[program music intro]
[program music in background]

Regina Barber DeGraaff [narrating]: Welcome to Spark Science. I’m your host, Regina Barber DeGraaff, and I teach physics and astronomy at Western Washington University. In March 2020, we interviewed an infectious disease medical doctor to create a show to better inform our listeners about the new virus that was shutting down the world. We invited Dr. Vijai Bhola back to our show to talk about how things have changed over the past year and how he thinks the pandemic is going to progress in the future.

[program music ends]

Regina Barber DeGraaff: It’s been one year since we’ve talked to Dr. Vijai Bhola, infectious disease specialist. It was an awesome show. It was at the beginning of the pandemic. But I want to welcome Dr. Bhola back to the show. Thank you for being here!

Dr. Vijai Bhola: It’s a pleasure to be back. Thank you for having me.

Regina: A lot has happened in the last year, but I also want to introduce the co-host for today’s show, Western Washington University physics student, editor for Spark Science for the last three years, Julia Thorpe. So, thank you for being my co-host.

Julia Thorpe: Hello. Thank you for having me. It’s a pleasure.

Regina: For all you listeners, Julia’s also going to edit this show.

Julia: Yep.

Regina: So this is really Julia show. [Julia laughs] Let’s just start off with helping the listeners; what you do, Dr. Bhola. What does an infectious disease specialist do? What are you doing right now? Kind of your background.

Dr. Bhola: So I’m an infectious disease doctor by training. I just finished my infectious diseases fellowship July of last year. And what I’m doing right now, I’m working right now more in a general medicine capacity. Because I was supposed to actually be in Botswana for these six months. But because of COVID-related reasons, I find myself staying here stateside.

One very good thing I was able to do, which was very interesting for me, is assist with some of the counseling for the Novavax vaccines, which our hospital’s one of those sites. So that was a very interesting way to be involved in this process. So I wasn’t very [inaudible]; I was much more counseling patients of the side effects of the possible vaccines, and the process of the trials.

I think what was really fascinating is just how much things were changing over the central moving target. In terms of what are infectious diseases physicians, it’s primarily an inpatient, which means you work in a hospital and you see lots of consults. So any patients who have an infectious disease problem, or sometimes they have–patients have these fevers of undetermined origin, et cetera. They have pneumonias, infections with complex organisms, or complex infections. You would get called to consult on these.

In the world of COVID, you very commonly get get consulted on whether someone needs antibiotics because you have an abnormal chest X-ray and you’re not quite sure whether it’s a bacterial infection, or it’s just COIVD pneumonia, which doesn’t require antibiotics. And you get uncontrolled fever. Early on of course in the pandemic we’d get lots of those before we were quite clear on whether COVID causes the systemic inflammatory response that we now see and we now understand quite clearly. So, an infectious disease doctor has a really interesting life seeing strange infections.

Regina: I remember when we talked last year, you were saying that things could change at any minute. Like next week, the the things I could be telling you could be totally wrong. So now that it’s been a year, do you feel like as you are, your everyday in the hospital, do you think that the medical field has kind of gotten a hold on understanding COVID-19 now? Or do you think, like, tomorrow crazy stuff is going to happen?

Dr. Bhola: Oh, I hope you will publish this tomorrow because everything can change in a minute. We’re looking at a curve right now that’s heading downwards, but that can easily sort of plateau, or it can just really exponentially explode. I mean the possibilities of what can happen, we’re really at the junction where we’re not quite clear on how things will play out. We’re sort of opening up throughout the country a lot quicker than, and in a manner that’s probably not the safest. But we really are at a real inflection point, we’re really at a fork in the road where this thing can go, can still go either way. It can actually become worse than it was in the thick of the pandemic. Or we could just sort of resolve into a very nice summer. It’s really hard to tell how this will be going at this point.

Julia: So Dr. Bhola, you mentioned that socioeconomic status plays a strong role in how deadly a virus is, and we have sadly seen this in the last year. Can you help our listeners understand the issues related to this?

