With all the hysteria, misinformation and just overall questionable coronavirus-related media coverage out there these days, have you ever wanted to just get in front of a nationally prominent physician who has studied the issue – someone who knows what the heck they are talking about – and ask the questions you’ve always wondered about but don’t see the media asking? Well, I sure have, and you’ll find responses to several of my own burning questions below.
Dr. David Samadi is a urologic oncologist who specializes in robotics and minimally invasive surgery for prostate cancer. A former Fox News contributor and member of the network’s “Medical A Team,” he currently serves as Director of Men’s Health at St. Francis Hospital in New York. Dr. Samadi has also made various media appearances over the past several months on the topic of COVID-19, so he seemed like the perfect expert to field my questions.
Q - If we’ve never been able to get a workable vaccine against a coronavirus before, how is this one different? Wouldn’t it need to be changed every year?
A - The difference between other coronaviruses such as SARS and MERS, is COVID-19 is a novel or new coronavirus never before seen. This virus has also affected far more people worldwide than either SARS or MERS, creating more of an incentive to find a vaccine soon. When SARS and MERS appeared in 2002 and 2012, respectively, they fizzled out relatively quickly and affected a much smaller number of people. There was little economic incentive to do research on developing a vaccine because each posed a small threat to society in general. COVID-19, on the other hand, has resulted in a multitude of deaths across the globe, thus creating more of an incentive to find a vaccine.
At this time, it’s hard to say if an updated vaccine would be necessary each and every year, like what happens for the yearly flu vaccine. It’s possible, but I think it’s just too early to know for sure. Vaccines generally take years and years to develop testing them for safety effectiveness. If we actually are able to roll a vaccine out by 2021, that would be at a breakneck speed we’ve never seen before.
Q - Is natural herd immunity possible? If so, how long does it take? Why are there differing opinions on this?
A - There are two ways to achieve herd immunity – through vaccines or naturally. Both smallpox and polio achieved herd immunity through the development of highly effective vaccines that created lifelong immunity. If we’re successful at developing a vaccine for COVID-19, that would be one way to get to herd immunity and could end the pandemic. At this time we are not certain if we would need regular booster shots since this is a novel virus we still have much to learn about as we go along.
Natural herd immunity is possible if whatever virus we’re fighting actually results in lifelong immunity in those it infects. Right now, we’re not totally certain if someone who has been infected with COVID-19 actually has lifelong immunity – that’s the million dollar question. Getting to herd immunity naturally with people getting infected with the virus and allowing the virus to spread unchecked, then naturally infection rates increase dramatically and eventually, the curve flattens and disappears as more people are infected, recover and develop immunity. But doing it this way could take several years to achieve.
Q - I’ve seen that herd immunity can be as low as 25% because many are protected through T cells. Is this a factor? How so?
A - There is still much more we are still learning about this virus to really understand at this point if herd immunity is possible with only 25% of the population through T cell protection. For the past few months, much of the focus has been on antibodies, proteins produced by B cells, a type of white blood cell, that when they encounter a cell such as a virus that is foreign to the body, the antibodies either neutralize them making them unable to invade the host’s cells or mark them to be destroyed by other cells in the immune system. Even after an infection has been cleared, the B cells continue to produce antibodies helping the immune system to respond quickly if you are exposed to the same virus again.
T cells are also part of the immune response to foreign cells and their job is to detect and kill cells already infected. These T cells will remain in the body in higher numbers even after the infection is gone. Hypothetically, T cells could prove to be a big player in combating COVID. There is one study which found some patients with no symptoms had T cells that recognized the virus but had no antibodies. Another study found people who had a level of immunity even though they had not tested positive. The theory behind this is that maybe they were exposed to a different coronavirus such as the common cold that possibly formed these antibodies.
Q - Overall, including those who contracted it along with T cell, what percentage of the population do you think might be already immune to coronavirus?
A - Just a few days ago, a study in JAMA Internal Medicine of data from CDC found that as of this spring, only a small proportion of people in the U.S. had antibodies to the virus. However, the CDC believes this number to be much higher by anywhere from two to 13 times cases reported. In this study, as of early May almost 24 percent of New York’s population had shown antibodies, the highest of any other location tested, but still far below the 60 to 70 percent threshold for herd immunity.
I do believe the virus was likely already here as early as August to October of 2019. Many people have talked about the worst flu they ever experienced last fall or early winter and wondered was it COVID-19? Keep in mind, their presentation of symptoms may have been different than what we are seeing now. Until more people have antibody testing, it’s a guessing game as to the percentage who already have immunity.
Q - What is the real evidence of asymptomatic spread? What percentage of coronavirus cases are spread asymptomatically?
A - There have been reports of asymptomatic people spreading the virus, but the risk of transmissions from pre-symptomatic or symptomatic people is considered to be much, much higher. That’s because viral RNA shedding is higher during the onset of symptoms and then declines over the course of several days or weeks. If you’re around someone infected with the virus and they’re coughing up viral droplets, they are far more likely to be spreading the virus to you than someone asymptomatic with no symptoms whatsoever. Proven data from contact tracing studies in Europe have shown it’s actually very rare for an asymptomatic person to be transmitting the disease. At this time, it’s hard to say what percentage of coronavirus cases have been spread asymptomatically but I would guess a small percentage.
