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Monday, July 12, 2021

COVID-19 Update: Summer Edition

Episode 62


Speaker 1 (00:04):
Coming to you from Beaumont. This is your HouseCall.
Dr. Nick Gilpin (00:16):
Summertime is here, and with COVID cases down and vaccination rates up, things are starting to look a little more 2019 and a little less 2020, except for maybe the elastic waistband Renaissance, which by the way, I am completely fine with. But seriously, with things looking closer to normal than they have in a while, where do things stand right now with COVID? What kinds of activities should we be doing this summer to keep ourselves and our loved ones safe? How are we doing with vaccination rates? Is herd immunity still a thing? And is another surge likely? Stay tuned. We've got the answers to your COVID questions on the way. It's the summertime edition.
Dr. Nick Gilpin (01:03):
Hello. Welcome to the Beaumont HouseCall Podcast. I'm Dr. Nick Gilpin, and I'm here to help you and your family live a smarter, healthier life. Today, I'm talking about the current state of COVID-19, and my guest on the podcast is Dr. Justin Skrzynski. Dr. Skrzynski has been one of our trusted voices for COVID-19 updates at Beaumont Health. He's a hospitalist who's cared for hundreds of COVID patients throughout the pandemic, and he continues to play a very central role in the day-to-day operations and patient care activities for hospitalized patients, those with and without COVID-19 at the Beaumont Hospital in Royal Oak. As I teased earlier, today's conversation will focus on some of the current business of COVID. Such as with COVID restrictions winding down, what should people be doing to keep themselves safe this summer? We'll talk about our current COVID rates and what accounts for their decline. And what possibilities might exist for a future COVID surge.
Dr. Nick Gilpin (01:55):
And we'll discuss whether herd immunity is still the best way to think about this particular virus. And so with that, I welcome Dr. Justin Skrzynski to the podcast. Justin, thanks for being here.
Dr. Justin K Skrzynski (02:06):
My pleasure.
Dr. Nick Gilpin (02:06):
Good to see you as well, face to face. We're doing our podcasts in person again, which is a nice thing for us. So, Justin, you have been... to call you a soldier is probably underselling it a little bit. You're probably more like a Navy Seal to use that worn metaphor. You've seen a lot of COVID patients. You're still seeing COVID patients at the hospital, I know. Talk about what your life has been like and talk about what things are looking like right now.
Dr. Justin K Skrzynski (02:33):
Well, I got to say the last year and a half for me has been easily the most challenging in my career. And as you'd imagine, the hospitals are swamped. All the stories that people heard in the media, we lived it, and we lived it for a long period of time. But as you alluded to, things are getting better, and we are seeing cases wind down dramatically. And when I say dramatically, I mean orders of magnitude. So instead of the hundreds of COVID patients we have, we've got single digits or 10. And we can definitely get into which COVID patients we're still seeing as well. But for myself, for the rest of the staff, it's a much-earned reprieve. So we're still seeing them. But again, it's light years better than it was before.
Dr. Nick Gilpin (03:13):
What do you think accounts for this decline?
Dr. Justin K Skrzynski (03:16):
So I think there's a few different reasons. I would credit the number one is definitely the vaccine.
Dr. Nick Gilpin (03:22):
Dr. Justin K Skrzynski (03:23):
And that really cannot be understated.
Dr. Nick Gilpin (03:27):
Dr. Justin K Skrzynski (03:27):
I grabbed some numbers for Michigan. And for instance, we're a little over 50% in terms of both initiation and completion. Because again, you got to remember with these two shot vaccines, you have to wait a week or two after the second dose to say that you're fully vaccinated. So...
Dr. Nick Gilpin (03:45):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (03:45):
Here in Michigan, we're definitely over the halfway mark. That's excellent. Excellent progress. And again, when you're thinking about this virus. And it's got to jump person to person, to person. COVID is in people, and in order to get rid of COVID. You got to get it out of people. So when you vaccinate people, you're sort of taking away those available jumps that COVID can make.
Dr. Nick Gilpin (04:05):
Dr. Justin K Skrzynski (04:06):
So it's not going to spread nearly as fast. We're getting to warmer weather. People are outdoors. Now the warmer weather, it's kind of controversial whether or not the virus is actually affected by the heat, by the humidity. Those things are a bit up in the air. But we can look at places like India or Iran. Those places are definitely warm-weather climates. They still had their COVID surges.
