Video Update: CIMC’s Dr. Daniel Davis presents at Avalon City Council Meeting Dec 1

Date Posted: December 2, 2020

Video Transcript

00:01 i'd like to go right to
00:03 Dr Daniel Davis who is also on
00:05 teleconference with us and he'll be
00:06 doing another presentation on
00:09 uh covet 19 update thank you
00:13 so welcome dr davis good well thank you
00:16 for having me back
00:17 sorry for the audio difficulties and i
00:19 heard someone comment on the
00:21 picture you see there which was done by
00:24 one of our young
00:26 avalon residents iris
00:29 back in july but i like this picture so
00:32 i was looking for an opportunity to
00:33 stick it into
00:35 one of the presentations so given that
00:38 everyone
00:38 is now an expert on everything to run a
00:41 virus based on our previous
00:43 presentations i don't have to
00:44 spend quite as much time explaining
00:46 everything but we will spend
00:48 a bit of time talking about the back
00:51 beams because i think that's going to be
00:52 important going forward and i want to
00:55 [Music]
00:56 try and address people's concerns and
00:58 questions and
01:00 and then take any additional questions
01:02 um
01:03 so uh we will go over our numbers
01:05 including our catalina specific numbers
01:07 and then
01:08 spend most of the time talking about the
01:10 vaccine and
01:11 speculating as to what the next month
01:13 might look like
01:16 all right so these are graphs that
01:17 you're used to seeing these are the
01:19 california new cases on the top and the
01:23 depths on the bottom
01:24 and if we start labeling these as we go
01:27 further and further into this pandemic
01:31 what you see on the screen here is the
01:33 initial wave and the spring
01:36 but you see in the middle there is the
01:39 kind of early summer
01:40 early to mid summer wave and then what
01:43 you're seeing right now is the
01:46 mid ball wave and if we play our numbers
01:49 game
01:50 and the purists will react a little bit
01:53 because this isn't exactly how you
01:55 calculate the death rate but if you're
01:57 doing quick and dirty calculations at
01:59 home
02:00 you can see that at the beginning we had
02:03 about a 5
02:05 death rate based on the number of cases
02:07 versus the number of recruited deaths
02:10 in the summer we saw about a two percent
02:13 and what we're currently seeing based on
02:15 between 15 and 20 000
02:17 new cases a day and about 100 new deaths
02:20 a day
02:22 0.6 and so it looks like
02:26 we're doing a whole lot better with the
02:28 virus and i think we are doing better
02:30 for sure
02:31 but we are clearly seeing a surge in
02:35 new cases from people who have minimal
02:37 symptoms
02:39 people who are generally healthier than
02:40 what we saw back in the spring
02:42 and people who are asymptomatic as part
02:45 of our
02:46 impact tracing efforts uh we'll go a
02:48 little bit deeper uh
02:50 in a second um this is the map of
02:53 california with new cases and you see
02:55 see that los angeles is clearly in the
02:58 heart of things
02:59 as is imperial county down by the border
03:03 and if we look at the united states and
03:05 if you talk to dr mcgrardy
03:08 you will know that much of the united
03:10 states is right in the thick of things
03:12 and hospitals are again becoming taxed
03:16 with a very high positive rate
03:19 particularly in the center of the
03:20 country there
03:22 whether our time is yet to come um
03:25 and that we just haven't seen the cold
03:26 weather that drives everyone indoors
03:29 or whether we're going to dodge at least
03:32 the severe illness that they're seeing
03:33 in the midwest
03:34 remains to be seen if you go back a
03:37 couple of slides
03:39 it does have the look of a peak
03:42 and then a subsequent drop however
03:45 a lot of that may be driven by
03:48 and i'm going to move forward a little
03:50 bit here the amount of
03:52 tests so what you see here is the rate
03:55 of positive spaces on the top the same
03:57 one i've been showing you
03:58 but on the bottom you see the number of
04:01 tests being performed and we saw going
04:03 into the thanksgiving holiday
04:06 a huge wave in the number of tests in
04:09 part driven by people who were
04:11 symptomatic
04:12 many of whom did not have covid but had
04:14 the seasonal
04:15 upper respiratory infection but also
04:18 people who were being tested because
04:19 they had travel plans because they
04:21 wanted to risk stratify
04:23 in going home for the holidays or having
04:26 people over
04:27 or because their works were asking them
04:29 to be tested
04:30 and when you test twice as many people
04:33 you're going to see twice as many cases
04:37 but again many of these new cases are
04:40 less symptomatic than what we saw
04:42 early in the pandemic and that probably
04:45 explains most of why
04:47 the mortality rates are much lower now i
04:50 skipped over my favorite slide of all
04:52 and you should be used to seeing this
04:54 one this
04:54 reflects my role as the medical director
04:56 for riverside county fire department
04:59 and this is to me the most
05:02 telling slide up all because it tells us
05:06 how many patients are either calling
05:07 9-1-1 or going to the emergency
05:09 department
05:11 with an influenza-like illness and we
05:14 use that term because for the most part
05:16 up until this year the main illness that
05:19 taxed
05:20 the medical system every winter
05:23 was influenza so we got used to using
05:26 the term influenza-like illness
05:29 now there's a new term floating around
05:31 out there which is
05:33 p-i-c that's pneumonia
05:36 influenza and covid but it hasn't caught
05:40 on and we still use influenza like
05:42 illness but what we're seeing here
05:44 is the continuation of the same graph
05:46 i've showed you each time i've spoke
05:49 and that is from about a year ago now
05:52 the initial wave
05:53 of influenza like illness due to
05:55 influenza
05:56 where 10 of emergency department visits
06:00 and 6 of ems calls were due to
06:04 a flu-like illness that tapered off in
06:07 february going into march
06:09 of 2020 and then we saw the first spike
