COVID-19 Vaccine: To Get or Not to Get?

As mentioned in a previous post, the race of the vaccines is ON and more competitive than ever at this point. Well, there seems to finally be some progress in the race. Operation Warp Speed is a federally funded program working hard to produce and deliver hundreds of millions of safe, effective, and affordable vaccines by January 2021. They have been active in the vaccine race since March, and have already been developing plans for delivery of the vaccine upon approval. Just several days ago, the U. S. department of Human Health Services announced partnerships with large chain pharmacies and networks that represent regional chains to cover up to 60% of all pharmacies in the United States, which will greatly increase access to the vaccine once available. This is great news, right? Well, not exactly. The public opinion on the vaccine seems to be pretty indecisive, surprisingly. I know all I’ve heard for awhile was “I can’t wait for them to just have a vaccine already so things will go back to normal,” but now that that is becoming more of reality, people are starting to express distrust for the vaccine. Even physicians and nurses are expressing distrust for the new vaccine. There are many reasons one may be distrustful of a vaccine, but today I will be discussing one individual in particular whom I believe is responsible for much of the public’s distrust.

Andrew Wakefield is a former British physician, according to his Wikipedia page, who has been struck off the medical register in 1998 due to his claims of a link between vaccines and the MMR vaccine. He has since become known for anti-vaccination activism. In 1998, Wakefield published a report from a study that hypothesized a link between vaccination and developmental disorders (this study has since been retracted). In his study, Wakefield investigated 12 cases of children referred by a pediatric gastroenterology unit who had a history of normal development followed by a loss of acquired skills to try and determine the cause of the regression. At a first glance (and as a student who has been involved in research), this study was quite poorly conducted and interpreted. The sample size was considerably small, and given the retrospective nature of the study, Wakefield essentially concluded that the the MMR vaccine may have been the causative agent from word of the parents of the affected children. This was also a case series study, which results from these studies are generally only generalizable to very specific populations. This study had no control subjects and relied on descriptions of histories in order to pinpoint a cause. Dr. Zane Thomas also outlines several discrediting factors of Wakefield’s study in an article published by the Cambridge Center for Behavioral Studies. One of the first flaws pointed out in this article is the lack of randomization of the study, which impacts the validity of the study. It is even thought that Wakefield picked his participants from a program called Justice Awareness and Basic Support (JABS), which is a program offering support for “vaccine-damaged children.” Another concern discussed is the fact that the children exhibiting bowel problems may have been doing so prior to vaccination, discrediting any causal relationship. The last major point that was discussed in Thomas’s article, in my opinion, is that of the obvious research bias exhibited by Wakefield. It is mentioned that Wakefield and colleagues’ objective of the study was to seek evidence of a causative connection between the MMR vaccine and certain conditions in children. This makes it seem as if they knew what resulted they wanted to obtain, and would tailor their study to provide these results, indicating some serious researcher bias.

Another article I would like to discuss is a study published by the New England Journal of Medicine that also examines the relationship of the MMR vaccine and developmental issues. This group of researchers conducted a retrospective cohort study of ALL children born in Denmark between 1991 and 1998. The researchers received the subjects’ MMR vaccination status from the Danish National Board of Health and information on the subjects’ autism statuses was obtained from the Danish Psychiatric Central Register. They also were able to obtain information on confounders through several other reputable sources. This study ended up enrolling 537,303 subjects, with 82.0% having received the vaccine. After adjustment for confounding variables, the researchers assessed the risk of developing a developmental disorder from the MMR vaccine to be .92%. This study was able to use unvaccinated children as a control and ultimately was able to conclude that the risk of acquiring autism was similar in both vaccinated and unvaccinated children. They also were able to observe that there were not “clustering” of cases of autism at any time after immunization. This study seems to be very unbiased, in their objective was to examine the relationship between the MMR (not to prove a relationship), used a representative sample and controls, and used scientifically ethical research methods and data analysis. This study did a wonderful job at discrediting the initial Wakefield study.

Back to the topic at hand, I believe it is safe to conclude that Wakefield is largely responsible for the distrust of not only the COVID-19 vaccine, but for vaccines in general. Personally, I do think that more people are weary of the vaccine due to it being generated in such a short amount of time and not knowing about long term side effects more than they are worried about autism spectrum disorders. Either way, something I still don’t understand is why everyone was pushing so hard for a vaccine that only 50% of healthcare personnel would admit to being comfortable with getting. In my own experience, I have heard my peers talking about herd immunity and how they plan to rely on others to get vaccinated so that they will not have to, but if everyone has this same train of thought, no one will get vaccinated. This is a very scary time for our country and I am honestly very disappointed in much of our country’s response to both the virus and our attempt at flattening the curve. What I believe I am most disappointed in, however, is how our country managed to take a virus and turn it into a political issue. I promise this virus does not care if you are left or right, so stop behaving as if it is the case. This is science, not a political platform.

