Duke experts talk omicron variant
Dr. Cameron Wolfe and Dr. David Monteflori with Duke talk about the COVID-19 omicron variant and explain the threat it poses.
recording in progress. Good morning. Everyone will get started in just a few moments. We're just giving zoom a minute or two to add everybody into the room. Thanks so much. We'll get started shortly. Okay, good morning, everyone there will still be people getting added but we are going to go ahead and get started. Thank you everyone for joining us. Welcome to the latest media briefing on the COVID-19 pandemic. I'm Gregg Phillips with communications. The ο variant has spent the last week making itself known as the latest concerning mutation of COVID-19 first affected in South Africa cases have since been found in multiple countries, including here in the us. We have to Duke experts with us today to discuss what we know about the variants so far and the likely timeline for figuring out what we don't currently know and how everybody can go ahead. Following public guidance and being safe. Was today is David Monty Fury. He's a professor and director of the laboratory for AIDS vaccine research and development at the Duke University Medical Center where he has been studying the emerging strains of covid 19. Good morning to you. Good morning. Also joining us is Cameron Wolfe. He is an infectious disease specialist at Duke Health and an associate professor at the School of Medicine where he studies infectious diseases and biological and emergency preparedness for hospital systems. Good morning Dr Wolfe. Good morning, Greg. Good morning. Dave Dr Monti Fury. We'll start with you what's being done right now to assess the omicron variant and what do we know so far about. So what we know so far um that that people are getting the most information from despite it being still limited information is from the the sequence of the genes of the virus and in particular the spike protein that's in the vaccines and is the target of the immunity that the vaccines induce. We know what that sequence is. We know that there are a lot more mutations and despite protein of this variant than in any of the previous variants, there are over 30 mutations. Um and um we know that some of those mutations have been a problem in some of the earlier variants and now you have them all together here. So and what we can glean from that information is primarily what people are working on now and then, you know the big question, how contagious is this variant? Um Right now it is a concern in South Africa. Will it take off in other parts of the world where the variant is being found? Now? Those are really you know, the two key questions on my mind right now. Sure, absolutely. And we'll dig into those more as we move along, dr wolf like to move over to you, obviously this isn't the first variant of concern to emerge. How do you think about new variants from a patient treatment clinical perspective when this has it's a great question, Greg, I mean I think I sort of split it up into two ways I think as David said you discussion on on how contagious the viruses? How easy is it spread? And that's factored both by things unique to the virus. So how quickly does it divide and replicate? And also can it evade your own defense, be that natural immunity or vaccine? But then quite separately there's clinical management. Clinical management I think is Split two ways. Also both in terms of treatment options. For example do our monoclonal antibodies do our medicines that we've learned how to work with over the last two years still have the same efficacy and then separately. What's the severity? So people when they get infected are they coming into hospital in critically ill. And does the immunity that they come with from vaccines for example or previous infection affect that we've seen so far with previous variants. That vaccine and natural immunity has been very effective at mitigating severity. I think we're still learning how that plays out here but with some early Sure. Absolutely. Thank you both for those quick introductions. We're gonna open up to questions. Thanks to everyone who submitted questions in advance. We have plenty of them. You can also pose questions via the Q. And a window at any time. You'd like to ask the question in person, please raise your hand in zoom and we'll meet you when your turn comes around. If you're calling him by phone you can raise your hand by pressing star nine. Um So we'll go through some of the questions we already have Dr Monte Fiori. Um you've mentioned some of these concerns and questions we have answered. Um Do we have any sense of a timeline As for example, like how soon we might know whether this via this variant is particularly resistant to vaccines for example, or how soon we'll find out just how contagious it is. Yeah. So, multiple laboratories around the world are racing right now to isolate the virus and to grow it up in the laboratory to do the initial tests to give us an indication of to what extent this variant might escape our vaccines. And I was just on a call before this one where there are two or three laboratories now that have isolated the virus and are growing it up and we expect other laboratories to have the virus, many other laboratories to have it growing up by the end of next week. And then the tests can be done relatively quickly. Um The timeline, we will certainly see a lot of data before the holidays. Um and I would expect to start seeing some of those data coming out Um as early as um uh 10 a week to 10 days from now. Some initial results. And and those initial results will be testing serum samples from people who have received the various vaccines to see how well the antibodies and those serum samples are able to neutralize the virus in the laboratory and that is usually a fairly reliable predictor of how well the vaccines would be expected to work against the variant. Absolutely Greg. I think there's also a really important clinical timeline. That's almost exactly the same as what David described. So there's both laboratory confirmation of efficacy but there's also a clinical to say South Africa has really a very rough, quite robust reporting system in terms of how they're sharing data with the rest of the world, which really needs to be celebrated. One of the things that we've seen there already is the start of an uptick in hospitalizations and yet over the next week or two, what will be carve into that a little more. Is that uptick simply because of a larger number of people falling sick, particularly how many people within those severe cases or how many cases in general? We're in vaccines, visuals, how many cases were in previously infected individuals. And that gives you a real clinical sense then, of how well natural and vaccine immunity is holding up in the real world. Some preliminary modeling data would say that natural immunity here is actually not holding up as well as has been seen in previous variants. And so Having been if you were infected with the wild type virus for example, at the very beginning of 2020, there was actually data to support the fact that that immunity was quite protective against alpha delta and gamma