Dr. Nick Gilpin (04:24):
It's a good point.
Dr. Justin K Skrzynski (04:25):
Yeah. So it's perhaps not the weather so much as the fact that people are outdoors. You're not inside where you can build up those viral particles in the air that people are going to breathe in. So I think vaccine definitely number one. And number two is the fact that we're not in close proximity inside like we used to be.
Dr. Nick Gilpin (04:43):
Yeah. I agree with all that. And I think there's probably just less virus to go around right now. I mean, we know there's a substantial proportion of people in our neck of the woods that are unvaccinated, right. And I would hazard to guess that the patients you are seeing in the hospital right now that are coming in with COVID are largely unvaccinated folks. True?
Dr. Justin K Skrzynski (05:03):
Yeah, absolutely.
Dr. Nick Gilpin (05:04):
Now I think the other thing to layer onto that is there's probably a lot of people who have had COVID. They may not have been vaccinated, but they may have had COVID. And I think that those numbers are a little bit more difficult to get at. Because we're not out there really doing good, intense seroprevalence studies to know who all has had it and has not had it, some people say, "Well, I know I got the antibodies because I got tested." But we know that that's not always all it's cracked up to be. So it's a combination of people vaccinated. People who have had COVID who have some protection. Doing the right kinds of activities during the summertime, and there you go. I mean, that probably explains why things are looking good. But that also makes me a little bit nervous because I know it's Michigan. Summer only lasts three months or less. And I worry like I think we all should worry that things could look bleak again in the fall. What do you think?
Dr. Justin K Skrzynski (05:57):
Absolutely. And honestly, that is one of the big things that we're concerned about. And that's why you'll hear us harp on it quite frequently, but that it's vaccination because when we go back indoors, and we're back in close proximity, we got good vaccination numbers so far. But again, we have a huge segment of the population that's going to still be vulnerable.
Dr. Nick Gilpin (06:18):
Yeah. So COVID numbers are down. Restrictions are being lifted. Things are looking a lot closer to normal than they have in quite a few months. But now there's this other boogeyman out there that we've got to talk about. And that's the growing concern around Delta. So Delta is the B.1617 variant that was originally identified in India. Are you concerned about Delta? Talk about that.
Dr. Justin K Skrzynski (06:45):
Yeah. Yeah, for sure. So, let's go back, for instance, into the late winter into the spring.
Dr. Nick Gilpin (06:51):
Dr. Justin K Skrzynski (06:51):
We had that really, really devastating surge of cases, which is completely unexpected. And one of the big things driving that is what we'd now call the Alpha variance. So that was the UK variant. That was the B.1.1.7.
Dr. Nick Gilpin (07:03):
Dr. Justin K Skrzynski (07:05):
And that's a more contagious variant. And we saw how fast that can burn through a community that's unprotected. So at that time, not many people in terms of the vaccine rollout yet. Things were still ramping up. People were still indoors, all those big risk factors for COVID transmission. Plus, you get on top of that a variant which is more contagious. We saw what it can do. Now, the problem is, with Delta, we know Delta is even more contagious than that. So if you're vaccinated, you're still very much protected. A lot of the data coming out from Pfizer from Moderna, very promising, very good protection. But the problem is that again, you've got a big segment of the population, and you've got a virus that definitely can transmit much more easily. That is a setup for issues moving forward.
Dr. Nick Gilpin (07:51):
Yeah. Important point. Bears repeating. More transmissible than garden variety COVID. More transmissible than Alpha, which was more transmissible than the thing that came before it. That's a bad recipe. Potentially more virulent, I think the jury is still out. Again, that's a tough one to quantify, virulence in general. I read somewhere recently that I think one in five cases of COVID in the United States is Delta. And therefore, that's leading scientists to say, "This will become the dominant strain if we let it happen." And so I think here we go again. It's another push to get people, to get those shots in arms as quickly as possible. Because if we do have another surge, if. Chances are pretty good it's going to be Delta.
Dr. Justin K Skrzynski (08:36):
Yeah. Yeah. For sure. And in terms of what you said about that becoming the dominant strain, we very... that became very readily apparent during this last surge when we had Alpha.
