>> Steve: ALL OF US, WHO HAVE LIVED THROUGH THIS PANDEMIC, HAVE OUR OWN SENSE
ABOUT WHETHER IT REMAINS AN ACUTE HEALTH THREAT OR SOMETHING LESS PERILOUS.
BUT EXPERTS AT THE WORLD HEALTH ORGANIZATION THIS WEEK GAVE THEIR OFFICIAL PERSPECTIVE ON
THE MATTER.
WITH US NOW ON THAT: IN BRECKENRIDGE, OUTSIDE DENVER, COLORADO:
DR. STEFAN BARAL, PROFESSOR OF EPIDEMIOLOGY AT THE JOHNS HOPKINS SCHOOL OF PUBLIC HEALTH
AND A POPULATION HEALTH AND FAMILY PHYSICIAN PROVIDING CARE IN THE SHELTER SYSTEM IN
TORONTO.
DR. BARAL, AS I WELCOME YOU TO THE PROGRAM, I KNOW JOHNS HOPKINS ISN'T IN COLORADO AND I
KNOW TORONTO IS NOT IN COLORADO, SO WHAT ARE YOU DOING IN COLORADO?
>> WELL, INDEED, BOTH MY WIFE AND I AS CLINICIANS WORK PRETTY HEAVY DURING THE TRADITIONAL
HOLIDAY SEASON, SO THIS IS OUR WEEK OFF THAT WE TAKE IN LIEU OF THE NORMAL SORT OF CHRISTMAS-NEW
YEARS HOLIDAY SEASON.
WE'RE HERE ON HOLIDAY AND ENJOYING IT.
>> Steve: GREAT.
GLAD TO HEAR THAT.
LET'S SET THIS UP WITH THE FOLLOWING.
IT'S THREE YEARS THIS PAST MONDAY SINCE THE W.H.O. DECLARED COVID-19 WAS A GLOBAL PUBLIC
HEALTH EMERGENCY.
AND HERE IS THAT ORGANIZATION'S LATEST PRONOUNCEMENT ON WHERE WE'RE AT.
IT SAYS ON MONDAY THE EXPERT COMMITTEE DETERMINED THAT COVID-19 "CONTINUES TO
CONSTITUTE A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN AND THAT THE COVID-19
PANDEMIC IS PROBABLY AT A TRANSITION POINT AND THAT WE NEED TO NAVIGATE THIS TRANSITION
CAREFULLY AND MITIGATE THE POTENTIAL NEGATIVE CONSEQUENCES."
OKAY.
THAT'S W.H.O.-SPEAK.
CAN I GET YOU TO TRANSLATE THAT INTO ENGLISH FOR THE REST OF US?
>> SURE, YEAH.
I THINK IT'S REALLY IMPORTANT THIS TERM PHEOIC, OR THE PUBLIC HEALTH EMERGENCY OF
INTERNATIONAL CONCERN, WHEN IT'S ACTIVATED IT PROVIDES THE W.H.O.
ADDITIONAL RESOURCES BOTH IN TERMS OF ADMINISTRATIVE RESOURCES, FUNDING RESOURCES,
HUMAN RESOURCES TO WORK IN TERMS OF ORGANIZING ITS SURVEILLANCE SYSTEMS, ORGANIZING THE WORK
BETWEEN COUNTRIES TO ENSURE THAT IF NEW VARIANTS ARE EMERGING THAT WE CAN KNOW ABOUT THEM
QUICKLY, IF THERE ARE NEW SURGES THAT WE CAN KNOW ABOUT THEM QUICKLY.
AND I THINK THAT REALLY ISN'T IN PLACE YET.
AND I THINK THIS SORT OF CONTINUATION OF THE PHEOIC AT THE W.H.O. LEVEL ALLOWS THEM A
LITTLE BIT MORE TIME TO I THINK FINALIZE THOSE THINGS.
AND I THINK THAT'S AN IMPORTANT DISTINCTION BETWEEN THE PHEOIC AS AN ADMINISTRATIVE TOOL AND
WHETHER IT'S AN EMERGENCY FOR PEOPLE IN TERMS OF THEIR DAY-TO-DAY LIVES, WHICH I THINK
ARE TWO VERY DIFFERENT THINGS.
>> Steve: OKAY, UNDERSTOOD.