variants. However, initial data from South Africa would suggest that that is not holding up as a here. Whether that translates you too protective vaccine immunity also I think we'll get a really good clinical sense of week or two and it's helpful from South Africa's point of view for us even domestically in the U. S. Because they have predominantly used fighter and J. And J. Vaccines which are commonly used here in the US and I think will translate really effectively as we predict what this does here and Greg. I would just add that these early laboratory tests that will be done do provide a fairly reliable indication of how we would expect the vaccines to perform against the variant. But you always need the clinical data to back it up. That is really the most important information to have. Sure. Absolutely. And dr Montefiore to stay with you and kind of zoom in on this as a as a real world kind of question, what would you say to anybody right now that may be considering the vaccine or considering a booster but concerned about holding off because they think it might not be effective against the new variant. Well, we are still dealing with primarily the delta variant in the world and especially here in the United States and people who um uh elderly people and people who are immune suppressed because they're on immuno immuno suppressive drugs or have some under other underlying disorder really need to get boosted because the uh their their immune system needs that extra boost to give them really good immunity. And so, you know, that's the way I would look at it right now. We're dealing with delta and that boost is going to be really important for those people um um to to protect them from the current uh predominant uh variant that's circulating and it is also likely to strengthen the immune response to the omicron variant. We do know that boost the boost does strengthen the immune response against all of the variants other than omicron of course, which hasn't been tested but all of the previous variants, it does strengthen the immune response to all of those variants compared to what was seen after the initial vaccination series. Absolutely, Dr Wolf. You mentioned one of your clinical concerns being how the current treatments, how effective they'll be against macron monoclonal antibodies and such. What kind of timeline should we expect before we know whether existing treatments are also effective against this new variant. Yeah, I mean, it kind of parallels the discussion we've just been having in terms of vaccine efficacy. So, oh, Let's split the treatment down into three groups, these monoclonal as antivirals which we're now starting to see released and then there's in hospital and so monoclonal you can predict and model and map out what various mutation points will do in terms of their binding and therefore their effectiveness. We have already seen preliminary press releases at least warnings from Regeneron for example, who hold down really? The main workhorse is that we've used here in the United States to say look we don't think it's going to be as effective. Conversely, I saw this morning that GSK who makes the tremor have actually come out and said look we think in the laboratory that ours continues to bind well. So preliminary data exactly. So far from the laboratory we need to see in real cases to fully understand how that works and frankly whether it modifies which drug we might use first. Yeah the antivirals. So there's been a lot of talk recently on multiple revere and fighter also have a pretty really work in a fundamentally different way. They do not act primarily on the spike protein which has had most but not all of the mutations seen here with a micro So again, preliminarily there's not there's not biologically valid reason why they would work less. But those drugs are still working their way through various stages of FDA approval here. Hospital treatments are very different. So hospital treatments fundamentally in the U. S. And elsewhere have focused on reducing the hyper inflammation that your own body. Yeah sort of mistakenly begins to show if you've been fighting off covid of any variant and so there's no again there's no reason why that would be diminished with Macron. But but again we will see that when we start to get more set. You're about severity. Sure, absolutely. Um, staying with you dr walker who had a question coming here about case numbers in north Carolina which we've seen increased pretty dramatically in the last couple of days. Uh, do you have any kind of theories about why those daily numbers have jumped this week? Yeah, I mean as David said earlier, we uh, we are in a delta wave still states 100% at least of the cases we've sequenced here at duke have all been delta so far. So it's not a new variant causing. Thank you. Think when you overlap, what's happening in december, what are we saying the same as last year? Congregate activity which was thanksgiving had the widest most frequently used travel weekend go back to largely pre pandemic travel amounts. I think it's getting colder and I think we have to be realistic that when that happens, what do we do? We as a community hunker down and spend more time inside in closing it areas where we know covid transmits readily. So I suspect that is nothing yet to do with variant activity and everything to do with the fact that frankly maybe we just eased our guard off a little bit and it's also occurring at a time when we when we learned from last year that Covid spread easily. So it does, you know, it does pose a warning. I think let's be realistic about what's coming up in the next few weeks we have christmas parties that many workplaces are now starting to think about again and we have christmas and New Year holidays again. I suspect most folks will have had trouble plans set in stone be reconsidering and we need to think about that within the context of covid in general, not just so what what helps in that situation? Yes, boosting and vaccination helps but it's also masking distancing, handwashing, air quality, all of those things. Yeah, that's what's driving this peak. So where the omicron adds to the so doctor if you are ready to follow up on that, you know last year obviously we saw a big bump and there were no vaccines and there was a lot of public health guidance encouraging people to be careful. Do you think there's a danger of complacency this year because millions of people are vaccinated and boosted and what kind of advice adding on to what dr Wolper said, would you give to people who are pondering their holiday plans are deciding how and whether they should gather? Well I think oh macron and the possibility that it could become the next wave of uh and and dominate the pandemic. We don't know that yet but the possibility that it might um should raise some concern and make people more careful this holiday season and be sure to wear your mask, do social distancing is as much as possible avoid large gatherings um and you know hopefully prevent this variant from taking off and really causing a problem. We we should anticipate that this variant might be able to out compete Delta again we don't know that but you know I think we should be