 Back to think tank. Welcome back to think tank talks. Welcome back to enter the variance. We're going to talk about the variance with our chief scientist, Mike to work. Welcome to the show Mike. Thank you, Jay. Good to be here. Well, virtually there too. Yeah, well, science right. So it's really extraordinary how far the technology is going. I just saw something called, I guess it's a business system made by the poly company POLY company that makes these conference funds, you know, and they and they have taken all of this, you know, zoom type communication to a new and more expensive level, this money to be made and they're trying to make it. Anyway, Mike, you know, you've done a lot of work examining the variance and, you know, as if life wasn't complicated enough these days. Or as you know they say in the Chinese culture, interesting enough these days, we have the variance enter the variance and every time you look there's another one, and they're all over this country already and they're different. And that's the part you have to wrap my mind around they're all different different implications, different characteristics, you've been studying them so how far have you gotten in your studies what do you thoughts about that should we care a lot about them or what. We should care a little bit about them but more and as time goes on. The variants, some of them have actual major changes in the spike protein that the, that the vaccines target. So far, none of them seems to have enough changes to actually make all the vaccines useless. But there's some concern that some of the vaccines that actually been tested in South Africa are showing maybe 50% efficacy instead of 90% efficacy. And that's the problem with evolution is, once you let these viruses out and you don't control them, they will start mutating and once in a while we'll get lucky. And you come up with some that's more contagious, or something that's more resistant to vaccine, and the worst case be something that's both. And just adds to the urgency we've got to get the vaccination program up and running, so we can reduce the case load and thus reduce the chances of more mutations. Yeah, I noticed that, you know, all the variants we know about came from outside the United States, which and it just goes to prove the point that if you have a global pandemic and you have all these cases going on out there. And in many countries, there really isn't a effective vaccine program right now. The more cases you have it's mathematical isn't it. The more cases you have the more mutations you have, and the more mutations you have the more the likelihood. The more likelihood is that there'll be a couple of zingers in there, and they will travel faster they'll be more contagious more deadly more resistant to the existing vaccines. Right. Right, or they may end up like AIDS and become less deadly, but that way have the victims hand around longer to spread the disease more. We just don't know yet, but we really don't want to have to get to the point where we do know and what we have to worry about we want to get ahead of it, get everybody vaccinated, and get this thing under control. Just a point of curiosity. So what we what we have seen in the past month or two is development the emergence of vaccines in various places in the world. Variants in various places in the world, which are more dangerous, more deadly, more contagious, more arguably resistant to our existing vaccine technology. But couldn't it be that they could likewise the variants could likewise be less dangerous, less contagious, or, and that they could effectively, you know, take over the earth with a less threatening COVID. Is it possible logically. Well, let's contagious variances unlikely to take over because it will eventually be out competed by the more contagious ones, but unless a more contagious variant that's less deadly. That's a possibility. It could crowd out the less contagious but more deadly one. We can't really bank on that. I don't really want to hope for that. Well, we, I mean, hope that it becomes less deadly the way AIDS has. Or you can, but you also just need to make sure you try to kill it off because it could be just more contagious and just as deadly. That's probably as likely scenario is more contagious and less deadly. Well, if you had what strikes me that if you if that happened, if there was a mutation that was more contagious but less deadly in fact not deadly at all. And you let it out into the population, then the world would have this, you know, less, less deadly, more contagious strain of the virus. And that's pretty risky in itself, because it could then mutate into something who knows what, then it becomes more dangerous, and it's everywhere and you know we haven't done the right thing. So that's essentially what we do with the Saban style polio vaccine polio vaccine you get in the sugar cube on drops that you can swallow. It's a live virus that's been attenuated where it doesn't cause polio symptoms, but confers unity to polio viruses. So if you have a vision, doing something like that and making it very contagious. The problem with that polio vaccine is sometimes a, the vaccine virus will revert back to a dangerous form. That's why we took, there's three strains of polio out in the wild. One had a tendency to revert. Once we wiped out that strain of polio we took that strain out of the vaccine to keep it from going wild again. The other two have less tendency to revert but they're still out there in Afghanistan. We've