TWiV 689 COVID-19 Clinical Update #39

This Week in Virology

Host: Vincent Racaniello

Guest: Daniel Griffin

Aired 06 December 2020

Vincent Racaniello: This Week in Virology, the podcast about viruses, the kind that make you sick.

VR: From MicrobeTV. This is TWiV. This Week in Virology Episode 689, recorded on December 3rd, 2020. I’m Vincent Racaniello and you’re listening to the podcast all about viruses. Joining me today from New York, Daniel Griffin.

Daniel Griffin: Hello, everyone. Vincent, do I say hello everyone or hello everybody? I think I alternate?

VR: I don’t think it matters, whatever you feel like on a given night. Yes.

DG: All right. Let me start. I was emailing with my buddy Peter Hotez earlier today, and he was on the recent– what was it, stick to the vax? I think that was pun on stick to the vax maybe.

VR: Peter Hotez, sticks with the vax.

DG: I have decided I’m going to put a disclaimer right up front. This is similar to what you might hear when you got on an airplane and they say, “This flight is headed to San Francisco, so if that is not your final destination, you might want to get off now.” Vincent, it may seem a while ago, but when we started these, it was actually– I’d come to Vincent. Our listeners may not know this backstory. We were trying to keep all the physicians here in the New York tristate area updated on what we were learning, what was happening, and Vincent very generously offered this forum as a chance for us to once a week share that knowledge.

These updates started back in March, and it was all about what we were learning about COVID, the therapeutics, what we were seeing firsthand as practicing clinicians. It’s really what we’re here to share is the truth of what we’re seeing. There’s no real agenda here. We’re not trying to grow any audience. At some point, maybe Vincent will kick me off if no one wants to listen to me anymore. This has been I think a tremendous service. I want to thank Vincent for that.

I will say there’s no warm soup here. I’m not here to make these difficult times easier. I’m just here to basically share what’s going on, what we’re learning, the cold hard truth. Oddly enough, I think some anti-vaxxers, I’m told the word trolls is applicable here at times. For the next 30 minutes, we’re not going to talk about anti-vax theories. If you’ve tuned in accidentally to the wrong podcast, this might be time to jump off. The next 30 minutes, you’re never going to get them back, [chuckles] so spend them well.

Okay. Now, that I’ve made my disclaimer. My quotation, “One ought never to turn one’s back on a threatened danger, but to try to run away from it. If you do that, you will double the danger. But if you meet it promptly and without flinching, you will reduce the danger by half.” Can people guess who that’s– that’s Winston again. I like Winston Churchill.

Now, these are dark times already. People keep saying, “Oh, we’ve got a dark winter ahead of us.” There are over 100,000 Americans in the hospital right now with COVID-19. Yesterday, the numbers were almost 3000. Today, we have over 3000 people who died here in the U.S. of COVID-19. We’ve reached capacity at the hospitals here in New York. I got an alert from one of the hospitals yesterday. We have numbers of people stuck here in the ER because there’s no open beds. The ICUs are overflowing into the other areas.

This is not a great sign. We are not even seeing the post-Thanksgiving search. Just want people to think about when they’re making their decisions, we are as bad right now as it has ever gotten. More people died today than have ever died in a single day from COVID-19 here in the States. More people are in the hospital right now with COVID-19 than ever. Really think about that.

All right, let’s move through our phases: our pre-exposure period. A little update here for our clinicians. I got a lot of questions about this. New York has now recommended broader use of eye protection. I know we’ve talked a little bit about the science behind this. It takes a little while for the recommendations to catch up with the science, but New York State Department of Health now strongly recommends universal use of eye protection by healthcare personnel for all patient interactions. This is in addition to the face masks.

I got an email asking about this and it was entertaining. It was a whole loop. It was a number of clinicians in a clinic, and one of them emailed me saying, “We only do well visits. We don’t let people come in if they’re sick and not sure if this really applies to me.” I responded back and said, “You think [chuckles] they’re well visits.” What percent of those people are pre-symptomatic, are asymptomatic. That’s really the thing. If you get a call the next day and they say, “You know what, I wasn’t feeling 100% when I saw you and today I just got a test and you were not wearing your eye protection,” that’s a potential exposure.