cautious and be thinking about that possibility and behaving in a way that would, would mitigate the spread of that variant and your risk of being exposed to it. Absolutely, thank if I can just back up on what David said, they're a little bit as well. It's worth looking at what's happening in South africa within the context of socially what was going on in that country. So they are, they're coming into their summer. So in theory indoor congregations less problematic however they were coming out of a period when in fact they're national rates of Low for for 2020 and what you had seen the federal government they do was in fact withdraw negation efforts and they had gone back to phase one restrictions really their lowest level of restrictions with widespread social gatherings and um probably sadly in hindsight some very big political rallies in and around Johannesburg and Pretoria and so like as we think about how that affects us, I mean I think it's a good warning to say we've been down that road before we know how lots of congregate and rallying activities cause Delta to take off, it looks like that at least probably somewhat contributory in south africa as well, but it also means that on the converse side, uh, we still need clarity as to really how much of that is Macron and how much of that is the social circumstance that was existing in and around those big city. You're absolutely thank you. And you mentioned the situation in South Africa, one of the things that we're seeing lots of reports office that they have a very robust testing system there and I'm wondering if you could speak to the testing environment in the US and whether we are sufficiently equipped to be able to pick up any increase in rates of our Macron or if we're going to be severely delayed because we don't have quite as comprehensive testing in the US. Yeah, I mean there's been a lot said about testing and so what sort of, let's carve that out a little bit. First of all you need tests and I don't think, I'm saying something that folks wouldn't have heard before if I say that testing in the United States has problematic compared to, for example, what about european colleagues? It is hard and it is expensive to have tests readily available for folks. And so I was actually pleased to see the administration yesterday plan actually come out and really trying drive home more testing and at home testing plan for folks who are insured, which leaves a carve out. But then you can think also then about what, what kind of testing are we talking. So there's both rapid tests which are that were discussed. They won't tell you whether you've got a macron but they'll tell you whether you're positive or not for covid in general. That's helpful because that then allows you to make individualist decisions how you keep yourself away from other folks. How do you get your medical care how you stop transmission cycles with your behavior. And so you know encouraging people to get testing in the lead up to travel or congregational activities around christmas I think it's gonna be really helpful for us understanding oh macron is different and you know that requires molecular level sequencing or by good fortune. Some labs actually have a particular machine capability that can identify a macron based on particular molecular dropout called an S drop out. And so there are some labs who can give you preliminary information already to say look hey we think this is behavior um on our testing platform. Like and I'm a cranberry in. So when the U. S. For example reports the number of states that I've had positive cases. Yes bevy more already seen that sort of preliminary data to say look actually we're seeing dropouts here on our testing primers that hint that this is a macron but we need more secrets to figure it out sequencing takes time. I mean in any labs hands that's a good number of days to get cohorts of sequencing and batch batch them and understand what it looks like. And so, you know, an individual one sequences, but we'll learn fairly quickly where this is transmitting and how fast it's transmitting. And then you'll see sort of week by week. So macron increased at a pace that hints that it takes over from Delta. Or does it stay relatively control? Lots to work on. That's right. So I would I would just add to that, as you know, as you said, knowing whether or not you're infected with a particular variant does require the molecular test. Unfortunately, some of the pcr tests using this s gene dropout gives you a preliminary indication of whether or not it's home a crime. But then that needs to be verified by genetic sequencing. And that's done in specialized laboratories early in the pandemic. The United States wasn't really doing a very good job with this genetic surveillance. There weren't many places that were monitoring the genetics of the virus that was circulating here and what we saw were places like the UK and Israel that really led the way in the majority of sequences coming in were from those regions. And they were able to detect variants very early on and in particular the alpha variant. Um but we've now been through the alpha variant, the beta variant and now, you know, Delta. And that has raised the level of genetic surveillance. The urgency for that in the importance of that has has raised the level of it in the United States and many other parts of the world to where we have much much better genetic surveillance uh than than we had previously. And so we are much more capable of detecting potential variants of concern much earlier and monitoring them so that we can learn about them, learn how contagious they are and where they're spreading much quicker than before, earlier in the pandemic. Well that's certainly encouraging at least um we have a raised hand um uh in the audience there, Jason brian you are now um you did go ahead and ask your question. Hey folks, this Jason de bruin with north Carolina public radio. Thanks for the opportunity to ask the question. This is going to be sort of a basic um in some ways just sort of ignorant question. But I want to make sure I get it. Right, I'm thinking I know the M RNA vaccine targets that Spike, Right. That spike on the edge of the virus that allows it to attach to a healthy cell, you know, gain entry and then reproduce it. Am I understanding correctly that it's at least it looks like the omicron variant has that same Spike. And so the MRNA vaccine is likely to be effective against that variant in ways that it's effective against the other variants and then contrast that with because it is a variant and it seems to have changed, it's likely that, you know, your natural immunity if you've had covid say Delta or some other variant is not as effective. Um as as in providing that immunity, which of course gets to the final question. Even if you you know, even if you've had covid get get vaccinated, get boosted. That's of course the final question. But I want to make sure that I'm sort of thinking about in the right way so I'll stop there and sort of let you jump in. So I'd be happy to answer that question. Uh First of all, all of the coronavirus is have a spike protein. It's basically the same spike protein. And