Episode 6: Virus Variants, Vaccines and Valentine's

On Friday, Feb. 12, the COVID Pod team sits down with Ashish Jha, dean of the School of Public Health, to discuss the variations underlying the COVID-19 pandemic and efforts to stop its spread: virus variants, new vaccines in development — and even a COVID-19-conscious approach to socializing on Valentine’s Day. 

Transcript

Cate Ryan

Welcome back to The COVID Pod with Dr. Ashish Jha. Today, we are talking about variation. And this year has been filled with so much change, but on today’s episode, we are specifically focusing on virus variants, new vaccine types and possibly some variations to typical Valentine’s day plans. Today is Friday, February 12, 2021. My name is Cate Ryan and I am joined by Emilija and Rahma from the Brown Daily Herald. 

Emilija Sagaityte

Hello, my name is Emilija Sagaityte, and I am a senior editor at The Herald.

Rahma Ibrahim

And my name is Rahma Ibrahim. I am a science and research section editor.

Cate Ryan

As always we are so grateful to welcome Ashish Jha who is Dean of the School of Public Health here at Brown University. Thanks for listening, and feel free to email us if you have any questions. 

Cate Ryan

The first thing that we were thinking about is the Centers for Disease Control and Prevention (recent change of) guidelines to say that anyone who is asymptomatic and has received the second dose of their vaccine does not need to quarantine if exposed to COVID-19. And last time, we talked about how it was sort of unclear whether the vaccine would completely reduce transmission. So what do you think is the implication of these new guidelines?

Ashish Jha  

Yeah, so this is like the million dollar question, right? Do vaccines reduce transmission? And I think the C.D.C. is right in their decision or their recommendations. I think they’re coming in line with what I think the emerging evidence is, and the emerging evidence is that vaccines reduce transmission. Am I 110 percent sure? No. But that’s what all the data seem to suggest. And by the way, almost every vaccine, not every vaccine, but almost every vaccine reduces transmission of the disease, so why would we think this one is going to be different? 

And then the question is, how much? And could we envision that these vaccines would reduce transmission 100 percent? I don’t think so. So there probably will be still a little, but my best guess, based on all the data, is that it’s probably in the 70 to 90 percent reduction range. But we’re not sure. And I think the C.D.C. is basically saying, but that’s where all the evidence is pointing and that’s what we should focus on. And we will get better data. And I suspect that that’s the range it will come out. And that’s great news, by the way, because if it didn’t reduce transmission, then my gosh, then we have a whole different set of problems.

Emilija Sagaityte

So speaking of vaccines, we wanted to transition to speaking about another development, the U.S. and Worldwide Vaccine Tracker that was developed through a collaboration between Brown’s School of Public Health and Microsoft AI for Health, which just launched online February 5th. Could you tell us about the purpose of this tool, describe what all those numbers and maps show and explain a bit about how this tracker was created?

Ashish Jha  

Absolutely. So we’ve had a collaboration with Microsoft for a while now. And if you go to the website, globalepidemics.org, which is run by us at the School of Public Health, we’ve been tracking cases by community, by congressional district. We’ve been doing a whole lot of work on testing and testing targets. And so vaccines seem like the obvious next place to go in terms of tracking the data. 

The data largely comes from — and there are other vaccine trackers, like Bloomberg has one — they all sort of come from the same place. They come from states, and they come from the C.D.C. So we’re not doing our own personal tracking, but we’re really pulling in data. And the idea behind this, and what I hope will be really useful for people, there are two sets of things that I think are going to be important. 

One is, there’s a lot of information that we need to have beyond just how many people have gotten vaccines. We need to know who’s getting vaccinated (and) how much it varies by age, by race and ethnicity. And we’re starting to pull those together into one place. We’re hoping that that’s going to be a useful set of insights. But the other part is, I’ve described three sets of things now that we’re tracking: cases, testing, vaccines. They are not unrelated to each other. In fact, you may think that it’s really important to vaccinate people in places where there’s a high number of cases happening, and I would agree with that. So what this tracker lets you do is start pulling these three things together. And so you can go to your community — and again, we don’t have the data quite as granular as we would like, just because it isn’t available yet, and it will be — but ideally, what we’d like to be able to get to in the weeks ahead, is you can go to your county, certainly your state, look at infection numbers, look at vaccination numbers, look at testing numbers and really get a sense of how the broader pandemic control’s happening. And we’re not aware, or I’m not aware, of any tracker that’s really pulling it all together like that.