COVID-19: Episode I Lost Count… “Race of the Vaccines”

Since the very beginning of the outbreak of the novel SARS-CoV-2, pharmaceutical companies from around the world have been racing against not only time, but against each other, as well, to be the first to manufacture an approved vaccine for the coronavirus. Companies have taken many different approaches to this, including protein subunit vaccines, RNA vaccines, whole virions, non-replicating viral vectors, etc. If it can be used to develop a vaccine, you can bet the option has been or currently is being explored. One of the big name companies participating in this vaccine race is Bharat Biotech of India. According to their website, Bharat Biotech is a world-class biotechnology company with a mission to deliver safe, affordable, and high quality vaccines to people and have a focus on emerging markets, such as the market created by recent the SARS-CoV-2 outbreak.

If you navigate to their vaccine section of their website, you can see that Bharat Biotech has recently been approved to begin Phase 3 clinical human trials after successful interim analysis of their Phase 1 & 2 trials for their newly manufactured vaccine, COVAXIN. According to this informational webpage released by the FDA, Phase 1 trials typically last several months and enroll anywhere from 20-100 individuals to participate. The main focus of this phase of the trial is to establish a safe dosage and the effectiveness of a safe dosage of the vaccine. If the study passes Phase 1 of clinical trials, it may proceed to Phase 2 (about 70% of studies are approved to progress). Phase 2 of clinical trials can last anywhere from months to two years, and can enroll several hundred people in the study. The main purpose of this portion of the study is to determine efficacy and side effects in patients. Typically, only about 33% of vaccines or drugs will progress past this stage. Phase 3 of clinical trials can last anywhere from a year to four years, and enrolls anywhere from several hundred to several thousand participants. COVAXIN is, as previously mentioned, beginning Phase 3 of clinical trials and was actually approved for the enrollment of 26,00 participants across 25 centers in India. This phase has an emphasis on the monitoring of adverse reactions to the drug. The fourth and final stage of clinical trials focuses on, once again, the safety and efficacy of the drug/vaccine and is eligible to enroll thousands of participants.

While their website offers little information on the science behind the vaccine, the CDC has released a document summarizing many of the key components of vaccines in the running, including COVAXIN. COVAXIN is an inactivated whole agent vaccine. This means that the vaccine contains whole organisms (viruses) that have been inactivated by treating the pathogen with a chemical that kills the organism without significantly altering the surface epitopes. Essentially, the antigen is capable of remaining immunogenic through the epitopes, but is incapable of reproducing. The inactivated organism is injected into the patient and elicits an immune response that creates antibodies and memory cells against the pathogen, in this case SARS-CoV-2, but the virus is unable to replicate, so the immune response will not be overpowered by the invading organism. This allows the patient to build up active immunity to the antigen so that when the live virus is encountered later in life, the body already has made a primary immunogenic response and can use that to generate a much more effective and stronger secondary response when encountered in vivo. Since COVAXIN is an inactivated vaccine, it will require 2 doses to elicit a response large enough for the body to maintain an immunogenic response (booster shot). The second vaccine is proposed to be given 14 days after the initial vaccine.

No information that I have encountered addresses the nature of the study used to determine the effectiveness of COVAXIN, but many human clinical trials, including many (I imagine) exploring COVID-19, utilize a double blind placebo study design, In this study design, there are two (at least) groups of patients treatment. One of those is typically the experimental drug group, and the other is a placebo group. A placebo is a substance that has no medicinal effect (like a sugar pill or inactive ingredients) that can be used to compare whether or not the experimental drug really shows any significant difference in prevention. The placebo is harmless and usually has no effect, good or bad, on the patients physical health. Mentally, the placebo could elicit the placebo effect, which can be confounding but is less of a concern in preventative drug studies due to the objective nature of the results. In this study design, participants are “blindly” assigned to either the experimental or placebo/control group, meaning they don’t know which group they are in. Likewise, the researcher administering the vaccine is also “blind” in that they are also unaware of which patients are receiving the real vaccine versus the placebo. This is an extremely effective study design because it greatly diminishes any bias that could impact the findings of the studies.

Another topic of discussion regarding vaccines is that of the speculation of companies potentially requesting an Emergency Use Authorization (EUA) for their naive vaccines. As noted by this Wikipedia page on EUAs, n EUA allows the FDA to facilitate availability of the unapproved vaccine during a declared state of emergency. This would allow companies hand out their vaccine during states of emergencies while the product remains unapproved. This could cause chaos in the testing process because an the efficacy standards of the vaccine may be compromised under the circumstances. In other words, the companies may begin to release a vaccine that is “maybe effective” under the EUA since it is an emergency; however, any vaccine attempting to gain FDA approval should have higher efficacy standards than “maybe.” EUAs may also speed along the research portion of the vaccine clinical trials, which may result in an increased risk of error in approval of a substance that might not yet be ready for approval.

