The Pandemic As I Understand It To This Point
Well, this week’s episode with Professor Robert Booy explored the pandemic and specifically the vaccinations issue and immunity and it was a really interesting discussion to have someone literally at the coalface there. I mean, Robert is an Infectious Diseases Paediatrician, and since 2005, he’s worked at the University of Sydney in the fields of Vaccinology, Epidemiology, and Infectious Diseases.
If anybody knows about these things, Robert is certainly that person. He’s currently a Senior Professorial Fellow at The University of Sydney’s Children’s Hospital, Westmead Clinic. And from 2005 to 2009, he also held the position of Clinical Head of Clinical Research at the National Centre for Immunisation Research and Surveillance at Westmead Children’s Hospital and still remains an affiliate of that organisation.
Now, it was such like many of you. It’s been a very, very challenging time and lots of words and lots of terminologies thrown around. I thought I’d just give you a little bit of a 101, the pandemic, as I understand it. And hopefully, that will be of some help to you. It’s interesting to start with definitions because of an epidemic, pandemic, endemic.
What does epidemic, pandemic, and endemic mean?
An epidemic is a definition of a widespread occurrence of an infectious disease in a community at a particular time, but a pandemic is prevalent over a whole country or the world. So we are clearly in a pandemic. Endemic — of a disease or a condition — is regularly found amongst particular people or in a certain area, endemic. Haven’t heard that expression that much, but a pandemic is certainly where it is at. And, you know, this whole thing. Is this real or not? I believe it is real. I really do believe it is real.
I think it was 2017 or 18, but I fear not that many years ago we had the worst ever flu season globally that we ever had since the Spanish Flu. And there were 650 000 people who died. Now, it’s sobering to compare that to the four million plus that has died so far from this pandemic. And to put it into perspective, that 650 000 didn’t have any lockdowns. People were not obsessed with washing their hands or covering their faces when they sneeze or wearing masks.
Without any lockdowns, without any of those measures, there were 650 000 deaths. One can only imagine how few flu deaths there would have been in that worst ever year if the world had locked down and people were obsessed about their hygiene, I would guess that figure would be reduced significantly. They might have been 100 000 deaths.
This is obviously a real thing and it is really happening. You just have to speak to people who have lost loved ones or people who have had COVID-19 and are still suffering from some of the symptoms of that lung covid. In my practise, I’ve seen many patients with chronic fatigue, a very frustrating condition for those that suffer from it and are poorly understood and often poorly acknowledged by the medical profession, because it’s very hard to put your finger on one thing definitively, the diagnosis.
Lung covid, I think, is going to be something that we are going to see more of. But certainly, I already know people, young and old, who have experienced that. So I’m not really in any doubt as to whether this is real and this is a pandemic. We could argue about the numbers. There are people that say that four million is an over-exaggeration because there’s a difference between dying from COVID-19 and dying with COVID-19.
Remember, you may have listened to what I did on called The Elephant In The Room. And I quoted the statistics that while we have, say in the first year of COVID-19, there were 2.6 million deaths. Now there are 4/4. But in the first 12 months, there were 2.6 million deaths, which equates to seven, just over 7000 deaths a day. It is quite shocking to hear that. But it’s also sobering to know that on a year in year out basis, Cardiovascular disease, the biggest killer of all on the planet, results in something like 50 000 deaths globally per day. Cancers, the second biggest killer, that’s something like 27 000 deaths per day. And Diabetes, it’s up there as well, about 11 and a half thousand deaths per day. And that’s year on year. That’s not just in 2020 or 2021. That’s a year on year.
So one could argue that dying with COVID-19 and from COVID-19 could confuse those figures. But one could also argue that that is an underestimation because globally, we may not really know the true number of deaths that have occurred. So this is very real. And these are some of the pandemics that we are facing.
How is the virus being transmitted?
The question is, how is it transmitted? And initially, it was thought that obviously contact would be a one way. So if someone touched something which had the virus on it, for example, if you put your hand in front of your face and you sneezed or coughed, as we used to do before the pandemic, and then you went to shake someone’s hand and you had that virus, then you would be transmitted by contact with that person. And as you put your hand to your mouth or your eyes or your nose, you would transmit it. So that’s contact.