you're absolutely right. That is what is in the M. RNA vaccines and as well as the J and J. Vaccine and many of the other vaccines. Uh and it's in the vaccines because the spike protein is as you said, the part of the virus that allows the virus to latch onto a cell and infect a cell. And if the body makes antibodies to that spike protein, they can block the ability of the virus to infect a cell. That's that's the goal of these vaccines. What's happening is that the sequence the amino acid sequence of the spike protein is changing. We have seen changes in all of these variants of concern. Uh And they're some of these changes. So a lot of these changes just happen randomly and get accumulated in in the virus and they don't really matter to the virus, they don't do anything, they don't allow it to escape. Are vaccines. They don't make the virus more or less contagious or are likely to cause severe disease. But some of them do matter. And there are a set of mutations in current variants that we know about. Uh that when you when you have those mutations in the spike protein, they do allow the virus to partially evade our vaccines in the worst case so far has been the beta variant. Um and we now know that the omicron variant contains Three of the worst mutations that we have seen in previous variants. And in addition it has um close to 30 mutations total spread throughout its spike protein. But most concerning our 15 mutations that are in the portion of the spike protein of the omicron variant. That is where the the spike protein actually attaches to a cell. So and that's where the key regions are that the antibodies that can protect you buying too. So you know that that's why scientists are very concerned about omicron. It's because of those mutations in the spike protein and in particular the region of the spike protein that the antibodies buying too. It's also it's also why I think you'd be concerned when you see reports that natural diminished because natural immunity, you make antibodies against spike vaccine immunity. You make antibodies against Spike although there is subtly different. Bye. And so if reports from South Africa would suggest my natural antibodies are not holding up well to binding against this variance spike and therefore stopping viral entry and stop action. The extrapolation question that we're all grappling with is well, hang on. If those natural antibodies in very well. What about the vaccine antibodies that are targeting the same place and they also diminished because of the mutation talked about and if that's true then then you see breakthroughs. Hope that answers your question. Yeah, that's that's certainly helpful. Um, yeah, I don't, I don't have a follow up right now. So thanks. Okay, thank you both very much. Another question we've had uh that would like to to address is that there are some suggestions circulating online that macron may cause less severe disease than other. Various. Is that premature? Is that pure rumor? What do we know about that? Yeah, I think that's a little premature to describe in that set. Um, you know certainly have been reports from South African physicians already who say look most of the omicron cases that we've seen. But we need to remember that that's true for delta. That's true for beta and gamma rays or two. And it's worth remembering that the majority of the cases early on that have been picked up in South Africa have often occurred in young healthy folk where we may not expect really severe cases. It's only when you get to really analyze a variant like this many more thousands of infections and look at the way it impacts hospitalization. Look at the way severe cases take place that I think we'll learn how to address the question of severity. So for example with delta variant an alpha, it took quite a few more weeks after we already saw that the virus was more contagious and was spreading for us to then look at hospitalization rates and see you're actually here. It's also causing more severe illness. And so we it would be premature for us to talk about severity without a better understanding of truly what's happening on the hospital side of South Africa. And then also what happens in the US. Far more vaccinated population. I think South Africa's rates of vaccines in and around Johannesburg and Pretoria sort of sit in the mid to high thirties. You know our vaccine rates have markedly better. Not perfect but we're up in the sort of 50 to 75 last so how does that impact severity is not known. So I'd be really cautious about prematurely chalking this up as being mild. Sure, absolutely. Um Doctor Dr Wolfe was just talking about the vaccination rates and obviously here in the U. S. We are up to I guess in some areas at least 75%. But one of the ongoing question seems to be if our vaccination rates here in the U. S. For example are kind of flattening out where they are. Is that gonna be sufficient to get to the kind of much heralded herd immunity or is that an idea that we need to let go of now and we're just simply not going to get to the point where we can eradicate this the same way we have polio and other diseases that were beaten by vaccines. I think we definitely need to keep trying to get more and more people vaccinated the way the pandemic has been going in the United States, we have not reached that magic number of herd immunity. That's reversing things the way that we'd like to see this pandemic reversed and hopefully eventually shut it down. The key is going to be for more people to get vaccinated. Absolutely. Thank you both very much. And you've both alluded to this a little bit but I wanted the opportunity to reinforce it. Obviously the information that's coming in about the omicron variant is not realistically going to be here in time for people to adjust their holiday plans. But what I'm hearing from you guys is that masking and social distancing uh something that we really need to lean heavily into this holiday regardless of whether we're more concerned about omicron or delta. Um And what I want to ask you is if people, you know kind of scheduling in person holiday parties in a way that they wouldn't have last year. Do you think that maybe people should even if they're vaccinated boosted? Think about this holiday the same way they did last year when we didn't have vaccines because we are still facing a pandemic? Well I suppose go ahead kim. Okay. Um, it's a really good question because the big fundamental differences we are heavily vaccinated. Let's not, let's not undersell that that is a far better position than we were in in december. Um, you know, as a vaccinated individual, my risk of getting severe hospitalized, requiring illness has plummeted that said, you know, we also know what causes transmissions risk and we also know what allows viruses to continue to spread. Its me being in close indoor environments without airway protection. Nascar Fords and so it would be unwise. I think for us to assume that simply because we much more vaccinated as an individual or as it can, that will simply lead this to go away. I mean up taking rights as someone mentioned it, carol and heavy covid rates. If you're sitting at the moment in michigan or colorado