Here & Now

Noon Wednesday: COVID-19's Present and Future

Marisa Wojcik:

Welcome to “Noon Wednesday,” I’m Marisa Wojcik, multimedia journalist with “Here & Now” on PBS Wisconsin. Today is October 6. Wisconsin just surpassed 8,000 deaths due to COVID-19. Hospital beds and intensive care units are reaching peak capacities while the state only inches forward in vaccinations. All of this while some are considering a vaccine booster and a new pill that could be taken upon receiving a positive covid test. To understand what’s current with covid, we turn to the Medical Director of Infection Control at UW Health and infectious disease specialist at the UW School of Medicine and Public Health, Dr. Nasia Safdar, thank you so much for joining us.

Nasia Safdar:

Thank you.

Marisa Wojcik:

So, the state’s data is showing cases and hospitalizations are either kind of holding steady or still increasing depending on where you are in the area of the state. Have we kind of hit this peak of the delta wave, or are we still going to see the worst of it as we approach more of the fall and winter months?

Nasia Safdar:

You know, it is obviously hard to completely predict, but I think what’s happening is in areas that have high levels of vaccination, you are not seeing quite a sharp a peak as you would otherwise expect. There is a stuttering effect where you are either holding steady or seeing more hospitalizations and it levels off. It would be great to have fewer hospitalizations, and no one county or region exists in a vacuum. Here, for instance, we provide care for patients all over the state and beyond, and hospital rates go up regardless of what local vaccination rates look like.

Marisa Wojcik:

And the 7-day average of those hospitalized is over 1,000 and more than 300 in the ICU. The hospital association data shows more than 40% of hospitals are at their peak capacity. Would you consider this even more of a crisis than what we saw last year, and are non-covid patients with critical care needs being likewise impacted?

Nasia Safdar:

I think it depends what sort of capabilities exist within a particular health system. I dont think we are quite there where we were last year. Last year, there was the need to postpone elective procedures and surgeries and repurpose those rooms for patients with COVID. That is not happening at the moment everywhere, although some health systems have had to do it because of their capability. I think the concern it may happen, though, exists. I mean, it’s not just the physical space that’s the issue, but the work force. You know, as infections are in the community, healthcare workers also tend to come down with them, and given there’s a need for highly trained people to care for COVID patients, that really limits what one is able to do.

Marisa Wojcik:

And with school having been in session now for at least a month, not only are we in person for the university, but also for K-12. Are we seeing more pediatric cases, considering that delta is considered a worse variant than what we saw last year?

Nasia Safdar:

I think overall, pediatric cases increased compared to the earlier days of the pandemic. I think there’s a big spectrum how severe the illness is ranging all the way from having no symptoms to landing in the hospital. There’s a syndrome of massive inflammation that happens after one recovered from COVID that’s more common in children that lands some of them in the ICU. Having said that, I think the mitigating measures that places should take, such as schools, for instance, with masking, testing, monitoring, and all of those, those do appear to be effective in containing the number of cases. You know, in order to eradicate COVID, we all came to the conclusion that eradication is not a practical option, but learning to live with it and manage is the next goal.

Marisa Wojcik:

Are you worried about the long COVID symptoms of children?

Nasia Safdar:

I think we have to understand those a lot better, not just in children, but in adults. I think there’s a big spectrum of symptoms. Some have to do with how severe your initial COVID illness was, like persistent shortness of breath and fatigue and so on that improve over time, and others are not related with the initial severity of illness, and that’s things like feeling foggy and memory issues, and those are concerning. It is concerns because we can’t predict them or have good therapeutics against them. The main goal for COVID should still very much be upstream prevention.

Marisa Wojcik:

New federal Department of Health and Human Services report vaccinations prevented around 5500 infections and 700 deaths in elderly in Wisconsin. Is it frustrating to be a part of this life saving research, putting so much energy into it, and yet there’s so many choosing not to get vaccinated at this point?

Nasia Safdar:

Well, I think one does wish that more people would embrace what’s in front of us as an effective way to prevent COVID. Having said that, I mean, a life saved is a life saved. We take everything that we can get, but given that capacity’s not so much an issue in this country with vaccines and the supply’s there, it would be great if the demand also went up.

Marisa Wojcik:

And now many are considering whether or not to get a booster as the efficacy of the initial vaccine series wanes over time anywhere between six and eight months. Would you recommend that those who can get a booster should?

Nasia Safdar:

Absolutely. If you are in the group that’s eligible for a booster, you should. I suspect many people who have taken the two doses are in the group that they are believers in vaccine effectiveness and the data and so they will take a booster meant I think for those reluctant to take the vaccine to begin with, I doubt the availability of booster will affect their decision making.

Marisa Wojcik:

And even now a new pill from Merck is seeking federal approval. It is designed to be taken upon a positive COVID diagnosis, and supposedly will help prevent more severe symptoms. Do you see this and other solutions that are not vaccines being promising in the fight towards combating COVID?

Nasia Safdar:

Well, absolutely. You know, the vaccines are great, but we still don’t have one for pediatrics, and we need that for the first order of priority. Having said that, there will still be some people with breakthrough infections or can’t take the vaccine or be able to take the booster, so to manage the cases we do get, we need a really good outpatient regimen. Right now, we don’t really have much. We have the monoclonal antibodies, it is an infusion that needs monitoring, and it is complicated, and with that comes barriers to access, but if there was an oral pill to take within the safety of your home and not go out and expose others to your illness, I think that could be just as effective in how we manage COVID cases.

