Expert Explains Realistic Expectations For Coronavirus Precautions, Vaccines

Published: Wednesday, September 30, 2020 - 1:03pm
Updated: Wednesday, September 30, 2020 - 2:17pm
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LAUREN GILGER: The pandemic has come with a series of assurances, some more rooted in science than others. Wearing a mask helps prevent the spread of COVID-19. Home is where you're safest. A vaccine will set things right again. But so much of what we've learned over the last six months have come with caveats. Everyone must wear a mask. Not everyone has the luxury of staying at home all the time, particularly for work. And scientists have never been able to develop a vaccine for any coronavirus. These caveats mean we have to manage our expectations moving forward. What is really possible in the near future, and what might still be different another six months or a year from now? I spoke to Dr. Anita Kohli, an infectious disease specialist with Arizona Liver Health, and I started by asking her about the possibility of a COVID-19 vaccine and whether that will actually accomplish what we're all hoping for anyway.

ANITA KOHLI: I mean, I think part of any strategy to combat this type of infectious disease has to be the development of a vaccine. Of course, because of that, I am very hopeful. I think it does beget more questions, though. When will we have a vaccine that is safe? When will we know about its efficacy? How efficacious will it be in both the short term at preventing infections, then really thinking about is this a vaccine that will provide long-term immunity? There is good data to show that probably we can develop an immune response that will provide some form of short-term immunity that may be weeks to months. But is this vaccine going to provide us an immunity that will last a year, two years, lifelong immunity? That's a more difficult question to ask. And I think the jury is still very much out in that regard.

GILGER: One of the things we mentioned in the intro here and that keeps coming up as we talk about vaccines on The Show, is this idea that, like, there has never been a successful vaccine for any kind of coronavirus, and like, the common cold is a coronavirus, right? What are the challenges in this?

KOHLI: So, you know, normally to develop an immune response to a coronavirus-type cold, you have to have a severe disease. But in general, with most coronaviruses, disease is mild, your body mounts an immune response. It is not very robust, and so you don't develop as long-term immunity. To develop a robust immune response, you're going to have to develop a vaccine that invokes a a very strong response, so that if the body sees this virus again, not only does it react, it reacts in a very strong way to fight off a virus that is pretty potent and can have some serious consequences. Traditionally, our bodies don't do that today. You've got to develop a vaccine that can do something that our body doesn't normally do.

GILGER: OK, so then at the same time as we've been waiting for this vaccine to be announced, created, there have been big strides made in the kinds of medications we can use to treat the virus, right? What have we learned about how to effectively prevent people from having to go on a ventilator or from dying from this in the meantime?

KOHLI: Since March or April, we have learned a tremendous amount about this virus. Now we have both dexamethasone and remdesivir that are being used under emergency use authorizations for hospitalized patients with COVID. We know these medications can shorten the duration of hospitalizations and reduce mortality. This is great progress, but we need more medications and ones that are even more effective than these to really be able to save all lives of people who are hospitalized with this. And I think even more importantly than thinking about treating hospitalized patients is thinking about what medications can we use before people are hospitalized to keep them from requiring that advanced level of care. In that regard, there are a lot of medicines in, in clinical trials for addressing just that.

GILGER: Yeah.

KOHLI: And that's a lot of what we're working on in our office.

GILGER: Interesting. So in your mind, is it more likely that we'll see a COVID-19 medication that you can take before we see a vaccine?

KOHLI: I do. I think we're gonna have a medication for patients who have not been hospitalized before we see a vaccine that is approved. We already have two medications that we use in the hospital fairly routinely. These medications are being studied in patients who have not been hospitalized, along with a variety of very promising other medications that are really advancing through clinical trials very quickly. Of course, once we have these new medications, it sort of then begets the question of how do we get these medications into the hands of providers? How do we get them to patients depending on whether they're going to be IV medications, injection medications, inhaled medications. So while we're developing the medications, we should also be thinking about how do we develop the infrastructure for delivery of these medications to patients that are not in the hospital. And I don't see that infrastructure in existence at this point. But we really do need to start thinking about it in health care community.

GILGER: Let's spend the last few minutes here, Dr. Kohli, talking about testing, which has been another major part of the response to the pandemic. And expectations have not always been met. For example, there was a period of time not so long ago in which it would take a week for someone or more to get test results, and it would make it difficult for people to make sure they weren't sick or spreading the virus unwittingly. Has testing changed enough? Where are we with that?

KOHLI: I mean, we have made incredible strides with testing, specifically here in the state of Arizona. You know, there were initially delays — 10 days, two weeks, sometimes even longer. Sometimes samples would expire because they couldn't be tested in time. And I think everyone in the community sort of understands that that's what was happening. Nowadays, we have large testing facilities. The lines are far diminished. And now a lot of new technologies, including the development of an oral saliva test for COVID. The sensitivity of that test appears to be as good as the nasal pharyngeal swab. And this is a game changer, really. So now you have a simple, easy test that can be resulted very quickly, and you're not going to wait in lines for nasal pharyngeal swabs and you could even potentially do these tests at home. So this is great news from a public health perspective.

GILGER: So in that sense, like rapid testing, you say, you know, changes the game, right? Is this something you think we can expect to be doing all the time in our future, if and when or even if there is a vaccine?

KOHLI: Absolutely. I mean, testing is the backbone here. You have to identify cases so that we can treat people and or keep them from infecting other people effectively. It is the sort of the groundwork of an adequate public health response, and vaccination is sort of different levels. So vaccination is to prevent people from getting it. But even when you vaccinate, some people are going to get this disease. Vaccines do not work for all people, and it will allow us to get back to life as normal as possible. But you've got to lay the groundwork for all of these new tools and get our community used to using them and using them appropriately.

GILGER: So final question for you then, Dr. Kohli. Like, if we're talking about managing expectations about what the quote-unquote "end of this pandemic" looks like, is there a point at which everyone can return to normal or expect to return to life as normal? Or is that something that is just not going to happen?

KOHLI: I think there'll be a new normal. Part of that new normal will be that COVID-19 even happened to begin with. We have to learn how to prevent these problems, to react sooner, to prevent spread. We will see with the vaccine how good it is at preventing infection. I guarantee you it will not work for everybody. So we will have to learn to test and to treat, and that we will be part of the new norm. Although, we do test and treat for influenza every year. So in an ideal world, this will just become part of that routine testing that we do for people with upper respiratory tract infections or other sort of infectious viral symptoms. And now we'll have very adequate therapy. I think given the mortality rate with this disease, the aggressiveness of testing will be more than what we've done with sort of standard influenza, and that will be part of that new norm.

GILGER: All right. That is Dr. Anita Kohli, director of clinical research and an infectious disease specialist with Arizona Liver Health. Dr. Kohli, thank you so much for joining us to talk through this.

KOHLI: No, thank you for having me today.

GILGER: Arizona Liver Health is offering COVID-19 clinical trial programs in Mesa to both treat and prevent COVID-19. You can find more information at azclinicaltrials.com [or call (480) 360-4000].

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