Mark Moran [00:00:03] Hello and welcome to TGen Talks. I'm Mark Moran. On December 31st of 2019, the Wuhan Municipal Health Commission in China reported a cluster of cases of pneumonia. A novel coronavirus was eventually identified and labeled COVID-19. Since that time, nearly one hundred ninety-five thousand Americans have died and over six point five million have tested positive for the disease. Globally, the number of deaths has reached nearly one million, with over 29 million citizens testing positive. 2020 has been unlike any year in recent memory. In addition to the human toll, businesses and schools have been shuttered. Economies have virtually crumbled, all while scientists have raced to increase testing and develop a vaccine for this deadly outbreak. Our guest today on TGen Talks is Dr. David Engelthaler, co-director of TGen North the Pathogen and Microbiome Division of TGen located in Flagstaff, Arizona, who shares his insights on the latest information and developments surrounding COVID-19. Dr. Engelthaler, welcome.
Dr. David Engelthaler [00:01:17] Thanks, Mark. It's great to be here.
Mark Moran [00:01:19] The number of reported cases of COVID-19 in Arizona is going down and no new known deaths have been reported. Hospitalizations continue to decline and the percentage of tests coming back positive has been dropping for several weeks in a row. What do you think we should read into this? And can we draw any trends at this point?
Dr. David Engelthaler [00:01:37] Well, there's no doubt that that's all good news. These numbers are are have been heading down for well over a month now and really across the board, as you mentioned, it's the cases, it's the positivity rates. It's the number of deaths. It's the hospitalizations. So the trends have all been really good and this has been good for Arizona. And the same is true for many parts of the country as well. What we should take into that is that this pandemic is definitely been on the decline for a while, but it hasn't gone away. So we still have to keep our guard up, which is really hard to do when the case numbers go down.
Mark Moran [00:02:14] Early on, it was hard to get a test. They were in really short supply. How has the increase in testing and the ability to do so been affecting the numbers? Do you think we're better able to make predictions about this disease?
Dr. David Engelthaler [00:02:27] There's a couple of things when we really increase our testing capability we're much more likely to be able identify the cases that are out there. But we're also able to identify individuals who may be infected, who may have the virus and maybe they can't transmit it. So we actually start to get some confusion. In our case, tracking is everything a case that's positive. We don't really know, but we're definitely getting a better look at this virus as it exists in the communities.
Mark Moran [00:02:57] Arizona is at eleven percent positive from nearly one point six million tests. What level do you think we need to reach from an epidemiological standpoint to feel comfortable that the disease is under control or manageable, contained, so to speak, to borrow a term from the other crisis we're facing these wildfires.
Dr. David Engelthaler [00:03:16] The numbers right now, if we if we look across the whole pandemic, we're at about eleven percent. But week over week for the past month, we are definitely down below five percent on average around the state. And in many places in the state, we're at two percent or even lower positivity rates. Again, this is all great news. The percent positivity rates have been going down. I think we really do want to see it stay below five for hopefully for a couple of months period of time. That just means that there's fewer people out there that have the virus and it's harder than for the virus to really move on to additional individuals.
Mark Moran [00:03:56] Even as we're seeing some positive signs in parts of the country, including Arizona. That's not the case everywhere. And we're seeing some disturbing upticks nationally and even internationally. You mentioned remaining vigilant, keeping our guard up. It's school time again, though, for example. And how likely is a second wave, given that COVID is as unpredictable as it has proven to be?
Dr. David Engelthaler [00:04:17] What we really have to understand is this pandemic is dynamic and it will continue to shift in and we'll likely see additional waves, hopefully nothing like the surge that we went through this summer. Case numbers will continue to go up and down and in different locales, and that could be driven by a number of different things. One of those, I think, is the universities opening up and potentially schools opening up. We are seeing increased numbers of positive individuals and university campuses across the country, including here in Arizona. That's going to affect our numbers. It's also going to possibly affect the amount of virus moving around in our communities as students also live in communities and interact. So, we're likely to see some bumps in the number of cases as we continue through the rest of this year.
Mark Moran [00:05:09] We're talking with Dr. David Engelthaler on TGen Talks. Dr. Engelthaler is the co-director of TGen North, a pathogen and microbiome division of TGen located in Flagstaff. Dr. Engelthaler the CDC and numerous health care experts have warned that now layering the flu season, a top COVID-19 will likely create some new challenges later this year. What are you hearing and what do you think we can expect?
Dr. David Engelthaler [00:05:33] We've certainly been worried about flu or potentially other pathogens and diseases on top of COVID. And now that the flu season is really coming upon us, everybody's looking at this very closely. I have, you know, actually some optimism here. And the reason why is we think that the overall number of infections between individuals for any pathogen is down. And that's because of everything we're doing, increased distancing, masking, a lot of hand washing that we weren't really doing in previous years. I think that probably bodes well for us when the flu season comes around. We're going to help keep those numbers down. The other reason for I have a little bit of optimism is there's a whole lot of talk about vaccines right now and hopefully that'll generate more interest in individuals getting their flu vaccine this year than they have in previous years. It's not a perfect vaccine, but it does really help slow down the spread of flu and limit the overall number of cases that we have. So though those two pieces actually may be working for us this year versus in previous years. But there's no doubt influenza is it's a serious disease, has a lot of the same symptoms of COVID. It so it causes a lot of confusion as to what are we seeing in our hospital? What are we seeing in our schools? And so that's going to probably create some additional confusion and concern as we move through the flu season, which is also school season.
