person that's the problem that we have with the influenza drugs like everybody wants to use Tamiflu P- but it doesn't work that well after you've already had been actions for days when you're feeling crummy. It only really works if you get it right off the bat. It'd be nice if we could out the patients that are getting really sick. And that's usually a week into it or a little bit longer and then intervene at that time code affecting their immune system not necessarily affecting the viruses. Very very interesting. This this virus seems to have a lot of tricks up at sleeps. Definitely I'll viruses do yes I love. What are what are infectious disease colleagues? Always say it's just a microbes world. We just live in IT I. It seems like there's no better tactic illustrate that than right now by Saturday. He was in ICU. On life support on the machine on a ventilator doctors now trying a hail Mary pass to save his life. A treatment called convalescent plasma. But not just any plasma it has to come from a patient who survived. Corona virus has been better for fourteen days now tests negative with a compatible blood type. One other therapy at at. I've been reading a little bit more recently. Taylor and maybe you can speak a little bit more about it as well is. I've been hearing about convalescent plasma as a possible treatment for some of these more severe cases Kobe. One thousand nine hundred two. You happen to be familiar with that. Therapy is a gift. So maybe it's a little bit more about it. Yeah so the idea. There is if someone gets infected and then they get rid of the infection on their own. Presumably their immune system did something to get rid of that infection and a lot of times. What it does is it will make antibodies. And so if you have an infection in you get better. You're often protected from having that same infection again because of your antibody response so the idea is that you would take the antibodies from someone. That's gotten better from SARS to infection. Purported maxine you take those antibodies out of the patients. You clean them up and then you'd give them to someone when they're acutely ill when they're still trying to fight that action themselves. This has been worked. It's called passive immunity and it's worked for many many years. It's one of the first things that was discovered to worked against different pathogens over one hundred years ago right now. There's not a ton of people out there that we can say for shirked you got better from this infection and we collected your buddies or we know how to collect your antibodies. No the right doses. All of this questions. You have with antivirals but it's something that we are actively trying figure out and with that comes the question of how do we test to see if somebody has had the virus already recovered from it and a Lotta Times? You'll test for those candies. But in order to test for those antibodies you need to have a good clinical could taps out there and then it almost becomes a catch twenty two. You need enough people to have recovered to develop those tests to detect that have recovered and that's kind of the point. Where at right now? Where a lot of companies are trying to develop these. Antibodies tests to test people. Antibodies that we need to figure out are those tests really reliable in the population and then once we identify those patients can get antibodies from them and transport. Use them into other patients. And there's always side effects again with interest thing. I won't get into the details but they're putting someone else's antibodies into another person. You always have different risks that go along with that. They're going to be looking closely at especially for viral infections. Sometimes it can make things worse. Yup Not something to be taken lightly by any means right. Don't go bleeding your neighbor next door. I was just about to go do that. I WanNa turn just briefly touch on the on the topic of immunity. Now that we've sort of been talking about that for the last few minutes. Can you just for our listeners? Who may not be familiar with this concept? Can you explain the concept of herd immunity to our listeners? And what exactly that means yeah. So that's that's why we think vaccination is so important for the whole population is this concept of herd immunity and the general idea. Is that enough people in a community. Have either seen a virus or seen a pathogen or seen part of that virus or pathogen through vaccine that their immune system has responded by usually making these antibodies. So that the next time they encounter that virus they won't get sick or that their immune system to take care of it ends with that. You would have the idea that. Say all of your friends around. You have seen this virus. But you haven't but they kind of make this protective shield around you. His they're not going to transmit that virus. They're not gonNA get infected with it again so even though you might not have seen that virus before the viruses meeting and make it to you because your friends that are forming this protective circle around. You aren't GonNa let it aren't gonNA keep transmitting it. And for each virus and each pathogen. It's a different amount of friends that you need around you to have protection so for the measles we know you have to have a lot of people around. You have immunity for that virus to get stamped out and for if one person walked into the room with the virus you'd have to have over ninety percent of the people in that room to have that immunity to it for that virus not to spread through the population so we don't know for Corona virus is how many people are it's GonNa take to have that herd immunity but we do know that right now. No one has it so. This virus came into a population where nobody was protected from it. We didn't have an immune response in the community and that's able to just spread like wildfire because nobody is naturally into it now. A lot of people are becoming immune to it by getting infected. At what point enough people have been infected and our immune that the virus slows spreading down. We'll have to see sure is cirque any even idea or any sort of theories about somebody who was infected with this virus. What the duration of their immunity could be right now or is that something that we still are working on figuring out. Actually there are some clues from the first SARS starts infections. That came up players ago so they looked at the duration of antibody response in patients after they had been infected and what it looked like is it definitely seemed to stick around for a year but once you started going beyond that more to like two years or longer. The amount of antibodies in Houston systems decreased. Now the patients weren't gonNA BE RE exposed to the virus. So