Dr. Bhola: Oh, this is a really fascinating question/topic. And I think, if nothing else, I hope that when this COVID has all been settled and socioeconomic factors that have been raised so prominently will become something that we really pay more attention to because it is a very critical role in terms of health dynamics. You know, if we look back a little bit, back to the point of the Spanish flu, the pandemic, we did see back then (this is back in 1918) that poverty and low socioeconomic factors played a very severe role–a sincere role–in mortality. So for example, in India, there was something like a 40-times mortality at that time compared to Denmark, for example.

And then, during the HIV pandemic, they coined this term syndemic, which means a pandemic–infectious disease pandemic–superimposed upon what can be considered a pandemic of poverty. Where we saw, especially in lower-income nations, a lack of healthcare access, lack of understanding, lack of education, lack of protecting methods; that the HIV pandemic really exploded in particularly low-income countries.

And the COVID pandemic is really following the same pattern and the “syndemic” is really appropriate to apply what we’re seeing right now. In short, we’re seeing approximately a two-fold increased risk within the United States in persons of Black, Asian American, and Native American origin. And so, we really have to ask ourselves that question, like why is there this two-times increased risk? And some studies have tried to tease this out. Is it a native genetic factor or is there something social that comes in?

And at least one study in New York sort of tried to tease out this very question. And it’s suggested that, for example, Black Americans, yes there’s twice the death rates as, per example, White Americans. However, when you correct such as more obesity, other poor health determinants, then it seemed as if it wasn’t actually the Black race being a risk factor as much as Black race is a risk factor for many other poor health determinants. And therefore, there’s a higher mortality in terms of COVID.

Now the jury is out on this. But what is quite clear is that if you are a minority, you have a much higher risk of dying of COVID. And some of the issues, you also have a higher exposure. For example, if you have what people can traditionally consider a white collar job, your job is more likely within the pandemic to be ones that you can do at home on a computer. Whereas if you were in a civil sector that is of traditionally lower economic groups, you tended to have to go out there; jump into public transportation at the beginning of the day; probably put your kids in the daycare where they would have exposures; go to work in a service industry where you met a lot of people; may not have been provided much protective equipment; and then you came home to probably a more crowded household then there are now one’s mixed up in there.

And so that combination of factors, the risk, the exposure to the virus is one major factor, as well as the poor determinants of health. And so this is a very real phenomenon and we are living in the wealthiest nation that the world has ever seen. And so, post-pandemic, these poor determinants of health will still be there. And so they are things that need to be addressed. And then next pandemic, they will be factors again.

And we say next pandemic, because there’s a sort of frame of thought now that we need to think as the inter-pandemic period. Not a matter of “if there will be another pandemic,” but when. Because we know it will. It has since the dawn of agrarian society, we’ve had pandemics. And so we really expect that these things will become just a part of our lives and we have to be able to hunker down into those modes. And we have to be prepared for when that time comes.

[program music]

Regina [narrating]: This is Spark Science and we’re talking with Dr. Bhola about the next pandemic

[program music fades]

Julia: So, following up on that question, what do you think that we can learn from this pandemic? And do think that the next pandemic will go differently? And what can we do to ensure that it might go differently?

Dr. Bhola: Um, very good questions. And I think the most important thing to start with is that we’re not really at the phase of a next pandemic yet, because we are not out of this current pandemic. You know, Dr. Fauci said, he was saying around August that we were still knee-deep–waist-deep into this pandemic. And that’s pretty much where we’re at. If you look at the curve, we had a peak, and then we had another peak around July, and then we really went up over the winter season.

We do need to keep in mind that we have all these variants, and with opening up, and with vaccine pressure, the vaccine now has mutation pressures because they are vaccines around. And so for the first time, they have a real incentive to multiply. Now this pandemic is not necessarily over; I think we can probably go back to that as a topic in itself. So we could talk about it a bit more, but I do want to answer your question in terms of preparing for the next pandemic.

