Dr. Eric Topol: COVID BA.5 variant “worst we’ve seen”

Dr. Eric Topol

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Marianne O’Hare : This week on Conversations on Health Care , Mark Masselli and
Margaret Flinter welcome Dr. Eric Topol , fleeting - analyst during the
COVID - 19 pandemic, he says we need to do more to generate new
vaccine discovery as these variants con tinue to evolve.

Dr. Eric Topol : The virus has not finished its evolutionary arc. The variant BA.5 is the
worst variant, there is more to come .

Marianne O’Hare : Saturday s and Sunday s morning at 8 : 30 on the Feder al News
Network, our production community hea lth center, chc radio.com.

Mark Masselli : Our guest recently wrote the following “ it's frankly sickening to watch
this virus continue to outrun us knowing we are so damn capable of
getting ahead of it. ” We're going to learn more from the writer
himself. Dr. Eric Topol is one of the most prominent and prolific
COVID experts, as well as one of the top 10 most cited medical
researchers.

Margaret Flinter: Dr. Topol is the founder and the Director of the Scripps Research
T ranslational Institute. And we've always learned a lot from his visits,
including the last one, which was in December when the Delta surge
was occurring.

Mark Masselli : Dr. Topol , well I thank you for returning to Conversations on Health
Care .

Dr. Eric Topol: Thank you. All right. Good to be with you both.

Mark Masselli : That's great. Well, let's start with the COVID Omicron variant, BA.5
and its , has three key mutations in its spike protein, and that makes it
better at infecting cells and better at slipping past our immune
system. What more can y ou tell us? And what keeps you up at night
about BA.5 and other offshoots that could be on their way?

Dr. Eric Topol: Yeah, well, I think the key here is that although there's reluctance to
accept it, the virus is getting worse. The variant BA.5 is the wor st
variant and I don't say that because it's causing the most deaths or
hospitalizations. I say it because if you look at its biology, that you just
mentioned, the immune escape , the ability to have growth and fitness
advantage that we haven't seen before. If you're looking at the
properties of the virus, it's getting worse.

Also, parenthetically, it's lasting longer contagiousness, so instead of
what might have been seven days or eight days, it's clearly longer
now. I don't know anyone in my network now at the moment, who
isn't either infected or re - infected almost , it's just extraordinary. So ,
it ’s spread potential we're seeing and the most re - infections that
we've seen since the beginning of the pandemic. So , these are

Dr. Eric Topol

qualities that should raise concern, because the virus is not finished
its evolutionary arc. There's more to come, unfortunately and so
rather than being complacent and capitulating, we should be arming
up for how we can get ahead of the virus, which we've never done
since the pandemic began .

Margaret Flinter: I couldn't agree with you more about what we're seeing in our social
networks. I'm going to go off a little bit to the side on the issue of
COVID for a moment and speak about a person , because we just
learned recently that Dr. Anthony F auci has announced that he's
going to step down from his post by the end of President Biden's first
term, he played a very forward and prominent role, certainly, in this
first couple of years of the COVID vaccine. What do you think about
the role that he p layed? How effective was he as a communicator?
And do you think he helped America to better understand what they
needed to do ? Any thoughts on what might have been done
differently?

Dr. Eric Topol: Well, I think he's been extraordinary in his ability to tr y to
communicate and just work tirelessly. He really is indefatigable, an
extraordinary person and scientist and physician. So he's done his
absolute best, but he's been under profound attack. I don't know how
he's withstood this. I don't know how he can g o on for a couple more
years with all the things that have been done to personally ad
hominem go after him just as a reflection of the anti - science anti - vax
organized efforts that we have right now. And he's been, you know,
right in the middle of it and be aring a lot of the brunt like so many
other people, but especially him because he's been in it for much of
the pandemic center stage.

Mark Masselli : You know, I want to pick up on the threat of anti - science , anti vaccine,
you issued a clarion call that we need to apply money pressure and
government strength to create a variant proof COVID vaccine. And
you wrote in the LA Times that I quote , that nasal sprays deserve an
operation warp speed like program to accelerate their success. I’m
just wondering what th e hurdles are and are part of the hurdles that
anti - vax anti - science effort that's going on. I don't think we have the
attention of our government in terms of the investment s that they
need to make. And I guess as part of that, are there other drugs in the
pipeline in addition to the nasal spray we need, or should be keeping
an eye on?