got to get everybody cured of this disease, and we're close to it. And then we can get rid of all the polio vaccine and not worry about it. So yes, you can see something like that happening with a COVID virus. So you can see, maybe something that it has to be a virus that is less deadly, but also confers immunity to the deadly versions. And I'm not sure we know how to engineer a virus like that. But we do know how to do it now with the mRNA technology is engineer a vaccine very quickly for any new variants. Yeah, the problem problem is that, you know, query have we done that, are we doing that. I doubt the Trump administration was, you know, encouraging and supporting that or funding it, maybe in Europe. And I remember a quote in the newspaper by the Turkish guy that headed up the bio and tech company that partnered with Pfizer for the existing Pfizer vaccine he said, oh gee whiz we can handle variance. It'll take 6090 days we'll just adjust the vaccine to deal with that. I've heard more about it since though. Pfizer and Moderna are both looking at this they will want to test the problem is you'll have to test the new vaccine and make sure it's as effective as what you have now. But then you can envision a case where they say, well, hey, maybe we don't want to vaccinate everybody and let the variance get out because then every year we have to be cynical. Well, I mean you could get cynical about this you know no sooner you get your shot no sooner this, there seem to be a solution and struggling through a distribution system, you know when enter the variant. Now what, and we don't have enough data to know what it means. All we can do is look at scenarios and try to prepare for various possibilities. I've done some toy pandemic simulations to kind of illustrate the principles. Yes, please. Okay, so all this is a snapshot of where we are. United States has got 27,000,000 cases so far and going on half a million dead more people than we lost in World War Two. The world's on 100 million cases and Hawaii. Hawaii is about 11,000 of the total US caseloads right like 25,000 cases. It's not exponential in Hawaii we seem to have stabilized that it kind of steady linear growth. United States is slowing down, fortunately, people are getting the message. So that's just where we are. So the next slide I show a simulation. I'm so in this simulation I've changed up the colors a bit for what we had before blue are the people who are susceptible green are the people who are immune. Red is the people who are contagious and black are the dead ones. And in this case I've taken a virus that infects like 30% of its neighbors. If you've got the virus 30% of the people in contact with you all average get it from you. And then every 10 weeks or so another tourist comes in or somebody goes to the man comes back brings the virus in so you can see that it kept going around and around. The top line is the infected people versus time you see how it goes up and down up and down. That's because immunity is waning. I put in a time for the immunity to wane up about six months. So you get the virus, you're immune for most six different six months or so. And then, you know, tourists bring the virus back in and people get sick again. And this goes in waves, you know, a couple of years in this simulation and the death rate goes keeps going up and up and up and up in this case. In this simulation 800 weeks 15 something like 15% of the population is dead. So that's a that's kind of the worst bad case, but what if the virus is more contagious and just as deadly. So that's the next simulation I'll show if you go to the next. So this one is spreading faster because it's infects about 40% of the people that you come in contact with instead of 30%. And you add in the tourists bringing the disease in and it just goes fast zipping around the whole population very quickly. You can see the black dots growing in the simulation. The end result of that is that the population never really gets a rest from the disease. It's it spreads so quickly that you don't your waves don't go down very low before the next wave comes along. And they get a higher death rate just because the immunity because it's so contagious that there's less herd immunity possible. And this one only starts to slow down where about 15% of the population has died of the virus. So they're not infectable anymore. So now let's have fathers as what if we had a vaccine for that contagious virus with that vaccine or 94% effective. And that's the next simulation. So in this simulation, the green spots of people are a vaccine or naturally immune. You see the red just never gets a chance to really get going. Every once in a while, there'll be a cluster red cells show up that they never really spread because there's so much right now. Now this is flickering because the immunity is waning, but we keep vaccinating. The vaccine about 5% of the population every week, and that's enough to keep the virus at bay. So if we go to the next slide, you see what's happened. That top red curve is we had an initial spike when we just started vaccinating of cases, but it was far fewer than the cases we had. We had like 3% of people sick at any one time. This is like 0.3%. And then it never really picks up again. The death rates way lower, less than a percent, even after 800 weeks of the simulation. So the 94% effective vaccine and vaccinating every 50,000, 5% of the population every week, we get rid of it. It's gone. Well, what if we only had a vaccine that