BUT DO YOU THINK WE ARE STILL IN THE MIDST OF A PUBLIC HEALTH EMERGENCY?
>> I MEAN, I THINK -- I THINK IT'S A REALLY IMPORTANT ELEMENT.
YOU KNOW, COVID WILL CONTINUE TO REPRESENT A PRIORITY FOR PUBLIC HEALTH DEPARTMENTS AT THE
MUNICIPAL, PROVINCIAL, FEDERAL, AND INTERNATIONAL LEVELS FOREVER.
I THINK SIMILAR TO THE WORK THAT WE INVEST IN INFLUENZA EVERY YEAR, COVID NOW IS ANOTHER VIRUS
IN OUR ECOSYSTEM OF VIRUSES THAT WE HAVE TO RESPOND TO.
AND I THINK, YES, IN THAT SENSE, IN THE SHELTER SYSTEM, WE CONTINUE TO HAVE -- WE SADLY HAD
SOMEBODY PASS AWAY JUST A FEW WEEKS AGO OF COVID.
WE'VE CONTINUED TO OCCASIONALLY SEND PEOPLE TO THE HOSPITAL RELATED TO COVID.
IT'S OBVIOUSLY VERY DIFFERENT THAN IT WAS.
BUT FROM A CLINICAL PERSPECTIVE, FROM A PUBLIC HEALTH PERSPECTIVE, IT WILL REMAIN, YOU
KNOW, A VIRUS THAT WE HAVE TO RESPOND TO.
BUT I THINK IT'S REALLY IMPORTANT TO SAY THAT, YOU KNOW, WHAT I TELL MY FAMILY IS THAT I
DON'T THINK THAT THEY HAVE TO SITUATE THEIR ENTIRE LIVES AROUND THIS VIRUS ANYMORE.
I DON'T THINK THAT THEY HAVE TO KIND OF PLAN THEIR LIVES AROUND THIS VIRUS.
THEY ARE PROTECTED.
WE'VE HAD, YOU KNOW, VACCINES.
WE'VE HAD NOW -- MOST PEOPLE GET INFECTED BY COVID.
AND SO I THINK THAT, YOU KNOW, THE WAY THAT THEY LIVE THEIR LIVES, THEY SHOULD MAKE SURE
THEY'RE TAKING CARE OF THEIR OTHER HEALTH ISSUES AND ALSO ENJOYING THEMSELVES IN THE WAY
THAT WE DO AS HUMAN BEINGS.
>> Steve: LET ME PICK UP ON THAT WORD PROTECTED YOU JUST USED.
PRESUMABLY YOU THINK THAT EVERYBODY SHOULD HAVE AS MANY SHOTS AND BOOSTERS AS IS
REQUIRED.
IF THERE ARE SOME PEOPLE OUT THERE RIGHT NOW WHO HAVE STILL ONLY HAD ONE OR TWO SHOTS, YOU
KNOW, WHAT'S YOUR VIEW ON HOW MUCH -- HOW PROTECTED THEY REALLY ARE AT THE MOMENT?
>> SURE.
I MEAN, I THINK AT THIS POINT THERE'S A REALLY SOLID UNDERSTANDING THAT HYBRID
IMMUNITY, SO I THINK IT'S A RELATIVELY NEW TERM, WHAT WE'RE CALLING IMMUNITY THAT IS
RESULTING FROM BOTH THE VACCINE AS WELL AS FROM HAVING HAD THE INFECTION, IS REALLY STRONG IN
TERMS OF PROTECTING YOU FROM SEVERITY, PROTECTING YOU FROM GOING TO THE HOSPITAL.
AND I THINK AT THIS POINT THAT THAT REPRESENTS THE VAST MAJORITY OF PEOPLE.
AND SO I DO THINK THAT MOST PEOPLE ARE PROTECTED FROM GOING TO THE HOSPITAL.
WE DO HAVE FOLKS THAT I SEE REGULARLY THAT ARE ON DISEASE MODIFYING DRUGS FROM AUTOIMMUNE
CONDITIONS THAT ARE OTHERWISE IMMUNOCOMPROMISED.
AND THOSE FOLKS, WE REALLY DO ENCOURAGE THEM TO STAY UP TO DATE ON THEIR VACCINES.