Dr. Eric Topol: Well, you're making some important points there. Lot to go over. You
know, firstly, you know, back in January 2021, in nature, Dennis
Burton, who Chairs Immun ology at Scripps Research, and I wrote
about the need to pursue a variant proof vaccine. And here it is a year
and a half later, and we still haven't done it, we have no shortage of
candidates, that is ways that we can induce broad neutralizing

Dr. Eric Topol

antibodies that, at least theoretically, if not, in practice, would knock
out any variant that this virus could present to us. But we haven't yet
developed a program, because it's been politically not supported with
funding , and so basically, all these great discover ies sit in academic
labs all around the country in the world. And there's no organized
effort to develop a v ariant proof vaccine that has great promise.

And the nasal vaccines are a somewhat similar category, there's three
that are in phase three trials, b ut there's no operation warp speed,
like initiative. Remember, that was a $10 billion, which is a small
amount these days, considering we spent trillions . $10 billion to
basically de risk and accelerate the first vaccines, which worked really
well. But we' ve never done something like that again. And we and
many others have been calling for that. That is we shouldn't be at all
discouraged, we can get ahead of this virus, we can do this, we're just
not doing it. And then add to the woes, concerns that I have is that we
likely will develop Paxlovid resistance over time . Millions of the blister
packs are going out, you know, every week or month, here and we're
going to see the virus in Em pro, the main protease, it's going to find a
way to resist Paxlovid , and wh ere is our backup. And again, we have a
long list of really good candidate backup pills, but we're not, you
know, pursuing those in the accelerated way we could. So , the point is
the potential to get ahead of the virus is vast, but we're just doing like
va riant chasing and not putting in the aggressive pursuit that we need
to do.

Margaret Flinter: Well, I understand that we do have another vaccine, probably joining
what's available . Now CDC is about to review Nova v ax ’s COVID - 19
vaccine, at least for emergen cy use in adults and the FDA already gave
its okay. I understand there is some concern about severe allergic
reactions as a potential side effect. And then there was a poll by
Morning Consult that said that 77% of unvaccinated U.S. adults,
probably or defi nitely would not get a protein based vaccine, such as
this one for Novavax, which kind of leaves us with the question, is
there any vaccine that today's unvaccinated adults are likely to be
willing to get? And is there anything particular you would say abo ut
this one in terms of advice for people who, maybe until now have said
no, anything that would be inclined to change their mind?

Dr. Eric Topol: Well, I’ve already touched on this entrenchment the anti - va x , anti -
science has been profound and it's never b een adequately countered.
An aggressive strategy to deal with this and misinformation,
unfortunately, and we are ranked 67th in the world, behind Rwanda,
Iran, Sri Lanka, and many countries on the list, you would never have
imagined that for boosters, no l ess primary vaccination. There's no
reason why Novavax wouldn't be one of the good vaccines to take
and hopefully it also be shown to be useful as a booster . There are
new data out today to show it works well against Omicron variants

Dr. Eric Topol

like mRNAs with boosti ng. So , I'm not optimistic given the
entrenchment. Now, we can break this vaccine at this point, this
vaccine resistance . It's really unimaginable how profound that is. And
it's the same thing that's holding back our aggressive get ahead plans.
It's the sa me problem. People say Oh, it's over , the pandemic i s over ,
wrong. But that's the same group that are anti - vax that are , an d anti -
science , the science here is what's so exciting to get ahead of the
virus, and we're just ignoring it or not giving it any pri ority.

Mark Masselli : You know, you said the CDC has failed to warn Americans about the
sub variant spread. But as you said, it seems like the public is tuned us
out. And I'm wondering what that prescription might be for the public
health community, in ter ms of trying to right the ship, if you will, and
get us headed true N orth, in terms of following the science and
following the data, we simply haven't been able to engage the larger
public. Are they just worn out? Or do we have to really adopt a new
messag e to reach them?

Dr. Eric Topol: Well we're all tired . I mean, nobody can say that they think this
pandemic is a good place to be still in it, and it's not at it, I would
consider an endemic steady state phase whatsoever. So , the problem
is our CDC has bee n a profound disappointment. Rather than getting
the message out a year ago, when we knew about how boosters were
life saving. They resisted that for months, and there was infighting
with other agencies. And still today, that's why our boosters among
age 5 0 and older, four shots, only one in four Americans have had
that which is amazing, actually. And that's where we are basically so
vulnerable. But beyond that, how can you possibly recommend a five
day isolation still, when we know the virus last s 10 days or not longer
for contagiousness? It's unfathomable , and so the lack of a warning
until last week, when finally, there was a public, and basically the
message is we got this . No, we don't have this because they haven't
gotten the boosters, right. They have n't gotten the isolation, right .
They haven't gotten a plan right , to get ahead of the virus . Until that
happens they don't have this. And it's an illusion. So , we look to the
CDC to provide leadership to prevent disease. But if anything, they're
spreading it, which is extraordinary, by not having appropriate
isolation guidelines and messaging.