Emilija Sagaityte

Have you been able to notice any trends so far between those three factors? 

Ashish Jha  

Yeah. So I would say right now, we’re just, well, a couple of things. I mean, we’re just starting to pull this stuff together. It is true that we see no real correlation between places with high infections versus places that are doing a good job on vaccinations or a bad job, or vaccines are getting out. And that’s unfortunate, because you actually want to see more aggressive vaccinations happening in places with high infection numbers. We don’t see that yet. We don’t see that happening, so that’s a problem. And my hope is that we can take these kinds of data, go back to policymakers and say, ‘You’ve got to really push on vaccinations, and especially in those areas.’

Emilija Sagaityte

And the tool also mentioned trying to see whether the U.S. can reach that goal of 100 million doses in 100 days, and kind of looking at the status of vaccine distribution right now, what does it seem to suggest about our nation’s ability to reach that goal? And what factors or efforts do you think may influence those trends?

Ashish Jha  

The 100 million in 100 days is what President Biden said in early December when he was President-Elect Biden, he wasn’t in office yet. And that seemed like a really ambitious goal at the time. To be perfectly honest, we’re at almost 1.5 million doses a day right now, and that’s what we’ve been averaging. So my gosh, we got to be able to hit 100 million in 100 days, it’s like something’s gonna have to go horribly wrong for that not to happen. 

Personally — and the people in the administration don’t like me saying this I don’t think, but I’ll say it — I think we should be hitting two million a day, like that’s where we need to be. And I’m not saying they don’t like me for saying this; I’m just saying that’s a very ambitious agenda. And that’s what I would like for us to do, and so we’re targeting 1 million a day. I think we’re gonna hit that easily. You know President Biden did come out and say he thought we could do 150 (million). That’s 1.5 (million) a day. I think we’re gonna blow through that. I think the question is, are we going to get to 2 million a day? And the reason why I say 2 million a day is my target is, I’m not just making up a random number, I’m thinking about two things. I’m thinking about the U.K. variant, and how it’s spreading and when it will become widespread in the United States. And I’m thinking about, what is it going to take to vaccinate all elderly, older, high-risk individuals. And if you try to get older, high-risk individuals all vaccinated before the U.K. variant becomes widespread, you (have) to be at 2 million a day in order to get there. And that’s the challenge. So that’s why that should be our internal target.

Rahma Ibrahim

Speaking of variants, which is a term that’s been in the news a lot recently, could you give us and our listeners a quick overview on the difference between variants and strains?

Ashish Jha  

You know, so it’s a really good question. And ultimately, these things are really about functionality. So let’s take a moment and actually take one more step back and talk about mutations versus variants versus strains. 

The way to understand the biology here is that RNA viruses, like this virus, are notorious at making mistakes. Every time they replicate, they’re just a ton of mistakes that they make, a ton of mutations, and 99.9999 percent of those mutations are irrelevant, they have like little to no meaning. And the helpful part about these mutations is actually you can use them to track where the virus is spreading and who’s spreading it to whom through these genomic sequencing analyses. But all of those different mutations are functionally the same. 

So what causes something to be a strain? It’s a different strain if it takes on different functional capabilities. So if it becomes more contagious, if it becomes more or less deadly, if it is able to evade immune response much more effectively, if there’s something functionally meaningfully different about it, then you call it a different strain. And while you’re sorting out whether a set of mutations is a strain or not, we often talk about it as a variant. And variant is really kind of meant as a short-term, shorthand for, this probably is a different strain, but we’re not 100 percent sure, and we’re still sorting it out. So I think most biologists and immunologists I talked to would call the U.K. variant a different strain because I think we have pretty good evidence now that it really is functionally really different. And some of the other variants like, you know, there was a little talk of the L.A. variant that popped up in Los Angeles, and calling that a variant made sense because we didn’t know, is it really a different strain, or is it just gonna turn out to be nothing? So I see variant as a short-term terminology used when you’re not sure whether there’s a different strain or not, and you’re sorting it out. 