AND SO FOR SOME FOLKS THAT MEANS AS LITTLE AS EVERY THREE MONTHS BETWEEN DOSES.
BUT I THINK FOR THE VAST MAJORITY OF PEOPLE HAVING HAD TWO OR THREE DOSES PLUS AN
INFECTION IS PROVIDING REALLY SUSTAINED PROTECTION FROM GOING TO THE HOSPITAL.
BUT I WILL NOTE IT'S PROBABLY NOT GOING TO PROTECT FOLKS FROM GETTING INFECTED.
AND SO IF FOLKS ARE TESTING THEMSELVES REGULARLY, IF THEY'RE HAVING, YOU KNOW, LIKE A MILD
UPPER RESPIRATORY TRACT INFECTION, THEY MAY VERY WELL TEST POSITIVE FOR COVID AT SOME
POINT, BUT I THINK IT'S IMPORTANT TO SEPARATE THAT FROM WHAT WE HAD WHEN A COVID
INFECTION REALLY MEANT VERY HIGH CHANCE OF GOING TO THE HOSPITAL OR VERY SIGNIFICANT CHANCE OF
GOING TO HOSPITAL FOR MANY PEOPLE.
>> Steve: IF PEOPLE HAVEN'T HAD ANY VACCINES YET TO THIS POINT AND SOMEHOW THEY END UP
SEEING YOU, DO YOU, FOR LACK OF A BETTER EXPRESSION, DO YOU WASTE YOUR BREATH ON THEM AT
THIS POINT OR ASSUME THERE'S NO POINT IN TRYING TO CONVINCE THEM THAT SHIP HAS SAILED.
>> I SEE A LOT OF PEOPLE WHO HAVEN'T BEEN VACCINATED IN THE SHELTER SYSTEM AND I THINK THAT
IS A RESULT OF SOMETIMES MISTRUST OF GOVERNMENT, IT CAN BE MISTRUST OF THE SYSTEM.
I ALWAYS -- I DON'T THINK OF IT AS WASTING BREATH.
I ALWAYS TALK TO THEM.
I'VE BEEN DOING THAT FROM THE BEGINNING.
AND SOME FOLKS, THEY ABSOLUTELY DON'T WANT TO TALK ABOUT IT AND THAT'S OKAY.
I DON'T -- I DON'T JUDGE THEM FOR THAT DECISION, AS I DON'T JUDGE THEM FOR SOMETIMES --
OTHER HEALTH CONDITIONS OR OTHER HEALTH DECISIONS THAT THEY MAKE.
I THINK IT'S IMPORTANT TO SORT OF CHANGE THE FRAME.
I KNOW OFTEN THERE'S BEEN A SORT OF BLAMING FRAME FOR FOLKS WHO HAVEN'T GOTTEN VACCINATED.
I WOULD TURN IT AROUND.
I USE IT AS AN OPPORTUNITY.
FOLKS SOMETIMES WILL CHANGE THEIR MINDS.
OR THEY DON'T.
AND I THINK IT'S IMPORTANT THAT WE DON'T DISENGAGE FROM THOSE FOLKS BECAUSE THEY MAY HAVE
OTHER HEALTH NEEDS, WHETHER IT BE INFLUENZA VACCINATION, BLOOD PRESSURE CONTROL, DIABETES
CONTROL, MENTAL HEALTH, ET CETERA.
INDEED, I'M ALWAYS UP FOR A CONVERSATION WITH ANYBODY WHO WANTS TO HAVE IT.
>> Steve: LET ME PICK UP ON ANOTHER WORD THAT YOU USED A FEW MOMENTS AGO AND THAT WORD WAS
"FOREVER," AS IN THIS THING IS GOING TO BE WITH US FOREVER.
IN WHICH CASE, IF THAT'S TRUE, HOW DOES THIS PUBLIC HEALTH EMERGENCY EVENTUALLY END, OR
DOES IT?
>> YEAH, AND I THINK THAT'S THE SEPARATION BETWEEN, YOU KNOW, LIKE THE SORT OF ADMINISTRATIVE
OR THE RESPONSIBILITY OF PUBLIC HEALTH DEPARTMENTS WHERE THE RESPONSE TO COVID WILL NEVER
END.
I THINK THAT'S AN IMPORTANT THING AND I THINK WE UNDERSTOOD THAT EARLY.