Mark Moran [00:07:07] Let's talk a little bit more in detail about that. How will the burden of a pandemic weigh on school administrators, parents, even students themselves as they head back into the actual classroom? School environments are difficult enough as it is. How can behaviors of elementary school kids, for example, be strictly governed?
Dr. David Engelthaler [00:07:25] In Arizona, universities are starting to meet on campus. There's a whole lot of online learning and remote learning as well. And then schools, the K through 12 are all putting their plans in place to start in-person sessions. But with a lot of the recommendations, pretty much all the recommendations that have been out there with the distancing in the masking and increasing hygiene and all of that. So I think that we can do things responsibly. It doesn't mean that there won't be cases. It doesn't mean that that it won't cause, you know, mini outbreaks. That's most likely going to happen. I think it would happen anyways. But the schools really do need to take the responsibility of ensuring all those practices are in place. And that's a tough thing to do with kids. They don't want to keep their masks on. They don't want to be physically distant. They've been isolated for months. So I think that this is a really tough job that school administrators are going to have and parents are going to have and really that the students need to have to. And then they have to have some responsibility here. And this is a, you know, a probably a really important time for them to learn some of those lessons.
Mark Moran [00:08:36] There's currently a lot of talk around a vaccine. Right now, there are no U.S. approved drugs or vaccines for the virus. But the media is pushing a number of stories about having one by year's end. How optimistic do you think this timeline is?
Dr. David Engelthaler [00:08:51] It's incredibly optimistic, but I also think it's realistic. We don't really know what that means if we have some vaccines that are available, say, November or December. How many and which kinds and how they'll get out there. So those are all questions that are unanswered. But we do know that there's been tremendous success in vaccine development, identifying good candidates that have been moving through the series of clinical trials that are necessary to ensure that they're safe and effective. And we're really getting good information that a couple of these vaccines likely will be through all those trials and approved for use at some point this year. They're already doing mass production. They're already putting out all those plans in logistics in place to move vaccine out to different areas. And then the the state and local health departments are putting in plans to then how do we get that vaccine into the people that need it the most?
Mark Moran [00:09:49] And who are the people who are going to need it most?
Dr. David Engelthaler [00:09:52] Right now, the people that are going to need it the most are still the highest risk for dying, that no matter what we've done throughout this entire pandemic, those that were at risk for dying. Sadly died. And those are the ones who are going to need the vaccine and their caregivers, their bubble around them. And then all of the kind of the first responder frontline medical workers are going to be on the list to get vaccine as well. Maybe, just maybe a good chunk of them will get vaccine this year.
Mark Moran [00:10:21] You mentioned this briefly, but once we do have a vaccine, what can we expect in terms of distribution? What are some of just the logistical challenges of rolling out a vaccine globally likely to be?
Dr. David Engelthaler [00:10:33] This is incredibly complex thinking about vaccines that some need to be held at very cold temperatures and maintained in cold temperatures during distribution up until the point that they're really used for vaccinating individuals. The fact that we need to move millions of doses to all four corners of the Earth. We can't just get it to, you know, the rich countries or just some specific locales. It's got to get to everybody or this virus will continue to survive and thrive. So the logistics are enormous. The good news is, is that we've been use doing vaccines for decades now and delivering very large numbers of vaccines that are being produced that year. We do this with influenza. We do this with childhood immunizations. Most parts of the world with a tuberculosis vaccine. There's a lot of tools and resources that are going to be brought to bear. CDC and WHO and other health organizations have been working on the plans for months on how distribution would work in the United States. It's working with the state health departments and all the states already have plans for the distribution of vaccines. Again, we do this on a regular basis for other vaccines. It's just gonna have to be a hurried timeline, but using the resources and the capabilities and the talents that we already have.
Mark Moran [00:12:01] Given that this will be a new vaccine, how can doctors ensure that number one, from a medical standpoint and health standpoint that people will feel safe to put it in our bodies? And second of all, how can the medical field help people understand fact from fiction, given that we're dealing with an incredibly high noise floor of election-year antics, which could be politicizing a vaccine that seems to be right now the next best step?
Dr. David Engelthaler [00:12:29] I have to admit, this is maybe my biggest concern this year is a lot of this pandemic has become political or are ideological and in what people read and believe in and risk and how they respond to this. We can't let vaccines fall prey to that. We know how to make sure that vaccines are safe and we know how to deliver them out to the people that need it the most. And in reality, we're all going to need the vaccine to really make sure that we can stop COVID in 2021, which has got to be everybody's goal. My fear on how this has become political is that I do see that that anti vaccine group is actually growing by leaps and bounds. And it's not because they don't like vaccines. It's maybe more because of politics, maybe some ongoing fears about really what we should and shouldn't be doing around COVID and who should be out in public and who shouldn't. And the fact that we still don't know enough about this disease to test know for certain that the vaccines are going to work and really help eliminate the virus. So because of all those uncertainties and because of a kind of a hyper partizan atmosphere, we will see more anti vaccine language and we all need to work hard to push back against that. This is something that we're we're literally all in this together. We know that vaccines are the one thing we can do to to stop a disease in its tracks. We've done it before and I'm certain we'll do it again this time. But hopefully everybody's gonna be on board.
Mark Moran [00:14:01] Fascinating information, as always. Great to speak with you, Dr. Engelthaler. Thanks for being here.
Dr. David Engelthaler [00:14:06] Thanks, Mark. It's great to be here.
Mark Moran [00:14:07] That's Dr. David Engelthaler, co-director of TGen North, the Pathogen and Microbiome Division of TGen, located in Flagstaff, Arizona. You can listen to more TGen Talks at TGen.org/TGenTalks. TGen is an affiliate of City of Hope. Thanks for listening to TGen Talks. I'm Mark Moran.