for other states, point to what the following in terms of planning. You know what we're talking about here is to say, look plan in a way that acknowledges what the event is and acknowledges what your risk is. So if you're planning an event, can you make attempts to keep the numbers relatively small. Can you make attempts to have folks masked where they will, can you make if they can't are there options for you to get tested before you travel or join. So for example, you know, we have a vaccine mandate. For example on the indoor setting of Cameron stadium where if you're not, if you can't produce your documentation, then we're going to require you to have a test. I mean, I think those sorts of individualist, situational mitigation efforts are going to be even more and it's hard because you know, we sort of have had two years of thinking about, you know, top down government rolls or pandemic restrictions that we don't think about apply to everyone. Well, I think we're moving into a situation where it's going to need to become much more individualist. So I am planning to travel for christmas fruit, but I plan to travel with my n 95 mosques in my family mosques. I plan to travel knowing that we are all vaccine and I plan to travel, recognizing that if I have any symptoms beforehand and probably anyway, I will get a test because I'm going to visit in laws who are elderly and may not need me to be irresponsible and ted up with code. So it has to be an individualist approach. It has to be community centric and it has to be dependent on what your activities are going to be. But let's not stick our head in the sand and think that it's going to go away just because it's a vaccinated community, it's clearly not sure. Absolutely. Thank you for characterizing that for me dr money theory. I wanted to go back to something you mentioned earlier about the beta variant, you mentioned that that was obviously one of the most effective variants of getting around vaccines. And you also mentioned that it has some of the same spike mutations that we've seen in a micron. Is there anything we learned through the analysis of the beta variant that could help us when it comes to getting in the trenches against the omicron? Various well, there there are several things that we learned uh number one that ended up being a local outbreak despite the fact that that variant spread to many other parts of the world. South Africa is the only place where um it really took off in and was a major problem for a while. So um again, we don't know what's going to happen with omicron. Will it be a case like beta and be primarily a problem where the initial outbreak occurred uh and not become a globally dominant variant? Or will it behave like alpha and delta did and swiftly become a dominant variant in the world. So, keeping a very close eye on that, we don't know the answer yet, but we also do know that some of the mutations that are in the spike protein are mutations that did create the biggest problem with the beta variants so that the beta variant was able to evade the astrazeneca vaccine nearly completely. That vaccine was almost completely ineffective against that variant. But the M RNA vaccines and some of the other vaccines were still um they had reduced efficacy but they were still very effective against debate a variance. So we haven't really seen a variant yet. That has been a serious problem for our vaccines and we're hoping that won't be the case with. Oh macron but again because there's so many additional mutations, we just have to wait to get those answers. Sure, absolutely. Thank you both. We've got another raised hand in the chat. So we're gonna go ahead and um you carol Pearson, you're muted. Please go ahead and ask your question. Okay, be muted carol. Yeah, I think. Okay we will we'll attempt to come back to carol in a moment. We can figure out what's going on with the microphone there. Dr Montefiore, I'm gonna stay with you. We've had a question coming about, looking at the origins of our Macron, It was reported that the variant was in samples collected at schiphol airport in Amsterdam on november 19th and 23rd. So the question is is it considered possible or increasingly likely that the variant already had time to spread over a longer time band and a wider geography before it was first isolated in Botswana and south africa. Well that that's entirely possible. Yes, but my understanding is the first report of the omicron variant was actually Before. The reports in the Netherland about November nine in Botswana. So it's still possible that it did originate there. But again, despite how good the genetic surveillance is. Um not everybody who is getting infected as having their virus sequenced. There are a lot more infections occurring in the world than are being sequenced relatively speaking. It's a it's a small portion of infections that are being sequenced. So yes, it's entirely possible that this variant did actually occur somewhere else previously before it was observed in Botswana in South Africa and and and um it could also be present in more countries than we're aware of right now. And as more sequencing is done, we're finding the variant and more and more places in the world. Sure, absolutely. Thank you. And and a follow up we have to that which is more of a big picture thing. Is that is there anything about the timeline of when variants of concern have been popping up and where that gives us any kind of understanding as to how the rest of the pandemic might play out? Or is it more random than we can then we can really predict. So that's a good question. We've actually had three different variants that rapidly became the dominant variant. They were more contagious than the previous variant. Um And and over a matter of months became the dominant variant. The first one was the D 6, 14 g variant early last year Over a period of about three months. That variant overtook the initial Wuhan globally and became the dominant variant. It was the majority of of sequences that were coming in from from around the world. It didn't take very long for it to dominate the pandemic. And then later we saw alpha come along And over a period of about five months that became the dominant variant globally. And then Delta came in and Delta had kinetics very similar to the original de 6 14 G variant in that in a matter of only about three months it was clear that that was becoming a dominant variant. So I think we're going to know in a relatively short period of time whether or not a macron is going to follow a similar pattern. On the other hand, there have been other variants of concern that at first appeared to be more contagious as though they might actually dominate the pandemic but then they petered out, they were not able to compete with other variants. We saw that what was called the new york variant and the California variant. Those did start to spread. They were a problem for a while but then they got out competed by other variants and you don't really find those variants anymore. So there are these different ways that omicron could potentially go based on what we've seen with previous variants and we just have to wait and see how this variant is