Table of Contents
- Published on Sep 17, 2020
Video Transcript
[MUSIC PLAYING]
JOHN WHYTE: Hi, Everyone.
I’m Dr. John Whyte, Chief
Medical Officer at WebMD.
And you’re watching Coronavirus
in Context.
Today, I’m joined
by the president of the American
Medical Association, Dr. Susan
Bailey.
Dr. Bailey, thanks for coming
on today.
SUSAN BAILEY: Oh, it’s
my pleasure.
Thanks for having me.
JOHN WHYTE: Let’s start
off, you’re an allergist,
immunologist.
Perfect background to talk to us
about the vaccine.
What’s going on?
We recently heard
about a clinical hold.
What’s your thoughts
on the timeline that everyone’s
talking about?
SUSAN BAILEY: Well, you know,
the vaccine timeline,
as everybody is aware because
of Operation Warp Speed,
has been greatly amplified.
But no steps are being skipped.
I think it’s
important for everyone
to understand that all
the manufacturers are going
through the standards
phase I, phase II, phase III
processes.
It’s just that some of them
have kind of overlapped
a little bit.
And the federal government
has subsidized the vaccine
manufacturers.
And so some of them are already
actually making vaccine
for the public before it’s been
approved, with the hopes of, you
know,
the phase III trials coming out
OK.
The, the–
JOHN WHYTE: Otherwise, they’re
going to have to throw it out.
So–
SUSAN BAILEY: Exactly.
Exactly.
And so in a normal market
in a situation, manufacturers
would never take on that kind
of financial risk.
So that’s why– that’s one
of the reasons why it takes so
long.
But the– the pause
in the AstraZeneca Oxford
vaccine for a patient that
developed transverse myelitis,
you know, it’s sobering,
because as we know
transverse myelitis can either
be a response
to a viral infection
or to an autoimmune reaction
from a viral infection.
And so there’s a great deal
of concern that that might,
indeed, be vaccine related.
And the AstraZeneca vaccine
is a viral vector vaccine,
a Trojan horse vaccine, if you
will,
that brings
in a spike protein-type particle
for the body to develop
an immune reaction to.
Whereas the two others that are
in phase III trials
in the United States
are actually mRNA vaccines.
A totally different type
of vaccine.
Actually, it’s a new technology
that’s really never been proven
to be effective.
JOHN WHYTE:
But from an immunology
perspective, so let’s say,
you know, they’re testing 30,000
people in phase III
clinical trial.
And say a transverse myelitis
is one in 20,000, you know,
one in 30,000.
How concerned are you, though,
about safety issues
where we’re going from 30,000
people to 300 million people?
What’s that timeline that we
really need for post markets,
you know, surveillance,
from any immunology perspective.
So how do we know?
SUSAN BAILEY: Well, really
the only way
you know is by getting it
to more people.
And the fact that there are
multiple vaccines
in various phases
across the world that are all
going on simultaneously,
although, obviously, they can’t
really, you know, completely
share phase III data.
But at least we will have
an accumulation of many more
patient experiences
with certain types of vaccines
than in an individual trial
of 30,000 patients.
So I’m hoping in the long run
that will be very helpful to us
in terms of kind of having
some post marketing surveillance
on steroids, because we’ve got
so many different, you know,
types of vaccines out there
at the same time.
But I think it just highlights
the importance of not cutting
corners,
being extremely safe, and very
aware of the fact
that if this vaccine does not
have the complete confidence
of the physician community,
we won’t be able to get
the confidence of our patients.
JOHN WHYTE: Well, talk
about that.
Because we need transparency.
And drug development in general
is not
transparent
by its very definition.
And there’s already
misinformation out there.
There’s
misinformation
about other vaccines
that people aren’t taking
that we know folks need.
We’ve seen it in HPV.
We’ve even seen it in PNEUMOVAX.
What’s the role of physicians
and physician leadership
in being out there?
You know, there is a lot
of physicians on social media.
But others will say you know
what, I don’t want to get
in to that.
And then other voices
are amplified and heard.
So what’s the AMA doing in terms
of physician leadership,
physician voices on topics
like vaccination?
SUSAN BAILEY: The AMA is trying
to be very
proactive in developing
physician leaders to–
to amplify the message
of evidence and good science.
We have what we call
an Ambassador Program
that physicians that are AMA
members
can sign up for and get
intense education about AMA
messages and ideas and thoughts
that we want to get out.
And– but you’ve
got to be established
as a trusted source
of information before anybody is
going to trust you
in the future.
So we, through the JAMA Network,
their incredible body of work,
and hopefully, you know, being
a trusted agent for those
to look to, that we can amplify
that message.
But you’ve got to– it’s got
to be multi-pronged.
You’ve got to do social media.
You’ve got to do press releases.
You got to do MMRs.
Especially in this day when you
can’t have meetings,
it’s especially challenging.
JOHN WHYTE: Should we have more
physicians on social media?
SUSAN BAILEY: I think we should.
I think that it’s,
um, a great way
to communicate with the public.
And it is– patients are craving
good, honest, trustworthy
information from their doctors.
And I think not only is it
a good way for us
to communicate with each other,
I think it’s a good way
to spread good science messages
to–
to our patients.
JOHN WHYTE: Now, it’s
great to have an immunologist
on because I’ve got
a lot of questions.
SUSAN BAILEY: Oh, boy.
JOHN WHYTE: I want to ask you,
antibody testing, what’s
the role of antibody testing?
It’s kind of gone
through these cycles
over the last, you know, six,
seven months.
Tell us the latest.
What’s Dr. Bailey’s
recommendation?
SUSAN BAILEY:
Uh, my recommendation
at this stage of the game
is that antibody testing should
still really only be utilized
as part of an overall evaluation
of a patient,
not
as a definite diagnostic point.