Rahma Ibrahim

We’ve also heard of other variants, the South African, the Brazilian variants, and you’ve mentioned the U.K. — which might be a strain — and the L.A. variant. So how many variants do we know of so far? And what do we know about them? And how far have been traveled?

Ashish Jha  

There are lots of variants. And the ones that I think we’re all paying super close attention to right now are the U.K. one, the other one found initially in U.K. B.1.1.7. There’s B.1.351 that’s from South Africa. And there’s one that’s called P.1, which is the one from Brazil. And we don’t, by the way, know that that’s where they originated; that’s where we first identified them. So that’s the other part of it. 

But if we’re going to shorthand it and say, the U.K., the South Africa and the Brazil, those are three that are all here in the United States. And we think the U.K. variant is circulating reasonably widely. I suspect it’s in all 50 states or most of the states. It’s been identified, I think, in 35, but my take is, the other 15 probably just haven’t identified them yet. The South Africa variant is interesting in that it may be a bit more contagious. The U.K. variant is clearly more contagious. The South Africa variant may be more contagious, but it does seem to be more effective at evading immune response. I still am very optimistic, and we can talk more about this that our vaccines will work against it, but we’re less sure — it may work a little less well, I wouldn’t say we’re less sure. And then on the Brazil variant, we know much less about it. There is some data to suggest that people who have been previously infected may not have protection against the Brazil variant. But I don’t think we know enough about that right now, and there’s a lot of work being done to sort that out.

Rahma Ibrahim

On that same note of people being previously infected with COVID-19 and their risks for being infected again with these variants, I know you mentioned we don’t necessarily know much about that, but what does the data that we have currently say about people’s ability to be infected twice, by another variant?

Ashish Jha  

So the vast majority of the infections right now of the virus circulating is still the native strain, the original strain. And people getting reinfected with the original strain we think (is) exceedingly unlikely. We don’t know the real number. Officially, it’s about 10 or 12 people have been reinfected in the United States out of 25 million. I suspect the real reinfection rate is higher than that, but probably not much higher, meaning bottom line, if you’ve been infected, your chances of getting reinfected are not zero, but they’re really, really low.

How does the variant stuff change that? I don’t know that I’ve seen any data that suggests that the U.K. variant changes that at all, so if you were previously infected, recovered, now you get exposed to the U.K. variant, I don’t think it changes your likelihood of getting reinfected. But we’re not sure. There is some evidence that South Africa and Brazil variants lead to more reinfections because of some amount of immune escape, but the evidence is really weak and certainly not perfect. I wouldn’t be surprised if there is a little bit of immune escape, certainly from the South Africa variant where we may have the best data on that. But I actually think that the vaccines will protect us against that. 

What’s interesting, right, here’s the bottom line, natural immunity from having been previously infected may not protect you against the South Africa variant, but vaccines probably will. And that’s interesting, just a reminder that vaccines can generate much, much better immunity than natural infection can. I think a lot of people assume that natural immunity is the best immunity, but we have very good evidence for lots of diseases that’s not true, that we can generate much, much better immunity using vaccines than natural infection does. 

Emilija Sagaityte

Kind of going back to vaccines, and how many have come about from research in recent months: I do think that Pfizer and Moderna seem to have become household names when talking about the COVID-19 vaccines. But last time, you had alluded to some other companies who are in the process of developing and testing their own vaccines, like Johnson and Johnson, Novavax, AstraZeneca, as well as some developed in other countries, like I believe Sputnik V was being developed in Russia. So what do you make of all of these different versions? How are they different? How are they similar?

Ashish Jha  

So there are a lot of different ways of making vaccines, and you’ve seen companies around the world trying to make them in different ways. And my personal take is, we need all the vaccines we can get. As long as they’re safe and effective, we should be able to come up with different modalities. Different modalities have advantages and disadvantages. mRNA vaccines, like the Moderna and Pfizer, which are fabulous vaccines, are really hard to store and manage, they need to be frozen. The Pfizer one particularly needs to be frozen, minus 96 degrees for extended periods of time, whereas (vaccines) like the Johnson and Johnson vaccine can be refrigerated, does not need to be frozen. And so you can imagine why that would be a huge advantage in many, many places. 

