COVID-19: What about vaccines? What about travel?

By Carl Lachman

The following is the transcript of a remote video interview I recently did with Dr. Dan Gluckstein, an infectious disease specialist in Pomona, California who has 34 years of experience in this field. I thought it would be interesting to get his perspective on the COVID-19 virus, what he thinks about the upcoming vaccines, and what he thinks about travelling right now.

Many of us are getting a little tired of the dramatic changes we have all endured with this virus and many of us are wanting to get away. Hawaii, for instance, is just a nonstop flight away from California and has a new system to allow visitors. If you book a vacation and follow the instructions for testing at www.hawaiitourismauthority.org, you could be on a sandy beach in less than three days.

Of course, if 2020 has taught us nothing else, life could be different tomorrow, so this article might be out-of-date very quickly!

The following transcript has been edited for length and clarity. You can watch the full video of the interview below:

So, the first question…tell us what a virus is.

A virus is microscopic assembly of proteins, genetic material and sometimes sugar and fat molecules that can invade a living cell and use the cell's bio machinery to create new copies of itself. There are thousands of known viruses and they can infect a broad variety of species from plants to bacteria, to fungi, to parasites and animals like us.

And how does a virus attack our bodies?

So, first off, they need to get into our body either by direct contact, or by breathing it in, or by eating it, or by sex, or injecting it through the skin, or through breaks in the skin.

Viruses use molecules to attach to an enter specific cells that they infect and then make copies of themselves to continue the infection.

OK, and so some of those things sound rather difficult as far as getting the virus, but there is some of them are that are very easy as far as how we get a virus. Is that correct?

That's right and it depends on a lot of different things. Different viruses require a sufficient number of viral particles to come into contact with the kind of cells they infect. We don't know this number yet for now with COVID-19, but for a virus called Borough virus, it takes as few as 10 viral particles to cause a really nasty vomiting, diarrhea disease that we probably all had.

There's been a lot of talk about testing, and if someone wanted to get tested, are some of the tests more reliable than others?

To some degree it depends on the question you're asking, but the usual tests we use currently is taking a specimen from the nose, the throat, or even saliva, and testing for the genetic material of COVID-19, and these are usually called PCR tests, but there's some other new technologies to actually look for the genetic material of the virus.

Increasingly, we're seeing some other tests that use similar specimens from the nose, mouth, or throat to look for antigens…and these may be faster and maybe more likely to be positive just when somebody is actually infectious, because we know some of the nucleic acid genetic material tests can be positive, even weeks or months after you've recovered from the infection and are no longer contagious.

Now, there are also tests that look for the antibodies our bodies actually make in response to the virus and these proteins can then be detected in the blood. These are most useful at this point to just say you had COVID infection at least two to three weeks ago or longer.

There are some future antibody tests that may be able to tell us if we're actually immune to the virus, but we don't at this point know if these correlate with immunity, and that's one of the key issues moving forward with vaccines. Do they produce these kinds of antibodies, and do they truly protect us from infection?

You know one of the ways that testing is coming up is with our clients who want to travel. They want to take a vacation. So, first, would you take an airplane today? And how would you do it?

Well…we know at this point, and particularly just in the last few weeks, that COVID is increasing in the United States in multiple areas, including Southern California as well in a number of different countries around the world, particularly Europe.

So, air travel is clearly an increased risk. It may not be as much just when you're on the plane, but because of our inability to control our exposures as we move from our home, to the airport, and then in the airport to the check-in gate, and then getting on the plane, you really can't control if you're exposed to maskless persons…so I would generally not recommend doing it unless it's absolutely necessary.

And, in particular, taking a vacation, a lot of folks in Southern California want to go to Hawaii, and but evidently Hawaii is requiring a recent test before you go, do you happen to know anything about that?

Yeah, there are several different ways. I haven't looked at it in detail but usually it would be one of these genetic material tests and I don't know if some airlines have started using the antigen test. Where they have you coming over early at the gate and actually test you with an antigen test, that tends to correlate pretty well with, “Do you have infectious virus?”

None of these things are 100% sensitive at any one test, which is part of the problem, but they are being used pre-boarding so it would reduce the likelihood at the time you're tested that you have COVID, but it doesn't mean depending on your exposures in the preceding 10 to 14 days that you might start to shed virus potentially while you're on the flight, or shortly after you arrive.

And, that's the difficulty because we know this virus has at least a two day period where you may shed virus with absolutely no symptoms, and then some people remain asymptomatic throughout the time of infection, which is usually a period of about 7 to 10 days where you're actually shedding virus.