Antibodies for COVID treatment

As most everyone knows, President Trump and the First Lady were recently diagnosed with COVID-19. President Trump was using an experimental antibody drug cocktail (REGN-COV2) manufactured by Regeneron Pharmaceuticals to speed up his recovery, as discussed by Dr. Thomas Campbell, an infectious disease specialist at the University of Colorado School of Medicine. In his article, Campbell asserts that REGN-COV2 contains two monoclonal antibodies. He describes monoclonal antibodies as lab-engineered proteins that act like the effector cells of the immune system that are normally naturally produced at exposure to a viral infection. Regeneron decided which antibodies to use as monoclonal antibodies by observing antibodies that were present in human patients that recovered from COVID-19, as well as in mice that were genetically engineered to have human-like immune systems. The findings of their observations led the researchers to two key antibodies, where were manufactured into the monoclonal antibodies REGN10933 and REGN10987 that are used in the REGN-COV2 treatment. Both of these antibodies bind to different segments of the SARS-CoV-2 glycoproteins, which hinders the ability for the virus to enter human cells and replicate.

Monoclonal antibodies mimic the action of naturally made human antibodies in the immune system. They can be made from either mouse proteins, human proteins, or a combination of the two, as discussed in this article by the American Cancer Society. They can be useful in treating a variety of diseases, including even cancer! The process of making a monoclonal antibody first requires researchers identifying the correct antigen to target for attack. After this has been determined, they can make copies of an effective antibody in the lab by cloning a single B-cell. Since this antibody comes from a single B-cell and targets a single epitope, it has been coined as a “monoclonal” antibody.

Trump’s monoclonal antibody therapy utilized the method described above and involves the action of two monoclonal antibodies, as discussed previously. Media outlets described his therapy as being made from fetal stem cells, which got a lot of attention from the public due to Trumps political affiliations; however, this was a false claim that carried on much further than it should have. In a fact check by USA Today, Alexandra Bowie of Regeneron told the media that REGN-COV2 is, in fact, not made from human embryonic stem cells. Bowie goes on to say that position statements on the use of embryonic stem cells by Regeneron are for transparency purposes and that their statement was a general position statement of their company in general, not specific to the method used for this particular drug. The specific cells used to isolate the antibodies generated for this drug actually came from a B-cell line isolated from human donors and mice that were genetically engineered to have human immune systems. Another area of confusion in regards to the use of stem cells was Regeneron’s use of HEK293T cells (an immortalized epithelial cell line), which were briefly used to create SARS-CoV-2 like viral particles to test the monoclonal antibodies. Bowie affirmed that HEK293T cells were used, but held her position that embryonic/human stem cells were not involved in the production of REGN-COV2.

As discussed in the introductory paragraph, the monoclonal antibodies used in REGN-COV2 target the glycoprotein spike of the SARS-CoV-2 virus to inhibit the virus from being able to enter the host cell and replicate. These types of drugs are designed to treat existing cases of infection, not to prevent future cases of infection. Due to the nature of the drug and the mechanism of its action, I would venture to say that these synthetic antibodies will not provide future immunity since they are already antibodies. Antibody therapy can treat an existing infection but will provide no long-term immunity. To me, ithis concept can be analogized to “if you give a man a fish, he’ll eat for a day; but if you teach a man to fish, he will eat for his whole life.” If we provide our body with the necessary antibodies to fight off infection (“give” ourselves the antibodies), we will have what we need to fight the current infection. However, if we teach our bodies to generate their own antibodies and memory cells, then our body will be able to better protect itself in the future. Hopefully, a generation of a vaccine in the near future will be able to help provide the latter very soon.

Real life “Contagion”

Watching the movie “Contagion” was definitely a strange experience during these strange times. At several different points in the movie, I found myself either laughing or cringing at how relatable some of the situations seemed to be (in particular, Matt Damon forcing hand sanitizer onto his daughters hands after leaving the grocery store). While the virus in the movie did seem much more lethal than the virus our world is currently dealing with, there were still many parallels between the imaginary pandemic being played out on screen and the real life pandemic we are battling today. On several occasions, I found myself criticizing the public’s response to the epidemic and yelling at the TV things like “Why are you STILL not wearing your mask??” and “Why would you be so CLOSE to someone that you don’t know in public??” Some of the biggest parallels I was able to draw were based around the public’s response to the ongoing crises.

The first thing that really stood out to me was how the public failed to listen to expert advise on social distancing, and the public also failed to wear masks to protect themselves and others, much how citizens today are handling the pandemic. At no point in the movie were “uninfected” people required to mask up as we do currently. Granted, that may be due to the lack of a possibility of being asymptomatic in the movie. I also found it super strange in the movie how people were rioting and looting as if that was solving any of the problems at hand, but again, so have people in this day and age. What I really don’t understand is the rioting against a virus, in both the movie and in real life. I don’t understand why people riot against a microorganism that literally cannot change its behaviors in response to your protests. I guess this aspect of the film could be summed up as the stupidity of the public.

Another relatable aspect of the movie was the empty grocery stores and stocking up of canned foods and hand sanitizers. At the beginning of the COVID mess, my mom spent hundreds of dollars on non-perishable foods, as it seemed people were doing in the film as well. The dad yelling at his daughter to not touch anything in the store also hit really close to home for me (LOL). Although it hasn’t gotten to the point of raiding my neighbors houses for groceries, the fear of not having food due to the virus was/is a very real concern for both citizens in the film and citizens today. This leads me to another, more broad, parallel that I picked up on, which is the fear evoked by not knowing and uncertainty. The fear of not knowing whether or not you’ll get food or the fear of not knowing how long this all will last is very real and , honestly, very rational in my opinion. I thought the movie did a good job of not really tending to the uncertainty it evoked, especially at the end when the movie ended very vaguely with the production of the vaccines. It kind of emphasizes that we never know when it will end, or if it ever really will.

