 Welcome to the show policy for the people. I'm your host, Minara Mordecai. Today is a special episode with a public health expert who will help us understand the research on the COVID-19 pandemic. She will also help us find the middle ground between panic and denial. I'm joined by a very special guest, Dr. Dora Ilyasova, a senior epidemiologist with the MTX Group. She brings with her over 20 years of research and teaching experience. She's presented on a number of topics on herd immunity, mathematical modeling, and disease risk, and the future of COVID. I encourage you to send questions throughout the show. Dora, welcome, and thank you so much for joining and being here today. You probably know that Hawaii is experiencing a rapid spike in COVID-19 cases because of the Delta variant. And the question on everyone's mind is what does the future look like? What are some of the expert opinions and predictions for how COVID will play out after the current wave? Can you start us off with that? Well, thank you very much for inviting me. And before we are lost in... I would like to draw a line between the infection with COVID-19 and the severe disease which everybody is afraid. Coronavirus is basically a family, a large family of viruses that cause mild respiratory disease, which we know as common cold. But COVID-19 disease is a very severe one. So that we are afraid of. So with this Delta virus right now, it happens after we already have the first, I would say, wave or vaccination. So now we have two pockets of the population. One pocket is vaccinated and another pocket is unvaccinated. If you look at the data at the wave in January and compare it with the wave today, you would see that this wave is not as big as it was in January. Also, if you look at ages and we know that older people are more susceptible to this severe disease compared to younger people, you would see that the reduction in hospitalization among older people is three times. In the middle age, two times, and there is no difference in younger people compared to January. So the idea probably... I mean, there are several opinions on how the future will look like. Like there is an epidemiologist in the UK who specializes in COVID and he really is on top of everything. He thinks that we will have, after Delta, we have many other variants. And at the end, everybody will get COVID sooner or later. The idea with vaccination is that probably if we are vaccinated, this will not be as severe as it is without vaccination. I sort of like have a more optimistic outlook. I don't have... I have to say that I have... It's not exactly my area of research, so I don't have my axe to grind. I don't have a theory that I defend in the literature and that is, you know, and I'm very opinionated about something. So, but I do believe that virus will mutate and we will have other ways. But the more people... The more we have immunity in population, whether people already acquired this disease, they have natural immunity, or they are vaccinated, it's a sort of like immunity through vaccination. We will have less and less and less ways and hopefully at some point it will be gone or we will have a common cold. So it will look more like a flu vaccine where we're getting yearly flu vaccine that's a different variant. Yeah, it could be. It could be like flu is a different type of virus and it also mutates and we are guessing every year with the flu vaccine, we are guessing what is the drift, how will look the new virus. Probably that will be the same with COVID or until the virus will completely become a common cold or I'm not a virologist and I can't say exactly how it will mutate. It's a special area of research, but it looks like the less amount of people susceptible to the virus we have, the smaller is the wave. And even with the virus mutating, that will be smaller and smaller and smaller. So either natural immunity or vaccine immunity will help mitigate serious cases or morbidity. Yes, I mean, I always try to imagine or to draw a parallel about antibodies that are developed either through natural immunity. These antibodies are proteins, specific proteins. Let's imagine that they are special agents and the special agents are trained to defend us against specific invaders. So some people are saying, oh, there are still even those who are vaccinated, they still get severe disease. Well, yes, no matter how great is the defense, sometimes it fails in some people, but most people are pretty well protected. Okay, we actually just got a question from a viewer that specifically to, and you and I talked about briefly about it takes a long time to get FDA approved and FDA has a lot of components to it. Do you know much what's going on with FDA and boosters, the booster shots? There's some issues that are happening because people are disagreeing with the president's advice to the country to do the boosters. Do you know much about that? What's happening with FDA? I'm not very much familiar with the FDA process only in main basic terms, but I understand that immunity is tapering or not. So the question is who should get this shot? And it is very, very logical. It sounds very logical to me to advise to get booster shots for people who are immunocompromised, like, for example, like my father, who has a rheumatoid arthritis. So that's okay. And while we're on the topic of FDA, there's conversation when people were hesitant to do the vaccine because it wasn't fully approved and you and your whole family got vaccinated before there was a full FDA approval. What was your decision like? What were the factors that encouraged you to do it before the full approval? Like I said, I am very little familiar with the FDA process, but I do know that it is a very, very rigorous process. It doesn't