This is really moving into a universal precautions approach, at least for the foreseeable future here. For front-facing healthcare workers, we’ll talk about why there is a finite period of time that we’re going to need to be practicing this really high level of caution. Universal recommendation here in New York when clinicians are interacting, and I extend this to all staff, when you’re within that six feet, when you’re going to potentially be at risk, protect your mouth, protect your nose, and protect your eyes.

People are still taking zinc, vitamin D, vitamin C. This all seems fine. There was a nice article in Nature analysis of vitamin D levels among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. I’m going to push out here again and say, we really need to do some randomized controlled trials. We currently, in the U.S., spend over a billion dollars a year on vitamin D supplements in testing. That’s a lot of money.

It would be nice to know, is that well-spent money? If it’s not, then you could give a little bit of that to Vincent and the lab. Support MicrobeTV. [chuckles] It’s important. We do a lot of studies looking at small molecule inhibitors, pharmaceutical agents. Vitamin D is something a lot of people take for a lot of different reasons. It would make sense to really understand its role in COVID-19.

I also want to talk about testing here. This is, hopefully, the pre-exposure period. Hopefully, you haven’t been exposed yet. We really ramped up testing over the last couple of weeks here. I was doing one of those– I call them the microphone bouquet interviews this morning. You’ve got a whole bunch of microphones and you’re not sure who you’re talking to, but you look at the sea of cameras. We were talking about what we’ve done with rapid testing in the last few weeks and I was there with Bonnie Simmons.

She’s the head of our tristate urgent cares. She’s my buddy, Adam Fiterstein’s, boss. She always wonders, “Again, whenever I call, you pick up the phone.” I’m like, “Bonnie, you’re a hero of mine. You really allowed us to make this happen, all this rapid testing.” What we saw right before Thanksgiving is a lot of people were going and getting tested. A lot of people with asymptomatic and pre-symptomatic infections were being picked up, diagnosed, pulled out, contact tracing, and then those people were being picked out.

I really think we were saving lives here. We were detecting people before they went to those gatherings. We were picking up who else was infected that they were interacting with. This is really taken on and people are realizing the utility. Two days before symptoms, five days of symptoms, the rapid test gives you a result in about 15 minutes has really been tremendous. This is free. This is something that we as a society are picking up. This is not something we charge people for.

I was there this morning. It was quite cold. There were two lines of cars and just going around the quarter. These were all people that were basically driving up, getting swabbed. They would then drive on. By the time they got to work, school, home, they would be alerted by the results and basically told like, if you just got to work, stay in your car, turn around, go home, or otherwise, all right, you’re clear and can move forward. So much more helpful than finding out in four or five days after you’ve exposed people that, “Oh, by the way, when you went to that Thanksgiving dinner, when you went to work, when you went to school, you were shedding virus.” Really embracing this and a lot of people are moving in this direction.

Now, vaccines. All right. I’ll call this better than vitamin D. If you have a choice, a good vaccine or vitamin D? I’m going with the vaccine. I might also, at some point, remember to take some of that vitamin D that’s still sitting on the shelf in my medicine cabinet only growing in value, I’m sure. We got more information, and it’s always amazing. I was always like, “Wow, is this really only the last week?” It always seems like old news, but we got more information on the Moderna vaccine and Moderna has now applied for EUA for their vaccine.

Some of this was covered in the previous TWiV. Listen for more in-depth there, but what do we, as clinicians are going to bullet point at this? Moderna reported a vaccine efficacy of about 94.1%. If you looked at the secondary endpoint, severe disease 100%. No one who received the Moderna vaccine ended up requiring an ER visit or hospital care. Also was reported that the vaccine was well-tolerated. There were no serious safety concerns. I’ll make the point here of the difference between reactogenicity and severe adverse effects. You get the vaccine. Feel a little under the weather for a day or two. Shane Crotty has been tweeting out. I’ve been re-tweeting this– it’s The Rock. He goes to the gym and he’s really sore the next day. That’s what it’s like. That’s the reactogenicity, that’s your immune system learning. Then you move forward, but no serious safety concerns.