going to behave. I think there's a bit of an elephant in the room when we talk about variant emergence though, which is that variance will continue to emerge at a pace that is somewhat proportional to the amount of virus that exists in our global community. And you know, it shouldn't be news to people. So far. We have had wide disparities and inequities frankly in the way that our vaccines are destroyed and not just vaccine distribution but in the way we have assisted globally to ensure that vaccines get to arms of individuals. So for example, South Africa would say reasonably robust supply of vaccines and yet have not to convince their public through many reasons. Mm to increase their vaccine uptake. So I do think there needs to be a recognition that it is incumbent upon all of us. Not just U. S. But globally that we will continue to see variants and we will continue to have our own global issues fall back on us domestically. Unless we can increase our global rate of actually not taking mitigation and we have not. No one I think could justify that. That has horrible thus far. I want to pick up a little bit. You mentioned shuffle earlier and I think there's if folks want to listen in to find something that could be incredibly instructive clinically next week or so it's to think about what actually happened on that plane. The KLM plane. So that oh, It was a large plane over 600 individuals on that plane where 61 or 62 depending point that you read have tested positive, irrespective of how many of those will ultimately turn out Macron and it's not fully reported yet. 10% of a congregate activity under any circumstances is really significant for what we've seen so far at any point over the last two years with Covid. And so I think in the same way that we learned a heck of a lot about clinical transmission last year by seeing some of the poor cruise liners stuck off japan. You can have sentinel events like that one plane trip that inform us dramatically as to the transmissibility and vaccine of asian capacity of So for example, there now reporting that the 1st 14 sequences that they know omicron are all in vaccinated individuals. And that's that's disturbing frankly. And I think much to learn over the next week or two as the dutch authorities help us understand what why. And I do think it then bleeds into the following question which is all about travel, but Well sure, absolutely. And that's I think that's a good opportunity to talk about travel. You know, we've had this question come in talking about travel restrictions mentioned that americans returning don't have to isolate when they come back to this country. Does that blow a hole in efforts to contain it and how effective our travel bans and travel restrictions up to and including isolation after travel in containing this. Well, let's be frank. I mean they're not historically been very effective at containing it at all. I think we need to recognize that viruses transmit readily and unless you're going to take a far more aggressive almost draconian approaches say Australia and use just ban all travel. Um it you can't ban a country, you can you can attempt to restrict people who are coming from the country, but that also that involves restricting your own U. S. Citizen. That's not something found palatable so far franklin. We need to be mindful that the US has domestic transmission of omicron so that horse has bolted. That is true for many european countries already travel restrictions can help I think delay a pandemic of in a particular country a little bit. So you know, if we've right shifted our cases case burden somewhat in a way that gives us more information for groups like David's lab to help us understand vaccine, responsiveness or monoclonal antibody treatment effectiveness that's helpful. But we can't kid ourselves into thinking that it alone will. And the question from carol I think is really important because travel ban that then does not involve careful testing before you get on and after you get off the plane and does not involve quarantine efforts and mitigation affect efforts on people once they step off the plane leaves leaves large holes effectiveness. And so we've somewhat addressed that by the Um administration requiring testing now to be within 24 hours of hopping on the plane. I mean I think that's helpful. It doesn't address the one you hop off the plane question remains a whole. And I think the other big red flag here is travel bans have consequences. They not only have economic and social consequences to us, they have profound economic and social consequences to the country's upon which their plot. So we have sat here for the last 45 minutes talking about the need to find more data and how we have been both open arm reliant and thankful for South Africa to be as open in the disclosure of sequencing and data as they have been. But they are now calling to say, hey we're going to run out of testing re agents here. If you keep travel bans in place, we can't get we can't get laboratory equipments that resupplied in ways that we need to if you continue to restrict all the flights to us. So we really have to be sensitive to not shoot ourselves in the foot with travel politically exposed and we need to be very careful actually called. Sure. Absolutely. Thank you. Dr one if you're coming back to you. Um, how much do we know? This is a question we just had come in. How much do we know about transmission of omicron within the U. S. So far? Well there have been um a small number of cases in the U. S. And I expect that number to increase substantially over the coming days but really we do not have a clear idea of how contagious this variant is. Is it going to be more contagious than Delta And I'll compete Delta. We really don't know it's just too early. Sure. Thank you. And and staying with you. We had a question just about something you said earlier and you said that we haven't really seen a variant yet. That has been a serious problem for our vaccine. I'm wondering you know how much of that is uh like is there a danger of overconfidence in that or is that just a reflection of of how well the vaccines were put together building on decades of vaccine science that led us to this point. What more can you say about that? Well I think um it's just a fortunate event that the initial that the spike from the initial Wuhan form of the virus is inducing an immune response that so far has been cross protective against the variants that have emerged for the most part with some exceptions. So that's good news. We're in uncharted territory here in terms of um the ability of this virus to evade natural immunity and vaccine induced immunity. We're learning it's almost two years of the learning process now. So we're able to make predictions now that we couldn't make before but there's still a lot of gaps in what we know and we're going to learn a lot from um a crime that I believe will help us in the future as additional variants come down? The pike. Sure, thank you. We've got Jason de bruin with his hand raised again. So Jason. Well you go ahead and ask your follow up question, you sort of already touched on this. Um and it's a question that I know I've been asking