Margaret Flinter: Well, we could spend the rest of our time talking about that issue. I
couldn't agree with you more on that length of time that people
should be qua rantining. But I wonder if I can ask you about this issue
of COVID and children, and really everywhere, slower than I would
have hoped uptake, particularly some states in the southeast. Parents
are so slow to inoculate their children that we're seeing fewe r vaccine
doses even ordered from the state supply what's going on there? And
are you seeing any data around adverse effects in children from not
taking advantage of the vaccine of this youngest group of kids?

Dr. Eric Topol

Dr. Eric Topol: It's really discouraging, agai n, that the whole anti - vax influence also
being felt with children. First, we saw it in the 5 - to - 11 group. And
there's really no risk there that are beyond the local, you know, the
usual things that we see from as far as like myocarditis, pericarditis,
it' s just, it basically is not an issue. And then we may have the six
months to five year olds, it's even worse. So , here we have such a
large population of children that are at risk. And a lot of them did
have BA.1 infections in early part of this year. But that doesn't protect
them BA.5 or subsequent infections. So here, we have a great way to
keep them insulated from getting very sick , from spreading their
infections , from you know the Long COVID that can occur in children.
And we're not doing it. And it's a shame because so much work went
into getting pediatric vaccines validated, and it's all part of that same
continuum. And we're one of the few countries now that have gotten
down to, you know, the six month level, but we don't have it being
implemented at any scale in the country, because of the anti - vax
movement.

Mark Masselli : I'm trying to figure out what the practical suggestions are to people
around their daily life and talking more about adults. In terms of
masking up, how effective are those KN 95s , and the N 95 s It seems
that part of the strategy here or, you know, the results have been that
the government and the like are trying to keep businesses open and
they haven't figured out any sort of nuanced conversation with
people . How important are mas k c are so that you can continue to
engage in social conversations with your friends and your neighbors
and your families . What's the fine line for people in terms of that they
may be able to f ollow , so they're not getting infected?

Dr. Eric Topol: Well, of co urse, it's not just ma sks , like you said, the good ma sk , high
quality KN 95, N 95, which help ed . It's also distancing. It's also
filtration, and ventilation, all those things that we're not doing largely
right ? If we did all those things, like how can we not have masking in
public transport? It's incredible. If you go on a plane now, rarely, we'll
see people with masks. And that's in the airport, and all kinds of, you
know, you name the type of public transport. I mean, if you go to
Mexico, they use masks. I mean, we're distinct deniers, denialism of
the benefit of the mask . But it goes beyond that we're not doing the
simple things that would help , they're not foolproof by any means.
This is a hyper infectious version of the virus. So , none of these things
are going to be a 100%. but they help.

In the meantime, we use this as a chance to get ahead of the virus, so
that our vaccines work better in the future, that we have other
backup drugs, that we have nasal sprays, that will protect us from
infection and tran smission, because basically, we've lost that edge,
largely. So it's just you know, these are temporizing measures to help
us get through to when we, when we have something better to offer

Dr. Eric Topol

people , and we're not using them.

Margaret Flinter: Yeah and althoug h I hate to raise the specter of a new threat to
health, as we talk, the World Health Organization, Monkeypox
committee is getting ready to meet and decide if it reaches the
definition of a pandemic, but we're certainly reading a lot about it in
the press. How do you see this viral disease? What's likely to be the
pathway in the coming months with monkeypox ?

Dr. Eric Topol: Well, you know, I'm concerned about it, but I don't look at it in
anywhere near the issue that we're facing with SARS - CoV - 2 which
obvio usly has caused millions of deaths and worldwide turmoil. I
mean, monkeypox is a serious virus, and it's spreading. And it's very
concerning, and we aren't keeping up in terms of vaccines, and you
know, sure, but it's in a different, you know, order magnit ude of
concern that, you know, what we don't want to do is get distracted,
which is what's happened .

We can't afford to be strict. We got so many things going on between,
you know, a book banning abortions and the war in Ukraine and
monkeypox . I mean, you can add a long list that we -- inflation, that
we were missing, what's really critical, which is we still have COVID,
and we haven't done anything to contain it. And that's what we really
need to do. And I see these things, unfortunately, as distractions f rom
the main agenda.