Here’s where we are, as of today, February 12th. The Johnson and Johnson vaccine has been submitted for authorization to the F.D.A., and the F.D.A. is going to meet on February 26, two weeks from today, they’re going to make a decision. I would be shocked if they don’t authorize it based on the data we’ve seen, but they might not. F.D.A. has a pretty high bar, they’re gonna do a very vigorous review. But I say I’d be shocked because I know the people that are working on developing that vaccine, and they wouldn’t have submitted it unless the data was really very good. And so I expect an authorization in the day or two that follows. There are a few million doses sitting around, but not tens of millions. So in March, probably not a huge impact of the Johnson and Johnson vaccine; you’ll start seeing some people get vaccinated. And then once we enter April and May, you’ll see that become much more widespread. 

The one thing I will say about the Johnson and Johnson vaccine is its headline numbers seem to be not as good as Moderna and Pfizer. People are like, Oh, it’s only 65 or 85 (percent effective). It’s a very good vaccine based on all of the data I have seen so far. We’ll see more in the next couple of weeks. It’s a very, very good vaccine, I would recommend it for any family member. I would not be hesitant to get it myself. I’ve gotten the first dose of the Moderna vaccine, I’ll be getting my second soon, but the point is, I would be very supportive of my wife getting it. She has not been vaccinated yet. So it’s a very, very high quality vaccine. And I would not pay too much attention to the headline number. 

Novavax again, we were going to get more data on that. I think the AstraZeneca trials that are being done in the United States, I expect them to read out, meaning get some data on those, in the next month, so by the time we get to mid-March. And I can imagine a late March, early April F.D.A. review and an authorization. 

Sputnik V came out with their data. It’s really good. 

So the good news here is, this is a virus where we figured out how to make good, effective vaccines, thank goodness. But there are just going to be challenges of producing enough, getting them out. And then by the time we get to May, we’re gonna have a different problem, which is we’re gonna have so much vaccines in the United States, and we’re going to have not enough people who want to get vaccinated because we’re going to run into all the people who have vaccine hesitancy, people who are worried about taking the vaccines, and we’ve got to start working on addressing those concerns now.

Emilija Sagaityte

And so I know you touched upon this a little bit before, but given the evidence to date, what do you think it suggests about then these vaccines’ potential help with distribution as well as minimizing the impact from those variants we talked about both here in the U.S., as well as looking more globally?

Ashish Jha  

So I think the evidence we have right now says that certainly the Moderna, Pfizer vaccine, also I think Johnson and Johnson, is going to work very well against the U.K. variants. So I’m not worried about that. I think it will work a little less well against the South Africa variant, but well enough that, if you got vaccinated, you’re gonna do fine. Even if you might have a slightly higher risk of getting infected, I think people will not get sick and die, which is what we care about, preventing severe illness. So I’m really, really, at this point, very confident that these vaccines are going to hold up well against the variants we have. It doesn’t mean that there won’t be a variant in the future that will escape our immune response, and I actually think one of the things we need to be doing is much more genomic surveillance to look for those variants. And then if you see one emerging that looks like that, working on updating our vaccines so that they can be more effective. 

There’s a lot of work here. This is not a one and done, like it’s not going to be we all get vaccinated. We have to continue monitoring, continue paying attention. And the last point on this is because it’s a global pandemic, if we just get America vaccinated, but the world isn’t vaccinated, it’s going to be a huge problem, obviously just from an equity point of view, but also if we see large outbreaks happening elsewhere, America’s largely vaccinated, it’s going to be the ground for emergence of new variants that will render our vaccines less effective. So there’s both a, I think, a selfish as well as a more solidarity-oriented set of reasons for really having a global approach to vaccines.

Cate Ryan

Speaking of all of these complex problems, we sort of wanted to highlight something hopeful, which is the course that you’re teaching with Dr. Megan Ranney called Pandemic Problem-Solving, which is for civil servants and other leaders. What do you think that will look like over the next month or so, and what are you looking forward to with that course? 

Ashish Jha  

I’m super excited about this. And the reason is, you know, the pandemic has felt kind of paralyzing, right? Like, it’s just sort of disrupted our lives. And people feel like, I don’t know how to manage problems, and like, what can I do, and we’re all in this sort of suspended animation just waiting for these vaccines so we can start getting things back. 