for months now but it's a it's around the vaccine equity piece and I just I wonder if maybe you could provide some more comments about, you know, is it possible that if the U. S. And other First World countries had for instance donated more to covax or if the, you know, if the companies uh we're distributing or selling the vaccine at a lower rate that we never would have even seen omicron in the first place and that the whole world would be safer? I think that's certainly a possibility. Um but how likely is it with the availability of vaccines and the ability to get these vaccines out to people? And the extraordinary difficult job of dealing with vaccine. Hesitancy which is not something that's just seen in the United States, it's seen everywhere in the world. So we have many challenges to vaccinating enough people globally to really have a major impact on preventing other variants from arising in the future. Is it possible that if we had a better global effort that the omicron variant would not have emerged. Yes, it's possible. How much of an impact would it have had? I I think that, you know, depends on how effective the global vaccine effort would have been up to this point and we just, you know, we don't know but we do know that the sooner we can vaccinate the majority of people in the world, the sooner we're going to shut the virus down. As Cameron mentioned earlier, the more virus that exists in the world that's replicating in people and that's spreading from person to person, the higher risk of variants arising and spreading. So we in order to shut this down, we just need to protect enough people to reverse the trends that we've been seeing globally and not just locally. There's some there's some parts here that will require some really careful research, moving for sociological research. So sometimes I think that easy band I think is just to say, well we'll donate more vaccine and not to say that that's not a good thing. It clearly, but it's also an understanding of why hesitancy exists in certain countries. It's also an understanding of how logistics and supply chains and healthcare networks exist to vaccinate in certain countries and then it's sharing as South Africa is trying to do frankly data on the impact. And so for example, zero prevalence surveys in and around Johannesburg Pretoria show widespread natural So there's people with antibody of rights in the 60-80 and I think one of the local issues that may have come out to some extent for some folk there is the recognition that maybe the natural Okay, so for example, something for us to really consider describing as more data comes out on that because that theory exists here in the United States. Well, I've had covid so I'll be fine is to look very carefully at natural immunity and see how it holds up here and reflect that back to communities that may be struggling with vaccine hesitancy and and and put good data in because it may well be that we can increase vaccine rates through not just simply supplying more of exit. I think we're all on the same page. That better and more equitable distribution of that will certainly help all of us question. Sure, absolutely. Thank you both. And Dr Monte Fury, I'd like to come back to you on something. Dr Walford said there is uh there are a lot of people out there saying, well I had covid back in 2020 I have natural immunity. I'm safe and there's no need to get vaccinated. What would you say to those people? Well, that would be nice if it were true. But unfortunately it's not what we know is that most people who have covid experience a very mild case of covid and in general, they don't really mount a very strong immune response. Their body is able to deal with the virus and eliminate the virus fairly easily and quickly before the immune response has the chance to really gain in strength. And so um and the majority of cases the immunity the natural immunity that's provided by infection is not very strong. And in fact what we know is that it's far weaker than the immunity that the vaccines give you. The vaccine induced immunity tends to be much stronger than what you see in most people who have recovered from covid infection. Absolutely thank you. Um pivoting slightly dr wolf yesterday President biden kind of mapped out the trajectory for the US trying to reassure people about the emergence of a macron. What did you make of the plan that he presented? Whether elements in it that you talked particularly interesting. Is there anything else you think the U. S. Should be doing right now from a from a policy? Yeah I mean it was a really multifaceted plan and let's be honest having a plan is certainly helpful. Um You know the part that I was pleased to see was a focus on travel like we talked about a little earlier about testing. Certainly a focus on home testing I thought was a real bonus. And if that translates into simply wider availability of testing that impacts transmission rights would have been a great goal. Uh You know there's a discussion on boosters. We've had a little bit of that here and how that will will will help us from an individual and more importantly perhaps from a community um focus on mobile vaccine clinics was raised be a helpful event, although I think most people at this point will will recognize that vaccine availability has not as bigger issue as it was january when supply was sparse. Like it's pretty easy for folks. These get their supply of excess. You know, we still have a lot of people who are on vaccines or insufficiently vaccinate. And it was um, There was some focus on that. So for example, continuing to roll out vaccine in our 5 to 11 year olds and our teenagers, we know that will help moving forward under fires were a long way away from that. What was missing. And I think it was difficult for me to to hear the absence of see the absence of this was any discussion on Yes, yeah. Ah you know, we have struggled in the U. S. To have a singular focus when it comes to mosque in when it comes to broad social mitigation efforts. And yet we've talked David and I have talked about that a lot here already. And recognizing the importance of that is we've learned at over two years. I do think if rates continue to increase over the winter, there needs to be a frank national discussion on that. Whereas I think so far that has not been politically something where folks have had a lot of appetite to re tackle that was missing yesterday comments on masking comments on distancing better use of finances that do exist in some of the plans to fix air handling systems, for example, in indoor schools. We need to be thinking about that. We know that's effective works the money is sitting. So there are lots of techniques that, that we can do. Some of them were mentioned yesterday. Very effective. But there was um, we don't follow up question sort of related to that regarding home testing and individualized testing. Um, you know, if people have access to testing at home and want to be responsible about it, what kind of, what kind of circumstances under which people should be testing? You've mentioned if you're planning say travel with family. But I mean if you're you're at home, you're worried about