- Good morning, everyone.
So we're currently experiencing a large resurgence
in COVID-19 cases in our community
and in many communities across the United States.
And this resurgence is due to the new version
of the SARS-CoV-2 virus called the delta variant.
And I know that many people have questions
about delta variant,
why it's different,
why we're seeing this surge in cases now,
particularly across areas of the South,
in the Midwest where vaccination rates are lower
than they are in other parts of the country.
So we have some graphics that our team here at IXL
in partnership with Dr. Peter Angeletti's team
at UNL have developed
to help us demonstrate the delta variant,
how it invades
and impacts human respiratory epithelial cells,
and why delta variant is more severe
and is causing more serious outbreaks than we've seen
in previous waves of the pandemic.
So we're gonna go ahead
and take a quick look at delta variant
and what's different about this virus.
So this is a representation of the SARS‑CoV‑2 virus.
It's the virus that causes COVID-19.
One of the most important features
of the virus are these proteins here
that stick out from the cell surface.
Those are spike proteins.
They're actually what give the virus its appearance
that make it look like a crown
under electron microscopy.
It's why it's called coronavirus.
But the other important thing about these spike proteins is
it's how the virus attaches itself to our cells
and allows it to gain entry.
And what we've seen
with delta variant is there's some changes
in the spike protein that allow the virus
to bind more tightly to its cell receptor
and to gain entry into cells more readily.
And we're gonna look at a video now
that demonstrates that.
So this video shows us a human respiratory epithelial cell.
These are the cells that line your airways
and inside your lungs.
And this is one of the primary targets for coronaviruses
and the delta variant.
And here, we see the delta variant virus binding
to its cell receptor,
which is the ACE2 receptor
on the outside of the cells.
And that's how it gains entry inside the cell.
Once it's in the cell,
it releases its RNA genetic code.
And that genetic code is then turned
into proteins by the cell.
Those viral proteins are then able
to go inside kind of the the manufacturing area of the cell.
This is called the endoplasmic reticulum.
And what the virus does is it now hijacks the cell,
and turns it into a virus factory.
So now, the cell is just making virus, proteins, and RNA.
Those get packaged into a new virus
that then moves through what's called the Golgi apparatus
to get enveloped.
And then it comes out of the cell surface,
and goes on to infect other cells in the body,
and also to infect other people.
Those are the viruses that we shed out of our nose
and our respiratory epithelium
that make it infectious.
And what we know about the delta variant is, again,
it does a much better job of binding
to the cell surface receptor and gaining entry.
It also does a better job of turning your cells
into that virus factory,
so it produces many more progeny,
many more daughter virus particles
than previous versions of the coronavirus.
And we know that people
with delta variant can shed up to a thousand times
or more the amount of virus
from their nose and respiratory epithelium
than with the previous virus.
Again, this is taking us through the process one more time.
Remember, the RNA gets turned into proteins,
which then hijack the cell.
And now the cell is just making new viruses.
Those new virus particles get packaged together.
They come through the Golgi apparatus,
and they get enveloped,
and then they are extruded outside
of the cell going on to infect other cells.
Now I think if we move forward,
we can look at how vaccines protect us.
So if we stop here...
And let's go back a little bit if we can,
or start again.
No worries.
All right, keep going.
Just a second.
Stop right there.
Perfect.
So this is the receptor on the cell
that the virus binds to.
That's the ACE2 receptor.
And again, this is the spike protein.
And that spike protein
and the ACE2 receptor work like a key and a lock.
They fit very tightly together.
And the better the fit,
the more the virus is able to gain entry,
the tighter that bond.
And we know, again,
delta variant gives you a very tight fit,
a much tighter fit with that ACE2 receptor.
Now, a way to prevent the virus
from gaining entry are these things
which are antibodies.
So those antibodies also target that spike protein,
and they bind to the spike protein,
and block its ability to be able to bind
to the cell receptor.