The last big parallel I picked up on was the dishonesty of the government/health organizations with the public about the severity of the situation as a whole. In both the movie and real life, the government and health officials downplayed the severity of the virus. In the movie, they withheld information involving the number of deaths from the public in an attempt to not elicit irrational fear. However, when the janitor overheard the conversation, he was able to figure out just how much the public was actually in the dark. In our situation today with the coronavirus pandemic, I feel as if our government and other country’s governments have been less than honest with us about many aspects of the virus, especially concerning when and where it was first isolated. In the US, our government definitely downplayed the severity of it and its contagiousness, leading to the ultimate failure of our country to successfully fight this pandemic. In the movie, places were being quarantined and guarded by military officials to ensure a lock down, which I think would’ve been a good idea for our country to have explored in the initial stages of the spread of the virus.

Overall, it was kind of ironic in a twisted way to watch a movie about something that is literally going on outside of our own windows currently. It was funny at times to think some of the comments I was thinking about the movie in comparing our actions with theirs, and thinking about how funny it is that I am even able to draw these comparisons. Watching the movie was a humbling experience in many ways, mostly because it helped be realize that our situation could always be worse, especially with a more lethal virus. It was also fun to be able to think about the microbiology of it all and how one tiny organism can cause such non-tiny chaos and damage and quite literally change the world as we know it.

Antibiotics aiding in the anti-antibiotic problem

We’ve all been prescribed an antibiotic at some point in our lives, whether it was for a mild infection or something more severe. Either way, most everyone is familiar with the term “antibiotic medication” and the immense potential that these medications have in fighting bacterial infections! Personally, I have had so many ear infections in my life that it would probably take more fingers than I have to show you how many amoxicillin prescriptions I have been prescribed in my life. Antibiotic medications are easily one of the most profound discoveries of recent times and have saved so many lives that otherwise may have succumbed to what began as a minor infection. However, antibiotics today do not seem as effective as they once were or have been in the past, and this is due to the ever morphing nature of bacteria. The process of bacteria becoming resistant to these medications is in part by spontaneous mutation of the bacterial genome, but is enhanced exponentially by the misuse and over prescription of antibiotics in today’s society.

One of the main factors contributing to the quick acquisition of resistance in bacteria is the overprescription of antibacterial drugs by physicians. According to an article released by the CDC Newsroom, at least 30 percent of antibiotics prescribed in the United States are unnecessary. Furthermore, the CDC announces that most of the unnecessary prescriptions of antibiotics are given to patients presenting with respiratory conditions, which are commonly caused by viruses! In total, the CDC has calculated that there have been over 47 MILLION excess prescriptions every year. By having individuals take antibiotics unnecessarily, the bacteria in their body begin to acquire mechanisms of gaining resistance, Not only does this promote antibiotic resistance, but also puts patients at risk for developing allergic reactions or even contracting a potentially lethal C. difficile infection.

Another way that bacteria are developing resistance against these miracle drugs is through the use of antibacterial animal feed being provided to animals that are slaughtered for human consumption. An article published by the A Greener World, it is discussed that almost all farms in the U. S. provide low levels of antibiotics in their animal feed or water, not to treat sickness, but to allow the animals to live in close confinement while lowering the risk of disease outbreak amongst the animals. The USDA estimates that a whopping 80% of all antibiotics produced in the U. S. are used in animal food production. Not only is this inhumane treatment of the animals, but the dosages of antibiotics being provided is enhancing antibiotic resistance within the animals. This allows the normal microbiota of the animals to be naturally selected for resistance, and when these bacteria are consumed by humans, it can cause disease that can be hard to treat due to the increased resistance of the bacteria. This is one of the reasons that some strains of E. coli and S. aureus that are contracted from animals have become so hard to combat in humans. What once was treatable by a simple antibiotic prescription can now become a life threatening illness.

In an even more relevant light, the novel Coronavirus also may be aiding in the selection of resistant bacteria. While COVID-19 is a virus and it is known to not be treated with antibiotics, many hospitalized patients are receiving cocktails of multiple antimicrobial medications in hopes of preventing secondary infections to the Coronavirus. While on a surface level, this may seem smart to prevent unnecessary and potentially life threatening complications of the virus, on a deeper level it is contributing to the ever growing issue of antibacterial resistance. In an article published by MedicalNewsToday, Neil Powell, who is conducting this research and is also a consultant pharmacists, says that the majority of COVID-19 patients are prescribed antibiotics because it becomes hard to tell whether a patient with the virus has an overlying bacterial infection due to the similarities in signs and symptoms among the two. Not only does this pose a threat to the microbiota of individuals, but could also have implications for the environment. The increased use of antibiotics could lead to increased levels of antibiotics in water, which creates an aded burden on water treatment facilities. This also becomes an issue when hospitals and high risk individual receive this water that may be housing resistant bacteria.