THIS VIRUS, GIVEN ITS PROPERTIES, GIVEN ANIMAL RESERVOIRS AND PEOPLE WHO DON'T
KNOW THEY HAVE IT AND THE VACCINE IS NOT PROTECTING FROM INFECTION AS MUCH AS SEVERITY,
WE UNDERSTOOD THIS WAS SOMETHING THAT WAS NEVER GOING TO BE ERADICATED OR EVEN LONG-TERM
ELIMINATED.
I THINK THAT'S AN IMPORTANT ELEMENT.
THAT'S NOT GOOD NEWS.
THAT'S JUST BEING PRAGMATIC AND REALISTIC.
I THINK PUBLIC HEALTH DEPARTMENTS REQUIRE THE RESOURCES.
SO, FOR EXAMPLE, IN THE CONTEXT OF THIS EMERGENCY, IN THE UNITED STATES, THE EMERGENCY IS REALLY
TIED TO RESOURCES, AND SO, YOU KNOW, THE IDEA OF ACCESS TO VACCINATION, ACCESS TO TREATMENT
IS ALL RELATED TO IT BEING A STATE OF EMERGENCY.
IN CANADA, SIMILARLY, A LOT OF OUR INVESTMENTS AS IT RELATES TO COVID, WHETHER IT BE WASTEWATER
SURVEILLANCE AT THE SHELTER LEVEL, WHICH IS VERY USEFUL TO US, OUTREACH VACCINATION SERVICE
WHICH IS VERY USEFUL TO US IS ALL SORT OF ENDING IN THE NEXT COUPLE OF MONTHS.
AND SO I THINK WHAT WE NEED TO START DOING IS DISENTANGLING THIS IDEA OF IS IT A DAY-TO-DAY
PRIORITY FOR THE AVERAGE PERSON AND IS IT A PRIORITY FOR PUBLIC HEALTH DEPARTMENTS BECAUSE THEY
REQUIRE ADDITIONAL RESOURCES THAT WILL NEED TO BE SUSTAINED MOVING FORWARD FOR COVID, BUT I
DON'T THINK THAT THE AVERAGE PERSON WHO HAS THIS PROTECTION REALLY NEEDS TO WORRY ABOUT
COVID DAY TO DAY AND MAKE IT ONE OF THEIR PRIORITIES THAT THEY SORT OF WAKE UP IN THE MORNING
THINKING ABOUT AND THEN GO TO SLEEP THINKING ABOUT.
>> Steve: WELL, THAT MAY ANTICIPATE MY NEXT QUESTION BECAUSE I JUST WANTED SOME
CLARIFICATION ON THE WORLD HEALTH ORGANIZATION'S USE OF THE WORD "PROBABLY," IN THAT WE ARE
PROBABLY IN A TRANSITION PERIOD.
IF THAT'S THE CASE, WHAT ARE WE TRANSITIONING FROM AND TO?
>> SURE, YEAH.
I MEAN, I THINK WHAT WE ARE SEEING RIGHT NOW IN TERMS OF, YOU KNOW, THERE'S STILL -- LET
ME JUST SAY ONE THING.
THE W.H.O. REPORTED A NUMBER OF PEOPLE DYING EVERY WEEK FROM COVID.
BUT I THINK IT'S REALLY IMPORTANT TO SAY THERE'S NOT YET A STANDARD IN TERMS OF HOW WE
ATTRIBUTE MORTALITY RELATED TO COVID.
SO I THINK THAT'S LIKE ONE OF THE THINGS THAT THEY'RE CONTINUING TO WORK ON IN THIS
TRANSITION PERIOD.
IT'S JUST LIKE STANDARDIZING THE DEFINITIONS THAT WE USE FOR COVID RELATED MORTALITY, COVID
RELATED HOSPITALIZATION, SURVEILLANCE FOR NEW VARIANTS AND OTHER ELEMENTS.
AND SO I THINK THAT THEY ARE TRANSITIONING TO HAVING THAT BE REALLY CODIFIED, HAVING A SOLID
UNDERSTANDING OF THAT, AS THEY DO FOR INFLUENZA.
THERE'S A REALLY WELL-ESTABLISHED SYSTEM THAT'S BEEN ONGOING FOR DECADES AS IT
RELATES TO INFLUENZA.
I THINK THAT'S WHAT THEY'RE TRANSITIONING TO.