Now, we have about 70,000 people that have been vaccinated. We’ve got months of this. We’ve exceeded two months of median follow up, post-vaccination as required by the U.S. Food and Drug Administration (USFDA) for the EUA. We’ll be seeing that reviewed on the 17th. That’s the other bullet point. Thursday, December 17th, the Moderna vaccine is scheduled to be reviewed. What do we know so far? This primary analysis that we got us an update, 196 cases of which 185 cases of COVID-19 were observed in the placebo group, only 11 cases in the vaccinated group.

That has mentioned all the severe cases were in people that had not gotten vaccinated. Someone died and that was another person who did not get vaccinated. Pretty impressive. Between Pfizer and Moderna, projections are that we should have enough vaccine for approximately 40 million doses by the end of this month. We expect to start vaccinating people this month. Seventy million doses per month starting in January.

A projection is we will have the ability to vaccinate 100 million Americans by the end of February. Pfizer ultra-cold vaccine did just get approval in the UK. People probably have heard about that. I’m just going to hit a couple important dates for our clinicians to keep an eye on, one already past, December 1st. The ACIP – this is the Advisory Committee on Vaccines – and this was a little bit different. Normally, this committee meets after a vaccine is licensed, and then they give advice on who should get it. This is a little bit of a twist. They met and they said, “When a vaccine gets an EUA, we’re going to give some preemptive recommendations on who should be prioritized.”

My wife really liked this. Initially, they had, we’re going to have phase 1 and 2 and down the line. What they did is they created phase 1A, B, and C. This way, a whole bunch of people are in phase one. I thought that was clever. What they did basically is nothing that surprised anyone. They said, “We’re going to do healthcare workers right up front, and then we’re going to move down the line.”

We’ll be moving into educators and firefighters and police officers, and people in food and really critical people. Then we’re going to move into phase 1C and that’s the 65 and over. I’m going to talk a little bit about when I think people will actually see the vaccine. December 10^th – that’s a week from the time we’re recording this – the FDA will review the Pfizer vaccine. December 17th, the FDA will review the Moderna vaccine. Just to talk a little bit about the numbers. Front-facing healthcare workers, this is phase 1A, healthcare personnel. This includes EMTs, EMS, and also that it’s going to move right into the long-term care facility residents.

VR: You too, right?

DG: What’s that?

VR: Are you included in that?

DG: In the long-term care facility resident or the–?

VR: No, healthcare.

DG: I am, actually.

VR: Very good, very good.

DG: I was talking with people I work with and I think I may have seen more COVID patients, or had more exposure to COVID patients than anyone else I know. I have a lot of exposure. I go see people in the ER. I see people in the ICU. I see people out in the urgent care settings as well in the clinics. If you can get exposed to COVID, I make it my business.

VR: Daniel, are you going to feel somewhat relieved that you have a vaccine?

DG: Tremendously relieved, actually. I’m going to answer that question. I keep skirting. People keep saying, “Dan, are you going to get the vaccine and when?” I heard Barack Obama. He’s going to get the vaccine as soon as it’s ready. I think that’s the thing. A week from today, we’re recording this on Thursday. A week from today, the FDA is going to have their review of the Pfizer vaccine. All the information is going to be out. One of the people on our vaccine committee is going to be tasked with listening to all the questions, reviewing all the data.

Hopefully, when we record next time, I’ll have all the information to go ahead and say, “Yes, I feel this is safe. We’re ready to go.” If stuff comes up, I’ll let people know otherwise. I anticipate a little more than a week after this drops. I’ll be getting in line for my vaccine and I’ll stream that live on YouTube or something.

VR: Get someone to tape it on your iPhone, record it on your iPhone. We could splice it in here.

DG: Okay, yes. I think that that will help people. You want to see someone– I was talking to my mom earlier today. I answered it, no one other than the truth. She’s like, “Yes, well aware of that.” I’m going to get the vaccine if I feel it’s safe and effective. I think that that will help get the message out there. If I don’t think it’s safe and effective, I’m going to wait until I feel confident. Hopefully, that’ll help our listeners. Phase 1A is going to start in December. We are all ramped up and ready to go. Then we move into phase 1B, and that’s all the essential workers I mentioned – education, food and agriculture, police, firefighters, correctional officers, transportation.

