Learn about the Science of COVID-19 with Dr. John SantaLucia (Part 3)

We have a question on the chat. It’s, “You mentioned that the SARS-CoV-2 virus gains access to our lungs by ACE receptors. Do people taking blood pressure ACE inhibitors have any protection or susceptibility to COVID?”

Dr. John SantaLucia:

I do not know the answer to that question. That is a fantastic question.

Rev. Susan Mozena:

Yeah. Here’s a question from Don Ditmars. Slide 11, John. “Hand-washing, what is the effectiveness of alcohol-based hand effectiveness?” Maybe hand sanitizers? I think maybe that’s what Don’s asking about?

Dr. John SantaLucia:

Soap and water is superior to using an alcohol-based hand sanitizer. That being said, the hand sanitizer is better than nothing, so if that’s all you have access to, then by all means use hand sanitizer. But if you have access to soap and water, it’s more effective. That’s the basic advice. When I’m out and about, if I see a hand sanitizer there, I’ll take a little dollop of it and wash my hands myself. So, it does help. Not zero effectiveness, it’s just that soap really works well.Dr. John SantaLucia:

Soap literally dissolves the virus and causes it to degrade.

Rev. Susan Mozena:

Yeah. Here’s a question from Jan Esser. “John, you mentioned that the sequencing was done very quickly and was completed in January. Was this done by China?”

Dr. John SantaLucia:

Yes, it was. It was done by China. It was published, and subsequent to that, as I mentioned, over 100,000 have been sequenced from throughout the entire world, and the Chinese sequence was correct. It was 100% correct. Now, there have been mutations that have occurred since then, but it was published by the Chinese, yes, in Nature magazine. I actually give the reference on the slide.

Rev. Susan Mozena:

I think this is Joanne DeFazio. “Does a smaller intake of the virus result in a lesser illness?”

Dr. John SantaLucia:

We do not know, but our previous experience with diseases are, I mentioned earlier, that concept of the dose makes the poison. So, one of the elements about this wearing masks that I didn’t put on the slide, and I really should have, is the element of time. How long are you exposed to how much virus does make a difference. So if you were in a crowded room and everyone’s wearing masks, it ain’t going to help you much, you know? If you’re in a crowded room for a long period of time and there’s multiple people infected, you’re getting a large dose, then it becomes very likely that you’re going to get the disease. So, the amount of time is a critical, critical element.

Rev. Susan Mozena:

Question from Pete SantaLucia, whom I think is your brother.

Dr. John SantaLucia:

Yeah.

Rev. Susan Mozena:

Slide number three, John. “Since vaccine reproduces the spike protein, this then binds to ACE2 receptor. Since the vaccine reproduces a spike protein, this then binds to ACE2 receptor. The purpose of the ACE2 receptor is lung protection. Could this saturation of ACE2 receptors potentially increase risk for lung injury?”

Dr. John SantaLucia:

You know, that’s one of the reasons that testing is so critical. This protein, we don’t know some of these effects, like he’s bringing up here, are real possibilities, but I will tell you that Moderna and Pfizer, they’re aware of those types of effects, and it would not surprise me if they have actually made mutations to that spike protein. I don’t know this for a fact, but it wouldn’t surprise me if either they provided a fragment of the spike protein rather than the whole spike protein, and introduced mutations into it so that it, in fact, no longer binds ACE2, but still presents the fragments of the protein that your immune system needs in order to build antibodies. So, that’s the answer to that question.

[UPDATE:  In fact, both Moderna and Pfizer vaccines did mutate the S protein with a tandem proline-proline mutation.  I suspect that those mutations greatly weaken the interaction of the synthetic spike protein with the ACE2 receptor.]

Rev. Susan Mozena:

Okay. Question from Jan Esser, “When you indicate mutation, I had heard that the mutation made the virus symptoms appear more quickly.”

Dr. John SantaLucia:

Yeah, that’s a sort of preliminary result. Now, we really don’t know that. There’s a lot of things we’re learning as we go with the virus. I mentioned that there’ve been several hundred mutations already detected in isolates from different patients. We don’t know the correlation yet between the identity of the mutations and either the severity of the disease or the risk for them transmitting the disease. Those are two really big concerns that the virus will mutate in a way that makes it more deadly or makes it more transmissible.

Dr. John SantaLucia:

I think so far, the indications that I’ve read and the reports I’ve read, indicate that the mutations we’ve seen so far do not make the virus more deadly, but they may make it more transmissible. So, the actual circulating form of the virus is actually a little different than the original isolate from Wuhan, China. It has mutated a little bit. The main version of the virus that is in America actually came from Europe, so those mutations do have an effect on transmissibility, but I would say the jury is still out on the quantification of that effect.

Rev. Susan Mozena:

Here’s a question.

Dr. John SantaLucia:

Yes.

Rev. Susan Mozena:

“How long will the COVID-19 vaccination provide immunity?”