Droplets is another one. So you cough or sneeze and a droplet then falls onto a surface and you touch that surface and it is then transmitted to you. But more recently, we have learnt that aerosols are the mode of transmission and aerosols can stay in the air for minutes or perhaps even hours. But certainly aerosol creates a whole new challenge for us. And I know in our own practise in the city, we have taken this issue very seriously for many, many years, not just because of this pandemic.
In each room, we have a filter which is the fine filter that is fine enough to filter out the same size as a virus, so 0.1 of the micron or 100 nanometres. I don’t think that means anything to anyone, really, other than to say the HEPA filter is fine enough to filter out viruses. But even with that, we have a second filter, which is a UV filter, which then filters the air even further. And aside from when we go into taking mercury amalgam filters. Our fillings are, we use a third air filter. We take air quality really seriously. We have done this for many years. But I digress. Aerosol is a way of transmitting it and it’s becoming acknowledged now that it is
Why does wearing a mask important?
And when I hear people like Professor Raina McIntyre, who is I believe I’ve heard this correctly, I think she’s done her PhD on Personal Protective Equipment and she feels quite strongly that masks are important. And I am willing to accept that. To anybody that is skeptical of wearing masks, I have this question to ask you, and that is: When you coughed or sneezed prior to this pandemic, did you or did you not put your hand in front of your nose or mouth? And I hope the answer was yes. And the reason, the question then is: Why? And I think the answer is obvious.
When you go into an operation and you’re in the operating theatre and just before you are put under, you are probably quite reassured to look around the room and notice in this incredibly sterile environment, the practitioner’s wearing surgical masks. And you’d be quite grateful for them doing that. Or would you rather go out? Don’t worry about it. It’s not that important. There’s no evidence to show it makes a difference. Or if you, for that matter, came to the dentist and had the dentist or hygienist and the nurse sitting over the top of you with their mouth open, breathing into your face, would you feel comfortable with that? And I think the answer is obviously no. So I think masks are important. Okay, so we’ve got a pandemic which is transmitted and and and it is real.
Now, there’s another term that’s been brought up called the R-naught, which is well, I’ll just read it. What are the R-naught values mean? There are three possibilities that exist. When the R-naught, this is a measure of its transmissibility, if you like, if ideally, you want an R-naught. This is the number of people that will be reinfected by a single person. And if it’s less than one, that’s good, because we’ll end up with a disease that becomes extinct. If it equals one, well, that means that one infected person will cause another infection. And while this disease stays alive, it’s stable. But it’s not going to result in an outbreak or an epidemic. It’s when the R-naught is more than one that becomes a problem.
The original variant of the COVID-19 (Coronavirus) had an R-naught value of around 2.7. This is from WHO, actually, I think it’s from the CDC in America. When the Alpha variant, I remember I talked to Robert about this, we’ve had the Alpha, Beta, Gamma, and now we’re in the Delta variant will be going up to Epsilon, Eta. I’ve forgotten my Greek alphabet, but it’s worrying to think that we’re up to the fourth letter already and we’re only eighteen months in.
The first variant was the Alpha variant was sixty percent more infectious than the original variant. And now the Delta variant is said to be 60% more contagious or infectious than the Alpha variant which would put it with an R-naught value and it’s somewhere between and nine. I guess the bottom line here is, the factors between four and nine means depending on how you use numbers, you know, what numbers you use.
But anyway, that’s the R-naught value and the R-naught value of four to nine, where an R-naught value of one or less means we’re going to be okay. Definitely suggests to me that this is something to be taken very seriously. Then we get to the vaccines and the vaccines are such an interesting issue. And just to explain that vaccines traditionally have used either a protein from a virus or an inactivated virus, I think this is called protein or viral vectors. And it was injected into the arm and it launches an immune response. And that immune response, then provide you with immunity. That’s protein viral vectors and examples of that are Novavax, which, as we’ve heard today, as of the 27th of July, when I’m recording this.
Let’s talk about vaccines
As we’ve heard today, Novavax, which the government had bought 53 million doses from a company that actually didn’t have a lot of experience in making vaccines one can only imagine why. But anyway, we bought 53 million doses. That’s not going to be available until 2022. That is the old traditional protein viral vectors. And Janssen made by Johnson and Johnson, which we haven’t heard a lot about in Australia, is another one of those protein viral vectors. And interestingly, in South Australia, COVAX Professor Nikolai Petrovsky, who, my partner in the surgery and nephew, Dr Lewis Ehrlich, interviewed, Lewis and I attended a webinar put on by the UNSW (University of New South Wales) Kirby Institute, chaired by Professor Raina McIntyre. And the guest speaker was Nikolai Petrovsky.