So after SARS, which was originally around 2002, there’s a 2004 paper, “What have we learned from SARS?” [Dr. Bhola laughs] And then there were reflections post-MERS, which occurred around 2012, about what did we do wrong? And now we’re here again, saying oh, what did we do wrong? I think we got off the hook pretty easily with both SARS and MERS. COVID really, you know, sucker punched us because we weren’t prepared, and sort of deliberately lack of preparedness. We just choose to not believe that something like this can happen.

And I hope that the impetus because of how severe COVID has affected the world can really help us prepare better in the future. Preparedness really, unfortunately to a large extent, lies with the political directorates in each and every country. Because almost every nation–within China, within England, within the U.S.–we all sort of downplayed the pandemic. And because of doing that, we lost critical, critical times. China initially jailed its initial physician who talked about this. Within England, there was a paper that came out of Oxford that really suggested this thing could be deadly. And that sort of pushed the political directorate there to react and become a little bit more concerned about this in a real way. And within the U.S., you know, the initial response was a sort of denial.

So if we compare and contrast that, for example, to countries like Vietnam and Taiwan, which they got out of the pandemic and their economies grew almost, you know, within a couple–within a month or two. They sort of immediately went into defensive mode, sort of contact tracing testing very aggressively, performed these measures. And they were actually able to take their pandemics down to smoldering within a matter of months.

So to be honest, if you were to look in retrospect and say, how can we do this thing differently? If, for example, in the major powers-for example, in China they reported quickly; the U.K. and the U.S. really bonded together and said, okay, let’s do quick contact tracing, limitation of travelers, widespread use of mass, decreased movement to some extent. Arguably, if we were to say we could have had a pattern of improvement just as well as in Vietnam and Taiwan, we could have been out of this thing potentially within a couple of months. And when I say out of it, not clearly out of it. But to a measure that really more closely approximates a cautious level.

As we talk about how bad COVID is, we really have to mention it could have been much worse. MERS, for example, had a mortality approaching somewhere, let’s say, 8 or 9. Whereas COVID-19 has a mortality somewhat variable, but let’s say within the U.S., like 1.8. If we combine the mortality of MERSS, a deadlier virus, with the ability to spread the way COVID-19 is, we could have a completely, completely different disaster on our hands. And so yes, COVID-19 is bad, but this could have been a lot worse.

Regina: I wanted to bring back to what you said earlier about studies that are out there figuring out why patients of color have such a high mortality rate. And then you said the jury’s still out. And I just wanted to kind of explain to our listeners what you mean by that, because there are all these other factors: the socioeconomic factors; access to health; the systemic racism that is in our country that makes it so that people can’t have the access to health. But also, there’s also studies that show that people of color are not getting, not just access to health, but once they actually get to the hospital, their treatment is different.

Dr. Bhola: So, there has been a historical mistrust of the medical community and the establishment in general by minorities, especially within the Black community. I can’t speak to exactly what are the statuses now. You know, what we have right now is a very heightened awareness within all medical systems. So I think it’s difficult–it may be difficult to quantify right now the difference in how the health care system is perceived on the side of the Black patients.

But that is definitely something that I–you know, I can’t say I’ve seen it–but that is definitely an area we do need to look very closely at to really understand what are the actual biases within medical systems, number one; where hospitals are located and how hospitals are funded in the geographical areas where minorities are located, definitely; and the the way practitioners interpret symptoms of minorities of color. So for example, there definitely have been studies in the past saying that physicians had a tendency to underplay the symptom–underappreciate the symptoms–if they were coming from a minority or Black patients, and for example, Black female patients. You know, there has been those suspicions and data to support that actually. So that is definitely something that we do need to look closely at. And though I can’t say I know the detail offhand, definitely that is a very important aspect to take into consideration.

Regina: Yeah, and I think that that’s one thing that can come out of the pandemic. If we’re being, like you said, in the medical community vigilant about this, then after this pandemic is over, how does this affect medical treatment in the future? I wanted to let Julia ask the question about vaccines.

Julia: So currently, children are not eligible for the vaccine. They have not gone through the trials for the vaccine. And I wanted to know how that may change the outlook of herd immunity that people are hoping for in these next few months.