Dr. John SantaLucia:

We do not know the answer to that. The testing that has been done so far indicates that the vaccines are highly effective, thank goodness. The Moderna and Pfizer vaccines are both greater than 90% effective. The AstraZeneca vaccine, there’s a little bit more of a [variable] indication of its effectiveness, but certainly above 70% in that case, somewhere between 70% and 90%. So, the effectiveness [of the vaccines] are very high for protection in the timeframe in which it’s been measured, which is just a few months here. But we don’t know how long that immunity will last, and it could be you need a booster shot for some of these vaccines in order to retain your immunization level, so that is something yet to be determined.

Rev. Susan Mozena:

Question from Don Ditmars, “Why two immunization shots? Should they be from different sources?” And I might even amend that question and say, can they be from different … should they, or should they definitely not, be from different sources?

Dr. John SantaLucia:

They definitely … If you get the first stage immunization, and it’s the Moderna vaccine, then you need to get the second one from Moderna, absolutely. You cannot mix and match them. And I think that is one of the public health challenges as this gets rolled out is keeping track of who’s got which vaccine and when, and when they need to get a booster dose, all that stuff. But this is definitely something you should be communicating with a medical doctor about. I’d mentioned at the beginning, I am not an expert in immunology. I do not know the actual reason why you need to get two doses to get full immunization from these first two vaccines, but I know that it’s important.

Rev. Susan Mozena:

Here’s a question, referring back to slide number eight, John.

Dr. John SantaLucia:

Yeah, that would be another great question [for Keith Bellovich next week]

Rev. Susan Mozena:

For Keith. All right. John, here’s a question, again from your brother, Pete. Slide eight, “There is info on the internet, I’ve heard, that claims that mRNA in vaccine could, via reverse transcriptase, be interpolated into our DNA and thereby cause unknown side effects. Is this scientifically possible?”

Dr. John SantaLucia:

Okay. Scientifically possible? Yes. Scientifically likely? Highly, highly unlikely that this is going to happen. So, we do have a weak reverse transcription activity in human cells, so the telomerase gene works by reverse transcriptase type of mechanism. So, human cells really do not have much of an ability to do reverse transcription. They also don’t have much of an ability on their own to do integration, actually incorporate that [i.e. integrate the S gene into the human genome]. Let’s say reverse transcription, rare as it is, and it would also be hard for it to incorporate with the signals needed to translate the proteins, et cetera. So, I think that is extremely low probability event.

Dr. John SantaLucia:

Now, a person who was infected with AIDS and they had an active AIDS infection, so let’s say they weren’t taking a therapy for it, that could be an indication of … that could become problematic. That would be more possible, I would say, but there’s a rare possibility. And even a person with AIDS, if they were taking their drug treatment, then I don’t think that would be, even for them, a concern.

Rev. Susan Mozena:

Question from Jan Esser, “Many people seem to be wearing their mask under the nose. Do droplets come primarily from mouth or is exhaling, I would say, through your nose, an issue?”

Dr. John SantaLucia:

This virus is a respiratory virus. It comes out in whatever air … If it comes out of your nose or through your mouth, the virus are in those droplets. Put a mirror up next to your nose and you’ll see it fog the mirror. That’s respiratory droplets from your nose, so if a person was infected, those respiratory droplets would contain virus. Now, a sneeze is … got a lot more virus in it because it’s bringing up the mucosa from your lungs and deep in your lungs, in the alveolar cells, that mucus that’s in there, that contains the maximum amount of virus. So if you sneeze, that has a lot more, but there is, to be sure, definitely virus. So that’s just not … It may be more comfortable to wear it under your nose like that, but that is like, why bother wearing the mask if you’re doing that? You might as well not wear the mask.

Rev. Susan Mozena:

Thank you for that answer, John, because I’m particularly annoyed by people who only cover their mouth with their mask. Here’s a question from Howard Hill. “Which vaccine should be taken if you’re in a high risk group, over 70, chronic conditions, high blood pressure, et cetera?”

Dr. John SantaLucia:

I can give a very definitive answer on this question. You need to talk to your doctor. If you are in any kind of high-risk category whatsoever, then no answer from a PhD scientist here is going to be correct for your specific case.

Rev. Susan Mozena:

I thought that’s what you were going to say.

Dr. John SantaLucia:

Most of us who are … The majority of people who are healthy, then probably any of these vaccines would be a very important, protective to you and your family and your friends and neighbors. But these people who are in these high-risk categories, that’s one of the reasons it’s so important for the rest of us to get vaccines to protect [the broader community and immunocompromised in particular]. Some of these people just will not be able to [get vaccinated].

