CAZENOVIA — Last week, the Cazenovia Forum presented a virtual lecture by Dr. Shannon Magari, titled “The Science of COVID-19: Controls, Testing, Vaccines, and What Lies Ahead.”
Magari is a visiting scientist at the T.H. Chan Harvard School of Public Health and a principal owner of Colden Corporation, an occupational health, safety and environmental consulting firm, where she serves as the vice president of health sciences and co-chair of the litigation support practice.
She holds a doctor of science in environmental health from Harvard University with a concentration in occupational epidemiology. She currently serves as the president of the Northeast Biological Safety Association.
Over the past year, Magari and her team have helped develop COVID-19 safety plans and conducted workplace audits to protect workers in a variety of industries, including energy production and distribution, healthcare, food, pharmaceutical, and television production.
Magari began her presentation by advising listeners to obtain information on the pandemic from vetted sources, like the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and scientific literature and journal articles.
She went on to say that she is cautiously optimistic about the current COVID-19 numbers.
“Things are down from the holidays, but the slope isn’t as steep as I would like it to be,” she said. “The testing volume overall is down, which is concerning, and we are still waiting to see how the variants are playing out, but it is generally encouraging. The hospitals are clearing out and the death toll is lowering — although 1,200 people a day is too many, particularly since a fair portion of them are preventable deaths.”
Variants
Magari then explained the difference between mutation, variant and strain.
The genetic material of SARS-CoV-2 (the coronavirus that causes COVID-19) is called ribonucleic acid (RNA). To replicate, and therefore establish infection in the body, SARS-CoV-2 RNA must hijack a host cell and use the cell’s machinery to duplicate itself.
Often, errors occur while duplicating the RNA, which results in viruses that are similar to the original, but not exact copies. The errors in the RNA are called mutations.
“When there are a significant number of mutations and they change the way the virus behaves — when there is something biologically interesting — we get a variant,” Magari said. “When that variant sticks around, we call it a strain.”
According to Magari, it is estimated that there have been thousands of SARS-CoV-2 variants since the beginning of the pandemic; multiple variants have been documented in the US.
Known variants include the United Kingdom lineage, the South African lineage, the Brazilian lineage, the New York City lineage, and the California lineages.
Some of the variants, like the UK lineage, are more contagious and more harmful than the parent strain.
Magari explained that viral mutations and variants in the US are routinely monitored through sequence-based surveillance, laboratory studies and epidemiological investigations to determine whether they evade detection, treatment or vaccination.
“For some of these variants, some pieces of various tests are going dark, so we’ve got to stay on top of which tests are still working,” she said. “For now, for the variants that we have in the United States, all of our tests are still working. [However], we were reading reports of a strain in Brittany that was evading complete detection by three of the most common targets, so that’s concerning, but the FDA is on top of it.”
The good news, according to Magari, is that the new vaccine platforms can be modified quickly in response to variant strains.
“I’m talking six weeks and we can have a new booster, if we need it,” she said.
She also noted that the more a virus spreads, the more likely it is for mutations to take hold. Therefore, in order to stop the variants from emerging, it is necessary to stop the spread.
Transmission
Magari explained that there are three major modes of SARS-CoV-2 transmission: contact, droplet and airborne.
Contact or “fomite” transmission describes infection spread through direct contact with an infectious person or with a contaminated surface. According to the speaker, this type of transmission is responsible for fewer than 10 percent of cases.
Droplet transmission involves exposure to virus-containing respiratory droplets (larger and smaller droplets and particles) exhaled by an infectious person. Transmission is most likely to occur when someone is close to an infected person, typically within about six feet.
Airborne transmission involves exposure to very small droplets (less than 5 μm) or “aerosols” that can remain suspended in the air over greater distances or longer times (typically hours).
Controls
Magari said that recognition of airborne SARS-CoV-2 transmission has led health and safety professionals to consider ventilation systems, in addition to social distancing and mask wearing, as part of their control strategies.
According to the speaker, additional controls that can be expected throughout 2021 include vaccines, symptom self-checks, temperature screening, exhaled breath screenings (currently in trials), and molecular and antigen testing.
“I want people to be able to go into their bathroom every other morning, for three or five bucks a week, and take antigen tests to screen themselves,” Magari said.
She then stated that each of the available FDA approved tests (molecular, antigen and antibody) is important and has a particular role in the public health response.
“I’m here to tell you that they are all good and they all have a purpose,” Magari said. “In fact, something that you repeat more often that has a lower sensitivity can actually be a stronger, more powerful public health tool . . . because it identifies [a person’s] infectious period. As a society, we are going to start looking for testing that helps us understand not only if someone is infected, but if they are infectious. Some of these PCR tests are so sensitive that people are testing positive for weeks and weeks and weeks, and they are no threat to anyone. After their symptoms are largely over with, they are not infectious anymore.”
Magari urged everyone to “double down” on controls like hand washing, wearing close fitting masks, covering coughs and sneezes, and practicing social distancing (the further apart the better).
“We are in the eleventh hour,” she said. “The vaccines are here. It’s time to make sure we stay as healthy as possible while we are waiting to get vaccinated.”
Herd immunity
Magari next discussed the importance of herd immunity.
Also known as community or population immunity, herd immunity is a form of indirect protection from an infectious disease that happens when a sufficient percentage of a population has become immune to the infection (either through vaccination or previous infections), thereby making the spread of disease from person to person unlikely. As a result, the whole community becomes protected — not just those who are immune.
In other words, if only a few people are vaccinated and one person gets infected, the disease can spread very fast, but if a lot of people are vaccinated, the disease cannot spread very far, so the community stays safe.
Magari expressed that herd immunity against SARS-CoV-2 should be achieved by protecting people through vaccination, rather than by exposing them to the pathogen that causes the disease.