was 50% effective, but we're still vaccinating 5% of the population next week. That's the next simulation. So on this one, it does get initial spread, but you know, even the 50% effectiveness, this vaccine, because we keep vaccinating 5% every week, which in Hawaii got 50,000 a week. But again, the virus is never going to get a toehold. Even at just a 50% effectiveness, we've tamped it down. And so if you look at the next slide, we'll show the results of this. Clearly, there's an initial spike, but it's still smaller than the spikes with the unvaccinated populations. You do get some subsequent waves as exogenous sources bring the virus back in, but they're nowhere near as big as before and death rates still low. So even a 50% effective vaccine, if you vaccinate everybody, if you keep vaccinating people to stay ahead of the Waynean immunity is effective. But what if you decide, or for some reason, there's a shortage and you can't vaccinate 5%, you know, you can't vaccinate faster than the immunity Wayne's. What if you can only vaccinate 2% of the people a week, you know, 50 weeks to vaccinate everyone with an immunity that Wayne's after half a year. So you got one year to vaccinate everyone and the immunity Wayne is after half a year and you've got only 50% effectiveness in the vaccine. What happens then? Now that's in the next simulation. And this one, you see it looks almost as bad as the very first one I showed. These waves of contagion keep coming around. The black dots keep increasing. And it's because we're not vaccinating in this simulation fast enough to keep up with the Waynean immunity. So you can see the results in the next slide or summarize. So the red peaks, the peaks are almost as high as in the unvaccinated population. There's still nice big gaps between the waves of contagion and they do eventually attenuate. But you still have quite a quite a bad crisis and you still end up with, you know, over 80, 800 weeks of this simulation, 10% or so of the population having died of this disease. And this is a poise simulation. It's something that could be coded up by a bright high school kid with access to MATLAB. More sophisticated simulations will undoubtedly show slightly different results. But this general serve the general principles. You've got to vaccinate fast enough to keep ahead of Waynean immunity. You've got to vaccinate. Having a vaccine isn't enough. You must vaccinate the people. And that's the only way to protect your entire population from this thing. You know, there's a national conversation going on. There's not debate going on as to whether you take the second shots that were being held in abeyance. And instead of giving them to the people who received the first shots, you give them to new members of the population. Thus, by definition, you know, reducing the efficacy of the series of shots for everyone. But where do your numbers show on that? What do your analyses show on that question? Should we be doing that? Or should we make sure to give everybody the full two doses? Well, I didn't address that in the simulation. But my look at the simulation is that you're better off vaccinating as many people as you can as fast as you can. And then trying to fill up the pipeline with vaccinating, get the second vaccines and before the first vaccine community is waned, which looks like we're looking at months for that to happen, not days or weeks. So you have time. You should get everybody as many people vaccinated as possible. The simulation showing, in this simulation, we didn't just vaccinate. The simulation didn't make a distinction between high risk people who would die of the disease more readily or people were low risk. It just said, randomly vaccinate the population. And that was enough to slow it down and stop the contagion from spreading. And there's some thought that we should even be vaccinating the spreaders, you know, people, well, certainly healthcare providers will see a lot of sick people, but also people who face the public a lot and have a lot of contact with a lot of people. So if we vaccinated the spreaders first, maybe we would be more effective at slowing it down. That's a bit controversial because now you're not vaccinating the people in the nursing home first. So what I really hope is that we can get the production and distribution up to the point where we don't have to make that kind of a choice. And we need to get as many people vaccinated as soon as we can and then get the cycle going of revaccinating as soon as we can get that going again. So efficacy is not critical. It's the primary thing is to get as many people vaccinated as possible. Some of these vaccines are more efficacious than others, but in the end, it doesn't matter. Just get them all out there and get people vaccinated. I guess that's what I hear you saying. Yeah, what the simulations are showing is that if the vaccine is even only 50% effective, if you vaccinate enough people, you can shut down the epidemic. And that's sort of the good news. The bad news is you've got to vaccinate enough people, which is the bigger logistic problem. You know, right now we aren't able to get vaccine out as fast as it was promised, and we really, really need to get it out there. If we can vaccinate fast enough, we can stay ahead of the contagion, even with a less effective vaccine and buy time for a more effective vaccine as new strains of disease develop. Yeah, well, we also have a time factor on how long the vaccines last. In other words, if you say let's let's