So when that lock and key can't fit together,
the virus can invade yourself,
and it's taken away, and killed,
and disposed of by the immune system.
And these antibodies are what are produced
when you get vaccinated, right?
The vaccines produce very high levels
of neutralizing antibodies.
Much higher than the levels of antibodies you get
with natural infection.
And that's the reason,
at least one of the main reasons we think
why vaccines for COVID-19 work so much better
than protection from previous infection.
You get much higher titer of antibodies
with two doses of the vaccines.
And when you have these high titers of antibodies, again,
you block the spike proteins' ability
to bind to its cell receptor.
It can't get into your cells.
It can't hijack them to make more viruses.
And again, it's taken away and killed by the immune system.
And that's why it's so important
that we get as many of our community vaccinated as possible,
so we can avoid that scenario
of the virus infecting a cell,
and we can get to this scenario
where everybody has antibodies
that prevents that cell invasion
and replication of the virus.
So I think that's what we have for the graphics.
And again, I think it's really helpful
to kind of be able to visualize what's going on
at a cellular level.
I think we have an even a more close up version
of the virus invasion
and what happens when it gets inside the cell
that we can play here.
But I'm happy to take any questions now.
Yes?
- [Audience 1] So they always are saying
that the delta variant is more transmissible
and obviously more contagious.
Is there anything else that it does particularly
to the human body that like the other versions
of COVID haven't done that you've noticed
that's like strikingly different?
- Right, great question.
So again, you're correct.
It does appear that the virus is much more transmissible.
Probably twice as transmissible from person to person
as the original virus was.
And people shed much more virus
from their respiratory epithelium.
One of the reasons why it is much more transmissible.
The other thing that seems
to be more and more clear is it's able
to cause more severe disease in an individual
compared to previous versions of the virus.
So if you look at some of the studies
that have come out of Canada and Europe,
the delta variant seems to cause around two times
or even two to three times the rate of hospitalization,
the rate of ICU admission for a given person
compared to older versions of the virus.
And so it not only spreads more easily,
it causes more severe disease.
And that's I think one of the reasons
why we're seeing so many more ICU admissions
from this current wave of delta variant
than we would necessarily suspect.
Infections are primarily occurring
in unvaccinated individuals,
particularly serious infections
that are requiring hospitalizations.
And previously, we didn't see as many hospitalizations
in people in their 30s, and 40s, and 50s.
But now, we're seeing that quite commonly.
And so, that I think is very good evidence
that the delta variant is able
to actually cause more severe disease in people
than previous variants.
- [Audience 2] First, any question?
- [Audience 3] What do we know about the transmission
of the delta variant to a fetus
in either a woman who is vaccinated or unvaccinated?
- That's a great question.
We don't have a lot of data
on infections of the fetus in pregnancy.
We do have more and more data now,
however that show pregnant women are especially vulnerable
to delta variant infection.
And we're seeing many more hospitalizations
among pregnant women compared to previous versions
of the virus.
We also know from studies that have been done now
on tens of thousands of pregnant women in clinical trials.
And in addition,
millions of vaccinations, obviously,
that had been given across the US
that these vaccines are safe in pregnancy.
They don't affect fetal development.
They don't affect childbirth.
They don't affect fertility.
So the vaccines have a very good safety profile.
And it's very important for pregnant women to get vaccinated
because their rate of complications from infection
with COVID-19 are much greater than non-pregnant women.
Yes?
- [Audience 4] Have you encountered any misconceptions
about the vaccine and the delta variant specifically
that you wanna dispel?
- Well, I'm not sure that there are specific misconceptions
about the delta variant.
But obviously, a lot of misinformation and misconceptions
out there around the vaccine.
One of which I just pointed out
that people have really attached to the rumor
that there are fertility issues associated
with the vaccine.
And that's simply not been demonstrated
in any of the data we have.
There's also no evidence
that there are long-term effects from the vaccine.
Again, we don't routinely see long-term effects
from vaccines that would manifest themselves
after several weeks after vaccination,
and so have no reason to believe
that we would have long-term effects from these vaccines.