06:13 in coronavirus in late march early april
06:17 where the rates of ed visits were about
06:21 10
06:21 again and the rates of ems calls were
06:25 six to seven percent very similar
06:28 then in the summer when we saw a huge
06:30 number of cases
06:32 the rate of emergency department visits
06:35 was only three to four percent
06:37 and ems called two to three percent and
06:39 now
06:40 where we see record numbers of cases we
06:43 haven't budged from one percent
06:45 for the last two or three months so
06:48 there still remains at least in southern
06:50 california and this being riverside
06:52 county
06:53 a disconnect between a sort of
06:56 sensationalized report from the news
07:00 and what we see at least in our area
07:03 clinically now that being said that
07:06 graph of the united states tells you
07:08 that
07:08 not every sort of united states is
07:10 experiencing this the same way and i
07:12 think we learned that
07:14 uh from the beginning of the endemic but
07:17 thus far we have not been overwhelmed um
07:20 in our areas here and so we have to
07:23 decide or we have to
07:25 to prepare for um our wave
07:28 or hope that this one passes us by
07:31 and that will bring up the issue of the
07:34 vaccine
07:34 and again this is the graph i showed you
07:37 before where the number of new cases
07:39 pretty much parallels the number of
07:41 tests
07:43 now here's catalina's data on the bottom
07:46 uh i
07:46 tried to compile both tests
07:49 that are positive here on the island as
07:53 well as
07:54 people that we sent tests for over town
07:58 [Music]
07:59 and then received a positive test but it
08:02 gets a little bit tricky
08:04 because we don't necessarily have all of
08:06 those cases
08:07 compiled but nevertheless you see
08:10 that catalina tends to mirror what's
08:12 happening in california
08:13 overall and we've even had a few
08:16 additional cases since i made this graph
08:18 two days ago
08:19 uh with a couple of positives in the
08:21 last 24 to 36 hours
08:23 uh but again we saw a spike in cases
08:27 in july and august it tapered off in
08:30 september and october and now we're
08:32 seeing
08:33 the number of cases go up again and
08:35 whether we'll see it come back down
08:37 uh or not remains to be seen
08:43 overall one of the observations that
08:45 we've made
08:47 is that most of the cases have not been
08:50 from the tourists
08:51 coming in with the disease most have
08:53 been people who live here in the island
08:56 and went over town either
08:59 to los angeles area or sometimes even
09:01 down into mexico
09:03 contracted it from people they knew
09:05 brought it back to the island
09:07 so i think our initial fear about the
09:09 tourists being the main
09:11 vector into catalina uh perhaps is a bit
09:14 unfounded
09:15 but thus far even though the
09:18 medical center is not a public health
09:20 entity and we don't have the right
09:23 to actually track people down
09:27 and demand to know everyone with whom
09:30 positive cases come into contact
09:32 doing it on a volunteer basis has been
09:35 largely successful
09:36 and that we haven't seen sustained
09:39 spread
09:39 in general we'll hear of a positive case
09:42 or identify a positive case
09:44 and then maybe one or two generations
09:47 beyond that
09:48 but there has not been the sustained
09:50 spread despite the fact
09:52 that avalon itself has very high density
09:54 compared to
09:56 los angeles and to long beach as i
09:58 showed one of the very first
10:00 presentations and that when we've
10:02 identified cases
10:04 in general we've been successful at
10:05 doing what's now being called hospital
10:08 at home
10:09 that is keeping people in their house
10:11 quarantined but being able to gauge
10:13 their symptoms
10:15 and even monitor their oxygen saturation
10:17 values
10:18 so that we've been able to make
10:19 appropriate triaging
10:21 and that has really been a testament to
10:23 the coordination between the community
10:25 and the medical center the folks that
10:28 we've had to transfer over have
10:29 generally done well
10:31 they've generally been admitted for
10:34 monitoring and in some cases therapy
10:37 but knock on wood we've had no deaths
10:39 directly due to coronavirus
10:41 and one of our biggest priorities has
10:43 been the long-term care facility
10:46 which shares walls with the hospital so
10:49 we've been particularly vigilant at
10:51 trying to keep those residents safe
10:54 all right so now let's jump into the
10:56 vaccine i made some graphics to try and
10:58 explain how this all works and so
11:02 we're going to start with a traditional
11:04 vaccine
11:05 here you see my version of a virus kind
11:08 of looks like a coronavirus with those
11:10 little spike proteins but i put some
11:12 other proteins shaped like
11:14 triangles out there as well and the
11:16 traditional way of making a vaccine was
11:19 to
11:19 do something to deactivate the virus
11:22 either
11:22 kill it with heat or grind it up into
11:25 little pieces do something
11:27 that then allows it to be safely
11:29 injected into a person without causing
11:31 disease
11:33 but then allowing the immune system to
11:35 start to recognize those proteins
11:38 and here you see antibodies by version
11:40 of antibodies that recognize the
11:42 triangles and here's some that recognize
11:45 the circles once these antibodies
11:48 have been formed they are retained in
11:51 the body at least in the memory of
11:53 certain immune cells
11:55 so that when the virus reappears
11:59 immediately antibodies start to emerge
12:02 and do two things one they
12:06 prevent the virus from being able to
12:07 attack healthy cells
12:09 by glomming on to the outside
12:12 where those proteins sit and number two
12:15 they
12:15 plant a flag in those viruses so the
12:18 immune system knows to destroy those
12:20 those viral cells
12:24 and so antibodies become the main host
12:28 defense
12:28 against a reinfection
12:32 now what's different this time through
12:34 why didn't we just do the same thing
12:36 well done well it turns out that the