The moral of the story here is that antibiotic resistance is on the rise, and once it surpasses our level of antibiotic knowledge, we’re in for it. If we do not begin to practice more sustainable antibiotic use, bacteria will become much harder to combat and what would have been easily treated with penicillin could become a death sentence for many. In order to combat this, it will take a combination of better practices from physicians, civilians, and farmers. It becomes the physicians job to only prescribe antibiotics when they are absolutely necessary. It is the civilians job to adhere to the medication regimen and complete the prescription if prescribed, and it becomes the farmers duty to stop using antibiotics in animal feed, or to at least lower the levels to the minimal level possible. Hopefully, everyone working in harmony to solve this issue can buy researchers a bit more time to develop new drugs that can be used to combat the more pesky, resistant strains that are becoming more populous in our environment today.

Bacterial Gene Editing Incorporated into Humans: This is CRIPSR technology

With medical technology and disease therapy advancing by the day, it shouldn’t be surprising that today’s researchers are finding ways to edit the human genome for both medical and non-medical purposes. One of the current systems used to do this is called the CRISPR Cas9 system and is a bacterial gene editing complex that allows specific DNA sequences to be removed, altered, or inserts new sequences into preexisting DNA and is currently being translated to human genetics as means of gene editing. While I will not get into the details of the system in this blog post, this video published to Youtube by Mayo Clinic does a great job of explaining the CRISPR Cas9 in simple, relatable terms. According to this article, the CRISPR Cas9 system is being explored in the context of agriculture and gene therapy to combat disease. In the context of health, the therapy shows promise of treatment for rare metabolic disorders and genetic disorders, including hemophilia and Huntington’s disease. Interestingly, it is also being used to create transgenic animals to produce organs for transplant for human patients. This new technology shows much promise in the medical world as a potential treatment or therapy option.

One of the diseases/conditions that is currently being explored as a potential candidate of CRIPSR Cas9 mediate therapy is that of insomnia and stress induced hyperarousal, as discussed in this article published by Science Advances Magazine this past September (2020). It is known that hyperarousal and insomnia are associated with strong activation of corticotropin releasing hormone (CRH) from the hypothalamus and also strong activation of hypocretin neurons that can be found in the lateral hypothalamus. Both of these areas of the brain are associated with the stress response in the human body, so it makes sense that over activation of these areas would cause an increased stress response, that would in turn increase physiological hyperarousal and make it harder for someone to sleep through the night. However, recent research has found that CRISPR Cas9 mediated gene therapy that removes the gene encoding CRH neurons of the hypothalamus can aid in the abolishment of hyperarousal caused by this mechanism and significantly counteracts stress-induced hyperarousal. While this is no cure to cancer, insomnia is a condition that can greatly decrease someone’s quality of life. I know that personally, if I go one night without decent sleep, my whole next day is super unproductive and all thrown off. I couldn’t imagine the world of difference that someone suffering from insomnia may experience as a result of this gene therapy.

While this system shows great promise for gene therapy as a means of combatting disease, it is also becoming increasingly common for parents to want to genetically modify their potential offspring. As with any genetic “meddling,” so to say, some ethical problems should be considered when thinking about using this gene editing system for non-therapeutic purposes. One of the issues to be considered is how normalizing gene editing for gene enhancement purposes could put individuals who are conceived naturally at a disadvantage. Practicing this type of gene editing could alter the human gene pool and introduce mutations into the population that might have otherwise not occurred in nature. While the mutation may be overall advantageous, it was not a naturally occurring mutation. This could alter the process of natural selection even further than current medical practices allow us to. The routine use of gene editing for enhancement purposes could allow us to breed “super humans” to excel in some area, whether it be sports, academics, or some other realm where it is desirable to have a significant advantage; however, this could be unethical because natural talent would no longer be recognized or even as advantageous as it is to humans now.

            I do not believe that we could cure all genetically associated diseases with this process or any similar gene therapy process, although it does seem promising for many diseases. I do not think that it could cure everything due to the complexity of the human genome, in combination with the plethora of side effects that may arise from editing the human genome. Personally, I would avoid editing a human’s genome where at all possible. Of course, if someone’s life depended on the editing of their genes then I would likely be much more inclined to proceed with this extreme measure. Also, if I knew my baby had a chance of inheriting a debilitating disease or a condition that would lower their quality of life, I would likely be on board with editing that part of their genome in hopes of them leading a somewhat normal life. In general, I think altering the way of nature is a path that should be avoided at most times, although I do recognize and appreciate the fact that we have these options for the cases that it could help humankind.

First the Pandemic, Now a Twindemic…

At this point, I assume that everyone is pretty familiar with “the pandemic,” in reference to COVID-19. That word has been thrown around more than any other word in the past 7 months, in my opinion. But now, there’s a new term floating about: “the Twindemic.” What could this possibly mean, you might ask. The fall 2020 twindemic is in reference to the upcoming and highly anticipated co-occurances of both the seasonal influenza virus with COVID-19. The lingering question, after realizing that this is where we are headed in the near future, is how do we deal with this upcoming twindemic and what does this mean for our health as a nation?