potential symptoms. What kind of parameters should people be using to test themselves for code? I mean I'll describe what we do. We have a, we have a supply at home. I feel fortunate both financially and available tests are privy to cruel, but I use them in situations. For example, when my kids have sent mild symptoms typical for kids for Children, but I need to understand as a physician in front of immunocompromised patients have I been directly exposed in my home situation to my kids who have coped because if that's the case I need to do a very different thing when it comes to stay. Um, similarly as we come into the winter and we've seen a resurgent number of influenza para influenza and respiratory syncytial virus cases. Our kids are going to have, uh, you know, I'm going to have respiratory illnesses and to help begin to differentiate which are sort of the regular common colds as opposed to covid can be incredibly impactful for not only what happens to your child, but what happens to parents do they need to stay out of work? What happens to daycare transmission rates? What happens is to my staff who want to come to work, But so far I have not been able to because they don't have that sort of immediate testing capacity that can impact decisions like that. And so like if you're an employer right now, that can be incredibly financially impactful for your workplace to understand in far more real time what's happening to your workforce. Whereas at the moment, the only two choices, they get a much harder and time less urgent test. That means they're either at work and symptomatic which causes more issues or they take time off work because they're not sure and you've lost it For a day or two. The flexibility that that gives you is really huge as an employer. The final thing you mentioned is travel like I do, I don't want to be responsible even if I know I'm fully vaccinated and boosted and therefore not likely to get. I don't want to take my minor illness. two people who made grave risk of covid than me. And so we plan to test ourselves prior to christmas travel and I think having flexibility built into your travel plans to responsibly say, look, I can't come this time because he is my testing. It is actually a really safe and responsible thing. I don't want anyone to be responsible for someone else's infection. Yeah, absolutely. Thank you. Were getting ready to wrap up here shortly, but I had wanted to give you each of the chance to reiterate one thing in particular, Dr Montefiore. I'll start with you. You know, we addressed the issue of vaccines for people who feel like they already have natural immunity. But one of the questions that doesn't ever seem to go away is people worried about what they're putting in the body, worried about what they're putting what's in the vaccine. So I would just like to give you a chance to to explain to people what is in the vaccine, why it's in there and why it's safe for people to get. Yeah, that's a very good question. And I think it is still a concern for a lot of people who are hesitant to get vaccinated. They hear a lot about the MRNA vaccines and they don't really understand what MRNA is. A lot of people don't unless you're a scientist, you really don't understand it well enough to appreciate how safe it is. And so as scientists, we try to educate the community. Um these M RNA vaccines are are very very safe. This technology is um it has been around for about 20 years and now we've seen it in billions of people. Um and it's actually safer technology than many of the vaccines that have been used for years and years and years in our in our Children and adults. The the MRNA is not something that's new to your body. It's there's lots of MRNA and every cell in your body. Um It's what drives the functions of the every cell in your body. And this is just another messenger RNA that encodes despite protein that helps train the immune system to target that that protein to prevent infection. It doesn't last very long in the body. That's why you need to get boosted. And early on the boost was after only 3 to 4 weeks because the messenger RNA, the M. RNA doesn't last very long. So and and and we've seen that it's very very safe. So it's a very exciting and helpful technology because he can be so rapidly deployed and because of its safety record. Absolutely thank you so much. And and dr walker you've talked about individualized decisions and why masking and social distance are important. But we see so many people saying masks don't work there no good. Could you just take a brief moment before we close to explain why I'm asking is effective and what makes it so important. Well they do work. So let's counter that straight off. Absolutely help. So we know this is a respiratory virus transmitted on small. Yeah. And shielding my exhalation absolutely prevents those droplets from moving in a way gets to you. Now. It's probably true that masking wouldn't be so necessary if our distancing was perfect that I wasn't close enough to you. But we live in a community where that doesn't, it doesn't. Yes. So my ability to wear a mask to stop my infectious respiratory droplets moving to it's okay to we've mitigated here, like in the hospital, for example, when we instigated a mask policy for all of our staff, our staff infection rates at work flat. It was, it was an incredible change in 2020, we continue to wear mosques every day. They also offer and we shouldn't forget they offer protection to you. And so if I am inhaling through a good quality mask, even if people around me are not masked, my protection level has gone up. So it's important to think of masks as being both protective for my spread to you. Remember, Covid can be infectious before I have symptoms, particularly if I'm vaccinated, my symptoms may be mild. So I may not know that I'm putting you at risk. The mask protects you just as important. The mask protects me. And so I tell patients, for example, who I see, we do it as a family. If I know I'm in the car. I wear a high grade mosque And 95 Mosques or Kn 95 mosque in that situation is better protecting for me. Any surgical grade mask or high intensity mask is good protection for you. We have learned that things like gators, for example, particularly when they get wet and sweaty or sort of, some of the less Phil trading masks were not as effective. So I think the choice of mask is important, but also beyond that, simply the amount of time that you're prepared to wear the mask is crucial. There's no point thanks. But they absolutely work. They need to be a part of what we, we need to get used to continuing to have to seven. That is going absolutely. Thank you. Thank you both for reinforcing those points. We're gonna leave it there. We've reached the hour. Thank you everyone for joining us. Thanks so much to our panelists, David, monty Fury and Cameron Wolfe for sharing your perspectives. As always, if you'd like to be notified of upcoming briefings, please email Duke news at Duke dot E. D. U. In the meantime, please stay. Well, always consider your source when you're listening to information where a mask and get vaccinated. Thank you so much and have a great day. Thank you. Thanks, David. Thanks