The safety profile of these vaccines is very much in line
with all of the other routine vaccinations
that we typically use.
And again, we've had now hundreds of millions of doses,
over 300 million doses of these vaccines given to Americans
and billions of doses given to people worldwide.
And there has been no vaccine ever I think
that has had the safety profiling and monitoring
that these vaccines have had prior to full licensure.
And so I have extreme confidence
in the safety of these vaccines
and certainly the efficacy data
of these vaccines is quite clear.
We are seeing primarily unvaccinated people
being hospitalized now with delta variant.
And the rate of hospitalization for people
who are fully vaccinated is still low.
Certainly, breakthrough infections are more common
with delta.
And we know that the vaccines aren't perfect.
None are,
but we're seeing a dramatic reduction
in severe infections and hospitalizations in people
who are fully vaccinated.
Yes?
- [Audience 5] I know that there are a lot of unknowns
when it comes to the vaccines.
But obviously, as we learn more about the delta variant,
possibly other variants,
how much do you expect that we will have
to tweak vaccines or feature other Medicare
or anything else that we have to do
to prevent our bodies to fight it?
- That's a great question.
There's a lot of questions
that experts and scientists have about:
How long will immunity last?
When will we really need people to get boosters?
Will those boosters need be to different?
Well, we need to modify the vaccine
to reflect some of the newer variants.
Right now, I don't think we have the answers
to those questions yet.
What is clear is that the longer we allow the pandemic
to go on.
And this is not just a problem here in the US.
This is globally, right?
The more people that are infected with new variants
of the virus,
the more we have partially immune
partially vaccinated populations out there
with the virus circulating,
the more opportunities we give for new variants to arise
that may eventually be able to do a better job
at escaping the protection from the vaccines.
We hope that we can vaccinate enough
of the world's population,
so we prevent that from happening.
And then we just have
to worry about periodic booster vaccines
for people going forward.
I think it's true that eventually
most of us will need a booster shot.
Right now, we're not seeing evidence
that indicates that there's an emergency
that we need boosters right now.
And from a global perspective,
we're all better off,
and we're all better protected
if we vaccinate a larger proportion
of the world's population,
so we can suppress global transmission of the virus
rather than focusing on
what might be incremental improvements
in individual protection with the booster right now.
Yes?
- [Audience 4] Is there any indication
that this hits harder on children?
There's been a lot of discussion about that.
- Well, I think it's-
- [Audience 4] Do we know yet?
- I don't know that we have definitive answers on that.
But certainly, anecdotally,
we're seeing many more pediatric admissions for COVID-19
than we have in previous waves.
I think it's also important to remember
that we are seeing at the same time rising rates of RSV
or respiratory syncytial virus,
parainfluenza virus infections,
and even early influenza infections in children,
which this is an unusual time in the middle of summer
to see many of those respiratory viruses.
And this is probably an effect of the face masks
kind of being removed,
and a lot of the non-pharmaceutical interventions
that we were taking that were suppressing all
of these respiratory viruses,
not just COVID-19.
I think now that those protections have been lifted,
we're seeing a resurgence in all
of these different respiratory viruses.
So we're seeing not only a surge in COVID 19 cases in kids,
but I think a combination of all of these other viruses.
Which for the very young infants
and children who have underlying comorbidities,
these infections can be very serious,
RSV and parainfluenza.
And so all of these I think are going to be eating
into our pediatric critical care resources,
which are obviously pretty limited to begin with.
And so I'm very worried about what's gonna happen
with the pediatric hospital capacity over the coming weeks.
- [Audience 6] Do you think that members
of the community should at this point be kind of scared
of what's happening?
- I think people should be very concerned
about the trends we're seeing.
I think many of us were hopeful several weeks ago
that our course of the delta wave would be more similar
to the UK.
So in England in the UK,
they've seen a pretty dramatic spike in cases,
but their hospitalization rates did not go up
at near the same proportion as they had with previous waves.