do everybody and let's hustle to do that. And then you and it takes you, let's say, you know, using your assumption in the charts and takes you six months to do that. Well, now you got to start it up all over again and vaccine and give them vaccinations again in six months now. Right, well, that's that. So what I showed was assuming that you were constantly revaccinating people about 5% every week of the population with even a 50% effective vaccine and this simulation which isn't necessarily truly like COVID, but it illustrates the principle. You're not waiting six months, you're not a vaccine everybody this week and then waiting six months vaccinate everybody again, you're vaccinating people every week, and then they come back, you know, six months later but it's staggered now. So you can keep up with the demand. So you have an ongoing constant vaccination program. And that's what was in this simulation, which with modern with the Pfizer and Moderna technology, you can do you don't have to incubate it in chicken eggs. You can grow it and a bat, you know, essentially using this mRNA technology and have those vaccines ready. And I agree with the Turkish camera was named but the leader of biotech data. They can do it 90 days and they can put out new vaccines, maybe combining the old mRNA for the new strains pretty quickly. You just need to make sure that pipeline spilled and get the machine going to keep that pipeline filled. Now, of course, this makes a huge revenue stream for the vaccine makers, you know, an ongoing reliable source of income. If the immunity is actually permanent, then you need less, there's less urgency. If the immunity once you're vaccinated stays for more than six months stays a couple of years, then you can, you have less of a logistics problem because you can take more time between vaccinations. Yeah, the one thing I can't wrap my head around is the notion that all the variants vary from the other variants, they spring up, you know, in the different geographical locations different mutations and not the same. So that if the guy the Turkish guy in Germany and buy on buy on buy on tech buy on tech. And he finds something on variant one. Good. Now we all, you know, run to that side of the boat. We make a new vaccine for variant one. It's probably going to be different than the existing vaccines we have today. And then of course, we have to go very in two and three and how many others. And my question to you is, so how do I know which vaccine to take. And well, you know, that spike protein can't change that much without reducing its own effectiveness at infecting cells. So that's probably why is so far the vaccines, even the older vaccines seem to be effective against the new variants are at least a 50% like a modern and the Pfizer seem to be retaining effective is better than AstraZeneca vaccine. So it's not clear that you need a new vaccine for every variant. Now there's other ways these viruses can mutate you know they have to fuse their outer jackets with your cell in order to release their payload into the cell, they take advantage of cholesterol do that. So some of those mutations maybe in that part of the process making it easier for them to infect your cells without affecting the spike protein. As I said, if the spike protein changes too much, then it's no longer effective at infection so there's going to be all I think I think we're still in early days, determine how quickly we have to come a new vaccines. At this point yet where we have to panic that we need a new vaccine I think we need to get the vaccines we have out there as soon as possible, and then as many arms. And what would be really great is they could come up with an oral vaccine, instead of having to take a shot, because then you could distribute it really quickly, even at home, you could just take have it mail to your house and take it. It's not the necessity of, of refrigeration or anything like that. Yeah, shelf stable. So what this suggests to me. I mean, you make a comparison you have to make a comparison between this and, and the flu, because the flu changes every year and it changes by virtue of exactly the same mutation process. And, you know, like a big question I would ask you is, if I take. If I have last year's flu, if I have been affected with last year's flu, and I take this year's flu vaccine. Will that help me. Yeah, I mean, most likely will. I mean, the problem is that they have it to predict in advance which flu that which flu virus is going to be dominant and have to cook it up and chicken eggs and they haven't applied the mRNA technology yet to the through far as I can tell, which could make it faster and more effective to actually get the strains out because they can take like a year in advance. What's going to be next year strain and start the process with that current technology will do better with the mRNA technology than that will be won't have to wait a whole year to cook up the new vaccine. Take a flu vaccine every year, and if you've had last year's vaccine, you'll have some immunity to get similar flu viruses that may still be circulating. And you might have some cross the minute in this year's. And it can't hurt you to take this year's as well. This year's vaccine as well. Well, if I, if I could develop a vaccine that would wrap all of the previous vaccines into it. In other words, so we, you know, at the end of this year, say, this calendar year, it will be probably more variance more mutations. Because so many people are infected