Q - Common sense would seem to say that inhaling what you exhaled for long periods of time would be a bad idea. Is the “no danger whatsoever” claims for wearing masks that we are getting now just politics? Is there really any danger?
A - To say there’s ‘no danger’ depends on the person and situation. It’s summer and very hot and humid right now so if wearing a mask, especially outdoors, feels confining making it harder to breathe for someone with asthma, they should take frequent breaks from wearing one too long. I wear masks during surgery for long periods of time and have no issues. One concern being talked about is if there’s a build-up of carbon dioxide levels in the body from breathing in and out your same air when wearing a mask. There really is no danger of this happening. However, anyone with asthma or a lung condition should speak with their doctor if they have concerns wearing a mask. My bigger concern with the general public wearing face masks is, are they regularly washing cloth masks and always throwing away paper masks each time they are worn instead of reusing them? Cloth masks in particular could be a real collector of germs lurking on them, and then you put it back on your face without washing. That’s not a good plan.
Q - Do masks work to stop the spread? If so, to what degree? Is there settled science on this and, if not, why are we being led to believe this is the case?
A - As the virus continues to spread, I think it’s strange masks were not recommended at the very beginning of the pandemic. Originally, we were told masks are ineffective, that they wouldn’t help. Health officials have flip flopped and suddenly they’ve decided masks are effective with many state governors mandating their citizens to wear a mask just about everywhere. As far as stopping the spread of COVID-19, it really depends of the type of mask as some are more effective than others. Surgical face masks are very popular but offer little to no protection. It makes you look like you’re officially creating a barrier but not much of one. It’s important to not wear them over and over but change them 2-3 times a day. The face cloth masks are also popular but don’t forget to wash them. Wearing them over and over again without washing will do more harm than good. Masks providing the best protection are KN95 or a gas mask, both however are extremely uncomfortable and not practical.
There are a few studies favoring the wearing of face masks to control the spread of the virus, but all stress the importance of hand washing and social distancing. Other studies have found face masks are not that effective as they tend to cause you to be touching your face more frequently, they limit communication through facial expressions or lip reading, and again, if not thrown away after each use or washed frequently, may actually increase the risk of infection.
Bottom line, there is no way to stop the virus unless you wear a mask 100% of the time and only if worn properly. And even then, unless you are washing hands frequently and keeping a healthy distance from non family members or when in a crowd, even masks are not completely foolproof.
Q - Why does the media hype cases constantly but seem to ignore the deaths stabilizing and death rates declining?
A - Drama sells. Good news doesn’t bring in big ratings. Our news media has become flawed in their constant fixation on showing a particular narrative they’ve chosen to push. Right now, they have tunnel vision about only reporting on the high number of new cases, full hospitals, ICUs overwhelmed, but barely a mention of how the daily number of deaths has been declining over the past 2 months. All this does is continue to spike the public’s panic and fear over this virus when it’s not necessary. If you’re not going to balance the news with a look at both sides of an equation then yes, the numbers of coronavirus are going up because we have gotten better at testing and more people are getting tested, but the number of people dying from this virus has dropped substantially because we’re getting much better at knowing how to treat it to prevent deaths. To me, this is irresponsible journalism. There should be no agenda in our news – do your job and report the facts from all angles.
Q - Now one of the talking points is long term effects (lung scarring, etc.). What percentage of cases do you suspect may lead to some sort of long term negative effect for people? Is there a chance the media is simply focusing on certain cases to scare people or is this legitimate concern statistically?
A - Of course the media will pounce on a topic that grabs the public’s attention enticing fear. Again, drama sells. However, there are legitimate concerns we need to take seriously that many COVID-19 victims have experienced. We just don’t know how long many of these symptoms may last long term. A year ago, COVID-19 wasn’t even on our radar. It was just about six months ago when this virus made a splash in the media which is such a short period of time to really know what kind of long term effects may result from it. What may help is an app developed by researchers from King’s College of London and Massachusetts General Hospital called the COVID Symptom Study. Anyone who has had the infection can contribute or join by describing their symptoms they have each day. So far, more than 4 million people have contributed to this study.
What’s been found so far is that most people do recover completely within 14 days with about one in 10 people who still have symptoms after three weeks. Some symptoms that seem to linger longer than others include loss of sense of smell, blood clot issues, triggering of diabetes, and lung damage or scarring of people who needed to go on ventilators. Elderly who were on ventilators are more likely to experience scarring, but those of all ages have seen diminished lung capacity and exercise capacity. Whether this is a long term issue or not, is not known at this time. Blood clots cutting off circulation to the lungs have been another issue in these patients as 23 percent to 30 percent who had severe COVID-19 and on a ventilator have had this.
Dr. Samadi is also an opponent of lockdowns and a strong advocate for schools reopening in the fall. I didn’t ask about those issues because I knew where he stood, but I did think of even more questions after sending these, and I’m sure many of you will think of some as well. Feel free to ask them in the comments and maybe we can get him in for another round in the future!
You can follow Dr. Samadi on Twitter @drdavidsamadi!