Mark Masselli : You know, we had Dr. Fauci on in February 2020, just as the virus was
making its way from China over to the United States and around the
globe. And one thing he told us was Coronavirus is mutate, and you've
been talking about the evolution of the virus itself. Walk us through
where are we headed? You know, obviously, it's transmissibility has
been high, will its lethality get higher? I mean, what do we know? Are
we able to track the evolution of a virus like this? Or are we sort of
waiting for it to play its own hand?

Dr. Eric Topol: Yeah, I don't think we're ever going to see like the val idity get higher,
because we have this immunity wall, right. I mean, we have parts of
our immune response that have been primed by vacci nes and
boosters and infections, right. So , that's the point is that the virus
keeps evading our immune system more. And there's now sign s as of
Friday from the new CDC report that we're losing some of that
protection against hospitalization that we had ju st from going from
BA.1 to BA. 2.12.1. So that trend, it's not like an on off switch. It's just
like, this attrition of protection. We'll see probably more of that over
time with whether it's Sigma or Pi, whatever the new Greek letter o r
family, eventually we're going to get out of the sub variants. And
we're going to get into a new family, and who knows what the name
of that is going to be, but it's going to happen . And it's just, you know,
when? Whether it's before the end of the year or early next year, a nd

Dr. Eric Topol

we're not at all prepared for that because it's not -- the virus still has
room to evolve.

Margaret Flinter: Well Perhaps a final question i t’ s almost flu vaccination time. Hard to
believe we’re in to July, but in August, I'm sure we'll be back out there .
Share your thoughts on the importance of everyone getting a flu
vaccine this year and how that preventative step fits into everything
else that we've been discussing?

Dr. Eric Topol: Well, yeah, flu vaccines, they're good. And they do help raise your
imm unity across the board , and so that's good. But I'm glad you asked
me that as a final note, and that is, flu vaccines don't work very well.
You know, their effectiveness doesn't get to 50%. We've had vaccines
against this virus at 95%. There's never been a flu vaccine at that
level, actually give us optimism that this virus can be squashed that
we can get ahead of this virus. We were in terms of a great effective
vaccine, but then the virus evolves. So , this is a different virus, we can
do much better. We j ust have to do it.

Mark Masselli : We've been speaking with Dr. Eric Topol, Director of the Scripps
Research Translational Institute. Thank you, Dr. Topol for the clarion
call and vision that you've had all during the course of this pandemic.
And thanks to our audience for joining us. You can learn more about
the Conversations on Health Care , and sign up for our e - mail updates
at www.chcradio.com . Thank you again, Dr. Topol .

Dr. Eric Topol: Thank you . Thanks for havin g me. Take care. Bye - bye.

Margaret Flinter: Thanks Dr. Topol.

Mark Masselli : At Conversations o n Health Care we want our audience to be truly in
the know when it comes to the facts about health care reform and policy . Lori Robertson is an award winning jo urnalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics. Lori, what have you got for us this week?

Lori Robertson: Children under five, including those as young as six months of age, are
now able to be vaccinated against COVID - 19. There are two vaccine
options authorized by the FDA on June 17 th , one from Pfizer -
BioNTech for kids six months through four years of age, and another
for Mo derna for kids six mo nths through five years of age.

The FDA concluded that the known and potential benefits of the vaccines outweigh the known and potential risks. An independent panel of experts advising the agency agreed in unanimous 21 to zero votes, backing both vaccines. The littlest kid vaccines are essentially
identical to their older counterparts, except they contain smaller amounts of mRNA. That's the active ingredient in the shots that the
immune system recognizes and responds to generating immunity.

Dr. Eric Topol

The other big di fference for the Pfizer - BioNTech vaccine is that the
primary series includes three doses instead of two. The little kid
M o derna vaccine is still a two dose vaccine. Both vaccines are
expected to primarily protect young children from getting seriously ill
w ith COVID - 19 . Similar to how the adult and older kid vaccines have
been faring against the Omicron variant.

The shots are also likely to provide some limited and temporary
protection against infection and milder illness and may reduce your
child's symptoms if infected. As with the Pfizer vaccine for older kids,
the primary way the two vaccines for younger kids were evaluated for
effectiveness was by comparing the antibody immune responses of
children who had been vaccinated with those of young adults who
ha d received the adult dose and for whom clinical trials already
established efficacy

In this so called immune - bridging approach. If the neutralizing
antibody levels against the virus are similar, and a similar proportion
of children mount an antibody respon se, then it is inferred that the
vaccine works in younger children. The clinical trials for the vaccines
did not reveal any serious safety concerns. The Moderna trial included
around 4800 vaccinated children who were followed for a median of
two and a half months after the second dose. The Pfizer - BioNTech
trial included about 3000 vaccinated children, about a third of whom
were followed for at least two months following the third dose.

