Episode 38: COVID-19: Mother Nature’s Work or Something Else?

Karie Dozer [00:00:05] I'm Karie Dozer and this is TGen Talks. Today on the show, how much longer will we be dealing with COVID-19? Do we really know where COVID came from? And will we need vaccinations against COVID for years to come? We travel to Flagstaff on the show today to TGen North to find answers. And welcome to TGen Talks, I'm Karie Dozer, your host, and I'm here with Dr. David Engelthaler. He's the Director of Pathogen and Microbiome Division, more commonly known as TGen North. Dr. Engelthaler, thanks for joining me.

Dr. David Engelthaler [00:00:41] Karie, it's great to be here.

Karie Dozer [00:00:43] It has been about eighteen months since the first reported case of COVID-19 in the United States. If COVID-19 were a book with forty chapters, what chapter are we in now in June-July of 2021?

Dr. David Engelthaler [00:00:58] That's a great question. In eighteen months, it does seem like eighteen years in some regards. This has been such an amazing phenomenon that's occurred and obviously devastating. And we've learned a lot and we've gone through a lot and we definitely are at the tail end of this pandemic, especially for our country. Now, the pandemic as a whole, which is really a global phenomenon, is not going away anytime soon. So many of the countries around the world are really just getting started with vaccinations. And it's going to take a while to get to the place that the U.S. is in. But in the U.S., we are really on the tail end of this pandemic.

Karie Dozer [00:01:37] Does the book have an ending?

Dr. David Engelthaler [00:01:39] Also, a great question. I think it probably is going to have a maybe a trilogy or there'll be a series of books, meaning that the virus isn't going to completely go away. We don't think it will. We do think it's become endemic within the human population, would somewhat adapt it to us and is easily spread. We don't think it's going to go away just because we have high vaccination rates, because it is very effective at finding the next susceptible person. And we think that'll happen, at least for the next couple of years.

Karie Dozer [00:02:12] Plenty of theories out there about where COVID-19 began. Was it created in a lab? Did it occur in nature? How much do we know about that answer right now and how much may we never know?

Dr. David Engelthaler [00:02:26] Yeah, there's still a lot of confusion around that and that's because there's been a real lack of information. You know, this absolutely started in China - we know that. The virus itself is clearly related to other SARS-like viruses that come out of bats, but that's pretty much the end of where we know. We don't know -- did the first human case really have contact with a bat or some other animal that the virus went through? Or was the virus actually captured at one point in and studied in the laboratory? One thing we can say, this was not created out of whole cloth. It was not invented, doesn't appear to be a bioweapon or anything like that. But there's a lot of circumstantial evidence that would suggest that the virus may have actually been in a laboratory at some point and then accidentally escaped. Some of that circumstantial evidence is well, the virus first showed up in a city where there was a laboratory that was studying these viruses; specifically, one of the only laboratories in the world, by the way, was right there. So, there's really strong circumstantial evidence. Some other evidence is that we haven't found a direct connection between the virus that we have and circulating viruses in nature. So, we haven't found the primary host. So it's not obvious or necessarily easy for humans to have been exposed to that. There's a number of other lines of evidence, but they're all circumstantial at this point. So, we may never know.

Karie Dozer [00:03:57] Does it matter where it came from and does it matter how it reached humans?

Dr. David Engelthaler [00:04:02] Yeah, I love that question because it's like, OK, well, we had the pandemic, so what does it matter? Well, let's just say, for instance, that there was an accidental lab escape. What does that mean? Well, one, we've got to make sure that never happens again. We need to figure out if that was the case, how did that happen? How could that be prevented? And so that's really important to know. Also, it's important to know do these viruses -- are we constantly at risk that they're going to just show up out of nature? Or is it really because of all the science that we're doing now by studying these things in the lab that's putting us at risk? Those things we really do need to know the other parts, like who's to blame and all of that? That's, you know, that's political discussions and not as important in the scientific realm, but there's still a lot to learn about this if we know where it started from.

Karie Dozer [00:04:52] On the website, TGen has a new thing called a COVID Dashboard. What is it? What information can I find there? And what are you guys putting into it every day?