12:39 celonovirus
12:40 and other similar viruses are really
12:42 hard to grow in culture
12:44 and so it's really hard to make enough
12:46 of it to be able to create enough
12:49 vaccines
12:50 to keep everyone safe there are
12:52 countries that have tried that
12:54 um and china is probably the most
12:56 prominent
12:58 but the prediction is that they may have
13:00 trouble vaccinating everyone and their
13:02 hope is that
13:03 it disappears before they need to
13:05 because again it's very hard to grow
13:07 this particular virus
13:09 in culture enough to be able to create
13:11 enough vaccines
13:13 so what we're seeing is some different
13:15 technologies
13:17 that may ultimately be more effective
13:19 and safer
13:20 than the traditional approach so here i
13:23 have a regular human cell and that green
13:25 thing is the nucleus
13:27 and from that nucleus little copies of
13:31 messenger rna are constantly being made
13:35 so here you see four different colors
13:37 and each of those
13:38 encodes a certain protein that's
13:40 necessary for all sorts of stuff
13:43 the growth for the immune system
13:46 for digestion for hormones
13:50 and so once these pieces of mrna make it
13:53 out of the nucleus
13:55 then sort of the machinery of the cell
13:57 takes over and starts building
13:59 proteins almost like a blueprint so here
14:02 you see the
14:02 green moon the red
14:06 cross lightning blue lightning bolt or
14:09 purple whatever that thing is
14:11 this would be normal function of a cell
14:14 now somehow we need to get virus protein
14:17 in there for the immune system to
14:19 recognize and these new technologies
14:22 take a vaccine and introduce
14:26 mrna that represents the virus the viral
14:29 proteins into the cell
14:31 one strategy is just to take mrna
14:34 encapsulate it surround it with a
14:37 balloon
14:39 that looks almost like a cell
14:42 and another strategy is to take a virus
14:44 that isn't real harmful
14:46 it's uh and the one that's being used
14:48 the most is the
14:49 adenovirus that normally would infect
14:51 the chimpanzee
14:52 but doesn't cause disease in humans and
14:56 put some of the coronavirus blueprint
14:59 inside
15:00 and each of those has a way of getting
15:02 it into a human cell
15:04 where then the mrna sits there and gets
15:08 made into proteins
15:09 just like it was human mrna messenger
15:13 rna
15:14 so the blueprint from the virus is used
15:17 just as easily as the blueprint from a
15:19 human cell
15:20 to make proteins in this case the spike
15:23 protein
15:24 that's the one that makes forget the
15:26 chronovirus its name
15:28 the thing that kind of characterizes the
15:30 coronavirus and everyone has targeted
15:33 and now just antibodies against that
15:37 spike protein form and ultimately confer
15:40 the same sort of immunity
15:42 now there were some questions we didn't
15:44 know if that would work
15:46 it wasn't ever demonstrated that you
15:49 could get
15:49 mrna from coronavirus or any virus for
15:52 that matter
15:54 into humans levels or that the human
15:56 cells would make enough protein
15:58 to stimulate antibody production
16:02 or that the virus wouldn't mutate so
16:05 fast that by the time
16:06 the vaccine was delivered that that
16:09 spiked protein
16:10 was different and that no longer did the
16:12 original antibodies
16:14 recognize that spike protein so
16:17 the biggest question in everyone's mind
16:20 was would it work
16:21 and this technology was unproven now
16:26 the first two vaccines that you've heard
16:28 about on the news
16:29 the one from pfizer and the one from
16:32 moderna
16:33 use those little balloons and
16:37 the big question there was whether the
16:38 mrna which is kind of unstable could
16:41 make it all the way into a human cell
16:44 several of the other vaccines being
16:47 tested
16:47 use one of those adenoviruses a
16:50 non-harmful virus
16:52 and the question there was whether our
16:54 immune systems especially those of us
16:56 who are over the age of 50
16:58 would have seen enough adenoviruses in
17:00 our life even if we never saw that once
17:02 meant for chimpanzees that we've seen
17:05 enough of them
17:06 that we would destroy that virus before
17:08 it could transfer
17:10 its mrna to the human cell
17:13 so there are some questions about that
17:15 technology
17:17 now there are some questions about
17:18 vaccines in general
17:21 that apply probably more to a
17:23 traditional vaccine
17:24 when you mush up a virus and inject it
17:27 in there
17:28 does it maybe work too well does the
17:30 immune system form too many antibodies
17:33 that either overreact if you ultimately
17:36 see then a covet again
17:38 or those antibodies that start to react
17:41 with
17:41 normal human protein because some of
17:43 them look kind of similar
17:45 and we think that a lot of diseases that
17:47 we didn't realize were autoimmune might
17:49 actually be related to the formation of
17:52 antibodies
17:53 that cross react between virus
17:56 proteins and human proteins and actually
17:58 start attacking
18:00 that person in theory that would be less
18:03 of an
18:03 issue with these mrna or these
18:07 adenoviral
18:09 strategies because they're targeting one
18:12 specific protein as opposed
18:14 to just putting the whole virus in there
18:16 and letting
18:17 whatever happens happen but that was
18:20 still a question
18:21 and then the question i think still
18:24 lingers
18:24 how long is this going to last we've
18:27 heard news reports that antibody levels
18:29 dropped pretty quickly in some patients
18:31 and even maybe people who would grow on
18:34 a virus more than once
18:36 so do we have any answers well
18:39 if you've listened to the news in the
18:41 last couple of weeks
18:43 you've heard that those first two
18:45 mrna-based vaccines have had
18:47 incredible effectiveness incredible
18:50 efficacy
18:51 and this is beyond anything anybody
18:54 could have even
18:54 hoped for we were talking about maybe 50
18:58 being successful that's kind of what the
19:01 influenza vaccine is like every year
19:03 and both of them came in with almost