Dr. Nick Gilpin (08:48):
Dr. Justin K Skrzynski (08:48):
And that very rapidly became the dominant strain in Michigan. Because again, it's just... that's how it works. If that's the one that spreads more, that's the one that's going to end up in the community more. So the problem is that as you see that transmissibility. The ease of infection rise, that sort of this ratcheting effect where you're going to end up with a more and more contagious COVID that's more and more common. So without... we certainly don't want to be doom and gloom about the fact that we're going to see more surges.
Dr. Nick Gilpin (09:18):
Dr. Justin K Skrzynski (09:18):
And that's certainly not the intention. But the idea is that if we go into this eyes open, there is a very reasonable way to manage this and avoid those things moving forward.
Dr. Nick Gilpin (09:28):
It's a great point. Can't argue there. So let's pivot a little bit. So summer's here, right. I'm happy. You're happy. Things are looking very good at our hospitals right now. I'm getting a little bit of my bandwidth back. I'm sure you are too. Talk about the kind of things you're doing. I mean, what are you doing for fun? What should people in our community be doing for fun? How should we be enjoying this summertime in Michigan right now?
Dr. Justin K Skrzynski (09:52):
Well, personally, I actually just got back from a lovely hiking trip down in Texas. That was-
Dr. Nick Gilpin (09:56):
... very cool.
Dr. Justin K Skrzynski (09:56):
... great to be outside. And to that extent, that's... outdoor is the place to be if you're concerned about infection. If you really want to go back to sort of the normal activities, outdoors is the place to do them. Obviously, it's Michigan weather, so you never know what you're going to get. But at the same time, you can take things outdoors, that's the safest place to be. You're not going to build up those viral particles in the air. Chances are you're going to be spaced out more. There's a lot less risks. So any of the typical outdoor things we do are going to be much safer than bringing the same activities indoors.
Dr. Nick Gilpin (10:29):
Yeah. That's a message I've been hammering a lot is... and now that we've seen some more data, not just from the US but from other countries as well, showing that such a low risk of getting COVID from doing anything outdoors. I mean, probably less than a 1% risk, relatively speaking, outdoors is absolutely the way to go. That being said, travel is a great thing too. And when we're starting to get a little bit more travel in our lives, or certainly the opportunity to travel. But I want to throw a little bit of caution here. I think domestic travel right now probably is a reasonable thing to do. I think coast-to-coast cases are relatively low. I think, when you start to dip into international travel, we got to remind people to be careful.
Dr. Nick Gilpin (11:13):
There are still a lot of countries out there that I would consider extremely vulnerable. Vaccination rates in other countries are poor by and large. And so, obviously, that concerns me a little bit from a global health perspective that we could be lying in wait for the possibility of another surge. And one of the ones that immediately comes to mind, or I've been thinking a lot about lately is the summer games, the summer Olympics in Tokyo. Tokyo or Japan have an impressively bad vaccination rates right now. And they're about to be welcoming people from all over the world. And I'm watching that space very closely.
Dr. Justin K Skrzynski (11:51):
Yeah. Japan is a bit odd case because you've got a country which is very wealthy, very industrialized, excellent infrastructure, great education, very technologically advanced. And for some reason, their vaccine rollout is very poor. And from what I understand, there's a variety of factors playing into the fact that they really want these games to happen. They're going to push that through. But that just kind of belabors the point of exactly what you said. Is that you've got a lot of people from around the world. You've got a lot of opportunity for people who were completely separated before to now come into contact. That's really how this virus spread to begin with.
Dr. Justin K Skrzynski (12:30):
And one of the frustrating things about COVID is the fact that, again, you have this period where people are asymptomatic, and that's still the most frustrating part of the virus is that you can walk around. If you look at the studies, it looks like people are actually most contagious right before they develop symptoms.
Dr. Nick Gilpin (12:47):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (12:48):
So you can get on a plane. You can have a tour of Europe without even knowing that you've got COVID and then have spread that all along. So it's not possible to simply say, "Okay, well, those who have symptoms can stay home, or those who are concerned can stay home," because it's very possible for an otherwise healthy feeling person to still be contagious.