Dr. Bhola: So there was just recently, Dr. Velinski was saying it seems as if spread within children is not as aggressive. I think we don’t understand that very well. If there is spread within children, just given the nature of children and how they congregate, and it’s a bit difficult to get kids to do anything.
COVID Follow Up with Dr. Vijai Bhola
[laughter]

It can be difficult to get adults to follow these guidelines. So it’ll be even harder in kids. So it’ll be sort of trying to compare the rate of spread within children, with the increased tendency of children to congregate and get in close contact with each other. So, within COVID-19, I’m not sure we appreciate exactly how efficiently it’s spread within kids as compared to within adults, but that’s important. But there are a large reservoir of individuals that do have contact with their parents and their grandparents, and so they can potentially be reservoirs of spread. And the details on that, I’m not sure if we have an answer  But we do want to vaccinate everyone that we possibly can.

They are starting to look at using one of the mRNA vaccines within the 12- to 17-year-old age group. And so as time goes by, when that data becomes available, then we’ll be able to vaccinate children also. Which would be a great thing. You many to vaccinate as many people as you can. Really, in order to know whether a vaccine is effective. When a study’s effective, it has to be tested in the study’s proper sample population. In young adults, for example. So you want to see how it works within children and within pregnant women, for example. So those are two blind spots that we have currently.

The issue is that you don’t really want to run those trials initially because the adverse events are emotionally felt a lot more powerfully in kids and pregnant women, for example. In case of pregnant women, if there are adverse events, those can potentially be really negative long-term adverse events. So data, in general speaking, kids and pregnant women, lags behind because you tend to have to see any intervention study in adults before that is expanded to kids and pregnant women.

[program music]
[program music fades to background]

Regina [narrating: You’re listening to Spark Science, and we’re discussing COVID-19 vaccines with Dr. Vijai Bhola.

We want to let our listeners know that our next episode features a Western Washington University biologist who studies RNA. So there’s more mRNA vaccine information coming your way.

[program music]
[program music fades out]

Dr. Bhola: So our traditional viruses are typically, you–one classic way that we do (there are different types, of course), but a classic way is to grow virus, weaken it, and then give it to the person. Whereas the mRNA vaccines, we just need to be able to create the mRNA that codes the protein that you’re interested in, and then replicate that very rapidly. How quickly and how easy are those processes is something we really need to think about. So if you want to grow a live virus, it’s a very long complicated process. You have to grow it for a critical mass and that will take at least six weeks. Things have to be grown in eggs. We need to get a lot of chicken eggs to the extent that things are all–we don’t think of how many chicken eggs do you need! [laughing]

Regina: And that’s why if somebody’s allergic to eggs, right, that there’s an issue with this?

Dr. Bhola: Not necessarily.

Regina: Well how does that work?

Dr. Bhola: The egg allergy is sort of overrated for the most part? Because while you do use eggs to generate the virus, for the most part you’re not really giving the person egg proteins. You sort of extract the virus after that. It’s not just–you know, you don’t just create the soup and hand someone this soup. You sort of grow it and you take out the portions of the soup that you really want. You sort of extract this. To go to that quality, to go through that process takes weeks and weeks on end to develop an evaluated process. And then when you have that massive–and then it takes, each batch will take a certain period of time to generate. So that’s a very long process.

You have to be lucky enough with an mRNA vaccine to know what site you need to produce. But if you’ve gone through that step and you know what site to produce, it’s a lot quicker to do the reverse transcriptase, the DNA polymerase reverse transcriptase reactions to get a really large quantity of that vaccine. So there’s a huge time factor between ability to generate things in whether you are going to the traditional vaccines or you are going to the mRNA vaccines. There’s so many vaccines that we already have very, very efficacious–we have companies all over the world that have the equipment and infrastructure to produce the mRNA vaccines–to produce a traditional vaccine, sorry–that there really isn’t one, a reason, and two, there really isn’t a financial incentive to reinvent the wheel. So a lot of those traditional vaccines probably probably need to be where they are.