19:05 identical numbers of
19:07 95 and if really all you care about is
19:10 people who get really sick
19:12 that getting a little bit of a cold
19:14 doesn't really bother you too much
19:16 the moderna vaccine has zero cases
19:19 of severe illness so that would make it
19:22 a hundred percent
19:23 successful in preventing uh severe
19:25 coveted disease
19:27 now granted they haven't had a huge
19:29 number of
19:30 patients yet but again you know
19:33 the numbers have been so incredibly good
19:36 uh that they will probably both get
19:38 approved and be available
19:40 for dosing before the end of this month
19:42 now december
19:44 now there were some questions about that
19:47 adenovirus like i said we were
19:49 kind of worried that it wasn't going to
19:51 work as well in people over the age of
19:53 50 because
19:55 we might attack the the
19:58 friendly virus that was going to deliver
20:00 the mrna
20:02 and destroy it before it could do its
20:04 job but it turned out that there was a
20:07 human error that has made this really
20:09 hard to interpret
20:10 the first 3 000 patients in their study
20:13 got the wrong dose
20:15 they realized that after those first 3
20:17 000 and corrected it
20:19 so they have more than 10 000 close to
20:22 20 000 with the correct dose but then it
20:25 turned out that the
20:26 half dose did better than the correct
20:28 dose and so now
20:30 they're trying to get it approved at the
20:32 lower dose which was a mistake to begin
20:34 with
20:35 and most scientists are saying hey wait
20:37 a sec you can't do it that way that
20:39 wasn't your intent
20:41 and in fact if you look at the two
20:42 groups the first three thousand were
20:45 younger people and this is our big
20:48 concern about this
20:49 adenovirus that maybe it doesn't work as
20:52 well in older people so maybe these
20:54 these effectiveness numbers are not as
20:56 good they tried to say that
20:59 the the the wrong dose was about 90
21:02 percent effective
21:04 what they thought was going to be the
21:05 right dose was only about 50 or 60
21:07 percent effective
21:08 let's split the difference and call it
21:10 70 what do you guys think
21:13 and uh most people are saying i don't
21:15 think so
21:16 so we're waiting to see if anybody will
21:18 even approve this one
21:19 especially if the first two are as
21:22 effective as they appear to be
21:25 now there are some advantages in the
21:27 more traditional vaccines especially
21:30 the first one i showed you where all you
21:32 do is try and fill it
21:34 and put it in a syringe and inject it
21:35 into your arm
21:37 again it's going to be hard to produce
21:38 enough but the nice thing is that you
21:40 can keep that in a refrigerator
21:43 the problem with at least one of the
21:45 mrna vaccines that has to be
21:48 kept not just in a freezer but a
21:50 supercooled freezer
21:52 they apparently have created something
21:54 they call the pizza box
21:55 that allows it to stay cold with some
21:57 sort of cardboard
21:58 container packed in dry ice and that it
22:01 can be
22:02 delivered to a regular refrigerator
22:05 freezer
22:06 and kept there for about a week and so
22:08 in our preparations
22:10 we are anticipating that we may end up
22:12 getting that virus first
22:14 where we have to use the pizza box to
22:16 keep it poop or a week and
22:18 deliver all the vaccines very quickly as
22:20 opposed to the
22:21 other one which you appear to be able to
22:24 just keep it in a regular freezer
22:26 but some of these other vaccines you
22:28 might just say well i don't they just
22:30 pack it up and
22:31 say you know they're not even close to
22:33 the effectiveness of the
22:34 first two and they screwed up their
22:37 study
22:37 why not just uh call it a colorado day
22:41 but again it may be that they use some
22:43 of these other vaccines in places that
22:45 don't have the storage capabilities
22:48 because they can be kept in things like
22:49 just regular refrigerators
22:52 we haven't seen any issues about the
22:54 vaccines working
22:55 too well um safety issues etc
22:59 there have been lots of rumors going
23:01 around maybe the russian vaccine maybe
23:03 the chinese vaccine
23:05 but we haven't seen any data yet so we
23:07 don't know
23:08 if there have been any people where
23:10 either an overreaction or an autoimmune
23:13 reaction have occurred
23:14 but in those first two where
23:17 theoretically that's less of a risk
23:20 their data has now been submitted and
23:22 they did not see
23:23 any increase in either of those events
23:26 so it appears to be as safe
23:29 as it um as we hoped it would be with
23:32 such a targeted
23:35 therapy or targeted way to create the
23:39 antibodies and then the last question is
23:42 it gonna last
23:42 well this is where you'll hear a lot
23:45 about antibodies disappearing
23:47 after two year four or six months that's
23:50 really not
23:50 the thing that we should be measuring
23:52 the most important thing are the t
23:54 cells you'll hear about t cells the t
23:57 cells are the ones that kind of keep the
23:59 blueprints for
24:01 the antibodies and that they can ramp up
24:04 production in
24:05 a matter of hours once there's a
24:08 exposure re-exposure to the virus and
24:12 that's a little harder to to measure
24:14 it's not something where you just drop
24:15 blood and measure it so that's why
24:17 most of the studies are focused on
24:19 antibodies rather than
24:20 t cell reaction but it wouldn't surprise
24:23 me if the fact that antibodies fade over
24:25 time is used to tell us that we probably
24:28 ought to get
24:29 a redosing at some interval maybe on an
24:33 annual basis similar to the flu
24:36 the last question which i didn't put on
24:38 here but i think
24:40 unfortunately doesn't seem to be as big
24:42 of an issue as you as we feared is
24:44 whether
24:45 the virus would mutate quickly enough to
24:47 where
24:48 the initial antibodies were no longer
24:51 recognizing that spike protein that the
24:53 spike protein
24:54 had changed enough to make it look like
24:56 a new virus