Dr. Nick Gilpin (13:08):
Great point. I can't really add anything to that, except for that is one of the unique challenges with COVID, unlike other Coronaviruses that came before it. You could say, "Stay home if you're sick, and the chance that you're going to spread it around is low." Not so with COVID. So excellent point. So let's pivot then to vaccination gaps because we talked about how our country is starting to get a little bit better in this space, but there are still gaps in getting folks vaccinated. What are your patients telling you? When you see those patients in the hospital that come in with COVID, and it's June right now, and you got to have that conversation. "Man, that vaccine's out there. Why didn't you get it?" What are people telling you?
Dr. Justin K Skrzynski (13:53):
Yeah, I mean, that's a very tricky question, and I've had kind of a variety of answers. It's difficult. It's difficult for somebody who's in the hospital with COVID to look you in the eye and say, "You know what? I didn't believe it was real, or I didn't take it seriously."
Dr. Nick Gilpin (14:09):
Dr. Justin K Skrzynski (14:09):
And lot of the times, what people say is they didn't get around to it, or they didn't have time. I've had a few people say they don't believe in the vaccine. I've had a few people say that they think it's dangerous or risky. But it's hard when you actually have the [inaudible 00:14:25] to say that any potential imaginary downside to the vaccine is worse than the illness at hand. I will say that the patients that I do have that have been vaccinated, and there's a few. But I think they fall into a couple categories.
Dr. Justin K Skrzynski (14:42):
One is the people who test positive for COVID. They have no symptoms. They've been vaccinated, and that's fine. That's to be expected because this person walking around the community would not have been sick. They would not have needed hospitalization. I'm thinking, for instance, one lady I had, who came in for a broken hip, tested positive for COVID. She had zero symptoms of COVID.
Dr. Nick Gilpin (15:00):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (15:02):
Just completely incidental. That's fine. That means the vaccination did its job. This person had COVID. They didn't get sick, and that's okay. The other group of patients that I see who did get vaccinated and are still sick, those are the ones who have very advanced illness. So I'm thinking of patients with chronic disease and especially the diseases that compromise the immune system. So one of the key groups that we worry about, for instance, our transplant patients.
Dr. Nick Gilpin (15:28):
Dr. Justin K Skrzynski (15:28):
So these patients need to be on medications that suppress the immune system that makes it so their body does not reject their transplant. But at the same time, that's going to blunt their response to the vaccine. So again, that's why when we think about, why is it important to get this virus out of the community? Not just to protect the vulnerable individuals in particular, but to actually get it out of the community is because you have people who can't respond to the vaccine. And just by odds, you're going to have some people who won't have that complete protect.
Dr. Nick Gilpin (15:57):
And I think one of those... or other vulnerable populations that we have to think about are young kids, right. Because we've got kids under the age of 12 who are not eligible to get vaccinated right now. Some of those may be participating in clinical trials. But that's a bit of a hurdle here as well. So let's talk about that. How are we navigating unvaccinated kids in the community? And what do you know about when the vaccine might be available for those kids under 12 years old?
Dr. Justin K Skrzynski (16:25):
Yeah. So in terms of the second part of that question, at least. It looks like... so those trials are underway, it seems.
Dr. Nick Gilpin (16:31):
Dr. Justin K Skrzynski (16:31):
So even very young children, up to that 12 age mark, Pfizer, Moderna, both of those trials are underway. Now in terms of what do we do in the meantime?
Dr. Nick Gilpin (16:43):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (16:43):
And that's a tricky question because the younger the kids get, the less they're going to be able to comply with distancing, with masking, and frankly, that's a huge part of childhood. Is the fact that kids get together. They play. They socialize. Now the question is, even though children are not nearly as affected by COVID, and if there is a silver lining to this disease is the fact that kids are largely spared, not 100%.
Dr. Justin K Skrzynski (17:11):
And again, that's a primary cause for concern is that the kids themselves can get sick. You hear stories about various side effects, sometimes potentially even lethal, that can occur with COVID infection in young kids.
Dr. Nick Gilpin (17:23):
Dr. Justin K Skrzynski (17:23):
So it's still a very serious thing. The other question too is, can kids transport that virus from one place to another and then get that to a vulnerable individual like somebody that we had just talked about? So it's tricky because, again, the younger you get, the more difficult it is for kids to actually do the things which are going to mitigate that. So I think that if we actually do have a good vaccination program, that's not only a way to protect the kids, but that's also way to prevent them from ferrying that virus to another person who might get very ill from it.