According to Magari, achieving herd immunity will require 80 percent or more of the population to be vaccinated.
Vaccines
A significant portion of the presentation was dedicated to the COVID-19 vaccines, with particular focus on the different vaccine platforms and the current safety and efficacy data.
Magari explained that a vaccine functions to “train” the immune system to recognize and defeat a pathogen without getting a person seriously sick.
There are currently three vaccines available in the US — the two-dose Moderna and Pfizer vaccines, which both use messenger RNA (mRNA) technology, and the single dose Johnson & Johnson version, which is an adenovirus vector vaccine.
All three vaccines work by prompting a person’s own cells to produce the SARS-CoV-2 spike protein – the protrusions on the virus that allow it to attack human cells – so their immune system learns to quickly recognize and fight a real infection in the future.
Unlike the mRNA vaccines (Moderna and Pfizer), which deliver coated pieces of genetic material into cells, the Johnson & Johnson vaccine uses another virus (an adenovirus) to carry genetic material into the cells.
The adenovirus, which normally causes colds, has been modified so that it can no longer replicate and make the person sick. The genetic material in the mRNA vaccines is RNA, while the genetic material in the Johnson & Johnson vaccine is DNA; both instruct the host cells to make copies of the spike protein of SARS-CoV-2.
After describing the biological mechanisms involved in the different platforms, Magari emphasized that the Moderna, Pfizer, and Johnson & Johnson vaccines are all 100 percent effective at preventing hospitalization and death.
“I would take any one of them at any time,” she said. “In fact, I was kind of hoping I got J&J this morning because I would have been done after one shot . . . There is absolutely a place for every single one of these. Public health practitioners are very much looking forward to J&J. Pfizer and Moderna have to be very, very cold, while J&J can be stored in a regular refrigerator and it’s stable. I want people to stop trying to [focus on the] efficacy numbers they see in the [news]. You absolutely cannot make those comparisons. These vaccines were trialed at very different times . . . different variants were circulating. The numbers are apples and oranges, and the fact of the matter is that in practice, it doesn’t matter. The power of a vaccination isn’t necessarily in the ‘me’ . . . the power of this vaccine is in the ‘we.’”
Vaccination myths and safety
Magari next debunked a number of prevalent vaccine-related myths with the following facts:
The vaccines do not alter a person’s DNA.
The mRNA is very fragile and is degraded naturally within days.
mRNA vaccines do not contain a live virus and do not cause COVID-19 in the vaccinated person.
The vaccination will not give the person positive diagnostic test results. Vaccines do not contain microchips or tracking devices.
Federal and state COVID-19 apps and websites serve as a method of two-way communication, providing people with information and allowing them to report adverse effects. They are not designed to track people.
Magari also provided the following information to explain how the vaccines became available so quickly:
mRNA vaccine research started after 9/11 as an effort to become better prepared for acts of bioterrorism. mRNA vaccines are faster to produce than traditional vaccines.
High prevalence of the disease allowed for outcomes to be studied rapidly.
Researchers used existing networks to conduct vaccine trials.
Phase 2 and Phase 3 trials were thoughtfully combined.
Manufacturing began while clinical trials were still underway.
“I want everyone to know what I know about why these things are safe, why I have taken it, why my family has taken it, and why my mother [was eager] to get one,” Magari said.
She specifically noted that there are eight general public vaccine safety monitoring systems in place, that it is unusual for side effects to appear more than eight weeks after vaccination, that no significant safety concerns were identified in the clinical trials, that 72.1 million people in the US have received at least one dose of the vaccine, and that there have been very few cases of severe allergic reactions.
Side effects of mRNA vaccines, especially after the second dose, may include fever, sore/red arm, headache or muscle aches.
“It doesn’t necessarily mean that if you don’t get them it is not working,” Magari said. “Some people just react differently.”
According to Magari, preliminary reports indicate that the probability of transmission after vaccination appears to be low.
Magari concluded her discussion of vaccines by highlighting the fact that the coronavirus has disproportionately impacted black, brown and Latinx communities in the US.
“Those are the communities that are not taking up the vaccine at the rates we want to see,” she said. “The black and brown communities are being vaccinated at half the rate of the non-Latin white community. It’s not good. As a society we need to engage with folks and have difficult conversations about any kind of hesitancy about the science and why we took it . . . We all have to be micro-influencers.”
Reinfection
Magari explained there is much to learn about reinfection with the same or different strain of SARS-CoV-2.
She noted that WHO reported that recovered COVID-19 patients have been re-infected with new strains, that the CDC recommends vaccination for individuals who have already had COVID-19, and that researchers are currently investigating the efficacy of one shot for people who have had COVID-19.
COVID 2.0
Magari concluded her presentation by looking to the future and the “new, new normal.”
The presenter said that even after SARS-CoV-2 has become endemic, she envisions continued controls, such as mask wearing, limited gatherings, social distancing, testing, and a focus on indoor air quality.
She also discussed the possibility of “Movement Passports,” and highlighted the need for a new global watchdog to replace the WHO, increased emerging infectious disease surveillance, a greater focus on total worker health, and investments in public health infrastructure, particularly in data modernization and staffing.
“We were lacking just some basic organization early on,” Magari said. “I think we are picking up speed, but making sure we are thinking about that for the next pandemic is really important.”
Established in 2006, the Cazenovia Forum is a non-profit organization that hosts regularly scheduled public affairs lecture series that offer citizens from Cazenovia and the surrounding areas the opportunity to hear nationally and internationally known experts on a variety of key issues, and to engage in thoughtful discussion.
To learn more about the Cazenovia Forum, visit cazenoviaforum.com.