24:58 that's essentially what happens to
24:59 influenza every year
25:01 for the y influenza the pain um
25:04 but we're able to create a vaccine
25:06 quickly every year
25:08 not as effective as we would like but
25:10 still works okay
25:11 and that's based on the idea that it's
25:13 always mutating and the proteins are
25:15 always changing
25:16 for last year's vaccine doesn't
25:18 necessarily work but very well this year
25:21 um we haven't seen that kind of behavior
25:23 with coronavirus
25:24 for the most part that's like protein
25:27 has been unchanged since the beginning
25:31 and how are we going to dose this well
25:33 we just got
25:34 word about two hours ago
25:37 from the national committee that's
25:39 working at this and their
25:40 recommendations were fairly similar to
25:42 what we're seeing from
25:43 california and from los angeles the
25:46 first folks out of the two
25:48 will be the health care worker um
25:50 somewhere in there will be first
25:51 responders
25:52 who aren't health care related so that
25:54 would be like policemen
25:56 and firemen who were part of the ems
25:58 system
26:00 and they decided to set nursing home
26:02 patients in that first tour as well
26:05 then the second tier would be some blend
26:08 of folks who have higher
26:10 conditions so heart disease um some sort
26:13 of
26:13 immunologic problems or so patients who
26:17 perhaps were in chemotherapy or have
26:20 other
26:20 forms of immunocompromise and then
26:23 there's a lot of discussion about what
26:25 to do with
26:26 uh folks like prisoners who are packed
26:29 into
26:30 small areas and have had high rates
26:33 um or people who live in areas that have
26:35 had higher rates than other areas
26:38 so they decided not to try to take that
26:40 on yet because we don't have enough
26:42 vaccine
26:43 to get all the way down that line and
26:44 you can see from this graph
26:46 once you start getting to those
26:48 populations you need a whole lot of
26:50 vaccine the best
26:52 guess is that it will be available to
26:55 everyone
26:56 probably by the spring
26:59 um but it will come out in little waves
27:02 and that
27:03 each step will vaccinate
27:06 an increasing population based on
27:09 vulnerability
27:12 other stuff really happened to panned
27:15 out too too well
27:17 one thing you will see in the next week
27:19 or so is a new
27:20 guideline for quarantining probably
27:24 that if you're exposed but you don't
27:26 have any symptoms
27:28 that rather than getting tested right
27:29 away you'll wait for
27:31 a week or at the most 10 days and then
27:33 get tested
27:35 and at that point if the test is
27:37 negative
27:38 then you can be out of quarantine um
27:41 that's still being debated but it
27:42 appears that everyone kind of goes along
27:44 with that and then
27:45 again that's for asymptomatic people
27:48 that could potentially have impact on
27:51 catalina and avalon given that a lot of
27:54 the
27:54 testing that we do is based on someone
27:57 at work or someone in the household
27:59 identified as positive and so rather
28:02 than rushing to get tested then
28:04 especially within the first week where
28:06 it's likely to be negative even if
28:08 it was passed on
28:11 the guideline will be to get tested at
28:14 that 7-10 day mark but at that point if
28:16 the test is negative
28:18 then um then the quarantining is no
28:20 longer necessary so we will definitely
28:22 next
28:22 let you know about that as far as
28:25 treatment goes although we'd like to
28:26 think that that's partly responsible for
28:28 the decreasing mortality
28:30 it's probably not the main reason why we
28:32 mostly let
28:33 the people testing positive have lesser
28:36 symptoms that are generally healthier
28:38 but
28:38 we are now routinely using steroids the
28:42 antiviral medications still requires
28:44 ib administration so it's mostly
28:46 reserved for hospitalized patients
28:49 we haven't really seen emergency
28:50 departments administering the antivirals
28:52 because they have to be given
28:54 for a period of time over multiple days
28:58 the oral medications that i've been
29:01 excited about are still
29:02 under investigation so we haven't seen
29:04 any results yet
29:06 we heard a little bit about monoclonal
29:08 antibodies so
29:09 instead of giving someone a vaccine
29:11 you're sort of using
29:13 uh antibodies either somebody who
29:16 recovered from covid and using
29:18 whatever antibodies are in their
29:19 bloodstream and just taking the good
29:22 with the bad
29:23 or very specific antibodies that are
29:26 able to be produced that work against
29:29 coronavirus but they haven't been as
29:31 effective as we hoped
29:32 they really haven't been a game changer
29:35 although they are fda approved
29:37 not all centers are even using them and
29:39 there isn't that much available
29:41 one interesting thing is that many of
29:42 the newer antidepressants
29:45 also have some activity against one of
29:47 the immune receptors
29:49 that seems to be involved in the switch
29:52 from just
29:53 coronaviruses occlude maybe a little bit
29:55 of a cough to
29:57 this major immune system over reaction
30:00 that lands people in the icu on a
30:02 ventilator and ultimately leads to their
30:04 death
30:05 and so there may be recommendations over
30:07 the next couple of weeks to use
30:09 antidepressants for the critical period
30:12 of time
30:12 between diagnosis and the first say
30:16 the week and a half to try and prevent
30:18 that transition
30:19 from just an upper respiratory infection
30:21 to a life-threatening
30:24 disease that's that has you in the icu
30:26 so don't be surprised if you hear
30:28 that um between now and the end of the
30:30 year uh that one of the
30:32 therapies we have available is an
30:34 antidepressant not because
30:36 any people are necessarily depressed but
30:39 um because they seem to prevent that
30:42 that transition
30:43 so what can all of you and all of we do
30:46 this
30:46 is a critical point this probably
30:50 is the the most important part of
30:52 tonight's
30:53 talk but if you can hang in there just a