Nikolai Petrovsky’s company in South Australia has received over 50 million dollars worth of grants not from the Australian government, but from the American National Institute of Health. The NIH over the last 20 years has developed probably between 5 and 10, I think at least 10 vaccines over the last 20 years. And he’s using a protein viral vector. Unfortunately, the Australian government didn’t see fit to support that. I’m not really quite sure why. I’m sure that will be the subject of many books moving forward. But I would recommend that you have a listen to Dr Lewis Ehrlich: Mouthing Off talking to Nikolai Petrovsky.
Now that we’re talking about vaccines and protein viral vectors is one. Novavax is an example of that. Janssen is another. And the COVAX vaccine coming out of South Australia, from Flinders University, which hopefully will be available at the end of this year or next year, although if we get to see it in Australia, that depends on the wisdom of the Australian government.
The Australian government did order 53 million doses of Novavax not coming until 2022. New technology is mRNA. Now DNA is a double helix. RNA is just one of those helixes. So messenger RNA is what Pfizer, the biotech Pfizer vaccine is or the Moderna vaccine. And what happens there apparently is that the protein, the mRNA enters the cell nucleus and then stimulates a part of the cell called ribosome to produce a protein which is then released and the body mounts an immune response to that protein, totally new technology.
Now, the difference between Pfizer and AstraZeneca is that where Pfizer and Moderna use messenger RNA, remember that one helix, AstraZeneca uses the DNA, a double helix and is far more stable so it doesn’t need to be refrigerated at minus 30 degrees. And I must say, I’m drawn to the AstraZeneca, well, for two reasons.
One, it doesn’t need to be, it’s not quite as transport and technique sensitive, but he’s a big one. And 21, that’s been a regular listener of my programme or has read a book and my book, A Life Less Stressed. You will know that my view of the chemical food and pharmaceutical industries’ influence on all levels of health care is not always as good as it should be. I’m not the only one that thinks that. When I see AstraZeneca being not for profit, meaning it’s about two dollars a vaccine and all the others are for profit, like, well, as far as I know, Pfizer is about twenty dollars a shot. Moderna is about the same.
AstraZeneca — not for profit, two dollars. If there was a problem with AstraZeneca, then I trust that. I know there has been. But I think to be honest with you here, and I’m just digressing here for a moment, but if I was working for Pfizer in the PR department or the sales department, one of the best things I think I could do would be to create doubt. And if you could create doubt at the highest levels, that would be good, because then people would be reluctant to have the not-for-profit vaccine, and that’s exactly what’s happened in Australia.
Yesterday, I heard that the Australian government has ordered 85 million Pfizer vaccines. Everybody’s holding out as though Pfizer is the gold standard. I’m sure there are complications with Pfizer as well. In fact, we’ll talk about complications in a moment. But I just think from a marketing perspective, that would be a slam dunk. You’ve created doubt about AstraZeneca. There’s a reluctance on the part of the population to use it. And Pfizer is held up as the gold standard.
And bingo, you’ve got a sale of which actually has occurred, a sale of 85 million doses. Let’s say it’s a 10 or 12. Well, let’s say it’s 20 dollars at 10 dollars that’s 850 million dollars. And at 20 dollars a dose, that’s 1.7 billion dollars. That’s just for Australia as the small country of 25 billion dollars. You just might start to get your head around. What are some of the things that are involved here? I personally will have the AstraZeneca vaccine. There it is. I’ve said it because a) I don’t like the fact that it’s so technique sensitive in terms of its freezing and transport and all that. And b), most importantly, I like the fact that AstraZeneca is just about as effective. We don’t know about the Delta variant, but just about as effective and it’s not for profit. So there it is.
When it comes to efficacy, there are apparently two terms that are kind of a little interchangeable. But it’s worth mentioning that there’s something called efficacy and there’s something called the effectiveness. This is new to me, so I’ll just share with you this, efficacy is the degree to which a vaccine prevents disease and possible transmission under ideal controlled circumstances, whereas a vaccine’s effectiveness refers to how well it performs in the real world, including against new variants and in people who have been excluded from clinical trials. Very important there.