Dr. Nick Gilpin (17:57):
Well, I think everything you said is absolutely true. And I guess the color commentary I would add is that I think right now when you look at our numbers in the community with COVID-19, extremely low. I think as of this morning when I last checked the percentage of tests positive in the tri-county, Metro Detroit area is less than 1%. I mean, we haven't seen these numbers since pre-COVID, right, since before this thing even existed. So I think right now, a lot of those activities involving kids are by virtue of that, just safer. And I think that we can kind of get away with some things. Kids being unmasked in certain situations that may be safer. I think we have to reassess that situation if and when numbers start to surge back up again, and certainly, we'll have that conversation in much more depth when we get closer to getting back to school.
Dr. Nick Gilpin (18:45):
For now, I want to sort of shamelessly plug listeners for a podcast that we did recently with... Asha Shajahan talked with Dr. Bishara Freij, one of our pediatric infectious disease specialists. And you can listen to that podcast. It's called the children and COVID-19 vaccinations, and it's available wherever you get your podcasts from. Okay. Shameless plug over. Back to podcast. Let's talk a little bit more about the vaccine stuff, and with these gaps in vaccination rates and vaccine rates seeming to slow down, this was actually something I just saw on the news last night. A lot of conversations starting to happen in different areas, different businesses, and industries around mandating the COVID vaccine.
Dr. Nick Gilpin (19:31):
Schools are starting to talk about mandating the vaccine. Hospitals and healthcare systems are starting to talk about this. One Texas hospital recently won a pretty big decision in court on this issue, which then, of course, potentially sets a precedent. But obviously, this is still a contentious issue and a very highly politicized issue. So let's talk about why this issue of mandatory vaccination makes sense from the perspective of a healthcare system and kind of go for there. If you feel comfortable kind of dipping into that space. Give me your thoughts.
Dr. Justin K Skrzynski (20:03):
Absolutely. So that is definitely a hot button issue. I think a lot of people would point to this and say, "Well, this is a mechanism of control, or this is somehow infringing on my rights." But I would point out that we've accepted mandatory vaccines for a long, long time now. And in the form of flu shots, for instance, even.
Dr. Nick Gilpin (20:26):
Dr. Justin K Skrzynski (20:26):
You think about the vaccines that your children require to go to school or to go to college, to participate in sports. Military, for instance. So mandatory vaccines have been with us for a long time at this point.
Dr. Nick Gilpin (20:39):
Dr. Justin K Skrzynski (20:39):
If you look at the numbers for any of these COVID vaccines. And I think we always like to fall back on the numbers. And to us, to you and I, I think that's probably one the most convincing things, and that's the medical mind talking. We look at the numbers. We say, "Okay, well, incredibly low side effect rates. If you line them up next to other vaccines, amazing how effective they are. Amazing how safe they are." It's difficult, I think, to point that out to somebody else and have that have the same impact. Unless again, they'd got that same sort of medical scientific mind. A lot of people are going to say things like, "Well, do you think that it was rushed? Do you think that it's too soon to know what the downstream effects are?" All of these things together, and that also gets into the idea of, "Well, it's under emergency use versus approval." So, again, to us, I think it's night and day because the impact that we've seen on the pandemic because of the vaccination. It's amazing.
Dr. Justin K Skrzynski (21:39):
It really is. And for the horror show that we had over the past year and a half to have that not only a reprieve but an off-ramp from this, that really can't be undervalued. It's an incredibly important thing. So to get back to your original question of what should or should not happen? What are the ethics and the morality and all of this of mandating those vaccines? Personally, I'm all for it.
Dr. Nick Gilpin (22:05):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (22:06):
And especially in a healthcare situation, you got to think that we're going to be exposed to people on a very close basis. We're going to be some of the first people to encounter anyone with variant strains. The dangerous variants that we talked about. We're the first stop. And again, if you have really good protection for the healthcare workers. We're going to wear all the PPE. We have all the barriers necessary, but things still slip through the cracks. You got to protect your workforce. And that's the first shield against having those things necessarily spread out into the community. So I think from a healthcare standpoint, absolutely. But also from a moral and ethical standpoint. Again, we're doing something now, which we've accepted as a society for a long time.