30:56 little bit longer
30:58 we're racing the clock right now that
31:00 thing is on the right in case you didn't
31:02 pick that up
31:04 because the vaccine will be available it
31:06 will be available before the end of the
31:08 year
31:09 but not everyone is going to get it
31:11 hopefully the most
31:12 vulnerable get it sooner
31:15 but we're also injuring traditionally
31:18 the worst time of the year for flu-like
31:20 illnesses
31:21 and so this is the critical time to kind
31:24 of
31:25 bunker down and do what you're supposed
31:27 to do
31:28 the reason that i included the data that
31:31 most of our cases have been
31:33 folks who live on the island to go off
31:36 the island
31:37 and then come back with the disease is
31:39 to underscore the importance that we
31:41 really have
31:42 control over whether this becomes a
31:45 raging inferno on the island or not
31:48 and that has little to do with us
31:51 bringing
31:51 allowing tourists in or not this is the
31:54 actions that we take on a daily basis
31:57 whether we're wearing the mask whether
31:59 we're
32:01 mingling with family and extended family
32:04 to where we potentially are exposing
32:07 some of the folks who have chronic
32:08 illness to this
32:10 this is the time unfortunately for us
32:14 thanksgiving and christmas happen to
32:15 fall right smack in the middle of our
32:17 flu season
32:18 if it all within australia would be the
32:20 opposite where
32:22 the flu season would be july and august
32:24 and we could
32:26 pretty much expect nice sunny warm
32:29 weather
32:30 around christmas time but that's not the
32:32 case here and so
32:34 we are entering the peak traditionally
32:36 the peak of our flu season influenza
32:39 we're entering in the time where we tend
32:42 to spend more time with each other
32:44 and with our family and this is when
32:47 we're seeing coronavirus spike not
32:49 surprisingly
32:50 so do what you need to do
32:53 i am not one who believes but we need to
32:56 regulate everyone but i believe that if
32:58 we
32:59 give them the information they'll make
33:00 the right choices
33:03 keep working with the hospital we're
33:04 doing the best we can and
33:06 you know so far knock on wood it's been
33:09 effective in preventing
33:11 uh unchecked spread so whenever you get
33:15 symptoms if you can call first
33:16 set up an appointment we just added in a
33:19 bunch of extra shifts for the
33:20 telemedicine
33:21 stuff so you should be able to get one
33:23 of the four
33:24 main providers at um um
33:28 your any uh weekday anyways and um
33:31 and so call and try and set something up
33:34 so we can talk it through
33:36 uh check the website uh we'll put the
33:38 regulations on there
33:40 because again we're expecting there to
33:41 be a change in the way that we
33:43 quarantine over the next week or two
33:46 and so that may affect when you're being
33:48 sent in by your work or when you've had
33:49 an exposure
33:51 in your personal life it may affect the
33:53 way that we treat that and that's partly
33:55 why we have you talk to one of us so we
33:57 can
33:58 figure out what the best strategy is
33:59 going to be i like the term be a patient
34:02 patient
34:03 and supporting each other as much as we
34:06 feel like this is a small town where
34:08 everyone knows everybody else's business
34:10 and has been
34:12 at times perhaps not as understanding
34:15 i can tell you from living over town
34:17 it's been much better
34:19 than it's been over there catalina is
34:21 like a dream come true for
34:23 epidemiologists and public health folks
34:26 because
34:26 as scary as this has been as frustrating
34:29 as
34:29 this has been as devastating as as it
34:32 has been for
34:34 folks who have businesses here and
34:35 depend on on tourism
34:38 um this has been an amazingly successful
34:43 effort by everyone and if we can hang in
34:45 there
34:46 a little bit longer i think we'll see
34:48 this through to the end
34:50 um without seeing any major catastrophes
34:53 with that
34:54 i will take whatever questions anybody
34:56 has
35:00 are there questions from that uh coming
35:02 in on you for you michael
35:04 uh i have one question that came in
35:07 uh the um
35:11 comment is submitted by jim johan he
35:13 writes dr davis
35:14 given the reporting that many people in
35:16 the u.s state they are unlikely to take
35:18 the vaccine for cove in 19
35:20 how would you endeavor to convince a
35:22 doubter to take it
35:25 i'm hoping that trying to explain it
35:27 that's
35:28 my version of probably two weeks worth
35:31 of
35:31 medical school in five minutes
35:35 but i think i presented it much better
35:37 than any of my professors
35:39 not to keep my own horn but
35:43 i can assure you that getting
35:45 coronavirus
35:46 is much more dangerous as far as the
35:49 long-term effects
35:50 than getting one of these initial mrna
35:52 viruses
35:53 i think people have a little bit of fear
35:55 of the mrna viruses
35:57 with their new technology but really the
36:00 concern was not that they were going to
36:02 do something harmful
36:03 that they just wouldn't work i'm
36:06 astounded that they've worked as well as
36:08 they have
36:09 because putting a little um
36:12 root of mrna into a
36:15 little balloon that's basically like um
36:18 a bubble so uh putting that in there and
36:22 expecting it to get into human cells
36:24 enough to where we start making the
36:26 proteins that normally we would have to
36:28 smush up a virus to make
36:31 i didn't think it would work and it
36:32 didn't work in the initial trial so the
36:34 fact that both of them would come up
36:36 with the same numbers is
36:38 amazing to me but the concern that it's
36:41 somehow dangerous
36:42 because mrna is unstable um
36:45 well that's just not how the biology
36:47 works this is very targeted and
36:49 for me it feels very similar to what's
36:51 happened in cancer therapy
36:54 where now if you have a cancer therapy
36:56 where we have a specific molecular
36:59 target
36:59 you can get chemotherapy that is
37:02 basically
37:03 a pill that doesn't cause a lot of side