When people do clinical trials, they usually don’t do it on unhealthy subjects. They like to find healthy subjects, usually in the age range of about 20 to 30 or 40 who have no underlying conditions. That’s quite a challenge in our world, but that’s another story. They’ll do a clinical trial there and they will then describe their efficacy, which, as we heard, is 70, 80, 90%. And then the different measure there is effectiveness. I’ll leave that thought with you. But remember, there is a difference between efficacy and effectiveness.
I talked to Robert about immunity. When it comes to immunity there are different types of immunity and basically, there’s innate immunity, which is the defense system from which you with which you born. It protects you against all antigens. Innate immunity involves barriers that keep harmful bacteria from entering your body. These barriers form the first line of defense in the immune system. I digress here for a moment. But the nose is a very important barrier. The difference between nasal breathing and mouth breathing. But I digress. Couldn’t resist putting in a plug there for nasal breathing.
Adaptive immunity involves specialised immune cells and antibodies that attack and destroy foreign invaders and are capable and are able to prevent disease in the future by remembering those substances, what they look like and mounting a new immune response. And that’s what our immune system, white blood cells, B cells, T cells, killer cells, all those are all about.
Now sterile immunity. This was interesting because sterile immunity means that the immune system is able to stop a pathogen, including viruses, from replicating within your body, which means you will not get an infection. Interesting. That’s what measles, mumps, rubella, all that is all about. Of course, that’s why you get the injection, the vaccine. And it works because those kinds of viruses do not mutate. They have a stable serotype. See, I’m throwing in some terminology there.
This typically happens when immune cells in the body are able to bind to the pathogens in places that prevent them from being able to enter a cell where they can start making copies of themselves. That’s what viruses do. Some of these immune cells may produce sterilising antibodies, which are proteins that recognise specific proteins and structures on the surface of the viruses or the pathogens. This is why the old-fashioned way of doing vaccines focussed on proteins and viruses, inactive viruses so that the body could mount that immune response and remember it. To achieve sterilising immunity, your body needs to produce enough neutralising antibodies that it needs to be able to do so in the long term. Ideally, it leads to long-term immunity.
The last one is when we hear a lot about and this is herd immunity, resistance to a spread of an infection within a population that is based on pre-existing immunity of a high proportion of individuals as a result of previous infection or vaccinations. We hear this a lot, and I think it is going to be one of the challenges because of the mutating nature of the virus. Interestingly, because of that, the Coronavirus vaccines do not provide sterile immunity. You will still be able to be infected and you will still be able to be contagious, however, with the vaccine, your viral load is so low that, you know, this makes you less contagious. And this is why the vaccine is being proposed as such an important part of this whole pandemic.
When it came to sterilising immunity, and I asked Robert, well, you know, that’s not what we can expect from Coronavirus. No, because measles, mumps and rubella, and all those other ones don’t change. They don’t mutate. There aren’t variants, which is what is so challenging about the Coronavirus and why we need flu vaccines or why people have flu vaccines every year. So that’s an important one.
Sterile immunity is not going to be achieved with the Coronavirus. That’s almost certain, although when you listen to Nikolai Petrovski, he’s hopeful that his vaccine will achieve that, although that would be an amazing breakthrough, because I think Coronaviruses do poses with a very big challenge, and that is their ability to mutate.
The last one that we hear about is herd immunity, resistance to the spread of an infectious disease within a population that is based on pre-existing immunity of a high proportion of individuals as a result of previous infection or vaccination. This is an interesting one to consider whether we will actually be able to achieve herd immunity given we can’t achieve sterile immunity and given the ability of the virus to mutate variants. You know, there are some challenges there. But there they are, innate, adaptive, sterile and herd immunity.
What are some complications?
Finally, and this was a question I asked Robert, but I’ll share it with you in this. Now, just very quickly, he goes into it in a little more detail. Interestingly, the complications are, as with any vaccine or in fact, with anything really, you can have a peanut butter sandwich, anaphylaxis. An immediate allergic response, which is quite very seriously. And with the injection of adrenaline, you will recover. This is why I think there are asking people to stick around for 10 or 15 minutes after the vaccine to ensure there is no anaphylaxis and that’s a good thing to be more cautious.