Dr. David Engelthaler [00:05:01] The COVID Sequencing Dashboard is, essentially, a dashboard we built for the state of Arizona that tracks the virus and all the variants of the virus over time throughout the, at least, the remaining months of this pandemic. We're looking like, when did the first UK variant show up? How about this Delta variant that originated out of India? We can actually show exactly what's happening in Arizona on this dashboard. It's pretty easy to use and look at. And for most people, it's just of general interest. We hear about these variants, what's going on in our own neighborhood, but it's also being used by health departments and health officials to understand what is the variance that we have to deal with right now. What are my patients going to be seeing? What are these communities experiencing right now?

Karie Dozer [00:05:52] I'm here with Dr. David Engelthaler at TGen North talking about the progression of COVID-19. Where we are in our battle with it?  What's the future of the vaccine? How long will we be giving the vaccines that we have now and how soon will they have to change?

Dr. David Engelthaler [00:06:06] Yeah, there's a lot in there. And you're absolutely right, Karie, is that these vaccines came out really fast and they're incredibly effective. And for now, it looks like the vaccines cover the variants that are out there, which is great news. Some maybe -- some variants might escape some antibodies. But overall, the vaccines look like they work and they're going to continue to work. So, we have to continue to watch the variants and see if new mutations occur that allow the virus to escape these vaccines. But for now, they're providing a tremendous amount of immunity. They've, essentially, made the pandemic really go away in the U.S. We still have the virus, but we have a lot of other viruses -- a lot of other diseases that we have to deal with. But the vaccines are the one thing that really brought the pandemic to its knees. And then moving forward, it looks like since the virus isn't going to go away right away. We may need boosters from these vaccines because the virus continues to mutate, as we were just talking about with these different variants. We might need boosters to essentially effectively respond to the new variants of the virus, much like we do with influenza every couple of years. So, I think these vaccines are going to be around for a while because the virus is going to be around for a while.

Karie Dozer [00:07:23] TGen houses a lot of data. You take in information from all counties and probably from other states as well. What does the information that you have compiled tell you about how quickly the virus will continue to change and how well we are doing staying on top of it.

Dr. David Engelthaler [00:07:40] One of the things that has happened during this pandemic is that we've really been able to pull a lot of this next generation science into an emergency response and use it and really start to, what I've been calling, generate "pathogen intelligence". We're getting intel on the virus by doing the sequencing of it, by looking at the genetic code, by understanding all those different changes. So, yeah, we generate a ton of information, but this is really what we're doing now with 21st century sciences. We're digitizing the natural world. So, we're turning it into data so that we can analyze it and share it. And we constantly are looking at data from around the world because we're all generating this type of data and we can easily share it with each other. So, that is something that we've got to not only close out this pandemic with, but parlay it into all the other infectious diseases that we work with. Develop intel on all those pathogens. We can better track, then, the most important variants that are out there of the different other viruses and bacteria that are really plaguing our hospitals, but also our communities in other ways that in a way that we haven't been looking at before. So, I'm really excited that we're actually advancing the state of both clinical medicine and public health by using these technologies right now.

Karie Dozer [00:09:02] Most Americans will look back on -- let's say Americans travel in space. We landed on the moon and 40 years later, we are circling the earth. We're collecting data from asteroids. In other words, the progress has been light speed. Can you characterize in the last ten years how genomics has advanced and really the speed with which you guys are doing things quicker, faster, better to give people a little hope about what might happen next time?

Dr. David Engelthaler [00:09:32] Yeah, well, there's a couple of things. And you mentioned, you know, going to the moon. The whole idea of a moon shot is where you get a lot of your intellectual capacity and other resources really focused singularly on a goal. That happened during this pandemic, one with the vaccines. And that's part of how we were able to get this out. Besides the fact that, you know, the U.S. really led the way with funding and de-risking allowing for manufacturing to occur at the same time. So, we get really rapid distribution. All of that. But another area, where this was in genomics now, we are sequencing this one virus like we've never done before and we didn't realize we could. So, by everybody focused on that and by TGen putting a ton of energy into this, we've really increased our ability to do this faster and cheaper, as you're saying. Ten years ago, when we were sequencing, you know, sequencing one individual, even just an individual virus, would have cost us hundreds and hundreds of dollars. Now, we've now pushed that down below a hundred dollars. We're aiming and gearing to get us to the twenty-five dollar genome. That means by sequencing, that will be as expensive as any other tests we run in a hospital now. So, that would just revolutionize how we can actually think about practicing medicine and public health. We get precision medicine and precision epidemiology in a way that we couldn't even think about ten years ago. We are -- instead of just counting cases, because the tests that we have a really good at saying, "yes, this is a case"...doesn't tell you anything else. But by sequencing, we learn all the secrets of that virus. We understand who's related to who and we get all of this intel. So, instead of just sequencing, let us really get the information we need to jump ahead of these outbreaks as soon as we can and treat every patient for the disease that they have, not the type of disease that they have.