37:05 effects it is much more effective than
37:07 20 30 years ago when you would have
37:09 gotten blasted with chemo that just took
37:11 your entire
37:13 immune system with it and your hair and
37:15 your gut everything else in your body
37:18 this is very similar to the way these
37:20 vaccines work so this is like
37:22 targeted therapy and you know everything
37:25 has come up
37:27 you know in our favor so
37:30 if people are worried you know i
37:32 encourage them to ask questions you know
37:33 you can access us via email or
37:36 to the server or you know tina
37:39 min who's our communications director
37:43 she sends a lot of the emails to us when
37:45 it becomes a very technical question
37:47 but the biggest concerns about vaccines
37:50 are that they're so messy that you're
37:52 throwing a bunch of proteins from the
37:54 virus into somebody's body
37:56 and it's causing either an overreaction
37:59 or
37:59 a reaction to something that's going to
38:02 attack yourself
38:03 and that just isn't as much of a concern
38:06 with these
38:07 and given what we're seeing and i think
38:10 i've mentioned before that i'm
38:11 responsible for one of the
38:13 the curricula that trains
38:16 healthcare providers around the country
38:18 on covid so i get to see a lot of the
38:20 data early on
38:22 um coronavirus catching coronavirus
38:25 leaves you with a lot of long-term
38:26 effects
38:27 and the covet syndrome is something very
38:30 real that probably
38:32 has to do with that over activation of
38:34 the immune system
38:36 so i would much rather take my chances
38:38 with any vaccine
38:40 other than getting coronavirus and i
38:42 would much rather take my chances with
38:44 an mrna which is very targeted
38:47 and very specific to one protein
38:50 and just thank our lucky stars that it
38:53 has worked as well as it has
38:55 but that's the best i can do to try to
38:57 convince someone i don't know if people
38:59 want pictures of me getting mine but
39:00 i'll be
39:01 you know i'll take it with me somebody's
39:03 willing to give it to me i tried to
39:05 enter
39:06 a trial and they didn't need middle-aged
39:08 white guys in the trial
39:10 unfortunately for me but i wanted to be
39:13 press center so
39:14 early on i was i was trying to be part
39:17 of the modern trial
39:18 they just never called me back because i
39:20 didn't fit the demographic that they
39:22 needed for the study but
39:24 yeah i i have less fear about this
39:27 technology
39:28 than than any uh vaccine that's come
39:31 before
39:32 and that again i'm just amazed at how
39:34 it's worked
39:42 stock in the vaccine companies
39:44 unfortunately
39:46 i was smart about it i would have
39:47 invested about nine months ago but
39:49 uh i didn't and i'm kicking myself but
39:52 at least
39:54 i can promote them without feeling like
39:56 i have a conflict of interest
39:59 um could you just please repeat
40:02 the information um or
40:05 answer the question has there been any
40:08 data that
40:09 shows you can contract the virus
40:10 multiple times
40:14 there there are data so
40:18 so let's see that you have to figure out
40:20 how to answer that so
40:21 part of the problem with that is
40:24 that there's a subset of people who get
40:27 covered
40:28 maybe 5 10 somewhere in that range
40:33 who keeps shedding virus from their
40:36 nose for months and months and months
40:40 for a while we thought that was just a
40:42 long infection
40:44 and finally and since south korea was
40:47 was one of the early countries affected
40:49 they decided to actually try and
40:51 grow the virus which is not easy to do
40:53 like i said
40:54 and found that the stuff coming out of
40:55 people's nose after the fact is just
40:58 dead virus it doesn't do anything it's
41:00 not infectious
41:02 the problem is that we don't have easy
41:05 ways to
41:06 test other than sending the virus to a
41:09 special lab to try to grow it
41:11 so there are definitely people who had
41:13 soviets
41:15 got better and then got an illness again
41:20 got their nose swabbed and tested
41:21 positive again
41:24 now initially again those people were
41:26 accused or that it was said that they
41:28 had it
41:28 twice now the thought is maybe they just
41:31 got a regular old virus
41:33 the second time and they were one of
41:34 those people that are just shedding it
41:37 for a long period of time
41:40 so the answer is we don't really know
41:43 and we don't
41:43 have access to the testing that would
41:45 answer the question
41:47 it's certainly not a common thing it's
41:50 more of a nuisance than anything because
41:52 we would have liked to be able to clear
41:54 people to go back to work
41:56 when they stopped testing positive from
41:58 their swabs and we just can't do that
42:00 because some people
42:01 that's positive over and over and over
42:03 again
42:04 and now there are people who had covered
42:07 this spring and summer
42:08 who are catching regular colds like
42:10 people do this time of year
42:12 and if they are one of those unlucky
42:14 ones that keep shedding virus
42:17 they're going to that's positive
42:21 so it doesn't exactly make sense from
42:24 what we know
42:25 i think for me the most reassuring thing
42:27 about the vaccine
42:29 but the moderna one was not the 95
42:33 efficacy it was that zero people that
42:36 got the vaccine
42:38 got anything more than a little bit of a
42:40 cold
42:42 and that tells me it's blocking
42:45 the subsequent response that rather than
42:48 it being an
42:49 overreaction the second time or with the
42:51 re-exposure
42:53 it it modulates it makes it into not
42:55 much of a
42:56 of an illness and that's exactly what
42:58 we've hoped for
43:02 i have one question uh i think it says
43:05 we
43:05 y'all have tested about 1379 people
43:09 how many of those would be duplicates
43:14 oh boy that's a good question um
43:18 i would just be making a wild guess that
43:20 would be kind of a
43:21 lyra type question but i can tell from
43:24 when i ordered covet tests
43:27 that it feels to me like maybe