I ALSO THINK IT'S IMPORTANT WE BE PRAGMATIC WITH THE POPULATION TO SAY THAT COVID-19 WON'T GO
AWAY, THAT I THINK IT WILL CONTINUE TO BE SOMETHING THAT CAN CAUSE PEOPLE TO GET SICK,
WHETHER THAT BE MILD, MODERATE, OR EVEN SEVERE CONDITIONS, AND THE BEST PROTECTION FROM THAT
OBVIOUSLY ARE THE VACCINES THAT WE HAVE ACCESS TO.
>> Steve: I GATHER YOU HAVE SAID THAT WE STILL HAVE MASSIVE SYSTEMIC PROBLEMS AS IT RELATES
TO COVID-19 THAT WE ARE CONTINUING TO IGNORE.
LIKE WHAT, FOR EXAMPLE?
>> SURE.
WELL, I THINK -- YOU KNOW, WE JUST PUBLISHED A PAPER FROM ONTARIO SHOWING -- AND I THINK
THIS WAS UNDERSTOOD EARLY, THAT IN THE FIRST FEW MONTHS OF COVID IT AFFECTED SORT OF HIGH INCOME
FOLKS.
THESE WERE FOLKS COMING BACK FROM SWITZERLAND, COMING BACK FROM THE U.S., IN THAT SORT OF
JANUARY TO MARCH 2020 PERIOD.
BUT IT VERY RAPIDLY, AS DOES INFLUENZA AND OTHER CONDITIONS, TRANSITIONED TO SORT OF LOCAL
TRANSMISSION RELATED TO THOSE FOLKS THAT IN THE CONTEXT OF LOCKDOWNS CONTINUED TO BE OUT
WORKING AND SERVING SOCIETY, AS NEEDED TO BE, BECAUSE I THINK WITHOUT THEM, WITHOUT INTERNET
WORKING, WITHOUT GROCERIES BEING THERE, YOU KNOW, THINGS WOULD HAVE IMPLODED VERY QUICKLY.
AND WHAT WE SAW WAS, EVEN THOSE EARLY WAVES THAT WE SAW MUCH HIGHER LEVELS OF MORBIDITY,
MORTALITY, AND INFECTION IN LOWER INCOME COMMUNITIES.
BUT WHAT'S INTERESTING TO ME IS THAT THAT'S ACTUALLY THE SAME AS IT IS NOW IN 2022, WHEN WE
LOOKED AT THIS, WE STILL SEE LOWER INCOME COMMUNITIES MORE AFFECTED.
AND IT'S NOT ALL RELATED TO VACCINATION.
IT'S RELATED TO WORKPLACE EXPOSURES, IN SHELTER SETTINGS, IN AMAZON FACTORIES, PEOPLE WHO
USE TRANSIT MORE, ALL OF THOSE THINGS ARE RELATED TO INFECTION RISKS THAT I THINK ARE REALLY
IMPORTANT TO PAY ATTENTION TO.
AND I DON'T THINK THAT WE'VE SORT OF SUSTAINED THOSE INVESTMENTS.
A LOT OF THE HOTELS, FOR EXAMPLE, IN TORONTO THAT WE USED AS ISOLATION SITES, TOURISTS
HAVE COME BACK TO TORONTO, THEY'RE NOW OPENING BACK UP AS HOTELS SERVING TOURISTS AND
VISITORS.
SO I THINK IT'S REALLY IMPORTANT THAT WE CONTINUE TO MAKE THE INVESTMENT IN FOLKS' WORKING AND
LIVING CONDITIONS THAT ARE GOING TO HELP PROTECT THEM BECAUSE WE JUST HAVEN'T DONE THAT TO DATE
IN A PLACE LIKE ONTARIO WHERE I THINK WE REALLY CONSIDER EQUITY AND JUSTICE AS REALLY CENTRAL TO
OUR SOCIETY.
>> Steve: WHAT DOES THAT ACTUALLY LOOK LIKE ON THE GROUND?
>> I THINK WHAT THAT MEANS IS, YOU KNOW, FOR EXAMPLE, IN SHELTER SETTINGS WE STILL HAVE
PEOPLE SLEEPING 25 PEOPLE TO A ROOM, AND I THINK OVER THE LONG TERM, WE NEED TO DO BETTER WITH
HOUSING PROGRAMS IN ORDER TO MAKE SURE THAT THEY AREN'T AT SUSTAINED RISK.