That’s going to start in January, and then phase 1C, that’s 65 and over. That’s our high-risk. That’s going to be January moving into February. This is really happening pretty quick. This is good stuff. Once we move into March, that’s when we’re really moving into wider distribution. People wonder about children. Hasn’t been tested on children yet, but Pfizer has announced that they’re going to be starting to test in the 12- to 18-year-old population. They’re going to have 3,000 people in that initial venture, I should say. Moderna has also said they’re going to be moving their vaccine into that population as well.

We’re going to have important information on, can we use this vaccine in younger individuals? Eighteen’s kind of arbitrary, right? Not sure how immunology and the right to vote somehow got pegged at 18. I was worried when they raised the drinking age to 21. That would somehow– but no. Really arbitrary there. I did want to talk a little bit actually about this whole ultra-cold thing with Pfizer. We always talk about vaccine hesitancy and we’re talking about the patients being hesitant.

Unfortunately, I think because of some issues with communication here, we’ve had vaccine hesitancy on the part of clinics, physicians, healthcare organizations saying, “I just don’t want to have to deal with Pfizer and this ultra-cold, and I don’t want to buy these deep freezers.” The other side is, you have all these people spending a lot of money buying these freezers. I’ll talk a little bit about this. I’m on this national vaccine initiative committee and actually Wednesday, yesterday, I was in a meeting with basically our whole group and Pfizer’s medical director.

This is, I believe Catherine Jensen is her name, really bright woman. After the conversation, I talked to John Head, who’s like our senior person. He was actually saying, “I guess when you have a lot of money, you can hire really good people.” I was impressed by that. They’ve really figured this stuff out. It’s pretty amazing. They’ve got these thermal shippers, which really are a little bit larger than we’ll say like five personal pizza boxes. It’s really five personal pizza boxes. Each personal pizza box has about 200 vials, actually 195 vials, five doses per vial.

They’re in this box, surrounded by dry ice. We’ll talk a little about dry ice, and basically you send this out. You could say 195 times five, about 1,000 doses in this thermal shipper. That thermal shipper itself is basically a deep freezer. You repack it with dry ice every few days, everything is in there. You don’t have to buy one of these deep freezers. It’s small enough that it fits under a desk. They even send you these special thermal gloves. I asked about that on the call. “How I’m I going to touch those negative 70 degree things?”

I’ve remembered going into the deep freeze, and you pull it out and you get freezer burn on your finger. They send goggles. They send special gloves. You need to grab as many vials as you want, let them come up to room temperature, add some saline, invert it a few times and then fill your syringes. It’s really, really user-friendly, really something that can get out there. It’s actually something, not only that I think we’re going to do here in the U.S., but there’s already plans to use the same technology throughout Sub-Saharan Africa, low-middle income countries as well. Really no issues here.

Everyone should start getting signed up, registered, so they can make this happen. You get your first dose with Pfizer, three weeks later you get your second dose. Within five days, you are at these wonderful levels of protection that we’ve all heard about. Just want to let people know that this whole cold storage, ultra-cold stuff, it’s really not an issue. Pfizer’s worked this out. There’ll be a little details adjusted at the end point, once the FDA comes and says, this is exactly the way we want you to do it. How many times can you recharge that thermal freezer with your–? What kind of ice is that?

DG: Dry ice?

VR: Dry ice.

DG: I promised I would mention dry ice and I’m going to make a video this weekend on homemade dry ice, because everyone’s like, “Oh my gosh, we’re going to run out of dry ice,” and it’s really easy to make. Don’t try this at home and people will listen and do that when I say that, but you can really just take one of those CO2 fire extinguishers and a cloth bag and either tape it or have a really good glove and you blast it into the bag and presto, you have dry ice. I’ll be blasting that on Twitter this weekend, but we’re not going to run out of dry ice. It’s easy to make dry ice. We’ve got lots of CO2. We’re good to go. Apparently, there was a CO2 shortage in England a couple of years back. They couldn’t make beer or something, so nothing to worry about.