43:30 20 of the people i'm ordering them on
43:34 haven't have a kova test already in the
43:37 system
43:38 that would be a wild guess on my part
43:40 but somewhere between
43:42 20 and a third so maybe a quarter of
43:46 people right and and then
43:49 like you say like if i go somewhere and
43:51 i'm gonna
43:52 i'm gonna have my eye done i'm gonna
43:53 have to have a coded test
43:55 so what percentage of the the 1379 you
43:59 think are people that feel they have
44:02 well i guess it's not many because we've
44:04 only got 41 cases so that's the answer
44:06 never mind i answer my own question
44:14 any more michael from the body i know
44:17 i have one more question um
44:21 and might be kind of a ridiculous
44:23 question but i'm just curious
44:25 why is this has this vaccine been so
44:28 easy to develop as opposed to other
44:32 vaccines for other
44:34 different things that have years and
44:35 years and years and years and years and
44:37 we don't have a vaccine for them
44:38 why is this one so easy to develop or
44:41 the appearance the appearance that it's
44:43 easy
44:43 to develop yeah well certainly fast
44:47 and i think part of it was that
44:50 there was so much funding poured into
44:52 these companies that they were able to
44:54 do
44:54 trials with 30 000 people
44:57 in a matter of weeks and we've never
45:00 seen that before it takes usually years
45:02 to enroll that many people
45:04 and there isn't that sort of breakneck
45:06 you know let's get everybody enrolled
45:08 now normally there wouldn't be
45:12 um you wouldn't be applying for
45:15 emergency use authorization on a vaccine
45:19 yeah that's that's not something that we
45:22 you know it may have come up with
45:24 with ebola i don't know the history long
45:27 enough but
45:28 in general a vaccine would have been
45:30 developed
45:31 you know slowly over years and there
45:33 would have been some time
45:34 to wait and see you know how long the
45:38 immunity was going to last
45:39 if people got it two or three years
45:41 later
45:43 most viruses are not ones that would
45:46 kind of cycle through
45:47 rapidly every year and so you know if
45:50 you take something like
45:52 measles or chickenpox for example
45:55 it's always kind of around and so when
45:58 you're testing
45:58 a kid you're testing them to see from
46:01 the point they got their vaccine at age
46:03 five and you're waiting to see you know
46:05 did they get it
46:06 at age 12 did they get it at 15 did they
46:09 get it at 20 did they
46:11 and now now we know that the chickenpox
46:13 vaccine has to be redosed
46:15 when when we're older to prevent
46:17 shingles so
46:18 these sort of long studies looking for
46:21 infection over years to even decades
46:26 looking at long-term side effects but
46:28 most of those appear fairly early on
46:31 and then not having the ability to
46:33 enroll tens of thousands of patients
46:35 in a matter of weeks so you know
46:39 the idea that are we cutting some
46:41 corners
46:42 the one piece the two pieces we don't
46:44 know about you know
46:45 could there be some really long-term
46:47 effects uh the answer is
46:50 yes there could be i don't want to lie
46:52 and say oh no we
46:53 we've waited enough time to know that
46:55 there's not going to be
46:57 most of the immunologic effects you'd
47:00 see a little bit early
47:01 and so i think we're feeling pretty good
47:03 that we haven't seen
47:04 any increase any change in the signal
47:07 but
47:09 long term for us now means nine months
47:11 and that's not that long
47:13 but again i can tell you working on this
47:15 covet
47:16 um curriculum the long-term effects
47:19 from getting kovid are very real
47:22 and those are not small that's where
47:26 i would much rather take my chances on
47:29 the vaccine which is targeted than
47:31 getting covered even if i don't die from
47:33 the disease
47:34 you know even not being able to taste
47:36 wine that would
47:38 you know diminish the quality of my life
47:41 and if i lost my taste that would be a
47:43 huge bummer so i would take the vaccine
47:46 just to be able to keep taking the line
47:48 for the rest of my life
47:50 and that alone would be enough to drive
47:52 me towards it um
47:54 but i think that the main thing was
47:57 was going to be the the breakneck speed
48:01 that we were able to enroll
48:02 patients and studies and they were
48:04 working around the clock on the
48:06 on the vaccines but you saw
48:09 and you saw people you know come up with
48:12 it
48:12 and then germany come with vaccines
48:15 in the same time frame everybody poured
48:18 everything into this
48:20 to get it out there with a patient but
48:23 at break next season and that's why
48:25 we're seeing a vaccine
48:30 any other questions thank you so much dr
48:33 davis it's always a pleasure to have you
48:35 thank you

CIMC Video Update: Dr. Daniel Davis presents at Avalon City Council Meeting

Dr. Davis addresses the surge in new cases in LA County and throughout the US, examines data surrounding influenza-like symptoms of ER and EMS patients as well as Catalina Island's cases over time compared to the rest of the nation. He discusses the success of CIMC's voluntary contact tracing efforts, at-home quarantine for positive cases and the continued safety of long-term care residents at CIMC.

Dr. Davis summarizes how vaccines are created including an explanation of adenovirus and mRNA vaccines, how effective these vaccines will be and how long they may last, as well as vaccine distribution timeline and safety.

Also covered are new quarantine and testing guidelines for those who have been exposed to COVID-19, and discussion of new treatments. Dr. Davis encourages our continued personal responsibility to contain the virus until the vaccine arrives by limiting our exposure, wearing masks and social distancing even through this very difficult and different holiday season.

COVID-19 testing is available at CIMC by appointment. Please call (310) 510-0096 Monday-Friday 8am-5pm to schedule. CIMC ER remains open 24/7 and all services at the CIMC clinic remain open for in-person, telemedicine, and virtual care.