Similar to the vaccines for older kids and adults. The most common
side effects in young children were pain, redness and swelling at the
injection site, along with fatigue, headache, fever, loss of appetite or
irritability. Most of these symptoms were mild and resolved within
two days for the Pfizer vaccine or three days for the Moderna vaccine.
Many experts , the Centers for Disease Control and Prevention and the
American Academy of Pediatrics recommends that all children six
months of age and older get vaccinated unless they have a medical
reason not to such as an allergy to a vaccine ingredient. You can find
about the vaccines for the youngest children on our website. I'm Lori
Robertson, Managing Editor of FactCheck.org .

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Marianne O’Hare : FactCheck.org is committed to factual accuracy from the country's
major political players and as a project of the Annenberg Public Policy
Center at the University of Pennsylvania . If you have a fact that you'd
like checked, email us at chcradio.com . We'll have FactCheck.org’s
Lori Robertson chec k it out for you here on Conversations on Health
Care.

Each week conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives . Around the

Dr. Eric Topol

world there are some 300,000 health facilities that do not have
adeq uate electricity or lighting. And in these clinics and hospitals in
the third world, many women give birth in near or total darkness.
When Berkeley California OB GYN Dr. Laura Stachel changed careers
after a life altering back injury, she decided to focus her attention on
confronting this global health issue, which is one of the factors in the
high rate of maternal infant death s in the world.

Dr. Laura Stachel : You lost the light and the only way to get light was to burn the
calendar ,

Female: Yeah burn ed th e calendar .

Dr. Laura Stachel : So you could see and then cut the cord . Okay, you get the prize for
the most amazing story.

Marianne O’Hare : In Nigeria where the problem is particularly pronounced tens of
thousands of women and newborns die during childbirt h.

Dr. Laura Stachel : So much of what we do requires electricity, the monitors , the lights,
the machinery for helping with deliveries . It never occurred to me
that in other parts of the world, that the things that we assume to be
completely fundamental to medical care would be a bsent.

Marianne O’Hare : Dr. S ta chel ’ s husband Hal Aronson is a solar power engineer. And
together they formed We Care Solar, they developed a portable solar
power and lighting kit that could charge via solar panels by day and be
ins talled in clinics to provide power at night.

Hal Aronson : What was remarkable was that when they saw that they wanted to
keep it,

Marianne O’Hare : And they said, please leave it here because this will help us save lives
even right now.

Hal Aronson : And tha t was the lightbulb moment for us. Even a little bit of power
could go a long way towards saving a life .

Marianne O’Hare : The kids come equipped with everything a clinician would need for
communication and a medical emergency , electricity for walkie - talkie s
and cell phone powering and power enough for a variety of lights and
enough power to run some diagnostic equipment in the event of a
surgical emergency.

Dr. Laura Stachel : We had a doctor who requested a solar suitcase last Thanksgiving. He
called us fiv e weeks later and he said I want to tell you what
happened. The night that I came, I was able to save a woman with
twins using the light. And I would have called you the next day but
there was an outbreak of cholera , the next day. And for the next 30
days , e very man , woman and child that had cholera came to our clinic
and we use d the Solar Suitcase every night. He said for the first time

Dr. Eric Topol

in the history of this village, no one died of cholera. We saved 122
patients. And he said in the past 50 % of these peopl e would have
died .

Marianne O’Hare : We Care Solar has grown from a backyard manufacturing operation
with friends pitching in to a full scale manufacturing plant in Berkeley,
California. They've provided kits to hundreds of clinics around the
world and are hoping to scale up their operation to meet the pressing
need not just in remote clinics, but also during disasters as well. We
Care Sola r -- providing power and light for clinics around the world,
improving the outcomes of the patients being served. Now th at's a
bright idea.

Mark Masselli : I’m Mark Masselli .

Margaret Flinter: And I'm Margaret Flinter .

Mark Masselli : P eace and health .

Marianne O’Hare : Conversations on Health Care is recorded in the Knowledge and
Technology Center Studios in Middletown, Conne cticut, and is
brought to you by the Community Health Center now celebrating 50
years of providing quality care to the underserv ed where health care
is a right, not a privilege chc1.com and chcradio.com .