Marisa Wojcik:

And to be clear, you know, we heard these stories about people who are in the hospital, sick with COVID, and they are asking if they can now get the vaccine, and it is too late to get the vaccine, and this pill wouldn’t be for something like that. It is also too late once the symptoms, the severe symptoms have already set in, is that correct?

Nasia Safdar:

That is correct. This is really designed to prevent hospitalization, and once that has happened, then this would be feudal to use at that point. There are other medications for patients with COVID who get hospitalized, but nothing trumps the effectiveness of the vaccine.

Marisa Wojcik:

Considering this, this pill now and other ways in which we’ve come to start fighting this virus in many different ways, are there parts of your research or other’s research you see that you are excited about and on the horizon of as another facet, another angle towards the future of fighting covid?

Nasia Safdar:

Well, I think in the vaccine development realm, there’s potentially promising developments about nasal vaccines, which would make it even easier for people to get it, and looking at the effectiveness of these who are older, compromised, and conventional doses do not take as well, I think all of these are promising lines of inquiry. There’s over 300 different candidates as far as therapeutic agents in various stages of clinical trials for COVID. There’s no shortage of research underway to identify what those are, but we do have to have them go through the rigorous process of evaluation for effectiveness and safety before we jump the gun, and that’s true for this Merck product as well. You know, the only data seen so far is in the form of a press release so it needs to be independently valued.

Marisa Wojcik:

Beginning in 2022, you will transition to a new role as the Associate Dean of Clinical Trials at the UW School of Medicine and Public Health. However, in your current work as an infectious disease specialist, you have already been involved in clinical trials, particularly related to COVID-19. What have those looked like?

Nasia Safdar:

Well, so one of the trials, for instance, that’s still underway is using a topical combination of things. It is internasal iodine applied with a swab, and then there’s antiseptics available over the counter and pretty well tolerated, but using in a program to see if they reduce COVID infections. That’s one of the COVID trials that’s potentially low cost and high impact if it is found to work.

Marisa Wojcik:

You do a lot of media availability, and you do a lot of research simultaneously. Do you see how to talk about this research, how to almost market this to people to make sure they are getting the most accurate information? Do you see that as being a part of the future of research and science in developing new ways to combat viruses like this?

Nasia Safdar:

Oh, absolutely. I mean, honestly, research means nothing if it’s conducted and does not get applied, and the people that apply it and take it forward is the public, so being able to effectively communicate what research is doing, how it’s helping the human condition and human health is really critical.

Marisa Wojcik:

And so how will your work going forward as you transition to the new role, how will it expand and how important are things like clinical trials important to the continued fight against Sars-Cov-2 and COVID-19 and has this all really accelerated since the urgency of this pandemic?

Nasia Safdar:

Well, I think the Sars-Cov-2 pandemic highlighted the gaps we have in clinical infrastructure and highlighted miracles that happen when people collaborate to rapidly bring something from collaboration to authorization and to the public and the outcomes and seeing the real world outcomes around us. The mortality of COVID even dependent on the vaccine has come down because of the new developments, and new development you think of is the product of research. We often don’t see that, all the back end work, but thinking about things, independent of infectious diseases, but think of breast cancer, for instance, go in the physician’s office, diagnosed, and you are offered treatment options, those are a result of decades of research. We being able to benefit from that I think is very important and the way to do that is to be active in trials. So my role is to lead and develop and accelerate a program of clinical trials research so it will beyond by own work, for instance, in infectious diseases, but really will be to support the participation of as many patients as possible in clinical trials, for them to offer them the opportunity. Too often, that opportunity is limited and we want to change that.

Marisa Wojcik:

And you do want your work to expand beyond COVID, but do you also see COVID clinical trials expanding as you’re doing this future work?

Nasia Safdar:

Absolutely. I think for as long as the pandemic is a threat, which, you know, for us it’s for the foreseeable future, seems to be, will want to absolutely offer to our patients any clinical trials that are happening and lead some locally as well that will be national and large trials. Friendships, the NIH has a number of products they are testing. These are such trials they can be offered to anybody in the nation. You don’t even have to travel. You can enroll in a study and agree to take a particular candidate intervention. It’s those kinds of things we really want to facilitate. A lot of what clinical trial’s leadership program does is collapsing barriers to clinical trial participation and my role will hopefully alleviate some of the barriers.

Marisa Wojcik:

You said a few moments ago that you don’t think that eradication of this virus is going to happen. Did you always think that, or is it just recently that that kind of seems like the reality, and if it’s not eradication, what is the management?

Nasia Safdar:

I don’t know that I always thought that. I think we were all hopeful in the beginning, especially in these highly effective vaccines came out that this might be the end. I think we believed it would be a little bit of smoldering of the virus, making its way into respiratory viruses like others do, and it would cease to be the kind of threat that it still is, and now I think what we’re learning is the way these, this particular virus mutates and strains that emerge, some of them are more threatening than others, and delta is one of them, and who knows what the next one will be. To find a way to manage this threat, meaning using all the tools at our disposal, including vaccines and including more readily available, easy to take inexpensive therapeutics, and provide the best possible care to those hospitalized with COVID regardless of other things. I think all of this needs to be brought to bear, and, of course, research and aid and development and implementation of new things, and so we may find something that will completely alleviate it, but until that happens, we have to continue to use everything we can at our disposal.

Marisa Wojcik:

All right. Dr. Nasia Safdar, as always, thank you so, so more for your work and joining us today.

Nasia Safdar:

Thank you.

Marisa Wojcik:

For more from “Here & Now” and PBS Wisconsin, visit pbswisconsin.org, and thank you so much for joining us on “Noon Wednesday.”