IN A PLACE LIKE THAT WHERE SOMEBODY IS MILDLY SICK, IT SPREADS TO EVERYBODY WITHIN A
NIGHT AND IT'S REALLY HARD TO PREVENT.
WE HAVE AN ISOLATION SITE, A SINGLE ISOLATION SITE THAT WE USE, BUT IT'S REALLY HARD TO GET
FOLKS TO NOT ALL BE AFFECTED AND AGAIN IT CAN CAUSE TREMENDOUS MORTALITY.
I THINK IN PLACES LIKE THESE AMAZON FACTORIES, I THINK THEY NEED TO BRING IN OCCUPATIONAL
HEALTH SERVICES AND REALLY THINK ABOUT HOW ARE THE WAYS WE CAN MAKE SURE THAT FOLKS ARE
PROTECTED IN THEIR HOMES AND IN THEIR WORKPLACES.
SOME OF THAT IS ABSOLUTELY OUTREACH SERVICES WITH VACCINATION PROGRAMS AND REALLY
ENCOURAGING FOLKS.
SOME OF IT IS ABSOLUTELY UPGRADING VENTILATION SYSTEMS, LOOKING AT SAFER, CLEANER AIR.
IT'S ABOUT BRINGING FOLKS IN AND REALLY THINKING ABOUT THIS SYSTEMATICALLY AND WHAT ARE
THESE SORT OF SYSTEMIC BARRIERS THAT CONTINUE TO PUT PEOPLE IN HOSPITAL RELATED TO COVID.
I THINK IF WE DO THOSE THINGS, I THINK WE CAN REALLY IMPROVE COVID OUTCOMES FOR THE NEXT 10
OR 20 YEARS AS COMPARED TO JUST THINKING ABOUT THIS SORT OF DAY TO DAY.
>> Steve: LET ME PICK UP ON THAT.
BECAUSE OF COURSE THE COVID-19 THAT PEOPLE MAY CONTRACT TODAY IS CERTAINLY NOT THE SAME
COVID-19 THAT THEY MIGHT HAVE CONTRACTED TWO OR THREE YEARS AGO.
DO WE KNOW ENOUGH YET ABOUT THE LEVEL OF IMMUNITY PEOPLE CAN GET THROUGH THE MIXTURE OF VACCINES
AND PREVIOUS EXPOSURE?
DO WE HAVE AN ADEQUATE AMOUNT OF INFORMATION ABOUT THAT YET?
>> I MEAN, COLLECTIVELY -- SO WE PUBLISHED ON THIS.
OTHERS HAVE.
I WILL SAY THIS, THAT COVID IS THE MOST STUDIED VIRUS IN HISTORY, IT'S THE MOST STUDIED
HEALTH CONDITION IN HISTORY.
I THINK AT THIS POINT THERE HAVE BEEN ALMOST 400,000 PAPERS RELATED TO COVID.
SO I WILL SAY WE HAVE A LOT OF INFORMATION THAT WE CAN WORK WITH.
AND I THINK THE BEST INFORMATION WE HAVE IS THAT PEOPLE WHO ARE -- YOU KNOW, WHO HAVE HAD
INFECTION AND WHO HAVE HAD VACCINES ARE REALLY WELL-PROTECTED.
BUT I ALSO THINK IT'S REALLY IMPORTANT TO SAY THAT THERE ARE FOLKS THAT ARE IMMUNOCOMPROMISED
THAT REQUIRE ONGOING VACCINATION AND MAY REQUIRE ADDITIONAL SORT OF PROTECTIONS THAT WOULD
INCLUDE HIGH-QUALITY MASKS FOR THEMSELVES TO MAKE SURE THAT THEY'RE PROTECTED FROM THESE
SETTINGS.
I THINK THAT'S AN IMPORTANT THING, THAT WE IN MODERN MEDICINE CAN'T PROTECT EVERYBODY
IN THE SAME WAY AND WE NEED TO MAKE SURE THAT THOSE FOLKS HAVE ADDITIONAL SERVICES IN TERMS OF
OUTREACH VACCINATION, ENCOURAGING THOSE FOLKS THAT ARE IN HIGH EXPOSURE OCCUPATION,
AGAIN, GOING OUT TO THEM, HAVING THOSE OUTREACH SERVICES OR AT LEAST MAKING SURE THAT WHEN
THEY'RE SEEING THEIR FAMILY DOCTORS THAT THEY RECEIVE PROTECTIONS VIA MANAGEMENT OF
THEIR CHRONIC CONDITIONS.