approve only because the vaccine has shown to be effective, but also it approves all the QA and manufacturing process and everything, but as soon as the data on the effectiveness of vaccine has been published and they will publish before the approval. This is pretty much no greater for me. And some people say, do you believe in vaccine? And I'm like, why do you need to believe? You just look at numbers. That's in the numbers tell the story. OK, so we knew the effectiveness of the vaccine was there even before, well before there was a full FDA approval. Right. And that was research supported. Right. Correct. And this data didn't change. The data is there. It just the process of approval is more than looking at the data that are published and show that vaccine can prevent people from getting a disease. I wanted to switch. You did a presentation on herd immunity. And we hear a lot about that. Can you explain briefly what is herd immunity and why it's important or if it's still important? I'm not sure if it still is. So can you talk a little bit about that? Well, I would prefer to say community. OK, we'll go with that. Community immunity. Right. It's a concept. It's a concept that is saying that if there is. A less susceptible if some portion of the population is less susceptible to the virus already has an immunity, then we are. It doesn't mean that nobody gets sick, but it means that there is no epidemic. What means that the disease is spread in exponential proportion. Right. So it's a huge wave. So people, some people can get sick, but it cannot become an epidemic. That's what herd immunity means. And it's all, again, it's a theory. And there are a lot of calculations into thinking what proportion should be in the room before the community reaches this community immune threshold. And there are the devil is in details how you calculate all the parameters that go into this equation. Do you think it's still important for us to reach a certain goal or a marker, at least in this country? With mutating virus, the idea is that maybe we will never reach herd immunity. Exactly. Maybe we will reach the point when people get the virus, but the number of severe diseases will not be so huge. OK. Interesting. While we're on the topic of immunity, is natural immunity, does it operate the same way as vaccine immunity? Is it pretty similar? Is there any differences between natural and vaccine? That is a very interesting question. I was interested in that myself. And I recently read a paper where they took the serum from people who have been vaccinated with the virus. And it turned out that it and tested against Delta virus, for example, right? So how they tested, they see how much this antibody, how effectively this antibody can neutralize the virus. And all of this, and I think it's all of this, and both the natural immunity and the vaccine immunity is against another train of the virus, correct? So every single situation shows that the potency of neutralizing virus is lower. But with vaccine, it's lower three times. And with natural immunity, it's lower six times. So the interpretation of this data, again, these are experiments in the test, too, right? But the interpretation would be, and I hope that this is true, that the vaccine protects you better from Delta virus compared to the natural immunity. Oh, that's interesting. Well, there is another interesting study done in the UK even before vaccine was developed. It was they took the serum from people who never had COVID-19. And it turned out that some people do have natural immunity, probably developed against other coronavirus. Other strains, other types of coronaviruses. So interestingly, that the highest level of this sort of natural immunity was among children. And after 16 years old, it was precipitously going down. Interesting. That actually brings me to another question that we have from a viewer, which is why are we seeing more children getting infected now? Actually, I looked at the number of hospitalizations, and they are not higher than they were in January. Infected maybe because the transmission of virus, transmissibility of virus, Delta virus, is higher than the previous one. But if you look at the number of hospitalizations, it's similar to what we saw in January. And what does that mean that transmissibility is higher? Delta? It means that if you and I meet each other and one of us has this virus, it's much easier to jump from me to you or from you to me compared to other strains that we saw before. But again, I'm not sure about the severity that it shows higher severity than the strain. Is it because there's more COVID-related molecules that are being transferred from person to person? What makes it more likely that you would catch it if we're talking? Oh, the virus muting. That if it can break into and invade ourselves much easier than was before. OK. So in the past, it may have entered someone's system but didn't necessarily stick around because. Right. We got it. So yeah, this one is more persistent. OK. Yes. No, it has to be like, for example, you probably are asked, have you been in contact with a person who has been tested positive for COVID-19? And then the question is, how long you've been in contact? If you get tested and you had a little bit of exposure, and your risk is much lower of catching a disease, to longer exposure, which means that the proportion of the virus that you get is much higher, the level. I see. OK. We actually got another question from a viewer, and this is related to the variants. What are the chances that another variant, and you said that there's some projections that we're going to have many variants coming forward? Well, WHO already said that we had several variants. I don't have my teaching to read the names of this