All right, let’s move into our incubation post-exposure period. Little changes here. The CDC updated its guidance and they basically said, this makes sense. I’ve been talking about this for a little while, but now it’s official. When we used to say, you got exposed, now you got to quarantine for 14 days, my wife, her famous, “That’s excessive.” Yes, she’s right, nobody did that.

Now, what they’ve said is what you can do is, at the end of seven days, get a test if the test is negative, then you can move forward. That was just updated December 2nd and this does not need to be a PCR. They’ll specify that. You can go ahead and get your rapid test, 15 minutes later, you find out you’re good to go, you move forward. I would say that’s really positive.

All right, now we move into the viral symptom phase. Now, unfortunately, you have not missed the bullet. You’ve actually got infected. You’re starting to have symptoms. Just some monoclonal antibody updates. People have not really forgotten about the monoclonal antibodies. There still tends to be a tremendous demand and, actually, when this episode drops on Saturday, there’ll be some stuff in the news about Eli Lilly and my involvement with them. Tell people, watch the news. We’ll talk more about this next week.

I did want to add a little bit of a discussion. I was listening to TWiV 688 and there was a whole discussion about subcutaneous versus intradermal and the half-life of the antibodies. It did, it reminded me of rabies when the woman who wrote in was talking about injecting herself in belly and all these different things. Just a couple of things to talk about. Intradermal, if anyone ever had their skin test for tuberculosis, that’s where you put the needle just a little under the skin and you raise a little blood, that’s intradermal that’s in the skin.

Subcutaneous is sort of down in the fat layer, but above the muscles, you’re not getting it into the muscle. You’re pulling a nice chunk of fat. That’s easy to do on me, particularly because I don’t go to the gym anymore, but one day it’ll be harder, hopefully. The rest of my life is so hard. Why is my belly so soft? You grab a nice chunk and you put the injection in there. The reason we’re studying monoclonal antibodies in the subcutaneous is you don’t have to go to a clinic. You don’t have to go to a hospital. Anyone can grab a nice chunk and inject in the way they do as a Prolia, for instance, some of our other medicines, so we’re studying that as well.

Why’d you do four different sites? It’s a question of volume at this point, it’s to serve a large volume. What about half-life? The half-life is different with the different antibody preparations so that Eli Lilly, the bam bam, the bamlanivimab, half-life is about 21 days to get a really high dose, 21 days it’s about half of that. The half-life is a little bit longer with the Regeneron antibodies. I think I mentioned GSK has made the stock modification, so their antibody has an even longer half-life.

Next thing I guess I’ll mention is that this is passive immunity. When you give someone this infusion or you do the subcutaneous injection, then you’re not going to see immune response. You’re not going to see lymph nodes. You’re not going to see soreness of the site. About 2% of the time, people get a little bit itchy, so that’s why we observed that. We get a little bit itchy, we give them Benadryl, hasn’t been an issue to date. Making some progress there.

That early inflammatory phase. People should go back and listen to Immune 39: A Tonka Truck full of salt. They have a discussion right at about 57 minutes about this cytokine storm and the whole early inflammatory responses, really sophisticated, complicated thing. It reminded me of a book and a movie based on the same book, Smilla’s Sense of Snow written by the Danish author, Peter Hoeg. The main character is a Greenlander and she presents this idea that a lot of people have heard where the Inuit have multiple words for snow. I think in this book, it’s 23, the myth is that there are 50. I think it’s an interesting discussion.

When we’re talking about this early inflammatory phase and we talk about cytokine storms, really, there’s a lot of complexity here. I think that you get the immunologist response, it’s very complicated. From the therapeutic point of view, we’re still limited in what we do here. We still use steroids during this period. We still do oxygen. We still do medications to prevent people against clots, so a lot of supportive care.

Secondary infection phase. I think I mentioned last time, but we’re starting to see more issues here with resistant organisms because of overuse of antibiotics early on, so let’s really be careful, so a reminder there to our clinicians. If you see these people in the urgent care, you see people in the outpatient setting, what do you do? You might get them hooked up with a pulse oximeter, or you might monitor them. You want to make that decision, do they need to come into the hospital? You might consider aspirin, things like that, but no antibiotics. This is a viral illness.

