>> Steve: Many people had hoped that vaccines would mean the end of Covid-19 post haste.
Then, as break through cases cropped up, so did concerns about vaccine efficacy and virus
transmissibility.
Now, with a new OMICRON variant entering the fray, let's clear up any confusion about what's
going on.
Joining us now, immunologist and researcher Jennifer Gommerman, who joins us from the discovery
district on the downtown campus of the University of Toronto where she is a professor of
immunology.
And Dr. Gommerman, it's great to have you here tonight how are you doing?
>> Jennifer: Great to be here.
Thank you.
>> Steve: Let's start with why are the break through cases as high as they apparently are?
>> Jennifer: Of course as we vaccinate more and more people there are fewer people who
haven't had the vaccine.
Cases are going to be more and more focused on the vaccinated.
That is partly a numbers game.
But it's also important to keep in mind that these vaccines were designed to protect us against
moderate to severe Covid-19 that requires hospitalization.
And so the vaccines actually weren't designed to prevent what we call transmission,
person-to-person transmission.
And so break through cases are expected to happen.
They're not happening as much as we thought they would.
Because there is apparently some immunity within the upper respiratory tract that is
preventing transmission.
You're not a sitting duck.
But they will happen.
And that is expected.
>> Steve: All right.
Let me follow up with this.
Because of course for the first year or more of Covid-19, everybody got -- everybody who
got it got, I guess run of the mill Covid-19 and then the delta variant came and weigh we
realized almost everybody in the hospital had Dell T now OMICRON is on the way we're told.
Do we yet -- when I say "we" I mean "you" have a good sense of what kind of Covid-19 most
people are getting these days?
>> Jennifer: Let's talk about delta first.
The key thing about delta is that it's highly transmissible.
And so when you get it, it's also very good at infecting us.
You get a larger viral road.
That can cause more severe disease.
We know that high levels of the virus are not good.
But really the main difference with delta is its transmissibility.
It can really just drift through a school or a congregate setting in a way that the previous
variants were slower to do.
Now, OMICRON, which we're hearing about quite a bit and I'm involved in a
government-funded organization that studies variants as they emerge.
OMICRON is worrying because it's possible that it will also have the same kind of
transmissibility as delta or maybe even more.
We really don't know what's going on yet with OMICRON until the experiments that are
happening right now reveal whether it's going to be more transmissible and what impact
it's going to have on the pre-immune population.
So people who've had Covid-19 or people who have been vaccinated.
>> Steve: In which case, how much do you think we ought to worry right now about waning
immunity?
>> Jennifer: I have spoken about this before to the media.
I don't like the word "waning" because it really implies something very negative.
We know that antibody that is are provoked by vaccination or infections will not stay super
high forever.
That's not physio logical.
We know as time goes, your antibody levels will decline.
That's important.
Because we need to make room for other immune responses to happen.
You so we have declining antibodies and antibodies -- I guess you can think of them as
the first fire wall that the virus has to contend with if it wants to get inside our body.
As our rates decline breakthroughs will become more common.
It doesn't mean that moderate or severe Covid-19 is going to start appearing everywhere.
It might happen in people who are immunocompromised but if you have good immunity there are
other ways the immune system deals with a break through infection.
That's called cellular immunity.
The immune system is kind of like a Swiss army knife where antibodies are just one tool.
But if the virus gets past those antibodies, then the cellular immunity that's inside our body
can deal with the virus.
>> Steve: All right.
At the risk of being too self-indulgently give an example and get your conclusion as to
where we are.
I have had two AZs ASTRAZENECA shots, one booster shot which was Pfizer.
I have also had Covid-19.
So I have those natural immunities built up as well.
Am I in reasonably comfortable positioning for not getting OMICRON?
>> Jennifer: Provided are you a healthy person, then you are in reason shape for not getting
moderate to severe Covid-19 caused by the variants that we have looked at so far.
With OMICRON, we simply don't know yet how good our immunity is going to handle that virus.
We know that when you're immunized, you generate cells that actually get better and
better over time.
