On May 18, 2021, Yale’s Department of Internal Medicine hosted a panel on Clubhouse, a social networking app that allows members to gather in audio chat rooms and discuss issues in a live podcast style. The event focused on the future after COVID-19, from herd immunity to mask longevity and even, the US mental health crisis.
The following experts participated in the panel discussion:
- Jamie Meyer, MD, Associate Professor of Medicine and Infectious Diseases and Epidemiology in the Department of Chronic Disease Epidemiology
- Sheela Shenoi, MD, Assistant Professor of Medicine in Infectious Diseases and Associate Director of the Office of Global Health in the Department of Internal Medicine
- Prerak Juthani, MD-MBA student
This event was moderated by Perry Wilson, MD, Associate Professor of Medicine in Nephrology, and Director of the Clinical and Translational Research Accelerator.
Below are some highlights from the event. Conversations have been edited for brevity.
Q: Now, there are still not a huge number of variants of special interest, but why are there so many variants? Is SARS-CoV-2 a virus that's particularly prone to rapid mutation, or is there another reason that we keep seeing all these variants?
Meyer: Creating variants, forming mutations, this is what viruses do. But variants form when there are high levels of the virus circulating in the community. We put selective pressure on the variants, so those that are more contagious, more highly-transmissible, or potentially even more lethal, are the ones that grow out the most. The fact that we are picking up on them is in part because we're monitoring them.
Q: What are our strategies to improve the worldwide pandemic?
Meyer: When you're in the midst of a crisis, getting as many people vaccinated as quickly as possible is important. And we have seen, from the Moderna and Pfizer vaccines, from CDC data, that after the first dose, there is a significant protective benefit. I think what we don't know is necessarily the durability of that response. I think there's the thought that the second dose that is the booster provides, potentially, a longer-lasting protective benefit. But that's okay. You can deal with that as more vaccines become available. The priority now is sort of stemming the tide.
Q: Do vaccines prevent transmission?
Wilson: Data is still emerging, but one clever study looked at antibody levels over time in people who are vaccinated and could tell how many of them developed asymptomatic infection. It showed that even asymptomatic infections were substantially reduced by vaccination. There were also some studies that looked at nasal carriage of virus, and again, you saw a dramatic reduction in those asymptomatic infections among the vaccinated versus the un-vaccinated crowd. Although we're going to want to get more data, we are not gonna see substantial transmission from fully vaccinated people to un-vaccinated people. That's really what was driving the CDC - the masks protect you a bit, but really we wear masks to protect other people in case we're shedding virus.
Q: Are masks here to stay?
Shenoi: I think masks are here to stay in a small way. I think, unfortunately, masks in this country have been politicized. There's so much more significance attached to mask-wearing in this past year outside of the public health or individual medical or protective benefits. I think there's a lot of people who are still very cautious and very nervous about COVID and thinking that the CDC recommendations to lift all the mask recommendations was premature, given that only a third of the country is vaccinated. I think there's a lot of caution that will keep masks in our nomenclature for a long time. And I would not be surprised, as we move toward this possibility of long-term COVID or something approaching the flu, where we see resurgence every year or so, to have times where masks are going to be part of our daily lives.
Q: What's your thought on vaccine passports? Is this something that's useful from a public health perspective? And would the American people, in particular, accept such a thing?
Meyer: Vaccine passports are a highly controversial hot topic. I do think that there are some countries and cultures in which it's very acceptable and is a part of the culture there. I was working at a mass vaccination site, and I vaccinated a guy from Haiti who told me, "Oh, yeah, this is my vaccine passport now. I carry one around anyway." But I don't think that's necessarily a part of American culture, and I do think, in the US anyway, that people would find that overly restrictive. There is one little pocket in American culture where it is acceptable and there's precedent for it, and that is us as healthcare workers - we're required to show documentation of our annual mandated influenza vaccine, MMR vaccines, hepatitis B and that we’ve completed certain other types of trainings, never mind vaccination. So I do think that there is precedent for it in those little pockets, but it's hard to see that it would otherwise be widespread. I think from a public health perspective, the way that we get around this, both the honor system and the controversy of vaccination passports, is again to vaccinate as many people as possible so that we don't necessarily have to achieve herd immunity as we just talked about, but we get as close as possible as we drive those case rates down.
Q: Have we given up on herd immunity?
Shenoi: I think we all had very high hopes that we would be able to achieve a certain level of vaccination and/or immunity through natural infection, although, of course, we've learned that's short-lived. But I think the reality's setting in that the levels of vaccination that we would need to achieve herd immunity are unlikely. Not only in this country, but globally, it's gonna require a massive effort that's not gonna be achievable in a rapid or timely way. And so, I hate to say that we're giving up on herd immunity or that we're giving up on vaccination, because I think it's still so critical to getting to the post-COVID future. And just to clarify, we're not anywhere near post-COVID. We still have a long way to go. We've made significant progress in the US, but unless we address things on a global scale, this is far from over.
Q: Is there something that you wish was getting more attention in the popular press, in the mainstream media that isn't getting quite enough attention? If so, what is that?
Meyer: I would say that there's a lot of things, but one of the biggest challenges we've had through this pandemic is that anyone could seem like an expert or present themselves as an expert. And it's really hard to know who is telling the truth and what the truth is, and there's a lot of confusing messages out there. It's hard to know where reliable sources are to be found. I wish that there was more directed myth-busting. I just have been bombarded with texts and phone calls from families and friends this past week as vaccination rolls out among 12 to 15-year-olds, filled with a million myths that they've read on Facebook, on Twitter. It's very hard for people to know who to trust.
Q. Will the mental health effects of COVID help us recognize that mental health is its own crisis in this country?
Shenoi: I really hope that among the many lessons learned from this pandemic, is that we need to strengthen the mental health infrastructure in our country and not just in our country, of course. Globally. I was so buoyed to see the current administration is pouring some resources, I don't know if it's really enough but resources to bolster the public health infrastructure, so that we are in a better position to manage the next crisis. The next public health crisis. And similarly, I hope that there's going to be more resources for all of these other gaps, including mental health services in this country as well.
After this, the audience had the opportunity to ask questions.
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