Even in the last couple of days there's been news about vaccine work and success in these preliminary stages from Pfizer. How quickly do you think an actual vaccine will be available in an average person's doctor’s office?

It's still going to be quite a while. We know these results are extremely encouraging and the fact that they're saying from the data they set out in the press release that it looks like it's about 90% effective in preventing symptomatic infection. They still need to continue to collect some safety data for at least another two weeks before presenting it to the FDA for a possible emergency use authorization. That will likely happen either late this month or early December, as long as there are no other safety, or production problems, or questions about the data.

We know the vaccine supply will be quite severely limited early on, and the general distribution plans highlight giving the vaccine early, preferentially, to people who are very high risk for getting exposed to COVID and/or getting very sick if they get COVID.

So, this is generally with increasing age, particularly above age 65 years, underlying diseases, and occupational or socioeconomic conditions that would make you much more likely to be exposed to the virus and be unable to avoid people with potential infection.

Then gradually this would be expanded to the general population, but that would probably take somewhere around six to nine months, and looking at the US population as a whole, close to half the population meets one of the earlier distribution sort of criteria for this.

As well, almost all vaccines require two doses, so the logistics are difficult and several of them, including the Pfizer vaccine, have to be stored at extremely low temperatures.

So they wouldn't be generally able to be stored in a standard refrigerator or freezer, so distribution is going to be a difficult issue, and this is still being worked out between Health and Human Services, the CDC, the various state health departments, and other distribution channels.

Clearly this is going to be a difficult phase, and because you have to get two doses of the same vaccine, we have no study data looking at if you got vaccine A for the first, and vaccine B for the second, that it would work, so that's probably going to be maintained, at least for a while.

If we fast forward a couple of months, you're probably in the group that's offered the vaccine first. Do you get it? Do you have any hesitancy?

Not as long as the data looks good. I actually volunteered for enrolling in a study. I was never notified to participate, though one of my friends was. If you do want to look at enrolling in these studies, because these will continue for at least another year, and some of them even longer depending on the specific vaccine, because we're clearly going to need some long-term efficacy data as well as safety data.  So, you can look at… www.COVIDvaccinestudy.com... or also www.CoronavirusPreventionNetwork.org.

Does it really matter who manufacturers the vaccine?

Well, it certainly does in the sense that we want a vaccine that's held to the highest standards in production for both reliability and safety.

There are lots of different vaccines under development around the world, that are currently in various different phases. And, again, the Pfizer vaccine and several others are in this longer testing for efficacy, both in the US and worldwide, and, in a sense fortunately, since we have a lot of disease spreading in the US now, that will allow us to get efficacy data faster than if we had a hard time finding COVID cases.

The US is currently not participating in some of the international COVID vaccine development and distribution programs. So it's really much more dependent on internal US development and supply, though certainly a lot of the corporations producing these are multinationals.

And, should there be a non-US corporate development that didn't come through Operation Warp Speed -- and Pfizer actually capitalized the early development on their own -- we may be sort of cut out, or have to pay a higher price, if we were to try and purchase from a non-US company in the future, and depending on the supply, as well.

OK, and you've already mentioned that you'll probably have to get two shots for the vaccine, but do you think that this will be something that in the future every year you get your COVID shot, like a flu shot?

It's a possibility. We'll just have to see what sort of longer term data we discover about how well they protect us and how long they protect us. Theoretically they may work fairly well. We already know, though, there has been a lot of press about sort of some genetic variants in the coronavirus.

They don't seem to have been large enough to really affect the infectivity or clinical disease very much, which is not true with our problem with developing flu vaccine where it has to be changed fairly frequently due to the rapid changes in the flu virus and how it interacts with our immune system.

There certainly is a reasonable chance we may need a booster, whether it's once a year, every two years, and whether it might have to be modified as the virus changes.

You know, one thing with the Pfizer vaccine is that it's an RNA vaccine -- and the first of its kind looking at going into commercial production and administration – in a sense if the virus changes, we would fairly quickly be able to produce a fair amount of vaccine just by slightly tweaking the RNA that's in the vaccine itself to match what the virus is showing us in the real world, which is a bit different than how we have generally had to culture viruses, isolate the proteins of those viruses, and then make them into a vaccine.

So, in a sense, these new nucleic acid-based vaccines may allow us to react much more quickly to changes in the coronavirus, and actually react to other potential new viruses as they come along -- and they certainly are going to -- as the world becomes smaller and we interact more with lots of animal species and travel more at some point in the future, when it's safe to get on a plane again.

Right, well thank you very much for joining us and answering these questions. We've really appreciated your insight that you've shared with us today. Thank you Dr. Gluckstein.

You're very welcome. Glad to speak with you tonight.