right now. So now I have safe five, plus the original. And so six all together seems to me if science could do this. The best thing to do would be to give me a shot with all of the vaccines in it. Now, you know, with six different vaccines in that, in that, in that shot. What basis to do clinical trial to prove that it's safe to give all those variants at once. But that clinical trial doesn't have to be back the new vaccine versus nothing it could be the new vaccine versus the first vaccine, which would be the most ethical way to do the trial. So they will have to do clinical trials before they do that but they can do that. I mean, got it done in a year. And do that in a year show that a multi-valid vaccine is really effective and safe. And then roll that out. Then we don't have to worry about safety so much in the future because we know it's safe and just keep giving those vaccines. We need science, you know, to inform us as to what the best thing is. We don't, we don't want to tell, you know, go on old wives tales. We don't want to go on rumor. We don't go on conspiracy theories or blame game. And I mean, I'm happy to see that Biden is respecting science, but in terms of the individual human well two questions. One is, is Biden doing the best thing he can do right now to deal with COVID? Or is there something else you would urge him to do? Well, it certainly is doing the right thing to get people to wear their masks in public transport. And airlines are happy that that's happening. They've put a lot of stewards and stewards's minds at ease and pilots at minds at ease. Right. And trying to accelerate getting the vaccine. That's right. If he has to invoke the Defense Production Act to get the vaccination supplies made. That's the right thing to do too. Helping industry ramp up production would be the next thing that would really need to be done. If there's a bottleneck in production, then anything the government can do to help fund that. And then with this bottleneck, we should do. And the pharmacy, the pharmacy distribution system that that sounds like a good idea. It seems to me that would be better than an ad hoc arrangement, you know, handled by the hospitals. Yeah, no, I mean, next week we'll start shipping it to the pharmacies and before we go into CVS whenever my turn in line comes up, probably way way down the list because I don't have any really underlying risk factors. Yeah, doing it to the pharmacies is a very good idea to do as many kind of pharmacies as you can. All the ones are the right refrigeration facilities. And helping them develop those refrigeration facilities, especially in the rural areas and where they're underserved populations. Yeah, you do have to have a system within the pharmacy is not like you can just do it with the existing structure existing infrastructure you have to build people systems to get them through the process. Oh, my last question is, is, you know, what about the individual? I mean, it seems to me that the anti-vaxxer movement has diminished. It seems to me that people, you know, would like to have the vaccines now. There's been so much good information out there about it and his transparency has been helping. And the truth I worry about complacency and it will make the conclusion that I'll get a shot. I'll be fine. We'll all be fine. And then they stop wearing masks. So what's your advice to the individual? Wear your mask until enough people are vaccinated that the contagious not around anymore. That's, it's hard to do. It's one way we can get back to commerce. You know, I'll be more comfortable after I've been back to going to a restaurant and even after we're a mask until I start eating dinner. That would be fine. Right now I'm not even comfortable going to a restaurant, no matter how many precautions they're taking. I say, get vaccinated as soon as you can. Get your loved ones vaccinated. And then we can get back to work, get back to business, get back to having fun, going to movies maybe. Can I wear my mask then? Sure. Except when you, sorry to put it. Thank you for that. There's been all kinds of, you know, commercials and suggestions, including from the scientists about how you should, you shouldn't go with these flimsy masks. You know, there've been a lot of entries into the marketplace of masks that are really not effective. I've just been talking about wearing double masks. I've been talking about masks that has fabric that interwoven with other components that make them safe. But what are your thoughts about that? Well, yeah, wear a double layer mask. This is just a plain double layer mask to different kinds of cloths that like such static charge between them traps of particles. But you can also get masks like this one as a place where you can put in a filter like a coffee filter like kind of material, maybe better. But you can also get an N95 mask, which they're available now. I just ordered a bunch from Amazon. 50 for $50. It's a, you can go with the N95s and then you could, if you don't like the look and you want something decorative and you could put a decorative mask on over your N95 and be safe. You can still be a fashion statement. Thank you. I want to be expressive with your eyes. You have to learn to do that. Mike, the word chief scientist on variants and enter the variants today. Thank you so much, Mike. Thanks for making those charts and scenarios really appreciate it. I'll talk to you again soon about the same things or other things that develop in our adventure with COVID. Aloha, Jerry.