What we're seeing currently in places like Florida
and Louisiana, Arkansas, Missouri, Mississippi,
everywhere in the US that we're seeing delta wave growth,
we're seeing hospitalization
and ICU admission rates that are going up
at the same rate or even higher than they were
back in the fall.
And that's a really dire warning sign
that we're not going to have the same experience
that the UK did.
We're seeing hospitals already overwhelmed in places,
in parts of Florida, and parts of Texas, and Louisiana.
And unfortunately, I think that trend's going to continue.
So I'm concerned this is going to be the worst phase
of the pandemic for much of the US,
particularly states like ours
that have low vaccination rates.
- [Audience 7] How far behind those states are we?
Is there weeks, months before?
- So we're probably a month,
three to four weeks behind many of the states
that were the earliest to experience a delta surge.
And so that means
that most of those states have not yet peaked by any means.
And so we're going to see continued growth
for at least the next three to four weeks,
if not longer to be honest.
If we follow a time pattern similar to the UK,
we may be in for another six weeks of growth.
That doesn't account for the fact
that we're about to open schools, right?
And we know that in the UK,
kids and schools drove transmission
of the delta wave quite significantly.
And so when we open schools,
particularly if we open schools
without kids with face masks
and other non-pharmaceutical interventions,
there's layers of Swiss cheese that we've talked about
and how you block propagation of the virus
through a community,
we're just gonna be throwing gasoline on a fire
at that point.
And we're gonna see much higher rates of transmission.
And unfortunately, the way things are going,
that translates into increased hospitalizations,
increased ICU admissions,
and we're gonna see increased deaths.
And those deaths are not gonna be an 85-year-olds anymore.
Those deaths are now occurring in 45-year-olds.
And that's gonna be a significant difference.
- [Audience 8] How frustrating is it for you personally
to try to go to all these lengths to get through the people?
I mean, we've got this simple breakdown that you have
that everybody has seen the photos of the lungs,
the unvaccinated versus vaccinated.
I mean, how many more ways can you get through
to members of the public?
- Well, we're gonna keep trying.
We're gonna keep talking about the data we have
and the facts.
And hope that people can change their behavior.
And that collectively,
we can work on reinstituting many of these protections
that got us through the fall and winter wave.
I'm actually encouraged somewhat by some of the data
that's coming out of states
that are experiencing large waves of delta variant.
And even here,
we are starting to see more vaccinations happening
compared to where we were a couple of weeks ago.
If we can build on that momentum
and get enough of the community vaccinated,
we'll be free of this.
If we were able to reach high rates of vaccination
in the community,
80% of the community vaccinated,
we really would have a very mild experience
with this delta wave.
And I think the UK is a great example of that, right?
They have much higher vaccination rates,
particularly among kind of young and middle-aged adults.
And that's why they're not seeing this explosive growth
in hospitalizations.
So if we can get there...
And we don't have much time,
but if we can get there,
we can really avert the worst part of this.
And again, that's been encouraging to see
that we are starting to make an impact in vaccination.
So hopefully, we can continue.
- [Audience 9] Should people including those
who are vaccinated be changing their habits right now?
- Yes, absolutely.
I think that the CDC was right on
in adjusting their masking guidance.
Yeah.
It could take issue whether they should have changed it
to begin with several couple of months ago.
But at any rate,
I think it's clear that not only should unvaccinated people
be wearing face masks in public, indoor spaces,
but vaccinated folks as well.
And we know that we're seeing higher rates
of breakthrough infections.
We know that vaccinated people are able
to transmit to others.
That happens at a lower rate
than it does with unvaccinated,
but it still happens.
And so if we want to maximize protection of the community
and minimize the number of cases,
minimize hospitalizations and deaths,
everybody should be wearing face masks indoors,
in public settings.
Then we should be doing a lot of the things
that we did back in the fall and winter
that allowed us to navigate that surge that we experienced.