It should be used to help
determine whether a patient
who’s had COVID-19
is a candidate to donate
convalescent plasma
or for community surveillance.
Since the antibody responses do
seem to wane fairly quickly
after acute infection, at least
IGG, they’re not breaking out
various antibiotic classes,
we may be looking at much more
of a T-cell mediated immune
response that is a little bit
more challenging to measure.
JOHN WHYTE: Do you think there’s
reinfection possibility?
Or is that pretty low?
SUSAN BAILEY: You know, I don’t
think we know that either.
There’s the case out of Hong
Kong that’s been reported.
I have not seen any of the data
about that.
But it– there– there are so
many hot spots in the country.
People are not traveling around
like they were at the beginning
of the pandemic.
If reinfection were
a common thing, I would think
that we would have seen a lot
of it by now.
And– and I don’t think
we really have.
So, um, I don’t know.
Don’t know.
JOHN WHYTE: Instead
of reinfection,
let’s talk
about multiple infections.
Let’s talk about flu, influenza,
and the importance of the flu
vaccine.
And talking about lots
of misconceptions
about the COVID vaccine that’s
not even here yet,
we’ve got plenty
of misperceptions about flu.
And I’m sure you’ve heard it
as I’ve heard it,
you know, it gave me the flu
last year, when we know it–
it hasn’t.
So what do listeners need
to know about the flu vaccine
this year?
SUSAN BAILEY: The flu vaccine,
if you have–
if there’s ever been a time when
it has been more important,
it’s this year.
There’s going to be plenty
of flu vaccine available.
There aren’t going to be
any shortages.
It’s important for people–
we just have to reiterate
this message over and over
again.
The flu vaccine does not have
any live viral particles in it.
That is unless you get
the nasal spray.
That’s a different– that’s
a different thing.
But the flu shot cannot give you
the flu.
If you feel bad after a flu
shot, it may be just
because of the immune response
that you’re getting
to the shot– and that’s a good
thing–
or you waited too long
and caught the flu
before your flu shot had
a chance to kick in
and it was just bad timing.
So a flu vaccine is safe.
The AMA wants everybody
over the age of six months
to get a flu vaccine this year.
We just can’t risk overwhelming
our health care system
this winter
with a so-called “twindemic” flu
and COVID at the same time.
JOHN WHYTE: Some people might
get it at the same time.
SUSAN BAILEY: Oh, yeah–
JOHN WHYTE: So if people
with flu
keep coming to the hospital,
people with COVID coming
to the hospital, then perhaps
people with both coming in.
I want to get back to,
you know, how quickly does
the flu vaccine work post
once you get your shot?
SUSAN BAILEY: Typically,
within 14 days you people should
be fairly well protected.
JOHN WHYTE: Because people don’t
always understand that.
It’s not like you get it,
and boom, you know,
you’re protected right away.
SUSAN BAILEY: It’s like putting
on a coat of armor
and you’re immediately immune.
It takes a while for it
to kick in.
JOHN WHYTE: Right.
SUSAN BAILEY: I’ve gotten
questions, no, the flu vaccine
won’t keep you from getting
coronavirus.
There’s some people that don’t
understand that.
JOHN WHYTE: It’s from viruses.
Yeah.
SUSAN BAILEY: Yeah.
When we do have a COVID vaccine
available, I’m sure the two are
going to be compatible.
So you can get a flu vaccine
and then get
a coronavirus vaccine.
And I would not be at all
surprised in the future
if we see combination flu,
coronavirus vaccines that people
get every year.
JOHN WHYTE: Let’s talk
about burnout.
You heard it from many
of your colleagues as well.
The, you know, the response
of being there every day,
seeing death, seeing morbidity,
taking care of patients,
being on the front line.
Physicians were burned out
before COVID.
We’re having shortages still
in some areas of PPE.
What is the AMA doing
about burnout?
SUSAN BAILEY: You’re right,
burnout has been
a longstanding problem.
And it’s been on the AMA’S radar
for a long time.
Burnout is not a moral failing.
Burnout is not a form
of personal weakness.
Burnout is a systems issue.
Burnout is the result of being
asked to function
in a medical world that is not
there to help you do your best
job, unfortunately.
And that we need to help systems
understand what policies
and procedures and scheduling,
and you have it, that they are
utilizing that are contributing
to burnout.
There’s some evidence
that physicians
in private practice
have less burnout, possibly
because they’re making
their own decisions
and understand that– why
they’re being made?
JOHN WHYTE: What keeps you up
at night?
SUSAN BAILEY: What keeps me up
at night?
I worry about the physician
population
becoming not only burned out,
but just becoming completely
demoralized
by the whole pandemic.
The– you know,
in the beginning,
we had Health Care Heroes.
And you know, people were given
physicians and other front line
health care workers
pats on the back for putting
themselves in harm’s way.
And that’s kind of been
forgotten.
Public’s memory of things
like that, unfortunately,
is very short.
And one of the messages that I
like to talk about when I talk
to medical groups
is that physicians really are
heroes, and that it’s just bred
into us by the nature
of our medical training,
and that regardless of
whether you feel like a hero
or not, you are.
And as a physician,
we have a very special calling.
And we still– we will always
have our patients, which is what
gives us the most joy.
JOHN WHYTE: Well, Dr. Bailey
I want to thank you for taking
time today.
I want to thank you
for your insights.
Thank you for your leadership
of really helping try to improve
the health care system
for physicians
or other providers,
for patients.
SUSAN BAILEY: Happy to join you
anytime.
Thanks so much.
JOHN WHYTE: And thank you
for watching Coronavirus
in Context.
I’m Dr. John Whyte.
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