You want to be really careful. If you’re giving more than 10% of your COVID patients antibiotics, you’re overdoing it. Most patients can be managed at home without antibiotics with really not hospitalization in most cases. If they do need to be in the hospital, if they get to this late phase, this is when we start seeing those infections. The multi-system inflammatory phase, it was like a déjà vu back to April today. I don’t know if that works right, but anyway. Early on in April, we talked a bit about the Irish patients, I don’t know if our listeners who are with us still remember that.

Our Irish patient had an episode at one point where things seemed to be going along really well and I’m thinking this is great. We come in and he’s completely paralyzed. I don’t know if our listeners remember that. Same thing happened over the last two days with one of my patients in the ICU. They’re getting to the end of week four, we’re starting to talk about discharge planning, getting this person set up with rehab and completely paralyzed. Again, this is this Guillain-Barre syndrome that we see as part of this multi-system inflammatory phase. That individual has been started on IVIG. It’s a five-day treatment that we use and the motor comes right back.

A frightening thing, but I think now that we understand it, this shows the difference in managing patients. Back when we first saw this in April, we did not know what was going on, what’s happening. This person was doing so well, suddenly they’re paralyzed and they’re on a ventilator because they can’t figure it out on their own, but now we understand where this fits in.

The tail phase. I’m going to finish off here, because we’ve got a few emails and my goal is to keep this all in under 30 minutes. I’m going to suggest that we create some kind of survey to decide what to call this tail phase. Now, it’s been recognized. Is it long COVID? Is it long-haul trucker COVID? Is it long-term COVID? Is it long-lasting COVID? Is it post-COVID?

Actually, I’ll let our listeners know, so we’re recording this on Thursday, but there is a large multi-hour conference going on today, Thursday, and Friday, where a lot of clinicians, a lot of researchers are all having an NIH-sponsored discussion, trying to better understand, not only what’s going on here, but how to put together research projects to try to get a better understanding of how to take care of some of these folks.

I’ll stop there before we hit emails and just remind everyone that we have finished our MicrobeTV fundraiser which went very well, I’m happy to say. We’re going to be able to generously support MicrobeTV, which is great. We’re now supporting the Peace Corps, HIV, and AIDS programs. Just remember that the other virus is still responsible for a lot of suffering and deaths throughout the world, so encourage people go to www.parasiteswithoutborders.com, so we can do our matching support for the months of December and January.

VR: All right. Last time, we made a new email address for Daniel: [email protected], so you can send the emails there, and I save him the trouble of getting them. Actually, they come to me, but they’re still for Daniel and we have a bunch. Let’s do a couple.

DG: All right.

VR: I’m going to lump the first two together, both Joy and Dennis are worried about long-term COVID. They say they both have it and what can be done? Are there any therapeutics insight? I’ve gotten this question many times, Daniel, so what can you tell us?

DG: That was, I think really encouraging about what is going on today, what’s going on tomorrow is that it is recognized that this is a phenomenon. It is recognized that these people are suffering and that we need to really bring science to bear. This can’t be just, “Oh, try some antihistamine. See if the melatonin helps you sleep.” We need to really get these people together.

A couple of things I will say is at United in Research, I’ve mentioned that website before, we are going to basically create a COVID positive community and we are going to basically give people a way to go on the web to register as citizen scientists and to basically participate in the different trials and the different approaches to how do we understand what’s going on with people who continue to suffer from COVID.

We’re going to be following serologies. There’ll be questionnaires. There’ll be all kinds of biomarker analysis. There’s going to be a lot of individuals looking at this. I will say, at this point, we still have primitive where we focus on symptoms but this is going to be moving hopefully to better therapeutics, but there are hundreds of thousands of individuals suffering with this post-COVID syndrome and we’re committed to finding answers.

VR: All right. Next one is from Kayem who lives in Washington DC, and he says, “My kid’s school is doing almost everything right, distancing, mask-wearing, no moving around, no testing unfortunately.” He says, “There’s no testing as in addition to practical issues. They seem to be worried about moral hazard. Anyway, new cases are spiking here in D.C. We are now cresting the record set at the peak in May. Mayor has tightened some restrictions but indoor dining still permitted. I think things are going to get worse.”