Yes?
- [Audience 5] I know ideally,
we want the vaccination rate of a 100%.
That's probably living in a perfect world, though.
So but what rate would you say?
Is it ideal that you would be able
to achieve that probably 75%, 80?
- So it's a bit of a guesswork, right?
But if you look at the epidemiology
and modeling based on what we think the reproductive number
of this viruses,
it gets you to a herd immunity threshold
of around 85% or so.
And so ideally, you'd like to have 85%
of the entire population vaccinated.
And obviously, we don't have vaccines eligible
for children under the age of 12 right now.
And so that takes a bit of the population off the table.
The reality is,
in the real world is a lot messier than that, right?
And so transmission generally occurs
in smaller pockets of the population.
And it's particularly school-aged children,
young adults and middle-aged adults.
They're the most connected in our society, right?
They bump into the most people every day.
They're most responsible for virus transmission.
So if you can just get vaccination levels up high
in that particular population,
the rest can kind of take care of itself.
So I do think that a legitimate target seems to be
at least 70% of the entire population vaccinated.
Again, if you look at the UK,
that's about where they are.
And again,
their experience with delta wave has been much, much better.
Hospitalization rates much lower.
I think once you get to 75% or 80%,
you really start to see dramatic suppression
of transmission.
The reality is we have a long way to go, right?
So the more vaccinations we can get in the community,
the better off we'll be.
Again, I think once we get to rates.
There are states in the US
that have achieved those rates.
States in the Northeast,
particularly Vermont, and Maine,
and New Hampshire have pretty high vaccination rates.
And they're seeing a relatively mild waves
of the delta so far.
So we have a long way to go,
but I think we can get there.
And again, if we can get to those rates,
we'll really navigate this relatively smoothly.
- [Audience 6] Is there (sound breaks up)
you might have four local school districts
who right now are just recommending masks
and not requiring them of their students,
especially the younger ones?
- Right.
Well, I know there have been some school districts
that have now moved towards at least mandating vaccines
in elementary school students who don't have the option
to be vaccinated.
Again, I think the CDC's guidance is pretty straightforward
and pretty clear.
And the CDC recommends universal masking for all students
in a classroom setting.
Important to remember that respiratory viruses transmit
through proximity, contact and duration, right?
Particularly in indoor settings
where there's less air exchange,
there's higher concentration of the virus in the air.
There's nowhere in our communities
where population density indoors is as high
as it is in schools.
Nowhere.
Office buildings, prisons, anywhere else,
doesn't approach the population density
that we put kids in for seven hours a day together
in a school.
So it is obvious that schools are one
of the highest risk environments for transmission
of this virus,
particularly of delta variant.
And again, the UK I think demonstrated that quite clearly
with their recent wave.
And so we need to take the maximum protections for students.
I think it's possible to have students,
and it's a priority to have students in person in school.
We all know that that's the best place for kids to be.
But the way to do that safely is to put all
of these layered non-pharmaceutical interventions,
those layers of Swiss cheese together.
Certainly, vaccine is the most important tool we have.
But many kids aren't eligible to get vaccinated yet.
And other things such as face masks, densification,
increasing air exchange,
and ventilation in schools,
all of those are gonna be important factors
to create a safe school environment.
Yes, Julie?
- [Julie] What would you tell to a bunch of high school kids
who've gone out and gotten the vaccine,
even though they don't feel they're high risk?
What would you tell them?
It's like, "Okay, now, you guys should wear masks too?"
- Yes.
- [Julie] What would you say that would persuade them?
- I would recommend highly
that even if they're fully vaccinated,
which I commend those high school students
that have gone out and gotten vaccinated,
but would recommend that they continue to wear face masks.
Again, because they're going to be in one
of the highest risk environments that we can have
in a school setting for long periods of time together.
And we know that all of these interventions work
on a population scale, right?
So vaccinations, and face masks, and distancing;
we like to think of them on an individual basis.
What's it doing for me?