The Pfizer vaccine, the 20 dollar a shot vaccine having to be kept at 30 degrees and minus 30 degrees centigrade. Myocarditis is a complication, which is an inflammation of the muscles around the heart and that affects mainly young men. Again, mild cases are treatable and reversible and don’t leave anybody with a long-term problem. But there are other issues with myocarditis that could result in heart failure. Now, if it was more severe, myocarditis being more severe.
AstraZeneca has been implicated in clotting and that clotting could occur in a leg. You would know that after a few weeks or months, you might have persistent pain in the leg. It could happen in the abdomen, so persistent pain in the abdomen or you might have a headache because the clot may start to occur in the head. And if a headache, and if any of those pains lasted for any longer than, a day or two, you would certainly want to, particularly if it was after you’ve been given a vaccination, if you went to see medical advice and attention, then you can be given anti-clotting medications and that will probably be all right.
What is the long-term effect of the vaccine?
Yes, there are some chances of people dying as there are in anything. And then the question is, what is the long-term effect of the vaccine? And I have heard one expert say that we have over 40 years of experience in vaccines and we know them in the long term to be very safe. I do find that very reassuring, provided that the type of vaccine that we are using has had 40 years of experience, and that is the protein or the viral vector, which, you know, is the old-fashioned kind of vaccine.
But the newer vaccines, the question is, what are the long-term implications of the newer vaccines? And the answer is we don’t know. You can take that for whatever it’s worth, but we simply do not know. But what is clear is that for things to move on in this world, vaccination is going to be part of that experience and I am not an anti-vaccine. I’ve had all my vaccinations. When my grandchildren were born, I dutifully went off and had my whooping cough vaccination, which will last for 10 years. I’m a dentist. I’ve had Hepa B vaccinations. I’ve had my or, I’m not anti-vax. Have I had flu vaccines before? No, I haven’t. I’ve always felt that a healthy lifestyle was a very important thing. And one of the things that I have constantly referred to through this pandemic, and you, if you’re a regular listener, will go back and listen to How To Improve Immune Function. That is really important in this virus and in this pandemic.
This is about you taking control. Doesn’t guarantee that you will be immune. No, it doesn’t. But you do have control: sleeping well, breathing well through your nose, more important than ever, eating well, taking some supplements to help support them. And one of the first things I did at the beginning of this year, last year was put out what the orthomolecular news service put out, and that was a basic 1-2 grams at least of Vitamin C. Liposomal Vitamin C is the best way of doing it, 1000-2000 international units of Vitamin D, Zinc 150 milligrams equivalent to about 25 milligrams of elemental of Zinc and Magnesium, 400 milligrams. There, it’s basic. So I think we should be on that. You should be breathing through your nose. You should be sleeping well. You should be eating well. Yeah, all of those things.
Anyway, the simple fact is that vaccines are going to be part of this solution. And that’s why I’m going to having that AstraZeneca vaccine, because at the end of the day, I know many people in education, in hospitality, in tourism, in entertainment, in sport, in life who want to go and visit their relatives overseas and want their relatives to be able to come here. And whether we like it or not, vaccines are part of that solution. I just thought I’d take this opportunity to do this Healthy Bite and give you The Pandemic As I Understand It Up To This Point, and share with you some of that.
Look, it’s a huge and complicated issue and challenge. I don’t envy leaders in this field. You know, it’s a very challenging time to be a leader. I think some of the public health messages, I think one of the things I would say about public health messages like lockdowns and masks and all that is you cannot be nuanced in public health messages on this scale. It has to be to the lowest common denominator, the simplest message that covers all the bases as simply and as effectively as we can.
I think in Australia, we’ve done incredibly well in terms of keeping our rates down and our deaths down. I think that’s a real credit to us as a society. We are clearly more about us than me. There are other countries like the States I think they champion the right of the individual to bear arms and to do whatever they want to do. And good luck to them with 600 000 deaths under their belt.
I’m not sure whether that will be, which amendment that comes under, but probably the first or second, but anyway, I digress. I’m very proud of the way Australia has gone to this point. I know our leaders have come under criticism for the way the vaccine rollout has occurred. And I think one could certainly explore that. I’m not going to explore that in this particular podcast at this point anyway. I may in the future. I’m not shying away from that but I just wanted to share with you the pandemic as I understand it up to this point. I hope this finds you well until next time.
This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.