Karie Dozer [00:11:36] What is next? What is the next COVID-19 for people who are weary of this one and can't wait to close the book on it? What's next? Will there be a next? And if so, do we have any idea how soon?

Dr. David Engelthaler [00:11:49] Well, undoubtedly, there will be a next. We've had pandemics and we continually have outbreaks of disease outbreaks. And some of them are very small and people don't know about them because they went away quickly, or they were in some part of the world that didn't catch the news attention. You know, before this pandemic, there was the really massive Ebola outbreak that was in Western Africa for the first time in very large cities, causing tens of thousands of cases. A really big deal -- the world was focused on that and seeing is this going to explode out of the African continent and cause problems. We had the original SARS outbreak that actually did become a pandemic and showed up all around the world, but it quickly went away. So thankfully, that virus didn't last very long. These things do continue to come out of nature. I got to say, they also come out of our labs. We study these things. We've had accidental lab escapes before and they've caused real problems. And sometimes, thankfully, they were small. But other cases, you know, we've had to deal with outbreaks that we didn't know originally came out of labs. And it was only because we're trying to improve our knowledge and we're trying to develop a vaccine. But it's an area that the more we use science to investigate these very dangerous pathogens, we got to put a lot of energy in making sure we're doing that safely while we're learning information. At the same time, Mother Nature, you know, is out there in many cases trying to kill us. There are there are really bad things out there. And the more we interact with Mother Nature, maybe it's from growth in in our development moving into, you know, parts of the world, maybe in rainforests or in other places where we're getting exposed to bugs we weren't exposed to before. And then all of a sudden we have a new infectious disease. So, we've got to continue to have this global effort to develop pathogen intel so that we understand what's in Mother Nature, what's in our labs, and what can we do to be ready for the next one.

Karie Dozer [00:13:50] So TGen North is a lab that's been studying it now for eighteen months and it's been obviously the bulk of what you've been doing here. What would you tell people listening about the staff you have here, what they've accomplished in the last  eighteen months and what it's like to be on the forefront of this kind of research?

Dr. David Engelthaler [00:14:08] Yeah, that it's really been absolutely the honor of my career is to work with this group here during this time. We have big letters up on our wall here that say we have the ability therefore we have the responsibility. And that's been our ethos for a long time, that we have this ability to use this really advanced science and technology to make a difference in the world. Therefore, we have the responsibility to do that. When this pandemic first occurred, there was no more glaringly obvious way for us to use this technology. And so we did and we jumped in. We kind have this moniker of being genomic first responders. And that's that a real thing, because the way that we use the science, the technology, we're really agile at it. And we could just shift all of our focus to responding similarly to this one problem. And that's what everybody did here. That's not what they signed up for. They didn't come here to be emergency responders or whatnot. These were scientists and researchers really trying to understand infectious diseases and hoping that maybe one day we can come up with a new diagnostic test that makes a difference or maybe a new drug here. We could do all of that in very short order and make a big impact. It was a lot of work in. It was an amazing time, even though it was very devastating for the community. I think a lot of people here felt a sense of pride that they could do something about it.

Karie Dozer [00:15:35] Yeah, that must be really rewarding. Dr. Engelthaler, thanks for taking the time today.

Dr. David Engelthaler [00:15:39] You bet. Karie, great to be here 

Karie Dozer [00:15:43] And thank you for listening to TGen Talks. For more, go to TGen.org/TGenTalks. TGen is an affiliate of City of Hope. For TGen Talks, I'm Karie Dozer.