ONE OF THE THINGS THAT WE KNOW, FOR EXAMPLE, IS THAT PEOPLE WITH UNCONTROLLED DIABETES,
UNCONTROLLED HYPERTENSION, ARE MORE LIKELY TO END UP IN HOSPITAL FROM COVID.
PEOPLE WITH UNCONTROLLED CHRONIC OBSTRUCTED PULMONARY DISEASE CAN END UP IN HOSPITAL FROM COVID.
AND SO I THINK WHAT IT SPEAKS TO IS WE HAVE TO DO BETTER WITH LINKING PEOPLE TO FAMILY
DOCTORS, MOVING AWAY FROM WALK-IN CLINICS, ALL OF THOSE THINGS THAT ARE SORT OF CENTRAL
TO OUR HEALTH SYSTEM ARE ACTUALLY ALSO GOING TO IMPROVE COVID OUTCOMES.
>> Steve: IS THERE ANY REASON TO BELIEVE THAT VACCINES BECOME MORE EFFICACIOUS AS TIME GOES
ON?
>> I THINK THAT'S A FAIR QUESTION.
I THINK THERE'S A LOT OF PRODUCTION OF NEW VACCINES AS WE SPEAK.
I THINK THERE WAS SOMETHING LIKE 100 PRODUCTS BEING EVALUATED.
I WILL SAY THAT I THINK FOR THE VAST MAJORITY OF PEOPLE, THE mRNA VACCINES, ESPECIALLY FOR
OLDER, MORE IMMUNOCOMPROMISED PEOPLE, HAVE PROVIDED GREAT PROTECTION.
AND I'LL SAY IN THE PRE-VACCINE AREA, WHEN WE WERE RESPONDING TO OUTBREAKS IN THE SHELTER
SETTING, WE WOULD HAVE HUGE OUTBREAKS AND WE WOULD SEND LARGE NUMBERS OF PEOPLE TO THE
HOSPITAL.
YOU KNOW, IT WAS IMMEDIATELY DIFFERENT.
WE STARTED VACCINATING IN ABOUT JANUARY OF '21 IN THE SHELTER SETTING, AND YOU COULD
IMMEDIATELY SEE THAT THE SHELTERS THAT HAD BEEN VACCINATED, EVEN IF THERE WAS AN
OUTBREAK, IT WAS UNLIKELY THAT WE WOULD SEND PEOPLE TO THE HOSPITAL AND IT JUST WAS A VERY
DIFFERENT DYNAMIC.
THERE WAS MUCH LESS TRANSMISSION OVERALL.
SO I THINK THAT THE VACCINES MAY GET BETTER.
OBVIOUSLY PHARMACEUTICAL COMPANIES ARE ACTIVELY WORKING ON THIS.
BUT I DO THINK THAT THE VACCINES, THE ORIGINAL VACCINES, EVEN THE WILD-TYPE VACCINES ARE
PROVIDING GREAT PROTECTION AGAIN IN THE CONTEXT THAT NOW MOST PEOPLE HAVE ALSO BEEN INFECTED
WITH COVID.
NOT EVERYBODY.
>> Steve: LET ME DRILL DOWN A LITTLE DEEPER ON THAT ONE.
BECAUSE, OF COURSE, GOING BACK TO THIS THEME THAT THE COVID OF TODAY IS NOT THE SAME THING OF
COVID OF YESTERYEAR, WE HAVE DIFFERENT STRAINS, WE HAVE DIFFERENT SUBVARIANTS, WE HAVE
DIFFERENT SUB-TYPES, HOW CONCERNED ARE YOU THAT WHATEVER VACCINES ARE BEING PRODUCED
RIGHT NOW OR IN THE FUTURE MAY NOT ACTUALLY BE AS EFFECTIVE BECAUSE THIS THING JUST KEEPS
MUTATING ALL THE TIME?
>> SURE.
