COVID Expert Follow Up: What We’ve Learned and the Path Ahead

COVID Expert Follow Up: What We’ve Learned and the Path Ahead

This post is a follow-up to our original interview with Dr. Matt Ferrari, conducted in April 2020, as COVID-19 was still new to most of us, and we were trying to figure out what was safe to do on and off our bikes. Much has changed since then, including the development and rollout of COVID-19 vaccines. So we caught up again with long-time Stan’s friend Dr. Matt Ferrari, Director of the Center for Infectious Disease Dynamics & Associate Professor of Biology at the Center for Infectious Disease Dynamics at the Pennsylvania State University to get his take on where we are now with the pandemic.

Stan’s NoTubes: It’s been quite a year! Looking back at what has unfolded, what has surprised you most about this pandemic?

Ask an Expert - Dr Matt Ferrari

Matt Ferrari: The vaccine story is the big surprise. It’s amazing that we were able to develop a vaccine, test it, produce it and roll it out in this kind of time frame. A year ago, we were predicting that it would be 18 months to two years until a vaccine was ready. Then we’d have to take time to test it and make it, including scaling up production and rollout. So to see half a billion people around the planet vaccinated at least once so far is unbelievable.

SNT: Tell us more about vaccine development and why it was so fast this time?

MF: Vaccines are a special medical intervention because you typically only give them to healthy people. We are cautious because in developing them, you have to take lots of people who are healthy and give them a medical intervention. You do that to a half billion people, and of course, thousands will have a bad day the next day. We normally don’t do things at this scale and speed because we’re worried about negative reactions. But this past year there was a pandemic, so there was a pressing need to do it fast.

Sequencing this virus and developing candidate vaccines only took a few weeks. Then developing the trials and the manufacturing took months, but even those got done really fast. Normally, you give a vaccine and a placebo and wait and see who and who doesn’t get sick; however, testing a vaccine during a pandemic speeds things up because there are so many opportunities for exposure.

What it shows is really hopeful. When we put our minds to it, we can speed up the way in which medical interventions make it into the marketplace and start helping people.

SNT: What about this pandemic has unfolded as you expected?

MF: Unfortunately, it was everyone’s reactions to population-wide, preventative restrictions like mask wearing, social distancing, limiting events, and closing restaurants and bars. In public health, we call those non-pharmaceutical interventions, and they are necessarily broad and non-specific. They are what you use when you don’t have a drug or vaccine.

Drugs are for people who are sick, and vaccines are for people that are healthy. When we don’t have drugs and vaccines, we have to rely on general interventions. They suck because we all have to make big sacrifices for the public good. People get tired and as they relax their efforts, the virus comes back. Last February or March, there was a group doing projections, and they suggested we might have to have repeated lockdowns with resurgences. Everyone castigated them in the press and said there was no way we’d have to do that. But sure enough that’s what happened.

We asked everyone to do something hard to prevent a scary outcome. People did it, but then they feel like they are done and relax. If you want to continue to achieve an outcome, you have to stay on it. There’s a good sports analogy. To stay fit, you have to keep training. You have to keep doing the hard stuff. Serena Williams doesn’t just go from Grand Slam to Grand Slam. She works her ass off in between to get ready for the next one.

SNT: We’ve learned a lot about the virus, but what do we still have to figure out?

MF: There are two things that we don’t know. First is how and why the virus is variable in harming people. Yes, we know that if you’re older, male, and have preexisting conditions, you have a worse outcome: a 10% chance of a severe outcome and 1-1.5% chance of mortality. While that’s a small number across the country, it’s big on an individual level because we just don’t really know who is at risk and who we have to worry about most. From a medical treatment perspective, it’d be nice to figure out who we really need to watch so we could monitor them and get ahead of the treatment.

Second, we don’t know what will happen next. The virus is changing as all viruses do all the time. We worry about functional changes - like the way it works in the body. We’ve seen concerning shifts in some variants. For example, B.1.1.7 is 50% more transmissionable and 50% higher in mortality rate. That’s like going from 1 to 1.5% mortality rate. Again, small in absolute numbers, but large in consequences over billions of people around the world. P.1 and P1.351 are two other variants, and those second groups have a different enough spike protein structure that they can evade the immune system a little bit. You are less protected against them with the J&J, Pfizer and Moderna vaccines. You might go from 90% protective down to 75% or 80% protective. Yes, they’re still really protective against severe disease. You might still get it, but you are less likely to get severely sick.

New variants are likely to arise. We just don’t know what. Will the next variant combine aspects of current ones or do something totally different? The way to deal with that is to monitor and have systems in place to react. If you know something bad will happen, you should be vigilant and be prepared to react. You can’t necessarily prevent it because you don’t know what it will be. You have to monitor, see it happen and pivot quickly.

SNT: With so many conflicting messages, information disorientation has been a side effect of this pandemic. Now some states have lifted nearly all restrictions, while there are lockdowns again in Europe and India. Vaccine availability has been aggressively increasing, but so have decidedly non-medical-based attitudes toward the vaccine. What's your assessment of our situation now?