Dr. John SantaLucia:

I know that the AstraZeneca vaccine has been indicated to have a particularly strong, positive effect in elderly. And so it’s early days. We’re just testing right now. The tests, phase III clinical trials, that have been done [so far], some of the different vaccines have indicated what the age distribution was of the cohort that they tested it on. Other vaccine [manufacturers] have not released that information yet, but I think the AstraZeneca vaccine [may be] a little more effective in older populations the mRNA-based [vaccines].

Rev. Susan Mozena:

Here’s a question from Jay Lidell. “When vaccinations become available,” and I think maybe maybe you partly gotten into this answer, “should we care which manufacturer’s vaccine we get?”

Dr. John SantaLucia:

You should keep track of it in case someone else doesn’t. I would know, did I get the Pfizer vaccine, or [crosstalk 00:11:22]

Rev. Susan Mozena:

No, I think Jay was asking, “Should we,” depending on how it’s rolled out, let’s say in our community, “Should we care about which one is being offered to us?” Because they’re not-

Dr. John SantaLucia:

We don’t have that kind of information to know if one is better than the other, for example. The two that I’ve seen data on are … Three. I’ve seen data for three of the vaccines, AstraZeneca, Pfizer, and Moderna. All seem to be highly protective, highly effective with essentially no side effects. Very, very mild, like sore arm kind of thing? And so they seem to be almost equally, highly effective, so I don’t have any recommendation as to which one is better than the other.

Dr. John SantaLucia:

It may not matter. I think it doesn’t really matter, to tell you the truth. What matters is you get vaccinated, because the longer you’re not vaccinated, the longer you’re vulnerable to getting this disease. I’d say that’s the way more important thing. It’s going to be rolled out in stages. First, our healthcare workers will get it. Then there’s some elderly populations that will get it. Then there’ll be some various people groups who are particularly vulnerable to dying from the disease. Those folks will get the vaccine first.

Dr. John SantaLucia:

If it’s available to you, I will be first in line, once it’s available for me. I think we’re in group four Holly — is that right?

Speaker 3:

Yes.

Dr. John SantaLucia:

Yeah. We’re in group four, so we’re probably not going to have access to it [for some time]. The general population won’t have access to this until probably June or July, something like that.

Rev. Susan Mozena:

Right.

Dr. John SantaLucia:

In the meantime, the virus is raging, so we should be doing everything you can to-

Rev. Susan Mozena:

Right. Couple more questions here I think we have time for. From Marcia Ball, “You noted four different approaches to vaccines. Is there any reason to believe that one approach or another would offer better protection against mutations?”

Dr. John SantaLucia:

That is a great question. I will say this, that we are really blessed that we have so many vaccines, and it may indeed be the case that the virus mutates in such a fashion that one or more of the vaccines then become ineffective. And if that is the case, at least we have a backup vaccine. That would be an argument for you getting a second vaccine if that were to occur. But I have a feeling that will be in the news. Everyone is going to know about that. If there is a virus mutation, and say the vaccine you got no longer is effective, that you’ll be getting a call that says, “You should come in and get a new vaccine.”

Rev. Susan Mozena:

Right. This next question is, actually, I think related to that. “Is it likely the vaccine will need to be taken seasonal like the flu vaccine due to mutations?”

Dr. John SantaLucia:

We do not know.

Rev. Susan Mozena:

Oh.

Dr. John SantaLucia:

We do not know the answer to that.

Rev. Susan Mozena:

Then another question here, “What’s the longest time as sneezes droplets remain in the air indoors?”

Dr. John SantaLucia:

Oh, great question. In the air, it doesn’t last very long, because the droplets eventually sort of … the particulates that they’re in are somewhat heavy, so they have a bias to sort of end up on the floor eventually. So, within a few hours, basically, they are … A room that had an infectious person in it, the virus has probably then been deposited on a floor, and unlikely you would get it, particularly if you’re-

Rev. Susan Mozena:

It depends on ventilation too, right John?

Dr. John SantaLucia:

Oh, yes. Some buildings are ventilated with HEPA filters and those capture the vast majority of the virus. Again, situations, or if you have to, like to get food, then minimize the [amount of ] time, and by all means, wear a mask, for sure. I mean, it’s mandated in Michigan, but some parts of the country it’s not mandated, but-

Rev. Susan Mozena:

Okay, one last question-

Dr. John SantaLucia:

Try to be sensible about minimizing your risk. That’s a good point.

Rev. Susan Mozena:

Yup. “Is the percentage of individuals who are asymptomatic carriers unusual for this type of virus and/or viruses in general?”

Dr. John SantaLucia:

Yes. I think it is. This virus, the number of individuals who are nearly asymptomatic or completely asymptomatic, seems to be very, very high, higher than … Think about when someone gets influenza, you know it, right? I mean, they’re sick. There are many people … And there are very few people who have influenza with no symptoms at all. So, this does seem to be unusual in the population [of people who are infected but asymptomatic].

Dr. John SantaLucia:

Well, it’s been a joy giving this and I’m glad to continue the conversation. People can email me.