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Transcript of JoCo on the Go Podcast 08/28/2020

Theresa Freed [00:00:00] On this episode, hear from Johnson County local health officer Dr. Joseph LeMaster, he'll address the vaccine trials happening, how close we are to an approved vaccination and how a COVID-19 vaccine could be distributed. Also hear how COVID-19 treatments are improving as we learn more about the disease.

Announcer [00:00:17] Whether you live in or just love Johnson County, JoCo on the Go has everything Johnson County. Here's what's happening and what's coming up in the community you call home.

Theresa Freed [00:00:30] Thanks for joining us for JoCo on the Go. I'm your host Theresa Freed, a Johnson County resident and employee of Johnson County Government. COVID-19 has created a vastly different year: mask mandates physical distancing, hospitalizations for otherwise healthy people and disruptions to school and work. So what's the key to returning to some normalcy? Getting a handle on the disease with a vaccine. Johnson County Local Health Officer Dr. Joseph LeMaster is here today to talk about the outlook for a vaccine and much more. Can you start by talking a little bit about the vaccine trials that are happening?

Dr. Joseph LeMaster [00:01:03] KU Medical Center is taking part in one of those, a vaccine that was produced in England by Oxford University and AstraZeneca Pharmaceuticals. This is a vaccine that was based on some work that had been done earlier on other similar viruses to coronavirus. So they were building off of what they had before. And the virus has very special characteristics. You've seen all the pictures that we have shown of the virus and the little things that look like crowns, which is why we call it coronavirus. The spikes are all a special protein we call the spike protein. So the thing that is peculiar about this virus is that spike protein. So most of the viruses are one way or another trying to induce immunity against the spike protein. The way that vaccine trials work, there are three stages of them. In the earliest stages before you ever would see them in a place like KU at the place where they originally developed. They are safety trials. So they just want to make sure that when they give the vaccination to people that they don't have an immediate reaction to it or any really severe reactions after we get to that pass that phase. And the phase we're in now are called the phase three trials where they have previously not seen any negative side effects to the vaccine. And now the question is, does it work to reduce uptake? Does it work to reduce transmission in the community? So the vaccine is then given randomly to one out of two people in a out of a large number of people. There are so-called randomized. So the person who goes into that trial will be randomized either to receive the vaccine or to receive a placebo, which has nothing in it really, that that is a vaccine of any sort. Then for a while after that, you would have a series of blood draws perhaps every three months to determine whether you have had an immune response to the vaccination. During the period that you participate in the trial, you would not be eligible to receive the vaccine after it is released commercially because you would be participating in the trial. So there could be some delay in you receiving active vaccine if you were in the placebo arm and you won't know whether you were or not. So this is something to consider. It is very important for people to participate in these trials because it gives us an idea about whether the vaccine works or not. The other thing that will be monitored among people in these large trials is the differences between the placebo and the active arms of the trial, those who receive the vaccine versus the placebo in the rates of infection that they receive in the community. So they'll be actually watching for people who get COVID or don't get COVID in the different arms. You would expect if the vaccine is working that the transmission or people getting the virus from the community in the vaccine arm that received the vaccine would be really, really low, whereas it would be the same as it is in the underlying community overall in people who received the placebo. Sometimes when a vaccine works really, really well after we've been monitoring the results, both in terms of the antibody tests and in terms of whether people who received the vaccine actually get COVID or don't get COVID versus people who did who receive the placebo. Sometimes we find that the evidence that the trial has had a positive effect, that the vaccine works to prevent COVID. Sometimes in a situation like that in a randomized trial. The investigative team will stop the study early because the effect is so dramatic and they can demonstrate that effect to be so dramatic that they don't take the study all the way out to the end. That would mean that's called early stopping on the basis of an effective result. Sometimes that also happens if something some side effect that's unanticipated happens and they consider that the agent that's being given is dangerous. So you've probably heard that in some other types of drug trials that have come out. But in a vaccine trial, that rarely happens because we've done all the safety work before it gets to the public, to the public phase, the phase three, which we're getting ready to do in Kansas City now.

Theresa Freed [00:05:56] When a vaccine is ready, what will that look like?

Dr. Joseph LeMaster [00:05:59] So in terms of the timeline of available vaccine, the fact that we're having these vaccine trials in Johnson County and the Kansas City region doesn't really make any big difference to the availability of the vaccine of an effective commercial vaccine in the near future. This is not the only trial that's being conducted. There are other vaccines that are being tested around the country, around the world. And, of course, it's like a horse race. Everybody wants to be first over that line. So the development teams are working furiously. We still believe that it probably we probably will be lucky to see vaccine available before the first of the year. The teams are working as hard as they can. Everybody wants to be first to release their results and to make their vaccine available. You've probably heard that mass production of these vaccines in anticipation of the distribution has already begun even before the results of the trial are complete. So that as soon as we have the results of the trial, distribution can start immediately. So there won't be a long gap after the trial results are completed or that the information is available. This is going to happen really quickly at the end.

Theresa Freed [00:07:14] Do we know more about the effectiveness of a COVID-19 vaccine?