I MEAN, I THINK IT'S REALLY IMPORTANT TO SAY, YOU KNOW, I DON'T PAY AS MUCH ATTENTION TO
THE VARIANTS IN A BROAD SENSE, LIKE IN A DAY-TO-DAY SENSE, AS SOME OTHER FOLKS.
I THINK THAT THIS IS A VIRUS THAT WILL CONTINUE MUTATING AND CHANGING OVER ITS LIFE SPAN,
SIMILAR TO INFLUENZA AND OTHER CORONAVIRUSES.
I DON'T THINK WE'VE EVER SEQUENCED OTHER CORONAVIRUSES THIS CLOSELY.
WHILE WE HAVE THESE TRADITIONAL WAVES OF CORONAVIRUS, THE SORT OF SEASONALITY OF CORONAVIRUSES,
WE NEVER SEQUENCED IT THIS CLOSELY.
BUT I THINK THAT WE WOULD SEE THAT IT WAS ALSO FULL OF NEW VARIANTS EVERY YEAR AFFECTING
US.
I'VE SORT OF SEPARATED THAT IDEA FROM THIS IDEA OF -- ULTIMATELY FOR ME IT IS WHAT IS RESULTING
IN SOMEBODY GOING TO THE HOSPITAL.
AND I JUST DON'T THINK THAT WITH THESE NEW VARIANTS, WHETHER IT BE THE VIRUS CHANGING OR JUST US
CHANGING IN TERMS OF INCREASED IMMUNITY, WE'RE JUST NOT SEEING THE SAME LEVEL OF
HOSPITALIZATION.
AND THAT CAN CHANGE.
AND IF IT DOES CHANGE, THEN I THINK WE HAVE TO REACT DIFFERENTLY AND ACT DIFFERENTLY.
BUT WE'VE NOT SEEN IT CHANGE ANYWHERE IN THE WORLD, RANGING, YOU KNOW, FROM -- I SHOULD SAY
OUTSIDE OF CHINA WHERE THEY'VE JUST SORT OF HAD THEIR INITIAL WAVES THAT WE EXPERIENCED A
COUPLE YEARS AGO.
WE'VE JUST NOT SEEN THE PLACES THAT HAVE ALREADY HAD THESE LARGE WAVES, HAVE LARGE WAVES
THAT HAVE RESULTED IN SIGNIFICANT MORBIDITY AND MORTALITY, WHICH I THINK IS WHAT
MOST PEOPLE ARE PAYING ATTENTION TO.
>> Steve: IN OUR LAST 30 SECONDS HERE, IS THE LONG-RANGE PLAN TO HAVE COVID
BECOME JUST LIKE THE FLU WHERE BASICALLY WE KNOW IT'S COMING EVERY YEAR, WE GET OUR FALL SHOT
OR WINTER SHOT, AND LIFE GOES ON?
>> YEAH, AND I THINK IT'S REALLY IMPORTANT TO SAY -- SO, BROADLY, YES.
THE SAME WAY THAT WE SEE PUBLIC HEALTH RESPONDING TO INFLUENZA WITH THEIR SEASONAL CAMPAIGNS,
WE ARE GOING TO SEE THEM SAYING IT IS INFLUENZA AND COVID SEASON.
I THINK THIS QUESTION ABOUT ANNUAL SHOTS IS SOMETHING THAT WE NEED BETTER RESEARCH FOR.
WE HAVE THAT RESEARCH FOR INFLUENZA.
WE NEED TO ASK THAT QUESTION, WHETHER THAT IS GOING TO RESULT IN THE SAME SORT OF BENEFITS FOR
PEOPLE.
BUT BROADLY, YES.
PUBLIC HEALTH IS GOING TO HAVE TO REACT AND RESPOND TO COVID.
I THINK MAYBE I'D SAY UNFORTUNATELY, BUT REALISTICALLY, FOR AS LONG AS WE
ALL ARE ALIVE.
>> Steve: GOTCHA.
DR. STEFAN BARAL, WE ARE REALLY GRATEFUL THAT YOU COULD SPEND SOME TIME WITH US, TAKING YOU
AWAY FROM YOUR VACATION TO SHARE THIS VERY IMPORTANT INFORMATION WITH OUR VIEWERS AND LISTENERS.
SO THANKS SO MUCH.
>> IT WAS A PLEASURE.
THANKS FOR HAVING ME.