But the reality is that they have their effect
on a population scale.
And when you apply these in layers across the population,
they have a synergistic effect in reducing transmission.
So it's important for us to work together on all of this
and to recognize that we're not just wearing face masks
to protect ourselves,
not even just wearing face masks
to protect our family members,
we're protecting our friends,
our extended family,
grandma and grandpa.
We're protecting the neighbor
who had a kidney transplant,
who's on immunosuppressive medicines,
who may not have as good and effectiveness
of the vaccine as others.
We wear masks to protect all of those other people
in the community,
and they're wearing masks to protect us.
And that's how we can collectively defeat this virus.
Yes?
- [Audience 10] And they've indicated
that there's a potential
that maybe the worst is yet to come.
The first wave was terribly, terribly difficult
for our first line responders
- Right.
- [Audience 10] on the front lines.
What is their mindset right now?
How do you prepare them?
Or what have you learned from the first wave
that can make potentially a second wave more
easily navigated?
- Well, I'm definitely concerned
about our first line responders.
I'm concerned about our healthcare workers.
I've been in awe of my colleagues in the hospital
since the beginning of the pandemic,
particularly nursing staff and respiratory therapists
and all of the techs who've worked just tirelessly
in very difficult conditions,
both physically and psychologically,
having to watch people isolated
going through the last phases of their lives alone.
And that's taken a huge mental toll on people.
And I think for many of our healthcare workers
kind of looking now with this looming crisis again,
it's pretty overwhelming for them.
And so I'm worried about the state of mental health
for many of our healthcare workers
and how we're going to help them navigate
through this next phase.
That's gonna be hard.
And so,
again, I think trying to protect our healthcare resources
including our people is a really important part
of why we need to take aggressive action now.
We're going to see potentially case rates
and hospitalization rates
similar to what we saw in the fall.
But as opposed to what we had in the fall,
we have hospitals that are already full
with some of these other respiratory virus admissions
that we've been seeing.
And just in general,
most of our hospitals have been really busy.
We don't have the surge capacity that we had previously.
And we have a bunch of nurses and doctors
who've been dealing with this for 18 months.
And a lot of them are just burned out understandably.
So that's gonna be a lot harder for us
to deliver good care to all of the people
that may be flooding our doors.
And we know that when the hospitals are overwhelmed,
when healthcare workers are stressed and overworked,
and taking care of too many patients,
when critical care nurses are taking care
of three or four or five patients
instead of one or two,
that we know that your outcomes get worse.
That's been shown not just for COVID,
for every illness that requires admission.
And so we're gonna see worse outcomes
in our hospitals if we continue to stress the system.
- [Audience 10] Are you able to show us
what a healthy lung looks like
and what infected lung looks like?
- Yeah.
Let's see if our magicians from IXL can do that.
There we go.
All right.
So this is a 3D rendition of a CT scan or a CAT scan
of what a healthy lung should look like.
So this is really a wonder of a technology
that we can do these 3D reconstructions now
based on CT scans.
This is a real CT scan of a real patient's lung, by the way.
What we have now is a comparison
of a CT scan of a patient's lung,
a patient who recovered from COVID-19.
And you can see the extensive amount of damage.
There is scarring, and fibrosis, and inflammation
throughout this lung.
That is going to be, in most cases,
in many of these severe cases of damaged lung
like this permanent.
This person is never gonna have normal
pulmonary function again.
As a matter of fact,
we've seen patients here at our hospital
and hospitals across the country have seen patients
whose fibrosis, scarring,
and inflammation in their lungs is so bad
even after they recover from the infection
that they require a lung transplant
because their lungs are no longer able
to oxygenate adequately.
And so COVID-19 is a severe disease,
especially of the lungs and respiratory tract
and in even young people.
So again, these are often people
in their 40s, and 50s, and even 30s
that we're seeing extensive lung damage.
It can cause longstanding and permanent disability
even after you recover.
Thanks, guys.
This was a great graphic.