Dr. Nick Gilpin (22:48):
Yeah. All great points. I don't think I could say it any better. I agree with you. I think as a healthcare system in simple terms. We're a healthcare system. It's a global pandemic. I think it makes sense. We want to keep our workforce safe. We want to be able to keep our hospitals open for providing care for the community. That we want to... And that was one of the big problems during our first surge. Not only were our hospitals overwhelmed with sick COVID patients, but our workforce was also getting sick, and it was really compromising our ability to provide care. And it's incredible how few people, in general, it takes to really precipitate a surge. I noticed that a lot when I would go out and talk with friends and family members in the community that are not working in the healthcare field. And they would... if you didn't work in a hospital or know someone that was directly in a healthcare situation, you might've overlooked the fact that we were so busy because a lot of the world outside of hospitals looked relatively normal.
Dr. Nick Gilpin (23:55):
It takes very little of a vulnerable population to drive a surge. And it's important for us to keep the lights on. One of the pushbacks I hear is, "Well, it's not fully approved." And what does that really mean? Full FDA approval is a thing that happens when something has been studied and approved by the FDA. And it's a much more rigorous evaluation process than granting what we currently have, which is emergency use authorization. And there's also a much stronger legal precedent for companies, businesses, organizations for mandating the vaccine. So I do expect that we will continue to see more and more organizations mandating a vaccine. And I suspect that if and when full FDA approval occurs, which will probably be sometime in the next few months, we will probably see even more organizations jump on board at that time.
Dr. Nick Gilpin (24:47):
But I also think it's important to add to this conversation that emergency use authorization does not mean experimental. It does not mean untested. I think that those ideas get conflated, and people tend to say, "Well, it's still experimental, so I'm not going to take the vaccine." That's not true. It's really been tested thoroughly. Not just in the many, many thousands of people who enrolled in the clinical trials. But in the phase three and beyond trials that are ongoing right now where millions and millions of people are getting vaccinated and were being monitored. And our response to the vaccine is being monitored.
Dr. Justin K Skrzynski (25:29):
For the people that would say that it was somehow rushed, and that, again, the fact that it's under emergency use versus approval. It wasn't rushed really. If you think about the mRNA vaccines, for instance, that technology has been around for almost 20 years at this point.
Dr. Nick Gilpin (25:43):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (25:44):
And you say, "Well, why is it that you could bring this to market so rapidly where before it takes years and these approval processes take years?" And it's because [inaudible 00:25:53] you don't have many diseases that shut down the global economy. And if I could put my cynic hat on for a minute too, is that it's when you throw a lot of money at a problem, it tends to go away kind of fast.
Dr. Nick Gilpin (26:08):
Dr. Justin K Skrzynski (26:08):
And also you have... it's not often as well that you have such a focus. You think about even the diseases that we... everyone wants sort of their moonshot of, "We're going to cure cancer. We're going to do this. We're going to do that." But at the same time, very rarely do you get a disease that's going to be the focus of international attention. And it turns out that when you have the entire scientific community of the planet focusing on a problem, you can solve it pretty fast. Now, does this mean... I think that might be a good learning point for us as well, where it looks like if we actually sort of train that laser of the medical and scientific community on a problem, it's actually impressive how rapidly we can get solutions to it. So that might be a lesson moving forward as well. But at the same time, you certainly don't want to always be redlining the engine either.
Dr. Nick Gilpin (26:59):
Dr. Justin K Skrzynski (27:00):
Those safety checks, those things exist for a reason. You can trace the entire chain of vaccine development back. That is all out in the open for you in terms of the literature. In terms of all the research, the manufacturing. That's all in the open. And if you're still suspicious, you can certainly do your own research, and that is all available to you. But at the same time, you do have all the assurances of the millions upon millions of people that have gotten it. And now you're almost a year out from the original people that got it from these... in these phase three trials, still doing good.
Dr. Nick Gilpin (27:41):
Still doing good and still seeming to have a pretty good immune response to the vaccine. So I would say, everything you just said, I agree with. I would say, let's stay tuned because I expect we're going to be seeing a lot more mRNA technology making its way into our vaccines. I think this is an opportunity. We're seeing that this is safe and effective technology. So I'm happy about that. That's been a win for us. Let's talk for just a second about this idea of herd immunity. We've sort of danced around this a little bit and I've been doing some of my own reading and checking in with the literature. And the paradigm here for the longest time was seemingly that this virus was going to disappear, or it was going to fade into oblivion.