who knows what level of antibodies? You'd need to be protected in that what you would go below that level that you need to be protected but it does seem like antibodies went away over time. Got It so. We're not sort of at a point yet where someone who has confirmed that they've had the infection tested positive for it gone through south isolation had been confirmed that that they are now negative for the virus and that they've cleared it they still can't necessarily it's too soon to say whether or not they can just breathe a sigh of relief. That now they don't have to worry about getting sick going for probably not in the immediate time period. We're talking years here but we don't know for the rest of your life you're probably not gonNA be protected although if this turns into something that circulates in the happy relation every year you get continually re exposed to it which did not happen with the first stars we got rid of that and we you know kind of locked it away in labs. It wasn't in the population so with this one. If it does start to circulate and you start to see it again and again every couple of years maybe your immunity will get boosted enough naturally that you will be protected for a longer period of time record. Come up with a vaccine right right. Could this could you save course? It may be too early to tell but could you see this develop into a situation where like we get the seasonal influenza vaccine annually. It may be something similar to that where we may in a few years live in a society where a annual Baranova respect seen. Maybe something that we have to put as part of a routine health maintenance visits it's possible it's also possible that this virus could die down and we don't necessarily see high mortality rates anymore from it and then perhaps it's something that we have more like smallpox. Where if we have an emerging virus than we could go up and back at the top at that point and we have stockpiles of the vaccine at the ready. I don't know what what it's going to. The vaccination strategy is going to be certainly right now. It would be a different scenario than if we got this virus under control right now just me vaccinate people to get to control the spread germs expense and that brings me to my last point of sort of just vaccine development. Of course. Can you talk through just in general? What does vaccine developed? What is the vaccine development process? Look like so it's funny. The vaccine development processes something that can take many many many years as it should Although some people wouldn't like you don't want to believe that we actually do that vaccines and make sure they're safe before we use them in the populations and so there's no way around that process we the vaccines have to go through. Multiple levels of clinical trials starting out with small groups of people that are healthy to see if the vaccine has any harm to those people and then moving to looking at patients that are exposed to the virus and seeing does a vaccine. Actually work in those clinical trials. You're talking about thousands millions of patients that need to be involved and so those trials take many many months to years before those trials can start. You have to find a vaccine that might work and you have to make that vaccine. Luckily there were some early wins so to say in the lab where we were able to take In the general not me they were able to take knowledge from the first SARS virus and kind of plug and Chug vaccines in the lab and actually get new vaccine platforms in the sequence from this virus so once they figured out what type of virus it was and what the DNA sequence was they were able to plug it in and start making these acceding candidates and actually what used to take years in the lab to figure out vaccine candidates they were able to do in the matter of months which is amazing and they were able to start some of those early clinical trials already but they still. The clinical trials will take months to years. So it's GonNa take a while after that you have to remember. Once you've proven vaccine is safe and that it works then you have to make it in a huge scale so then we have to figure out how you can make enough doses to get them out to everyone and distributed across the world. So it's not something that's easy or quick and that's even assuming that we find ones that work some some of the vaccines that seemed to work really well for the first stars at least in animal models it works better in the younger populations not necessarily in the older populations where you need it. The most. So it's GonNa be the first one we try might not be the one that ends up working right. Right awesome well. Is there any final messages? You have for audience or anything else. You'd like them to know that. Maybe we didn't talk about today Not Really I think we've covered a lot of things I know people are asking. What do we do at home and religious? Stay home and watch your hands. Try Not to go out to the community as much as possible We really rely on everyone else to keep each other safe this. It doesn't seem like we're doing much but is one of my mentors day. What is bad cats at saying? It's your kid you don't just stand there do nothing because that's actually really important. Yeah that sounds like Doing nothing sounds like the perfect life motto. Right now also. Well thank you so much Taylor for coming out and talking with us. I think we have a lot of good information that hopefully our listeners can learn from and as we talked about during this interview we talked a lot about how a lot of information has yet to come forward and theirselves so much to learn so hopefully in the future we can have you come on again. enlighten us a little bit more warm friendly awesome. Thanks dealer medicine remakes them. We hope you enjoyed today's episode of inside the hospital. And if you've gotten something out of this episode we would appreciate you recommending our show to your friends and family in the form of DM's social media posts or even as a sketchy chain letter on. What's up big ups to all the healthcare providers out there right now. This team lives to fight for humanity and big ups to all of you at home for firing one of the biggest weapons. We have against this thing right now. Social distancing questions about anything covert nineteen related or otherwise. Leva voice message on anchor or hit directly on our social media channels which will link in our show notes. Thanks again to our guest for today's episode. Dr He'll sergeant and to our guest interviewer Doina for holding gown. Although this is his first appearance on the show I can assure you it won't be as last. Thanks again for listening. Stay stay home and keep it locked. I'M KT and you're in the mix with medicine remixed.