These are called "B" cells, they become memory "B" cells.
And if they're reactivated they become memory "B" cell.
Those memory "B" cells can keep learning more and more about what your were vaccinated
against and that is the spike protein of the during that process we do know and this is
published, peer-reviewed data, that the breadth of the immune response actually increases over
time so our immune system is better able to deal with variants.
Whether it is going to be able to deal with a variant like OMICRON is obviously the $60
million question that we're looking at various attempts at.
From what we know about the immune response, there should be some immunity even to variants
like OMICRON.
You about the data have yet to emerge to really validate that statement.
>> Steve: Well, this is the big concern, right?
Because I guess we're up to about 80% of Ontarians now or almost 80% who have been double
Vaxxed and some people are going off and getting their booster shots as well.
Women' sure they're asking the question: Am I doing all this for naught given that OMICRON
may be more powerful than any of the inoculations that I am taking.
What would you say to them?
>> Jennifer: That's a super fair question that's on everyone's mind.
But when you have been vaccinated you are not starting at square one.
You've generated an immune response that is going to have some cross-protective immunity.
For example, so far the variants we've seen, the one that's the most divergent is beta.
So this is the variant that was first detected in South America.
Beta had a lot of mutations where the antibody response to beta took a hit.
It wasn't a complete nullification of that antibody response.
It definitely took a hit in terms of its ability to neutralize the virus in a dish.
Now, the cellular immunity -- in particular the "T" cell response did not take a hit against beta.
In fact, some of our "T" cells can recognize Sars COVI-2 that had been previously trained to
recognize other circulating coronaviruses.
So this exquisite specificity of the immune response is a little more relaxed when it comes to
the "T" cell response.
So if we take beta as an example -- and it's a good example because it's the most
mutated of the bunch, then hopefully T-cells will soon be able to respond to OMICRON.
And I think there is a good chance they will.
What you are doing is not for naught if I can use a double naught.
So if people haven't been vaccinated, this is the best way that they can prepare for
OMICRON.
And we know that vaccine companies are already adjusting their vaccine strategies to deal
with OMICRON.
But they did that when beta came out as well.
Vaccine companies quickly modified mRNA templates to deal with beta.
What they found is that when mice were immunized with the beta specific vaccine as opposed
to the original recipe mRNA vaccine, neither animal showed any differences in their ability
to clear a beta Sars-COVI-2 variant.
So that's teaching us that the immune response is pretty good at Dodge ball.
You know, pretty good at dealing with these variants.
Whether this will be true of OMICRON, again, remains to be tested in the lab.
>> Steve: That's the tough part about all of this, right?
Every time we think we're catching up this thing mutates and says you think we've caught
up?
No we've got another trick up our sleeve.
Is this the way it's going to be for the next who knows, years, years, deck aids?
>> Jennifer: Well, it's anybody's guess.
We haven't had a virus quite like this before.
It's possible that like influenza where we need yearly boosters because the virus
itself changes from year to year, that maybe we'll need to do that as well for Sars COVI-2.
Ordinarily we would vaccinate in the fall but this pandemic and the timing of vaccine roll out
department let us do that.
So boosting now is sensible for some of the population.
For example, people over 65 or people who are immunocompromised.
But ordinarily we would be doing this in the fall.
And that would prepare us for the winter, prepare us against whatever variants have crotched
up.
So maybe that's what we'll be attacked going forward.
I think it's also important to remember that if you're vaccinated, it doesn't make you
bullet proof.
You can still get a break through infection or mild COVID.
I think we have to accept that this is not a panacea.
And that it's going to be our best tool for fighting Sars COVI-2.
But in times of high rates, we're going to have to also exercise other public health
measures.
So that's the best I can do for predicting the future.
I wish I had a crystal ball.
>> Steve: That's pretty good.
And I hear you on the issue of break through because I was double Vaxxed and got it any
way.
Now, presumably I got a less severe case of it than otherwise would have happened because I
was double Vaxxed.
But it was still plenty nasty I can assure you.
Let me do the comparison, though with vaccinated and unvaccinated people.