And what Megan and I and our whole team realized was, there are lots of people who, during the pandemic, have confronted problems, and solved them, and made progress and done really remarkable things. And they have lessons for all of us on how we get through the rest of this pandemic, and how we deal with future ones. And so it’s a very problem-solving kind of oriented course, where we have experts in business, political leaders, all sorts of folks who are going to participate and talk about how they dealt with uncertainty, how they made decisions. And then the hope is that the students in the course —  a lot of them are from N.G.O.s or government or private sector — are going to talk about how those lessons apply to their real life. So it is very practical, supposed to be hands-on. And I guess for me, it’s meant to give people hope and something they can actually do and teach them a set of skills. But I have to tell you, I’m going to learn a ton because while it’s been really fun watching people make decisions and watching leaders figure out how to do this stuff, the course will actually teach us how to apply this to a much broader swath of issues. And so I expect to learn a lot about how to think about these things. 

And the last point is, it’s an interesting foray for Brown, right, because we don’t do this kind of stuff. We teach courses in pretty traditional ways to undergrads, graduate students, but I think the way in which the world is changing, universities have an obligation to teach people who are not our traditional students. And it’s not even like executive education. It’s just a different model. It’s in the middle of crises, universities have to step up and pull together knowledge and share it widely and in constructive ways. And that’s what this is about. So I think this is part of a broader strategy that Brown is thinking about, which is, how do we engage and be more relevant in the world in the middle of crises? How do we bring our expertise to bear, and I love that by the way, because that’s, of course, what I think all universities should be doing, and I’m particularly excited that Brown is doing it.

Cate Ryan  

Yeah, that sounds like such a great resource for so many people. So before we end, we wanted to also touch on something else kind of fun, which I guess is Valentine’s Day, and we specifically wanted to bring up this article that was published in The Brown Noser, which is the satirical newspaper that’s written by Brown undergrads. So this is a joke, but it was headlined, “Paxson Clarifies That Every Student Allowed One Little Kiss On Valentine’s Day,” and that it’s obviously a joke, but we just wanted to ask in all seriousness, how should students on college campuses like Brown be approaching making new friends or new romantic relationships during this COVID semester?

Ashish Jha  

Oh, boy, that is a really hard question. Because those are really important things. Social, personal, romantic relationships are like the heart of being human, right? And so how long can you continue to suspend these things? So look, I mean, first of all, it’s much easier if you can do stuff in pods, you can’t always. The issue around this, in my mind, is we have added a set of protections that obviously make life much, much easier here in terms of not just the mask stuff, but I think the fact that people are getting tested on an ongoing basis. I think it’s totally safe for people to spend time outdoors together; I think there’s things that people can do. And, obviously, I’m not going to say people should feel comfortable on Valentine’s Day violating their pod rules because, you know, it is risky. And right now is particularly so with these variants circulating. But so I feel like I don’t have a great answer beyond, I’m really sympathetic to the moment we’re in, I think there are ways of socializing with people that is safer than others. And I guess the other thing I will say is, I expect that all of this is going to start really meaningfully turning around in the next couple of months, I think there’ll be more vaccines, there’ll be plenty of vaccines by April, May. So if people can hold on a little bit longer, that will help; if you can’t, try to do things more safely. There is no perfect thing here. But it’s hard to tell people to just completely ignore Valentine’s Day if that’s important to you. So some amount of risk is probably just a reality of life in a pandemic. 

How is that for a non-answer? I feel like I didn’t really give you an answer. I went right up to the edge. It’s very hard, right? Because on one hand, like the right answer is, you can’t do anything. But the reality is like, that’s just not life. And asking people to suspend life forever, I think it’s not realistic. So I think people have to make trade-offs. And people have to make choices and understand there are risks. And as long as we’re, I think, all open and transparent about it, that’s really all you can expect.

Cate Ryan

Yeah, thank you, that makes a lot of sense. And we’re all looking forward to these changes with the vaccination rates going up and everything over the next few months. So we’ll continue to see everything unfold and hopefully a more bright way. But thanks so much, again, for being here with us this week, and we look forward to more conversations to come this semester.

Ashish Jha  

That sounds great. See you all very soon and stay well.