In a recent article published by the New York Times a mere three weeks ago, it becomes evident that there is growing fear among healthcare officials in how to best handle this upcoming twindemic. As many officials are weary about a surge in COVID-19 cases as the weather cools down, they’re becoming even more weary with the realization that an even a mild flu season could hamper hospitals already dealing with influxes of COVID-19 cases. The potential consequences of this twindemic seem to be so concerning that officials are pushing for the vaccine on a global level, even before it has become available in doctor’s offices and clinics. In order to promote increased vaccinations this flu season, the CDC even purchased an additional 9.3 MILLION (!!!!) doses of the vaccine for uninsured adults (this is in addition to the usual 500,000 vaccines that they purchase each season).

Personally, I have already noticed an increase in advocating for flu vaccines this season. Any time I have picked up prescriptions from a pharmacy in the past 2 months, I have been asked about my flu vaccine and told about the anticipated increased demand. Even donating plasma recently, the company I donate with is offering free flu vaccine vouchers that can be redeemed at any Walgreens. These efforts are wonderful on the communities part, especially the plasma company providing a way for individuals in Durham to receive a free vaccine without proof of insurance, who may otherwise not have access to this service.

This year, the CDC discusses actually having two different flu vaccines available on their “What You Need To Know 2020-21″ FAQ style page. It turns out there are two egg-based vaccines being made available this year, one trivalent and one quatravalent. The quatravalent vaccine has been developed to protect against four influenza strains: A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus, A/Hong Kong/2671/2019 (H3N2)-like virus, B/Washington/02/2019 (B/Victoria lineage)-like virus, and B/Phuket/3073/2013-like (Yamagata lineage) virus. The A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus is a type-A influenza virus and originated in the Maonan district in the Guangdong province of China. It was first identified in 2019. The A/Hong Kong/2671/2019 (H3N2)-like virus is a type-A influenza virus that originated in Hong Kong in China and was first identified in 2019. The B/Washington/02/2019 (B/Victoria lineage)-like virus is a type-B influenza virus that was first identified in 2019 in the state of Washington of the United States of America. The B/Phuket/3073/2013-like (Yamagata lineage) virus is a type-B virus that was first identified in 2019 in the Phuket province of Thailand.

The above mentioned strains are the strains that scientists and researchers predict will be the most prominent and virulent among the world population this flu season. While these predictions are generally very reliable and good at protecting the majority of vaccinated individuals from contracting an influenza virus, there is still a possibility that a different strain will rise above and be able to infect humans across the globe due to having no adaptive immunity from the flu vaccine. This actually happened not long ago in the 2014-2015 flu season. According to an article from the Washington Post, picking the right strains to vaccinate against each year is a guessing game of sorts that, while backed by data, is not excluded from uncertainty. Not matching the flu strains in the vaccine to the circulating viruses could lead to a dismal and deadly flu season, and unfortunately, every couple of years, scientists are thrown are curveball when it comes to fabricating the vaccine. One of the potential contributors to this problem is the ability of the influenza virus to very quickly morph into alternate strains in a phenomenon known as antigenic drift, and this process has the ability to drastically decrease the effectiveness of any given years flu vaccine.

Luckily, last year’s (2019-20) vaccine was found to be relatively effective according to a summary released by the American Academy of Family Physicians (AAFP) on the CDC’s Interim Flu Vaccine Effectiveness Report. The main takeaways from the CDC’s report as noted by the AAFP’s summary was that the used vaccine was 45% effective overall against the seasonal influenza A and B type viruses. More specifically, the article states that the vaccine was 50% effective against the B-strains and 37% effective against the A-strain. Compared to past seasons, Dr. John Epling makes the statement that the vaccine was about as effective as it typically is in a season where the vaccine has matched the circulating strains well. This goes to show that for last year’s flu vaccine, the scientists manufacturing it did a good job of predicting the circulating strains so that vaccinated individuals were protected from disease, thus limiting the spread of the disease throughout the season. The 2019-20 vaccine also substantially protected individuals aged 6 months to 17 years with a 55% effectiveness rate observed in this population. Even though those percentages do not seem very “effective,” it is important to remember that the vaccine is the best way to protect any individual from the seasonal influenza and its complications.

Personally, I agree with the statement that the vaccine, while not especially effective when looking at the numbers, is still the best means of protection against the virus. Even if it only lowers your chance of getting the disease by 45%, even a 55% chance of contracting the disease sounds better than a 100% chance, or leaving it up to fate to decide if you will be infected. Growing up, I actually never received a flu vaccine because my mother was afraid of me getting sick by the vaccine. Miraculously, I somehow never got the flu, either, even being enrolled in a 4A public school system. Once I turned 18, I was able to make my decisions regarding the flu vaccine, and after some research about how they are made and how they work, it became apparent to me how beneficial such a small vaccine could actually be to both my health and the health of those that I care about that are around me. I suppose the TLDR of this paragraph would have to be that some protection is always better than none.