I’m optimistic. I’m planning to go back and race on June 5 at my first event. But I’m cautious and concerned. I know everyone is overwhelmed. The increase in vaccine rollout is unbelievable, but I’m worried that it will plateau. Right now we’re vaccinating all the people that want to be vaccinated. Sooner or later, we’ll bump into those who don’t want to get vaccinated, and it will slow our progress.

We have a distributed system of governance. Different states make different decisions. It can cause spikes that spread. As several experts have stated in recent months, having some states relax restrictions while other states stay closed is like having a designated area in the pool where you can pee. It just doesn’t make sense. If you live next to a state that’s open, you might as well not be doing anything.

We’re all concerned about our local situation, but viruses don’t respect borders, and there are significant inequities in vaccine access - even just within the U.S.. There has been a black market for knowledge about where and how to get vaccinated. But even if you are in the know, there are still inequities. Some clinics are only open on weekends, but if you don’t work a 9-to-5 weekday job, you might not be able to access it even if you know about it.

In the short term, if we don't have a directed distribution system to overcome inequity, we will just reinforce it. We will see this reflected nationally and globally, too. We have 75% of older people vaccinated in the U.S., but other countries don’t have any doses yet.

We all want to protect our local tribe, but we have to force ourselves to pick our heads up and look around and act in the greater good. We have to get the whole world back in order. We’re so deeply interconnected. That’s something you probably already know -- think of Stan’s supply chains, for example. We need people to be safe and healthy all around the globe.

SNT: What’s the impact of some parts of the world getting vaccines more quickly than others?

MF: The delayed rollout around the world is the reason we won’t get rid of COVID sooner. To get rid of it, we’d have to get the whole world vaccinated quickly. Yes, we can get the U.S. vaccinated and mostly to zero soon, but it will still be circulating elsewhere. We’ll travel and go and get infected and bring it back again and again.

This virus will be with us for a long time due to the delayed global vaccine rollout and inequities. We missed the tiny window we had to eradicate it completely. But it won’t be as bad once we can get everyone vaccinated. It will be like the flu in the future.

SNT: Does that mean routine seasonal COVID vaccinations?

MF: I anticipate that we’ll have to get repeated vaccines, but probably less frequently than annually. Other coronaviruses that are out there tend to change significantly to the point that you can get reinfected on the order of every seven to 10 years. If that happens with this virus, we’ll get people revaccined at some optimal interval less than that. The good news is that there is almost no risk to us to get vaccinated frequently.

It’s tricky though because if the vaccination interval is too long, people will not comply with the need for repeated vaccination. So it might be best to just get it done every year like people are already used to for flu vaccines.

SNT: What will it take to finally get out of this pandemic? Best case & worst case?

MF: Getting “out of the pandemic” doesn't mean no coronavirus anywhere. It means getting to a place where risk to the population and the individual are low enough that we can return to in-person interactions and indoor events. Any specific number I say will turn out to be wrong, but if we can get to something like 75% immunized or vaccinated, then risk will drop below a concerning level.

An important part of this is that we’ll have to get the vaccine tested and authorized and rolled out in children - not just adults. Getting it into kids is the last operational hurdle. I think we can get close to a lot of normality once we can get the vaccine to kids. I’m guessing that will roll out sometime in the fall.

SNT: Many cyclists are eagerly signing up for bike events or will soon. What are best practices for staying safe at events?

MF: Stick to the basics that have worked from the beginning: hygiene, masks, and distance. A vaccine on top of all that is even better. You won’t want to be the reason someone else doesn’t get to participate in the event. You want to protect everyone in the peloton and not only yourself. If everyone has that mindset, we’re likely to do the right things.

Contact your event and find out about their COVID event protocol. Processes are what save us. We can return to a lot of outdoor activities if promoters think about and put processes in place. Such protocols will also prevent the spread of other viruses, too - we’ve all gone to events and gotten the race flu from something we picked up there.

One thing I’ve told some friends is to keep your bike with you at all times because then you can’t get too close to anyone. You’ll have no choice but to maintain some distance.

SNT: So is it safe to go to events if you have a vaccine?

MF: It’s safer than if you don't have a vaccine. Remember that the vaccine isn’t 100% effective, and you won’t know if you got the unlucky draw of still being able to get COVID until you get sick. Get your vaccine as soon as it’s your turn, keep your distance, keep washing your hands.

SNT: Any parting thoughts on what we’ve learned this past year that can help us in the future?

MF: The most important thing is to recognize that community health is personal health. Our communities have to be healthy for us all to be safer. In this country, we often focus on individual freedom and protecting ourselves. We don’t always think about protecting others around us. When we do, it makes them and all of us safer.

It’s like when you’re mountain biking in the woods, you know to just stop and check on someone with an injury or flat. That’s what we’re asking everyone to do when we all wear a mask or get a vaccine.

For the most up-to-date information about COVID-19, visit the Centers for Disease Control and Prevention (CDC) website.

Our original interview with Dr. Ferrari can be found here.