Corona Letters #56 - Q & A with Dr. Lee

 I am delighted to invite the esteemed Dr. Lee back to this space.   Dr. Lee has agreed to be interviewed by me with great hesitation.  He considers himself more of a student of Covid-19 than an expert and wants anyone reading this to do all the research they can before making any decisions regarding their health and the health of their loved ones.   He strongly encourages listening to doctors, nurses and other scientists and not politicians.   That being said, let the interview begin.

Me:  Dr. Lee, thank you for agreeing to be interviewed.   People seem to be very curious about the vaccine and wonder what your thoughts are on it.     Would you be vaccinated?  And what would you want to know before you were vaccinated?   How soon do you think it will be available and do you think herd immunity is a viable alternative?

Dr. Lee: Ah, "the vaccine".  I suppose you are referring to the Pfizer/BioNTech vaccine, which was recently reported in the press.  It does look very promising, with a 90% efficacy rate reported.  I think everyone should understand that these are results from an interim readout in a clinical trial - in other words, we're still a ways from having a vaccine available.  But it's a clever approach, and it's part of a wave of new science in approaching infectious diseases.  Moderna takes a similar approach.  In fact, did you know that more than 200 vaccines are in development today? More than 50 are in clinical trials, and 10 are in late stage trials!  And that's just vaccines!  There are antibody trials, anti-virals, bleach (just kidding)...  I just gave a talk a few weeks ago about our own efforts in developing a therapeutic, and I noted that the first case of Covid-19, coming out of China, was less than 1 year ago!  It usually takes years, even decades, to develop a vaccine.  It's just amazing how much effort there has been around the global scientific community to find effective treatments, and to understand the biology of SARS-CoV2, in such a short amount of time.  I think this says it all about how serious we, as scientists, take this pandemic.  We are not turning any corners soon!

Would I be vaccinated? Hell yes!  As long as the trials are performed properly, and not rushed or accelerated because some "genius" thinks they might be ready by Election Day (eyeroll).  Vaccines, by their nature, activate the immune system, and so trials must demonstrate their safety, as well as efficacy.  There is a possibility, for example, that some vaccines could exacerbate Covid in some patients - a phenomenon called antibody dependent enhancement.  Not likely with coronavirus - I think it was seen with the dengue virus - but that's what the trials are for.  Any vaccine that is approved by a politician? Would not take it.  Approved after proper execution of a well designed clinical trial?  I think that is my reponsibility as a good human being.  I think the best estimates are that there will be sufficient doses to achieve herd immunity by the end of 2021 - that is, assuming people agree to be vaccinated.  By the way, vaccination is arguably one of the most important scientific advances in medicine, ever.  Think about how devastating polio was, or tuberculosis, or smallpox.  And while the mortality rate of CoV2 is comparatively low, remember, this is a very recent phenomenon.  We don't yet know what the long term effects will be, but we do know that the current pandemic is putting an enormous strain on our healthcare system, and does put our most vulnerable people at risk.  Since it will be some time before the vaccine is widely available, masks and social distancing are must do's, and again our responsibility as decent humans.  

Me:  Wow.  That is an incredibly detailed answer.  Thank you.   I kind of feel like the interview should end now but I should probably ask at least a couple more questions.   So, assuming you get vaccinated, how would you engage with the public?  Would you be footloose and fancy free? (In other words, would you go maskless?).  What do you think is appropriate post-vaccine etiquette when it comes to masks? And other safety measures such as social distancing?

Dr. Lee:  I would follow the advice and guidance of people who are way more expert than me.  These are not only the scientists (yay!) and medical professionals, but epidemiologists as well who understand the dynamics of the disease in the population.  I would not have a problem wearing a mask even after being vaccinated, for example, if it helps to keep infection rates at bay among the not-yet vaccinated by not promoting a sense of easing restrictions just yet.  Like I said, it will be some time before the vaccine is widely available, so we can't let our guards down too early.

Am I being overly cautious? As a scientist - no, No, NO! Again - again! - covid is a novel disease, and poorly understood.  Clearly some people are affected more severely than others.  Why is that? Genetics? Prior exposure to other coronaviruses? Blood type? I can't tell you - but scientists around the world are trying to figure that out!