His question, “Is there a point at which we should be pulling our son out of school? Obviously, I don’t expect an exact threshold, but conceptually does it make sense that at some point, the background might get high enough to overwhelm the in-school precautions, or are the safety measures enough that we don’t have to worry about community spread outside the school?”

DG: Yes, I always get questions about the schools and I think that this is important. I’m going to be doing another talk for one of the schools this Sunday. I think Shane Crotty is going to be like going before me actually, my buddy Shane Crotty. The science is mounting, the evidence is that you can make schools a safe place. That doesn’t mean everyone’s making it a safe place, but you can do it.

As you described, if they put all these proper mitigation measures in place, if they keep the kids separated, if they wear masks and watch that they’re not indoor dining at school, and I really commend my son who’s always horrified that they sit too close when people eat and that is true, Barnaby, you should be horrified like I am. We can make the school safe.

The interesting thing is not only have I been weighing in and giving advice and commenting on schools in the New York area, but actually throughout the country. My first involvement in schools was actually in March in Texas, and I still remember the conversation. This was the superintendent of one of the largest school districts in Texas. He asked me and I’ve known him for a while, so he said, “Dan, what do you think? Should we close the schools?” I said, “You know what? You can either close them now or you can wait until it’s too late.”

We didn’t understand back in March, we didn’t know that we could make schools a safe place. This is a different scenario. I don’t think it’s like, “Oh, just in New York you have resources to make the school safe.” I’ve talked to schools throughout the country. We can make schools safe in Idaho, in Texas, in Montana, in California, in Colorado, and that’s one of the things. I’ll go ahead and say I’m not sure closing schools makes a lot of sense even here in New York City where real estate and space is actually quite tough. The New York City Mayor wants to open the schools again and wants to do it in a way that they think is safe because there are clear harms to closing the schools.

The teachers, I’m thinking about teachers here too, they can be made safe if we do what we know works. If we don’t give them masks, if we don’t put measures in place, if we don’t have the distancing, that’s a problem. The other thing that is right around the corner, the rainbow at the end of this dark tunnel, is right after we do the healthcare workers, we’re going to start vaccinating the teachers. In the coming months, the teachers are going to be safe as well, and I think that’s really going to help us with opening schools.

VR: All right. One more from Paul who is in Manchester, UK. He sends a link to a BBC article about lung damage and wants to hear Dr. Griffin’s thoughts. This is an article about a new scanning mechanism that has identified lung damage months after the initial infection. Know anything about this?

DG: Yes, I actually appreciate that you bring this up, Paul. If anything, I think people underestimate the damage, the morbidity of COVID-19. Some less-than-wise people have said, “Oh, COVID, you get it, either you live or you die.” Yes, no, most people who get COVID don’t just live or die. A lot of the people that don’t die are really negatively impacted and we see the people with the long haul, the tail of COVID, but there’s also a lot of individuals who were physically active and they find themselves compromised.

We’ve had several serious athletes who find that they went from running six to seven miles a day to having trouble going up a flight of stairs. We’re appreciating that there can be for a lot of individuals much more lung damage than was initially appreciated. We’re also recognizing heart damage as well. I think these studies are really important to let people know that you really want to not get COVID because, yes, you may survive, you may come out the other side, you may be able to tell everyone how great you’re doing, but let’s see you try to run a mile after you’ve had COVID, it may not go so well.

Let’s really for the next few months and until– I guess this reminds me of my other movie as we’ll finish here soon. I watched Greyhound. It always takes me about a week because I watch in like seven-minute increments. This is World War II and it’s a shipping convoy and they’ve left the safety of air cover of the U.S., and now they’re heading towards air cover over in England. They’re how many hours till we’re back in air cover. That’s where we are right now, it’s only weeks and months till we’ve got the air cover of the vaccine.

Let’s just be safe. Let’s zigzag. Let’s avoid those crowds. Let’s wear those masks. Let’s wash our hands, so we can get back to the air cover of the vaccine and the pre-COVID world.

VR: All right. That’s our COVID-19 clinical update number 39 from Dr. Daniel Griffin. Thank you, Daniel.

DG: Pleasure as always and everyone be safe.

[00:37:30] [END OF AUDIO]