Where the mRNA becomes really exciting is the ability to generate vaccines in a pandemic situation. If you’re able to get to the point that you know what you need to produce, then you could potentially have the infrastructure to ramp up those vaccines very quickly. And for example, as we’re seeing right now with the emergence of these SARS variants, if we can then now start tweaking so that we know, if for example we figure out what proteins do we need to use for these variants, then we could start putting these things in together with the other standard vaccines. And trying to really almost dance with the pandemic and dance with the variants to figure out which ones they are and produce the appropriate vaccines fruit them.

Now, the other issues are in terms of storage and dissemination. The mRNA vaccines need to be stored at really low temperatures, like negative 70 Fahrenheit. So that’s really difficult to do in different countries’ settings. It really complicates the process. That is much different to most of the traditional vaccines which can be stored in a regular refrigerator. You know, especially in low-income settings, these things are very critical. So there are tremendous advantages to the classic method of just using an inactivated live virus.

Regina: But so the Johnson & Johnson vaccine does not need to be refrigerated. Does that mean it’s not an mRNA vaccine?

Dr. Bhola: Yeah, so Johnson & Johnson is not. It’s one of those that uses an adenovirus. The adenovirus is a virus that’s very much present in humans, so we know it can spread in humans. But it really doesn’t do that much. It’s a fairly safe virus to use to infect people or to use as a vehicle to get that genetic information or deliver that protein that you want. And so the Johnson & Johnson is not an mRNA vaccine and so it doesn’t need that level of refrigeration. That’s one of the really strong points to the Johnson & Johnson vaccine. In addition, of course, to the preliminary data being use of it as a one-time vaccine. They’re still investigating whether giving booster vaccines and the duration of booster vaccines are important. But we know if you can give one a vaccine that can be kept in a regular refrigerator, then that really gives you an advantage in a pandemic setting.

Regina: I have relatives that don’t usually get the flu shot. I hope that now everyone, those same relatives are clamoring for the vaccine now, the COVID-19 vaccine, that maybe this will start–I shouldn’t say it’s not maybe going to change everyone’s minds about getting the flu shot, but I hope that number goes up after this.

Dr. Bhola: I do hope so, too. But the anti-vaccine movement is really a powerful one. And I’ll admit when you have people–because as human beings, we’re already opposed to something that’s new. And so there’s something that’s new. And if there’s any sort of fearmongering, we’re very susceptible to that fearmongering. So even if it’s a very small minority opinion, and they speak a lot, they use their loudspeaker a lot, then it makes you think twice. Should I be doing this? You know, should I be using 5G technologies. You know, you wouldn’t think about it before. But it suddenly raises questions. And then just naturally human behavior is going to be delayed, a delayed reaction.

And you know, they did one study in New York during the thick of the pandemic. This was around April, I believe, when the thick of the pandemic in New York. And there was something near 60 to 70% of people said yes, they would take the vaccine at that point in time. And so, as time goes by, the anti-vaccine movement is something that’s going to become more and more powerful, unfortunately. And WHO actually names it one of the top 10 threats to global health. And it may not sound like much, but vaccination really has been one of the greatest inventions, the greatest measures towards public health, like, ever. And so, if we start to chip away at that absolute foundation block that we have, we could lose real ground.

And what becomes especially concerning is within the Black population, because there already is this distrust of the establishment, and because of course there’s less access to care (that’s been pretty well documented), there’s even more fail within the Black population. So for example, in vaccine trials, whereas the minority populations, their sort of kneejerk reaction is, “Oh, you guys want to use me as guinea pigs.” And so that actually—

Regina: Like the U.S. has done in the past. It’s a reasonable fear.

Dr. Bhola: It’s a fear that’s there for a very real reason. And so the vaccine hesitancy really affects disproportionately those already marginalized populations. And they have devastating consequences. So for example, in Minnesota, there were Ethiopian immigrants who were not vaccinating their kids. They were really well targeted by the anti-vaccine movement. And we had a measles outbreak in Minnesota, which is almost unheard of to really have these types of problems occurring in the wealthiest nation ever.