Dr. Nick Gilpin (28:28):
Once we sort of all got enough of us protected, vaccinated, or otherwise infected that the virus would just sort of slowly go away. But that concept is being challenged by the idea that I think this virus is very unlikely to disappear, considering just how widespread it is. I mean, it's global at this point. And how many pockets of individuals across the world, not just in the United States, not just in Michigan, but worldwide are unvaccinated and are probably unlikely to get vaccinated anytime really soon. So with that being said, this is... I want to talk about what might happen in lieu of herd immunity. And I wonder if you have any thoughts on that.
Dr. Justin K Skrzynski (29:11):
I think that's an excellent point. And that was sort of the golden numbers that we kept hearing. Is something like 70 to 80%. Once you have that vaccination rate, that's when you achieve this herd immunity. And really, what we're talking about is the idea that, again, COVID is in people. It doesn't just exist out in the ether. COVID is in people, and it's got a short duration of time that it actually can exist in a person.
Dr. Nick Gilpin (29:35):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (29:36):
A couple of weeks. And it's got to find a new host before your body gets rid of it. And so it's got to keep doing this sort of jumping act where it goes person to person, to person kind of leapfrogging, and that's how it stays alive. So the idea is that if you take enough available people off the board, so to speak, in terms of where this virus can jump, eventually, it's going to get to a dead end.
Dr. Justin K Skrzynski (29:58):
And then you think all of these different lines of the virus are going to get to dead ends. Eventually, you're not going to see that spread around anymore. And that that still would be the best-case scenario. But the problem is, as you mentioned, the vaccine rate is declining. We're not getting anywhere near the numbers that we initially thought. When you have more contagious variants, that's effectively further that this vaccine, or I'm sorry that this virus can jump. So when it's doing this sort of leapfrog act, the more contagious it is, means the further it can jump means that even if you take more people off the board, it can still sort of propagate around.
Dr. Nick Gilpin (30:36):
Mm-hmm (affirmative).
Dr. Justin K Skrzynski (30:37):
So when we see things like Alpha, like Delta, and that ups the number in terms of what we need to see to actually get this sort of mythical herd immunity.
Dr. Justin K Skrzynski (30:46):
So are we going to get that? Probably not. And furthermore, the people who were infected, are they really functionally immune to this virus? Also, probably not. If you look at some of the studies, it's variable. It's a difficult thing to say because, again, you have so many asymptomatic cases. It's such a variable thing. But it looks like people do have some protection from having recovered from COVID. It's not nearly as good as being vaccinated. It's perhaps not as long-lasting as being vaccinated, but it's some. Those people are kind of gray. They're not black or white, but they're kind of in the middle.
Dr. Nick Gilpin (31:21):
Dr. Justin K Skrzynski (31:22):
So the idea is, well, it seems like, just by the numbers, we're going to fall short. It seems like we're not going to hit the numbers necessary for this thing to disappear out of the community.
Dr. Justin K Skrzynski (31:33):
And then we end up in a situation exactly, as you said, which is that we do have these pockets where this virus can sort of keep re-circulating. Now, if, let's say, that those who are not vaccinated they recover, are they susceptible again in a year? Possibly, potentially. It seems that some certainly are. So again, remember COVID is in people. So if it can keep doing this sort of circular act where it keeps jumping around these different communities and just reinfecting people as their immunity wears off, that's always your reservoir. And then, at any given point, that can flare. And if you do have more mutations. The more this thing exists, the more chance you have for additional variants, the more chance you have that if that's the worst-case scenario that it would mutate in such a way that it can dodge the response from the vaccine.
Dr. Nick Gilpin (32:20):
Right. I think that's the doomsday scenario, right. Is something... some catastrophic mutation really alters this virus in such a way that the vaccines and the treatment options that we have are rendered less effective. And now we've got sort of back to the drawing board. I think the other scenario you laid out makes good sense. It kind of mimics what we see in other infectious diseases. I think you see pockets of places where people are not vaccinated. Where we see measles outbreaks, and we see pertussis outbreaks. And that very much could be what COVID looks like for many months to come. Hopefully, we will not see these tidal wave surges. At least we may see them in other parts of the world where vaccine rates are way behind what we are seeing. But hopefully, we've gotten enough people, maybe not critical mass, but enough of a mass that we can stem those tides in some fashion.