variant. But there are at least five more variants that is of interest. Because virus mutates, but not all the variants are interesting to us, because not all of them are seen as an important threat. Do you know what are the chances that there is a variant coming that will be worse than Delta? Well, usually, OK, how do these mutations happen? The virus goes through the person's system and changes. And those mutants survive. It happens randomly, but those mutants who can invade and transmit much faster than others, they survive and take over compared to previous strains. It's like evolution. Whether or not it's severe, from just a regular point of view, if the virus is deadly, and the person dies very quickly, the person cannot transmit the disease. So it always has to be in the middle to be really, really dangerous. That's interesting. When we talked briefly about vaccine effectiveness and we share the numbers, the vaccine is 95% effective or something along those lines. What does that really mean? How do we think of that in terms of population? Let me give you a couple of numbers. Like, for example, Moderna vaccine, they say, what is the rate of infection among those who got placebo? It's like about 1,000 cases per 1,000 person a year. So how do we interpret that? If we take 1,000 people and let them live one year, 1,000 person a year, 56 of them will get infected. So if we all take people who are vaccinated, the rate is 3 per, as far as I remember, 1,000 person a year. So if you take 1,000 people and let them live one year, you will see three people still get the virus. So 56 minus 3 and divide by 56 and it will be approximately 94.94, which is 94%. So what we are saying is that you take the rate of those who have placebo minus the rate of those who have been vaccinated and divide by the rate that we see in unvaccinated, and say, OK, 95% of cases we prevented based on the vaccine. But it doesn't mean that if you have a vaccine, the rate is zero. And also, if you think about that, 56 cases in 1,000 people, it's also not that 100% of them are getting. It's not like if 90% of people, if you are not vaccinated, will get the virus. And only 5% of those who are vaccinated will get the virus. So that's I try to explain what is behind these numbers. OK, that makes sense. That's really clear, actually, I understand it. We don't have a lot of time left, but I do want to just one important question that you and I discussed previously, which is pre-existing conditions. They are affecting COVID numbers significantly. Can you talk more about that like this obesity and diabetes? What are we seeing in the United States and how they're affecting with fatality? Yes, this is something that it's a, to me, it's a wake up call for the whole nation, because if you look at the map of obesity in 1990, then 2000, 20, you will see it. And we know that the rate of severe disease in obese people and the rate of dying, having COVID-19, is much, much higher than compared to normal weight. So it's not only COVID-19, it's other chronic diseases, including cancer, cardiovascular disease, you name it. And it is preventable. It is preventable just looking at the trends. I hope that this will be a wake up call for the whole nation to look very, very seriously at this pre-existing condition. So what are we talking about? If you take away obesity from patients, are we seeing, would we see a drop in mortality rate? Significantly, yes. Yes, of course. Yeah, we will see. Especially, you will see the difference in younger population compared to the older population. You know, elderly people are susceptible to this virus. We know and most of them develop severe disease. But if you look at the younger populations, the difference between obese and normal weight is very, very high. OK, we got one more question from the audience. And this is related to possibly development of a new drug that would prevent COVID from sticking to the fat cells. Do you know much about that? I wish that would be there because it is extremely important. I've read several things about potential therapeutic agents, especially those that we know are already on the market repurposing other drugs. But so far, we don't see one winner that would say, OK, we do have effective therapeutic and that will prevent us from having a severe disease. So you haven't seen anything too promising yet? No, no, there are a lot of promising things. And just like there is no one winner that would say, OK, here is the protocol. Everybody will take it and it works. I see. OK. It's only one day. And then one last question I have for you is if you have anything else that you want to share with us as far as recent COVID research that you feel like is important for the public to be aware of? It seems to me that common sense most likely will tell people what to do. But it is interesting that I've read several papers on mathematical modeling what is important in protecting people from COVID-19. And usually, there's good ventilation, mass vaccines. Of course, there was not even vaccines. So I would feel that not being panicking and not feeling that you will get out of your house and you are getting into the war zone and you are going to be killed. But at the same time, just sticking to common sense, prevention measures would help a lot. Well, thank you so much. This was so fascinating and interesting. I really do wish. We could have a much longer conversation, which I hope we will continue because Dora and I are actually cousins. This is how our idea for this show started because we had a long conversation about her expertise. So I'm so happy to have my own family that we're all very proud of on the show. Thank you, Dora. This was pleasure as always. And we will see you soon. Take care, everybody. Thank you.