Speaking of epidemiologists, a powerful tool in their arsenal is data - data around testing, data around mortality rates, geographical data, etc.  And they are good at understanding the data behind the data - are death rates reporting deaths on the day the patients died? Or does it take some time before the deaths are reported? Do some states have greater reporting rates than others? Is it politically motivated?  It always cracks me up (in a sad way) when non experts suddenly become expert at interpreting scientific data.  Last I checked, Fox News is not a peer reviewed journal and certainly not a well respected scientific source.  In general, I think we need MORE testing, and better tests, now more than ever.  Testing helps to generate this necessary data, whether it's testing in the context of public health (for example to help prevent community spread) or in the clinic, to perhaps help determine the most appropriate intervention.

In summary - follow the advice and guidance of people who are way more expert than me. Or you. And not Fox.

Me:  Hmm.   Since you mention the politicizing of Covid-19, I want to ask you about the damage that is being done by under-reporting Covid cases.  I have read that some hospitals in rural areas are not always listing the cause of death as Covid. It seems that this is at least partially politically motivated   As in, if there are too many covid deaths reported, it might make a certain administration look bad.   Do you think this is true?   And what are the dangers of this?

Dr. Lee: I can't really answer that question very well, without seeing the data, but without a doubt the current outgoing administration has downplayed Covid, and their response to the pandemic, from the beginning.  Because this was an election year, I can assume that there may have been some politically motivated decisions to help the outgoing administration look good.  I think what one CAN do is to look at the overall data for the US and compare it to the rest of the world, including testing rates, total number of tests, total number of cases, and death rates.  For the richest country in the world, we have failed big time.  And I think that we are now seeing that in those states in the US which have not mandated widespread mask wearing, the case numbers are rising very fast.  And that's the leading indicator.  The lagging indicator - death - will come soon, I'm afraid.  Whether these states choose to report these deaths as Covid related or not - well...

Me:  While that isn't a real answer, it is a thoughtful response and much appreciated.   I think I'm just going to ask one more question since you've given my readers a lot to digest already.  Speaking of digestion,  my final question is focused on the upcoming holiday.   Thanksgiving is traditionally a time for gathering and many families want to honor this tradition despite the pandemic.   What are your thoughts on gathering over the holidays?  Would it be okay to have Grandma over, sitting across the room with a mask?    And what about all those crazy college co-eds coming home?   They've been tested multiple times a week for months.   Should they quarantine when they come home?  Should they sit with Grandma at the table?   Should everyone just get tested before the holidays and resume everything as usual?  

Dr. Lee: Well, here's the thing.  I LOVE Thanksgiving, and all the good food.  You know this about me.  So, the fewer people are at our house, the more there is for me!

In all seriousness, I think that we have to remain diligent and disciplined, now more than ever.  I know it's been a tough year, and with winter upon us, we have many dark months ahead.  But I think that we are more resilient than we give ourselves credit for, and our ancestors have had to battle far more fierce demons than we have had to.  We do need to look out for one another, and take care of our mental and emotional well being - I don't mean to downplay this.  But I am optimistic about the vaccine, and of scientific advancement, and of policies which are based on good science, and ultimately in the general goodwill of friends, neighbors, co-workers and family who genuinely look out for one another, regardless of politics or other influences.  And for that, I am truly thankful!

Me:  Awww.   That wasn't really an answer either, but it was sweet.   Thank you, Dr. Lee, for answering these questions today, and thank you to my readers who contributed to some of these questions.  I hope that you all got the answers you were looking for.     I certainly learned a lot with these answers and will continue to educate myself as best I can, through science, and not politicians who have something to gain by swaying me one way or another.  It is my responsibility to educate myself to the best of my ability and to question the accuracy and validity of every resource I encounter.   Any parting thoughts Dr. Lee?

Dr. Lee:  I'm really not an expert on Covid, but I've learned a lot this year because of the work I do.  I'm very lucky to work with really talented and dedicated scientists every day, and I can tell you that we are all honestly motivated by the chance that we can do some good, and help people.  And I think that most of us are doing all that we can with the same motivation - a chance to do some good.  Trust us - trust me - when I say that the science is real, that progress is real, and that there is good reason for hope.  But until the vaccine is widely available, you know what you need to do.  Because that's what the science says.

Me:  Amen.  Thank you so much for your time.   Now you can go back to watching the news, scratching your head, and drinking copious amounts of whiskey.

Good night all!  Be safe out there!