Dr. Nick Gilpin (33:13):
I also think we have to explore the possibility that this virus is going to become what we call endemic. Meaning it's just going to be a circulating virus in our lives for many, many years to come. We may not get rid of the virus, but we may acclimate to it. Our bodies will get better at handling it. We'll have some immune protection either from having had prior COVID or having been vaccinated. And it will just cause consistently less and less and less severe disease as time goes on to the point where it essentially becomes the equivalent of a common cold. I would be fine with that scenario. I would like to hurry up and get there. And I think, again, the thing I've been harping on forever, and you have to is the way that we get there is through vaccination, right. We got to get that protection on board for our people, and that will prevent those big outbreaks. That'll keep our hospitals and our healthcare systems open for business and keep people in the community safe.
Dr. Justin K Skrzynski (34:11):
Absolutely. Absolutely. And you got to think that the virus that's... one of the things is everyone sort of attributes intent to COVID. Everyone thinks that COVID's trying to hurt people, or it's trying to mutator. It's trying to find a way around the vaccine.
Dr. Nick Gilpin (34:24):
Dr. Justin K Skrzynski (34:25):
There is no intent. It's a thing. It's a thing like a rock or a tree. It doesn't want anything and...
Dr. Nick Gilpin (34:33):
It wants to make more copies of itself, right.
Dr. Justin K Skrzynski (34:34):
Dr. Nick Gilpin (34:34):
Dr. Justin K Skrzynski (34:34):
Dr. Nick Gilpin (34:35):
Dr. Justin K Skrzynski (34:35):
Its only goal is to reproduce itself.
Dr. Nick Gilpin (34:38):
Dr. Justin K Skrzynski (34:38):
And so there's... it's not like it's got this master plan to try and to dodge things. But at the same time, it's up to us to handle it that way too. No one would look at a hurricane and say that it's not there. No one look at a storm and say, "Okay, well, that damage didn't exist. That storm didn't happen." And honestly, I think we have to treat COVID the same way, where it's something that's going to happen, and hopefully, we don't have more surges. But if we do, it's something we have to manage realistically, eyes open. We have to have a long-term plan for the same thing. Just like we have storm infrastructure in place, we have to have the capacity to absorb further COVID cases.
Dr. Justin K Skrzynski (35:17):
And again, we have so much more knowledge than we did a year and a half ago, I think personally, in terms of how we handle these patients in the hospital. And this is not just me with the stories that I have. This is actual numbers too. That people do much, much better than they did before. And it's because we more know-how. It's because we have more tools at our disposal. Still, very deadly disease. You don't want to mess with it. It's not like you can just check yourself into the hospital, and you're guaranteed to get better. It's still a huge dice roll. But at the same time, we're learning.
Dr. Justin K Skrzynski (35:51):
So I think as long as we continue to learn, we continue to adapt. And as a society, people step up and do their part, which again is to get vaccinated. That's starting to sound like propaganda. But at the same time, that is the way to do it. And everyone wants their normal lives back. We're getting there. It looks great. It's wonderful to go out, see people without masks, see people are healthy, having fun. That's what we want moving forward. And that is the way to do it.
Dr. Nick Gilpin (36:18):
Great points. Well, let's leave it there, Justin, great talking with you. And thanks for joining me today.
Dr. Justin K Skrzynski (36:23):
Absolutely. My pleasure.
Dr. Nick Gilpin (36:24):
And I also want to remind our listeners to send along any questions or suggestions to our email address, which is, Dr. Shajahan and I are always looking for the best questions for a future mailbag episode. And I will leave you today with this healthy thought. Summertime is a great time to be outside with friends and family, enjoying outdoor sports and activities. Exactly the kinds of activities that are less risky during a respiratory virus pandemic. But with a new variant emerging and pockets of unvaccinated people all across the globe, more outbreaks and surges could be lurking around the corner. So now is as good a time as any to get that COVID vaccine and keep yourself, your family, and your friends safe and sound into summer and beyond.
Speaker 1 (37:14):
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