To Wear or Not to Wear: What’s Really the Deal with the Masks?

Recently, there has been a lot of debate about whether or not wearing a face mask or covering is actually doing anything to prevent transmission of the novel Coronavirus. Honestly, at the very beginning of this whole situation (back in March), I was pretty embarrassed to be wearing a mask in public because I felt like I was the only person doing it. Now, things have changed drastically, seeing as wearing a mask in public is pretty much mandated in every state at this point. To make matters even more complicated, different media outlets are offering different viewpoints on this discussion, so how do we know which are true and which are not? It is super important to make sure that you are getting your information from reputable sources when making an informed decision on about whether or not you think a mask is offering any protection at all.

So, why have masks become mandated if there still seems to be circulating evidence that they may not help? While I honestly have not found any reputable sources claiming and backing up their inefficacy, there seem to be many claims by the public that masks are ineffective at slowing the spread. However, if you turn to the Center for Disease Control and Prevention’s (CDC) Considerations for Wearing Masks page, the CDC offers several reasons as to why the public should engage in mask wearing in public spaces. The most important reason for these guidelines is arguably that masks prevent the spread of the virus from infected individuals to non-infected individuals. Simply put, if someone infected is wearing a mask, the likelihood of them transmitting droplets to another individual in close proximity goes down DRASTICALLY. So, for everyone claiming that you wearing a mask won’t protect you from inhaling droplets, you’re kind of right. But that’s not the point. The point is to protect others by wearing your mask in the event that you are infected without your knowing.

This image depicts the science behind mask wearing in the community and how it slows the spread of COVID-19. This image was taken from the CDC’s Considerations for Wearing Masks article.

Okay, so now we know the CDC is encouraging mask wearing in all public areas. That’s a pretty good indication that the masks are beneficial to the general public in slowing transmission if the CDC is arguing for them. In response to the CDC’s reasoning, you might think, well why are people who have COVID-19 even out in public? Shouldn’t they be quarantining at home? The answer to that is yes, however, many infected individuals (especially of the college age) have tested positive asymptomatically! These individuals have no indication of being sick and would otherwise continue their normal activities. However, mask mandates help to keep the transmission from these unknowingly affected individuals at bay. In an article from the Mayo Clinic, the staff emphasize that the reason we didn’t mandate masks earlier on in the pandemic was due to a lack of knowledge of the extent at which infected individuals could spread the disease prior to symptoms occurring. We now know that the virus can run its course in an individual with no symptoms occurring. Both incubating individuals and asymptomatic carriers can unknowingly spread the disease to others if proper precautions are not taken. The Mayo Clinic article also emphasizes the guidelines provided by the previously mentioned CDC and support from the World Health Organization (WHO) in recommendations for slowing the spread.

Another article published by the BBC also touches on the emerging information regarding asymptomatic carriers, claiming that the number of asymptomatic infected individuals can account for nearly one third of all positive cases. At first, it was believed that the asymptomatic infected individuals were not very contagious, but now, it is believed that these people are still as contagious as symptomatic individuals and could have been responsible for nearly 80% of the positive virus cases in China. The article also mentions that a Hong Kong study has shown evidence that up to 44% of virus transmission from infected individuals can happen prior to the individuals showing any symptoms. While the BBC does not make a claim on the effectiveness of wearing a mask to slow the transmission of the virus from these silent carriers, one could easily pull together resources from the CDC and these statistics to make an informed decision to wear a mask in public, not to protect yourself, but out of sheer consideration for those at risk around you.

Overall, there is A LOT of information out there about the mask situation. It can be hard to try and pick out what is true and what isn’t. There are currently lots of studies going on that are trying to crack the code about the effectiveness of masks and which type of masks are better than others, but it may be awhile before the public hears the results of these studies. It’s a scary time in the world right now, especially with all the new information regarding silent carriers. Could I have already been/am I currently infected? I very well could be and have not the slightest clue. So, in the meantime, it isn’t that hard to just decide to wear the damn mask in the chance that it does actually help slow transmission.

This is one of my favorite depictions on why we should wear a face mask. This photo comes from a Reddit page.

Crohn’s Disease and the Microbiome

While browsing some information about micro biomes and their important in disease presentation and management, I came across some interesting articles that explored specifically the micro biomes role in managing Crohn’s disease. I was unfamiliar with what this disease was, so I did some research on the internet and found this great resource published by the Crohn’s Colitis Foundation that described what the disease was, what causes it, signs and symptoms, etc. Simply put, Crohn’s Disease is an inflammatory bowel disease marked by chronic inflammation of the GI tract. This seems to be manifested in affected individuals as a reduction in appetite in conjunction with increased metabolic demands. Some of the signs and symptoms, such as diarrhea, can also limit the body’s ability to absorb important macromolecules. Because of this, diet is a huge factor when considering managing Crohn’s disease.