Dr. Joseph LeMaster [00:07:18] So there are a couple of things to consider about this. First off, the vaccine will initially be made available to the highest risk populations. So first responders, health care providers, et cetera. Then it will be to higher risk people like those in nursing homes or others who are at high risk. And then the general population. So that will all happen over a period of months. Imagine sort of three to six months for everybody to get vaccinated. And after that. The real question is, how long does that vaccine work? There's some concern that the vaccine's effectiveness may be short lived, that immunity may be as low as three to four months in duration, which might mean that until we have good evidence of herd immunity that there are there's a need to have repeated administrations of the vaccine. We believe that if the majority of the population take part in the vaccine trials, those who are not already immune take part in the vaccine trials that we should be able to reach herd immunity fairly quickly. Not everyone in the population needs to have the vaccine in order for us to reach herd immunity. It's somewhere around 70 to 80 percent. And that usually will cause the reproductive number or the number that we look at that tells us that that the vaccine is going to either increase in its its prevalence in the community or it's going to die out. So once we get to that amount, then the amount of infection that we see in the community will go down quickly. There are some people who feel very strongly that they do not want themselves or their child to be vaccinated. And in actual fact, we need to discuss that when we get to that point. It really would depend on how many people did not want to have the vaccine. We strongly will encourage everybody to have it.

Theresa Freed [00:09:13] Obviously, there's a lot of urgency to develop a vaccine. Does that pace impact safety?

Dr. Joseph LeMaster [00:09:19] There is no evidence for this vaccine thus far to have any side effects or have any unsafe complications as a result of taking it. The laws and rules that surround the production and testing of vaccinations in this country are very stringent. And if a vaccine is released, it already has gone through the most strict of testing to make sure that it's safe before it is, it is released. That's the point of these large of these large studies that are being done. One thing that's important to realize is the same safety protocols that are in place for these vaccine trials are the same that we use for any vaccine trials. None of those protocols have been skipped over or eliminated in order to get this vaccine out.

Theresa Freed [00:10:10] It's a bit of a waiting game right now. In the meantime, how has treatment of the disease changed or improved as we learn more about its effect on the body?

Dr. Joseph LeMaster [00:10:18] So we know that there is a lot of virus out there, especially in our county. If you look at the county Web site, you'll see very high numbers of cases being diagnosed each day. The risk factors for the complex type of COVID that is that would put you in the hospital, in an ICU, on a ventilator, are in fact related to things that you've heard about. Older people are at higher risks. Those who are obese, who have hypertension, who have diabetes. Those people are at high risk. That does not mean that the risk of those complications is zero in young people. And we still see young people all around the country, including children, who get COVID and get severe complications, end up in the ICU, end up on ventilators or dying. The issue is that you don't really know if you become infected, if that might happen to you. Your risk may be less, but it doesn't mean it is zero. But then looking at our overall rates of hospitalization and especially ICU and ventilator use and deaths of COVIDs. I think that we can kind of safely say and people can see on our county Tableau web site, that the number of deaths have not followed the increase in the number of cases, that the number of deaths still remain relatively low. And part of that is because we have better treatments now than we did at the beginning. So you've heard a lot about convalescent plasma. We are using that. We use high dose steroids. There are different ways of even positioning patients that are becoming hypoxic when they're in the hospital so that their lungs work better. They do better if they're prone, which means laying on their stomach rather than laying on their back there. And then there are other treatments that we've been using. You've probably heard about Remdesivir, which is an antiviral agent that we use in certain patients that are at high risk of going on the ventilator. All of these things that we've learned over the previous months, what works, what doesn't work. There have been some randomized controlled trials that have been done during this period of time to show us how and guide our art therapy for for treating the patients so that our death rates are coming down, or at least not going...we're not seeing more deaths than we than we did initially. And I think that's very good news because we are learning how to treat this appropriately so that people know that death is less likely. On the other hand, it's important to realize that some of the complications that happen with people in that have COVID have been things that have long lasting effects. As an example, we know that COVID produces some kind of changes in the clotting system so that people have, for instance, strokes and renal failure ending up on dialysis and those produce long lasting effects. So when they happen to you and they happen sometimes to quite young people, even though you might survive COVID, lifestyle could be very different after COVID than it was before. So this is these are all reasons to say, yes, we are getting better at treating COVID and preventing death. But that does not mean if you get COVID, that very bad things could not happen to you. So it's important to do all we can to protect ourselves and each other by all of us wearing masks and reducing the transmission. Washing your hands before you eat or touch your face or touch anybody else. And maintaining that six foot of distance.

Theresa Freed [00:13:55] A lot of great information. And we have much more on our Web site. Visit jocogov.org/coronavirus. You can also subscribe to a daily newsletter with the latest information on the county and state's response to the pandemic. Thanks for joining us. And thanks for listening.

Announcer [00:14:11] You just heard JoCo on the go. Join us next time for more everything Johnson County, have a topic you want to discuss? We want to hear from you. Follow us on Facebook and Twitter at JoCoGov. For more on this podcast, visit jocogov.org/podcast. Thanks for listening.