Do they both have the same likelihood of transmitting the virus?
>> Jennifer: No, they don't.
And that's another reason for us not to throw up our arms and say I'm not going to get vaccinated
T is going to work.
It is going to blunt transmission.
The reason for that, we know that if you get a break through infection with delta and if you
are vaccinated versus unvaccinated, you'll have pretty similar levels of virus in your
nose and in your mouth.
But you will shed that virus for much less time if you're vaccinated than if you're
unvaccinated.
So you have much lower chances of spreading it to more people.
There's also some data -- I don't believe it's yet published or in a peer-reviewed journal
but it's in a preprint format that shows that the virus that is in the mouth or nose of a
break through in infected person is less likely to create cells in a dish than those vaccinated.
It could be because of those fire wall I was telling but.
Maybe it's sticking to the virus and keeping it from infecting the cells in the dish.
We don't know the mechanism.
But between that and what I told you a second ago about the longevity of how long you're
infectious, I think that really does cut down your ability to transmit.
And let me give you an example.
One of my colleagues, her daughter, under 12, had not yet been vaccinated.
And she got COVID at school.
And they didn't know until the school reported another case and then they realized she was
positive and needed to stay home.
Thankfully she is fine.
She's been a bit sick.
But what is incredible to me is that her parents, who are both double Vaxxed and were
definitely sharing the same space, same meals, the same environment with their daughter
for several days while she was infectious did not have a break through.
So I think for a lot of people they're not going to experience a break through at least at this
moment as their antibodies decrease, breakthroughs will happen.
>> Steve: That's interesting.
In terms of that young student, now that she has natural immunity having had Covid-19
you're still recommending she get the vaccine any way.
>> Jennifer: Absolutely.
So immunity with the vaccine has been proven to be better than immunity with Covid-19.
It make the sense because the vaccine is focusing the immune response to the spike protein.
That's the mechanism the virus uses to get inside our host cells.
If we focus on that and not on the other distracting elements of the virus we're going to have
sharper, better immunity.
And so yes, if you have the virus you should still get vaccinated.
You will want to consult with your doctor in terms of how long to wait after you've recovered.
But really the people who have had this virus and been vaccinated they have immune
super powers.
It seems that their antibody response in their cellular immunity is really very good so
why not enjoy that?
Because, you know, that might actually help even more against emerging variants.
Although we don't know that.
>> Steve: That's the thing.
I had lots of people joke to me that oh, you've got super powers now you're triple Vaxxed and
have had the disease.
And then I say yeah, but here comes OMICRON.
We don't categorically know whether any of what I've been able to enjoy so far will
actually protect me against that.
My next question for you is: Are you satisfied that the country is doing everything it
needs to be doing in order to prevent OMICRON from going through the population in the
way delta did and beta before it?
>> Jennifer: Absolutely.
I mentioned as part of COVARNAD.
It is the HIR funded initiative to study variants of concern we've met several times since
OMICRON came out.
We're actually trying to get a viral ice isolate.
I know that the microbiology labs in Winnipeg are on the case.
There are a lot of things that happen immediately.
I think the government has invested money in pandemic preparedness through
organizations like COVARNAD and others.
They did this in 2002 -- sorry 2003 as well when Sars emerged in Toronto but it wasn't
maintained.
Now I think we do have excellent infrastructure in place to rapidly respond to variants of
concern.
When COVID ends -- and it will end, I would urge that we not dismantle that infrastructure
because we will have other pandemics in the future.
And it's really not easy to build that build.
It's very interdisciplinary, reagent intensive.
It requires a lot of paperwork to make sure we can move samples around, et cetera.
So it's really important that once this is over that the really effective mechanisms for
dealing with a very rapidly emerging variant are kept.
>> Steve: Better not to start from scratch next time out.
>> Jennifer: That's right.
>> Steve: Got it.
That's Dr. Jennifer Gommerman, professor, immunology.
University of Toronto.
We're really grateful for your time here tonight on TVO.
Thanks so much.
>> Jennifer: Wonderful to be here and thanks very much.