[program music fades in]

And so these are real concerns that we have to keep in mind. And I do hope that your relatives choose to get vaccinated.

Regina [narrating]: This is Spark Science and we’re interviewing Dr. Vijai Bhola, who is cautioning us against letting our guard down and to continue pandemic precautions.

[program music]
[program music fades out]

Dr. Bhola: What I do want to make sure we mention is, you know, there’s a lot of optimism now. For lots of reasons. We have good reasons to be optimistic, no two ways about it. And we want to be out of this pandemic. Most importantly, we want to believe what we want to happen. But right now is still a very concerning time in this pandemic. Some of really concerning things are the variants that are coming out.

mRNA vaccines seem to be effective in terms of mortality. So it has a mortality benefit within some of these variants. And so we think that we’re covered. But we have noted is that there are decreased antibody titers. So, it seems to have enough antibody response to still the variants for the most part. However, the fact is there is a decreased antibody response, and that’s something that we need to keep in consideration. We don’t understand the significance of this in the long term. And they are always possible that there’ll be slightly different variants.

And so we do have variants. We have the South African variant, for example. We have the U.K. variant. The U.K. variant’s considered a variant of concern. The two things that we are most concerned about is a combination of the ability to spread and the ability to kill. You need both of them to really have a pandemic. And at least some preliminary data has been suggesting that the U.K. variant could spread quicker and have an increased mortality rate. Like a 1.6 mortality rate.

Now these are preliminary data. We don’t know which direction they’ll end up going. But there is still concern that we can have variants. And these variants, just like coronavirus appeared in 2020 in the U.S. and led to an outbreak, a new pandemic. The potential is that those things still can happen. And now the vaccine has what it–the virus, sorry–has something it did not have before. It has selection pressure. So the same way when you have a patient in the hospital who’s getting antibiotics for a month, the bacteria, generally speaking, have the ability to get resistance. It happens before your eyes within months.

So we’re going to see now the virus sort of having this need to have these variants spread. So there is still a possibility that these variants lead to this pandemic propagating all over again. And us having to go through the process of finding the right vaccination or vaccine components that add to the vaccine that can then come to this issue. And so what you want to do to remove that selection pressure, you want to get vaccinations out as soon as you can. So what is happening now in the U.S. where you have states sort of just releasing their social distancing and use of masks really gives this virus the opportunity of a nice environment to learn and grow. You have vaccinated and unvaccinated patients. It can bounce back and forth.

So we we still are at a very critical time. And our numbers are something like 60,000 cases per week, average. And this pandemic, the first surge we had was actually somewhere around 40,000. So we really are at a very bad point still. We’re still looking at close to 1,000 deaths per day. Whereas in January/February of last year, hundreds of deaths was like a critical, mindblowing concept. Well we’ve gotten so accustomed to having a peak of something like 3,300 deaths a day that we think, okay, 800 is not that bad. And so we’re really in a phase where, again, our human nature is to want to relax. But if we do relax too quickly, we can have a brand new pandemic on our hands.

[program music fades in]

So this is not over by a long shot. But what I really want to emphasize is that this is not the time to really relax all measures. We still have to be cautious.

[program music]
[program music in background]

Regina [narrating]: I’d like to thank Dr. Bhola for taking the time to speak with us about the COVID-19 pandemic. We hope that next year Dr. Bhola will get to pursue his dreams in international health.

Spark Science is produced in collaboration with KMRE and Western Washington University. Today’s episode was recorded in Bellingham, Washington in my house on my computer during the Great Pandemic that’s still going on as April 2021. Our producers are Suzanne Blais and myself, Regina Barber DeGraaff. Our audio engineers are Ariel Shiley, Julia Thorpe, and Zerach Coakley.

If you missed any of our show, go to our website, sparksciencenow.com. And if there’s a science idea you’re curious about, send us a message on Twitter or Facebook at SparkScienceNow. Thank you for listening to Spark Science.

[program music outro]