While diet is important for obtaining the proper nutrients with this disease, the diet is also super important in maintaining or introducing good microorganisms into the individuals microbiome. Why is this important at all, you may ask? Turns out, people with Crohn’s disease actually seem to have a “signature” microbiome, according to this entry in BMJ Journals. This profile of a microbiome includes reduced microbial diversity and a less stable microbial community, as well as 8 specific microbial groups that seem to act as a microbial signature. With this information, not only can doctors now address the microbial issues of Crohn’s disease patients, but also use these “profiled” micro biomes as biomarkers of Crohn’s disease in the diagnostic process, which is super cool. 

So back to the diet: how does this help to treat or manage this IBD? In the words of Dr. Fabio Cominelli in an article published by University Hospitals: “The main mechanism of diet is alteration of the microbiome.” By identifying which bacteria are in the gut due to consumption of different foods and determining positive/negative effects of these foods, the microbiome is a very useful tool in determining what foods may have more advantageous effects than others when managing Crohn’s disease via intestinal microbes. For example, in a separate study, researchers examined the effects on the microbiome of CD patients incorporating Splenda into their diets. The results of this study showed alterations in the microboimes of both CD patients and the control group; however, the CD patients also exhibited increased inflammation when compared to the controls. Dr. Cominelli’s research also explores the use of fecal transplants and probiotic use as means of altering the micro biome in CD patients. 

After reading the previously mentioned articles and studies, it has become increasingly evident to me how important the microbiome is in not only causing disease/illness, but also in treating disease and illness. Never would I have considered the microbiome to be so complex, yet still seemingly simple when it comes to being able to alter it simply by changing your diet. If I would’ve been asked how I might approach altering an individuals microbiome, I would’ve probably jumped straight to the more invasive ideas of fecal transplants and what not, since a complex solution is usually what aids in solving a complex problem. All in all, microbiomes are much cooler than I though they could be and are definitely an interesting field of research to look into. 

My COVID-19 Journey (thus far…)

My name is Savanna Hagler and I am in my last semester here at UNC. I am from the Charlotte, NC, area and am studying exercise and sport science and neuroscience. My future plans are to attend PA school within the next three years. I love memes and making my friends laugh. In my free time, I enjoy hiking and swimming, or honestly anything outdoors. I love my friends and am so sad about the current state of our country and how it has affected my college experience. What started out as what I considered to be a “fun” and much needed extension of spring break ultimately has transformed into a rather permanent alteration of life as I knew it.

In the beginning, it seemed too surreal to actually be of any real importance to me. Sure, a more than a few people in China and Italy were pretty sick, but all in all, only four people had the novel Coronavirus in the United States at this time, so how concerned did I really need to be? I was just excited for the extension of my spring break and couldn’t wait to return to campus extra energized, less sleep deprived, and ready to conquer the remainder of my sixth semester at UNC. Unfortunately, none of that was meant to be.

With the extension of spring break, I figured educators and deans were just trying to play it safe and to encourage self-quarantining for those who went out of town for their break. Never in a million years did I think that our country would be in the state it is in today as a direct result of our lack of control on this situation. Honestly, I thought that officials and authorities were being way too liberal in their handling of the situation and didn’t really see the need for the stay at home orders and what not. I now realize that no matter how strictly they would have tried to enforce them or how liberal their approach was, many people would still simply choose not to comply with officials for whatever reason and our country would very likely be in the same state it is in currently.

At first, I was embarrassed to wear a mask in public. I said it. I hated that my mom made me wear a mask if I wanted to grocery shop for myself (this was before it was mandated). I look back and laugh now because I have a different mask in every bag and vehicle that I regularly use. If I had a dime for every “Oh shit, my mask,” that has exited my or my housemates mouths, I would probably be rich enough to not need a college degree at this point. I’ve also become an avid contact lens wearer due to the frustration experienced by having my glasses fog up with every breath while wearing glasses. All in all, I hate the masks, but so does everyone else. I also realize that wearing the mask is my duty to the community since I am choosing to remain active in it, unlike many of my fellow peers.

Besides the downward decline made by the country throughout all of this, I believe it is also safe to say that my mental health took quite a beating as the situation unfolded. Being home with my parents and siblings for five months with no real escape for the first time since high school had its consequences. Not being able to see or hang out with my lovely college friends whom I consider my family was heart breaking. Everyone turned twenty-one on their own with no celebration. Everything that I was looking forward to for my last spring semester was stripped away from me piece by piece. The only good thing that I can confidently say came out of my at home experience was getting to spend some quality time with my dog, Chico, whom I miss dearly when I am away at school.

Overall, my Covid-19 journey has not been a great one, but I don’t think anyone else’s really has been great, either. I can’t wait for things to go back to normal, or at least approach a return to normal. It seems as if we are on a never ending downward decline as a country in our handling of this situation. My favorite analogy of all of this so far is that it’s like in elementary school when you would get silent lunch, but a few kids keep talking during it so you keep getting silent lunch. I really wish those few people would just shut up so we can work on healing as a country. It is not a conspiracy. It is not political. It is a literal virus that does not discriminate in its victims.

Here is my attempt at hyperlinking and I have included an image of me with my sweet pup, Chico.

Savanna and Chico in quarantine, spending some quality time together.